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M&R > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

In what ligament on this diagram could you find the ovarian VAN? What is it called?

A
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2
Q

How long does the first stage of oocyte development last?

A
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3
Q

In what phase of meiosis does the primary oocyte stay during the first stage of oocyte development?

A
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4
Q

What changes does the primordial follicle undergo during the first stage of oocyte development?

A
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5
Q

What are the two phases of the menstrual cycle?

A

Follicular phase (2 weeks)
Luteal phase (2 weeks)

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6
Q

What event occurs between the follicular and luteal phases of the menstrual cycle?

A

Ovulation

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7
Q

What is the difference in GnRH release before and after puberty in females?

A
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8
Q

What type of ovarian cell makes progesterone and androstenedione in response to LH?

A

Theca cells

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9
Q

What type of ovarian cell makes aromatase in response to FSH?

A

Granulosa cells

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10
Q

In what phase of meiosis does the secondary oocyte stop when released into the fallopian tube?

A

Metaphase of meiosis 2

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11
Q

What effect does low concentrations of estrogen have on LH secretion from the pituitary gland? (Follicular phase)

A

Inhibitory effect

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12
Q

Why does FSH rise slightly, then fall during the follicular phase of the ovarian cycle?

A

Negative feedback from estrogen released by maturing secondary follicles

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13
Q

What effect does estrogen have on LH secretion during the first 10 days of the menstrual cycle?

A

Inhibitory

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14
Q

After 10 days of the menstrual cycle what significant effect does estrogen have on LH?

A

As estrogen levels increase, it stops inhibiting LH and gains a stimulatory effect on LH

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15
Q

What causes the LH spike seen at the end of the follicular phase of the mesntrual cycle?

A

Rising estrogen levels
Increasing levels of GnRH

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16
Q

What is significant about the LH spike at the end of the follicular phase of the menstrual cycle?

A

It triggers ovulation

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17
Q

Does FSH spike during ovulation?

A

Not nearly to the degree as LH, it mostly rises due to the effects of increased GnRH as well as ovulation itself

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18
Q

What happens to the secondary follicle after the ovulation occurs?

A

It degrades into the corpus luteum

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19
Q

What purpose does the corpus luteum serve?

A

It secretes:
-Estrogen (lower amount)
-Inhibin
-Progesterone

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20
Q

What role does inhibin have in the menstrual cycle?

A

Inhibition of FSH

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21
Q

Which important hormone of the luteal phase of the menstrual cycle has an inihibitory affect on GnRH?

A

Progesterone

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22
Q

What two hormones in the luteal phase of the menstrual cycle stimulate endometrial growth?

A

Progesterone
Estrogen

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23
Q

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?

A

It allows for a release of the inhibition of GnRH, which increases allowing a new cycle to occur

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24
Q

How much weight gain is recommended for a woman under 18.5 BMI during pregnancy?

A

28-40 lbs

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25
Q

How much weight gain is recommended for a woman between a BMI of 18.5 and 24.9 during pregnancy?

A

25-35 lbs

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26
Q

How much weight gain is recommended for a woman between a BMI of 25 and 29.9 during pregnancy?

A

15-25 lbs

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27
Q

How much weight gain is recommended for a woman with a BMI of over 30 during pregnancy?

A

11-20 lbs

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28
Q

Which factor is responsible for development of the testicle?

A

Testis-determing factor (TDF)

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29
Q

What factor is required for sertoli cells to aggregate at 6 weeks gestation?

A

TDF

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30
Q

At 7 weeks (if Sertoli cells have aggregated) what is secreted by Sertoli cells?

A

AMH

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30
Q

What hormone is required for male internal genitalia?

A
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31
Q

What hormone is required for male external genitalia?

A
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32
Q

What important structures in male physiology develop from the Wolffian duct (mesonephric duct)?

A
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33
Q

What important structures develop in female physiology from the Mullerian duct (paramesonephric duct)?

A
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34
Q
A
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35
Q

What is the signifiance of production of estrogen and inhibins by the dominant follicle in the mid-follicular phase of the menstrual cycle?

A
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36
Q

What role does hCG have in preservation of the corpus luteum?

A
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37
Q

What hormone helps to induce LH receptors on the dominant follicle? When does this occur?

A

FSH

After negative selection against subordinate follicles

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38
Q

What is the main estrogen found in menopause?

A

Estrone

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39
Q

What is perimenopause? How long does it typically last? What hormone slowly rises?

A
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40
Q

How is menopause diagnosed?

A

Diagnosed retrospectively; cessation of menses for 12 months in a previously cycling woman

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41
Q

What is premature ovarian insufficiency (POI)? What is the prevalence?

A
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42
Q

What is early menopause?

A
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43
Q

What score is used to measure hair growth in cases of hirsutism?

A
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44
Q

What is hypertrichosis?

A
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45
Q

What syndrome do 80% of patients presenting with hirsutism have?

