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Clin Med Exam 2 > Female Reproductive Tract > Flashcards

Female Reproductive Tract Flashcards

1
Q

Origin of Female reproductive disorders

A

> central
ovarian
end-organ dysfunction

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2
Q

Central: Neuroendocrine feedback axis

A

> Pituitary
Hypothalamus
CNS -> Hypothalamus

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3
Q

Central: hypothalamic-pituitary function

A

Change in rate or dose of secretion of Gonadotropin-Releasing hormone (GnRH) by the hypothalamus

May cause an altered pituitary response

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4
Q

Altered pituitary function ->

A

results in ovarian dysfunction

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5
Q

Ovarian dysfunction ->

A

altered target tissue response

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6
Q

Factors affecting GnRH release:

A

Psychological stress

Body fat content

Change in rate, frequency, intensity of exercise

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7
Q

Amenorrhea ->

A

altered GnRH release from the hypothalamus in young athletic woman

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8
Q

Disorders of the ovary:

A

Proper ovarian function dependent upon responsiveness of the ovaries, follicles to gonadotropins

1) Polycystic Ovary Syndrome (PCOS)
2) Anovulation
3) Hirsutism
4) Infertility
5) Dyslipedemia
6) Abnormal uterine bleeding
7) Amenorrhea

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9
Q

Polycystic Ovary Syndrome (PCOS) =

A

result of altered response to gonadotropins

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10
Q

Anovulation =

A

ovaries do not release an oocyte during a menstrual cycle

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11
Q

Hirsutism =

A

imbalance of sex hormones resulting in excessive hair growth

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12
Q

Infertility =

A

inability to reproduce

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13
Q

Dyslipedemia =

A

unhealthy levels of one or more kinds of lipid in the body

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14
Q

Abnormal uterine bleeding =

A

dysfunctional uterine bleeding -> atypical timing, rate, and length of bleeding through the menstrual cycle

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15
Q

Amenorrhea =

A

absence of a menstrual period in a woman of reproductive age

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16
Q

Disorders of the uterus, fallopian tubes, and vagina

A

Normal menstrual bleeding directly related to normal growth state of the uterine endometrium

Disorders of the uterus often present with abnormal vaginal bleeding

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17
Q

Disorders of the uterus, fallopian tubes, and vagina include:

A

> Hormonal dysfunction

> Fibroids, benign tumors

> Malignant tumors

> Initial presentation -> abdominal and pelvic pain with fever, elevated WBC count, positive endocervical culture

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18
Q

Pelvic Infection =

A

can produce adhesions and scarring of the endometrium and/or fallopian tubes -> may result in infertility

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19
Q

Common infectious agents:

A

gonorrhea
anaerobic bacteria chlamydia

Infection symptoms can be minimal or absent

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20
Q

Secondary prevention:

A

aggressive screening

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21
Q

Tertiary prevention:

A

Prompt antibiotics

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22
Q

Disorders of pregnancy:

A

The typical and multiple steps of pregnancy increase the likelihood of localized and systemic disorders

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23
Q

Implantation ->

A

opportunity for miscarriage

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24
Q

Genetic predisposition to diseases may be manifested during pregnancy

A

Diabetes = the placenta produces a hormone called human chorionic somatomammotropic (HCS)

Transient gestational diabetes = 2-5% of pregnancies

Correlation with Type 2 diabetes mellitus

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25
Q

human chorionic somatomammotropic (HCS)

A

> causes an elevation in blood glucose

> Due to insulin resistant features of pregnancy = blood glucose is more difficult to regulate

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26
Q

Pregnancy: blood glucose control

A

Poor control of blood glucose during pregnancy has an effect of the mother, the pregnancy, and the fetus

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27
Q

Mother ->

A

> Retinopathy
Nephropathy
Ketoacidosis
Hypoglycemia
Infection
Preeclampsia
Increased rate of cesarean section

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28
Q

Retinopathy:

A

damage to the blood vessels that supply the retina resulting in vision problems

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29
Q

Nephropathy:

A

kidney damage and loss of function

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30
Q

Ketoacidosis:

A

inadequate insulin supply or insulin resistance leads to build up of ketones in the body due to fat as a fuel source

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31
Q

Hypoglycemia:

A

low blood glucose levels

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32
Q

Infection:

A

high blood glucose impairs the body’s immune system = decreased ability to respond to pathogens

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33
Q

Preeclampsia/eclampsia:

A

high blood pressure during pregnancy that can lead to a cascade of significant conditions such as impaired liver function, kidney dysfunction, swelling, fluid on the lungs

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34
Q

Fetus ->

A

> Death

> Spontaneous abortions

> Congenial Anomalies

> Macrosomia

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35
Q

Macrosomia =

A

large body size = high maternal blood glucose triggers increased fetal insulin secretion resulting in a larger fetus size

Large fetus size increases the risk of fetopelvic disproportion = traumatic vaginal delivery or increased cesarean section frequency

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36
Q

Neonatal:

A

> Hypoglycemia
Hypocalcemia
Polycythemia
Hyperbilirubinemia

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37
Q

Hypoglycemia =

A

low blood glucose level

38
Q

Hypocalcemia =

A

low blood calcium level

39
Q

Polycythemia =

A

excessive number of RBC >65% which can slow or block the flow of blood to capillaries resulting in tissue death from lack of oxygen affecting organs

40
Q

Hyperbilirubinemia =

A

jaundice causes yellow coloration of the skin and sclera in newborns result of elevated serum bilirubin

Sclera of eyes 2-3 mg/dL

Yellow skin tone on face mg/dL advancing to body 15 mg/dL to feet 20 mg/dL

41
Q

Separation of the placenta from the wall of the uterus at birth =

A

life threatening hemorrhage

10% of maternal blood supply is shunted to the fetus at full term (40 weeks)

42
Q

Maternal adaptation to risk of hemorrhage =

A

pregnancy is a hypercoagulable state and suppressor of the fibrinolytic system which modulates the degradation of clots

43
Q

___ increases ~50 times in the first month postpartum

A

Thrombophlebitis

44
Q

Disorders of pregnancy

A

Miscarriage, Ectopic Pregnancy, and Placental Disorders

~15% of all pregnancies terminate is spontaneous abortions, before seek 24 gestation, due to genetic or environmental factors

45
Q

Vaginal bleeding and pain in the first trimester =

A

Ectopic pregnancy

Fallopian tube damage

Embryo not viable

Diagnosis made via localized intrauterine ultrasonography and weak B-hCG levels

46
Q

Ectopic pregnancy =

A

implantation of the blastocyst into the lining of the fallopian tube rather than the uterine endometrium

47
Q

Fallopian tube damage or scarring from previous pelvic infections or endometriosis =

A

impedes movement of a zygote from the ovary to the uterus = leading to a predisposition for ectopic pregnancies

48
Q

Embryo is not viable if implanted in the fallopian tube =

A

growth of the embryo results in rupture of the fallopian tube = potentially life-threatening unless surgically eliminated

49
Q

Placenta Previa =

A

third-trimester bleeding = placental obstruction of all or part of the internal cervical

Increased risk: multiple prior pregnancies particularly with caesarean section deliveries

50
Q

Placental Abruption =

A

premature separation of a normally implanted placenta

Increased risk: hypertension, smoking, and multiple pregnancies

51
Q

Intrinsic disorders of the breast:

A

Malignant: Breast Cancer

Benign: Fibrocystic Disease

52
Q

Breast =

A

example of estrogen- and progesterone- target tissue

Displays cyclic changes through menstrual cycle

53
Q

Benign Breast Disease =

A

Subtle imbalances in relative levels of estrogen and progesterone

Clinical manifestation can range from normal pre-menstrual breast tenderness relieved with menstruation to fibrocystic disease causing fibrosis and cysts associated with mammary epithelial hyperplasia

Fibrocystic disease with epithelial cell hyperplasia is a risk factor for breast cancer

54
Q

Menstrual disorders:

A

Amenorrhea

55
Q

primary amenorrhea =

A

failure of onset of menstrual periods by age 16

56
Q

Secondary amenorrhea =

A

lack of menstrual periods for 6 months in a previously menstruating woman

57
Q

Amenorrhea cause:

A

Normal physiologic such as pregnancy and menopause

Disorders of the uterus or pathway of menstrual flow

Disorders of the ovary

Disorders of the hypothalamus or pituitary

58
Q

Amenorrhea Clinical Manifestations:

A

Nonpregnant patient -> Infertility

Ovarian Insufficiency

59
Q

Osteoporosis =

A

Long-term complication of inadequate estrogen production

60
Q

Inadequate estrogen =

A

thinning of estrogen dependent epithelia = atrophic vaginitis

61
Q

Inadequate progesterone =

A

amenorrhea and irregular vaginal bleeding = increased risk of endometrial cancer

Most common cancer of female genital tract

Risk factors include early menarche, late menopause, nulliparity, obesity, hypertension, and diabetes

62
Q

Normal physiologic processes:

A

Common Causes:
Pregnancy
Menopause

63
Q

Pregnancy =

A

Pathophysiologic Mechanisms: Sustained high estrogen and progesterone

How to Make a Diagnosis: Serum hCG, history

Intervention: Prenatal care

64
Q

Menopause =

A

Pathophysiologic Mechanisms: Lack of estrogen

How to Make a Diagnosis: Clinical diagnosis

Intervention: Recommendations for osteoporosis prevention

65
Q

Disorders of the uterus and outflow tract:

A

Common Causes:
Disorders of sexual development

Congenital anomalies (eg, imperforate hymen)

Asherman syndrome

66
Q

Disorders of sexual development =

A

Pathophysiologic Mechanisms: Excessive androgen exposure

How to Make a Diagnosis: Physical examination

Intervention: Surgical treatment

67
Q

Congenital anomalies (eg, imperforate hymen)

