SDR Lectures Flashcards
0
Q
primary follicle
A
oocyte is surrounded by differentiated and metabolically active granulosa cells
1
Q
Stress invokes what to inhibit the reproductive system?
A
Opioid neurons - ß-endorphins and CRH containing neurons
2
Q
secondary follicles
A
6-10 primary ones
multiple layers of granulosa cells
an outer layer of theca cells
fluid-filled antrum
3
Q
Primordial follicles consist of
A
an oocyte surrounded by a flat layer of epithelial-like cells (granulosa precursors)
4
Q
tertiary follicle
A
Graffian follical 1 secondary one larger antrum multple layers of granulosa cells multiple layers of theca cells (theca interna and externa)
5
Q
Theca cells produce
A
androgens from cholesterol in response to LH
6
Q
granulosa cells produce
A
estradiol 17ß from androgens in response to FSH
with aromatase
7
Q
luteal cells are made from
A
left over theca and granulosa after oocyte release
8
Q
luteal cells secrete
A
estradiol but less than the follicle did
9
Q
When does corpus luteum stop secreting progesterone and estradiol?
A
after sitting for ten days it becomes whitish scar tissue = corpus albicans
10
Q
Where does estrogen bind to kisspeptin for + feedback?
A
MPOA
11
Q
When does estrogen turn into + feedback?
A
2–pg/ml for 36 hrs
12
Q
What does LH do on the granulosa cell?
A
increase release of progesterone intra-follicularly to increase proteolytic enzymes like collagenase that weak the follicular wall
13
Q
high progesterone causes
A
increase in collagenase (proteolytic enzymes)
follicular hyperemia or blood movement into the follicule
intrafollicular prostaglandin sythase increasing P F2 alpha increasing fluid moving in follicle and adds progesterone receptor
lead to follicular rupture and ovulation
14
Q
First 14 days of ovarian cycle is what in the uterus?
A
proliferation (follicular) phase
15
Q
What causes proliferation in the uterus (endometrial growth and myometrial thickening)
A
estrogen
16
Q
What does estrogen do in the uterus
A
endometrial growth
myometrial thickening
lengthening of uterine glands and arteriole vessels
water rention (and cervical mucus thinning)
uterine contractions
17
Q
When does progesterone increase in level over estrogen?
A
After ovulation
18
Q
What is the 2nd 14 days of the ovarian cycle in the uterus?
A
the secretory phase
ran by progesterone
19
Q
What does progesterone do to the uterus?
A
stops endometrial growth stimulates uterine gland branching lengthening of spiral arteries cervical mucus thickening increase body temperature
20
Q
What does inhibin act on
A
FSH
It’s inhibition allows for the 1st small surge of FSH to recruit follicles
21
Q
What happens to spiral arteries without pregnancy?
A
low estrogen and progesterone cause them to retract
22
Q
What causes necrosis and sloughing and bleeding
A
decrease in O2 to the tissues from spiral arteries retracting
23
Q
insulin causes
A
thecal cells to increase androgen production
24
what do adipose tissue convert androgens to with their aromatase?
estrone - disrupting LH/FSH cycle
25
What does estrone do to LH/FSH
increaess LH so there is more androgen secretion
| Decreases FSH so no aromatase work in granulosa cells
26
wedge resection:
androgen amount stays
| but less barrier around ovary
27
What happens in puberty?
GABA decreases, glutamate increases
28
menarche
age when first surge of LH happens from enough estradiol and progesterone formation
29
Why are periods erratic in menapoase at first
follicles are not robust so less estrogen build up regularly
| but sensitivity to - feedback decreases to that sometimes a surge can happen (compensation)
30
What produces hCG
trophoblasts 8 days after ovulation
31
what does hCG do?
binds to LH receptors and keeps ovary functioning and corpus luteum lives (to produce progesterone, estriol)
32
When does hCG stop rising?
after week 9 (month 3)
| b/c placenta can produce its own prog/estriol
33
When is prog dominant vs estr
progest: during pregnancy
estr: at the end
34
What causes estrogen to increase over prog at the end of pregnancy
placenta producing a large amount of CRH -> fetal pituitary products ACTH -> fetal adrenal DHEA -> to placenta that aromatizes it to estrogen
35
What does estrogen do to prostaglandin synthetase
increases production of PGF2 alpha
36
What strengthens contractions caused by estrogen?
baby head in cervix -> hypothalamus oxytocin secretion from posterior pituitary on SM and more PG
also stress of labor -> sympathetics -> NE/E
37
estrogen on breast growth
increases ductile growth
| increases fat deposition
38
What does progesterone do on the mammary gland?
-> growth of alveolar structures
39
What does baby suckling do?
