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Endo/Repro Exam 2 > DSA > Flashcards

DSA Flashcards

1
Q

Menstrual cycle occur with the maturation of the

__________

A

hypothalamic-pituitary-ovarian axis.

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2
Q

(GnRH) from the hypothalamus stimulate(FSH) and(LH) from the anterior pituitary, which stimulates ________ and _______ from the _______

A

estrogen and progesterone relase from ovarian follicle

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3
Q

What initiates an increase in FSH -> follcular growth and estradiol secretion at the begining of our period?

A

Decreasing levels of estradiol & progesterone from the regressing corpus luteum of the cycle b4

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4
Q

• LH stimulates

A

theca cells to make androgens (androstenedoine and testosterone)

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5
Q

• FSH stimulates

A

granulosa cells to convert androgens -> estrogens

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6
Q

• LUTEAL PHASE

levels of LH and FSH

A

supressed. d/t negative feedback of elevated cirulated estradoil and progesterone

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7
Q

what happens if conception does not occur

A
  1. CL regresses -> decreasing estrogen and progesternoe levels
  2. will eventually. cause a. rise in FSH
  3. FSH will stimulate. new follicular. growth
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8
Q

• 5 peptides or biogenic amines that affect the reproductive cycle have been isolated from the hypothalamus •

  1. Gonadotropin-releasing hormone (GnRH) •
  2. Thyrotropin-releasing hormone (TRH) •
  3. Somatotropin release inhibiting factor (SRIF) or somatostatin •
  4. Corticotropin-releasing factor (CRF) •
  5. Prolactin release-inhibiting factor (PIF) •

All exert specific effects on the hormonal secretion of the anterior pituitary gland.

A

released from arcuate nucleus in pulses bc short half life -> release LH and FSH

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9
Q

Estradiol appears to ______ the hypothalamic release of GnRH and induce the midcycle LH surge •

Gonadotropins have and ____ effect on GnRH release

A

enhance

inhibit

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10
Q

ESTROGEN •

During early follicular development estradiol levels are low • Approximately _____ before ovulation, estradiol (E2) levels begin to increase

A

1 wk before

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11
Q

Estrogen levels 1 day before ovulation

A
  1. Estrogen levels reach. max 1 day before the midcycle LH peak.
  2. After peak but before ovulation, there is a marked decrease
  3. During luteal phase, estradoil levels rise 5-7 days after ovulation -> goes to normal
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12
Q

Progesterone in the ovarian cycle

A
  1. Follicular stage: small amount of progesterone is made d/t peripheral conversion of adrenal pregnenolone and PG sulfate
  2. Unruptured luteinizing graafian follicle begins to make increasing amounts of progesterone
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13
Q

What happens as the graafian follicle is formed?

A

Granulosa cells differentiate

  1. Cumulus oophorus -> adheres to ovum
  2. Corona radiata -> innermost layers of granulosa cells that become elongated. released with oocyte. at ovulation
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14
Q

Hormonal changes in cycle

A
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15
Q

• The first day of menstruation is known as cycle day 1. What happens

A

Endometrial glands and stroma disintegrate

Leukocytes infiltrate

RBC invate

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16
Q

Proliferative phase

Characterized by endometrial growth/proliferation d/t ______.

What else happens

A

Estrogen

Increase in lgenth of spiral arties

Increase in mitosis

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17
Q

Secretory phase

1. progesterone secretion by the corpus luteum stimulate the glandular cells to secrete ___________.

2. Gland change:

3. Mitosis: ________

4. Endometrial lining:

A
  1. mucus, glycogen and other substances
  2. glands become totruos
  3. mitosis is rare
  4. endometrial lining: full thiccnes
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18
Q

1 day prior to the onset of menstruation____________ occurs resulting in ischemia of the endometrium, leukocytes infiltration and RBC extravasation.

A

spiral arteries constrict where they. meet. with straight.at. statum basale

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19
Q

Intact ______ pathway is important in regulating menstruation

A

coagulation

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20
Q

Menarch (period) occurs within 2-3 years _____ thelarche (breast budding) at Tanner stage ____, rare before Tanner stage ___

A

after

IV

III

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21
Q

By the age of ____ years old 98% of females will have had menarche

A

15

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22
Q

Primary amenorrhea is defined as:

A
  1. absence of menarche by age 13 years _without secondary sexual developmen_t
  2. OR by the age of 15 with secondary sexual development
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23
Q

Menstrual cycles are often _____ throughout adolescents, especially from first to the second cycle.

