NR 507 FINAL EXAM STUDY GUIDE 1
Reproductive:
endometrial cycle and the occurrence of ovulation- the menstrual cycle
consist of three phases: the follicular/proliferative phase (postmenstrual),
followed by the luteal/secretory phase (premenstrual), and the
ischemic/menstrual phase. *Ovarian hormones control the uterine
(endometrial) events of the menstrual cycle. During the
follicular/proliferative phase of the ovarian cycle estrogen produced by the
follicle causes the endometrium to proliferate (proliferative phase) and
induces the LH surge and progesterone production in the granulosa layer.
During the luteal/secretory phase, estrogen maintains the thickened
endometrium, and progesterone causes it to develop blood vessels and
secretory glands (secretory phase). As the corpus luteum “starved”
endometrium degenerates and sloughs off, causing menstruation, the
ischemic/menstrual phase.
uterine prolapse- the descent of the cervix or entire uterus into the vaginal
canal due to weakened pelvic fascia and musculature and poor support from
the vaginal muscles and fascia.
polycystic ovarian syndrome- most common cause of anovulation and
ovulatory dysfunction in women. Defined as having at least two of the
following three features: irregular ovulation, elevated levels of androgens
(e.g., testosterone), and the appearance of polycystic ovaries on ultrasound.
PCOS is associated with metabolic dysfunction, including dyslipidemia,
insulin resistance, and obesity. One of the most common endocrine
,disturbances affecting women, especially young women, and is a leading
cause of infertility in the U.S. Strong genetic component to PCOS, various
features of the syndrome may be inherited. PCOS patients are three times as
likely to have insulin resistance, higher for obese women. Tend to have
increased leptin levels. Symptoms within 2 years of puberty & include:
dysfunctional bleeding or amenorrhea, hirsutism, acne, acanthosis nigricans,
and infertility. 60% are obese. Increased risk for gestational DM, pregnancy-
induced HTN, preterm birth, and perinatal mortality.
testicular cancer and conditions that increase risk- most common cancer in
men, age 15-35. Slightly more common on the right than on the left. 90% of
testicular cancers are germ cell tumors arising from the male gametes. Two
types: Seminomas-most common, least aggressive, make up 30-35% of
testicular cancers & Nonseminomas-include embryonal carcinomas,
teratomas, and choriocarcinomas, which are the most aggressive, but rare
form of testicular cancer. Risk factors include: genetic predisposition, history
of cryptorchidism, abnormal testicular development, HIV, AIDS, Klinefelter
syndrome, and history of testicular cancer. Can arise from specialized cells of
the gonadal stroma-these tumors, which are named for their cellular origins,
are Leydig cell, Sertoli cell, granulosa cell, and theca cell tumors and
constitute less than 10% of all testicular cancers.
symptoms that require evaluation for breast cancer- painless lump, palpable
nodes in the axilla, retraction of tissue (dimpling), chest pain, dilated blood
vessels, edema, edema of the arm, hemorrhage, local pain, nipple/areolar
eczema, nipple discharge in non-lacting woman, pitting of the skin (like
surface of an orange peel), reddened skin, local tenderness and warmth, skin
retraction, ulceration.
signs of premenstrual dysphoric disorder- One of these symptoms must be
present for a diagnosis: marked affective lability, marked irritability or anger
or increased interpersonal conflicts, marked anxiety, tension. One of these
,must also be present: decreased interest, difficulty concentrating, easy
fatigability, low energy, increase or decrease in sleep, feelings of being
overwhelmed, physical symptoms, such as: breast tenderness, muscle or
joint aches, bloating or weight gain. (Greater than 5 of these symptoms
occur during the week before menses onset, improve within a few days after
menses onset, and diminish in the week postmenses).
dysfunctional uterine bleeding- bleeding that is abnormal in duration,
volume, frequency, or regularity; and has been present for the majority of
the previous 6 months. May be acute or chronic. PALM-COEIN System for
classification of abnormal uterine bleeding: PALM-structural causes: Polyp,
Adenomyosis, Leiomyoma, Malignancy. COEIN-nonstructural causes:
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet
classified. Increased endometrial bleeding is correlated with a change from
ovulatory to anovulatory cycles due to high estrogen levels.
pathophysiology of prostate cancer- More than 95% of prostatic neoplasms
are histologically similar to adenocarcinomas and rely on androgen-
dependent signaling for their development and progression. Most of these
neoplasms occur in the periphery of the prostate. Prostatic adenocarcinoma
is a heterogeneous group of tumors with a diverse spectrum of molecular
and pathologic characteristics, and therefore clinical behaviors and
challenges. The biologic aggressiveness of the neoplasm appears to be
related to the degree of differentiation rather than the size of the tumor.
