OBGYN: sexual diff, DUB, PMS/PMDD, sexual dsyf, fertility Flashcards

1
Q

define gonads
men?
women?

A

primary sex organs
men=testes
women=ovaires

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2
Q

gonads produce?

A

sex cells called gametes–sperm and ova

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3
Q

secondary sex organs provide?

A

route by which sex cell unite

men: epididymis, vas def, protate, etc
women: FTs, vagina, uterus, external genitalia, etc

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4
Q

how many chromosomes in cell dna

A

22

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5
Q

gametes have how many chromosomes

A

22 + X o Y

total=23

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6
Q

who determines the sex of baby

A

father

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7
Q

what week of gestation will the embryo differentiate into male or female

A

6-7th week

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8
Q

what week does testosterone secretion begin

A

8th week

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9
Q

SYR gene is only present in?

A

males—sex determination region on the Y chromosome

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10
Q

SRY gene produces

A

testes-determining factor–which will produce male gonads

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11
Q

when can you determine via US the sex of fetus

A

15-16th week the EARLIEST

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12
Q

general causes of AUB

MCC?

A

structural issues

  • polps
  • adenomyosis
  • leiomyoma (fibroids)
  • malignancy

non-structual issues

  • coagulopathy
  • ovulatory
  • endometrial
  • iatrogenic

MCC=lack of ovulation (90%)

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13
Q

when AUB is caused by anovulation, it is called?

A

Dysfunctional uterine bleeding (DUB)

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14
Q

in a normal cycle, what causes the proliferation of endometrium

A

estrogen secreted from follicle

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15
Q

what acts on endometrium to limit growth and cause changes in vasculature of endmetrium–which limits bleeding during menses

A

proegsteorne

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16
Q

describe progesterones effect on proliferating endometrium

A
  1. limit growth
  2. cause changes in vasculature of endometrium
    * *all of which limits bleeding during menses
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17
Q

what happens if a follicle forms but never releases the ovum?

A

follicle will continue to produce estrogen—->encouraging proliferation beyond normal 14 days
*****no progesterone is being produces

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18
Q

what happens when there is no progesterone produced bc no ovulation occured

A

no progesterone=inhibiting the thickened endometrium from shedding in a predictable fashion w/o excessive blood loss

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19
Q

what happens without ovulation (3)

A
  1. flow becomes irregular–>Metrorrhagia
  2. menorrhagia—>excessive bleeding
  3. Menometrorrhagia–>both excessive + irregular flow
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20
Q

define the following:

  1. metrorrhagia
  2. Menorrhagia
  3. Menometrorrhagia
A
  1. irregular flow
  2. excessive flow
  3. both excessive + irregular flow
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21
Q

causes of DUB (5)

A
  1. girls at the edges of reproductive years–prepubescent and perimenopausal
  2. PCOS
  3. obesity
  4. hyperthryoidism and hypothyroidism
  5. estrogen secreting tumors
22
Q

tx for DUB
1st line
2nd line

A
  1. NSAIDS= FIRST LINE

2. hormonal contraception*****

23
Q

why is NSAIDS helpful in DUB

A

they reduce prostaglandin syntehsis w/in the endometrial tissue–>causes vasoconstriction—>decreased menstrual blood loss

24
Q

how do hormonal contraceptives help DUB

A

they override the HPG (hypopituitarygrowth) axis and mimic normal menstrual bleeding or suppress it early

25
Q

PMS and PMDD

A

cyclical recurrence of distresing physical, psychologic or behavioral changes that impair interpersonal relationships or interfere with usual activites

26
Q

s/s of PMS and PMDD occur when in the cycle

-how long can these s/s last

A

after ovulation—- after day 14
during luteal phase

can last up to 4 days into the menstrual cycle

27
Q

what is most imp for establishing diagnosis of PMS or PMDD

A

symptom frequency and severity vs the actual symptoms

28
Q

diagnostic criteria for PMDD

A

“Presence of at least one psychological or physical symptom that causes significant impairment and is confirmed by means of prospective ratings (i.e. at least present for 2 cycles of a symptom diary, etc.).”

29
Q

most women report what around their menses

A

some form of distress

—90%

30
Q

enough distress around their menses to interrupt their daily life and routine is called?

A

PMS–pre-menstrual syndrome

31
Q

women report predictable symptoms that cause significant impairment around their menses is called?

A

PMDD— premenstrual dysphoric disorder

32
Q

the s/s of PMS and PMDD are brought on by?

A

ovulation
NOT
menstruation

**bc the s/s are before menstruation and after ovulation

33
Q

list the most distressing s/s of PMS/PMDD (4)

A
  1. emotional—depression, anger, irritability, fatigue
34
Q
tx for PMS and PMDD 
initial tx
1st line med 
2nd 
severe severe cases
A

PMS
mediated by lifestyle, social and psychological factors–>tx is mainly symptomatic tx*

Initial tx:

  • validation of premenstrual experience
  • education on PMS and self help techniques

1st line medical
-hormonal contraceptions—regulates womens cycle and decrs amount of circulation hormones

2nd
-SSRIs continually or during premnstrual pd

severe cases—menses can be terminated by using GnRH and suppressing the entire cycle—-very intense tx tho and we try to avoid this…

35
Q

four phases of sexual response

A
  1. excitement
  2. plateau
  3. orgasm
  4. resolution
36
Q

define sexual dysfunction

causes?

A

lack of satisfaction with sexual function—

causes

  • pain
  • deficiency in sexual desire, arousal or orgasm/climax
37
Q

define dyspareunia

A

painful intercourse

-pain at arousal, orgasm, or any time during intercourse

38
Q

causes of dyspareunia

A

inadequate lubrication:

  • low estrogen levels can decr lubrication—lactation, menopause,
  • drugs can decr lubrication—-anything that has drying effect such as antihistamines
39
Q

four categories that sexual dysfunction is divided into

A
  1. disorders of desire
  2. disorders of arousal
  3. disorders or orgasm
  4. disordrs of pain—- dyspareunia
40
Q

define infertility

A

inability to concieve after ONE FULL YEAR of unprotected sex with same, opposite partner

*can be reduced to 6 MO for women 35 YO+

41
Q

majority of intertility is MC male or woman fault?

A

woman

42
Q

factors contributing to intertility

A
  • ovulatory factors
  • age
  • abnormalities of reproductive tract—endometriosis, adhesions, and scarring from PID
43
Q

list the five female intertility tests

A
  1. ovulation is occuring normally
  2. endometrium is responidng normally to hormones
  3. reproductive tissues are free of tumors or infections
  4. woman has any chronic conditions interfering with fertilization or implantation
  5. reproductive tract is adequately patent
44
Q

list the imp perineal muscles holding bladder, urethra and rectum

A

transverse perineal muscles

levator ani

45
Q

pelvic organ prolapse (POP)

-define

A

descent of one or more of the following

  • vaginal walls
  • uterus
  • vaginal apex (after a hysterectomy)
46
Q

define cystocele

MCC

A

descent of a portion of bladder wall into vagianl canal

-caused MC trauma of childbirth

47
Q

define rectocele

A

bulging of rectum and posterior vaginal wall into vaginal canal

causes

  • childbirth
  • yrs after menopause MC time it comes
  • life long chronic constipation and straining
48
Q

uterine prolapse

-define

A

descent of cervix or entire uterus through vaginal wall

severe cases— the cervix will protrude thru introitus

49
Q

first line tx uterine prolapse

A

pessary—removable mechanical devise that holds uterus in position
-pelvic fascia may be strengthened thru KEGEL exercises or by estrogen tx in menopausal women

50
Q

MC pessary?

A

Gellhorn