Female reproductive disorders Flashcards
1
Q
Menorrhagia
A
Excessive flow and duration
Regular intervals
2
Q
Metrorrhagia
A
Excessive flow and duration
Irregular intervals
3
Q
Hypomenorrhea
A
Decreased flow
4
Q
Polymenorrhea
A
Shortened interval <19-21 d
5
Q
Oligomenorrhea
A
Lengthened interval >35 d
6
Q
Menometrorrhagia
A
Irregular or excessive bleeding during menses and between menses
7
Q
what is dilation and curettage? (D&C) What is it used for?
A
- remove tissue from inside uterus
- used to diagnose and treat certain conditions like heavy bleeding or to clear the uterine lining after a miscarriage or abortion
8
Q
what is dysmenorrhea?
A
Pain associated with menses- 1-2 days up to everyday
9
Q
what is the cause of dysmenorrhea?
A
Prostaglandin overactivity- leads to uterine contractions
10
Q
dysmenorrhea signs and symptoms
A
mild discomfort to severe pain
N/V
fatigue
diarrhea
11
Q
dysmenorrhea imaging
A
rule out bx
12
Q
dysmenorrhea tx
A
Prostaglandin (NSAIDS)
Heat
Avoid- nicotine, alcohol, caffeine
Birth control- IUD or longer acting progesterone
13
Q
leiomyoma
(uterine fibroid)- what is it?
A
Common benign uterine tumor
discrete (individual and separate), round and firm, enlarged uterine mass
14
Q
leiomyoma
(uterine fibroid)- who is this common in?
A
older patients
15
Q
leiomyoma
(uterine fibroid)- depend on _____?
A
estrogen to live
16
Q
leiomyoma
(uterine fibroid)- signs and symptoms
A
Bleeding= MC Pain- outgrows blood supply and "dies" Dysmenorrhea Pressure/fullness in pelvis Infertility Anemia
17
Q
leiomyoma
(uterine fibroid)- imaging
A
Pelvic US D&C Saline hysteroscopy Hysterosalpingography Laparoscopy
18
Q
leiomyoma
(uterine fibroid)- tx
A
GnRH agonist to shrink - Triptorelin - Goserelin - Leuprolide Birth control Myomectomy D&C Transexamic acid Uterine arterial embolization or endometrial ablation Hysterectomy
19
Q
endometriosis-
what is it?
A
endometrial tissue outside endometrial cavity
develops during menstrual cycle
20
Q
endometriosis- risk factors
A
20-30
early menarche
longer duration of flow- short cycles
heavy bleeding during cycles
MORE menses
21
Q
endometriosis- what helps?
A
exercise >4hrs/wk
higher parity
longer lactation period
DECREASES menses
22
Q
endometriosis- signs and symptoms
A
Infertility + 3Ds - dysmenorrhea - dyspareunia - dyschezia Pain w uterine motion Tender adnexal masses
23
Q
endometriosis- what are they called on ovaries?
A
chocolate cysts-
build up of blood due to menstrual cycle- erodes into underlying tissue and distorts organs w implants
24
Q
endometriosis- early vs older
A
early- red petechial lesions
older- dark brown, blue or black filled w debris- powder burn lesions
- thickening and scarring
- adhesions
25
endometriosis- treatment
```
NSAIDS
Remove large endometriomas
Decrease menses
- oral contraceptives- progesterone
- progesterone therapy- depo Provera or Mirena
- danazol
GnHR agonist
```
26
adenomyosis- what is it?
endometrial tissue within wall of uterus
27
adenomyosis- risk factors
Same as endometriosis- childbearing age
28
adenomyosis- signs and symptoms
severe dysmenorrhea
abdominal pressure and bloating
SYMMETRICAL enlarged uterus
29
adenomyosis- diagnosis
hysterectomy
30
adenomyosis- treatment
```
Same as endometriosis
NSAIDS
Remove large endometriomas
Decrease menses
- oral contraceptives- progesterone
- progesterone therapy- depo Provera or Mirena
- danazol
GnHR agonist
```
31
what is a cystocele?
prolapse of bladder anteriorly- towards vagina
32
what is it called when bladder and urethra prolapse together?
cystourethrocele
33
what is a rectocele?
prolapse of rectum or large bowel posteriorly
34
what is it called when the small bowel prolapses?
enterocele
35
pelvic organ prolapse- signs
feel bulge when patient coughs
36
Uterine prolapse- risk factors
menopause
any condition that increases intra-abdominal pressure
childbirth- vaginal delivery
can also occur if no childbirths
37
uterine prolapse- signs and symptoms
```
relieved by lying down
vaginal fullness
low back pain
falling out sensation
etc.
