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EOR Gyn Flashcards

1
Q

define dysfunctional uterine bleeding and name the two types

A

abnormal frequency/intensity due to NONORGANIC causes (NOT reproductive, systemic or iatrogenic) .

  1. chronic anovulation
  2. ovulatory
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2
Q

describe the pathophys of dysfunctional uterine bleeding - chronic anovulatory

A

Disruption of hypothalamic-pituitary-ovarian axis. Seen at the extremes of age. Unopposed estrogen, without ovulation there is no progesterone = unopposed estrogen → incr endometrial growth w/ irregular, unpredictable shedding as the endometrium outgrows its own blood supply.

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3
Q

describe the pathophys of dysfxn uterine bleeding - ovulatory

A

regular cycle with prolonged progesterone secretion (due to decreased estrogen) → blood loss from endometrial vessel dilation and prostaglandins.

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4
Q

what is the normal frequency, duration and volume

A

freq: 24-38 days, duration: 4-8days, volume: 5-80mL

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5
Q

cryptomenorrhea vs menorrhagia

A
  • Cryptomenorrhea: light flow/spotting

- Menorrhagia: heavy/prolonged bleeding @ normal interval

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6
Q

metrorrhagia vs menometrorrhagia

A
  • Metrorrhagia: irregular bleeding between cycles

- Menometrorrhagia: irregular, excessive bleeding between cycles

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7
Q

oligomenorrhea vs polymenorrhea

A
  • Oligomenorrhea: infrequent menstruation, cycle length >35 days
  • polymenorrhea: frequent menstruation, cycle interval < 21 days
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8
Q

txt goals and options for dysfxn uterine bleeding

A

control acute bleed, prevent future bleeding, minimize endometrial CA risk
Acute severe bleed: high dose IV estrogen or high dose OCPs. reduce dose as bleeding improves
MC Anovulatory or Ovulatory: OCPs, progesterone if estrogen is contraindicated, GnRH agonists (leuprolide).
Sx: hysterectomy or endometrial ablation

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9
Q

which parts of the cycle do estradiol and progesterone dominate?

A

estradiol- follicular (up to day 14)

progesterone - luteal (after day 14) up to menses

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10
Q

when does body temperature spike in the menstrual cycle?

A

just after ovulation (after LH + FSH spike)

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11
Q

when is the proliferative and secretory phase of the cycle?

A

proliferative - day 5 -14

secretory- day 14- 28 –> menses

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12
Q

what is the MC gyn CA in US?

A

endometrial

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13
Q

what increases the risk of endometrial CA?

A

Estrogen-dependent CA

  • risk increases with estrogen exposure (nulliparity, anovulation, PCOS, obesity, late menopause, tamoxifen, HTN, DM)
  • OCPs are protective
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14
Q

how is endometrial CA dx - what does Bx and US show?

A

endometrial Bx = adenocarcinoma, US= endometrial stripe >4mm.

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15
Q

txt for endometrial CA : stage I, II/III, IV

A

Stage I: total hysterectomy + BSO +/- radiation
Stage II/III: total +BSO + lymph node excision +/- radiation
Stage IV: systemic chemo

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16
Q

pathophys for endometriosis

A

retrograde menstrual flow, hematogenous/lymphatic spread, stem cells from bone marrow, coelomic metaplasia (congenital development).

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17
Q

MC site of endometriosis

A

ovaries

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18
Q

uterus grows up and out of the pelvis (past pubic symphysis) at what GA?

A

12 wks

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19
Q

what does endometriosis increase the risk of ?

A

infertility

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20
Q

what is the triad of symptoms for endometriosis ?

A
  1. Cyclic premenstrual pelvic pain 2. Dysmenorrhea 3. dyspareunia . +/- dyschezia
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21
Q

how do you Dx endometriosis?

A

laparoscopy w/ Bx for definitive

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22
Q

what is a “chocolate cyst” ?

