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NM 717 Comps > Module 3 Gynecology Flash Cards > Flashcards

Module 3 Gynecology Flash Cards

1
Q

What is the HPO axis?

A

The hypothalamic-pituitary-ovarian axis

Hypothalamus (GnRH)->Anterior Pituitary (LH/FSH)-> Ovaries (Estrogen/Progesterone)

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2
Q

What are the uterine phases in order?

A

Menstrual phase
Proliferative phase
Secretory/progestational phase

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3
Q

What are the ovarian phases in order?

A

Follicular phase
Ovulatory phase
Luteal phase

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4
Q

What is the primary hormone in the luteal phase?

A

Progesterone

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5
Q

When does the menstrual phase begin/end?

A

Day 0-6/7

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6
Q

When does the proliferative phase begin/end? What is occurring in it?

A

Day 7/8-14

The endometrium begins to build to prepare for a fertilized egg

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7
Q

When does the secretory/progestational phase begin/end? What is occurring in it?

A

Day 14-28/30

The endometrium continues to thicken and progesterone rises to help maintain a healthy pregnancy for a fertilized egg. If an egg is not fertilized, the progesterone drops and the cycle begins again

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8
Q

When does the follicular phase occur and what is happening in it?

A

Day 0-13

The dominant follicle is developing due to an increase in estrogen.

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9
Q

When does the ovulatory phase occur and what is happening in it?

A

Day 14

LH and FSH surge triggers the dominant follicle/ovum to release/ovulation to occur

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10
Q

When does the luteal phase occur and what is happening in it?

A

Day 15-28/30

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11
Q

What does progesterones role in the menstrual cycle?

A

It helps proliferate the uterus and maintain a healthy home for a fertilized egg

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12
Q

What occurs due to the progesterone withdrawal?

A

Shedding is induces and the cycle begins anew

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13
Q

When someone presents with abnormal uterine bleeding and we given them a progesterone challenge, what result do we expect?

A

Withdrawal bleeding when the progesterone is ended

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14
Q

How can a patient prevent toxic shock syndrome?

A

Change tampon q 4-8 hours
Use the lowest absorbency that lasts you a few hours
Don’t leave tampon in for more than 8 hours

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15
Q

What increases risk of toxic shock syndrome?

A

Risk: tampon use (although dec. in cases after the withdrawal of highly absorbent tampons and polyacrylate rayon-containing products from the market. Half of cases NOT related to menstruation.

TSS more likely if:
Used high aborbency tampons
Used tampons continuously for more days of their cycle
Kept a single tampon in place for a longer period of time

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16
Q

What signs and symptoms are seen with toxic shock syndrome?

A

Rapid (within 48 hours) onset of:
-FEVER!! >38.9 C(102.0F)
-Rash-erythroderma, diffuse, red, macular rash resembling SUNBURN (on palms and soles)
-Hypotension Systolic<90 mmhg
-Multiorgan involvement
-GU pain, VOMITING, watery DIARRHEA
-Myalgias
-Thrombocytopenia
-Neuro: HA, somnolence, confusion, irritibility, agitation, hallucinations

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17
Q

What bacteria are most cases of toxic shock syndrome caused by?

A

Staph. aureus
-Most Methicillin-susceptible Staph aureus

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18
Q

How is toxic shock syndrome treated?

A

Remove foreign body and ABX

Vancomycin, clindamycin, zosyn

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19
Q

What is amenorrhea?

A

The absence of menses for one or more cycle

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20
Q

When we could consider a patient to have frequent menses?

A

Menses more often than every 24 days

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21
Q

When we could consider a patient to have infrequent menses?

A

Less often than every 38 days

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22
Q

When should we suspect an outflow tract abnormality?

A

A patient who has gone through the tanner stages but never had a period

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23
Q

What are the steps your should go through for a cost effective amenorrhea work-up?

A

UPT-> TSH and prolactin levels-> progestin challenge test-> no bleed=FSH/LH level

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24
Q

How should the progestin challenge test be ordered?

A

10mg for 10 days. After stopping, shedding should be expected. This means the HPO axis is working

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25
Q

What is the Rotterdam criteria for PCOS?

A

Exclusion of other etiologies an 2/3 of the following

Oligo/Amenorrhea
Clinical and/or biochemical signs of hyperandrogenism (abdn. hair growth)
Polycystic ovaries and exclusion of other criteria

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26
Q

What result do you expect with a progestin challenge test for a patient with PCOS?

