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EOR - Women's Health > Endometriosis, Infertility, Cysts, Sexual Assault, Urinary Incontinence > Flashcards

Endometriosis, Infertility, Cysts, Sexual Assault, Urinary Incontinence Flashcards

1
Q

24 yo nulligravid f w. 18 mo hx of painful intercourse, difficulty defacating, and dysmenorrhea - sx are cyclical and occur w. menses - her menses are regular but very heavy - she has no hx of STI and is monogamous w. her husband

A

endometriosis

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2
Q

2 PE findings of endometriosis

A

-retroverted uterus w. nodularity
-ttp of uterosacral ligaments and cul-de-sac

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3
Q

endometriosis is a condition in which ectopic endometrial tissue implants are found in extrauterine sites, mc the _ (4)

A

ovaries
fallopian tubes
cul-de-sac
uterosacral ligaments

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4
Q

3 d’s of endometriosis

A

dyspareunia
dyschezia
dysmenorrhea

also infertility

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5
Q

20% of women w. endometriosis will have what sx

A

chronic stomach pain

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6
Q

definitive dx for endometriosis is _,
which is confirmed w. _

A

laparoscopy confirmed w. bx

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7
Q

t/f: US, barium enema, IV urography, CT, and MRI are all acceptable for dx of endometriosis

A

f!

they are not specific or adequate

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8
Q

6 tx options for endometriosis

A

NSAIDs
OCPs
danazol
depo-provera
GnRH agonists
surgery

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9
Q

first line tx for endometriosis

A

OCP

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10
Q

moa for combined OCP and progesterone analogs in endometriosis tx

A

combined OCP: ovarian suppression
progesterone analogs: inhibit growth of endometrium

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11
Q

name 2 progesterone analogs

A

medroxyprogesterone
levonorgestresl

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12
Q

how do GnRH antagonists tx endometriosis

A

pituitary GnRH suppressed -> decreased estrogen

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13
Q

moa for donazol

A

steroid -> inhibits mid-cycle FSH/LH surge

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14
Q

2 surgical options for endometriosis

A

-lapraoscopic ectopic endometrial tissue removal
-hysterectomy

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15
Q

definition of infertility

A

inability to conceive w.in 12 mo of unprotected intercourse

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16
Q

primary infertility is defined as infertility in the absence of

A

previous pregnancy

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17
Q

secondary infertility is defined as infertility after a

A

previous pregnancy

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18
Q

fertility is _% female
and _% male

A

female: 65%
male: 20-40%

unknown: 15%

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19
Q

mc cause of infertility

A

anovulation

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20
Q

4 causes of infertility

A

anovulation
tubal dz
male factor
idiopathic/multifactorial

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21
Q

steps in work up of infertility

A
  1. detailed hx - type of coitus, when, where, how often
  2. ovulation tracking
  3. semen analysis
  4. labs
  5. hysterosalpingogram vs laparoscopy
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22
Q

variables in ovulation tracking

A

-menstrual diary
-luteal phase progesterone level
-basal body temp

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23
Q

if progesterone level is < _ on day 21 of the luteal phase, you know your pt did not ovulate

A

3 ng/ml

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24
Q

body temp indication of female infertility

A

no mid-cycle basal body temp increase

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25
Q

4 labs useful in dx of female infertility

A

TSH
prolactin
LH
FSH

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26
Q

3 meds used in tx of female infertility

A

-clomiphene citrate
-metformin
-bromocriptine

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27
Q

moa for clomiphene citrate

A

hyperstimulates ovulation

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28
Q

when is metformin used for infertility

A

if PCOS is the cause

increases ovulation

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29
Q

when is bromocriptine used to tx female infertility

A

hyperprolactinemia

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30
Q

39 yo AA f w. hx abnormally heavy menstrual bleeding and increased pelvic pressure - no pain - enlarged uterus

A

leiomyoma

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31
Q

PE finding of leiomyoma

A

enlarged uterus w. asymmetric contours

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32
Q

benign smooth muscle cell tumors

A

leiomyoma

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33
Q

6 sx of leiomyoma

A

polymenorrhea
menorrhagia
intermenstrual bleeding/metorrhagia
pelvic presure
increased abd girth
uterine mass

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34
Q

what pt pop do you think of when you see leiomyoma

A

AA
fam hx

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35
Q

3 types of leiomyoma

A

subserosal
intramural
submucosal

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36
Q

what type of leiomyoma projects into the pelvis and may be pedunculated

A

subserosal

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37
Q

what type of leiomyoma is contained w.in the uterine wall

A

intramural

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38
Q

what type of leiomyoma projects into the uterine cavity

A

submucosal

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39
Q

dx for leiomyoma

A

US
MRI if uterine mass

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40
Q

symptomatic tx for leiomyoma

A

NSAIDs
OCPs
danazol
leuprolide

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41
Q

what medication shrinks leiomyomas pre operatively

A

leuprolide

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42
Q

definitive tx for leiomyoma

A

myomectomy
endometrial ablation
hysterectomy

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43
Q

mc surgical tx for fibroids

A

hysterectomy

44
Q

22 yo nulligravida f w. pelvic pain and irregular menstrual bleeding - not sexually active or pregnant - never been on OCPs - uniltateral ttp on left side of pelvis

A

ovarian cyst

45
Q

most cysts are asymptomatic, but can cause

A

bloating
low abd pain
dyspareunia
lbp

46
Q

how are ovarian cysts classified

A

functional (normal menstrual cycle)
non-functional (abnormal menstrual cycle)

47
Q

mc type of ovarian cyst

A

follicular

48
Q

3 types of functional ovarian cyst

A

-follicular
-corpus luteum
-theca lutein

49
Q

ovarian cyst caused by dominant follicle failing to rupture

A

follicular

50
Q

ovarian cyst caused by dominant follicle rupturing but then closing again -> does not dissolve

A

corpus luteum

51
Q

type of ovarian cyst caused by overstimulation of HCG produced by placenta -> only seen in pregnancy

A

theca lutein

52
Q

5 types of non-functional ovarian cysts

A

PCOS
endometriomas
dermoid
ovarian serous
mucinous cystadenoma

53
Q

3 characteristics of non-functional ovarian cysts

A

> 10 cm
irregular borders
internal septations

54
Q

3 main complications of ovarian cysts

A

hemorrhagic
rupture
torsion

55
Q

ovarian cyst hemorrhage is mc w. what 2 types of cysts

A

follicular
corpus luteal

56
Q

rupture of ovarian cysts commonly occurs after

A

sexual intercourse

57
Q

risk of ovarian torsion 2/2 to ovarian cyst increases if cyst is > _ cm

A

5

58
Q

what type of ovarian cyst is mc larger but asymptomatic

A

follicular

59
Q

what type of ovarian cyst mc causes localized pelvic pain, amenorrhea, or delayed menses

A

corpus luteum

60
Q

4 sx of ruptured ovarian cyst

A

pain
hypotn
abd pain radiating to shoulder
tachycardia

61
Q

what do you think when you see hx of ovarian cyst plus waxing/waning pain, n/v, and low grade fever

A

ovarian torsion

62
Q

first line imaging for suspected ovarian torsion

A

US abd/pelvis

63
Q

definitive dx for ovarian torsion

A

direct visualization during surgery

64
Q

work up for ovarian cysts

A
  1. transvaginal/abd US
  2. MRI if indeterminate
  3. CA125
  4. US guided aspiration
65
Q

lab for ovarian cyst work up

A

CA-125

66
Q

most ovarian cysts resolve w.in

A

1 month

67
Q

when is f/u imaging required for incidentally discovered simple ovarian cysts in women of reproductive age

A

> /= 5 cm

68
Q

management of simple ovarian cysts > 5 cm but < 7 cm in premenopausal females

A

annual imaging

69
Q

management of simple ovarian cyst > 7 cm

A

MRI
surgical assessment

70
Q

indication for further work up for ovarian cysts (3)

A

-persist beyond 2-3 menstrual cycles
-post menopausal woman
-fam hx ovarian ca

71
Q

sexual assault is defined as

A

-any involuntary sexual act in which a person is coerced or physically forced to engage against their will
-any non consensual sexual touching of a person

72
Q

t/f: physical contact needs to occur for dx of sexual assault

A

f!

73
Q

rape constitutes both a _ (2)

A

psychiatric emergency
legal situation

74
Q

considerations for management of rape victim (3)

A

-document all procedures
-save clothes
-take samples

75
Q

work up for rape victim should include cultres from the (3)

A

vagina
anus
pharynx

76
Q

what tests to order for rape victim (7)

A

gonorrhea
chlamydia
syphilis
hepatitis
HIV
UA
pregnancy (regardless of contraception)

77
Q

pharm for for rape victim

A

-abx prophylaxis: rocephin PLUS doxy
-tetanus
-emergency contraception

78
Q

f/u for rape victim

A

-24-48 hr after d.c
-one week
-six weeks
-+/- 12-18 weeks

79
Q

when are repeat cultures performed for rape victim

A

six week f.u

80
Q

when would 12-18 week f/u be required for rape victim

A

repeat HIV titers

81
Q

when should category of “spouse or partner neglect/violence” be used

A

-non accidental acts of physical force that result in physical harm to intimate partner
-or have potential to result in physical harm or evoke significant fear

82
Q

non accidental acts of physical force include

A

shoving
slapping
hair pulling
pinching
restraining
shaking
throwing
biting
kicking
hitting w. fist or object
burning
poisoning
choking
holding head under water

83
Q

when should the category of “spouse or partner violence, sexual” be used

A

-forced or coerced sexual acts w. intimate partner
-sexual violence, physical force, or psychological coercion
-whether or not sexual act is completed
-sexual acts w. partner who is unable to consent

84
Q

when should category of “spouse or partner neglect” be used

A

-egregious act or omission by one partner that deprives a dependent partner of basic needs
-or has reasonable potential to result in physical or pschological harm to dependent partner
-one partner is extremely dependent on the other for care/assistance

85
Q

5 major types of urinary incontinence

A

urge
stress
overflow
functional
mixed

86
Q

urge incontinence is caused by _ overactivity

A

detrusor

87
Q

urge incontinence is characterized by

A

-frequent, small amt of urine
-occurs at night/disrupts sleep

88
Q

urge incontinence is mc seen in what pt pop (2)

A

elderly
nursing home

89
Q

tx for urge incontinence

A
  1. kegels
  2. anticholinergics/TCAs
90
Q

what anticholinergic is mc used for urinary incontinence

A

oxybutinin

91
Q

what TCA is mc used for urinary incontinence

A

imipramine

92
Q

stress incontinence is caused by

A

weakness of pelvic floor

93
Q

stress incontinence occurs w.

A

sneezing
coughing
laughing
bending
lifting

94
Q

if pt experiences _, you can probs rule out stress incontinence

A

nocturnal incontinence

95
Q

tx for stress incontinence

A
  1. kegels
  2. vaginal estrogen
  3. pessary
  4. surgery: mid urethral sling
96
Q

overflow incontinence is caused by

A

impaired detrusor contractility -> bladder distension

97
Q

overflow incontinence commonly occurs in what 2 pt pops

A

diabetics
neuro d.o

98
Q

hallmark sign of overflow incontinence

A

elevated postvoid residual volume

99
Q

tx for overflow incontinence

A
  1. intermittent self catheterization
  2. cholinergics
  3. alpha blockers
100
Q

what cholinergic is used for overflow incontinence

A

bethanechol -> increase bladder contractions

101
Q

what alpha blockers are used for overflow incontinence

A

terazosin
doxazosin

decrease sphincter resistance

102
Q

normal voiding sx but difficulty reaching the toilet due to physical/mental disabilities

A

functional incontinence

103
Q

tx for functional incontinence

A

scheduled voiding times

104
Q

mc type of urinary incontinence

A

mixed: stress PLUS urge

105
Q

tx for mixed incontinence

A
  1. lifestyle mods/kegels
  2. treat predominant sx

EOR - Women's Health (15 decks)

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