Gyn 1 Flashcards
When are gynecological exams necessary?
pelvic pain
vaginal bleeding
vaginal d/c
what are some common patient issues that we need to be aware of?
possible past history of sexual abuse
fear of pregnancy
denial
modesty/shame
what are common physician issues?
fear of causing pain
respect for the patient
uninhibited patient
confidentiality
what is LMP?
last menstrual period
PMP means?
previous menstrual periods
What do we need to know about normal menses?
lasts 3-7 days
21-35 days in between
30mL blood lost
a tampon saturated is 5-15 mL
what are symptoms of pregnancy?
morning sickness, breast tenderness, delayed menses
what should we look out for in cases of suspected domestic violence?
inconsistent explanation of injuries
frequent ER visits
head and neck injuries
low birth weight infants
what to ask in family history for gynecological concerns?
breast CA, other CA
endometriosis
PCOS
infertility
what is the introitus?
the vaginal opening, intro - into, to enter in.
what does an enlarged uterus indicate?
pregnancy
adenomyosis, malignancy or myomas
What conditions are associated with CMT?
cervical motion tenderness
- PID
- ovarian cyst
- endometriosis
- adhesions
are the ovaries larger or smaller during menopause?
smaller
normal is 3x2x2cm, menopausal is 1x0.7x0.5cm
when would you perform a rectovaginal exam?
on a patient >40years with suspicious of endometriosis
- assess septum, utero-sacral ligaments, uterus, cul-de-sac, adnexae and cervix
what pregnancy tests are used? which is most sensitive? cheapest? used specifically for miscarriages?
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
what are pap smears useful in detecting?
uterine CA
wet preps are useful in detecting?
vaginal infections - trich, BV, yeast, etc
what is the normal pH of the vaginal secretions?
3.5-4.5
when you have suspicion of a mass - what imaging would you order?
TVUS - transvaginal ultra sound (BEST TOOL)
abdominal US as well.
MRI/CT less common
However, with things like cancer, CT is warranted
when would you use a laparoscopy?
exploration of disease process and treatment
when would you use an endometrial biopsy (EMB)
for unexplained vaginal bleeding or a thickened endometrium visualized on TVUS
dysmenorrhea suggests what?
endometriosis/adenomyosis and uterine fibroids
What is dysmenorrhea
sharp or cramping pain before or at onset of menses - often with h/a, n/d, constipation or urinary frequency
what additional exams do you want to perform with pelvic exams?
thyroid, abdominal, vitals (including WtH ratio and circumference)
which conditions are related to the menstrual cycle in terms of pelvic pain?
- dysmenorrhea
- endometriosis
- mittelschmerz
which conditions are unrelated to the menstrual cycle that cause pelvic pain?
PID, ruptured cyst or ectopic pregnancy, adnexal torsion, uterine or ovarian cancer
What are the emergency situations of pelvic pain that may require surgery?
tubo-ovarian abscess ectopic pregnancy rupture/torsion of ovarian cysts appendicitis bowel perforation
when inquiring about an infective process, always make sure you ask these PERTINENT questions to help you grade where the patients severity lies?
nausea
vomiting
fever
chills
what are red flag symptoms when assessing for a pelvic mass
syncope/hemorrhagic shock
peritoneal signs (rebound, rigidity, guarding)
post-menopausal bleeding
fever/chills
sudden, severe pain w/ n/v, diaphoresis or agitation
What labs can you order for a pelvic mass?
UA complete and culture
CBC
pregnancy test
TVUS or laparoscopy
what key points need to be considered when diagnosing pelvic pain
- 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
what is the definition of abnormal vaginal bleeding?
- prolonged, painful, excessive or irregular bleeding
what is menorrhagia?
menorrhagia - excessive duration (>7 days) and/or amount (>80mL) of bleeding
polymenorrhea is..?
polymenorrhea - too frequent menses (<21 days)
metorrhagia is..?
metorrhagia is spotting unrelated to menses, occurring frequently and irregularly between menses
oligomenorrhea
too few periods (<35 days)
amenorrhea
no menses
what does most AUB (abnormal uterine bleeding) result from?
hormonal abnormalities in the HPA axis
what is anovulation?
no progesterone. excess estrogen causes stimulation of the endometrial glands causing irregular and incomplete sloughing off of the endometrium
most common cause of DUB
what are the common causes of abnormal vaginal bleeding? what if it’s inflammatory?
most common causes are uterine polyps and submucosal fibroids
if it’s inflammatory it’s most likely endometritis
what is the most common reason for post-penetrative sex spotting or infertility issues
endocervical polyps
what are the ssx’s of hemorrhagic shock?
light-headedness
syncope, tachycardia
what are the risk factors for endometrial cancer?
obesity, DM, HTN, prolonged unopposed estrogen use, PCOS (highest incidence of endometrial cancer before the age of 40), age older than 35
what pe’s do you want to perform for abnormal vaginal bleeding?
skin (bleeding d/o, jaundice, hirsuitism, acne)
thyroid
abdominal (splenomegaly)
what is the common cause of a NT mass in the uterus?
uterine fibroids
30% of these are concomitant with cancer. EMB for cancer.
what are red flags of abnormal vaginal bleeding?
hemorrhagic shock
pre-menarchal and post menopausal vaginal bleeding
bleeding in pregnancy
when would you run a prolactin test?
for oligomenorrhea and amenorrhea - rarely does it show up in other bleeding disorders
what is prolactin?
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
what is saline infused ultrasonography?
allows the potential space to be better visualized in order to observe:
- pedunculate myomas
- endometrial polyps
- endometrial hyperplasia
when is the endometrium considered thickened?
> 4mm
what test should be ordered if PCOS is suspected?
serum testosterone and
FSH/LH - (3/1 normal, 1/3 = PCOS) at day 3 of the cycle
what are the keys to abnormal vaginal bleeding?
- 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
after menstruation the endometrium is __ mm?
less than 2 mm
the endometrium can increase to a maximal thickness of __ mm in the late follicular phase
11 mm. More than that is too thick!
in the secretory phase, the endometrium will reach __ mm
14 mm
what are the 3 types of estrogen and what are their significances?
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.
