Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro Exam II > Dunn: prolapse, bleeding, menopause > Flashcards

Dunn: prolapse, bleeding, menopause Flashcards

1
Q

prolapse types

A

bladder/ cystocele
bacpassage/ rectocele
womb/ uterine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

baden-walker halfway system

A 
ervic at ischial spines- 0
halfway to hymen- 1
to the hymen - 2
halfway past hymen- 3
maximum descent- 4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

prolapse Treatment Options

A 
Nothing
Conservative Measures including Kegels, Weight Loss
Estrogen Cream
Pessary
Bladder Sling
Colposacropexy
Colpocleisis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Stress Incontinence

A

occurs with sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It is the most common type of bladder control problem in women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Overactive Bladder

A

OAB defined based on symptoms

Urgency, with or without urge incontinence, usually with frequency and nocturia
In the absence of pathologic or metabolic conditions that might explain these symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Urge Incontinence

A

happens when you have a strong need to urinate but can’t reach the toilet in time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mixed Incontinence

A

This is a combination of

 Stress incontinence and urge incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DIAPPERS

A

Delirium - addresses by toileting
Infection – urinary exacerbates incontinence and causes frequency and urgency
Atrophic urethritis and vaginitis – contribute to irritative symptoms
Pharmaceuticals – anticholinergics = detrusor underactivity-may cause retention; cholinergics = detrusor overactivity – may cause frequency;α-agonist=outlet overactivity - may cause retention;α-blockers = outlet underactivity – may cause stress incontinence
Psychological disorders – toileting
Excessive urine production – or physiologic or pharmacologic nocturia
Restricted mobility – toileting
Stool impaction - retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Urodynamic Studies

A

Cystometry
- A study of bladder filling: the bladder is filled with fluid and pressures are measured

Uroflowmetry
- Measures of flow rate

Pressure - Flow
- Simultaneous measurement of bladder pressure during contraction with flow to assess degree of obstruction

Electromyographic Studies
- Stimulus evoked responses measure contractions and reflexes: most useful in conjunction with cystometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dx of overactive bladder

A

most cases of overactive bladder can be dxed based on:

  • pt history, symptom assessment
  • physical exam
  • urinalysis

initiation of noninvasive treatment does not require an extensive further workup

(rule out DIAPPERS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OAB–> disabling conditions

A

increased risk of hospitalization, admission to nursing homes, depression

UTIs and skin irritation

increased risk of falls and fractures (morbidity and mortality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

barriers to tx of OAB

A

Pt misconceptions and fears (normal aging, not severe or frequent enough tot treat, too embarrassing to discuss, tx will not help)

physician concerns (no validated screening tools, nearly 2/3 are symptomatic for 2 years before seeking tx, 30% of pts who seek tx receive no assessment, nearly 80% not examined)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

nocturia

A

waking 1 or more times to void at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PALM-COEIN classification for uterine bleeding in nongravid reproductive-age women

A

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

algorithm for uterine bleeding

A
  1. rule out non-uterine source
  2. rule out pregnancy
  3. See how much bleeding it is and whether regular or not
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Endometrial Polyp

A

Hyperplastic overgrowths of endometrial glands and stroma that project from the surface of the endometrium
Common cause of perimenopausal and early postmenopausal uterine bleeding
Generally benign, but malignancy highest in postmenopausal women
Growth of polyps can be stimulated by estrogen therapy or tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Uterine Leiomyoma

A

Most common type of benign tumor in females
- Leiomyosarcoma is malignant variant

Symptoms

  • Asymptomatic
  • — Abnormal/painful menses
  • — Abdominal pain

Subtypes based on location

  • Pedunculated
  • Subserosal
  • Submucosal
  • Intramural
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Fibroids

A

Most common benign neoplasia of female genitals
Smooth muscle and connective tissue growth
E/P sensitive (will stop growing during pregnancy and menopause
Rarely (1.5%) become leiomyosarcoma
Complications: torsions and infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Adenomyosis

A

Triad=noncyclical pain, menorrhagia, enlarged uterus w/o adnexal tenderness
Endometrial tissue growth within myometrium
Tx: NSAIDs, OCPs, Progestins, ablation, hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fibroids (Uterine Leiomyomas) - risk factors, etc.

A

covering
Tend to increase over time as they are stimulated by estrogen
Most common noncancerous tumors of women of childbearing age
1/5 women greater than 30yo will have fibroids
Leading cause of hyterectomy in the US
Present usually with abnormal uterine bleeding or pelvic pain/pressure
Risk Factors
- Race: 2-3x higher in African Americans than Caucasians and tend to present earlier
- Menstrual history: early menarche (,10yo)
- Obesity
- Diet, alcohol: red meats, beer
- HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Uterine Fibroids (Leiomyomas) classification and treatment

A

Classified by position in the uterine wall

  • Intramural
  • Within uterine cavity: submucosal, pedunculated submucosal, pedunculated vaginal
  • Growing outward from the uterus-can be
  • – Cervical
  • – Subserous
  • – Intraligamentous
  • – Pedunculated subserous (abdominal)

Treatment Expectant management in those who are asymptomatic or decline medical or surgical treatment

  • Symptoms treatment to regulate bleeding (i.e. OCPs)
  • GnRH agonist but may return to pretreatment state once therapy is discontinued
  • Surgery: Myomectomy, endometrial ablation, Uterine artery embolization, hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Uterine Leiomyoma-myxoid degeneration

A

Larger leiomyomas outgrow blood supply and undergo degeneration

Types of degeneration

  • Hyaline
  • Cystic
  • Red carneous
  • Myxoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Postmenopausal Bleeding

A

General Considerations

  • Uterine bleeding in menopausal women
  • Bleeding may be a single episode of spotting or profuse bleeding for days or months
  • Usually painless
  • – Pain present if cervix is stenotic, if bleeding is severe and rapid, or if infection, torsion, or extrusion of tumor is present

Incidence:
4-11% of postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Etiology of postmenopausal bleeding

A 
Atrophic endometrium-59%
Endometrial polyps-12%
Endometrial cancer-10%
Endometrial hyperplasia-9.8%
Hormonal effects-7%
Cervical Cancer-<1%
Many who take estrogen therapy develop vaginal bleeding
Frequency depends upon the regimen used
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Atrophic Endometrium

A

Hypoestrogen causes atrophy of the endometrium and vagina results in microerosions which is prone to light bleeding or spotting
Classic vaginal findings: pale, dry vaginal epithelium that is smooth and shiny with loss of most rugation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Endometrial Hyperplasia

A

Proliferation of endometrial glands resulting in greater gland-to-stroma ratio than observed in normal endometrium
Postmenopausal women should be estrogen deficient, so endometrial hyperplasia is abnormal and requires an explanation
Endogenous estrogen production from ovarian or adrenal tumors or exogenous estrogen therapy are possible causes
Obese women have high levels of endogenous estrogen due to the conversion of androgens to estradiol, which occur in peripheral adipose tissue
Classification
- Simple or complex hyperplasia without atypia
- Simple or complex hyperplasia with atypia

27
Q

Cancer

A

Approx 5-10% of PMB is endometrial cancer
Incidence increases with age
Adenocarcinoma of the endometrium is the most common genital cancer in women over 45 years of age

28
Q

Management of post-menopausal bleeding

A

Exclusion of cancer is the main objective; therefore, treatment is usually unnecessary once cancer) or premalignant histology) has been excluded

Atrophy
- Vaginal estrogen therapy

Endometrial polyp
- Polypectomy

Endometrial hyperplasia
- Cyclic progestin therapy

Endometrial hyperplasia with atypia
- Hysterectomy

Carcinoma of endometrium
- Hysterectomy with BSO and LND for staging

29
Q

terms related to the timing of menopause

A

Perimenopause – time leading up to menopause -0 the time when ovarian function and hormone production are declining but have not yet stopped
Menopause: a permanent cessation of the menstrual cycle
Greek “meno” (month) and “pausis” (a pause)
Defined as not having a period for 12 months
Post menopause: time in woman’s life after last period
Premature menopause: menopause occurring before age 40

