Physio Flashcards
the sperm binds to the ____, which is comprised of 3 glycoproteins that form a mucus-like latticework
zona pellucida
the acrosomal rxn requires which ion
calcium
what portions of the sperm enter the oocyte
cytoplasmic portion of sperm head and tail
purpose of cortical reaction in the oocyte
prevents polyspermy
the cortical rxn in the oocyte requires which ion
calcium (and IP3)
at the early stage of pregnancy, what produces steroid hormones necessary to maintain pregnancy
the corpus luteum
HCG very closely resembles which hormone
LH
______ (hormone) sustains corpus luteum in the beginning of pregnancy, immunosuppressive agent, growth-promoting activity, promotes placental development
HCG
during early weeks of pregnancy, fetus derives nutrition from the endometrial _____. Subsequently, nutrition is provided by diffusion thru the placenta
endometrial decidua
most important placental peptide hormone
HCG
____ (hormone) coordinates fuel economy by contributing to the conversion of glucose to fatty acids and ketones. Promotes mammary gland development in the pregnant mother
somatomammotropins
the _____ is critical for steroid hormone synthesis in the pregnant mother
placenta
why is estriol more delayed than progesterone and estradiol in pregnancy
estriol contributes to development of placenta. the corpus luteum is first so estriol can be late
the (corpus luteum/placenta) can produce adequate amounts of cholesterol, the precursor for steroid hormone synthesis
corpus luteum
the (placenta/fetus) lacks 3-B hydroxysteroid DHase, aromatase so it needs the maternal-placental-fetal unit to make estrogen and progesterone
the fetus lacks 3-B hydroxysteroid DHase, aromatase.
the (fetus/placenta) lacks 17-a-hydroxylase and 17,20-desmolase and 16-a hydroxylase
the placenta
maternal pregnancy response: blood volume (increases/decreases)
increases due to increased plasma volume and erythrocytes. meets demands of enlarged uterus, vascular system
maternal pregnancy response: mean arterial pressure (increases/decreases)
decreases during midpregnancy then rises during third trimester, but remains lower than normal
maternal pregnancy response: cardiac output (increases/decreases)
increases during first trimester, mostly due to increase in SV. Much of increased blood flow is to kidney and uterus
maternal pregnancy response: alveolar ventilation (increases/decreases)
increases due to increased tidal volume, due to steroid effects on medullary respiratory centers
maternal pregnancy response: maternal arterial pCO2 (increases/decreases)
decreases as a result of increased alveolar ventilation
maternal pregnancy response: demand for dietary protein (increases/decreases)
increases, as well as iron and folic acid (increased production of RBCs)
maternal pregnancy response: BMR (increases/decreases)
increases by 15%
(oxytocin/prolactin) promotes milk let-down and uterine contractility
oxytocin
(oxytocin/prolactin) promotes milk synthesis
prolactin
(oxytocin/prolactin) released in response to suckling
both
from where is oxytocin released
hyth (PVN and supraoptic) to post pit
from where is prolactin released
ant pit
(mammogenic/lactogenic) hormones promote initiation of milk production
lactogenic
(mammogenic/lactogenic) hormones promote cell proliferation
mammogenic
estrogen, GH, cortisol, prolactin, relaxin, progesterone: (mammogenic/lactogenic) hormones
mammogenic
prolactin, hCS, cortisol, insulin, thyroid hormones, withdrawal of estrogens and progesterone: (mammogenic/lactogenic) hormones
lactogenic. estrogen and progesterone are withdrawn when the placenta is delivered
during pregnancy, which hormones inhibit milk production
estrogen and progesterone, in placenta
the ____ is the secretory unit of the breast
alveolus
contractile myoepithelial cells surround each alveolus and adipose cells and promote milk let-down in response to:
oxytocin
secretory epithelial cells comprise the alveolus and secrete milk in response to:
prolactin and cortisol (permissive hormones)
_____ provides a concentrated, low-volume form of nutrition for the neonate’s immature GI tract. No fat compared to mature human milk. Protein rich
colostrum
_____ (hormone) maintains milk production after parturition
prolactin
dopamine (increases/decreases) during breast feeding
decreases (because it inhibits prolactin)
