Reproductive Flashcards
1
Q
What’s the general approach to treating female hypogonadism?
A
E days 1-21, T days 12-21 (mimic menstrual cycle).
2
Q
What’s the effect of estrogen on the heart and bones?
A
Cardioprotective, maintains bone density.
3
Q
Describe the process of getting an erection.
A
PNS NO increase blood flow to the organ but also constricts the arteriovenous anastomosis (albuginea pushes on it, not stretchy), blood diverts to the helical arteries..
4
Q
What are the 5 Ps in asking about sexual history?
A
Partners, practices, protection from STDs, past history of STDs, pregnancy prevention.
5
Q
What is the state of FSH and LH after labour?
A
Low for 2-3 weeks after delivery.
6
Q
What kind of mucosa lines the fallopian tubes? Describe the rest of it.
A
Simple cuboidal, folded up in the ampulla. Theres a thick musculatis with inner circular and outer longitudinal tract. The mucosa has Peg cells (secretory, darker staining) that secrete nutritive fluid.
7
Q
What is complete selection?
A
When people of a genotype don’t have viable offspring at all. Dominant alleles lost quicker, recessive exponentially decay until they are ‘fixed’ to an asymptote.
8
Q
What do you give PCOS women is pregnancy is desired?
A
Clomiphene citrate.
9
Q
What do Sertoli cells do?
A
Release antimullerian hormone in development, secrete Androgen Binding Protein in adults (condenses testosterone in testes). They also create the basal lamina, phagocytose residual bodies, secrete inhibin B, establish the blood-testes barrier.
10
Q
Where is there aromatase?
A
Adipose, lover, skin, brain,
11
Q
What is fecundability?
A
Monthly probability that woman will conceive - drops at about 37 years old.
12
Q
What is Finasteride?
A
5 alpha reductase inhibitor. Good for BPH, male pattern baldness, female hirsutism.
13
Q
Which cells in the breast make milk?
A
Alveolar cells.
14
Q
Where is a PAP smear done?
A
At the transformation zone between endo and exo cervix.
15
Q
How does PGF2alpha affect the uterus?
A
Stimulates myometrium contraction via FP receptor, promotes gap junction formation between cells.
16
Q
What are androgens bound to?
A
T and DHT bound to SHBG and albumin, DHEAS, DHEA, and A4 bound to albumin.
17
Q
What separates the testes into lobules?
A
Tunica albuginea
18
Q
If not breastfeeding, how long until prolactin reverts to normal after delivery?
A
Prolactin returns to non pregnant levels within 1-2 weeks.
19
Q
What hormone stimulates BPH?
A
DHT
20
Q
How do you generally treat CAIS?
A
Remove testes (increased risk of gonadal hyperplasia) and give estrogen replacement therapy.
21
Q
What are the symptoms of Beck-Wiedemann syndrome?
A
Height in 97th percentile, neonate omphalocele, macroglossia, visceromegaly, ear pits, adrenocortical cytomegaly, renal abnormalities, hypoglycemia. Maybe asymmetrical growth. Maybe embryonic tumours in childhood.
22
Q
What’s the difference between cervical softening and ripening?
A
Softening is decreased rigidity, hypertrophy of stroma and glands, and increased mucus obstructing cervical canal. Ripening is decreased tissue integrity and tensile strength, collagen disorganization, increased water content and collage solubility.
23
Q
Describe the symptoms of Huntington’s disease.
A
Chorea, tremor, dementia, psychiatric symptoms, death averaging 17 years after onset. Autosomal dominant.
24
Q
What do you give instead of estradiol?
A
Esthinyl estradiol, mestranol (prodrug).
25
What is Fitzhugh-Curtis syndrome?
Perihepatic adhesions.
26
Describe the path of the sperm.
Made in testes seminiferous tubules, goes to straight tubules (tubuli recti), goes ot rete testis, to ductulus afferentes, then to epidydimis. Then it goes to the van deferens, widens into the ampulla. On ejaculation, goes to ejaculatory duct then prostatis urethra, then membranous urethra, then penile urethra.
27
Where is there 5alpha reductase?
Urogenital tract, skin, hair follicles.
28
What's the epithelial lining of straight tubules in the testes?
Mainly Sertoli cells.