30
Q

Menopause-Related Changes

A

Vasomotor symptoms- hot flshes

Sleep quality

Mood changes

Urogenital symptoms

Sexual well-being

Skin changes

31
Q

Meno-myths

A 
Menopause signifies old age
Women go crazy at menopause
A woman’s sex life is over at menopause
Menopause always causes weight gain
Menopause is a medical condition that always needs to be treated
32
Q

conditions resulting from estrogen deficiency

A 
Well Established:
Vasomotor Symptoms
Urogenital Disorders
CHD Risk Factor (Lipids)
Skin Changes

Association:
Cardiovascular Disease
Bone Loss/Osteoporosis

33
Q

consequences of decreased progesterone

A 
Irregular periods
Premenstrual syndrome (PMS)
34
Q

consequences of decreased androgens

A 
Decrease in mood
Diminished energy
Impaired sexuality
Muscle weakness
Osteopenia
35
Q

Risks and benefits of ht

A

It is known with good certainty that
HT does not increase CHD risk in women who initiate therapy close to the onset of menopause( within-5 years of last menses)
HT does not prevent and may increase the risk of CHD in women who initiate therapy years after menopause
VTE is an infrequent but well established risk of HT
Risk increases approximately 2-fold with HT use
Greatest risk occurs in the first year of use
Absolute risk remains low in HT users due to the low baseline incidence of VTE in the general, non-hospitalized population

36
Q

Diseases Associated with Menopause

A

Coronary Heart Disease

Osteoporosis

Breast Cancer (?)

Colon Cancer (?)

Dementia (?)

37
Q

New Studies: CAD

A

Age at initiation of HT determines cardiovascular risk is confirmed
Initially thought to increase risk
However, 18.3% of never-users vs 6.9% of HT users died during follow-up
Starting early equals the most benefit.

JAMA 2007: Women who initiated hormone therapy closer to menopause tended to have reduced CHD risk compared with the increase in CHD risk among women starting HRT more distant from menopause.

38
Q

Hormone therapy for dementia

A

Critical window!
Estrogen protects against dementia when taken early in peri-menopause or early in menopause.
In contrast to WHI – (mean age of initiation was 63)

39
Q

Estrogen-Progestin HT and breast cancer

A

A WHI analysis confirms a small risk of breast cancer mortality with estrogen-progestin HT
E/P hazard risk was 1.26 in WHI
Now, after follow up for 11 years, combination HT users have similar risk vs. nonusers
Tumors more likely node +

40
Q

Unopposed estrogen and breast cancer

A

Estrogen only HT has different risk for breast cancer than E/P HT.

Estrogen only HT decreases risk in all age groups, but benefits younger women more.

(Young = 60 years or less and within 10 years of menopause onset)

41
Q

estrogen and risks of VTA, CVA

A

E3N student has shown no increased risk of VTE
Risk of CVA similar to non-users
And in fact, decreased

42
Q

Transdermal estrogen

A

The authors believe evidence will eventually point to a superior safety profile for transdermal estrogen vs oral
Offer estradiol gel or spray if patch causes irritation (should have same safety profile)
Micronized progesterone appears safer when progesterone is required

43
Q

Options for Mild Vasomotor Symptoms

A 
For mild vasomotor symptoms
Lifestyle changes (limited efficacy)
Nonprescription remedies—tested only short term with little efficacy over placebo but no evidence of harm
Dietary isoflavones
Black cohosh
Vitamin E
44
Q

Options for Moderate-to-Severe Vasomotor Symptoms

A 
Hormone therapy is the only FDA-approved treatment
“gold standard”
SSRIs and gabapentin 
early studies show efficacy
women studied have fewer hot flashes than those in HT trials
Progestogens effective
however, large doses required
Clonidine (oral or transdermal)
45
Q

