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Endo/Repro Exam 2 > DSA > Flashcards

DSA Flashcards

1
Q

Menstrual cycle occur with the maturation of the

__________

A

hypothalamic-pituitary-ovarian axis.

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2
Q

(GnRH) from the hypothalamus stimulate(FSH) and(LH) from the anterior pituitary, which stimulates ________ and _______ from the _______

A

estrogen and progesterone relase from ovarian follicle

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3
Q

What initiates an increase in FSH -> follcular growth and estradiol secretion at the begining of our period?

A

Decreasing levels of estradiol & progesterone from the regressing corpus luteum of the cycle b4

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4
Q

• LH stimulates

A

theca cells to make androgens (androstenedoine and testosterone)

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5
Q

• FSH stimulates

A

granulosa cells to convert androgens -> estrogens

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6
Q

• LUTEAL PHASE

levels of LH and FSH

A

supressed. d/t negative feedback of elevated cirulated estradoil and progesterone

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7
Q

what happens if conception does not occur

A
  1. CL regresses -> decreasing estrogen and progesternoe levels
  2. will eventually. cause a. rise in FSH
  3. FSH will stimulate. new follicular. growth
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8
Q

• 5 peptides or biogenic amines that affect the reproductive cycle have been isolated from the hypothalamus •

  1. Gonadotropin-releasing hormone (GnRH) •
  2. Thyrotropin-releasing hormone (TRH) •
  3. Somatotropin release inhibiting factor (SRIF) or somatostatin •
  4. Corticotropin-releasing factor (CRF) •
  5. Prolactin release-inhibiting factor (PIF) •

All exert specific effects on the hormonal secretion of the anterior pituitary gland.

A

released from arcuate nucleus in pulses bc short half life -> release LH and FSH

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9
Q

Estradiol appears to ______ the hypothalamic release of GnRH and induce the midcycle LH surge •

Gonadotropins have and ____ effect on GnRH release

A

enhance

inhibit

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10
Q

ESTROGEN •

During early follicular development estradiol levels are low • Approximately _____ before ovulation, estradiol (E2) levels begin to increase

A

1 wk before

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11
Q

Estrogen levels 1 day before ovulation

A
  1. Estrogen levels reach. max 1 day before the midcycle LH peak.
  2. After peak but before ovulation, there is a marked decrease
  3. During luteal phase, estradoil levels rise 5-7 days after ovulation -> goes to normal
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12
Q

Progesterone in the ovarian cycle

A
  1. Follicular stage: small amount of progesterone is made d/t peripheral conversion of adrenal pregnenolone and PG sulfate
  2. Unruptured luteinizing graafian follicle begins to make increasing amounts of progesterone
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13
Q

What happens as the graafian follicle is formed?

A

Granulosa cells differentiate

  1. Cumulus oophorus -> adheres to ovum
  2. Corona radiata -> innermost layers of granulosa cells that become elongated. released with oocyte. at ovulation
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14
Q

Hormonal changes in cycle

A
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15
Q

• The first day of menstruation is known as cycle day 1. What happens

A

Endometrial glands and stroma disintegrate

Leukocytes infiltrate

RBC invate

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16
Q

Proliferative phase

Characterized by endometrial growth/proliferation d/t ______.

What else happens

A

Estrogen

Increase in lgenth of spiral arties

Increase in mitosis

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17
Q

Secretory phase

1. progesterone secretion by the corpus luteum stimulate the glandular cells to secrete ___________.

2. Gland change:

3. Mitosis: ________

4. Endometrial lining:

A
  1. mucus, glycogen and other substances
  2. glands become totruos
  3. mitosis is rare
  4. endometrial lining: full thiccnes
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18
Q

1 day prior to the onset of menstruation____________ occurs resulting in ischemia of the endometrium, leukocytes infiltration and RBC extravasation.

A

spiral arteries constrict where they. meet. with straight.at. statum basale

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19
Q

Intact ______ pathway is important in regulating menstruation

A

coagulation

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20
Q

Menarch (period) occurs within 2-3 years _____ thelarche (breast budding) at Tanner stage ____, rare before Tanner stage ___

A

after

IV

III

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21
Q

By the age of ____ years old 98% of females will have had menarche

A

15

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22
Q

Primary amenorrhea is defined as:

A
  1. absence of menarche by age 13 years _without secondary sexual developmen_t
  2. OR by the age of 15 with secondary sexual development
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23
Q

Menstrual cycles are often _____ throughout adolescents, especially from first to the second cycle.

A

irregular

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24
Q

Most normal cycles range from _____ days even in first gynecologic year.

A

21-45

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25
**Secondary amenorrhea** is defined
**absence of menstruation for 6 months.** **It is rare to not have pd for longer an 3 months. If so, workup is needed: check urine or serum B-hcG to rule out pregnancy.**
26
Oligomenorrhea
**Menstrual cycles at \> 35 day cycles**
27
**Menorrhagia**
Menorrhagia (hypermenorrhea): Regular intervals that are very heavy with excessive and/or prolonged menses (\>80mL and \> 7 daysvals)
28
**Metrorrhagia**
**irregular bleeding** intervals; often times in the middle of cycle
29
**Menometrorrhagia**
Heavy & irregular uterine bleeding
30
**Intermenstrual bleeding**
Scant bleeding at ovulation for 1 or 2 days
31
First menses is usually reported as **medium flow**. • * Mean blood loss per menstrual period is ____ • * Most report changing a pad\_\_\_\_ times a day • * Greater then ____ has been associated with **anemia** • * Changing a pad ____ is considered excessive especially if bleeding is lasting \> ___ days.
**30cc** **3-6** **80cc** **every 1-2 hours** **more than 7 days**
32
what. is the classification system for abnormal bleeding in reproductive-aged women
1. **PALM** (structural causes) 2. **COEIN** (nonstructural causes)
33
**PALM (structural causes) of abnormal bleeding**
**AUB= abnormal uterine bleed** 1. Polp (AUB-P) 2. Adenomyosis (AUB- A) 3. Leiomyoma (AUB-L) 1. submucosal myoma (AUB- L sm) 2. othre myoma (AUB- L o) 4. Malignancy and hyperplasia (AUB-M)
34
**_AUB-P_** **What happen:** **Cause:**
* Endometrial polyps form on endometrium and creat soft friable protrusion into endometrial cavity: * causes menorhagia (heavy bleeding \>80cc), spontaneous of post-menopausal bleeding.
35
**AUB-A**
* **Adenomyosis**: endometrial glands and stroma break through the muscle wall of the uterus (myometrium) \>2.5mm in basiis layer * Cells that break through will not undergo proliferative/secretory cycles * can cause endometriosis (15%) * Sx: asymptomatic, secondary dysmenorrhea and menorhaggia *
36
**What is the MOST common neoplasm of the uterus?**
**AUB-L** ## Footnote **Uterine leiomyomas (FIBROIDS)**
37
Polyhydraminos Oligohydraminos
too much fluid too little fluid
38
**AUB-L**
Uterine Leiomyomas (fibroids) ## Footnote Fibroids are benign tumors from the smooth muscles of the myometrium. 45% of wommen will have them by 5th decade.
39
Symptomatic fibroids can cause:
1. Excessive uterine bleeding 2. Pelvic pressure/pain 3. Infertility
40
• Most common indication for hysterectomy is \_\_\_\_\_\_\_\_\_\_
**SYMPTOMATIC FIBROIDS**
41
• RISK FACTORS for developing fibroids
1. Increasing age in reproductive years 2. African-american women have a 2-3 fold increase 3. Nulliparity (a woman who has never had a child) 4. FH
42
Top 3. areas where fibroids occur
1. Subserosal fibroid 2. Interstitial fibroids 3. Submucosal fibroids
43
**Fibroid** Pathogenesis: Sx:
* Pathogenesis: unknown, rarely form b4 mencarche or enlarge after menopause. Estrogen causes proliferation. of smooth muscle cells. can enlarge during pregnancy * Sx: most are asymptomatic * pelvic pain * severe pain not. common unless undergoing acute infarction * Frequency of urination bc presses on bladder * Prolonged or heavy bleeded * Increased incidence of infertility. (common d/t submucosal fibroids).
44
(aub-m)
**ENDOMETRIAL HYPERPLASIA, a precursor to endometrial cancer.** Endomestrial lining keeps growing d/t persitant unopposed estrogen by granulosa theca cell tumors (make EST), obesity, exogenous estrogens, tamoxifin
45
**• Hyperplasia- precursor to malignancy** Simple without atypia • (\_\_\_& chance to develop cancer)... Complex without atypia • Simple with atypia • Complex with atypia
**Simple without atypia (1%)** **Complex without atypia • (3%)** **Simple with atypia • (9%)** **Complex with atypia (27%)**
46
most common type of endometrial hyperplasia? Risk factors? Presentation?
1. **Type 1: Endometrial adnenocarcinoma** 2. **Obesity and unopposed estrogen** 3. **Postmenopausal bleeding is the most common presentation**
47
**AUB-C**
**Coagulopathies, nonstructural cause,** associated with heavy flow often d/t von willibrand factor disease
48
**AUB-O**
**Ovulatory Dysfunction:** unpredictable menses with variable flow often d/t polycystic ovarian syndrome
49
**AUB-E**
**Endometrial Causes** such as infection
50
**AUB-I**
**Iatrogenic**: IUD, IUS, exogenous hormones
51
AUB-N
**Not Yet Classified** Reserved for entities that are poorly defined &/or not well examined, ex
52
**treatment options for abnormal uterine bleeding.**
**1. Coordinate endometrial sloughing** * **MPA (medoroxyprogesterone) or combined oral contraceptives (OCP's)**:If someone has AUB: give progesterone, make it seem like she had her cycle, have her come off of progesterone, causing her to slough. **2. Endometrial supression** 1. **Give progesterone daily,** tricks body to think pregnany 2. **Continous OCPs,** BC without placebo pills. Instead, start a new padk. 3. **IUS** (intrauterine system)
53
**Be familiar with the work up options for uterine bleeding.**
**Laboratory Tests** 1. Pregnancy test (blood or urine) • 2. CBC 3. Screening for bleeding disorders * Von Willebrands profile * PT and PTT 4. TSH 5. Chlamydia trachomatis
54
Available Tissue Sampling Methods (When indicated)
1. Office endometrial biopsy 2. Hysteroscopy directed endometrial sampling
55
What are indications for **in office endometrial biopsy**
* 1. AUB in post-menopausal women * 2. Women 45-menopase with ANY AUB. * 3. Woman \< 45: any bleeding that occurs d/t unopposed estrogen exposure; obesity, PCOS or prolonged amenorrhea * 4. + glandular cells on cervical cytology test.
56
**PUBERTY** • Average duration is ____ years. • Usually occurs between \_\_\_\_y/o (mean is \_\_\_)
**Puberty**-\> development of secondary. sex xharacteristics. and reproductive capability. 4-5 10-16 Mean: 12.4. years old
57
Stages of normal pubertal. development (4)
**_TAGM (thelarche, adrenarche, growth spurt, menses)_** * **1. Thelarche** (breast development) is the first sign of puberty and REQUIRES estrogen * 2. **Pubarche/adrenarche** (pubic hair/axillary hair develpment) REQUIRES androgens. * 3. **Max growth or peak height velocity.** * Occurs 2 years earlier in girls, 1 year before onset of menses. * 4. **Menses**, requires pulsatile GnRH, FSH and LH, estrogen and progesterone from ovaries and normal outflow tract
58
what races go through puberty earlier
**African american -\> and hispanic**
59
**Tanner. stageing** is the stages of breast development
* **Stage 1:** Preadolescent: papilla elevates * **Stage 2:** breast bud form; breast and papilla elevate into a small mound with arealar region enlarging * **Stage 3:** Breast.and areola get bigger w/o separation of countours * **Stage 4:** areola and papilla project to to form a secondary mound above breasts * **Stage 5:** mature stage: projection of papilla only, d/t retraction of areola.
60
Tanner. stageingis the stages of **pubic hair** development
* Stage 1: preadolescent: **none** * Stage 2: **sparse** hair along labia with slight pigment * Stage 3: hair **spreads** over junction of pubes * Stage 4: **adult type** hair * Stage 5: a**dult type hair that. spreads to medial thigh**

Endo/Repro Exam 2 (17 decks)

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