Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/214

Click to flip

214 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Amenorrhea
1. Absence of menstruation by age 15-16
2. Absence of three expected cycles
Break-through bleeding
Unexpected bleeding while on exogenous hormones
Dysfunctional uterine bleeding
Bleeding unrelated to anatomic abnormalities.
Menorrhagia
Regular cycles, prolonged/excessive menses
Metrorrhagia
Irregular/frequent cycles
Menometrorrhagia
Irregular/frequent cycles, prolonged/excessive menses
Definition: Midcycle bleeding
In ovulatory women, light menses at mid-cycle estradiol trough
Oligomenorrhea
Irregular/infrequent cycles and intervals of amenorrhea
Polymenorrhea
Cycles more frequent than 21 days
Normal menstruation
1. Structurally stable endometrium
2. Rapid withdrawal of hormonal support
3. Universal endometrial events
4. Progressive vasoconstriction and final hemostasis of coiled arterioles
5. Return of hormonal support with increasing estrogen levels to a) promote healing and b) induce endometrial regrowth
5 components
Estrogen's effect on endometrium
ESTROGEN-PRIMED

Upregulation of E2 and P receptors
Impact on receptors
Effect of addition of Estrogen/progesterone on endometrium
PROGESTERONE-STABILIZED

Secretory effect: Halts growth
Receptors: Down-regulation of E2 and P
Predecidual rxn
Secretory effect, receptor effect
Effect of removal of Estrogen/progesterone on endometrium
UNIVERSAL ENDOMETRIAL SHEDDING

Limited menses
PCOS: Clinical presentation
Menstrual irregularity; hyperandrogenism; irregular insulin regulation; peripubertal onset; absence of other endocrine problems
Polycystic Ovarian Syndrome
How does shedding occur when there is a lack of progesterone?
Unopposed estrogen --> Unstable endometrium --> Non-universal (potentially-heavy) shedding
Ratio of gonadotropins in PCOS
If there is a change -->
LH/FSH > 1
Normal rhythm in an anovulatory adolescent
21-45 days (with great cycle to cycle variation)
What is the normal rhythm in an anovulatory adolescent due to?
Feedback inhibition between FSH and estrogen.
Most common causes of cycles being outside 21-45 days.
Pregnancy, and anatomic defects (polyps/fibroids)
Categories of ovulatory causes of cycles being outside 21-45 days
-Pregnancy
-Anatomic
-Infectious
-Blood dyscrasias
-Other
5 in #
Anatomic causes in ovulatory women of cycles being outside 21-45 days
-Fibroids
-Polyps
-Hemangiomas
-Congenital malformations
-Myomas
5 in #
"Other" causes in ovulatory women of cycles being outside 21-45 days
-Endometriosis
-Midcycle Spotting
2 in #
Most common cause in anovulatory women of cycles being outside 21-45 days.
-Psychogenic
-stress
-diet
-exercise
-body fat
5 in #
Categories of anovulatory causes of cycles being outside 21-45 days
-Hypothalamics
-Endocrinopathies
-Other
3 in #
Endocrinopathies that cause menstrual irregularities
-PCOS
-Thyroid
-Prolactinoma
-CAH
-Cushings
-POF
6 in #
Other ovulatory causes that cause menstrual irregularities
-ovarian steroid producing tumors
-Endometrial cancer/hyperplasia
-Menopause
3 in #
Common causes of menstrual irregularities in young women
Either: Pregnancy

Peripubertal: PCOS

Later: Other endocrinopathies/hypothalamic
Peripubertal or older
Common causes of menstrual irregularities in older pre-menopausal women
-pregnancy
-Perimenopausal/unopposed estrogen
-Fibroids/polyps
Abnormal uterine bleeding history
Age of patient

Diet/Eating disorders: Last two meals, inducement of vomiting/diarrhea
Exercise
Stress

Ethnic/Family Hx
ROS
Menopausal Sx
Sexuality
Regularity of cycles
Onset of hirsuitism
10 major points
AUB physical exam
Vital signs
Skin (acne, hirsuitism, striae, AN)
Thyroid
Galactorrhea
Signs of systemic disease
5 major points
Abnormal Uterine bleeding workup (labs/biopsy)
Endocrine testing: thyroid, hcg, androgens, prolactin, gonadotropins?

anemia: bleeding disorder? platelets?