Testicular testosterone provides the main source of androgens in the
prostate and is the major circulating androgen, whereas DHT predominates
in prostate tissue and binds to the androgen receptors with greater affinity
than does testosterone. Androgen production outside of the testes, or extra
testicular sources. Testosterone is converted to dihydrotestosterone, DHT is
the most potent intraprostatic androgen.
, HPV and the development of cervical cancer- almost exclusively caused by
cervical human papillomavirus (HPV) infection. HPV strains 16 & 18 are most
often implicated as causing 70% of all cervical cancers and also contribute to
many vaginal, vulvar, penile, anal, and oropharyngeal cancers. Most HPV
infections are cleared from the immune system; vast majority of infections
do not cause cervical cancer. Screening before age 21 not recommended.
Women with multiple sex partners are more likely to be exposed to high-risk
HPV, but women with only one lifetime sexual partner can also become
infected. Transformation zone is where the two cell types of squamous
epithelium cells and columnar epithelial cells come together and this is
where carcinoma in situ is most likely to develop. PAP test or HPV screening
necessary for early detection; 90% can be detected by these. Viral DNA
becomes integrated into the genomic DNA of the infected basal cell of the
cervix and directs the persistent production of viral oncogenes. Persistence
of infection with high-risk HPV is a prerequisite for the development of
cervical intraepithelial neoplasia, lesions, and invasive cervical cancers.
Endocrine:
body’s process for adapting to high hormone levels- Feedback systems. Most
hormone levels are regulated by negative feedback, in which tropic hormone
secretion raises the level of a specific hormone. The elevated level of the
specific hormone then causes negative feedback, decreasing secretion of the
tropic hormone. Positive feedback systems, in which elevated hormone
levels increase a response which then further increases hormone secretion,
is seen most often in reproductive hormones. Negative feedback is the most
common & occurs when a chemical, neural, or endocrine response decreases
the subsequent synthesis and secretion of a hormone. Positive feedback
occurs when a neural, chemical, or endocrine response increases the
synthesis and secretion of a hormone. Positive feedback also occurs when an
increased hormone level further increases the synthesis and secretion of that
same hormone. The sensitivity or affinity of the target cell to a particular
Reproductive:
endometrial cycle and the occurrence of ovulation- the menstrual cycle
consist of three phases: the follicular/proliferative phase (postmenstrual),
followed by the luteal/secretory phase (premenstrual), and the
ischemic/menstrual phase. *Ovarian hormones control the uterine
(endometrial) events of the menstrual cycle. During the
follicular/proliferative phase of the ovarian cycle estrogen produced by the
follicle causes the endometrium to proliferate (proliferative phase) and
induces the LH surge and progesterone production in the granulosa layer.
During the luteal/secretory phase, estrogen maintains the thickened
endometrium, and progesterone causes it to develop blood vessels and
secretory glands (secretory phase). As the corpus luteum “starved”
endometrium degenerates and sloughs off, causing menstruation, the
ischemic/menstrual phase.
uterine prolapse- the descent of the cervix or entire uterus into the vaginal
canal due to weakened pelvic fascia and musculature and poor support from
the vaginal muscles and fascia.
polycystic ovarian syndrome- most common cause of anovulation and
ovulatory dysfunction in women. Defined as having at least two of the
following three features: irregular ovulation, elevated levels of androgens
(e.g., testosterone), and the appearance of polycystic ovaries on ultrasound.
PCOS is associated with metabolic dysfunction, including dyslipidemia,
insulin resistance, and obesity. One of the most common endocrine
,disturbances affecting women, especially young women, and is a leading
cause of infertility in the U.S. Strong genetic component to PCOS, various
features of the syndrome may be inherited. PCOS patients are three times as
likely to have insulin resistance, higher for obese women. Tend to have
increased leptin levels. Symptoms within 2 years of puberty & include:
dysfunctional bleeding or amenorrhea, hirsutism, acne, acanthosis nigricans,
and infertility. 60% are obese. Increased risk for gestational DM, pregnancy-
induced HTN, preterm birth, and perinatal mortality.
testicular cancer and conditions that increase risk- most common cancer in
men, age 15-35. Slightly more common on the right than on the left. 90% of
testicular cancers are germ cell tumors arising from the male gametes. Two
types: Seminomas-most common, least aggressive, make up 30-35% of
testicular cancers & Nonseminomas-include embryonal carcinomas,
teratomas, and choriocarcinomas, which are the most aggressive, but rare
form of testicular cancer. Risk factors include: genetic predisposition, history
of cryptorchidism, abnormal testicular development, HIV, AIDS, Klinefelter
syndrome, and history of testicular cancer. Can arise from specialized cells of
the gonadal stroma-these tumors, which are named for their cellular origins,
are Leydig cell, Sertoli cell, granulosa cell, and theca cell tumors and
constitute less than 10% of all testicular cancers.
symptoms that require evaluation for breast cancer- painless lump, palpable
nodes in the axilla, retraction of tissue (dimpling), chest pain, dilated blood
vessels, edema, edema of the arm, hemorrhage, local pain, nipple/areolar
eczema, nipple discharge in non-lacting woman, pitting of the skin (like
surface of an orange peel), reddened skin, local tenderness and warmth, skin
retraction, ulceration.
signs of premenstrual dysphoric disorder- One of these symptoms must be
present for a diagnosis: marked affective lability, marked irritability or anger
or increased interpersonal conflicts, marked anxiety, tension. One of these
,must also be present: decreased interest, difficulty concentrating, easy
fatigability, low energy, increase or decrease in sleep, feelings of being
overwhelmed, physical symptoms, such as: breast tenderness, muscle or
joint aches, bloating or weight gain. (Greater than 5 of these symptoms
occur during the week before menses onset, improve within a few days after
menses onset, and diminish in the week postmenses).
dysfunctional uterine bleeding- bleeding that is abnormal in duration,
volume, frequency, or regularity; and has been present for the majority of
the previous 6 months. May be acute or chronic. PALM-COEIN System for
classification of abnormal uterine bleeding: PALM-structural causes: Polyp,
Adenomyosis, Leiomyoma, Malignancy. COEIN-nonstructural causes:
coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet
classified. Increased endometrial bleeding is correlated with a change from
ovulatory to anovulatory cycles due to high estrogen levels.
pathophysiology of prostate cancer- More than 95% of prostatic neoplasms
are histologically similar to adenocarcinomas and rely on androgen-
dependent signaling for their development and progression. Most of these
neoplasms occur in the periphery of the prostate. Prostatic adenocarcinoma
is a heterogeneous group of tumors with a diverse spectrum of molecular
and pathologic characteristics, and therefore clinical behaviors and
challenges. The biologic aggressiveness of the neoplasm appears to be
related to the degree of differentiation rather than the size of the tumor.
Testicular testosterone provides the main source of androgens in the
prostate and is the major circulating androgen, whereas DHT predominates
in prostate tissue and binds to the androgen receptors with greater affinity
than does testosterone. Androgen production outside of the testes, or extra
testicular sources. Testosterone is converted to dihydrotestosterone, DHT is
the most potent intraprostatic androgen.
, HPV and the development of cervical cancer- almost exclusively caused by
cervical human papillomavirus (HPV) infection. HPV strains 16 & 18 are most
often implicated as causing 70% of all cervical cancers and also contribute to
many vaginal, vulvar, penile, anal, and oropharyngeal cancers. Most HPV
infections are cleared from the immune system; vast majority of infections
do not cause cervical cancer. Screening before age 21 not recommended.
Women with multiple sex partners are more likely to be exposed to high-risk
HPV, but women with only one lifetime sexual partner can also become
infected. Transformation zone is where the two cell types of squamous
epithelium cells and columnar epithelial cells come together and this is
where carcinoma in situ is most likely to develop. PAP test or HPV screening
necessary for early detection; 90% can be detected by these. Viral DNA
becomes integrated into the genomic DNA of the infected basal cell of the
cervix and directs the persistent production of viral oncogenes. Persistence
of infection with high-risk HPV is a prerequisite for the development of
cervical intraepithelial neoplasia, lesions, and invasive cervical cancers.
Endocrine:
body’s process for adapting to high hormone levels- Feedback systems. Most
hormone levels are regulated by negative feedback, in which tropic hormone
secretion raises the level of a specific hormone. The elevated level of the
specific hormone then causes negative feedback, decreasing secretion of the
tropic hormone. Positive feedback systems, in which elevated hormone
levels increase a response which then further increases hormone secretion,
is seen most often in reproductive hormones. Negative feedback is the most
common & occurs when a chemical, neural, or endocrine response decreases
the subsequent synthesis and secretion of a hormone. Positive feedback
occurs when a neural, chemical, or endocrine response increases the
synthesis and secretion of a hormone. Positive feedback also occurs when an
increased hormone level further increases the synthesis and secretion of that
same hormone. The sensitivity or affinity of the target cell to a particular
