Final-New Material-Rachael Flashcards

Question

Sexually Indifferent Stage

Answer 1

* During embryonic development * Adjacent to each primitive gonad * Wolffian (mesonephric) ducts are more medial * Müllerian (paramesonephric) ducts are more lateral, but then fuse in the midline more caudally

Answer 2

* Sexual determination: depends upon the sex chromosomes, X and Y * SRY gene on Y chromosome * activates a gene network that directs the gonads to develop as testes * No SRY, goes to ovaries * Testes generate regulatory molecules * MIS=Mullerian Inhibiting Substance * peptide hormone

Answer 3

* Female in absence of SRY gene

Answer 4

* produced in the ovary (after it differentiates) by granulosa cells * expressed mainly by small growing follicles * level of MIS is thus a good indicator of the size of the ovarian reserve * Used in IVF to predict how the woman will respond to controlled ovarian stimulation

Answer 5

* Mutation in androgen receptor * "complete androgen insensitivity" * Testes develop * Externally as a female * development of the male external genitalia depends upon androgen * Breasts develop because testosterone converted to estrogen * Recognized via amenorrhea * Uterus never developed because MIS caused regression * No armpit or pubic hair because these depend on androgen signaling

Answer 6

* Removal of abdominal testes * gonadectomy * Increased risk for testicular cancer * Cryptorchidism (failure of testes to descend) * Low androgen levels * Wait until early adulthood and then gonadectomy so that naturally goes through puberty * After gonadectomy, kept on hormone therapy

Answer 7

* Penis and prostate development depends upon dihydrotestosterone (DHT) * Mutation in 5-alpha-reductase type 2 * Born externally female * Hypospadias * Urethra not in phallus but in the perineum * At pubery the large levles of testosterone stimulate the development of male structures * Male secondary structures develop * Initially raised as girls and then develop male gender identity *

Answer 8

* Occurs in absence of SRY gene * But doesn't occur by default * Several genes (RSPO1, WNT4, FOXL2) have been shown to be necessary to initiate ovarian development * actively repress gene network for testes development

Answer 9

* Prior to birth, oogonia stop proliferating * At birth, germ cells in ovaries are primary oocytes * Initiated meiosis but are then in meiotic arrest * Oocyte+support cells=follicle * Not developing=primordial follicles * oocyte in meiotic arrest surrounded by a single layer of follicle cells * Once starts to develop: * Oocyte enlarges * Follicle cells differentiate to granulosa cells, proliferate * Zona pellucida: glycoproteins * Spindle shaped theca cells * Fluid-filled antrum

Answer 10

* Local signals in ovary cause follicles to develop into early antral stage * Independent of gonadotropins * Before puberty and any time in monthly cycle

Answer 11

* Follicles that have undergone initial development * Further stimulated by rising gonadotropins (FSH) and (LH) * If intial development not later hormonally supported, undergoes **atresia** * 99.9% * Happens all throughout childhood * Fewer ovulations, less ovarian cancer risk * Growing, antral follicles

Answer 12

* Dominant follicle selected by day 7 * Day 7-14 matures * Egg and small cluster of granulosa cells detaches from wall and follicle floats free within antrum * Ovulation on day 14 * **Follicular phase**

Answer 13

* Remaining follicle cells into corpus luteum * Granulosa cells increase, BM broken down, invaded by blood vessels * Corpus luteum secretes progesterone and estrogen * Degenerates day 25 and 28 when LH levels decline * Fertilized embryo will make chorionic gonadotropin, LH analog that allows corpus luteum to persist during first trimester * **Luteal Phase**

Answer 14

* Growth stimulated by Gn * Decreasing estrogen and progesterone from end of cycle release the negative feedback on the anterior pituitary * FSH=granulosa cells * LH=theca cells * Start secreting estrogen * Granulosa: enzyme aromatase (makes beta estradiol) * Theca: androgen precurosor

Answer 15

* Follicle enlarges and increases estrogen secretion * Causes negative feedback inhibition * Gn levels decline (esp. FSH) * Granulosa secrete inhibin to prevent FSH * Selection because negative feedback limits FSH * Granulosa cells develop LH receptors in late follicular phase and start reponding to LH

