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OBGYN > Amenorrhea/Bleeding > Flashcards

Amenorrhea/Bleeding Flashcards

1
Q

46XX w/primary amenorrhea

A

Mullerian agenesis

= no Müllerian ducts = no uterus or upper vag

+ boobs, pubes, ovaries but -uterus = primary amenorrhea

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2
Q

46XY w/primary amenorrhea

A

Androgen insensitivity

=no androgen receptor! Balls present and making testosterone but due to lack of receptor wolf degrades, MIF degrades mullerian.

+testes +breast -pubes -uterus =primary amenorrhea

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3
Q

45X w/primary amenorrhea

A

Turners!

No ovaries and no estrogen!

Streak ovaries, short stature, webbed neck, infertility, amenorrhea, broad chest, urinary track abnormalities, bicuspid aortic, aortic core Tatian, dysgerminomas risk, normal intelligence

  • ovaries,breast,pubes but + uterus = primary amenorrhea
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4
Q

Amenorrhea and can’t smell

A

Kallman syndrome = no GnRH = no LH & FSH = no E&P

-boobs +uterus

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5
Q

+ boobs, pubes, ovaries but -uterus = primary amenorrhea

A

Mullerian agenesis 46XX

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6
Q

+testes +breast -pubes -uterus =primary amenorrhea

A

Androgen insensitivity 46XY

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7
Q

Causes of primary amenorrhea

A 
Kallman syndrome
Mullerian agen(46XX)
Androgen insensitivity(46XY)
Turners (45X)
Swyer Syndrome(46XY)
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8
Q

What is important to do for ppl with androgen insensitivity that you don’t do for mullerian agenesis?

A

Remove testes once developed to prevent cancer and then start hormone therapy.

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9
Q

Kallmann syndrome tx

A

Replace hormones appropriate for sex

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10
Q

what might need to be done for women with mullerian agenesis & androgen insensitivity?

A

elevate the vagina to increase its length to increase satifaction with sex

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11
Q

all girls should develop menarche by —- and begin to develop secondary sex char by —-.

A

15, 13

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12
Q

testosterone in mullerian agen vs androgen insens?

A

normal in mullerian but elevated in androgen insen.

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13
Q

what does a negative progesterone challenge test tell you?

A

absence of withdrawal bleeding is caused by either inadequat estrogen priming of the endometrium or outflow tract obstruction(imperforate hymen).

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14
Q

what does a positive Progesterone challenge test tell you?

A

diagnostic of anovulation! = need to give cyclic progesterone to prevent endometrial hyperplasia. give Clomiphene if pregnancy is desired.

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15
Q

What does a negative estrogen-progest challenge test tell you?

A

diagnostic of outflow obstruction or endometrial scarring(Asherman Syndrome) = do hysterosalpingogram(HSG) to ID

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16
Q

What does a positive estrogen-progest challenge test tell you?

A

bleeding = there just wasnt enough estrogen in the first place. look at FSH to ID etiology.

  • elevated FSH = ovarian failure
  • low FSH = need to r/o brain tumor.
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17
Q

what is asherman syndrome?

A

scarring of the uterus due to extensive uterine curettage and infection-producting adhesions.

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18
Q

define primary amenorrhea

A

girl who has never had a period

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19
Q

define secondary amenorrhea

A

women of reproductive age who has stopped having periods for >6 months.

^nobody waits that long to investigate though lol

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20
Q

causes of secondary amenorrhea

A
  1. Pregnancy
  2. Hypothyroidism
  3. Prolactinoma
  4. Meds
  5. Menopause
  6. Savage Syndrome/Resistant ovarian Syndrome
  7. Asherman’s Syndrome
  8. Hypothalamus
  9. Primary Ovarian Insufficiency
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21
Q

how does hypothyroid cause secondary amenorrhea? how do you treat?

A

hypothyroid = increased TSH = increases prolactin production = inhibits GnRH causing amenorrhea.
*will also see dec FSH & LH(duh) just like wiht a prolactinoma.

tx: levothyroxine

22
Q

work up and tx of prolacintoma

A

suspect if galactorrhea or amenorhea. get prolactin level then MRI.

tx: Pramixpaxole < cabergoline

23
Q

what drugs will cause secondary amenorrhea?

A

DA antagoinist like atypical antipsychotics.

24
Q

hormone levels in menopause…

A

elevated FSH and LH

25
Q

28 yo women who has 2nd amenorrhea. FSH and LH are elevated. U/S shows many follicles. dx? tx?