>35: endometrial biopsy, imaging?
3 major points
Abnormal Uterine Bleeding treatment
If identificable cause, treat that.

If no cause, give hormones (progestin alone, oral contraceptive (progestin dominant, but estrogen)), progestin releasing IUD
4 major points
PCOS treatment
-Weight loss --> Reduce insulin
-Oral contraceptives/Progestins
-Insulin sensitizers (Metformin)
-Hirsuitism: OC, or spironolactone
4 major points
Non-environmental components of sexual identity
-Genetics
-Gonadal sex
-External genitalia
-Phenotype
-Hormonal influences
#:5
Where/what are the gonads at 5 weeks in development?
Gonadal protruberances are over the mesonephric ducts.
When do primordial germ cells move towards the gonadal protuberances?
4-6 weeks
Cellular origin of thecal cells
Mesenchyme
Cellular origin of leydig cells
Mesenchyme
Cellular origin of granulosa cells
Epithelial
Cellular origin of sertoli cells
Epithelial cells
What is the other name for the mesonephric ducts?
Wolffian ducts
What is the other name for the Wolffian ducts?
mesonephric ducts
What is the other name for the paramesonephric ducts?
Mullerian ducts
What is the other name for the Mullerian ducts?
paramesonephric ducts
Male duct system?
Wolffian
Men are animals.
Female duct system?
Mullerian
My 5th grade teacher was a female duct.
What is the region on the Y chromosome that forces the indifferent gonad into a testis?
SRY (sex determining region of Y) on the short arm
What product of sertoli cells initiates female duct inhibition?
Mullerian Inhibition Substance (no longer Mullerian Inhibition Factor)
What is Mullerian Inhibition Substance a product of?
Sertoli cells
Products of the Wolffian ducts
vas deferens, epididymis, seminal vesicles
Products of the Mullerian ducts
fallopian tube, uterus, vagina
Male and Female structures that come from the: Genital tubercle
F: clitoris
M: penis
Male and Female structures that come from the: urogenital sinus
F: vagina
M: raphe
Male and Female structures that come from the: labioscrotal swelling
F: labia majora, minora
M: scrotum
What stimulates the production of androgens in the fetus?
hCG
What is the key component leading to male phenotype?
Androgens
If there are ambiguous genitalia, and testicles in the scrotal sac, CAH is not the cause of the ambiguity. Why?
SRY -----> testicles dropping into scrotal sac

