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REPRO II Exam 2 > Dunn OB/GYN X > Flashcards

Dunn OB/GYN X Flashcards

1
Q

amenorrhea

A

no menses for 3 cycles

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2
Q

17yo F no menses

  • cramping monthly with breast tender
  • fam hx late menarche
  • suprapubic tenderness
  • rectal mass
A

primary amenorrhea

pregnancy test, CBC, US, FSH/LH, E2, karyotype

exam under anesthesia - imperforate hymen**

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3
Q

hematocolpos

A

retained menstruation by imperforate hymen

female who just reached puberty

tx - cup open

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4
Q

thelarche

A

onset of female breast development

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5
Q

appearance of sex hair

A

pubarche

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6
Q

onset of axillary and pubic hair, body odor, acne

A

adrenarche

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7
Q

onset of menstruation

A

menarche

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8
Q

tanner stage

A

1 - prepubertal
to
5 - mature

breast and pubic hair analysis

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9
Q

failure to menstruate by age 16

A

primary amenorrhea

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10
Q

secondary amenorrhea

A

absence of menses 3 cycles or >6 months

more common

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11
Q

no secondary sex characteristics

A

FSH and LH

low -hypogonadotropic gypogonadism

high - karyotype

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12
Q

yes secondary sex characteristics

A

genetic male or female?

female - mullerian anomaly - no uterus - renal issues as well

male - androgen insensitivity - complete vs. partial

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13
Q

secondary amenorrhea work up

A

had menstruation, but then stopped

pituitary and thyroid - normal
-then do progestin challenge

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14
Q

causes of primary amenorrhea

A

constitutional delay
45XO - turner
46XY
pituitary tumor

congenital adrenal hyperplasia**most common cause

second most common cause - Mayer-Rokitansky-Küster-Hauser syndrome

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15
Q

webbed neck, amenorrhea

A

turner syndrome

45X

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16
Q

Mayer-Rokitansky-Küster-Hauser syndrome

A

absent uterus

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17
Q

clue to diagnosis of primary amenorrhea

A

karyotype patient

FSH, LH, PRL levels

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18
Q

headache and visual field defect

A

pituitary tumor

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19
Q

diagnosis of primary amenorrhea

A 
height, weight, BP
secondary sex characteristics
look for androgen excess - virilization
visual fields
chromosomes
FSH, LH, E2
hydroxyPROG, androgen, PRL, TSH
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20
Q

causes of secondary amenorrhea

A 
stressed - hypothalamic
weight loss/gain - anorexia
post pill
PCO syndrome
premature menopause - idiopathic
hyperPRL
drug induced
pregnancy**
thyroid disease
21
Q

sheehans

A

infarct pituitary

cause of secondary amenorrhea

22
Q

asherman

A

adhesions/fibrosis of uterine cavity after D and C

cause of secondary amenorrhea

23
Q

evaluation of secondary amenorrhea

A 
life events
weight/exercise
pregnant
drugs
galactorrhea
hot flashes

PE - height weight BP secondary sex characters

  • virsutism/virilization
  • cervical stenosis
24
Q

tests for secondary amenorrhea

A

primary - FSH, LH, E2, TSH PRL, androgens, US, visual fields

secondary - CT pituitary, dexamethasone suppression test, hydroxyPROG

25
Q

32yo LMP 1 month ago, irregular menses

  • trying to get pregnant 1 year
  • ruptured appendix, age 14
  • smoker
A

primary infertility

endometriosis

  • subfertility
  • painful menses
26
Q

peritonitis

A

tubal issues

27
Q

work up for primary infertility

A

FSH, LH, progesterone, semen analysis, HSG
-diagnostic laparoscopy

FSH day 3
progesterone day 22

28
Q

endometriosis

A

amount present does not predict amount of pain

powder burn appearance

hemosiderin laden macros

29
Q

endometriosis

A

endometrium outside the uterus

have seen in lungs, bowel, vagina - how did it get there? metaplasia?

symptoms do not always correlate to grading**

30
Q

diagnosis of endometriosis

A

laparoscopy and biopsy
-gold standard**

careful history

US - of little help

elevated CA125 - but lacks sensitivity

31
Q

dysmenorrhea, dyspareunia, infertility

A

triad of endometriosis

also - abnormal bleeding

  • pain with defecation during menses
  • disordered cycles
32
Q

etiology of endometriosis

A

retrograde menstruation

peritoneal metaplasia

33
Q

predisposing fx endometriosis

A

family hx
disordered immunity
toxins
recurrent ovulation

34
Q

management of endometriosis

A

based on patient

pain - medical management
infertility - surgical management
no problem - no tx

35
Q

medical tx endometriosis

A

progestins

continuous oral contraceptives
provera
mirena

danazol - GnRH suppression
-like inducing menopause

36
Q

cochrane conclusions

A

chinese rectal/herbl medicine - better than danazol - pain and shrinkage of masses

auricular acupuncture - pain relief

NSAIDs - better than placebo

COC as effective GnRH agonist

37
Q

laparoscopy with diathermy

A

improves infertility and pain

surgical burn it off

38
Q

menopause patient on HRT with E2

A

endometriosis can come back

39
Q

chocolate cyst

A

ovaries with endometriosis

endometrioma

40
Q

12 months sex without contraception

A

infertility

41
Q

biggest influence on infertility

A

age of women

42
Q

subfertility

A

failing to conceive when expect to

43
Q

main causes infertility

A 
ovulation issue
sperm issue
tubal problem
cervical problem
endometriosis
44
Q

patient with regular cycle

A

ovulating normally

45
Q

test for ovulation

A

basal body temperature char
progesterone - raises temp
LH surger in urine
endometrial biopsy

46
Q

test for tubal patency

A

hysterosalpingogram
laparoscopy with dye

all of these tests potentially therapeutic

47
Q

testing cervical factor

A

sample of mucous of cervix

-good backup for men who don’t want semen sample

48
Q

semen analysis

A 
examined 1-2 hours at room temp
count >20 mil
motility >50%
morphology >15% normal
repeat if abnormal

REPRO II Exam 2 (21 decks)

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