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Clin Med II - Exam 5 > Dobbs - Uterine Disorders > Flashcards

Dobbs - Uterine Disorders Flashcards

1
Q

regular interval btw menses, excessive flow and duration

A

menorrhagia

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2
Q

decreased flow during normal duration of regular menses

A

hypomenorrhea

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3
Q

metorrhagia

A

irregular interval of menses, excessive flow and duration

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4
Q

shortened interval btw menses < 9-21 days

A

polymenorrhea

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5
Q

irregular or excessive bleeding during menses and btw menses

A

menomotorrhagia

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6
Q

lengthened interval btw menses > 35 day intervals

A

oligomenorrhea

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7
Q

procedure to remove tissue from inside the uterus

A

dilation and curettage (D&C)

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8
Q

D&C is used to dx and treat (2)

A

heavy bleeding

clear uterine lining after miscarriage/abortion

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9
Q

pain associated w. menses

1-2 days of mild discomfort-severe pain everyday of menses

A

dysmenorrhea

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10
Q

sx associated w. dysmenorrhea (3)

A

n.v

fatigue

diarrhea

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11
Q

what causes dysmenorrhea

A

prostaglandin overactivity

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12
Q

tx for dysmenorrhea (4)

A

NSAIDs

heat

avoid nicotine, etoh, caffeine

reduce frequency of menses

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13
Q

persistent dysmenorrhea → r.o (3)

A

leiomyomas

endometriosis

ovarian cysts

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14
Q

common benign uterine tumor

round, firm, often multiple; composed of smooth m/CT

A

leiomyoma (same-same uterine fibroid)

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15
Q

fibroids depend on

A

estrogen

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16
Q

fibroids are classified by

A

location

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17
Q

uterine fibroids may be asymptomatic; name 4 sx if not

A

bleeding → MC

pressure or fullness in pelvis

menorrhagia, metorrhagia, intermenstrual bleeding, dysmenorrhea

anemia w. heavy bleeding

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18
Q

during bimanual exam, you feel firm, enlarged, irregular uterine mass; what do you think

A

uterine fibroid

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19
Q

mc dx for uterine fibroid

A

US

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20
Q

other dx options for fibroids (4)

A

saline hysteroscopy

hysterosalpingography

laparascopy → large fibroids

MRI/CT

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21
Q

tx for asymptomatic fibroids

A

obs

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22
Q

tx for symptomatic fibroids (3)

A

myomectomy or D&C

uterine arterial embolization or endometrial ablation

hysterectomy

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23
Q

pharm for uterine fibroids

A

GnRH agonists (Lupron)

transexamic acid → non hormonal; eases heavy periods

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24
Q

s.e of Lupron

A

medical menopause → sweats, mood disturbance, sleep disturbance, feel awful

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25
Q

major consideration pre uterine arterial embolization/endometrial ablation

A

no desire for future fertility

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26
Q

condition where endometrial tissue is found outside of endometrial cavity

A

endometriosis

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27
Q

4 locations for endometriosis

A

ovaries

uterosacral ligament

GI tract

lungs/brain → uncommon

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28
Q

definitive dx for endometriosis

A

have to visualize it (surgically/histologically)

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29
Q

when you see pt w. infertility, think

A

endometriosis

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30
Q

infertility in endometriosis is related to

A

adhesions

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31
Q

chocolate cysts on ovaries

A

endometriosis

insertions filled w. blood

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32
Q

rf for endometriosis (5)

A

family hx

early menarche

long duration of menstrual flow

heavy bleeding during menses

shorter menstrual cycles

33
Q

decreased risk for endometriosis (3)

A

4 or more hr exercise/week

higher parity

longer duration of lactation

34
Q

US for endometriosis is used to

A

r. o other conditions
* only way to dx endometriosis is to see it surgically*

35
Q

3 d’s of endometriosis

A

dysmenorrhea

dyspareunia

dyschezia

also infertility!!!

