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reproductive disorders Flashcards

1
Q

cervical cancer prevention

A

HPV vaccine: Gardasil/Gardasil 9
- females/males ages 9-29
- HPV subtypes: 16, 18, 6, 11

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2
Q

cervical cancer pathogenesis

A
  • cervical cell dysplasia: atypical cells with nuclear and cytoplasmic changes
  • continuum of change: indistinct changes, in situ, invasive cancer (or regress)
  • cervical intraepithelial neoplasia (CIN): grading for dysplastic changes > premalignant
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3
Q

cervical cancer diagnosis

A
  • Pap smear (endocervical cells in transformation zone)
  • screening for HPV, age, history
  • dysplasia: cone biopsy, endocervical curettage, hysteroscopy
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4
Q

cervical cancer risk factors

A
  • early age of 1st intercourse
  • multiple sex partners
  • smoking
  • STI
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5
Q

cervical cancer manifestations

A
  • poorly defined endocervical lesions
  • abnormal vaginal bleeding/ discharge/ spotting
  • bleeding after sex
  • hematuria
  • pelvic and back pain
  • fistulas (rectal vaginal or vesicle vaginal)
  • metastasis to supraclavical/inguinal lymph nodes
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6
Q

endometriosis

A

the growth of endometrial tissue outside the uterus

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7
Q

endometriosis risk factors

A
  • no deliveries
  • high exposure to estrogen (early period/ late meno)
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8
Q

endometriosis treatment

A
  • treat pain
  • suppress endometrial growth > hormone suppressors
  • surgery goal: restore normal anatomy and slow progression
  • definitive: hysterectomy with salpingo - oophorectomy (removing uterus, ovaries, fallopian tubes)
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9
Q

endometriosis diagnosis

A
  • laparoscopy
  • symptoms mimic other pelvic disorders
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10
Q

endometriosis manifestations

A
  • start in reproductive years
  • pain (dysmenorrhea)
  • bleeding between periods
  • bleeding into other structures
  • pain with poop/pee
  • infertility: adhesions distort pelvic anatomy and impair ovary transport
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11
Q

endometriosis 4 D’s

A
  • dysuria (pain peeing)
  • dyspareunia (painful intercourse)
  • dyschezia (pain pooping)
  • dysmenorrhea (painful bleeding)
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12
Q

uterine leiomyomas - fibroids

A
  • benign tumors from smooth muscle of uterus
  • most common of pelvic tumors
  • develop in different layers (intramural fibroids are most common)
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13
Q

uterine leiomyomas - fibroids manifestations

A
  • none or…
  • enlargement of uterus (abd dissention, abnormal bleeding, pain, infertility, anemia)
  • rectal pressure/constipation
  • may grow during pregnancy
  • menopause estrogen replacement therapy
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14
Q

uterine leiomyomas - fibroids diagnosis

A
  • examinations/symptoms
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15
Q

uterine leiomyomas - fibroids treatment

A
  • depends on symptoms
  • hysterectomy
  • may regress with menopause
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16
Q

pelvic inflammatory disease (PID)

A

polymicrobial infection upper reproductive tract (uterus, fallopian tubes, ovaries)

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17
Q

PID associated with

A

STI microbes: N. gonorrhea, C. trachomatis
endogenous microbes: H. influenzae, streptococci

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18
Q

PID factors

A
  • nulliparity
  • many sex partners
  • pervious PID
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19
Q

PID manifestations

A
  • lower abd and back pain
  • dyspareunia
  • painful cervical motion
  • purulent discharge
  • fever above 101
  • increased ESR (erythrocyte sedimentation rate)
  • coinfection
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20
Q

PID treatment

A

antibiotics

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21
Q

polycystic ovarian syndrome (PCOS)

A
  • endocrine disturbance > increased androgenic hormones
  • frequent source chronic anovulation
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22
Q

PCOS cause

A

unknown and autosomal dominant

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23
Q

PCOS etiology

A
  • elevated LH with normal estrogen and FSH levels
  • elevated free testosterone
  • hyperprolactimia
  • hypothyroidism
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24
Q

PCOS manifestations

A
  • hyperinsulinemia (^ hormones) which effects ovaries
  • long term: cardiovascular disease and diabetes
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25
Q

