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(DIT) Rapid Fire + 4/5 Stars > Female Reproductive > Flashcards

Female Reproductive Flashcards

1
Q

Oogenesis

A 
Oogonium (one 2N) -->
Primary oocyte (one 2N) arrested in prophase I until ovulation
OVULATION
Secondary oocyte (one 1N, one polar body) arrested in Metaphase II until fertilization

FERTILIZATION
Ovum (one 1N and one polar body)

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2
Q

Draw Two cell theory of estradiol production

A

page 272

Pulsatile GnRH –> FSH and LH secretion

LH stimulates theca cells… Cholesterol converted by desmolase to androstenedione

Androstenedione crosses basement membrane, enters granulosa cell

Granulosa cell is stimulated by FSH
Aromatase converts androstenedione to estrone
Estrone –> estradiol

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3
Q

Steps of female reproductive cycle

A
  1. increased FSH
  2. follicle maturation
  3. increased estrogen
  4. negative feedback –> positive feedback
  5. LH surge triggers ovulation
  6. Formation of corpus luteum
  7. increases progesterone (and estrogen) –> negative feedback
  8. decreased FSH and LH
  9. Degeneration of corpus luteum
  10. decreased progesterone and estrogen
  11. Menstruation, decreased inhibition of FSH
  12. increased FSH - starts over
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4
Q

Draw reproductive cycle

A

page 273

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5
Q

Pregnancy steps

A

Fertilization w/in 1 day of ovulation in ampulla of tube

Implantation 6 days after fertilization

Syncytiotrophoblasts secrete hCG

  • corpus luteum maintained
  • hCG has same alpha subunit as LH, FSH, TSH - acts like LH on follicle
  • hCG in blood 1 week after fertilization, in urine 2 weeks after
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6
Q

Location steps

A

alveoli –> lobule –> ducts

Suckling stimulates release of:
Prolactin - anterior pituitary –> milk production (secretion)
Oxytocin - posterior pituitary –> milk ejection - alveoli –> ducts

Estrogen and progesterone inhibit milk production

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7
Q

Average age of menarche

A

just under 12.5 years

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8
Q

Treatment of anovulatory cycles

A

OCPs

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9
Q

Menorrhagia

A

heavy, prolonged periods

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10
Q

Metrorrhagia

A

Frequent, irregular periods

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11
Q

menometrohhagia

A

heavy, frequent, irregular periods

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12
Q

Oligomenorrhea

A

more than 35 day cycle, infrequent periods

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13
Q

polymenorrhea

A

less than 21 day cycles, frequent periods

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14
Q

primary dysmenorrhea

A

no cause

tx: NSAIDs +/- hormone contraceptives

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15
Q

Progestins

A

birth control
abnormal uterine bleeding
oppose proliferative effect of estrogen on endometrium

adverse effect - irregular bleeding, wt gain, mood changes
decreased bone mineral density

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16
Q

Estrogens side effects

A

endometrial hyperplasia
growth of estrogen-responsive cancers
increased risk of DVT, PE
metabolized by P450 - caution with inducers

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17
Q

Side effects of combined estrogen-progestin contraceptives

A

venous thromboembolism
HTN
MI and stroke
Hepatic adenoma

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18
Q

Risks of paraguard (copper IUD)

A

uterine perforation

increased risk of PID w/in 3 weeks of insertion

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19
Q

Menopause

A

avg 51.4 years
under 40 yo = primary ovarian insufficiency

cause: depletion of ovarian follicles

12 mo amenorrhea

Ovaries stop: decreased estradiol, decreased inhibin

no negative feedback: increased GnRH, FSH, LH

Estrone becomes main estrogen

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20
Q

Symptoms of low estrogen levels

A

“Menopausal Symptoms wreak HAVOC”

Mood change - depression
Sleep disturbances
Hot flashes - vasomotor sx
Atrophy of vagina
Vaginal dryness
Osteoporosis
Coronary artery dz
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21
Q

Menopausal hot flashes

A

Occur in 75% of menopausal women

Starts in face/chest then generalizes
associated w/ diaphoresis and palpitations, followed by chills and shivering
lasts 2-4 minutes

May cause sleep disturbances

Tx: estrogen replacement > SSRI, SNRI, gabapentin

Herbal tx: soy isoflavones, red clover, black cohosh, vitamin E

22
Q

Hormone replacement therapy for menopause

A

Use estrogen + progesterone if uterus present
-unopposed estrogen increases risk of endometrial cancer

For relief of sx, not to prevent chronic dz (CAD, osteoporosis)

Use for only shortest about of time and at lowest dose needed

Avoid if:
Coronary heart dz
active liver dz
Hx of breast cancer, stroke, venous thromboembolism

23
Q

Vulva cell type

A

stratified squamous
Labia majora - keratinized
labia minora - nonkeratinized

24
Q

Vagina cell type

A

stratified squamous, non keratinized

25
Q

Ectocervix cell type

A

nonkeratinized stratified squamous

26
Q

Endocervix cell type

A

simple columnar epithelium - mucus secreting

27
Q

Transformation zone

A

squamo-columnar junction

metaplastic cells transform columnar –> squamous depending on age and hormonal status

immature squamous cells vulnerable to HPV

majority of cervical cancers arise at squamocolumnar junction

28
Q

Body of uterus cell type

A

simple columnar ciliated, secretory

long tubular glands

29
Q

Fallopian tube cell type

A

simple columnar, ciliated, secretory

peg cells - resting

30
Q

ovary cell type

A

simple cuboidal

31
Q

Sarcoma botryoides

A

aka embryonal rhabdomyosarcoma

infants and kids under 5

grape like mass out of vagina

32
Q

Clear cell adenocarcinoma

A

rare

DES exposure in utero

mullerian duct anomalies - T shaped uterus
Vaginal adenomas - patches of columnar epithelium in vagina