Effect spinal afferent receptors -> hypothalamus -> dopaminergic neurons (↓prolactin) and oxytocin neurons (ejection of milk)
40
Prolactin acts to
lactogenesis
| - feedback on dopaminergic neurons (to stop more prolactin)
41
Where are dopaminergic neurons?
in the acruate nucleus of the hypothalamus
| some terminate at portal capillaries of the median eminence
42
Where does DA inhibit prolactin
anterior pituitary
| DA also inhibits LHRH
43
how does prolactin give infertility
increases DA -> decrease GnRH -> decreases LH and FSH
| b/c huge increase in prolactin in the beginning, not when it decreases (western countires)
44
Sheehan's syndrome is caused by
large blood loss in delivery killing anterior pituitary (that's when it needs blood)
45
Sheehans causes
```
no lactotrophs (can't lactate)
no ACTH (no pubic hair and hypOtensive b/c no cortisol)
no somatotrophs (hypoglycemia from low cortisol and GH)
no thyrotrophs (no TH, fatigue and lethargy)
No gonatotrophs (no LH/FSH infertility and amenorrhea)
```
46
Male LH acts on vs FSH
LH: leydig - testosterone
FSH: Sertoli - aid spermatogenesis, increase androgen binding protein
47
What does ABP do?
binds to testosterone to ensure that a high concnetration remains in the seminiferous tubules
48
Sertoli cells produce
ABP
| Inhibit
49
What shapes FSH release?
Inhibin
50
What shapes LH release
testosterone
51
inhibin made up of
A and
| A-B or B-B
52
2 beta subunits together = (ßb-A)
activin
53
what is activin
stimulates FSH production but works at lower rates than inhibin so control is mostly by inhibin
also resides in FSH producing cells of pituitary glands and exerts a pararine effect
54
how much of testosterone is circulating unbound?
3%
55
4 ways testosterone can act
1. diffuse in cell
2. convert to DHT and act (prostate and hair)
3. Aromatize to estrogen
4. On an plasma membrane receptor
56
What can testosterone do?
Fetal development of epididymis, vas deferns, seminal vesicles
Pubertal growth of penis, seminal vesicles, musculature, skeleton, larynx
Spermatogenesis
57
DHT does
Fetal development of Penis, penile urethra, Scrotum, Prostate
Pubertal growth of Scrotum, Prostate, Sexual hair, Sebaceous gland
Prostatic secretion
58
what does high early fetal exposure to testosterone do?
Eliminate the possibility of + feeback signaling.
| Also a role in gender self-identification and gender preference
59
What does high testosterone do around birth
testicular descent
60
How does testosterone increase finally at puberty?
Excitatory glutaminergic inputs to LHRH and less GABA
61
Kallmans syndrome symptoms
Small phallus, small scrotum, muscle mass feminine, wide hips, frail looking, shy, socially withdrawn
62
Kallman's syndrome physiology
failure of LHRH neurons to migrate to the hypthalamus
| Normally olfactory bulbs develop and span LHRH neurons that migrate but some tissue damage stops it
63
Kallman's syndrome treatment
give testosterone
| More muscle at shoulderes, less fat at hips
64
How much folic acid should a woman have before conception?
800 micrograms
65
Exercise before conception?
30 min a day
66
Diabetes on pregnancy
birth defects
Eclampsia
heart malformations
67
blood levels sugar indicated by
HbA1c
68
First day of gestation
1st day of last menstrual period (LNMP, LMP)
| - 2 weeks before = ovulation
69
When do diagnostics work?
blood test
urine test
ultrasound
8 days
day of menses
6 weeks, more at 9 weeks
70
Minimum gestation for baby to be healthy
24 (42, induce labor)
71
Vitamins to recomend: (6)
```
Folic acid
Ca
Vitamin D
Iron
300 + calories
prenatal vitamins
```
72
Foods to avoid (4)
Alcohol
unpasteurized milk and its cheese
raw meat
mercury containing fish
73
Smoking in pregnancy
cleft lip, heart defects, low growth
premature
stillbirth
sudden infant death
74
Assymetric FGR (fetal growth restriction)
head is normal, rest of the body is smaller
75
FASD to pregnancy
FGR
microcephaly + CNS defects
Upper lip, poor philtrum, palepbral fissures, short flat bridged nose
76
Obestity to pregnancy
```
Difficult becoming pregnant
Gestational diabetes
hypertensive disorders
Deep vein thrombosis/pulmonary embolism
Preterm devlivery (physician indused for elss complications; otherwise prolonged)
C section
Shoulder dystocia- erb's Palsy (waiter's tip)
Stillbirth
```
77
Teratogens
```
Warfarin (Coumadin): blood thinner
Valproic acid: anti-seizure
Carbamazipine: anti-seizure
Isotretinoin (Accutane)
Ace inhibitor
```
78
weeks most sensitive to malformation
3-8
79
Uncontrolled Diabetes --> large baby?
hgih blood glucose, mother insulin doesn't cross placenta so just acts as a growth factor
[also high sugar effects respiratory system and gives hypoxia]
80
Uncontrolled diabetes can cause
```
hypoglycemia
hypoxia
cardiac defects
polyhydramnios
preterm delivery
neonatal respriatory distress syndrom
stillbirth
```
81
Methotrexate
attakcs rapidly dividing cells
use in ectopic pregnancies and cancer
NOT in regular deliveries
82
Cause of preterm labor?
