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WH Dx 6 Flashcards

1
Q

PCOS is a condition that

A

causes irregular periods, acne, extra facial hair, hair loss on head, excess weight, and obesity

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2
Q

causes irregular periods, acne, extra facial hair, hair loss on head, excess weight, and obesity

A

PCOS

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3
Q

PCOS clinical manifestations
9

A
  1. oligomenorrhea - < 9 periods/yr
  2. amenorrhea - no period for 3 or more months
  3. hyperandrogenism
  4. polycystic ovaries found on TVUS
  5. metabolic issue/CV risks - overweight, obese
  6. sleep apnea
  7. depression
  8. anxiety
  9. trouble getting pregnant
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4
Q

PCOS should be suspected in any women who

A

is of reproductive age who presents with irregular menses and symptoms of hyperandrogenism

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5
Q

PCOS DD
3

A
  1. non-classic congenital adrenal hyperplasia (NCCAH)
  2. thyroid disease
  3. hyperprolactinemia
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6
Q

PCOS education
3

A
  1. This condition is caused by hormone imbalances include elevated testosterone levels
  2. This condition can increase your risk of DM, high cholesterol, sleep apnea, mood disorders, and less interest in sex.
  3. Managing weight may help your periods become more regular and improve your chance of getting pregnant.
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7
Q

PCOS medication

A

oral contraception - pill or mini pill can be some options

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8
Q

PCOS test
3 - criteria, labs (7), US

A
  1. use Rotterdam criteria (used to make diagnosis but only when other conditions have been excluded)
  2. Labs - androgens, total testosterone, 17-hydroxyprogesterone, HCG, prolactin, TSH, FSH
  3. pelvic US to assess for polycystic ovaries
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9
Q

PCOS f/u

A

1 month to assess s/sx

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10
Q

PCOS red flags
4

A
  1. worsening of sx
  2. sx not improving on meds
  3. increase in abd and/or pelvic pain
  4. abnormal bleeding patterns such as heavy menses, passing clots
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11
Q

pelvic pain - chronic pelvic pain CPP clinical presentation
5

A
  1. noncyclic pain localized to the pelvic
  2. 3-6 months or longer
  3. pain may radiate to pelvis, urinary or GI
  4. impaired quality of life
  5. mental changes
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12
Q

pelvic pain - pain that worsens with eating and or improve with BM suggests

A

GI process

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13
Q

pelvic pain - pain with urination or defecation can be
3

A

endometriosis
bladder pathologies
intestine pathologies

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14
Q

pelvic pain - pain with specific activities or position changes suggests
2

A

MS
vascular etiology

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15
Q

Acute pelvic pain is

A

lower abd or pelvic pain lasting less than 3 months

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16
Q

pelvic pain DD
4

A

appendicitis
UTI
pregnancy
PID

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17
Q

pelvic pain education
3

A
  1. Can be caused by many things
  2. treated depending on cause of pain
  3. a pain clinic may be beneficial as they can provide acupuncture, relaxation techniques, and more
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18
Q

pelvic pain meds
2

A

tylenol
ibuprofen

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19
Q

pelvic pain tests
6

A

bimanual pelvic exam
speculum exam
pregnancy test
Urinalysis
STD testing
pelvic US

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20
Q

pelvic pain f/u

A

in 4 weeks to review results, US results, and assess pelvic pain; will refer to pelvic floor PT

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21
Q

pelvic pain red flags
5

A
  1. worsening of symptoms
  2. worsening of pain
  3. change in bowel or urinary habits such as being unable to have a BM or urinate
  4. change in characteristic of pain
  5. abnormal bleeding
22
Q

PID

A

acute and subclinical infection of the upper genital tract involving any or all of the uterus, fallopian tubes, and ovaries

23
Q

acute and subclinical infection of the upper genital tract involving any or all of the uterus, fallopian tubes, and ovaries