androgens ----> wolffian duct formation --> formation of scrotum and penis, but not active dropping
CAH = congenital adrenal hyperplasia
Sexual development disorders: Endocrine classification
-Incompletely-masculinized males
(male pseudohermaphroditism)
-Masculinized females (female pseudohermaphroditism)
-True hermaphrodites
3 categories
Causes of male pseudohermaphroditism
-androgen insensitivity
-5 alpha reductase deficiency
-testosterone synthesis defects
3 categories
Causes of female pseudohermaphroditism
-CAH
-Maternal androgen intake or production
Problem in androgen insensitivity
No androgen receptors
Problem in 5-alpha-reductase deficiency
No conversion to DHT --> No conversion at external genitalia.
What does 5-a-r do?
Definition of true hermaphrodite
Both ovarian and testicular tissue
T/F: Patients with androgen insensitivity have Wolffian ducts
F: No androgen receptors --> No Wolffian duct completion
T/F: Patients with androgen insensitivity have Mullerian ducts
F: MIS is produced --> Mullerian duct regression
Why is 21-hydroxylase deficiency an emergency?
No Aldosterone --> Salt wasting
Genotype of classic Turner's syndrome
(45, X)
Turner phenotype
Short, shield chest, increased carrying angle elbow, high arched palate
Why is a mosaic Turner syndrome an emergency?
Y chromosome --> undescended testicles --> possibility for malignancy
Why does a female need later genetic influences?
Otherwise she will lose the mantle cells around all the eggs and lose all the eggs
What are the four components that must be looked at when examining difficult sexual differentiation cases?
1. karyotype
2. gonadal development
3. internal genital ducts
4. external genitals
2 most common causes of no menstrual period
1. vaginal agenesis
2. turner's syndrome
2 common sexual development causes of malignancy
1. androgen insensitivity
2. y cell line with streaks
In men, what does LH stimulate? (Be as specific as possible.)
Increased desmolase activity in Leydig cells --> More testosterone
In men, what does FSH stimulate?
1. Spermatogenesis
2. Sertoli cells
What is the negative feedback process for FSH in men?
Sertoli cells release inhibin which acts on the anterior pituitary.
What is the negative feedback process for LH in men?
Testosterone inhibits release of LH (Ant. Pit.) and GnRH (Hypothal.)
In childhood, which is higher: LH/FSH
FSH
In adulthood, which is higher: LH/FSH
LH
In senescence, which is higher: LH/FSH
FSH
Cholesterol -->
-----------> Pregnenolone (using Desmolase)
Pregnenolone -->
-------------> 17OH-Pregnenolone (using 17alpha-OHlase)
17OH-Pregnenolone-->
-----------> DHEA (using 17,20-lyase)
DHEA -->
-----------> Androstenedione (using 3B-OHsteroid-dehydrogenase)
Androstenedione -->
-----------> Testosterone (using 17B-OHsteroid-dehydrogenase)
Mediated by what hormone?: Differentiation of epididymis, vas deferens, and seminal vesicles
Testosterone
Mediated by what hormone?: Increased muscle mass
Testosterone
Mediated by what hormone?: Pubertal growth spurt
Men: Testosterone
Women: Estrogen
Mediated by what hormone?: Epiphyseal closure
Men: Testosterone
Women: Estrogen
Mediated by what hormone?: Growth of penis and seminal vesicles
Testosterone
Mediated by what hormone?: Deepening of voice
Testosterone
Mediated by what hormone?: Spermatogenesis
Testosterone and FSH
Testosterone's effect on anterior pituitary
Negative feedback
Mediated by what hormone?: Libido
Testosterone
Mediated by what hormone?: Differentiation of penis, scrotum, prostate
DHT
Mediated by what hormone?: Male hair pattern
DHT
Mediated by what hormone?: Male pattern baldness
DHT
Mediated by what hormone?: Sebaceous gland activity
DHT
Mediated by what hormone?: Growth of prostate
DHT
First stage of ovarian follicle development: How long does it last?
Primordial --> Primary: 13-50 years
Second stage of ovarian follicle development: How long does it last?
Primary --> Secondary --> Graafian: 70-85 days
Third stage of ovarian follicle development: How long does it last?
Graafian --> Dominant: 48 hours
During which stage do granulosa cells first proliferate in an ovarian follicle?
Primordial follicle
What is the function of granulosa cells in the primordial follicle?
Nurture the oocyte with nutrients and steroids
During which stage do theca interna cells first proliferate in an ovarian follicle?
Primary follicle
What is the composition of antral fluid during the second stage of follicular development?
-steroid hormones
-mucopolysaccharides
-proteins
-FSH
4 components
What is the average diameter of a graafian follicle?
2-5 mm
When does the third stage of follicular development occur?
5-7 days after menses
On what day does ovulation occur?
14 days before menses
When is an oocyte's meiosis 1 completed?
Ovulation
When is an oocyte's meiosis 2 completed?
After fertilization
What is the composition of the corpus luteum?
GRANULOSA CELLS
theca cells
capillaries
fibroblasts
What is the fate of the corpus luteum?
Fertilization: Secretes steroid hormones until placenta does

