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Flashcards in Other Topics Deck (30)
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1
Q

barrier methods of contraception

A
  • condoms, diaphragms, cervical caps
  • protection against STIs: decreased risk HIV, gonorrhea, nongonococcal urethritis, herpes
  • natural membrane condoms less effective than latex
  • rare reports of toxic shock syndrome with diaphragm and contraceptive sponge
2
Q

sterilization

A
  • reduces risk of ovarian cancer
  • most commonly used method
  • hysterectomy, BSO, tubal ligation, vasectomy
  • NOT reversible
  • 1.85% risk pregnanyc, 30% risk of ectopic pregnancy
  • SE include functional ovarian cysts,
3
Q

Intrauterine Devices

A
  • Advantages: high level of efficacy, no increased rate of pelvic infxn and infertility
    • Skyla: good for 3y
    • Mirena: good for 5y, good for women with menorrhagia
    • ParaGuard: good for 10y
  • Disadvantages: not for use in women at high risk for bacterial STI in last 3-6mo
    • may not be effective in women with uterine leiomyomas because they alter the size or shape of the uterine cavity
  • Side effects:
    • ParaGuard - increased menstrual blood flow, dysmenorrhea
    • Mirena: more frequent spotting up to 6mo after placement or amenorrhea (30% by 2y, 60% by 12y)
    • expulsion duirng first year (likely in first month), 5%
    • uterine perforation (0.1%)
    • not associated iwht increased risk pelvic infxn for low-risk pts
4
Q

implanon

A
  • advantages: up to 3y
  • disadvantages: not for use in women who cannot tolerate unpredictable and irregular bleeding
  • SE: causes irregular bleeding that doesn’t normalize over time
5
Q

OCPs

A
  • Advantages: increased bone density, reduced menstrual blood loss (and anemia), low risk ectopic, improved dysmenorrhea from endometriosis, improved acne, decreased risk ovarian and endometrial CA and various benign breast dzs, prevention of atherogenesis, decreased activity of RA and incidence and severity of acute salpingitis
  • disadvantages: user dependent, increased risk thromboembolism, contraindicated with hypercoagulable state (smoking >35, hx VTE), contraindicated in ER/PR pos breast CA
  • SE: breakthrough bleeding, amenorrhea, mastalgia, weight gain, increased risk CV event
6
Q

LARCs

A
  • long acting reversible contraceptives
  • prevent pregnancy through primarily spermicidal effect caused by sterile inflammatory rxn
  • if woman develops infxn with IUD in place, dont remove device, treat as STI
  • if TOA forms, start IV abx and remove device immediately
7
Q

Copper containing (ParaGuard) MOA, Indications, Contraindications

A
  • MOA: local inflammaatory response induced in uterus leads to lysosomal activation
  • Indications: 10y
  • Contraindications: pregnancy or suspicion of pregnancy, abnl uterus (i.e. fibroids), acute PID, postpartum endometritis or postabortal endometritis, known or suspected uterine or cervical CA, genital bleeding (unknown), mucopurulent cervicitis, Wilson dz
8
Q

Progestin releasing IUD (mirena - levonorgestrel releasing intrauterine system)

A
  • MOA: progestin renders endometrium atrophic, stimulates cervical mucus thickening (blocks sperm penetration into uterus), decreases tubal motility (prevents ovum/sperm union), may inhibit ovulation
  • indications: good for 5y
  • Contraindications: preg, uterine anomaly, PID, postpartum endometritis or infected abortion in past 3 mos, uterine or cervical neoplasia/abnormal pap, genital bleeding (unknown orig), untreated cervicitis or vaginitis, acute liver dz or liver tumor, susceptibility to pelvic infxn, breast cancer, prior ectopic
9
Q

Implanon

A
  • single rod, etonogestrel
  • MOA: progestin continuously suppresses ovulation, increases cervical mucus viscosity, causes endometrial atrophy
  • Indications: up to 3y
  • Contraindications: preg, thrombosis or VTE, hepatic tumors, liver dz, undx abnormal genital bleeding, breast CA
10
Q

Most androgenic OCP

A

levonorgestrel

11
Q

least androgenic OCP

A
  • desogestrel, gestodene, drospirenone
12
Q

OCP MOA, indications, contraindications, adverse effects

A
  • MOA: suppression of hypothalamic GnRH, prevention of FSH and LH secretion, prevent menorrhagia, progestins inhibit ovulation
  • Indications: 3wks each month
  • Contraindications: preg, HTN, smoker >35yo, DM, thrombogenic cardiac valvulopathies, cerebrovascular or coronary artery dz, migraines, thrombophlebitis, hx VTE, undx abnl bleeding, breast CA, cholestatic jaundice of preg, hepatic adenomas or CA or liver dz, endometrial CA
  • Adverse effects: breakthrough bleeding, amenorrhea, breast tenderness, weight gain, increased risk CV dz
13
Q

