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Pathophysiology > L23: Reproductive Pathologies > Flashcards

L23: Reproductive Pathologies Flashcards

1
Q

___ amenorrhea: No history of menstruation

____ amenorrhea: Cessation of menses after a variable time

A

Primary
Secondary

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2
Q

Differentials for primary amenorrhea?

A
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3
Q

Testing to evaluate primary amenorrhea?

A
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4
Q

How to evaluate 1 amenorrhea w/o a uterus?

A
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5
Q

How to evaluate 1 amenorrhea w/a uterus?

A

Measure FSH
1) Is it high?
2) Is it low or normal?

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6
Q

True or False: There is an abrupt increase in gonadotropic hormones
(FSH, LH) at menopause in
females

A

True

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7
Q

A patient has primary amenorrhea. You measure their FSH and it is normal suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis

A

A. Anatomical blockage
C. Mullerian Angenesis

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8
Q

A patient has primary amenorrhea. You measure their FSH and it is elevated suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis
D. Gonadal Dysgenesis

A

D. Gonadal Dysgenesis

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9
Q

A patient has primary amenorrhea. You measure their FSH and it is low suggesting…
A. Anatomical blockage
B. GnRH Deficiency
C. Mullerian Angenesis
D. Gonadal Dysgenesis
E. Delayed Puberty

A

B. GnRH Deficiency
E. Delayed Puberty

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10
Q

What is Tanner Staging (a sexual maturing rating of secondary sexual characteristics) a reflection of?

A
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11
Q

True or False: LH, FSH, and Estrogen are low prior to Puberty

A

True

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12
Q

Three major sites of Estrogen (E2) Biosynthesis?

A
  1. Ovary
  2. Peripheral Tissues
  3. Estrogen Target Tissues
  • Androstenedione–originating from adrenal, ovary, or both–to E1 then to E2
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13
Q

In sexually active females, __ is greater than ___
A. E1>E2
B. E2>E1

A

B. E2>E1

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14
Q

What are two important enzymes for E2 biosynthesis from androgen precursor?

A

Aromatase
17BHSD

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15
Q

If a patient has normal tanner staging + 1 amenorrhea, it suggests…

A

Mullerian Agenesis and Anatomical Blockage

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16
Q

If a patient has pre-pubertal breast development + 1 amenorrhea, it suggests…

A
  1. Gonadal Dysgenesis
  2. Delayed Puberty
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17
Q

Four common causes of secondary amenorrhea?

A
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18
Q

True or False: Low FSH and LH, as well as an estrogen deficiency is associated with Functional Hypothalamic Amenorrhea (secondary amenorrhea)

A

True

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19
Q

True or False: Normal secondary sexual characteristics are typical in individuals with Functional Hypothalamic Amenorrhea (secondary amenorrhea)

A

True

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20
Q

How do you restore LH and FSH in Functional Hypothalamic Amenorrhea (secondary amenorrhea)?

A

Exogenous GnRH

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21
Q

Describe The Female Athlete Triad (Functional Hypothalamic Amenorrhea)

A
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22
Q

How does the Triad affect:
- GnRH
- LH pulse frequency
- estrogen
- ovulation
- leptin
- ghrelin

A
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23
Q

True or False: Many CNS substances regulate kisspeptin secretion and hence hypothalamic GnRH secretion.

A

True

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24
Q

Anterior pituitary gonadotrophs
synthesize and secrete __ and __

A

FSH/LH

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25
True or False: Estrogen (positive feedback) decreases the GnRH pulse frequency
False - increases
26
True or False: Low GnRH pulse frequency favors LH secretion → LH surge
False - high GnRH
27
How does progesterone affect GnRH pulse frequency?
Progesterone decreases the GnRH pulse frequency
28
True or False: Low GnRH pulse secretion favors FSH secretion
True
29
How can stress affect CRH?
Increases it
30
____ activate opioid receptors to inhibit GnRH secretion A. LH B. Endorphins C. Beta endorphins C. CRH
C. Beta endorphins
31
True or False: Stressors decrease hypothalamic CRH secretion to inhibit GnRH secretion
False - stressors INCREASE hypothalamic CRH secretion to inhibit GnRH secretion
32
Treatment for Athlete Triad?
33
Where is testosterone produced? androstenedione?
34
Where is DHEA produced? DHEAS?
35
All of the following are produced in the ovary except: A. Testosterone B. Androstenidone C. DHEA D. DHEAS
D. DHEAS
36
All of the following are produced in the adrenal zona reticularis except: A. Testosterone B. Androstenidone C. DHEA D. DHEAS
A. Testosterone
37
True or False: The majority of testosterone occurs in peripheral tissues (70-80%)
True
38
In the peripheral tissues, which enzyme converts Androstenedione to Testosterone? How do target cells convert testosterone to potent DHT?
17-B-HSD 5a-reductase
39
What are the two causes of androgen excess in women of reproductive age?
1) PCOS 2) Non-classic congenital adrenal hyperplasia - deficient in CYP21A2
40
What four features would you expect to see in a patient with Non-classic congenital adrenal hyperplasia?
1. Irregular menses 2. Elevated androgens 3. Hirsuitism 4. Elevated serum 17-hydroxyprogesterone
41
____: Scoring system that uses visual grading of hair growth over 9 androgen-sensitive body areas
Ferriman-Gallwey scoring system for hirsuitism
42
How to evaluate 2 amenorrhea?
43
How to further evaluate 2 amenorrhea?
44
How to further evaluate 2 amenorrhea?
45
How to further evaluate 2 amenorrhea?
46
How to further evaluate 2 amenorrhea?
47
How to further evaluate 2 amenorrhea?
48
Three features of PCOS?
49
____ potentiates adrenal DHEAS synthesis
Hyperinsulinemia
50
True or False: PCOS is associated with androgen excess, which can be seen with: acne, androgenic alopecia, and hirsutism
True
51
True or False: In PCOS patients, there is proliferative endometrium
True
52
How to diagnose PCOS?
53
True or False: Elevated LH/FSH supports PCOS and is diagnostic
False - elevated LH/FSH supports PCOS but is NOT diagnostic
54
How are GnRH, FSH, and LH dysregulated in PCOS?
55
How is the ovary affected by PCOS?
1. Elevated androgen synthesis 2. Increased LH/FSH ratio 3. Dysregulation of these enzymes
56
How does PCOS affect the adrenal glands?
1. Dysregulation of synthetic enzymes 2. Increased DHEAS synthesis
57
In PCOS, there is high androstenedione, which leads to excess testosterone and DHT but normal ___
estrogen
58
Having a lot of DHT in hair follicles plays a role in ____
hirsuitism
59
How does Insulin Resistance play a role in PCOS?
60
61

Pathophysiology (26 decks)

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