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    Physiology Repro

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    BiswarupDas

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    © All Rights Reserved
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    ‘2h yoa.olé woman coms tothe dnc because her polo wooks ate, ard shot experiencing fatgue and morning nausea She had he let period aknost 8 ‘weeks ag. Shes gravida 0 para O wr previous regular menso= and an Uurvemartatio modical toys had her monarch at he ago 1S oat. She hes a singe sotal prner and doesnot we contraception, A presentation he ial Signs ae itn normal ts. Qecleyal examination reveals breast and vere enaigement. Theres aso yaness and scheningin he cecal and vagal [© A. The venous congestion inthe patents reproduce organs is due tose nuence of estogens ©. estena as he lngostBioad concerto amang the esvogons inthis patent © C Hyperesragenena is the most prbable cause ofthis patent’ monstl clay Inthe paints condition, blood estrogen vl falls ramatialy [© E-Asthe patents coetion progresses, he esr vets may soup te 1000t0 eae} ‘2h yoa.olé woman coms tothe dnc because her polo wooks ate, ard shot experiencing fatgue and morning nausea She had he let period aknost 8 ‘weeks ag. Shes gravida 0 para O wr previous regular menso= and an Uurvemartabi modical stay she nad her monarce ath agp 13 oa. Sho has singe soxl prior and doesnot use cotaception. presentation her ‘Wal sigs re wthin norma its, Gynecological examination rowel reas 3nd Uterine eraigement. There sao cjanasis an setenng the crucal and | The venous congestion inthe pant’ reproductive organsis ue 7% tose nuence of estogens ‘A. Eerenohas tho gest blood concentaten amang te skagen 8% Inti paent © C.Hyperesrogenemia is he most prbable cause of his patent's 13% monstnul lay ©. Inthe paint’ contin, blood cetrogen level als romatcaly 12 As the patent's contin progresses, her ett eves may soup 48% to 1000t0d Result: Bistrot Explanation: ‘Corect answer E: This woman presents wth several presumptive and probable sigs of pregnancy. Dosinnvecagnossraqutes an HCG Blood est and an trate examination shouldbe pefomed we assume the patients pregnant. then the ‘estabonal apes B wets bated onthe lst nn natu poo. AL Ss Stage. placorta i dovelcping. wach ater 1 weeks of pegrancybeghns ‘toducng nomones such es human chavnic gonadotoin, progesterone, tumaa placental lactogen, and askogens. ‘Tero ate3 mor pes of estrogen: stone estradil and est. Al ‘estogen fveserense dung pregrney but estel eels go up Highest with ‘an over 1000 old nreace dung pregnancy. stl production tas nthe placenta whore colesterc converted ito ‘tognenolene. This hermane Istuther rocessd by ho fetal ronal ands Into esti! trough maple compat enzymatic modtctons.Amajoty of ‘stl transported theughout te body na conbgated for with suo: ‘lucuronide. Unconjugated extol is commonly measured a prt of eat ‘eath pone ding the second semester es the tle tee a topoten (AFP ruran choonc gonadotropin HCG}. and uncengated esl (UES) Related Videos: ‘Antero ar: Srccrina for Down Som (Aneunaty First Aid References: Fst Ad forthe USMLE Step 1 (209, 29h 69,618 Fst Afr the USMLE Step 1 (2018, 2h oa 63,61 Fst A forthe USMLE Step 12017, 27h ed 59,595 B bsctcto tt ‘Tero ate 3 mor ype of estrogen estrone eral and est Al ‘esvogen levels ease dung pregrncy but esti eels go up highest wth ‘an over 1000 old increase dug pregnancy. stil production tas nthe placenta whore colesterc converted ito ‘tognonolene. This hermane stun jxocessd by ho etal arena ands Int esi! trough mutple compat enzymatic moctctons.Amajoty of esto traneperied treughout