Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ENRP Exam 1 > Puberty And Menstrual Disorders - Dr. Moulton > Flashcards

Puberty And Menstrual Disorders - Dr. Moulton Flashcards

1
Q

hormones stimulated during menstruation

A

GnRH (hypo) —–> LH + FSH (AP) —-> Estrogen + Progesterone (Ovarian Follicle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Follicular Phase and Luteal phase

A 
Follicular = start of bleeding to ovulation (proliferative)
Luteal = ovulation to start of next bleed (secretory)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

regressing corpus luteum does what

A

decrease in E and P secreted = increase in FSH = increases estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

LH role

FSH role

A
  1. LH : stimulate theca cells = produce androgens (androstenedione + testosterone)
  2. FSH : stimulates granulosa cells = converts the androgens into estrogens E1 + E2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

no pregnancy after ovulation effects what H to start next cycle

A

FSH increases as p and e decrease = makes new follicle mature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what causes LH surge

A

rise in Estrogen to a certain point (E induces GnRH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

P levels peak when

A

5-7 days after ovulation form corpus luteum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primordial Follicle

A

after 8-10weeks the fetus makes oocytes surrounded by granulosa cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cumulus oophorus

A

cuboidal layer of cell around the adult graafian follicle = becomes corona radiata when oocyte released during ovulation with the corona radiate around it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

corpus luteum is made up of what cells + life length

A

granulosa cells, theca cells, capillaries, CT + 9-10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

if pt is not menstruating order

A

FSH and LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

proliferative phase what histo things happen

A

endometrial growth from E strimulation increase length of spiral arteries + mitoses seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Secretory phase what happens and histo

A
  1. P from corpus luteum = mucus and glycogen secretion (glands become full) + stroma = edematous
  2. Spiral arteries continue to extend into superficial layer become convoluted
  3. endometrium reaches maximum thickness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

1 day prior to ovulation what happens

A

constriction of spiral As = ischemia of endometrium, WBC infiltration + RBC extravasation = necrosis to slough away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when does conception need to happen before Corpus luteum regresses

A

by day 23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what medications can cause heavy bleeding

A

Warfarin , Aspirin, Clopidogrel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when does menstruation happen

A

2-3 years after Thelarche (breast budding) at tanner stage 4, (rare to start before Tanner stage 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Primary amenorrhea definition

A
  1. no menstruation by 13yo + no secondary sexual characteristics
  2. no menstruation by 15yo + secondary sexual characteristics present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

first menses is described how + optimal weight

A
  1. medium flow
  2. 30cc blood loss (3-6 times pad change)
  3. 21-45days
  4. 48kgs (106lb) leptin increases E to start
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

anemia can be caused from how much blood loss

A

80cc (1-2 hours per pad, longer then 7 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

gonadostat

A

regulates the release of GnRH and the HPAxis (CNS does also inhibit HPAxis during prepuberty)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

initial puberty changes that happen at 8yo-11yo

A

zona reticularis or adrenal cortex makes adrenal androgen production (DHEA and androstedione)
= pubit hair and axillary hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

secondary sex characterisitics caused by

A

lowered sensitivity to gondadostat = GnRH increase + follicular maturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Thelarchy

A

breast development
= 1st sign of puberty (can develop unilaterally first 6mos)
= needs E
= peak height and growth 1 year before menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

order of puberty

A

TAGME

  1. Thelarche
  2. Adrenarche
  3. Peak height
  4. Menarche
  5. sexual hair and breasts mature fully
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Precocious puberty is what

A

puberty before 8 women and 9 men (2.5 years SD before normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Heterosexual precocious puberty

A

development o secondary sexual characterisitics opposite of sex type
= virulizing neoplasms
= congenital adrenal hyperplasia
= Androgen exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Isosexual precocious puberty

A

premature * sexual maturation appropriate for sex

= constitutional and organic brain disease (tumor, infection, trauma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Androgen secreting neoplasms

A

usually ovariam (Sertoli-Leydic cells) or adrenal tumor

30
Q

Congenital adrenal hyperplasia (CAD)

A

most common from 21-hydroxylase defect* = excessive androgen made = high androgens + low cortisol

  1. female with ambigous genitalia, virilization (classic)
  2. premature pubarche and adult disorder looking like PCOS (nonclassic), late onset adrenal hyperplasia
31
Q

Isosexual Precocity

  1. true
  2. pseudoisosexual
A
  1. true = premature activation of H-P-O axis

2. pseudoisosexual = estrogen exposure (tumor)

