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AYA disorders of female health > Disorders of female health 2019 > Flashcards

Disorders of female health 2019 Flashcards

1
Q

Breast glands @ birth are?

A

are rudimentary

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2
Q

Is prepubertal breast development the same in boys and girls?

A

Prepubertal breast development in girls and boys is the same

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3
Q

What develops in breast tissue during puberty in females?

A

At puberty, breast goes through various stages including the development of milk producing ducts in females

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4
Q

What happens to the female breasts during the menstrual cycle?

A
  • During the menstrual cycle, female breasts undergo proliferation
  • increased nodules, lobular enlargement, swelling
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5
Q

Is nipple discharge benign or pathological?

A

can be both

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6
Q

What are the cause of nipple discharge?

A
  • Contact dermatitis
  • Infection
  • Montgomery tubercles
  • Mammary duct ectasia
  • Intra-ductal papilloma
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7
Q

Montgomery tubercles

A 
Are sebaceous (oil) glands that appear as small bumps around the dark area of the nipple. 
enlarged/visible in pregnancy and breastfeeding
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8
Q

Mammary duct ectasia?

A

A noncancerous breast condition where the milk ducts become swollen

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9
Q

Intra-ductal papilloma?

A

Is a benign tumor found within breast ducts. The abnormal proliferation of ductal epithelial cells causes the growth.

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10
Q

Galactorrhea, what is it?

A

Defined as secretion of milk or milk like fluid from breast in absence of breastfeeding/pregnancy

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11
Q

What is the most often cause of galactorrhea?

A

Hyperprolactinemia but can be drug induced

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12
Q

What labs would you order for galactorrhea w/u? What about imaging studies?

A

Work-up:

  • serum prolactin level (must be fasting, and in the morning)
  • TSH, BUN/Cr, pregnancy test, +/- MRI
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13
Q

What are the 5 classes of drugs that may cause/contribute to development of galactorrhea?

A

1) antipsychotics (olanzapine, risperidone)
2) Antidepressants
3) Anti-HTN
4) Anticonvulsants
5) Prokinetics

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14
Q

What are some other medications that can contribute to galactorrhea?

A

estrogens, anesthetics, cimetidine, ranitidine, opiates, methadone, morphine, heroin, cocaine, marijauana, alcohol

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15
Q

Fibroadenomas, what are they?

A

Most common benign mass in AYAs

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16
Q

What does a fibroadenoma look like on exam?

A

Well circumscribed, smooth, sharply demarcated

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17
Q

What population does fibroadenoma affect most commonly?

A

More common in African Americans

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18
Q

How is Dx made for fibroadenoma? What type of imaging would you consider with regard to fibroadenoma?

A

Dx: CLINICAL exam

. ~Can consider breast US~

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19
Q

What is the recommended management of fibroadenoma?

A

most resolve on their own

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20
Q

What is the incidence of fibrocystic breast changes and what is the mean age of occurrence?

A

Occur in about 50% of women
and
the mean age 15-17 years

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21
Q

What is the the pathophysiology of fibrocystic breast changes?

A

Unknown but thought to be related to hormonal imbalance

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22
Q

What are the s/s of fibrocystic breast changes?

A
  • breast nodules
  • upper outer quadrants
  • tenderness and swelling prior to menses
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23
Q

How is fibrocystic breast diagnosed and how is it managed?

A

Dx: CLINCALLY!
Mgmt: mild analgesia, supportive bra, consider OCPs

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24
Q

Incidence of breast malignancy in AYA and what does it indicate if diagnosed?

A

Rare in adolescence
AND
If found in this age group, usually metastatic site
-Genetic testing: not routinely recommended in AYAs

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25
Q

How is DYSMENORRHEA defined?

A

Defined as pain associated with menstruation
can be
Primary vs secondary

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26
Q

What causes dysmenorrhea?

A

Etiology:-Prostaglandins

  • Leukotrienes
  • Other factors: younger age, low BMI, smoking, early menarche
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27
Q

What is necessary to acknowledge regarding dysmenorrhea?

A

Cause of missed days of work/school but underreported to providers

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28
Q

What are the S/S of dysmenorrhea ?

A

S/S: begin 1-3 years after menstruation.
Pain within a few hours of onset of menstrual cycle. Spasmodic pain in lower abdomen that can radiate to back and anterior thighs.
Pain resolves in 24-48 hours. Assoc sxs of n/v fatigue, mood changes, dizziness, diarrhea, backache, headacheDiff Dx: 1)Endometriosis2)Anatomical abnormalities3)Other: IBS, MS pain, GU, constipation

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29
Q

What are associated s/s of dysmenorrhea ?

A 
N/V/D
 fatigue
 mood changes
 dizziness, 
diarrhea
 backache
H/A
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30
Q

What are the top DDx for dysmenorrhea?

A

1) Endometriosis
2) Anatomical abnormalities
3) Other: IBS, MS pain, GU, constipation

31
Q

How would you Dx dysmenorrhea?

A

Dx: H&P

32
Q

What labs might you consider evaluating r/t dysmenorrhea?