A

irregular

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24
Q

Most normal cycles range from _____ days even in first gynecologic year.

A

21-45

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25
Q

Secondary amenorrhea is defined

A

absence of menstruation for 6 months.

It is rare to not have pd for longer an 3 months. If so, workup is needed: check urine or serum B-hcG to rule out pregnancy.

26
Q

Oligomenorrhea

A

Menstrual cycles at > 35 day cycles

27
Q

Menorrhagia

A

Menorrhagia (hypermenorrhea): Regular intervals that are very heavy with excessive and/or prolonged menses (>80mL and > 7 daysvals)

28
Q

Metrorrhagia

A

irregular bleeding intervals; often times in the middle of cycle

29
Q

Menometrorrhagia

A

Heavy & irregular uterine bleeding

30
Q

Intermenstrual bleeding

A

Scant bleeding at ovulation for 1 or 2 days

31
Q

First menses is usually reported as medium flow. •

  • Mean blood loss per menstrual period is ____ •
  • Most report changing a pad____ times a day •
  • Greater then ____ has been associated with anemia •
    • Changing a pad ____ is considered excessive especially if bleeding is lasting > ___ days.
A

30cc

3-6

80cc

every 1-2 hours

more than 7 days

32
Q

what. is the classification system for abnormal bleeding in reproductive-aged women

A
  1. PALM (structural causes)
  2. COEIN (nonstructural causes)
33
Q

PALM (structural causes) of abnormal bleeding

A

AUB= abnormal uterine bleed

  1. Polp (AUB-P)
  2. Adenomyosis (AUB- A)
  3. Leiomyoma (AUB-L)
    1. submucosal myoma (AUB- L sm)
    2. othre myoma (AUB- L o)
  4. Malignancy and hyperplasia (AUB-M)
34
Q

AUB-P

What happen:

Cause:

A
  • Endometrial polyps form on endometrium and creat soft friable protrusion into endometrial cavity:
  • causes menorhagia (heavy bleeding >80cc), spontaneous of post-menopausal bleeding.
35
Q

AUB-A

A
  • Adenomyosis: endometrial glands and stroma break through the muscle wall of the uterus (myometrium) >2.5mm in basiis layer
    • Cells that break through will not undergo proliferative/secretory cycles
    • can cause endometriosis (15%)
  • Sx: asymptomatic, secondary dysmenorrhea and menorhaggia
    *
36
Q

What is the MOST common neoplasm of the uterus?

A

AUB-L

Uterine leiomyomas (FIBROIDS)

37
Q

Polyhydraminos

Oligohydraminos

A

too much fluid

too little fluid

38
Q

AUB-L

A

Uterine Leiomyomas (fibroids)

Fibroids are benign tumors from the smooth muscles of the myometrium. 45% of wommen will have them by 5th decade.

39
Q

Symptomatic fibroids can cause:

A
  1. Excessive uterine bleeding
  2. Pelvic pressure/pain
  3. Infertility
40
Q

• Most common indication for hysterectomy is __________

A

SYMPTOMATIC FIBROIDS

41
Q

• RISK FACTORS for developing fibroids

A
  1. Increasing age in reproductive years
  2. African-american women have a 2-3 fold increase
  3. Nulliparity (a woman who has never had a child)
  4. FH
42
Q

Top 3. areas where fibroids occur

A
  1. Subserosal fibroid
  2. Interstitial fibroids
  3. Submucosal fibroids
43
Q

Fibroid

Pathogenesis:

Sx:

A
  • Pathogenesis: unknown, rarely form b4 mencarche or enlarge after menopause. Estrogen causes proliferation. of smooth muscle cells. can enlarge during pregnancy
  • Sx: most are asymptomatic
    • pelvic pain
    • severe pain not. common unless undergoing acute infarction
    • Frequency of urination bc presses on bladder
    • Prolonged or heavy bleeded
    • Increased incidence of infertility. (common d/t submucosal fibroids).
44
Q

(aub-m)

A

ENDOMETRIAL HYPERPLASIA, a precursor to endometrial cancer.