Duration of HT Use

A

FDA 20031
Recommends shortest duration and lowest dose consistent with treatment goals
ACOG 20042
The lowest effective estrogen dose should be used for the shortest possible time to alleviate symptoms
NAMS 20043
Recommends duration and dose consistent with treatment goals

46
Q

American College of Obstetricians and Gynecologists on HT

A

Hormone therapy remains an effective therapy for treating women with vasomotor symptoms and vaginal atrophy. The benefits and risks should be discussed in detail with each patient before initiating therapy and when renewing her annual prescription so that she can make the best decision for her own health.”

47
Q

Recommendations from the ACOG Task Force on HT

A

For women who need or prefer an alternative to HT, data support the use of bisphosphonates or SERMs
In women with menopausal symptoms, HT may be appropriate as a first choice of therapy
All women should be advised to have adequate intake of vitamin D and calcium intake of at least 1,000–1,500 mg/d
After discontinuation of HT or bisphosphonates, the effect of HT withdrawal on bone density should be assessed

48
Q

HCG and normal/ abnormal pregnancy

A

If normal – HCG should double every 48 hours

If abnormal – HCG can stay the same, decrease,
or increase minimally

49
Q

Normal pregnancy - what we see

A

1ST Trimester bleeding(threatened abortion aka threatened miscarriage)
Physical Findings – cervical os closed, cardiac activity
Transvaginal US –
Gestational Sac at
1,500 – 2,000 MIU

50
Q

Risk associated with1st trimester bleeding

A

Miscarriage
Abnormal placental implantation
IUGR

51
Q

Abnormal pregnancy(in uterus)

A

Missed abortion
Complete abortion
Incomplete abortion
Molar pregnancy

52
Q

Risk factors for spontaneous abortion

A 
Maternal age
Age 20 to 30 years (9 to 17 percent), age 35 years (20 percent), age 40 years (40 percent), and age 45 years (80 percent)
Previous spontaneous abortion
? Increasing gravidity
Prolonged time to implantation interval
Prolonged time to conception
Smoking
>10 cigarettes per day
EtOH
Cocaine
NSAIDs around time of conception
Caffeine
Low folate levels
Extremes of maternal weight
Fever during early pregnancy
Unrecognized celiac disease
53
Q

Fetal Etiologyof Sp. Ab.

A

Chromosomal abnormalities
50% of all spontaneous abortions
Most commonly due to aneuploidies
- 52% autosomal trisomy; 19% monosomal X; 22$ polyploidies
- Trisomy 16 is most common, almost always lethal
Congenital abnormalities
Trauma
- Consider chronic villus sampling and amniocentesis

54
Q

Maternal etiology of sp. Ab.

A

Uterine structural issues
- Ex: uterine septum, sub mucosal leiomyoma, intrauterine adhesions

Acute maternal infections
- Ex: Listeria monocytogenes, Toxoplasma gondii, parvovirus B19, rubella, herpes simplex, cytomegalovirus

Maternal endocrinopathies
- Ex: thyroid dysfunction, Cushing’s syndrome, PCOS

Hypercoagulable states:
- Ex: SLE, antiphospholipiod syndrome

Unexplained

55
Q

Sx for spontaneous abortion

A

Vaginal bleeding
Pelvic pain
Absence of fetal movement (rate, as usually before movement is perceived)
Incidental finding on US/hand-held Doppler

56
Q

Work up forspontaneous abortion

A

Hand-held Doppler
Pelvic exam
- Source and severity of bleeding
- Size of uterus

Pelvic US
- Potential predictors include: abnormal gestational sac, abnormal yolk sac, slow fetal HR, sub chorionic hematoma

hCG
- Single value is usually not predictive, but may be useful for BL value if dx is initially uncertain

