Female

Question 1

How does an ovarian follicle develop?

Answer 1

• Starts as promordial follicle
• Starts do build up the proteins around it and the nucleus gets bigger
  
  • more and more protein
• As a graffian follicle, the egg has a large nucleus and is surrounded by the fluid filled antrium
  
  • must store lots of proteins b/c it will not receive any nutrients for about a week after it ovulates until it becomes implanted

Question 2

What surrounds the antrum?Why?

Answer 2

• Granulosa layer- convert the androgen steroids into estrogen
• Theca interna- where androgen steroids are made
  
  • it has the white blobs
• Theca externa- connective tissue

Question 3

How does the Hypothalamic-Pituitary-Axis affect males and females?

Answer 3

• Male
  
  • GnRH causes the release of LH and FSH
  • LH goes to the Leydig cell and increases testosterone synthesis
  • FSH goes to the sertoli cell and increases androgen binding protein which works with the testosterone formed in the leydig cell
  • this supports sperm development
• Female
  
  • GnRH causes the release of LH and FSH
  • LH goes to the thecal cell to increase androgen synthesis
  • FSH goes to the granulosa cell and increases aromatase which turns the androgen into estrogen
  • this supports egg development

Question 4

How do you diagnose amenhorrhea?

(chart)

Answer 4

Question 5

Compare the three pituitary glycoprotein hormones and HCG.

Answer 5

• TSH, FH, LH, HCG
• All have the same alpha subunit.
• Specificity for each hormone is found at the beta subunit and protein structure
• HCG differs from LH only b/c it has 32 additional amino acids in its Beta-subunit
• TSH and HCG also look very similar and can bind to the same receptors
  
  • cannot measure TSH during pregnancy, must look at free T3 and T4

Question 6

What causes cervical cancer?

What part of cervix is at greatest risk?

Answer 6

• HPV is responsible for almost 100% of cervical cancer and can also cause cancer at other sites
• The cervic transforms over the lifespan and is at greater risk during some stages than others
• squamocolumnar junction is at greatest risk
  
  • at birth it is inside and is protected
  • as a young adult it is exposed
  • as an adult it is inside again and more protected

Question 7

Does the HPV vaccine prevent all cervical cancers?

Answer 7

No, pap smears are still required.

Question 8

What causes endometriosis?

Answer 8

• Endometrial cells back flow into the pelvis
  
  • through falopian tube, into lymph, or into blood

Question 9

What is a Leiomyoma?

Answer 9

• Uterine fibroid- not a cancer, but a smooth muscle tumor; does not metastasize
• occur in 30-50% of women
• can be asymptomatic or very painful

Question 10

Stats about endometrial cancer

Answer 10

• Most common cancer of the femal reproductive system but least deadly
  
  • about 40,000 cases/year
  • about 7,000 deaths
• commonly affects post-menopausal women and one of the first symptoms is bleeding
  
  • they get this checked out b/c they havent had a period in many years and know something must be wrong

Question 11

What are the different degrees of uterine prolapse?

Answer 11

• A= normal uterus
• B= first degree prolaps- descent of uterus within the vagina
• C= second degree prolapse- the cervix protrudes through the introitus
• D= third degree prolaps- the vagina is completely everted

Question 12

What is cystocele?

Rectocele?

Answer 12

• Cystocele- the bulging of the bladder through the vagina
• Rectocele- the bulging of the rectum through the vagina
  
  • Ex. the chick on the cruise ship

Question 13

What is salpingitis?

Answer 13

• Inflammation of the fallopian tubes
• almost always seen as a component of pelvic inflammatory disease
  
  • often caused by an infection (chlamydia, gonorrhea, tuberculosous) or endometriosis
  • also can be seen after ectopic pregnancy that has damaged the fallopian tubes

Question 14

What is pelvic inflammatory disease?

Answer 14

• inflammation of the fallopian tube or the ovary or both
• usually caused by infection or endometriosis

Question 15

What is polycystic ovarian syndrome?

Answer 15

• Leading cause of infertility
• High LH and low FSH
  
  • LH- makes lots of androstendione
  • FSH- converts androstendione into estrogen
• Without the FSH you have a bunch of androstendione building up, it goes into circulation
  
  • causes excess androgens-
  • fat will convert androstendione into estrogen and now the pituitary will think that everything is ok, plenty of estrogen
    
    • problem is that it is not in the ovary where it needs to be

Question 16

What are the symptoms of polycystic ovarian syndrome?

Treatment?

Answer 16

• Symptoms:
  
  • Irregular or no menstruation
  • excess androgen
  • enlarged ovaries with multiple cysts
• Treatment:
  
  • Medications to regulate menstrual cycle (oral contraceptives)
  • meds to reduce excessive hair growth
  • meds to achieve pregnancy
  • surgery

Question 17

What is the surgery for Polycystic ovarian syndrome?

