Female Reproductive Case Studies - (RS)

Question 1

The symptoms of the menopause are primarily due to?

Answer 1

Lack of estrogen production by the ovaries. Most of the symptoms are estrogen-related. You would never give someone straight estrogen, you need to give progesterone with it

Question 2

Menopause is typically diagnosed by a?

Answer 2

rise in circulating FSH. LH also increases during menopause, however, FSH is typically used because it is a more dramatic increase

Question 3

How does hormone replacement therapy affect menopause?

Answer 3

reduces the symptoms associated with the menopause. Is controversial because of the increased risk of cardiovascular disease, cerebrovascular disease, and breast cancer. Is being displaced by the developments of Selective Estrogen Receptor Modulators (SERMs) which mimic the effects of estrogen on bone, but not the detrimental effects on uterus and breast.

Question 4

Puberty is characterized by?

Answer 4

Pulsatile GnRH secretion initially at night an then also during the day.

Question 5

After puberty hypothalamic GnRH secretion can be diminished by?

Answer 5

Significant weight loss, exercise, and stress. Ballerinas or anorexic girls that have very little body fat will be absent of menses.

Question 6

A diagnosis of hypothalamic amenhorrhea is obtained by?

Answer 6

Increased FSH and LH release after injection of exogenous GnRH. If you got decreased FSH and LH release after injection of exogenous GnRH the problem would be at the level of the pituitary

Question 7

What is polycystic ovary syndrome?

Answer 7

No dominant follicle emerges and ovulation does not occur. (you need that for the LH surge because of the positive feed back). This is one of the most common causes for infertility in women

Question 8

What is polycystic ovary syndrome characterized by?

Answer 8

Reduced estrogen production by the granulosa cells, reduced progesterone production by granulosa and thecal cells, continued production of androgen by the thecal cells throughout the cycle, irregular or completely absent menses

Question 9

What treatment options exist for polycystic ovarian syndrome?

Answer 9

Combination birth control pills (estrogen + progesterone) to restore regular menstrual period, clomiphene to restore ovulation, 5-alpha reductase inhibitors to block conversion of testosterone to dihydrotestosterone, weight loss to control abnormal blood glucose and diminished insulin sensitivity

Question 10

When does endometriosis occur?

Answer 10

Occurs when tissue from the uterine endometrium spreads to the peritoneal cavity often around the ovaries. The tissue responds just like normal tissue in the uterus. How do you get rid of the blood? You can’t, it must be resorbed slowly and causes inflammation and pelvic pain. It does show necrosis which is why you get the inflammatory response. Endometriosis and symptoms subside in a pregnant woman. Everything responds normally

Question 11

What is the leading theory for the cause of endometriosis?

Answer 11

Retrograde menstruation

Question 12

Treatment of endometriosis may involve

Answer 12

Oral contraceptive therapy to regulate hormonal balance, OTC pain relievers, surgery to remove ectopic tissue

Question 13

Characteristics of an ectopic pregnancy often include

Answer 13

Abnormal fetal development. As well as abnormal fetal nutrition, abnormal blood supply, abnormal placental develop, hCG will be normal

Question 14

Many ectopic pregnancies occur in the fallopian tube, which stretches and may spontaneously rupture. Where is the most dangerous region for rupture that places the patient at risk for massive hemorrhage is?

Answer 14

The interstitial area which generally ruptures at 12-16 weeks gestation. Rupture of any region is dangerous, it’s just not equally dangerous

Question 15

What is the treatment of ectopic pregnancy?

Answer 15

Single dose of methotrexate to inhibit rapidly dividing cells, especially in early cases, methotrexate series, laproscopy and salpingectomy (removal of the fallopian tube)