29
What is Drospirene?
A spironolactone derivative, weak antagonist at mineralocorticoid and androgen receptors.
30
What's true about pregnancies with \<10ng/mL and women with \<5ng/mL
Miscarry 80% of the time and usually never get pregnant.
31
How do COCs suppress ovulation?
Suppress pulsatility, P blocks LH, E blocks FSH.
32
Describe Friedrich's Ataxia. What's the repeat?
Autosomal recessive! GAA repeat in first intron of frataxin. Causes degeneration in posterior columns of spinal cord, also cardiomyopathy, foot deformities, kyphoscoliosis. The long repeat binds to the promoter, silencing the gene. Also it might interfere with splicing. Frataxin is also localized to the mitochondria, involved in iron metabolism - loss of it results in Fe buildup, ox damage, also ETC malfunction.
33
What is menorrhagia?
\>80mL bleeding or duration of flow over 7 days.
34
What is the most significant hormonal change associated with the early follicular phase?
FSH increase.
35
What's the fertilizable lifespan of egg and sperm?
12-24h and 48-72 hr.
36
Is it the luteal of follicular phase of menstruation variable?
Follicular. Luteal pretty consistent at 2 weeks.
37
Describe phase 1 of parturition.
Quiescence - cervix softens, uterine cavity not contractile. P, NO, relaxin. Progesterone decreases ER expression, decreases CAP expression, increases calcium uptake into SR and decreases CA entry into cells. Increases K+ efflux.
38
What are the adverse effects of progestins?
Weight gain, acne, hirsutism, breakthrough bleeding when used without E in contraceptives.
39
Describe the male hypothalamic-pituitary-gonadal axis.
Hypothalamus produces GnRH, Anterior Pituitary produces LH and FSH. Sertoli cells produce Inhibin B that inhibits the anterior pituitary, Leydig cells produce testosterone that inhibits hypothalamus and pituitary.
40
What's the difference between gene flow and genetic drift?
Genetic drift is just a chance in the frequency in a population of an existing allele, gene flow is new genes being brought in through migration.
41
What do the seminal vesicles do? What's their epithelium?
Secrete yellowish fluid that's mostly fructose - makes up 70% of ejaculate. Cuboidal or pseudostratified.
42
What is metrorrhagia?
Irregular intervals of bleeding but a light/normal volume and duration.
43
What is Levenorgestrel?
Plan B - take 2x 12hrs apart of all at once - most efficacious in 24h.
44
How does prolactin affect GnRH?
Decreases pulse, reducing FSH and LH levels.
45
What are some differences between the male and female sexual response cycle?
Males have refractory period before resolution, females sometimes have no orgasm sometimes no plateau.
46
What are the symptoms of 5 alpha reductase deficiency?
Ambiguous genitalia, underdeveloped prostate - if at puberty, increased secondary sex characteristics, deep voice, male pattern pubic hair, blind vaginal pouch. Generally male gender identity.
47
In what % of men are structural chromosomal abnormalities found in peripheral lymphocytes?
\<1% normospermic men 5% oligospermic men 10-15% azoospermic men
48
What's the epithelial lining of the epididymis?
Pseudostratified columnar, has some smooth muscle that moves sperm, has rounded basal cella and columnar/Principal cells which have long microvilli/stereocilia that uptake residual bodies.
49
Describe the proliferative phase of the menstrual cycle.
~days 6-14. Endometrium thin (1mm) then estrogen makes it proliferate (3mm). Glands become straight tubes.
50
How does oxytocin affect uterine contractility?
Increases it - OT receptor is Gq, rise in calcium increases contractility and also phosphorylates MLC.
51
Describe PCOS.
Hyperandrogenic chronic anovulation. LH higher than FSH. Unopposed E - endometrium all glands no stroma. Can cause insulin resistance, infertility, sleep apnea, obesity, lipid abnormalities, menstrual disorders, hirsutism, acne, increased endometrial cancer risk.
52
What is the ZP made of?
ZP1-4, secreted by oocytes.
53
What are the conditions to be infertile post partum?
\<6mo postpartum, breastfeeding exclusively, amenorrhea.
54
Describe galactopoiesis.
Maintenance of milk production after it is established.
55
What kind of secretion is lactation?
Apocrine.
