Menarche

Question 1

What is the time frame of the follicular phase of the ovulatory cycle?

Answer 1

it begins with the onset of menstruation and culminates in the preovulatory surge of LH

Question 2

what is the time frame of the luteal phase of the ovulatory cycle?

Answer 2

it begins with the onset of the preovulatory LH surge and ends with the first day of menses

Question 3

what is the effect of the decreasing levels of estradiol and progesterone from the regressing corpus luteum of the preceding cycle?

Answer 3

it is going to initiate an increase in FSH by a negative feedback mechanism, which stimulates follicular growth and estradiol secretion

Question 4

What does LH stimulate in the ovarian follicle?

Answer 4

the theca cells to produce andorgens

Question 5

what does FSH stimulate in the ovarian follicle?

Answer 5

the granulosa cells to convert the androgens made in the theca cells into estrogens

Question 6

what happens to the LH and FSH levels during the luteal phase?

Answer 6

they are significantly suppressed through the negative feedback effect of the elevated circulating estradiol and progesterone

Question 7

what happens to the levels of progesterone and estrogen near the end of the luteal phase if conception does not occur?

Answer 7

they will decline

Question 8

what type of hormone is GnRH?

Answer 8

a decapeptide synthesized in the arcuate nucleus

Question 9

what effect does estradiol have on the hypothalamus?

Answer 9

it appears to enhance the hypothalamic release of GnRH and induce the midcycle LH surge

Question 10

what effect do the gonadotropins have on GnRH release?

Answer 10

an inhibitory effect

Question 11

when do estrogen levels generally reach a maximum peak?

Answer 11

1 day before the midcycle LH surge

Question 12

during the follicular development, the ovary secretes only a very small amount of progesterone. Where does the bulk of the progesterone come from?

Answer 12

the peripheral conversion of the adrenal pregnenolone and pregnenolone sulfate

Question 13

prior to ovulation the unruptured luteinizing graafian follicle begins to produce what?

Answer 13

increasing amounts of progesterone

Question 14

at about 8-10 weeks of fetal development, what do the oocytes become surrounded by?

Answer 14

the precursor granulosa cells- this complex is called the primordial follicle

Question 15

what do the inner most layer of the granulosa cells of the cumulus oophorus become?

Answer 15

the corona radiata

Question 16

what does the corpus luteum produce?

Answer 16

copious amounts of progesterone and some estradiol

Question 17

what is the endometrium responsive to?

Answer 17

circulating progestins, androgens, and estrogens

Question 18

what kind of arteries does the functional layer of the endometrium contain?

Answer 18

spiral arteries

Question 19

what kind of arteries does the inner/ basalis layer of the endometrium contain?

Answer 19

straight/ basal arteries

Question 20

the cyclic changes in the histophysiology of the endometrium can be divided into 3 stages. What are these stages?

Answer 20

the menstrual phase, the proliferative (estrogenic) phase, and the secretory (progestational) phase

Question 21

what is the proliferative phase characterized by?

Answer 21

endometrial growth/proliferation secondary to estrogenic stimulation/ increase in the length of the spiral arteries and numerous mitoses can be seen in these tissues

Question 22

when does the secretory phase occur?

Answer 22

following ovulation

Question 23

what stimulates the secretory phase?

Answer 23

progesterone secretion by the corpus luteum stimulates the glandular cells to secrete mucus, glycogen, and other substances

Question 24

does mitosis occur during the secretory phase?

Answer 24

it is rare

Question 25

what happens if conception does not occur by day 23?

Answer 25

the corpus luteum begins to regress, secretion of progesterone and estradiol declines, and the endometrium undergoes involution

Question 26

what typically happens one day prior to the onset of menstruation?

Answer 26

there is marked constriction of the spiral arteries ( results in ischemia of the endometrium) leukocytes infiltrate and there is RBC extravasation

Question 27

restoration of blood vessels require successful interaction of platelets and clotting factors; what medications can impair this coagulation system and be associated with heavy bleeding?

Answer 27

warfarin, aspirin, and clopidogrel

Question 28

what is the purpose of the human papillomavirus vaccine?