deposition of mucopolysaccharides around the orbit that cause the eye to protrude
exopthalamos
separation of nail from nail bed
onycholysis
thyroxine has (a catabolic/an anabolic) effect on tissues
catabolic
_____ (disease): common thyroiditis, slow developing, autoimmune, production of anti thyroid antibodies which gradually destroy the gland
Hashimoto’s
dietary ___ deficiency leads to hypothyroidism and goiter
iodine
there is (elevated/reduced) TSH and (elevated/reduced) TH in patients with primary hypothyroidism
elevated TSH, reduced TH
______ coma is the end stage of untreated hypothyroidism
myxedema coma
Hashimoto’s patients are typically treated with
thyroxine
major action of _____ is to stimulate the kidney to reabsorb sodium and water and enhance potassium secretion
aldosterone
in renal tubule cells, aldosterone increases activity of proteins involved in _ (ion) transport and increases txn of Na/K pump and expression of apical _ (ion) channels
Na, Na
net: increase sodium reabsorption and potassium secretion
what measurement is used to diagnose cushing’s
urinary or salivary cortisol measurement
what is the benefit of a dexamethasone suppression test for cushing’s disease
can diagnose different types of cushing’s
in adrenal tumor cushing’s, cortisol is (high/low) and ACTH is (high/low)
cortisol is high
ACTH is low
in ACTH producing tumor in cushing’s, cortisol is (high/low) and ACTH is (high/low)
both are high
in a normal state (not cushing’s), cortisol is (high/low) and ACTH is (high/low)
both are low
(cushing’s/addison’s): hypoadrenal function
addison’s
(cushing’s/addison’s): hyperadrenal function
cushing’s
(cushing’s/addison’s): lack of aldosterone results in hypotension, hyperkalemia
addison’s
(cushing’s/addison’s): hypokalemia and hypertension
cushing’s
(cushing’s/addison’s): hypoglycemia, weakness, weight loss, poor tolerance to stress
addison’s
fetal circulating prostaglandin is (lower/higher) than adult
5x higher bc placenta makes a lot
where does gas exchange occur in the fetus
placenta
pulmonary vascular resistance in the fetus is (high/low/normal)
very high
the sum of both ventricles in the fetus is known as the
combined cardiac output
first breath in of fetus requires a transpulmonary pressure of 60cmH2O to (increase/decrease) the lung volume by 40mL
increase
_____ (disease) is caused by def of surfactant, often found in premature births
Respiratory Distress Syndrome
fetal to neonatal: pulmonary vascular resistance (increases/decreases)
decreases dramatically
fetal to neonatal: pulmonary blood flow (increases/decreases)
increases dramatically
fetal to neonatal: mean pulmonary arterial pressure (increases/decreases)
decreases dramatically
placental insufficiency causes ______
Type II intrauterine growth restriction IUGR
any insult to the placenta that interferes with gas exchange may lead to fetal _____
asphyxia
closure of placental circulation (increases/decreases) pressure in the aorta
increases (placenta receives 50% of combined cardiac output in fetal circulation)
closure of placental circulation causes peripheral resistance to (increase/decrease)
double, causing an increase in aortic and left ventricle pressure
closure of the ________ (fetal circulation shunt) is caused by reversal of right/left atrial pressure
foramen ovale
increased pulmonary circulation in the neonate causes (increased/decreased) venous return to the LA
increased
when the baby is born, there is (an increase/a decrease) in RA pressure
a decrease
(foramen ovale/ductus venosus) closes within three hours
ductus venosus
(foramen ovale/ductus venosus) closes within three months or even years
foramen ovale
closure of the ductus venosus forces portal blood to perfuse the ____
liver
failure of ductus vensosus closure=
portosystemic shunt
closure of the _____ (fetal circulation shunt) is mediated by increases in PO2 and decreases in circulating prostaglandins. Bradykinin from lung is involved as well
ductus arteriosus
failure of ductus arteriosus closure leads to: (3 things)
pulmonary HTN, CHF, cardiac arrhythmias
if baby is born at high altitude, the ______ (fetal circulation shunt) may not close correctly because partial pressure of oxygen is lower
ductus arteriosus
if the ductus arteriosus doesn’t close entirely, how does that cause reversal of blood flow?
