Test 3 Deck 6 Flashcards by Max Kaczmarek

Chronic pelvic pain description?

Noncyclic pain >6 months
Localized to an atomic pelvis, anterior abdominal wall at or below the umbilicus
Pain sufficiently severe to cause functional disability or lead to medical intervention

How well did you know this?

Not at all

Perfectly

Patients w/ chronic pelvic pain are more likely to develop what?

IBS, vulvodynia, interstitial cystitis, depression, fribomyalgia, chronic fatigue syndrome, temporomandibular disorder, migraine

How well did you know this?

Not at all

Perfectly

If a patient has a hx of ___ __ it makes them more likely to have chronic pelvic pain.

Sexual abuse

How well did you know this?

Not at all

Perfectly

What is important to remember on a gynecological exam for chronic pelvic pain?

They may hurt. Let the patient know you can stop whenever and start w/ outer paplation w/ q tip. Then slide in a single digit to look for trigger points, regions of tenderness, and nodules. Rectals are indicated. You may see allodynia and hyperalgesia

How well did you know this?

Not at all

Perfectly

What are some causes of chronic pelvic pain?

Pelvic adhesions (surgery)

Pelvic congestion syndrome (varicoceles)

How well did you know this?

Not at all

Perfectly

What is the treatment for pelvic congestion syndrome?

OCP, ovarian vein embolization, or hysterectomy

How well did you know this?

Not at all

Perfectly

What is the treatment for overall chronic pelvic pain?

Refer to GYN,

Antidepressants specifically TCA (amitryptyline)

How well did you know this?

Not at all

Perfectly

What is the treatment for vulvodynia?

Behavior therapy 
Topical lidocaine
Topical gabapentin
Antidepressants (TCA first line)
Anticonvulsants

How well did you know this?

Not at all

Perfectly

Pt presents w/ rawness, itching, cutting pain in vulvar region. Lacks physical signs, has new onset insertional dyspereunia (and pain w/ tampon insertion/bathing). Light touch applicator on vulva elicited tenderness and it’ erythematous. Dx__ trx__

Localized provoked vulvodynia

Neuropathic pain meds
Topical lidocaine

How well did you know this?

Not at all

Perfectly

Pushing around and hit a trigger point on outside?

Myofascial pain syndrome (muscle, but can be from chronic things like endometriosis, interstitial cystitis, or IBS)

How well did you know this?

Not at all

Perfectly

Pt. Having trigger pain involving the levator ani muscles. Pt. Complaining of lower abdominal pain, low back pain, dysperenuia, and chronic constipation. What is the treatment?

Reduce spasm and trigger points. PT, massage, botulinum toxin, analgesics, muscle relaxants

How well did you know this?

Not at all

Perfectly

Pt. Presents w/ complaint of pelvic girdle pain following pregnancy/ right around pregnancy. The pain is focused around the SI joints. You know this originates from injury or inflammation of pelvic and/or lower spine ligaments. DX__ trx__

Peripartum pelvic pain syndrome

PT, exercise, analgesics (NSAIDs/Tylenol)

How well did you know this?

Not at all

Perfectly

Pt. Presents w/ sharp, severe, shooting pain in clitoris, vulva, rectum. Aggravated by sitting. Doesn’t awaken patient from asleep and is relieved by a nerve blockade. Dx___ trx___

Pudendal neuralgia

PT, gabapentin/TCA, botulinum toxin, pudendal nerve stimulation/ surgical nerve decompression

How well did you know this?

Not at all

Perfectly

What is called when the uterus prolapses?

Procidentia

How well did you know this?

Not at all

Perfectly

Pt. Presents w/ bulge symptoms. Complaint of feeling like sitting on a ball. The symptoms are exacerbated by posture, and relieved by supine position. The have been using their fingers to help the remove stool. Dx__ trx__

Pelvic organ prolapse

Minimal sx: watch
Corrections:
Estrogen
Kegel’s
Pressaries
Surgery

How well did you know this?

Not at all

Perfectly

Pt. Presents w/ urinary frequency, urgency, and pelvic pain. You perform an exam and find mucosal changes (hunner ulceration) and reduced bladder capacity. they are triggered by alcohol, caffeine, smoking, spicy foods, citrus, fruits and juices (cranberry juice). DX___ dif. Dx__ trx__

Interstitial cystitis

Painful bladder syndrome

Pat education and avoidance of triggers

How well did you know this?

Not at all

Perfectly

What are the different types of incontinence?

Stress (involuntary leakage w/ increased in intraabdominal pressure)

Urge (void and right before need to go bad)

Overflow (incomplete emptying)

Functional (mixed stress and urge)

How well did you know this?

Not at all

Perfectly

Transient incontinence

DIAPPERS

Delirium/demmentia
Infection
Atrophic vaginitis/urethritis
Psychiatric disorders
Pharmacological disorders
Endocrine disease
Restricted mobility
Stool impaction

How well did you know this?

Not at all

Perfectly

If you pee when you cough, sneeze or lift, what iincontinance is that associated w/?

Stress

How well did you know this?

Not at all

Perfectly

If you pee, but you couldn’t make it to the toilet fast enough, what is that??

Urgent

How well did you know this?

Not at all

Perfectly

What is the cause of stress urinary incontience?

Pelvic floor or urethra weakness

How well did you know this?

Not at all

Perfectly

What is the cause of urge incontience?

Detrusor instability

How well did you know this?

Not at all

Perfectly

Pt. Presents w/ stress and urge incontinence symptoms. They complain of frequency, hesitation, nocturia, and dribbling. DX__ causes__

Incomplete bladder emptying

Overdistension/ bladder outlet restriction (surgery/injury)

CA++ blockers
Alpha adrenergic agonists

How well did you know this?

Not at all

Perfectly

What is the MC type of incontinence in women?

Mixed

How well did you know this?

Not at all

Perfectly

What is the q-tip test?

Change in angle by >30 degrees to horizontal suggests hyper mobility

What is the treatment for incontiinence?

Pelvic floor strengthening Kegel excersises 50-60 contractions a day Isotonic 10 seconds Biofeedback Dietary changes Addition of calcium glycerophphate my help reduce urgency Schedule voiding Estrogen replacement Incontinence pessary Surgery

What do anticholinergics do for incontinence?

Work on detrusor muscle

What does imipramine do for incontience?

Use for mixed

What can you use to treat for refractory urgency and anal incontinence?

Sacral neuomodulation (implantable system) Percutaneous tibial nerve stimulation

What medications does someone w/ stress incontinence want to avoid?

Alpha antagonists

What medications does someone w/ overflow incontience want to avoid?

Alpha agonists Anti-cholinergics Ca++ blockers

Diagnosis of menopause?

No menses for 1 year

Cessation of menstruation prior to age 40?

Premature ovarian failure

How long does menopause transition take?

4-7 years

What stages are associated w/ reproductive stages of the reproductive aging workshop?

-5, -4, -3

At what stage does the menopausal transition begin?

-2 (early) -1 (late)

How can you tell the difference when the menopausal transition begins?

Elevation of FSH

Early menopause transition does what to the menstrual cycles?

Variable cycle length (>7 days dif from normal)

What does late stage perimenopause (menopausal transition do to the period?

>= 2 skipped cycles and an interval of amenorrhea (>= 60 days)

How long is early post menopause?

4 years

Are you still able to become pregnant during early menopausal transition?

Yes

At what age can contraception be discontinued by all women?

55 y/o

What is the leading cause of death in women >50?

Cardiovascular disease

What is hormone therapy not recommended for?

Cardio protection

Horomone therapy reduces ___ cance risk, reduce __ fracture risk, but increase risk of cancer, stroke, blood clots, VTE, choleystitis, and possible ovarian cancer.

Colon, hip

When is hormone therapy indicated?

Vasomotor symptoms, vaginal atrophy, osteoporosis prevention and treatment

If the uterus is present what must you add to estrogen therapy?

Progestin to reduce the risk of endometrial cancer. Unopposed estrogen leads to endometrial hyperplasia

Estrogen CI:

1. Undiagnosed vag bleeding 2. Breast cancer 3. Estrogen dependent neoplasia 4. Thromboembolism 5. Thromboembolic disease (stroke, MI) 6. liver dysfunction 7. Pregnancy

What are the Hormonee therapy preps that may be used if the pt. Has a uterus?

Estrogen + progestins | Estrogen+ based oxide emissions

What other medications besides hormone therapy may be used for vasomotor treatment?

CNS agents; She really hit SNRIs (desvenlafaxine, and venlafaxine)

Who is screened for osteoporosis?

1. >=65 2. Or 1 or more risk factors 3. Sustain fractures

What z-score would indicate evaluating for osteoporosis?

WHO criteria for osteoporosis?

Normal BMD 2.5 to -1 Osteopenia -1 to -2.5 Osteoporosis < -2.5

Secondary causes that may want you to consider screening for osteoporosis?

``` Hyperparathyroid Hyperthyroid Renal failure Hypercortisoolism Alcoholic ```

What vitamins are recommended for women >=51 for prevention of osteoporosis?

Calcium 1200 mg, Vit D 800-1000 IU

What is the treatment for osteoporosis?

``` Regular weight bearing Stop smoking Decrease alcohol Lower weight Minimize fall risks Ca 1200-1500 Vit D 800 ```

Who get’s osteoporosis treatment?

1. Total hip/femoral neck/spine t-scores <=-2.5 2. Osteoporotic vertebral/hip fracture 3. -1 - -2.5 w/ oe or more additional risk factors for fracture

What are good antiresporptive agents?

Estrogen, SERMs, bisphosphanates, dnosumab

What are good medicines to stimulate bone formation (anabolic agents)?

Recombinant parathyroid hormone

What are the long term safety concerns of bisphosphanates?

Osteonecrosis of the Jaw, and atypical femur fractures

What drug decreases bone resorption by blocking the function and survival, but not the formation of osteoclasts?

Bisphosphonates

What drugs are agonists at the bone level and prevent vertebral fracture

SERM (Raloxifene)

What drugs inhibit osteoclast development and activity?

Monoclonal antibodies (denosumab)

What drug can be used in lieu of estrogen that reduces the risk of vertebral fractures and decreases the rate of bone resorption?

Salmon calcitonin

What drug is the only drug that builds bone by iincreasing osteoblast number and activity/ can only be used for 18-24 months?

Recombinant parathyroid hormone

T-score to DEXA scan frequency?

- 2 to -2.5 q 1 year - 1.5 to -2 q 3-5 year as - 1.01 to -1.5 q 10-15 years - 1 or higher q 15 years

Osteoporosis risk factors?

1. >65 2. Vertbral compression fix 3. Fragility fracture 4. Fam hx 5. System glucocorticoids >3 months 6. Malabsorption 7. Primary hyperparathyroid 8. Falling 9. Osteopenia on radiograph 10. Hypogonadism 11. Early menopause 12. Anticonvulsant therapy 13. Smoker 14. Alcoholic 15. Excessive caffeine 16. Weight <57 kg 17. >10% weight loss at 25 18. Chronic heparin therapy

Test 3 Deck 6 Flashcards

(67 cards)