56
What's the difference between prevalence and incidence?
Prevalence is % of living people affected, Incidence is % of people born affected.
57
Where is A4 made to T?
Ovary, skin, adipose
58
How can SSRIs affect menstruation?
Can also cause PRL release and inhibit menstruation.
59
What is preeclampsia? And eclampsia?
Inadequate spiral artery remodeling - eschemic placenta. New onset high BP (\>14-/90) on 2 occasions more than 4 hours apart and proteinuria. Eclampsia is when there's seizures.
60
What kind of receptor is the GnRH receptor?
Gq.
61
What's the repeat in Fragile X? What are the symptoms?
CGG in 5'UTR of FMR1 gene. \<200ish is premutaiton because not methylated - full mutation is methylated. Risk for repeat expansion depends on maternal. Leading cause of male intellectual disability, macroorchidism, ADD, anziety, stereotypic movement. Premutation has symptms too! mRNA increased, RNA toxicity/inclusion bodies, sequestration of RNA binding proteins. Can cause FXTAS (more in males) or FXPOI.
62
What temperature are the testes kept at?
35C
63
Describe mammogenesis.
Estradiol causes duct branching, progesterone stimulates lobule growth. Prolactin also contributes.
64
Describe some features of Hirschprung's disease.
Chronic colon distention, onset shortly after birth. Very high heritability, 4x more in males, long segment in 15-25% of cases. Inactivating mutation in RET is a major gene influence in long form.
65
What is the repeat and what are the symptoms in Myotonic Dystrophy / Dystrophia Myotonica? How does it work?
Dominant, CTG repeat in 3'UTR of DMPK or CCTG in intron 1 of ZNF9. Myotonia, dystrophy, cataracts, cardiac conduction abnormalities, infertility, insulin resistance, congenital form has developmental abnormalities. Normally attracts CUG-BP and muscleblind (splicing regulator). Long repeats more strongly attracts muscleblind, CUG-BP is free to go off and splice other things. 13 genes expressed in embryonic form (similar to fetal splicing).
66
What is the length of the epidydimis?
4-6m, takes like 20 days for sperm to pass through.
67
What does ovarian reserve testing tell you?
Amount of eggs left - no info about quality.
68
What are the relative potencies of E2, E1, E3?
E1 1/10 as potent as E2, E3 1/100 as potent as E2.
69
Describe phase 3 of parturition.
Functional progesterone withdrawal - E exceeds P. Encompasses the process of labour until completion of delivery of the fetus. Prostaglandin synthesis from fetal membranes, cervical effacement and dilation (Ferguson reflex with oxytocin). Uterine contractions start at rate of 1/10min then up to 1/min with increasing force.
70
Where is T made to DHT?
Skin, liver, urogenital tissues
71
What age do you need to correct cryptorchidism by to avoid infertility?
2-3
72
Describe FXTAS and FXPOI.
FXTAS affects more males, onset after 50, progressive, cerebellar ataxia, peripheral neuropathy, atypical parkinsonism, dementia, white matter lesions in the middle cerebellar peduncle, decrease in intellect. FXPOI is irregular menstruation, increased FSH, early menopause, highest risk around 100 repeats.
73
What is the male urethra lined with?
Transitional epithelium until the prostatic urethra, past that is stratified columnar, then right at the end is nonkeratinized stratified squamous.
74
How is ED a predictor?
Usually comes 2-5 years before serious vascular event.
75
What are the ovarian cell types and what do they make?
Granulosa (estrogens and some progesterone) Theca, theca luteal, Stromal (androgens and some 17OH progesterone) Granulosa Luteal (Progesterone and some estrogens)q
76
How are androgens metabolized?
In the liver - conjugated with glucuronic acid or sulfate, and excreted in urine or bile.
77
How do you diagnose someone with an intellectual disability? What are some risk factors?
IQ \< 70, limitation in adaptive skin, onset under 18 but after 6. High maternal age, low parental education.
78
What is Leuprolide?
GnRH antagonist Mimicks continuous release if given continuously and provides negative feedback to LH/FSH release.
79
What's an endometrioma?
Bleeding into ovary.
80
What do Inhibins A and B do? What phase do they function in?
Inhibit FSH. Inhibin A in luteal phase, Inhibin B in follicular phase.
