Quiz 4 Flashcards
In what ligament on this diagram could you find the ovarian VAN? What is it called?
How long does the first stage of oocyte development last?
In what phase of meiosis does the primary oocyte stay during the first stage of oocyte development?
What changes does the primordial follicle undergo during the first stage of oocyte development?
What are the two phases of the menstrual cycle?
Follicular phase (2 weeks)
Luteal phase (2 weeks)
What event occurs between the follicular and luteal phases of the menstrual cycle?
Ovulation
What is the difference in GnRH release before and after puberty in females?
What type of ovarian cell makes progesterone and androstenedione in response to LH?
Theca cells
What type of ovarian cell makes aromatase in response to FSH?
Granulosa cells
In what phase of meiosis does the secondary oocyte stop when released into the fallopian tube?
Metaphase of meiosis 2
What effect does low concentrations of estrogen have on LH secretion from the pituitary gland? (Follicular phase)
Inhibitory effect
Why does FSH rise slightly, then fall during the follicular phase of the ovarian cycle?
Negative feedback from estrogen released by maturing secondary follicles
What effect does estrogen have on LH secretion during the first 10 days of the menstrual cycle?
Inhibitory
After 10 days of the menstrual cycle what significant effect does estrogen have on LH?
As estrogen levels increase, it stops inhibiting LH and gains a stimulatory effect on LH
What causes the LH spike seen at the end of the follicular phase of the mesntrual cycle?
Rising estrogen levels
Increasing levels of GnRH
What is significant about the LH spike at the end of the follicular phase of the menstrual cycle?
It triggers ovulation
Does FSH spike during ovulation?
Not nearly to the degree as LH, it mostly rises due to the effects of increased GnRH as well as ovulation itself
What happens to the secondary follicle after the ovulation occurs?
It degrades into the corpus luteum
What purpose does the corpus luteum serve?
It secretes:
-Estrogen (lower amount)
-Inhibin
-Progesterone
What role does inhibin have in the menstrual cycle?
Inhibition of FSH
Which important hormone of the luteal phase of the menstrual cycle has an inihibitory affect on GnRH?
Progesterone
What two hormones in the luteal phase of the menstrual cycle stimulate endometrial growth?
Progesterone
Estrogen
In a situation where fertilization of an oocyte does not occur, what is the signifiance of the decreased levels of progesterone, estrogen, and inhibin as the corpus luteum degenerates?
It allows for a release of the inhibition of GnRH, which increases allowing a new cycle to occur
How much weight gain is recommended for a woman under 18.5 BMI during pregnancy?
28-40 lbs
How much weight gain is recommended for a woman between a BMI of 18.5 and 24.9 during pregnancy?
25-35 lbs
How much weight gain is recommended for a woman between a BMI of 25 and 29.9 during pregnancy?
15-25 lbs
How much weight gain is recommended for a woman with a BMI of over 30 during pregnancy?
11-20 lbs
Which factor is responsible for development of the testicle?
Testis-determing factor (TDF)
What factor is required for sertoli cells to aggregate at 6 weeks gestation?
TDF
At 7 weeks (if Sertoli cells have aggregated) what is secreted by Sertoli cells?
AMH
What hormone is required for male internal genitalia?
What hormone is required for male external genitalia?
What important structures in male physiology develop from the Wolffian duct (mesonephric duct)?
What important structures develop in female physiology from the Mullerian duct (paramesonephric duct)?
What is the signifiance of production of estrogen and inhibins by the dominant follicle in the mid-follicular phase of the menstrual cycle?
What role does hCG have in preservation of the corpus luteum?
What hormone helps to induce LH receptors on the dominant follicle? When does this occur?
FSH
After negative selection against subordinate follicles
What is the main estrogen found in menopause?
Estrone
What is perimenopause? How long does it typically last? What hormone slowly rises?
How is menopause diagnosed?
Diagnosed retrospectively; cessation of menses for 12 months in a previously cycling woman
What is premature ovarian insufficiency (POI)? What is the prevalence?
What is early menopause?
What score is used to measure hair growth in cases of hirsutism?
What is hypertrichosis?
What syndrome do 80% of patients presenting with hirsutism have?
PCOS
What type of tumor is responsible for 0.2% of women with hirsutism? How is the site of the tumor deduced?
