Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENRP Exam 1 > Puberty And Menstrual Disorders > Flashcards

Puberty And Menstrual Disorders Flashcards

1
Q

The menstrual cycle occurs with the maturation of what?

A

The HPO axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does GnRH stimulate?

A

FSH and LH from the anterior pituitary which stimulates estrogen and progesterone from the ovarian follicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What hormones does the anterior pituitary secrete?

A

FSH, LH, TSH, prolactin, GH and ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

FSH and LH are synthesized and stored in which cell type?

A

Gonadotrophs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which hormones does the posterior pituitary secrete?

A

Vasopressin and oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The normal ovarian cycle can be divided into which two phases?

A

Follicular and luteal phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The follicular phase of the ovarian cycle begins with what?

A

The onset of menstruation and culminates in the pre-ovulatory surge of LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The luteal phase of the ovarian cycle begins with what?

A

The onset of preovulatory LH surge and ends with the first day of menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What do decreasing levels of estradiol and progesterone from the regressing CL of the preceding cycle initiate?

A

An increase in FSH by a negative feedback mechanism which stimulates follicular growth and estradiol secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the 2 cell theory of ovarian follicular development and estrogen production?

A

LH stimulates the theca cells to produce androgens (androstenedione and testosterone); FSH stimulates the granulosa cells to convert these androgens into estrogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What suppresses LH and FSH levels during the luteal phase?

A

Negative feedback effect of elevated circulating estradiol and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If conception doesn’t occur, what happens to estrogen and progesterone levels during the luteal phase?

A

They decline near the end of the luteal phase as a result of CL regression; FSH will then rise which initiates new follicular growth for the next cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which 5 peptides are secreted from the hypothalamus and affect the reproductive cycle?

A

GnRH, TRH, somatostatin, CRF, PIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Estradiol enhances the hypothalamic release of which hormone to induce the mid cycle LH surge?

A

GnRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the average age for menarche?

A

12.43 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When does menarche occur?

A

Within 2-3 years after thelarche (breast budding) at tanner stage IV (rare before stage III)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is primary amenorrhea?

A

No menstruation by 13 yo without secondary sexual characteristics OR by age 15 with secondary sexual characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the average blood loss per menstrual period?

A

30cc (changing pad 3-6 times a day); >80cc has been associated with anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is puberty?

A

The development of secondary sexual characteristics and the acquisition of reproductive capability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When does puberty usually occur?

A

Between 10-16 yo (mean is 12.4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the factors that determine the onset of puberty?

A

Genetic factors including race; geographic location (girls that live in metropolitan areas, at altitudes near sea level begin earlier); nutritional status (obese will have early onset whereas malnourished will have later onset)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When does a female infant acquire the lifetime peak number of oocytes?

A

By mid gestation (16-20 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is the HPO axis suppressed?

A

Between the ages of 4-10 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the gonadostat?

A

The hypothalamic-pituitary system regulating gonadotropin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

At what age is there an increase in DHEA, DHEA-S, and androstenedione?

A

Between the ages of 8-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the initial endocrine changes associated with puberty?

A

Adrenal androgen production and differentiation by the zona reticularis of the adrenal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What causes growth of axillary and pubic hair (adrenarche or pubarche)?

A

Rise in adrenal androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

At what age is there a gradual loss of sensitivity by the gonadostat to the negative feedback of sex steroids?

A

Around 11 years of age; in combination with the intrinsic loss of CNS inhibition of hypothalamic GnRH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When do sleep associated increases in GnRH secretion occur and gradual lay shift into adult type secretory patterns?

A

Around the onset of puberty

30
Q

What leads to the development of secondary sexual characteristics at the onset of puberty?

A

Increase in GnRH promotes ovarian follicular maturation and sex steroid production

31
Q

What event occurs by mid to late puberty?

A

The positive feedback mechanism of estradiol on LH release from the anterior pituitary gland is complete and ovulatory cycles are established

32
Q

What are the stages of normal puberty development?

A

Thelarche —> adrenarche —> peak height velocity (max growth) —> menarche —> mature sexual hair and breasts

33
Q

What is thelarche?

A

Breast development and first physical sign of puberty; unilateral development in first 6 months is not uncommon; requires estrogen

34
Q

Pubarche and adrenarche require which hormone?

A

Androgens

35
Q

When does maximal growth or peak height velocity occur?

A

Occurs 2 years earlier in girls; occurs about 1 year before onset of menses

36
Q

What does menarche require?

A

Pulsatile GnRH from the hypothalamus, FSH and LH from the pituitary, estrogen and progesterone from the ovaries, and a normal outflow tract

37
Q

What is the tanner staging for breast development?

A
  1. Preadolescent elevation of papilla only;
  2. Breast bud stage; elevation of breast and papilla as a small mound with enlargement of the areolar region;
  3. Further enlargement of breast and areola without separation of their contours;
  4. Projection of areola and papilla to form a secondary mound above the level of the breast;
  5. Mature stage; projection of papilla only resulting from recession of the areola to the general contour of the breast
38
Q

What is the tanner staging for pubic hair development?

A
  1. Preadolescent, absence of pubic hair;
  2. Sparse hair along the labia; hair downy with slight pigment;
  3. Hair spreads sparsely over the junction of the pubes; hair is darker and coarser;
  4. Adult type hair; there is no spread to the medial thigh;
  5. Adult type hair with spread to the medial thighs assuming an inverted triangle pattern
39
Q

What is precocious puberty?