Endomestrial lining keeps growing d/t persitant unopposed estrogen by granulosa theca cell tumors (make EST), obesity, exogenous estrogens, tamoxifin

45
Q

• Hyperplasia- precursor to malignancy

Simple without atypia • (___& chance to develop cancer)…

Complex without atypia •

Simple with atypia •

Complex with atypia

A

Simple without atypia (1%)

Complex without atypia • (3%)

Simple with atypia • (9%)

Complex with atypia (27%)

46
Q

most common type of endometrial hyperplasia?

Risk factors?

Presentation?

A
  1. Type 1: Endometrial adnenocarcinoma
  2. Obesity and unopposed estrogen
  3. Postmenopausal bleeding is the most common presentation
47
Q

AUB-C

A

Coagulopathies, nonstructural cause, associated with heavy flow often d/t von willibrand factor disease

48
Q

AUB-O

A

Ovulatory Dysfunction: unpredictable menses with variable flow often d/t polycystic ovarian syndrome

49
Q

AUB-E

A

Endometrial Causes such as infection

50
Q

AUB-I

A

Iatrogenic: IUD, IUS, exogenous hormones

51
Q

AUB-N

A

Not Yet Classified

Reserved for entities that are poorly defined &/or not well examined, ex

52
Q

treatment options for abnormal uterine bleeding.

A

1. Coordinate endometrial sloughing

  • MPA (medoroxyprogesterone) or combined oral contraceptives (OCP’s):If someone has AUB: give progesterone, make it seem like she had her cycle, have her come off of progesterone, causing her to slough.

2. Endometrial supression

  1. Give progesterone daily, tricks body to think pregnany
  2. Continous OCPs, BC without placebo pills. Instead, start a new padk.
  3. IUS (intrauterine system)
53
Q

Be familiar with the work up options for uterine bleeding.

A

Laboratory Tests

  1. Pregnancy test (blood or urine) •
  2. CBC
  3. Screening for bleeding disorders
    • Von Willebrands profile
    • PT and PTT
  4. TSH
  5. Chlamydia trachomatis
54
Q

Available Tissue Sampling Methods (When indicated)

A
  1. Office endometrial biopsy
  2. Hysteroscopy directed endometrial sampling
55
Q

What are indications for in office endometrial biopsy

A
    1. AUB in post-menopausal women
    1. Women 45-menopase with ANY AUB.
    1. Woman < 45: any bleeding that occurs d/t unopposed estrogen exposure; obesity, PCOS or prolonged amenorrhea
      • glandular cells on cervical cytology test.
56
Q

PUBERTY

• Average duration is ____ years. •

Usually occurs between ____y/o (mean is ___)

A

Puberty-> development of secondary. sex xharacteristics. and reproductive capability.

4-5

10-16

Mean: 12.4. years old

57
Q

Stages of normal pubertal. development (4)

A

TAGM (thelarche, adrenarche, growth spurt, menses)

  • 1. Thelarche (breast development) is the first sign of puberty and REQUIRES estrogen
    1. Pubarche/adrenarche (pubic hair/axillary hair develpment) REQUIRES androgens.
    1. Max growth or peak height velocity.
      * Occurs 2 years earlier in girls, 1 year before onset of menses.
    1. Menses, requires pulsatile GnRH, FSH and LH, estrogen and progesterone from ovaries and normal outflow tract
58
Q

what races go through puberty earlier

A

African american -> and hispanic

59
Q

Tanner. stageing is the stages of breast development

A
  • Stage 1: Preadolescent: papilla elevates
  • Stage 2: breast bud form; breast and papilla elevate into a small mound with arealar region enlarging
  • Stage 3: Breast.and areola get bigger w/o separation of countours
  • Stage 4: areola and papilla project to to form a secondary mound above breasts
  • Stage 5: mature stage: projection of papilla only, d/t retraction of areola.
60
Q

Tanner. stageingis the stages of pubic hair development

A
  • Stage 1: preadolescent: none
  • Stage 2: sparse hair along labia with slight pigment
  • Stage 3: hair spreads over junction of pubes
  • Stage 4: adult type hair
  • Stage 5: adult type hair that. spreads to medial thigh

Endo/Repro Exam 2 (17 decks)

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