6. Reproductive Flashcards
Basic PathoPhysiology of Mense cycles
Day 1-12
- GnRH -> FSH, LH -> Estrogen
- FSH increase cause follicle & egg matruation
- LH stimulates the maturing follicle to produce estrogen to build endometrium (preparing pregenancy environment)
Ovulation 12-14
- LH surge cause release egg
Day 14-28
- Estrogen decrease and Progesterone increase
1st day of mensteration
- fall of estrogen and progesteron cause lose of endometrium (shed tissue and bleed)
Type of amenorrhea explain
- Amenorrhea
- Cryptomenorrhea
- Menorrhea
- Metrorrhea
- MenoMetrorrhagia
- Oligomenorrhea
- Polymenorrhagia
- not bleeding
- light bleeding
- Large bleeding
- Irregular bleeding
- Large irregular bleeding
- Prolonged cycle length >35 days
- Frequent cycle interval <21 days
US normal, normal pep, but irregular bleeding
Name/Etio/Dx/Tx
Name: DUB (dysfunctional uterine bleeding)
Etio: Anovulation(high estrogen), Ovulation
Dx: Diagnosis of exclusion
Tx
- OCP
- Progesterone
- Surgery
- Hysterectomy (definitive)
- Endometrial ablation (pt who wants keep productive)
Diffuse pelvic pain right before or with the onset of menses
Name/Tx
Name: Dysmenorrhea
Tx: NSAID
Physical, behavioral & mood change with cyclical occurence during luteal phase (1-2 weeks before mense)
Name/Other type/Tx/Workup differentiate
Name: Premenstural syndrome
Other type: Premenstrual dysphoric disorder (PMDD)
- additional sx: Anger & irritabillity
Tx: SSRI, OCP
Workup: Hyper/hypothyroidism check (may mimic)
Failure of mense before 15y or no second sex characteristic by 13y
Name
- Uterine present + breast absent=?
- Uterine absent + breast present=?
Name: Primary amenorrhea
- 2type
- FSH, LH low - hypothalamus
- FSH, LH high - Turner
- Mullerine, androgen
Not bleeding but no genetic issue
Possible 5 dz/Dx/Tx
- MC cause pregnancy
- Hypothalamus
- Dx: low LH, FSH
- Tx: Clomephen
- Pituitary dysfunction
- Dx: low FSH, LH, + Prolactin high
- Tx: TSS
- Ovarien failure
- Dx: high FSH, LH + low estrogen
- Uterine disorder
- Dx: Pelvic US, hysteroscopy
- Tx: estrogen tx
age of 50y women + has not bleeding for a year
+ hot flashes and mood change
Name/Risk/PE/Dx/Complication/Tx
Premanopause vs perimanopause Term?
Name: Menopause
Risk: 50-52y
PE: bone density low, Vaginal atropy
Dx: FSH (1st) -> FSH high LH high but estrogen low
Complication: Osteoporosis
Tx: HRT
- Estrogen only
- Benefit: good for sx
- Risk: endometrial cancer, thromboembolism
- Often use this for nonintact uterus
-
Estrogen + progesterone (best option often)
- Benefit: protect against endometrial cancer
- Often use this for intact uterus
Vaginal atrophy: estrogen cream
Premanopause - no sx
Perimanopause - estrogen drop and shows sx
leiomyoma vs adenomyosis
Leiomyoma
- Benign smooth muscle tumor
- MC AA
- PE: Asymetric, firm, nontender mass
- Dx: US
- Tx: Observe + leuprolide (GnRH inhibitor)
- Definitive: hysterectomy, myodectomy for preserve inferility
Adenomyosis
- Ectopic endometrial hypetrophy within muscle layer of uterine
- PE: Symetric, soft, tender mass
- Dx: MRI
- Tx: Total abdominal hysterectomy
infection post C-section + fever, tachycardia
Name/Pathogen/Tx
Name: Endometritis
Pathogen: GBS
Risk: C-section
Tx: Clinda + gentamycin
Prophylaxis: 1st gen cephalosporin
nulliparty + pelvic pain + painful intercourse
Name/Patho/Risk/Dx/Tx
Name: Endometriosis
Patho: ectopic endometrial tissue (MC ovaries)
Risk: Nulliparty, <35y
Dx: Laparoscopy w/ biopsy
Tx: OCP + NSAID, Danzol, leuprolide
- Surgical
- Keep fertility -> abalation
- Not keep fertility -> total abdominal hysterectomy
Precursor to endometrial cancer + Post menopausal bleeding
