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Practice Topics Exam 4 > Female Urology and Reproductive > Flashcards

Female Urology and Reproductive Flashcards

1
Q

Menstrual Cycle - Mencarche - Normal

A

11 to 15 years

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2
Q

Menstrual Cycle - Length of cycle - Normal

A

20-45 days (avg 28 days)

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3
Q

Menstrual Cycle - Ovulation - Normal

A

14 days

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4
Q

Menstrual Cycle - Menstruation - Normal

A

5 days

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5
Q

Menstrual Cycle - Menstrual pain

A

Cramping before bleeding begins
Peaks 24 hrs
Decreases gradually
Does not limit function

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6
Q

Menstrual Cycle - Length of cycle? - Abnormal

A

Infrequent menstruation - more than 31-35 days apart
OR
Frequent menstruation - less than 2 weeks apart

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7
Q

Menstrual Cycle - Bleeding - Abnormal

A

Lasts more than 7 days

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8
Q

Menstrual Cycle - Menstrual pain - Abnormal

A

Severe abdominal cramping that limits function
Occurs days before bleeding
Lasts more than 3 days
Pain inc as bleeding dec

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9
Q

Age related changes - Perimenopause/Menopause transition

A

Usually occurs between 45-50 years old
Time leading up to complete menopause is usually 3-4 years
Hormonal levels decline and irregular cycle occurs

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10
Q

Age related changes - menopause

A

End of reproductive potential with permanent cessation of ovarian function

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11
Q

Age related changes - postmenopause

A

Live 1/3 of life cycle in this stage with increased life expectancy
Estrogen plays protective role - so keep that in mind with post menopausal patients

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12
Q

Menopause - clinical implications

A

1 Increased urinary incontinence
2 Increased risk of pelvic organ prolapse
3 Increased risk of dyspareunia/pain

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13
Q

Menopause - clinical implications - Inc in urinary incontinence includes what

A

Inc post void residual
Dec power of detrusor mm
Dec pelvic floor mm and collagen support

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14
Q

Menopause - clinical implications - Inc risk of pelvic organ prolapse includes what

A

Dec estrogen is associated with collagen changes and dec vascularity of supporting tissue
So CT not holding things up

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15
Q

Menopause - clinical implications - Inc risk of dyspareunia/pain includes what

A

Dryness of vagina
Dec vascularization of the urethra with dec blood flow and blood volume
Genital atrophy from dec hormones

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16
Q

Menopause - clinical implications - impacts what

A

ALL SYSTEMS!

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17
Q

Menopause - clinical implications - GI system

A

Bloating
Abdominal pain
Irritable bowel

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18
Q

Menopause - clinical implications - Integumentary

A

More thinning

Bruise easier

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19
Q

Menopause - clinical implications - Endocrine

A

Mostly estrogen is declining

Can lead to decrease in metabolism

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20
Q

Menopause - clinical implications - Cardiovascular

A

Inc in truncal obesity can inc risk of CV complications

After menopause - women become higher risk

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21
Q

Menopause - clinical implications - Musculoskeletal

A

OP
Fractures
Postural changes

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22
Q

Menopause - clinical implications - Nervous

A

More impairments in cognitive function

Sleep disturbances

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23
Q

Pelvic floor mm - description

A

Skeletal muscle sling from pubic bone to coccyx - surrounds the urethra, vagina, and rectum

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24
Q

Purpose of the pelvic floor mm

A

Support internal pelvic organs
Closes off urethra for continence
Closes off rectum for continence
Participate in sexual arousal and orgasm

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25
Q

Puborectalis

A

Most medial
Pubic bone - wraps around urethra, vaginal opening, and rectum
Like a lasso around the openings

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26
Q

Micturation - phases

A

Storage/Filling phase

Emptying phase

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27
Q

Micturation - Storage/Filling phase

A

Parasympathetic receptors are inhibited
Sympathetic receptors are stimulated
Sympathetic will keep detrusor relaxed and keep bladder neck contracted

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28
Q

Micturation - Emptying phase

A

Sympathetic receptors are inhibited - relaxation of bladder neck, cessation of stretch receptors
Parasympathetic receptors are stimulation - detrusor contraction is strengthened

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29
Q

Micturation - Sympathetic =

A

Storage

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30
Q

Micturation - Parasympathetic =

A

Emptying phase

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31
Q

Micturation - bladder fills at what rate

A

Constant rate!

