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2024 - Élo - Revision LMCC > Gyn > Flashcards

Gyn Flashcards

1
Q

Name most common etiologic causes of 2e amenorrhea (2)

A
  • Ovarian causes—40%
  • Hypothalamic causes—35%
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2
Q

Describe tx: Primary Ovarian Insufficiency (3)

A
  • Patient education (diagnosis)
  • Hormone replacement therapy until age of menopause
    • Maintain age-appropriate bone density
    • Cardiovascular health
  • Yearly F/U of HRT, TSH levels; bone scan as needed
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3
Q

Describe tx: Primary dysmenorrhea (3)

A
  • NSAIDs
  • Hormonal suppression (OCPs, Depo-Provera, Mirena)
  • Nonpharmacologic (i.e., physical exercise, topical heat, high- frequency transcutaneous electrical nerve stimulation (TENS))
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4
Q
A
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5
Q

Describe steps for primary amenorrhea (3)

A
  • B-hcg
  • Pelvic ultrasound
  • Serum levels of FSH
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6
Q

In amenorrhea, if present + high FSH, think of what? (2)

A
  • Gonadal dysgenesis: Turner Syndrome, Swyer syndrome
  • 17 alpha hydroxylase deficiency
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7
Q

Describe: Gonadal dysgenesis (3)

A
  • Present streak gonads, functionless, fribrous tissue, can’t respond to FSH stimulation
  • Can’t produce sex hormones -> no 2e female sex characteristics
  • Associated with Turner’s syndrome and Swyer syndrome
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8
Q

How to dx: Turner’s syndrome

A
  • Karyotype: 45X or Mosaic (45X + 46XX OR 45X + 46XY)
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9
Q

Describe presentation: Turner’s syndrome (6)

A
  • Short stature
  • Widely spaced nipples
  • Low-set ears
  • Wide or webbed neck
  • Broad chest
  • Arms turn outward
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10
Q

Describe tx: Turner’s syndrome (3)

A
  • Streak gonads surgically removed
  • Estrogen therapy (low doses) + progesterone (2 yrs after) 10 days per month to induce menstrual bleeding
  • Growth hormone therapy
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11
Q
A
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12
Q

Describe lab: 17 alpha hydroxylase defiency (3)

A
  • high progesterone
  • high deoxycorticosterone
  • serum 17-alpha-hydroprogesterone < 0.2 ng/ml
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13
Q

Describe tx: 17 alpha hydroxylase defiency (3)

A
  • Exogenous glucocorticoid replacement therapy (hydrocortisone or dexamethasone)
  • Mineralocorticoid receptor blockade (ex: spironolactone)
  • Low-dose estrogen + progestin (2 yrs later)
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14
Q

DDX of uterus on pelvic ultrasound + low FSH (2)

A

hypothalamic or pituitary disorder

  • congenital GnRH deficiency (ex: Kallman syndrome)
  • constitutional delay of puberty
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15
Q

Name DDX of anatomic abnormality in pelvic ultrasound (for amenorrhea) (2)

A
  • Outflow tract obstruction -> surgery
    • Transverse septum (inside vagina)
    • Imperforate hymen
  • Absent uterus
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16
Q

Name DDX: Absent uterus (3)

A
  • Mullerian agenesis (46XX - genetically female)
  • Complete androgen insensitivity syndrome (46 XY)
  • 5-alpha reductase deficiency (46 XY)
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17
Q

How to differenciate DDX: Absent uterus (2)

A

Karyotype + serum testosterone

  • Mullerian agenesis (46XX - genetically female)
  • Complete androgen insensitivity syndrome (46 XY)
  • 5-alpha reductase deficiency (46 XY)
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18
Q

Describe sx: Mullerian agenesis (5)

A
  • 46XX - genetically female
  • Short vagina
  • absent/rudimentary and obstructed uterus
  • ovaries N, breast N
  • Development/FSH/Testosterone
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19
Q

Describe tx: Mullerian agenesis (3)