Answer 17

• laparoscopic ovarian drilling
  
  • popping the cysts
• the goal is to stimulate ovulation by reducing levels of LH and androgen hormones

Question 18

Ovarian tumors:

Which one is most common and most deadly? Why?

Answer 18

• Surface epithelial cells tumors are most common of the ovarian tumors, but overall arent that common
• Most deadly because they go unnoticed for a really long time before they are detected
  
  • by then they have already metastasized
  • poor prognosis (~23,000 cases/year with about ~14,000 deaths/year)
  • Women with BRCA1 mucation have risk of 30% compared to other women with risk of 2%

Question 19

Where do teratomas come from?

Answer 19

Mature teratomas arise from germ cells and are seldom malignant

Question 20

What are the cardiovascular and hematologic changes seen in pregnancy?

Answer 20

• Increased blood volume, RBCs
• increased SV, HR, CO
• decreased HCT
• BP stays about the same but with increased venous pressure in legs

Question 21

What are the respiratory changes seen in pregnancy?

Answer 21

• increased RR, TV, MV, PaO2, and O2 consumption
• decreased PaCO2 (slight alkalosis), airway resistance, ERV, FRC, TLC
  
  • no change in VC

Question 22

What are the GI changes seen in pregnancy?

Answer 22

• increased bile secretion, bile stasis, and gallstones
• decreased LES tone (frequent heartburn), bilirubin (normally, unless they have cholestasis)

Question 23

What are the endocrine changes seen in pregnancy?

Answer 23

• Increased estrogen, progesterone, cortisol, growth hormone, placental lactogen, prolactin
• decreased bs, TSH (but normal T3/T4

Question 24

What other changes do you see druing pregnancy?

Answer 24

• Increased GFR, pain threshold, CSF

Question 25

What is the difference between a partial molar pregnancy and a complete molar pregnancy?

Answer 25

* Partial mole- some chorionic villi are vesicular and there is a deformed fetus present that is not viable * triploid (two DNA from dad, one DNA from mom) * Complete mole- all chorionic villi are vesicular, no fetus or embryonic tissue * diploid paternal dna

Question 26

What is pre-eclampsia?

Answer 26

* Mother has HTN, proteinuria, and edema * happens in 5-10% of pregnancies * causes inadequate blood flow to the fetus * inadequate development of placental spiral arteries * fetus is starved for nutrients so it tells mom to crank up the BP * Develops in third trimester, can progress to eclampsia

Question 27

What is HELLP?

Answer 27

* Hemolysis, Elevated Liver enzymes, Low Platelet count * complication or varient of pre eclampsia but more serious (1% mortality) * often involves liver problems, liver can rupture * DIC is seen in 20% of pts with HELLP * can progress to eclampsia

Question 28

What is eclampsia?

Answer 28

* involves seizures and can be fatal * with current medical care, pre eclampsia and HELLP rarely progress to eclampsia

Question 29

What is placenta previa? What are the different classifications? Symptoms?

Answer 29

* When the placenta is too close or covering the cervix * Symptoms: * painless vaginal bleeding * generally not a big issue

Question 30

What is placenta accreta/increta/percreta?

Answer 30

* Placenta is embedded too deeply in the uterus * Accreta- attaches to myometrium * increta- invades the myometrium * percreta- reaches serosa * \*\*this is a serious medical problem during delivery * removing the placenta will cause hemorrhage; often requires a total hysterectomy

Question 31

What is abrupto placenta?

Answer 31

* premature detachment of the placenta * can be partial or complete * usually causes vaginal bleeding, but not always * painful * Obstetric emergency- significant risk to fetus and mom * fetus is basically holding their breath one this happens * mom at risk for shock, renal failure, and coagulopathies from mixing of blood

Question 32

What are the four Ts of postpartum hemorrhage?

Answer 32

* Four t's can be the cause of the hemorrhage * Tone- soft, boggy uterus * trauma- laceration * tissue- retained placenta * thrombin- blood not clotting

Question 33

What is uterine rupture?

Answer 33

* Uterus ruptures * extremely painful * often happens d/t old c-section scar * this is an obstetric emergency- life threatening to mom and baby * both may have neurolgic problems d/t coagulopathy and stroke

Question 34

What is an amniotic fluid embolism? What are the signs and symptoms?

Answer 34

* Amniotic fluid enters maternal circulation * Rare * life threatening for mom and baby * Fetal cells trigger coagulation in maternal circulation * results in PE, can progress to DIC if pt survives long enough * most survivors will have long term neurological disorders