Exam 3 - reproductive system

Question 1

Female:

Sex hormones are synthesized where?

Answer 1

ovary

Question 2

What are the phases of the menstrual cycle?

Answer 2

• proliferative/follicular phase
• ovulation
• secretory/luteal phase

Question 3

Brief hormone stuff about menstrual cycle.

Answer 3

Estrogen starts it all. Causes LH to spike. this spike causes ovulation.

Question 4

Proliferative phase (menstrual cycle)

Answer 4

• aka follicular
• 1-14 days
• proliferation of glands
• mediated by estrogen. spike causes LH to peak and FSH (When LH goes up, so does FSH)

Question 5

Ovulation

Answer 5

• at day 14-16
• mature follicle in the ovary releases an egg
• signs: inc temp, subnuclear vacuoles in endometrial cells, mittelschmerz “pelvic pain”

Question 6

Luteal Phase

Answer 6

• at day 14/16-28 (depends on ovulation)
• mediated by PROGESTERONE
• histology: inc gland tortuosity and secretion, edema of stromal cells
• fertility work-ups: at day 21

Question 7

Menses

Answer 7

• serum estrogen and progesterone drop

- causes endometrial cell apoptosis

Question 8

What is FSH’s function in the menstrual cycle?

Answer 8

• prepares follicle of the month - inc follicle size
• inc aromatase synthesis
• inc synthesis of LH receptors

Question 9

What is LH’s function in the menstrual cycle?

Answer 9

• testosterone synthesis: aromatase converts it to estradiol in granulosa cells
• LH surge: due to estrogen. causes ovulation when LH>FSH. moves follicle from meiosis I prophase to meiosis II metaphase

-progesterone synthesis (for secretory phase)

Question 10

Pregnancy hormone changes: hCG

Answer 10

• hCG: human chorionic gonadotropin
• made in placenta
• analogue of LH (maintains corpus luteum)

Question 11

Pregnancy hormone changes: progesterone

Answer 11

• until 10 weeks = made in corpus luteum
• after 10 weeks = made by placenta

-if progesterone drops: possible spontaneous abortion

Question 12

How does OCPs work?

Answer 12

• usually mix of estrogen and progestins
• baseline estrogen prevents estrogen surge (prevents LH surge, prevents ovulation)
• progestins stop proliferative phase (gland atrophy, inhibit LH which prevents LH surge)

Question 13

Menopause: definition and onset

Answer 13

Def: no menses for 1 year after age 40 (avg age =51)

onset: genetically determined. Earlier with smokers

Question 14

Menopause physiology

Answer 14

• decrease in ovarian function.
• decreased estrogen levels overall

*she said this was all we need to know. slide 16)

Question 15

What is the treatment for menopause? and why is it controversial?

Answer 15

• treatment = estrogen replacement. Helps inc overall levels

controversial: long-term severe risks of CAD, stroke, clots, etc. Should only do for a year or 2 at a time

Question 16

Menorrhagia (Menstrual dysfunction)

Answer 16

> 80 ml blood loss

excessive clots

Question 17

Dysmenorrhea (Menstrual dysfunction)

Answer 17

• painful menses

- primary type (inc prostaglandins or uterine contractions)

Question 18

Dysfunctional uterine bleeding

Answer 18

• abnormal. no anatomical cause
• typically hormone imbalances
• most are postmenarchal or perimenopausal
• 90% anovulatory (no egg release)

Question 19

Anovulatory DUB (dysfunctional uterine bleeding) causes

Answer 19

• excessive estrogen relative to progesterone (absent secretory phase)
• inadequate luteal phase (inadequate progesterone)
• irregular shedding of endometrium (persistent luteal phase)

Question 20

menorrhagia DUB

Answer 20

• most common
• regular normal intervals
• excessive flow and duration

Question 21

hypomenorrhea DUB

Answer 21

• regular normal intervals

- decreased bleeding

Question 22

metrorrhagia DUB

Answer 22

(metro = “time”)

• irregular intervals
• excessive flow and duration

Question 23

menometrorrhagia DUB

Answer 23

-irregular or excessive bleeding during menstruation and btwn periods

Question 24

oligomenorrhea DUB

Answer 24

-menses at intervals > 35 days

Question 25

polymenorrhea DUB

Answer 25

-menses at intervals <21 days

Question 26

What is primary amenorrhea?

