240 Obstetrics and Gynecology Board Review •••
❍ What are the earliest histologic changes in the endometrium following ovulation and when do they occur?
Progesterone causes mitotic arrest. The earliest histologic change that can be identified is the development of
subnuclear vacuoles. Both mitotic arrest and subnuclear vacuoles are present by postovulatory day 3 (day 17,
assuming a normal 28-day cycle).
❍ By which postovulatory day do the endometrial glands appear exhausted as it relates to the secretory phase?
By postovulatory 6 (day 20, assuming a normal 28-day cycle).
❍ On which postovulatory day does the endometrium demonstrate peak endometrial stromal edema?
Postovulatory day 8 (day 22, assuming a normal 28-day cycle).
❍ On which postovulatory day does predecidual change first begin to appear and where does it first appear?
Postovulatory day 9 (day 23, assuming a normal 28 day cycle). Predecidual change (periarteriolar cuffing) first
appears around the spiral arterioles. Predecidual cells contain glycogen.
❍ When does implantation of the fertilized ovum typically occur?
At approximately postovulatory day 9 (day 23, assuming a normal 28-day cycle).
❍ How big is the dominant follicle at the time of ovulation?
Approximately 20 and 26 mm.
❍ Define normal menstrual flow quantitatively.
Approximately 30 cc.
❍ Define menorrhagia.
Menses at regular normal intervals with excessive flow and duration.
❍ Define hypomenorrhea.
Menses at regular intervals that is decreased in amount.
❍ Define menorrhagia quantitatively.
Blood loss in excess of 80 mL.
❍ Define oligomenorrhea.
Menses at intervals >35 days.
❍ Define polymenorrhea.
Regular menses at intervals of 21 days or less
❍ Define metrorrhagia.
Menses at irregular intervals.