Female Reproductive Health Flashcards
1
Q
Benign Breast Disease etiology/patho
A
common in teens & 20s fibrocystic disease fibroadenoma intraductal papilloma abscess
2
Q
proliferative
A
increased cell production = increased risk of cancer
3
Q
benign breast disease s/s
A
pain
palpable mass
nipple discharge
4
Q
benign breast disease DX
A
palpation
ultrasound
mammogram
biopsy
5
Q
benign breast disease TX
A
often not needed
self-breast exam
education
6
Q
mastitis
A
erythema/inflammation of breast
most common in breast feeding
7
Q
mastitis trigger
A
nipple irritation tissue trauma chafing from ineffective infant latch nipple fissures yeast infections fatigue stress poor nutrition plugged milk ducts
8
Q
mastitis s/s
A
usually 4-6 wks post birth local tenderness swelling warmth erythema pain while breastfeeding systemic: flue-like symptoms, loss of appetite
9
Q
mastitis TX
A
lactation consult (improve BF technique) analgesics antipyretics cold compresses rest healthy diet lancing (culture if needed)
10
Q
galactorrhea
A
discharge of milk (or milk-like substance) from breast in absence of pregnancy (or more than 6 mon postpartum in those that did not BF)
11
Q
galactorrhea causes
A
medications (oral contraceptives, psych meds, codeine, morphine)
pituitary tumors (most common)
thyroid disorders (increased TRH in hypothryoidism)
chronic renal failure (increased prolactin from impaired kidney fx)
neurogenica cause, injury etc
12
Q
galactorrhea s/s
A
systemic: headache weight changes appetite changes history of thyroid or endocrine disorders visual changes
13
Q
galactorrhea DX
A
prolactin >5x normal
increased T4/TSH
14
Q
galactorrhea TX
A
dopamin agonist
15
Q
breast cancer RF
A
age gender family hx of 1st degree relative <50 y/o BRCA1 or 2 mutation menarche <12 menopause <55 proliferative benign breast disease high-fat diet HRT
16
Q
breast cancer classification
A
estrogen receptors
progesterone receptors
human epidural growth factor receptor 2
BRCA1/2
17
Q
breast cancer s/s
A
may be asym dimpling inverted nipple thickening of skin blood-tinged discharge
18
Q
benign ovarian cysts types
A
follicular: form when ovum fails to be released during follicular phase
corpus luteal: form in absence of pregnancy, corpus luteum does not dissolve
lutein: form from excessive hCG from multiple gestations or ovarian hyperstiumulation
19
Q
benign ovarian cyst s/s
A
pelvic/ab pain painful intercourse abnormal menses ab pressure polyuria urgency ab distension fullness w/out eating
20
Q
benign ovarian cysts DX and TX
A
ultrasound/lab
oral contraceptives or laparoscopic removal/drainage for larger cysts
21
Q
polycystic ovary syndrome PCOS
A
abnormal function of hypothalamic-pituitary-ovarian axis or elevated hormones/androgens causes excessive cysts
22
Q
PCOS s/s
A
menstrual dysfunction anovulation (infertility) hyperandrogenism (hirsutism & acne) irregular menses obesity metabolic syndrome diabetes insulin resistance
23
Q
PCOS DX and TX
A
endocrine testing
oral contraceptives (hyperandrogenism)
clomiphene (infertility)
meformin (insulin resistance)
24
Q
ectopic pregnancy
A
any gestation that occurs outside endometrial lining (usually in fallopian tube)
25
ectopic pregnancy RF
```
damage to fallopian tubes
previous ectopic preg
smoking
infertility meds
mulitple sex partners
advanced maternal age
history of STD
```
26
ectopic pregnancy s/s
```
triad: ab pain, amenorrhea, vaginal bleeding
dizziness
weakness
fever
vomiting
syncope
```
27
ectopic pregnancy DX and TX
serum hCG and ultrasound
methotrexate (based on gestational age)
surgery (to prevent rupture)
28
ovarian cancer
unknown cause
most common cause of GYN cancer death
linked to genetics (BRCA) high-fat diet and talc powerders
29
ovarian cancer s/s
```
silent
ab bloating
pelvic/ab pain
frequency
painful intercourse
back pain
constipation
weight loss
fullness w/out eating
```
30
ovarian cancer DX
no good screening test exists
| CA125 & surgical staging of disease
31
ovarian TX
aggressive debulking surgery
chemo
poor prognosis due to typically advanced disease
32
abnormal uterine bleeding prepuberty
precocious puberty (hypothalamic, pituitary or ovarian in origin)
33
adolescene ab uterine bleeding
anovulatory cycle
34
ab uterine bleeding reproductive age
comp of pregnancy
| or porliferations
35
ab uterine bleeding perimenopause
anovulatory cycle
irregular shedding
proliferations
36
postmenopausal ab uterine bleeding
proliferations
| endometrial atrophy