81
What lines the alveoli?
Simple columnar/cuboidal epithelium.
82
What is the blood supply of the uterus?
Uterine artery branches to arcuate arteries (anastomose in myometrium) which become radial (basal endo layer) which become coiled spiral arteries (functional endo layer).
83
What's the epithelial lining of the rete testis?
Cuboidal, cilia and microvilli.
84
Describe sexual excitement.
Male: beginning of erection, partial testes elevation, thickening scrotal skin, testes pulled closer to body. Female: increase blood to genitals stimulates vaginal secretions, swelling of vestibular bulbs, vaginal swelling, pH elevation, hardening and enlargement of clitoris.
85
What's a good treatment for PCOS?
Clomiphene.
86
What is the primary estrogen in menopause?
Estrone.
87
What happens after 2 weeks to the corpus luteum?
The cells apoptose, fibroblasts invade and turn it into corpus albicans.
88
What is asthenozoospermia?
Decreased sperm motility.
89
What relationship do prostaglandins and labour have?
Myometrium always sensitive to prostaglandins, not just at term. They'e made in the endometrium, myometrium, fetal membranes, decidua, and placenta.
90
Describe the secretory phase of the menstrual cycle.
~days 15-28. Progesterone stimulates the glands to secrete/acumulate glycogen, and they dilate and coil. Spiral arteries also lengthen and spiral. Max endo thickness ~5mm.
91
How can endometriosis cause infertility?
Immune cells in follicular fluid, decreased follicular estradiol, granulosa cell function abnormalities, might not be receptive to fertilization and implantation.
92
What is the general treatment for BPH?
Finasteride
93
Describe luteinization
After ovulation, ruptured follicle remnants become corpus luteum. Gene expression altered, proliferation genes downregulated, LHR upregulated. Theca cells become theca-luteal (have LHRs, produce mostly androgens). Granulosa cells become granulosa-luteal (have LHRs and FSHRs, produce progesterone and some estrogen and inhibin A).
94
What is spermiogenesis?
No cell division, maturation of spermatid into spermatozoa. Formation of flagellum, condensation of chromatin, loss of excess cytoplasm as residual body, formation of acrosome.
95
What's the Window of Implantation?
Before day 24 of the menstrual cycle.
96
What kind of glands are mammary glands?
Compound tubule-alveolar.
97
What is teratozoospermia?
Increased sperm with abnormal morphology.
98
What % of oocytes had aneuploid conditions in 20-25 y/o women and in 40-45 y/o women?
17 and 79
99
What's in the testicular interstitium?
Leydig cells, nerves, CT, lymphatics, fenestrated capillaries.
100
What is luteal phase assessment?
Serial measurement of urinary LH. Mid-luteal progesterone level assessment \>5ng/mL means ovulation, but you want double digits.
101
What are some things that increase GnRH pulsatility?
Kisspeptin and leptin.
102
What is Flutamide?
Androgen receptor antagonist, administered orally and not very effective alone because it blocks T feedback inhibition leading to increased LH and then increased T.
103
Describe the mini pill?
Just low dose P - doesn't necessarily stop ovulation, timing is critical every 24h. Safe for chronic smokers \>35 years old, breastfeeding women, women with diabetes with vascular disease.
104
How do you determine the length of the trinucleotide repeat?
If short, use PCR. If long, use southern blot.
105
Why do we give menopausal women E and P always together?
To prevent endometrial hyperplasia.
106
What does the ovary produce?
Estrogen, Progesterone, Inhibin A and B, Testosterone, Andronestenedione, AMH.
107
What is Ulipristol?
SPRM that prevents ovulation - works up to 5 days after intercourse.
108
What's a hydatidiform mole? What's the difference between complete and partial?
2 sets of chromosomes both from father (or partial - 2 sets from dad, one from mom). Complete has no fetal tissue, scalloping of chorionic villi, trophoblastic stromal inclusions. Has p57 expression.
109
What are the types of selection?
Stabilizing, directional, disruptive/destabilizing.
110
How do you determine menstrual cycle length?
Days of beginnings of consecutive period.
111
How do you induce ovulation?
FSH+hCG/LH
112
What is the average homozygosity for a child whose parents are 1st, 3rd, and 4th degree relatives?