Answer 26

- absence of menses by 16 y/o | - constitutional (growth) delay = most common cause

Question 27

What is secondary amenorrhea?

Answer 27

- no menses for >6 months in pt who has had normal menses | - MCC = pregnancy

Question 28

Amenorrhea: Pathology

Answer 28

- hypothalamic or pituitary disorder (dec LH and FSH synthesis => Dec estrogen and progesterone) - ovarian disorder (dec estrogen and progesterone synthesis. FSH and LH inc) - end-organ disorder (blood flow obstruction (normal FSH, LH, progesterone, estrogen)

Question 29

Polycystic ovary syndrome: disease associations and clinical findings

Answer 29

- obesity - insulin resistance - acanthosis nigricans (skin stuff, skin folds) Clin find: oligomenorrhea, hirsutism(hair)- due to inc testosterone, infertility, obesity, DM etc

Question 30

Polycystic ovary syndrome: pathology

Answer 30

*** increased LH secretion by anterior pituitary (**LH/FSH > 3) *** dec pituitary FSH secretion

Question 31

FSH and LH as male sex hormones

Answer 31

- FSH = stim spermatogenesis (seminiferous tubules) | - LH = stim testosterone (leydig cells)

Question 32

Male hormones: testosterone

Answer 32

- sex characteristics - enhances spermatogenesis - inc libido

Question 33

Male hormones: sex hormone binding globulin

Answer 33

- binds testosterone and estrogen (greater affinity for testosterone) - made in liver

Question 34

Hypogonadism: pathogenesis

Answer 34

- dec testosterone production - resist to testosterone -primary or secondary

Question 35

Primary hypogonadism (what causes, hormone effects)

Answer 35

-Testicular dysfunction (leydig cell, seminiferous tubule) - dec testosterone secretion -( dec T, inc LH)

Question 36

secondary hypogonadism (what causes. hormone effects)

Answer 36

- pituitary (tumor) or hypothalamic (Kallmann's syndrome) dysfunction - (dec T, dec or normal LH)

Question 37

Infertility causes

Answer 37

- decreased sperm count (leydig, seminiferous tubule, pituitary, or hypothalamus dysfunction) - end-organ dysfunction (obstruction, dysfunction of accessory organs/ejaculation)

Question 38

Infertility labs: seminiferous tubule dysfunction

Answer 38

- testosterone = normal | - FSH = inc

Question 39

Infertility labs: Leydig cell dysfunction

Answer 39

- testosterone = dec | - LH = inc

Question 40

Infertility labs: pituitary dysfunction

Answer 40

-HYPOPITUITARYISM - testosterone = dec - LH = dec - FSH = dec

Question 41

Infertility labs: end-organ dysfunction

Answer 41

- normal hormone levels | - variable sperm count

Question 42

What do you look for with a sperm analysis?

Answer 42

- volume - count - morphology - motility serum hormone levels

Question 43

What are the 3 causes of ED?

Answer 43

- psychogenic (nocturnal penile tumescence test) - dec testosterone - vascular insufficiency (atherosclerosis, leriche syndrome - butt and genital area)

Question 44

In what zones does benign prostatic hyperplasia occur?

Answer 44

-***transitional and periurethral zones

Question 45

benign prostatic hyperplasia: pathology

Answer 45

- inc sensitivity of prostate to DHT (dihydrotestosterone) - DHT causes hyperplasia - get nodules due to hyperplasia of glandular and stromal cells. (yellow-pink, soft)

Question 46

Prostate cancer

Answer 46

- most common cancer in adult males - 90% of 90y/o have it - asymptomatic until advanced -DHT -dependent and ***development in peripheral zone

Question 47

pt has LBP, pelvic pain, obstructive uropathy, and possible spinal cord compression. what does he have?

Answer 47

Prostate cancer

Question 48

Prostate cancer Treatment: early vs late

Answer 48

Early: surgery, radiation, radioactive seeds Late: hormones, chemo, radiation. -if you are old just watch.