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McCance-Reprod.
Reproduction, Ch 23
| Question | Answer |
|---|---|
| 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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