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49 Cards in this Set

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Normal function of menstrual cycle:
1. endocrine control
2. ovary: hormones
3. uterus: cycling
1. Hypothalmus: GnRH (pulsative and timing)
Anterior Pituitary: Gonadotropins (LH and FSH)
2. Follicle: produce Estrogen
Corpus Lutenum: Progesterone (when egg ovulates)
3. Menstrual lining (endometrial growth)
Proliferative phase: 11 days
Secretory phase: 12 days (thick and profound vesicles)
implantation or menses: 5 days
what is feedback
estrogen or progesterone->
FSH/ LH->
Hypothalamus
Primary amenorrhea
pt has never had menstral cycles

*genetic or chromosomal abnormalites
secondary amenorrhea
previously has had menstrual cycle but then stops

*syndromes or illnesses
Underlying conditions of Amenorrhea:
prenancy; hypothalamic dys (exercise/stress/thyroid); pituitary dys (adenomas- b); ovary dys (pco/meno/chromo); outflow tract anomalies (Mulerian Duct Abberancies- primary/genetic)
galactorrhea
production of breast milk when not breast feeding
r/o:
pituitary, ovaries
X-ray will conclude on pituitary

give OC to see if there is a normal cycle- ovaries

high FSH & LH after= ovaries weren't working
low= ovaries were working
treatment for hypothalamic suppression
weight gain, less exercise
metrorrhagia
irreg and frequent bleeding
(train/metro)
menorrhagia
prolonged or excessive bleeding
(men)
menometrorrhagia
irreg and frequent, prolonged or excessive bleeding
oligomenorrhea
infrequent menstrual flow
dysfunctional uterine bleeding
bleeding source is uterine/ hormone
abnormality in estrogen or progesterone levels
postmenopausal bleeding
any bleeding 6 months after last period

(cancer?)
Polysystic ovary dis
(stein-leventhal syndrome)
1. estrogen excess
2. cause of infertility & amenorrhea
3. Clomiphen Citrate (Clomid)-stimulate ovulation
4. hyperplasia will result of endometrial build up
5. hyperplasia may become atypical-> precancerous disease
PCO dis tx:
-Progesterone (medroxyprogesterone)
-estro/pro combo (OC-if estro not high)
-estro (oral or IV- with heavy blood flow)
-NSAIDs (decrease bleeding-lower prostraglandins, vasoconstrict, pain)
-D&C (when pharm has failed-will have to redue)
-Abblation (cauterize endo-lasting effect, scaring, lowers bleeding, sterilized)
most common cause of second amen
pregnancy
uterine cancer suspected in:
-post meno bleeding
-abnormal bleeding in middle age or older females (get a tissue specimen)
- family hx
-prolong estrogen increses risk
infertility
unprotected intercourse, timed appropriately, for 12 months
Male factors:
hormonal disorders
Test
androgen dis, assoc with rare tumor, thyroid dysfunction

TSH, prolactin levels
Male:
disorders of sperm production
tx
post traumatic, varicocele, toxins, auto-immune, infections
semen anaylsis (inital test)
male:
sexual dys
impotence (meds, depression, chronic health conditions) and decresed libido
femal problems:
-disorder of ovulation (inital evaluation)
-cervical mucos changes
-hostile endometrium
-abberant tubal/uterine anatomy (scaring)
causes of anovulation

test:
-PCO syndrome
-hypothyroidism
-pituitary adenoma
-adrenal hyperplasia
-hypothalamic dysfunction
-ovarian failure (menopause)

*the ovaries on up**
hostile environments tested by:

tx:
-serum progesterone (1 wk after ovulation)

-endometrial biopsy (less reliable may cause miscarriage)

*Clomid or progesterone
dysmenorrhea
recurring pain, occurs consistantly with menstrual cycle
primary dysmenorrhea
pain results from the normal menstrual cycle (more then normal)
secondary dysmenorrhea
pain results from pathologic menstrual process
** cervical stenosis, enometriosis, adenomyosis, pelvic congestion, adhesions, somatization/ depression**
1. scant flow?
2. pain worse at night or standing
3. dyspareunia
4. hx of infertility
5. worse with stress
6. accompanying mood swings
1. cervical stenosis
2. pelvic congestion
3. adhesions/ endometriosis
4. adhesions
5. somatization
6. depression
Pelvic exam and testing:
1. uterus mobile or fixed
2. os sounded
3. recto-vaginal exam
4. mental status exam
5. hysterosalpingogram
6. laparoscopy
1. endometriosis/ adhesions
2. cervical stenosis
3. nodules/ endo
4. somatization/ dep
5. cervical stenosis
6. endo, adhesions, pelvic veins or dilation
usually made as a diagnosis of exclusion
primary dysmenorrhea, starts shorly after menarche, within the first three to six cycles
symptoms of dysmenorrhea made by:
sloughing of endometrial tissue, progesterone levels, prod of prostoglandins (inflamation)
tx of dysmenorrhea
decreasing prostaglandins sythesis (NSAIDs)
or reducing amount of progesterone and endometrial tissue sloughed (OC)
Physical signs of a uterine fibroid:
-diagnosis made by abd and pelvic exam
-finding of a firm mass or irreg, nodualr uterus

-if lg or uncertain, do a SONOGRAM to r/o enlarged ovaries
symptoms:
most are..
and the rest
-asymptomatic (picked up on exam)
*prob b/c: symetrical enlargement= pregnancy or diff to distinguish from ovarian pathology

-bleeding (menorrhagia)
-pressure (urinary & constipation)
-pain/tenderness (degeneration, gradual, severe- fever & leuko)
-distortion of abd (lg fibroid)
-infertility
TX for uterine fibroids
-observation and reassurance
*most don't need therapy- esp asymp
*examine often- rate of growth&symp
*no size limits to fibroids
-surgical (myomectomy-4 childbearing)
*20% reaccurance
*adhesions (likely)
*more blood loss

-hysterectomy
-arterial embolization (UAE)
medical management of uterine fibroids:
Lupron (GnRH antagonist)
-reduce the size 40-60%
-return back to original size in 3months after stopping
-used to DEC. SIZE for VAGINAL HYSTERECTOMY
-correct anemia b4 surgery if iron only doesn't work
uterine fibroids:
benign/malignant
symp/ asympto
symptoms based on... most common
treatment
-benign
-asymptomatic
-size and degeneration (severe deg=fever and leuko)....abnormal bleeding
-surgical removal (hysto or myomectomy)
cervical dysplasia
or cerv. intraepithelial neoplasia
or CIN
-dysplasia: abnormal maturation

cellular changes
*immaturity
*disorganization
*nuclear abnormalities
*increased mitotic activity
cytology classification:
squamous epithelia cell abnormailities
Atypical squamous cells
-ASCUS (unditermined significance)
-ASC-H (can't exclude HSIL)

Sqamous intraepithelial lesion
-LOW grade (HPV, koilocytosis CINI
-LGSIL)
-HIGH " (CIN II, III - HGSIL)

Squamous CEll Cancer
cytology:

Glandular Cell abnormalities
Atypical glandular cells (AGC)
-endocervical, endometrial, NOS

AGC, favor neoplastic
-endocervical or NOS

Endocervial Adenocarcinoma in situ AIS

Adenocarcinoma
cytology:

Other
Endometrial cells
-in women >40 y/o
observation follow-up
-CIN I only
-high likelyhood it will revert back to normal 90%
-repeat pap 6-12 months
HPV testing 12 months
ABlative Techniques:
-cryocautery (good for CIN i-but now use observation)

-laser vaporization (historical now; used with lg transformation zones)
ecisional tech
Leep
Leep cone
cold knife conization (CKC)

-used for diagnostic purposes as well as therapy for dysplasia
LEEP
most are using this procedure
loop electrical excision procedure
tx for AIS
CKC
Hysterectomy
-radical tx for dysplasia
-multiple recurrences
-poor follow up
-other GYN issues
pap smears done to detect...

colposcopy done to determine...

tx by ablating or excising the transformation zone will...
detect dysplasia

high grade or low lesion

lower chance of lesion progressing into CA