Answer 16

* Estrogen from follicle cross threshold and estrogen causes postive feedback * Causes rapid rise in LH ("surge") * Causes ovulation * Just prior to ovulation, LH causes a blip of progesterone secretion (needed for ovulation) * First division of meisosis occurs just prior to ovulation

Answer 17

* LH stimulates formation of corpus luteum * Secretes estrogen and progesterone * Negative feedback on Gn * Prevents further follicle development and ovulation * LH levels fall below a threshold and corpus luteum regresses * Release hypothalamus and pituitary from negative feedback inhibition * FSH and LH steadliy increase to start new cycle

Answer 18

* Endometrium into functional layer under estrogen and progesterone control * Basal layer that regenerates functional layer after menustration * Middle and Late Follicular Phase: * High estrogen cause proliferation (**proliferative phase**); cervix secrete thin watery mucus * Inductiov of progesterone receptors * Luteal Phase * Progestrone prevent further proliferation * Blood vessel growth * **Secretory Phase** * Cervix secrete thick mucus * Inhibit contractions * Menustration * Drop in progestrone and estrogen * Vasocontriction causes ischemia * Later vasodialation to causes bleeding and contraction of myometrium

Answer 19

* Menorrhagiae: excessive uterine bleeding * Dysmenorrhea: painful menustration

Answer 20

* "Fibroids" * Benign growths in myometrium * Abnormal entometrial growth over fibroids leads to excessive bleeding * More common in older women, have hystorectomy

Answer 21

* Occurs in PCOS * PCOS: annovulation: no switch to luetal or secretory phase * Lots of estrogen and not a lot of progesterone * Endometrium keeps proliferating * Miss a bunch of periods and then have a really bad period * Increased risk for endometrial cancer * Treated with hormonal contraceptives

Answer 22

* Stimulates milk production in the breast/growth * Estrogen and progesterone prevent lactation * Suckling stimulates mechanoreceptors * Magnocellular Cell: * Release oxytocin from posterior pituitary * Milk ejections from myoepithelial cells * Parvocellular cell that release dopamine at the median eminence * Dopamine travel to the anterior pituitary via hypophyseal portal vessels and inhibit prolactin secretion * Suckling inhibits dopamine release

Answer 23

* Pituitary tumor (prolactinoma) that secretes prolactin * Cause infertility because prolactin inhibits GnRH secretion * Low GnRH, low FSH and LH * Hypogonadotropic hypogonadism * anovulation * amenorrhea and galactorrhea * osteoprosis * Dopamine antagonists can cause hyperprolactima * Gonadal hormone treatment * First line treatment is dopamine agonist * bromocriptine and cabergoline

Answer 24

* Most common cause of anovulatory infertility * Chronic ovulation problems with hyperandrogenism * Amenorrhea or oligomenorrhea * Hirsutism, acne, hair loss on scalp * Ovaries enlarged with multiple immature follicels * Hyperplasia of theca cells * Fewer granulosa cells * No domininant follicle chosen and on LH surge * Often insulin resistant: hyperinsulinemia , greater T2DM risk * Ultrasound show "necklace of black pearls"

Answer 25

* Normal follicle development when estrogen and progesterone levels drop due to degeneration of corpus luteum * Granulosa respond to FSH and Theca to LH * In PCOS, LH secretion is elevated (FSH the same or decreased) * Theca cells and androgens produced but there is not enough FSH to stimulate granulosa cells * Failure of follicle development to progress * Androgen converted to estrogens in adipose tissue * Abnormal feedback regulation * LH continues to be high compared to FSH * Hyperinsulinemia contributes because insulin stimulates androgen production

Answer 26

* Decrease hyperandrogenism and negative effects on uterus * Estrogen and progestrone restore normal LH levels * PCOS causes there to be unopposed estrogen because never progress to luteal phase that has progesterone * Continued proliferation leading to menorrhagia * Increases risk for endometrial cancer

Answer 27

* SERM * In hypothalmus and anterior pituirtary, acts as estrogen antagonist * prevents negative feedback effect of estrogen, allows FSH secretion to increase so that follicle development can be stimulated * Taken at a certain time in cycle to snap out of bad habits * Potential for mulitple ovulations * Alters uterine environment making it harder to concieve * Usually 1st line in those wanting to concieve

Answer 28

* Letrozole and anastrozole efficicay in ovulation induction * Prevent androgens from converting to estrogens * Limit estrogen negative feedback on GnRH * Shorter half-life allowing normal estrogen secretion later in cycle * Less risk for multiple ovulations * More estrogen stimulation of endometrial development during proliferative phase

