Reproductive Flashcards
1
Q
What is the function of the Ovaries?
A
- Secretion of female sex hormones.
- Development and release of female
gametes, or ova.
2
Q
Name the 2 phases of the Menstrual cycle
A
- Follicular Phase
2. Luteal Phase
3
Q
What happens during the Follicular Phase?
A
Follicles develop and get ready to release an egg at Ovulation.
4
Q
What is the time frame of the Follicular phase?
A
Day 0 (or 1) of Menstural cycle through Day 14.
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.
6
Q
What is the time frame of the Luteal Phase?
A
Day 14-28
7
Q
Name the structure left behind after ovulation/menstruation.
A
Corpus Luteum AKA: yellow body
8
Q
Name the 4 organs involved in menstruation.
A
Hypothalamus, Anterior Pituitary, Ovary, Uterus (endometrium)
9
Q
When does the basal body temperature spike during the menstrual cycle?
A
Just after ovulation.
10
Q
Where is Lutenizing Hormone (LH) secreted from?
A
Anterior Pituitary
11
Q
What is the function of LH?
A
It’s the “jail break” hormone–it breaks the egg out of it’s capsule
12
Q
Where is Follicle Stimulating Hormone (FSH) secreted from?
A
Anterior pituitary
13
Q
What is the function of FSH?
A
Causes the Ovary to BUILD a Follicle and get ready to RELEASE an Ovum.
14
Q
Can you measure GnRH levels in the blood to determine/predict ovulation?
A
No. W/menstruation, it is not released systemically.
15
Q
Ovulation occurs within 10-12 hours of the peak of this hormone.
A
Lutenizing Hormone (LH)
16
Q
This hormone develops a dominant follicle.
A
FSH
17
Q
FSH rises ______ and peaks around ___________.
A
Rises Early
Peaks around Ovulation
*Follicular phase
18
Q
During the follicular phase, LH peaks when?
A
At Ovulation
19
Q
During the Luteal Phase, what happens to both FSH and LH?
A
They taper off
20
Q
Estrogen peaks when in the menstrual cycle?
A
Just before Ovulation–in the follicular phase
21
Q
When does Progesterone rise/peak
A
Just after Ovulation–in the Luteal Phase
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
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
24
Q
If a woman doesn’t Menstruate every month, what is the likely issue (broad sense)?
A
Communication issue along the HPA axis.
25
What is the most Potent form of Estrogen?
EstraDiol (E2)---produced during the reproDuctive years.
26
What is the form of Estrogen only produced during Pregnancy?
Estriol (E3)---it is secreted from the placenta
27
What is the weakest Estrogen. When is it mainly secreted?
EsTRONE (E1)---main one during Menopause. Rhymes with "Crone-think Crony/old woman"
28
What is the weakest Estrogen. When is it mainly secreted?
EsTRONE (E1)---main one during Menopause. Rhymes with "Crone-think Crony/old woman"
29
Estrogen dominates during this phase of the Menstrual cycle.
Follicular phase (1st phase)
30
Describe the secretion of Estrogen in the menstrual cycle.
Prominent early in follicular phase and as menstrual flow stops. Then it increases and stays increased over pre-ovulatory levels for a while.
31
What is the function of Estrogen in the uterus?
It builds up and thickens the lining of the Uterus in preparation for implantation.
32
Progesterone dominates during this phase of the Menstrual cycle.
Luteal phase (2nd phase)
33
Describe the secretion of Progesterone in the Menstrual Cycle.
It increases after ovulation. It has a quick peak and decrease.
34
What is the function of Progesterone in the Uterus?
Sustains Uterine lining--promotes pregnancy salvation
35
What is the Function of Fallopian Tubes?
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.
36
What is the usual site of FERTILIZATION?
The ampulla, or distal 1/3 of the fallopian tube.
37
What factors defend the vagina from infection?
1. At puberty the pH becomes more acidic (4 to 5) and
| 2. The squamous epithelial lining thickens
38
When is vaginal pH acidic and squamous epithelial lining thickened?
Between puberty and menopause--when women are most likely to be sexually active
When estrogen levels are high & normal population of Lactobacillus acidophilus
39
Define Dysmenorrhea
Painful Menstruation
40
What is Primary Dysmenorrhea?
Excess Endometrial Prostaglandin release (PGF2a) during normal menstrual cycles
PGF2a causes smooth muscle contraction
41
What are Clinical Manifestations of Primary Dysmenorrhea?
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
42
What is Secondary Dysmenorrhea?
Related to Underlying Pelvic Pathology
| Can present as Primary Dysmenorrhea
43
What are Clinical Manifestations of Secondary Dysmenorrrhea?
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
44
What are some conditions r/t secondary dysmenorrhea?
Endometriosus
Fibroids
Adenomyosis
45
Define Vulvitis (Vulvodynia)
Pain or inflammation of the vulva, vestibule or both
| Vulvitis (acute); Vulvodynia (chronic)
46
What is the pathophysiology of Vulvitis
Contact dermatitis
Dermatoses
Complex, multi-system abnormality (cause unknown)
47
What are common Structural causes for Abnormal/Dysfunctional Uterine bleeding?
```
Polyps
Adenomyosis
Leiomyomata (fibroids)
Malignancy (hyperplasia)
*these are more common (plus annovulation)
```
48
What is the most common cause of Abnormal/Dysfunctional Uterine Bleeding?
Anovulation (failure to ovulate)
49
What are common Non-Structural causes for Abnormal/Dysfunctional Uterine bleeding?
```
Coagulopathy
Ovulatory Dysfunction: Anovulation, PCOS
Endometrial
Iatrogenic
Not Classified
```
50
What are clinical manifestations of Abnormal/Dysfunctional Uterine Bleeding?
Unpredictable, Variable bleeding
| Change in Flow, Duration, Frequency, Quality, Associated Symptoms, Symptoms of Anemia
51
If no cause of abnormal uterine bleeding is identified, it is classified as what?
Annovulatory bleeding
52
Is Amenorrhea considered Abnormal/Dysfunctional Uterine bleeding?
Yes
53
What is Primary Amenorrhea?
No start of any period.
By age 13 without secondary sex characteristics
By age 15 regardless of secondary sex characterisitics
54
What is Secondary Amenorrhea?
No menses for 3+ previous cycles or 6 months (in women who previously menstruated).
55
What are causes of Primary Amenorrhea?
```
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)
```
56
What are causes of Secondary Amenorrhea?
```
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
What is the most common Endocrinopathy in reproductive-age women?
PCOS (poly-cystic ovarian syndrome)
58
What is Cervical Dysplasia?
Pre-cancerous cell changes
59
What is Cervical Carcinoma In-Situ?
Advanced form of Cervical Dysplasia.
| A precursor to Cervical Cancer
60
What is Invasive Carcinoma of the Cervix?
```
#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
What is the Transformation Zone?
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
What is Endometriosis?
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
What causes Endometriosis?
```
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
What are the Clinical Manifestations of Endometriosis?
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
Name common causes for female infertility
```
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
Name common causes for male infertility
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
What is a Benign Ovarian Cyst?
= Functional Cysts (Follicular cysts and Luteal cysts)
Most common in Reproductive years
Occurs when hormonal imbalances--Puberty and Menopause
68
What is a Follicular cyst?
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
What is a Corpus Luteum cyst?
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
What is a Dermoid Cyst?
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
When does Oogenesis begin?
In Utero
Peak # follicles by 20 wks GA
Follicle Atresia starts at 24 wks GA-Continues through Menopause (only some achieve ovulation)
72
What happens to Oogenesis birth-puberty?
Follicles are suspended in Prophase 1 until near ovulation (puberty)
73
Puberty is driven by an ________ in pulsations of what hormone from the Pituitary?
Increase of GnRH
74
Females must have a certain ____ to drive GnRH pulsatile release.
BMI
| i.e. a very athletic female--not enough Estrogen for GnRH; Soy-based compounds affect release of GnRH
75
What is the likely problem in a young woman WITH underarm and pubic hair but NO breast growth?
Adrenal Tumor
76
What does Thelarche mean?
Breast Development
77
What does Adrenarche mean?
Pubic Hair Growth
78
What staging is used for Telarche and Adrenarche?
Tanner Staging (1 none-5 full)
79
What is precocious puberty?
Puberty that starts before expected
| *right now def: menarche before 9y/o
80
What is the mean onset of menarche?
12.8 yrs (range 9-17)
81
What is the likely reason female puberty is trending w/earlier onset?
Obesity (extra Estrogen)
82
What ethnic group starts female puberty earlier (in general)?
African Americans
83
What ethnic group starts female puberty later (in general)?
Asian Americans
84
What is the definition of delayed puberty in females?
No breast enlargement by 13 y/o
85
What is the most common reason for delayed puberty in females?
What are possible causes?
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
What is the vaginal opening called?
| What does it include?
Vestibule
| Labia Minora, Urethra, Vaginal Orifice, Hymenal ring
87
What is the Introitus?
Opening of Vagina
88
What is the Forschette?
The softer tissues near Hymenal ring
89
Where do most OB traumas, lacerations happen w/delivery?
Perineum
90
What is the Perineum?
Strip of tissue between Vaginal opening and Rectal opening
91
What is Phimosis?
Symptoms?
Cause?
Where the foreskin cannot be retracted away from the Glans
Edema, erythema, tenderness, purulent discharge
Poor Hygiene or Chronic Infections
92
What 2 hormones allow for Erection?
How is it sustained?
Norepinephrine--constricts arteries
Nitric Oxide--relaxes smooth muscle
Veins are compressed, allowing blood to remain in penis
93
What 2 hormones allow for Erection?
How is it sustained?
Norepinephrine--constricts arteries
Nitric Oxide--relaxes smooth muscle of Arterioles
Veins are compressed, allowing blood to remain in penis
94
Sperm requires a temperature that is ___-___ degrees cooler than body temperature
1-2
95
Sperm requires a temperature that is ___-___ degrees cooler than body temperature
1-2
96
Where are sprem stored?
