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OBGYN > REI > Flashcards

REI Flashcards

1
Q

How do OCPs relieve primary dysmenorrhea?

A

Creating endometrial atrophy

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2
Q

GCCT screening

A

All sexually active 25yo and younger (including if presenting for pain, because could be PID)

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3
Q

HPV screening

A

As adjunct to cytology in women 30yo and older, or if Pap smear in a younger woman shows ASCUS

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4
Q

Secondary dysmenorrhea that does not resolve with ibuprofen, OCPs, depo-provera -> next step?

A 
Diagnostic laparoscopy (can confirm endometriosis and r/o other causes)
Some use a course of GnRH first
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5
Q

42yo woman with worsening menstrual pain, regular menses, very heavy flow. Soft, boggy uterus on exam, without masses.

A

Adenomyosis: at menses, gland tissue tries to slough but cannot escape and causes pain, monthly

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6
Q

Treatment of adenomyosis

A

Hysterectomy (definitive)
GnRH (but pain recurs after DC)
Endometrial ablation or IUD if want to stay fertile

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7
Q

Primary versus secondary dysmenorrhea

A

Primary dysmenorrhea: normal exam

Secondary dysmenorrhea: abnormal exam, such as a fixed uterus with uterosacral ligament nodularity

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8
Q

Endometrial biopsy indications

A

All woman over 40yo with irregular bleeding, to r/o endometrial carcinoma (even if fibroids sense on US)

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9
Q

Fibroids on pathology

A

Well-circumscribed, non-encapsulated myometrium

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10
Q

Endometriosis on pathology

A

Endometrial glands/stroma and hemosiderin-laden macrophages

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11
Q

Contraindications to HRT for menopause

A

Vaginal bleeding (must r/o endometrial cancer). Document UW with endometrial stripe <4 mm or negative tissue biopsy, first.

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12
Q

Menopause demographics

A

Average age 51, has remained stable

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13
Q

Premature ovarian failure

A

Menopause < 35 yo

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14
Q

Bisphosphonate treatment

A
  • Risk factors: hx fracture, low BMI, current smoking

* First document BMD wtih DEXA, and repeat every two years

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15
Q

HRT

A
  • Most effective tx for severe symptoms of hot flashes, night sweats, vag dryness
  • Use smallest dose for shortest time possible
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16
Q

Reason for noncompliance on HRT

A

Vaginal bleeding

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17
Q

HRT side effects

A

*Reduced LDL (increases catabolism and lipoprotein receptors), increased HDL and TG

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18
Q

Osteopenia

A

T-score -1 to -2.5

*If between -1.5 to -2, consider risk factors (fracture hx, FHx, race, smoking, nutrition, low BMI, alcohol)

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19
Q

Estrogen source after menopause

A

Aromatization of circulating estrogens

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20
Q

PCOS infertility workup

A

Check testosterone levels

Once diagnosis established, progesterone levels helpful during medical treatment to check if ovulation occurring

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21
Q

PCOS treatment

A

Weight loss, metformin, and ovulation induction agents (or OCPs to regulate cycles)

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22
Q

Hyperprolactinemia causes

A

Pituitary mass, antipsychotics, TCAs

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23
Q

Hypothalamic amenorrhea hormone levels

A

Normal FSH, low estrogen

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24
Q

Hypothalamic amenorrhea treatment

A

Weight gain
If this fails, exogenous gonadotropins (LH and FSH)
(Clomid does not work as well d/t baseline hypoestrogenic state)

25
Q

Decreased ovarian reserve workup

A

Clomiphene challenge test: give days 5-9 of cycle, and check FSH on days 3 and 10.

26
Q

PMDD diagnosis

A

Severe form of PMS, with 5/11 of clearly defined symptoms, functional impairment, and prospective charting of symptoms

27
Q

PMS risk factors

A

Deficiency in vitamins A, B6, E, calcium, magnesium; Family history; Mental health problems

28
Q

PMS treatment

A

Vit A, B6, E; OCPs (suppress HPO axis); SSRI; exercise (endorphins)
*Hysterectomy has no effect because ovaries still there. Would only change menstrual bleeding component.

29
Q

PMS differential

A

Hypothyroidism, PMS, PMDD

*Get prospective calendar diary

30
Q

Predictable sequence of sexual maturation

A

Thelarche (breast) -> adrenarche/pubarche -> growth spurt -> menarche

31
Q

Early/late menarche

A

Before 9 or after 17

32
Q

Reasons for delayed menarche

A

Inadequate body weight <85-106 lb; sleep problems; optic exposure to light problems; psychosocial (eating disorder, excess exercise, stress, depression)

33
Q

Short stature, webbed neck, heart defects, abnormal faces, delayed puberty

A

Noonan’s syndrome: normal karyotype

34
Q

Failure to establish secondary sexual characteristics, short stature, pterygium colli, shield chest, cubitus valgus

A

Turner’s syndrome: 45X

35
Q

Vaginal and uterine agensis

A

Mullerian agenesis a.k.a. Rokitansky-Kuster-Hauser syndrome. Normal ovarian function and secondary sex characteristics.

36
Q

Delayed menarche, lack of secondary sexual characteristics, lack of sense of smell

A

Kallmann syndrome: olfactory tract hypoplasia and arcuate nucleus does not secrete GnRH
*Treat: pulsatile GnRH

37
Q

7yo girl with menarche, tanner III breasts, tall stature, otherwise normal. Normal MRI of brain and pelvic US. Prepubartal LH and FSH, normal DHEAS and androgen.

A

True precocious puberty: HPO axis increased GnRH pulsatile secretion, increase sex steoird

38
Q

Premature menses before breast and pubes

A

McCune Alrbright syndrome

39
Q

Precocious puberty treatment

A
  • R/o other causes (brain, adrenal, ovarian)

* GnRH agonist to suppress pituitary FSH and LH production

40
Q

4yo girl with pubic hair but no breast or menses. Labs show high DHEA and DHEAS levels, and low LH and FSH.

A

CAH: 21-hydroxylase deficiency -> blocked conversion of 17-hydroxyprogesteron to desoxycorticosterone -> accumulation of androgens and inadequate cortisol -> precoucious adrenarche with pubes
*Tx: steroid replacement

41
Q

17yo girl without menarche. Normal breast and pubes. Small vaginal opening and blind pouch. Normal ovaries but no uterus or cervix on US. Next study?

A

Mullerian agenesis: renal anomalies in 30%. Normal secondary sex characteristics due to normal ovaries. Karyotype usually normal, and testosterone normal for female.
*Renal US

42
Q

Anorexia nervosa method of amenorrhea

A

H-P dysfunction: Lack of GnRH pulsatility -> decreased pituitary stimulation to secrete FSH and LH -> anovulation and amenorrhea

43
Q

H-P amenorrhea causes

A

Functional (weight loss, obesity, exercise), drugs (weed and tranquilizers), neoplasia (pituitary adenoma), psychogenic (anxiety, anorexia)
*Low FSH and LH levels

44
Q

Amenorrhea

A

D&C -> Intrauterine synechiae or adhesions -> trauma to basal layer of endometrium

45
Q

Initial amenorrhea workup

A

Beta-hCG, TSH, prolactin -> if normal, FSH and LH

46
Q

New onset irregular menses, hirsutism with normal testosterone and elevated DHEAS

A

Adrenal tumor

47
Q

18yo girl with hirsutism, acne, irregular menses. FHx of same. Normal TSH, prolactin, testosterone, and DHEAS.

A

R/o late-onset 21-hydroxylase deficiency by checking 17-hydroxyprogesterone.
*Labs make pituitary or adrenal tumor, or PCOS unlikely.

48
Q

Causes of hirsutism

A
  • PCOS (high testosterone) or hyperthecosis (severe form)
  • Adrenal tumor (high DHEAS)
  • Late-onset CAH (high 17-hydroxyprogesterone)
  • Idiopathic hirsutism
  • Cushing’s syndrome (overnight dexamethasone suppression test or 24hr urinary measurement cortisol)
  • Sertoli-Leydig cell tumor (suppressed FSH and LH, elevated testosterone, ovarian mass - get US)
  • Hypothyroid
  • Anabolic steroids
49
Q

Treatment of hirsutism

A

OCPs (regulate ovulation, lower ovarian androgen production, increase SHBG); spironolactone; lupron; depo-provera

50
Q

Acanthosis nigricans

A

Hyperinsulinemia and high androgens

51
Q

Postpartum hair loss

A

D/t high estrogen levels in pregnancy -> synchrony of hair growth

52
Q

Medroxyprogesterone acetate (MPA)

A

Treatment of anovulatory bleeding by converting endometrium from proliferative to secretory, then withdrawal to mimic effect of corpus luteum involution -> sloughing

53
Q

Treatment of endometrial polyp

A
  • Observation or medical progestin if < 1.5cm and infertility not an issue
  • Hysteroscopic polypectomy if infertility an issue
  • Hysterectomy if polyps and premalignant/malignant changes
  • Curettage?
54
Q

Obesity and irregular bleeding workup

A

Endometrial biopsy

55
Q

Intermenstrual bleeding workup

A

Pelvic ultrasound to evaluate for structural abnormalities (myoma, polyp, malignancy)

56
Q

Teen with spotting and adnexal mass workup

A

Pregnancy test -> negative, then pelvic US

57
Q

Dysfunctional uterine bleeding

A

Irregular or increased menstrual bleeding without identified etiology, even with 2cm functional ovarian cyst (common finding and not associated with abnormal menses)

58
Q

Submucosal leiomyoma treatment

A
  • Hysteroscopy with myoma resection
  • Endometrial ablation if done with childbearing
  • OCPs may help with heavy menses but contraindicated if >35 and smoker

OBGYN (4 decks)

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