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Lifespan Patho Final > Reproductive > Flashcards

Reproductive Flashcards

1
Q

What is the function of the Ovaries?

A
  1. Secretion of female sex hormones.
  2. Development and release of female
    gametes, or ova.
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2
Q

Name the 2 phases of the Menstrual cycle

A
  1. Follicular Phase

2. Luteal Phase

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3
Q

What happens during the Follicular Phase?

A

Follicles develop and get ready to release an egg at Ovulation.

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4
Q

What is the time frame of the Follicular phase?

A

Day 0 (or 1) of Menstural cycle through Day 14.

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5
Q

What happens during the Luteal Phase?

A

Growth. The body waits to see if an egg is fertilized, and is supporting or not supporting a pregnancy.

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6
Q

What is the time frame of the Luteal Phase?

A

Day 14-28

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7
Q

Name the structure left behind after ovulation/menstruation.

A

Corpus Luteum AKA: yellow body

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8
Q

Name the 4 organs involved in menstruation.

A

Hypothalamus, Anterior Pituitary, Ovary, Uterus (endometrium)

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9
Q

When does the basal body temperature spike during the menstrual cycle?

A

Just after ovulation.

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10
Q

Where is Lutenizing Hormone (LH) secreted from?

A

Anterior Pituitary

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11
Q

What is the function of LH?

A

It’s the “jail break” hormone–it breaks the egg out of it’s capsule

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12
Q

Where is Follicle Stimulating Hormone (FSH) secreted from?

A

Anterior pituitary

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13
Q

What is the function of FSH?

A

Causes the Ovary to BUILD a Follicle and get ready to RELEASE an Ovum.

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14
Q

Can you measure GnRH levels in the blood to determine/predict ovulation?

A

No. W/menstruation, it is not released systemically.

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15
Q

Ovulation occurs within 10-12 hours of the peak of this hormone.

A

Lutenizing Hormone (LH)

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16
Q

This hormone develops a dominant follicle.

A

FSH

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17
Q

FSH rises ______ and peaks around ___________.

A

Rises Early
Peaks around Ovulation
*Follicular phase

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18
Q

During the follicular phase, LH peaks when?

A

At Ovulation

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19
Q

During the Luteal Phase, what happens to both FSH and LH?

A

They taper off

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20
Q

Estrogen peaks when in the menstrual cycle?

A

Just before Ovulation–in the follicular phase

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21
Q

When does Progesterone rise/peak

A

Just after Ovulation–in the Luteal Phase

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22
Q

Estrogen and Progesterone are released from?

A

The Ovary
Their release causes negative feedback to the Hypothalamus to stop secreting GnRN, and thus the Anterior Pituitary to stop releasing LH/FSH

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23
Q

What happens if Estrogen and Progesterone don’t shut down the Hypothalamus and Anterior Pituitary?

A

Over-production of Follicles and Over-stimulation of the Ovary—->No Dominant, Mature Ovum to be Released

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24
Q

If a woman doesn’t Menstruate every month, what is the likely issue (broad sense)?

A

Communication issue along the HPA axis.

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25
Q

What is the most Potent form of Estrogen?

A

EstraDiol (E2)—produced during the reproDuctive years.

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26
Q

What is the form of Estrogen only produced during Pregnancy?

A

Estriol (E3)—it is secreted from the placenta

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27
Q

What is the weakest Estrogen. When is it mainly secreted?

A

EsTRONE (E1)—main one during Menopause. Rhymes with “Crone-think Crony/old woman”

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28
Q

What is the weakest Estrogen. When is it mainly secreted?

A

EsTRONE (E1)—main one during Menopause. Rhymes with “Crone-think Crony/old woman”

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29
Q

Estrogen dominates during this phase of the Menstrual cycle.

A

Follicular phase (1st phase)

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30
Q

Describe the secretion of Estrogen in the menstrual cycle.

A

Prominent early in follicular phase and as menstrual flow stops. Then it increases and stays increased over pre-ovulatory levels for a while.

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31
Q

What is the function of Estrogen in the uterus?

A

It builds up and thickens the lining of the Uterus in preparation for implantation.

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32
Q

Progesterone dominates during this phase of the Menstrual cycle.

A

Luteal phase (2nd phase)

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33
Q

Describe the secretion of Progesterone in the Menstrual Cycle.

A

It increases after ovulation. It has a quick peak and decrease.

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34
Q

What is the function of Progesterone in the Uterus?

A

Sustains Uterine lining–promotes pregnancy salvation

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35
Q

What is the Function of Fallopian Tubes?

A

Conduct the Ova from the spaces around
the ovaries to the uterus.

The Fimbriae move, creating a current that draws the ovum into the infundibulum. Once the ovum has entered the fallopian tube, cilia and peristalsis keep it moving toward the uterus.

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36
Q

What is the usual site of FERTILIZATION?

A

The ampulla, or distal 1/3 of the fallopian tube.

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37
Q

What factors defend the vagina from infection?

A
  1. At puberty the pH becomes more acidic (4 to 5) and

2. The squamous epithelial lining thickens

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38
Q

When is vaginal pH acidic and squamous epithelial lining thickened?

A

Between puberty and menopause–when women are most likely to be sexually active

When estrogen levels are high & normal population of Lactobacillus acidophilus

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39
Q

Define Dysmenorrhea

A

Painful Menstruation

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40
Q

What is Primary Dysmenorrhea?

A

Excess Endometrial Prostaglandin release (PGF2a) during normal menstrual cycles

PGF2a causes smooth muscle contraction

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41
Q

What are Clinical Manifestations of Primary Dysmenorrhea?

A

Pain A/W menses onset
Peaks 1st 48 hrs after onset
Resolves w/in 1-3 days and does NOT persist after cessation of menses

More common in younger women, reduces in time esp. after childbearing

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42
Q

What is Secondary Dysmenorrhea?

A

Related to Underlying Pelvic Pathology

Can present as Primary Dysmenorrhea

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43
Q

What are Clinical Manifestations of Secondary Dysmenorrrhea?

A

Pain (may start prior to menstruation)
Lasts full duration of menstruation
Persists after cessation of menses
Pain w/sex, non-cyclic pelvic pain

Pain increases over time (peak 20-30’s)
Pain correlates w/other symptoms i.e. pain w/sex or abnormal pelvic exam at anytime during cycle

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44
Q

What are some conditions r/t secondary dysmenorrhea?

A

Endometriosus
Fibroids
Adenomyosis

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45
Q

Define Vulvitis (Vulvodynia)

A

Pain or inflammation of the vulva, vestibule or both

Vulvitis (acute); Vulvodynia (chronic)

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46
Q

What is the pathophysiology of Vulvitis

A

Contact dermatitis
Dermatoses
Complex, multi-system abnormality (cause unknown)

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47
Q

What are common Structural causes for Abnormal/Dysfunctional Uterine bleeding?

A 
Polyps
Adenomyosis
Leiomyomata (fibroids)
Malignancy (hyperplasia)
*these are more common (plus annovulation)
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48
Q

What is the most common cause of Abnormal/Dysfunctional Uterine Bleeding?

A

Anovulation (failure to ovulate)

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49
Q

What are common Non-Structural causes for Abnormal/Dysfunctional Uterine bleeding?

A 
Coagulopathy
Ovulatory Dysfunction: Anovulation, PCOS
Endometrial 
Iatrogenic
Not Classified
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50
Q

What are clinical manifestations of Abnormal/Dysfunctional Uterine Bleeding?

A

Unpredictable, Variable bleeding

Change in Flow, Duration, Frequency, Quality, Associated Symptoms, Symptoms of Anemia

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51
Q

If no cause of abnormal uterine bleeding is identified, it is classified as what?

A

Annovulatory bleeding

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52
Q

Is Amenorrhea considered Abnormal/Dysfunctional Uterine bleeding?

A

Yes

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53
Q

What is Primary Amenorrhea?

A

No start of any period.
By age 13 without secondary sex characteristics
By age 15 regardless of secondary sex characterisitics

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54
Q

What is Secondary Amenorrhea?

A

No menses for 3+ previous cycles or 6 months (in women who previously menstruated).

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55
Q

What are causes of Primary Amenorrhea?

A 
Pregnancy! (#1 cause)
HPO axis dysfunction (Turner's)
Anterior Pituitary D/O's
Ovarian D/O's
Endocrine D/O's
Developmental/Structural defects (no patent vagina/uterus)
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56
Q

What are causes of Secondary Amenorrhea?

A 
Pregnancy! (#1 cause)
Annovulation
Thyroid D/O
Hyperprolactinemia (r/t Pituitary tumor, thyroid D/O)
HPO axis dysfunction
Anterior Pituitary D/O
Ovarian D/O
Endocrine D/O----think PCOS
Structural Defects
57
Q

What is the most common Endocrinopathy in reproductive-age women?

A

PCOS (poly-cystic ovarian syndrome)

58
Q

What is Cervical Dysplasia?

A

Pre-cancerous cell changes

59
Q

What is Cervical Carcinoma In-Situ?

A

Advanced form of Cervical Dysplasia.

A precursor to Cervical Cancer

60
Q

What is Invasive Carcinoma of the Cervix?

A 
#1 killer of women in medically under-served countries
*cause-HPV high-risk types 16, 18

Invasive carcinoma of the cervix consists of cancer invasion into adjacent tissues and metastasis.

61
Q

What is the Transformation Zone?

A

The line where Columnar and Squamous epithelium meet. It is very vulnerable to
the oncogenic effects of HPV.

As women age, the transformation zone moves, and the cervix is covered by more Squamous epithelium which is less sensitive to HPV.

62
Q

What is Endometriosis?

A

Functioning Endometrial tissue or implants outside of the Uterus that respond to hormonal fluctuations of the menstrual cycle.

The tissue bleeds w/cycle—>inflammation, fibrosis, scarring, adhesions, pain

63
Q

What causes Endometriosis?

A 
Unknown.  Theories:
Retrograde menstruation (Samson's Theory)--most adopted--cells travel up and out Fallopian tubes and implant

Impaired cellular and humoral immunity

Genetic predisposition and polymorphisms (metadysplasia)

64
Q

What are the Clinical Manifestations of Endometriosis?

A

Pelvic Pain (dysmenorrhea-few days before to many days after, dyspareunia-pain w/sex, dyschezia-pain w/bm)
Constipation
Abnormal Uterine Bleeding (heavier)
Infertility (implants grow on overies, imparing function)

65
Q

Name common causes for female infertility

A 
Endometriosis
Disrupted Ovulation r/t hormones (TSH,
estrogen, progesterone, etc.), chronic conditions, and stress
Age
Tubal Pathologies
Adhesions and Scarring from PID-blockages
Rare conditions
20% unknown
66
Q

Name common causes for male infertility

A

Hormonal D/O’s (i.e. thyroid disturbances, low testosterone levels)–can be dx’d and tx’d

Elevations in temperature: Illness, Abnormal placement of the testes, Varicoceles, exposure to high temps

Abnormalities of the seminal tract
and sexual dysfunction that disrupts ejaculation

67
Q

What is a Benign Ovarian Cyst?

A

= Functional Cysts (Follicular cysts and Luteal cysts)

Most common in Reproductive years
Occurs when hormonal imbalances–Puberty and Menopause

68
Q

What is a Follicular cyst?

A

A Functional Cyst (part of normal pathophysiology).

A follicle/s are stimulated, but No Dominant follicle develops.

Dominant Follicle fails to rupture OR one or more of the Non-Dominant follicles Fail to Regress.

Cysts vary in size and symptoms from one episode to the next, often recur. Most are fluid filled; the more solid an ovarian cyst, the greater the chance of malignancy.

Usually unilateral–usually self-resolve
5 to 6 cm as large as 8 to 10 cm
Usually Assymptomatic, if rupture = Acute Pelvic Pain

69
Q

What is a Corpus Luteum cyst?

A

A Functional Cyst (part of normal pathophysiology). Less common than follicular cysts, but more symptoms.

Failed Regression/Complication of Corpus Luteum post-Ovulation

Usually Unilateral–usually self-resolve
5 to 6 cm as large as 8 to 10 cm
Usually Assymptomatic, if Rupture = Acute Pelvic Pain (and sometimes hemorrhaging).

70
Q

What is a Dermoid Cyst?

A

Benign Ovarian Teratomas.
Contain elements of the 3 germ layers; common ovarian neoplasms that contain skin, hair, sebaceous and sweat glands, muscle fibers, cartilage, and bone.

Usually asymptomatic, found incidentally
on pelvic examination. They have malignant potential.

Requires surgery, they DO NOT self-resolve.

71
Q

When does Oogenesis begin?

A

In Utero
Peak # follicles by 20 wks GA
Follicle Atresia starts at 24 wks GA-Continues through Menopause (only some achieve ovulation)

72
Q

What happens to Oogenesis birth-puberty?

A

Follicles are suspended in Prophase 1 until near ovulation (puberty)

73
Q

Puberty is driven by an ________ in pulsations of what hormone from the Pituitary?

A

Increase of GnRH

74
Q

Females must have a certain ____ to drive GnRH pulsatile release.

A

BMI

i.e. a very athletic female–not enough Estrogen for GnRH; Soy-based compounds affect release of GnRH

75
Q

What is the likely problem in a young woman WITH underarm and pubic hair but NO breast growth?

A

Adrenal Tumor

76
Q

What does Thelarche mean?

A

Breast Development

77
Q

What does Adrenarche mean?

A

Pubic Hair Growth

78
Q

What staging is used for Telarche and Adrenarche?

A

Tanner Staging (1 none-5 full)

79
Q

What is precocious puberty?

