Reproductive Flashcards
What’s the general approach to treating female hypogonadism?
E days 1-21, T days 12-21 (mimic menstrual cycle).
What’s the effect of estrogen on the heart and bones?
Cardioprotective, maintains bone density.
Describe the process of getting an erection.
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..
What are the 5 Ps in asking about sexual history?
Partners, practices, protection from STDs, past history of STDs, pregnancy prevention.
What is the state of FSH and LH after labour?
Low for 2-3 weeks after delivery.
What kind of mucosa lines the fallopian tubes? Describe the rest of it.
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.
What is complete selection?
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.
What do you give PCOS women is pregnancy is desired?
Clomiphene citrate.
What do Sertoli cells do?
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.
Where is there aromatase?
Adipose, lover, skin, brain,
What is fecundability?
Monthly probability that woman will conceive - drops at about 37 years old.
What is Finasteride?
5 alpha reductase inhibitor. Good for BPH, male pattern baldness, female hirsutism.
Which cells in the breast make milk?
Alveolar cells.
Where is a PAP smear done?
At the transformation zone between endo and exo cervix.
How does PGF2alpha affect the uterus?
Stimulates myometrium contraction via FP receptor, promotes gap junction formation between cells.
What are androgens bound to?
T and DHT bound to SHBG and albumin, DHEAS, DHEA, and A4 bound to albumin.
What separates the testes into lobules?
Tunica albuginea
If not breastfeeding, how long until prolactin reverts to normal after delivery?
Prolactin returns to non pregnant levels within 1-2 weeks.
What hormone stimulates BPH?
DHT
How do you generally treat CAIS?
Remove testes (increased risk of gonadal hyperplasia) and give estrogen replacement therapy.
What are the symptoms of Beck-Wiedemann syndrome?
Height in 97th percentile, neonate omphalocele, macroglossia, visceromegaly, ear pits, adrenocortical cytomegaly, renal abnormalities, hypoglycemia. Maybe asymmetrical growth. Maybe embryonic tumours in childhood.
What’s the difference between cervical softening and ripening?
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.
Describe the symptoms of Huntington’s disease.
Chorea, tremor, dementia, psychiatric symptoms, death averaging 17 years after onset. Autosomal dominant.
What do you give instead of estradiol?
Esthinyl estradiol, mestranol (prodrug).
What is Fitzhugh-Curtis syndrome?
Perihepatic adhesions.
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.
Where is there 5alpha reductase?
Urogenital tract, skin, hair follicles.
What’s the epithelial lining of straight tubules in the testes?
Mainly Sertoli cells.
What is Drospirene?
A spironolactone derivative, weak antagonist at mineralocorticoid and androgen receptors.
What’s true about pregnancies with <10ng/mL and women with <5ng/mL
Miscarry 80% of the time and usually never get pregnant.
How do COCs suppress ovulation?
Suppress pulsatility, P blocks LH, E blocks FSH.
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.
What is menorrhagia?
>80mL bleeding or duration of flow over 7 days.
What is the most significant hormonal change associated with the early follicular phase?
FSH increase.
What’s the fertilizable lifespan of egg and sperm?
12-24h and 48-72 hr.
Is it the luteal of follicular phase of menstruation variable?
Follicular. Luteal pretty consistent at 2 weeks.
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.
What are the adverse effects of progestins?
Weight gain, acne, hirsutism, breakthrough bleeding when used without E in contraceptives.
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.
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.
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.
What is metrorrhagia?
Irregular intervals of bleeding but a light/normal volume and duration.
What is Levenorgestrel?
Plan B - take 2x 12hrs apart of all at once - most efficacious in 24h.
How does prolactin affect GnRH?
Decreases pulse, reducing FSH and LH levels.
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.
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.
In what % of men are structural chromosomal abnormalities found in peripheral lymphocytes?
<1% normospermic men 5% oligospermic men 10-15% azoospermic men
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.
Describe the proliferative phase of the menstrual cycle.
~days 6-14. Endometrium thin (1mm) then estrogen makes it proliferate (3mm). Glands become straight tubes.
How does oxytocin affect uterine contractility?
Increases it - OT receptor is Gq, rise in calcium increases contractility and also phosphorylates MLC.
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.
What is the ZP made of?
ZP1-4, secreted by oocytes.
What are the conditions to be infertile post partum?
<6mo postpartum, breastfeeding exclusively, amenorrhea.
Describe galactopoiesis.
Maintenance of milk production after it is established.
What kind of secretion is lactation?
Apocrine.
What’s the difference between prevalence and incidence?
Prevalence is % of living people affected, Incidence is % of people born affected.
Where is A4 made to T?
Ovary, skin, adipose
How can SSRIs affect menstruation?
Can also cause PRL release and inhibit menstruation.
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.
What kind of receptor is the GnRH receptor?
Gq.
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.
What temperature are the testes kept at?
35C
Describe mammogenesis.
Estradiol causes duct branching, progesterone stimulates lobule growth. Prolactin also contributes.
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.
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).
What is the length of the epidydimis?
4-6m, takes like 20 days for sperm to pass through.
What does ovarian reserve testing tell you?
Amount of eggs left - no info about quality.
What are the relative potencies of E2, E1, E3?
E1 1/10 as potent as E2, E3 1/100 as potent as E2.
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.
Where is T made to DHT?
Skin, liver, urogenital tissues
What age do you need to correct cryptorchidism by to avoid infertility?
2-3
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.
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.
How is ED a predictor?
Usually comes 2-5 years before serious vascular event.
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
How are androgens metabolized?
In the liver - conjugated with glucuronic acid or sulfate, and excreted in urine or bile.
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.
What is Leuprolide?
GnRH antagonist Mimicks continuous release if given continuously and provides negative feedback to LH/FSH release.
What’s an endometrioma?
Bleeding into ovary.
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.
What lines the alveoli?
Simple columnar/cuboidal epithelium.
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).
What’s the epithelial lining of the rete testis?
Cuboidal, cilia and microvilli.
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.
What’s a good treatment for PCOS?
Clomiphene.
What is the primary estrogen in menopause?
Estrone.
What happens after 2 weeks to the corpus luteum?
The cells apoptose, fibroblasts invade and turn it into corpus albicans.
What is asthenozoospermia?
Decreased sperm motility.
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.
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.
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.
What is the general treatment for BPH?
Finasteride
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).
