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Exam 4 > AUB/Puberty > Flashcards

AUB/Puberty Flashcards

1
Q

Prolonged heavy bleeding that may lead to anemia

A

Menorrhagia

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2
Q

Irregular bleeding between periods

A

Metrorrhagia

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3
Q

Prolonged, heavy irregular bleeding

A

Menometrorrhagia

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4
Q

Bleeding that occurs less than every 35 days

A

Oligomenorrhea

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5
Q

Bleeding that occurs more than every 21 days

A

Polymenorrhea

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6
Q

Structural causes of AUB

A

P- Polyps (intermenstrual bleeding)
A- Adenomyosis (chronic pain)
L- Leiomyomas (fibroids usually benign treat with Ulipristol)
M- Malignancy or Hyperplasia

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7
Q

Non-structural causes of AUB

A

C- Coagulopathy (Von Willebrand, hx of heavy bleeding since menarche)
O- Ovulatory dysfunction (irregular, short cycle) Normal for adolescents, will improve after 2 yrs
E- Endometrial causes
I- Iatrogenic (post-GYN surgery, HRT, contraceptives)
N- Not otherwise classified (PID, cervicitis, trauma, endometritis)

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8
Q

Non-pregnant bleeding that is irregular in timing, frequency, or flow

A

AUB

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9
Q

The most common cause of AUB during reproductive years

A

Abnormal pregnancy- threatened abortion, incomplete abortion, ectopic pregnancy

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10
Q

Labs and diagnostics with AUB

A 
Physical exam along with :
UPT/HCG
CBC- for anemia
Prolactin, FSH/LH, androgens
Thyroid function
Coag studies 
STI screening
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11
Q

Procedure to rule out endometrial hyperplasia or cancer in high-risk women >35 and in young women who are at extreme risk for endometrial hyperplasia/carcinoma

A

Endometrial biopsy

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12
Q

Most AUB is due to

A

Ovulatory Dysfunction

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13
Q

AUB is considered an _________ diagnosis

A

exclusion

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14
Q

Treatment for AUB is determined by

A

hemodynamic status and degree of anemia

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15
Q

Antifibrinolytic used to treat heavy bleeding

A

Tranexamic acid

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16
Q

True or False: Patients who are trying to conceive should not use tranexamic acid

A

False- TXA is safe to use while trying to conceive

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17
Q

Contraindications with use of tranexamic acid

A

history of clot

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18
Q

Treatment for menorrhagia

A

NSAIDs, mefenamic acid

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19
Q

This medication is contraindicated for patients with PUD or coagulation issues

A

Mefenamic acid

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20
Q

Treatment for irregular/light bleeding

A

Medroxyprogesterone acetate PO x 10 days. May repeat if successful.

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21
Q

Heavy bleeding <3months with normal HgB

A

Mild- observe patient, instruct to keep a menstrual calendar, encourage use of NSAIDs aka Antiprostaglandin (decreases menorrhagia)

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22
Q

Heavy, frequent bleeding every 1-3 weeks with mild anemia

A

Moderate- taper monophasic OCP (Ethinyl estradiol/norgestrel) AND an antiemetic; cycle 3-6 months

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23
Q

Limit and stabilize endometrial growth

A

Progestins

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24
Q

If estrogen use is contraindicated to control bleeding this medication is an alternative

A

norethindrone

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25
Q

Prolonged heavy bleeding with HgB <9

A

Severe- treat at home with taper OCP (Ethinyl estradiol/norgestrel) every 4 hours until bleeding subsides. Rx iron supplement and antiemetic

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26
Q

Intractable heavy bleeding treatment

A

GnRH agonist leuprolide IM monthly for up to 6 months (medical menopause) Requires 2-4 weeks to stop bleeding. DOES NOT stop bleeding acutely.

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27
Q

Admit to the hospital when HgB < than

A

7 and/or orthostasis, unable to tolerate PO

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28
Q

Treatment for bleeding unresponsive to medical therapy

A

levonorgestrel releasing IUD- Mirena
Endometrial ablation
Hysterectomy- last resort

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29
Q

95% of AUB/DUB in adolescents is due to

A

Anovulation

30
Q

Injectable progesterone SE

A

weight gain, reduction in bone mineral density

31
Q

1st measurable sign of puberty in girls

A

Growth spurt

32
Q

1st measurable sign of puberty in boys

A

scrotal and testicular enlargement usually between 10-12 years old

33
Q

Growth spurt begins ____ years earlier in girls

A

2

34
Q

50% pubertal timing is related to

A

genetics and ethnicity

35
Q

Peak height girls

A

11.5-12 years old

36
Q

Peak height boys

A

13.5-14 years old

37
Q

SMR- No breast or pubic hair

A

Stage 1

38
Q

SMR- breasts are fully developed, contours distinct with the areola. Pubic hair inverted triangle pattern

