Menarche Puberty and Menstrual Disorders

Question 1

The major charactistic of follicular growth and estradiol secretion is explained by what two gonadotropin and two cells

Answer 1

Gonadotorpin: LH FSH
cell: theca and grnaulosa

Question 2

LH stimulates the _ cells to produce androgens

FSH stimulate the _ cells to convert the androgens into estrogen (E1 and E2)

Answer 2

1. Theca cells

2. Granulosa

Question 3

Does estrogen level reach it’s peak before or after LH?

Answer 3

1 day before

Question 4

Prior to ovulation _ follicle begins to produce increasing amount of progesterone

Answer 4

Graafian

Question 5

what is the cumulus oophorus?

Answer 5

The innermost 3-4 layers of multiplying granulosa cells that become cuboidal and adhere to the ovum.

Question 6

what forms the corona radiata?

Answer 6

The innermost layer of the granulosa cells for the cumulus become elongated and connects to the wall.

Question 7

After ovulation, what makes up and forms the corpus luteum?

Answer 7

Luteinzed granulosa cells, theca cells, capillaries and connective tissue

Question 8

What occurs first, Thelarche or menarche?

Answer 8

Thelarche

Question 9

At what Tanner stage does Thelarche take place?

Answer 9

Tanner Stage IV. rare before stage III

Question 10

If secondary ammorrhea lasts greater than _ days further work up is indicated

Answer 10

90 days.

Question 11

what is mean blood loss per menstraul period?

Answer 11

30 cc. most report changing a pad 3-6 times a day

Question 12

Greater than _ cc is associated with anemia

Answer 12

80

Question 13

What is primary amenorrhea?

Answer 13

No menses by age 13 w/o secondary sexual development OR by age 15 with secondary sexual development

Question 14

what defines secondary amenorrhea?

Answer 14

no menses before 6 months

Question 15

What is polymenorrhea?

Answer 15

abnormally frequent menses at intervals

Question 16

What is menorrhagia (hypermenorrhea)?

Answer 16

excessiave and/or porlonged menses

Question 17

what is Metrorrhagia:

Answer 17

irregular episodes of uterine bleeding. Menometrorrhagia is heavy and irregular uterine bleeding

Question 18

What is oligomenorrhea

Answer 18

menstrual cycles at > 35 days cycles

Question 19

what is dysfunctional uterine bleeding?

Answer 19

-Abnormal bleeding NOT due to medications, blood sycrasia, systemic disease, truama, or ganic conditions
- usually caused by aberration in the HPPO axis restulingin anovoluation
Most DUB occurs around the years of menarche

Question 20

What is adenomyosis (AUB-A)

Answer 20

Kinda like endometriosis. adenomyosis is when the endometrial lining gets inside of the muscle of the uterus. if you were to palpate it it’ll be boggy large and soggy.

Question 21

90% of these AUB will come with endometrial bleeding (post manopausal bleeding)

Answer 21

malignancy and hyperplasia (AUB-M)

Question 22

what disease is a cuase of ovulatory dysfucntion and can cause AUB-O.

Answer 22

Polycystic ovarian syndrome

Question 23

during late childhood there is an increase in serum concentration of _ and _ _ which can begin the onset of puberty

Answer 23

DHEA
DHEA-S
androstenedione

Question 24

By the late puberty, the positive feedback mechanism of _ on _ release from the anterior pituitary gland is complete and ovulatory cycles are stablished?

Answer 24

estradiol on LH

Question 25

The gonatostat's negative feedback mechanism is matured by _

Answer 25

fetal development.

Question 26

Positive feedback mechanism of the gonatostat is comple by _

Answer 26

puberty

Question 27

what are the stages of pubertal development?

Answer 27

1. Thelarche 2. Pubarche/adrenarche 3. Maximal growth or peak hight velocity 4. menarche

Question 28

What are the orders of the normal pubertal develoment?

Answer 28

``` Ages -->stage 9-10 = Thelarche 10-11 = adrenarche 11-12 = peak height velocity 12-13 = menarche 14-15 = mature sexual hair and breast ```

Question 29

which racial group undoes puberty earlier white, african american or hispanic

Answer 29

White > African > hispanic

Question 30

what are the tanner stage associated with the breast development?

Answer 30

Stage 1: preadolescent: elevation of the papilla only Stage 2; breast bud stage; elevation of breast and papilla as a small mound with enlargement of the areolar region Stage 3; Further enlargement of breast and areola w/o separation of their contours Stage 4; projection of aerola and apilla to form a seocndary mound above the level of the breast Stage 5; Mature stage; projection of papilla only. resulting from recession of the areola to the general contour of the breast

Question 31

what are the tanner stages associated with pubic hair deveopment?

Answer 31

Stage 1; Preadolescent; absence of pubic hair Stage 2; sparse hair along the labia; hair downy with slgiht pigment Stage 3; hair spreads sparsely over the junction of the pubes; hair is darker nd coarser Stge 4: adult-type hair; there is no spread ot the medial surface of the thigh Stage 5: adult type hair with spread to th emeidal thight assuming an inverted tirangle pattern

Question 32

what are some indication for endometrial biopsy?

Answer 32

a. postmenopausal woman sample with any spotting or bleeding and endometraillining >4mm b. age 45 to menopause with any AUB, including intersmensutal bleeding, menorrhagia C.

Question 33

what is asherman syndrome?

Answer 33

with removal of miscarrage product, causing intrauterine scarring which can shut the uterine and thus prevent mensturation

Question 34

what are some risk factors of GDM?

Answer 34

- maternal obsesity - maternal age (over 25) - previous delivary of baby larger than 9lbs - Hx of unexplained perinatal loss or malformation - family hx of diabetes - especially first degree relatives - glycosuria at first pre-natal visit - metabolic syndrome: 3 or more risk facotrs of atheroscerotic disease and T2DM - Polycystic ovarian syndrome (chronic anovulation in the setting of obesity, hyperinsulinemia, T2DM, lipid abnormalities, hirsutism, infertility and ovarin cysts) - hypertension - glucocorticoid use at tiem of pregnancy - ethnic groups with high prevalnce of T2DM (hispanic and south asians mostly)

Question 35

T or F: woman with polycystic ovarian syndrome do not require to be on birth control since they cannot get pregnant.

Answer 35

False. They can get prgnant