A
  • Psychological counceling
  • Surgical creation of vagina + vaginal dilators
  • Possible to have children via assisted reproduction techniques (egg harvesting, in vitro fertilization, surrogate pregnancy) OR uterus transplantation
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20
Q
A
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21
Q

Describe: Complete androgen insensitivity syndrome (5)

A
  • Defective receptor, Testosterone N
  • No tissues response:
    • Female external genatalia
    • Sparce body hair
    • Almost no pubertal acne
    • Well-developed breats
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22
Q

Describe management: Complete androgen insensitivity syndrome (3)

A
  • Testes in abdomen/pelvis/inguinal canal -> high risk of cancer -> surgical removal after puberty
  • Counceling
  • Vaginal surgery/dilation
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23
Q

Describe: 5-alpha reductase deficiency (3)

A
  • Do not undergo DHT-dependent masculinization during fetal development
  • at birth: female or ambiguous external genitalia
  • at puberty: testosterone levels rise ++ -> male-pattern hair growth, acne, muscle mass, deeper voice
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24
Q

Describe management: 5-alpha reductase deficiency (2)

A
  • Counceling
  • DHT therapy (if male) or estrogen therapy (if female)
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25
Q

Name initial lab studies for secondary amenorrhea (5)

A
  • FSH
  • Prolactin
  • Estradiol
  • TSH
  • If signs of virilization -> testosterone
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26
Q

Descrive tx, dx: Prolactinoma (2)

A
  • IRM
  • Tx: Cabergoline (Dopamine agonist) -> inhibits prolactine secretion
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27
Q

Describe signs and tx: Polycystic ovarian syndrome (PCOS) (6)

A
  • Lab: Testosterone > 60 ng/dL + Signs of virilization
  • Oligomenorrhea or amenorrhea
  • Obesity, insulin resistance -> metformin therapy, weight loss
  • Hyperandrogenism -> OCP (if no desire to be pregnant), ideally progestin w/ antiandrogen properties (ex: drospirenone) -
    • spironolactone if OCP C-I
  • If desire pregnancy -> clomiphene citrate
  • If androgen levels +++ > 150 ng/dL -> CT Scan abdomen and pelvis to look for androgen secreting tumours
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28
Q

In secondary amenorrhea, what to think of if normal TSH/prolactin/androgen and:

  • High FSH + low estradiol in female < 40 years old
A

Primary ovarian failure

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29
Q

Describe sx: Primary ovarian failure (2)

A
  • Hot flashes
  • Vaginal dryness
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30
Q

Describe tx: Primary ovarian failure (2)

A

Tx: Hormone replacement therapy

  • Estrogen: to decrease risk osteoporosis and Cardiovasc disease
  • Progesterone: to decrease endometrial hyperplasia and cancer
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31
Q

In secondary amenorrhea, what to think of if normal TSH/prolactin/androgen and:

  • Low FSH + low estradiol in female
A
  • Functional hypothalamic amenorrhea
    • Systemic illness (ex: DB1, celiac disease)
  • Large tumor that compresses FSH and LH secreting neurones -> IRM
    • Pituitary gland
    • CNS
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32
Q

In secondary amenorrhea, what to think of if normal TSH/prolactin/androgen and:

  • FSH and estradiol normal
A

Uterus is not responding

  • Asherman syndrome: scar tissue in uterine cavity
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33
Q

Describe dx: Asherman syndrome (2)

A
  • golden standard: hysteroscope
  • 10-day medroxyprogesterone test to access uterine function
    • if bleeding -> healthy uterus
    • if no bleeding -> scar tissue in uterine cavity -> hysterosalpingogram or hysteroscopy
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34
Q

What’s the tx of primary dysmenorrhea (2)

A
  • Non pharmacological treatment:
    • Reassurance
    • Topical heat
    • Physical exercise
    • • High-frequency TENS
  • OCP or NSAIDs
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35
Q
A
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36
Q