A

Stage 5

39
Q

SMR- breast buds present; straight, fine hair

A

Stage 2

40
Q

SMR- Nipple/areola form separate mound; adult-like hair limited to area, not on thighs

A

Stage 4

41
Q

SMR- Breasts/areola grow no separation between the contours of 2 breasts; hair is darker, coarse, curlier and spreads sparsely over

A

Stage 3

42
Q

SMR- infantile state, genitalia increases slightly in size but little change in appearance; no true pubic hair

A

Stage 1

43
Q

SMR- Penis is adult size; hair fully distributed

A

Stage 5

44
Q

SMR- scrotal enlargement, change in color of scrotal skin; hair at the base of the penis

A

Stage 2

45
Q

SMR- Penis has increased in length; hair spreads over the pubic symphysis more curly, coarse

A

Stage 2

46
Q

SMR- Penis grows longer and width increases; hair adult in character but limited to area, not on thighs

A

Stage 4

47
Q

Missing X chromosome, infertile

A

Turner Syndrome

48
Q

Extra X chromosome, low sperm count, feminine physical characteristics

A

Klinefelter’s Syndrome

49
Q

Pubertal development (more common in girls) occurring below the age limit set for normal onset of puberty that occurs before age 8 in Caucasian females and 7 in AA/Hispanic. Age of onset may be advanced by obesity.

A

precocious puberty

50
Q

Obtain these lab values in girls who present with pubic and/or axillary hair but no breast development

A

Androgen levels and 17-hydroxyprogesterone

51
Q

Central precocious puberty is an issue occurring with

A

Brain/Pituitary

52
Q

Peripheral puberty is an issue occurring with

A

ovaries, testes, adrenals

53
Q

Precocious puberty in boys occurs at what age?

A

less than 9

54
Q

Signs of central precocious puberty in girls

A

breast development and tall for age

55
Q

Obtain this imaging to determine bone age

A

Xray of left hand and wrist. If bone age >2yr older than age expected= peripheral puberty

56
Q

If diagnosed with central precocious puberty, the clinician should order this study to rule out CNS lesions in boys

A

MRI of brain

57
Q

True or False: Accelerated growth and skeletal maturation are indicative of final adult stature.

A

False: skeletal maturation advances at a more rapid rate than linear growth, final adult stature may be compromised.

58
Q

Treatment for central puberty to increase final projected height

A

leuprolide IM monthly or histrelin subdermal implant replaced annually

59
Q

With central precocious puberty, the clinician would expect LH/FSH levels to be increased or decreased?

A

Increased

60
Q

Puberty is considered delayed in girls if no pubertal signs by age ____ or menarche by _____.

A

13, 16

61
Q

With peripheral precocious puberty, the clinician would expect LH/FSH levels to be increased or decreased?

A

decreased

62
Q

Puberty is considered delayed in boys if no pubertal signs by age ____ or >5yrs has elapsed since 1st sign without progress.

A

14

63
Q

Central hypogonadism

A

HYPOgonadaltrophic
Brain issue
Decreased LH/FSH
Causes: stress, poor nutrition, excessive exercise, Kallmann Syndrome, hypothyroidism
Girls: prolactinemia
Boys: lesions; hyperprolactinemia
Treatment: determine if functional or permanent and refer to Endocrinology

64
Q

Primary Gonadal Failure

A

HYPERgonadaltrophic
Testes/Ovary issue
Increased LH/FSH but decreased response
Girls: Turner Syndrome (XO) missing X chromosome
Boys: Klinefelter Syndrome (XXY) extra chromosome
Treatment: Monthly IM testosterone for boys and PO estrogen first then add progesterone after 18-24 months for girls

65
Q

Constitutional Delay

A

MOST COMMON
50% of cases r/t family hx/ethnicity
Can be caused by excessive exercise or poor nutrition
Treatment: reassurance

66
Q

This type of delay is diagnosed if short stature and normal growth velocity is shown on the growth chart

A

Constitutional growth delay

67
Q

Why is the Estrogen component is necessary for the treatment in hypogonadal patients?

A

Promotes bone mineralization and prevents osteoporosis

68
Q

Why is progesterone therapy needed in combination with estrogen in delayed puberty?

A

counteracts the effects of estrogen on the uterus; promotes endometrial hyperplasia

69
Q

Undescended testes that affect 2-4% of male newborns, may lead to infertility and testicular malignancy if left untreated.

A

Cryptorchidism- surgical orchidopexy should be performed if descent has not occurred by 6-12 months

70
Q

A common, self-limited condition that occurs in 75% of normal pubertal boys

A

Gynecomastia

71
Q

Gynecomastia typically resolves in ____ years and is more common in _____ boys.

A

2, obese

72
Q

Treatment for gynecomastia

A

Antiestrogens and aromatase inhibitors may be beneficial if initiated early.

Exam 4 (3 decks)

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