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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
What is considered delayed puberty?
No secondary sex characteristics by 13 No thelarche by 14 No menarche by 15-16 If Menarche isn't within 5y of thelarche
26
What is secondary amenorrhea?
Prior normal menses that has stopped for 6months or more
27
What is Kallman Syndrome
Defective FGF/KAL gene that prevents the migration of GnRH neurons to the hypothalamus and delays puberty. Common symptoms: Anosmia, Hypogonadism, and infertility
28
Turner Syndrome
45XO abnormality | Symptoms: Shield chest, Webbed neck, short stature, streak ovary, decreased estrogen, increased FSH/LH
29
If primary amenorrhea is present along with secondary sex characteristics, and US shows no uterus, what 2 disorders are in the differential?
Androgen Insensitivity Syndrome | Mullerian Agenesis
30
What is the karyotype of a person with AIS?
46XY
31
What causes mullerian dysgenesis/agenesis?
Failure of fusion of the paramesonephric ducts
32
Outflow obstruction anomalies
Imperforate Hymen | Transverse Vaginal Septum
33
What are some history and physical findings related to secondary amenorrhea?
changes in weight strenuous exercise abnormal facial hair galactorrhea
34
What is the first thing to check in a patient with secondary amenorrhea?
TSH level to rule out thyroid disease.
35
If prolactin levels are high and TSH is normal in a patient with secondary amenorrhea, what is the differential?
Prolactinoma. Perform MRI
36
If prolactin levels are <100ng/ml in a patient with secondary amenorrhea and normal TSH, what are some differentials?
Ectopic prolactin production (bronchocarcinoma, ovarian dermoid cyst, RCC, Gonadoblastoma) Breast Feeding Excessive exercise Head trauma Meds (antipsychotics, antidepressants, OC's)
37
In a patient with a tumor in the sella Turcica, what visual disturbance may be seen?
Bitemporal Hemaniopia
38
What is a progesterone challenge test?
Administration of PG causing bleeding is a positive test and is most commonly caused by PCOS
39
Nonclassical Congenital Adrenal Hyperplasia
Adrenal DO of elevated 17-hydroxyprogesterone levels that causes secondary amenorrhea
40
What is the leading cause of female anovulatory infertility?
PCOS
41
Diagnosis of PCOS needs 2/3 of the following criteria:
Oligomenorrhea/Amenorrhea Hyperandrogenism US positive for cysts
42
Treatments for PCOS
Weight loss OC Spironolactone Metformin
43
Signs of Hyperandrogenism
Hirsutism | Virilization
44
Polymenorrhea
menses <21 days apart
45
Menorrhagia
prolonged/excessive bleeding
46
Metrorrhagia
irregular episodes of bleeding
47
Oligomenorrhea
cycles >35 days apart but less than 6 months apart At 6 months would be secondary amenorrhea
48
PALM-COEN classification of abnormal uterine bleeding (AUB)
``` PALM= Structural Polyp Adenomyosis Leiomyoma Malignancy ``` ``` COEIN= Nonstructural Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not classified ```

ENRP Exam 1 (20 decks)

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