te body n@ conpgated fom vith sufi oF ‘lucuraide, Unconjgated extol s commonly mossurd a part of oat ‘health panel daring the second semostor asthe tle tee aloo ftepotcin (FP human choenc gonadotropin ACG, and unconjugated esl (VES) ‘and quadruple test apo eteproen (47, human crencescgonadotopn| {HCG} uncorussod etl UES and sin} Areal ow eves re 8 oer progres neater. ‘Option A: Venous congestion n pregnancy fsa rest of progestin action. not cestegen. ‘Option: stone ea weak estogen and ispredominant posmenopausa, fer ovarian fat. is produced by prphra fat by aromatzaton ot Drolonged eevogen stmuistion an ln forhean deen, bese canes, 998 ‘Option C: The patent pregnant resulting the patient's menstrual dey ‘Option: Esuogen levels ise andl ring noral vsti, During fetal velopment tne cterent esiogens stone, estado and esti increase n Looming objective: Ett ha the ages encontation mong al he ‘esvogen n pregnancy. however, i ot detecablo non pregnant women Lesvac Fst Ad forthe USMLE Step 12019, 29th od 63,615 Fst forthe USMLE Step 1 2048, 2h oa 63,61 Fst A forthe USMLE Sep 12017, 27h ed 59, 595 Fst Afr the USMLE Step 12017, 27th ed 59, 505 stil poauction tans nthe placenta where cholestercsconverted ito pregnenolone. This mane sfurhor ores by hoot eronal gland Int esti hugh mustplecomplestd enaymase moctications.Aajonty of stot stranspered troughout te body ina conkcated fom with suf oF ‘hiterida.Unconegaied esol comely mueaured a pst fool ‘neath panel daring the second semester a the tile tes ona feepotehn (AFP, human chorionic gonadtopin iC and unconjugated esl (UES) ‘ne quadrupo tes po otepxoahn (47, human cree ganadatopn| (nC), uncoruased etl (UES, a nein). Arma low eves are 3 eer proses inceator. ‘Option A: Venous congaston pregnancy Ia ecu of progesth actor, not cestegen. ‘Option B:Esronois a weak esvogon ands predominant postmenopausal fer crrian fue, Ris produced by porghera ft by aromatzaton ot Snerontenedione, Worn an elevated BM hive am incresed ek for toonged esrogen stmustion and ao for ean dsease, beast cance and = recase duly progeny. . ‘Option CT pats prepares steps remtuny ‘option: Etogon lve oan fl cing normal ation, Curing fata evelopment the diferent estrogens fetone estradiol, and esti nreosen Leaming objective: Eee hae he ages concatatin among al he ‘estogersn pregnancy, however, is ot detcable in nan pregnant women. re £18 yoa-old woman presonss wih an regular menstua cyl. Sho Sas that Not ‘monsnul eyes have been ht with iogdar breakthrough bloding forthe pat ‘vee months. Ske also complane ear loss and increased the roth of facial and ogy hale She nadmonaiche aT Vial sigs te winin neal ints. Hor weights 9720 hg (2188 bande is 67cm (5M 2 Physcal examination shows ‘excessive ha gow onthe patent face, back, nea alba region, and on tops. "Tate to a gray-bronn skin cacobation onthe posto neck An abdominal uteesound shows multiple peripheral cstineth ares: Which oftho folowing ‘cals played a dect role nthe dvelopment of ths patents excessive ha grow? © A Overan foliar ct © a Aapocyos © Pht gonadoope ote © 0.Overan tne cle © = Panay ctovophs eae} Leave £18 yoa-old woman presonss wih an regular menstua cyl. Sho Sas that Not ‘monsnul eyes have been ht wth iogdar breakthrough bloding forthe pat ‘tree months. She also complane ef haloes and increased the roth of acl fend body ha, Sota monercho at 1. Vial signs ao whn nora knits. Her ‘weight 970 kg (213.81) and hog i157 em (6 ih Physical examination shows excessive Mar roman te patent face, back, nea aba reton anon ‘the hips. There ase a gay brown skin dlscobration onthe poster neck AN donna! uleccue! shows mutpepaipheal jt im bath vais, Which af