A

PID

24
Q

PID most cases are caused by

A

STD or BV-associated pathogens

25
Q

PID - patients at risk include
5

A
  1. sexually active females
  2. multiple sex partners
  3. younger than 25
  4. partner with STD
  5. prior history of PID or STI
26
Q

PID acute s/sx
7

A
  1. acute onset of lower abd or pelvic pain, pelvic organ tenderness, inflammation of genital tract
  2. lower abd pain is cardinal presenting symptom
  3. abnormal uterine bleeding
  4. urinary frequency
  5. abnormal vaginal discharge
  6. abd tenderness on palpation, greatest in lower quadrants
  7. acute cervical motion, uterine, and adnexal tenderness on bimanual pelvic exam
27
Q

PID cardinal presenting symptom

A

lower abd pain - variable, may worsen during sex or with jarring movement, pain during or shortly after menses

28
Q

lower abd pain - variable, may worsen during sex or with jarring movement, pain during or shortly after menses

A

PID

29
Q

PID - abnormal uterine bleeding occurs in

A

1/3 or more patients

30
Q

PID - bimanual exam findings

A

acute cervical motion
uterine tenderness
adnexal tenderness

31
Q

Acute cervical motion tenderness, uterine and adnexal tenderness on bimanual exam

A

PID

32
Q

PID - ___ diagnosis remains the most important practical approach

A

clinical

33
Q

PID DD
4

A

ovarian cyst rupture
ectopic pregnancy
endometriosis
IBS
pelvic pain

34
Q

PID education
4

A
  1. This is an infection that affects the reproductive system.
  2. Most commonly caused by infections spread through sex.
  3. Can lower your risk of getting PID by using condoms every time, not having sex with someone with an infection, or remaining abstinent
  4. Refrain from sex until therapy is completed, symptoms have resolved, and the sex partner has been evaluated and/or treated for potential STI
35
Q

Common STDs that cause PID
2

A

gonorrhea
chlamydia

36
Q

PID medication

A

antibiotic, analgesics

37
Q

PID tests
4

A
  1. pregnancy test
  2. microscopy of vaginal discharge
  3. STD testing
  4. HIV screening
38
Q

PID f/u

A

48-72 hours after starting antibiotics to assess for clinical improvement of abd tenderness and reduced cervical motion tenderness

39
Q

PID AG

A

HPV vaccine 9-45 years old

40
Q

PID red flags
4

A

worsening of symptoms
increased pain/discomfort
no improvement once starting tx
symptoms return quickly

41
Q

postcoital bleeding

A

spotting or bleeding that occurs during or after sex and is not related to menstruation

42
Q

spotting or bleeding that occurs during or after sex and is not related to menstruation

A

postcoital bleeding

43
Q

postcoital bleeding causes can include
5

A
  1. infection - STD, PID, endometriosis
  2. noninfectious - cervical ectropion, polyps
  3. contraception
  4. laceration to tissue
  5. malignancy - cervical cancer
44
Q

postcoital bleeding physical exam should include
3

A
  1. inspect external genitalia and urethra
  2. speculum exam
  3. bimanual exam
45
Q

postcoital bleeding DD
4

A

vaginitis
STD
endometriosis
PID

46
Q

postcoital bleeding education
3

A
  1. this may go away on its own, depending of cause
  2. use protection each time you have sex
  3. use lubricants if experiencing vaginal dryness as this can cause irritation and bleeding
47
Q

postcoital bleeding meds
3

A

treatment depends on cause
1. infection - treat with antibiotics
2. atrophic changes - lubricants
3. change BC to progestin-only pill

48
Q

postcoital bleeding tests
5

A
  1. pregnancy test
  2. pap test with HPV testing if not done in last 6-12 months even if not due yet
  3. STD - gonorrhea, chlamydia, trichomoniasis
  4. BV wet mount smear
  5. Pelvic US
49
Q

postcoital bleeding f/u

A

4 weeks to assess for changes

50
Q

postcoital bleeding red flags
4

A
  1. worsening s/sx
  2. increased bleeding
  3. change in vaginal discharge
  4. pain/discomfort

osci (20 decks)

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