A

PCOS

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46
Q

What type of tumor is responsible for 0.2% of women with hirsutism? How is the site of the tumor deduced?

A
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47
Q

What criteria is used to diagnosis PCOS?

A
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48
Q

What are the factors of infertility testing?

A
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49
Q

Define infertility, fecundability, and fecundity:

A
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50
Q

Besides couples diagnosed with infertility and those seeking evalation, who else should infertility evaluation be offered to?

A
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51
Q

After a thorough H&P, what additional screening tests for infertility can be done?

A
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52
Q

What is the best predictor for ovulation?

A
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53
Q

What processes of physiological reproductive aging are complete by 28 weeks gestation?

A
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54
Q

What processes of physiological reproductive aging are complete by 6 months (after birth)?

A
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55
Q

What processes of physiolgical reproductive aging continue through menopause?

A
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56
Q

What are three notable pathologies of age related decline in fertility?

A
57
Q

What type of fluid is secreted by the prostate gland? What % of semen volume does it comprise? Which zone is most responsible for BPH?

A
58
Q

How does BPH contribute to urinary symptoms like hestiancy, post void dribbling, and nocturia?

A
59
Q

What is the most common cause of gross hematuria in men?

A

BPH (does NOT exclude a formal workup)

60
Q

What is the most common corrective surgery for BPH?

A

Transurethral resection of the prostate (TURP)

61
Q

What is the most common cause of gross hematuria in a patient over 50?

A

Bladder cancer

62
Q

What are the main causes of hematuria?

A
63
Q

How is hematuria diagnosed?

A
64
Q

What labs should be done in evaluation of hematuria cases?

A
65
Q

What syndrome is responsible for 90-95% of prostatitis cases?

A

Chronic pelvic pain syndrome

66
Q

What three acute onset symptoms are most common of testicular torison? What deformity represents up to 90% of cases?

A
67
Q

What is the difference between intravaginal and extravaginal testicular torsion?

A
68
Q

How is testicular torsion diagnosed? What length of time is considered the period of viablity?

A
69
Q

Undescended testes are also known by what condition? By what age do most spontaneously descend? What significant risks are incurred?

A
70
Q

What is the etiology of testicular varicocele? Which side is most common?

A
71
Q

What is the most common presentation for testicular tumors? What mode of imaging can distinguish from minor trauma, orchitis, or torsion?

A
72
Q

What is the difference between phimosis and paraphimosis? Which is a surgical emergency?

A
73
Q

What is the most common GU organ injury?

A
74
Q

What grade of renal trauma is displayed here?

A
75
Q

How is renal trauma managed?

A
76
Q

What are risk factors for Fournier’s gangrene? What is the classic presentation?

A
77
Q

What parental benefits are incurred by breastfeeding?

A

-Increased oxytocin release (increased bonding, reudction of chance of post-partum bleeding)

-Delayed onset of menses (helps restore iron stores)

78
Q

What are the key hormones involved in lactation? What is the role of FIL?

A

FIL helps to decreases prolactin levels in the event that suckling no longer occurs a sufficient amount

79
Q

What is significant about proteins in human breast milk, such as lactoferrin?

A

Lactoferrin enhances iron absorption

80
Q

What long chain polyunsaturated fatty acids are available in human breast milk but not other milks? Why are they significant?

A

Docosahexaenoic acid (DHA) and Arachidonic acid (ARA)

They are important for brain development

81
Q

What role does bifidus factor have as found in human breast milk?

A

It supports the growth of beneficial bacteria

82
Q

What role does bile-salt stimulated lipase have as found in human breast milk?

A

It facilitates the complete digestion of fat in the infant’s small intestine.

*Fat in artificial milks is less completely digested

83
Q

What vitamin is often not present in breast milk in adequate amounts?

A

Vitamin D

84
Q

Are infants born with a store of iron?

A

Yes, but preterm infants or those with low birth weight may need iron supplements

85
Q

When should a lactating mother be concerned about vitamin B12 in breast milk?

A

-Vegan diet
-Gastric bypass
-Gut malabsorption problems

86
Q

How long does the american academy of pediatrics recommend that infants should be exclusively breastfed?

A

6 months

87
Q

What are the only true contraindications for breast feeding?

A

-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

88
Q

Onset of copious milk secretion post-partum is mostly stimulated by what event?

A

The sudden drop in progesterone

89
Q

Does the heart appear larger or smaller on CXR during pregnancy? Where is the apex found as opposed to normal physiology?

A
90
Q

Myocardial sensitivty is increased during pregnancy due to circulation of what molecules? What is the common pathology resulting from this sensitivity?

A
91
Q

How much does the cardiac output increase during pregnancy? Is this due to an increase in HR or SV?

A
92
Q

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?

A
93
Q

Does the mitral or tricuspid valve close first during pregnancy? What causes this to occur?

