Pathophys Exam 2

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Pathophys Exam 2
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2010-11-03 10:37:55
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Reproductive System
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Reproductive System
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  1. LH stimulates
    Leydig cells
  2. FSH stimulates
    sertoli cells
  3. synthesized by the hypothalamus
    regulates synthesis and release of hormones from the pituitary gland
    GnRH
  4. initiates spermatogenesis by binding to sertoli cells and increasing levels of androgen binding protein
    FSH
  5. Regulates production of testosterone
    LH
  6. Produced by sertoli cells under the influence of FSH, suppressing the release of FSH
    Inhibin
  7. Androgens
    • testosterone
    • dihydrotestosterone
    • androstenedione
    • promote metabolism and musculoskeletal growth
  8. Most testosterone is converted to
    DHT
  9. precursor for testosterone
    androstenedione
  10. secreted by the leydig cells
    testosterone
  11. Hypogonadism clinical features
    • fatigue
    • depression
    • decreased libido
  12. Hypogonadism diagnosis
    <300 ng/dl testosterone level
  13. testicular failure
    primary hypogonadism
  14. lack of stimulation by gonadotropins
    secondary hypogonadism
  15. decreased or absent GnRH
    tertiary hypogonadism
  16. Testosterone replacement therapies
    • long acting intramuscular preparations
    • short acting intramuscular preparations
    • scrotal patches
    • Transdermal patches
    • Transdermal gel
    • Oral agents
  17. Phosphodiesterase 5
    degrades cGMP
  18. Number of men affected by ED
    18-30 million
  19. Percentage of men in their 40s
    5%
  20. percentage of men with ED over 65
    15-25%
  21. Causes of ED
    • organic
    • physiologic
    • endocrine
    • psychogenic
  22. Risk factors for ED
    • diabetes
    • cigarette smoking
    • mental disorders
    • vascular disease
    • neurogenic disorders
  23. Bloodwork/Labs for ED
    • Testosterone
    • Fasting Lipid panel
    • Fasting glucose
    • Thyroid
    • Liver and kidney function
  24. ED drug therapy
    • Phosphodiesterase 5 inhibitors
    • intracavernosal injections or suppositories
    • testosterone if hypogonadism present
  25. contraindicated in patients that are taking nitrates
    Phosphodiesterase Inhibitors
  26. Pharmacological treatment for priapism
    • alpha adrenergic agonists
    • beta adrenergic agonists
    • guanylate cyclase inhinbitors
  27. % of men that experience prostatitis in their lifetime
    50%
  28. recurrent infection and inflammation of the prostate and urinary tract
    • chronic bacterial prostatitis
    • chronic pelvic pain syndrome
  29. risk factors for prostatitis
    • bladder outlet obstruction
    • diabetes mellitus
    • suppressed immune system
    • catheter
    • STDs
  30. treatemt for prostatitis
    • antibiotics
    • usually iv then oral
    • therapy for weeks to months
  31. BPH
    • Benign prostatic hyperplasia (BPH)
    • age related nonmalignant enlargement of the prostate gland
  32. BPH common in men
    • >60
    • 50% have symptoms
  33. normal prostate physiology
    • secrete fluids that make up 20-40% of ejaculate volume
    • provides high zinc concentration
  34. two types of prostate tissue
    • epithelial
    • stromal
  35. embeded with alpha 1 adrenergic receptors
    stromal tissue
  36. testosterone is converted to DHT by
    5 alpha reductase
  37. type 1 5 alpha reductase
    hair follicles, sebaceouse glands in scalp, liver and skin
  38. type II 5 alpha reductase
    prostate genital tissue, scalp
  39. stimulates growth of stromal tissue in the prostate
    estrogen
  40. ultimate mediator of prostatic hyperplasia
    DHT
  41. Two prostatic factors
    • Dynamic
    • Static
  42. results in contraction of the prostate gland around the urethra and narrowing of the urethral lumen
    Dynamic prostatic factor
  43. Gives rise to symptoms such as weak urinary stream, post-void dribbling, frequency of urination and nocturia
    Static prostatic factor
  44. Surgery for BPH is necessary if
    • urinary retention
    • recurrent UTI
    • hematuria
    • bladder stones
    • renal insufficiency
  45. Three types of estrogen
    • estradiol
    • estrone
    • estriol
  46. most potent and plentiful estrogen
    estradiol
  47. estrogen comes from
    ovaries, adrenal glands and placenta
  48. effects of progesterone
    • development of breast tissue and endometrium
    • competes with aldosterone
    • increases body temp with ovulation
    • smooth muscle relaxation during pregnancy
  49. produced by the ovary after ovulation to prepare for implantation
    progesterone
  50. age of menopause
    48-55
  51. Primary amenorrhea
    gonadal, congenital or hormone regulation disorder
  52. Secondary amenorrhea
    • body fat : muscle ratio important
    • ovary, pituitary or hypothalamus dysfunction
  53. treatment for amenorrhea
    • correct underlying cause (prolactin, TSH)
    • oral contraceptives
  54. Primary Dismenorrhea
    • associated with a physical abnormality or pathological process
    • related to intrinsic factors
  55. Secondary Dysmenorrhea
    caused by specific conditions
  56. Increases prostaglandins
    progesterone
  57. Afflics approximately 80% of women
    PMS
  58. Higher in luteal phase
    increases sodium and water retention
    prolactin
  59. peaks in luteal phase
    stimulates anxiety and nervous tension
    estrogen
  60. may produce depression
    progesterone
  61. aldosterone
    increased fluid retention
  62. candidiasis
    20-25% of cases
  63. trichomonas
    10% of cases
  64. bacterial vaginosis
    30-35% of cases
  65. Normal characteristics
    • white/clear
    • floccular
    • high viscocity
    • pH <4.5
  66. Candidiasis characteristics
    • white
    • no odor
    • floccular
    • high viscosity curdlike
    • pH 4-4.5
  67. trichomoniasis
    • yellow/green
    • malodorous
    • homogenous
    • low viscosity/frothy
    • pH 5-6
  68. BV caracteristics
    • white/gray
    • fishy smell
    • homogenous
    • low viscosity
    • pH > 4.5
  69. may lead to pelvic inflammatory disease
    BV
  70. Treatment for candida albicans
    antifungals
  71. treatment for trich
    • oral metronidazole
    • all partners should be treated
  72. treatment for BV
    • clindamycin
    • metronidazole
    • treating partners not necessary
  73. HPV 16 and 18
    cause 70% of cervical cancer
  74. Risk factors for cervical cancer
    • early age of intercourse
    • multiple partners
    • promiscuous male partner
    • smoking
    • STIs
  75. Gardasil
    • 16, 18, 6, 11
    • additional coverage for warts
    • 0, 2 and 6 month
  76. Cervarix
    • 16 and 18
    • 0, 1 and 6 months
  77. Diagnosis of PID
    • Lowerabdominal pain
    • adnexal tenderness
    • painful cervix on exam
  78. treating PID
    • 14 days of broad spectrum antibiotics
    • treat partners for previous 60 days
  79. complications of PID
    • infertility
    • ectopic pregnancy
  80. % of women diagnosed with PCOS that are obese
    50%
  81. Causes of PCOS
    • increased LH
    • increased production of androgens
    • increased prolactin
  82. mechanism of insulin resistance that goes with PCOS
    decreased levels of sex hormone binding globulin = increased free testosterone
  83. Non-hormonal therapy for PCOS
    • metformin
    • Thiazolidinediones

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