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CNM > CNM Purple Big Book: Gynecology Normal > Flashcards

CNM Purple Big Book: Gynecology Normal Flashcards

1
Q

Perineal muscles

A

bulbocavernosus
ischiovernosus
superficial/deep transverse

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2
Q

Pelvic floor muscles

A

levator ani

pubococcygeus

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3
Q

bulbocavernosus

A

surrounds vagina acting as a weak sphincter

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4
Q

ischiovernosus

A

surrounds clitoris, responsible for clitoral erection

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5
Q

superficial/deep transverse perineal muscles

A

converge with urethral sphincter

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6
Q

levator ani

A

pubococcygeus, iliococcygeus, and ischiococcygeus muscles

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7
Q

pubococcygeus

A

pubovainalis
puborectalis
pubococcygeus proper

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8
Q

what stimulates development of internal pelvic structures?

A

estrogen initiated during puberty

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9
Q

when do internal pelvic structures reach their adult size/appearnace?

A

by about at 16

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10
Q

why is the pH of the vagina acidic?

A

because of the prevalence of lactobacilli and d/t the influence of estrogen

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11
Q

what size is the non-pregnant uterus?

A

8 cm in length
5 cm in width
3 cm thickness

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12
Q

how long are the fallopian tubes?

A

~10 cm

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13
Q

gonadotropins

A

LH, FSH released from anterior pituritary gland in response to GnRH

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14
Q

Estrogen - where, when, etc

A

primarily released by ovary in response to FSH, also by adrenal cortex, corpus luteum - predominant in follicular phase;
Results in dev of seconddary sex characteristics and ultimately in maenstruation;

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15
Q

thelarche

A

breast development

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16
Q

adrenarche

A

growth of pubic and axillary hair; results from secretion fo adrenal androgens; usually starts after breast devlopment begins

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17
Q

estrone

A

estrogen of menopause;

converted from androstenedione produced by adrenal gland and ovarian stroma

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18
Q

estradiol

A

most potent; derived from ovarian follicles, partic dominant follicle’Primary estrogen of reproductive age

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19
Q

estriol

A

least potent; estrogen of pregnancy;

dreived from conversion of estrone and estradiol in liver, uterus, placenta and fetal adreanl gland

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20
Q

pH of vagina

A

<4.5

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21
Q

progesterone - from where, what, etc.

A

steroid hormone produced by ovarian corpus luteum and conversion of adrenal pregnenolone/pregnenolone sulfate;
Luteal phase
As supplied by ovary, level of 3ng/mL+ indicates ovulation
In the breast: subcutaneous fluid retention

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22
Q

Prostaglandin (PGE)

A

derived from arachidonic acid
Increased production by UTERUS as with primary dysmenorrhea
Increases uterine activity resulting in ischemia

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23
Q

Prolactin

A

from anteroir pituritary
Progressive release druing pregnancy
Stimulates synthesis of milk proteins in mammary tissue
Stimulates epithelial growth in breast during pregnancy

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24
Q

Adrenal hormones

A

Cortisol - metabolizes proteins, carbs, fats
Aldosterone - regulates Na , K; dec Na/incr K secretion by kidney
Androstenedione - converted to estrone in adipose tissue
Testosterone - can be converted to estradiol

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25
Q

LH surge

A

peak 10-12 hrs before ovulation

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26
Q

Ovulation

A

PGE and proteolytic enzymes break down follicular wall; occurs 32-44 hrs after beginning of LH surge;
Maximal prdxn of spinnbarkeit;;
increase of basal body temp 0.2-0.5 F

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27
Q

spinnebarkeit

A

refers to ability of cervical mucus to be stretched between examining fingers;
increased stretch = increased influence of estrogen

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28
Q

Luteal phase: corpus luteum

A

formed from ruptured follicle

Secretes progesterone - peak 7-8 days postovulation

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29
Q

Proliferative phase of uterine cycle

A

estrogen influence
endometrium grows/thickens
lasts approximately 10 days from end of menses to ovulation

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30
Q

Secretory phase of uterine cycle

A

progesterone influence
Av 12-16 days
Endometrial hypertrophy
Increased vascularity

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31
Q

Menstruation - of uterine cycle

A

declining progesterone from CL

endometrium undergoes involution, necrosis, sloughing (3-6 days)

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32
Q

screening mammography

A 
Age 40-50:
ACS: annual; NCI: q 1-2 yrs
strong fam hx = earlier/more frequently
>50 yr: annually
10-15% false negative rate for detection of malignancies
33
Q

