OBGYN: sexual diff, DUB, PMS/PMDD, sexual dsyf, fertility

Question 1

define gonads
men?
women?

Answer 1

primary sex organs
men=testes
women=ovaires

Question 2

gonads produce?

Answer 2

sex cells called gametes–sperm and ova

Question 3

secondary sex organs provide?

Answer 3

route by which sex cell unite

men: epididymis, vas def, protate, etc
women: FTs, vagina, uterus, external genitalia, etc

Question 4

how many chromosomes in cell dna

Answer 4

22

Question 5

gametes have how many chromosomes

Answer 5

22 + X o Y

total=23

Question 6

who determines the sex of baby

Answer 6

father

Question 7

what week of gestation will the embryo differentiate into male or female

Answer 7

6-7th week

Question 8

what week does testosterone secretion begin

Answer 8

8th week

Question 9

SYR gene is only present in?

Answer 9

males—sex determination region on the Y chromosome

Question 10

SRY gene produces

Answer 10

testes-determining factor–which will produce male gonads

Question 11

when can you determine via US the sex of fetus

Answer 11

15-16th week the EARLIEST

Question 12

general causes of AUB

MCC?

Answer 12

structural issues

• polps
• adenomyosis
• leiomyoma (fibroids)
• malignancy

non-structual issues

• coagulopathy
• ovulatory
• endometrial
• iatrogenic

MCC=lack of ovulation (90%)

Question 13

when AUB is caused by anovulation, it is called?

Answer 13

Dysfunctional uterine bleeding (DUB)

Question 14

in a normal cycle, what causes the proliferation of endometrium

Answer 14

estrogen secreted from follicle

Question 15

what acts on endometrium to limit growth and cause changes in vasculature of endmetrium–which limits bleeding during menses

Answer 15

proegsteorne

Question 16

describe progesterones effect on proliferating endometrium

Answer 16

1. limit growth
2. cause changes in vasculature of endometrium
   * *all of which limits bleeding during menses

Question 17

what happens if a follicle forms but never releases the ovum?

Answer 17

follicle will continue to produce estrogen—->encouraging proliferation beyond normal 14 days
*****no progesterone is being produces

Question 18

what happens when there is no progesterone produced bc no ovulation occured

Answer 18

no progesterone=inhibiting the thickened endometrium from shedding in a predictable fashion w/o excessive blood loss

Question 19

what happens without ovulation (3)

Answer 19

1. flow becomes irregular–>Metrorrhagia
2. menorrhagia—>excessive bleeding
3. Menometrorrhagia–>both excessive + irregular flow

Question 20

define the following:

1. metrorrhagia
2. Menorrhagia
3. Menometrorrhagia

Answer 20

1. irregular flow
2. excessive flow
3. both excessive + irregular flow

Question 21

causes of DUB (5)

Answer 21

1. girls at the edges of reproductive years–prepubescent and perimenopausal
2. PCOS
3. obesity
4. hyperthryoidism and hypothyroidism
5. estrogen secreting tumors

Question 22

tx for DUB
1st line
2nd line

Answer 22

1. NSAIDS= FIRST LINE

2. hormonal contraception*****

Question 23

why is NSAIDS helpful in DUB

Answer 23

they reduce prostaglandin syntehsis w/in the endometrial tissue–>causes vasoconstriction—>decreased menstrual blood loss

Question 24

how do hormonal contraceptives help DUB

Answer 24

they override the HPG (hypopituitarygrowth) axis and mimic normal menstrual bleeding or suppress it early

Question 25

PMS and PMDD

Answer 25

cyclical recurrence of distresing physical, psychologic or behavioral changes that impair interpersonal relationships or interfere with usual activites

Question 26

s/s of PMS and PMDD occur when in the cycle | -how long can these s/s last

Answer 26

after ovulation---- after day 14 ***during luteal phase*** can last up to 4 days into the menstrual cycle

Question 27

what is most imp for establishing diagnosis of PMS or PMDD

Answer 27

symptom frequency and severity vs the actual symptoms

Question 28

diagnostic criteria for PMDD

Answer 28

“Presence of at least one psychological or physical symptom that causes significant impairment and is confirmed by means of prospective ratings (i.e. at least present for 2 cycles of a symptom diary, etc.).”