A

Consider: CBC, ESR if IBD suspected.
Test for
STIs and pregnancy

33
Q

How would you manage dysmenorrhea?

A

1) Education
2) NSAIDs
3) Hormone therapy (OCPs, Depo, IUD)
4) Non-hormonal therapy: not been shown to be effective

34
Q

How is premenstrual disorder defined?

A

Defined as a constellation of physical, cognitive, affective, and behavior symptoms occurring cyclically during luteal phase and resolve with onset of menses

35
Q

Prevalence of premenstrual disorder in AYA an adult women?

A

Affects up to 80-95% of AYAs and adult women

36
Q

PMS and PMDD fall under the premenstrual disorder Dx, which is worse?

A

PMDD (most severe)

37
Q

Why is PMDD more severe?

A

Patho: - alterations in neurotransmitters such as GABA and serotonin
- brain function - hormonal factors

38
Q

What are the s/s of premenstrual disorder?

A

S/S: Emotional: depressed mood, anger, irritability, lability, restlessness, tension, confusion, poor concentration, decrease energy
Physical: extremity swelling, breast tenderness, weight gain, bloating, changes in appetite, headache, joint/muscle pain, abdominal cramps/painDx: Three findings:1)Sxs occur in luteal phase, resolve within a few days of menses onset2)Sxs prospectively documented over several menstrual cycles3)Sxs must be recurrent enough and severe enough to disrupt ADLs

39
Q

What are the 3 findings required to make Dx of premenstrual disorder?

A

:1)S/s occur in luteal phase, resolve within a few days of menses onset

2) S/s prospectively documented over several menstrual cycles
3) S/s must be recurrent enough and severe enough to disrupt ADLs

40
Q

What is the recommended management of premenstrual disorder? Non-pharm and pharm management?

A 
Mgmt=>Non-pharmalogical
1)Calcium may reduce physical s/s
2)Chasteberry 
3)CBT
4) Lifestyle changes
Pharmacological:
1) OCPs
2) High dose estrogen patch
3) NSAIDs
4) SSRIs: FDA approval for Fluxoetine, Sertraline, Paroxetine
41
Q

What is the recommended pharmacological management of premenstrual disorder? What are the 3 FDA approved SSRI drugs?

A

OCPs

2) High dose estrogen patch
3) NSAIDs
4) SSRIs: FDA approval for Fluxoetine, Sertraline, Paroxetine

42
Q

What are the 3 types of abnormal uterine bleeding?

A
  • Menorrhagia
  • Metrorrhagia
  • Oligomenorrhea
43
Q

What are the recommended Hx questions to ask R/T abnormal uterine bleeding?

A 
age of menarche
 regularity of cycles, duration of cycle
flow (number of pads/tampons)
 sexual Hx
 STI S/S
 systemic illness s/s
family Hx for AUB
medications
44
Q

What should you examine on physical R/T abnormal uterine bleeding?

A 
PE:
 VS, 
ht/wt, 
SMR, 
presence/absence of galactorrhea
\+/- pelvic exam
45
Q

Abnormal uterine bleeding (AUB) W/U should include?

Is it recommended to biopsy the uterus for AUB?

A
  • UPT
  • CBC, ferritin
  • STI screening
  • Consider bleeding disorder workup
  • FSH, LF, testosterone, DHEA-S, 17 hydroxyprogesterone
  • +/- pelvic US
  • NOT recommended to do endometrial bx
46
Q

How would you manage AUB? How would you approach management if hgb > 12, hgb 10-12?

A

•HD instability requires immediate mgmt!
•For AUB-O - hgb > 12: reassurance, MVI with Fe, recheck in 3 months
- hgb 10-12: 1.35 mcg
COCs one pill every 6-12 hours for 24-48 hours until bleeding stops.
May need antiemetic and oral Fe therapy)
Consider NSAIDs2.
Then taper COCs one pill daily by day 53.
Start new 28 day pill pack (withdrawal bleeding likely with placebo pills)
4.Continue COCs 3-6 months- Hgb < 10: If stable, mgmt as above.
If HD unstable, admit and may require as much as 50 mcgs COC every 6 hours to control bleeding.

47
Q

Define primary amenorrhea.

A

Primary: lack of menses by 14 years without secondary sexual characteristics or lack of menses by 16 years

48
Q

Define secondary amenorrhea

A

Secondary: lack of menses for 6 months, or duration of 3 prior cycles

49
Q

What are causes of primary amenorrhea without secondary sexual characteristics?

A

genetic or enzyme defects:
Turner syndrome
- 17- alpha-hydroxylase def,
pituitary/hypothalmic hypogonadismPrimary and Secondary with normal secondary sexual characteristics: hypothalmic causes, pituitary causes, ovarian causes, hyperandrogenism, uterine causes, pregnancy

50
Q

What are the causes of primary and secondary amenorrhea with normal secondary sexual characteristics?

A

Primary and Secondary with normal secondary sexual characteristics: hypothalmic causes, pituitary causes, ovarian causes, hyperandrogenism, uterine causes, pregnancy

51
Q

What are the causes of primary and secondary amenorrhea with normal secondary sexual characteristics?

A 
hypothalmic causes
 pituitary causes
 ovarian causes,
 hyperandrogenism,
 uterine causes, pregnancy
52
Q

What would you illicit on a Hx R/T amenorrhea?

A 
S/s of systemic illness
 family Hx
 PMH
 pubertal G&amp;D
 emotional status
 medications
 nutritional status
53
Q

What must you assess on PE for amenorrhea?

A 
SMR
 Ht/wt
 VS
 acne/hirsutism
insulin resistance
external genital exam**
54
Q

What causes pelvic masses?

A

Etiology is different based on age

55
Q

Congenital causes of pelvic masses?

A

Congenital anomalies-Agenesis-Mullerian duct remnants- urachal cysts and pelvic kidney

56
Q

What are non-congenital causes of pelvic masses?

A
  • Pregnancy
  • TOA/infection
  • Adnexal torsion
  • Ovarian masses (benign vs malignant)
57
Q

How is endometriosis defined?

A

Defined as condition in which ectopic endometrium is found outside uterus and can be found in up to 50% of AYAs undergoing laparoscopy

58
Q

What are the S/S of endometriosis?

A 
S/S: worsening dysmenorrhea
 premenstrual or pelvic pain
 deep dyspareunia
CMT
possible ovarian mass on exam
59
Q

What is the recommended management of endometriosis?

A

Mgmt: initial consider NSAIDs and OCPs.

If pelvic pain non-responsive, refer to GYN

60
Q

At what age is a Pap smear indicated and what does it screen for?

A

Indicated for 21 years and older

Purpose: screen for cervical changes as a results from HPV exposure

61
Q

What is the exception to the recommended 21 years and older routine Pap smear?

A

Exception is if HIV positive, requires screening twice year following diagnosis and annually afterwards

62
Q

What is the prepubertal vaginal environment vs the pubertal environment?

A

Before puberty, vagina is colonized with various flora-Vaginal pH is > 4.7

  • After puberty, estrogen-stimulated epithelial cells produce more glycogen
  • lactobacilli become main flora-
63
Q

What is the main flora in a pubertal vagina and what is the pH?

A
  • lactobacilli become main flora

- Vaginal pH < 4.5-

64
Q

How soon before menarche does vaginal discharge begin?

A

Vaginal discharge can be normal and may begin 6-12 months prior to menarche

65
Q

What are the 3 main types of vaginitis?

A
  1. BV
  2. VVC
  3. Trichomonas
66
Q

How is vaginitis diagnosed?

A

1.H&P
2.Lab: saline wet mount, KOH slides, rapid POC testing
if purulent or malodorous discharge, test for STIs

67
Q

In vaginosis, what organisms replace normal flora and who is it found in (sexually active or not)?
What are the S/S of vaginosis?

A

Common cause of abnormal vaginal discharge and odor
-Normal flora is replaced with Gardnerella and mycoplasma hominis
Can be transmitted sexually but is found in nonsexually active women
S/S: asymptomatic, grayish-white fishy odor discharge

68
Q

How is vaginosis Dx and how is it treated (non-pregnant)?

A

-Dx: 3:4- gray/white discharge, vaginal pH > 4.5, positive whiff test, wet prep showing clue cells
Tx: non-pregnant patients: metronidazole 500 mg PO bid for 7 days (other txs: metronidazole intra-vaginally, clindamycin intra-vaginally)
Should avoid douching and reduce number of sexual partners

69
Q

What is the most common cause of vulvaginal candidiasis? (VVC)

A

-Second most common cause of vaginitis after BV and is caused by candida albicans
Most women have at least one episode during their lifetime

70
Q

What are the risks for vulvaginal candidiasis? (VVC)

A 
Risk factors: 
immunocompromised
pregnancy
 IUD
OCPs
71
Q

What are the S/S of VVC?
Dx how?
Rx Tx?

A

S/S: intense burning, vulvar pruritis, erythema, external dysuria, dyspareunia, discharge (cottage cheese like)

  • Dx: wet prep or KOH, rapid testing
  • Tx: topical intravaginal wit the “azoles” or consider oral Fluconazole 150 mg one dose
72
Q

Who needs a pelvic exam, modified or complete?

A
  • females over age 21-
    S/S of vaginal or uterine infection (not vaginitis)
  • menstrual disorders
  • undiagnosed lower abdominal pain (+/-)
  • sexual assault
  • suspected pelvic mass- if requested by patient
73
Q

What is the sequence of pelvic exam?

A

-empty bladder
•Inspect external genitalia.
•For speculum exam, select correct size, warm it if possible, may or may not use lubricant.
Tell patient you are going to touch speculum to thigh and then inform you are inserting into the vagina (posteriorly and downward)
•Inspect vaginal walls, cervix, obtain any testing if indicated
•For bimanual exam: insert one or two gloved, lubricated fingers into vagina while other hand is on abdomen.
Check for masses along vaginal walls and assess for any CMT, palpate uterus pushing backward of cervix allows uterus to move anteriorly, palpate adnexa

AYA disorders of female health (1 decks)

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