BRCA1/2

A

5-10% br CA is hereditary
mutated BRCA1 gene = 80% risk br CA by age 65
Test if strong fam hx or Ashkenaxi Jew

34
Q

Climacteric/perimenopause

A

used to describe the physiologic changes associated with the change from reproductive to nonreproductive status
2-8 yrs before menopause until 1 yr after last period
Rhythmic ovarian/endometrial responses of menstrual cycle decline/eventually stop; # responsive follicles decr with resultant decr prdxn estradiol throughout climacteric. Decr estradiol = incr FSH.
End of clim, ovary contains no follicles & endometrium atrophies = reproductive capabilities terminated

35
Q

premature menopause

A

premature ovarian failure

cessation of menses before age 40

36
Q

menopause

A

after menopause, LH & FSH both increased

Generally rely on cessation of menses, hypoestrogenic sx, age and consistently elevated FSH for dx of menopause

37
Q

Lab findings of menopause

A

FSH: >40 mIU/mL
LH: 3-fold elevation (20-100 mIU/mL)
estradiol: <20 pg/mL

38
Q

vaginal pH in climacteric

A

pH 5.0 or more

39
Q

Some vaginal sx of climacteric

A

may have pruritis, leukorrhea, friability, increased susceptibility to infectino, dyspareunia

40
Q

Urinary tract changes with climacteric

A

Decreased muscle tone: urethra/trigone area
Atrophic changes in urethra/periurethral tissue = stress incontinence may occur
Hypoestrogenic effects in trigone area; lowered sensory threshold to void = sensory urge incontinence may occur
Urinary urgency, frequency, dysuria d/t atrophic changes in urethra and periurethral tissue

41
Q

Vasomotor sx of climacteric: hot flashes

A

75% of women get them

generally cease w/i 2-3 yrs after menopause

42
Q

CV effects of climcateric

A

Lipid levels:

incr in LDL (ideal 60)

43
Q

Cognitive fxn in menopause

A

memory impairment may be indirectly r/t decr estrogen secondary to hot flashes and sleep disturbance
Rish of demetia incr in healthy women 65-79 yr using ET or EPT

44
Q

screening for cholesterol and HDL

A

Age 20:

Q 5 yrs

45
Q

screening for plasma glucose

A 
Age 45 (& younger women with risk factors):
q 3 yrs
46
Q

Thyroid function/TSH screening

A

Age 65:
q 3-5 yrs
begin earlier if presence of autoimmune condition or strong family hx of thyroid dz

47
Q

hearing screening

A

Age 65 & older

48
Q

screening for visual acuity/glaucoma by opthalmologist

A

Age 40-64:
q 2-4 yrs
Age 65+:
q 1-2 yrs

49
Q

Contraception >40yr

A

COC: safe for healthy, non-smoking, non-obese perimenopausal women. Non-contraceptive benefits may be esp attractive: relief of vasomotor sx, menstrual regulation
POP also safe option
IUD: good option, LNG may help with heavy bleeding
Barrier methods acceptable
Sterilization: most prevalent method in US among married women
Fertility awareness less effective during perimenopause with irregular cycles

50
Q

Deciding when to stop contraception

A

Reaching age 55 (90% have reached menopause by then) vs 2 FSH levels while off hormonal contraceptives and using a nonhormonal contraceptive

51
Q

HT Indications

A

relief of menopausal sx r/t estrogen deficiency: vasomotor instability, vulvar/vaginal atrophy
Prevention of osteoporosis
Potential reduction of risk for colon CA

52
Q

C/I to HRT

A 
thrmoboemobolic disorders or thrombophlebitis
Known or suspected creast cancer
Estrogen dependent CA
Liver dysfunction or dz
Undiagnosed abnormal uterine bleeding
Known or suspected pregnancy
53
Q

Potential risks of HRT

A

endometrial hyperplasia/CA
Breast CA (relationship w HT inconclusive; possilbe small but signif incr witih long-term HRT)
Gallbladder dz
Thromboembolic disorders

54
Q

Followup after HT initiation

A

Reevaluate in 3 months; if no problems, annually after that
Evaluate sx each time; discontinue as appropriate
Consider nonhormonal drugs for osteoporosis prevention if longterm therapy needed