A

possible sequelae of endometriosis

= Endometrioma: involving ovaries large enough to be considered tumor

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23
Q

while expectant mgmt for endometriosis with minimal symptoms/trying to conceive, what are medicine txt options for more serious cases?

A

Medical therapy: NSAIDs, COCs, Progesterone, GnRH agonists (leuprolide), testosterone (Danazol- induces pseudomenopause by suppressing FSH/LH and midcycle surge)

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24
Q

Surgical options for txt of endometriosis?

A

endometrial ablation, TAH

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25
Q

islands of endometrial tissue in myometrium → diffusely enlarged uterus. = what dx?

A

adenomyosis

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26
Q

S+S of adenomyosis?

A

worsening menorrhagia, dysmenorrhea

tender, symmetric, enlarged “boggy uterus”

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27
Q

txt options for adenomyosis?

A

total abdominal hysterectomy (TAH). conservative used to preserve fertility (analgesics, low dose OCPs)

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28
Q

what race are leiomyomas MC in?

A

African americans

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29
Q

intrauterine growth related to estrogen production - regresses after menopause. what is the Dx?

A

leiomyoma (fibroids)

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30
Q

what is the MC symptom of leiomyoma (apart from the most common who are asymp)?

A

painless bleeding

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31
Q

txt of leiomyoma

A

MC observation or meds (leuprolide GnRH agonist, progestins)- prior to Sx to shrink + control vascularity) + Sx (hysterectomy/myomectomy).
*- Goal is to achieve pregnancy, if this is not wanted then just hysterectomy. Ability to conceive after myomectomy is very low so this is rarely done.

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32
Q

what is endometritis? what increases the risk of it?

A

infection of endometrium, chorioamnionitis (fetal membrane infection), usually polymicrobial (vaginal flora, aerobic/anaerobic)
Risk: postpartum + post abortive. C section MC

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33
Q

txt of endometritis ? prophylaxis w/ c section?

A

post-C Section - clindamycin + gentamicin. Post-vaginal delivery or chorioamnionitis - ampicillin + gentamicin

prophylaxis w/ 1 dose 1st gen cephalosporin during C-section

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34
Q

what is the grading of uterine prolapse ?

A

I - descent into upper vagina ⅔ vagina.
II - cervix approaches introitus (vaginal opening)
III - outside introitus.
IV- entire uterus outside vagina (complete)

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35
Q

txt for uterine prolapse?

A

Txt: Pessaries, estrogen (for atrophy), Sx hysterectomy, uterosacral or sacrospinous ligament fixation.

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36
Q

what causes PID? MC organisms?

A

ascending polymicrobial infection caused by cervical microorganisms (Chlamydia trachomatis, Neisseria gonorrhoeae..and potentially Mycoplasma genitalium)

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37
Q

when in the cycle does PID typically show symptoms? what are S+S?

A

presents usually in the 1st half menstrual cycle. pelvic/abdominal pain + one of the following… adnexal tenderness, cervical motion tenderness (chandeliers sign), fundal tenderness. + vaginal discharge/friable cervix, irregular bleeding, dyspareunia, N/V, fever.

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38
Q

Dx options for PID? findings in labs, Bx, imaging

A
  • inc WBC on microscopy of vaginal discharge, inc ESR, inc CRP, + GC/Chlamydia
  • Endometrial biopsy = endometritis
  • imaging : TVUS or MRI = thickened, fluid filled tubes, tubo-ovarian abscess, hyperemia on dopplers( suggest infection).
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39
Q

txt for PID? who do you hospitalize? what can untxted PID lead to?

A

txt underlying cause
Hospital txt: pregnancy, failure to oral therapy, severe illness w/ high fever N/V, tubo-ovarian abscess.
Prevention/Education: Untreated can lead to infertility, chronic pelvic pain, ectopic pregnancy, pelvic adhesions

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40
Q

what can help prevent the reccurence of ovarian cysts?

