Term
Kallman's Syndrome
1) can result in a patient coming to the doctor with concern about delayed pubertal development
2) can be corrected by administration of a long-acting GnRH agonist
3) is characterized by the presence of a hypothalamic tumor of GnRH secreting neurons
4) a and b only
5) all of the above |
|
Definition
| 1- You cannot correct it with long-acting agonist and must give estrogen/androgen replacement |
|
|
Term
Select the answers that are true regarding Kisspeptin.
1) Kisspeptin plays a key role in GnRH release
2) Kisspeptin neurons are located in the arcuate nucleus and project away from GnRH neurons
3) Kisspeptin neurons have steroid hormone receptors that play a key role in negative feedback for GnRH release
4) There is a decrease in Kisspeptin neuron activity at menopasue |
|
Definition
1 & 3
increases after menopause due to FSH surge and they project TO GnRH neurons |
|
|
Term
The following are all clinical uses of continuos GnRH agonist because they result in a reduction of LH and FSH except?
1) Fibroids
2) Endometriosis
3) Prostate cancer
4) Ovarian Cancer |
|
Definition
| 4- Not hormone sensitive tumors |
|
|
Term
The dominant follicle escapes regression because:
1) LH induces FSH receptors on the granulose cells
2) FSH induces LH receptors in the granulose cells supplying the granulose cell with additional sources of cAMP
3) The dominant follicle increase FSH levels by increasing estradiol production
4) Granulosa cells produce androgens to compensate for falling FSH levels. |
|
Definition
| 2) FSH induces LH receptors in the granulose cells supplying the granulose cell with additional sources of cAMP |
|
|
Term
Testosterone serum concentration has peaks during the following periods:
1) puberty through adulthood
2) 2 to 3 months after birth
3) fetal period
4) with the development of prostatic cancer
5) all of the above
6) a, b, c
:
b, c, d |
|
Definition
| 6- puberty-adult, fetal and first 2-3 months after birth |
|
|
Term
In terms of development from the indifferent stage of the external genitalia, which answers contain homologous structures (indifferent - male - female)?
1) genital tubercle - glans penis - clitoris
2) urethral folds - penile shaft - labia minora
3) genital swellings - scrotum - labia majora
4) all of the above
5) none of the above |
|
Definition
|
|
Term
T or F
Ovaries form normally without SGC migration |
|
Definition
False- you get streak gonad
Testis will form ok |
|
|
Term
All of the following birth control methods have the important quality of immediate reversibility except:
1) intrauterine device
2) combined oral contraceptive
3) Implanon implant
4) depo-Provera
5) progesterone only pill (POP) |
|
Definition
|
|
Term
All of the following are true of progesterone receptors, EXCEPT
1) There are three isoforms, PR-A, PR-B and Pr-C
2) PR-A is the agonist receptor type associated with characteristic progesterone effects
3) "functional progesterone withdrawal" refers to the change in PR-A/PR-B preceding activation
4) All of the above are true |
|
Definition
|
|
Term
CYP1A2 activity increases in pregnancy
1) true
2) false |
|
Definition
False- it decreases, which is why caffeine is so sensitive.
2D6 increases, meaning you have to increase beta blockers |
|
|
Term
All of the following are risk factors for preclampsia, EXCEPT:
1) chronic hypertension
2) smoking
3) diabetes
4) obesity |
|
Definition
| 2) Correct: Although many of the risk factors for preeclampsia are also cardiovascular risk factors, cigarette smoking is actually associated with decreased risk of developing preeclampsia |
|
|
Term
| What androgen compounds are used to bring about masculinaization? |
|
Definition
1) Long-lasting Enanthate, Cypionate or Propionate esters of testosterone given IM every 2 weeks (less often is worse)
- More lipidophillic compared to testosterone and are hydrolyzed in vivo
2) Oral preps like Alkylated testosterones (Methyltestosterone or Fluoxymesterone)
- short-acting options for postpubertal hypogonadism
**Methyltestosterone is difficult to monitor so it is less popular**
3) Transdermal androderm patches of androgel
- MOST effective at achieving stable circulating hormone levels
4) Anabolics: 19-nortestosterone, oxandrolone, oxymetholone and stanozolol
- Enhanced anabolic:virilizing effects to promote linear growth in children. |
|
|
Term
| Which method of ovulation induction places patients at higher risk for DVT/PE and why? |
|
Definition
FSH + hCG injections have risk (20-25%) of Ovarian Hyper-stimulation Syndrome (OHSS), where high estrogen levels lead to increased vasoactive substances (VEGF), which increase capillary permeability in the peritoneal cavity and produce
- Ascites
- Hypovolemia
- Hemoconcentration
**ALSO highest risk of multiple gestation (20%)** |
|
|
Term
| What are the major events that take in the 2nd week of embryonic development? |
|
Definition
**Initial blastocyst implantation in uterine wall happens at day 6-7**
"Week of 2's"
1) Implantation completion (8-12)
- Syncytiotrophoblast cells erode uterine lining to create pools (Lacunae) of maternal blood (later become placenta).
