3-1-16-Menarche, Puberty, And Menstrual Disorders (Moulton)

Question 1

Decreasing levels of estradiol and progesterone from the regressing corpus luteum of the preceding cycle initiate an increase in ___ by a negative feedback mechanism, which stimulates follicular growth and estradiol secretion

Answer 1

FSH

Question 2

___ stimulates the theca cells to produce androgens (Promotes cholesterol —-> androstenedione/testosterone)

___ stimulates the granulosa cells to convert androgens into estrogens (promotes androstenedione/testosterone —-> estrone (E1) and Estradiol (E2))

Answer 2

LH

FSH

Question 3

During the ovarian cycle, ___ undergo sequential development, differentiation, and maturation until a mature graafian follicle is produced. The follicle then ruptures and releases an ovum

Answer 3

Primordial follicles

Question 4

At about 8-10 weeks of fetal development, oocytes become surrounded by precursor granulosa cells. This oocyte-granulosa cell complex is called a ___

Answer 4

Primordial follicle

Question 5

In the adult ovary, a graafian follicle forms. The innermost 3-4 layers of multiplying granulosa cells become cuboidal and adherent to the ovum and this is known as the ___

Answer 5

Cumulus oophorus

Question 6

If pregnancy does not occur, menses ensues and the corpus luteum is gradually replaced by an avascular scar called ___

Answer 6

Corpus albicans

Question 7

The endometrium is divided into these 2 zones:

Answer 7

Functionalis (outer layer) –> undergoes cyclic changes in morphology during the menstrual cycle and is sloughed off at menstruation. Contains spiral arteries

Basalis (inner layer) –> remains relatively unchanged during each cycle and after menstruation provides stem cells for the renewal of the functionalis. Contains Basal arteries

Question 8

The cyclic changes in histophysiology of the endometrium can be divided into these 3 stages:

Answer 8

1) Menstrual phase
2) Proliferative or estrogenic phase
3) Secretory or progestational phase

Question 9

___ phase is the only portion of the cycle that is visualized externally

Answer 9

Menstrual

Question 10

___ phase is characterized by endometrial growth secondary to estrogenic stimulation. Increase in the length of the spiral arteries and numerous mitoses can be seen in these tissues

Answer 10

Proliferative

Question 11

This phase follows ovulation, progesterone secretion by the corpus luteum stimulates the glandular cells to secrete mucus, glycogen and other substances. Glands become tortuous and lumens are dilated and filled with these substances. Stroma becomes edematous, mitosis is rare, spiral arteries continue to extend into superficial layer of the endometrium and become convoluted. Endometrial lining reaches its max thickness

Answer 11

Secretory phase

Question 12

The initial reproductive health visit should occur between the ages of ___ years

Answer 12

13-15

Question 13

The ACOG recommends a first Pap test at the age of __ years

Answer 13

21

Question 14

___ is defined as absence of menarche by age 13 years without secondary sexual development OR by the age of 15 with secondary sexual development

Answer 14

Primary amenorrhea

Question 15

___ is defined as the absence of menstruation x 6 months. It is rare for girls and adolesecents to remain amenorrheic for more than 3 months

Answer 15

Secondary amenorrhea–> if > 90 days, further workup is indicated–> check urine or serum beta-hCG to rule out pregnancy

Question 16

List 4 causes of menstrual irregularity:

Answer 16

Pregnancy
Endocrine causes
Acquired conditions
Tumors

Question 17

Mean blood loss per menstrual period is 30cc. Blood loss greater than 80cc has been associated with ___

Answer 17

Anemia

Question 18

___: abnormally frequent menses at intervals less than 21 days

Answer 18

Polymenorrhea

Question 19

___: excessive and/or prolonged menses (>80 mL and > 7days) occurring at regular intervals

Answer 19

Menorrhagia (hypermenorrhea)

Question 20

___: irregular episodes of uterine bleeding

Answer 20

Metrorrhagia

Question 21

___: heavy and irregular uterine bleeding

Answer 21

Menometrorrhagia

Question 22

___: scant bleeding at ovulation for 1-2 days

Answer 22

Intermenstrual bleeding

Question 23

___: menstrual cycles at > 35 day cycles

Answer 23

Oligomenorrhea

Question 24

___ is defined as abnormal uterine bleeding that cannot be attributed to medications, systemic disease, trauma, or organic conditions. It is usually caused by aberrations in the H-P-O axis resulting in anovulation

Answer 24

Dysfunctional Uterine Bleeding (DUB)

Question 25

Define the PALM-COEIN classification system for abnormal bleeding in reproductive-aged women:

Answer 25

PALM: Structural causes
P-Polyp (AUB-P)
A-Adenomyosis (AUB-A)
L-Leiomyoma (AUB-L)
M-Malignancy and hyperplasia (AUB-M)

COEIN: Nonstructural causes
C-Coagulopathy (AUB-C)
O-Ovulatory dysfunction (AUB-O)
E-Endometrial (AUB-E)
I-Iatrogenic (AUB-I)
N-Not yet classified (AUB-N)

Question 26

In general, adrenal ___ production and differentiation by the zona reticularis of the adrenal cortex are the initial endocrine changes associated with puberty

Answer 26

Androgen

Question 27

A rise in ___ causes growth of axillary and pubic hair

Answer 27

Adrenal androgens

Question 28

___ is AKA as breast development and is the 1st physical sign of puberty and requires estrogen

Answer 28

Thelarche

Question 29

___ is pubic hair/axillary hair development and requires androgens

Answer 29

Pubarche/adrenarche

Question 30

___ is the onset of menses and requires pulsatile GnRH from the hypothalamus, FSH and LH from the pituitary, estrogen and progesterone from the ovaries, normal outflow tract

Answer 30

Menarche

Question 31

This Tanner stage of breast development is pre-adolescent; elevation of papilla only

Answer 31

Stage 1

Question 32

This Tanner stage of breast development is the breast budding stage; elevation of breast and papilla as a small mound with enlargement of the areolar region

Answer 32

Stage 2

Question 33

This Tanner stage of breast development is further enlargement of the breast and areola without separation of their contours

Answer 33

Stage 3

Question 34

This Tanner stage of breast development is a projection of areola and papilla to form a secondary mound above the level of the breast

Answer 34

Stage 4

Question 35

This Tanner stage of breast development is the Mature stage; projection of papilla only, resulting from recession of the areola to the general contour of the breast

Answer 35

Stage 5

Question 36

This Tanner stage is Pre-adolescent; absence of pubic hair

Answer 36

Stage 1

Question 37

This Tanner stage is sparse hair along the labia; hair downy with slight pigment

Answer 37

Stage 2

Question 38

This Tanner stage is hair spreading sparsely over the junction of the pubes; hair is darker and coarser

Answer 38

Stage 3

Question 39

This tanner stage is adult-type hair; there is no spread to the medial surface of the thighs

Answer 39

Stage 4

Question 40

This Tanner stage is adult-type hair with spread to the medial thighs assuming an inverted triangle pattern

Answer 40

Stage 5

Question 41

The normal ovulatory cycle can be divided into these phases:

Answer 41

Follicular–> begins with onset of menstruation and culminates in the preovulatory surge of LH

Luteal–> begins with onset of preovulatory LH surge and ends with the 1st day of menses