GYN 3 Flashcards
(125 cards)
1
Q
What is the age for primary amenorrhea w/o normal growth or secondary to sex development?
A
Age 13
2
Q
What is the age for primary amenorrhea w/ normal growth or secondary to sex development?
A
Age 15
3
Q
What is the criteria for secondary amenorrhea?
A
No menses for ≥ 3 cycles or 6 consecutive months
4
Q
What are the clinical features of amenorrhea?
A
- Persistent absence of menses
- Neuroendocrine or anatomic abnormality
5
Q
What are the dx test for amenorrhea?
A
- Progesterone challenge Test
- FSH/LH
- Prolactin
- TSH
6
Q
What is the tx for amenorrhea if you want to get pregnant?
A
Ovulation induction
7
Q
What is the tx for amenorrhea if you do not want to get pregnant?
A
Oral estrogen and progesterone
8
Q
What does dysmenorrhea mean?
A
Painful menses, requires medication
9
Q
What is primary dysmenorrhea classified as?
A
Painful uterine muscle activity
10
Q
What is secondary dysmenorrhea classified as?
A
Identifiable cause
11
Q
What are the clinical features of primary dysmenorrhea?
A
- lower abdominal pain/SP pain
- Intermittent pain
- N/V/D
12
Q
What are the clinical features of secondary dysmenorrhea?
A
- Pain that last longer than menses
- gets worse B4 it gets better
13
Q
What are the PE findings for primary dysmenorrhea?
A
Normal PE
14
Q
What are the PE findings for secondary dysmenorrhea?
A
- Asymmetrical/irregularly
- Enlarged uterus
- Tender-boggy uterus
- Uterine motion restriction
- Adnexal tenderness
15
Q
What should a clinician do if pt has secondary dysmenorrhea?
A
Conduct diagnostic studied for suspected underlying disease
16
Q
What is the tx for primary dysmenorrhea?
A
- NSAIDs
- Heat
- Exercise
- Psychotherapy
17
Q
What is the tx for secondary dysmenorrhea?
A
Treat underlying disease
18
Q
What does DUB mean?
A
Dysfunctional uterine bleeding
19
Q
What does DUB include?
A
- Pregnancy
- Systemic Disease
- Cancer
20
Q
Who/what should alway be considered for DUB?
A
- Women in child bearing years
- A complicated pregnancy
21
Q
What establishes a dx of DUB?
A
Exclusion of all possible pathological causes
22
Q
What is PE for DUB pelvic exam assessing for?
A
- Masses
- Irregular uterus
- Adnexal tenderness
23
Q
What are the dx lab test for DUB?
A
- Pregnancy test
- Pap test
- CBC
- TSH
- Liver
- FSH
- Prolactin
- Progesterone
24
Q
What are the dx imaging test for DUB?
A
- Pelvic US
- Endometrial biopsy
25
What is the tx for both adolescent/young and menopausal women with DUB?
```
Adolescent/young:
- estrogen oral contraceptives
Menopause:
- Oral contraceptives, should not be unopposed estrogen
- DandC
```
26
What is PMS?
Cyclic occurrence of symptoms that interfere with life; consistent and predictable in relation to menses
27
What is psychoneuroendocrine disorder?
- Biologic, psychological, social parameters
28
What are common sx of PMS?
- HA
- Breast tenderness/mastodynia
- Pelvic pain
- Bloating
- Premenstrual tension
29
What are severe sx of PMS?
- Irritability
- Dysphoria
- Mood lability
(if these disrupts daily function then PMDD)
30
What are some other known sxs of PMS?
- Clumsiness
- Decreased energy
- Sleep changes
- Mood swings/behavioral changes
31
What is the dx criteria for PMS?
At least 1 of each:
- Affective: depression, angry, outburst, irritability, confusion, social w/d symptom
- Somatic: mastodynia, bloating HA
32
What is the tx for PMS?
- Habit change: < Caffeine, Chocolate, ETOH, Na+
- Behavioral: Stress management, CBT, exercise
- Pharm: Fluoxetine, Sertraline, SSRIs, Hormonal intervention
33
What are functional cysts?
An anatomical variation that arises from normal ovarian function
34
What are the two types of functional cysts?
Follicular and Corpus Luteum cysts
35
What causes a follicular cyst?
- Follicle fails to rupture
| - Ovulation does not occur
36
Causes of a follicular cyst results in what?
- Lengthened follicular phase
| - Transient 2nd amenorrhea
37
What causes corpus luteum cysts?
Abnormal changes in the follicle of the ovary after an egg is released the opening to seal off
38
What are the clinical features of functional cysts?
- Secondary amenorrhea
| - Mild-moderate unilateral lower abdominal pain
39
What is the PE findings for functional cysts?
- Palpable, mobile, cystic adnexal mass
40
What are the dx test for functional cysts?
- Pelvic US
| - Unilocular simple cyst
41
What is the tx for functional cysts
Will spontaneously resolve in approx. 6 wks
42
What is the primary cause of PCOS?