Answer 29

* Metformin * Safe and effective in lowering androgen levels

Answer 30

* Exogenous FSH * Menotropin * mixture of gonadotropins from menopausal urine * Urofollitropin * purified FSH from urine * Follitropin * Recombinant FSH * FSH may lead to multiple ovulations * Ovarian hyperstimulation syndrome, increased vascular permeability (edema, nausea, abdominal pain) * Severe: clotting abnormalities, renal failure, respiratory distress

Answer 31

* Induce damage to ovarian tissue * Breaks the cycle of androgen production and abnormal negative feedback * No risks of hyperstimulation or multiple pregnancy

Answer 32

* Hormonal Contraceptives * Weight Loss * Metformin

Answer 33

* Clomiphene * Weight Loss * Aromatase Inhibitors * Metformin * FSH * Surgery

Answer 34

* Implantation of fertilized embryo * Measure by increase in chorionic gonadotropin * Measure ovulation by LH surge

Answer 35

* Suppress the secretion of gonadotropins (FSH and LH) thorugh negative feedback inhibition * Inhibit during luteal phase * Suppress ovulation * Prevent rise in FSH needed for initiation of follicle development and selection of dominant follicle * Prevents LH surge needed to trigger ovulation * In follicular phase, estrogen makes thin water mucus that sperm can traverse * In luteal phase, progesterone makes thick mucus. Progesterone in HC does this * Reduce endometrial growth and interfere with implantation * Side effect: mid-cycle bleeding from abnormal endometrial proliferation

Answer 36

* Estrogen and progestin * Placebo causes withdrawl bleed * Sign not prego, but not essential * Continuous for women who suffer menorrhagiae or dysmenorrhea

Answer 37

* Low Dose Pills * Not as reliable at preventing ovulation but work by thickening cervical mucus * Must be taken at the same time everyday * Good for lactating mothers * Long-Acting Methods * Depo-Provera * Injected every 3 months * Inhibition of estrogen may cause loss in bone density

Answer 38

* Block or delay ovulation since sperm can be in reproductive tract for days * Plan B (levonorgesterol in higher dose) * Negative feedback inhibitior of GnRH * Only works if taken **before** LH surge * Use within 12 hrs, but can be effective for 5 days * Ella (ulipristal acetate) * selective progesterone receptor modulator * Blocks progesterone action in follicle * Small increase in progesterone caused by LH surge * Delay ovulation even if begining of LH surge has already occured * Not effective if taken after the peak of LH surge * May affect endometrium, but very low doses so maybe not

Answer 39

* Cardiovascular Risk * Rare in young women and pregnancy increases these risks even greater * Promote thrombosis (VTE); pulmonary embolism, MI or stroke * Clotting due to estrogen * Newer progestin (drospirenone, desogestrel) have higher risk than older (levonorgestrel) * Breast Cancer * Tumors stimulated by estrogen * Estrogen and Progesteronen promote breast growth * No increase in breast cancer (but study done in older women) *

Answer 40

* Menstural Symptoms: * Menorrhagia, dysmenorrhea, PCOS * Endometrial Cancer: * Decreased endometrial proliferation * Lowest risk in those of HC for longest * Ovarian Cancer: * Lowest risk in those on HC for longest * Androgen Secretion * Treat hyperandrogenism because decrease gonadotropin androgen secretion * Reduce severity of acne

Answer 41

* Progesterone antagonist * Terminate pregnancy in first 7 weeks * Need progesterone to keep gestation * Progesterone maintains endometrium and quiet myometrium * Mifepristone and then prostaglandins * prostaglandins induce myometrial contractions * Mifepristone induces shedding of endometrium * Ella progesterone antagonist is used at a much lower dose

Answer 42

* Sperm matures as goes through female reproductive tract * Acrosome: large vesicle in head of sperm; contains digestive enzymes * Sperm bind to zona pellucida; acrosome reaction is undergone * Release of digest enzyme; allows sperm to burrow through zona pellucida * Many sperm undergo acrosome reaction, but only one “wins” * Once sperm membrane fuses with egg membrane; triggers a reaction in the ovum (cortical reaction)