A

Expect bleed

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27
Q

If a patient has a negative progestin challenge test, how should we respond as the APRN?

A

Further workup and referral!

A negative progestin challenge test means the person did NOT have a withdrawal bleed. For Varney Island purposes, think something is “big bad wrong” with the HPO axis - refer.

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28
Q

What conditions would we expect a high FSH?

A

Ovarian problems-aka high functioning hypothalamus but lack of ovarian function
-premature ovarian insufficiency
-Menopause
-Turner syndrome

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29
Q

What conditions would we expect a low or normal FSH?

A

Pituitary or hypothalamus issue
-Hypothalamic amenorrhea
-PCOS
-Rare causes of gonadotropin deficiency

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30
Q

What are the possible abnormalities related to a patient who has a negative progestin challenge test?

A

Addison’s Disease
Turner Syndrome
Autoimmune thyroid disease
Cushing syndrome
Congenital adrenal hyperplasia
Asherman syndrome
Sheehan syndrome

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31
Q

What types of AUB cycles are related to anovulatory cycles?

A

Scant, light or amenorrheic cycles

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32
Q

What types of AUB cycles are related to ovulatory cycles?

A

Heavy menstrual bleeding

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33
Q

What are the most common cause of AUB for <18 y/o?

A

Often anovulatory due to
-dysregulation of the HPO axis
-Inherited coagulopathy

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34
Q

What are the most common cause of AUB for 19-39 y/o?

A

-Leiomyomas
-Polyps
-PCOS
-Hormonal contraception

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35
Q

What are the most common cause of AUB for 40+ y/o?

A

-Menopause
-Endometrial hyperplasia
-Leiomyomas
-Endometrial carcinoma**

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36
Q

PALM-aka structural disorders

How can you differentiate adenomyosis from other causes of AUB?

A

**Heavy menstrual bleeding and dysmenorrhea
PE: Enlarged uterus, tender to exam, Enlarged uterus, usually symmetric, moderate tenderness on palpation, increased menses
Presentation: Usually in older reproductive age
Cause: Caused by endometrial tissue implanted in the myometrium

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37
Q

PALM-aka structural disorders

How can you differentiate leiomyoma from other causes of AUB?

A

Enlarged uterus, usually asymptomatic, often painless, may be associated with AUB

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38
Q

PALM-aka structural disorders

How can you differentiate polyps from other causes of AUB?

A

-Post-coital bleeding!
-Painless bleeding

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39
Q

PALM-aka structural disorders

How can you differentiate malignancy/hyperplasia from other causes of AUB?

A

40 y/o+
Post/Peri-menopausal bleeding

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40
Q

**What bleeding disorders could impact the menstrual cycle?

A

Von Willebrand
Hemophilia

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41
Q

What does COEIN stand for?

A

-Coagulopathy
-Ovulatory dysfunction
-Endometrial (endometriosis, CA, infection)
-Iatrogenic (IUDs/Meds)
-Not Otherwise Classified

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42
Q

On what cycle day do you draw a progesterone level to check for ovulation?

A

cycle day 21

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43
Q

What is the difference between ovulatory dysfunction and ovulatory insufficiency?

A

Dysfunction: when you are producing to many oocytes or the ovaries are not working properly

Insufficiency: when the ovaries are not producing enough oocytes

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44
Q

What hormone should be checked if the ovaries are not functioning properly?

A

Estrogen

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45
Q

What is primary dysmenorrhea?

A

Painful menses. Primary starts from when periods begin

-dysmenorrhea in the absence of other disease
-typically recurrent, crampy, and may radiate to the back or thighs
-can be accompanied by nausea, fatigue, and general malaise
-generally starts just BEFORE the onset of menses and lasts 2-3 days

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46
Q

What is secondary dysmenorrhea?

A

Painful periods that occur later in life

caused by a disorder
ex. endometriosis or (MOST COMMON cause)
Leiomyomata

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47
Q

Should we be more concerned about primary or secondary dysmennorhea?

A

SECONDARY because it is caused by a disorder/disease

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48
Q

What is PMS/PMDD and when in the cycle does it occur?

A

PMS: symptoms only during the luteal phase of an ovulatory cycle and relieved within 4 days. (Anger, anxiety, depression, irritability, confusion, social withdrawal)

PMDD: Severe psych symptoms during the luteal phase. At least 5 symptoms present in the final week before menses that improves with the onset of menses. Key: symptoms are associated with distress

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49
Q

What are our options for treating PMS/PMDD

A

1) nonpharmacologic approaches such as diet, exercise and psychotherapy
2) SSRIs
3) hormonal agonists and antagonists
4) vitamins and botanical products.

