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GIGU Final > Menarche > Flashcards

Menarche Flashcards

1
Q

What is the time frame of the follicular phase of the ovulatory cycle?

A

it begins with the onset of menstruation and culminates in the preovulatory surge of LH

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2
Q

what is the time frame of the luteal phase of the ovulatory cycle?

A

it begins with the onset of the preovulatory LH surge and ends with the first day of menses

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3
Q

what is the effect of the decreasing levels of estradiol and progesterone from the regressing corpus luteum of the preceding cycle?

A

it is going to initiate an increase in FSH by a negative feedback mechanism, which stimulates follicular growth and estradiol secretion

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4
Q

What does LH stimulate in the ovarian follicle?

A

the theca cells to produce andorgens

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5
Q

what does FSH stimulate in the ovarian follicle?

A

the granulosa cells to convert the androgens made in the theca cells into estrogens

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6
Q

what happens to the LH and FSH levels during the luteal phase?

A

they are significantly suppressed through the negative feedback effect of the elevated circulating estradiol and progesterone

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7
Q

what happens to the levels of progesterone and estrogen near the end of the luteal phase if conception does not occur?

A

they will decline

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8
Q

what type of hormone is GnRH?

A

a decapeptide synthesized in the arcuate nucleus

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9
Q

what effect does estradiol have on the hypothalamus?

A

it appears to enhance the hypothalamic release of GnRH and induce the midcycle LH surge

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10
Q

what effect do the gonadotropins have on GnRH release?

A

an inhibitory effect

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11
Q

when do estrogen levels generally reach a maximum peak?

A

1 day before the midcycle LH surge

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12
Q

during the follicular development, the ovary secretes only a very small amount of progesterone. Where does the bulk of the progesterone come from?

A

the peripheral conversion of the adrenal pregnenolone and pregnenolone sulfate

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13
Q

prior to ovulation the unruptured luteinizing graafian follicle begins to produce what?

A

increasing amounts of progesterone

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14
Q

at about 8-10 weeks of fetal development, what do the oocytes become surrounded by?

A

the precursor granulosa cells- this complex is called the primordial follicle

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15
Q

what do the inner most layer of the granulosa cells of the cumulus oophorus become?

A

the corona radiata

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16
Q

what does the corpus luteum produce?

A

copious amounts of progesterone and some estradiol

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17
Q

what is the endometrium responsive to?

A

circulating progestins, androgens, and estrogens

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18
Q

what kind of arteries does the functional layer of the endometrium contain?

A

spiral arteries

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19
Q

what kind of arteries does the inner/ basalis layer of the endometrium contain?

A

straight/ basal arteries

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20
Q

the cyclic changes in the histophysiology of the endometrium can be divided into 3 stages. What are these stages?

A

the menstrual phase, the proliferative (estrogenic) phase, and the secretory (progestational) phase

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21
Q

what is the proliferative phase characterized by?

A

endometrial growth/proliferation secondary to estrogenic stimulation/ increase in the length of the spiral arteries and numerous mitoses can be seen in these tissues

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22
Q

when does the secretory phase occur?

A

following ovulation

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23
Q

what stimulates the secretory phase?

A

progesterone secretion by the corpus luteum stimulates the glandular cells to secrete mucus, glycogen, and other substances

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24
Q

does mitosis occur during the secretory phase?

A

it is rare

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25
Q

what happens if conception does not occur by day 23?

A

the corpus luteum begins to regress, secretion of progesterone and estradiol declines, and the endometrium undergoes involution

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26
Q

what typically happens one day prior to the onset of menstruation?

A

there is marked constriction of the spiral arteries ( results in ischemia of the endometrium) leukocytes infiltrate and there is RBC extravasation

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27
Q

restoration of blood vessels require successful interaction of platelets and clotting factors; what medications can impair this coagulation system and be associated with heavy bleeding?

A

warfarin, aspirin, and clopidogrel

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28
Q

what is the purpose of the human papillomavirus vaccine?

A

it offers protection against cervical cancer, cervical dysplasia, vulvar or vaginal dysplasia, and genital warts associated with the gardasil HPV genotypes

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29
Q

when is the median age of menarche?

A

12 years

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30
Q

what is primary amenorrhea?

A

the absence of menarche by age 13 without secondary sexual development OR by the age of 15 with secondary sexual development

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31
Q

what is the median length of the first cycle after menarche?

A

34 days

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32
Q

what is secondary amenorrhea defined as?

A

the absence of menstruation for 6 months

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33
Q

what are the general causes of menstrual irregularity?

A

pregnancy, endocrine causes, acquired conditions, or tumors

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34
Q

what is greater than 80 cc blood loss associated with?

A

anemia

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35
Q

what is dysfunctional uterine bleeding (DUB) (also known as abnormal uterine bleeding now)?

A

abnormal uterine bleeding that cannot be attributed to medications, blood dyscrasias, systemic disease, trauma, or organic conditions

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36
Q

what is dysfunctional uterine bleeding usually caused by?

A

aberrations in the H-P-O axis resulting in anovulation

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37
Q

what is polymenorrhea?

A

abnormally frequent menses at intervals less than 21 days

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38
Q

what is menorrhagia (hypermenorrhea)?

A

excessive and/or prolonged menses occurring at regular intervals

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39
Q

what is metrorrhagia?

A

irregular episodes of uterine bleeding

40
Q

what is menometrorrhagia?

A

heavy and irregular uterine bleeding

41
Q

what is intermenstrual bleeding?

A

scant bleeding at ovulation for 1-2 days

42
Q

what is oligomenorrhea?

A

menstrual cycles at >35 day cycles

43
Q

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

A

PALM-COEIN

44
Q

what are the causes of the PALM abnormal bleeding in reproductive-aged women?