What’s the tx of leiomyomas (2)

A

Myomectomy or uterine artery embolization

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37
Q

Describe tx: PMS and PMDD

A
  • Non pharmacologic
    • Patient education
    • Diet: avoid; Na+, simple sugars, caffeine, alcohol
    • Supplements—CaCO3, Mg2+, Vit E
    • Exercise
    • Psychotherapy (CBT)
    • Relaxation therapy
  • Pharmacological
    • NSAIDS (ex: naproxen)
    • SSRIs (citalopram, fluoxetine, sertraline)
    • Combined OCPs
    • Spironolactone (during luteal phase only)
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38
Q

Name C-I for OCPs (14)

A
  • < 6 wk postpartum if breast-feeding
  • Breast CA (current)
  • Smoker > 35 y.o. (> 15 cigarette/d)
  • Uncontrolled HTN (systolic > 160 mm Hg or diastolic > 100 mm Hg
  • Venous thromboembolism (current or Hx)
  • Ischemic heart disease
  • Valvular heart disease (PulmHTN, A b, Hx of SBE)
  • Diabetes with retinopathy/nephropathy/neuropathy
  • Migraine headaches with focal neurologic Sx
  • Severe cirrhoris
  • Liver tumor (adenoma or hepatoma)
  • Undiagnosed vaginal bleeding
  • Known thrombophilia
  • Known or suspected pregnancy
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39
Q

Name progestin only OCPs (2)

A
  • Progestin-only pill
  • Depo-Provera injection
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40
Q

Name side effects: OCP (5)

A

Most resolve in first 3 cycles:

  • Breast tenderness
  • Nausea
  • Irregular bleeding
  • Chloasma
  • No evidence for weight gain and/ or mood Ds
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41
Q

Name criterias for Good Candidates for p Only (8)

A
  • CI or sensitivity to E
  • > 35 yr and smoker
  • Migraine headaches
  • Breast-feeding
  • Endometriosis
  • Sickle cell disease
  • Anticonvulsant Rx
  • Difficulty complying with daily pill (for DMPA)
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42
Q

Name side effects: Copper IUD (3)

A
  • Pelvic pain
  • ↑ Menstrual ow
  • Spotting
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43
Q

Name side effects: Levonorgestrel-releasing intrauterine system (LNG-IUS) (4)

A
  • Pelvic pain
  • Depression, headache, acne, breast tenderness (maximal in rst 3 mo of use)
  • ↑ Menstrual flow or spotting in first few months then ↓ bleeding
  • Functional cysts
44
Q

Name benefits: Levonorgestrel-releasing intrauterine system (LNG-IUS) (4)

A
  • Decreased menstrual flow (in over 75% of patients)
  • Decreased endometrial CA
  • Improved dysmenorrhea
  • Prevents endometrial hyperplasia in women taking tamoxifen
45
Q

Name: Emergency Contraceptions (EC) (3)

A
  • Plan B (up to 5 days): Levonorgestrel-only method (2 doses 12h apart)
  • Yuzpe Method (up to 5 days): Oral administration of 2 doses of 100 mg EE and 500 mg levonorgestrel 12 h apart
  • Postcoital Insertion of Copper IUD: Can be placed up to 7 d after intercourse to prevent conception and left in place to provide ongoing contraception
46
Q

Describe management: Missed abortion (3)

A
  • D&C
  • Misoprostol
  • Expectant managemen
47
Q

Describe: Complete abortion (1)

A

Spontaneous expulsion of all fetal and placental tissue before 20 wk of gestation

48
Q

Describe management: Complete abortion (2)

A
  • Ensure hemodynamic stability
  • Supportive
49
Q

Describe management: Incomplete abortion (3)

A
  • D&C
  • Misoprostol

Incomplete expulsion of the products of conception before 20 wk of gestation

50
Q

Describe management: Threatened abortion (1)

A

Expectant management

51
Q

Describe management: Inevitable abortion (3)

A
  • D&C
  • Misoprostol
  • Expectant management
52
Q

Differenciate:

  • Missed abortion
  • Complete abortion
  • Incomplete abortion
A
  • Missed abortion:
    • Death of the fetus occurring in utero with retention of the pregnancy
  • Complete abortion:
    • Spontaneous expulsion of all fetal and placental tissue before 20 wk of gestation
  • Incomplete abortion:
    • Incomplete expulsion of the products of conception before 20 wk of gestation
53
Q

Differenciate:

  • Threatened abortion
  • Inevitable abortion
A
  • Threatened abortion:
    • Bleeding occurring during the first 20 wk of gestation without the passage of tissue or cervical dilation.
    • In the presence of fetal cardiac activity, a high proportion of pregnancies continue.
  • Inevitable abortion:
    • Bleeding ± ROM
    • Cramping
    • Dilation of the cervix
54
Q

Describe: Septic abortion (1)

A
  • Infection of retained products of conception by S. aureus, GN bacilli, or gram positive cocci.
55
Q

Describe: Lab investigations for recurrent miscarriages

A

TIE GAME

  • Thrombophilic
  • Immunologic: Antiphospholipid antibodies
  • Endocrine: Fasting glucose or Hb(A1c), TSH (hypothyroidism), PRL
  • Genetic/chromosomal: Cytogenetic analysis of both partner
  • Anatomic: Hysteroscopy, Hysterosalpingography
    1. Environmental/toxicologic
56
Q

Name methods of abortion (5)

A

First trimester:

  • Vacuum curettage
  • Misoprostol

Second trimesteR:

  • D&E
  • Labor induction
  • Oxytocin
57
Q

Describe labs of menopause (4)

A
  • ↑ Serum FSH
  • ↑ Serum LH
  • ↓ Serum estradiol
  • ↑ Vaginal pH > 6
58
Q

Name: Indication for Spine XR in Postmenopausal women (3)

A
  • Historic height loss > 6cm
  • Prospective height loss > 2 cm (↑kyphosis)
  • Acute, incapacitating back pain: to R/O vertebral #
59
Q

Describe the management of Vasomotor Sx in menopause (5)

A

Resolves within 5 yr

  • Reassurance and lifestyle Ds: Use fans to keep cool, dress in layers, quit smoking, exercise, weight loss if overweight, avoid hot food, caffeine, and EtOH
  • Alternative medicine: Evidence lacking for long-term safety/efficacy for black cohosh, dietary soy, phytoestrogens clover, Vit E, kava, evening primrose oil, Chinese herbs
  • Nonhormonal Rx: venlafaxine/SSRIs, gabapentin, clonidine, bellergal
  • Nonestrogenic hormonal Rx: Ps
  • Systemic HRT: Estrogen therapy (ET), estrogen/progesterone therapy (EPT)
60
Q

Describe the management of Urogenital Sx in menopause (3)

A

Generally, Worsen with age

  • Reassurance, patient education, and smoking cessation
  • Vaginal moisturizer (polycarbophil gel/Replens)
  • Local ET: intravaginal E is the Rx of choice for isolated vaginal Sx (e.g., Vagifem). At recommended dose/frequency do not need to add P
61
Q

Describe the management of Osteoporosis Sx in menopause (7)

A

Generally Worsens with age

  • Patient education: exercise, healthy diet, and smoking cessation
  • Osteoporosis RF assessment
  • Vit D (800 IU/d) and Ca2+ supplementation
  • Bisphosphonates (alendronate, risedronate)
  • Selective estrogen receptor modulators (SERMs)
  • Calcitonin: approved for Rx, not prevention of osteoporosis
  • E
62
Q

Name C-I to estrogen therapy (4)

A

CULT

  • Cancer (breast or uterine)
  • Undx vaginal bleeding
  • Liver disease (acute)
  • Thromboembolic disease (active)
63
Q

Name C-I to progesterone therapy (4)