33
Q

Squamous cell carcinoma of vagina

A

HPV 16, 18, 31

34
Q

Lichen sclerosus

A

Prepuberty/postmenopausal

Inflammatory condition of vulva - thinning of epidermis

smooth white plaques

lead to shrinking of introits, fusion of labia majora and minora

Sx: pain, pruitis, dyspareunia

dx via bx

Tx: topical corticosteroids

assoc w/ increased risk of squamous cell carcinoma of vulva

35
Q

Squamous cell carcinoma of vulva

A

chronic inflammatory condition
HPV infection 16*, 18, 31 –> koilocytosis

coexist w/ cervical cancer

36
Q

Paget dz of vulva

A

intraepithelial cancer
adenocarcinoma
10-20% underlying malignancy (100% in breast Pagets)

37
Q

Cervical dysplasia

A 
can lead to cancer
Risk:
persistent high risk HPV 16, 18
early coitarche
multiple sex partners
immunosuppression
smoking -impairs immune system
OCP use - not protecting against STDs
Hx of STDs
Sx: abnormal bleeding esp postcoital
vaginal discharge
pelvic or LBP
bowel and bladder sx
ureteral obstruction --> pyelo, uremia, renal failure
38
Q

HPV mechanisms –> cancer

A

E6 binds p53 - degrades it
E7 binds Rb, inactivates it

Most squamous cell but some adenocarcinoma

39
Q

Screening for cervical cancer

A

Pap - transformation zone
HPV - koilocytes
darkening of cell

HPV DNA testing

40
Q

CIN 1

A

mild dysplasia
low grade SIL
bottom 1/3 epithelium

41
Q

CIN2

A

Moderate dysplasia
high grade SIL
precancerous
bottom 2/3 epithelium

42
Q

CIN3

A

severe dysplasia
high grade SIL
precancerous
throughout epithelium

43
Q

CIS

A

full thickness of epithelium involved

next step invasion

44
Q

Risk of endometrial hyperplasia

A

Too much estrogen

anovulation - stuck in estrogen dominant phase - PCOS

increaed estrogen production - obesity, granulosa cell tumor

–> endometrial carcinoma

45
Q

Endometrial carcinoma

A

MC in US
post menopausal 55-65 yo
prognosis stage 1 80-90%

Present: irregular bleeding or post menopausal bleeding

dx: endometrial bx

46
Q

Endometritis

A

inflammation of endometrium

ascending infection
acute: postpartum
Chronic: PID, retained FB

**Plasma cells in endometrium

TX: broad spectrum Abx - gentamycin, clindamycin

47
Q

Adenomyosis

A

endometrium extends into myometrium
-enlarged globular uterus tender to palpation

Sx: menorrhagia, dysmenorrhea, dysparenia, pelvic pain

Tx: hysterectomy

48
Q

Endometriosis

A

Endometrial tissue found outside uterus

  • functional
  • -> fibrosis and adhesions
  • pain

Sx: dysmenorrhea, pelvic pain, dyspareunia, infertility, dysuria, dyschezia - bowel involved

MC site: ovaries - ovarian cysts filled with old blood - Chocolate cyst

Uterine ligaments
bowel
bladder
lungs
bone
heart

powder burn implants

49
Q

Treatment of Endometriosis

A

NSAIDs, OCPs, progestine

leuprolide - continuous GnRH agonist

Danazol - synthetic androgen –> negative feedback

  • Use in endometriosis, fibrocystic breast dz, hereditary angioedema
  • SE: acne, hirutism, deepening of voice, wt gain, hot flashes, decreased HDL, hepatotoxicity
50
Q

Leiomyosarcoma

A

rare malignant tumor arising de novo from myometrium

rapidly enlarging uterus

51
Q

Uses of leuprolide

A

GnRH analog binds GnRH receptors
initial release of FSH, LH, estrogen

Continuous administration down regs GnRH receptors –> decreased FSH, LH, estrogen
–> hypogonadotrophic state

Leiomyomas - shrink prior to surgery
-short term

Endometriosis
Central precocious puberty
Advanced prostate cancer

Infertility

  • continuously to suppress intrinsic hormone production during IVF
  • given once to induce ovulation

SE: amenorrhea, hot flashes, decreased libido, depression, bone loss

52
Q

Leiomyomas (Leiomyomata uteri)

A

MC - 70-80%
Benign tumor of sm.m. of myometrium

Monoclonal
hormonally sensitive - shrink after menopause

Multiple well circumscribed tumors

Histo: whorled pattern of sm.m.

Sx: most asx

  • menorrhagia
  • dysmenorrhea
  • pelvic pressure/discomfort
  • acute pelvic pain - twisted on stalk or outgrow blood supply –> degeneration
  • infertility
  • miscarriage
  • urinary frequency

Dx: PE followed by US
-nontender enlarged uterus w/ irregular contours

Tx: hysterectomy or myomectomy
Leuprolide pre-op to shrink

(DIT) Rapid Fire + 4/5 Stars (162 decks)

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