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BMS 752 (Medical Physiology) > Reproductive Physiology > Flashcards

Reproductive Physiology Flashcards

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USMLE® Step 1 flashcards
1
Q

gonad

A

generic term refering to the reproductive organs of both genders

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2
Q

germ cells

A

cells that produce gametes

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3
Q

what type of regulation cycle is used by most primates

A

menstrual cycles

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4
Q

estrous cycles

A

variable reproductive cycles such as going into heat or a rut

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5
Q

menstrual cycle

A

the periodic release of an egg from the ovary to a prepared uterus, and the shedding of the uterine lining if the egg is not fertilized

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6
Q

what are the two key componenets of a menstrual cycle

A
  1. release of generally one egg
  2. growth and maturation of the uterine lining
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7
Q

define menarche

what is the average age?

the range?

A

the onset of menstration

12.8

9-15.5

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8
Q

what is the length and standard deviation of a normal menstrual period?

A

28 +/- 3 days

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9
Q

what is the mean for the onset of menopause? the range

A

51

35-65

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10
Q

four functions of the hypothalamus

A
  1. temperature control
  2. hunger
  3. thirst
  4. pituitary stimulation
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11
Q

what happens if the anterior pituitary is stimulated by the hypothalamus?

what happens if there is no communication between the hypothalamus and anterior pituitary

A

the anterior pituitary will secrete the appropriate hormones for its stimulation

prolactin will be produced because there will be no inhibiting factors from the hypothalamus

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12
Q

what stops the anterior pituitary from secreting large amounts of prolactin

A

inhibition from dopamine produced in the hypothalamus

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13
Q

arcuate nucleus

A

a collection of neurons that produce GnRH in the hypothalamus

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14
Q

what was Knobils experiment

A

he removed the arctuate nucleus from monkeys and gave them endogenous GnRH to see how the they would respond to differently levels

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15
Q

what were two important early discoveries from Knobils experiment

A
  1. when the arctuate nucleus was removed prolactin stayed high
  2. increasly high doses of GnRH only increased LH levels to a certain amount before they dropped off
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16
Q

why did the monkeys in Knobils experiment stop producing LH despite increasing levels of GnRH

A

the target cells downregulated their receptor production because there was too much GnRH

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17
Q

what were three final conclusions from Knobils experiments

A
  1. the ovary and production of steroids are most important to menstruation
  2. GnRH is secreted in pulses
  3. constant GnRH will cause down regulation of receptors
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18
Q

knowing the effect of GnRH what are twoclinical applications

A
  1. GnRH infusing pumps to stimulate the ovaries
  2. Downregulation of GnRH receptors
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19
Q

what effect can clinical down regulation of GnRH receptors have

A

reversible menopause or andropause

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20
Q

Lupron

A

a GnRH agonist that will bind to receptors and stop the release of sex hormones

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21
Q

what drives the rhythm of the menstrual cycle

A

maturation of the follicle and oocyte

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22
Q

how does the hypothalamus regulate ovarian function (2examples)

A

provides fine tuning in response to environment by increasing or decreasing amplitude and frequency of GnRH pulses (sick or starving)

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23
Q

when do women make primary oocytes and primordial follicles?

A

prior to birth

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24
Q

what happens when a woman has no more eggs

A

menopause

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25
Q

what are the three steps in the life cycle of a follicle

A
  1. resting phase
  2. active phase
  3. ovulation or death
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26
Q

what determines the activation of a follicle

A

it is a spontaneous daily event that happens with no known contributatory factors

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27
Q

what four actions signal follicle activation

A
  1. flattened granulosa cells becoming cuboidal
  2. proliferation of granulosa
  3. formation of the zona pelucida
  4. growth of the oocyte
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28
Q

what are the three phases of the ovarian cycle

A
  1. follicular
  2. ovulation
  3. luteal
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29
Q

what three events happen in the follicular phase

A
  1. menses
  2. follicle recruitment
  3. selection of the dominant follicle
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30
Q

when is FSH the highest during the follicular phase? when does it decrease?

