Quiz 2

Question 1

Cards 24-31 from Q1 deck

Question 2

Be able to draw menstrual cycle - take to Dr. Seibert to review prior to final exam.

Question 3

How does the pituitary know which one to release FSH or LH because both are stimulated by GnRH release from hypothalamus?

Answer 3

The characteristics of the Pulsitile release determines which one is released.

Question 4

Steroids are derived from _______ and produced by ______, _____ and _______

Answer 4

Cholesterol
Ovaries, testes and adrenal cortex

Question 5

69% of sex hormones (estrodiol and testosterone) are bound to ______
30% bound to _______
And 1% is _____

Answer 5

SHBG (sex hormone binding globulin produced by the liver)
- that’s why estrogens help with acne - they accelerate the SHBG production so less free hormones are circulating. Also helpful with menopause. ONLY with ORAL form.

Albumin
Unbound/free

Question 6

Estrogens are derived from ________ and converted by ______

Answer 6

Androgens/testosterones
Aromatase.

Question 7

Estrone comes from _____
Estrodiol (2) comes from ______
Estriol (3) comes from _______

Answer 7

Body fat
Ovaries
Placenta (3rd source)

Question 8

Eggs are arrested in _______

Answer 8

Prophase I - after “crossing over occurs”

Question 9

A woman will ovulate about ______ times in her life

Answer 9

400

Question 10

What is AMH (anti-mullerian hormone) a measurement of?

Answer 10

Secreted by Granulosa cells - a marker of reserve.

Question 11

Activism stimulates ______ synthesis and secretion
Inhibin ______ FSH.

Answer 11

FSH
Inhibits - you don’t want a pregnancy with 12 fetuses.

Question 12

Granulosa cells have ______ receptors and produce ______ to convert ________ into ______
Theca cells have ______ receptors and produce ______ that are converted to ______ by _______

Answer 12

FSH
Aromatase
Androgens
Estrodiol
LH
Androgens
Estrodiol
Aromatase from Granulosa cells.

Question 13

What is the signal for the LH surge?

Answer 13

Estrodiol positive feedback a sustained 200pgx50hours. This triggers hypothalamus to pulse out GnRH like crazy to trigger the LH surge (with a little FSH trailing behind)

Question 14

GnRH pulses during early follicular phase = ________
GnRH pulses during mid-follicular = ______ = ______
Ovulation = ______ = _________
Post ovulation + progesterone influence = _______

Answer 14

Rapid + shallow
Increasingly rapid rate = increased FSH
Very rapid and deep = LH surge.

Question 15

Estrogen generally has a ________ on the hypothalamus that ______ FSH release

Answer 15

Negative
Inhibits

Question 16

Which hormone is responsible for spinnbarkeit thin stretchy cervical mucus?
Thick?

Answer 16

Estrogen. - to facilitate sperm. Swimming.
Progesterone - to form a plug and protect the uterus

Question 17

What hormone inhibits LH, relaxes myometrium and tubes, develops breast lobules and promotes the secretory endometrium?

Answer 17

Progesterone

Question 18

T/F: during early menarche (11-15) there is earlier ovulation due to the body’s sensitivity to hormones

Answer 18

True. You could get pregnant during your period.

Question 19

Follicular/proliferative phase is dominated by _______

Answer 19

FSH and E2

Question 20

Draw slide 51 - feedback loops - add to diagram

Question 21

When does hCG first appear?
How long does it stimulate the CL progesterone secretion?

Answer 21

9-13 days after ovulation
For 9-10 weeks or 100 days until the placenta takes over.

Question 22

What does SERM mean and what is an example?

Answer 22

Selective Estrogen Receptor
Clomiphene (Clomid) - tricks the pituitary into producing more FSH and LH (act as as anti-estrogen)

Question 23

No period by age 14 with no secondary sex characteristics is known as _________ amenorrhea.

Answer 23

Primary

Question 24

Secondary amenorrhea is absence of _____ cycles (regular period) or _____ (irregular period)

Answer 24

3
6months

Question 25

If you’re not ______ then you don’t get your period.

Answer 25

Ovulating.

Question 26

What is the progesterone challenge?

Answer 26

Give progesterone for 5-10 day. There should be withdrawal bleeding within 14 days of stopping the Pg - if this bleeding occurs, then ANOVULATION is the reason.

Question 27

What labs do you draw in amenorrhea?

Answer 27

TSH, prolactin.

Question 28

Make a flow chart for amenorrhea.

Question 29

If you give estrogen and Pg and you DO have withdrawal bleeding, what is the cause? if you do NOT have withdrawal bleeding?

Answer 29

Ovarian failure (not producing estrogen) Endometrium failure (unable to respond to estrogen) OR Ectopic production of prolactin.

Question 30

Asherman’s syndrome - do chart on this.

Question 31

How can we asses ovarian function? In ovarian failure, FSH and LH will be _______ Pituitary or CNS failure, FSH and LH will be ______

Answer 31

High. (Chromosome eval. - Fragile X?) NL or low

Question 32

What is the normal prolactin level?

Answer 32

20-100. >100 considered abnormal.

Question 33

What is going wrong with the IV compartment (hypothalamus) if there is amenorrhea?

Answer 33

Weight loss, anorexia, bulimia, exercise, stress (deployment), OCP (post-pill), Kallmann’s Syndrome (amenorrhea+anosmia).

Question 34

Compartment III - Pituitary - what could go wrong?

Answer 34

Empty Sella Syndrome - subarachnoid tissue doesn’t separate pituitary from Hypo-T Sheehan’s syndrome - acute necrosis of pituitary (PP syndrome) -failure of lactation, loss of pubic and axillary hair, can be life threatening. Pituitary adenoma.

Question 35

Compartment II - ovaries - what could go wrong?

Answer 35

Turner’s Syndrome, Mosaicism, XYY Gonadal Dysgenesis, Gonadal a genesis, resistant ovary syndrome, premature ovarian failure, radiation and chemotherapy.

Question 36

Compartment I - uterine/outflow tract

Answer 36

Asherman’s Mullerian Anomalies Androgen Insensitivity (testicular feminization)

Question 37

Meds/herbal remedies that cause AUB

Answer 37

Warfarin, heparin, NSAIDs, hormonal contraceptives, ginkgo, ginseng, motherwort.

Question 38

PALM-COEIN

Answer 38

Structural Causes Polyp Adenomyosis (endometrial tissue IN the myometrium) Leiomyoma (uterine fibroids) Malignancy and hyperplasia Non-structural Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not yet classified

Question 39

Make a card about Lynch syndrome?