A

structural causes

45
Q

what does the P stand for in PALM?

A

polyp

46
Q

what does the A stand for in PALM?

A

adenomyosis

47
Q

what does the L stand for in PALM?

A

leiomyoma

48
Q

what does the M stand for in PALM?

A

malignancy and hyperplasia

49
Q

what are the causes of the COEIN abnormal bleeding in reproductive-aged women?

A

non-structural causes

50
Q

what does the C stand for in COEIN?

A

coagulopathy

51
Q

what does the O stand for in COEIN?

A

ovulatory dysfunction

52
Q

what does the E stand for in COEIN?

A

endometrial

53
Q

what does the I stand for in COEIN?

A

iatrogenic (relating to illness caused by medical examination or treatment- like an IUD)

54
Q

what does the N stand for COEIN?

A

not yet classified

55
Q

what can polyps cause?

A

menorrhagia or spontaneous or post menopausal bleeding

56
Q

what would the ultrasound findings of a patient with endometrial polyps suggest?

A

focal thickening of the endometrial stripe

57
Q

how would you detect a poly?

A

saline hysterosonography and hysteroscopy

58
Q

what is an adenomyosis?

A

the extension of the endometrial glands and stroma into the uterine musculature

59
Q

what are the symptoms of adenomyosis?

A

they may be asymptomatic; severe secondary dysmenorrhea (pain with menstrual cycles) and menorrhagia(heavy vaginal bleeding); dyspareunia (pain with intercourse) with deep penetration

60
Q

how is adenomyosis diagnosed?

A

histopathology

61
Q

what is a leiomyoma?

A

a fibroid- a benign tumor derived from smooth muscle cells of the myometrium

62
Q

what is the most common indication of hysterectomy?

A

symptomatic fibroids

63
Q

what are the risk factors for developing fibroids?

A

increasing age during reproductive years, african american women, nulliparity (never been pregnant), and a family history

64
Q

what stimulates the proliferation of smooth muscle cells?

A

estrogen

65
Q

what happens to fibroids during pregnancy?

A

they can dramatically enlarge

66
Q

what is a subserosal fibroid?

A

if a fibroid occurs on the outside of the uterus

67
Q

what is an interstitial fibroid?

A

if a fibroid occurs in the muscle of the uterus

68
Q

what is a submucosal fibroid?

A

if a fibroid occurs on the inside of the uterus with a protrusion into the endometrium

69
Q

if a fibroid does produce symptoms, what would they be?

A

pelvic or lower back pain, frequency of urination, prolonged or heavy bleeding, increased incidence of infertility

70
Q

which fibroids are associated with prolonged or heavy bleeding?

A

submucosal or intramural (interstitial) fibroids

71
Q

what fibroids are more associated with infertility?

A

submucosal fibroids

72
Q

what is endometrial malignancy/ hyperplasia?

A

it represents an overabundant growth of the endometrial lining usually as a result of persistent unopposed estrogen

73
Q

what is endometrial hyperplasia a precursor to?

A

endometrial cancer

74
Q

what is type 1 hyperplasia?

A

endometrial adnenocarcinoma- the most common type

75
Q

what is type 2 hyperplasia?

A

clear cell and papillary serous

76
Q

what is the presentation of endometrial hyperplasia?

A

postmenopause bleeding or irregular uterine bleeding( after the age of 35)

77
Q

what would indicate an in office endometrial biopsy?

A

abnormal uterine bleeding in post menopausal women or if there are positive glandular cells on a cervical cytology

78
Q

what is an in office endometrial biopsy and when is it best used?

A

it’s a blind biopsy and it is better if used when the pathology is global (like hyperplasia) rather than focal (polyp)

79
Q

what are the contraindications of an in office endometrial biopsy?

A

pregnancy (absolute) and bleeding diathesis (relative)

80
Q

what is the removal of fibroids called?

A

myomectomy

81
Q

what are three surgical options to treat AUB?

A

D&C, uterine endometrial ablation, and hysterectomy

82
Q

what is a therapeutic D&C used for?

A

performed for endometrial structural abnormalities (polyps, small submucosal fibroids)

83
Q

what is a diagnostic D&C used for?

A

performed for irregular menstrual bleeding or postmenopausal bleeding to rule out endometrial hyperplasia or cancer

84
Q

what is endometrial ablation?

A

it uses radio frequency to the bipolar mesh electrode while at the same time applying suction to the endometrium

85
Q

what is the average duration of puberty?

A

4-5 years

86
Q

between the ages of 8-11, there is an increase in serum concentrations of what?

A

DHES, DHEA-S, and androstenedione

87
Q

what are the initial endocrine changes associated with puberty?

A

adrenal androgen production and differentiation by the zona reticularis of the adrenal cortex

88
Q

what does rise in adrenal androgens cause?

A

growth of axillary and pubic hair (adrenarche or pubarche)

89
Q

what happens around 11 years of age when talking about the onset of puberty?

A

there is a gradual loss of sensitivity by the gonadostat to the negative feedback of sex steroids; in combination with the intrinsic loss of CNS inhibition of hypothalamic GnRH release

90
Q

what does an increase in GnRH promote?

A

ovarian follicular maturation and sex steroid production, which leads to the development of secondary sexual characteristics

91
Q

what are the stages of normal pubertal development?

A

TAG ME- thelarche, adrenarche, growth spurt, menses

92
Q

what does thelarche require?

A

estrogen

93
Q

what does pubarche/adrenarche require?

A

androgens

94
Q

when does maximal growth or peak height occur?

A

about 1 year before onset of menses

95
Q

how many stages are there in the tanner staging?

A

5

GIGU Final (15 decks)

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