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ENRP Exam 1 > Disorders of Development and Menstruation > Flashcards

Disorders of Development and Menstruation Flashcards

1
Q

Describe the HPO axis in relation to menstration

A

GnRH from the hypothalamus stimulates FSH/LH of the anterior pituitary which then stimulates estrogen/progesterone release from the follicle

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2
Q

Name the 6 hormones of the AP

A
  1. FSH
  2. LH
  3. TSH
  4. ACTH
  5. GH
  6. Prolactin
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3
Q

Name the 2 hormones of the PP

A
  1. ADH

2. Oxytocin

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4
Q

Describe the Follicular phase of menstration

A

Defined as days 0-14
Begins with menstration and ends with the LH surge

LH/FSH stimulate follicle to release Estrogen, which eventually causes an LH surge

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5
Q

Describe the Luteal Phase of menstration

A

Days 15-28
Ends with first day of menses
Release of follicle, formation of corpus luteum which secretes progesterone to maintain endometrium

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6
Q

LH acts on which cells of the ovary?

A

Theca to produce androgens

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7
Q

FSH acts on which cells of the ovary?

A

Granulosa to take the androgens from theca cells and make estrogen

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8
Q

When are estrogen and progesterone at their highest in the menstrual cycle?

A

During the luteal phase 5-7 after ovulation

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9
Q

2 zones of the endometrium

A
  1. outer functionalis- lost in menses

2. Inner basalis- unchanged during cycle

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10
Q

What hormone promotes endometrial growth?

A

Estrogen

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11
Q

What is the role of progesterone in the cycle?

A

stimulates glandular secretion of mucus, glycogen

Prepares endometrium for pregnancy

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12
Q

Why does the functionalis layer of the endometrium slough?

A

After day 23 of no pregnancy, the Luteum stops secreting PG, and the spiral arteries constrict causing necrosis

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13
Q

When should menarche occur relative to Thelarche?

A

2-3y after at Tanner stage IV

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14
Q

Primary Amenorrhea

A

No menses by 13 w/o secondary sex characteristics OR 15 w/ secondary sex characteristics

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15
Q

Normal Menstrual cycle in young females

A

Menarche by 13
21-45 days duration
Flow 7d or less
3-6 pads or tampons/day

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16
Q

How many pad/tampon changes are considered excessive and may lead to anemia?

A

every 1-2 hours especially if lasting longer than a week

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17
Q

When does a female acquire lifetime peak number of oocytes?

A

mid-gestation 16-20w

6-7mil

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18
Q

What keeps a female from entering puberty?

A

The Gonadostat

  1. Low circulating levels of estradiol
  2. CNS inhibition of GnRH release
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19
Q

What is one of the first signs of puberty onset?

A

Thelarche

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20
Q

What is precocious puberty?

A

in North America, onset of puberty prior to 8 in females or 9 in males

21
Q

What are the two subtypes of precocious puberty?

A

Heterosexual- development opposite what is phenotypically expected

Isosexual- appropriate phenotypic maturation

22
Q

Congenital Adrenal Hyperplasia

A

21-hydroxylase defect that results in heterosexual precocity
classical- female w/ ambiguous genitalia
nonclassical- can cause premature pubarche and resemble PCOS

23
Q

Isosexual Precocious Puberty

A

Most commonly idiopathic caused by premature activation of HPO axis.
Diagnose by GnRH test which is positive if there is an LH surge

24
Q

What are some Syndromes that cause Pseudoisosexual Precocity?

A

McCune-Albright

Peutz-Jeghers

25
Q

What is considered delayed puberty?

A

No secondary sex characteristics by 13
No thelarche by 14
No menarche by 15-16
If Menarche isn’t within 5y of thelarche

26
Q

What is secondary amenorrhea?

A

Prior normal menses that has stopped for 6months or more

27
Q

What is Kallman Syndrome

A

Defective FGF/KAL gene that prevents the migration of GnRH neurons to the hypothalamus and delays puberty.
Common symptoms: Anosmia, Hypogonadism, and infertility

28
Q

Turner Syndrome

A

45XO abnormality

Symptoms: Shield chest, Webbed neck, short stature, streak ovary, decreased estrogen, increased FSH/LH

29
Q

If primary amenorrhea is present along with secondary sex characteristics, and US shows no uterus, what 2 disorders are in the differential?

A

Androgen Insensitivity Syndrome

Mullerian Agenesis

30
Q

What is the karyotype of a person with AIS?

A

46XY

31
Q

What causes mullerian dysgenesis/agenesis?

A

Failure of fusion of the paramesonephric ducts

32
Q

Outflow obstruction anomalies

A

Imperforate Hymen

Transverse Vaginal Septum

33
Q

What are some history and physical findings related to secondary amenorrhea?

A

changes in weight
strenuous exercise
abnormal facial hair
galactorrhea

34
Q

What is the first thing to check in a patient with secondary amenorrhea?

A

TSH level to rule out thyroid disease.

35
Q

If prolactin levels are high and TSH is normal in a patient with secondary amenorrhea, what is the differential?

A

Prolactinoma. Perform MRI

36
Q

If prolactin levels are <100ng/ml in a patient with secondary amenorrhea and normal TSH, what are some differentials?

A

Ectopic prolactin production (bronchocarcinoma, ovarian dermoid cyst, RCC, Gonadoblastoma)
Breast Feeding
Excessive exercise
Head trauma
Meds (antipsychotics, antidepressants, OC’s)

37
Q

In a patient with a tumor in the sella Turcica, what visual disturbance may be seen?

A

Bitemporal Hemaniopia

38
Q

What is a progesterone challenge test?

A

Administration of PG causing bleeding is a positive test and is most commonly caused by PCOS

39
Q

Nonclassical Congenital Adrenal Hyperplasia

A

Adrenal DO of elevated 17-hydroxyprogesterone levels that causes secondary amenorrhea

40
Q

What is the leading cause of female anovulatory infertility?

A

PCOS

41
Q

Diagnosis of PCOS needs 2/3 of the following criteria:

A

Oligomenorrhea/Amenorrhea
Hyperandrogenism
US positive for cysts

42
Q

Treatments for PCOS

A

Weight loss
OC
Spironolactone
Metformin

43
Q

Signs of Hyperandrogenism

A

Hirsutism

Virilization

44
Q

Polymenorrhea

A

menses <21 days apart

45
Q

Menorrhagia

A

prolonged/excessive bleeding

46
Q

Metrorrhagia

A

irregular episodes of bleeding

47
Q

Oligomenorrhea

A

cycles >35 days apart but less than 6 months apart

At 6 months would be secondary amenorrhea

48
Q

PALM-COEN classification of abnormal uterine bleeding (AUB)

A 
PALM= Structural
Polyp
Adenomyosis
Leiomyoma
Malignancy 
COEIN= Nonstructural
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not classified

ENRP Exam 1 (20 decks)

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