A

How to Make a Diagnosis: Physical examination

Intervention: Surgical treatment

68
Q

Asherman syndrome =

A

Pathophysiologic Mechanisms: Endometrial adhesions following vigorous curettage

How to Make a Diagnosis: Lack of response to estrogen-progestin trial; visualization of scant endometrium

Intervention: Hysteroscopy, lysis of adhesions

69
Q

Disorders of the ovary:

A

Common Causes:

Gonadal dysgenesis

Premature ovarian insufficiency

Polycystic ovary disease

70
Q

Gonadal dysgenesis =

A

Pathophysiologic Mechanisms: Deletion of genetic material from the X chromosome

How to Make a Diagnosis: Karyotype

Intervention: Remove streak gonads if Y chromosome is present in view of high risk of dysgerminoma

71
Q

Premature ovarian insufficiency =

A

Pathophysiologic Mechanisms: Lack of viable follicles

How to Make a Diagnosis: Check gonadotropins, ultrasound for antral follicles

Intervention: HRT for osteoporosis prevention

72
Q

Polycystic ovary disease =

A

Pathophysiologic Mechanisms: Altered intraovarian hormone relationships

How to Make a Diagnosis: Clinical diagnosis in patients with chronic anovulation and androgen excess

Intervention: Decrease ovarian androgen secretion (wedge resection, oral contraceptives); increase FSH secretion

73
Q

Disorders of the hypothalamus or pituitary:

A

Stress, athletic endeavor, underweight

74
Q

Stress, athletic endeavor, underweight =

A

Pathophysiologic Mechanisms: Altered GnRH pulses

How to Make a Diagnosis: Check serum TSH, PRL, gonadotropins

Intervention: Replacement if deficient; search for tumor if excessive

75
Q

Dysmenorrhea:

A

Pain and cramping typically in the lower abdominal area occurring days before and during menstrual flow

Primary: absence of identifiable pelvic disease

Secondary: underlying pelvic disease such as endometriosis

76
Q

Primary dysmenorrhea:

A

Etiology = Prostaglandins

Distinguishing Features = Lack of organic pelvic disease

77
Q

Secondary dysmenorrhea
Categories:

A

Endometriosis

Pelvic inflammatory disease

Anatomic lesions

Premenstrual syndrome (PMS)

78
Q

Endometriosis:

A

Etiology = Ectopic endometrium, including intramyometrial endometrial tissue

Distinguishing Features = Finding of endometriosis lesions on laparoscopy

79
Q

Pelvic inflammatory disease =

A

Etiology = Infection

Distinguishing Features = Positive culture

80
Q

Anatomic lesions (imperforate hymen, intrauterine adhesions, leiomyomas, polyps) =

A

Etiology = Congenital, inflammatory, or neoplastic

Distinguishing Features = Findings on physical examination, ultrasound

81
Q

Premenstrual syndrome (PMS)

A

Etiology = Unknown

Distinguishing Features = Association with emotional, behavioral, and other symptoms

82
Q

Dysmenorrhea
Clinical Manifestations:

A

Sweating, weakness and fatigue, insomnia, nausea, vomiting, diarrhea, back pain, headache, dizziness, and syncope

With premenstrual syndrome (PMS) additional symptoms include: sensation of bloating, weight gain, edema of hands and feet, breast tenderness, acne, anxiety, aggression, mood irritability, food cravings, and change in libido

83
Q

Dysmenorrhea
Treatment approach:

A

lifestyle changes including more sleep, exercise, improved diet, along with decrease in tobacco, alcohol, and caffeine

84
Q

Dysmenorrhea
Pharmacological approach:

A

serotonin-reuptake inhibitors (SSRIs)

85
Q

Vaginal Bleeding is abnormal if it occurs:

A

Prepubertally

At times of usual menses but is of longer duration

At time of usual menses but is heavier than usual

Between menstrual periods

After menopause in the absence of pharmacologic hormone treatment

86
Q

Preeclampsia-Eclampsia with pregnancy

A

Characterized by hypertension, proteinuria, and edema

One of the most common causes of maternal death in the United States

Demonstrates the complexity of pathophysiologic mechanisms of pregnancy

Demonstrates the serious consequences

87
Q

Pregnancy Induced Hypertension (PIH)

A

can be diagnosed in isolation during pregnancy or as a component of preeclampsia-eclampsia

Treatment for PIH is different than those for essential hypertension of nonpregnant patient

88
Q

Placental Insufficiency =

A

can lead to underperfusion of the placenta and fetal growth restrictions

89
Q

Preeclampsia-eclampsia

A

> Pregnancy-induced hypertension

> Excessive weight gain (>1 kg/wk)

> Generalized edema
Ascites
Hyperuricemia
Proteinuria
Hypocalciuria

90
Q

Preeclampsia-eclampsia
Predisposing factors:

A

First pregnancy, obesity, preexisting diabetes or hypertension, malnutrition, and family history

91
Q

Preeclampsia-eclampsia
Clinical Manifestation:

A

Clinical triad of hypertension, edema, proteinuria

Increased deep tendon reflexes, placental abruption, renal changes, hepatic rupture

Clin Med Exam 2 (10 decks)

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