A

PUB

  • Pregnancy
  • Undx vaginal bleeding
  • Breast CA
64
Q

Describe presentation: Bacterial vaginosis (5)

A
  • odor
  • Amsel criteria (3 of 4)
    • Thin homogeneous vaginal discharge
    • Clue cells on N/S wet mount or Gram stain
    • Positive Whiff test on KOH wet mount
    • Vaginal pH > 4.5
65
Q

Describe tx: Bacterial vaginosis (2)

A
  • Metronidazole
  • Clindamycin
66
Q

Describe: Vaginal candidiasis (6)

A
  • pruritus
  • edema, fissures excoriations, dysuria
  • thick flocculent white discharge
  • DX criteria:
    • Normal vaginal pH (4–4.5)
    • Hyphae and buds on saline wet mount (yeast)
    • Positive yeast culture from the vagina
67
Q

Describe tx: Vaginal candidiasis (2)

A
  • Fluconazole
  • Clotrimazole
68
Q

Describe: Vaginal trichomoniasis (6)

A
  • Dyspareunia, pruritus
  • « Strawberry cervix »
  • Dx criteria:
    • Trichomonas (motile agellum) seen on N/S wet mount
    • High number of Polymorphonuclear leukocytes (PMNs) on saline microscopy
    • Positive culture
    • Vaginal pH 5 – 6
69
Q

Describe tx: Vaginal trichomoniasis (2)

A
  • Metronidazole
  • Tx partner
70
Q

Describe tx: Gonorrhea (5)

A
  • (Cefixime or Ceftriaxone) + (Azithromycin or Doxycycline)
  • Alternative: Azithromycin or Spectinomycin

Co-treatment for chlamydia

71
Q

Describe tx: Chlamydia (3)

A
  • Doxycycline
  • Azithromycin
  • Alternative: Erythromycin
72
Q

Name indications for Repeat screening for Gonorrhea (2)

A
  • All cases 6 mo post-Rx
  • Test of cure with culture 3 to 7 d after initiation of treatment when:
    • gono pharyngeal infx
    • tx with nonrec regimen
    • suspected tx failure
    • uncertain compliance
    • reexposure to untreated partner
    • PID or disseminated infx
    • pregnancy
73
Q

Name indications for repeat testing of C.TRACHOMATIS (2)

A
  • All cases 6 mo post-Rx
  • Test of cure in 3 to 4 wk recommended when:
    • Uncertain compliance
    • non recommended regimen
    • Pregnancy
74
Q

Describe: Syphilis (4)

A
  • 1°:
    • painless chancre (genital ulcer), regional LAD
    • Resolves in 2-8 wk
  • 2°:
    • symmetric maculopapular rash (palms and soles)
    • fever, malaise, LAD, mucous lesions, condyloma lata, alopecia, meningitis, headaches, uveitis, retinitis
  • Latent: axp
  • 3°: aortic aneurysm, aortic regurgitation, coronary artery ostial stenosis
    • Neurosyphilis (form of 3°): Argyll-Robertson pupil
    • Gumma (form of 3°): tissue destruction in any organ.
75
Q

Describe tx: Syphilis (3)

A
  • 1°, 2°, early latent: Benzathine Penicillin G, Doxycycline
  • Neurosyphilis: Penicillin G
  • Gumma: Benzathine Penicillin G
76
Q

Describe tx: Herpes (2)

A
  • Acyclovir
  • Famciclovir
77
Q

Describe: Chancroid (3)

A
  • Painful genital ulcers with granulomatous bases
  • H. ducreyi
  • May progress to inguinal ulcers, painful inguinal LAD
78
Q

Describe tx: Chancroid (4)

A
  • Ciprofloxacin
  • Eryhtromycin
  • Azithromycin
  • Ceftriaxone

Must empirically treat all individuals with sexual exposure in the last 2 wk from onset

79
Q

Describe: HPV Condyloma Acuminata (2)

A
  • Frequently asx
  • Lesion: external genital warts (condyloma acuminata)—multifocal cauli ower-like exophytic fronds → ± pruritus or local discharge
80
Q