A

OCPs

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41
Q

MC cause ovarian torsion?

A

MC caused by ovarian cyst >5cm

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42
Q

pathophys of PCOS

A

Due to insulin resistance. Abnormal hypothalamic-pituitary-ovarian axis → increased insulin and increased LH driven = increase ovarian androgen production.

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43
Q

PCOS: what are the levels of testosterone and LH:FSH ratio? what does US show?

A

incr testosterone, LH: FSH >3:1, US - “string of pearls”

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44
Q

medical txt for PCOS

A

combo OCPs (normalizes bleeding and suppresses androgen), spironolactone for anti-androgen (or leuprolide, finasteride), infertility = clomiphene, metformin, lifestyle changes.

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45
Q

what are the increased risk factors for ovarian CA?

A

+FH, incr ovulatory cycles (infertility,nulliparity, >50yo, late menopause), BRCA

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46
Q

Dx of ovarian CA?

A

biopsy MC epithelial

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47
Q

how is txt of ovarian CA monitored?

A

Serum Ca-125 levels to monitor txt progress.

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48
Q

what strains of HPV are most common to cause cervical CA? (5)

A

HPV 16,18, 31, 33 and 45.

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49
Q

2 types of cervical cancer?

A

2 types: MC squamous, also adenocarcinoma (columnar cells) (clear cell carcinoma linked with DES- death sentence)

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50
Q

MC common symptom of cervical CA?

A

post coital bleeding/spotting MC symptom.

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51
Q

Dx of cervical cancer?

A

Dx: colposcopy w/ biopsy

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52
Q

txt of cervical cancer based on stage 0, I-IIa, IIb/IVa, IVb

A

Stage 0: carcinoma in situ: local txt (excision, ablation), TAH-BSO
Stage I - IIa: microinvasion: Sx (conization, TAH/BSO, radiation)
Stage IIb/ IVa: local advanced: radiation/chemo
Stage IVb (distant METS): palliative radiation, chemo.

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53
Q

what are the guidelines for pap smear? (starting age, stopping age + frequency of testing

A

Start: Age 21
Frequency: Cytology every 3 years between ages 21-29. Cytology with HPV every 5 years 30-65 → if HPV + → colposcopy
Stop: Age 65 if routine screening in last 10 years

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54
Q

what can cervicitis lead to?

A

PID

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55
Q

what are the two levels of cytology from a pap smear?

A

LSIL (low grade squamous intraepithelial lesion)

HSIL (high grade squamous intraepithelial lesion- ALL layers of squamous epithelium w/ abnormal cells)

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56
Q

what are the 3 levels of histology from Bx of cervical dysplasia?

A 
CIN I (LSIL) = mild dysplasia contained to ⅓  basal epithelium thickness
CIN 2 (HSIL) = moderate dysplasia including basal ⅔ 
CIN 3 (HSIL) = severe dysplasia >⅔ basal → full thickness = carcinoma in situ
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57
Q

what is an easy way to guess someone has cervical cancer?

A

Lesion w/ the naked eye = past the basement membrane = CANCER

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58
Q

txt for cervical dysplasia CIN 1 vs CIN2/3

A

CIN 1- observation or excision (LEEP - loop electrical excision procedure or cold knife cervical conization)
CIN2/3: excision (LOOP or cold knife) or ablation with cryocautery, laser cautery or electrocautery.

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59
Q

what is the easy classification system for abnormal uterine bleeding? what does it stand for?

A

PALM COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia, Coagulopathy, Ovulatory dysfxn, Endometrial, Iatrogenic, Not-yet-classified)

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60
Q

what defines primary vs secondary amenorrhea

A

Primary: failure of menarche onset by age 15y (w/ 2ry sex characteristics) or 13y (w/out 2ry sex characteristics)
Secondary: absence of menses for >3 months but had previous menstruation.

