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Quiz: 1.Know all STI: pathophysiology, etiology, clinical manifestations, diagnostic tests,
treatment, and complications.
Ans: Use EB's chart
· How is each transmitted during pregnancy to the fetus?
· Know the different stages of syphilis.
· what organism causes each STI and is it viral, bacterial etc.?
· Do you treat both partners and why?
· What age group has the greatest risk of STIs and why? Young women
· What causes cervical cancer? HPV exposure
Quiz: 2. Understand the different uterine tumor types
Ans: · Leiomyomas (uterine fibroids): benign smooth muscle tumors in the myometrium;
most remain small and asymptomatic
o Occurs in the fundus of the uterus in multiples or in singles throughout
o Subserous, submucous, or intramural
o Manifestations: abnormal uterine bleeding (increased uterine surface area), pain,
distorted uterine cavity that can put pressure on a nearby structure
o Evaluation: enlarged and irregular uterus; confirm diagnosis with MRI
Treatment: GnRH antagonists, IUD, oral contraceptive, hysterectomy or myomectomy
(removal of fibroid)
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, Quiz: 3. What is PCOS and what does it cause? Clinical manifestations? Treatment?
Causes? Pathophysiology?
Ans: · At least two of the following: irregular ovulation, elevated levels of androgen
(testosterone), polycystic ovaries on ultrasound
· Patho: hyperandrogenic state is a cardinal feature, glucose intolerance increases the
severity
· Manifestations: obesity, menstrual disturbance, hyperandrogenism, DM, HTN
· Causes: associated with metabolic dysfunction, dyslipidemia, insulin resistance, and
obesity
· Treatment: goal is to reverse androgen excess and causing cyclic menstruation; first line is
oral contraceptives to establish a regular period, weight loss, progesterone therapy if
pregnancy is not desired
Quiz: 4. What is the difference between primary and secondary amenorrhea and what is
compartment II?
Ans: · Primary amenorrhea: failure of menarche and the absence of menstruation by age
13
· Secondary amenorrhea: absence of regular menses for 3 months or irregular menses for
6 months in women who have previously menstruated; exclude pregnancy before further
evaluation
· Compartment II: disorders that involve the ovary and are linked to genetic abnormalities;
gonadal dysgenesis (turner syndrome) or androgen insensitivity syndrome (AIS)
Quiz: 5. What are the signs of puberty in girls and boys? What delays puberty?
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, Ans: · Reproductive maturation involves the hypothalamic pituitary-gonadal (HPG) axis,
the CNS, the endocrine system; adrenarche is the increased production of adrenal
androgens (axillary and pubic hair growth and body odor)
· Girls: 8-9 years of age, with thelarche (breast development); puberty is complete with the
first menstrual period (could be 1-2 years after menarche or first period)
o estradiol causes breast development, maturation of the reproductive organs, and fat
deposits in the hips
o estrogen and increased growth factors leads to rapid skeletal growth in girls and boys
· Boys: 11 years of age, occurs with increased weight and BMI; complete with the first
ejaculation of mature sperm
o Testosterone causes growth of testes, scrotum, and penis
· Delays in puberty: lack of circulating estrogen leads to inadequate bone density; low
gonadotropin levels: need skull imaging to rule out pituitary or other CNS tumor
o Girls: functional hypogonadotropic hypogonadism (FHH), disruption in the HPG axis;
treat with estrogen
o Boys: deficient FSH/LH, disruption of HPG axis; treat with testosterone
Quiz: 6. What is the pathophysiology behind the signs and symptoms of menopause?
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, Ans: · Cessation of ovulation and menses due to ovarian failure, marks the end of
reproduction; premature menopause (before 40 years old); defined by the point that
marks 12 consecutive months of amenorrhea
· "climacteric": gradual changes of ovarian function that start before menopause due to a
loss of ovarian follicles resulting in reduced ovarian production of estradiol, increased
FSH/LH, and decreased inhibin
· Changes:
o Ovarian: utero- number of follicles steadily decrease, starts in the late 30s
o Uterine: primarily endometrium affected, proliferative growth; longer exposure to
estrogen causes greater thickness of endometrium which causes heavy/unpredictable
bleeding
o Breast: become smaller and lose firmness because fat deposits increase
o Genital tract: vagina shortens and loses elasticity, vaginal pH increases which causes
vaginitis, urethral tone declines causing frequency/urgency/UTIs/incontinence (estrogen
deficiency)
o Systematic: vasomotor flushes (hot flashes) due to rise in temp and dilation of blood
vessels and increased noradrenaline levels
o Cardiac: as estrogen levels decrease, BP and LDL levels rise which causes weight gain
Quiz: 7. What does breast milk contain?
Ans: · Breast milk is the most appropriate nourishment for newborns.
· Colostrum is rich in immunologic components (IgA, lactoferrin, leukocytes, growth factor)
o Secretory IgA and antimicrobial factors (lysosomes and lactoferrin) protect the infant
against infection
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