Answer 43

* Exocytosis of vesicles * Change the zona pellucida; zona hardening * Other sperms that are bound fall off and prevents other sperms from fertilizing the egg * Zona pellucida stay with the fertilized egg (conceptus) * Give rise to embryo and extra embryonic tissue * Sperm-egg fusion stimulated the second division of meiosis * Male and Female pronucleus fuse and then divide to make zygote (other female nucleus is the polar body)

Answer 44

* First cell divisions through fallopian tube occur without any growth; cleavage * 70-100 cells * Zona pellucida prevents it from implanting where it shouldn’t * Blastocyst

Answer 45

* Once reaches the uterus, there is zona hatching * Two kinds of cell in blastocyst * Trophoblast: Outer layer that forms extra embryonic tissue (chorion) * Inner Cell Mass: Cell concentrated on one side; forms embryo

Answer 46

* Trophoblast is sticky and adheres to endometrium * Promotes proliferation * Divides into two groups * Syncytial trophoblast: cell membrane break down, so many nuclei in one membrane * Invasive into endometrium * Proteolytic enzymes * Makes chorionic gonadotropin * Makes lacuna * Cellular trophoblast: normal cells * Forms chorionic villi

Answer 47

* Occurs 6 to 7 days after fertilization * syncytial trophoblast * invasisive and proteolytic enzymes * embyro nourished by digestion of endometrium * Digestion of endometrial tissue creates lacunae * produce chorionic gonadotropin * Pregnancy test * LH analog, maintains corpus luteum * Cellular trophobasts create branched structures, known as chorionic villi * developing embryo forms a disc that pulls away from the proliferating trophoblast to create a new space * amniotic cavity

Answer 48

* from the trophoblast and the endometrium * during pregnancy the endometrium is known as the **decidua** * Placenta 5 wks after implantation * fetal part of the placenta, or chorion, is made up of the chorionic villi * branched * blood vessels just under trophoblast layer * villi protrude into large spaces (lacunae) in the decidua * maternal blood into lacunae to wash over villi * exchange of nutrients, wastes, and blood gases * Source of estrogen and progesterone after 8 weeks of pregnancy

Answer 49

* Development of the amnion * Fluid filled * Chorion develops on one side and then fuses with the amnion * Chorion will be on one side of the uterus

Answer 50

* Gonadosteroid make the uterus prime for immplantation * Estrogen in follicular phase proliferates endometrium * Progesterone in luteal phase stimulates secretion and promotes blood vessel growth * Estrogen and Progesterone by corpus luteum * Early in pregnangy CL stimualted by HCG * By 4 weeks there are detectable levels of HCG

Answer 51

* Progesterone: smooth muscle relaxation in the myometrium, developmental changes in endometrium for decidua formation * Progesterone supplementation in women who have a history of preterm labor

Answer 52

* Progesterone stimulates growth of milk-producing cells in the glands * Estrogen stimulates growth of duct cells * Estrogen stimulated prolactin

Answer 53

* Delivery of infant and placenta * Estrogen stimulates proliferation in the myometrium * synthesis of gap junctions between myometrial smooth muscle cells * Coordinated contraction * synthesis of enzymes involved in prostaglandin synthesis * Prostaglandin cervical ripening * Soft, flexible and dialated * Prostaglandins stimualte myometrial contractions * oxytocin is the strongest stimulator of uterine contractions * estrogen increases responsiveness to oxytocin by increasing expression of oxytocin receptors

Answer 54

* Head pushes head against the cervix * Stretch receptors in the cervix * Feed onto the hypothalamus * Activate neurosecretory cells to release more oxytocin * Positive feeback stimulation to make sure that the baby is born “all the way”

Answer 55

* Milk is produced by secretory structures known as alveoli * Alveoli are arranged in clusters called lobules * The lobules are connected to outlets at the nipple by ducts * The alveoli are surrounded by special contractile cells known as myoepithelial cells.