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50
Q

What is the difference between PMS and PMDD?

A

How it is affecting their life. PMDD affects their life significantly despite treatment.

Severe symptoms and life impaction=PMDD

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51
Q

Describe the endometrial biopsy procedure.

A

Insert speculum, clean cervix, use allis or tenaculum to stabilize cx, insert sound, insert curette and take sample. Move back in forth with tip moving from fundus to os. Repeat once or twice.

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52
Q

What is the main risk factor for cervical cancer?

A

HPV

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53
Q

Which types of HPV are cause most cervical cancer cases?

A

16 and 18!

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54
Q

What is the Guardasil vaccine schedule?

A

11-14 two doses. Second dose 6-12 months after first

15-45: three doses(0, 2 and 6 months)

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55
Q

If your Pap comes back ASCUS or LSIL on a 21-29 year old patient. How can you respond?

A

Repeat in 12 months!

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56
Q

At what age should cotesting of Pap and HPV occur?

A

Age 30

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57
Q

How should you respond to a patient with ACUS and negative HPV?

A

Repeat in 3 years

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58
Q

How should you respond to a patient 30+ who tests positive for HPV?

A

COLPO!

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59
Q

How do you respond to a patient who tests ASC-H on her Pap?

A

COLPO!

60
Q

How do you respond to a patient who tests HSIL on her Pap?

A

COLPO!

61
Q

When can you resume a regular pap schedule?

A

After two negative Paps within a year

62
Q

When evaluating a patient for abdominal pain. What are some RED FLAGS?

A

Persistent pain
Sudden pain
Pain with vomiting
High fever

63
Q

When should you start an infertility work up for a patient?

A

35 y/o+ 6 months of trying
<35 y/o 1 year of trying

63
Q

What should first steps of fertility workup be for a patient when testing should be initiated?

A

Sperm analysis
Educate on ovulation testing at home

64
Q

Describe Bartholin Gland Cysts and how you would treat them.

A

Approx 4 and 8 o’clock in the vaginal vestibule. Infected fluid can cause abcess. Erythematous and painful. Tx: antibiotics and warm compresses. Incision and drainage possibly.

65
Q

Describe HPV on the vulva. What causes it?

A

Condylomatas- commonly caused by low-risk HPV-6 and 11. Not associated with cancer

66
Q

Describe HSV and how you would treat it.

A

HSV1 and HSV2. Chronic, recurrent condition, sexual contact. Painful blisters on the vulva, perineum, vagina, cervix, or anus. Majority asymptomatic. Serologic testing or vulvar culture. Tx: acyclovir, famciclovier or valacyclovir.

67
Q

Describe folliculitis and how you would treat it.

A

Common- hair follicles and sebaceous gland of the vulva. Yellow-white or red-colored, pinhead-sized pustules with a central hair. Avoid trauma (shaving) and Tx is antibiotic cream or ointment

68
Q

Describe Hidradenitis Suppurativa and how you would treat it.

A

Chronic skin disease-recurrent inflammatory response in areas where apocrine glands reside. Frequent recurring boils. May 1st appear in adolescence. Painful, nodular lesions or abscesses in axillary or genital region. No dx tests. Topical or systemic tx. Possible immunosuppressive therapy, laser, or surgical tx. Refer to specialist.

69
Q

Describe Lichen Sclerosus and how you would treat it. What is the biggest concern?

A

Thin skin, white patches or depigmentation, atrophic papules that may coalesce into plaques. Itching, pain, dyspareunia. May have evidence of scratching. Loss of vulvar architecture. Dx with bx. Tx: topical steroids (clobetasol)

**Risk for vulvar cancer

70
Q

Describe Lichen Planus and how you would treat it.

A

Autoimmune. Affects the skin, mucocutaneous sites, mouth, scalp and genitalia. Primarily perimenopausal and postmenopausal folks. Vulvar soreness, burning, pruritus, dyspareunia. Architectural changes to vulva and vagina may be present. Dx by bx. Can be refractory to tx - refer

71
Q

Describe Vulvodynia.

A

Chronic genital pain. Lasts at least 3 months with no known cause. Dx of exclusion. See pages 400-402 in Varney

72
Q

Describe Vulvar Cancer and how you would teat it.