30%, 3%, 1% generally.
113
Describe phase 4 of parturition.
Uterine vasoconstriction, uterus/cervix/vagina revert to non pregnant state, lactation and return of menstrual regularity. Cervix typically returns in 12-16 weeks.
114
What does estrogen do in the male?
Bone growth, epiphyseal closure, masculinisation of developing brain, regulation of fluid in ejaculate.
115
What does testosterone do in the male?
EMbryonic development of Wolffian-duct derived structures, pubertal growth of penis, seminal vesicles, larynx, spermatogenesis, anabolic effects on ekeltal muscle and erythropoiesis, libido, aggression, inhibition of breast development.
116
How do T and E affect SHBG?
E increases it, T decreases it.
117
What is adrenarche?
Precedes puberty (7-8 in boys), an increase in DHEA, DHEAS, and androstenedione.
118
What are the phases of the linear human sexual response cycle?
Desire, excitement, plateau, orgasm, resolution.
119
Describe the vagina.
No glands, nonkeratinized stratified squamous endothelial lining, inner circular and outer longitudinal muscle layers.
120
How does progesterone affect the hyp/pit axis?
Negatively feedbacks.
121
What is adenomyosis?
Glands and stroma invading the uterine musculature.
122
How does TRH affect prolactin?
Increases.
123
What hormone do you need to replace to increase male fertility?
LH and FSH.
124
What are the bulbourethral / Cowper's glands?
In the membranous urethra and provide a negligible amount of the volume of ejaculate. Provide fluid just after erection.
125
What % of testosterone is bound and what % is free?
1-2% free, 54% bound to albumin loosely, 44% bound tightly to SHBG.
126
What is the usual treatment for androgen replacement therapy?
Oral testosterone or 17-alpha-alkylated testosterone. Can also give T patches, buccal tablets, or IM T enanthanate (preferred in children).
127
Wheat are the stages of blastocyst implantation?
Apposition - inner cell mass aligns with luminal epithelium of endometrium Adhesion
128
What are some risk factors for female sexual dysfunction?
Decreased E, decreased T, increased PRL. certain meds (e.g. antipsychotics), gynecologic, neurologic, psychological stress.
129
What is a Nabothian cyst?
A benign cyst resulting from blockage of cervical mucus secreting glands.
130
Describe sexual plateau.
Male: Full erection, glans swells/colour deepens, testes enlarge and are pulled closer, glands secrete fluids. Female: Swelling of labia, clitoris, outer 1/3 of vagina, increase secretions, uterus elevation, clitoris restracts.
131
What are some symptoms that come with decreased testosterone?
Anemia, decreased energy and libido, decreased bone and muscle mass.
132
How does estrogen affect the HPO axis?
High estrogen will increase pulsatility (right before ovulation)
133
What is cervical mucus like in the ovulation, luteal, and pregnancy phases?
Ovulation - thin and watery, also 10x more of it so sperm can pass. Luteal - thick and viscous Pregnancy - forms plug
134
What are the four phases of lactation?
Mammogenesis, lactogenesis, galactokinesis, galactopoiesis.
135
Describe menstruation.
~days 1-4. No fertilization, so P regresses as corpus luteum dies. Arterial cells make prostaglandinsm local hypoxia releases cytokines. Cytokines cause vascular permeability, leukocyte immigration. Leukocytes, epithelial, endothelial, and stromal cells make enzymes including MMPs (matrix metalloproteins).
136
What's the epithelial lining of the ductulus afferentes of the testes?
Cuboidal, cilia and microvilli.
137
What's the difference between Prader-Willi and Angelman?
Both 15q 11.2 Prader Willi is paternal deletion, Angelman is maternal.
138
What are the symptoms of Angelman syndrome?
Developmental delay from 6 months, gait ataxia, intellectual disability, speech impairment, inappropriate laughing/excitability, often microcephaly and seizures.
139
How does PGE2alpha affect the uterus/cervix?
Stimulates contraction via EP1 and EP3, relaxation and cervical ripening via EP2 and EP4.
140
What does progesterone have to be at to initiate menstruation?
\<5ng/mL
141
What is adrenarche?
About 2 years before puberty there's an increase in DHEA and DHEAS.
142
Describe the arterial supply of the erectile tissues of the penis?