hypoxia > hypoxic vasoconstriction > increased pulm vascular resistance > build up > reversal of flow > “persistent fetal circulation”
how do you treat persistent fetal circulation
with drugs that inhibit cyclooxygenase so you don’t make prostaglandins
most common cause of blue baby syndrome
tetralogy of Fallot
four components of tetralogy of Fallot
- pulm stenosis 2. right shifted aorta 3. RV hypertrophy 4. ventricular septal defect
symptoms of menopause due to (lack of estrogen/rise of FSH)
lack of estrogen
diagnosis of menopause: rise in circulating (LH/FSH)
FSH
why is hormone replacement therapy controversial for menopause
increased risk of CVD, cerebrovascular disease, breast cancer
what are SERMs
selective estrogen receptor modulators, replacing hormone replacement therapy for menopause
puberty is characterized by pulsatile GnRH secretion initially during the (night/day) and then also at (day/night)
initially at night then also during the day
polycystic ovary syndrome: (multiple primordial follicles emerge as dominant follicles/no dominant follicle emerges and ovulation does not occur)
no dominant follicle emerges and ovulation does not occur
polycystic ovary syndrome: reduced (estrogen/progesterone) in the granulosa and thecal cells
reduced estrogen in granulosa. reduced progesterone in both granulosa and thecal
polycystic ovary syndrome: continued production of androgen by (granulosa/thecal) cells throughout cycle
thecal
polycystic ovary syndrome: treat with clomiphene to restore:
ovulation
polycystic ovary syndrome: treat with weight loss to control:
abnormal blood glucose and diminished insulin sensitivity
polycystic ovary syndrome: treat with 5-a-reductase inhibitors to block conversion of testosterone to:
dihydrotestosterone
polycystic ovary syndrome: treat with combination bc pills to restore:
regular periods
occurs when tissue from the uterine endometrium spreads to the peritoneal cavity, often around the ovaries
endometriosis
cause of endometriosis
retrograde menstruation
hCG is (high/low) in ectopic pregnancy
low
most dangerous region for rupture of ectopic preg: (interstitial/ampullary/isthmic)
interstitial–ruptures at 12-16 weeks, closest proximity to uterine and ovarian vessels»_space; hemorrhage
why would you treat ectopic pregnancy with methotrexate
halt rapidly dividing cells, especially in early cases
the only hormone under primarily negative control from the hypothalamus
prolactin
hyth secretes dopamine, prolactin (increases/decreases)
decreases
hyth secretes somatostatin, GH (increases/decreases)
decreases
hyth secretes GnRH, LH (increases/decreases)
increases
hyth secretes TRH, TSH (increases/decreases)
increases
hyth secretes CRH, ACTH (increases/decreases)
increases
initiates its actions at target tissues by binding to nuclear receptors: (ACTH, vasopressin, epi, IGF-1, thyroid hormone)
thyroid hormone
oxytocin: (promotes uterine quiescence/is released directly into general circulation)
is released directly into general circulation
chemical structure most similar to ADH: (oxytocin, ACTH, TSH, FSH, prolactin)
oxytocin–both have nine amino acids
ADH (vasopressin) is produced primarily in the _____ neurons of the hyth
supraoptic
if the pituitary is removed or transsected, the plasma concentration of what hormone will increase
prolactin–under inhibitory control by hyth
In patients with central diabetes insipidus, there is an inappropriately (high/low) secretion rate of ADH in response to changes in plasma osmolality, but there is no impairment in the renal response to ADH.
low
In Central Diabetes Insipidus: Because plasma levels of ADH are depressed, there is an impaired ability to concentrate urine, and a (small/large) volume of dilute urine is excreted.