37
dysfuncitonal uterine bleeding
hemorrhaging that occurs on noncyclic basis or in abnormal amounts
frequently reported by women (common reason for a hysterectomy)
variety of causes (often an imbalance between estrogen and progesterone)
38
estrogen causes
proliferation of endometrium
39
progesterone
limits and stabilizes endometrial growth
40
dysfunctional uterine bleeding TX
drugs for uterine bleeding
conjugated estrogens w/ medroxyprogesterone
NSAIDS sometimes adjunct therapy
41
dysfuncitonal uterine bleeding s/s (6 cat)
```
menorrhagia
intermenstrual bleeding
metrorrhagia
menometrorrhagia
polymenorrhagia
dysmenorrhea
```
42
dysfunctional uterine bleeding DX adn TX
CBC, hCG, testosterone, TSH, ultrasound
NSAIDs, hormone therapy
severe: ablation/hysterectomy
43
amenorrhea
abscence of spontaneous menstruation in women of reproductive age
absence by age 15 (primary)
cessation of regular menstruation for at least 3 months not preg/lactation/hormone meds/menopause (secondary)
44
amenorrhea s/s
no periods
45
amenorrhea DX and TX
pregnancy test, progesterone, LH, FSH
depends on causative factors
psychological treatment (if cause is ex: anorexia, bulimia)
46
dysmenorrhea
primary (painful menstrual cycle in absence of pelvic disease)
secondary: result of underlying idsease (PID, endometriosis)
pain increased to prostaglandin levels
47
dysmenorrhea s/s
primary: occurs w/in 6 mo of menarche
secondary: usually in 20/30s
high intensity cramping w/ menses
heavy, irregular flow
painful intercourse
vaginal discharge
poor response to analgesics
48
dysmenorrhea DX and TX
suspect PID: lab to rule out infection/preg
| NSAIDS, oral contraceptives, lifestyle management
49
premenstrual syndrome
unknown causes
| deficiency/ imbalance of hormones, MG, CA, serotonin etc
50
PMS s/s
emotional: mood swings, irritability, withdrawal, poor concentration, insomnia, depression, changes in sexual desire
physical: increased thirst, cravings, breast tenderness, bloating, weight gain, HA, fatigue, swelling of hands/feet, skin/GI problems, ab pain
51
premenstrual syndrome TX
diet: add complex CHO/calcium rich foods, avoid sugar, caffeine/alcohol
SSRIs may improve mood
NSAIDs for pain
52
endometrial polyps
exact cause unknown
hyperplastic growth of endometrial glands & stoma
may be d/t imbalance of estrogen & progesterone
53
endometrial polyps s/s
```
abnormal heavy bleeding
ab pain
post-menopausal bleeding
infertility
miscarriage
```
54
endometrial polyps DX and TX
ultrasound, hysteroscopy, biopsy
typically no TX
if symptomatic (bleeding) = surgical removal
55
adenomyosis
exact etiology unknown
invasion of glandular endometrial tissue into myometrium
r/t invasive procedures (c-section)
56
adenomyosis s/s
```
menorrhagia
pelvic pain
intercourse pain
dysmenorrhea
30-50s
obese
mulitple children
early menses
hx of uterine surgery
```
57
adenomyosis DX & TX
MRI
oral contraceptives
mirena IUD
(goal is to control diameter)
58
leiomyomas (fibroids)
exact etiology unknown
estrogen/progesterone promote growth
most common in reproductive years (regress in menopause tho can cause bleeding)
59
leiomyomas (fibroids) s/s
pelvic "fullness"
bloating
intercourse discomfort
infertility
60
leiomyomas (fibroids) Dx & TX
exam/ultrasound
| only TX if symptomatic: surgery
61
endometriosis
unkonwn cause
endometrial cells move from uterus and implant outside of uterous
increased incidence w/ 1st degree relative
62
endometriosis s/s
pelvic pain before/during menstruation
painful intercourse
infertility
bleeding between menses
63
endometriosis DX and TX
```
NSAIDs
leuprolid acetate (suppresses ovarian function)
surgical removal (reduces overgrowth of tissue)
```
64
endometrial cancer
most common GYN cancer
starts as endometrial hyperplasia
type 1: estrogen
type 2: non-hormonal (genetics/leiomyomas)
RF: obesity, DM, high-fat diet, increased exogenous estrogen, early menarche, hx anovulation, infertility, nulliparity
if stage 1: excellent survival rate
65
endometrial cancer s/s
vaginal bleeding (post-menopausal bleeding)
pelvic pain
pelvic fullness
unintentional weight loss
66
endometrial cancer DX & TX
biopsy
| surgical removal, chemo,radiation
67
pelvic organ prolapse
pelvic floor muscles become weak (age) or injured (childbirth) = organs drop
RF: decreased estrogen, menopause, pelvic tumors, obesity, COPD, chronic constipation, marfans
68
pelvic organ prolapse s/s
```
sensation of fullness
vaginal spotting
painful intercourse