Answer 56

* Problems with sexual differentiation of XX infants * when excess androgens are produced during development * can be due to an adrenal tumor in the mother * most often in the disorder known as congenital adrenal hyperplasia * defects in the enzymatic pathways that produce cortisol * Low cortisol cannot exert negative feedback regulation on the secretion of the pituitary hormone ACTH, which stimulates hormone production by the adrenal gland * adrenal glands produce large amounts of androgens, which have the effect of masculinizing XX females * precocious sexual development in males

Answer 57

* Failure of both testes to descend into the scrotum by birth * Surgical correction of cryptorchidism is done ideally before 2 years of age and is known as orchiopexy * Cryptorchidism increases risk for testicular cancer and orchiopexy reduces this risk

Answer 58

* most common malignancy in young men * vast majority of testicular cancers (95%) are germ cell tumors * these tumors arise when there is disrupted growth and development of germ cell precursors * the cure rate approaches 80% * removal of the tumor, followed by radiation, or chemotherapy * chemotherapy drug **cisplatin** has proved to be very effective in the treatment of testicular cancer

Answer 59

* non-cancerous growth of the prostate gland * pelvic pain and difficulty in urination * prostate is more responsive to DHT, one therapeutic approach uses 5-a-reductase inhibitors, such as dutasteride and finasteride * Another medical approach is to use a–blockers (an example is tamsulosin), which relax smooth muscle in the prostate and urethra to ease urinary symptoms * Surgical resection of the enlarged prostate can also be done using an instrument inserted in the urethra.

Answer 60

* most frequently diagnosed cancer among men in the United States * Detection of prostate tumors was traditionally done by digital rectal examination * Prostate-specific antigen (PSA) is a protein produced by the prostate, and its levels rise in the blood when the prostate enlarges, as it would if a tumor was present * high rates of false positives and false negatives * Treat with hormonal therapy * Radiation * prostatectomy

Answer 61

* mammography also causes overdiagnosis, that is, the identification of tumors that may not be otherwise clinically significant in a woman’s lifetime * non-invasive (confined to breast ducts or lobules) or invasive (spread to surrounding connective tissue) * Another term for non-invasive breast cancer is carcinoma in situ * To determine whether breast cancer has metastasized, the axillary lymph nodes (lymph nodes of the armpit) are dissected and examined. * over-expresses hormone receptors (either for estrogen or progesterone) or the growth factor receptor HER2 * treat it with drugs that interfere with estrogen, such as tamoxifen (which is a selective estrogen receptor modulator; SERM) or letrozole (an aromatase inhibitor that prevents estrogen synthesis). Tumors that are positive for HER2 are treated with trastuzumab (tradename: Herceptin), an antibody-based drug that binds to the receptor and prevents cell growth.

Answer 62

* mastectomy (removal of the breast) or lumpectomy, in which the tumor and surrounding tissue are removed * lumpectomy after radiation * Adjuvant therapy refers to any of the various systemic therapies: chemotherapy, hormone therapy, or trastuzumab.

Answer 63

* hormone replacement therapy increased the risk of heart disease and breast cancer

Answer 64

* acute infection of the upper reproductive tract in women, namely endometritis * salpingitis (infection of the fallopian tubes) * oophoritis (infection of the ovaries) * Usually by the clap * pelvic pain, tenderness upon palpation, and (sometimes, but not always) vaginal discharge * Can lead to infertility and tubal dysfunction * Treat with antibiotics

Answer 65

* endometrial tissue is found in ectopic locations, usually in the pelvic cavity * pelvic pain, tissue damage, and lowered fertility * retrograde menstruation (i.e. menstruation through the fallopian tube instead of the cervix) allows ectopic endometrial tissue to implant in the pelvic cavity * persist there due to an insufficient immune response * treated surgically, or with drugs that decrease estrogen levels such as oral contraceptives or the GnRH agonist leuprolide

Answer 66

* painful menstruation * High prostaglandin levels * sensitize pain fibers in the uterus * treated effectively with NSAIDs (non-steroidal anti-inflammatory drugs) * oral contraceptives * Progesterone opposes prostaglandin function * less endometrium overal lowers prostaglandin secretion as well

Answer 67

* end of ovarian follicle production, there is also a marked drop in production of estrogen * decrease in the size of the breasts and uterus * bone density and cardiovascular system * lack of estrogen leading to hot flash * HRT for vaginal dryness and hot flash and osteoporosis * Treatment of estrogen loss: * selective estrogen receptor modulators (SERMs), such as raloxifen * act as estrogen antagonists in some tissues, while acting as estrogen agonists in other tissues * Raloxifene may now also be prescribed to prevent breast cancer in post-menopausal women at high risk for invasive breast cancer.

Final-New Material-Rachael Flashcards

(95 cards)