he follng cas played acrect roe inthe development of ts pants excessive har row? B.Rapoones % © Prtaygonadetopie cal ox ovarian nace cats om Result: Explanation: ‘Comet answer D: Tis pation presets with igs of hyperaaragonin Inching rts, olgomenortes, se ovaries with maple pephera cysts (Sting of peas’ sign. The symptoms strongly suggest pelyeystc ovary ‘synarome (PCOS) PCOSis an endocrine sedar which has eproductne, metabo; and yperanarogess Bsc 6 oad fora patont presents tothe pyc’ ofico wih an absonce rmonsuations. Her lst petiod was 6 morths ago. Since akmesta year and a half 39, he irtnonalyrestntedher dt athe expanse of carbonydates, erred Intnsiey, and et 1.0 (387 Spe had hor mentcho at the ago of 2 and rmonstutee nomoty until yoot She isnot sonny activ. On physical ‘xara her blood pressures 100/60 rm Hg, heart at S/n, espatory rates Pin and temperatures 33°C 9657). Hor weight 55.0 (121.31) 2nd hot heights 156 em (5 #5 in Physical exainaton reveal good development of muscles aed decreased adposty. Aone scan shows decreased calm mineral ‘deposits Which statement about Ps paen’s conten cect? | Hypenroptiod muscles roto cout of adationa nckogens ‘hich erfere we the pants menstrual cycle 1. Ths patenthos insu reste Decreased aapostycontibutes to hypoostogonan pation The patent shoud be checes for hyperthyroidism becouse such ‘etensve poy kel 1 esl rom hyo hperuncton 6 oad fora patont presents to he pyc’ ofico wih an absonce rmonsuations. Hels peti was 6 months ago. Since ames year and ha Soo, ene tenon eercedher ant tthe mxpanrecfenmohyntas, exerees Intnsiey, and et 150g (397 Se had hor mantcho at the ago of 2 and rmonstutee nomoty until yoot She isnot sonny activ. On physical ‘exarnaon her blood pressures 100/60 rm Hg, heart at S/n, espatory rates 2imin and temperate s 35°C 9657). Hor weight 55.0 121.31) nd hr height i166 om (55 in}. Physical examination reveal good development of muscles and decreased aeposty. A bone scan shows decreased calium mineral ‘depos Which statement about Ps paen’s conten caret? | Hypontoptiod muscles reo cout af adationa anaragens BK ‘hich erfere we the pants menstrual cycle 1. Ths patenthos insu reste % (Decreased aapostycontibutes to hypoestogonomiamn ins 63% ton © E The patentshoud be checked erhyportyoidambecause such 9% extensive pos ike 1 esl rom hyo yperuncton ee Explanation: Comat newer : This pationt has the sgns and symptoms of the female _athete triad FAN which includes ogo famenrthea eating order. nd ‘ecreased bone density. This sa complex dsotder whch sa consequence of ‘Severo energy dt at leads o endoctna and metabo distrbances low 2M orb a aia osu in ered hypotslanic funeon hat cauees 1 decrease pals secration of thing and fllevtropi hormones Uinienintum lence te decreas sacreton of eatogen ane pogsstrene by ‘he ovaries Howevot tbe aerod Tuncionng of acipcytes i shown to contibuto to this conden aswel dpore tee sa curce of mary edocine and paracrine cubsances. Bene oe1INF@ Rotehogenic ISFBP —merlelins Foy acids Breen Tc sities L SEF Anse Resin ‘ SEG postagloncns —e *Ghtenine eae} Related Video: © Scent Aneomes esses ane First Aid References: Fst Afr the USMLE Step 1 2018, 2h e555, Fst Ad forthe USMLE Step 1(2018, 28th: 550, Fst Ad forthe USMLE Sop 12017, 27h oh 537 ‘spdoctne and prseine sussiances Fst Ald forthe USMLE Step 1(2018, 2h e550, Bene cea, TNFa otehogenie ISFBP — merlelins poy acids Prete 1 -ToFB Since L SEGF tones esitin SEG prostgloncns a Ghtnine = aiponecin — Unerownfectrs LL oe “The decroso in bodyfat porcentage plays a double role inthe pathophysiology of menrun ceorérs in FAT Deeper naocyts are the Source leptin, anamano mpicatedin apoio