Repro IV

Question 1

estrogen sources

Answer 1

ovary - 17B estradiol
placenta - estriol
adipose - estrone aromatization

potency - estradiol > estrone > estriol

Question 2

indicator of fetal well being

Answer 2

1000x increase in estriol

Question 3

estrogen receptor

Answer 3

cytoplasm

to nucleus when bound

Question 4

pulsatile GnRH

Answer 4

increased LH and FSH

LH - to theca internal cells
-cholesterol to androgen via desmolase

FSH - granulosa cell

• androgen (from theca internal) to estrogens
• via aromatase

Question 5

progesterone

Answer 5

maintain pregnancy

thick cervical mucus

increased body temp

inhibit LH and FSH

uterine smooth m relaxation

decreased estrogen receptor expression

delivery - low progesterone - disinhibit prolactin
-get lactation

Question 6

tanner stages

Answer 6

1 childhood
2 pubic hair (pubarche) and breast bud (thelarche)
3 pubic darker, breast larger
4 penis width increase dark scrotum glans devleop
5 adult - areola no longer raised

Question 7

menstrual cycle

Answer 7

proliferative phase - follicular
increase in FSH - more estrogen
-increased estrogen - LH surge
-result in ovulation - day 14

secretory phase - luteal

• corpus luteum - synthesize progesterone
• loss of CL - apoptosis of endometrium - low P

Question 8

metrorrhagia

Answer 8

irregular time

Question 9

menorrhagia

Answer 9

heavy bleeding

Question 10

menometrorrhagia

Answer 10

heavy and irregular

Question 11

oogenesis

Answer 11

primary oocyte - begin meiosis I during fetal life

• arrested in prophase I
• complete meiosis I - prior to ovulation

meiosis II arrested in metaphase II
-until fertilization

no fertilization in 1 day - secondary oocyte degenerate

Question 12

meiosis I and II

Answer 12

I - 46 sister to 23 sister

II - 23 sister to 23 single

Question 13

mittelschmerz

Answer 13

mid cycle ovulatory pain

peritoneal irritation

can mimic appeidicitis

Question 14

hCG detection

Answer 14

in blood - 1 week after conception

in urine - 2 weeks after conception

Question 15

lactation

Answer 15

PRL - induce and maintain lactation

oxytocin - milk letdown - and uterine contraciton

Question 16

breast milk

Answer 16

no vit D

also no vit K

Question 17

hCG

Answer 17

from syncytiotrophoblast

maintain CL and progesterone

after 10 weeks - placenta synthesize own estriol and progesterone - CL degenerate

Question 18

hormone subunit

Answer 18

LH, FSH, TH, hCG

• identical a-subunit
• B subunit unique

B subunit - detected on pregnancy test

Question 19

elevated hCG

Answer 19

multi gestation
hydatidiform mole
choriocarcinoma
down syndromw

Question 20

low hCG

Answer 20

ectopic, edward, patau

Question 21

estrogen source after menopause

Answer 21

peripheral conversion of androgens

so get hirsutism

Question 22

menopause marker

Answer 22

elevated FSH - no more negative feedback estrogen

Question 23

spermatogenesis

Answer 23

begin at puberty

spermatogonia to spermatid

spermatid undergo spermiogenesis

spermatogonium - 46 single chromosomes
primary spermatocyte - 46 sister chromatids
secondary spermatocyte - 23 sister chromatid
spermatid - 23 single chromosome

mature spermatozoon - 23 single chromosome

• has acrosome - nose
• and head, nucleus, neck, middle piece, tail

Question 24

androgens

Answer 24

T, DHT, androstenedione

potency - DHT (high) - T - androstenedione

Question 25

klinefelters syndrome

Answer 25

47 XXY male ``` testicle atrophy eunuchoid body shape tall, long extremities gynecomastia female hair pattern ``` presence of inactivatd X chromosome - Barr body dysgenesis of seminiferous tubule - low inhibin - high FSH abnormal leydig - low testosterone - low LH - high estrogen

Question 26

turner syndrome

Answer 26

45X0 female short stature ovarian dysgenesis - streak ovary shield chest bicuspid aortic valve preductal coarctation lymph defect - web neck and cystic higroma horseshoe kidney MCC primary amenorrhea low estrogen - high LH and FSH mitotic or meitotic error pregnancy possible some cases - need exogenous estradiol and progesterone

Question 27

double Y male

Answer 27

XYY phenotypic normal very tall random nondisjunction event noninherited severe acne, learning disability, autism

Question 28

true hermaphroditism

Answer 28

46XX or 47XXY ovotesticular disorder of sex development both ovarian and testicle present - ovotestis ambiguous genitals

Question 29

primary hypogonadism

Answer 29

low T and high LH

Question 30

female pseudohermaphrodite

Answer 30

XX ovary present external genitals virilized or ambiguous excess androgen during early gestation

Question 31

male pseudohermaphrodite

Answer 31

XY testes present external genitals female or ambiguous androgen insensitivity syndrome

Question 32

aromatase deficient

Answer 32

cannot synthesize estrogen from androgen masculinzed female high serum T and androstenedione

Question 33

androgen insensitivity syndrome

Answer 33

46 XY defect in androgen receptor normal appearning female -rudimentary vagina, no uterus or fallopian tube testes in labia major - removed cancer risk high T, estrogen, and LH

Question 34

5a reductase deficient

Answer 34

auto rec 46XY - male no DHT - ambiguous genital until puberty - when testosterone cause masculinization and growth external gintalia

Question 35

kallman syndrome

Answer 35

failure complete puberty hypogonadotropic hypogonadism defect migration GnRH cells - formation of olfactory bulb low synthesis of GnRH see anosmia - can't smell low GnRH, FSH, LH, testosterone infertile - low sperm count in male, and amenorrhea in women

Question 36

hydatidiform mole

Answer 36

poliferation trophoblast association - theca-lutein cyst, hyperemesis gravidarum, hyperT tx D and C, methotrexate, monitor hCG

Question 37

complete mole

Answer 37

46XX or 46XY very very high hCG increasd uterine size can convert to choriocarcinoma no fetal parts enucleated egg and single sperm - duplicate paternal genes risk malignant trophoblast disease cluster of grape on U/S, or honeycombed or snowstorm

Question 38

partial mole

Answer 38

69XXX, 69XXY, 69XYY elevated hCG has fetal parts 2 sperm to 1 egg low risk malignancy see fetal parts on imaging