Answer 28

it offers protection against cervical cancer, cervical dysplasia, vulvar or vaginal dysplasia, and genital warts associated with the gardasil HPV genotypes

Question 29

when is the median age of menarche?

Answer 29

12 years

Question 30

what is primary amenorrhea?

Answer 30

the absence of menarche by age 13 without secondary sexual development OR by the age of 15 with secondary sexual development

Question 31

what is the median length of the first cycle after menarche?

Answer 31

34 days

Question 32

what is secondary amenorrhea defined as?

Answer 32

the absence of menstruation for 6 months

Question 33

what are the general causes of menstrual irregularity?

Answer 33

pregnancy, endocrine causes, acquired conditions, or tumors

Question 34

what is greater than 80 cc blood loss associated with?

Answer 34

anemia

Question 35

what is dysfunctional uterine bleeding (DUB) (also known as abnormal uterine bleeding now)?

Answer 35

abnormal uterine bleeding that cannot be attributed to medications, blood dyscrasias, systemic disease, trauma, or organic conditions

Question 36

what is dysfunctional uterine bleeding usually caused by?

Answer 36

aberrations in the H-P-O axis resulting in anovulation

Question 37

what is polymenorrhea?

Answer 37

abnormally frequent menses at intervals less than 21 days

Question 38

what is menorrhagia (hypermenorrhea)?

Answer 38

excessive and/or prolonged menses occurring at regular intervals

Question 39

what is metrorrhagia?

Answer 39

irregular episodes of uterine bleeding

Question 40

what is menometrorrhagia?

Answer 40

heavy and irregular uterine bleeding

Question 41

what is intermenstrual bleeding?

Answer 41

scant bleeding at ovulation for 1-2 days

Question 42

what is oligomenorrhea?

Answer 42

menstrual cycles at >35 day cycles

Question 43

what is the classification system used for abnormal bleeding in reproductive-aged women?

Answer 43

PALM-COEIN

Question 44

what are the causes of the PALM abnormal bleeding in reproductive-aged women?

Answer 44

structural causes

Question 45

what does the P stand for in PALM?

Answer 45

polyp

Question 46

what does the A stand for in PALM?

Answer 46

adenomyosis

Question 47

what does the L stand for in PALM?

Answer 47

leiomyoma

Question 48

what does the M stand for in PALM?

Answer 48

malignancy and hyperplasia

Question 49

what are the causes of the COEIN abnormal bleeding in reproductive-aged women?

Answer 49

non-structural causes

Question 50

what does the C stand for in COEIN?

Answer 50

coagulopathy

Question 51

what does the O stand for in COEIN?

Answer 51

ovulatory dysfunction

Question 52

what does the E stand for in COEIN?

Answer 52

endometrial

Question 53

what does the I stand for in COEIN?

Answer 53

iatrogenic (relating to illness caused by medical examination or treatment- like an IUD)

Question 54

what does the N stand for COEIN?

Answer 54

not yet classified

Question 55

what can polyps cause?

Answer 55

menorrhagia or spontaneous or post menopausal bleeding

Question 56

what would the ultrasound findings of a patient with endometrial polyps suggest?

Answer 56

focal thickening of the endometrial stripe

Question 57

how would you detect a poly?

Answer 57

saline hysterosonography and hysteroscopy

Question 58

what is an adenomyosis?

Answer 58

the extension of the endometrial glands and stroma into the uterine musculature

Question 59

what are the symptoms of adenomyosis?

Answer 59

they may be asymptomatic; severe secondary dysmenorrhea (pain with menstrual cycles) and menorrhagia(heavy vaginal bleeding); dyspareunia (pain with intercourse) with deep penetration

Question 60

how is adenomyosis diagnosed?

Answer 60

histopathology

Question 61

what is a leiomyoma?

Answer 61

a fibroid- a benign tumor derived from smooth muscle cells of the myometrium

Question 62

what is the most common indication of hysterectomy?

Answer 62

symptomatic fibroids

Question 63

what are the risk factors for developing fibroids?

