1. Fun with mutations. For the following mutations discuss the effect of the mutation on the sexual development of the child. Remember sex is not always determined by X and Y and looking down is also not always the answer.

Mutation knocking out the testosterone receptor in an XY infant.

Mutation knocking out 5a reductase in XY embryo:

  1. Discuss how the Sertoli cells cause the initiation and maintenance of spermatogenesis.
  1. Describe the changes in the neuroendocrine reproductive axes of children as they go through puberty.
  1. You’re up late one night watching M*A*S*H reruns, and you see the episode where Major Hoolihan of the 4077 is wondering if she’s pregnant. There are, of course, no simple urine test kits around, so Captain Hawkeye Pierce must perform a surgery on Radar’s pet rabbit. He carefully removes one of the rabbit’s ovaries and applies a urine sample from Major Hoolihan to see if it induces ovulation. What hormone is this test looking for and where is it produced? What is its function? What other hormone does it most closely resemble?
  1. Some classes of drugs are dopamine receptor blockers that are used clinically as antipsychotics. Propose what side effects this drug would have, particularly in males, with respect to the hypothalamic-pituitary axis of prolactin secretion.
  1. One of your friends who foolishly chose not to join the fun and games adventure known as MSP is confused about prolactin and oxytocin and wants to know in what ways they are similar and different.
  1. You are interviewing a (very well-informed) patient who is an expectant mother that really wants to know everything about her pregnancy. She first asks what she can expect of the relative levels of estrogen and progesterone and their effects on the uterine muscle throughout her pregnancy.

Next, she notes that there are high levels of prolactin secretion during pregnancy, and she wonders then why she will not lactate until after pregnancy.

  1. You are presenting a patient to your preceptor, and as you note that the patient is requesting birth control pills, your preceptor interrupts you and casually pulls out a conveniently placed chalkboard. Your preceptor asks you to draw the levels of LH, FSH, estrogen (Estradiol), and progesterone you would expect this patient to have while on the pill.

“Very nice!” your preceptor exclaims. You confidently return to the examining room with the pills, and the patient asks if she will still ovulate and menstruate. You respond:

Before your patient she leaves, she also wants to know if there are any risks she should be aware of while taking the pill.

  1. Although your preceptor is an internist, today seems like Ob-gyn day, as your next patient is a 43 year-old woman with some questions about menopause. She wants to know what the symptoms of menopause are, what treatments are available, and what risks are associated with the treatments.
  1. Some women experience "break through bleeding" while taking oral contraceptives. Briefly explain why this occurs (hint: think about endometrial morphology).
  1. Deprovera is a more effective contraceptive than the pill which doesn't result in "breakthrough bleeding". How is this possible?
  1. GnRH agonists are effective short-term contraceptives, but must be combined with other another agent when utilized for long-term therapy. What is the other agent and why is it necessary?