A

FSH is the highest during menses, decreasing during follicle recruiment

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31
Q

what happens hormonally during ovulation

A

there is a surge in LH

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32
Q

what three events happen during the luteal phase

A
  1. progesterone production
  2. corpus luteum apoptosis
  3. Luteal rescue by HCG
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33
Q

what are the general time periods for the follicular phase, ovulation, and the luteal phase of the menstrual cycle

A
  1. follicular phase: day 1-14
  2. ovulation: day 14
  3. luteal phase: day 14-28
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34
Q

if follicles are activated every day, what happens to the activated follicles?

A

they die unless in the follicular phase (FSH is present)

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35
Q

what hormone allows for follicular growth

A

FSH

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36
Q

Follicle cohort

A

all of the recently activated follicules stimulated by FSH

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37
Q

T/F the size of the follicular cohort varies with age

A

true

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38
Q

what two hormones are secreted by growing follicles?

what is their effect on menstruation

A

estradiol and inhibin B

decrease production of FSH by through negative feedback at the hypothalamus and anterior pituitary

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39
Q

what stops more follicles from growing during the follicular phase

A

estradiol and inhibin B decease the amount of FSH, which slows follicular growth

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40
Q

what are the four states of a follicle

A
  1. primordial
  2. preantral
  3. antral
  4. preovulatory
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41
Q

FSH is needed to progess between what two follicular states?

A

preantral and antral

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42
Q

T/F preovulatory follicles can be seen under a microscope

A

true

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43
Q

how is the “leading follicle” chosen from the follicle cohort?

how does the criteria change as the mother ages

A

the follicle that tolerates the decline in FSH is considered the leading follicle

younger mothers select the fittest follicle, older mothers select the first follicle that is activated

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44
Q

describe the hormonal process during menstruation (6)

A
  1. FSH stimulates the production of follicles
  2. follicles produce estrodiol and inhibit to decrease FSH
  3. high estradiol produces an LH surge which triggers ovulation within 38 hours
  4. follicle remains form the corpus luteum which produces progesterone
  5. fertilized egg produces HCG which saves the corpus luteum
  6. without fertilization estrogen and progesterone decrease and lead to menstruation
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45
Q

what hormones are produced by theca cells in response to LH?

what how are these hormones altered by granulosa cells stimulated by FSH

A

androsteinedione and testosterone

aromatized into esterone and estradiol

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46
Q

can estrogen be converted back into testosterone

A

no, they are converted by one way enzymes

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47
Q

what two factors allow a follicle to become the “dominant follicle”

A
  1. increased number of FSH receptors
  2. increased vascularity
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48
Q

what happens when extrogenous FSH is given during selection of the dominant follicle?

when might this be useful

A

more follicles survive the selection phase to ovulate

IVF to harvest more eggs

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49
Q

how much estradiol needs to be present for ovulation to occur

A

200 picograms/mL for 24 hrs

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50
Q

how long does the LH surge during ovulation lasat

A

48-50 hours

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51
Q

what are three specific responses to the LH surge during ovulation

A
  1. resumption of meosis with the expulsion of the 1st polar body
  2. release of collagenase and prostaglandins to weaken follicle wall
  3. follicular rupture
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52
Q

what will a mature oocyte look like on microscopy

A

a single large cell surrounded by cumulus cells

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53
Q

what is a denuded oocyte? how can one be made?

A

a oocyte with all the cumulus cells stripped away by pipetting or enzymes, leaving only the zona pellucida

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54
Q

ovum pickup

A

the process by which a ovulated mature oocyte is released by the ovaries and picked up by the fallopian tubes

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55
Q

where does ovum pick up occur

A

in the “pouch” formed by the peritoneum between the bladder and the anterior wall of the uterus

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56
Q

what are the three major events of the luteal phase

A
  1. progesterone production
  2. corpus luteum death without a fertilized egg
  3. CL saved by HCG produced by a fertilized egg
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57
Q

why is 28 days a normal cycle?

A

because it takes 14 days for a oocyte to mature, and 14 more days before the corpus luteum dies so the cycle can restart

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58
Q

what type of tissue makes up most of the uterus

A

smooth muscle

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59
Q

what hormone causes proliferation of the endometrium

A

estradiol

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60
Q

what is the effect of progesterone on prolferative endometrium

A

switches cells from hypertrophy to secretion to stop growth and supply nutrients for a fertilized egg

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61
Q

what is HCG?

what produces it?

A

human chorionic gonadotropin

a fertilized embyro implanted into the uterus

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62
Q

how is it possible that a sperm can enter the fallopian tubes within one hour of sexual intercourse

A

there are cillia that beat and help it move

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63
Q

what are three descriptors of normal cervical mucosa

A
  1. scant
  2. thick
  3. cloudy
64
Q

what is cervical mucosa like around ovulation

A

copius, clear, and supportive

65
Q

what causes the change in cervical mucosa throughout the menstrual cycle

A

estradiol

66
Q

what are three functions of the fallopian mucosa

A
  1. produce suppportive secretions for the egg and sperm
  2. help the egg and sperm move
67
Q

what happpens one a sperm penetrates an egg?

why is this relevant

A

cortical granules inside the egg release their contents to harden the egg

it is unlikely that one sperm would fertilize one ovum, so it prevents polyspermia

68
Q

syngamy

A

the fusion of two cells, in our case to produce a zygote

69
Q

how long after syngamy will the first mitotic division take place

A

24 hours

70
Q

under microscopy a zygote appears to have three protonuclei

what does that mean

A

polyspermia

71
Q

what is totipotency?

why is a relevant?

A

the ability for any cell from a blastocyst to produce a fetus

blastomeres can be removed for genetic testing

72
Q

at what point does an embryo lose totipotency

A

when it enters the uterus 5 days after ovulation

73
Q

what happens 6 days after ovulation

A

“hatching” when the blastocyst breaks out of the zona pellucida

74
Q

what is the state of the embryo 7 days after fertilization

A

it should be implanted on the uterus

75
Q

what is the hormonal cause of spotting during early pregnancy

A

as the corpus luteum dies the placent takes over producing progestrone, and sometimes there is too much of a decrease

76
Q

statistically speaking older mothers are less likely to carry to term and more likely to produce a fetus with birth defects

why?

A

because older eggs are less capable

77
Q

what happens to an older mother who is fertilized with older eggs

A

she has a success rate higher than she would using her own eggs

78
Q

how does male endocrine control differ from female

A

FSH acts on the testes to stimulate sperm production

LH stimulates secretion of androgens

79
Q

what are the negative feedback mechanisms that control male endocrine function

A

inhibin from sertoli cells reduces FSH

increased circulating testosterone decreases LH

estrogen aromatized from testosterone deceases FSH

80
Q

what cells in the testes secrete testosterone

A

leydig cells

81
Q

list the androgens from least to most potent

A

dihydroepiandrosterone, androstenedione, testosterone

82
Q

what is testosterone converted into

A

dihydrotestosterone

83
Q

what is the enzyme that converts testosterone into DHT

A

5 alpha reductase

84
Q

what is the key andogren for skin and prostate

A

DHT

85
Q

what are 3 specific effects of androgens

A
  1. hair thickening and darkening on the face, pubic, and axilla
  2. muscle growth and maintenance
  3. vocal cord changes
86
Q

what is the function of the sertoli cells

A

secrete androgen binding protein to keep levels of testosterone between the cells high where it can act on developing spermatocytes

87
Q

what two hormones are secreted by sertoli cells

A
  1. androgen binding hormone
  2. mullerian inhibiting hormone
88
Q

how do sperm cells develop as they move toward the lumen of seminiferrous tubules

A

spermatogonium –> primary spermatocyte –> secondary spermatocyte –> spermatids –> spermatozoa

89
Q

what three things are needed for sperm production (what do they do)

A
  1. FSH (sertoli cell function)
  2. LH (stimulates leydig cells to make androgens)
  3. high levels of intratesticular testosterone
90
Q

what would happen if a 30 yr old person were given high doses of testosterone

A

estrogen would increase through aromatase

increased estrogen and testosterone would decrease FSH and LH

decreased FSH and LH would lead to a lower sperm count

91
Q

semen

A

the 1.5-5mL of fluid emitted at ejaculation

92
Q

what percent of the total sperm content semen are motile and morphologically normal

A

about 1/2

93
Q

T/F sperm counts have increasesed 1-2% a year since 1985

3 possible causes

A

false

  1. increased scrotal temperature
  2. environmental estrogens
  3. high stress
94
Q

hormonally what happens during menopause

A

the ovaries no longer secrete estrogen so the hypothalamus and anterior pituitary produce FSH and LH to try and increase estrogen

95
Q

if a male were to present with extremely high levels of FSH and LH what would you expect

A

primary testicular failure caused by infection or pituitary tumor

96
Q

is andropause natural

A

yes and no, there will be a decrease in testosterone and sperm production around 50 but men will continue tot produce until death

97
Q

amenorrhea

A

absence of menstration

98
Q

primary amenorrhea

A

never had a period before

99
Q

secondary ammenorrhea

A

the absence of a period for three months in a women who prevously had them

100
Q

primary ovarian failure

A

dysfunction of the ovaries that doesnt allow for menstruation

101
Q

secondary ovarian failure

A

pituitary gland malfunction leading to decreased LH and FSH

102
Q

tertiary ovarian failure

A

hypothalamic failure to produce GnRH

103
Q

what are three possible causes of primary ovarian failure

A
  1. turners syndrome
  2. gonadal dysgenesis
  3. premature menopause
104
Q

gonadal dysgenesis

A

failure of the germ cells to migrate to the gonads during development

105
Q

at what age would menopuase be considered premature

A

younger than 35

106
Q

what lab values would you expect in primary ovarian failure

A

increased LH and FSH as the pituitary tries to stimulate estrogen production

107
Q

what lab values would you expect in secondary ovarian failure

A

defininatly decreased FSH and LH

possibly increased prolactin or decreased TSH leading to hypothyroid

108
Q

what would you expect to see in tertiary ammenorrhea

A

low BMI, high stress level, or delayed puberty

109
Q

what hormonal activity signals the start of puberty

A

nocturnal secretion of GnRH

110
Q

what will stimulate the onset of puberty

A

increased body size, specifically body fat, that stimulates leptin production

111
Q

leptin

A

a peptide secreted by adipocytes that regulates eating behavior, energy, and reproduction

112
Q

what is the sequence of female pubertal development

A
  1. breasts
  2. pubic hair
  3. growth
  4. menarche
113
Q

if estradiol levels are found to be normal in an amenorrheic patient what can we conclude

A

that her ovaries, pituitary, and hypothalamus are all working properly

114
Q

how can a chromosomal XY fetus end up without male genitalia

A

if the androgen receptors in development are not sensitive the testes will not descend and male genitalia will not form

115
Q

what are the four determinants of gender

A
  1. genetic
  2. gonadal
  3. ductal
  4. genital
116
Q

what determines if somone is genetically male of female

A

a male will have a Y chromosome with a functional SRY gene

117
Q

SRY

A

sex determining region of the Y chromosome which determines if ovaries or testes will form

118
Q

what is the ductal determinant between males and females

A

females will have muellarian ducts, men will have vestigial muellarian ducts and prominent wolffian ducts

119
Q

what is the gentital determinant of gender

A

whether there are ovaries or testes indicated by high levels of androgens

120
Q

how can a genetically male person produce enough estrogen to have normal female sex characteristics

A

aromatase produced in adipose tissue will convert testosterone into estradiol

121
Q

what will a fetal ovary produce that will determine gender

A

estradiol and oocytes

122
Q

what will fetal testes produce that determine gender

A

testosterone to maintain the wolffian ducts and anti-muellarian hormone to regress the muellarian ducts

123
Q

what do the wollfian ducts and mullerian ducts determine

A

internal genital development

124
Q

what will the wolffian ducts form into

A

vas deferens, seminal vesicles, prostate

125
Q

what will the mullerian ducts form into

A

fallopian tubes, uterus, upper vagina

126
Q

what is the default phenotype of the external genitalia

A

female

127
Q

what hormonal process must happen to masculinize the the external genitalia

A

testosterone must be converted into DHT with 5 alpha reductase

128
Q

what happens to the wolffian and mullerian ducts if there is no SRY gene present

A

the wolffian ducts will regress, the mullerian ducts will develop, the external genitalia will be female