regulation acts onthe typathnlaml custo naclusto decease eppete ad al sults seerton of gonadetopinreleasng hamene Peripheral scpostos also ‘ona the enzye aromatase ntich converts androgen ino esogen. this patient the decrease in blood estrogens partly eased by decreed aaiposty. en ‘The decrease in boy fat percentage plays a double role nthe patnopinysiology of menstrusl orders FAT. Perera apocytes ae the cir eflepin¢herione impaled in peti rqidaton. Racts ont -ypotalame arcuate nclusto decease appette ae als sults secretion of ganadotpinreeasing namane Peipheraecpostes aso ‘contain he entjneeroncinse which converts ercropeesino exkogees this pation the decrease in blood estrogens Isparta caused by decreased ediposty. ‘Option A: Muscos are nt capable of anctogen secretions however they do possess encrogenrocopiors ‘Option B: Tare ar no sues wtih show ish senstvty decroasos in FAT, In fct hysclactivty and increased loan muscle corant are protective wth ‘eg nin sone ‘Option: Estrogens ate meted nthe vor. Th ner doesnot contribute to ypoesuogenemia in FA. ‘Option: Thyroid hormones induce uncoupling of ada phosphoration and he okecttonvanspot chain which ads to creased thormegeness and ‘mot lip mobizaton from te ay tssue storages: however. this ate ‘eplaye eign of decreased tyro nctoning such a radar end ow temperate, tLoamingobjecwe: Apocyta deiloncy plays a fle nthe patnophysilogy of ‘oma atloe td FA, They produce Important hormones and eraymee such 5 leptin, which regustes preducton aa secretion of he gonadotepi- ‘elening hormone and conve ncrogens nt estogens Bsc ‘8 2tyoa-ld woman prsonts wit eguar menses, cna, and Wctease body hat ‘row Sho say her average menstualcyl lasts 38 doy and tte that she hae heavy mensnal lesang. She hac het menarche at the age 13 year. He Blood pressures 25/80 mm He, now tate 73m, espa am, and tomperauris 367°C G81 Her ody weights 11.0 ky 22271) and heh is 70 ‘(6 87}. Physical examaton shows papular acne on er fertend and cheeks. “Tete are dark his present on her per tp petal region, tna aba, and ips. sal a dating of the anon the ee at peso nock Wc of tha follwing endocrine abnoraltes woul also most ey be foun ts patent? © A Hypotnricem {.Alostrone perproucton .erenaine hypersecrtion © E Hypoestogersm eae} ‘8 2tyoa-ld woman prsonts wit eguar menses, cna, and Wctease body hat ‘row Sho say her average menstualcyl lasts 38 doy and tte that she hae heavy mensnal lesang. She hac het menarche at the age 13 year. He Blood pressures 25/80 mm He, now tate 73m, espa am, and tomperatr is 367°C G8 Her body weights 110 hy 2227 and heights {em (5 17m) Pryseal examination shows papular acne on her eehead and cheeks. Tere ae dark as preset on her upper ip, porate nea aba the foloning endocrine abnermaiics wouk aso mos ely be ound nts patent? A Hypatnyoasm * i iesuinresitance 59% Aldosterone yperprocicion 1 1. Acrenaine rypersecrton @ Ft we Result: @ rconect Leave Explanation: ‘comect answer B: Ths paint presents wth sigs of hperandrogeism (acne and increased body hat gro) and reguar menses, which are 2 of the 3 components of plyeysti ovarian syrome PCOS) To confi the ‘agnor an utraeound seamenaton eho be petrmed to 29 the presence of pareyste ovaries a Sting of peal sign) PCOS charted ‘by mip endocrine dsturbonces whic nla hypernogens and ‘noun resets -Amajoty of women wih BOOS have isn resstance and obey. ‘cents econ, a dark sk olringn te kn fos 59 vSua gn of ‘noun reastance which canbe seen inthis pation Decreased porn ‘tssuo insulin senstivy causes compensatory hypernsulnena whe Increases Grit puse tequency. Ins eases increased Wenig homone socrton wich tart odominato ovr to flict stnusing