36
Q

what is dyschezia

A

pain during defecation

37
Q

tender nodules in posterior vagainal fornix

pain w. uterine motion

tender adnexal masses

A

clinical findings for endometriosis

38
Q

repetitive, but probs will be a questions on exam:

dx for endometriosis

A

direct visualization of implants during laparoscopy or laparotomy PLUS tissue bx

39
Q

tx fo endometriosis

A

obs

NSAIDs

surgery

40
Q

pharm for endometriosis

A

OCP

IUD

progresterone therapy (Depo Provera, Mirena)

danazol

GnRH (Lupron)

41
Q

endometrial tissue from uterus exists w.in and grows into the muscular wall of the uterus

A

adenomyosis

42
Q

symmetrically enlarged uterus

A

adenomyosis

43
Q

sx of adenomyosis if not asymptomatic

A

severe dysmenorrhea

abd pressure/bloating

heavy bleeding

44
Q

what do you think when you see: middle aged woman, severe dysmenorrhea, hx of childbearing, symmetrically enlarged uterus, menorrhagia

A

adenomyosis

45
Q

definitive dx for adenomyosis

A

hysterectomy

also pelvic US, MRI

46
Q

tx for adenomyosis

A

NSAIDs

hormones

hysterectomy

47
Q

2 types of pelvic organ prolapse

A

anterior vaginal wall

posterior vaginal wall

48
Q

types of anterior pelvic organ prolapse

A

cystocele

cystourethrocele

49
Q

types of posterior pelvic organ prolapse

A

rectocele

enterocele

50
Q

mc type of pelvic organ prolapse

A

cystourethrocele

51
Q

rf for uterine prolapse

A

post pregnancy/labor

vaginal delivery

post menopause

increased intra-abd pressure

smoking

52
Q

sx of uterine prolapse are worse after __

and relieved by __

A

prolonged sitting

lying down

53
Q

sx of uterine prolapse

A

vaginal fullness

urinary sx

lower abd pain

low back pain

“falling out sensation”

54
Q

management of uterine prolapse requires

A

gyn referral!

55
Q

non surgical management of uterine prolapse

A

wt reduction

smoking cessation

pelvic m exercises

vaginal pessary

56
Q

abnormal menstrual bleeding and bleeding dt other causes (pregnancy, systemic dz, cancer)

A

abnormal uterine bleeding (AUB)

57
Q

mc cause of AUB

A

pregnancy

58
Q

exclusion of all possible pathologic causes of AUB establishes dx of

A

dysfunctional uterine bleeding (DUB)

59
Q

AUB includes (5)

A

bleeding btw periods

bleeding after intercourse

spotting any time after menstrual cycle

bleeding heavier or for more days than normal

bleeding after menopause

60
Q

causes of AUB (many!!)

A

PCOS

pregnancy

miscarriage

ectopic pregnancy

adenomyosis

birth control

hormones

STIs

fibroids

clotting d.o

polyps

endometrial hyperplasia

cancer

61
Q

4 structural causes of AUB

A

PALM

polyp

adenomyosis

leiomyoma

malignancy/hyperplasia

62
Q

5 nonstructural causes of AUB

A

coine

coagulopathy

ovarian dysfxn

iatrogenic

not yet classified

endometrial process

63
Q

evaluation of AUB depends on

A

age → hormonal flow

ex have they had first period? vs menopause

64
Q

2 exams that is especially important for evaluation of AUB

A

rectovaginal → palpate uterus

cytological → pap smear

65
Q

mc cause of AUB

A

iatrogenic

66
Q

gold standard eval tool for AUB

A

hysteroscopy → direct visualization of endometrium

67
Q

other important imaging for AUB (2)

A

pelvic US

endometrial bx

68
Q

tx to try for AUB

A

progesterone

OCP

surgical

69
Q

bleeding that occurs after 12 months of amenorrhea in a middle-aged woman

A

postmenopausal bleeding

70
Q

2 lab values highly suggestive of menopause

A

FSH > 30 miUL/mL

estradiol < 20

71
Q

mc cause of postmenopausal bleeding

A

use of exogenous hormones

72
Q

mc gyn cancer

A

endometrial

73
Q

mc type of endometrial ca

A

adenocarcinoma

74
Q

rf for endometrial ca

A

increasing age

obesity

nulliparity/infertility

late menopause

early menarche

DM

unopposed estrogen

genetic predisposition

prior pelvic xrt

75
Q

cardinal sx of endometrial ca

A

abnormal uterine bleeding

76
Q

other sx of endometrial ca

A

abnormal vaginal d.c

intermittent spotting

lower abd cramps/pain

77
Q

dx for endometrial ca

A

incidental on pap

pelvic US

D&C

endometrial bx

78
Q

tx for endometrial ca

A

gyn referral!

total hysterectomy w. salpingo-oophrectomy

xrt

chemo

79
Q

basis of tx and staging for endometrial ca

A

total hysterectomy w. combined oophrectomy

Clin Med II - Exam 5 (23 decks)

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