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Women's Health Final > Ch. 16 Common Gyn Pelvic Disorders > Flashcards

Ch. 16 Common Gyn Pelvic Disorders Flashcards

1
Q

What are 8 common causes of GYN acute Pelvic Pain

A 
1-Ectopic Pregnancy
2- Abortion
3- Menstruation
4- Ovulation Pain
5- Endometriosis
6- Salpingitis
7- Ruptured Ovarian Cyst
8-Adnexal Torsion
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2
Q

What are some common causes of Chronic Pelvic Pain in GYN (12)

A 
1- Endometriosis
2- Adenomyosis
3- Uterine Fibroids
4- Chronic Salpingitis
5- Adhesions
6- Dysmenorrhea
7- Pelvic relaxation
8- Recurrent Ovarian Cyst
9- Hydrosalpinx
10-Post-tubal ligation pain syndrome
11- Psychopathology
12- Dyspareunia
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3
Q

What are some common causes of Non-GYN Acute Pelvic Pain? (6)

A 
1- Appendicitis
2- Cystitis
3- Diverticulitis
4- Urethral Calculus
5- Gastroenteritis
6- Trauma
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4
Q

What are some common non-GYN causes of chronic pelvic pain? (12)

A 
1- Chronic appendicitis
2- IBS
3- Ulcerative Colitis
4- Diverticulosis
5- Interstitial Colitis
6- Radiation Cystitis
7- Bladder cancer
8- Urethral syndrome
9- Chronic constipation
10- Colorectal carcinoma
11- Celiac Disease
12- Fibromyalgia
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5
Q

What is the diagnosis when there is endometrial glands and stroma found outside of the endometrial cavity?

A

Endometriosis

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6
Q

What are the risk factors of endometriosis? (3)

A

1- Menarche before 11
2- Cycle length less than 27 days
3- heavy and prolonged cycles

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7
Q

What are the diagnostic test for endometriosis With the first 2 being the gold standard of Diagnosis (6)

A 
1-Visualization via laparoscopy or laparotomy
2- May also use ultrasound as diagnosis
3- History of lesions
4- Imaging (CT scan, MRI, Sono)
5- Endometrial biopsy
6-CA-125
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8
Q

What are some differentials with endometriosis? (7)

A 
1- PID
2- Pelvic Adhesions
3- Ovarian Cyst
4- Ovarian Masses
5- Leiomyomas
6- depression
7- sexual abuse
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9
Q

What is the plan of care for endometriosis(4)

A

1- First line of treatment: NSAIDS for pain reduction with Combined Oral Contraceptives to suppress menstruation
2- A diet in increased omega 3 fatty acids
3- Decreased animal fats
4- discussion on fertility plans

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10
Q

What is the main cause of PID?

A

STIs

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11
Q

What are the main causes of STI causes of PID?

A

Gonorrhea and Chlamydia

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12
Q

What are the 2 risk factors for PID

A

STIs and Race of African American Women

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13
Q

What are the Signs and Symptoms of PID?

A 
1- Abdominal Discharge
2- Post Coital Bleeding
3- Intermenstrual bleeding
4- Fever
5- nausea
6- Vomiting
7- UTI symptoms
8- Low back pain
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14
Q

What is a protective factor against PID

A

Hormonal Contraceptives

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15
Q

There is a minimal criteria for PID. What are the requirements to empirically treat?

A

-Pelvic/lower abdominal pain plus:
1- Cervical Motion Tenderness
2- Uterine Tenderness
3- Adnexal tenderness

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16
Q

What are some indications for hospitalization with PID? (3)

A

1- no improvement of symptoms within 72 hours of ABX therapy.
2- The patient presents with high fever
3- Positive for HIV or another immunodeficiency

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17
Q

How is PID diagnosed? (4)

A

1- Nucleic Acid Amplification Test (NAAT) from vaginal or cervical swabs
2- Wet Prep
3- Urinalysis to R/O UTI
4- Transvaginal Ultrasound

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18
Q

What are some common differentials of PID? (8)

A 
1- Acute Appendicitis
2- Ectopic Pregnancy
3- Ovarian Torsion
4- UTI/Pyelonephritis
5- Vaginal infections
6- Endometriosis
7- Ovarian cyst/mass
8- Degeneration of Leiomyoma
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19
Q

How is PID treated? (3)

A

1- Ceftriaxone 250mg IM x1 then doxycycline 100mg po BID x 14 days
2- may consider adding flagyl 500mg BID x 14 days
3- Treat partner if Gonorrhea and Chlamydia

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20
Q

What percentage of adnexal masses are malignant?