Otherwise: Regresses during second half of cycle into corpus albicans (scar)
Final possible step in steroid hormone genesis in the zona reticularis of the adrenal cortex.
DHEA --> Androstenedione (using 3beta-hydroxysteroid dehydrogenase)
Final possible step in steroid hormone genesis in the testes.
Androstenedione --> Testosterone (using 17beta-hydroxysteroid dehydrogenase)
Final possible step in steroid hormone genesis in the testes.
Testosterone --> 17beta-estradiol (using aromatase)
Enzyme and precursor for estradiol production
Testosterone --> 17beta-estradiol (using aromatase)
Which cells produce testosterone in women?
Thecal cells
Which cells produce estradiol in women?
Granulosa cells (with aromatase)
What is the name of the first half of the menstrual cycle?
Follicular phase (after the maturation of the follicles)
What is being produced during this half?
What is the name of the second half of the menstrual cycle?
Luteal phase (after corpus luteum)
What is secreting hormones from the ovary?
Which ovarian cells have FSH receptors?
Granulosa cells
Which hormone stimulates estradiol production in women?
FSH
What is the local action of estradiol during the follicular phase?
Supports FSH's trophic effect on the follicle
What changes the effect of estradiol on the anterior pituitary from a negative feedback to positive feedback?
A critical level (> 200 picograms estradiol/ml plasma)
Mediated by which hormone: Maturation/maintenance of uterus
Estrogens
Mediated by which hormone: Maturation/maintenance of fallopian tubes
Estrogens
Mediated by which hormone: Maturation/maintenance of cervix
Estrogens
Mediated by which hormone: Maturation/maintenance of vagina
Estrogens
Mediated by which hormone: Development of female secondary sex characteristics
Estrogens
Mediated by which hormone: Development of breasts
Estrogens and Progesterone
Mediated by which hormone: Proliferation/development of granulosa cells
Estrogens
Mediated by which hormone: Maintenance of pregnancy
Estrogens and Progesterone
Mediated by which hormone: Lowering of uterine threshhold to contractile stimuli
Estrogens
Mediated by which hormone: Stimulation of prolactin secretion
Estrogens
Mediated by which hormone: Blocking the action of prolactin on the breast
Estrogens
Action of estrogen on estrogen receptors
Up-regulation
Action of estrogen on progesterone receptors
Up-regulation
Action of estrogen on LH receptors
Up-regulation
Action of estrogen on FSH/LH secretion
Negative (<200 picograms/mL plasma) AND positive feedback (>200 picograms/mL plasma)
Mediated by which hormone: Maintenance of secretory activity of uterus during luteal phase
Progesterone
Mediated by which hormone: Raising uterine threshold to contractile stimuli during pregnancy
Progesterone
T/F: Progesterone is very active in the body.
False.

Estrogen up-regulates progesterone's receptors so it has an effect.
T/F: Estrogen is very active in the body.
True.

Progesterone down-regulates estrogen's receptors so it has less of an effect
What drives the ovaries to secrete estrogen at puberty?
Pulsatile secretion of FSH and LH
Progesterone: General effect on female reproductive tissues
Increases secretory activity
Estrogen's effect on: uterus
-Cell proliferation
-Cell growth
-Increased contractility
Estrogen's effect on: Fallopian tubes
-Stimulates ciliary activity
-Increased contractility
(moves sperm towards uterus)
Estrogen's effect on: Vagina
-Proliferation of epithelial cells
Progesterone's effect on: Uterus
-Increased secretory activity
-Decreased contractility
Progesterone's effect on: Fallopian tubes
-Increased secretory activity
-Decreased contractility
Progesterone's effect on: Vagina
-Increased differentiation of epithelial cells
-Decreased proliferation of epithelial cells
What is ferning?
Copious, watery, elastic cervical mucus created by estrogen in follicular phase

Made so that channels form for sperm to move through.
Follicular and Luteal phase's effect on: Uterine glands
Follicular: Grow (due to estrogen)

Luteal: Become tortuous, accumulating glycogen in vacuoles and increasing mucus secretions (progesterone)
Follicular and Luteal phase's effect on: Uterine stroma
Follicular: Grows (estrogen)

Luteal: Becomes edematous (progesterone)
Follicular and Luteal phase's effect on: spiral arteries of endometrium
Follicular: Elongation (estrogen)

Luteal: More elongation and coiling (progesterone)
Follicular and Luteal phase's effect on: Cervical mucus
Follicular: Ferns (estrogen)

