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Clin Med- Repro > PEARLS book > Flashcards

PEARLS book Flashcards

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1
Q

if the egg is not fertilized, the corpus lutetium soon _______, causing a FALL OF ESTROGEN AND PROGESTERONE LEVELS

A

deteriorates!

endometrium is no longer maintained and sloughs off, “menstruation”

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2
Q

What predominates during the follicular phase?

A

estrogen!

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3
Q

GnRH from the hypothalamus causes an increased in FSH and LH from the pituitary gland, which…..

A

stimulates the ovaries

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4
Q

____ causes follicle and egg maturation in the ovary

A

FSH

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5
Q

____ stimulates maturing follicle estrogen production

A

LH

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6
Q

_____ builds up the endometrium (“proliferation”)

A

estrogen

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7
Q

What predominates during the luteal (secretory) phase?

A

Progesterone

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8
Q

abnormal frequency/intensity of menses due to nonorganic causes

A

dysfunctional (abnormal) uterine bleeding

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9
Q

cryptomenorrhea

A

light flow or spotting

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10
Q

Menorrhagia

A

heavy or prolonged bleeding at normal menstrual intervals

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11
Q

Metorrhagia

A

bleeding between menstrual cycles

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12
Q

Menometrorrhagia

A

irregular intervals with varying degrees of bleeding

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13
Q

Management for anovulation (due to unopposed estrogen)

A

OCPs
Progesterone
GnRH agonists

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14
Q

cluster of physical, behavioral, mood changes with cyclical occurrence during luteal phase menstrual cycle (7-14 days before onset of menses)

A

PMS

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15
Q

benign uterus smooth muscle tumor
*growth related to estrogen production (regresses with menopause)

most common in african americans

A

Leiomyoma (uterine fibroids)

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16
Q

Most commonly presents with bleeding and menorrhagia! can present with abdominal pressure also

*exam shows lg, irregular hard palpable mass in abdomen or pelvis during bimanual exam

A

Leiomyoma (uterine fibroids)

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17
Q

How is diagnosis of leiomyoma (uterine fibroids) made?

A

ultrasound

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18
Q

Most leiomyoma (uterine fibroid) cases are managed through…

A

observation!

sometimes inhibition of estrogen

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19
Q

presence of normal endometrial tissue outside the endometrial (uterine) cavity

*ectopic endometrial tissue responds to cyclical hormonal changes!

A

endometriosis

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20
Q

MC site of ectopic endometrial tissue?

A

Ovaries

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21
Q

Risk factors:
nulliparity
family hx
early menarche

onset usually under 35!!**

A

Endometriosis

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22
Q

Classic triad=

  1. cyclic premenstrual pelvic pain (or low back pain)
  2. Dysmenorrhea
  3. Dyspareunia
also dyschezia (painful defecation)
**most common cause of infertility!!**
A

Endometriosis

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23
Q

How is endometriosis definitively diagnosed?

A

Laparoscopy biopsy

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24
Q

Endometriosis involving the ovaries large enough to be considered a tumor, usually filed with old blood appearing chocolate colored (chocolate cysts**)