15 drops/minute

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32
Q

Micturation - sensations and capacity

A

First sensation to void = 40% capacity (about 150 mL)
First desire to void is about 60% capacity
Strong desire to void is at more than 90% capacity (about 400-500 mL)

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33
Q

Micturation - patient education

A

Nerve signals from bladder go to brain sacral micturation center
Brain tells bladder that it cannot contract
Signals to bladder neck/outlet to contract more so can continue filling
(outlet pressure more than bladder pressure)

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34
Q

Pelvic floor mm dysfunction - classified by

A

symptoms, signs, and conditions

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35
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction

A 
1 Lower UT symptoms
2 Bowel symptoms
3 Vaginal symptoms
4 Sexual function
5 Pain
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36
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction - Lower UT symptoms

A

Urinary incontinence
Urgency
Frequency

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37
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction - Bowel symptoms

A

Obstructed defecation
Functional constipation
Fecal incontinence
Rectal/Anal prolapse

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38
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction - Vaginal symptoms

A

Pelvic organ prolapse

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39
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction - Sexual function

A

Orgasmic dysfunction
Dyspareunia in women
Erectile and ejaculatory dysfunction in men

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40
Q

Pelvic floor mm dysfunction - 5 symptoms/5 types of dysfunction - Pain

A

Chronic pelvic pain

Pelvic pain syndrome

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41
Q

Pelvic floor dysfunction - underactive PFM

A

1 Dec strength and endurance
2 Poor coordination of PFM with changes in intraabdominal pressure (cough, sneeze, laugh)
3 Urinary or fecal incontinence, prolapse

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42
Q

Pelvic floor dysfunction - underactive PFM - Causes

A 
PFM avulsion (maybe childbirth)
Age 
High BMI 
Type 2 D
Heavy lifting 
Constipation 
Overstretching of the PFM and CT Pudendal nerve damage
Birth trauma 
Dec mobility
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43
Q

Pelvic floor dysfunction - overactive PFM

A

1 Inc in PFM tension, active spasm
2 Incoordination of PFM causing dysfunction of urogenital or colorectal systems
3 Musculoskeletal pain from hypertonicity

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44
Q

PFM Dysfunction Diagnosis - Underactive

A

1 Urinary incontinence
2 Prolapse
3 Fecal incontinence

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45
Q

PFM Dysfunction Diagnosis - Overactive

A 
1 Levator ani syndrome
2 Chronic pelvic pain
3 Vaginismus
4 Tension myalgia
5 Coccygodynia
6 Interstitial cystitis/painful bladder
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46
Q

Pelvic floor dysfunction - overactive PFM - Causes

A 
Multifactorial
Symptom of other pathology 
Job stress, menstrual cycle, constipation 
Hx of abuse
Habitual postures
Orthopedic malalignment
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47
Q

Urinary incontinence - is what

A

symptom of ANY involuntary leaking of urine

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48
Q

Urinary incontinence - prevalence

A

35-38% in women

often is underreported though

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49
Q

Stress urinary incontinence is what

A

Involuntary leakage with activities, sneezing, or coughing

Anything that causes inc abdominal pressure

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50
Q

Stress urinary incontinence is due to

A

Due to increased abdominal pressure relative to urethral closure pressure

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51
Q

Urge urinary incontinence is what

A

Sudden, unexpected urge with uncontrolled loss of urine

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52
Q

Mixed urinary incontinence is what

A

Combination of both stress and urge

Is the most common

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53
Q

Less common types of urinary incontinence - Insensible UI

A

Loss of urine where the person has no idea how it occurred

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54
Q

Less common types of urinary incontinence - Continuous UI

A

Complaints of continuous leakage

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55
Q

Less common types of urinary incontinence - Postural UI

A

Leakage with changes in position - most common is leaning over and then when they come back up
Or also from sit to stand (this is huge with males post prostectomy)