Answer 63

increasing age during reproductive years, african american women, nulliparity (never been pregnant), and a family history

Question 64

what stimulates the proliferation of smooth muscle cells?

Answer 64

estrogen

Question 65

what happens to fibroids during pregnancy?

Answer 65

they can dramatically enlarge

Question 66

what is a subserosal fibroid?

Answer 66

if a fibroid occurs on the outside of the uterus

Question 67

what is an interstitial fibroid?

Answer 67

if a fibroid occurs in the muscle of the uterus

Question 68

what is a submucosal fibroid?

Answer 68

if a fibroid occurs on the inside of the uterus with a protrusion into the endometrium

Question 69

if a fibroid does produce symptoms, what would they be?

Answer 69

pelvic or lower back pain, frequency of urination, prolonged or heavy bleeding, increased incidence of infertility

Question 70

which fibroids are associated with prolonged or heavy bleeding?

Answer 70

submucosal or intramural (interstitial) fibroids

Question 71

what fibroids are more associated with infertility?

Answer 71

submucosal fibroids

Question 72

what is endometrial malignancy/ hyperplasia?

Answer 72

it represents an overabundant growth of the endometrial lining usually as a result of persistent unopposed estrogen

Question 73

what is endometrial hyperplasia a precursor to?

Answer 73

endometrial cancer

Question 74

what is type 1 hyperplasia?

Answer 74

endometrial adnenocarcinoma- the most common type

Question 75

what is type 2 hyperplasia?

Answer 75

clear cell and papillary serous

Question 76

what is the presentation of endometrial hyperplasia?

Answer 76

postmenopause bleeding or irregular uterine bleeding( after the age of 35)

Question 77

what would indicate an in office endometrial biopsy?

Answer 77

abnormal uterine bleeding in post menopausal women or if there are positive glandular cells on a cervical cytology

Question 78

what is an in office endometrial biopsy and when is it best used?

Answer 78

it's a blind biopsy and it is better if used when the pathology is global (like hyperplasia) rather than focal (polyp)

Question 79

what are the contraindications of an in office endometrial biopsy?

Answer 79

pregnancy (absolute) and bleeding diathesis (relative)

Question 80

what is the removal of fibroids called?

Answer 80

myomectomy

Question 81

what are three surgical options to treat AUB?

Answer 81

D&C, uterine endometrial ablation, and hysterectomy

Question 82

what is a therapeutic D&C used for?

Answer 82

performed for endometrial structural abnormalities (polyps, small submucosal fibroids)

Question 83

what is a diagnostic D&C used for?

Answer 83

performed for irregular menstrual bleeding or postmenopausal bleeding to rule out endometrial hyperplasia or cancer

Question 84

what is endometrial ablation?

Answer 84

it uses radio frequency to the bipolar mesh electrode while at the same time applying suction to the endometrium

Question 85

what is the average duration of puberty?

Answer 85

4-5 years

Question 86

between the ages of 8-11, there is an increase in serum concentrations of what?

Answer 86

DHES, DHEA-S, and androstenedione

Question 87

what are the initial endocrine changes associated with puberty?

Answer 87

adrenal androgen production and differentiation by the zona reticularis of the adrenal cortex

Question 88

what does rise in adrenal androgens cause?

Answer 88

growth of axillary and pubic hair (adrenarche or pubarche)

Question 89

what happens around 11 years of age when talking about the onset of puberty?

Answer 89

there is a gradual loss of sensitivity by the gonadostat to the negative feedback of sex steroids; in combination with the intrinsic loss of CNS inhibition of hypothalamic GnRH release

Question 90

what does an increase in GnRH promote?

Answer 90

ovarian follicular maturation and sex steroid production, which leads to the development of secondary sexual characteristics

Question 91

what are the stages of normal pubertal development?

Answer 91

TAG ME- thelarche, adrenarche, growth spurt, menses

Question 92

what does thelarche require?

Answer 92

estrogen

Question 93

what does pubarche/adrenarche require?

Answer 93

androgens

Question 94

when does maximal growth or peak height occur?

Answer 94

about 1 year before onset of menses

Question 95

how many stages are there in the tanner staging?

Answer 95

5