hormone a leads to nereased ovarian androgen production, Furthermore, insulin causes inereased production of androgens bythe ‘varies vin a ict tect onthe theca call nr, anarogensineoase Instn production, leading toa vicous eye of continuous reciprocal stimulation. Lasty sun decreases the production of sox hormone binds ‘lbutin (SHES) n the iv teh favor he eeuon of ree ancrogee. Not tat theres eaactve nel reestance, The ovary remains ove 1 Related Videos: © Paro Ov eae 05 First Aid References: Fst Ad forthe USMLE Stp 12019, 28h od 631 Fst Afr the USMLE Step 1 2018, 28 eh: 627 Pst ad forthe USMLE Step 12017, 27h 605 B bsctto tt Toads ierenred ovaran andogen position Furthermore, insulin causes inereasd production of androgens bythe ‘varies via dec fect on the theca calls nt, androgens increase ‘nin roo, encing tao ee of contri tipo stimulation Lasy sun decreases te production of sox homone nde ‘lbulin (SHG) in heres wth favors he crculaton of tee androgens, [Note atthe is ceed ineuln estance, The ovary remain ertve to Insula aco and subsoquon! andiogen producto, despa asstomie stata oa —— but patent ‘wants hypetyoidem would show ther symgome such ae bracyear a, [esvac ‘Option A: Hypothyrocsem can esta mons yenctn, bua patent ‘wah ise hypetyoiem would show other smote such ae bacco, ypothorni. halos, sleepinec, and cald intolerance, This patents nt ‘@perencng any of these aceon santas ‘Option c: Adosteronehyperproducton causes hypertension and hypokalemia but does not cause menstal cycle aerators er hyperandogeism. This patent hss mld rypentension, hisuton and aigomnarhea. THs combraton ef symptoms more key to stm fom an etiology of PCOS compared to hyperadostronism. ‘Option: Acrenine hypersecretion would manfest 36 pane atacks and alptasons, sweating, Uembing or shaking, shommess ofboth, chest ‘ecomfon, and other symptoms of adrenergic hyperstmulston. Th patents rotemonsring these symptoms at ve time ‘Option E: Obese women wih PCOS can siustaneousiy have ypatesrogensm and myperancogentsm due toinceased omaton of hurogors nthe ovres and patil earwerion of ancrogens ino eatogens it peripheral apose tissue Learing objective: Piyeysti vain syrrome (PCOS) s cheractetzed by ‘mutele endocine abnernatics, namely hyperanciogenim and pepheral ‘neulnresiclance Hypernauinemia secondary to pepo inn rsttance toads to hyperanogenam rom nreosed LH secretion and et stimulation coftnecs cle Bsc te ‘73 year-old ulrauida presen for evation S weeks afr ho ast menstial ato Her previous mentation cyte was regu, ae hor mckcal istry s benign. Shes sexalyactve with one pane and doesnot use conteacepton. A tue psc pregnancy test snegatho. The wal signs a as follows blood pressure 120/80 mm Hg, heart et min espa rto Tin, ad temperturo [355°C (98.°F} The physical examinton enable for breast engorgement, Increases plgmentaton of te ripples and nea aba. The gynecalogi xanation Measurement of wach of the ellowing substances most appropriate in hs ease? © A Blood estct © 8. Urray naman chon gonacovenin Blood progesterone Urinary estogen metabolites © € Bax human chorionic gonadetiopn Bsc h e ‘73 year-old ulrauida presen for evation S weeks afr ho ast menstial ato Her previous mentation cyte was regu, ae hor mckcal istry s benign. Shes sexalyactve with one pane and doesnot use conteacepton. A tue psc pregnancy test snegatho. The wal signs a as follows blood pressure 120/80 mm Hg, heart et min espa rto Tin, ad temperturo [355°C (98.