abnormal uterine bleeding, paps

Question 1

causes of abnormal uterine bleeding

Answer 1

PALM-COEIN
polyp
adenomyosis
leiomyoma
malignancy and hyperplasia
coagulopathy
ovulatory dysfunction
endometrial 
iatrogenic
not yet classified

Question 2

endometrial polyp

Answer 2

hyperplastic overgrowths of endometrial glands and stroma
generally benign, but malignancy highest in postmenopausal women
can be E dependent

Question 3

fibroids

Answer 3

most common benign neoplasia of female genitals
smooth m and CT 
E/P sensitive
rarely become leiomyosarcoma
can cause torsions and infertility

Question 4

adenomyosis

Answer 4

triad- noncyclical pain, menorrhagia, enlarged uterus w/adnexal tenderness
Tx- NSAIDS, OCPs, ablation, hyseterectomy

Question 5

risk factors for fibroids

Answer 5

2-3x higher in african americans 
early emnarche
obesity
diet, alcohol, red meats, beer
HTN

Question 6

leiomyoma-myxoid degneration

Answer 6

larger leiomyomas outgrow blood supply undergo degeneration which can be hyaline, cystic, red carneous, or myxoid

Question 7

atrophic endometrium

Answer 7

most common cause of abnormal bleeding
hypoestrogen -> atrophy of endometrium
vag usually pale, dry, smooth and shiny with loss of rugation

Question 8

bacterial vaginosis

Answer 8

no inflammation therefore no pain or itching
overgrowth of normal flora anaerobic bacteria
loss of lactobacilli

Question 9

Dx of bacterial vaginosis

Answer 9

3+:
homogenous white-gray discharge
pH>4.5
\+whiff test with KOH
clue cells
gram stain is gold standard, but rarely done
PCR-based assay

Question 10

Tx of bacterial vaginosis

Answer 10

metronidazole (no alcohol)
clindamycin
tindazole

Question 11

trichomonas

Answer 11

bc motile causes bubbly appearance

Question 12

ASCUS

Answer 12

atypical squamous cells of undetermined significance

Question 13

ASC-H

Answer 13

atypical squamous cells- high grade

Question 14

AGUS

Answer 14

atypical glandular cells of undetermined significance

Question 15

LSIL

Answer 15

low grade squamous intraepithelial lesion

Question 16

HSIL

Answer 16

high grade squamous intraepithlial lesion

Question 17

screening 21-29

Answer 17

cytology alone every 3 years

Question 18

screening

Answer 18

cytology and HPV testing every 5 years

Question 19

recommendations to stop screening

Answer 19

65 with no CIN2+ in the last 20 yrs
plus either 3 consecutive paps or 2 consecutive negative HPV tests
can also stop after hysterctomy with removal of cervix and no CIN2+ Hx

Question 20

when should you not stop

Answer 20

Hx of CIN2, 3, AIS

Question 21

arm implant

Answer 21

etonogestrel
3 years
.05% failure

Question 22

ADR and CIs of arm implant

Answer 22

can have irregular spotting
acne
can cause bone mineral density decrease
SLE
hepatocellular adenoma
migraines with aura
unexplained vag bleeding before implantation

Question 23

paragaurd

Answer 23

copper IUD
up to 10 yrs
heavier periods
no side effects
CI in wilsons disease

Question 24

mirena

Answer 24

local progestin
up to 5 yrs
lighter-no periods
some rare side effects

Question 25

mechanism of cooper IUDs

Answer 25

mass effect
alters uterine and tubal fliud hinders sperm fnx and motility
inhibits fertilization
NOT abortifacient

Question 26

mechanism of mirena

Answer 26

impairs sperm motility/fnx
inhibits contraception
thickens cervical mucus 
atrophy of endometrium
impairs tubal motility

Question 27

depo provera

Answer 27

medroxyporgesterone acetate
every 3 months
bleeding irregularities
delayed return of fertility
weight gain
decrease in bone mineral density

Question 28

CI of depo provera

Answer 28

severe HTN

DM with vascular disease and or >20 yrs of disease