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34 Cards in this Set

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  • Back
What are follicular cysts, corpus luteum cysts, and PCOS each due to?
Follicular cyst: due to excessive LH & FSH. CL cyst due to insufficienlty strong LH peak. PCOS due to excess inhibin.
Growth of follicles is under the control of __. Ovulation & formation of the corpus luteum are under control of __. Ovarian cysts are problems of __ & __.
A __ cyst is a follicle that persists and grows beyond ovulation. A __ cyst is a corpus luteum that refuses to collapse into a __ __.
Follicular cyst; Corpus luteum; corpus albicans
Describe the pathophys of a follicular cyst.
Normally, 1 follicle becomes dominant (Graafian follicle) & the remainder undergo atresia. If follicle is overstim'd by too much FSH & LH, it becomes too thick to be ovulated by LH promoted proteases (~1"). It can then grow as lg as a baseball & persist for 60d.
What will eventually happen to a follicular cyst?
It will break.
What happens to menses w/ a follicular cyst? Why?
Menses is very delayed bcs no corpus luteum was formed & therefore no progesterone produced.
In the case of a follicular cyst, describe what happens to ovulation, progesterone, LH & FSH levels
No ovulation, No progesterone, Very high LH & FSH levels
Explain the endocrinology of a follicular cyst
Overdoses of pulses of GnRH or failure of GnRH nn to be regulated by E2 & P feedback results in excessive LH & FSH. Inhibin isn't being produced in the luteal phase (bcs no CL), so it can't feedback to the pituitary to shut off FSH.
Describe the pathogenesis of a Corpus Luteum cyst.
Ovulation & formation of the corpus luteum is under control of LH. If LH surge is lg enough to allow ovulation but not proper differentiatn of theca & granulosa cells or CL formation, a cyst will form. CL fills w/ blood p ovulation, but can't diff or collapse into a corpus albicans. Can grow as lg as a baseball.
What happens to menses with a corpus luteum cyst?
It is blocked or delayed; Can cause amenorrhea
In the case of a corpus luteum cyst, describe what happens to ovulation, progesterone, LH & FSH levels
Ovulation occurs, Progesterone is produced, FSH & LH remain normal in follicular phase, LH peak is poor
What is the most common cause of female infertility and of hirsuitism?
What is the pathogenesis of PCOS?
>2x inhibin in foll phase feeds back & limits pituitary FSH early. Limited FSH prevents dom follicle from being selected & several small follicles persist. Follicles are still being acted on by LH (bcs inhibin doesn't limit it). LH & inhibin promote androstenedione prodxn by theca cells, but there is limited FSH-stim'd estrogen prodxn by gran cells, leading to insuff estrogen to promote LH peak, so no ovulation. Multiple foll's continue to grow under LH influence.
The result of PCOS is excess __/__ & thus __. The lack of ovulation leads to failure of __ or menstrual __.
Androstenedione/Androgen; hirsuitism; progesterone; decidualization
In endocrinology of PCOS, w/o FSH, __ in the granulosa cells can't turn testosterone into __, resulting in lack of feedback by __ to turn off __. This backs up the pathways & lots of __ & __ are released. Lots of follicles in foll phase = lots of gran cells. Gran cells in foll phase produce __, so there is too much __, which feeds back to turn off __.
Aromatase; Estradiol; granulosa; GnRH; androstenedione & testosterone; Inhibin; inhibin; FSH
What is a complete hydatidiform mole?
Pregnancy comprising only placenta or trophoblast cells
What is the epidemiology of complete hydatidiform moles?
1 in 900 pregnancies, with rates higher (up to 1/100) in areas where pregnancy occurs at v young ages
What is the nl hCG in a 10w pregnancy? What is it in a 10w hydatidiform mole?
May peak at 100,000 nlly. In molar pregnancy, 1,000,000 bcs complete pregnancy is placenta, which produces hCG.
What is the pathophys of a complete hydatidiform mole?
LH promotes 1st meiotic division in ovary, so an inappropriate LH rise will not promote meiosis. If there's enough LH for ovulation, you will ovulate an ovum w/o genetic material. 2 sperm penetrate & combine, resulting in a diploide XX or XY lifeform of dispermic diandrogenous origin. Can get to morula, but not blastocyst stage bcs no inner cell mass.
What is the tx for a complete hydatidiform mole?
It will eventually spontaneously abort or can be removed by a D&C. Bcs the trophoblast is invasive by nature, ~40% of cases require hysterectomy or chemo to remove all tissue or stop tissue invading after evacuation of the mole.
What is the risk of Down's Syndrome?
1/830. If >35yo, 1/220
What is the risk of abortion with amniocentesis?
When & how is Down's Syndrome screened for? What is the principle test? What does a positive result indicate?
2nd trimester; Triple Screen test: hCG (principal) + alpha-FP + estriol. (+) result is indicator of high risk (~1/90)
Why is hCG the principal test to screen for Down's Syndrome?
There is restricted differentiation of trophoblast cells in Down's, with a buildup of intermediate syncytioTB cells, the optimal hCG producing cells. This leads to a 2-fold increase in hCG in the 2nd trimester in DS cases.
What is the cause of gestational diabetes?
Hyperglycemia due to hPL & estrogens, which raise maternal BGL in pregnancy to provide glc to the fetus for anabolism & growth.
What is the rate of gestational diabetes?
1/30. It is one of the top health concerns in pregnancy
What happens if gestational diabetes isn't treated?
Respiratory distress syndrome, preeclampsia, future DM for mother & child
How is gestational diabetes treated?
Dietary changes & exercise. Extreme cases may require daily insulin.
2nd or 3rd trimester, HTN, proteinuria
Leading cause internationally of maternal & infant illness & death; 8% of all pregnancies
What causes preeclampsia?
Failed or ineffective 2nd implantation. This is necessary to give the vascular supply needed for development. W/o effective 2nd implantation, poor nutrition & anorexia occur, leading to preeclampsia.
What is precocious puberty?
Signs of puberty before normal age. Ex: breast budding or pubic hair development in a 4yo girl.
What is the cause of precocious puberty?
Fat kids. Fat tissue increases leptin, which removes the NPY block from GnRH pulsation, resulting in FSH & LH release, etc.
What does precocious puberty result in in the adult? Why?
Shorter height. When puberty starts early it ends early, so growth stops at an earlier age than nl. Initial growth spurt may make them tall compared w/ peers, but they stop growing too soon.