32
Q

how to dx true isosexual precocious puberty

A
  1. administer GnRH and see riase in LH system that occurs in older normal women with HPO axis activiated
  2. MRI of head : tumors, granulomatous disease, hydrocephalus, infection, neurofibromatpsis, trauma
33
Q

True isosexual precocious puberty tx and what happens if you don tx

A

GnRH agonist (Leuprolide acetate) = suppress FSH and LH , arresting gonadal sex steroid secretion

  1. not treated = women do not reach 5ft
34
Q

pseudoisosexual precocity happens how + examples

A
  1. tumor increasing E WITHOUT activiating the HPO axis

2. McCune Albright (cafe au lait) + Peutz Jeghers syndorme (GI polyps + mucocutaneous pigmentation on lips)

35
Q

McCune Albright

A

cafe au lait, cystic bone defects, adrenal hypercortisolism

36
Q

Peutz Jeghers syndrome

A

sex cord tumor association = secreting E, GI polyps and mucocutaneous pigmentation

37
Q

delayed puberty 4 ways to dx

A

2nd sex char not by 13yo, thelarche not by 14yo, menarche not by 15-16yo, mneses not begun 5 years after thelarche

38
Q

turner syndrome is what type of delayed puberty

and what happens

A
  1. Hypergonadotrophic Hypogonadism (FSH over 30mlU, high LH)
  2. Gonadal dysgenesis
39
Q

Kallman Syndrome

  1. type of delay
  2. what happens
  3. factor
A
  1. Hypogonadotropic Hypodonadism
  2. anosmia (cant smell) and hyposmia (lower smell)
  3. KAL mutation on X chr = prevents GnRH neurons into hypothalamus
40
Q

XY Hypogonadotrophic hypogonadism what should you do

A

remove gonads due to risk of neoplastic transformation

41
Q

Turners syndrome

A

45XO, gonadal dygenesis

= webbing of neck(pterygium colli), broad flat chest, short, low development/puberty, coarctation of aorta

42
Q

2 reasons for primary amenorrhea WITH breast development

A
  1. Androgen insensitivity syndrome (AIS) = male level testosterone, testes in abd secrete antimullerian = no uterus, external Female features , XY
  2. Mullerian agenesis = XX, MRKUS, often associated with renal abnormalities , no uterus
43
Q

Androgen insensitivity syndrome (AIS)

A 
normal female breasts, genetalia external, no uterus or upper vagina
= XY
= male level testosterone 
= testes in abd
= remove gonads to prevent neoplasia
44
Q

MRKHS mullerian agenesis associated with

A

renal abnormalities + primary amenorrhea with normal female breast development

45
Q
  1. imperforated hymen
  2. transverse vaginal septum
    DX how + TX how
A
  1. vaginal bulge with blood inside , tx with hymenectomy

2. MRI, tx with surgery

46
Q

mild hypothyroidism can cause

A

hypermenorrhea (heavy bleeding), oligomenorrhea (infrequent periods)

47
Q

abnormal prolactin levels can cause and what imaging should you do

A

galactorrhea (over 100ng/mL), secondary amenorrhea

= do head MRI (empty sella syndrome, pituitary adenoma)

48
Q

Microadenomas are what and do what, tx, macroadenoma is what and tx

A
  1. <10mm on MRI, increase prolactin
  2. rare malignant
  3. DA agonist (Bromocriptine, parlodel, cabergoline, dostinex)
  4. over 10mm, DA agonist or transphenoidal resection or craniotomy = to prevent optic chiasm compression leading to bitemporal hemianopia
49
Q

What to do if someone does not bleed , 2ndary amenorrhea

A
  1. TSH and prolactin test
  2. If both normal do Progesterone challenge test
  3. If - progesterone challenge do estrogen /progesterone challenge
  4. If + E/P challenge = check FSH and LH levels
  5. High LH/FSH = ovary problem

Normal or low LH/FSH = HPO problem order MRI

50
Q

Progesterone challenge test

A
  1. Bleeding occurs with progesterone given = Normogonadotropic Hypogonadism (PCOS)
  2. No bleeding with Progesterone given = low E or outflow problem
51
Q

Estrogen/Progesterone challenge

A
  1. Bleeding occurs when given P and E = HPO axis problem or ovaries (high FSH + LH = hypergonadotropic Hypogonadism, ovary problem) ( normal or low FSH +LH = hypodonadotropic Hypogonadism , HPO axis problem)
  2. No bleeding = out flow problem
52
Q