A

Refers to the development of any sign of secondary sexual characteristics prior to an age 2.5 SD earlier than the expected age of pubertal onset; 8 years old for girls and 9 years old for boys

40
Q

Precocious puberty can lead to what?

A

Premature fusion of the long bones of the epiphysis

41
Q
A

When secondary sexual characteristics have not appeared by the age of 13; if thelarche has not occurred by age 14; no menarche by age 15-16; when menses has not begun 5 years after the onset of thelarche

42
Q

What is secondary amenorrhea?

A

Pt with prior menses has absent menses for 6 months or more

43
Q

What tests can be used to evaluate primary amenorrhea without sexual secondary sexual characteristics?

A

MRI of the brain, FSH, karyotype, progesterone prolactin; if karyotype comes back with a Y chromosome gonadectomy is recommended to prevent malignant neoplastic transformation

44
Q

What are some causes of menstrual irregularity?

A

Pregnancy, endocrine changes, acquired conditions, tumors

45
Q

What are some endocrine causes of menstrual irregularity?

A

Poorly controlled DM, PCOS, Cushing’s syndrome, thyroid dysfunction, premature ovarian failure, late onset congenital adrenal hyperplasia

46
Q

What are some acquired conditions that can cause menstrual irregularity?

A

Stress related hypothalamic dysfunction, meds, exercise induced amenorrhea, eating disorders (anorexia, bulimia)

47
Q

Which tumors can cause menstrual irregularities?

A

Ovarian and adrenal tumors, prolactinomas

48
Q

What will be seen upon a history and physical in someone with secondary amenorrhea?

A

Significant changes in wight, strenuous exercise, dietary habits, concomitant illness, abnormal facial hair, galactorrhea, dyspareunia, presence of hot flushes and/or night sweats

49
Q

Which labs should be performed for secondary amenorrhea?

A

Urine HCG, TSH, prolactin, FSH

50
Q

What are microadenomas?

A

Typically slow growing and rarely malignant; can be monitored with repeat prolactin measurements and imaging; tx should focus on management of infertility, galactorrhea, breast discomfort; consideration for dopamine agonist

51
Q

How are macroadenomas treated?

A

With dopamine agonists; transphenoidal resection or craniotomy

52
Q

What can cause hyperprolactinemia (<100ng)

A

Ectopic production due to bronchogenic carcinoma, ovarian dermoid cyst, RCC, gonadoblastoma; breast feeding and stimulation, excessive exercise, severe head trauma, hypothyroidism, liver or renal failure, meds (OCPs, antipsychotics, antidepressants, anti-HTN, H2 blockers, opiates, cocaine)

53
Q

What can cause hyperprolactinemia (>100ng)?

A

Pituitary adenoma and empty sella syndrome

54
Q

What is the history for a pt with hyperandrogenism?

A

PCOS and late onset CAH often appear during puberty and progress slowly; neoplastic disorders can occur at any time and rapid virilization is common

55
Q

What is seen on PE for a pt with hyperandrogenism?

A

Degree of hirsutism, acne, alopecia, should be documented; look for evidence of Cushing’s dz; Acanthosis nigricans; bimanual exam to assess for ovarian enlargement

56
Q

What is virilization?

A

A masculinization of a female associated with marked increase in circulating testosterone; enlargement of the clitoris, temporal balding, deepening of voice, decreased breast size, loss of female body fat distribution, and hirsutism; results from excessive male hormone production or exogenous hormone use

57
Q

Which labs should be performed to evaluate a pt with hyperandrogenism?

A

17-hydroxyprogesterone level to exclude CAH; 24 hr free urinary cortisol or overnight dexamethasone suppression test to r/o Cushings; prolactin and TSH to exclude hyperprolactinemia +/- thyroid dz; glucose and lipid levels; testosterone and DHEA-S

58
Q

If DHEA-S levels are above 7000 what should be suspected?

A

Adrenal androgen producing tumor

59
Q

If total testosterone levels are >200 what should be suspected?

A

Ovarian androgen producing tumor

60
Q

What is polymenorrhea?

A

Abnormally frequent menses at intervals of <21 days

61
Q

What is menorrhagia (hypermenorrhea)?

A

Excessive and/or prolonged bleeding (>80mL and >7 days) occurring at normal intervals

62
Q

What is menorrhagia?

A

Irregular episodes of uterine bleeding

63
Q

What is menometrorrhagia?

A

Heavy and irregular uterine bleeding

64
Q

What is intermenstrual bleeding?

A

Scant bleeding at ovulation for 1-2 days

65
Q

What is oligomenorrhea?

A

Menstrual cycles occurring >35 days but less than 6 months

66
Q

What is dysfunctional uterine bleeding?

A

Defined as abnormal uterine bleeding that cannot be attributed to meds, bloody dyscrasias, systemic dz, trauma and organic conditions

67
Q

What are the two classifications for abnormal bleeding in reproductive aged women?

A

PALM (structural causes) and COEIN (non structural causes)

68
Q

What does PALM stand for?

A

Polyp, adenomyosis, leiomyoma (submucosal myxoma or other myoma), malignancy and hyperplasia

69
Q

What does COEIN stand for?

A

Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

70
Q

How should massive abnormal uterine bleeding be treated?

A

Hospitalization and transfusions if hemodynamically unstable; 25mg IV conjugated estrogens then hormonal treatment (combination hormonal therapy, Mirena)

71
Q

How should moderate AUB be treated?

A

Combination OCP’s, Mirena

72
Q

How should AUB be treated when the pt is unresponsive to conservative therapy?

A

D&C, polypectomy, myomectomy, endometrial ablation, hysterectomy

ENRP Exam 1 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions