Abnormal Uterine Bleeding Flashcards Preview

Block 8 - Endo & Repro > Abnormal Uterine Bleeding > Flashcards

Flashcards in Abnormal Uterine Bleeding Deck (25):
1

What is the difference between primary and secondary amenorhea?

primary - failure of menarche by age 16
secondary - absence of menstruation for 6 mos in a woman who has previously had menses

2

What are the three general etiologies of amenorrhea?

anatomic - usually primary
ovarian failure (hypergonadotropic hypogonadism)
chronic anovulation - usually secondary

3

What are the anatomic causes of amenorrhea?

imperforate hymen, transverse vaginal septum, cervical stenosis, Asherman syndrome, mullerian agenesis

4

What are the ovarian failure (hyper hypo) causes of amenorrhea?

radiation, chemo, advanced oocyte atresia from X ch defects, surgical removal, premature ovarian failure, menopause

5

What are the chronic anovulation causes of amenorrhea?

with estrogen: PCOS, prolactin excess, thyroid abnormality, ovarian tumors
with estrogen absent (hypo hypo): hypothalamic functional disorders (eating disorders), inherited H/P abnormalities or lesions

6

What are indications for evaluation of amenorrhea?

pt and family concerned
no breast dev by age 14
any sexual ambiguity present

7

What is menorrhagia?

cyclic menstrual bleeding, excessive in duration (>7 days) or amount (>80ml)

8

What is oligomenorrhia?

bleeding or light spotting that occurs in intervals longer than 35 days

9

What is metorrhagia?

bleeding that occurs at irregular intervals

10

What is menometorrhagia?

excessive and prolonged bleeding episodes at irregular intervals

11

What is the PALM-COEIN system for AUB classification in reproductive age women?

Polyp
Adenomyosis
Leiomyoma (submucosa or other)
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
PALM is structural, COEIN is nonstructural

12

When is a pap smear appropriate to order?

can help screen for invasive cervical lesions
pts w abnormal cytologic findings must be evaluated
must useful in diagnosing asymptomatic intraepithelial lesions of cervix

13

When is it appropriate to order serum beta-HCG?

complications of pregnancy and trophoblastic dz

14

When is it appropriate to order transvaginal sonogram?

after transabdominal approach - more detail
saline infusion during imaging is helpful in evaluating endometrial lining

15

When is it appropriate to order an endometrial biopsy?

if no cause found or tissue inadequate for diagnosis, use D&C

16

When is it appropriate to order a hysteroscopy?

visualization by endoscopy - most direct way to assess endometrium
biopsy can be done at same time

17

What are the five sources of female genital tract bleeding?

vulva and vagina
cervix
uterus
uterine tubes
ovaries

18

What is Asherman syndrome?

extensive intrauterine scarring (synechiae) that causes amenorrhea
endometrial damage to basal layer

19

How can uterine leiomyomas be recognized?

enlarged, irregular uterine contour
asymptomatic, or menorrhagia and pelvic pressure
submucosal most likely to cause metorrhagia

20

How are the presentations of threatened abortion vs. ectopic pregnancy different?

threatened abortion: bleeding/pain at <20 wks gestation w/o cervical dilation
sonography! - gestational sac w/i uterus vs. cystic mass in adnexal area

21

What is the ddx of postmenopausal bleeding?

atrophy of endometrium --> chronic inflammatory rxn
exogenous hormones
tumors of reproductive tract - cancer til proven otherwise
vaginal atrophy and vaginal/vulvar lesions
(structural problems, endometrial hyperplasia)

22

What is the ddx for abnormal bleeding in a prepubertal girl?

trauma, foreign body, vaginal tumor, precocious puberty, prolapsed urethra

23

What is the ddx for abnormal bleeding in an adolescent?

anovulation, pregnancy, bleeding dyscrasias, breakthrough on contraceptives

24

What is the ddx for abnormal bleeding in reproductive age women?

anovulation, pregnancy, structural, breakthrough on contraceptives, cancer
pathologic causes more common here

25

What is the ddx of post-coital bleeding?

(cervical cancer), cervical erosion, cervical polyps, cervical or vaginal inf like trichomoniasis