Progestin-only pill

A
  • aka minipills
  • MOA: progestins inhibit ovulation
  • Indications: good for women at increased risk of CVD (HTN), hx of thrombosis, migraines, smoker >35yo, lactating women, reduced risk ovarian and endometrial CA
  • Contraindications: unexplained uterine bleeding, breast CA, hepatic neoplasms or liver dz, pregnant
  • Adverse effects: increased incidence irreg bleeding, higher preg rate
14
Q

depo-provera

A
  • MOA: inhibits ovulation and prevents sperm implantation
  • Indications: IM injection q3mos, given 5d after menses onset, does NOT suppress lactation, good for women for whom estrogen-containing contraceptive is contraindicated (migraine, sickle cell, fibroids), decreased risk of ovarian and endomet. CA
  • Contraindications: unexplained uterine bleeding, breast CA, liver dz, preg, hx of VTE
  • Adverse Effects: irreg bleeding, weight gain, breast tenderness, increased risk cervical CA, delay in return of fertility (12-18mo), shouldnt be used longer than 2y (d/t decreased bone mineral density)
15
Q

postcoital contraception

A
  • Copper IUD insertion (up to 5d after, 99-100% efficacy)
  • oral antiprogestins or mifepristone (within 72hrs or up to 120hrs after, 98-99% efficacy)
  • Levonorgestrel (delays or prevents ovulation, within 72hrs, 60-94% efficacy)
16
Q

obesity and contraception

A
  • IUD may be MORE EFFECTIVE than oral or transdermal
  • methods that include estrogen are considered less effective for obese women
    • therefore, IUD, DMPA, and progestin-only pills are most effective
17
Q

endometriosis etiology, RF, and sxs

A
  • hx of PID/STD, laparoscopy for chronic pelvic pain or dysmenorrhea, infertility
  • present in 30% infertile women
  • MC in 25-35yo white women, estrogen dependent inflammatory dz
  • MC locations: ovaries, anterior and posterior cul-de-sac, post broad ligaments, uterosacral lig, uterus, fallopian tubes, sigmoid colon, appendix, round lig
  • RF: nulliparity, prolonged E exposure (early menarche), exposure to DES in utero, lower BMI, high consumption trans unsaturated fat, outflow tract obstructions
  • Sxs: cyclical pelvic pain, dysmenorrhea (pain 1-2d before menses, persists throughout), dyspareunia, dyschezia, hematochezia, dysuria, hematuria
    • fixed uterus, retroflexed, nonmobile, palpable adnexal mass
  • complications: infertility
18
Q

endometriosis dx, tx

A
  • Dx:
    • transvag US: hypoechoic, vascular, or solid mass (irreg margins, spiculated - MOST ENDOMETRIAL TISSUE CANNOT BE SEEN ON US)
    • DEFINITIVE: exploratory laparoscopy and bx (“blue-black powder burn lesions” raised flame-like patches)
    • serum CA125 can be elevated
  • Tx:
    • mild-moderate (no reg absence from school/work, no US evidence): NSAIDs, OCPs, Depo, Mirena
    • Severe (reg absence from school/work, failed tx, recurrence): GnRH agonist (leuprolide) with OCPs
      • Laparoscopy
    • DEFINITIVE tx: hysterectomy + bilateral salpingo-oophorectomy
19
Q

Ovarian cyst

A
  • Etiology/RF: ectopic endometrial tissue within ovary - bleeds and results in hematoma
  • Sxs: asx or pelvic pain, menstrual irreg., urinary frequency, constipation, pelvic “heaviness”, syrup-like chocolate colored material)
  • Dx: US (first line), preg test, CBC, CA-125
  • Tx:
    • small, asx: OCP, repeat US in 6-8wk
    • Large, sx: cystectomy (first line), follow w/ long term OCP
      • oophorectomy (definitive) - recurrent cysts, no more childbearing, postmen.
  • Complications: hemoperitoneum (with rupture)
20
Q

Leiomyoma (fibroid) etiology, RF, sxs

A
  • etiology: E and P sensitive - grow during preg, shrink after men.
    • MC solid pelvic tumor, MC in AA females - benign, smooth muscle cell tumor of myometrium
  • RF: Black, early menarche, ETOH intake, + family hx
  • Protective factors: increased parity, long acting progestin only (depo), SMOKING
  • sxs: MOSTLY ASX
    • menorrhagia, pelvic pain/pressure, bulk related sxs (voiding diff. - constipation, urinary urgency, frequency), dyspareunia, dysmenorrhea, infertility
    • abdominal distention, enlarged, mobile uterus with irregular contour
  • complications: increased risk miscarriage
21
Q