Describe tx: HPV Condyloma Acuminata (7)

A
  • Patient applied:
    • Imiquimod
    • Podophyllotoxin
  • Provider-based:
    • Cryotherapy
    • Bi- or trichloroacetic acid
    • CO2 laser ablation, excision
  • Extensive or resistant lesions:
    • Excision with electrosurgery
    • CO2 laser removal
81
Q

Describe: PID Minimum Triad

A

Lower abdo pain + one of the following:

  • Adnexal tenderness
  • Cervical motion tenderness
  • Utrine tenderness
82
Q

Describe: Fitz-Hugh-Curtis Syndrome

A

Perihepatitis resulting in adhesions between the liver capsule and the abdo wall. Perihepatitis resolves with Rx of PID.

83
Q

Describe inpatient tx: PID (4)

A
  • Cefotetan + doxycycline then continue with doxycycline
  • Cefoxitin + doxycycline, then continue with doxycycline
  • Clindamycin + gentamicin then doxycycline or clindamycin

Note: consider adding metronidazole

84
Q
A
85
Q

Describe outpatient tx: PID (4)

A
  • Ceftriaxone + (doxycycline or azithromycin)
  • Cefixime + (doxycycline or azithromycin)
  • Levofloxacin

Note: consider adding metronidazole

86
Q

Name gold standard dx: PID

A

Laparoscopy

87
Q

Describe population screening (3)

A
  • There are slight differences among each province
  • Should begin within 3 yr of initiating sexual activity or over age 21, whichever is later
  • Should be conducted annually until three consecutive negative Pap tests
88
Q

Describe: Approach to cervical CA screening (Figure)

A
  • Unsatisfactory/inadequate sample
  • Normal
  • Benign atypia (infection, reactive Ds)
  • Atypical Squamous Cells - Uncertain Significance (ASCUS)
  • Low-grade Squamous Intraepithelial Lesion (LSIL)
  • Colposcopy
    • Atypical Glandular Cells of Uncertain Signifi- cance (AGUS)
    • High-grade Squamous Intraepithelial Lesion (HSIL)
    • Invasive cervical cancer (rarely)
    • Carcinoma in situ (CIS)
    • Atypical Squamous Cells - Possible HSIL (ASC-H)
    • Cervical Intraepithelial Neoplasia (CIN)

_______

  • If these Pap tests are normal → continue screening q2–3 yr
  • Should continue until the age of 69 yr, if there has been adequate screening over the past 10 yr
  • If there has been no Pap smear for 5 yr, begin annual Pap tests until three consecutive negative Pap tests, then should continue q2–3 yr
  • Discontinue screening at age 70 if > 3 normal Pap tests in the last 10 yr
89
Q

Describe HPV screening for:

  • HIV/immunocompromised
  • Total hysterectomy
  • Subtotal hysterectomy
  • Pregnancy
  • Women who have sex with women
A
  • HIV/immunocompromised: annual screening.
  • Discontinue screening for women who have undergone a total hysterectomy for benign reasons and no Hx of cervical dysplasia or HPV.
  • Subtotal hysterectomy (i.e., cervix intact): continue routine screening.
  • Screening frequency in pregnancy is the same as in nonpregnant women.
  • Women who have sex with women should follow the same screening protocol as women who have sex with men.
90
Q

Describe staging and rx of cervical CA

A
91
Q

Describe: Approach to the management of ovarian cysts (Figure)

A
92
Q

Describe: Approach to the management of uterine leiomyomas (Figure)

A
93
Q

Describe: Characteristics of benign vers s ma ignant ovarian masses

A
94
Q

Name first choice imagerie for pelvic masses (1)

A

U/S

95
Q

Name lab markers for ovarian masses (4)