A

Varney p. 414- associated with HPV exposure. Identify any growths noted by a client. Most common labia majora, S/S persistent pruritus possible lymphadenopathy. Biopsy. Refer for HPV lesion that doesn’t improve with tx.

73
Q

What types of exercises can you suggest to a patient with pelvic floor problems?

A

Kegels

74
Q

How can you differentiate between stress and urge incontinence?

A

Stress urinary incontinence (SUI) is the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing.

Urge urinary incontinence (UUI) is characterized by the complaint of involuntary leakage accompanied by or immediately preceded by urgency.

75
Q

How can you treat stress incontinence?

A

Pelvic floor exercises, dietary changes, weight loss, bladder training, Sx

Meds are not effective

76
Q

How can you treat urge incontinence?

A

Meds: Beta-adrenergic drugs (Myribetriq), antimuscarinic agent, Botox

Pessary, PFPT, behavioral modification, Sx

77
Q

Describe what you would likely feel with a breast cyst. How would you respond?

A

Smooth, round or oval, mobile, fluid-filled, well-described borders

Breast ultrasound

78
Q

Describe what you would likely feel with Fibroadenomas. How would you respond?

A

Nontender, firm or rubbery, mobile, well circumscribed

Breast ultrasound

79
Q

Describe what you would likely feel with breast cancer. How would you respond?

A

non-tender, gritty or rough, hard or rocky, fixed, ill-defined borders.

Diagnostic mammogram

80
Q

What kind of workup should you perform for a patient with galactorrhea who has not been pregnancy in the last 12 months?

A

Prolactin level
TSH
Breast Ultrasound

81
Q

How often are mammograms and breast exams recommended?

A

CBE: every year if >40

Mammogram: biennial or annually after 50 or for high risk patients

82
Q

What category on the Bi-RADS should we be concerned about and how should we respond?

A

Category 3 is probably benign

Category 4 and 5 should be referred immediately!

83
Q

What is the normal pH of the vagina?

A

3.8-5.0

84
Q

Who should be screened for intimate partner violence?

A

EVERYONE!!

85
Q

Who would we consider high risk for human trafficking?

A

more than one STI
other risk factors for nonconsensual sex

86
Q

What are the signs of BV and the treatment?

A

Fishy odor, +whiff and clue cells

Treat: Flagyl 500mg BID for 7days
OR
Clindamycin 300mg BID for 7days

87
Q

What are the signs of yeast and the treatment?

A

S/S: Vaginal itching, burning, irritation, dyspareunia, and vaginal discharge. Swollen red vulva, thick curd like discharge.

Treat: Antifungal “azole”. Fluconazole PO or Miconazole cream/suppository

88
Q

What are the signs of chlamydia and the treatment?

A

S/S: Most asymptomatic

PE: Cervicitis, mucopurulent discharge, cervical motion tenderness.

Treatment: Azithromycin or Doxycycline and abstinence for 7d+until partner treated

F/U: TOC 3m

89
Q

What are the signs of gonorrhea and the treatment?

A

S/S: Most asymptomatic. Dysuria, discharge, bleeding, sore throat, anal itching.

PE: Unremarkable or enlarged lymph nodes. Discharge.

Treatment: Rocephin and Azith and abstain for 7d

F/U: TOC not required for nonpregnant

90
Q

What are the signs of PID and the treatment?

A

S/S: Abdominal pain

PE: 1 of the following: cervical motion tenderness, adnexal tenderness, uterine tenderness. May have fever, mucopurulent discharge, hx of STI or active STI

Treatment: Doxycycline and rocephin with or without flagyl

91
Q

What are the signs of Syphilis and the treatment?

A

Primary: local symptoms
Secondary: Systemic symptoms

Rash on palms of hands, feet, and trunk. Patchy alopecia, condylomata lata, lesions on mucus membranes, low-grade fever, sore throat, hoarseness, malaise, HA, anorexia, and lymphadenopathy.

Treatment: Benzathine Penicillin G

92
Q

What are the signs of chancroid and the treatment?

A

S/S: Nontender indurated lesion and inguinal lymphadenopathy

Treatment: Test for STI if present for 7+ days. Azith and Doxy

93
Q

What causes condylomas?

A

Most often HPV 6 and 11. NON-cancerous!

94
Q

What are the signs of condylomas and the treatment?

A

S/S: Genital warts

Treatment: Podofilox, Imiquimod, TCA, cryotherapy, or sx

95
Q

What are the signs of HSV and the treatment?

A

Painful lesions

Treatment: Acyclovir, Famcyclovir, etc.

96
Q

What are the signs of Hepatitis B and the treatment?

A

S/S: Often asymptomatic or subtle enough to not notice (fatigue, nausea, etc.)

Treatment: symptom management only, notify health department

97
Q

What are the signs of HIV and the treatment?

A

S/S: Malaise, rash, nausea, diarrhea, HA, sore throat, lymphadenopathy (similar to mono) or asymptomatic

Prevention: PreP (Truvada)

Treatment: REFER!

98
Q

What are the signs of Zika and the treatment?

A

S/S: Mild and self limited

Concern during pregnancy due to risk of microcephaly, stillbirth, and more

Treatment: Supportive

99
Q

What are the signs of Trich and the treatment?

A

S/S: mostly asymptomatic. Itching, malodorous discharge, abd. pain

Treatment: Flagyl

100
Q

What are the signs of pubic lice and the treatment?

A

S/S: visible lice and nits, small puncture lesions/bites visible, bluish macules

Treatment: Permethrin and wash clothing/linens in hot water

101
Q

What are the signs of molluscum contagiosum and the treatment?

A

STI/Pox virus-viral infection

Usually self-limiting

Tx: Podophyllotoxin — Podophyllotoxin is an antimitotic agent that is commercially available as podofilox 0.5% (Condylox) in a solution or gel.
or
Cryotherapy — Liquid nitrogen is used to perform cryotherapy. A cotton-tipped swab dipped in liquid nitrogen and applied to individual lesions for 6 to 10 seconds can be used [19].

102
Q

What conditions should you NOT use expedited partner treatment for?

A

Syphilis
Herpes
HIV

103
Q

What are the most effective methods of BC?

A

Reversible: Implant, IUD
Permanent: Sterilization

104
Q

What are the medium effectiveness of BC?

A

Injection, Pill, Patch, Ring, Diaphragm

105
Q

What are the least effective BC?

A

Condoms (M/F), withdrawal, sponge, FAM, spermicide

106
Q

**What is the most common method that has most of the red contraindicated areas?

A

Combined hormonal birth control

**Estrogen is the problem

107
Q

**What are the highest risk factors associated with adverse effects of COC? AKA the biggest reason for contraindication of COC.

A

Cardiovascular risk factors
-MI
-Stroke
-DVTs

108
Q

List some of the category 4 contraindications to CHC.

A

Key!! Cardiovascular risk

-Current breast CA
-<21 days PP
-Breastfeeding
-Severe Cirrhosis (decompensated)
-Hx of DVT/PE or current DVT/PE
-HA with aura
-HTN (>160/100)
-Vascular Dx
-Current/hx of ischemic heart dx
-Known thrombogenic mutations
-Liver tumors
-Peripartum cardiomyopathy
-Smoker >35y/o >15cig per day
-Organ transplant
-Stroke
-SLE
-Valvular heart dx
-Viral hepatitis
-DM with vascular dx or >20yrs duration

109
Q

What is the cat-4 contraindication for POP, implant, and DMPA?

A

Current breast cancer

110
Q

What are the cat-4 contraindication for LNG-IUD?

A

-Distorted uterine cavity
-Current Breast Cancer
-Awaiting treatment for cervical cancer (i)
-Endometrial Cancer (i)
-Gestational trophoblastic disease
-Current PID (i)
-Immediate postseptic abortion
-Postpartum Sepsis
-Pregnancy
-STI’s current purulent cervicitis or chlamydial infection or gonococcal infection
-Tuberculosis- pelvic (i)
-Unexplained vaginal bleeding (i)

111
Q

What are the cat-4 contraindication for Cu-IUD?

A

-Distorted uterine cavity
-Awaiting treatment for cervical cancer (I)
-Endometrial Cancer (i)
-Gestational trophoblastic disease: persistently elevated B-hCG levels
-Current PID (I)
-Immediate postseptic abortion
-Postpartum Sepsis
-Pregnancy
-STI’s current purulent cervicitis or chlamydial infection or gonococcal infection
-Tuberculosis- pelvic (i)
-Unexplained vaginal bleeding (i)
-Allergy to Copper
-Wilson’s disease

112
Q

**What side affects are associated with the Cu-IUD?

A

Heavier menses, increased cramping/bleeding

113
Q

**When is smoking a contraindication to CHC?

A

> 35 and >15 cig/day

114
Q

**What type of BC should we be concerned about affecting other medications?

A

Oral contraception.

Ex: Prep or HIV treatment, Anticonvulsants, Rifampin and st. Johns wart

Most of the time is interferes with the medication, not the OC.

