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Medical Physiology > Pathologies of the Female Reproductive System > Flashcards

Pathologies of the Female Reproductive System Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some diseases of the female reproductive system?

A 
Hypogonadotropic hypogonadism.
Hyperprolactinemia.
PCOS.
Endometriosis.
Fallopian tube dysfunction.
Implantation failure.
Zona defects.
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2
Q

When can zona defects be recognised?

A

Only after egg retrieval.

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3
Q

Where does hypogonadism refer to?

A

A clinical syndrome.

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4
Q

As what does hypogonadism occur?

A

A result of ovarian failure.

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5
Q

What does hypogonadism cause?

A

The ovaries to produce less than physiologic levels of oestrogen.

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6
Q

Where does the fact that ‘hypogonadism cause the ovaries to reproduces less than physiologic levels of oestrogen’ lead to?

A

Undeveloped gonads.
Delayed puberty.
Failure to start/cessation of menstrual cycle.

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7
Q

What are primary causes of female hypogonadism often?

A

Genetic.

Autoimmune.

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8
Q

Why do secondary causes of female hypogonadism occur?

A

Because of cancer.
Medication.
Lifestyle issues.

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9
Q

How is functional hypothalamic amenorrhea commonly triggered?

A

By excessive exercise.
Nutritional deficiencies.
Psychological stressors.

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10
Q

What are the first steps to be taken for diagnosis of female hypogonadism?

A

Take medical history.

Measure oestrogen and gonadotropin hormone levels.

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11
Q

How can medical history and measurements of oestrogen and gonadotropin be used?

A

To narrow down the next steps for testing.

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12
Q

Why is hormone replacement an effective strategy?

A

It induces puberty/restores menstrual cycle.

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13
Q

What is prolactin?

A

A peptide hormone.

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14
Q

From where is prolactin released?

A

The anterior pituitary.

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15
Q

What does elevated oestrogen during pregnancy increase physiologically?

A

Lactotrophs size.

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16
Q

What does elevated oestrogen during pregnancy stimulate physiologically?

A

Secretion.

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17
Q

What does prolactin stimulate?

A

Mammary glands.

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18
Q

Why does prolactin stimulate mammary glands?

A

To produce milk.

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19
Q

For what does prolactin have supporting role?

A

Progesterone function.

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20
Q

What does prolactin decrease?

A

LH release.

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21
Q

What is the release of prolactin?

A

A balance between the stimulatory actions of 5HT and inhibitory actions of DA.

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22
Q

In what do the inhibitory actions of DA result?

A

A pulsatile release response.

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23
Q

What does kisspeptin release promote?

A

The release of GnRH hormone.

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24
Q

What does hyperprolactinemia suppress?

A

GnRH release via decreased kisspeptin release.

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25
Q

What are the causes of hyperprolactinemia?

A

Physiological = suppress cycle during nursing.
Stress = DA release inhibition.
Drugs = cocaine, antidepressants-SSRIs, verapamil.
Tumour.

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26
Q

What does verapamil block?

A

DA release.

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27
Q

What does DA agonist therapy represent?

A

The cornerstone of management of most patients with prolactinomas who require therapy.

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28
Q

What is DA agonist diagnosis and therapy?

A

Single measurement sandwich immunoassay.

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29
Q

How many nonpregnant females occur during DA diagnosis and treatment?

A

2-29 ng/ml.

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30
Q

How many pregnant females occurred in diagnosis and treatment of DA?

A

10-209 ng/ml.

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31
Q

How long is the tumour in DA diagnosis and treatment?

A

> 200nl/ml.

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32
Q

What is PCOS?

A

The most common endocrine disorder in women.

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33
Q

How much currency does PCOS have in women?

A

6-20%.

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34
Q

With what is the syndrome associated?

A 
Two or three of:
infrequent/absent ovulation.
morphological abnormalities of ovaries.
hyperandrogenism.
insulin resistance.
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35
Q

On what does PCOS is described?

A

Ultrasound scan.

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36
Q

As what is PCOS described?

A

The presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter.
Increased ovarian volume >10 ml.

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37
Q

What was the estimated economic impact pin 2004 in US of PCOS?

A

$4 Billion.

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38
Q

What is pathophysiology of female reproductive system?

A

complex.

not fully understood.

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39
Q

What is one hypothesis of the pathophysiology of female reproductive system?

A

That multiple developing follicles from elevated LH and lower FSH result in a higher population of thecal cells and androgen + oestrogen release.

40
Q

How is the fact that ‘elevated LH and lower FSH –> more thecal cells, androgen and oestrogen’ helps?

A

Maintain altered LH/FSH ratio.

41
Q

What does maintaining altered LH/FSH ratio prevent?

A

Ovulation.

42
Q

To what do elevated androgens contribute?

A

Insulin resistance.

Hyperinsulinemia.

43
Q

What do elevated insulin levels suppress?

A

Release of SHBG.

44
Q

What will elevated free form of the androgens increase?

A

Body hair growth.

45
Q

What is ideal but time consuming for diagnosis 7 treatment options?

A

The Measurement of free testosterone (T).

46
Q

What is the Ratio of total T:SHBG?

A

Practical alternative.

47
Q

What do not all women with hirsutism have?

A

Elevated T.

48
Q

What is the treatment with oral oestrogen progessing?

A

To combined anti-androgen if needed.

49
Q

What is the combination of anti-androgen with oral oestrogen, if needed?

A

Effective.

50
Q

Why is clomiphene given?

A

To treat anovulation.

51
Q

What does clomiphene inhibit?

A

Oestrogen negative feedback.

52
Q

What does clomiphene stimulate?

A

FSH.

53
Q

Why does clomiphene stimulate FSH?

A

To encourage complete maturation.

54
Q

What do drugs with insulin resistance may improve?

A

Anovulation.

55
Q

What are the daily injections of FSH?

A

Effective at inducing ovulation in patients resistant to other treatments.

56
Q

What is endometriosis?

A

A disease characterised by cyclical bleeding with retrograde flux of endometrial tissues.

57
Q

What are the causes of endometriosis?

A

Inflammation.

58
Q

To what does inflammation from endometriosis contribute?

A

Pain.

Infertility.

59
Q

Where doe endometrial-type mucosa occur in endometriosis?

A

Outside uterine cavity.

60
Q

How much is the prevalence of endometriosis?

A

5-10%.

61
Q

How much where the costs in 2008 for endometriosis?

A

10K euros/person.

62
Q

As what are the causes of endometriosis described?

A

Unknown.

63
Q

On what does endometriosis depend?

A

Oestrogen.

64
Q

What is a possibility of endometriosis?

A

Retrograde menstruation.

Genetic predisposition.

65
Q

What is Fallopian tube function?

A

An infection.

Inflammation impair function/passage of gametes.

66
Q

What are the causes of Fallopian tube function?

A

Primary ciliary dyskinesia.

Cystic fibrosis.

67
Q

What is Cystic fibrosis?

A

Defects in mucus and bicarb production.

Upsetting passageway for gametes.

68
Q

What is Implantation?

A

Reduced conception rates with infection/disease.

69
Q

What are some diseases associated with implantation?

A

Uncontrolled diabetes.
Subclinical hypothyroidism.
Uncontrolled coeliac disease.

70
Q

What is thrombophilia?

A

An increased clotting.

71
Q

What is Heparin?

A

A treatment of thrombophilia.

72
Q

What does Heparin do to treat Thrombophilia?

A

Reduces trophoblast invasion.

73
Q

With what are Elevated NK cells associated?

A

Implantation failure.

74
Q

What are the treatment strategies in elevated NK cells and implantation failure?

A

Not proven.

75
Q

What can elevated androgens induce in PCOS?

A

Endometrial atrophy.

Loss of periods.

76
Q

What can elevated insulin signalling cause?

A

Hyperplasia.

77
Q

What do reduced levels of blastocyst integrin expression reduce?

A

The ability of blastocyst to interact with the uterine epithelium.

78
Q

What is Zona pellucida?

A

A glycoprotein matrix.

79
Q

Of what does ZP consist?

A

4 ZP proteins.

80
Q

What does ZP protect?

A

The oocyte.
Zygote.
Blastocyst prior to implantation.

81
Q

What does Zona serve?

A

An important purpose in protecting the egg from being penetrated by more than once sperm.

82
Q

What cannot happen if polyspermy does occur?

A

Development.

83
Q

What can mutations in ZP1, 2 and 3 genes cause in a normal oocyte?

A

Loss of zona.

Very thin zona.

84
Q

What happens after IVF of oocyte with an abnormal zona?

A

Polyspermy.
Abnormal cell division.
Embryo is not viable.

85
Q

What does a ZP3 mutation cause?

A

Empty follicle syndrome.

86
Q

What happens in Empty follicle syndrome?

A

No oocytes are produced.

87
Q

From what does loss of zona occur?

A

Heterozygous mutations in ZP2 and ZP3.

88
Q

What polyspermy cannot be at IVF?

A

Prevented.

89
Q

How many polar bodies are in a normally fertilised oocyte?

A

2.

90
Q

How many pro-nuclei occur in a normally fertilised oocyte?

A

2.

91
Q

What are polar bodies and pro-nuclei doing in a normally fertilised oocyte?

A

Overlapping in the middle.

92
Q

What are the diseases of the female reproductive tract?

A

Varied.

93
Q

What is an underlying hormonal defect in most cases?

A

Causative.

94
Q

What are Diagnosis and Treatment in pathophysiology of female reproductive system?

A

Available.

95
Q

Why does the mechanism of pathophysiology remains?

A

To be elucidated in many cases.

Medical Physiology (12 decks)

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