A

10%

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21
Q

What diagnostic test is recommended when it comes to suspected pelvic mass?

A

Transvaginal Pelvic Ultrasound

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22
Q

What are some common differentials for adnexal masses? (3)

A

1- Benign cyst
2- metastatic ovarian malignancy
3- Primary ovarian malignancy

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23
Q

What are some common risk factors for Adnexal Masses? (2)

A

1- BRCA 1 & 2 mutations

2- Lynch syndrome

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24
Q

What is the mechanism of action when using oral contraceptives for the treatment/prevention of forming new cyst?

A

The oral contraception inhibits ovulation which also inhibits the formation of the new cyst

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25
Q

What is an indication for surgery with adnexal cyst? (4)

A

1- If cyst persist for more than a few months
2- > or equal to 5cm in postmenopausal women
3- fail symptom control with medical treatment.
4- If the mass persist beyond 12 weeks, refer to GYN

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26
Q

What is the cause of inflammation in endometriosis?

A

The endometrial tissue responds cyclically to estrogen which causes swelling and local inflammation

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27
Q

What are the key components of endometriosis development?

A

Overproduction of prostaglandins and local estrogen

28
Q

What are some common symptoms of endometriosis? (4)

A

1-Very painful menstrual cramps
2-Very heavy menstrual bleeding
3- Heavy spotting, or bleeding between periods
4- Inability or difficulty in becoming pregnant

29
Q

What are some signs of endometriosis? (4)

A

1- rapid or irregular heartbeat
2- Fluctuating blood pressure
3- Slightly elevated or reduced body temperature
4- Abnormal blood levels of reproductive hormones

30
Q

What are the risk factors for PID? (8)

A 
1- Age <25
2-Multiple sex partners
3- Sexual activity at an early age
4- douching
5- inconsistent condom use
6- smoking, alcohol
7- sex workers
8- prior history
31
Q

What sub diagnosis fall under PID (4)

A

1- Cervicitis
2- Endometritis
3- Salpingitis
4- Oophoritis

32
Q

What are some short term concerns with PID (2)

A

1- Peritonitis

2- Pelvic Abscess

33
Q

What are some long term concerns with PID? (2)

A

1- Infertility

2- High risk of ectopic pregnancy

34
Q

What are the signs and symptoms of PID?

A 
1- (first indication) Lower abdominal pain
2- tenderness during pelvic exams
3- Purulent discharge at cervix
4- Dysuria
5- Fever and leukocytosis
35
Q

What are the common diagnostic test ordered when diagnosing someone with PID?

A 
1- pregnancy test
2- Vaginal smear and cervical culture
3- CBC, ESR and CRP
4- Pelvic Sono
5- Laparoscopy
36
Q

What are some educational tips for a patient with PID? (3)

A

1- adherence to the medication
2- Avoidance of intercourse until ABX complete
3- evaluation and treatment of partners

37
Q

What are the follow up and referral directions for a patient with PID? (2)

A

1- re-evaluate in 48-72 hours then 1-2 weeks after start of antibiotics
2- repeat GC/CT cultures 3-6 months after completion of antibiotics

38
Q

What are adnexal masses present?

A

During reproductive years

39
Q

What are the symptoms of adnexal masses? (6)

A 
1- Pelvic pain that is a "dull" ache
2- Dyspareunia
3- Constipation
4- Nausea, vomiting, loss of appetite
5- heavy feeling in abdomen
6- pressure on the bladder
40
Q

How with the patient present upon palpation of the abdomen when there is an adnexal mass?

