Female Flashcards
1
Q
How does an ovarian follicle develop?
A
- Starts as promordial follicle
- Starts do build up the proteins around it and the nucleus gets bigger
- more and more protein
- As a graffian follicle, the egg has a large nucleus and is surrounded by the fluid filled antrium
- must store lots of proteins b/c it will not receive any nutrients for about a week after it ovulates until it becomes implanted
2
Q
What surrounds the antrum?Why?
A
- Granulosa layer- convert the androgen steroids into estrogen
- Theca interna- where androgen steroids are made
- it has the white blobs
- Theca externa- connective tissue
3
Q
How does the Hypothalamic-Pituitary-Axis affect males and females?
A
- Male
- GnRH causes the release of LH and FSH
- LH goes to the Leydig cell and increases testosterone synthesis
- FSH goes to the sertoli cell and increases androgen binding protein which works with the testosterone formed in the leydig cell
- this supports sperm development
- Female
- GnRH causes the release of LH and FSH
- LH goes to the thecal cell to increase androgen synthesis
- FSH goes to the granulosa cell and increases aromatase which turns the androgen into estrogen
- this supports egg development
4
Q
How do you diagnose amenhorrhea?
(chart)
A
5
Q
Compare the three pituitary glycoprotein hormones and HCG.
A
- TSH, FH, LH, HCG
- All have the same alpha subunit.
- Specificity for each hormone is found at the beta subunit and protein structure
- HCG differs from LH only b/c it has 32 additional amino acids in its Beta-subunit
- TSH and HCG also look very similar and can bind to the same receptors
- cannot measure TSH during pregnancy, must look at free T3 and T4
6
Q
What causes cervical cancer?
What part of cervix is at greatest risk?
A
- HPV is responsible for almost 100% of cervical cancer and can also cause cancer at other sites
- The cervic transforms over the lifespan and is at greater risk during some stages than others
-
squamocolumnar junction is at greatest risk
- at birth it is inside and is protected
- as a young adult it is exposed
- as an adult it is inside again and more protected
7
Q
Does the HPV vaccine prevent all cervical cancers?
A
No, pap smears are still required.
8
Q
What causes endometriosis?
A
- Endometrial cells back flow into the pelvis
- through falopian tube, into lymph, or into blood
9
Q
What is a Leiomyoma?
A
- Uterine fibroid- not a cancer, but a smooth muscle tumor; does not metastasize
- occur in 30-50% of women
- can be asymptomatic or very painful
10
Q
Stats about endometrial cancer
A
- Most common cancer of the femal reproductive system but least deadly
- about 40,000 cases/year
- about 7,000 deaths
- commonly affects post-menopausal women and one of the first symptoms is bleeding
- they get this checked out b/c they havent had a period in many years and know something must be wrong
11
Q
What are the different degrees of uterine prolapse?
A
- A= normal uterus
- B= first degree prolaps- descent of uterus within the vagina
- C= second degree prolapse- the cervix protrudes through the introitus
- D= third degree prolaps- the vagina is completely everted
12
Q
What is cystocele?
Rectocele?
A
- Cystocele- the bulging of the bladder through the vagina
- Rectocele- the bulging of the rectum through the vagina
- Ex. the chick on the cruise ship
13
Q
What is salpingitis?
A
- Inflammation of the fallopian tubes
- almost always seen as a component of pelvic inflammatory disease
- often caused by an infection (chlamydia, gonorrhea, tuberculosous) or endometriosis
- also can be seen after ectopic pregnancy that has damaged the fallopian tubes
14
Q
What is pelvic inflammatory disease?
A
- inflammation of the fallopian tube or the ovary or both
- usually caused by infection or endometriosis
15
Q
What is polycystic ovarian syndrome?
A
- Leading cause of infertility
- High LH and low FSH
- LH- makes lots of androstendione
- FSH- converts androstendione into estrogen
- Without the FSH you have a bunch of androstendione building up, it goes into circulation
- causes excess androgens-
- fat will convert androstendione into estrogen and now the pituitary will think that everything is ok, plenty of estrogen
- problem is that it is not in the ovary where it needs to be
16
Q
What are the symptoms of polycystic ovarian syndrome?
Treatment?
A
- Symptoms:
- Irregular or no menstruation
- excess androgen
- enlarged ovaries with multiple cysts
- Treatment:
- Medications to regulate menstrual cycle (oral contraceptives)
- meds to reduce excessive hair growth
- meds to achieve pregnancy
- surgery
17
Q
What is the surgery for Polycystic ovarian syndrome?
