1
Q
outline how steroidal contraception inhibits conception
A
- Progesterone only OC
- thickens cervical mucus which prevents sperm from reaching ovum - 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
2
Q
describe the hormones used in steroid contraception
A
- 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 - 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.) - Synthetic oestrogen
- mimics the active estrogen produced in the body - Synthetic prostagens
a) 19-nortestosterones: derived from testosterone, small amounts metablise to estrogen
b) 17-hydroxyprogesterones, pure progesterones w no metabolism to estrogen
3
Q
describe the different steroidal methods of contraception, incl. side effects
A
- 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) - 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
4
Q
What is hyperpituitarism?
A
An excess production of hormones from the pituitary gland, usually due to a pituitary adenoma
5
Q
Prolactinoma
- What is it?
- What does it cause?
A
- Increased prolactin secretion from AP gland
- amenorrhea, decreased menstruation, galactorrhea, infertility
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
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
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
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
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
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
12
Q
Hypospadia vs epispadia
A
- Hypospadia: urethra on ventral side of the penis
- Epispadia: urethra on the dorsal side of the penis
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
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
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)
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
- Non-invasive
- ductal carcinoma in-situ: epithelial lining of ducts
- lobular carcinoma in-situ: lobular cells - 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
Miscarriage
- describe
- distinguish bw the different classifications of miscarriage: threatened, inevitable, complete, incomplete, silent/missed
- 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
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
- 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
Placenta previa
- what is it? 3 types
- risk factors
- signs & symptoms
- implications of the condition for mother and/or baby
- 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
Distinguish between these common STIs, including treatment options: gonorrhea, genital herpes, chlamydia, & human papillomavirus (HPV)
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
pre-eclampsia
- patho
- signs & symptoms
- complications in severe preeclampsia
- treatment
- 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
Gestational diabetes
- define
- describe the potential effects of maternal hyperglycaemia for the pregnancy and baby
- 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
Steroidal contraceptives vs synthetic steroidal contraceptives
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
Hypothyroidism
- What is it?
- What does it affect?
- Signs and symptoms?
- Most common cause?
- Treatments?
- 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
Outline the normal physiological changes of pregnancy
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
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