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NU664D/ NU 664D Exam 2 Study Guide (Latest 2025/ 2026 Update) Primary Care Adult Woman I Review| Questions & Answers | Grade A (100% Correct Solutions)- Regis
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When is the follicular phase ovarian cycle begin
begins at the onset of menses and ends on the day before the LH surge (Days 1-14)
What happens during the follicular phase
Increase in FSH stimulates the ovary to develop follicles that contain and egg
The follicles produce
estrogen
estrogen causes the uterine lining to
thicken
LH is released from
the pituitary gland
LH surge
pituitary releases a large amount of LH
Luteal phase of the ovarian cycles begins
on the day of the LH surge - 24 hours before ovulation - days 15-28 of cycle
Luteal phases causes
rupture of the mature follicle and release of egg
Uterine cycle: proliferative phase
depends on estrogen - corresponds with follicular phase - causes endometrial lining to grow
uterine cycle: secretory phase
corresponds to luteal phase of ovarian cycle - corpus luteum produces progesterone - endometrium is receptive to implantation of blastocyst
Excessive estrogen
menorrhagia, dysmenorrhea, fibrocystic breast changes, mucorrhea, edema/leg cramps, bloating, cyclic weight gain, increased fibroid growth, withdrawal headache
Insufficient estrogen
amenorrhea, hypomenorrhea, break through bleeding before day 10, irritability, atrophy of vagina, hot flases, night sweats, decreased pelvic tone
excessive progesterone
loss of libido, increased yeast infections, oligomenorrhea, increased appetite, depressed mood/anxiety, skin changes, non-cyclic weight gain, HTN
insufficient progesterone
dysmenorrhea, menorrhagia, break through bleeding after day 10 of cycle
primary amenorrhea definition
primary amenorrhea: causes
imperforate hymen, gonadal dysgenesis, mullerian agenesis (MRKH syndrome) physiologic delay
primary amenorrhea: gonadal dysgenesis (turner syndrome) SXS
short stature, normal external female characteristics OR ambiguous genitalia, intra-abdominal tests, blind vaginal pouch, lack of secondary sex characteristics widely space nipples (shield chest), short webbed neck, absent pubic/axillary hair, lack of breast development, vagina and uterus present ovaries usually absent - replaced by scar tissue estrogen production is minimal
primary amenorrhea: mullerian agenesis dx
probable when FSH is normal and US shows absence of uterus
Tanner stages: Breast development - stage 1
prepubertal
Tanner stages: Breast development - stage 2
breast buds with elevation of breast and papilla, enlargement of areola (8-9y/o)
Tanner stages: Breast development - stage 3
further enlargement of breast and areola, no separation of their contour
Tanner stages: Breast development - stage 4
areola and papilla form secondary mound above level of breast
Tanner stages: Breast development - stage 5
mature stage, projection of papilla only, recession of areola
Tanner stages: Pubic hair - stage 1
Asherman's syndrome - definition
anatomic variation associated with trauma to the endometrium from surgical procedure, most cases occur within close proximity to pregnancy when a women is in a hypo-estrogenized state
Asherman's syndrome - clinical manifestations
intrauterine adhesions, scarring, or synechiae amenorrhea or disturbance of normal menses infertility
androgen insensitivity syndrome - definition
46XY genotypically male but has male and female characteristics
androgen insensitivity syndrome - clinical manifestations
uterus and ovaries absent, blind vaginal pouch, labia underdeveloped,, partially descended tests or they may be intra-abdominal
androgen insensitivity syndrome - dx
sonohysterogram, HSG, MRI
androgen insensitivity syndrome - tx surgery, IUD
Secondary amenorrhea: definition
absence of menses for more than 3 months in a girl who previously had regular menstrual cycles or 6 month absence in a girl who previously had irregular menses
Secondary amenorrhea: hyperprolactinemia subjective sxs
galactorrhea, amenorrhea, oligomenorrhea
primary ovarian insufficiency (POI) Other - tumor, eating disorder, stress, medications, chemo, autoimmune disorders
Hyperprolactinemia tx
bromocriptine 1.25mg OHS
hypothalamic amenorrhea lab findings
low FSH, LH, estradiol
hypothalamic amenorrhea risk factors
intense exercise, eating disorder, weight loss more than 10% below BMI
hypothalamic amenorrhea sxs
menstrual changes, tooth/gum decay, bruising, pale mucous membranes, brittle nails, stress/anxiety, normal breast thyroid and pelvic exam
primary ovarian insufficiency labs
increase in FSH and LH and low estradiol check FSH on day 3 of cycle for more accurate results
primary ovarian insufficiency symptoms
physiologic menopause in women < 40 irregular menses FSH levels equal to those in postmenopausal range
amenorrhea diagnostic work up
UPT, thyroid, prolactin - fasting, FSH/LH, estradiol, pelvic US
estradiol labs indicate
how well the ovaries are producing estrogen low when there is disordered eating
What to order if all amenorrhea wu is negative
progesterone challenge test pelvic US to measure endometrial stripe
endometrial stipe thickness over ____ indicates adequate production of estrogen?
6mm
What labs would you order for - breast tenderness, nausea, fatigue,
What labs would you order for - fatigue, depression, dry skin, brittle nails cold intolerance, constipation, memory problems, goiter, weight gain, facial puffiness
What labs would you order for - HA, visual field defects, galactorrhea
prolactin
What labs would you order for disordered eating?
estradiol
What labs would you order for short stature, shield chest, lack of secondary sex characteristics, ovaries absent
Karyotype, FHS/LH, testosterone
Provera challenge: continued failure
endometrial scarring is likely - hysterosalpingogram can confirm
Provera challenge: why is it used
to confirm presence of estrogen and intactness of the outflow tract (uterus, vagina) ordered prior to additional hormone testing
Dysmenorrhea: subjective (primary)
crampy, achy, dill, midline pain, radiation to back/legs/abdomen pain beginning hours-days before menses and persist for 24-48 hours
PMS symptoms
n/v, fatigue, dizziness, diarrhea, nervousness, and HA
Secondary Dysmenorrhea: definition
changes to timing or intensity of pain plus prescence of pelvic pathology
Secondary Dysmenorrhea: SXS
dyspareunia, HMB, IMB, postcoital bleeding, irregular cycles, urinary complaints, diarrhea, vaginal discharge
Secondary Dysmenorrhea: key differentiating factor presence of symptoms of pain and bleeding that persist beyond the normal menstrual cycle
primary dysmenorrhea: exam findings
normal, mild tender uterus
Secondary dysmenorrhea: exam findings