A

Puberty that starts before expected

*right now def: menarche before 9y/o

80
Q

What is the mean onset of menarche?

A

12.8 yrs (range 9-17)

81
Q

What is the likely reason female puberty is trending w/earlier onset?

A

Obesity (extra Estrogen)

82
Q

What ethnic group starts female puberty earlier (in general)?

A

African Americans

83
Q

What ethnic group starts female puberty later (in general)?

A

Asian Americans

84
Q

What is the definition of delayed puberty in females?

A

No breast enlargement by 13 y/o

85
Q

What is the most common reason for delayed puberty in females?

What are possible causes?

A

GnRH deficiency

Usually r/t Pituitary Tumors/Adenomas
Eating D/O’s
Discordant phenotypic sex–conflicting genitalia
Possible Malarian defect (way uterus forms-uterus may not communicate with vagina)

86
Q

What is the vaginal opening called?

What does it include?

A

Vestibule

Labia Minora, Urethra, Vaginal Orifice, Hymenal ring

87
Q

What is the Introitus?

A

Opening of Vagina

88
Q

What is the Forschette?

A

The softer tissues near Hymenal ring

89
Q

Where do most OB traumas, lacerations happen w/delivery?

A

Perineum

90
Q

What is the Perineum?

A

Strip of tissue between Vaginal opening and Rectal opening

91
Q

What is Phimosis?

Symptoms?

Cause?

A

Where the foreskin cannot be retracted away from the Glans

Edema, erythema, tenderness, purulent discharge

Poor Hygiene or Chronic Infections

92
Q

What 2 hormones allow for Erection?

How is it sustained?

A

Norepinephrine–constricts arteries
Nitric Oxide–relaxes smooth muscle

Veins are compressed, allowing blood to remain in penis

93
Q

What 2 hormones allow for Erection?

How is it sustained?

A

Norepinephrine–constricts arteries
Nitric Oxide–relaxes smooth muscle of Arterioles

Veins are compressed, allowing blood to remain in penis

94
Q

Sperm requires a temperature that is ___-___ degrees cooler than body temperature

A

1-2

95
Q

Sperm requires a temperature that is ___-___ degrees cooler than body temperature

A

1-2

96
Q

Where are sprem stored?

A

Epididymis and Vas Deferens

97
Q

How long does it take for sperm to mature?–not full development of sperm cell, just maturation–

A

~12 days

98
Q

How long does Spermatogenesis take?

A

70-80 days

99
Q

What is the male “equivalent” of Menopause called?

What are the symptoms?

A

Andropause

Fatigue, decreased labido

100
Q

When does male puberty begin?

A

As early as age 9 until age 16

101
Q

What hormone increases w/male puberty?

A

Testosterone

102
Q

During puberty in a male, the Hypothalamus produces LHRH–>Pituitary gland produces LH and FSH–>Testes produce _________ hormone?

A

Testosterone–produced in the Leydig cells

103
Q

What 2 hormones cause the Testes to produce sperm?

A

FSH and Testosterone

104
Q

What is the sequence of puberty in a male?

A 
Growth of Scrotum and Testes
Change in Voice
Lengthening of Penis
Growth of Pubic Hair
Enlargement of seminal vesicles and prostate gland
Growth Spurt
Change in Body Shape
Growth of Facial and Underarm hair

**Breast enlargement (gynecomastia) may occur and usually disappears within a year.

105
Q

What is the sequence of puberty in a female?

A 
Breast Budding
Pubic Hair 
Growth Spurt 
First Menstrual Period (menarche)
Underarm Hair
Body Shape Changes
Adult Size Breasts
106
Q

When is fertility attained in a male?

A

Later in adolescence

107
Q

Where in the Testes is the site of sperm production (spermatogenesis) in males?

A

Seminiferous Tubules; bulk of the Testes

108
Q

What provides Fructose for ejaculated sperm?

A

Seminal vesicles.

Secrete prostaglandins-promote smooth muscle contraction = sperm transport.

Joins Vas Deferens through Ejaculatory duct-which contracts rhythmically during emission and ejaculation

109
Q

What is the Epididymis?

A

Comma-shaped structure that curves over the posterior portion of each testis

110
Q

What is the Vas Deferens?

A

Duct with muscular layers capable of powerful peristalsis that transports sperm toward urethra.

Enters pelvic cavity through the spermatic cord.

111
Q

Name the 3 zones of the Prostate

A

Peripheral
Central
Transition–surrounds Urethra

112
Q

In what zone do 20% Prostate CA’s and most BPH happen?

A

Transition Zone

113
Q

In what zone do most Prostate CA’s occur?

