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CPD > Gyn 1 > Flashcards

Gyn 1 Flashcards

1
Q

When are gynecological exams necessary?

A

pelvic pain
vaginal bleeding
vaginal d/c

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2
Q

what are some common patient issues that we need to be aware of?

A

possible past history of sexual abuse
fear of pregnancy
denial
modesty/shame

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3
Q

what are common physician issues?

A

fear of causing pain
respect for the patient
uninhibited patient
confidentiality

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4
Q

what is LMP?

A

last menstrual period

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5
Q

PMP means?

A

previous menstrual periods

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6
Q

What do we need to know about normal menses?

A

lasts 3-7 days
21-35 days in between
30mL blood lost
a tampon saturated is 5-15 mL

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7
Q

what are symptoms of pregnancy?

A

morning sickness, breast tenderness, delayed menses

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8
Q

what should we look out for in cases of suspected domestic violence?

A

inconsistent explanation of injuries
frequent ER visits
head and neck injuries
low birth weight infants

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9
Q

what to ask in family history for gynecological concerns?

A

breast CA, other CA
endometriosis
PCOS
infertility

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10
Q

what is the introitus?

A

the vaginal opening, intro - into, to enter in.

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11
Q

what does an enlarged uterus indicate?

A

pregnancy

adenomyosis, malignancy or myomas

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12
Q

What conditions are associated with CMT?

A

cervical motion tenderness

  • PID
  • ovarian cyst
  • endometriosis
  • adhesions
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13
Q

are the ovaries larger or smaller during menopause?

A

smaller

normal is 3x2x2cm, menopausal is 1x0.7x0.5cm

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14
Q

when would you perform a rectovaginal exam?

A

on a patient >40years with suspicious of endometriosis

- assess septum, utero-sacral ligaments, uterus, cul-de-sac, adnexae and cervix

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15
Q

what pregnancy tests are used? which is most sensitive? cheapest? used specifically for miscarriages?

A

urine beta-hCG - can detect within 1 week of conception and cheap

serum beta-hCG qualitative - more specific and sensitive than urine

serum beta-hCG quantitative - used specifically with miscarriages and ectopic pregnancies

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16
Q

what are pap smears useful in detecting?

A

uterine CA

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17
Q

wet preps are useful in detecting?

A

vaginal infections - trich, BV, yeast, etc

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18
Q

what is the normal pH of the vaginal secretions?

A

3.5-4.5

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19
Q

when you have suspicion of a mass - what imaging would you order?

A

TVUS - transvaginal ultra sound (BEST TOOL)
abdominal US as well.
MRI/CT less common
However, with things like cancer, CT is warranted

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20
Q

when would you use a laparoscopy?

A

exploration of disease process and treatment

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21
Q

when would you use an endometrial biopsy (EMB)

A

for unexplained vaginal bleeding or a thickened endometrium visualized on TVUS

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22
Q

dysmenorrhea suggests what?

A

endometriosis/adenomyosis and uterine fibroids

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23
Q

What is dysmenorrhea

A

sharp or cramping pain before or at onset of menses - often with h/a, n/d, constipation or urinary frequency

24
Q

what additional exams do you want to perform with pelvic exams?

A

thyroid, abdominal, vitals (including WtH ratio and circumference)

25
Q

which conditions are related to the menstrual cycle in terms of pelvic pain?

A
  • dysmenorrhea
  • endometriosis
  • mittelschmerz
26
Q

which conditions are unrelated to the menstrual cycle that cause pelvic pain?

A

PID, ruptured cyst or ectopic pregnancy, adnexal torsion, uterine or ovarian cancer

27
Q

What are the emergency situations of pelvic pain that may require surgery?

A 
tubo-ovarian abscess
ectopic pregnancy
rupture/torsion of ovarian cysts
appendicitis
bowel perforation
28
Q

when inquiring about an infective process, always make sure you ask these PERTINENT questions to help you grade where the patients severity lies?

A

nausea
vomiting
fever
chills

29
Q

what are red flag symptoms when assessing for a pelvic mass

A

syncope/hemorrhagic shock
peritoneal signs (rebound, rigidity, guarding)
post-menopausal bleeding
fever/chills
sudden, severe pain w/ n/v, diaphoresis or agitation

30
Q

What labs can you order for a pelvic mass?