large
GH receptor (activates Gs/requires a receptor dimer to exert effects/must be internalized to exert its effects)
requires a receptor dimer to exert effects
result of impaired GH action: (failure to double birth weight at six months/short stature in 12 year old boy/fasting hyperglycemia and impaired glucose tolerance)
short stature in 12 year old boy
pit tumor secreting excess growth hormone in 4 yo: will cause (Acromegaly due to excess insulin-like growth factor (IGF)-1 production/Gigantism due to excess IGF-1 production)
Gigantism due to excess IGF-1 production–effects of GH on linear growth are mediated via IGF-1
GH is effective at treating (celiac/Turner syndrome/GH receptor def)
Turner
TSH action on thyroid follicular cells: (increases blood flow/increases iodide uptake)
increases iodide uptake
in which form are T3 and T4 most active: (bound to albumin/bound to transthyretin/bound to thyroglobulin/unbound/bound to thyroxine-binding globulin)
unbound
not essential for synthesis of thyroid hormones: (iodine/ferritin/thyroglobulin/protein synthesis/TSH)
ferritin
incorporation of dietary iodide into thyroid hormones is known as _____ (process)
organification
metabolic rate is least affected by increase in plasma level of: (TBG/TSH/TRH/free T4/free T3)
TBG
TBG transiently (increases/decreases) free T3 and T4
decreases
increased binding of a hormone to plasma proteins results in: (increase in plasma clearance of the hormone/increase in plasma reservoir for rapid replenishment of free hormone)
increase in plasma reservoir for rapid replenishment of free hormone
protein bound hormones are (active/inactive)
inactive and cannot be metabolized
In target tissues, nuclear receptors for thyroid hormones have a greater affinity for (T3/T4) than for (T3/T4).
higher affinity for T3
secretion rate, plasma concentration, half life, and onset of action are all greater for (T3/T4)
T4
Thyroid hormone receptors bind to DNA in a heterodimer with the (insulin/progesterone/GH/prolactin/retinoid X) receptor
RXR retinoid X receptor
T4 (increases/decreases) HR, RR, plasma [cholesterol]. Name action on each
increases HR, increases RR, decreases plasma [cholesterol]
Increased plasma (iodide/cholesterol) concentration is commonly observed in hypothyroidism.
cholesterol
Stimulation of the adrenal gland by ACTH has the most direct effect on release of (epi/NE/cortisol/androgens/aldosterone)
cortisol
portion of adrenal gland that secretes anti inflam hormone
fasciculata (cortisol)
Fasting hypoglycemia and fatigue are due to low (ACTH/cortisol) levels. Increased pigmentation suggests high levels of (ACTH/cortisol).
cortisol,
ACTH
The enzyme 21-hydroxylase is required for _____ and _____ synthesis.
cortisol and aldosterone
Low levels or cortisol result in high levels of _____ (hormone) due to loss of negative feedback.
ACTH
prolonged cortisol administration can cause (bone deposition and collagen formation/virilization/muscle weakness).
muscle weakness (skeletal muscle protein catabolism)
β-Adrenergic receptor desensitization occurs in response to chronically high (catecholamine/glucocorticoid) levels
catecholamine
genetic deficiency in 11β -hydroxysteroid dehydrogenase type 2: (increased mineralcorticoid/increased glucocorticoid/hyperkalemia/hypoglycemia/decreased blood pressure)
increased mineralcorticoid
11β-hydroxysteroid dehydrogenase type (1/2) is present in renal tubular cells and converts cortisol to cortisone, which does not readily bind to mineralocorticoid receptors.
type 2
cortisone treatment for autoimmune disease can cause: (increased cortisol secretion/increased ACTH/increased muscle mass/increased insulin)
increased insulin secretion
Increased plasma levels of cortisol tend to (decrease/increase) plasma glucose concentration
increase
PTH (increases/decreases) Calcium reabsorption and (increases/decreases) phosphate reabsorption in kidney
increases Ca reabs.
decreases phosphate reabs.
(increase/decrease) in PTH increases the rate of excretion of calcium by kidney
decrease
increases rate of deposition and decreases rate of absorption of bone: (estrogen/PTH/reduction of mechanical stress)
estrogen
untreated goiter is assoc with (hyper/hypo/eu)thyroidism
all three
Thyrotoxicosis or Grave’s disease is typically characterized by: Elevated serum T3, T4 and (thyroid/TSH receptor) antibodies
TSH receptor antibodies
high plasma levels of (thyroid hormones/immunoglobulins in Graves’) do not cause exophthalmos.
thyroid hormones
Used to tx what dz? Very high levels of iodine (Wolff-Chaikoff effect)
Iodinated iodine to destroy the gland (131I-)
Antithyroid agents such as PTU
Surgical removal of gland (thyroidectomy)
Graves’
____ deficiency prevents normal production of thyroid hormone by the thyroid gland, producing primary hypothyroidism.
Iodine
a deposition of mucoprotein in the subcutaneous and extracellular spaces that causes edema: characteristic of (hypo/hyper) thryroid
hypothyroid
weight (loss/gain) assoc with hyperthyroidism
loss
myxedema seen in (hypo/hyper)thyroid
hypothyroid
deficiency in iodine intake: (weight loss/tachycardia/increased synthesis of thyroglobulin)
increased synthesis of thyroglobulin
Hashimoto’s thyroiditis: elevated serum TSH and (TSH receptor/thyroid) antibodies
thyroid antibodies against thyroid peroxidase
_____ failure after menopause causes estrogen, progesterone, and inhibin levels to decrease to very low levels
ovarian
what leads to high levels of GnRH in menopause
loss of negative feedback from estrogen
A high concentration of estrogen, progesterone, and inhibin, all at the same time, indicates peak secretion from the corpus luteum about days __-__ of the cycle
18-24
high estrogen and progesterone and inhibitn= (high/low) LH and FSH
low
steroid hormone effects are (long/short) lived
long lasting via gene txn
The luteinizing hormone surge measured during the ovulatory phase of the menstrual cycle results from positive feedback exerted by (GnRH/estrogen/FSH/inhibin/progesterone)
estrogen
(thecal/granulosa) cells provide androgen precursors under influence of LH.
thecal
(thecal/granulosa) cells use androgens to synthesize estrogens, which is accomplished via FSH stimulated aromatase activity
granulosa
during 12 hrs before ovulation: (plasma [estrogen] is rising/surge of LH)
surge of LH (ovulation will not take place without a surge of LH before it)
progesterone synthesis is stimulated by the (LH/FSH) surge
LH
what stimulates increase in endometrium thickness in the week following ovulation (LH/FSH/progesterone/estrogen)
progesterone from corpus luteum
cause of menopause: Reduced numbers of follicles available in the ovary for stimulation by ____ hormones
gonadotropic
(Decreases/Increases) in both gap junctions and oxytocin receptors enhance myometrial contractility.
increases
enhanced responsiveness to pitocin: (increased/decreased) prostaglandin synthesis
increased–PGs initiate contractions which are augmented and sustained by oxytocin
pregnant: high urinary hCG and (high/low) plasma progesterone
high
(pulsatile/constant) GnRH mimics the physiologic release
pulsatile–constant is ineffective bc it downregulates pituitary gonadotropes
if ovulation is on day 15, when is implantation likely to occur
days 21-22
Binding of the sperm head to specific proteins of the zona pellucida causes a calcium signal in the sperm, resulting in the ______ reaction
acrosome
the fetus makes (aromatase/DHEA-S/progesterone/21-a-hyroxylase/testosterone) for the placenta to produce estrogen
DHEA-S
what hormone suppresses milk production before birth and for about two days after birth
estrogen
what hormone accounts for milk expression in response to conditioned stimuli (baby crying) (estrogen/oxytocin/prolactin)
oxytocin
hCG has the same stimulatory effect as (FSH/LH) on the corpus luteum. Administration of hCG prevents degradation of endometrium and onset of menstruation
LH
inhibit initiation of labor with prostaglandin E2 (agonist/antagonist)
antagonist.
Antagonism of progesterone’s effects (initiates/inhibits) labor
initiates labor
PGE2 strongly stimulates uterine smooth muscle contraction and is formed in increasing rate by the placenta (early/late) in gestation.
late
specific effect of RU486 (abortion pil): blocks (oxytocin receptors in uterine muscle/progesterone receptors in body)
blocks progesterone receptors so progesterone has no effect in the body
Very high plasma concentration of (estrogen/progesterone) maintains the uterine muscle in a quiescent state during pregnancy.
progesterone
In the final month of gestation the concentration of (estrogen/progesterone) begins to decline, increasing the excitability of the muscle.
progesterone
The placenta secretes (estrogen/progesterone/LH) from the trophoblast cells.
estrogen and progesterone
fertilization normally takes place in the (uterus/cervix/ovary/ampulla of fallopian tube)
ampulla of fallopian tube
suckling stimulates secretion of (oxytocin/ADH/both) from the PVN
oxytocin
During the latter stages of pregnancy, many women experience an increase in body hair growth in a masculine pattern. Why?
The maternal and fetal adrenal glands secrete large amounts of androgenic steroids that are used by the placenta to form estrogen
umbilical arterial blood has (lower/higher) PO2 and (lower/high) PCO2 compared to the umbilical vein
lower PO2 and higher PCO2
O2 saturation in the fetal IVC is (greater/lower) than O2 sat in the fetal aorta
O2 sat is greater in the fetal IVC
blood in which vessel has lowest PO2: (maternal uterine vein/maternal femoral vein/umbilical artery/umbilical vein)
umbilical artery
at birth, the pressure in the baby’s pulm artery (increases/decreases) greatly
decreases
In the circulatory system of a fetus, (aortic pressure/right atrial pressure) is greater before birth than after birth
right atrial pressure
In the circulatory system of a fetus, (aortic pressure/right atrial pressure) is greater after birth than before birth
aortic pressure
full development and function of seminiferous tubules requires (LH/oxytocin/FSH/androgens and FSH)
androgens and FSH
in human males, testosterone is mainly produced by (Leydig cells/Sertoli cells/seminiferous tubules)
Leydig cells (from pregnenolone precursors)
_____ (enzyme) contributes to erection by activating soluble guanylate cyclases to increase cGMP levels that relax smooth muscle and increase blood flow
nitric oxide synthase
pubertal growth spurt is mainly stimulated by (testosterone/dihydrotestosterone/estradiol)
estradiol
inhibin has direct negative feedback effects on the release of (GnRH/prolactin/FSH/LH/testosterone)
FSH
(FSH/LH) stimulates Sertoli cells to produce inhibin
FSH
(FSH/LH) stimulates Leydig cells to produce testosterone
LH
What stimulates the secretion of testosterone during embryonic development? (LH/inhibin from corpus luteum/hCG/GnRH from embryo’s hyth)
hCG
emission phase of male sexual act: (parasymp/symp)
symp (Point and Shoot)–beta adrenergic antagonists interfere with ejaculation
erection phase of male sexual act: (parasymp/symp)
parasymp (Point and Shoot)
(TRH/TSH) works via a GPCR-PLC-IP3-Ca system
TRH
(TRH/TSH) works via a GPCR-AC-cAMP system
TSH
T4 is converted to T3 via (peripheral deiodinase/thyroid peroxidase)
peripheral deiodinase
I- is oxidized to iodine in lumen of thyroid by ((peripheral deiodinase/thyroid peroxidase)
thyroid peroxidase
what stimulates colloid proteolysis in the thyroid, releasing T3 and T4?
TSH
what enzyme catalyzes the coupling of DIT to DIT in the thyroid
thyroid peroxidase
with what does the thyroid hormone receptor dimerize in the nucleus of the target tissue cell
RXR
Clomiphene acts primarily at the level of the hypothalamus to relieve the negative feedback effect of endogenous estrogen, thereby stimulating ____ release and, in turn, (decreasing/increasing) the production of anterior pituitary gonadotropins.
GnRH
increasing
clomiphene is (often/rarely) associated with ovarian hyperstimulation syndrome
rarely
clomiphene in IVF: induces (follicular growth/sperm production/testosterone)
follicular growth
most common causes of infertility in women (two)
endometriosis, polycystic ovarian syndrome
______ refers to a procedure involving administration of fertility drugs to induce maturation of multiple ovarian follicles, for subsequent retrieval and use in IVF.
controlled ovarian hyperstimulation
injectable gonadotropins (increase/decrease) the size of the ovaries
increase
In IVF how is the egg retrieved? (laparoscopy/ultrasound guided aspiration)
ultrasound guided aspiration
best embryo development state for transfer in IVF: (cleavage stage embryos at day 3/blastocyst stage embryos at day 5 when the embryonic genome is activated)
day 5 is better than day 3
(Estrogen/Progesterone) provides hormonal support to the endometrium so that implantation and nourishment are appropriate
Progesterone
Luteal phase support in IVF is a vaginal delivered _____ (hormone) supplement shown to improve implantation
progesterone
Which protocol starts GnRH agonist/antagonist on day 21 of the previous cycle? (Multiple dose GnRH antagonist protocol/Long GnRH agonist protocol/Short GnRH agonist protocol)
Long GnRH agonist protocol