What criteria is used to diagnosis PCOS?
What are the factors of infertility testing?
Define infertility, fecundability, and fecundity:
Besides couples diagnosed with infertility and those seeking evalation, who else should infertility evaluation be offered to?
After a thorough H&P, what additional screening tests for infertility can be done?
What is the best predictor for ovulation?
What processes of physiological reproductive aging are complete by 28 weeks gestation?
What processes of physiological reproductive aging are complete by 6 months (after birth)?
What processes of physiolgical reproductive aging continue through menopause?
What are three notable pathologies of age related decline in fertility?
What type of fluid is secreted by the prostate gland? What % of semen volume does it comprise? Which zone is most responsible for BPH?
How does BPH contribute to urinary symptoms like hestiancy, post void dribbling, and nocturia?
What is the most common cause of gross hematuria in men?
BPH (does NOT exclude a formal workup)
What is the most common corrective surgery for BPH?
Transurethral resection of the prostate (TURP)
What is the most common cause of gross hematuria in a patient over 50?
Bladder cancer
What are the main causes of hematuria?
How is hematuria diagnosed?
What labs should be done in evaluation of hematuria cases?
What syndrome is responsible for 90-95% of prostatitis cases?
Chronic pelvic pain syndrome
What three acute onset symptoms are most common of testicular torison? What deformity represents up to 90% of cases?
What is the difference between intravaginal and extravaginal testicular torsion?
How is testicular torsion diagnosed? What length of time is considered the period of viablity?
Undescended testes are also known by what condition? By what age do most spontaneously descend? What significant risks are incurred?
What is the etiology of testicular varicocele? Which side is most common?
What is the most common presentation for testicular tumors? What mode of imaging can distinguish from minor trauma, orchitis, or torsion?
What is the difference between phimosis and paraphimosis? Which is a surgical emergency?
What is the most common GU organ injury?
What grade of renal trauma is displayed here?
How is renal trauma managed?
What are risk factors for Fournier’s gangrene? What is the classic presentation?
What parental benefits are incurred by breastfeeding?
-Increased oxytocin release (increased bonding, reudction of chance of post-partum bleeding)
-Delayed onset of menses (helps restore iron stores)
What are the key hormones involved in lactation? What is the role of FIL?
FIL helps to decreases prolactin levels in the event that suckling no longer occurs a sufficient amount
What is significant about proteins in human breast milk, such as lactoferrin?
Lactoferrin enhances iron absorption
What long chain polyunsaturated fatty acids are available in human breast milk but not other milks? Why are they significant?
Docosahexaenoic acid (DHA) and Arachidonic acid (ARA)
They are important for brain development
What role does bifidus factor have as found in human breast milk?
It supports the growth of beneficial bacteria
What role does bile-salt stimulated lipase have as found in human breast milk?
It facilitates the complete digestion of fat in the infant’s small intestine.
*Fat in artificial milks is less completely digested
What vitamin is often not present in breast milk in adequate amounts?
Vitamin D
Are infants born with a store of iron?
Yes, but preterm infants or those with low birth weight may need iron supplements
When should a lactating mother be concerned about vitamin B12 in breast milk?
-Vegan diet
-Gastric bypass
-Gut malabsorption problems
How long does the american academy of pediatrics recommend that infants should be exclusively breastfed?
6 months
What are the only true contraindications for breast feeding?
-Infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)
-Mothers infected with HIV
*Also infants with PKU, urea cycle disorders, and several other metabolic disorders
Onset of copious milk secretion post-partum is mostly stimulated by what event?
The sudden drop in progesterone
Does the heart appear larger or smaller on CXR during pregnancy? Where is the apex found as opposed to normal physiology?
Myocardial sensitivty is increased during pregnancy due to circulation of what molecules? What is the common pathology resulting from this sensitivity?
How much does the cardiac output increase during pregnancy? Is this due to an increase in HR or SV?
What are the two main causes of decreased SVR via smooth muscle relaxation during pregnancy? At what point does BP stop decreasing and begin to increase?
Does the mitral or tricuspid valve close first during pregnancy? What causes this to occur?
What percentage of pregnant women experience a physiologic flow murmur during pregnancy?
