1
Q
2 phases of the female ovarian cycle
A
Follicular phase and luteal phase
2
Q
GnRH is released by….
A
Arcuate nucleus of the hypothalamus in a pulsatile function into the hypophyseal portal system
3
Q
Follicular phase can vary between ____ and ___ days, the luteal phase is almost always ____ days
A
10-20, 14
4
Q
Low body fat decreases leptin. This inhibits what hormone’s release?
A
GnRH
5
Q
FSH and LH are released by…
A
anterior pituitary in response to GnRH
6
Q
2 phases of the female menstrual cycle
A
Proliferative and secretory phases
7
Q
Inhibitors of GnRH (6)
A
- Dopamine
- seratonin
- GABA
- CRH
- Opoid B endorphin
- Excess DHEAs
8
Q
Activators of GnRH (6)
A
- Epi
- Norepi
- leptin
- Galantin
- neuropeptide Y
- Gulatmate
9
Q
Activin is released by…
A
The ovary
10
Q
Activin function
A
Positive effect on FSH secretion from the anterior pituitary, inhibit produciton of progesterone
11
Q
Inhibin is released by…
A
The ovary
12
Q
Inhibin function
A
Negative effect on FSH secretion from the anterior pituitary
13
Q
Follistatin is released by…
A
The ovary
14
Q
Follistatin function
A
Inhibits FSH secretion from the anterior pituitary AND inhibits activin activity from the ovary
15
Q
Estrogen and progesterone must be used together hormone replacement therapy. Why?
A
Progesterone prevents the overgrowth of the endometrial lining preventing uterine cancer from unregulated estrogen levels
16
Q
Neuropeptide Y function
A
Stimulates GnRH release from the hypothalamus at low levels, inhibits GnRH release at high levels, low estrogen causes an increase in neuropeptide Y levles
17
Q
Leptin function
A
Stimulates GnRH release from the hypothalamus, too much or too little will have a negative impact on GnRH release
18
Q
Too much DHEAs from obesity or PCOS causes….
A
…An inhibitory effect of GnRH release
19
Q
Galanin is release from…
A
The Hypothalamus
20
Q
Galanin function
A
Release from the hypothalamus and enters the portal circulation to have a positive effect on LH secretion from the anterior pituitary
21
Q
Melatonin is released from…
A
Pineal gland
22
Q
KISS1
A
Gene that encodes for kisspeptin, linked to stimulate GnRH pulsatile release
23
Q
A lack of KISS1 expression
A
Results in a lack of GnRH, –> hypogonadotropic hypogonadism
24
Q
Day 1 of menstrual cycle is the start of….
A
Menses
25
How many days after ovulation do you bleed?
14 days
26
Menses are brought on by declining levels of these 3 hormones, and an increase in this hormonal level
Estrogen, progesterone, inhibin / FSH
27
Highlights day 1 -7 follicular phase
- Menstruation as endometrial lining sloughs off due to low estrogen progesterone
- Low estrogen inhibits release of FSH LH, but FSH and LH release is slowly increasing the estrogen conc (Theca cells bind LH and produce androstedione) (Follicular cells bind FSH and produce aromatase that converts androstedione into estrogen)
28
Estrogen at low conc. has a ___ effect on LH and FSH, this changes at a high conc. to a ____
- Inhibitory
- Stimulatory (LH surge)
29
Highlights day 7-14 follicular phase
- LH surge occurs with positive feedback from estrogen, this triggers the follicle to secrete progesterone in low conc.
- Low conc. of progesterone (measured in ovulation predictor kits) stimulate FSH surge occurring immediately prior to ovulation
- Follicular rupture of mature follicle, remaining die via atresia
30
Highlights days 14-28 luteal phase
- Estrogen and progesterone and inhibin levels grow high from corpus luteum, this inhibits GnRH, FSH, and LH from the hypothalamus and pituitary
- Corpus luteum degenerates to corpus albicans unless stimulated by hCG to be retained, FSH levels begin to rise again, menses will begin
31
Does birth control save eggs?