61
Q

what is “central amenorrhea” ?

A

hypothalamus dysfxn (low FSH/LH): disruption of normal pulsatile GnRH release. Anorexia, exercise, nutritional deficiency, systemic dz, physiologic stress/psychological stress.

62
Q

how can pituitary dysfxn cause secondary amenorrhea?

A

(low FSH/LH, high prolactin): prolactinoma decr GnRH

63
Q

how can ovarian d/o cause secondary amenorrhea?

A

( increase FSH/LH, low estradiol): PCOS, premature ovarian failure. Turner’s syndrome.

64
Q

how do you check for ovarian d/o causing secondary amenorrhea?

A

+ progesterone challenge (withdrawal) test (ovarian d/o)
=this means she has estrogen but is not ovulating
- results (no bleeding) = lacking estrogen or outflow problem

65
Q

txt for secondary amenorrhea (hypothalamic, pituitary, uterine)

A

hypothalamic - stimulate gonadotropin secretion - clomiphene
Pituitary - transsphenoidal Sx tumor removal
Uterine - estrogen txt for endometrial regeneration

66
Q

what is “dysmenorrhea” and what causes it? (primary vs secondary)

A

painful menstruation that affects normal activities.
Primary: not due to pelvic pathology, due to increased prostaglandins → painful uterine muscle wall activity.
Secondary: due to pelvic pathology. (endometriosis, adenomyosis, leiomyoma, adhesions, PID) increased incidence with age.

67
Q

what organism most common causes mastitis?

A

Staph aureus (also strep or candida)

68
Q

mastitis: infectious vs congestive vs abscess (S+S)

A

Infection: unilateral pain, tender, warmth, nipple discharge
Congestive: bilateral pain/swelling, low grade fever and axillary lymph
Abscess: induration w/ fluctuance (pus). RARE

69
Q

txt for mastitis: infectious vs congestive vs abscess

A

Infection: supportive (warm compress, breast pump) + anti-staph abx (dicloxacillin,nafcillin, cephalosporin) fluconazole if fungal. Continue to FEED

Congestive: if mom does not want to breastfeed = ice packs, tight bras, analgesics, avoid breast stimulation. If breastfeeding = manually empty breast completely after baby is done feeding.

Abscess: I&D, discontinue breast feeding from affected breast

70
Q

what two types of breast CA are most common

A

ductal and lobule

71
Q

incr # menstrual cycles and increased estrogen = increased or decreased risk of breast CA ?

A

increased

72
Q

” in situ” means what?

A

An in situ tumor is one that is confined to its site of origin and has not invaded neighboring tissue or gone elsewhere in the body

73
Q

what is inflammatory breast CA show?

A

peau d’orange (lymph obstruction)= WORSE prognosis

74
Q

mammogram of breast CA shows what?

A

calcifications and/or spiculated mass

75
Q

what is the initial Dx modality to evaluate a breast mass in someone <40yo (dense breast tissue)?

A

US

76
Q

what is the staging of breast CA?

A

T(size), N (nodes) M (METS)
0: precancerous, DCIS or LCIS
I-III: w/in breast/regional lymph nodes
IV: METS

77
Q

what endocrine therapy (medications) are options for adjunctive therapy for breast CA pts with E/P-receptive or HER2 positive CA?

A

anti-estrogen - tamoxifen.
aromatase inhibitors -letrozole, anastozole
monoclonal Ab

78
Q

prophylaxis meds for breast CA (for post-menopausal or women >35yo with high risk).

A

SERM (tamoxifen/raloxifene) Tamoxifen preferred but higher risk DVT.

79
Q

mammogram screening guidelines: ACOG, ACS, USPTF

A

ACOG: >40y annual
ACS: >45yo annual; >54yo biannual
USPTF: >50 biannual

80
Q

when do you stop mammogram screening?