A
94
Q

What percentage of pregnant women experience a physiologic flow murmur during pregnancy?

A

96%

95
Q

How does BP vary positionally during pregnancy? What trend does BP follow over the course of pregnancy?

A

Blood pressure is lowest when the patient is lying on her left side, as taken in superior arm

96
Q

What hematologic changes contribute to a hypercoagulable state during pregnancy (and postpartum)?

A
97
Q

At what point does hematocrit reach a nadir during pregnancy?

A

About 25 weeks, then it rises slightly

98
Q

What are common causes of anemia in pregnancy? What are uncommon causes?

A
99
Q

What are three rare kinds of causes of anemia in pregnancy?

A
100
Q

What is critical to understand about WBC count during pregnancy?

A
101
Q

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?

A

-Idiopathic thrombocytopenic purpura
-Preeclampsia

102
Q

What are 4 significant changes to respiratory capacity in a pregnant woman?

A
103
Q

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?

A
104
Q

What are two significant renal changes during pregnancy?

A
105
Q

Besides increased insulin secretion during pregnancy, what are two causes of insulin resistance?

A
106
Q

What is the risk associated with first trimester hyperglycemia? What about third trimester hyperglycemia?

A
107
Q

What significant thyroid change are associated with pregnancy? What can result of maternal hypothyroidism is untreated?

A
108
Q

Are adrenal hormone levels increased or decreased during pregnancy? What is the source of increased CRH in the third trimester?

A
109
Q

Does pregnancy result in increased or decreased tone and motility in the sotmach and intestine?

A

Decreased

110
Q

What are two notable HEENT changes during pregnancy?

A
111
Q

What are two notable changes to the skin during pregnancy?

A

Increased blood flow
Increased pigmentation

112
Q

What is endometriosis?

A

Islands of hormonally functional endometrial tissue in extrauterine sites

**Inflammation associated with implants plays a critical role in Sx

113
Q

What is the epidemiology of endometriosis? What additional risks are conferred by endometriosis?

A
114
Q

What are the three main phenotypes for endometriosis?

A
115
Q

What surgical procedure is typically used for diagnosis of endometriosis as well as surgical excision?

A

Laparoscopy

116
Q

What is the therapeutic window for treatment of endometriosis in the estrogen threshold hypothesis?

A
117
Q

What are the effects of estradiol and progesterone on endometriosis?

A
118
Q

What are uterine fibroids?

A

Benign, clonal smooth muscle cell tumors ranging in size from several millimeters to many centimeters

119
Q

What effects do estrogen and progesterone have on uterine fibroids?

A
120
Q

What are common symptoms seen with uterine fibroids?

A

-Heavy menstrual bleeding
- Pelvic pain, backache or leg pains
-Constipation

121
Q

What are the three main types of uterine fibroid?

A
122
Q

What pathology is seen in the attached tissue biopsy?

A

Leiomyoma

123
Q

What are notable treatments for uterine fibroids/leiomyomas?

A

-MRgFU
-GnRHa (leuprolide, goserelin)
-SPRMs (Ulipristal)

124
Q

What is the etiology of bacterial vaginosis? What is the notable change in ph?

A
125
Q

What are the amsel criteria for bacterial vaginosis?

A
126
Q

What is balanoposthitis? What are common causes?

A

Infection of the glans and prepuce

C albicans, anerobic bacteria, Gardnerella, and pyogenic bacteria

127
Q

What histologic changes in malpositioned testes (i.e. cryptorchidism) can be seen here? (normal on left; pathology on right)

A

Thickening of the basement membrane of the spermatic tubules

128
Q

What is the most common type of cancer affecting caucasian males between 15-45 years of age? What is the etiology?

A

Germ Cell Tumors (GCTs)

These tumors occur as a result of environmental exposures and inherited/acquired genetic abnormalities

129
Q

What is testicular dysgenesis syndrome? How do they present?

A

A spectrum of disorders associated with GCts.

They can consist of cryptorchidism, hypospadias and poor sperm quality

130
Q

What is the most common type of germ cell tumor?

A

A seminoma

131
Q

Define labor:

A

Regular uterine contractions AND progressive cervical change

132
Q

Explain dilation and effacement using the following picture:

A

Good job!

133
Q

What are the two phases of the 1st stage of labor?

A

Latent
Active

134
Q

What comprises the latent phase of the 1st stage of labor? What comprises the active phase?

A
135
Q

What comprises the 2nd stage of labor?

A
136
Q

What is the 3rd stage of labor?

A
137
Q

What are the 3 Ps of abnormal labor?

A

Power
Passenger
Passage

138
Q

What interventions can be implemented to insufficient power in abnormal labor?

A

-Oxytocin augmentation
-AROM (artificial rupture of membranes)
-Assisted vaginal/cesarean delivery

139
Q

Which pelvis shape is the most common in females?

A
140
Q
A

M&R (8 decks)

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