Blood type antibody screen
- Administer anti-D for Rh(D) negative mothers

Serum progesterone
>4ng/mL is associated with a nonviable pregnancy

57
Q

Dx of spontaneous abortion

A

Expectant management if dx in question
The criteria for spontaneous abortion on pelvic ultrasound:
- A gestational sac >25mm in mean diameter that does not contain a yolk sac or embryo
- An embryo with a crown rump length (CRL) >7 mm that does not have cardiac activity
— If gestational sac or embryo are too small for these dimensions, repeat in 1-2 weeks

Criteria for the diagnosis of a failed pregnancy based upon lack of development over time:

  • After a pelvic ultrasound showed a gestational sac without a yolk sac, absence of an embryo with heartbeat in >2 weeks
  • After a pelvic ultrasound showed a gestational sac with a yolk sac, absence of an embryo with a heartbeat in >11 days
58
Q

Threatened abortion

A

Diagnostic criteria for spontaneous abortion are not met
Vaginal bleeding has occurred and the cervical OS is closed
First trimester bleeding may be associated with adverse outcomes later in pregnancy
- Prognosis is worse when the bleeding is heavy or extends into the second trimester
Up to 50% will miscarry
Tx: bed rest and expectant management

59
Q

Inevitable abortion

A

Symptoms of vaginal bleeding, crampy pelvic pain, and dilated cervix

  • Products of conception can often be felt or visualized through the internal cervical os
  • No passage of fetal tissue per os

Tx options:

  • Medical abortion
  • – Usually with Misoprostol (one time dose of 800 mcg per vaginum, or 600 mcg sublingual)
  • Surgical abortion
  • – D&C or D&E; Doxycycline 100mg Po for two doses 12 hours part on the day of the procedural to decrease risk of postabortal sepsis
  • Expectant management:
  • – Majority of expulsions occur in the first two weeks after diagnosis
60
Q

Incomplete abortion

A

Vaginal bleeding and/or pain are present, the cervix is dilated, and products of conception are found within the cervical canal on examination

After 12 weeks , the membranes often rupture, and the fetus is passed, but significant amounts of placental tissue may be retained, leading to an incomplete abortion

Tx options:

  • Medical abortion
  • – Usually with Misoprostol (one time dose of 800 mcg per vaginum, or 600 mcg sublingual)
  • Surgical abortion
  • – D&C or D&E; Doxycycline 100mg Po for two doses 12 hours part on the day of the procedural to decrease risk of postabortal sepsis
  • Expectant management:
  • – Usually Staph aureus or mixed infections
61
Q

Completed abortion

A

Products of conception are entirely out of the uterus and cervix
Cervix is closed and the uterus is small and well contracted
Vaginal bleeding and pain may be mild or may have resolved
More common outcome than incomplete >12 weeks gestation
Tx: examination of passed tissue to confirm products of conception, transvaginal US to visualize empty uterus, follow hCG levels until zero (should halve within 48-72) hours

62
Q

Missed abortion

A

Patient with or without symptoms having a closed cervical OS
- Women may notice that symptoms associated with early pregnancy such as nausea, breast tenderness, etc. have abated and they do not “feel pregnant” anymore

Tx options:

  • Medical abortion
  • – Usually with Misoprostol (one time dose of 800 mcg per vaginum, or 600 mcg sublingual)
  • Surgical abortion
  • – D&C or D&E; Doxycycline 100mg Po for two doses 12 hours part on the day of the procedural to decrease risk of postabortal sepsis
  • Expectant management:
  • – Majority of expulsions occur first two weeks after diagnosis
63
Q

Risk factors for ectopic pregnancy

A 
Previous Ectopic
* PID (worst agent is chlamydia)
Assisted Reproductive Technology
History of peritonitis
Smoking
Previous Tubal Ligation

Note– IUD does not increase risk

64
Q

Treatment for Ectopic pregnancy

A

Medical – Methotrexate –
Folic acid inhibitor
Surgical – Removal of ectopic
Removal of tube

  • future fertility is identical

Repro Exam II (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions