Puberty, Disorders of Development, and Menstrual Disorders (Moulton) Flashcards
Damage to the sella turcica can cause damage to what structure?
Pituitary gland
FSH and LH are synthesized and stored in cells called?
Gonadotrophs
Decreasing levels of __1__ and __1__ from the regressing corpus luteum of the preceding cycle initiates an increase in __2__ by a negative feedback mechanism, which stimulates follicular growth and __3__ secretion.
1) Estradiol and progesterone
2) FSH
3) Estradiol
LH stimulates the __1__ cells to produce __2__.
FSH stimulates the __3__ cells to do what?
1) Theca
2) Androgens (androstenedione and testosterone)
3) Granulosa
4) Convert Androgen to Estrogens (estrone and estradiol)
In the luteal phase, __1__ and __1__ are significantly suppressed through the negative feedback effect of the elevated circulating __2__ and __2__ levels.
What will initiate new follicular growth of next cycle?
1) LH and FSH
2) Estradiol and Progesterone
3) FSH
1) Where is GnRH synthesized?
2) What does it create and release?
3) What enhances hypothalamic release of GnRH?
4) What is the purpose of this?
5) What has inhibitory effect on GnRH release?
1) Arcuate Nucleus
2) LH and FSH
3) Estradiol
4) To induce LH surge (IN FOLLICULAR PHASE)
5) Gonadotropins
1) How are estradiol levels during early follicular development?
2) When does estradiol levels begin to increase
3) When does estrogen levels reach a max?
4) When does estradiol levels tank down?
5) What happens to estradiol during Luteal phase?
6) What happens at the end of Luteal Phase before menses?
1) Low
2) 1 week before ovulation
3) 1 day before Midcycle LH peak
4) Between LH Peak and Ovulation
5) Estradiol rises to max 5-7 days after ovulation
6) Estrogen returns to baseline
*Basically in Follicular phase (Start) estradiol is low low low until it 1 week before ovulation where it jumps up to give LH that mid cycle surge. Then right before ovulation it tanks again until 5-7 days post ovulation in Luteal phase where it rises again to the max until right before menses where it returns to baseline
During follicular development the ovary secretes a __1__ amount of progesterone.
The bulk of the progesterone comes from the peripheral conversion of the adrenal __2__ and __2__.
Prior to ovulation the unruptured __3__ follicle begins to produce increasing amounts of progesterone
Secretion of progesterone by the __4__ reaches a HUGE maximum 5-7 days after ovulation and returns to baseline before menstruation.
1) Small
2) Pregnenolone and pregnenolone sulfate
3) Luteinizing graafian
4) Corpus luteum
Basically small amount of progesterone during follicular phase. Most of progesterone comes from conversion of adrenal pregnenolone and pregnenolone sulfate .
Before ovulation Progesterone rises a bit
MAX Progesterone at 5-7 days post ovulation before baseline right before menses (like estradiol)
Primordial follicles undergo sequential development, differentiation, and maturation until a mature __1__ follicle is produced.
The follicle then rupture, releasing an __2__.
Subsequent luteinization of the ruptured follicle produces the __3__.
At about 8 to 10 weeks of fetal development, oocytes
become surrounded by precursor __4__ cells.
This oocyte __4__ cell complex is called a primordial follicle.
1) Graafian
2) Ovum
3) Corpus luteum
4) Granulosa
In the adult ovary, a graafian follicle forms. The innermost three to four layers of multiplying granulosa cells become __1__ and adherent to the ovum this is
known as the __2__.
A fluid filled __3__ forms among the granulosa cells which enlarges and the centrally located primary oocyte migrates to the wall of the follicle.
The innermost layer of the granulosa cells of the cumulus become elongated and form the __4__, which is released with the oocyte at ovulation.
1) Cuboidal
2) Cumulus oophorus
3) Antrum
4) Corona radiata
The LH surge initiates a sequence of biochemical and structural changes that result in __1__.
Cells on the follicular wall surface degenerate and a stigma forms, the follicular __2__ bulges through the stigma.
When this ruptures the oocyte is expelled into the
__3__ cavity and ovulation has occurred.
1) Ovulation
2) Basement membrane
3) Peritoneal
After ovulation the granulosa cells of the rupture follicle undergo luteinization. The luteinized granulosa cells, theca cells, capillaries and connective tissue form the ____.
Corpus luteum
The corpus luteum produces copious amounts of __1__ and some __2__.
Normal functional lifespan of corpus luteum is __3__ days.