Deep artereies branch into nutritine arteries which supply the trabeculae, and some into helicine arteries (empty directly into cavernous spaces). There is a shunt from the nutritine into the helicine.
143
How does proliferative vs secretory endothelium look on ultrasound?
Trilaminar and white.
144
What are the symptoms of Silver-Russel syndrome?
Growth restriction, inverse triangle face, hemihypertrophy.
145
What does DHT do in the male?
Embryonic differentiation of scrotum, penis, prostate, pubertal development of face and body hair, penis growth, differentiation of prostate, sebaceous gland activity, male pattern hair distribution and balding.
146
Describe the stages of labour.
Stage 1 is latent dilation until 3cm Stage 2 is rapid dilation until 10cm Stage 3 is immediately after fetal delivery and ends with placental separation and expulsion.
147
Describe the prostate and its secretions.
30-50 discrete glands that empty into prostatic urethra. Get corpora amylacea (glycoproteins) that increase with age. Secretion is milky-white, slightly alkaline, about 30% of semen volume. Also secretes prostatic acid phosphatase (PAP) and prostate-specific antigen (PSA).
148
What's the deal with placental CRH?
Made by syncytiotrophoblast cells, increases dramatically in final 6-8 weeks of pregnancy. Stimulates fetus to make DHEAS and also cortisol (fetal cortisol positively feedbacks CRH).
149
What are some progestins given?
Progesterone, medroxyprogesterone, norethidrone, norgestrel, levonorgestrel.
150
What is heritability?
The amount that a total variance depends on genes.
151
Describe a Graafian follicle.
Secondary oocyte (finishes MI). Granulosal layer thing, thecal layer thickens. Dominant follicle bulges against tunica albuginea 'stigma'.
152
What are the effects of a higher consanguity ration in a population?
Higher mortality rate, higher number of multifactorial traits, higher frequency of disorders, statistically lower IQ.
153
When in the menstrual cycle is estrogen and progesterone high?
Folicular and Luteal phases respectively.
154
Describe galactokiesis.
Oxytocin stimulates milk letdown.
155
When is there a luteal-placental shift?
7-9 weeks
156
What is menometrorrhagia?
Irregular bleeding AND too much blood.
157
What is the inbreeding coefficient?
% of gene loci that are homozygous as a result of inbreeding.
158
What does FSH stimulate in the male?
Sertoli proliferation, seminiferous tubule growth, spermatogenesis, ABP production, Inhibin B production.
159
What are aspermia and hypospermia?
No semen and little semen.
160
What causes androgenetic alopecia?
Need genetic predisposition, DHT causes follicular minituarization.
161
What's the definition of 'experiencing infertility'?
Have tried and failed for 12 months to conceive.
162
How is DHEAS converted to testosterone?
DHEAS to DHEA via sulfatase, to androstenedione via 3betaHSD, to testosterone via 17betaHSD.
163
When in the menstrual cycle are FSH and LH high?
Ovulation
164
What can androgen excess cause? How do you treat it?
Precocious puberty or anabolic androgenic effects Treat with GnRH agonists, removing tumor.
165
When does hCG begin to fall in a pregnant woman?
About 8 weeks into term.
166
What is polymenorrhea?
Cycle \<21 days
167
What are the layers of the uterus?
Simple columnar endometrium, 3 layered myometrium (middle circular, other 2 layers longitudinal) - SM cells make collagen. Also thin perimetrium.
168
In what fashion is GnRH released? What modulates secretion?
Pulsatile! Stimulated by leptin and kisspeptin. Inhibited by T, DHT, estrogen.
169
What is estrogen 'priming'?
Stimulates expression of progesterone receptors.
170
Where is A4 made to estrone and T made to estradiol?
Ovary, adipose, skin, bone, brain
171
How does the placenta male estrogens and progesterone?
Progesterone from maternal cholesterol, estrone and E2 from fetal DHEAS, E3 from fetal 16alphOH DHEAS
172
What are the layers of the endometrium?
Basal layer and superficial/functional layer.
173
Is the myometrium always sensitive to oxytocin?
No, only at term.
174
What needs to happen to initiate the acrosome reaction?
Sperm needs to bind to ZP3.
175
What are the parts of the fallopian tube going from distal to proximal?