115
Q

What medications are used for effective medication termination?

A

Mifepristone (Mifiprex, RU-486) and misoprostol (cytotec)

**There are more effective together.

116
Q

How are Mifiprex and Cytotec given for an at home termination? What SE are expected?

A

200mg PO mifiprex followed by 800mcg cytotec 24 hours later. Evaluation 7-14 post medication to confirm complete termination occurred.

SE: Heavy bleeding and painful cramping and nausea

117
Q

What options are available for emergency contraception?

A

Plan B, Ella, Copper IUD or Yuzpe method

118
Q

**What type of hormone is in the emergency contraceptives?

A

Progesterone only aside from the copper IUD

119
Q

**What is the ideal timing for the different emergency contraceptives?

A

Yuzpe/Plan B: within 72 hours

Ella/Cu-IUD: within 120 hours

120
Q

What is the criteria for lactational amenorrhea?

A

-Breastfeeding at least 95% of intake with no longer than 4-hour breaks during the day or 6-hour breaks at night
-Less than 6m old baby
-No resumption of menses

121
Q

How is nonoxynol-9 used to prevent pregnancy?

A

nonoxynol-9=spermicide

It is a hormone that comes in many forms but must be used with a barrier method.

122
Q

What is the MOA of the Cu-IUD?

A

It alters cervical mucus to make it thicker and less favorable for sperm to survive.

123
Q

**What does the male sterilization procedure do?

A

Cutting of the vas deferens. This is permanent.

124
Q

How do you calculate the likely day of ovulation?

A

Total cycle days-14=likely day of ovulation. Window = 14-5&+2

125
Q

How long can sperm survive in the vaginal canal?

A

3-5 days

126
Q

What does BBT tell you?

A

Ovulation has occured

127
Q

What does the LH surge tell you?

A

That ovulation is about to occur

128
Q

What do the different fertility awareness methods use to help determine fertile window?

A

-Periodic abstinence to avoid pregnancy when fertile
-Tracking temps
-Cervical secretions
-Hx of ovulatory days

129
Q

How does COC prevent pregnancy?

A

Suppresses ovulation and alters cervical mucus

130
Q

What is the MOA of POC?

A

Some ovulation suppression, but mostly alters cervical mucus. This is why it has a smaller window of error/is less effective than combined.

131
Q

If a backup method is needed, how long should it be used?

A

7 days

132
Q

What is the difference between HT vs BC?

A

The strength is different making the contraindications different.

133
Q

Is smoking on HRT contraindicated?

A

NO!!!

134
Q

What is the dominant estrogen in menopause?

A

Estrone (E1)

One: She’s down to only 1 estrogen

135
Q

What is the dominant estrogen in childbearing years?

A

Estradiol (E2)

Di: there is potential to get pregnant

136
Q

What is the dominant estrogen in pregnancy?

A

Estriol (E3)

Tri: There are 3 trimesters

137
Q

What happens to hormones in menopause?

A

FSH and LH increase and Estrogen/Testosterone decrease

138
Q

What T-score indicated normal bone density, osteopenia and osteoporosis?

A

Normal: -1, 0, 1+
Osteopenia: -2.5 to -1
Osteoporosis: -2.5 or lower

139
Q

What is the FRAX test?

A

helps to determine which women under 65 should have BMD testing. If someone has a FRAX >9.3% or higher, they should have a DXA

140
Q

What are the HRT contraindications?

A

-undiagnosed abnormal vaginal bleeding
-known, suspected, or history of breast cancer
-known or suspected estrogen-dependent cancer
-current or hx of DVT or PE
-current or recent (within last year) stroke or MI
-liver disease
-known or suspected pregnancy
-known hypersensitivity to ET/EPT

141
Q

What HRT should be given for vaginal atrophy?

A

LOCAL low dose estrogen. AKA vaginal estrogen

142
Q

What HRT should be given for vasomotor symptoms?

A

SYSTEMIC higher dose estrogen

143
Q

What must be given to someone starting HRT that has a uterus?

A

Progesterone-to prevent endometrial CA risk

144
Q

What patient can receive Premarin or Estrace only?

A

Someone who has had a hysterectomy

145
Q

What newer medication can be used for both systemic and vaginal symptoms?

A

Femring

146
Q

Why would a patient undergo a sonohysterography?

A

To get a batter look at the uterine cavity during a TVUS for abnormal bleeding

NM 717 Comps (31 decks)

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