96%
How does BP vary positionally during pregnancy? What trend does BP follow over the course of pregnancy?
Blood pressure is lowest when the patient is lying on her left side, as taken in superior arm
What hematologic changes contribute to a hypercoagulable state during pregnancy (and postpartum)?
At what point does hematocrit reach a nadir during pregnancy?
About 25 weeks, then it rises slightly
What are common causes of anemia in pregnancy? What are uncommon causes?
What are three rare kinds of causes of anemia in pregnancy?
What is critical to understand about WBC count during pregnancy?
It is normal for platelet count to fall during pregnancy, but 6% of normal pregnancies will be associated with a platelet count of < 150,000. What are two abnormal causes?
-Idiopathic thrombocytopenic purpura
-Preeclampsia
What are 4 significant changes to respiratory capacity in a pregnant woman?
Does pregnancy lead to a state of chronic hyperventilation or hypoventilation? What is the chief mechaism by which the body can maintain pH within normal ranges?
What are two significant renal changes during pregnancy?
Besides increased insulin secretion during pregnancy, what are two causes of insulin resistance?
What is the risk associated with first trimester hyperglycemia? What about third trimester hyperglycemia?
What significant thyroid change are associated with pregnancy? What can result of maternal hypothyroidism is untreated?
Are adrenal hormone levels increased or decreased during pregnancy? What is the source of increased CRH in the third trimester?
Does pregnancy result in increased or decreased tone and motility in the sotmach and intestine?
Decreased
What are two notable HEENT changes during pregnancy?
What are two notable changes to the skin during pregnancy?
Increased blood flow
Increased pigmentation
What is endometriosis?
Islands of hormonally functional endometrial tissue in extrauterine sites
**Inflammation associated with implants plays a critical role in Sx
What is the epidemiology of endometriosis? What additional risks are conferred by endometriosis?
What are the three main phenotypes for endometriosis?
What surgical procedure is typically used for diagnosis of endometriosis as well as surgical excision?
Laparoscopy
What is the therapeutic window for treatment of endometriosis in the estrogen threshold hypothesis?
What are the effects of estradiol and progesterone on endometriosis?
What are uterine fibroids?
Benign, clonal smooth muscle cell tumors ranging in size from several millimeters to many centimeters
What effects do estrogen and progesterone have on uterine fibroids?
What are common symptoms seen with uterine fibroids?
-Heavy menstrual bleeding
- Pelvic pain, backache or leg pains
-Constipation
What are the three main types of uterine fibroid?
What pathology is seen in the attached tissue biopsy?
Leiomyoma
What are notable treatments for uterine fibroids/leiomyomas?
-MRgFU
-GnRHa (leuprolide, goserelin)
-SPRMs (Ulipristal)
What is the etiology of bacterial vaginosis? What is the notable change in ph?
What are the amsel criteria for bacterial vaginosis?
What is balanoposthitis? What are common causes?
Infection of the glans and prepuce
C albicans, anerobic bacteria, Gardnerella, and pyogenic bacteria
What histologic changes in malpositioned testes (i.e. cryptorchidism) can be seen here? (normal on left; pathology on right)
Thickening of the basement membrane of the spermatic tubules
What is the most common type of cancer affecting caucasian males between 15-45 years of age? What is the etiology?
Germ Cell Tumors (GCTs)
These tumors occur as a result of environmental exposures and inherited/acquired genetic abnormalities
What is testicular dysgenesis syndrome? How do they present?
A spectrum of disorders associated with GCts.
They can consist of cryptorchidism, hypospadias and poor sperm quality
What is the most common type of germ cell tumor?
A seminoma
Define labor:
Regular uterine contractions AND progressive cervical change
Explain dilation and effacement using the following picture:
Good job!
What are the two phases of the 1st stage of labor?
Latent
Active
What comprises the latent phase of the 1st stage of labor? What comprises the active phase?
What comprises the 2nd stage of labor?
What is the 3rd stage of labor?
What are the 3 Ps of abnormal labor?
Power
Passenger
Passage
What interventions can be implemented to insufficient power in abnormal labor?
-Oxytocin augmentation
-AROM (artificial rupture of membranes)
-Assisted vaginal/cesarean delivery
Which pelvis shape is the most common in females?
