Reproductive – Flashcards

Mammography is a low-dose x-ray examination that identifies non-palpable lesions 2 to 3 years before clinical presentation. It is the standard screening tool. A baseline examination is recommended at age 40, with repeated examinations every 1 to 2 years until age 50 and every year after age 50. If a lesion is identified, ultrasound can be used to differentiate between solid and cystic lesions. Ultrasound is not diagnostic for malignancy. Fine-needle aspiration can be diagnostic but has a 1% to 2% false-positive rate and a 10% false-negative rate. Surgical biopsy yields better results. Other less frequently used, more expensive tests include: thermography (used for screening), chest x-ray examinations (used to detect pulmonary metastasis), and CT scan (used to detect liver and bone metastasis).

Cervical mucus forms a plug to impede penetration of sperm except at ovulation. Cervical secretions also supplement the energy needs of the sperm, protect sperm from phagocytosis and pH damage, and serve as a sperm reservoir.

Hydrocephalus or space-occupying lesions of the CNS could interfere with the production or secretion of GnRH by the hypothalamus and follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the pituitary gland. The ovary would not receive the necessary hormonal signals to initiate the menstrual cycle because of absent or low levels of circulating FSH and LH. Therefore the woman would not have menses; and if this condition occurred before puberty, she would lack secondary sex characteristics.

Women between 50 and 64 years of age are at highest risk for endometrial cancer, the risk peaking at 61 years. Women of Jewish ancestry have the highest incidence, and women of Japanese ancestry have the lowest incidence. There may be genetic susceptibility with an autosomal dominant inheritance pattern. The risk factors associated with endometrial cancer include excessive carbohydrate and fat intake, decreased glucose tolerance, hypertension, nulliparity, early menarche, habitual abortion, hyperestrogenism, history of endometrial polyps or leiomyomas, and exposure to estrogen without progesterone. Ovarian cancer is the cause of 5% of all female cancer deaths. It occurs more frequently in industrialized countries and in white women. The serous tumor form of ovarian cancer occurs in women from 50 to 55 years of age. The germ cell tumor form of ovarian cancer occurs in women younger than 30 years. The risk factors associated with ovarian cancer include nulliparity, low parity (borne few children), smoking, asbestos and talc exposure, and estrogen replacement after menopause. The risk of ovarian cancer is slightly decreased in women who were exposed to mumps, measles, and rubella viruses before 12 years of age or who have significant oral contraceptive use. There appear to be no genetic susceptibility factors.

Testicular enlargement occurs with both orchitis and cancer of the testis. However, the testis is swollen, tense, and tender and the scrotum is red and swollen in orchitis. The pain is sudden and sharp, radiating down into the involved testicle. The patient will develop a high fever, nausea, vomiting, and chills. In cancer of the testis, the enlargement may be associated with dull, aching pain. Occasionally, a hydrocele may be present. If the tumor has metastasized, the patient will experience low back pain or cough and hemoptysis, depending on the site of metastasis.

-Isosexual precocious puberty is premature development of appropriate sexual characteristics that may be GnRHdependent or independent. If it is GnRHdependent, the hypothalamic-pituitary-gonadal axis is working normally but prematurely. Called central GnRHdependent,it can be idiopathic (including familial), a result of central nervous system abnormalities (10% of cases are caused by lethal tumors), or severe hypothyroidism. In addition to early development of secondary sex characteristics, premature epiphyseal closure results in short stature. -GnRH-independent precocious puberty, termed peripheralor pseudoprecocious puberty, develops when sex hormones are produced by some mechanism other than stimulation of the gonadotropins. Causes include exogenous sex steroids, gonadal tumors or cysts, adrenal hyperplasia or tumor, ectopic gonadotropin-secreting tumors, familial Leydigcell hyperplasia, and McCune-Albright syndrome. Heterosexual precocious puberty results when secondary sex characteristics of the opposite sex develop (virilizationin females and feminization in males). It rarely develops independent of signs present from birth. In females, the causes include congenital adrenal hyperplasia, androgen-secreting tumors, and exogenous androgens. In males, causes include estrogen-producing tumors, exogenous estrogens, and increased peripheral conversion of androgens to estrogens. -Incomplete precocious puberty is partial development of appropriate secondary sex characteristics. In females, breast development usually occurs between 6 months and 2 years of age, but the process does not progress to complete puberty. In both sexes, premature growth of axillary and pubic hair occurs between 5 and 8 years of age. Incomplete precocious puberty can proceed to complete precocious puberty. It may be a variant of normal pubertal development, but an estrogen-secreting neoplasm must be ruled out. Treatment for all forms of precocious puberty is based on identifying and treating the underlying cause. Neoplasm of the adrenals, central nervous system, or ovaries must be ruled out.

Bacteria with motility properties can move unassisted into the upper reproductive tract. Other organisms can be carried by sperm cells. Because the uterine tubes are open to the pelvic cavity, bacteria that gain access to the uterine tubes can easily enter the pelvic cavity and come into contact with the peritoneum. A less likely cause would be bacteria that travel directly to the peritoneum from the blood or lymph.

The chancre of syphilis is a hard, painless, eroded, firm ulcer that ranges in size from 2 mm to 2 cm. Enlarged lymph nodes often accompany syphilis chancres. The lesion of H. ducreyi chancroid is an inflamed, painful, irregular ulcer that is 2 to 20 mm in diameter. Enlarged, fluid-filled lymph nodes also accompany the lesion, developing into a bubo that may rupture spontaneously. The lesion of granuloma inguinale is a hard, sharply defined, indurated nodule that is usually slow-growing and painless. The nodules bleed easily and contain granulation tissue. Adjacent nodules can coalesce and progress into a large, granulomatous, heaped ulcer.

