CNM Purple Big Book: Gynecology Normal Flashcards

Question

LH surge

Answer 1

peak 10-12 hrs before ovulation

Answer 2

PGE and proteolytic enzymes break down follicular wall; occurs 32-44 hrs after beginning of LH surge; Maximal prdxn of spinnbarkeit;; increase of basal body temp 0.2-0.5 F

Answer 3

refers to ability of cervical mucus to be stretched between examining fingers; increased stretch = increased influence of estrogen

Answer 4

formed from ruptured follicle | Secretes progesterone - peak 7-8 days postovulation

Answer 5

estrogen influence endometrium grows/thickens lasts approximately 10 days from end of menses to ovulation

Answer 6

progesterone influence Av 12-16 days Endometrial hypertrophy Increased vascularity

Answer 7

declining progesterone from CL | endometrium undergoes involution, necrosis, sloughing (3-6 days)

Answer 8

``` Age 40-50: ACS: annual; NCI: q 1-2 yrs strong fam hx = earlier/more frequently >50 yr: annually 10-15% false negative rate for detection of malignancies ```

Answer 9

5-10% br CA is hereditary mutated BRCA1 gene = 80% risk br CA by age 65 Test if strong fam hx or Ashkenaxi Jew

Answer 10

used to describe the physiologic changes associated with the change from reproductive to nonreproductive status 2-8 yrs before menopause until 1 yr after last period Rhythmic ovarian/endometrial responses of menstrual cycle decline/eventually stop; # responsive follicles decr with resultant decr prdxn estradiol throughout climacteric. Decr estradiol = incr FSH. End of clim, ovary contains no follicles & endometrium atrophies = reproductive capabilities terminated

Answer 11

premature ovarian failure | cessation of menses before age 40

Answer 12

after menopause, LH & FSH both increased | Generally rely on cessation of menses, hypoestrogenic sx, age and consistently elevated FSH for dx of menopause

Answer 13

FSH: >40 mIU/mL LH: 3-fold elevation (20-100 mIU/mL) estradiol: <20 pg/mL

Answer 14

pH 5.0 or more

Answer 15

may have pruritis, leukorrhea, friability, increased susceptibility to infectino, dyspareunia

Answer 16

Decreased muscle tone: urethra/trigone area Atrophic changes in urethra/periurethral tissue = stress incontinence may occur Hypoestrogenic effects in trigone area; lowered sensory threshold to void = sensory urge incontinence may occur Urinary urgency, frequency, dysuria d/t atrophic changes in urethra and periurethral tissue

Answer 17

75% of women get them | generally cease w/i 2-3 yrs after menopause

Answer 18

Lipid levels: | incr in LDL (ideal 60)

Answer 19

memory impairment may be indirectly r/t decr estrogen secondary to hot flashes and sleep disturbance Rish of demetia incr in healthy women 65-79 yr using ET or EPT

Answer 20

Age 20: | Q 5 yrs

Answer 21

``` Age 45 (& younger women with risk factors): q 3 yrs ```

Answer 22

Age 65: q 3-5 yrs begin earlier if presence of autoimmune condition or strong family hx of thyroid dz

Answer 23

Age 65 & older

Answer 24

Age 40-64: q 2-4 yrs Age 65+: q 1-2 yrs

Answer 25

COC: safe for healthy, non-smoking, non-obese perimenopausal women. Non-contraceptive benefits may be esp attractive: relief of vasomotor sx, menstrual regulation POP also safe option IUD: good option, LNG may help with heavy bleeding Barrier methods acceptable Sterilization: most prevalent method in US among married women Fertility awareness less effective during perimenopause with irregular cycles

Answer 26

Reaching age 55 (90% have reached menopause by then) vs 2 FSH levels while off hormonal contraceptives and using a nonhormonal contraceptive

Answer 27

relief of menopausal sx r/t estrogen deficiency: vasomotor instability, vulvar/vaginal atrophy Prevention of osteoporosis Potential reduction of risk for colon CA

