exam 4 group study guide test

Menstrual Cycle Overview

• Normal cycle length ranges from 24 to 38 days.
• Regular cycles exhibit variations in length of ≤ 7-9 days.
• Cycles remain consistent until perimenopause, where follicular phases shorten and frequency increases.

Ovarian Cycle Phases

• Follicular Phase:

  • Duration from menstrual onset (Day 1) to LH surge before ovulation.
  • Lasts 14 to 21 days, may shorten in perimenopause.
  • Involves development of follicles and oocytes.

• Luteal Phase:

  • Occurs after ovulation, where hormones support potential pregnancy and endometrial health.
  • Lasts approximately 14 days, concluding with the start of the next menses.

Endometrial Cycle Phases

• Desquamation: Shedding of endometrial lining (menses).
• Proliferative Phase: Endometrium proliferation with straight, tubular glands.
• Secretory Phase: Maturation of spiral arteries and endometrial glands for pregnancy.

Hormones Related to Menstrual Cycle

• FSH (Follicle Stimulating Hormone): Stimulates follicular development and egg maturation.
• Luteinizing Hormone (LH): Triggers ovulation during the cycle.

Dermatology Insights

• Sequela of Varicella: Includes diffuse vesicular rash, potential neurological impact, and pneumonia.

• Onychomycosis: Fungal nail infection affecting nail health.

• Furuncle (Boil): Painful, pus-filled bump due to Staphylococcus aureus infection of a hair follicle.

• Carbuncle: Cluster of boils indicating severe skin infection, often from bacteria entering through breaks in the skin.

Common Skin Conditions and Treatments

• Rosacea: Facial erythema in Northern Europeans; treated with Azelaic acid.
• Acne: Characterized by comedones, typically in teenagers; treatments include benzoyl peroxide and tetracycline.
• Seborrheic Dermatitis: Greasy, yellow scaling in older adults; treated with antifungal agents.
• Folliculitis: Hair follicle infection requiring oral antibiotics for treatment.
• Impetigo: Honey-colored crust lesions in children; treated with topical and oral antibiotics.
• Shingles: Caused by varicella virus; presents with unilateral lesions; treated with Acyclovir.

Terminology of Skin Lesions

• Macule: Flat, non-palpable lesion ≤ 1 cm; differs in color (e.g., freckles).
• Patch: Flat lesion > 1 cm; also differs in color (e.g., vitiligo).
• Papule: Raised, palpable lesion ≤ 1 cm; may be red or brown (e.g., nevi).
• Plaque: Raised lesion > 1 cm; examples include psoriasis.
• Nodule: Firm raised lesion; measures 1-5 cm (e.g., lipomas).
• Vesicle: Small, fluid-filled blister (e.g., chickenpox).
• Bulla: Large clear-fluid blister (e.g., burns).
• Pustule: Vesicle filled with pus (e.g., folliculitis).

Clinical Findings and Management of Psoriasis

• Chronic Plaque Psoriasis: Symmetric, well-defined salmon-colored plaques with thick silvery scales.
• Guttate Psoriasis: Associated with strep infections; presents as small, salmon-colored papules.
• Pustular Psoriasis: Painful plaques indicating severe skin condition.
• Erythrodermic Psoriasis: Generalized erythema affecting large areas of skin.

Sentinel Lymph Node Biopsy in Melanoma

• Indicated for the first draining lymph node in a tumor when nodes appear clinically negative.
• Necessary for lesions > 0.8 mm thick or those with ulceration.

Pathophysiology of Acne Vulgaris

• Involves the accumulation of lipids and keratin in hair follicles.
• Common bacteria, Cutibacteria acnes, convert sebum into fatty acids, eliciting inflammation.
• Management includes benzoyl peroxide and antibiotics like doxycycline; isotretinoin is used for severe cases.

Hormonal Regulation in Reproductive System

• Granulosa cells produce estradiol (E2) under stimulation from Follicle Stimulating Hormone (FSH).
• Luteinizing Hormone (LH) stimulates theca cells to produce testosterone, which is then converted to E2.
• Estrogens include:
  • E2: Primary estrogen.
  • E1: Weaker estrogen significant during menopause.
  • Estiol: Predominantly produced during pregnancy.
• After ovulation, progestin is produced, playing a role in the menstrual cycle.
• During the menstrual phase, estrogen and progesterone inhibit FSH and LH, establishing a negative feedback mechanism.

Hypothalamic-Pituitary-Ovarian (HPO) Axis

• GnRH (Gonadotropin-Releasing Hormone) leads to the release of FSH and LH.
• This hormonal cascade is crucial for the production of estrogen and progesterone.

Puberty Milestones

• Puberty is defined as the onset of secondary sexual characteristics until full sexual maturity.
• Thelarche: Breast development; first sign in girls (ages 7-14).
• Pubarche: Growth of armpit and pubic hair occurs between ages 8-15.
• Growth spurts driven by insulin growth hormone.
• Menarche: First menstrual bleed typically occurs between ages 9-16, about one year post growth spurt.

Precocious and Delayed Puberty

• Precocious puberty causes isosexual secondary sex characteristics.
• Delayed puberty may show significant growth restriction.

Tanner Stages

• Developmentally categorized stages for sexual maturation (not detailed here).

Common Gynecological Terms

• Oligomenorrhea: Menstrual cycles > 35 days apart (less than 9 cycles/year).
• Polymenorrhea: Menstrual cycles < 21 days apart.
• Menorrhagia: Excessive menstrual bleeding (> 80ml in 7 days), termed AUB/HMB.
• Metrorrhagia: Irregular bleeding between menstrual periods.
• Dysmenorrhea: Painful menstrual periods, classified into primary (absence of pathology) and secondary (due to conditions like endometriosis).
• Amenorrhea: Absence of menstrual periods.

Amenorrhea Types

• Primary: Menstrual cycles do not begin in adolescence; no pelvic pathology identified.
• Secondary: Occurs post-menarche; linked to medical conditions such as endometriosis.

Osteoporosis

• Characterized by reduced bone density, increasing fracture risk.
• Peak bone mass occurs at age 30; loss starts around age 40-50, accelerated post-menopause.
• Criteria for osteoporosis diagnosis includes DEXA scanning and screening for secondary causes (e.g., hyperparathyroidism).

HIV/AIDS Screening and Management

• 4th generation EIA tests for HIV-1 and -2; positive must further assess with antibody tests and Western blot methods.
• Viral load and CD4 T-cell counts monitored before initiating HIV treatment, with expected viral load decrease and CD4 increase indicating effective treatment.

Male Genitourinary Abnormalities

• Priapism: Painful, prolonged erection, often linked with sickle cell disease; managed via phenylephrine injection or surgery.
• Hypospadias: Abnormal urethra opening; requires surgical correction.
• Epispadias: Similar abnormality on the dorsal side; also requires surgery.
• Peyronie’s disease: Fibrous plaques causing penile curvature; treatments include Pentoxyfilline, Verapamil, or Collegenase.
• Balanitis: Inflammation of the penis head due to trauma or infections; managed with hygiene and treating underlying infections.

Testicular Abnormalities

• Torsion: Medical emergency; indicated by an elevated testis and horizontal position.
• Hydrocele: Fluid accumulation, identifiable with penlight transillumination.
• Spermatocele: Cysts at the epididymis head.
• Varicocele: Enlarged veins resembling a "bag of worms."
• Cancer: Often presents as a painless mass; negative transillumination.

Male GU Cancers

• Testicular cancer typically presents as a painless mass.
• Prostate cancer largely asymptomatic until advanced, indicated by PSA levels > 4.

Phimosis vs. Paraphimosis

• Phimosis: Inability to retract the foreskin over the glans.
• Paraphimosis: Retracted foreskin cannot return to its normal position, requiring urgent treatment.

Stages of Syphilis

• Primary: Chancre - painless ulcer at infection site.
• Secondary: Systemic symptoms like fever, rash, swollen lymph nodes.
• Latent: Aperiodic phase between secondary and tertiary stages.
• Tertiary: Complications can include neurosyphilis and cardiovascular issues, occurring years later.

Dermatological Considerations

• Sequela of varicella includes risk of pneumonia and neurological impacts.
• Onychomycosis is a fungal infection of the nails.

Skin Infections

• Furuncle: Painful bump (boil) due to Staphylococcus aureus infection of hair follicles.
• Carbuncle: Cluster of boils resulting from multiple infected follicles; may require systemic antibiotics or surgery.
• Acne: Often results from hormonal changes in adolescence; treated with topical or systemic antibiotics.

Knowledge of Common Skin Lesions

• Macule: Flat lesion ≤ 1cm, differing in skin color.
• Patch: Flat lesion > 1cm, differing in color.
• Papule: Raised lesion ≤ 1cm, can vary in color and indicate disease processes.

Mastery of ABCDE for Skin Examination

• A: Asymmetry
• B: Border irregularity
• C: Color variation
• D: Diameter > 6mm
• E: Evolving changes.