A

Endometrioma

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25
Conservative tx of endometriosis
ovulation suppression: OCPs + NSAIDs Progesterone tx
26
Surgical tx of endometriosis
Laparoscopy with ablation (if fertility desired) TAH-BSO with salpingoophorectomy (if no desire to conceive)
27
MC GYN malignancy in US **mostly post menopausal!!!*** Estrogen dependent cancer
endometrial cancer
28
``` Risk factors= Increased estrogen exposure Nulliparity Chronic anovulation Obesity Estrogen replacement therapy Tamoxifen HTN DM ```
Endometrial cancer
29
Clinical manifestations: abnormal bleeding..post menopausal bleeding*, menorrhagia
Endometrial cancer
30
Diagnosis made through endometrial biopsy (esp if endometrial stripe is greater than 4 mm!) **majority=adenocarcinoma
Endometrial cancer
31
Management for stage I endometrial cancer
TAH-BSO +/- post op radiation | stage II would be TAH-BSO with lymph node excision and post op radiation
32
Gravida Para Abortus
``` Gravida= # times pregnant Para= # of births, including viable or nonviable births (still births) Abortus= # of pregnancies lost ```
33
Cessation of menses longer than 1 year due to loss of ovarian function *FSH assay most sensitive initial test
Menopause
34
Estrogen deficiency changes: menstrual cycle alterations, vasomotor instability (i.e. hot flashes), mood changes, skin/hair/nail changes, CV events, hyperlipidemia, osteoporosis, dyspareunia *atrophic vaginitis: thin yellow discharge with pH greater than 5.5, pruritus
Menopause clinical manifestations
35
Cystic enlargement of ovarian structures (mature follicle that fails to rupture) *unilateral RLQ or LLQ pain dx made with ultrasound
Ovarian cysts
36
Highest mortality rate of GYN cancers *risk factors: family hx, increased number of ovulatory cycles (infertility, nulliparity, under 50, BRCA genes)
Ovarian cancer
37
Rarely symptomatic until late stages of dz. DOES PRESENT WITH ASCITES**
Ovarian cancer
38
1. amenorrhea 2. obestity 3. hirsutism *due to insulin resistance
PCOS
39
DES (a synthetic estrogen) can increase risk of...
Cervical carcinoma and vaginal cancer
40
HPV 16**, 18**, 31, 33
Related to cervical carcinoma
41
HPV 16, 18, 31 MC presentation= vaginal pruritus, post coital bleeding Dx= red/white ulcerative, crusted lesions. bx!
Vaginal cancer
42
Ascending infection of the upper reproductive tract MC cause= gonorrhea, chlamydia
PID
43
Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, N/V Lower abdominal tenderness, fever. **Chandelier sign**
PID
44
All 3: 1. abdominal tenderness 2. adnexal tenderness 3. cervical motion tenderness
PID
45
Dx made with pelvic ultrasound **tx underlying cause!
PID
46
Duct obstruction leading to retained secretions and gland enlargement *may be infectious or caused by trauma
Bartholin cyst
47
If infected...tender, unilateral vulvar mass, edema/inflammation if noninfected...non tender, unilateral mass
Bartholin cyst | usually will just self resolve
48
Classic triad: 1. unilateral/pelvic abdominal pain 2. vaginal bleeding 3. amenorrhea
Ectopic pregnancy
49
Serial beta-HCG fails to double (normal pregnancy should double every 24-48 H) *dx made with transvaginal ultrasound
ectopic pregnancy
50
Absence of gestational sac with levels of beta-HCG greater than 2000 strongly suggests...
ectopic or nonviable intrauterine pregnancy
51
Which drug can be give in a stable ectopic pregnancy to destroy trophoblastic tissue
Methotrexate
52
Management of choice if an ectopic pregnancy has ruptured?
Laparoscopic salpingostomy
53
Severe abdominal bleeding, dizziness, N/V, syncope, signs of shock
Signs of ruptured ectopic pregnancy
54
Abnormal labor progression..3 categories 1. power=uterine contraxns 2. Passenger= size or position of baby 3. Passage=uterus or soft tissue abnormalities
Dystocia
55
Nonmanipulative= first line. McRoberts maneuver (increase pelvic opening with hyper flexion of hips)
Used first line for SHOULDER DYSTOCIA
56
Manipulative= second line. woods "corkscrew" maneuver..180 should rotation; C section
Used second line for SHOULDER DYSTOCIA
57
Increasing pelvic opening with hyper flexion of hips..maneuver used for shoulder dystocia
McRoberts maneuver
58
Chlamydia trachomatis *MC cause cervicitis
Chlamydia
59
May be asymptomatic Mucopurulent cervicitis Increased freq, dysuria Abdominal pain, PID, post coital bleeding LGV; PAINLESS genital ulcer
Chlamydia
60
Dx with LCR***, cultures, DNA probe
Chlamydia
61
Neisseria gonorrheae May be asymptomatic Vaginal discharge, cervicitis, increased frequency, dysuria Dx= culture, DNA
gonorrhea
62
Haemophilus ducreyi
Chancroid
63
Trepomena pallidum
Syphillis
64
Flat, papular pedunculate or flesh colored growths..."cauliflower like" lesions
HPV

Clin Med- Repro (11 decks)

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