Ampulla, isthmus, uterine/intramutal part.
176
What are some things that decrease GnRH pulsatility?
CRH (stress), endorphins, prolactin.
177
What is a 'bloody show'?
In cervical dilation, sometimes the mucus plug is expelled.
178
What is hPL?
Secreted from syncytiotrophoblast, detectable in week 4-5, exponential rise reflects placenta size.
179
What are tocolytics?
Used clinically to stop contractions - PG synthesis inhibitors, OTR blockers, calcium channel blockers.
180
What are the genes that drug interact with warfarin?
CYP2X9 and VKORC1
181
When is there a division between theca interna and externa? What's the difference?
In the primary follicle, when the stromal cells differentiate. Interna is cuboidal and secretes A4, externa has fibroblasts and SM.
182
What is the lining of the endocervix and exocervix?
Endocervix is simple columnar, exocervic is nonkeratinized stratified squamous.
183
What are the 5 questions of infertility?
Are you ovulating? Is your partner making adequate sperm in adequate # with adequate motility? Are the fallopian tubes patent and normal? Is the uterine cavity ok? Is there any pelvic disease?
184
What are the 3 masses of erectile tissue?
2 dorsal corpora cavernosa and a single ventral corpus spongiosum.
185
What is Clomiphene?
Estrogen receptor antagonist, SERM - competes with E in hyp and ant.pit. End result is no negative feedback so increased E production (like Flutamide!)
186
What % of women with AUB have coagulpathies?
13%
187
What is capacitation?
Removing of epididymal and seminal plasma materials in the uterus, exposing the PM
188
What's the epithelial lining of the vas deferens?
Pseudostratified columnas with stereocilia/microvilli, thick muscular layer.
189
What is Asherman syndrome?
Too much endometrial scarring/excision - caused by D&C or manual placental extraction. Will have lighter and lighter periods sometimes with increased pain.
190
What is the effect of progesterone on the female reproductive tract?
Increases body temp half a degree C, decreases myometrial contractility, forms thick, non-elastic, viscous cervical mucus, breast growth, endometrial effects in secretory phase (increased vascularization, extension of spiral arteries , increased size and coiling of glands, increased glandular secretions, stromal edema, and differentiation).
191
What hormone surges after egg release?
LH
192
What male cells do FSH and LH act on?
Sertoli cells have FSH receptors, Leydig cells have LH ones.
193
What are Sildenafil and Tadalafil? What are some adverse effects and contraindications?
PDE5 inhibitors. Adverse effects related to vasodilation - flushing, headashe, nasal congestion. Sidenafil also has blue vision. Contraindications include people taking nitrates.
194
What is low hCG indicative of?
Inadequate implantation, or nonviable/ectopic pregnancy.
195
How is circulation established in pregnancy?
Syncytiotrophoblast penetrates endometrium and erodes maternal blood vessels. Creates high flow, low resistance remodeled arteries.
196
In which gametogenesis is there instability for Huntington's?
Male.
197
Describe lactogenesis.
Prolactin stimulates milk production, suckling reduces dopamine levels.
198
How do you get Silver-Russel or Beck-Wiedemann syndrome?
IGF2 is growth (active in dad), CDKN1C is growth restriction (active in mom) and can get LoM, GoMs, UPDs. IGF2/H19 area = In mom, CTCF blocks enhancer from reaching IGF2, in dad, methylation blocks H19 promoter.
199
What are PALM and COEIN?
Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometriosis, Iatrogenic, Not yet classified
200
What is formed from the Wolffian ducts?
Seminal vesicles, epididymis, ejaculatory ducts, vas deferens.
201
Where is DHEAS converted to DHEA?
Adrenals, liver, SI
202
What are the effects of estrogens in the female reproductive tract?
Causes thin, non-viscous, elastic, alkaline cervical mucus facilitating sperm entry, maintains vaginal wall wall thickness and lubrication, epithelial glycogen accumulation, increased lactic acid, decreased vaginal pH, increased activity of fallopian tube cells, increased uterine blood flow and contractility. Increased epithelial proliferation.
203
What receptor does hCG bind to?
LH
204
What's the treatment for endometrial hyperplasia with and without atypia?
With - hysterectomy Without - progestin
205
Describe Leydig cells.
Produce testosterons. Lots of SER and lipid droplets. Sometimes in cytosol of Leydig cells there are crystale of Reinke.
206
What are normal sperm/semen values?
1.5mL semen, 15M/mL sperm, 39M sperm total, 40% motile, 32% progressive motility, 58% alive About 4% normal sperm according to Kruger STRICT
207
What are some contraindications of combined oral contraceptives?
Breast cancer (or other E/P dependent neoplasm), high risk of thrombotic diseases, \>35y/o who smokes, diabetes with vascular disease.
208
What is the Clomiphene Challenge Test?
Give 50mg on days 5-9 and compare day 3 and 10 FSH. Want FSH \<13 and estradiol to increase a lot.
209
What do PDE5 inhibitors treat?
Erectile dysfunction - PDE5 degrades cGMP which dephosphorylates MLC - degrading it causes SM relaxation and so erection.
210
What hormone has a surge after ovulation?
LH
211
Describe phase 2 of parturition.
Activation - final 6-8 weeks of gestation. E:P ratio goes up, cervix ripens, CAP expression goes up.
212
Describe the process of ejaculation.
Sympathetic - SM contracts, bulbospongiosus at the proximal end of the penis rhythmically contracts, forcefully expels ejaculate. Ejaculation is followed by cessation of PNS impulses.
213
What are Type A and Type B cells?
At sexual maturity, A keep dividing and B differentiate into mature sperm. Type B remain connected by cytoplasmic bridges until the last stages of development (develop synchronously).
214
What LODs are suggestive for and against a good theta?
\>3 suggestive for
215
What are type I and II trinucleotide repeat diseases?
I: CAG, Gln (Q). Full mutation is shorter, brain affected. II: No AAs (in noncoding region), full mutation can be very long, affects several tissues.
216
How long after delivery until a woman starts to menstruate?
70% will by 12 weeks.
217
What are Kruger's definitions of normal sperm based on?
Examining sperm that could successfully migrate through the cervical mucosa.
218
How do you know when you have an antral follicle? Describe it.
The granulosa cells secrete follicular fluid and make a space (antrum). Granulosa cells around oocyte form cumulus oophorus, the ones around the ZP form the corona radiata. They convert the theca interna A4 into estradiol via aromatase.
219
What results do you want from the Antral Follicle Test?
Normal is 15-30, poor if \<6.
220
What are the major female androgens?
DHEAS\>DHEA\>A4\>T\>DHT
221
What are the general treatments for prostate cancer?
Leuprolide + Flutamide
222
What happens in capacitation?
Epididymal and seminal plasma proteins are removed in the uteris, exposing PH20 and Hyal-5 proteins which have hyaluronidase and ZOP binding activity.
223
What do you want menstrual cycle day 3 FSH and estradiol to be?
\<9IU/dL and \<60pg/mL respectively.
224
How is CRH thought to affect GnRH?
Decreases.
225
When in the male's lifespan is there high testosterone and gonadotropins?
Fetus, small spike in neonate, spike in puberty, in adult T declines after 3 (gonadotropins increase as there is less T to negatively feedback them).
226
What is anticipation?
Increased repeat number causing worse/earlier symptoms.
227
What is oligomenorrhea?
Cycle \>35 days
228
How do you know when you have a primary follicle?
Has primary oocyte (stuck in MI), enveloped by simple squamous follicular cells.
229
What is the Germinal Epithelium?
Complex stratified - contains spermatogenic and Sertoli cells.
230
When does the blastocyst implant in the endometrium?
Around day 4 it hatches the ZP and then implants after floating like 3 days.
231
How does FSH stimulate the ovary?
Makes the granulosa cells of the antral follicle secrete hormones, grow, differentiate into eventually the Graafian follicle. The GCs stop proliferating, increase estradiol synthesis, increase FSHR expression, express LHR.
232
How do you get trinucleotide repeat length variation?
Replication slippage - if template strand slips, shorter segment, if new one does, longer.
233
What's the cutoff for secondary amenorrhea?
3 consecutive missed periods.
234
What phase do sperm arrest in?
Primary spermatocytes arrest in MI prophase for 23 days, secondary are finished MI, Spermatids/spermatozoa are finished MII.