```
38
abnormal uterine bleeding (AUB)- what should be considered if childbearing age?
Complication of pregnancy
39
abnormal uterine bleeding (AUB)- causes PALM and COEIN
P- polyps
A- adenomyosis
L- leiomyoma
M- malignancy and hyperplasia
```
C- coagulopathy
O- ovarian dysfunction
E- endometrial process
I- iatrogenic
N- not yet classified
```
40
abnormal uterine bleeding (AUB)- what if everything else is excluded?
Dysfunctional uterine bleeding
41
abnormal uterine bleeding (AUB)- exams and imaging
```
pelvic exam
abdominal exam
rectovaginal exam
pap smear
hysteroscopy - bx= GOLD
transvaginal US- #1
```
42
abnormal uterine bleeding (AUB) - if you see endometrial cells in a postmenopausal W in a pap smear what should you be thinking?
endometrial cancer
43
abnormal uterine bleeding (AUB) - treatment
Progesterone- depo injections or IUD
Oral contraceptives
Endometrial ablation
Hysterectomy
44
postmenopausal bleeding- considered when?
post 12m of amenorrhea in middle aged W
45
postmenopausal bleeding- FSH and estradiol values
FSH- >30mlU/mL
| Estradiol- <20
46
postmenopausal bleeding- most common cause
exogenous hormones
47
polycystic ovary disease- stein leventhal syndrome- PCOS- what is it?
enlarged ovaries
thick sclerotic capsules and
abnormally high number of follices
48
polycystic ovary disease- stein leventhal syndrome- PCOS- signs and symptoms
amenorrhea
infertility
hirsutism
49
ovarian torsion- signs and symptoms
lower abdominal pain
| blue ovary- decreased blood flow
50
ovarian torsion- imaging
doppler US
51
Dermoid cyst of the ovary- what do ovaries contain?
Pleniprotential cells- can develop into any type of organ
Can be benign or malignant
52
What do tumors that contain hair, teeth and hair, etc. called?
Demoid cyst of the ovary
53
lichen sclerosus- what is it?
MC non-neoplastic vulvular epithelial disorder
54
lichen sclerosus- signs and symptoms
puritis
| think and wrinkled- "cigarette paper"
55
lichen sclerosus- treatment
antihistamines
| high potency topical steroids
56
lichen sclerosus, simplex chronicus and planus- diagnosis
bx- to confirm and rule out cancer
57
lichen sclerosus increases risk of
squamous cell carcinoma of the vulvula
58
lichen simplex chronicus- what is it?
benign epithelial thickening and hyperkeratosis resulting from chronic irritation- infection, chemical exposure, allergic causes
59
lichen simplex chronicus- signs and symptoms
thickened- leathery appearance
| pruritis- labia majora mc
60
lichen simplex chronicus - treatment
antihistamines
| medium potency steroid
61
lichen planus- what is it?
Inflammatory autoimmune disorder
62
lichen planus- signs and symptoms
```
Mucous membranes- vulva and vagina- also oral
Itching
burning
postcoital bleeding
dyspareunia
pain
Sharply marginated flat topped papules on skin
Erosions and ulcerations
```
63
lichen planus- treatment
topical hydrocortisone foam- more potent topical steroids
64
Behcet's syndrome- what is it associated with?