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56
Q

Less common types of urinary incontinence - Nocturnal enuresis

A

Leakage of urine while sleeping

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57
Q

Less common types of urinary incontinence - Coital UI

A

Leakage while involved in intercourse

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58
Q

UI epidemiology - any urine leakage during physical or non physical activity, or before reaching toilet

A
  1. 1 % women

15. 1 % men

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59
Q

UI risk factors

A 
1 PFM damage
2 Pelvic organ prolapse
3  Sphincter mm weakness or damage
4 Pudendal nerve damage
5 Neurological disorder 
6 Psychogenic
7 Constipation 
8 Medications
9 Inc age or dec cog function
10 Impaired mobility
11 Pregnancy or Obesity
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60
Q

Neurogenic Bladder Disorders are what

A

Voiding dysfunction from neurologic conditions caused by an interruption of the nerve supply to the bladder
Can be UMN or LMN lesion

61
Q

Neurogenic Bladder Disorders - Clinical presentation

A

Smaller urine volume on voiding
Incontinence
Urgency and frequency
Higher rates of UTIs

62
Q

Bladder Storage Symptoms

A 
Inc daytime urinary freq
Nocturia 
Nighttime freq 
Urgency
Overactive bladder symptoms
63
Q

Normal bladder habits - how many times a day/night

A

4-8 times a day

At night shoulder be 0-1 if under 65, 1-2 if over

64
Q

Normal bladder habits - time between urination

A

Generally urinate every 2-5 hours

65
Q

Normal bladder habits - Length of urination

A

8-10 sec

66
Q

Normal bladder habits - Urine color

A

light yellow

67
Q

Dietary recommendations - aim for how much fluid/day

A

48-64 ounces of water
Concentrated urine will irritate bladder
If over 80-100 oz is associated with inc incontinence

68
Q

Dietary recommendations - Bladder irritants

A

Coffee, tea, soda, medications, caffeine, chocolate, alcohol, nicotine, carbonation, high acid, artificial sweeteners

69
Q

Behavior Training - Forms of behavioral treatment for urinary incontinence

A 
Bladder training
Use bladder diary/voiding log
Urge suppression techniques 
Dietary modifications
Appropriate fluid intake
Weight loss
Pelvic floor exercises
70
Q

Bladder training - Bladder diary includes what

A 
How often
How many leaks
Size of leak
Activity during leak
Amount and type of fluid consumed
Amount and fluid voided
Number of pads used per day
Amount voided
71
Q

Bladder training - Bladder diary - how often is most effective

A

Have them do it for 3 days - gives you enough info and inc compliance/honesty

72
Q

Bladder training - Bladder diary - defining the size of the leak

A

Drops to a teaspoon = small
Tablespoon = moderate
1/4 of a cup = significant lea (will go through clothes)

73
Q

Bladder training - urgency control

A

1 Sit - perineal pressure inhibits bladder - sitting on the perineum can inhibit it
2 Relax
3 Distract
4 do NOT rush
5 When urge dissipates, wait until rx time or 5-15 min and then walk to toilet

74
Q

Bladder training - what else besides bladder control techniques

A

Scheduled voiding
Avoid just in case urinating
Prompted training for cognitive impaired or SNF/LTC

75
Q

Purpose of bladder training

A 
Improve bladder control by changing bx 
Break cycle of urgency/frequency
Dissociate functional bladder capacity 
Inc functional bladder capacity 
Inc self confidence
Correct improper voiding habits
76
Q

Dysfunctional bladder habits

A

Delaying bladder too long
Hoovering over toilet
Bearing down to initiate or complete urination
Not allowing full time for bladder to empty
Voiding just in case
Failing to wipe front to back
Urinary frequency over 10x/day

77
Q

Treatment of underactive PFM

A 
Bx training
Postural education 
Coordination of breath and PFM 
Strengthening PFM, abs, back
Inc PFM coordination, endurance, and force by skilled PT with training for internal eval
78
Q