A
- laparoscopic ovarian drilling
- popping the cysts
- the goal is to stimulate ovulation by reducing levels of LH and androgen hormones
18
Q
Ovarian tumors:
Which one is most common and most deadly? Why?
A
- Surface epithelial cells tumors are most common of the ovarian tumors, but overall arent that common
- Most deadly because they go unnoticed for a really long time before they are detected
- by then they have already metastasized
- poor prognosis (~23,000 cases/year with about ~14,000 deaths/year)
- Women with BRCA1 mucation have risk of 30% compared to other women with risk of 2%
19
Q
Where do teratomas come from?
A
Mature teratomas arise from germ cells and are seldom malignant
20
Q
What are the cardiovascular and hematologic changes seen in pregnancy?
A
- Increased blood volume, RBCs
- increased SV, HR, CO
- decreased HCT
- BP stays about the same but with increased venous pressure in legs
21
Q
What are the respiratory changes seen in pregnancy?
A
- increased RR, TV, MV, PaO2, and O2 consumption
- decreased PaCO2 (slight alkalosis), airway resistance, ERV, FRC, TLC
- no change in VC
22
Q
What are the GI changes seen in pregnancy?
A
- increased bile secretion, bile stasis, and gallstones
- decreased LES tone (frequent heartburn), bilirubin (normally, unless they have cholestasis)
23
Q
What are the endocrine changes seen in pregnancy?
A
- Increased estrogen, progesterone, cortisol, growth hormone, placental lactogen, prolactin
- decreased bs, TSH (but normal T3/T4
24
Q
What other changes do you see druing pregnancy?
A
- Increased GFR, pain threshold, CSF
25
What is the difference between a partial molar pregnancy and a complete molar pregnancy?
* Partial mole- some chorionic villi are vesicular and there is a deformed fetus present that is not viable
* triploid (two DNA from dad, one DNA from mom)
* Complete mole- all chorionic villi are vesicular, no fetus or embryonic tissue
* diploid paternal dna
26
What is pre-eclampsia?
* Mother has HTN, proteinuria, and edema
* happens in 5-10% of pregnancies
* causes inadequate blood flow to the fetus
* inadequate development of placental spiral arteries
* fetus is starved for nutrients so it tells mom to crank up the BP
* Develops in third trimester, can progress to eclampsia
27
What is HELLP?
* Hemolysis, Elevated Liver enzymes, Low Platelet count
* complication or varient of pre eclampsia but more serious (1% mortality)
* often involves liver problems, liver can rupture
* DIC is seen in 20% of pts with HELLP
* can progress to eclampsia
28
What is eclampsia?
* involves seizures and can be fatal
* with current medical care, pre eclampsia and HELLP rarely progress to eclampsia
29
What is placenta previa?
What are the different classifications?
Symptoms?
* When the placenta is too close or covering the cervix
* Symptoms:
* painless vaginal bleeding
* generally not a big issue
30
What is placenta accreta/increta/percreta?
* Placenta is embedded too deeply in the uterus
* Accreta- attaches to myometrium
* increta- invades the myometrium
* percreta- reaches serosa
* \*\*this is a serious medical problem during delivery
* removing the placenta will cause hemorrhage; often requires a total hysterectomy
31
What is abrupto placenta?
* premature detachment of the placenta
* can be partial or complete
* usually causes vaginal bleeding, but not always
* painful
* Obstetric emergency- significant risk to fetus and mom
* fetus is basically holding their breath one this happens
* mom at risk for shock, renal failure, and coagulopathies from mixing of blood
32
What are the four Ts of postpartum hemorrhage?
* Four t's can be the cause of the hemorrhage
* Tone- soft, boggy uterus
* trauma- laceration
* tissue- retained placenta
* thrombin- blood not clotting
33
What is uterine rupture?
* Uterus ruptures
* extremely painful
* often happens d/t old c-section scar
* this is an obstetric emergency- life threatening to mom and baby
* both may have neurolgic problems d/t coagulopathy and stroke
34
What is an amniotic fluid embolism?
What are the signs and symptoms?
* Amniotic fluid enters maternal circulation
* Rare
* life threatening for mom and baby
* Fetal cells trigger coagulation in maternal circulation
* results in PE, can progress to DIC if pt survives long enough
* most survivors will have long term neurological disorders