Nope, die off and get fewer and fewer, most fertile time is 23-25 of eggs, 30's is getting too old
32
1st polar body
Creates a primary oocyte after dividing, the first meiotic division that occurs upon ovulation
33
2nd polar body
Creates a 2ndary oocyte, occurs after fertilization via sperm
34
Granulosa cells produce...., what targets it?
Estrogen using aromatase from androstendione precursor from theca cells, FSH
35
Thecal cells produce..., what targets it?
Androstendione, LH
36
Two cell theory
The team synergy between theca release of androstendiones and granulosa conversion to estrogens
37
E1
Old lady estrogen, doesn't have enough aromatase to work
38
E3
Estriol, often seen in pregnancy
39
How many US pregnancies are unintended?
Nearly half
40
Why are so many women at risk for unintended pregnancy?
-Over the course of a year many women have periods where they stop the method they use or do not use it properly (gaps in contraception)
41
Noncontraceptive funcitons of oral contraceptive pills
- Treating acne
- endometriosis
- menstrual pain and regularity
- PMS/PMDD
- decreased risk of ovarian cancer including those with BRCA genes
42
Using no protection at all, within a year, what percent of couples who want to be pregnant will?
85%
43
What meethods of contraception have the highest failure rate
- Spermicides
- Fertility awareness
- Withdrawal
- Condom
44
Types of combination oral contraceptive pills, when does fertility return on all of them?
Monophasic - constant dose
Multiphasic - varying doses
21/7, 24/4, 84/7 - continuous formulations
Fertility returns within days of discontinuation
45
Ethinyl estradiol or mestranol definition and function
Exogenous estrogen found in combination OCP's, funciton to suppress FSH/LH secretion
46
Progestin definition and funciton
Exogenous progesterone found in combo ocp's, function to simulate pregnancy by suppressing ovulation
47
Contraindications for OCP's(5)
- Those at increased risk for VTE (factor V ligand)
- patient is in early 50's
- Smoker >35
- Migraines with aura at any age
- Obesity >35 years old (at risk for DVT)
48
Common OCP side effects (7)
- Intermenstrual spotting
- Nausea
- Breast tenderness
- Headaches
- Weight gain
- Mood changes
- Decreased libido
49
Progestin only pills
A smaller dosage than other OCP's and thus hav ea higher failure rate, taken consistently without free interval, irregular bleeding is common, often used in breastfeeding women because it has no impact on milk prodction
50
On progestin only pills, ovulation....
is NOT consistently suppressed
51
When should a OCP be started?
Immediately regardless of timing of menses is preferred method as long as there is no pregnancy
52
Depo-Provera definniotn and function
Approved contraceptive injection giving immediate protection repeated 11-13 weeks, inhibits follicle development and prevents ovulation
53
Depo-provera extended use contraindication
A long time usage could result in hypoestrogen resulting in osteopenia or other issues, recommended for no more than 2 years, return to fertility can take 12-18 months
54
Depo-provera benefits
Lack of estrogen so no incresaed risk of DVT, no further action required by patient (passive compliance)
55
Plan B is composed of....
Single 1.5mg levo norgesterel pills
56
Mifepristone 10mg one dose results in...
...early termination of pregnancy
57
Paragard
Copper IUD that acts as a spermicide via its main mechanism
58
Nexplanon
A subdermal implant of etonogestrel that lasts for 3 years with rapid return to fertility after removal
59
Mastoplasia
Ropy thickening of breast tissue often in upper outer quadrant persistent thru menstrual cycle
60
Galactorrhea
Abnormal breast discharge not necessarily milk
61
Gynecomastia
Swelling of breast tissue in boys or men caused by an imbalance of horomones estrogen and testosterone
62
Cooper's ligaments
Fibrous septa that extend from skin to underlying pectoralis fasciae forming triangular lobules radially around the nipple, often when invaded by breast cause dimpling of the skin
63
Lymphatic drainage of the breast
- 75% axillary
- remaining 25% to internal mammary vessels and direct lymphatics to mediastinum
64
Breast tenderness 3-4 days prior to menses is due to....
....increased levels of estrogen and progesterone that cause cell proliferation and water retention
65
Where do most breast cancers start?