palpable bulge
frequency
urgency
incontinence
cystocele
rectocele
enterocele
uterine prolapse
```
69
pelvic organ prolapse DX & TX
post-void residual
pessaries (support): vagina/uterus/bladder/rectum
exercises (kegel): PT
surgery
70
exocervix
stratified squamous epithelium
71
endocervix
columnar epithelium
72
transformation zone
transforms columnar epithelium to squamous epithelium (more likely to become cancerous)
73
cervicitis
inflammatory conditions associated w/ purulent drainage
infections vs noninfectious
related to STDS
74
cervical cancer
3rd most common cancer in woemn
HPV cause
RF: age of first intercourse, multiple sex partners, hx of STD
75
cervical cancer s/s
abnormal vaginal bleeding
malodorous discharge
dysuria
lower ab pain
76
cervical cancer DX & TX
papsmear, colposcopy, biopsy
| surgery radiation chemo
77
vaginitis
inflammation of vagina due to change in normal flora
| decreased estrogen after menopause
78
vaginitis s/s and DX
itching, discharge, malodorous discharge, pain
| exam, microscopic ID
79
vaginitis TX
ABX
personal hygiene education
perfume/dye free soaps
if atrophic: moisturizing products
80
vulvovestibulitis
pain in vestibule (surrounds vaginal opening)
81
vulvovestibulitis s/s & DX
pain
redness
burning in vestibule
DX: severe pain w/ pelvic exam
82
vulvovestibulitis TX
topical A & D ointment
witch hazel
lidocaine gel
surgery (last resort)
83
bartholinitis
inflammation of bartholin gland (lubrication & mucus secretion)
buildup of fluid causes cyst & discomfort
84
batholinitis s/s and DX
unilateral mass w/ or w/out pain
| physical exam
85
bartholinitis TX
excision & drainage
ABX
analgesics
recurrent/extreme: excision of gland
86
vaginal cancer
very rare
most often >60 w/ HX of HPV
if squamous: slow spread
adenocarcinoma: likely to mets
87
vaginal cancer s/s
```
abnormal bleeding
dysuria
painful intercourse
vaginal lump
pain/swelling in legs
```
88
vaginal cancer DX & TX
pap smear, colposcopy, biopsy
| surgery radiation chemo
89
vulvar cancer
vulvar intraepithelial neoplasia (VIN) r/t HPV
chronic irritation
history of lichen sclerosis
not common <70
90
vulvar cancer s/s
lump or sore causing itching (repeated injury)
91
vulvar cancer DX & TX
biopsy, imaging
| surgery, chemo, radiation
92
causes of infertility
```
cervix (stenosis or pH imbalance)
uterus (congenital or acquired defects)
ovaries (failure to ovulate most common)
fallopian tubes (abnormalities or drainage)
peritoneum (defects, infection, adhesion, masses)
```
93
infertility DX
failure to conceive after 1 year of unprotected intercourse
94
infertility TX
reproductive endocrinology interventions
| medications
95
clomiphene
selective estrogen receptor modulator
ovulation stimulator
stims relase of LH = increased ovarian follicles acts @ hypothalamus
SE: ovarian enlargement, vasomotor flushes, distention, breath discomfort, multiple births
contra: primary ovarian failure, leiomyomas, ab uterine bleeding, thrombophlebitis, liver disease, intracranial lesions
interx: ospemifene (toxic)
X
96
vaginismus
```
unknown cuases
vaginal tightness causing discomfort
burning pain
penetrationi problems
inability to have intercourse
pain with intercourse
```
97
vaginismus TX
pelvic floor exercises
| psychotherapy if needed
98
Orgasmic dysfunction
never orgasm, difficulty reaching orgasm, decreased intensity orgasm
primary: never achieved (genetic or trauma)
secondary: hypoactive sexual desire disorder
TX: psychotherapy
99
dyspareunia
painful intercourse, no specific cause
| TX: sex education/position changes, lube, psychotherapy (if needed)
100
menopause (climacteric)
natural process of aging, permanent cessation of menses
progressive decrease in estrogen secretion by ovaries
s/s: hot flashes, night sweats, irregular menses, bone mass loss
101
consequences of estrogen loss early, mid, post
E: mood disturbances, depression, irritability, insomnia, hot flashes, irregular menses, HA
M: vaginal atrophy, increased infections, painful intercourse, skin atrophy, stress urinary incontinence, sexual disinterest
P: atherosclerosis, CV disease, osteoporosis, alzheimer's like dementia, colon cancer
102
hormone replacement therapy
TX unpleasant symptoms of menopause
prevents long-term consequences of estrogen loss
estrogren-progestin combo risks: MI, stroke, breast cancer, dementia, venous thromboembolism BUT less risk of hip fracture/colorectal cancer
estrogen alone: increased risk of stroke/thromboembolism alone