PCOS reason you dont bleed

A

You have a bunch of follicles that are made and never ovulate = low Progesterone levels

53
Q

Asherman syndrome

  1. DX
  2. What
A
  1. D&C can cause this

2. Scar tissue inside uterus preventing menstruation from coming out

54
Q

Cervical Stenosis

  1. How
  2. What
A
  1. Elderly , low E , or cervical lacerations

2. Narrowing of cervix blood cant come out

55
Q

Nonclassic Conenital Adrenal Hyperplasia

A

Elevated 17-hydroxyprogesterone

= hirsutism, acne, menstrual irregularities

56
Q

Adrenal Androgen secreting tumor

A

DHEA - S over 7000 so high

57
Q

PCOS can be caused by what tumor

A

Sertoli-Leydig Tumor secreating Testosterone

58
Q

PCOS

  1. SX
  2. Associated with
  3. DX
A
  1. Leading cause of anovulatory infertility, acne, obesity, hair, sleep probs
  2. Insulin insensitivity, high insulin + high androgens = low sex hormone binding globulins (SHBG) = higher circulating testosterone **
  3. 2/3 needed : no/ or not as frequent bleeding, sx of hyperandrogenism (LH 2 : 1 FSH),
    US many small cysts
59
Q

PCOS reason for anovulation

A

High LH causing tromp and theca cells stimulation = androgen excess stimulating adipose tissue to secrete E = increases LH

60
Q

PCOS high labs + risk of

A
  1. High insulin, LH, testosterone

2. Endometrial cancer

61
Q

PCOS TX

A
  1. OCP, lower LH/FSH = increase SHGB
  2. Weight low 10lb
  3. Induce ovulation = clomiphene citrate
  4. Laser burn stroma
  5. Spironoactone = competitive binding on Testosterone Rs, lower T
62
Q

High FSH and high LH at 51 yo and 40yo

A

Hypergonadotropic Hypogonadism

  1. Menopause average age 51yo = postmenopausal ovarian failure
  2. 40yo = premature ovarian failure
  3. Can happen to people who have had mumps
63
Q

LOW FSH And LH what do you do and what can be cause

A

Hypogonadotropic Hypogonadism

  1. MRI of head to check HPO axis
  2. Normal MRI = anorexia, chronic illness (DM, IBD, depression, renal deficiency), Sheehan’s syndrome destruction of Pituitary
64
Q

Hirsutism vs virilization

A
  1. H = hair patterns growing like male on female , usually from T —> DIEA more potent
  2. V : genitals and body is male like in female, excessive androgen
65
Q

Hyperandrogenism labs you get

A
  1. 17-hydroxyprogesterone (CAD high)
  2. urine cortisol (Cushing)
  3. Prolactin + TSH
  4. Glucose, lipid,
  5. Testosterone (ovarian androgen making tumor)+ DHEA levels (adrenal androgen making tumor)
66
Q
  1. Polymenorrhea
  2. Oligomenorrhea
  3. Menorrhagia
  4. Metrorrhagia
  5. Menometrorrhagia
  6. Intermittent bleeding
A
  1. Polymenorrhea : less then 21 day cycles
  2. Oligomenorrhea : more then 35 day cycles, less then 6 months
  3. Menorrhagia : heavy bleeding more then 7 days of 80mL
  4. Metrorrhagia : irregular uterine bleeding
  5. Menometrorrhagia : heavy and irregular bleeding
  6. Intermittent bleeding : some spotting at ovulation for 1-2 days
67
Q

PALM is what

A

Structural causes of abnormal bleeding

  1. P : Polyp
  2. A : Adenomyosis
  3. L : Leiomyoma
  4. M : malignancy or hyperplasia
68
Q

COEIN is what

A

Non-structural reasons for abnormal uterine bleeding

  1. C : Coagulopathy
  2. O : Ovulatory Dysfunction (PCOS)
  3. E : Endometrial problem (endometriosis , infection)
  4. I : Iatrogenic (IUD, IUS ,Hs)
  5. N : Not yet classified
69
Q

Imaging done for endometrium

A

All around thickness = endometrial biopsy

Lesion or polyp to remove = hyperoscopy for visualization

70
Q

Massive bleeding hat to give

A

IV Estrogen, Mirena or OCP

ENRP Exam 1 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions