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Reproduction, Ch 23

Delayed puberty no clinical signs of puberty by age 13/girls or 14/boys. absence of menarche by 15/16.
causes of delayed puberty physiologic usually-just slow-familial, boys > girls. chronic condition that delay bone aging: lung dx, renal failure, CF. 5% H-P-G-axis problem.
Precocious puberty sexual maturity before 6 (black girls)/7 (white girls) and before 9 in boys. Check for familial occurence, r/o tumors, obesity r/t early puberty.
central precocious puberty GnRH-dependent:H-P-G axis is normal but early. Cause premature closure of epiphysis of long bones: short stature. GnRH depedent-no inhibition: idiopathic, CNS disorder, severe hypothyroidism.
Complete precocious puberty onset and progression of all pubertal features: thelarche, pubarche, menarche. 10% have lethal CNS tumor (H-P-G axis normal but early)
partial precocious puberty partial development of approp. 2ndary sex characteristics, thelarche: girls 6mo-2yrs., pubarche: 5-8yrs.-early increase in adrenal androgens
peripheral precocious puberty GnRH indepedent, sex hormones from somewhere else: adrenal/gonad tumor, testotoxicosis, exposure to exogenous sex steroids (contraceptives, environment
Mixed precocious puberty virilization of girl/feminization of boy. evident at birth.
primary dysmenorrhea painful menstration assoc with release of prostaglandin, not assoc with pelvic disease. anovulatory due to BCP-not primary.
secondary dysmenorrhea r/t pelvic pathology, can occur anytime in menstrual cycle.
prostaglandin affect dysmenorrhea women have 10 x's prostaglandin enhanced by progesterone. myometrial stimulant and vasoconstrictor.
Amenorrhea lack of menstration, usually pregnant.
primary amemorrhea failure of menarche/absence of menstration by 14 yrs without develop of 2ndary sex characteristics OR by age 16-no matter what. Primary amenorrhea different from delayed puberty-need to investigate.
Secondary amenorrhea absence of menstration for 3 or more cycles or 6 mo. in women who previous menstrated
Compartment IV disorders CNS disorder; hypothalamic. HPO axis dysfunction, no GrRH of hypothalamus, so pituitary not release FSH, LH and ovaries don't respond. no hormone-no estrogen dependent sex characteristics
Compartment III disorders anterior pituitary (tumor). If develop between onset and conclusion of puberty may have developed 2nd sex chararcteristics.
Compartment II disorders involves the ovaries. genetic-Turner syndrome (ovaries don't develop so no 2nd sex stuff or menses, high FSH/LH), androgen insensitivity syndrome (genetic male w/ external female parts:produce androgen and estrogen, no internal female parts-infertile)
Compartment I disorders defect in outflow tract; usually normal ovaries-so 2nd sex stuff present and regular growth, but no uterus/vagina (uterine hypoplasia)
causes of Secondary Amenorrhea most common:pregnancy then hypothyroidism. dramatic weight loss-malnutrition/excessive exercise. stress. PCOS.
PCOS polycystic ovary syndrome: 2 of the following: anovulation, oligo-ovulation, > androgens or s/sx hyperandrogenism and polycystic ovaries. Leading cause of infertility in US. polycystic ovaries not indicate PCOS, and don't have to be present to diagnose.
hyperprolactinemia overproduction of prolactin by pituitary-decreases GnRH by hypothalamus: < FSH/LH. hypothyroidism can cause this! > TRH binds to thyrotopes & lactotropes, > prolactin > dopamine < GnRH < FSH/LH.
Evaluating secondary amenorrhea 1) pregnancy (urine hCG) 2) TSH: > hypothroid; nl-check FSH prolactin: > hypothyroid (w/> TSH), drugs, idiopathic. > prolactin/nl TSH: CT scan 3) FSH: high-ovary failure, low-CT, nl: check testosterone/DHEAS/progesterone See Fig 23-1, p 821
signs of hyperandrogen state hirsutism, acne, and PCOS, anovulation.
PID infection=inflammation; uterus, fallopian tubes, ovaries or entire peritoneal cavity. Initiated by gonorrhea/chlamydia that cause damage and facilitate other bacterial infections. can cause infertility, death by sepsis. uterine/cervical mvt tenderness
Vaginitis STD or candida albicans; altered defense mechanism.
cervicitis inflammation of cervix prior to identification of pathogen. mucopurulent cervicitis: trichomonas, chlamydia, mycoplasma, ureaplasma (mucus exudate, vague pelvic pain, bleeding, dysuria.)
Endometriosis functioning endometrial tissue outside of uterus; retrograde menstration. can mimic other dx: PID, IBS, ovarian cyst, dysmenorrhea. dysmenorrhea NOT r/t degree of endometriosis. Sx: dyschezia, infertility, pain, dysmenorrhea, dyspareunia, constipation
CIN cervical intraepithelial neoplasm; CIN I-LSIL (low grade intraepithelial lesion); CIN II/III-HSIL-all or most of epithelium show features of cancer, underlying tissue not affected.
Cervical Cancer r/t HPV infection. Stage 0: CIS (HSIL), Stage I: confined to cervix, IA-w/micro, IB-wout/micro. Stage II: upper part of vagina, III: lower part of vagina, IV: mets IVa-bladder, rectum, IVb-beyond pelvis area;lungs
urethritis inflammation of urethra withouth bladder infection, STD
urethral stricture fibrotic narrowing of urethra by scarring. trauma or untreated urethritis
phimosis forskin cannot retract over glans; poor hygeine, chronic infection; check for urinary obstruction
paraphimosis forskin retracted but cannot be reduced to cover glans; surgical emergency if edema won't allow manual reduction to prevent necrosis
priapism spinal cord trauma, sickle cell dx, leukemia, pelvic tumor/infection or penile trauma. urologic emergency to prevent impotence. iced saline enema, ketamine, spinal anethesia.
balanitis inflammation of glans penis, assoc w/poor hygeine & phimosis. diabetic w/candida
peyronie disease bent nail syndrome, fibrotic condition of tunica albuginea of penis-"curves" painful erection/intecourse
Penile Cancer black > white. smoking, HPV, UV light/psoralen tx for psoriasis, HIV, phimosis common. squamous cell ca. premalignant lesions. Stage 1- 5yr 80% survival, average 50% for all stages.
Testicular Cancer rare, & most curable cancer, 95%. R > L. germ cell tumor-seminomas: most common, least aggressive, nonseminoma: more aggressive. delay tx 3-6 mo. 25% misdiagnosis with epididymitis, epididymorchitis, hydrocele, speratocele. Ri
varicocele abn dilation of vein within spermatic cord, "bag of worms." Lt side 95% of time, tender/painful. Rt side-tumor/thrombus of inferior vena cava. sudden in older man sign of renal tumor. valve prob :backflow, infertility due to < blood flow to testis.
hydrocele collection of fluid in tunica vaginalis. most common cause of scrotal swelling, transilluminates. US may reveal hidden tumor. not assoc w/infertility
spermatocele painless diverticulum of epididymis located between head of epididymis and testis (epididymis collects & transports sperm.) not assoc w/infertility. Tx painful cyst
cryptorchidism testicular maldescent. 50% of testis ca r/t to tumors arising from cryptorchid testes.
testicular torsion rotation of testis. acute scrotum-testicular pain & swelling. most common: neonates, pubertal adolescents. spontaneous, physical exertion, trauma. need sx within 6 hrs. manual detorsion need sx fixation.
orchitis inflammation of testes. uncommon. assoc with epididymitis. system infection: mumps, can case sterility. aspiration of hydrocele if occurs.
epididymitis inflammation of epididymis. rare before puberty, occur in sexuall active young. STD bacterial infection. UTI/prostatis related-older men. chemical: reflux inflammation from urine backflow; heavy lifting/straining, strictures. Painful
Benign Prostatic Hyperplasia 5a-reductase corresponds to age-depedent DHT, stay constant in the stroma of the prostate-disruption of balance of growth factors & tissue inteaction:remodel stroma-local inflammation; nodular hyperplasia, glandular enlarge-hypertrophy. begins periurethal
prostatitis inflammation of prostate. protection of lower urogenital tract from from infection-prostatic fluid contains prostatic antibacterial fluid (zinc containing polypeptide.)
acute bacterial prostatitis prostate is enlarged, tender, and firm or boggy. malaise, high fever, perineal pain, urinary retention. assoc w/bladder infection. Don't massage prostate, NO urinary catheter. complication: septicemia, abscess
chronic bacterial prostatitis recurrent urinary sx, persistent bacteria-gram negative. most common UTI in men. fibrosis cause repeated infection. prostatic secretion > 10 WBC. caculi make tx difficult.
nonbacterial prostatitis most common prostatis. milder sx, but persistent & annoying. cause by reflux of sterile urine into ejaculatory ducts, may have cystitis.
Prostate cancer most common male cancer in US. develop in androgen-dependent epithelium
Created by: Sniffen group



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