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607 Pathophysiology > Test 4 > Flashcards

Test 4 Flashcards

1
Q

outline how steroidal contraception inhibits conception

A
  1. Progesterone only OC
    - thickens cervical mucus which prevents sperm from reaching ovum
  2. Combined OC (estrogen and progesterone)
    - suppress growth of follicles and gonadotropins
    - in days 5-25 the hormones develop endometrial lining, follicles develop but stop before ovulation occurs
    - other 7 days the endometrium breaks down –> menstruation
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2
Q

describe the hormones used in steroid contraception

A
  1. Estrogen
    - inhibits release of FSH, suppressing follicular development
    - positive effects: maintains skin + blood vessel structure, cardioprotective effects (vasodilation, incr. HDL)
    - negative effects: enhances coagulation, sodium + water retention —> weight gain preceding menstruation
  2. Progesterone
    - inhibits release of LH, preventing ovulation
    - thickens cervical mucus
    - competes w aldosterone @ kidneys –> decr. sodium and water reabsorption; incr. basal body temp; smooth muscle relaxtion (reflux, etc.)
  3. Synthetic oestrogen
    - mimics the active estrogen produced in the body
  4. Synthetic prostagens
    a) 19-nortestosterones: derived from testosterone, small amounts metablise to estrogen
    b) 17-hydroxyprogesterones, pure progesterones w no metabolism to estrogen
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3
Q

describe the different steroidal methods of contraception, incl. side effects

A
  1. Progesterone only OCs:
    - low dose progestin
    - choice for lactating women
    - fewer side effects than COC bc small dose daily, but higher failure rates
    - narrow therapeutic range (same time everyday)
  2. Combined oral contraceptives:
    - estrogen and progestogen in varying amounts
    - 3 available types: monophasic (E+P constant), biphasic (P is incr. mid cycle) and triphasic (low E + P then incr. E + P then low E and doubled P)
    - side effects: weight gain/loss, headaches, acne/skin changes, libido changes, nausea/flushes/dizziness, amenorrhoea, permanent loss of fertility
    - Morning after pill: high dose estrogen, combination of E and P given 12 hours apart, or progestin only
    - IUCD: cause an inflammatory-like response in the uterus, and release progestogen
    - NuvaRing: combined hormonal contraceptive vaginal ring that releases progestin and estrogen
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4
Q

What is hyperpituitarism?

A

An excess production of hormones from the pituitary gland, usually due to a pituitary adenoma

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5
Q

Prolactinoma

  • What is it?
  • What does it cause?
A
  • Increased prolactin secretion from AP gland

- amenorrhea, decreased menstruation, galactorrhea, infertility

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6
Q
  • *Gigantism vs acromegaly
  • Similarity
  • Differences
  • Signs and symptoms
A
  • Both incr. GH secretion
  • Gigantism is incr. GH before epiphyseal growth plate ossification; –> incr. height
  • Acromegaly is the incr. after epiphyseal growth plate ossification –> incr. mm, skin growth and more robust skeletal features
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7
Q

Diabetes insipidus

  • What is it?
  • implications?
A
  • insufficient ADH release from the posterior pituitary gland
  • Polyuria and polydipsia
  • dehydration w/out fluid replacement can lead to electrolyte imbalances
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8
Q

Hyperthyroidism

  • What is it?
  • What does it affect?
  • Signs and symptoms?
  • Most common cause?
  • Treatments?
A
  • excess TH secretion
  • Incr. BMR and SNS activity
  • Decr. weight but incr. appetitie; restlessness, irritable; heat intolerance; palpitations
  • Grave’s disease; IgG antibodies mimic TSH, which incr. TH production and secretion
  • anti-thyroid drugs, thyroidectomy, radioactive iodine
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9
Q

Hyperparathyroidism

  • What is it?
  • 2 causes
  • Signs and symptoms
  • Treatments
A
  • Excess PTH (leads to incr. calcium in the blood)
  • hypercalcaemia –> oesteoporosis, kidney stones, effects on mm function, NS actvity (fatigue, headache, depression), GI system (anorexia, nausea/vomiting), insulin resistance, cardiac arrhythmias/bradycardia
  • removal of some/all parathyroid glands; vit D supplementation to incr. absorption of calcium
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10
Q

Hypercortisolism (Cushing’s Syndrome)

  • what is it? leading to?
  • causes?
  • Effects on body
  • treatments
A
  • cortisol constantly higher than normal. Leads to incr. gluconeogenesis
  • Exogenous cortisol (steroid medications mimic cortisol) or endogenous cortisol (incr. ACTH, pituitary adenoma)
  • Signs and symptoms:
    1. Severe protein breakdown (mm, bone and skin): i.e. mm wasting, bone fractures/osteoporosis, skin thinning
    2. Fat redistribution: fattening of face, fat deposition on upper back, central obesity
    3. Incr. gluconeogenesis: leads to hyperglycaemia and associated complications (diabetes mellitus, hypertension, poor wound healing)
    5. Cortisol dampens inflammatory response –> incr. infection risk and poor wound healing
  • treatment depends on cause: withdraw from steroid medications, steroid inhibitors, remove the tumors
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11
Q

Addison’s disease (primary hypoadrenalism)

  • what is it?
  • causes?
  • Signs and symptoms
  • treatment
A
  • decr. aldosterone and cortisol
  • autoimmune adrenalitis, infections (TB), adrenal damage/hyperplasia
  • Fatigue, mm weakness, weight loss, nausea/vomiting, decr. sodium retention, adrenal crisis
  • glucocorticoid and mineral corticoid replacement; preventing the person from having an adrenal crisis
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12
Q

Hypospadia vs epispadia

A
  • Hypospadia: urethra on ventral side of the penis

- Epispadia: urethra on the dorsal side of the penis

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13
Q

Testicular torsion

  • what is it?
  • causes
  • treatment
A
  • twisting of the spermatic cord of one of the testes which disrupts blood supply
  • causes sudden swelling and pain, nausea/vomiting, fever, hydrocele, loss of cremaster reflex
  • requires untwisting of testis ASAP
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14
Q

Testicular cancer

  • mostly affects which cells?
  • presents as?
  • treatments
A
  • gamete cells
  • early on is asymptomatic, then lump, enlargement, ache, hydrocele, etc.
  • orchiectomy (testis removal), chemo/radiation
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15
Q

Benign prostatic hyperplasia (BPH)

  • What is it?
  • causes?
  • treatment
A
  • prostatic enlargement
  • once urethra is constricted: urinary hesitancy, dysuria, dribbling, weaker flow, bladder fullness, nocturia
  • medications to shrink/relax bladder; TURP procedures (removes some/all prostate tissue)
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16
Q

Prostate cancer

  • Risk factors
  • patho
  • symptoms
  • metastasizes to where?
  • treatment
A
  • age, diet, genetics, chronic inflammation of prostate gland
  • tumour growth stimulated by testosterone
  • same as BPH but also haematuria and rectal obstruction
  • metastasizes usually to bones, but also liver, adrenal, lungs, lymph nodes
  • surveillance (low grade), hormone therapy, chemo/radiation, surgery
17
Q

Leiomyomas

  • what is it?
  • signs and symptoms
  • treatment
A
  • benign growth w/in myometrium. Can be intramural, subserous or submucosal
  • asymptomatic, or: cramping, heavy/prolonged periods, bleeding bw periods, pelvic pressure
  • myomectomy or hysterectomy
18
Q

Endometriosis

  • what is it?
  • patho
  • symptoms
  • treatment
A
  • ectopic endometrium which functions as normal
  • the endometrium proliferates and sheds like the normal endometrium but can’t escape during menstruation so just irritates and damages surrounding tissues causing inflammation and scarring
  • pain in general, pain w urination/sex/defecation, diarrhoea, constipation, nausea, infertility
  • can be left untreated, or: surgery, pain management, hormone therapy, hyterectomy, oophorectomy
19
Q

Polycystic ovarian syndrome (PCOS)

  • caused by?
  • causes what/patho?
  • signs and symptoms
  • treatment
A
  • altered levels of hormones in the body:
    1) decr. estrogen
    2) incr. androgens
    a) incr. insulin levels (–> insulin resistance –> hyperglycemia)
    4) abnormally high LH levels
  • causes decr. follicular development; immature follicles remain as fluid-filled cysts instead of mature follicles; no mature follicles –> decr. ovulation (infertility) and decr. estrogen production
  • Irregular menstruation, hirsutism, ovarian cysts
  • Lifestyle changes (diet), hormone therapy, medicines to suppress androgens
20
Q

Breast cancer

  • 2 types and their subtypes
  • signs/symptoms
A
  1. Non-invasive
    - ductal carcinoma in-situ: epithelial lining of ducts
    - lobular carcinoma in-situ: lobular cells
  2. Invasive
    - ductal carcinoma: starts in ducts and spreads to surrounding tissues
    - lobular carcinoma: starts in lobular and spreads to tissues
  • lumps/swelling, redness, change in nipple, crusting around nipple, change in breast size/shape, skin changes, nipple discharge
21
Q

Pelvic inflammatory disease (PID)

  • what is it?
  • causes? which leads to?
  • caused by?
A
  • repeated inflammation of the upper repro structures
  • causes tissue damage –> scarring; infertility, incr. risk of ectopic pregnancy, abscess formation
  • mostly due to gonorrhea and chlamydia
22
Q

Outline common signs & symptoms of sexually transmitted infections (STIs)

A
  • changes in appearance of external genitalia
  • discharge
  • dysuria
  • pruritus
  • dyspareunia
23
Q

hydatidiform mole (molar pregnancy)

  • 2 types
  • patho of the condition
  • signs and symptoms
A
  • complete vs incomplete
  • Complete: empty ovum, so the fertilised egg only has paternal chromosomes. Can be one sperm (DNA replicates) or 2 sperm.
  • Incomplete: double copy of paternal DNA and one copy of maternal DNA; too many copies
  • vaginal bleeding, larger than expected uterus, elevated HCG levels, hyperemesis gravidarum, hyperthyroidism, early onset PIH (pregnancy induced hypertension)
24
Q

Ectopic pregnancy

  • patho
  • risk factors
  • signs and symptoms
A
  • implantation outside uterine cavity (usually fallopian tubes); zygote grows into fallopian tube wall, causing breakdown of the tissue; inadequate supply of blood –> tissue damage, exhaustion of blood supply of tube –> fetal demise
  • bleeding, pain, rupture of tube; can lead to hemorrhagic shock
25
Q

Miscarriage

  • describe
  • distinguish bw the different classifications of miscarriage: threatened, inevitable, complete, incomplete, silent/missed
A
  • loss of pregnancy prior to 20w
  • threatened miscarriage: any presentation of consistent bleeding prior to 20w
  • inevitable miscarriage: miscarriage will happen, presents w bleeding, cervical dilation, possibly pain
  • complete: all products of pregnancy are expelled
  • incomplete: not all products of miscarriage are expelled, remains have to be removed
  • missed: signs of pregnancy spontaneously disappear (e.g. tender breasts); requires evacuation of the contents bc of dead tissue
26
Q

Placental abruption

  • what is it? 2 types and subtypes for one of them
  • risk factors
  • signs & symptoms
  • implications of the condition for mother and/or baby
A
  • premature separation of placenta; full (entire placenta separates from wall) or partial (only some of the placenta separates)
  • -> marginal is separation at margins of placenta with apparent blood loss whereas concealed/central is separation occurring centrally wherein blood loss is concealed/trapped
  • blunt trauma (crash, fall, DV), drugs (meth, cocaine), multiparity and maternal age >35, previous abruption
  • Bleeding, pain
  • Mother: hypovolaemic shock, renal failure, DIC
  • Fetal: intrauterine hypoxia and asphyxia, premature birth
27
Q

Placenta previa

  • what is it? 3 types
  • risk factors
  • signs & symptoms
  • implications of the condition for mother and/or baby
A
  • low lying placenta: marginal, partial or complete
  • having multiple placentas or larger than normal surface area (e.g. twins, triplets), maternal age >35, intrauterine fibroids, maternal smoking
  • Painless bleeding
  • postpartum hemorrhage (PPH), preterm birth, fetal hypoxia
28
Q

Distinguish between these common STIs, including treatment options: gonorrhea, genital herpes, chlamydia, & human papillomavirus (HPV)

A
  1. gonorrhea: bacterial infection
  2. chlamydia: bacterial infection
  3. genital herpes: viral infection; recurrent infections due to organism residing in nerves
  4. HPV: viral infection; cause numerous warts in the genital region; usually 6&11 cause genital warts and 16&18 cause cervical cancer
29
Q

pre-eclampsia

  • patho
  • signs & symptoms
  • complications in severe preeclampsia
  • treatment
A
  • new onset hypertension + proteinuria after 20w gestation up to 6w pp; develops seizures = eclampsia
  • primary pathology of abnormal placentation (placenta development) resulting in poor placental perfusion
  • local vasospasm in blood vessels which decr. blood flow supplying: kidneys = oliguria and proteinuria, retina = blurred vision, liver = injury and swelling, pain; also oedema bc incr. blood vessel permeability
  • Also formation of mini thrombi in microvasculature
  • haemorrhagic stroke, placental abruption
  • treatment: delivery of fetus and placenta (if possible), + managing symptoms after delivery; supplemental oxygen, medications
30
Q

Gestational diabetes

  • define
  • describe the potential effects of maternal hyperglycaemia for the pregnancy and baby
A
  • Incr. insulin resistance (normal) + decr. Insulin
  • maternal hyperglycaemia –> fetal hyperglycaemia
    1. fetal glycosuria and polyuria, which can cause polyhydramninos and assoc. complications
    2. Increased fetal insulin production –> increased glucose and protein uptake and increased conversion of glucose into fat –> macrosomia
    3. Delayed respiratory development: this includes a decrease in the development of type II pneumocytes and surfactant production –> IRDS
    3. increased fetal insulin (hyperinsulinaemia) –> insulin remains higher for longer after birth instead of dropping (and being replaced w glucagon), so glucose levels continue to drop once maternal supply is stopped –> hypoglycaemia

Also miscarriage, congenital abnormalities, IUGR

31
Q

Steroidal contraceptives vs synthetic steroidal contraceptives

A
  1. Synthetic:
    - suppress ovulation by controlling the natural feedback mechanisms of the HPO axis (suppressing normal activity)
  2. steroidal: mimic the continuous exposure to the endogenous steroids experienced during a pregnancy when there is suppression of the HPO axis
32
Q

Hypothyroidism

  • What is it?
  • What does it affect?
  • Signs and symptoms?
  • Most common cause?
  • Treatments?
A
  • decr. TH
  • decr. BMR and SNS activity
  • weight gain, lethargic, mental sluggishness, constipation, mm weakness/slowed reflexes, bradycardia, cold intolerance
  • most common cause is thyroiditis (usually Hashimoto’s disease)
  • Replacement synthetic thyroxine (T4) to maintain adequate TH and TSH levels
33
Q

Outline the normal physiological changes of pregnancy

A
  1. Respiratory system
    - intra-abdominal pressure incr. due to growth of uterus –> incr in diaphragmmatic breathing, incr tidal volume and relative hyperventilation
  2. Cardiovascular system
    - incr. cardiac output (to accommodate flow to placenta) –> incr. CO (incr. HR and SV)
    - decr. systemic vascular resistance –> incr. SR
    - drop in BP
  3. haemotological
    - incr. plasma volume (–> oedema)
    - incr. RBC volume
    - greater incr. in plasma vs RBC leads to anaemia
    - Incr. clotting factors –> hypercoagulability
  4. Musculoskeletal (due to growth of uterus)
    - incr. BMI
    - stretch marks
    - lower back pain
    - lordosis
    - siatica
    - calf cramps
  5. endocrine
    - incr. in anterior pituitary gland hormone secretion
    - pregnancy hormones (estrogen, progesterone, B-HCG)
    - incr. thyroid hormones
  6. dermatological
    - incr. pigmentation
    - distension and proliferation of blood vessels
  7. Renal
    - incr. renal blood flow
    - incr. GFR –> incr. urinary frequency
    - incr. kidney size (to accommodate for incr. blood flow)
    - ureter dilation
  8. GI
    - oesophageal relaxation (–> reflux)
    - incr. intraabdominal pressure –> haemorrhoids
    - constipation

607 Pathophysiology (10 decks)

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