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531 Childbearing Family > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is included in the workup of abnormal uterine bleeding (AUB)?

A
  • R/O pregnancy with urine HCG
  • CBC for H&H and platelet count to r/o anemia
  • TSH and prolactin if amenorrhea or anovulatory bleeding
  • PT, PTT, fibrinogen if coagulopathy suspected
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2
Q

When is endometrial biopsy indicated in the workup of AUB?

A
  • premenopausal women: prolonged irregular bleeding, unexplained post-coital bleeding, intermenstrual bleeding; endometrial cells or glandular on pap smear, anovulatory abnormal bleeding
  • Postmenopausal: abnormal uterine bleeding, hormone therapy with abnormal bleeding; unscheduled bleeding that lasts more than 3 months after starting COC; endometrial stripe greater than 5mm on ultrasound
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3
Q

When is pelvic US indicated in the workup of AUB?

A

anovulatory bleeding w/o response to tx, anatomic defect suspected

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4
Q

PALM-COEIN classification: what is included in the PALM portion of this classification?

A

Structural abnormalities

  • Polyps: endocervical or endometrial
  • Adenomyosis
  • Leiomyoma
  • Malignancy & hyperplasia
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5
Q

PALM-COEIN classification: what is included in the COEIN portion of this classification?

A

Hormonal abnormalities

  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
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6
Q

What are some abnormal causes of amenorrhea?

A
  • PCOS
  • anatomic factors
  • abnormalities related to the HPO axis
  • ovarian failure
  • CNS disorders
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7
Q

What is primary vs. secondary amenorrhea?

A
  • Primary
    • no menses by 14 in absence of secondary sexual characteristics
    • No menses by 16 regardless of presence of secondary sexual characteristics
  • Secondary: no menses in previously normal menstruating female for an interval of at least 3 cycles or none if they are irregular in 6 months
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8
Q

What are the categories of causes of amenorrhea?

A
  • dx of the genital outflow tract
  • disorders of the ovary
  • disorders of the anterior pituitary
  • disorders of the hypothalamus or CNS
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9
Q

What is the most common cause of pituitary associated abnormal bleeding?

A

hyperprolactinemia

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10
Q

What is included in the workup for amenorrhea?

A
  • TSH and prolactin
  • Progesterone (Provera) challenge
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11
Q

What is the effectiveness of the nonhormonal forms of contraception?

A
  • withdrawal: 20-60% effective
  • lactational amenorrhea: 98-99.5% effective
  • diaphragm: 88%
  • cervical cap: 77%, 86% for nulliparous women
  • male condoms: 85%
  • copper IUD: 99%
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12
Q

What are the timeframes for placement for the diaphragm and cervical cap? - think how far in advance can it be placed and how long after intercourse should it remain in place?

A
  • Diaphragm: can be inserted up to 6 hours before intercourse and should remain in place for at least 6 hours following intercourse but no longer than 24 hours
  • Cap: Can be inserted 48 hours prior and stay in place for at least 6 hours after
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13
Q

What is the MOA of the copper IUD?

A

Copper components fx tubal and endometrial fluids and incapacitates sperm; toxic fx on ovum; creates localized reaction in endometrial tissue which makes it unsuitable for implantation

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14
Q

What are the side fx of the copper IUD?

A

menstrual changes (heavier, longer menses/bleeding) , increased dysmenorrhea, increased blood loss, copper allx

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15
Q

How do COCs prevent pregnancy? How effective are they with typical use?

A
  • Inhibits LH to suppress ovulation
  • Progesterone only works but estrogen used to decrease abnormal bleeding fx of progesterone only methods - 91% effective
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16
Q

What are contraindications to COC use? (11)

A
  1. pregnancy
  2. estrogen dependent cancers
  3. undiagnosed dysfunctional uterine bleeding
  4. clotting disorders hx of stroke/MI/CAD, DVT, PE
  5. major surgery
  6. severe hepatic disease
  7. uncontrolled HTN
  8. over 35 yo and smoking
  9. active gallbladder disease
  10. migraine with aura
  11. under 21 days postpartum
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17
Q

What are special considerations for the ortho-evra patch and the NuvaRing?