A

1- Guarding

2- rebound tenderness

41
Q

What is found upon the pelvic exam when there is an adnexal mass? (3)

A

1- Cervical motion tenderness
2- Adnexal tenderness
3- Palpable mass

42
Q

What are the common diagnostic test that are ordered when working up a patient with a potential adnexal mass (6)

A 
1- pregnancy test
2- STI testing
3- Cervical and vaginal cultures
4- Trans vaginal Sono
5- Pelvic MRI
6- Laparoscopy
43
Q

What indications of adnexal mass needs to be present for surgery to be considered? (2)

A

1- >7mm

2- nonfunctional symptoms

44
Q

What are the differential diagnoses with adnexal mass (8)

A 
1- Ectopic pregnancy
2- PID
3- Tubo-ovarian cyst
4- Uterine Leiomyomas
5- Appendicitis
6- Diverticulitis
7- UTI
8- Renal Calculi
45
Q

What is Dyspareunia?

A

Painful Coitus (sexual intercourse)

46
Q

What does intromission mean

A

action or process of inserting the penis into the vagina

47
Q

What are the common diagnostic test ordered when working up a patient for dyspareunia? (5)

A 
1- Pregnancy test
2- vaginal smear/cervical culture
3- Sonogram
4- CBC and ESR
5- Diagnostic laparoscopy
48
Q

What is another name for Fibroid?

A

Leimymoma

49
Q

What are risk factors for Fibroids (5)

A 
1- Advancing age
2- Hyper-estrogen states
3- African Americans
4- HTN
5- Nulliparity
50
Q

What are the clinical presentations of fibroids (3)

A

1- Menorrhagia
2- Pelvic Pain
3- Palpable uterus above symphysis pubis

51
Q

What is the management of Fibroids? (3)

A

1- Myomectomy
2- Embolization
3- Hysterectomy

52
Q

What are the presenting symptoms with Fibroids? (5)

A 
1- Dyspareunia
2- bloating
3- Menorrhagia
4- Pelvic pressure
5- Urinary urgency and frequency
53
Q

What are the presenting symptoms with Adenomyosis? (4)

A

1- Menorrhagia
2- Chronic pelvic pain
3- Dysmenorrhea
4- Infertility

54
Q

Upon the pelvic exam in a patient with adenomyosis what will be present?

A

Enlarged/symmetrical uterus

55
Q

What are the different types of pelvic organ prolapses? (6)

A 
1- uterine
2- vaginal vault
3- cystocele
4- urethrocele
5- enterocele
6- rectocele
56
Q

What is ovarian cancer known as?

A

The silent killer

57
Q

What are the risk factors for ovarian cancer?

A 
1- Inherited gene mutation (BRCA1 & 2)
2- Increased age (post menopause)
3- early menarche
4- Late menopause
5- nulliparity
6- no breast feeding
7- obesity
58
Q

What is the screening method for ovarian cancer

A

There is none

59
Q

For patients with known family history of ovarian cancer what test can be done to potentially screen for ovarian cancer (2)

A

1- Pelvic sonogram

2- genetic mutation testing

60
Q

What are some symptoms of endometrial cancer? (6)

A 
1- Heavy periods
2- Pelvic lump
3- abnormal vaginal bleeding
4- changed bowel habits
5- difficulty in urination
6- pain during intercourse
61
Q

What is the most common GYN cancer?

A

Uterine cancer

62
Q

What are some common risk factors for endometrial cancer? (13)

A

1- Early menarche (<12)
2- Late menopause (>52)
3- infertility or nulliparity
4- obesity
5- treatment with tamoxifen for breast cancer
6- Estrogen replacement therapy after menopause
7- diet high in animal fat
8- diabetes
9- age greater than 40
10- Caucasian women
11- family history of endometrial cancer
12- prior treatment of breast and/or ovarian cancer
13- prior radiation therapy for pelvic cancer

63
Q

What is the most common cause of cervical cancer

A

HPV

64
Q

What is the HPV vaccination called

A

Gardasil Quadrivalent

65
Q

What is the maximum age Gardasil has been approved for

A

45

Women's Health Final (3 decks)

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