Hyperandrogenism
43
What are clinical features of PCOS?
- Hirsutism
- Anovulation or oligo-ovulation
- Infertility
- Irregular menses
44
What is the PE findings for PCOS?
- Excessive hair growth
- Increased acne
- Obesity
- Metabolic Syndrome
45
What are the dx test for PCOS?
- LH/FSH ratio: > 3x’s
- Screen for DM
- Lipids: >LDL
- Estrodiol level
- US
46
What is seen on the US in a pt with PCOS?
Necklace or sting of peals
47
What is the tx for PCOS?
- Oral contraceptives
- Metformin
- Refer: Endocrinologist
48
What is a key point to keep in mind when you have a pt with PCOS?
Endometrial hyperplasia can become malignant
49
What is torsion?
- Ischemic Condition, >50% occur on right side
50
What causes ovarian torsion?
- Enlarged Ovary
- Pregnancy
- Tumors
51
What are the clinical features of ovarian torsion?
- Sudden onset of severe unilateral lower abdominal pain
| - May occur with exertion
52
What is the hallmark PE finding in a pt with ovarian torsion?
Tenderness
53
What are the dx test for ovarian torsion and what would you see?
Doppler Ultrasound
| - lack of blood flow to the ovary
54
What is the tx for ovarian torsion?
Surgery- medical emergency!!
55
What is the MC cell type in ovarian cancer?
Malignant epithelial cells
56
How do epithelial cells spread in ovarian cancer?
Spread by direct extension within the peritoneal cavity
57
What cell would you find in a pt less than 20 with ovarian cancer?
Germ cells
58
What cell would you find in an older pt with ovarian cancer?
Stromal cells
| - "Functioning tumors"
59
Why is the mortality rate of ovarian cancer so high?
- 5th MC of all cancers in the US
| - Difficulty detecting disease prior to dissemination
60
What are some early warning signs/sxs of ovarian cancer?
- Increased abdominal girth
- Nausea or anorexia
- Urinary Symptoms: Incontinence, Frequency, urgency
61
What are the PE findings in a pt with a benign ovarian mass?
- Mobile
- Cystic
- Smooth
- Unilateral
62
What are the PE findings in a pt with a malignant ovarian mass?
- Fixed
- Solid/firm
- Nodular
- Bilateral
63
What are the dx test for ovarian cancer?
- Elevated CA-125 levels are associated with ovarian cancer
| - NOT used as a screening tool only to follow therapy response or evaluate recurrent disease
64
If you were a primary care PA what would be the next step once you diagnose your pt with ovarian cancer?
Refer
65
What is leiomyoma?
- AKA fibroids or myoma
- Benign tumor
- MC'ly found in AA women
66
Where does leiomyoma derive from?
Smooth muscle cells
67
What are the clinical features of leiomyoma?
- Progressively heavier menstrual flow
- Iron-deficiency anemia
- C/O something pressing down
- Sensation of pelvic mass
68
What is the PE finding for leiomyoma?
Uterus feels “hard or solid”, “lumpy-bumpy"
69
What are the dx test for leiomyoma?
- US: will confirm
- CT/ MRI: see large myomas
- Hysteroscopy
70
What is the tx for leiomyoma?
- 1st: treat sxs
- Reassurance
- Meds: progesterone, GnRH agonist
- Surgical intervention
71
Endometriosis usually occurs during what years?
Reproductive yrs
72
What is the MC site for endometriosis?
Ovary
73
What is retrograde menstruation caused by endometriosis?
- Transport of endometrial cells during menstruation
- Fragments pass through fallopian tubes to the pelvic cavity
- Once in pelvic tissue implants on peritoneal surfaces growing into endometrial lesions
74
Endometrial glands and stroma are located where to the uterine cavity?
Outside
75
What are the clinical features of endometriosis?
- Progressive Dysmenorrhea
- Progressive Dyspareunia
- Dyschezia
76
What is the PE finding in a pt with endometriosis?
- Painful uterine motion
- Uterus may be fixed and retroverted d/t cul-de-sac adhesions
- Adnexal tenderness
77
What is the dx test for endometriosis, and what is seen?
- Direct Visualization
- Dark brown, blue or black cysts
- Scarring/adhesions
- Chocolate cysts on the surface of the ovary
78
What is the tx for endometriosis?
- Pregnancy counseling
- Hormonal contraception
- GnRH agonist (Lupron)
- Surgery
79
What is the difference between adenomyosis and endometriosis?
- Adenomyosis is the growth of endometrial cells inside the uterine musculature
- Tissue cont. to act as it normally would: thickening, breaking down and bleeding.
80
When does sxs adenomyosis start?
Childbearing years
81
What are clinical features of adenomyosis?
- Prolonged menstrual bleeding
- Dysmenorrhea menses
- Cramping throughout menses
- Pass large clots
82
What is the PE finding in a pt with adenomyosis?
Tender "boggy" uterus
83
What is the tx for adenomyosis?
