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reproductive disorders Flashcards

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1
Q

cervical cancer prevention

A

HPV vaccine: Gardasil/Gardasil 9
- females/males ages 9-29
- HPV subtypes: 16, 18, 6, 11

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2
Q

cervical cancer pathogenesis

A
  • cervical cell dysplasia: atypical cells with nuclear and cytoplasmic changes
  • continuum of change: indistinct changes, in situ, invasive cancer (or regress)
  • cervical intraepithelial neoplasia (CIN): grading for dysplastic changes > premalignant
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3
Q

cervical cancer diagnosis

A
  • Pap smear (endocervical cells in transformation zone)
  • screening for HPV, age, history
  • dysplasia: cone biopsy, endocervical curettage, hysteroscopy
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4
Q

cervical cancer risk factors

A
  • early age of 1st intercourse
  • multiple sex partners
  • smoking
  • STI
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5
Q

cervical cancer manifestations

A
  • poorly defined endocervical lesions
  • abnormal vaginal bleeding/ discharge/ spotting
  • bleeding after sex
  • hematuria
  • pelvic and back pain
  • fistulas (rectal vaginal or vesicle vaginal)
  • metastasis to supraclavical/inguinal lymph nodes
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6
Q

endometriosis

A

the growth of endometrial tissue outside the uterus

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7
Q

endometriosis risk factors

A
  • no deliveries
  • high exposure to estrogen (early period/ late meno)
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8
Q

endometriosis treatment

A
  • treat pain
  • suppress endometrial growth > hormone suppressors
  • surgery goal: restore normal anatomy and slow progression
  • definitive: hysterectomy with salpingo - oophorectomy (removing uterus, ovaries, fallopian tubes)
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9
Q

endometriosis diagnosis

A
  • laparoscopy
  • symptoms mimic other pelvic disorders
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10
Q

endometriosis manifestations

A
  • start in reproductive years
  • pain (dysmenorrhea)
  • bleeding between periods
  • bleeding into other structures
  • pain with poop/pee
  • infertility: adhesions distort pelvic anatomy and impair ovary transport
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11
Q

endometriosis 4 D’s

A
  • dysuria (pain peeing)
  • dyspareunia (painful intercourse)
  • dyschezia (pain pooping)
  • dysmenorrhea (painful bleeding)
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12
Q

uterine leiomyomas - fibroids

A
  • benign tumors from smooth muscle of uterus
  • most common of pelvic tumors
  • develop in different layers (intramural fibroids are most common)
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13
Q

uterine leiomyomas - fibroids manifestations

A
  • none or…
  • enlargement of uterus (abd dissention, abnormal bleeding, pain, infertility, anemia)
  • rectal pressure/constipation
  • may grow during pregnancy
  • menopause estrogen replacement therapy
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14
Q

uterine leiomyomas - fibroids diagnosis

A
  • examinations/symptoms
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15
Q

uterine leiomyomas - fibroids treatment

A
  • depends on symptoms
  • hysterectomy
  • may regress with menopause
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16
Q

pelvic inflammatory disease (PID)

A

polymicrobial infection upper reproductive tract (uterus, fallopian tubes, ovaries)

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17
Q

PID associated with

A

STI microbes: N. gonorrhea, C. trachomatis
endogenous microbes: H. influenzae, streptococci

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18
Q

PID factors

A
  • nulliparity
  • many sex partners
  • pervious PID
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19
Q

PID manifestations

A
  • lower abd and back pain
  • dyspareunia
  • painful cervical motion
  • purulent discharge
  • fever above 101
  • increased ESR (erythrocyte sedimentation rate)
  • coinfection
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20
Q

PID treatment

A

antibiotics

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21
Q

polycystic ovarian syndrome (PCOS)

A
  • endocrine disturbance > increased androgenic hormones
  • frequent source chronic anovulation
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22
Q

PCOS cause

A

unknown and autosomal dominant

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23
Q

PCOS etiology

A
  • elevated LH with normal estrogen and FSH levels
  • elevated free testosterone
  • hyperprolactimia
  • hypothyroidism
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24
Q

