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38 Cards in this Set
- Front
- Back
Broadly, what are the beginning stages of pregnancy, starting at development?
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1. Gamete development and maturation
2. Ovulation 3. Fertilization 4. implantation 5. Clinical evidence of pregnancy 6. Documentation of normal development |
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In males, when is the initiation of spermatogenesis?
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Puberty
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When does ovulation normally occur?
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14 days after the onset of menses
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What's the definition of day 1 of the menstrual cycle?
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1st day of real, active bleeding.
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How many days after fertilization doe simplantation occur?
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6-8 days:
3 days in fallopian tube 3-5 days in uterus before physicla attachment |
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What is the source of HCG in the body/
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Trophoblast
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How many days after implantation does it take for beta HCG to be detectible?
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2-3 days following implantation
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What are we measuring when we do an assay for HCG?
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The BETA subunit:
the alpha subunit is shared by LH, FSH, and TSH! |
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What's the definition of gestaional age?
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Weeks from day 1 of the last normal menstrual period
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What's the mean gestational length?
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40 weeks from the last menstrual period
Conception at 2 weeks Implantation at 3 weeks Missed menses at 4 weeks |
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What are 4 causes of the loss of cyclicity?
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process works: Pregnancy
revs up: PCOS winds down: HA runs out of eggs: Menopause |
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What is the effect of progesterone and estradiol on GnRH release?
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Slows it down!
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What underlies PCOS?
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Chornically high GnRH pulses
-Lack of negative feedback from CL -High LH, low FSH |
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What hormone is overactive in PCOS?
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LH
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What is the implication of tonically high LH in PCOS?
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Increased androgens
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What is the impact of increased androgens in PCOS?
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No dominant follicle (no FSH)
No LH surge No ovulation No CL Weight gain Acne Hirsutism |
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What is the effect of increased estrogen in PCOS?
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Endrometrial proliferation without differentiation!
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What are women with PCOS very likely to get?
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Endometrial cancer!
Diabetes (type 2, gestational) dyslipidemia |
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What are the characteristics of people with PCOS?
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Infertile
Hirsutism Oligomenorrhea (in all women) Obesity |
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What is the official definition of PCOS?
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Menstrual dysfunction (>35 days cycles; <10 menses/year)
Hyperandrogenism Polycystic ovaries Lack of other causes. |
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What's the prevalence of PCOS?
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10-15%
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What's the inheritance of PCOS?
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AD with incomplete penetrance.
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What are some disease risks for PCOS? (other than the conditions they're definitely goign to get)
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Increased risk:
-HTN -CV disease -Pregnancy induced HTN -ovarian cancer |
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What's the diagnostic approach to PCOS?
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1. H and P
2. Rule out DM/IGT 3. If regular cycles/clear skin: pelvic ultrasound 4. If significant skin symptoms: serum free testosterone concentration |
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What's the goal of treatment with PCOS?
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1. Healthy lifestyle!
2. Increase insulin sensitivity 3. Decease hyperanndrogenism 4. Prevent cancer and bleeding |
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What's the traditional therapy for PCOS?
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Oral contraceptirves
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What are the effects of oral contraceptievesii n PCOS?
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Regulate menstruation
Prevent endometrial hyperplasia Improve hirsutism/acne |
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What are side effects of oral contraceptives in PCOS?
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Decrease in insulin sensitivity
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What can you give people with PCOS to help out with insulin sensitivity?
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Metformin
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What is the effect of giving metformin to peopel with PCOS?
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Decreased abdominal fat
Decreased BMI Decreased leptin |
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If people have problems with their skin in PCOS, what can you give them?
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Spironolactone.
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What underlies hypothalamic amenorrhea?
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Decrease in GnRH secretion
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What are causes of hypothalamic amenorrhea?
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Stress
Anorexia/eating disorders Intense physical exercise Developmental abnormality |
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What is the mediator of amenorrhea due to stress?
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Neurotransmitter system:
-Stress axis -Available energy axis |
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What are women at increased risk for?
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Bone problems
Lack of estrogen causes a lack of bone mass. Lots of stress fractures |
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What is the triad of amenorrhea?
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Exercise
Diet Stress |
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What are some endocrinopathies that you should rule out if someone is amenorrheic?
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FSH: premature ovarian insufficiency
Prolactin: pituitary adenoma TSH: primary hypothyroidism |
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What's the treatment for amenorrhea?
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1. Restore energy balance (diet, cut down on exercise)
2. Restore ovarian hormones (cyclic E/P) 3. Induce cyclic ovulation (pulsatile GnRH, FSH/LH) |