If pregnancy does not occur, menses ensues and the corpus luteum is gradually replaced by an avascular scar called __4__.
1) Progesterone
2) Estradiol
3) 9-10
4) Corpus albicans
The endometrium is divided into two zones, the __1__ layer undergoes cyclic changes in morphology during the menstrual cycle and is sloughed off at menstruation. This layer contains __2__ arteries.
The __3__ layer remains relatively unchanged during each cycle and after menstruation provides stem cells for the renewal of the functionalis. This layer contains __4__ arteries.
1) Outer portion or functionalis
2) Spiral
3) Inner portion or basalis
4) Basal
During the menstrual phase there is disruption and disintegration of the __1__ glands and stroma, leukocyte infiltration, and red blood cell extravasation.
This leads to sloughing of the __2__ layer and compression of the __2__ layer.
1) Endometrial
2) Functionalis
3) Basalis
The proliferative phase is characterized by endometrial growth secondary to __1__ stimulation.
Increase in the length of the __2__ arteries and numerous mitoses can be seen in these tissues.
1) Estrogenic
2) Spiral
During the secretory phase following ovulation, __1__ secretion by the corpus luteum stimulate the glandular cells to secrete mucous, glycogen, and other substances.
__2__ arteries continue to extend into superficial layer of the endometrium and become convoluted.
1) Progesterone
2) Spiral
a
Null
Medications such as ____, ____, and ____ can impair the coagulation system and be associated with heavy bleeding.
Warfarin, Aspirin, and Clopidogrel
1) What is the characteristic of Primary Amenorrhea?
2) What is Secondary menses?
1) No menstruation by 13 y/o without secondary sexual development
OR
No menstruation by age 15 WITH secondary sexual development
2) Absent Menses >6 months
While the mean blood loss per menstrual period is 30cc, greater than 80cc has been associated with?
Anemia
Female infant acquires the lifetime peak number of oocytes of 6-7 million by?
Mid-gestation (16-20 weeks)
Between the ages of 8-11, there is an increase serum concentrations of __1__, __2__, and __3__.
1) Dehydroepiandrosterone (DHEA)
2) Dehydroepiandrosterone sulfate (DHEA-S)
3) Androstenedione
In general, adrenal ____ production and differentiation by the zona reticularis of the adrenal cortex are the initial endocrine changes associated with puberty.
What does this cause?
Androgen
Axillary (adrenarche) and pubic hair growth (pubarch)
What leads to development of secondary sexual characteristics?
GnRH
Thelarche which is the first sign of puberty requires?
Pubarche/adrenarche (pubic hair/axillary hair development) requires?
Menarche requires?
1) Estrogen
2) Androgens
3) Pulsatile GnRH from hypothalamus, FSH/LH from pituitary, estrogen/progesterone from ovaries
Stages of breast development as defined by Tanner staging. (in mixed order)
__1__ is characterized by further enlargement of breast and areola without separation of their contours.
__2__ is characterized by elevation of papilla only.
__3__ is characterized by projection of papilla only, resulting from recession of the areola to the general contour of the breast.
__4__ is characterized by elevation of breast and papilla as a small mound with enlargement of the areolar region.
__5__ is characterized by projection of areola and papilla to form a secondary mound above the level of the breast.
1) Stage 3
2) Stage 1
3) Stage 5
4) Stage 2
5) Stage 4
1) Papilla ONLY
2) elevation of breast and papilla as small mount with enlargement of areolar region
3) Further enlargement of breast and areaola, NO contour
4) Projection of areola and papilla to form secondary mound
5) Further enlargement of breast/areola NO Separation of contour
Stages of Pubarche/adrenarche as defined by Tanner staging. (in mixed order)
__1__ is characterized by sparse hair along the labia; hair downy with slight pigment.
__2__ is characterized by adult-type hair; there is no spread to the medial surface of the thighs.
__3__ is characterized by absence of pubic hair.
__4__ is characterized by adult-type hair with spread to the medial thighs assuming an inverted triangle pattern.
__5__ is characterized by hair spreads sparsely over the junction of the pubes; hair is darker and coarser.
1) Stage 2
2) Stage 4
3) Stage 1
4) Stage 5
5) Stage 3
1) NO pubic hair
2) Sparse hair along labia
3) Darker/Coarser sparse hair around junction of pubes
4) Adult hair spread without spread to medial surface of thighs
5) Medial thigh and Inverted Triangle
1) When does Precocious Puberty Occur?
2) What must develop?
1) 2.5 STD (before Regular puberty age)
2) Secondary Characteristics