Terminal lobular ductal units composed of myoepithelial and epithelial cells
66
3D breast digitial tomosynthesis/ 3D mammography
A CT like type of digital mammogram that is highly detailed and views breast in slices, unfortunately still considered expeerimental by many insurance companies
67
Proper steps to take for all mammography screening
- Screening mammo
- If abnormal, diagnostic mammo
- Breast ultrasound
- Biopsy
68
Breast Imaging Reporting and Database System (BI-RADS) scale
0 - wasn't diagnostic due to external error
1 - continue regular screening if >40yrs, its negative
2 - benign, continue regular screening if >40yrs
3 - likely benign, recommend 6 month follow up
4 - suspicious abnormality, do a biopsy just to be safe
5 - likely cancer
6 - def cancer
69
Fibrocystic breast changes
General term for benign breast changes that may include mobile lumps or pain but entail poorly defined symptoms and etiology
70
Galactocele
Well circumscribed round milk filled cyst usually found in the central breast, thought to be due to spoiled milk buildup, treated easily with aspiration
71
Fibroadenoma
Firm freely mobile solid benign solitary breast mass 2nd most common tumor in the breast
72
Phyllodes tumor
Rare rapidly growing bulky tumors that distort the breast, may ulcerate thru skin due to pressure necrosis, wide exicsion required unless metastasis has occurred
73
Intraductal papilloma
Benign growth within the ductal system that presents as bloody nipple discharge (that isn't cancer), most common cause of unilateral nipple discharge***, relieved upon expression
74
Diagnosis for an intraductal papilloma
Ductogram
75
Fat necrosis
Bruised or dead tissue within the breast often due to trauma forming stellate lesions
76
Fat necrosis diagnosis
Mammography showing stellate area of distortion with calcification
77
Fat necrosis treatment
Excisional biopsy
78
Mastitis and abscess
Most often caused by a staph infection entering thru a cracked nipple in 9-33% of lactating women
79
Mastitis and abscess treatment
Continue frequent breast feeding, antibiotics, I&D if necessary
80
Paget's disease
Appearance of a psoriatic rash that begins on the nipple and spreads off the areola and into the skin of the breast indicating a rare type of cancer of breast
81
Untreated PID can lead to....
....scarring or infertility
82
Common causes of acute pelvic pain (<3 months) (6)
- Ectopic pregnancy
- Cervicitis
- PID
- Ruptured ovarian cysts
- UTI
- Appendicitis
83
Chronic pelvic pain (nonmenstrual) affects up to...
...1/7 US women
84
Common causes of chronic pelvic pain (>3months) (3)
- Endometriosis
- Pelvic adhesions
- IBS
85
Patient control during a pelvic exam
Telling the patient "you are going to feel ___" instead of saying "I'm going to do ___" do help them relax
86
Diagnostic tests for acute pelvic pain (5)
- serum hCG
- CBC
- UA with culture
- KOH for candida
- ultrasound
87
Pelvic congestion syndrome
Varicose veins in the pelvis causing chronic pelvic pain
88
Cervical motion tenderness/chandelier sign
Test used to differentiate PID from other potential causes of pelvic pain, done thru insertion and manipulation of cervix on bimanual exam
89
Gestational age vs embryonic age
Gestational age is 2 weeks longer than embryonic age because it starts at the last menstruation as opposed to fertilization
90
Paramesonephric duct
Mullerian duct, characteristic of the female
91
Mesonephric duct
Wolfian duct, characteristic of the male
92
Because feminization proceeds without active intevention, it is called ___. Masculinization is called ___ because it requires other active agents to alter fundamental female genotype
Development, differentiation
93
3 major steps of genital development in the female
Formation
Fusion
Resorption
94
Mayer-rokitansky-kuster-hauser syndrome (MRKH)
Agenesis, a lack of development of mullerian duct at all resulting in no cervix, fallopian tubes, vagina or uterus, but still the presence of ovaries, may have blind vaginal pouch appearing normal outside but will never develop a menstrual cycle
95
Lateral fusion defects
A lack of fusion between the 2 paramesonephric ducts resulting in a number of abnormalities including uteruse didelphys, double vagina, bicornuate uterus, septate uterus, unicornutate uterus
96
Septate uterus common presentations
A lack of fertility due to it acting as a proverbial IUD, or many miscarriages because the uterus cannot stretch properly
97
Basal vs functionalis endometrium
Basal remains the same throughout the menstrual cycle functioning to feed the functionalis layer, the functionalis layer grows and sloughs off each month
98
Uterus didelphys
Presence of a double uterus with single vagina due to lack of mullerian duct fusion, usually has good pregnancy outcomes despite that
99
Uterus didelphys and double vagina (complete uterus didelphys)
Presence of a double uterus with a double septated vagina, can cause problems with intercourse and vaginal delivery
100
Bicornuate uterus
Heart shaped uterus resulting from partial fusion of mullerian ducts giving 2 endometrial cavities with an indented fundus, uterus has trouble stretching like it is supposed to but pregnancy outcomes close to general population
101
Unicornuate uterus
Destruction of one mullerian duct almost ALWAYS mmissing a kidney and ureeter on same size, significant problems in pregnancy and infertility result
102
Septate uterus
Most common structural defect in a female, has 2 entometrial cavities due to a defect of resorption of midline septum, associated with risk of miscarriage, can be corrected with excellent results
103
Hydrocolpos
Distension of vagina by fluid due to congenital obstruction such as imperforate hymen
104
Uterine fibroids/leiomyomas/myomas
Benign smooth muscle growths of the uterus present in 3/4 women in their 30's most are assymptomatic
105
Uterine fibroids/leiomyomas/myoma treatment
Surgical removal, sound wave destruction
106
Uterine adhesions/Asherman syndrome
Scar tissue in the uterus resulting from surgery, endometriosis, or mullerian duct formation, can be asympomtamic or cause misscariages
107
Cervical insufficiency
Occurs when the cervix dilates too early during pregnancy causing miscarriage or premature birth, often due to uterine dfect or surgery
108
Cervical insufficiency treatment
Cerclage sutures keep the cervix closed and cut out near delivery
109
Most common causes of vulvar, cervical, and vaginal cancer
HPV subtypes 16 and 18
110
VIN
Vulvar intraepithelial neoplasia, classified by depth and epithelial cell maturation, with I being mild and III being severe dysplasia
111
Paget's disease of vulva
rare Vulvar skin cancer most often seen in post menopausal white women, treated with surgical removal
112
1/3 of patients with vulvar cancer will also have...
....A 2nd malignancy usually cervical or vaginal
113
Cervical cancer treatment even in early stages includes...
...hysterectomy
114
Most common gynecologic malignancy
Endometrial cancer
115
Endometrial cancer number 1 symptom
Abnormal uterine bleeding
116
Tumor marker in endometrial cancer or ovarian cancer
CA 125
117
2 preventative measures against ovarian cancer
Multiple pregnancies or oral contraceptives
118
Sister Mary Joseph's nodule
Metastatic implant in the umbilicus and a screeing test for ovarian cancer
119
Ovarian cancer diagnosis
Ultrasound imaging (often false positives) followed by diagnostic laporoscopy
120
PCOS is the most....
....common endocrine disorder among females
121
Hirsutism definition
Excessive hair growth in response to androgens
122
Textbook PCOS symptoms (3)
Ovulatory dysfunction, evidence for hirsutism, obesity
123
3 principle features of pcos (Rotterdam criteria)
1) androgen excess
2) ovulatory dysfunction
3) polycystic ovaries (not uncommon in general popuation, do not cause disease)
124
Most frequent cause of anovulatory infertility
PCOS
125
PCOS is strongly associated with
Insulin resistance
126
PCOS pathophysiology
Imbalance of excess LH to FSH ratio, excess androgen production, increased insulin levels
127
Signs of androgen overprudction in PCOS vs signs of true virilization
- Hirsutism, acne, oily skin
- Deeping of voice, male pattern baldness, clitoromegaly
128
Acanthosis nigricans
Discoloration of skin in skin folds, occurs when hyperinsulemia is present and thus correlates to PCOS as well
129
Hirsutism vs hypertrichosis
Hirsutism is androgen dependant male pttern hair growth while hypertrichosis is nonandrogen dependant vellus and terminal hair growth
130
PMS
Cyclic recurrence during the luteal phase of the menstrual cycle of a combination of distressing physical, psychologic, or behavioral changes that interfere with family, social, or work related activities
131
PMDD
A severe form of PMS that is debilitating, cyclic recurrence during luteal phase of menstrual cycle of combination of markedly depressed mood, feelings of hopelessness, marked anxiety and tesnion, labiality, persistent anger and irritability interfering with family, social, or work related activity
132
PMS is a...