HLA-B51
65
Behcet's syndrome- triad
- Recurrent oral ulcers
- Recurrent genital aphthae or ulcerations (painful)
- Uveitis
66
Behcet's syndrome- treatment
topical and systemic corticosteroids
67
Molluscum contagiosum- what is it? describe it
Benign epithelial poxvirus
| - Pearly, dome shaped papules w dimpled center or bx
68
Molluscum contagiosum- mc in?
young children
69
Molluscum contagiosum- in adults is
sexually transmitted
70
Molluscum contagiosum- treatment
Self
Cryotherapy curettage
Topical- imiquimod
71
Bartholin duct cyst and abscess- cause
obstruction
72
Bartholin duct- purpose
moisture vulva
73
Bartholin duct cyst and abscess - signs and symptoms
fluctuant/unstable tender mass- palpable
pain, tenderness,
difficulty walking
74
Bartholin duct cyst and abscess- treatment
Cyst- no abx
I&D
Cath placement
Marsupialization- wick gauze- drain fluid
75
atrophic vaginitis- cause
diminished estrogen levels
76
atrophic vaginitis - risk factors
post-menopausal
prepubertal
lactating
77
atrophic vaginitis- signs and symptoms
pale
flat
white
78
atrophic vaginitis- pH
high
79
atrophic vaginitis- treatment
```
estrogen- oral/systemic
if contradictions- topical:
- premarin vaginal cream
- estrace vaginal cream
- vagifern tablets
```
80
atrophic vaginitis- complications
infections and trauma due to thin vaginal epithelium
81
Paget disease of the vulva- what type?
in situ adenocarcinoma in epithelium of vulva and perineal regions
82
Paget disease of the vulva - signs and symptoms
pruritis
red crusty lesions
labia majora= MC
white coating- "cake icing"
83
Paget disease of the vulva- diagnosis
bx
84
Paget disease of the vulva - treatment
refer
85
foreign bodies- causes what?
drying and microulcerations
86
foreign bodies- signs and symptoms
malodorous vaginal discharge
| spotting
87
What should be evaluated in a menstruating W w sudden onset of febrile illness?
toxic shock syndrome
88
toxic shock syndrome- cause
staph infections
89
toxic shock syndrome- signs and symptoms
desquamation of palms and soles
hypotension
etc. like fever, sore throat
90
toxic shock syndrome- treatment
irrigation of saline
| b-lactamase resistance pen or vanco
91
Malignant disease of the vagina- what is it?
Metastatic or vaginal involvement via direct extension from cervix
clear cell adenocarcinoma
92
Malignant disease of the vagina - who are at risk?
DES daughters
93
Malignant disease of the vagina - signs and symptoms
Asymptomatic
Painless bleeding- early
Late- pain, weight loss, swelling
94
Malignant disease of the vagina- treatment
Surgery
| RT, chemo
95
Ectropion - what is it?
Eversion of columnar epithelium onto ectocervix
96
Ectropion- signs and symptoms
Cervix= red, granular and inflamed
97
Ectropion- what is it associated with?
pregnancy and puberty
98
Nabothian cysts- signs and symptoms
Asymptomatic
| Translucent-yellow mucous-filled cyst
99
Cervicitis- signs and symptoms
Asymptomatic
Similar to vaginitis
Acute- cervical friability (sign of infection or inflammation)
Postcoital bleeding/spotting
100
Cervicitis- labs
CBC- white count- nl or slightly elevated
101
Cervicitis - complications
infertility
ectopic
chronic pelvic pain
102
Cervical stenosis- at what level?
of internal os
103
Cervical stenosis - causes
cone bx
LEEP
Ablative techniques for tx of dysplasia
tx of dysplasia
104
Cervical stenosis- signs and symptoms
amenorrhea and pelvic pain
105
Cervical stenosis- imaging
unable to pass sound or dilator through cervical opening
106
Cervical stenosis- treatment
dilators
107
Incompetent cervix- occurs when?
weak cervical tissue causes or contributes to premature birth of loss of an otherwise healthy pregnancy
108
Incompetent cervix- causes/risk factors
Congenital
Cervical trauma
D&C
Hx of pre-term delivery
109
Incompetent cervix- treatment
Cervical cerclage
Bed rest
Frequent US
Progesterone