The rapid plasma reagin (RPR) test for syphilis detects previous exposure to syphilis. Because it is a quick, easy to-perform, and inexpensive test, it is good for mass screening of blood donors. A positive RPR test must be confirmed with a more specific but more expensive test. A donor who is syphilis-positive is probably a high-risk candidate for exposure to other transfusion-transmitted diseases like hepatitis B, hepatitis C, and HIV.

The patient is now included in a high-risk group. If a patient tests positive for one sexually transmitted infection, it is entirely possible that he or she has another. It is common practice to treat patients for both gonorrhea and Chlamydia if testing demonstrates that the patient is positive for either disease. This lessens the chance of passing an undiagnosed and untreated disease to other individuals.

It all comes down to anatomy. Because of the acidity of the male urethra, it naturally limits some microorganism growth. Also, because the male urethra is used as a passageway for semen and urine, the urethra is constantly flushed throughout the day as urination occurs. Ascending organisms can still affect males, but the organisms must travel a greater distance. Uncircumcised men are at slightly higher risk for STI infections. Once present in the cervix, STIs in women can spread to adjacent structures such as the uterus, fallopian tubes, and peritoneum. STIs in women also lead to a number of reproductive cancers and birth defects as STIs are passed from mother to baby. Infections in females are also often asymptomatic. The disease can progress to later stages before diagnosis and treatment.

BPH (benign prostatic hyperplasia) is a common condition and may become a problem if compression of the urethra occurs. The prevalence among U.S. men who are 60 years of age and older is approximately 50%; among men 70 years of age and older, the prevalence is 90%. The prostate increases in size throughout life and is the smallest at birth.

Polycystic ovary syndrome (PCOS). For a diagnosis of PCOS, a woman must have at least two of the following conditions: androgen excess, oligo-ovulation or anovulation, or clinical signs of hyperandrogenism and polycystic ovaries. Clinical manifestations usually appear within 2 years of puberty and include dysfunctional bleeding or amenorrhea, hirsutism, acne, and infertility. PMS is the cyclic recurrence of distressing physical, psychologic, or behavioral changes that impair interpersonal relationships or interfere with usual activities. The clinical manifestations of PID vary from sudden, severe abdominal pain with fever to no symptoms at all. Primary amenorrhea is the continued absence of menarche and menstrual function by 14 years of age without the development of secondary sex characteristics or by 16 years of age if these changes have occurred.

-sexual maturation before age 6 in black girls and age 7 in white girls. before age 9 in boys -caused by central (GnRH dependent) or peripheral (GnRH independent)

-painful menstruation associated with prostaglandin release in ovulatory cycles -related to duration and amount of menstrual flows

-failure of menarche and the absence of menstruation by age 14 without the development of secondary sex characteristics or by age 16 regardless of secondary sex characteristics

-absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated -causes- pregnancy, dramatic weight loss, malnutrition or excessive exercise, hypothyroidism, polycystic ovary syndrome

-oligo-ovulation or anovulation, elevated levels of androgens, leading cause of infertility in the US, multifactorial- hyperinsulinism, dysfunction of follicle development

-acute inflammation caused by infection, may involve any organ of reproductive tract- salpingitis & oophoritis, sexually transmitted diseases migrate from the vagina to the upper genital tract, polymicrobial infection

-inflammation of one or both ducts that lead from the vaginal opening to bartholin glands -caused by microorganisms that infect the lower female reproductive tract

-when the muscular and fascia tissue lose tone and strength with aging -the bladder, urethra & rectum are supported by the endopelvic fascia and perineal muscles.

-unilateral -produced when a follicle or number of follicles are stimulated but no dominant follicle develops and reaches maturity

-benign mass of endometrial tissue -common cause of intermenstrual or excessive menstrual bleeding

"uterine fibroids" -benign tumors of smooth muscle cells n the myometrium -cause abnormal uterine bleeding, pain and symptoms related to pressure on nearby structures

-functioning endometrial tissue or implants outside the uterus -possible causes- retrograde menstruation, spread through vascular or lymphatic systems, stimulation of multi potential epithelial cells on reproductive organs, or depressed Tc cells tolerate ectopic tissue

inability to retract foreskin from the glans of the penis

inability to replace or cover the glans with the foreskin

"bent nail" syndrome -slow development of fibrous plaques (thickening) in the erectile tissue of the corpus cavernosa, causing lateral curvature of penis during erection

condition of prolonged penile erection

inflammation of the glans penis usually associated with foreskin inflammation (prosthitis)

-inflammation/dilation of veins in spermatic cord -cause- inadequate or absent valves in the spermatic veins

scrotal swelling due to collection of fluid within the tunica vaginalis

-painless diverticulum of the epididymis located between head of the epididymis and the testes -contains milky fluid that contains sperm and does not cover the entire anterior scrotal surface

failure of one or more of the testes to descend from the abdominal cavity into the scrotum

acute inflammation of the testes

-enlargement of the prostate gland -symptoms associated with urethral compression -PSA monitoring

-persistent and sometimes excessive secretion of milky fluid from the breasts of a woman who is not pregnant or nursing -can also occur in med -women with this also experience menstrual abnormalities