vaginal bleeding

Question 1

what age is average menarche and menopause

Answer 1

11 and 51

Question 2

what is the most common cause of premenarchal bleeding

Answer 2

foreign object due to self insertion

Question 3

what is the most common cause of reproductive age bleeding?

Answer 3

pregnancy

Question 4

what is the most of postmenopausal bleeding

Answer 4

vaginal atrophy (especially after sex)

Question 5

what is important to consider in premenarche

Answer 5

sexual abuse

precocious puberty

Question 6

what is important to consider in postmenopasusal

Answer 6

endometrial cancer

Question 7

what is important to consider in reproductive age

Answer 7

think PAD (pregnancy, anatomy, abnormal uterine bleeding) 
Don't rule out cervical cancer but this is decreasing

Question 8

How do we do a speculum exam on a minor and why

Answer 8

under anesthesia because its dramatic

Question 9

How to shut off acute bleeding of the uterus

Answer 9

IV estrogen

Question 10

what is an absolute indication for significant uterine bleeding

Answer 10

hemoglobin < 7

Question 11

what is a mechanical method for hemorrhaging

Answer 11

intracavitary tamponade

Question 12

what is the most absolute cure for hemorrhaging

Answer 12

total hysterectomy

Question 13

what are the stages of abortion?

Answer 13

IUP-threatened-inevitable-incomplete-complete

Question 14

IUP definition

Answer 14

closed os, ultrasound shows live baby, no passage of contents.

Question 15

threatened abortion defined

Answer 15

closed os, no passage of contents, live baby.

Question 16

inevitable abortion definition

Answer 16

no passage of contents, dead baby, open os

Question 17

incomplete abortion definitino

Answer 17

passage of contents (some), retained parts, open os baby always dead.

Question 18

complete abortion

Answer 18

passage of contents is complete, closed os, no baby on ultrasound

Question 19

missed abortion

Answer 19

no passage of contents, dead baby, closed os. mom missed the death of baby and usually doesnt know that this happened.

Question 20

what to do with missed abortion

Answer 20

misprostol (1st trimester), induce delivery pitocin, d and c.

Question 21

what do we give Rh negative mothers

Answer 21

RhoGAM

Question 22

what are fibroids

Answer 22

leiomyoma are benign growths of the myometrium and respond to estrogen. They DO NOT cause cancer. highly vascular

Question 23

how to fibroids present

Answer 23

anemia, pain, infertility, visceral obstruction.

Question 24

how to diagnose firboids

Answer 24

transvaginal ultrasound, but the best is MRI. MRI is never gotten.

Question 25

treatment of fibroids

Answer 25

medicine: OCP/IUD. NSAIDs for pain. surgery: fertility is the question. if she wants kids then do myomectomy which is usually not effective long term. Hysterectomy is usually best. can give leuprolide to shrink d

Question 26

what is leuprolide

Answer 26

a GnRH analog that decreases testosterone and estradiol production.

Question 27

when is AUB

Answer 27

reproductive age woman only

Question 28

first line therapies for AUB

Answer 28

1) NSAIDs (can actually reduce bleeding because of their negative impact on prostaglandin 2) OCP/IUD 3) ablation or hysterectomy

Question 29

why is PCOS important for AUB

Answer 29

because this is classic anovulation which causes a predominantly estrogen++ system and also makes testosterone. Thus she becomes him.

Question 30

where does testosterone in PCOS come from

Answer 30

atretic follicles.

Question 31

how does PCOS present/diagnose

Answer 31

fat, hairy woman. metabolic syndrome. dyslipidemia, diabetes, infertility, hypertension. menometrorrhagia (no system control) need hyperandrogenism (DHEAs, testosterone, LH/FSH ratio > 3:1 imaging for follicles

Question 32

what is the biochemical test and result that suggests PCOS

Answer 32

LH/FSH ratio >3:1

Question 33

what is the treatment for PCOS

Answer 33

``` weight loss and exercise can produce results, but never by themselves. METFORMIN is the treatment OCPs and IUDs Clomiphine for helping with pregnancy. spironoleptone. ```

Question 34

why metformin for PCOS

Answer 34

pushes PCOS into ovulation

Question 35

what are the causes of AUB

Answer 35

PALM-COEIN: polyp, adenomyosis, leiomyomas, malignancy, coagulopathy, ovulapathy, endometrial issues, iatrogenic (IUD), not yet specified.

Question 36

what is a fibroid?

Answer 36

benign growth within the endometrium. nodular, asymmetric

Question 37

what are the different types of fibroids?

Answer 37

subsereosal, submucosal, transmural, abdominal, peduculated

Question 38

what is adenomyosis

Answer 38

endometrial growth, proliferatio of glandular tissue. SYMMETRIC. smooth and boggy

Question 39

Polyps are what?

Answer 39

peduculated mass in the uterus

Question 40

do fibroids cause cancer?

Answer 40

NO.

Question 41

are fibroids estrogen responsive>?

Answer 41

Yes. they may change with cycles. proliferate under cycles

Question 42

what is the patient experience of fibroids

Answer 42

asymptomatic lump, anemia/bleeding (highly vascular), painful, may cause infertility.

Question 43

what is a complication of large fibroids

Answer 43

visceral obstruction

Question 44

what is the diagnostic step for fibroids?

Answer 44

works: transvaginal ultrasound...MRI is best | best test is Biopsy.

Question 45

treatment of fibroids

Answer 45

meds: oral contraceptives (or IUD). NSAIDs for pain. surgery: does the patient want kids? wants kids: myomectomy (scooping out fibroids). hysterectomy --satisfaction rate is HIGH. leuprolide (gNRH) to shrink the fibroids.

Question 46

what does ovulation do?

Answer 46

switches axis to progesterone to stop proliferation of the endometrium

Question 47

what does estrogen do?

Answer 47

builds the endometrium. if there is no ovulation, then the endometrium will continue to build until it becomes avascular and eventually sheds--AUB

Question 48

when is AUB normal?

Answer 48

during menarche and menses

Question 49

treatment for AUB

Answer 49

medical: OCP (IUD also) --take over the cycle. NSAIDs can reduce bleeding. have a predominant prostaglandin effect in the uterus, thus they slow down bleeding surgery: ablation and hysterectomy.