Treatment of overactive PFM

A

Bladder retraining
Schedule interval is critical
Urgency control
Avoid just in case voiding

79
Q

Treatment of overactive PFM - Schedule interval

A

Short mandatory voiding interval for mod-severe urgency

No sooner than __ hours for mild symptoms

80
Q

Treatment of overactive PFM - Urgency control

A

Sit - perineal pressure to inhibit bladder
Relax
Distract with pos thoughts of being in control
Do NOT rush
When urge dissipates, wait until rx time or 5-15 min and walk to toilet

81
Q

Measurement of PFM dysfunction - ICS definition

A 
Pathophysiology = cause
Impairment = non functioning PFM (over or under)
Disability = leakage
82
Q

Pelvic organ prolapse is what

A

Descent of one or more of the pelvic organs into the vagina due to the loss of fibromuscular support

83
Q

Pelvic organ prolapse is described by

A

the compartment of the vagina in which it occurs

84
Q

Pelvic organ prolapse - Cystocele

A

Anterior vaginal wall prolapse
Most common
Bladder falling forward

85
Q

Pelvic organ prolapse - Retocele

A

Posterior vaginal wall prolapse

Rectum coming forward

86
Q

Pelvic organ prolapse - Apical

A

the loss of support of the uterus
vaginal vault
Uterus coming down and vaginal vault coming down
Common after hysterectomy

87
Q

Pelvic organ prolapse - epidemiology of ages 18-82 years

A

Stage 1 = 43.3 %

Stage 2 = 47.7%

88
Q

Pelvic organ prolapse - etiology

A 
Pelvic mm weakness, ligamentous lax
Multiple preg and deliveries
Obestiy 
Traumatic 
Prolonged labor/delivery 
Excessive and rep. straining with bowel mvmnts
Aging and DM inc risk
Neuro conditions
Posture and IAP management
89
Q

Prolapse risk factors

A 
1 Multiple preg and deliveries
2 Prolonged labor
3 Improper bearing down with delivery 
4 Nerve damage with delivery
5 Obesity
6 Aging
7 Chronic constipation
8 Chronic heavy lifting 
9 Chronic cough
90
Q

Prolapse symptoms

A

Urinary
Bowel
Sexual
General

91
Q

Prolapse symptoms - urinary symptoms

A

Incontinence, freq, urgency, hesitancy
Position change or manual reduction of prolapse needed to initiate/complete voiding
Weak/prolonged stream
Incomplete emptying/actual or sensory
Leaking immediately or dribbling post void

92
Q

Prolapse symptoms - bowel symptoms

A

Feelings of incomplete emptying/obstruction
Straining, digital evacuation
Splinting of vagina or perineum so that they aren’t pushing more out with bowel mvmnt

93
Q

Prolapse symptoms - Sexual symptoms

A

Due to changes in vagina anatomy
Dec lubrication and arousal
Dyspareunia

94
Q

Prolapse symptoms - general symptoms

A

Pressure/heaviness of vagina
Bulge coming out of vagina
General pelvic pain/maybe LBP
Worse at end of day with prolonged standing/walking
Urinary, bowel, sexual symptoms may be associated
Self conscious

95
Q

Impairments with prolapse

A 
High or low tone in levator ani
Posterior pelvic tilt
Glut weakness
Poor management of abdominal pressure
Poor coordination/stabilization of core
Improper voiding techniques
96
Q

Diagnosis pf pelvic organ prolapse

A

Pelvic exam

97
Q

Treatment of pelvic organ prolapse

A 
Rehab for underactive pelvic floor
Vaginal pessary 
Corrective surgery
Weight loss if obese
Hormonal replacement therapy
Control of constipation and vasalva activities
98
Q

Only ___% of patients actually seek tx for POP

A

10-20%

99
Q

Considerations for udneractive PFM

A 
Management of intra-abdominal pressures
Breath coordination
Posture - thoracolumbar ext, neut pelvis
Mm coordination with functional activity
Bx training - hydration, diet, urgency, freq
100
Q