°F} The physical examinton enable for breast engorgement, Increases plgmentaton of te ripples and nea aba. The gynecalogi xanation Measurement of wach of the ellowing substances most appropriate in hs ese? A. Bhood etd 1 Unnary hua chine ganador Blood progesterone Urinary estogen metabolites feezae © E Biced man cnodonc gonadovopin Result: @ covet Leave Explanation: Related Videos: ‘Comect answer E: The patent presents wih several presumptive [lay o| ‘menses, tent engargemot, nd cuancousnyperpigmentin) and probable (crea changes) signs of pregnancy. er a negative urine human horonc gonadatpn nCG et. the net step woul nude the © fas ssroenazn ‘Human chorionic First Aid References: gonadotropin Fst Ad forthe USMLE Stop 12019, 28h of 69 estigeta Fst Ad forthe USMLE Stop 1208, 260 ooh 544 Fst Afr the USMLE Step 12017 27H dh 598 Progesterone: ssma hormone concertration ea Valo} First Aid References: Frat Aid forthe USMLE Stop 12019, 29th od: 69 Frat Aid forthe USMLE Stop 1 (200,20 od St Human chorionic gonadotropin Fst Ad forthe USMLE Stop 12017, 270 588 Progesterone Plasma hormone concentration Months since start of last menstrual period Parturition HCG tsa hormone secreted by the seyotophoblats of he pacers, HOG canbe detected as ety as tweak post conception plasma and 2 weeks aac} HCG a norane secret by he syneyStophoblats of ho placenta. HOS anbe detoctd as ety as Took post A Gonadotepes © a. Tevopes € tacotepes 2 D.Coricotopes © E Somatoropes eae} ‘Ah 22,yoa. od GIP has an uncomplicated vaginal dotvey and dobors a newer boy 99+ I wooks The APGAR scores are @ and 9 ot Yand mines, respecwely Shorty ater the deer, the cid put on mother’s chest skint ‘sn andthe mothe i encouraged inate breasteding Which of the otowing calls functions oesable lottion during this process? 1A Gonadotepes 8. Thyctopes| @ Ctacouepes D.coricoropes aabea Somatoropes Resul © conect Explanation: Related Videos: ‘corect answer C: Lacon are the col the attiorphtany which Coect Explanation: ‘Correct answer : Lactoropes are thecal of the atti uty which preieoprlacen. Prolactin has may effect, butthe most prominent of lich Stimulation ofthe mammary glands to produce mk. ‘Serum prolactin level begs to incesse ding pregnancy o prepare the ‘mammary land or mi protction The delvery ofthe placent ete sudden drop nthe level of propesteene, estegen. and human placer lactogen we the prolctn level remain constr. Enforced polcin minance ever ter repute homanes hops to estas cation. © KG Mioncepon — Seng A Hypothalamus a Anterior putty Posterior ) hutary eae} Related Videos: Prutory Glan Anterior an Posten Lobe First Aid References: Fst Ad fr the USMLE Step 12019, 20h: 323 Fst A forthe USMLE Step 12018, 28 od 321 Fst A forthe USMLE Step 12017, 27 ed 318, lactogen, whl the prolactin level remains constant. Enforced polacin minance ever ater ropoducte homanes holst estas cation. Hypothalamus. First Aid References: Freep —Sucang Pater MUSE Sp 1009.29 323 Fst A forthe USMLE Step 1(208, 28h ed 321 Fst Afr the USMLE Sep 12017 27h dh 313, Anterior phuitay Posterior hutary ‘The nowoom sung rex nates prolactin production Tho sucking rote |sbased on stimulation of he senscry nerves that cary sensory signa rom eV} » ‘The nowoom sucking refx increases proacin production Tho sucking ex |S based on stl ofthe sensery nerves that cary sensory sana rom ‘meippio to the hypathaamas va spa eo. The atest mcius othe rypothnlamas receives hs input andthe uberinkesblar eran doar ‘equate dopamine Dopamine inhib prolactn release, so a decrease in {epamino wal tesut nan increase mn polcin rseaca. Astonaly, he sucking reflex stubs the release of cxytocn rom the posterior paar ‘Oxytocin causes contraction ofthe myoeptnelal es win thelectalon cts ‘and evreik jetion, ‘Anotoreoct of prolactin is inion o hypothalamic gonadotropin

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