- NSAID
- Combined oral contraceptives
- Endometrial ablation
84
What is a pelvic organ prolapse (POP)?
Defect in pelvic supporting structures - results in relaxation
85
What are the supporting structures affected by pelvic organ prolapse (POP)?
- Ant. vaginal prolapse (cystocyle)
- Post. vaginal prolapse (retrocele)
- Uterine prolapse
86
What are the causes of pelvic organ prolapse (POP)?
- Age
- Increasing parity
- Obesity
- Pelvic surgeries
- Menopause
87
What are the clinical features of pelvic organ prolapse (POP)?
- Sensation of vaginal fullness
- “Something is falling out”
- “Sitting on a ball”
88
What is the PE finding in a pt with pelvic organ prolapse (POP)?
Having the pt cough or strain to reveal a soft, reducible mass bulging into the vagina.
89
What is the dx test for pelvic organ prolapse (POP)?
Pelvic exam
90
What is the tx for pelvic organ prolapse (POP)?
- Pelvic floor exercises
- Topical Estrogen
- Surgical intervention
- Pessary
91
What carcinoma is MC'ly seen in Type 1 endometrial cancer?
Adenocarcinoma 85%
92
Type 1 endometrial cancer is MC'ly seen in who?
Younger women
93
Type 2 endometrial cancer is MC'ly seen in who?
Older women
94
Type 1 endometrial cancer is associated with what?
Estrogen exposure
95
Type 2 endometrial cancer is associated with what?
Endometrial atrophy
96
What is the MC clinical feature of endometrial cancer?
abnormal vaginal bleeding
97
What clinical feature would a menopausal woman have that would indicate endometrial cancer?
Intermittent spotting
98
What clinical feature would a premenopausal woman have that would indicate endometrial cancer?
- Excessive flow
| - Possible lower abdominal pain
99
What are PE findings in a pt with early and late-stage endometrial cancer?
- Usually unremarkable
- Early stages: normal uterus
- Late stages: enlarged uterus
100
What is the dx test and tx for endometrial cancer?
Dx: Endometrial bx
Tx: Hysterectomy
101
Does type 1 endometrial cancer have a poor for favorable prognosis?
Favorable
102
Does type 2 endometrial cancer have a poor for favorable prognosis?
Poor
103
What is menorrhagia?
Heavy (80 ml) or prolonged flow (7 days)
| - "gushing" or "open faucet" bleeding
104
What causes menorrhagia?
- Myoma
- Pregnancy complication
- Adenomyosis
- IUD
- Endometrial hyperplasia
105
What is metrorrhagia?
Intermittent bleeding
| - bleeding occurring b/w menses
106
What causes metrorrhagia?
- IUD
- Endometrial/cervical cancer
- Endometriosis
- Polyps
107
What is polymenorrhea?
Menses occurring too frequently, <21 days
108
What causes polymenorrhea?
Luteal phase defect
109
What is menometrorrhagia?
Bleeding occurring at irregular intervals
| - Amount and duration can vary
110
What causes menometrorrhagia?
Any condition that causes intermenstrual bleeding
111
What is oligomenorrhea?
Menses > 35 days apart
| - Bleeding usually decreases in amount
112
What causes oligomenorrhea?
Prolonged follicular phase
113
What defines infertility?
Failure of a couple to conceive after 12 months of frequent, unprotected intercourse
- affects reproductive ages 15-44 yo
114
What are the 3 categories affecting fertility?
- Female factors (65%)
- Male factors (20%)
- Unexplained or other conditions (15%)
115
How do you dx a male with infertility?
- Get hx
- Semen analysis: if abnl refer to urology and edno
- Infx disease panel: if intrauterine insemination or in vitro fertilization
116
How do you dx a female with infertility?
- Hx, confirm ovulation
- PE: asses cervix, uterus, adnexa
- Pelvic US
- Hysterosalpingogram
- Saline sonogram
- Laparoscopy
- Infx disease panel
117
What is natural menopause?
12 months of amenorrhea
| - age approx. 51 yo
118
What is induced menopause?
Permanent cessation of menstruation after bilateral oophorectomy or ablation of ovary function
119
What is premature menopause?
Menopause occurring before the age of 40
| - natural or induced
120
What is perimenopause?
Menstrual cycle and hormonal changes that occur a few yrs before and 12 months after the final menses
121
What hormones are still being produced by ovarian stroma during menopause?
- Androgens: testosterone and androstenedione
| - Testosterone is a major product
122
What hormone declines after menopause?
Testosterone but remains 2x higher in menopausal women with intact ovaries
123
What is the predominant endogenous estrogen in postmenopausal women?
Estrone
124
What are S/Sx of menopause?
- Atrophic vaginitis
- Sleep disturbances
- Hot flashes/flushes
- Osteoporosis
- Atrophic urethritis
- Mood/memory changes
- Skin, hair, nails changes
125
What is the tx for menopause?
- Estrogen therapy
- Combined Estrogen/Progestin therapy
- Natural remedies