Luteal: Does not fern (progesterone)
Estrogen's effect on pregnancy
Myometrium: Growth
Breast ducts: Growth
Prolactin secretion: Increased
External genitalia: Enlarged
Progesterone's effect on pregnancy
Endometrium: Maintenance
Uterine contractility: Decreased
Mediated by which hormone: Deposition of subcutaneous fat
Estrogen
Mediated by which hormone: Increase in basal body temperature during luteal phase of menstrual cycle
Progesterone
The _____ phase of the menstrual cycle is constant.
Luteal
Day 0 marks ____ in the menstrual cycle
Menses, ending the previous cycle.
What event in pregnancy happens this many days after ovulation: 1
Fertilization
What event in pregnancy happens this many days after ovulation: 4
Entrance of blastocyst into uterine cavity
What event in pregnancy happens this many days after ovulation: 5
Implantation
What event in pregnancy happens this many days after ovulation: 6
Formation of trophoblast and attachment to endometrium
What event in pregnancy happens this many days after ovulation: 8
Onset of trophoblast secretion of hCG
What event in pregnancy happens this many days after ovulation: 10
hCG rescue of corpus luteum
How many days after ovulation: Fertilization
1
How many days after ovulation: Entrance of blastocyst into uterine cavity
4
How many days after ovulation: Implantation
5
How many days after ovulation: Formation of trophoblast and attachment to endometrium
6
How many days after ovulation: Onset of trophoblast secretion of hCG
8
How many days after ovulation: hCG rescue of corpus luteum
10
Where does fertilization happen?
Ampulla of oviduct (fallopian tube)
How many cells are in the blastocyst?
100
Blastocyst composition (inner and outer)
Inner: Cells --> fetus
Outer: Trophoblast --> Fetal portion of placenta
The endometrium differentiates into ______ on implantation.
Decidual cells
Trophoblastic cells proliferate to form the ________
Syncytiotrophoblast
When is the syncyctiotrophoblast formed?
Day 5: Implantation
When is hCG first detectable in the urine?
9 days after ovulation
Choose:

Pregnancy is counted from date of last (menstrual period/ovulation)?
Menstrual period
How long is a trimester of pregnancy?
13 weeks
Major form of estrogen when not pregnant
17β-estradiol
Major form of estrogen when pregnant
Estriol
When do Braxton-Hicks contractions occur?
1 month before parturition
What are uncoordinated contractions in a pregnant woman called?
Braxton-Hicks contractions
Production of what local progesterones in the reproductive tract is stimulated by estrogen and inhibited by progesterone?
PGE₂ and PGF₂-α
Production of PGE₂ and PGF₂-α is stimulated by what hormone?
Estrogen
Production of PGE₂ and PGF₂-α is inhibited by what hormone?
Progesterone
Effect of PGE₂ and PGF₂-α on the uterus
Increase intracellular calcium concentration of uterine smooth muscle --> Increased contractility
Effect of oxytocin on the uterus
Powerful stimulant of contractions
How many stages of labor are there?
3
First stage of labor
Contractions moving from fundus towards head:
1. move baby out.
2. wide and thin the cervix.
Second stage of labor
Fetus forced through cervix and delivered through vagina
Third stage of labor
1. Placenta separates from uterine decidual tissue and is delivered
2. Contractions constrict uterine blood vessels limiting bleeding.
What hormone profile is necessary for lactation?
1. High prolactin levels
2. Low estrogen/progesterone levels
How does lactation suppress ovulation?
Ongoing lactation --> Maintained prolactin --> Inhibits GnRH/FSH/LH
placeholder
please remove me
Tx: Gonorrhea
cephalosporin/ciprofloxacin
Dx: Chlamydia
-by culture/pcr
-"the groove sign"
Tx: Chlamydia
doxycycline/azithromycin
Dx: Gonorrhea
gram - diplococci in PMNs from male discharge/female cultures on Thayer-Martin media.
Dx: Syphilis
rpr/vdrl: sensitive but not specific. disappear in convalescence
fta-abs: specific but not sensitive. positive forever
Tx: Syphilis
Penicillin G with antihistamines and NSAID pretreatment
Bug: Chancroid
Hemophilus ducreyi
Dx: Chanchroid
by culture or Gram - pus stain
Tx: Chanchroid
azithromycin/cephalosporin/ciprofloxacin
Bug: Granuloma inguinale
Calymmatobacterium granulomatis
Dx: Granuloma inguinale
Gram - Donovan bodies
Tx: Granuloma inguinale
tetracycline
Dx: Genital herpes
Tzanck smear (Giemsa stain) showing multinucleated giant cells at base of vesicle
Tx: Genital herpes
acyclovir