female genitourinary issues

Question 1

PID

Answer 1

33% of all cases in adolescents, 10x higher risk of gonorrhea and chlamydia
tx- abx, hospitalization

Question 2

ectopic pregnancy

Answer 2

emergent referral- could lead to tubal rupture, hemorrhage

need good history

Question 3

pregnant adolescent

Answer 3

normal adolescent developmental tasks conflict with tasks of pregnancy- uncertain of own identity, pose major risk to pregnancy role, may not seek prenatal care/ may not realize they are pregnant.
Not future oriented- may not accept reality of unborn child

Question 4

plan B

Answer 4

high dose hormone- sever N/V for a couple of days, induces very heavy period

Question 5

ovarian torsion

Answer 5

often preceded by ovarian enlargement- sudden, acute, severe unilateral abdominal and pelvic pain. from an ovarian tumor or cyst that twists/ curls in itself
radiation to back or thigh
colicky, crampy pain
may be intermittent
tx- need surgery asap to preserve blood flow to ovary

Question 6

the cyst

Answer 6

common- happens in 50% of women w/ irregular periods and 30% of women w/ regular menses.

Question 7

types of cysts

Answer 7

• corpus luteum cysts- vascular- 3- 15cm
• simple cyst
• functional cyst- 2- 3 cm, filled with follicular fluid (most common) or blood
  rupture of cysts may lead to hemoperitoneum

Question 8

cyst rupture

Answer 8

rapid onset, local peritoneal irritation, often tender adnexal mass, look for focal peritonitis, may note cervical motion tenderness

Question 9

PCOS

Answer 9

anovulatory from puberty, usually

Question 10

prevalence of PCOS

Answer 10

appears to be the same range among all races examined to date
about 6.5% using census definition
about 25% using the 2003 Rotterdam criteria (2 of 3):
1. irregular periods
2. evidence of androgen excess
3. polycystic ovaries on ultrasound

Question 11

menstrual disorders

Answer 11

primary amonerrhea- no menses by age 17
secondary amenorrhea- no menses for 6 mos in previously menstruating females
irregular menses common in adolescence

Question 12

menstrual irregularities in the female athlete

Answer 12

delayed menarche
anovulation with dysfunctional bleeding
oligomenorrhea or amenorrhea w/ hypoestrogenic states
treatment options- trial decreased exercise, oral contraceptives

Question 13

dysmenorrhea

Answer 13

primary dysmenorrhea, secondary dysmenorrhea.

therapeutic management- estrogen therpay, ral contraceptives, dietary changes, exercised, comfort measure

Question 14

menorrhagia

Answer 14

excessive or prolonged bleeding in a cycle

Question 15

metrorrhagia

Answer 15

uterine bleeding unrelated to menstrual cycle

Question 16

menometrooohgia

Answer 16

prolonged heavy and irregular bleeding

Question 17

menstruation d/t

Answer 17

estrogen and progesterone withdrawal

Question 18

abnormal vaginal bleeding

Answer 18

• nonuterine- vulva, vaginal, cervix

- uterine- fibroid, polyp, Ca, DUB/ “AUB,” break through bleeding

Question 19

DUB aka abnormal uterine bleed

Answer 19

• most common in adolescent and perimenopausal women
• estrogen breakthrough
• estrogen withdrawal
• abnormal uterine bleeding is usually hormonal
• elevated unopposed estrogen levels are more likely to have prolonged periods of amenorrhea then heavy withdrawal bleeding