Q5 - Female Repro

Question 1

Müllerian duct malformation can cause?

Answer 1

Anatomical malformations in the female reproductive tract.

Question 2

Female genitalia develops in _____

Answer 2

The absence of AMH and testosterone.

Question 3

Fusion of _______ ducts results in female genetalia.
Progressing _____ duct results in Male genetalia in the presence of _______ and _______

Answer 3

Mullerian
Wolffian
AMH (antimullerian hormone)
Testosterone

Question 4

Androgen insensitivity is female phenotype/male genotype (46,XY) is complete.

Question 5

Androgen insensitivity syndrome is _______ genetic mutation

Answer 5

X-linked recessive

Question 6

With complete androgen insensitivity, there is a mutation on the _____ gene with causes _______ dysfunction and end organ insensitivity to androgens.

Answer 6

AR
Androgen receptor

Question 7

Primary Dysmenorrhea is excessive ________ production.

Answer 7

Excessive prostaglandin production.

Question 8

What are the cutoffs for primary amenorrhea

Answer 8

14yo WITHOUT any development of secondary sex characteristics
16yo WITH development of secondary sex characteristics.

Question 9

Elevated FSH doesn’t tallow for the negative feedback loop to cause rise in LH and subsequent ovulation (pituitary tumor and hydrocephalus)
Lack of GnRH - hypothalamic defects. These can be some causes of Amenorrhea.

Question 10

Secondary amenorrhea cutoffs?

Answer 10

Regular period - missed 3 cycles
Irregular period - 6 months

Question 11

From ovulation to 1st day of menses is almost always _______

Answer 11

14 days - luteal phase
Follicular phase (before) is the one that varies from woman to woman.

Question 12

PALM COEIN for abnormal Uterine bleeding

Answer 12

Structural:
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia(precancer)
Non-Structural:
Coagulopathy
Ovulatory dysfxn (PCOS, thyroid, anorexia, puberty/menopause)
Endometrial
Iatrogenic
Not yet classified (infx, FOB, trauma)

Question 13

Difference between adenomyosis and endometriosis and leiomyoomas?

Answer 13

Adeno = endometrial tissue w/in myometrium smooth muscle layer
Endo = endometrial tissue outside the uterus.
Leio= benign (fibroid) tumors starting from a myometrial single smooth muscle cell.

Question 14

Adenomyosis can be treated with progestin only contraceptives. Can be accompanied by urinary/bowel symptoms.

Question 15

PCOS criteria

Answer 15

Menstrual irregularity/ovulation dysfunction
Hyperandrogenism
Insulin resistance
Low FSH, elevated LH, elevated testosterone -> LH cant surge because it’s already high -> no ovulation and no menstruation.

Question 16

All individuals with PCOS share a deficit in __________

Answer 16

Androgen secretion.
For those with abdominal adiposity/insulin resistance, the defect in androgen secretion is amplified, so those individuals may be more severe/symptomatic.

Question 17

Functional cyst results from _______

Answer 17

Follicle or corpus luteum.

Question 18

Ovarian cysts after menopause are extremely suspicious for cancer.

Question 19

Delayed or absent puberty can be caused by:

Answer 19

Delay in production of GnRH for HPG axis which further delays production of LH and FSH.
There is a GPCR (GPR54) that has been identified as the gatekeeper for activation of the BnRH axis. It is required for normal function and regulates the GnRH axis.
A work up with labs, birth history, possible head CT could be warranted, however is usually not required unless the delay in puberty is causing psychosocial problems.

Question 20

Premature development of secondary sex characteristics can cause premature closure of the epiphysis of long bones and result in lifelong short stature.

Question 21

All cases of precocious puberty require careful examination while not necessarily all cases of delayed puberty do.