A
  • CA-125 (N < 35 U/mL): ovarian tumors
  • AFP (N < 5.4 ng/mL): Germ cell tumors (endodermal sinus), dermoids, pregnancy, Hepatocellular Carcinoma
  • LDH (N < 250 U/L): Dysgerminomas
  • hCG (N < 5 mlU/mL): germ cell tumors GTD (choriocarcinoma), pregnancy, marijuana
96
Q

Describe PHARMACO tx of chronic pelvic pain (5)

A
  • 1. Analgesics:
    • First line - NSAIDs (ibuprofen, ASA, naproxen)
    • Second-line - opioids (avoid long-term use)
  • 2. Combined OCPs
  • 3. GnRH agonists (i.e., leuprolide/Lupron) ± add back Estrogen
  • 4. Progestins (i.e., MPA suspension/Depo Provera/Visanne)
  • Adjuncts:
    • ± SSRIs (fluoxetine, paroxetine, or sertraline)
    • ± Neuro modulators (gabapentin, amitriptyline or nortriptyline)
    • ± Trigger point injections
    • ± Peripheral nerve blocks
97
Q

Describe SURGERY tx of chronic pelvic pain (5)

A

If poor response to other tx

  1. Laparoscopic laser ablation
  2. Laparoscopic adhesiolysis
  3. Presacral neurectomy (superior hypogastric plexus excision)
98
Q

Name common locations of ectopic pregnancy (3)

A
  • Ampullary
  • Isthmic
  • Fimbrial
99
Q

Describe the approach to ectopic pregnancy (Figure)

A
100
Q

Describe the management of ectopic pregnancy (2)

A
  • Methotrexate (MTX)
    • Monitoring: serial (weekly) b-hCG levels until undetectable
  • Laparoscopic surgery or laparotomy. Indications:
    • Failed or contraindication to MTX Rx
    • Previous EP in same fallopian tube
101
Q

Name C-I to methotrexate (5)

A
  • Breast-feeding
  • Chronic liver disease (alcoholism, fatty liver, etc.)
  • Known sensitivity to MTX
  • Blood dyscrasias (i.e., thrombocytopenia, significant anemia)
  • Hepatic, renal, or hematologic dysfunction
102
Q

Describe investigations for prolapse (4)

A
  • No specific tests for prolapse
  • Imaging not usually necessary (unless procidentia to R/O urinary retention)
  • Biopsy all suspicious persistent vulvovaginal lesions
  • Cystocele evaluation:
    • a. UTI screen
    • b. Postvoid residual (PVR)
    • • ± Refer to gynecologist for urodynamic testing
103
Q

Describe pessaries for prolapse (5)

A
  • Device placed in vagina to provide support and/or fill space
  • Support pessaries (the ring) for earlier stages (II and III)
  • Space-filling pessaries (Gellhorn) for more advanced prolapse
  • Ideally changed and rinsed weekly with F/U q3mo
  • Lubricants or vaginal E (if atrophy) is often employed with pessaries in postmenopausal women
104
Q

Name indications for surgery for prolapse (4)

A
  • not recommended if asx
  • Advanced and asx: must assess efficiency of bladder emptying due to risk for complications of urinary retention (recurrent UTI, urosepsis) and assess exposed vaginal epithelium for erosions at risk for infection
  • More frequent F/U (q3 mo) if decided against surgery
  • Patient fails conservative management, is unable or unwilling to use pessary, or desires surgical management
105
Q
A
106
Q

Describe the management of OVULATORY DYSFUNCTION in infertility (4)

A
  • (A) Anovulation:
    • Clomiphene citrate (Clomid)
    • Gonadotrophins (hMG) ± IUI
    • Lifestyle/weight ∆ ± metformin (if PCOS)
    • IVF/intra-cytoplasmic sperm injection
    • Donor oocytes
  • (B) Hyperprolactemia: Bromocriptine (dopamine agonist)
  • (C) Thyroid dysfunction
  • (D) Functional hypothalamic amenorrhea: (appropriate behavioral or psychologic interventions)

2024 - Élo - Revision LMCC (6 decks)

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