Repro 1a

Question 1

FSH acts on ______ to induce aromatase that converts androgens to ________?

Answer 1

a. Granulosa Cells

b. Estrogen

Question 2

LH works on what to produce androgens?

Answer 2

Theca cells.

Question 3

Tell me about Turner’s.

Answer 3

a. Primary hypogonadism in phenotypic female
b. Presents: short, shield chest, streak ovaries, amenorrhea
c. Dx: karyotype, high FSH:LH bc of low estrogen

Question 4

Tell me about MRKH Syndrome,- aka Mullerian Agenesis.

Answer 4

a. variable uterus development, but no vagina
b. 2nd most common cause of primary amenorrhea
c. vagina may be short or absent… clit and labia are normal
d. Tx: progressive dilation.
e. no children, but does have ovary and eggs for if can find a surrogate

Question 5

Tell me about Congenital Adrenal Hyperplasia.

Answer 5

a. 21-hydroxylase deficiency, high 17beta-hydroxylase, HTN and HyperK.
b. ambiguous genitals, large labia/clitoris, normal uterus and higher
c. can carry kids, but might be hard.

Question 6

What are the most common vaginal neoplasms?

Answer 6

Squamous Cell Carcinoma > Adenocarcinoma > Malignant Melanoma

Question 7

Tell me about Squamous Cell Carcinoma.

Answer 7

a. keratin pearls on histology
b. most often HPV 16, 18, 45
c. PAP: HSIL (high grade squamous intraepithelial lesion), nuclear atypia and scant cytoplasm

Question 8

Tell me about Adenocarcinoma.

Answer 8

a. Hist: malignant glandular epithelium
b. HPV 16, 18, 45
c. PAP: nuclear atypia, glandular cytoplasm

Question 9

Walk me thru from CIN1 to Carcinoma in Situ.

Answer 9

CIN I: involves basal 1/3 of epithelium
CIN II: involves basal 2/3 of epithelium
CIN III: involves > 2/3 of epithelium
Carcinoma in Situ: involves entire thickness of epithelium

Question 10

Which cells secrete AMH to make the fetus a man?

Answer 10

Sertoli

Question 11

What is the only contraception proven to prevent HIV?

Answer 11

male condom

Question 12

Breastfeeding as contraception, what does prolactin suppress?

Answer 12

It suppress GnRH pulsatility resulting in hypothalamic amenorrhea.

Question 13

What are 8 contra-indications for OCPs?

Answer 13

a. migraine with aura
b. Hx of breast cancer
c. Hx of VTE
d. diabetes and associated CVD
e. smokers > 35 y/o
f. severe hyperlipidemia
g. uncontrolled HTN
h.

Question 14

What is Hysteroscopic Sterilization?

Answer 14

• wire coil in fallopian tubes
• less invasive, but irreversible contraception (as opposed to other forms of sterilization)
• can be done in office
• requires backup contraception for 3 months

Question 15

Give me the order of the stages of development.

Answer 15

a. boobs
b. pubes
c. spurt
d. squirt
(hair, then boobs)

Question 16

Describe sequence of events in pubarche.

Answer 16

a. pre-pube
b. long/straight
c. short/curly
d. cover labia
e. spread to thighs

Question 17

What is the hallmark of a mature hypothalamic-pituitary gonadal axis?

Answer 17

E2 can give positive feedback on pituitary leading to LH surge and ovulation.

Question 18

Where is leptin made, and why is it important?

Answer 18

Made from adipocytes. Leptin-deficient people (congential) exhibit hypogonadotropic hypogonadism. Thought to be one reason why obesity might lead to earlier puberty.

Question 19

What are the two ways that precocious puberty can occur?

Answer 19

a. Central- premature maturation of HPG axis, full-on puberty
b. Peripheral- “ovaries go rogue”, no GnRH, but exposure to sex steroids from gonads, adrenals or environment

Question 20

What are the causes of Central Precocious Puberty?

Answer 20

a. CNS tumor must be excluded, always do a head MRI
b. can be triggered by peripheral steroid production
c. Profound Hypothyroidism- only cause of precocious puberty with DELAYED bone age.

Question 21

What is McCune Albright Sydrome?

Answer 21

• Precocious puberty.
• cafe au lait spots, polyostotic fibrous dysplasia
• GnRH independent, autonomous ovarian fxn of FSH receptor

Question 22

How do you treat Central/Peripheral precocious puberty?

Answer 22

Central: long-acting GnRH agonist to suppress pulsatility, lupron in a 6y/o can add 10cm of height.

Peripheral:

• gonad tumor = surgery
• CAH = glucocorticoids
• McCune-Albright = aromatase inhibitor