Question 22

Central precocious puberty - GnRH dependent. Some are idiopathic (most times the case in females) and some result from CNS abnormality (most times the case in Males)
CNS lesion, excess sex steroid exposure, GnRH secreting tumors, CNS injury. Mutations on the _______ gene have recently been discovered to cause familial central precocious puberty

Answer 22

MKRN3

Question 23

Peripheral precocious puberty - GnRH independent = excess of ______ secreted from gonads or _______. Some causes include, ovarian cysts, ovarian tumors, primary hypothyroidism, adrenal pathology

Answer 23

Estrogens
Adrenal glands from exogenous sources.

Question 24

Dysmenorrhea - excessive prostaglandin synthesis - a potent myometrial stimulant and vasoconstrictor.

Question 25

__________ or _________ in ovarian hormones can result in secondary amenorrhea.

Answer 25

Excess (PCOS) Not enough (Menopause, Hyperprolactinemia, head trauma, ovarian tumor

Question 26

What is the majority of abnormal uterine bleeding (AUB) associated with?

Answer 26

Lack of ovulation.

Question 27

Examples of androgens?

Answer 27

Sex hormones Testosterone (ovary) Androstenedione (ovary) DHEA(ovary)/DHEA-S (adrenal gland) DHT

Question 28

What do androgens do in men? Women? Both genders?

Answer 28

Men: Deep voice, Hair growth on face, scalp, chest, underarms and genitals, sperm development Women: Regulate menstruation, conception and pregnancy, minimize bone loss, pubic and underarm hair. Both: Bone density, muscle development, puberty, RBC production, sexual desire and function

Question 29

In PCOS, there is an excess of ________. In appropriate gonadotropin secretion triggers a viscous cycle that makes ovulation hard-impossible. FSH levels are _____, LH levels are ______.

Answer 29

Androgens Low or below normal Elevated.

Question 30

In PCOS, what do elevated LH levels cause?

Answer 30

Persistent LH causes increase in concentration of androgens (from the ovary and adrenal glands). Androgens are converted into estrogen in the tissues. Since testosterone is also increased, it causes a reduction (50%) in sex hormone-binding globulin (SHBG) levels which means there is increased levels of free estradiol. This gives a positive feedback response to LH and a negative feedback response in FSH. Since FSH is never totally gone (due to an ovulation and lack of progesterone), different follicles are at different levels of maturity, and most fail (atresis)

Question 31

Women with PCOS have a __________ risk of uterine/ovarian cancer due to _______

Answer 31

3 times greater Anovulatory lack of progesterone - unopposed estrogen.

Question 32

2 kinds of functional cyst? What does a functional cyst mean?

Answer 32

Follicular cyst - dominant follicle fails to rupture, or non dominant follicle(s) fail(s) to regress. Fluid filled Luteum cyst - less common, more symptomatic - delayed menstruation or amenorrhea.

Question 33

Why can ovarian cysts be dangerous?

Answer 33

Luteum cysts especially can be very vascular, and if they get big and rupture can cause hemorrhage. If the cyst grows too large, they can increase the risk of ovarian torsion. They can also be an indication of a cancerous tumor.

Question 34

When is a luteum cyst normal?

Answer 34

During the first trimester of pregnancy, because the corpus luteum stays to produce progesterone to support the pregnancy until the placenta is established.

Question 35

Every month, when the pituitary gland secretes FSH, 120 follicles are stimulated. Usually, 1 dominant follicle emerges that produces more estradiol than the others. This causes an LH surge from the pituitary. LH surge stimulates rupture of the dominant follicle. Corpus luteum becomes vascularized and secretes progesterone which arrests the development of other follicles in both ovaries at that cycle.

Question 36

these 3 things trigger follicular rupture:

Answer 36

LH, proteolytic enzymes and prostaglandins.

Question 37

What 2 kinds of meds are commonly associated with sexual problems?

Answer 37

Antihypertensives and antidepressants.

Question 38

Treatment modalities to increase sexual desire in women?

Answer 38

Flibanserin (increase DA and NE in the brain), Exogenous testosterone, bippropion and therapy.