PCOS diagnosis

A
  • rule out other diseases
  • hyperandrogenism (acne/body hair)
  • fasting blood glucose
  • oligomenorrhea
  • ultrasound
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26
Q

PCOS treatment

A
  • symptom relief and lifestyle modifications
  • metformin: restores levels and helps restore normal menstrual regularity
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27
Q

ovarian cancer

A
  • ovulatory age: includes # of pregnancies and how long they had breast fed, how long oral contraceptives were used
  • lower incidence in parous vs. nulliparous women
  • family history > lynch syndrome 2: prostate, pancreatic, colorectal cancers… BRCA 1/2: cause types of ovarian cancer
  • autosomal dominant
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28
Q

ovarian cancer manifestations

A

few and vague: GI bloating and nausea, dysuria, pelvic/back pain

29
Q

ovarian cancer risk factors

A
  • genetics
  • no children
  • hormone use
30
Q

ovarian cancer diagnosis

A
  • pelvic exam
  • CA-125: test used but not definitive
  • transvaginal sonography (close look at ovaries)
  • surgical evaluation is required for diagnosis (remove tumor as much as possible so chemo/radiation work)
31
Q

ovarian cancer treatment

A

depends on surgical findings, prognosis, staging/grading of tumor

32
Q

ovarian cancer types

A
  • epithelial ovarian cancer: tumor starts on outside of the ovary
  • stroma cancer: starts in ovarian cells that make hormones
  • germ cell cancer: starts in the eggs
    ovarian cancer is usually in advanced stages by the time its diagnosed
33
Q

menstrual disorders: amenorrhea

A

absence of menstruation
- Primary: period has not occurred by 15
- Secondary: absence of period (3-6 months) - can be caused by pregnancy
diagnosis: history/physical, endocrine studies, B-HBG preg test

34
Q

menstrual disorders: dysmenorrhea

A

painful menstruation/increased prostaglandin F
- Primary: on or before period (not physical abnormality and occurs with ovulation)
- Secondary: result of another condition (associated with specific organic conditions > endometriosis)

35
Q

menstrual disorders: treatment

A
  • analgesic agents, hormone regulation
  • treat cause
  • prostaglandin synthetase inhibitors (ibuprofen)
36
Q

premenstrual syndrome (PMS)

A

mild to moderate physical/psych symptoms in 14 days
- increases with age
- diagnostic: 1 symptom

37
Q

premenstrual dysphoric disorder (PMDD)

A

severe form premenstrual distress, associated with mood disorders - psychiatric disorders
- diagnostic: 5-11 symptoms

38
Q

PMS and PMDD treatment

A
  • lifestyle changes: lower sugar and caffeine, lean protein; analgesics, OCP’s, diuretics for fluid retention, anxiolytics or SSRIs for anxiety/depression
39
Q

PMS/PMDD symptoms

A
  • cerebral: irritable, anxious, nervous, fatigue
    gastrointestinal: craving sweet/salt, nausea, vomit, constipation
  • vascular: headache, edema
  • reproductive: swelling/tender breasts
  • neurologic: clumsy, trembling
  • general: weight gain, dizzy, insomnia, acne
40
Q

breast cancer risk factors

A
  • sex, age, history, hormone influences
  • modifiable: obesity, physical activity, less than 1 alcoholic drink a day
41
Q

breast cancer detection

A
  • breast self exam (BSE)
    > premenopausal (after period)
    > postmenopausal (anytime)
  • know personal normal, should be done the same every time
  • know personal normal, pre/post menopause, hysterectomy
42
Q

breast cancer mammography

A
  • detect 1 mm lesions, self exam palpitation 1 cm exam
  • can grow 2-9 years
43
Q

breast cancer diagnosis

A
  • mammography/ultrasound
  • biopsy: needle aspiration (needle removes cells), stereotactic needle (ultrasound and needle biopsy), excisional (spot and surrounding tissue is removed - definitive)
  • painless, firm, fixed lesions, poorly differentiated boarders found anywhere in breast
44
Q

breast cancer classification

A

TNM system
- estrogen/progesterone receptor analysis

45
Q

breast cancer prognosis

A

related to extend of nodal involvement (sentinel biopsy)
- sentinel node: 1st node in lymphatic chain > if biopsy doesnt show cancer cells its likely no other lymph node has to be removed

46
Q

breast cancer surgeries

A

mastectomy: removing all or some of breast tissue
radical: remove all tissue down to chest wall
lumpectomy: remove lump and some surrounding tissues
axillary dissection: lymph node removal under armpit

47
Q

breast cancer treatment

A
  • surgery
  • chemo
  • hormone therapy: block effects of estrogen on cancer cells
    > tamoxifen: oldest - nonsteroidal antiestrogen that binds to estrogen receptors to block growth of cancer cells
    > aromatase: anastrozole - block enzyme that converts androstenedione and testosterone into estrogen in peripheral tissues
48
Q

hypospadias

A
  • in babies
  • urethra opening is on the bottom of the penis
    > the closer the opening is to the body the more severe
  • negative psych effects
    > embryologic developmental defect of urethral groove/penile urethra
  • fetal testes release androgens inactive/deficient weeks of 8-14
  • 10% occurrence with undescended testes
    > Chordee (ventral bowing of the penis)/inguinal hernia (pouching of intestine) may be present
49
Q

hypospadias/epispadias manifestations

A
  • urine coming out of an area other than urethral opening of glans peins, UTI, dyspareunia
50
Q

hypospadias/epispadias treatment

A
  • surgery
51
Q

epispadias

A
  • urethra opening is on top of the penis
  • associated with exstrophy of bladder (protruding through abdominal wall)
52
Q

erectile dysfunction

A

> persistent inability to achieve and maintain erections

53
Q

erectile dysfunction etiology

A
  • blood flow issues to and from penis
  • arteriosclerosis
  • hypertension
  • peripheral neuropathy involving erection nerves
54
Q

erectile dysfunction risk factors

A
  • penile artery/vein disorders
  • trauma to pelvic area
  • obesity/ physical inactivity
  • smoking
  • fibrosis or atrophy of penile SMOOTH MUSCLE
55
Q

erectile dysfunction causes

A
  • psychogenic: performance anxiety, strained relationship with sexual partner, depression, psych issues
  • organic: vascular, neurogenic, hormonal, pelvic/spinal cord injury trauma, infection
  • drugs: antipsychotics, chemo, antiandrogens, glaucoma EYE DROPS
56
Q

erectile dysfunction diagnosis

A

> detailed physical and history
- identification and management of metabolic conditions
- ID psych issues

57
Q

erectile dysfunction treatment

A
  • treat underlying cause
  • psychosexual therapy
  • medications: PDE inhibitors (Viagra) increases smooth muscle relaxation, induces vasodilation, increases corporal blood flow
58
Q

priapism

A

> involuntary, sustained erection for more than 4 hours or stimulation unrelated to sex
- corpora cavernosa: impaired blood flow
tissue death in hours… need immediate attention

59
Q

priapism: urologic emergency

A

> prolonged erection leads to ischemia and fibrosis of erectile tissues
- any age
- secondary to: disease (leukemia, sickle cell, stroke, renal failure) and drugs (antihypertensives, anticoagulants, antidepressant, alc, weed)

60
Q

priapism: Ischemic

A

> veno-occlusive (low flow/acidotic)
- nonsexual, persistent erection with little/no cavernous blood flow
- abnormal cavernoma, rigid, painful to touch
- EMERGENCY

61
Q

priapism: Nonischemic

A

> arterial (high flow)
- nonsexual, persistent erection with unregulated cavernous arterial inflow
- blood gases not acidotic or hypoxic
- penis not fully rigid or painful
- most commonly cause trauma

62
Q

priapism diagnosis

A
  • emergency
  • manage symptoms to preserve tissue and function
63
Q

priapism treatment

A
  • analgesics, sedation, hydration
  • ice packs, cold saline enemas
64
Q

hydrocele

A

> collection of serous fluid in scrotum without noted inguinal hernia
- fluid collections between parietal and visceral layers of tunica vaginalis (lining of scrotum)
- commonly seen after birth but can happen at any age
- unilateral or bilateral swelling

65
Q

hydrocele cause

A
  • congenital (not formed right), injury, STI, lymph obstruction, testicular torsion
66
Q

hydrocele manifestation

A

heavy feeling in groin/swelling

67
Q

hydrocele diagnosis

A
  • palpation
  • transillumination ultrasound
68
Q

hydrocele treatment

A
  • observation
  • elevation
  • aspiration/surgery

pathophys (6 decks)

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