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CPD > Gyn 2 > Flashcards

Gyn 2 Flashcards

1
Q

What is amenorrhea, what is the most common type, what needs to be ruled out and what do you need to be sure of to properly assess, amenorrhea?

A

defined as pathological absence of menstruation (usually endocrine dysfunction)

There are primary and secondary subtypes, secondary is most common (menses ceases >3-6 months & other symptoms are ruled out: pregnancy, lactation, menopause)

MAKE SURE the female has had her first menses!!! REALLY IMPORTANT QUESTION TO ASK

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2
Q

etiology of amenorrhea can be divided into two categories: ___ and ___? which is most common?

A 
anovulatory (MOST COMMON)- ovulation and menses absent - generally functional cause, mild decrease in E
or
ovulatory (LESS COMMON)- no menses, normal hormone function
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3
Q

There are 4 broad aspect causes of anovulatory amenorrhea - what are they?

A
  1. Hypothalamic Dysfunction - Anorexia nervosa, Severe stress
  2. Pituitary Dysfunction -
    Galactorrhea, Benign Pituitary Tumor
  3. Ovarian Failure/Dysfxn -
    Autoimmune disorders, Addison’s dz, DM
  4. Other Endocrine Dys - Hyperthyroidism (shuts down menstruation), Hypothyroidism (elevated prolactin), Obesity
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4
Q

what tests would you order for amenorrhea?

A

pregnancy test (-)
**FFT (free T3, free T4, TSH) & prolactin
FSH and estradiol levels
TVUS

if virilzation (PCOS, Cushing's, androgen secreting tumor)
- Free testosterone and DHEA
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5
Q

What additional questions should be asked in diagnosing amenorrhea?

A

Hx of: Endometriosis, Uterine Surgery, Celiac Disease

Medication - antidepressents (drug-induced virilization), antipsychotic drugs, phenothiazines, anti-HTN, opioids

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6
Q

What are key features of Cushing’s disease

A

moon facies
truncal obesity
abdominal striae
thin extremities

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7
Q

what are key features of hirsutism, what causes this?

A

male pattern hair growth in women (face, chest, back)

-excess androgens, testosterone.

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8
Q

What are red flags of amenorrhea?

A 
delated puberty (r/o genetic disorder)
virilization (PCOS, Cushing's, androgen secreting tumor)
visual field defects (prolactinoma)
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9
Q

what are the most common causes of secondary amenorrhea?

A

Pregnancy!!!!!
PCOS
Obesity
Thyroid Dysfunction

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10
Q

Dysfunctional Uterine Bleeding (DUB) is defined as? What periods of life does it occur? How it it diagnosed?

A

DUS - abnormal uterine bleeding in the absence of clinical or US evidence of structural Abnormalities (fibroids, polyps , cancer, hyperplasia)

occurs in anovulatory states (puberty, >45 y/o)
PCOS is also a common cause of involution

Diagnosis of Exclusion

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11
Q

There are two types of DUB, Anovulatory and Ovulatory - what are the differences?

A

Anovulatory - unopposed estrogen. No progesterone. excessive proliferation of the endometrium

Ovulatory - prolonged progesterone secretion - most likely due to LOW ESTROGEN levels

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12
Q

What tests would you order to help diagnose DUB?

A

Pregnancy
CBC & ferritin
TVUS - r/o structural abn
Serum salivary progesterone - day 21 - if <3 ng/mL= anovulation

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13
Q

What increases in the uterus that contributes to primary dysmenorrhea?

A

too much prostaglandin - it causes constriction of blood vessels which causes cramping.

This is the MOST COMMON form of dysmenorrhea

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14
Q

What are the most common causes of secondary dysmenorrhea?

A

secondary is due to underlying pelvic abnormalities

  • endometriosis is most common
  • adenomyosis
  • Fibroids
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15
Q

compare and contrast primary and secondary dysmenorrhea

A

both have pain at or around time of menses

primary has - normal pelvic exam, symptoms occurring when ovulatory cycles begin, peaks in the late teens, early 20s, with response to medical therapy

secondary - pelvic exam is abnormal, more likely to require surgical intervention

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16
Q

what are red flags for dysmenorrhea

A

new or sudden onset pain
unremitting pain
fever
vaginal d/c

17
Q

What are common ssx of PMS

A 
weight gain
breast swelling and pain
bloating
anxiety
anger
18
Q

What is diagnostic criteria for PMDD?

A

must have > 5 of the following most of the week before menses with at least one being from the first 4 in this list:

  1. feelings of sadness, hopelessness, self-depreciation
  2. tense (on edge) feeling or anxiety
  3. emotional liability with frequent tearfulness
  4. irritability or anger leading to interpersonal conflicts
  • loss of interest in daily activities
  • decreased concentration
  • fatigue, lethargy, lack of energy
  • change in eating habits (binging)
19
Q

What 3 symptoms need to have 2/3 to be present for PCOS diagnosis?

A

hyperandrogenism
anovulation
polycystic ovaries (TVUS)

20
Q

what metabolic abnormalities are observed in PCOS?

A

“the pivotal underlying issue is the woman’s inability to process insulin in the liver and muscles due to a probable genetic susceptibility that causes hyperinsulinemia”

hyperinsulinemia - glucose issues
abn lipid
obesity
metabolic syndrome

21
Q

what labs/imaging needs to be ordered for diagnosis of PCOS?

A 
salivary/serum E,P,T,DHEA,cortisol
Thyroid
Prolactin
Fasting Glucose/insulin
TVUS

** women meeting the criteria need serum cortisol to rule out Cushing’s syndrome **

22
Q

what is premature ovarian failure and what do we need to make sure to tell our patients?

A

premature ovarian failure is when ovaries do not produce enough estrogen despite high gonadotropin hormones in women <40

** Women need to know, when diagnosed with this condition, 10% of women STILL CONCEIVE WITHOUT MEDICAL INTERVENTION!!! **

23
Q

what is diagnostic of premature ovarian failure?

A

serum FSH, estradiol - IF FSH is >20 IU/mL and E < 20 pg/mL

repeat in 1 month

If the same? DIAGNOSTIC

always rule out pregnancy.

24
Q

what is the hallmark of perimenopause?

A

change in menses, change in bleeding pattern - if she’s consistent normally - it’s a change in the cycle

usually begins in the 40s

25
Q

what are the common ssx of menopause?

A

changes in bleeding patterns with menses
hot flashes/sweating
vaginal dryness, atrophy
recurrent night sweats

26
Q

what health problems are associated with menopause?

A 
OSTEOPOROSIS!!!!
- if she's celiac, she'll see bone loss in the vertebrae due to lack of mineral absorption
- run a bone mineral density in women over 65
CVD
- increased fasting blood glucose
- Boston Heart Panel - check lipids
BREAST CANCER
- each decade of life, increased risk
27
Q

diagnosis for menopause is..

A

clinical
cessation of menses (age >50) with hx of irregular menses
- FSH consistently increasing levels, suggestive of menopause

-POST MENOPAUSAL WOMEN ARE AT INCREASED RISK FOR OSTEOPOROSIS
evaluate these women - thyroid, adrenal dysfunction, celiac

28
Q

what risk factors are associated with menopause?

A 
> 7 oz alcohol/week
menses cessation > 6 mo
cigarette smoking
Rheumatoid Arthritis
sedentary lifestyle
low BMI
29
Q

What are secondary causes of amenorrhea? What labs would you order to rule them out?

A

BABY - test beta-hCG
Hypothalamic - test FSH and Prolactin, prolactin rules out a pituitary tumor
PCOS - test insulin

also - test the thyroid, always.

30
Q

If anything suggests virilization - what condition should be your first thought?

A

PCOS

31
Q

For Dysfunctional Uterine Bleeding (DUB), what hormone is high? what test would you order?

A

Estrogen levels would be high, with a lack of opposition from Progesterone. Test Progesterone levels.
Also test Ferritin to assure she hasn’t become anemic

serum P, E

32
Q

When during the cycle is PMS observed while also being diagnostic for PMS?

A

onset occurs a week before menses, during the luteal phase.

symptoms are relieved by onset of menses.

33
Q

What hormones are high when a patient is diagnosed with PCOS?

A

LH will be 2-3x higher than FSH (opposite of what it would be normally)

34
Q

PCOS presents with a few key features - what are these?

What labs would you order and why?

A

hyperandrogenism (hirsuitism!! male pattern baldness, facial hair..)
hyperinsulinemia (resulting in low glucose levels)
cystic stones visualized TVUS

Test salivary hormones with this condition. While also testing glucose levels

35
Q

What is the normal age for menopause? what are common symptoms?

A

45-55

hot flashes, vaginal dryness, osteoporosis

36
Q

What is the definition of perimenopause?

A

cessation of menses due to non-iatrogenic ovarian failure before the age of 40

37
Q

When PID presents, what does it look like? what would physical exams reveal?

A

it’s essentially an ascending vaginitis issue

pt presents with fever, pain and discharge

on PE you’ll find

  • inguinal LA tender to palpation
  • a fever greater than 101
  • CMT
  • BL adnexal tenderness

CPD (4 decks)

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