Question 29

most women report what around their menses

Answer 29

some form of distress | ---90%

Question 30

enough distress around their menses to interrupt their daily life and routine is called?

Answer 30

PMS--pre-menstrual syndrome

Question 31

women report predictable symptoms that cause significant impairment around their menses is called?

Answer 31

PMDD--- premenstrual dysphoric disorder

Question 32

the s/s of PMS and PMDD are brought on by?

Answer 32

ovulation NOT menstruation ****bc the s/s are before menstruation and after ovulation

Question 33

list the most distressing s/s of PMS/PMDD (4)

Answer 33

1. emotional---depression, anger, irritability, fatigue

Question 34

``` tx for PMS and PMDD initial tx 1st line med 2nd severe severe cases ```

Answer 34

PMS ****mediated by lifestyle, social and psychological factors-->tx is mainly symptomatic tx***** Initial tx: - validation of premenstrual experience - education on PMS and self help techniques 1st line medical -hormonal contraceptions---regulates womens cycle and decrs amount of circulation hormones 2nd -SSRIs continually or during premnstrual pd severe cases---menses can be terminated by using GnRH and suppressing the entire cycle----very intense tx tho and we try to avoid this...

Question 35

four phases of sexual response

Answer 35

1. excitement 2. plateau 3. orgasm 4. resolution

Question 36

define sexual dysfunction | causes?

Answer 36

lack of satisfaction with sexual function--- causes - pain - deficiency in sexual desire, arousal or orgasm/climax

Question 37

define dyspareunia

Answer 37

painful intercourse | -pain at arousal, orgasm, or any time during intercourse

Question 38

causes of dyspareunia

Answer 38

inadequate lubrication: * low estrogen levels can decr lubrication---lactation, menopause, * drugs can decr lubrication----anything that has drying effect such as antihistamines

Question 39

four categories that sexual dysfunction is divided into

Answer 39

1. disorders of desire 2. disorders of arousal 3. disorders or orgasm 4. disordrs of pain---- dyspareunia

Question 40

define infertility

Answer 40

inability to concieve after ONE FULL YEAR of unprotected sex with same, opposite partner *can be reduced to 6 MO for women 35 YO+

Question 41

majority of intertility is MC male or woman fault?

Answer 41

woman

Question 42

factors contributing to intertility

Answer 42

- ovulatory factors - age - abnormalities of reproductive tract---endometriosis, adhesions, and scarring from PID

Question 43

list the five female intertility tests

Answer 43

1. ovulation is occuring normally 2. endometrium is responidng normally to hormones 3. reproductive tissues are free of tumors or infections 4. woman has any chronic conditions interfering with fertilization or implantation 5. reproductive tract is adequately patent

Question 44

list the imp perineal muscles holding bladder, urethra and rectum

Answer 44

transverse perineal muscles | levator ani

Question 45

pelvic organ prolapse (POP) | -define

Answer 45

descent of one or more of the following - vaginal walls - uterus - vaginal apex (after a hysterectomy)

Question 46

define cystocele | MCC

Answer 46

descent of a portion of bladder wall into vagianl canal | -caused MC trauma of childbirth

Question 47

define rectocele

Answer 47

bulging of rectum and posterior vaginal wall into vaginal canal causes - childbirth - yrs after menopause MC time it comes - life long chronic constipation and straining

Question 48

uterine prolapse | -define

Answer 48

descent of cervix or entire uterus through vaginal wall severe cases--- the cervix will protrude thru introitus

Question 49

first line tx uterine prolapse

Answer 49

pessary---removable mechanical devise that holds uterus in position -pelvic fascia may be strengthened thru KEGEL exercises or by estrogen tx in menopausal women

Question 50

MC pessary?

Answer 50

Gellhorn