Abnormal Menstration

Question 1

Menorrhagia Vs Metrorrhagia

Answer 1

Menorrhagia = Heavy or prolonged bleeding
Metrorrhagia = Intermenstrual bleeding, spotting, or breakthrough bleeding

Question 2

Menstrual interval > 35 days

Answer 2

Oligomenorrhea

Question 3

Crampy or spasmodic pain in lower abdomen that occurs only in ovulatory cycles without the presence infectious process or injury

Answer 3

Primary Dysmenorrhea

Question 4

8 non pelvic sx of Dysmenorrhea

Answer 4

HA - N/V - bloating -back ache - diarrhea - syncope - breast tenderness

Question 5

Next best step for pt with primary dysmenorrhea that is refractory to tx w/ NSAIDS

Answer 5

Pelvic exam

Question 6

5 nonphamacologic tx for Primary Dysmenorrhea

Answer 6

Heat - Diet - Behavior modification - TENS - Exercise/yoga

Question 7

16 yo girl presents bc she is missing approx. 2 days of school each month for cramping, and severe head aches that coincide with her menses. Primary Tx? Next best step if breakthrough sx or refractory?

Answer 7

Ibuprofen / Naproxen Sulfate (NSAIDS)

OCP - thins endometrium = less prostaglandin production

Question 8

6 Causes of Secondary Dysmenorrhea

Answer 8

Endometriosis - Adenomyosis - IUD - Uterine Leiomyomata - Ovarian Cyst - Chronic pelvic disease

Question 9

Cyclic dysmenorrhea that lasts longer and becomes more severe over time w/ pelvic pain that is worse w/ menses and ovulation

Answer 9

Endometriosis

Question 10

PE findings for Endometriosis

Answer 10

Pelvic tenderness w/ uterine movement
Palpable nadules on exam
Fixed, tender, enlarged adnexa

Question 11

Imaging, Dx study, and tx for Endometriosis?

Answer 11

US - Laparoscopy - Pain tx + surgery + Post op hormone supression

Question 12

Treatment goal for Endometriosis?

Answer 12

Manage pelvic pain + prevent infertility

Question 13

What is the most common tumor of the female pelvis and what type of cells are is it composed of?

Answer 13

Uterine Leiomyomata - smooth muscle cells of the myometrium

Question 14

7 factors that increase risk for Leiomyomata

Answer 14

Early menarche - Meat consumption - family hx - Beer - hx of uterine infxn - Vit D def - Obesity

Question 15

8 factors that decrease risk for Leiomyomata

Answer 15

> 1 pregnancy, OCP, Progestin only injectable contraception, smoking, green veg + fruit, Vit A, Menopause, Exercise

Question 16

What tool can be used to verify luteal timing of PMS sx?

Answer 16

Cope calendar

Question 17

what is the difference between primary and secondary amenorrhea?

Answer 17

1 - No menses by age 15 w/ normal growth and development or > 2 yr after completing sexual maturation
2 - No menses for at least 3-6 months after having at least 1 menses

Question 18

Stress, athletics, and obesity cause what type of amenorrhea?

Answer 18

Functional hypothalamic amenorrhea

Question 19

Most common reason for primary amenorrhea?

Answer 19

Turner syndrome - XO

Question 20

1st step in every case of 2ndary amenorrhea

Answer 20

Hcg! pregnancy is #1 cause

Question 21

Scarring of endometrial lining due to previous infxn or surgery, known to cause amenorrhea? How do you dx?

Answer 21

Asherman’s syndrome

Pelvic US + Progestin challenge

Question 22

TX for Asherman’s syndrome?

Answer 22

Hysteroscope lysis of adhesions + estrogen tx to regrow endometrium

Question 23

What is PALM - COEIN used for?

Answer 23

All the causes of Abnormal Uterine Bleeding:
Polyp - Adenomyosis - Leimyoma - Malignancy
Coagulopathy - Ovulatory - Endometrial - Iatrogenic - Not classified

Question 24

Abnormal uterine bleeding in post menopausal women

Answer 24

CANCER!!! (10% will have endometrial cancer)

Question 25

What does a thickened endometrial stripe on US signify? best next step?

Answer 25

Endometrial Hyperplasia + Cancer | Endometrial biopsy

Question 26

What is indicated if endometrial bx comes back hyperplasia w/o atypia? W/ atypia?

Answer 26

1) Dialation and Curettage - > Progestin tx | 2) Hysterectomy

Question 27

A 54-year-old woman presents with chest and neck flushing. She states this began 6 months ago. The “warm feeling”, as she describes it, is becoming more frequent, and seems to occur mainly in the evening. She denies any recent infections. There are no dermatologic lesions seen on physical examination. Her final menstrual period was 14 months ago. These symptoms are most likely due to a decline in what hormone?

Answer 27

Estradiol

Question 28

A 29-year-old woman presents with cyclic pelvic pain that has been increasing over the last 7 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. What is the most likely diagnosis?

Answer 28

Endometriosis

Question 29

What is the most frequent cystic structure found in the ovary?

Answer 29

Follicular cyst

Question 30

A 23-year-old woman presents with pain in in the suprapubic area and right lower quadrant of her abdomen that began 4 hours ago. She denies vagina discharge and vaginal bleeding. Her vital signs are BP 115/65, HR 60, RR 12, and T98.1°F. Her last menses was one week ago. Which of the following diagnostic tests should be obtained first?

Answer 30

Hcg pregnancy test for all women of childbearing age sigh pelvic pain

Question 31

A 15-year-old girl presents for severe lower abdominal pain that occurs for the first two days of her menstrual cycle each month. She has associated nausea and diarrhea. She denies menorrhagia. She had a normal menarche at age 13 and is not sexually active. Abdominal and pelvic exams are normal. Which of the following is the initial best step in management?

Answer 31

Recommend ibuprofen starting one day before menses

Question 32

A 42-year-old woman presents for evaluation of irregular menses, associated with episodes of excessive daytime sweating and palpitations. She has not had a hysterectomy or oophorectomy. She is currently sexually active, although intercourse has been more uncomfortable lately. Which of the following disorders would you consider in this patient’s differential diagnosis?

Answer 32

Hyperthyroidism