REPRODUCTIVE:
endometrial cycle and the occurrence of ovulation
uterine prolapse
polycystic ovarian syndrome (PCOS)
testicular cancer and conditions that increase risk
symptoms that require evaluation for breast can
...
REPRODUCTIVE:
endometrial cycle and the occurrence of ovulation
uterine prolapse
polycystic ovarian syndrome (PCOS)
testicular cancer and conditions that increase risk
symptoms that require evaluation for breast cancer
signs of premenstrual dysphoric disorder
dysfunctional uterine bleeding
pathophysiology of prostate cancer
HPV and the development of cervical cancer
ENDOCRINE
body’s process for adapting to high hormone levels
Cushing’s Syndrome
causes of hypoparathyroidism
lab results that point to primary hypothyroidism
pathophysiology of thyroid storm
signs of thyrotoxicosis
NEUROLOGICAL
dermatomes
substance release at the synapse
Spondylolysis
location of the motor and sensory areas of the brain
pathophysiology of cerebral infarction and excitotoxins
agnosia
accumulation of blood in a subarachnoid hemorrhage
most common cause of meningitis
GENITOURINARY
diet and the prevention of prostate cancer
Impact of Benign Prostatic Hypertrophy (BPH) on the urinary system
GENETICS
the role of DNA in genetics
transcription
effects of genetic mutations
Trisomy
Down Syndrome
Klinefelter syndrome
Duchenne muscular dystrophy
Neurofibromatosis
diseases that have multifactorial traits
multifactorial inheritance
MUSCULOSKELETAL
ions that initiate muscle contraction
growth of long bones in children
bones belonging to the appendicular skeleton
IMMUNITY & INFLAMMATION
how vaccines are formed
populations at risk for getting systemic fungal infections and parasitic infections
systemic manifestations of infection
mechanisms responsible for the increase in antimicrobial resistance worldwide
functions of normal flora in the body
desensitization therapy
cells involved in “left shift” in the WBC count differential
forms of immunity
major histocompatibility class I antigens
inflammatory chemicals blocked by anti-inflammatory drugs
characteristics of acute phase reactant C-reactive protein
DERMATOLOGY
process by which a deep pressure ulcer heals
complications of the development of contractures during wound healing
ACID/BASE
causes of respiratory alkalosis
molecules that act as buffers in the blood
CARDIOVASCULAR
most common cardiac valve disease in women
when myocardial ischemia may be reversible
symptoms of stable angina
orthostatic hypotension
isolated systolic hypertension
results of sustained controlled hypertension
the relationship of insulin resistance on the development of primary hypertension
defects in the normal secretion of natriuretic hormones and the impact on renal system
effects of increased sympathetic nervous system activity due to primary hypertension
complications of unstable plaque in the coronary arteries
forms of dyslipidemia associated with the development of the fatty streak in atherosclerosis
events that initiate the process of atherosclerosis
signs and symptoms of increased left atrial and pulmonary venous pressures in left sided heart
differences between left and right sided heart failure
infective endocarditis
PERIPHERAL VASCULAR DISEASE
pathophysiology of deep vein thrombosis
Vichow’s triad
HEMATOLOGY
physiological response to hypoxia in anemia
populations at the highest risk for developing folate deficiency anemia
causes of iron deficiency anemia
expected lab test results found in long standing iron deficiency anemia
Sickle Cell Anemia
causes of aplastic anemia
underlying pathophysiologic mechanisms leading to autoimmune hemolytic anemia
secondary polycythemia
anemia of chronic renal failure
FLUIDS & ELECTROLYTES
conditions that result in pure water deficit (hypertonic volume depletion)
osmoreceptors that stimulate thirst and the release of ADH
causes of hypernatremia
effects of increased aldosterone
dependent edema
definition of isotonic
principle of capillary oncotic pressure
types of fluid compartments in the body
PULMONARY
most effective measure to prevent pulmonary embolus from developing in patients
when the practitioner will note tactile fremitus
cause of acute airway obstruction in the patient with chronic bronchitis
types of pneumothorax
results of the loss of alph-1-antitrypsin in emphysema
the result of loss of surfactant in ARDS
Characteristics of Cheyne-Stokes respirations
SHOCK
causes of hypovolemic shock; how the body maintains glucose levels during shock
Reproductive:
The Menstrual (Ovarian) Cycle:
Purpose: Pregnancy and menstrual bleeding (the menses).