A

when life expectancy is <10years

81
Q

pap smear guidelines

A

<21 no testing, 21-29 Q 3 years, 30-65 Q five years with pap (or w/out HPV Q 3 years).
>65 stop testing if no abnormal in 20yrs

82
Q

what is a fibroadenoma? what age pt is it most common in?

A

benign breast lump, nontender/mobile/rubbery. MC younger females.
does NOT wax and wane w/ hormone levels

83
Q

txt for fibroadenoma

A

nothing - observation

84
Q

breast - fluid-filled cyst due to exaggerated response to hormones. (may be tender, wax + wane w/ hormone levels) VERY COMMON: what is the Dx ?

A

fibrocystic changes

85
Q

Dx of fibrocystic changes in breast: FNA will show what kind of fluid? what is the txt for this?

A

straw-colored

Txt: observe or FNA to drain (if symptomatic)

86
Q

medical txt options for galactorrhea

A

txt underlying cause (synthroid (for hypothyroid) or dopamine agonists (cabergoline or bromocriptine) (for hyperprolactinemia)

87
Q

txt for gynecomastia. What are medications used? what is the ideal timeframe of txt?

A

supportive- stop offending meds, observe (most regress spontaneously), ideal txt in the first 6mo (>12 months tissue may turn fibrous).
Meds: SERM (tamoxifen) or aromatase inhibitors (blocks estrogen synthesis) or androgens (for hypogonadism)

88
Q

what are 3 clinical screening tools to Dx menopause-depression?

A

PRIME-MD (primary care eval of mental health d/o), PHQ-2, MRS (menopause rating scale)

89
Q

relative contraindications to hormone therapy for menopause include what?

A

Hx breast or endometrial CA, active liver dz, hypertriglyceridemia, porphyria (buildup of porphyrins), thrombolic d/o (CAD + stroke Hx), undiagnosed vaginal bleeding, endometriosis, fibroids

90
Q

three alternatives to hormone replacement therapy for menopause?

A

SSRI antidepressants, herbal supplements (black cohosh, evening primrose - not as effective)

91
Q

what is the timing of PMS symptoms

A 
luteal phase (1-2 weeks before menses) and resolve 2-3 days after the period starts 
*and at least 7 symptom free days in the follicular phase
92
Q

how is PMDD different from PMS?

A

it is severe PMS with a functional impairment
AND presence of at least five symptoms, including one affective symptom, such as mood swings, irritability, and/or depression

93
Q

what is “metal shmurz” ?

A

pain felt when ovulating (burst of follicle)

94
Q

medical txt for PMDD? (2)

A

OCPs- containing drosperidone along with estradiol (aka Yaz)

and/or SSRIs

95
Q

timeline of postpartum blues vs postpartum depression ?

A

blues: starts 2-3 days postpartum, lasts 10 days
depression: starts 2 wks-12mo postpartum, resolves 3-14 months

96
Q

conservative txt for PMS symptoms?

A

lifestyle (exercise/diet, caffeine/salt restriction, vitamin B6 +E),

97
Q

candida albicans: pathophys

A

yeast (MC opportunistic pathogen) - decrease in lactobacillus that usually prevent the overgrowth of yeast.

98
Q

causes of urogenital candida albicans

A

Abx, pregnancy, uncontrolled DM, impaired immune system, OCPs or hormone therapy

99
Q

txt for yeast infection ?

A

oral azole

100
Q

4 manifestations of chlamydia infection?

A
  1. Urethritis: mucopurulent discharge, purritis, dysuria, dyspareunia, hematuria. 40% asymptomatic
  2. PID: abd pain + cervical motion tenderness
  3. Reactive arthritis (reiter’s syndrome): urethritis, uveitis, arthritis - autoimmune rxn
  4. Lymphogranuloma venereum: genital/rectal lesion w/ softening, suppuration, lymphadenopathy
101
Q

Dx of chlamydia

A

nucleic acid amplification (vaginal swab or first-catch urine
(also can do a culture or blood antigen detection)

102
Q

txt for chlamydia infection

A

Azithromycin (1gm 1dose) or Doxycycline (100mg 10days). Retest in 10 days to ensure clearance + txt for gonorrhea

103
Q

2 manifestations of gonorrhea

A

Urethritis: anal, vaginal, pharyngeal discharge. PID
Dissemination: arthritis/dermatitis, rash

104
Q

txt for gonorrhea

A

ceftriaxone 250mg IM + txt for chlamydia. Cefixime as alternative

105
Q

3 most common organisms that cause cystitis?

A

MC E coli also Staph saprophyticus (sexually active women) enterococci (indwelling catheter)

106
Q

what differentiates pyelonephritis from cystitis on UA?

A

WBC casts

107
Q

what bladder analgesic turns your pee orange? (txt for cystitis) what is the ADR of this?

A

phenazopyridine (bladder analgesic- turns urine orange) - DONT USE >24 hrs cause of methemeglobinemia, hemyolytic anemia

108
Q

txt options for uncomplicated cystitis?

A

nitrofurantoin (macrobid), FQs, TMP-SMX

109
Q

what makes cystitis “complicated”? what are the txt options for this?

A

symptoms >7 days or underlying condition/elderly/males: FQs PO or IV, aminoglycosides 7-10 days

110
Q

txt for cystitis in pregnancy

A

amoxicillin or macrobid 7-14 days.

111
Q

txt for pyelonephritis?

A

FQ PO or IV, aminoglycosides 14 days (7 days in healthy young women)

112
Q

Dx of herpes?

A

PCR (best), tzank smear = multinucleated giant cells + inclusion bodies

113
Q

prevention/education for herpes in pregnancy

A

give acyclovir + Csection, breastfeeding not contraindicated unless lesion on the breast.

114
Q

can mom transfer HIV/AIDs to baby? how?

A

yes through birth or breastfeeding

115
Q

Dx of HIV (screening, definitive and monitoring txt)

A

antibody test- ELISA (screening), rapid test (blood or saliva). Western blot (confirmatory). HIV RNA viral laid (monitor infectivity and txt)

116
Q

pathophys of HPV

A

infects keritanized skin causing excessive proliferation + retention of stratum corneum ⇒ papula formation

117
Q

vaginal -tiny, painless papules evolve into soft, fleshy cauliflower-like lesions. Occur in clusters. Persist for months and may spontaneously resolve. Dx ?

A

condyloma accuminata - HPV

118
Q

HPV (condyloma accuminata)

A

whitening of lesion w/ acetic acid, histology = koilocytic squamous cells w/ hyperplastic hyperkeratosis

119
Q

5 txt options for removal of condyloma accuminata warts

A

chemical, salicylic acid, cryotherapy, laser, podophyllin (cytotoxic agent).

120
Q

HPV vaccine schedule

A

For Male + female 9-45yo. 3 doses (0,2,6mo) or 2 doses (0,6mo) for ages 9-14. Target age 11-12yo.

121
Q

primary syphillis

A

chancre- painless ulcer w/ raised indurated edges (papule that ulcerates) . heal spontaneously 3-4 wks + nontender lymphadenopathy nearby

122
Q

secondary syphillis

A

maculopapular rash, involve the palms + soles.

Condyloma lata + Systemic symptoms

123
Q

when does tertiary syphillis come up?

A

1-20yrs after inoculation

124
Q

tertiary syphillis: derm, neuro + cardiac symptoms

A
  1. Gumma (granulomas on skin/body tissues/bones.
  2. Neurosyphillis (HA, meningitis, dementia, vision/hearing loss, incontinence.
  3. CV = aortitis, aortic regurg + aneurysm.
125
Q

what is latent syphillis?

A

asymp infection + normal exam but positive serologic testing.