55
Q

HT regimen options

A

0.625 mg conjugated E or equivalent prevents osteoporosis in 90% menopausal women
10-14 days q month: 10 mg of MPA or equiv or daily doses of 2.5-5.0 mg for prevention of endometrial hyperplasia
Continuous combined: E/P daily (may have unpredictable bldg for a while before amenorrhea)
Continuous cyclic: E daily, P for 10-14 days/mo; withdrawal bleed when P done
Cyclic: E days 1-25; P last 10-14 days; then 3-6 days of nothing

56
Q

S/E oral estrogen:

A

increased HDL/triglycerides;

first-pass metabolism determines results

57
Q

effects E/EP patch

A

no significant impact on HDL/triglycerides;

may have less adverse effects on gallbladder and coagulation factors than oral E

58
Q

Vaginal estrogen creams

A

tx vulvar/vaginal atrophy;
will NOT provide relief from vasomotor sx;
some systemic absorption
NEED cyclic progestin with intact uterus

59
Q

Estring

A

little/no systemic absorption;
90 days duration
Do not need cyclic progestin

60
Q

Femring

A

SYSTEMIC absorption
tx vasomotor & vulvar/vaginal atrophy
90 day duration
Requires added progestin if intact uterus

61
Q

Topical sprays/gels/emulsions (17B-estradiol)

A

SYSTEMIC absorption
NO sig effect on HDL/triglycerides
May have less adverse effects on gallbladder and coag factors tahn oral E
Need cyclic progestin with intact uterus
Topical may not provide sufficient endometrial protection

62
Q

Progestin-only HRT

A

effective in relieving vasomotor sx
May have +impact on Ca balance
NOT effective on vulvovaginal sx
MAY have adverse effect on lipid profile

63
Q

Testosterone in HRT

oral/transdermal/injections/subQ

A

may use if E not effective enough on extreme vasomotor sx
may incr energy level, feeling of well-being, libido
S/e: acne, hirsutism, clitoromegaly
Does not appear to have neg lipid effect

64
Q

S/E of HRT

A

breast tenderness (E/P; usually only few weeks)
Nausea (E; relieved if taken AC/HS)
Skin irritation w patch
Fluid retention/bloating (E/P)
Alterations in mood (E/P)
TX of S/E: lower dose, dif route, dif formulation

65
Q

Bleeding on HT

A

Continuous cyclic: usually some bleeding; starts last few days P or just after. If bldg is earlier/heavy/persistent may indicate endometrial hyperplasia = eval
Continuous-combined: erratic spotting and light bldg 1-5 days in first yr; endometrial biopsy if heavier or longer than usual

66
Q

Nonhormonal mgmt of vasomotor sx

A

Antidepressants (ssri, srni) gabapentin, clonidine
Avoid caffeine, alcohol, cigarettes, spicy foods, big meals
Regular, mod exercise
Vit E - anecdotal reports of relief
Soy foods, isoflavine supplements

67
Q

False positive nontreponemal tests for syphilis

A

VDRL, RPR (become + by 1-2 wks after chancre)
False positives assoc with mononucleosis, collagen vascular dz, some other med conditions
Usually see low tieter 1:8

68
Q

Treponemal tests for syphilis

A

FTA-ABS
TPI
reported as +/- not quantitative
Usually remain + indefinitely after tx

69
Q

Genital herpes simplex

A

Gold standard: tissue culture of lesion
other tests: PCR, DNA probe, direct flourescent antibody/enzyme assay
Serum antibody test for HSV 1/2: may take 4-12 wks for seroconversion

70
Q

trich

A

wet mount: motile, flagellated protozoa
Greater than 10 WBC/high power field
vag pH >4.5

71
Q

HIV testing

A

Sensitive screening test: enzyme immunoassay EIA or rapid test: 99% sensitive at 12+ wks postexposure
Must be confirmed with highly specific tests: Western blot, IFA
HIV antibody detectable in 95% people by 6 months

72
Q

Estradiol levels

A

Follicular: 20-150
Midcycle: 150-750
Luteal: 30-450
Postmenopause; <20

73
Q

FSH levels

A

Follicular: 5-25
Midcycle: 20-30
Luteal: 5-25
Postmenopause 40-250

74
Q

LH levels

A

follicular: 5-25
midcycle: 75-150
luteal; 5-40
postmenopause:30-200

75
Q

Progesterone levels

A

follicular: <0.2

76
Q

Normal Bone Mineral Density T score

A

BMD w/i 1 standard deviation of young normal adult

T-score above -1

77
Q

Osteopenia

A

T-score between -1 and -2.5

78
Q

Osteoporosis

A

T-score at or below -2.5

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