Answer 28

``` thrmoboemobolic disorders or thrombophlebitis Known or suspected creast cancer Estrogen dependent CA Liver dysfunction or dz Undiagnosed abnormal uterine bleeding Known or suspected pregnancy ```

Answer 29

endometrial hyperplasia/CA Breast CA (relationship w HT inconclusive; possilbe small but signif incr witih long-term HRT) Gallbladder dz Thromboembolic disorders

Answer 30

Reevaluate in 3 months; if no problems, annually after that Evaluate sx each time; discontinue as appropriate Consider nonhormonal drugs for osteoporosis prevention if longterm therapy needed

Answer 31

0.625 mg conjugated E or equivalent prevents osteoporosis in 90% menopausal women 10-14 days q month: 10 mg of MPA or equiv or daily doses of 2.5-5.0 mg for prevention of endometrial hyperplasia Continuous combined: E/P daily (may have unpredictable bldg for a while before amenorrhea) Continuous cyclic: E daily, P for 10-14 days/mo; withdrawal bleed when P done Cyclic: E days 1-25; P last 10-14 days; then 3-6 days of nothing

Answer 32

increased HDL/triglycerides; | first-pass metabolism determines results

Answer 33

no significant impact on HDL/triglycerides; | may have less adverse effects on gallbladder and coagulation factors than oral E

Answer 34

tx vulvar/vaginal atrophy; will NOT provide relief from vasomotor sx; some systemic absorption NEED cyclic progestin with intact uterus

Answer 35

little/no systemic absorption; 90 days duration Do not need cyclic progestin

Answer 36

SYSTEMIC absorption tx vasomotor & vulvar/vaginal atrophy 90 day duration Requires added progestin if intact uterus

Answer 37

SYSTEMIC absorption NO sig effect on HDL/triglycerides May have less adverse effects on gallbladder and coag factors tahn oral E Need cyclic progestin with intact uterus Topical may not provide sufficient endometrial protection

Answer 38

effective in relieving vasomotor sx May have +impact on Ca balance NOT effective on vulvovaginal sx MAY have adverse effect on lipid profile

Answer 39

may use if E not effective enough on extreme vasomotor sx may incr energy level, feeling of well-being, libido S/e: acne, hirsutism, clitoromegaly Does not appear to have neg lipid effect

Answer 40

breast tenderness (E/P; usually only few weeks) Nausea (E; relieved if taken AC/HS) Skin irritation w patch Fluid retention/bloating (E/P) Alterations in mood (E/P) TX of S/E: lower dose, dif route, dif formulation

Answer 41

Continuous cyclic: usually some bleeding; starts last few days P or just after. If bldg is earlier/heavy/persistent may indicate endometrial hyperplasia = eval Continuous-combined: erratic spotting and light bldg 1-5 days in first yr; endometrial biopsy if heavier or longer than usual

Answer 42

Antidepressants (ssri, srni) gabapentin, clonidine Avoid caffeine, alcohol, cigarettes, spicy foods, big meals Regular, mod exercise Vit E - anecdotal reports of relief Soy foods, isoflavine supplements

Answer 43

VDRL, RPR (become + by 1-2 wks after chancre) False positives assoc with mononucleosis, collagen vascular dz, some other med conditions Usually see low tieter 1:8

Answer 44

FTA-ABS TPI reported as +/- not quantitative Usually remain + indefinitely after tx

Answer 45

Gold standard: tissue culture of lesion other tests: PCR, DNA probe, direct flourescent antibody/enzyme assay Serum antibody test for HSV 1/2: may take 4-12 wks for seroconversion

Answer 46

wet mount: motile, flagellated protozoa Greater than 10 WBC/high power field vag pH >4.5

Answer 47

Sensitive screening test: enzyme immunoassay EIA or rapid test: 99% sensitive at 12+ wks postexposure Must be confirmed with highly specific tests: Western blot, IFA HIV antibody detectable in 95% people by 6 months

Answer 48

Follicular: 20-150 Midcycle: 150-750 Luteal: 30-450 Postmenopause; <20

Answer 49

Follicular: 5-25 Midcycle: 20-30 Luteal: 5-25 Postmenopause 40-250

Answer 50

follicular: 5-25 midcycle: 75-150 luteal; 5-40 postmenopause:30-200

Answer 51

follicular: <0.2

Answer 52

BMD w/i 1 standard deviation of young normal adult | T-score above -1

Answer 53

T-score between -1 and -2.5

Answer 54

T-score at or below -2.5

CNM Purple Big Book: Gynecology Normal Flashcards

(78 cards)