126
Q

early latent vs late latent syphillis

A

Early latent <1yr (highly infectious), late latent >1yr (less infectious)

127
Q

Dx of syphillis: screening vs confirmatory

A

Screening- RPR + VDRL

Confirmatory: FTA-ABS (fluorescent treponemal antibody absorption) or microagglutination test for T. pallidum antibodies

128
Q

what is the “jarisch-herkheimer” rxn? how do you txt it?

A

acute febrile response to rapid lysis of syphillis spirochetes from txt w/ PCN G.
Myalgia+ HA. Txt with anti-pyretics in first 24hrs reduces incidence

129
Q

after txt of syphillis, what is the followup schedule? how do you know there has been adequate txt?

A

at 6months and 12 months after txt for clinical + serologic test. 4-fold reduction in titer = adequate mgmt.

130
Q

txt for trichomonas

A

metronidazole, tinidazole + MUST txt partner

131
Q

what contraceptive can reduce transmission of trichomonas?

A

spermicidal agents reduce transmission

132
Q

perinatal complications of trichomonas and BV

A

PROM, preterm labor, etc

133
Q

terbultaine is used how in OBgyn?

A

its a B2 agonist that helps relax smooth muscle (bronchial + uterine) - stops spasm. Helps slow down the process of labor

134
Q

what are prostoglandins used in the txt of postpartum hemorrhage?

A

misoprostol, methergine or hemabate

135
Q

MC cause of vaginitis, what is its pathophysiology?

A

BV: decreased lactobacilli (maintains pH) → overgrowth of normal flora (gardinella vaginalis). MC cause of vaginitis

136
Q

what is included in “Amsel’s Criteria” for BV?

A
  • Abnormal gray vaginal discharge
  • Vaginal pH greater than 4.5
  • Positive amine test
  • More than 20% of epithelial cells are clue cells
137
Q

Dx of BV

A

KOH prep = fish smell, clue cells + few WBCs, few lactobacilli

138
Q

Txt of BV

A

metronidazole, clindamycin

139
Q

vaginal CA - what is the most common type and location?

A

squamous cell

in posterior wall of the upper ⅓ of the vagina

140
Q

MC sign of vaginal CA

A

bleeding

141
Q

txt of vaginal CA based on staging

A

stage I = excision, Stage II+ = chemo

142
Q

txt of rectocele

A

standard posterior colporrhaphy or site-specific repair over crosslinked porcine small intestine graft augmented repair

143
Q

what are the different types of urinary incontinence? (5)

A
  1. Stress: leak w/ incr abdominal pressure (laugh, cough) [from laxity of pelvic floor muscles]
  2. Urge/overactive: sudden urge + involuntary loss of urine
  3. Overflow: bladder doesn’t empty completely → dribbling/leaking [CNS dz or BPH]
  4. Functional: physical/mental impairments causes pt to not reach the toilet in time
  5. Mixed: stress + urge
144
Q

medical txt options for incontinence (stress, urge, overflow)

A

stress- alpha agonists (psuedophed, midodrine)
Urge - anticholinergics (oxybutinin, tolterodine), Tricyclic antidepressants, Mirabegron
Overflow: cholinergics or alpha blockers (tamsulosin)

145
Q

non-pharm txt of stress incontinence

A

stress: Sx- incr. Urethral outlet resistance or artificial sphincter, vaginal cones to incr. Pelvic floor muscle strength, estrogen cream

146
Q

non-pharm txt of overflow incontinence

A

Urge: botox injection or bladder augmentation, Diet - avoid spicy foods, citrus, chocolate + caffeine

147
Q

Fitz-Hugh-Curtis syndrome

A

PID + perihepatitis

148
Q

MC cause of PID

A

chlamydia trachomatis

149
Q

classic pelvic finding of endometriosis

A

fixed retroverted uterus, with scarring, and tenderness posterior to the uterus.

Rotation (16 decks)

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