Starts with Menarche (first menstruation) ends with menopause (cessation of menstrual
flow for 1 year).
Cycles are anovulatory at first and may vary in length from 10 to 60 days then regular
patterns of menstruation and ovulation occur lasting from 21 to 45 days.
CYCLE: Commonly accepted cycle average is 28 (27 to 30) days, with rhythmic
intervals of 21 to 35 days (Normal).
Phases of the Menstrual Cycle: (two phases)
1- the follicular/proliferative phase (postmenstrual) followed by
2- the luteal/secretory phase (premenstrual).
Menstruation (menses),the functional layer of the endometrium disintegrates and is
discharged through the vagina.
Follicular/proliferative phase: GnRH and a balance between activin and inhibin from
the granulosa cells contribute to the rise of FSH levels, which stimulates several
follicles. The pulsatile secretion of FSH from the anterior pituitary gland rescues a
dominant ovarian follicle from apoptosis by days 5 to 7 of the cycle.
Together estrogen and FSH increase FSH receptors in the granulosa cells of the
primary follicleà making them more sensitive to FSH.
FSH and estrogen combine to induce production of LH receptors on the granulosa cells,
promoting LH stimulation to combine with FSH stimulation causing a more rapid
secretion of follicular estrogen.
As estrogen levels increase, FSH levels drop because of an increase in inhibin-B
secreted by the granulosa cells in the dominant follicle. This drop in FSH level
decreases the growth of less-developed follicles.
Estrogen causes cells of the endometrium to proliferate and stimulates production of
LH. A surge in both FSH and LH levels is required for final follicular growth and
ovulation.
An increase in stromal tissue in the late follicular phase is associated with a rise in
androgen levels. Androgen production enhances the process of follicle atresia.
Luteal/secretory phase (premenstrual): Ovulation is the release of an ovum from a
mature follicle and marks the beginning of the luteal/secretory phase of the menstrual
cycle.
Ovarian follicle begins its transformation a corpus luteum (hence luteal phase) (see Fig.
24.8, A)
Pulsatile secretion of LH from the anterior pituitary stimulates the corpus luteum to
secrete progesterone, which in turn initiates the secretory phase of endometrial
development.
Glands from the endometrium start to secrete a thin glycogen-containing fluid (the
secretory phase).
If conception occurs, the nutrient-laden endometrium is ready for implantation.
Human chorionic gonadotropin (HCG) is secreted 3 days after fertilization by the
blastocytes and maintains the corpus luteum once implantation occurs at about day 6 or
7. HCG can be detected in maternal blood and urine 8 to 10 days after ovulation.
If conception and implantation do not occur, the corpus luteum degenerates and
STOPS production of progesterone and estrogen. Without progesterone or estrogen to
maintain it, the endometrium becomes ischemic (“blood-starved”) and disintegrates,
hence the name ischemic/menstrual phase. Menstruation then occurs, marking the
beginning of another cycle.
Ovulation Occurs:
Ovulatory cycles- minimum length of 24 to 26.5 days:
Primary ovarian follicle requires 10 to 12.5 days to develop, and the luteal phase
appears relatively fixed at 14 days (±3 days).
Menstrual blood flow usually lasts 3 to 7 days, but it may last as long as 8 days or stop
after 1 to 2 days and still be considered within normal limits. Bleeding is consistently
scant to heavy and varies from 30 to 80 mL, with most blood loss occurring during the
first 3 days of menses.
Menstrual discharge consists of blood, mucus, and desquamated endometrial tissue
and does not clot under normal circumstances. It is usually dark and produces a
characteristic musty odor on oxidation. Environmental factors such as severe emotional
stress, illness, malnutrition, obesity, and seasonal variation may affect the length of the
menstrual cycle.
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