2) Bilaminar embryonic disc (8-12)
- Inner cell mass divides into outer Epiblast facing trophoblasts (becomes Embryo and lines amniotic cavity) and inner Hypoblast (becomes yolk sac)
- Trophoblast proliferates as 2 layers (cyto and syncytio)
- Blastocyst cavity is remodeled twice (primary and then definitive yolk sac)
- Amniotic and chorionic cavities appear
- Extraembryonic mesoderm splits into 2 layers that line chorionic cavity |
|
|
Term
| What are the major events that take in the 2nd week of embryonic development? |
|
Definition
**Initial blastocyst implantation in uterine wall happens at day 6-7**
"Week of 2's"
1) Implantation completion (8-12)
- Syncytiotrophoblast cells erode uterine lining to create pools (Lacunae) of maternal blood (later become placenta).
2) Bilaminar embryonic disc (8-12)
- Inner cell mass divides into outer Epiblast facing trophoblasts (becomes Embryo and lines amniotic cavity) and inner Hypoblast (becomes yolk sac)
- Trophoblast proliferates as 2 layers (cyto and syncytio)
- Blastocyst cavity is remodeled twice (primary and then definitive yolk sac)
- Amniotic and chorionic cavities appear
- Extraembryonic mesoderm splits into 2 layers that line chorionic cavity |
|
|
Term
Which of the following is NOT known to contribute to recurrent pregnancy loss? For those that are, explain why.
1) Luteal phase deficiency
2) Robertsonian translocations
3) Anti-phospholipid/cardiolipin syndrome (APS)
4) CREST syndrome
5) Asherman's syndrome |
|
Definition
4- Not known to be associated with >= 3 pregnancy losses.
1) Inadequate progesterone during "window of implantation" prevents blastocyte invasion.
2) Balanced and Robertsonian translocations are the 2 most common genetic abnormalities in RPL, and are found in 5-6% of cases.
3) Thromboembolism and thrombocytopenia
- **Factor V leiden is also involved**
5) Iatrogenic scarring of uterus from procedures |
|
|
Term
Which tissues receive the increased CO during pregnancy?
What periods are considered "highest risk" for hypoxia? |
|
Definition
1) Uteroplacental, Kidneys, Heart, Skin and Breasts get increased perfusion (No change in Brain, GI, MSK)
2) Early pregnancy, 28-32 week (peak of volume increase) and Immediately post-partum |
|
|
Term
There are numerous challenges of pharmacotherapy during pregnancy.
What are the major gestational effects on drug kinetics |
|
Definition
1) Absorption
- Reduced gastric emptying (progesterone) and decreased gastric acidity increases increase intestinal metabolism
2) Distribution
- Plasma volume increases (40-50%), in combination with fetal availability, lead to major increase in VOD.
3) Metabolism
- Affect oxidizing phase 1 (CYP) and conjugating phase 2 (UGTs, SULTs and NATs) enzymes
- Ex1) Decrease caffeine metabolism (1A2)
- Ex2) Increase beta blocker metabolism (2D6)
4) Elimmination
- 50% increase in renal blood flow and GRF (those drugs are excreted unchanged) |
|
|
Term
| Which closes first, the posterior or anterior neuropore? |
|
Definition
| Anterior (you get anencephaly earlier than spina bifida) |
|
|