A
  • Patch: avoid in women >90kg (198lbs); can reapply if off for less than 24 hours, change if out for more than 24 hours
  • Ring: no decrease in fx if out for less than 3 hours
18
Q

What are the major side fx that should be reported with COCs?

A
  • A: abdominal pain: hepatic mass or tenderness
  • C: chest pain: cough or SOB
  • H: headache
  • E: eye problems: visual changes, speech changes
  • S: severe leg pain
19
Q

What are some non-contraceptive benefits of COCs?

A
  1. Reduce risk of endometrial cancer
  2. Reduce ovarian cancer risk
  3. Reduce colon cancer risk
  4. Reduce anemia and blood loss
  5. May reduce PMS/PMDD
  6. Reduce PID
  7. Fewer ectopic pregnancies
  8. Reduce benign breast conditions/fibrocystic breast
  9. May reduce ovarian cysts
  10. Treat endometriosis
  11. Less dysmenorrhea
  12. Some improve acne and hirsutism (ortho tri-cyclen, yaz, estrostep FDA approved)
  13. Improved bone mineral density
20
Q

What are some drugs that may decrease the effectiveness of COCs?

What allergy is most common in COCs?

A

Drugs

  • Rifampin
  • Anticonvulsants (depo is a better option)
  • HIV meds
  • TB meds
  • Griseofulvin
  • St. John’s wort

Allergy: most common is to lactose component

21
Q

What are the instructions for 1 vs. 2+ missed pills with COCs?

A
  • 1: take late or missed pill as soon as possible and take remaining pill one time; no backup method needed
  • 2+: take most recent missed pill as soon as possible and continue remaining pills at the usual time, discard other missed pills; use back up BC for 7 days
22
Q

What population are POPs (progestin only pills) good for?

A

good for those with a CI to estrogen; niche for breastfeeding moms

23
Q

What are some benefits of POPs?

A
  • May reduce painful crises in pts with sickle cell disease
  • May reduce pelvic pain w/ endometriosis
  • May reduce frequency and severity of migraines
  • May reduce amt of menstrual blood loss
  • Preferred to COCs if 21 days or less postpartum and for lactating women
24
Q

How is Depo-Provera administered and what are important considerations?

A
  • Administration: Every 12 weeks, r/o pregnancy if more than 13 weeks
  • Considerations
    • Potent inhibitor of HPO axis: return to fertility may be delayed than other methods (15-18 mo)
    • BBW: reduction in bone density if use longer than 2 years
25
Q

How effective is the Nexplanon implant and for how long can it be used? Side fx?

A
  • 99.5% effective up to 3 years
  • Side fx: irregular bleeding, BP, user satisfaction
26
Q

How effective are the hormonal IUDs (Mirena, Skyla, Liletta, Kyleena) and how long can they be used for? MOA?

A
  • 99.8% effective 3-5 years (Skyla is for 3 years)
  • MOA: thicken cervical mucus, endometrial changes, some ovulation suppression
27
Q

What are some noncontraceptive benefits of hormonal IUDs?

A
  • Reduces menstrual blood loss
  • Reduces dysmenorrhea
  • Can be used to tx endometriosis, adenomyosis, menorrhagia
  • Can be used as progestin during hormone therapy
  • Decreased risk for PID (and if PID develops, do not need to remove IUD
  • Reduced r/f endometrial and cervical cancer
28
Q

How do emergency contraceptives work? What is not a part of the function of the emergency contraceptives that is important to include in counseling?

A
  • MOA: delays ovulation; copper IUD creates an inhabitable environment for a fertilized ovum to implant
  • Do not interfere with an implanted egg and presents no risk to embryo that has been implanted
29
Q

When can emergency contraceptives be used?

A
  • Plan B, next step: up to 72 hours
  • Ella (Ulipristal): up to 5 days
  • Copper IUD: up to 5 days
30
Q

How is dysmenorrhea defined?

A

Painful abdominal or pelvic cramps or back pain associated with menstrual cycle

31
Q

What are the normal time frames in the menstrual cycle? full cycle, duration of bleeding, regularity

A
  • Full cycle
    • Frequent: fewer than 24 days
    • Normal: 24-38 days
    • Infrequent: 38 days +
    • Absent = none (amenorrhea)
  • Duration of bleeding
    • Prolonged: 8 days +
    • Normal: 8 days or fewer
  • Regularity: depends on age
    • cycle to cycle variation generally +/- 20 days
32
Q

What hormones are involved in the menstrual cycle and what organ releases them?

A
  • Hypothalamus
    • GnRH
    • prolactin inhibiting factor
    • Follicle releasing factor
    • luteinizing releasing factor
  • Pituitary
    • FSH
    • LH
  • Ovaries
    • estrogen
    • progesterone
  • Corpus luteum
    • progesterone
33
Q

What are the phases of the ovarian cycle vs. uterine/endometrial?

A
  • Ovarian
    • Follicular phase: Days 1-14
    • Ovulation: Day 14
    • Luteal phase: days 15-28
  • Uterine/endometrial
    • Menstruation: days 1-7
    • Proliferative phase: days 7-14
    • Secretory phase: days 14-28
34
Q

What is the Rotterdam diagnostic criteria for PCOS?

A

Exclusion of other etiologies and 2-3 of the following

  • Oligo or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism
  • Polycystic ovaries
35
Q

What is the androgen excess and PCOS society diagnostic criteria for PCOS?

A
  • Hyperandrogenism: hirsutism and/or hyperandrogenemia
  • Ovarian dysfunction: oligo or anovulation and/or polycystic ovaries
  • Exclusion of other androgen excess or related dx
36
Q

What are the diagnostic criteria for PMDD?

A
  • One or more of the following sx: emotional lability, anger, feelings of hopelessness, anxious
  • One or more sx present for a total of 5 or more sx: poor concentration, appetite changes, decreased interest in activities, fatigue, overwhelmed, breast tenderness, bloating, weight gain, aching joints, insomnia or hypersomnia
37
Q

What is the diagnostic criteria for PMS?

A
  • Sx must occur in the majority of menstrual cycles in the past year (at least 2 cycles)
  • Not exacerbations of underlying conditions, not from other dx
  • Sx significant enough to interfere with ADLs
  • Sx can be moderate to severe (PMS to PMDD)
38
Q

What are some possible pharmacologic interventions for PMS/PMDD?

A

COC, SSRI, anxiolytics

39
Q

How can an HCP be reasonably certain a woman is not pregnant?

A

no symptoms or signs of pregnancy and meets any one of the following criteria:

  • is ≤7 days after the start of normal menses
  • has not had sexual intercourse since the start of last normal menses.
  • has been correctly and consistently using a reliable method of contraception
  • is ≤7 days after spontaneous or induced abortion
  • is within 4 weeks postpartum
  • is fully or nearly fully breastfeeding (exclusively breastfeeding or the vast majority [≥85%] of feeds are breastfeeds), amenorrheic, and 6 months or less PP
40
Q

What options are available for pregnancy termination?

A
  • Surgical abortion
  • D&C
  • dilatation and evacuation
  • mifepristone + misoprostol
41
Q

What is the clinical presentation of Toxic Shock Syndrome and what is the usual causative organism?

A
  • Clinical presentation
    • Fever/chills
    • Hypotension
    • Skin manifestations (sunburn like rash) especially on palms and soles
  • Typically caused by staph aureus

531 Childbearing Family (1 decks)

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