PCOS manifestations

A
  • hyperinsulinemia (^ hormones) which effects ovaries
  • long term: cardiovascular disease and diabetes
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25
PCOS diagnosis
- rule out other diseases - hyperandrogenism (acne/body hair) - fasting blood glucose - oligomenorrhea - ultrasound
26
PCOS treatment
- symptom relief and lifestyle modifications - metformin: restores levels and helps restore normal menstrual regularity
27
ovarian cancer
- ovulatory age: includes # of pregnancies and how long they had breast fed, how long oral contraceptives were used - lower incidence in parous vs. nulliparous women - family history > lynch syndrome 2: prostate, pancreatic, colorectal cancers... BRCA 1/2: cause types of ovarian cancer - autosomal dominant
28
ovarian cancer manifestations
few and vague: GI bloating and nausea, dysuria, pelvic/back pain
29
ovarian cancer risk factors
- genetics - no children - hormone use
30
ovarian cancer diagnosis
- pelvic exam - CA-125: test used but not definitive - transvaginal sonography (close look at ovaries) - surgical evaluation is required for diagnosis (remove tumor as much as possible so chemo/radiation work)
31
ovarian cancer treatment
depends on surgical findings, prognosis, staging/grading of tumor
32
ovarian cancer types
- epithelial ovarian cancer: tumor starts on outside of the ovary - stroma cancer: starts in ovarian cells that make hormones - germ cell cancer: starts in the eggs *ovarian cancer is usually in advanced stages by the time its diagnosed*
33
menstrual disorders: amenorrhea
absence of menstruation - Primary: period has not occurred by 15 - Secondary: absence of period (3-6 months) - can be caused by pregnancy diagnosis: history/physical, endocrine studies, B-HBG preg test
34
menstrual disorders: dysmenorrhea
painful menstruation/increased prostaglandin F - Primary: on or before period (not physical abnormality and occurs with ovulation) - Secondary: result of another condition (associated with specific organic conditions > endometriosis)
35
menstrual disorders: treatment
- analgesic agents, hormone regulation - treat cause - prostaglandin synthetase inhibitors (ibuprofen)
36
premenstrual syndrome (PMS)
mild to moderate physical/psych symptoms in 14 days - increases with age - diagnostic: 1 symptom
37
premenstrual dysphoric disorder (PMDD)
severe form premenstrual distress, associated with mood disorders - psychiatric disorders - diagnostic: 5-11 symptoms
38
PMS and PMDD treatment
- lifestyle changes: lower sugar and caffeine, lean protein; analgesics, OCP's, diuretics for fluid retention, anxiolytics or SSRIs for anxiety/depression
39
PMS/PMDD symptoms
- cerebral: irritable, anxious, nervous, fatigue gastrointestinal: craving sweet/salt, nausea, vomit, constipation - vascular: headache, edema - reproductive: swelling/tender breasts - neurologic: clumsy, trembling - general: weight gain, dizzy, insomnia, acne
40
breast cancer risk factors
- sex, age, history, hormone influences - modifiable: obesity, physical activity, less than 1 alcoholic drink a day
41
breast cancer detection
- breast self exam (BSE) > premenopausal (after period) > postmenopausal (anytime) - know personal normal, should be done the same every time - know personal normal, pre/post menopause, hysterectomy
42
breast cancer mammography
- detect 1 mm lesions, self exam palpitation 1 cm exam - can grow 2-9 years
43
breast cancer diagnosis
- mammography/ultrasound - biopsy: needle aspiration (needle removes cells), stereotactic needle (ultrasound and needle biopsy), excisional (spot and surrounding tissue is removed - definitive) - painless, firm, fixed lesions, poorly differentiated boarders found anywhere in breast
44
breast cancer classification
TNM system - estrogen/progesterone receptor analysis
45
breast cancer prognosis
related to extend of nodal involvement (sentinel biopsy) - sentinel node: 1st node in lymphatic chain > if biopsy doesnt show cancer cells its likely no other lymph node has to be removed
46
breast cancer surgeries
mastectomy: removing all or some of breast tissue radical: remove all tissue down to chest wall lumpectomy: remove lump and some surrounding tissues axillary dissection: lymph node removal under armpit
47
breast cancer treatment
- surgery - chemo - hormone therapy: block effects of estrogen on cancer cells > tamoxifen: oldest - nonsteroidal antiestrogen that binds to estrogen receptors to block growth of cancer cells > aromatase: anastrozole - block enzyme that converts androstenedione and testosterone into estrogen in peripheral tissues
48
hypospadias
- in babies - urethra opening is on the bottom of the penis > the closer the opening is to the body the more severe - negative psych effects > embryologic developmental defect of urethral groove/penile urethra - fetal testes release androgens inactive/deficient weeks of 8-14 - 10% occurrence with undescended testes > Chordee (ventral bowing of the penis)/inguinal hernia (pouching of intestine) may be present
49
hypospadias/epispadias manifestations
- urine coming out of an area other than urethral opening of glans peins, UTI, dyspareunia
50
hypospadias/epispadias treatment
- surgery
51
epispadias
- urethra opening is on top of the penis - associated with exstrophy of bladder (protruding through abdominal wall)
52
erectile dysfunction
> persistent inability to achieve and maintain erections
53
erectile dysfunction etiology
- blood flow issues to and from penis - arteriosclerosis - hypertension - peripheral neuropathy involving erection nerves
54
erectile dysfunction risk factors
- penile artery/vein disorders - trauma to pelvic area - obesity/ physical inactivity - smoking - fibrosis or atrophy of penile SMOOTH MUSCLE
55
erectile dysfunction causes
- psychogenic: performance anxiety, strained relationship with sexual partner, depression, psych issues - organic: vascular, neurogenic, hormonal, pelvic/spinal cord injury trauma, infection - drugs: antipsychotics, chemo, antiandrogens, glaucoma EYE DROPS
56
erectile dysfunction diagnosis
> detailed physical and history - identification and management of metabolic conditions - ID psych issues
57
erectile dysfunction treatment
- treat underlying cause - psychosexual therapy - medications: PDE inhibitors (Viagra) increases smooth muscle relaxation, induces vasodilation, increases corporal blood flow
58
priapism
> involuntary, sustained erection for more than 4 hours or stimulation unrelated to sex - corpora cavernosa: impaired blood flow *tissue death in hours... need immediate attention*
59
priapism: urologic emergency
> prolonged erection leads to ischemia and fibrosis of erectile tissues - any age - secondary to: disease (leukemia, sickle cell, stroke, renal failure) and drugs (antihypertensives, anticoagulants, antidepressant, alc, weed)
60
priapism: Ischemic
> veno-occlusive (low flow/acidotic) - nonsexual, persistent erection with little/no cavernous blood flow - abnormal cavernoma, rigid, painful to touch - EMERGENCY
61
priapism: Nonischemic
> arterial (high flow) - nonsexual, persistent erection with unregulated cavernous arterial inflow - blood gases not acidotic or hypoxic - penis not fully rigid or painful - most commonly cause trauma
62
priapism diagnosis
- emergency - manage symptoms to preserve tissue and function
63
priapism treatment
- analgesics, sedation, hydration - ice packs, cold saline enemas
64
hydrocele
> collection of serous fluid in scrotum without noted inguinal hernia - fluid collections between parietal and visceral layers of tunica vaginalis (lining of scrotum) - commonly seen after birth but can happen at any age - unilateral or bilateral swelling
65
hydrocele cause
- congenital (not formed right), injury, STI, lymph obstruction, testicular torsion
66
hydrocele manifestation
heavy feeling in groin/swelling
67
hydrocele diagnosis
- palpation - transillumination ultrasound
68
hydrocele treatment
- observation - elevation - aspiration/surgery

pathophys (6 decks)

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