A

Savage Syndrome/Resistant ovary Syndrome = basically early menopause =(
*no tx =(

26
Q

How do you dx secondary amenorrhea due to hypothalamus?

A

dx of exclusion! look at FSH and LH levels along with E & P levels

27
Q

causes of vaginal bleeding in premenstral girls. Whats the most common?

A
  1. Foreign Body (MC)
  2. sexual abuse
  3. precocious puberty
  4. Sarcoma Botyroides

dx: speculum Exam!

28
Q

causes of vaginal bleeding in reproductive age women. Whats the most common?

A
  1. Pregnancy(MC)
  2. Anatomy(PALM COEIN)
  3. Dysfunctional/abnormal Uterine Bleeding
29
Q

causes of vaginal bleeding in postmenopausal women. Whats the most common?

A
  1. Atrophy(MC)
  2. Endometrial Carcinoma
  3. Hormone Repacment Therapy(HRT)
30
Q

What are the escalating steps for heavy, life threatening bleeding.

A
  • always remember 2 large bore IVs + IVF
    1. IV estrogen to stop
    2. Balloon tamponade
    3. D&C
    4. Uterine A. Embolization
    5. Hysterectomy
31
Q

PALM COINE

A

Polyps, Adenomyosis, Leiomyomas, Malignancy, Coagulopathies, Ovarian Dysfunction, Endometrial probs, Iatrogenic = IUD, Not Yet Classified

^causes of anatomic causes of uterine bleeding

32
Q

What are Fibroids?

A

Leiomyomas in the Uterus = benign. Asymmetric, hard nodules, painful, may have iron def due to bleeding, can cause problems wiht pregnancy or obstruction due to location(due to size). Will increase in size with estrogen. dx: U/S tx: w/OCP

33
Q

Adenomyosis. tx?

A

endometrium grows into the myometrium. symmetrically enlarged, soft, tender uterus, menorrhagia and dysmenorrhea

34
Q

when is abnormal uterine bleeding(AUB) normal?

A

near menarche or menopause

35
Q

how do you dx AUB? Tx?

A

exclusion! tx: OCP & NSAIDs to reduce bleeding

36
Q

What happens in Polycystic ovarian Syndrome?

A

ovary is replaced by thousands of follicles that produce large amounts of estrogen which then is converted to testosterone = fat, hairy, irregular menses, deep voice, trouble getting prego, DM, dyslipidemia

dx: LH/FSH >3 makes dx. elevated testosterone but normal DHEAS
tx: OCP + Metformin(reduces androgens), clomiphene to help with getting prego

37
Q

IUP w/bleeding, closed OS, U/S shows live baby….

A

threatened abortion, get bed rest and see if its okay.

38
Q

IUP w/bleeding, open OS & U/S shows dead baby..

A

inevitable abortion

39
Q

IUP w/bleeding, + passage of clots, open OS, retained parts…

A

Incomplete abortion

40
Q

IUP w/bleeding, + passage of contents, closed OS, U/S shows nothing…

A

complete abortion

41
Q

1st trimester to induce abortion

A

misoprostol

42
Q

Rh - mothers need to be given….

A

Rogam! = mom doesnt Rh factor and will have Ab to this factor – baby will have this factor = give rogam toprevent abortion

43
Q

UPT +, vaginal bleeding…next step?

A

do U/S to diff = baby, abortion, molar prego or ectopic pregnancy

44
Q

How do you use B-quant in ectopic prego?

A

B-quant = bhcg.

  • If >/=1500 and in fallopian tube = ectopic.
  • if <1500 and in fallopian tube = wait! may still be traveling to uterus = wait 48hrs and try again.
45
Q

When can you use methotrexate + leukovorin for ectopic pregnancy?

A

if bhcg <5000 or 8000, <3cm, no heart tones, moms not on folate

46
Q

tx for non-ruptured ectopic prego…

A

salpingostomy = reach in and remove

47
Q

tx for ruptured ectopic prego…

A

salpingectomy = remove fallopian tube

48
Q

Heavy menstrual bleeding is defined as…

A

> 85 mL

49
Q

Oligomenorrhea

A

<9 periods a year

50
Q

Amenorrhea

A

No peroids for 3+ consecutive months

51
Q

Swyer Syndrome

A

46XY congenital lack of testes. Resulting in no MIS causing female appearance

OBGYN (25 decks)

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