A

UA complete and culture
CBC
pregnancy test
TVUS or laparoscopy

31
Q

what key points need to be considered when diagnosing pelvic pain

A
  • it’s common and may have a gyn or non-gyn cause
  • pregnancy should ALWAYS be R/O in childbearing aged women
  • quality, severity, location of pain and it’s relationship to menstrual cycle can suggest the most likely causes
  • dysmenorrhea is a common cause of pelvic pain, but is a dx of exclusion
32
Q

what is the definition of abnormal vaginal bleeding?

A
  • prolonged, painful, excessive or irregular bleeding
33
Q

what is menorrhagia?

A

menorrhagia - excessive duration (>7 days) and/or amount (>80mL) of bleeding

34
Q

polymenorrhea is..?

A

polymenorrhea - too frequent menses (<21 days)

35
Q

metorrhagia is..?

A

metorrhagia is spotting unrelated to menses, occurring frequently and irregularly between menses

36
Q

oligomenorrhea

A

too few periods (<35 days)

37
Q

amenorrhea

A

no menses

38
Q

what does most AUB (abnormal uterine bleeding) result from?

A

hormonal abnormalities in the HPA axis

39
Q

what is anovulation?

A

no progesterone. excess estrogen causes stimulation of the endometrial glands causing irregular and incomplete sloughing off of the endometrium

most common cause of DUB

40
Q

what are the common causes of abnormal vaginal bleeding? what if it’s inflammatory?

A

most common causes are uterine polyps and submucosal fibroids

if it’s inflammatory it’s most likely endometritis

41
Q

what is the most common reason for post-penetrative sex spotting or infertility issues

A

endocervical polyps

42
Q

what are the ssx’s of hemorrhagic shock?

A

light-headedness

syncope, tachycardia

43
Q

what are the risk factors for endometrial cancer?

A

obesity, DM, HTN, prolonged unopposed estrogen use, PCOS (highest incidence of endometrial cancer before the age of 40), age older than 35

44
Q

what pe’s do you want to perform for abnormal vaginal bleeding?

A

skin (bleeding d/o, jaundice, hirsuitism, acne)
thyroid
abdominal (splenomegaly)

45
Q

what is the common cause of a NT mass in the uterus?

A

uterine fibroids

30% of these are concomitant with cancer. EMB for cancer.

46
Q

what are red flags of abnormal vaginal bleeding?

A

hemorrhagic shock
pre-menarchal and post menopausal vaginal bleeding
bleeding in pregnancy

47
Q

when would you run a prolactin test?

A

for oligomenorrhea and amenorrhea - rarely does it show up in other bleeding disorders

48
Q

what is prolactin?

A

hormone that makes milk!
it shuts down the HPO axis.
most common cause other than lactation is a tumor on the pituitary
40% of hypothyroid patients have elevated prolactin

49
Q

what is saline infused ultrasonography?

A

allows the potential space to be better visualized in order to observe:

  • pedunculate myomas
  • endometrial polyps
  • endometrial hyperplasia
50
Q

when is the endometrium considered thickened?

A

> 4mm

51
Q

what test should be ordered if PCOS is suspected?

A

serum testosterone and

FSH/LH - (3/1 normal, 1/3 = PCOS) at day 3 of the cycle

52
Q

what are the keys to abnormal vaginal bleeding?

A
  • always exclude pregnancy even when hx doesn’t point toward it
  • DUB - the most common cause of AUB during reproductive years
  • vaginitis, foreign bodies, trauma and sexual abuse - common causes of vaginal bleeding before menarche
  • post-menopausal vaginal bleeding needs further evaluation to exclude cancer as the cause
53
Q

after menstruation the endometrium is __ mm?

A

less than 2 mm

54
Q

the endometrium can increase to a maximal thickness of __ mm in the late follicular phase

A

11 mm. More than that is too thick!

55
Q

in the secretory phase, the endometrium will reach __ mm

A

14 mm

56
Q

what are the 3 types of estrogen and what are their significances?

A

estrone (E1) - highest during menopause
estradiol (E2) - highest in childbearing years

E1 and E2 strongest forms of estrogen.

estriol (E3) - highest during pregnancy (breakdown product of E1 and E2 in the liver.

CPD (4 decks)

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