Epididymis and Vas Deferens
97
How long does it take for sperm to mature?--not full development of sperm cell, just maturation--
~12 days
98
How long does Spermatogenesis take?
70-80 days
99
What is the male "equivalent" of Menopause called?
What are the symptoms?
Andropause
Fatigue, decreased labido
100
When does male puberty begin?
As early as age 9 until age 16
101
What hormone increases w/male puberty?
Testosterone
102
During puberty in a male, the Hypothalamus produces LHRH-->Pituitary gland produces LH and FSH-->Testes produce _________ hormone?
Testosterone--produced in the Leydig cells
103
What 2 hormones cause the Testes to produce sperm?
FSH and Testosterone
104
What is the sequence of puberty in a male?
```
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
What is the sequence of puberty in a female?
```
Breast Budding
Pubic Hair
Growth Spurt
First Menstrual Period (menarche)
Underarm Hair
Body Shape Changes
Adult Size Breasts
```
106
When is fertility attained in a male?
Later in adolescence
107
Where in the Testes is the site of sperm production (spermatogenesis) in males?
Seminiferous Tubules; bulk of the Testes
108
What provides Fructose for ejaculated sperm?
Seminal vesicles.
Secrete prostaglandins-promote smooth muscle contraction = sperm transport.
Joins Vas Deferens through Ejaculatory duct-which contracts rhythmically during emission and ejaculation
109
What is the Epididymis?
Comma-shaped structure that curves over the posterior portion of each testis
110
What is the Vas Deferens?
Duct with muscular layers capable of powerful peristalsis that transports sperm toward urethra.
Enters pelvic cavity through the spermatic cord.
111
Name the 3 zones of the Prostate
Peripheral
Central
Transition--surrounds Urethra
112
In what zone do 20% Prostate CA's and most BPH happen?
Transition Zone
113
In what zone do most Prostate CA's occur?
Peripheral Zone
114
What is Prostatic Fluid?
What does it do?
Thin, milky substance. Has Alkaline pH, Enzymes, and Fibrinolysin.
Helps sperm survive Acidic Female Reproductive tract.
Helps mobilize sperm (breaks down mucus)
115
What secretes mucus into the ejaculate?
Bulbourethral glands (Cowper glands)
116
What support cells do Spermatids attach themselves to (for nutrients and Testosterone)?
Sertoli Cells of the seminiferous tubules
117
What hormone helps maintain the biosynthesis of Testosterone in males?
Prolactin
118
In the male, LH acts on _______ _____, to regulate testosterone secretion
Leydig cells
119
In the male, _____ acts on Sertoli cells to promote spermatogenesis.
What cell regulates spermatogenesis?
FSH
Germ cells
120
Disruption along the HPG (hypothalamus-pituitary-gonadal) axis may lead to?
Hypogonadism or Infertility
121
What hormone secreted by Sertoli Cells Inhibits FSH secretion?
Inhibin (regulation of FSH)
122
What is Paraphimosis?
Symptoms?
Cause?
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
What is Peyronie Disease?
What are the symptoms?
What age group is most likely effected?
"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
# Define Delayed puberty in males.
What is Ususal cause?
What causes 5 % of delays?
No secondary sex characteristics by 14 y/o
Physiologic delay
Disruption of HPG axis (DM, CF, Excessive exercise, THC use)
125
What are the Clinical Manifestations of Testicular Cancer?
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
Testicular Cancer is most prevalent in what Ethnic group?
What type of tumors are typical?
Cure rate?
Caucasian
Germ cell tumors (occur at basement membrane)
90% cure rate
127
What is Epididymitis?
Inflammation of Epididymis-hot, red on affected side
128
What causes Epididymitis?
STD's: Gonorrhea, Chlamydia
Organisms ascend the Vas Deferens from already infected Bladder or Urethra.
129
What can Epididiymitis cause?
Infertility, Testicular Infarction
130
What are the S/S of Epididymitis?
Acute Scrotal or Inguinal pain
| Positive Prehn sign (pain relief w/holding testicles up)
131
What is Orchitis?
Acute inflammation of the Testis (either r/t systemic dx or epididymitis)
132
What can Orchitis cause?
Irreversible damage to Testes in 1/3 cases.
133
What are S/S of Orchitis?
High Fever (to 104), Edema, Tenderness of Scrotum, Leukocytosis, Positive Prehn sign (pain relief w/holding testicles up)
134
What is the most common cause of Orchitis?
Mumps
Infectious microorganisms travel by Blood, Lymphatics OR
(more commonly) Ascent through the
Urethra, Vas Deferens, and Epididymis.
135
What are the Clinical Manifestations of Benign Prostatic Hyperplasia?
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
Does Benign Prostatic Hypertrophy cause Prostate CA?
No. But it does increase the risk.
137
What causes Benign Prostatic Hypertrophy?
Complex: Endocrine, Autocrine, Hormones, Growth Factors
138
What are some causes of infertility in Men?
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