A

Peripheral Zone

114
Q

What is Prostatic Fluid?

What does it do?

A

Thin, milky substance. Has Alkaline pH, Enzymes, and Fibrinolysin.

Helps sperm survive Acidic Female Reproductive tract.
Helps mobilize sperm (breaks down mucus)

115
Q

What secretes mucus into the ejaculate?

A

Bulbourethral glands (Cowper glands)

116
Q

What support cells do Spermatids attach themselves to (for nutrients and Testosterone)?

A

Sertoli Cells of the seminiferous tubules

117
Q

What hormone helps maintain the biosynthesis of Testosterone in males?

A

Prolactin

118
Q

In the male, LH acts on _______ _____, to regulate testosterone secretion

A

Leydig cells

119
Q

In the male, _____ acts on Sertoli cells to promote spermatogenesis.

What cell regulates spermatogenesis?

A

FSH

Germ cells

120
Q

Disruption along the HPG (hypothalamus-pituitary-gonadal) axis may lead to?

A

Hypogonadism or Infertility

121
Q

What hormone secreted by Sertoli Cells Inhibits FSH secretion?

A

Inhibin (regulation of FSH)

122
Q

What is Paraphimosis?

Symptoms?

Cause?

A

Foreskin is retracted and canNOT be moved forward (reduced) to cover Glans

Edema of Glans–restricts blood vessels. Can be a surgical emergency.

R/t indwelling Foley, not replacing Foreskin after cleansing

123
Q

What is Peyronie Disease?

What are the symptoms?

What age group is most likely effected?

A

“Bent Nail Syndrome”–probably inflammatory Dz

Slow dev. of fibrous plaques in erectile tissue (corpus cavernosa)–>causes lateral (usually dorsal/up) curvature of the penis during erection.

Painful erections and intercourse
Middle-aged men

124
Q

Define Delayed puberty in males.

What is Ususal cause?

What causes 5 % of delays?

A

No secondary sex characteristics by 14 y/o

Physiologic delay

Disruption of HPG axis (DM, CF, Excessive exercise, THC use)

125
Q

What are the Clinical Manifestations of Testicular Cancer?

A

Painless testicular enlargement and heaviness, gynecomastia, hydrocele

Risk of Testicular Cancer is 35-50 times greater for men with cryptorchidism or a hx of cryptorchidism.

126
Q

Testicular Cancer is most prevalent in what Ethnic group?

What type of tumors are typical?

Cure rate?

A

Caucasian

Germ cell tumors (occur at basement membrane)

90% cure rate

127
Q

What is Epididymitis?

A

Inflammation of Epididymis-hot, red on affected side

128
Q

What causes Epididymitis?

A

STD’s: Gonorrhea, Chlamydia

Organisms ascend the Vas Deferens from already infected Bladder or Urethra.

129
Q

What can Epididiymitis cause?

A

Infertility, Testicular Infarction

130
Q

What are the S/S of Epididymitis?

A

Acute Scrotal or Inguinal pain

Positive Prehn sign (pain relief w/holding testicles up)

131
Q

What is Orchitis?

A

Acute inflammation of the Testis (either r/t systemic dx or epididymitis)

132
Q

What can Orchitis cause?

A

Irreversible damage to Testes in 1/3 cases.

133
Q

What are S/S of Orchitis?

A

High Fever (to 104), Edema, Tenderness of Scrotum, Leukocytosis, Positive Prehn sign (pain relief w/holding testicles up)

134
Q

What is the most common cause of Orchitis?

A

Mumps

Infectious microorganisms travel by Blood, Lymphatics OR
(more commonly) Ascent through the
Urethra, Vas Deferens, and Epididymis.

135
Q

What are the Clinical Manifestations of Benign Prostatic Hyperplasia?

A

Symmetric enlargement of the prostate gland

S/S a/w uretrhal compression: urgency, poor urine stream, hessitancy, can’t fully empty bladder, have to go a lot, urinary retention, increased infections, hydronephrosis—>renal insufficiency

136
Q

Does Benign Prostatic Hypertrophy cause Prostate CA?

A

No. But it does increase the risk.

137
Q

What causes Benign Prostatic Hypertrophy?

A

Complex: Endocrine, Autocrine, Hormones, Growth Factors

138
Q

What are some causes of infertility in Men?

A

Any impairment of Sperm Quality or Quantity.
r/t (inadequate FSH, LH, Tetosterone) Spermatogenesis (production of Sperm-any reason)
Tissue trauma
Anti-Sperm Bodies–decreases sperm motility and quantity
Drugs/toxins: Tobacco, ETOH, Caffeine

Lifespan Patho Final (3 decks)

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