Pelvic pain - diagnoses consist of

A 
Endometriosis 
Dysmenorrhea
Hypertonus disorders
Interstitial cystitis
GI disorders
101
Q

Pelvic pain - pain and hypertonus disorders may be related to

A 
Delayed healing perineal lacerations
Trauma with delivery
Pelvic obliquity 
Multiple gyn/visceral diagnoses
Cauda equina
Scar tissue/adhesions
Mm spasm/guarding
Abuse
102
Q

Tx of overactive (hypertonic) PFM disorders

A 
Posture
Joint alignment
Aerobic exercise
Pain education
Manual therapy
Stretching
Biofeedback/Relaxation training
Dilators for stretching
103
Q

Painful bladder syndrome/Interstitial cystitis is what

A

Recurring pelvic pain, pressure, or discomfort in the bladder and pelvic region
Often associated with urinary frequency and urgency

104
Q

Painful bladder syndrome/Interstitial cystitis - what is often a co-morbidity or the driver of the symptoms

A

Hypertonicity of abdominal and pelvic floor muscles

105
Q

Painful bladder syndrome/Interstitial cystitis - exacerbated by

A

emotional or physical stress

106
Q

Painful bladder syndrome/Interstitial cystitis - Flares can ocur with

A

Consumption of acidic food

107
Q

Painful bladder syndrome/Interstitial cystitis - frequent comorbidities include

A

fibromyalgia, endometriosis, migraines, IBS, vulvodynia

108
Q

Painful bladder syndrome/Interstitial cystitis - treatment

A 
No cure
Manage s/s and treat bladder lining
Pharm - pain and bladder s/s
PT
Surgery
109
Q

Painful bladder syndrome/Interstitial cystitis - - PT treatment

A

Overactive PFM and myofascial pain in 85%
Bx retraining and dietary modifications
Pain neuroscience education

110
Q

Painful bladder syndrome/Interstitial cystitis - Surgery

A

Neuromodulation at S3 with interstim unit for treatment of urgency, frequency, retention

111
Q

Enodmetriosis is what

A

A disorder that occurs when endometrial tissue grows outside of the uterus
Tissue is biochemically and endocrine active

112
Q

Endometriosis - what does it look like

A

Chocolate cysts - formed by the implanted tissue as it reacts to the normal cycle

113
Q

Endometriosis - most common sites

A 
Ovaries
Fallopian tubes
Broad ligament
Pouch of douglas
Bladder
Pelvic mm 
Perineum 
Vulva
Vagina
Intestines
114
Q

Endometriosis - Epidemiology

A

Affects W of all groups
2-20% of american women affected
45% of all abdominal pain

115
Q

Enometriosis risk factors

A 
Early age menarche
Short menstrual cycles
Long duration of menstrual flow
Inverse relationship to parity
Family hx
116
Q

Endometriosis clinical presentation

A

Dysmenorrhea
Dyspareunia
Infertility
Pain - low back, pelvis, thigh, abdominals

117
Q

Endometriosis treatment

A

Depends on age, reproductive desires, stage of disease and symptoms

None
Pharm
Surgery
PT
Alternative tx are increasing
118
Q

Endometrial (uterine) cancer

A

Most common gynecological cancer

4th most common cancer for women

119
Q

Endometrial (uterine) cancer - risk factors

A

Age (avg is 60, 75% in post menopausal women, 25% premenopausal, 5% in under 40)
Obesity
Nulliparity (no children)
No genetic component

120
Q

Endometrial (uterine) cancer - Decrease risk with

A

Exercise!