Unknown
| something with uterine overdistension, inflammation, infection, premature HPA axis activity
83
Give baby what in pretem labor?
steroids: fetal lung development
Magnesium Sulfate: protect the brain by reducing energy use and minimuze free radical production
Tocolytics: stall labor (not really proven to work)
84
Premature Rupture of Membranes (PROM)
Rupture of fetal membranes (water breaking) >1hr before labor onset
If after 34 weeks, induce labor
85
Placenta Previa
Placenta implants in the lower part of the uterus blocking the cervix
C section it
86
Placental Abruption
Premature separation of palcenta from uterine wall
Stillbirth at high degree
associated with contractions, cramping, and bleeding
87
Preeclampsia
BP > 140/90
| proteinurea, low platelet count, impaired liver function, pulmonary edema
88
Eclampsia seizures treated with
magnesium sulfate to reduce neuroexcitity
89
Preeclamspia risks
```
heart attack
stroke
renal failure
retinal injury
death
```
90
If gestational diabetes
put patients on diabetic diet and closely monitor
91
Infancy stage:
Birth -2
Males have genital responses in utero and women are capable of vaginal lubrication from birth
Gender identify is forming
92
Early Childhood stage
```
2-5
exploration, independence, curiousity
Teach kids to use proper names
Don't shame
Private parts for private places
Gender stability
Parents should watch kids
```
93
Stage 1 pregnancy
```
learning of pregnancy -> ultrasound
Physical Sx
memory impairment
ambivalence especially when nervous aout pregnancy
fear of miscarriage
Task: acceptance
```
94
Stage 2 pregnancy
```
Ultrasound -> point of viability
sharing news
time of peace and fulfillment
realization of life within
best time for them
Task: recognition of fetus as separate from self
```
95
Stage 3
```
Pt of viability -> birth
Physical sx are back
nesting behavior
fear about birth process
fear about baby's health
Task: attachment
```
96
HPV
```
most common
8kb circular DNA
with L1 (!) and L2 capsid proteins
7-8 genes total
E1-5 - viral life cycle & interactions w/host
E6,7: oncogenes
```
97
E6 in HPV
p53 tumor supressor binding
98
E7 in HPV
bind pRb for degredations - which transactivates genes in cell replication
99
Cancer inducing HPV
16,18 (70%)
100
Low grade HPVs
stil have E6,7 but can't degrade tumor suppressors
can cause morbities like recurrent respiratory papillomatosis in newborns (requiring up to 100 ENT lesion excision to prevent suffocation)
101
HPV MA
haloes around the nuclei
swiss-cheese effect
brown nuclei = intracellular capsid protein production
102
HPV life cycle
abrasion -> access to basal cells at bottom of multi-layered squamous epithelium -> 10 replicated copies per cycle to shed and infect other cells/persons
In malignant infection, high risks trains break its circular genome and insert itself into the host DNA with intact E6,7 genes, cells become dysplastic and turn into carcinoma
103
Trichomonias
protozoanvaginitis > urethritis
transmitable tru items
see with PAP
104
Chlamydia
bacteria
can cause infertility
mostly women
triad: arthritis, conjunctivitis, urethritis
105
Gonorrhea
bacteria
treat with antibiotics
can cause sterility
106
Herpes
1 - oral
2 - genitals
no approved vaccine
107
Hepatitis B
virus
| vaccine
108
Syphilis
bacteria
| antibiotics
109
Chancroid
bacteria
developing countires and sex works
antibiotics
110
Koilocytosis
acute infection associated with with capsid protein synthesis
forms well-differentiated tumors
In productive time
111
Malignant progression of HPV
no koilocytes
| nonreproductive
112
Where does HPV stuff happen
Cervix transformation zone w/transition from vaginal exocervial sqamous epithium and endocervical columnar/glandular epithelium
113
HPV resolved on own unless
chronic and precancerous lesion forms
114
Cervical intraepithelial neoplasias (CIN)
Cprecancerouslesion I-III
115
CIN I
1/3 of epithelium is dysplastic
| koilocytosis is stil present at the surface
116
CIN II
2/3 of epithelium is dysplastic
117
CIN III
carcinoma in situ
stage 0 cervical cancer
entire depth is dysplastic
118
HPV detection
colposcopy
pap smears
hybrid capture - most sensitive
119
HPV destruction
detect and destroy with salicylic or trichloroacetic acid externally
ablate (cryotherapy), exise (conization w/LEEP), poison (pharmacotherapy) vaginally
120
HPV vaccine
IgG respose