129
Q

androgen insensitvity syndrome

A

non functional androgen receptors that lead to formation of the wolffian ducts but no DHT to masculinize the external genitalia

130
Q

what are three indicators of androgen sensitivity syndrome

A
  1. 46 XY genome
  2. absent uterus and upper vagina
  3. no androgen receptors mean no pubic or axillary hair
131
Q

two ways to produce a functiona vagina

A

progressive vaginal dilation or surgery

132
Q

what might be suspected besides menstration when a pediatric patient presents with vagina bleeding

A
  1. foreign body
  2. sexual abuse
  3. trauma
133
Q

what hormone would be absent with a lack of pubic hair

A

androgens

134
Q

what hormone is elevated in a pediatric patient with an enlarged uterus and early onset period

A

estradiol

135
Q

explain how high TSH can cause early onset period

A

TSH in high doses can cross react with GnRH receptors in the ovary and produce estradiol

136
Q

what four hormones are capable of cross reacting with other receptors at high doses

A
  1. FSH
  2. LH
  3. HCG
  4. TSH
137
Q

how can low thyroid cause an increase in estradiol

A

low T3/4 will not give negative feedback to the hypothalamus/pituitary to inhibit TRH and TSH

TSH can cross reaction with FSH and LH receptors to stimulate the production of estradiol

138
Q

a patient presents with early onset menses, elevated TSH, and an enlarged uterus

what would be the prescribed treatment

A

Thyroxine (T4) that will provide negative feed back to inhibit TSH production and stop FSH and LH cross-reactivity

139
Q

what are three causes of precocious puberty

A
  1. central lesion in the CNS
  2. peripheral increase in estrogen
  3. obesity
140
Q

why would obesity cause precocious puberty

A

adipose tissue contains aromatase which will convert androgens into estrogens and stimulate menses and breast development

141
Q

a patient with precocious puberty needs treatment, what are two options and why would they be effective

A

1) estrogens, because it will suppress GnRH production but won’t decrease estrogen
2) GnRH antagonists to down regulate GnRH receptors in the pituitary, deceasing FSH and LH production

142
Q

leuprolide

A

GnRH antagonist used to decrease estrogen or androgen production by downregulating GnRH receptors

143
Q

what is the most common cause of secondary ammenorrhea

A

pregnancyq

144
Q

why would low BMI cause hypothalamic amenorrhea

A

the hypothalamus would react to low body fat by inhibiting production of GnRH

145
Q

what are two causes of hypothalamic amennorhea

A

low bf

stress

146
Q

what is one long term side effects of hypothalamic amenorrhea

A
  1. osteoporosis caused by low estrogen
147
Q

three treatments of hypothalamuc amenorrhea

A
  1. estrogen replacement
  2. GnRH to stimulate FSH and LH production
  3. direct FSH and LH
148
Q

what causes menopause

A

primary ovarian failure

149
Q

why would high BMI delay menopause

A

because aromtase conversion of androgens to estrogens will continue to stimulate the uterus

150
Q

four symptoms of menopause

A
  1. amenorrhea
  2. vasomotor flushes
  3. decreased vaginal lubrication
  4. accelerated calcium loss
151
Q

when do menopausal women have the highest instances of hot flashes

A

the first 3 year post menopause

152
Q

why does menopause cause hot flashes

A

no estrogen production stimulates increased GnRH production

increased hypothalamic activity causes the hypothalamus to assume core temp is too high

153
Q

why does the menopause cause peripheral dilation, perspiration, compensatory tachycardia

A

hypothalamic disregulation causes the hypothalamus to think body temp is too high and tries to cool down

154
Q

what are the benefits of estrogen replacement therapy

A
  1. reduce intensity and frequency of hot flashes
  2. prevent osteoporosis
  3. maintain bladder and uterus function
  4. reduce the risk of colon cancer
155
Q

potential risks of estrogen supplementation

A
  1. increase risk of MI
  2. increased risk of breast cancer
  3. increase risk of DVT

BMS 752 (Medical Physiology) (13 decks)

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