Laboratory Diagnostics & Reproductive A&P Flashcards Preview

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Flashcards in Laboratory Diagnostics & Reproductive A&P Deck (21)
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Vaginal pH

Normal level

pH >4.5 indicates what

Normal pH is 3.8-4.5

pH >4.5 indicates bacterial vaginosis, trichomoniasis, atrophic vaginitis


Vaginal wet mount indications and contraindications

Indications: itching, burning, rash, odor, discharge

Cannot do during menses

No vaginal meds w/in 2-3 days

Irritations (tampons, intercourse) can alter results


Wet Mount findings

White cells

Clue cells



White cells: normal is <10 in high powered field - should be more epithelial cells than white cells

Clue cells: vaginal epithelial cells covered w/ bacteria - have shaggy borders w/ stippled appearance

-indicate bacterial vaginosis (fishy smell, pH >4.5)

Lactobacilli: normal flora - decreased w/ yeast infections or bacterial vaginosis

Trichomonads: STI flagellated parasite


Nucleic Acid Amplification Testing (NAAT)

For N. gonorrhoea and C. trachomatis

Can be done from vaginal fluid, endocervix swab, or on UA

NAAT detects more chlamydial infections that culture or early tests

For UA: collect >1 hr after last void, 1st catch UA is optimal


Diethylstilbesterol (DES)

Synthetic estrogen given between 1940-1970 to reduce miscarriages

DES daughters @ increased risk for rare clear cell vaginal cancer, infertility, t-shaped uterus, cervical and breast cancer

DES sons @ increased risk cryptorchidism, hypogonadism, and epidermal cysts

Moms have increased risk breast cancer


Theca cells

Granulosa cells

Preovulatory follicle cells

Theca cells secrete androgens and are stimulated by LH

- possible cancer source

Granulosa cells convert androgens to estrogen and are stimulated by FSH


Blood supply directly connecting anterior pituitary to hypothalamus

Hypothalamic-Hypophyseal portal circulation

No direct nerve connections here


Gonadotropin-releasing hormone (GnRH)

Hypothalamic hormone - responsible for LH and FSH release

Stimulated by norepinephrine, inhibited by dopamine

Low pulse frequency triggers FSH release, high-frequency triggers LH release


Follicular phase

1-12 days - 1st day after menses over

Low estrogen and progesterone state - FSH and LH levels increased

FSH stimulates estrogen release from granulosa cells and causes follicle and egg maturation in ovary

LH: low levels trigger theca cells to release androgens and stimulate estrogen production

Estrogen levels increasing, have initial negative effect on LH and FSH to prevent new follicles maturing


Ovulatory phase

Day 12-14

At day 12 - peak estrogen levels switch to positive feedback on GnRH

This causes a surge of estrogen, FSH and LH 

LH surge causes ovulation - egg released and follicle ruptures


Luteal phase

Ruptured follicle (corpus luteum) secretes progesterone & estrogen

These have negative feedback on GnRH

Progesterone maintains the endometrial linings & secretions for 9-11 days


If no conception in luteal phase

After 9-11 days, progesterone levels decrease

Menstrual period triggered w/ rise in FSH


If implantation occurs in luteal phase

Zygote produces HCG

HCG mimics LH -> causes corpus luteum to keep producing progesterone

Endometrial lining remains intact until placenta takes over


Follicular Phase Summary

Proliferative phase

Estrogen dominates

Mature follicle develops

LH surge triggers ovulation


Luteal Phase Summary

Secretory phase

Ovulation must occur to have luteal phase

Progesterone dominates w/ elevated basal body temperature

Further preparation of endometrium to receive fertilized egg


Breast Development during Pregnancy

Breasts increase in size from estrogen, progesterone, and prolactin secretion

Milk production is inhibited by progesterone effect on prolactin



Colostrum for the first 3-6 days

Milk production stimulated by prolactin

Ejection stimulated by oxytocin



Lasts for 4-5 years

Estrogen contributes to accrual of bone, bone plate fusion @ end of puberty, stimulates breast development

GH and sex steroids contribute - stimulate insulin-like growth factor secretion (IGF-1)


Delayed puberty

No secondary sex characteristics by 13 years old

No menarche by 15-16 yo

No menarche 5 years after thelarche (breast onset)


Delayed Puberty Causes

Hypergonadotrophic hypogonadism - >35 FSH

- Turners Syndrome

Hypogonadotrophic hypogonadism - FSH & LH <10

- HPO delay, suppressed

Anatomic defect


Precocious Puberty

Onset of secondary sex characteristics < 6yo (black) <7 yo (white)

GnRH-dependent (central): early HPO activation, get both breast and pubic hair development

GnRH-independent (peripheral)