Chapter 25 Reproductive Function And Pregnancy

Front 1

list three indications for performing semen analysis

Back 1

evaluation of male infertility
select donors fro therapeutic insemination
monitor the sucess of surgical procedures such as varicocelectomy and vasectomy

Front 2

a patient collecting semen should remain abstinent for a fairly strict period of ??days; he should transport the semen sample to the laboratoty within ??hours

Back 2

3 days but not more than 5 days
1 hour of collection

Front 3

what is the normal pH of semen?

Back 3

7.2 to 7.8;
acute prostatitis or epididymitis may raise the pH above 8.0 and urine can lower it to below 7.0

Front 4

normal sperm motility is considered to be greater than ??

Back 4

50%
there is a grading scale from 0-4 for assessing motility; a score of 2 is normal

Front 5

what are the two methods to detect sperm antibodies, and what type of antibody is clinically most significant?

Back 5

sperm antibodies can be detected by a direct or indirect mixed aggutination reaction or by immunobead assay;
the agglutination reaction can pick up IgG or IgA and the immunobead assay can pick up IgG, IgA or IgM;
IgA is the most clinically significant

Front 6

which common subunit is found in FSH, LH and TSH, and which subunit confersfunctional specificity?

Back 6

the alpha subunit is common
the beta subunit confers specificity

Front 7

what is the typical laboratory profile in an infertile male with a 47XXY karyotype?

Back 7

Klinefelter's syndrome
testosterone is decreased and the normal pituitary gland secretes excess FSH and LH because it receives no negative feedback in the form of inhibin from the testes

Front 8

what subunits do most immunometric assays for HCG measure, and when does HCG reach a maximum in a normal pregnancy

Back 8

the sandwich assays usually measure both the free beta-subunit, which is specific for HCG and intact HCG which contains both the alpha and beta subunits;
the maximum HCG level is usually reached at 10 weeks gestation

Front 9

a blighted ovum is indicated by what levels of estradiol and progesterone?

Back 9

estradiol of <200ng/mL and a progesterone of <15ng/mL indicate a blighted ovum

Front 10

what anticonvulsant is associated with an increased risk of neural tube defects?

Back 10

valproate

Front 11

assisted reproductive technology (ART), hormones to stimulate specific physiologic processes; state the function of the following medications
GnRH analog:
human menopausal gonadotropin (HMG):
HCG bolus:

Back 11

GnRH analog supresses normal FSH and LH synthesis and secretion;
HMG has predominantly FSH activity, so it will stimulate follicular growth of several follicles simultaneously
HCG bolus acts as the LH surge of the midcycle and simulates ovulation

Front 12

AFP concentrations peak at 12-14 weeks gestation yet maternal screening is performed in the second trimester; why is this

Back 12

fetal AFP diffuses across the amniotic membrane into the amniotic fluid and then from the amniotic fluid into the maternal serum (MS);
AFAFP levels peak at 13-14 weeks gestation, but due to changes in the transfer to MS and internal maternal clearance of AFP, the MSAFP levels increase by approximately 15% per gestation week in second trimester

Front 13

5 clinical factors in determining MSAFP multiples of the medium (MoM) and how each affects the MSAFP?

Back 13

maternal weight: MSAFP decreases with increasing weight
Race: blacks have 10-15% higher than whites
IDDM: levels are 20% lower than in the general population
Multiple gestation: MSAFP is proportional to the number of fetuses
Gestational age: MSAFP increases 15% per week in the second trimester

Front 14

what is the profile of maternal serum markers in fetal Down syndrome?
MSAFP:
Unconjugated estriol(uE3):
HCG:

Back 14

MSAFP: low by about 25%
Unconjugated estriol(uE3):low
HCG:high, usually 2.0MoM

Front 15

A 23 year old woman who has taken no prenatal vitamins has a MSAFP of her singleton fetus that is 6.8 multiple of the mean(MoM). The ultrasound is abnormal. What is the most likely diagnosis?

Back 15

with a MoM of 6.8, it is likely to be anencephaly

Front 16

What lecithin/ spingomyelin (L/S) ration indicates fetal lung maturity?

Back 16

an L/S ratio of 2.0 is indicative of fetal lung maturity

Front 17

True or false. The primary risk to the fetus in the hemolytic disease of the newborn is the accumulation of unconjugated bilirubin in the central nervous system (kernicterus).

Back 17

False, the placenta normally removes unconjugated bilirubin and it thus appears in th amniotic fluid; anemia is the primary risk to the fetus; after delivery both anemia and kenicterus threaten the neonate

Front 18

Briefly outlined are commonly use status or diagnosis in premature rupture of membranes.

Back 18

To detect amniotic fluid (AF) and the posterior vaginal pole, a sample of fluid is aspirated and placed on nitrazine-impregnated paper. An alkaline pH of 7.0-7.5 (recall that AF is an alkaline fluid, while vaginal secretions or acidic) will turn the paper tape blue color and indicate rupture of amnionic membranes.

Front 19

Although the lecithin/ spingomyelin (L/S) is frequently measured by thin-layer chromatography to assess fetal lung maturity, this method has several disadvantages. List them?

Back 19

The L/S ratio method is slow,labor intense, and only 25% sensitive in predicting respiratory distress syndrome at the level of 2.0 . Vaginal secretions and meconium both interfere with measurement.

Front 20

Back 20

The Liley Curve

A result in Zone I indicates mild or no disease. Fetuses in zone I are usually followed with amniocentesis every 3 weeks.
A result in zone II indicates intermediate disease. Fetuses in low Zone II are usually followed by amniocentesis every 1-2 weeks.
A result above the middle of Zone II may require transfusion or delivery.