Name/Patho/Dx/Tx
Name: Endometrial hyperplasia
Patho: estrogen high by hyperplasia
Dx: Transvaginal US (1st) - endometrial stripe >4mm -> Endometrial bx (definitive)
Tx
- Hyperplasia w/o atypia - progestin
- Hyperplasia w/ atypia - hysterectomy
Manopausal bleeding + hx of use estrogen
Name/Risk/Dx/Tx
Name: Endometrial Cancer
Risk: hx of use estrogen
Dx: Transvaginal US (1st) - endometrial stripe >4mm ->endometrial bx
Tx: Hysterectomy
Uterine prolapse
3 type/Grade/Sx/PE/Tx
3 type
- Cystocele: Posterior bladder herinating into Anterior vagina
- Enterocele: Small bowel herniate into Upper vagina
- Rectocele: sigmoid colon(rectum) herniate into Posterior distal vagina
Grade
- descent into upper 2/3 of the vagina
- cervix approaches introitus
- outside introitus
- entire uterus out
Sx: pevic or vaginal heaviness, fullness, falling out sensation
PE: Bulging mass when introabdominal pressure (valsalva)
Tx
- Prophylactic - kegel exercise
- Nonsurgical - pessaries
- Surgical - hysterectomy (grade 4)
Unilateral RLQ or LLQ pain + otherwise normal
Name/Dx/Tx
Name: Functional ovarian cysts
Dx: Pelvic US
Tx: Supportive
- Cyst <8cm - rest, NSAID
- if 8cm< - laparoscopy or laparotomy
- Repeat US after 6 weeks
Palpable overain mass + postmenopausal bleeding
Name/Risk/Dx/Tx/Protective factors
Name: Overian cancer
Risk: hx of fx, BRCA
Dx: Biopsy 90% Epithelial, CA 125 serum
Tx
- TAH-BSO
- Chemo + surgery
Protective factors: OCP
Amenorrhea + Obesity + Hirsutism + hx of DM
Name/Dx/Tx
Name: PCOS (polycystic overian syndrome)
Dx: LH:FSH >3:1, Labs - testosterone
- Pelvic US: string of Pearls
Tx: OCP (main)
- Hirsutism: spironlactone
- Infertility: clomiphene
Cervical test result/bx - tx
- Negative - Normal pap -> NO HPV test
- ASC-US - if >25y
- HPV test
- neg -> 3y
- POS -> colposcopy
- HPV test
- ASC-H - Colposcopy
- LSIL
- 25-29 -> colposcopy
- >30 - HPV test
- Neg -> Pap 1y
- POS -> colposcopy w/ bx
- HSIL - Colposcopy
Biopsy result
- CIN 1 - mild -> Observe or leep
- CIN2,3 - Moderate(1/3 - 2/3 thick), severe -> leep or abalation
Bleeding after sex, Non-menstrual bleeding
Name/Risk/Dx/Tx
Name: Cervical carcinoma
Risk: DES exposure (estrogen), HPV 16/18
- MC Squamous
Dx: Colposcopy w/ bx
Tx: early - leep, abalation
- Stage 1 - 2a - TAH-BSO
- Stage 2a above - TAH-BSO + Chemo
HPV vaccination recommendation
Age/type of vaccine/schedule
HPV vaccination: 11-26y
- Gardasil: HPV 6,11,16,18
- Gardasil 9: 5 more then regular
Schedule
- <15y 2 dose HPV 6month apart
- >15y 3 dose 2,4month apart
Cervical cancer screening
Age initiate/Discontinue/Recommendation pap
Age: 21
Discontinue: 65
Test
- 21-29: Pap test
- >30: Pap 3y HPV 5y
Painless cervical dilation in 2nd trimester
Name/Risk/Tx
Name: Cervical insufficiency
Risk: DES exposure
Tx: cerclage + bed rest (may add 17 alpha-hydroxyprogesterone)
Tender vulvar 4 or 8 o’clock
Name/Dx/Tx
Name: Bartholin cyst/abscess
Patho: bartholin duct obstruction
Sx
- Tender - infected
- Nontender - not infected
Dx: CBC, culture
Tx: I & D w/ abx
significant pruritus + red/white ulcerative
Name/Risk/Tx
Name: Vulvar cancer
Risk: 90% squamous (HPV 16,18,31)
Tx: Surgical remove + Chemo
Vagnial dryness, dyspareunia (painful sex)
Name/Tx
Name: Vulvovaginal atrophy
Tx: Vaginal estrogen cream
Unilateral breast pain
Name/Risk/Tx
Name: Mastitis/breast abscess
Pathogen: S. Aureus
Sx
- Unilateral - infected
- Bilateral - congestive
- Breast Abscess - induration with fluctuance
Tx
- Infected - dicloxacillin, Continue breast pump
- Congestive - ice pack, tight-fitting bras
- Breast abscess - I & D, discontinue breastfeeding from the affected breast