80% less likely compared to women that do not exercise

121
Q

Endometrial (uterine) cancer - most common symptom

A

Abnormal vaginal bleeding (esp post menopausal)

122
Q

Endometrial (uterine) cancer - diagnosis made by

A

tissue cytology exam

123
Q

Endometrial (uterine) cancer - treatment

A

surgery and radiation

124
Q

Endometrial (uterine) cancer - prognosis

A

good in early stages (90%)

poor for late stages (10%)

125
Q

Cervical cancer- risk factors

A 
HPV (93%)
Maternal use of DES
Smoking
Hormonal contraceptive use
High parity (births)
Low SES
Ethnic background
Young age of first intercourse
Multiple sex partners (more than 5)
126
Q

Cervical cancer - diagnosis

A

Pap screen/test can detect problems early

127
Q

Cervical cancer - treatment

A

Prevention, Gardisil vaccine

Depends on stage - hysterectomy, radiation therapy

128
Q

Cervical cancer - prognosis

A

Early stages is highly curable (85%)

Advanced (40%)

129
Q

Ectopic pregnancy is what

A

Fertilization and implantation of the embryo outside of the uterine cavitiy (more than 95% are in fallopian tube)

130
Q

Ectopic pregnancy presents with

A

Amenorrhea or menstrual irregularities with unilateral or bilateral abdominal and back pain

131
Q

Ectopic pregnancy s/s of…

A

normal pregnancy with fatigue, nausea, breast tenderness and inc urinary freq

132
Q

Ovarian cystic disease

A

Most common during reproductive years
Affects 3-7% of all women
Caused by hormonal imbalances

133
Q

Ovarian cystic disease - presentation

A 
Low back and pelvic pain
Abdominal pain and bloating
Painful urination, bowel movements and itnercourse
menstrual irregularities 
large cysts can lead to infertility
134
Q

Ovarian cystic disease - Diagnosis

A 
US
Lab tests (CBC, CA-125 for ovarian cancer)
135
Q

Ovarian cystic disease - Treatment

A

Depends on childbearing status
May drain spontaneously
Surgery might be necessary
Hormonal therapy restoration of progesterone

136
Q

Polycystic ovary syndrome (PCOS) - now considered what type of disease

A

A systemic metabolic/hormone disorder

137
Q

Polycystic ovary syndrome (PCOS) - epidemilogy

A

Affects 20% of women in US with 50% being obese

Most common cause of infertility - 75% have some degree of it

138
Q

Polycystic ovary syndrome (PCOS) - s/s

A

Impaired menstruation
glucose intolerance
Inc risk for type 2 diabetes, fibrocystic breasts, heart disease

139
Q

Ovarian cancer - epidemiology

A

5th most common cancer in W
accounts for 90% of deaths related to gyn cancers
Metastatic disease in 60-70% at time of diagnosis
Peak incidence is 40-70 years (half of cases in women over 65)

140
Q

Ovarian cancer - risk factors

A 
Family hx of breast, ovarian, colon ca
Personal hx of breast or endometrial cancer
Nulliparity
Never breast fed
Presence of BRCA-1 or BRCA-2 mutation
141
Q

Ovarian cancer - s/s

A

Early CA has no presentation and there is no screening tool

Symptoms of metastasis = unexplained weight loss, pleurisy, ascites

142
Q

Ovarian cancer - treatment

A

Surgery
Radiation
Chemotherapy

143
Q

Ovarian cancer - prognosis

A

Generally poor due to metastasis at diagnosis
Early stage treatment 90% for 5 yr survival rate
Tumor recurrence within 3 yrs after treatment in most women

144
Q

PT and gyn cancer

A

Medical tx is geared toward saving a life
PT is geared toward making their saved life worth living!

Generalized strengthening
Pelvic floor strengthening
Manual therapy for scar
Progressive dilator for stretching
Pain management
145
Q

Treatment algorithm - Medical provider treatment

A

UTI

Pelvic inflammatory disease

146
Q

Treatment algorithm - PT

A

Pelvic pain from mm origin (lumbar/SI dysfunction)

147
Q

Treatment algorithm - Specialized pelvic physical therapist

A

Pelvic floor mm dysfunction
Painful bladder syndrome
Defecation dysfunction
Dyspareuina

148
Q

Does my patient need to see a pelvic floor specialist

A 
P with sitting, can't touch it
Hx of gyn dysfunction
Hx of incontinence that isn't getting better 
Pelvic pain in brim of pelvis 
Suspicion that there is more to it
Tailbone pain....and more

Practice Topics Exam 4 (9 decks)

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