Leiomyoma dx and tx

A
  • dx: pelvic US - distinguishes fibroids from adnexal masses (first line, diagnostic)
    • hysteroscopy - less accurate than US
    • MRI - size and location (for surgical planning)
    • hysterosalpingogram - defines contour of endomet. cavity
    • EMB - if >40yo to r/o endometrial CA
  • tx: observation and reassurance if asx, small, postmen
    • bimanual q6mo
    • OCPs, POPs (first line)
    • GnRH agonists (most effective but cause bone loss)
    • myomectomy (contra in preg.) - used in AUB, bulk related sxs, infert, recurrent miscarriage
    • hysterectomy (definitive tx)
22
Q

Spouse or partner neglect/violence

A
  • F>M as victims
  • RF: young (<35), pregnant, single, divorced, ETOH or drug abuse in vitim or partner, smoking, low SES
  • Signs/sxs: injury explanation doesn’t fit with exam, frequent ED visits, HA, abd pain, fatigue
    • vague during hx, minimal eye contact, abuser in room answers all questions or refuses to leave, injuries to central area, bruising in various stages of healing
  • Dx: HITS (hurt, insult, threaten, screamed at), WAST (women abuse screening tool), PVS (partner violence screen), AAS (abuse assessment screen), WEB (women’s experience with battering)
  • Tx: speak with pt alone, document all hx and findings, screen women of childbearing age and refer to intervention services
23
Q

sexual assault in adults

A
  • sxs: sleep disturbance, decreased appetite, somatic sxs, depression, suicidality, anxiety, decreased self-esteem, sexual dysfunction, fragility of sense of masculinity and confusion about sexual orientation
  • tx: evaluate and collect evidence up to 24h after assault, report to authorities, FU 1-2 wk
24
Q

sexual assault in children

A
  • sxs: nonspecific, rectal or genital bleeding, STIs not acquired prenatally, sexually explicit acting out, signs of penetration, inappropriate knowledge of sexual activity, developmentally inappropriate play, swelling or blue discoloration of the anus
  • dx: forensic evidence collection, screen for STIs, evaluate for pregnancy
  • tx: evaluate and collect evidence up to 24h after assault, report to CPS, followup 1-2wk
25
Q

urge incontinence causes and sxs

A
  • etiology: overactive bladder (detrusor overactivity), uninhibitied bladder contractions (irritation within the bladder or loss of inhib. neuro control of bladder)
  • causes: cystitis, prostatitis, atrophic vag, bladder diverticulum, pelvic radiation tx, loss of neuro control from: stroke, dementia, spinal cord injury, parkinsons
  • sxs: loss of urine preceded by a sudden desire to pass urine, contractions with change in body position (supine to upright) or with sensory stim (running water, etc.), frequency and nocturia, urgency w/o urinary loss
26
Q

urge incontinence dx and tx

A
  • dx: voiding diary, cough stress test, PVR (<50mL), check serum Cr (elevated)
  • tx: pelvic floor muscle training, scheduled voiding, avoid diet triggers (ETOH, caffeine), anticholinergics (oxybutynin, ditropan), TCA (imipramine), pseudoephedrine (a-blocker), botox
27
Q

stress incontinence

A
  • F >30, may occur after childbirth in obese women
  • sxs: incontinence during physical inactivity or coughing, sneezing, jumping, lifting, exercising
  • dx: voiding diary, cough stress test (most reliable), PVR <50mL
  • tx: weight loss, pelvic floor exercises, incontinence pessary, periurethral bulking, retropubic urethropexy (TVT and other sling procedures)
28
Q

overflow incontinence

A
  • causes: anticholinergics, pelvic organ prolapse, DM, MS, spinal cord injuries
  • sxs: dribbling, inability to empty bladder, hesitancy, urine loss without recognizable urge or sensation of fullness
  • dx: voiding diary, cough stress test (no leakage), PVR >200-300mL
  • tx: urethral bulking procedure
29
Q

infertility RF

A
  • Female RF:
    • Ovary: PCOS, hx radiation, hypogonadotrop8ic hypogonadism, ovarian failure
    • Tube: hx PID, pelvic surgery, personal or family hx endometriosis
    • Uterus: asherman syndrome, structural abnl, hx of D&C, recurrent miscarriage, IUD
    • Cervix: abnormal PAP, cervical infxn
  • Male RF:
    • illness with fever in last 70-90d, viral orchitis, chemo, urogenital surgery, torsion, recent hot tub use, lube use, anabolic steroids, chronic ETOH/smoking/marijuana
30
Q

infertility sxs, dx, tx

A
  • sxs: inability to conceive after 1 yr trying
  • dx: US, EMB, pap, postcoital test, cervical cultures, ovarian reserve test (>35yo, unexplained, smoker), ovulation testing, BBT, midluteal progesterone, hysterosalpingogram, chromopertubation (GOLD STANDARD), hysterosonogram and pelvic US, semen analysis
  • tx: Clomid, IVF
  • Tubal infertility: 12% after 1 ep of PID, 25% after 2 eps, 50% after 3 eps