...diagnosis of exclusion, there is no single test to diagnose pms
133
Vitamins (2) to assist with PMS
B6 and magnesium
134
Pathogen most often responsible for bacterial vaginosis
Gardnerella vaginalis
135
Atrophic vaginitis
Inflammation of vagina and outer urinary tract due to thinning of tissues due to lack of estrogen
136
Atrophic vaginitis symptoms
Dryness, itching, soreness, painful intercourse, sores and cracks, painful urination but no wbc in urine dip, incontinece
137
Lichen planus/psoriasis of vagina
Inflammatory, autoimmune disorder of skin and mucus membranes
138
Lichen planus/psoriasis of vagina symptoms
Glassy, bright red erosions and ulceration involving vulva and vagina
139
Vulvovaginal candidiasis symptoms
- Intense vulvar itching
- Thick curd vaginal discharge
- erythema of vulva
- thick white patches
140
Intertrigonal candida infection
The spreading of a candida infection into the folds of skin creating a rash like appearance often under the breasts or in the thighs
141
Fluconazole (diflucan)
150 mg po once, preferred treatment for candida, works on C. albicans
142
Miconazole nitrate (monistat)
1 suppository at night x3, or cream at night x7, treatment for C. albicans
143
Terconazole (terazol)
1 suppository or vaginal cream at night x3, used for C. tropicalis
144
3 candida species and how they appear on wet mount
C. albicans - hyphae and buds
C. tropicalis - hyphae
C. glabrata - buds
145
Watery, bad smelling discharge is characteristic of ____, while frothy, bubbling discharge is characteristic of ____
BV, trich
146
BV signs and symtpoms
Unpleasant vaginal odor, thick grey white vaginal discharge
147
Amsel's diagnostic criteria for BV (3/4 of em)
- thin homogenous discharge
- fishy odor
- clue cells present on microscopy
- vaginal pH greater than 4.5
148
BV treatment (3)
- Metronidazole
- Clindamycin
- Metrogel
149
Trichomoniasis sypmtoms female
- strawberry cervix
- vaginal frothy discharge
- odor
150
Trichomoniasis symptoms male
- many asymptomatic
- urethral discharge
151
trichomoniasis drug of choice
metronidazole
Professional Development
flashcards
Decks in class (62)
# Cards
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Part 1122
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Part 2123
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Part 3120
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Part 4150
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Part 5124
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Part 6125
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Part 7148
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Part 8160
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Part 9198
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Part 10119
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Part 11131
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Part 12119
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Part 13126
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Part 14123
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Part 15133
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Part 16142
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Part 17124
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Part 18135
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Part 19127
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Part 20108
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Part 21160
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Part 22125
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Part 23145
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Part 24160
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Part 25170
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Part 26120
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Part 27130
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Part 28153
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Part 29124
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Part 30144
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Part 31181
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Part 32121
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Part 33165
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Part 34133
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Part 35116
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Part 36175
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Part 37170
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Part 38191
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Part 39222
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Part 40150
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Part 41124
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Part 42154
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Part 43183
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Part 44132
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Part 45103
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Part 46125
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Part 47165
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Part 48126
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Part 49114
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Part 50155
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Part 51151
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Part 52101
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Part 53128
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Part 54151
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Part 55130
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Part 56132
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Part 57149
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Part 58131
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Part 59151
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Part 60151
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Part 61136
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Part 62111
