Reproductive Systems (M & F)

Question 0

Secondary Amenorrhea

Answer 0

no menses for 2 consecutive cycles (or more) with history of having had menses (vs. primary - never have it)

Question 1

Primary amenorrhea

Answer 1

a) by age 14: absence of menorrhea & no start of puberty sequence
b) by age 16: absence of menorrhea, regardless of secondary sex characteristics

Question 2

Causes of primary amenorrhea

Answer 2

@ reproductive tract: not patent
@ ovary: agenesis, etc.
- Hormones: genetic/R abnormalities, ie testicular feminization
@ Hypothalamus: low BMI (<10th percentile)

Question 3

Polycystic Ovarian Disease (PCOS)

Answer 3

1. chronic anovulation - cycle in steady state, w/ lack of rise/fall in hormones
2. Hyperandrogenism - bc over-produced by ovaries,
   => hirsutism or masculinization (rare)
3. peripheral insulin resistance *not diagnostic, esp. @ skeletal mm.

Question 4

Treatment for PCO

Answer 4

1. Ovulation: clomifene citrate (estrogen R blocker)
2. Insulin resistance: metformin
3. Hirsutism: oral contraceptives (increase estrogen) or electrolysis for hair removal, or spironolactone (increase SHBG)

Question 5

Pre-testicular causes of Inferility

Answer 5

1. Hypopituitarism (not enough sex hormone production)

2. testicular exhaustion (too much FSH signaling)

Question 6

testicular causes of infertility

Answer 6

1. Genetic (ie: XXY/Klinefelter)
2. Developmental (cryptoorchidism, ectopia, anorchia)
3. Toxins/Drugs/Environment (ie: EtOH, chemotherapy, etc)
4. local disease (orchitis, atherosclerosis, varicocele)
5. systemic disease

Question 7

Systemic diseases that cause (primary testicular) infertility

Answer 7

cirrhosis, diabetes, malnutrition

Question 8

Post-testicular causes of infertility

Answer 8

= lesions to excretory duct (congenital, inflammatory, iatrogenic)

Question 9

“Parity” (in rating pregancies)

Answer 9

the total number of times a woman has given birth
0 = nulliparous
1 = primiparous
2+ = mutliparous
5+ = grand multiparous

Question 10

“Gravida” (in rating pregnancy status)

Answer 10

the total number of times a woman has conceived

Question 11

Complete Androgen Insensitivity (aka testicular feminization)

Answer 11

= receptor defect –> NO response in body to testosterone, but still produced.
Have: testes, high testosterone/LH/FSH & estrogen
Female external genitalia but NO internal genitalia