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GYN 3 Flashcards

1
Q

What is the age for primary amenorrhea w/o normal growth or secondary to sex development?

A

Age 13

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2
Q

What is the age for primary amenorrhea w/ normal growth or secondary to sex development?

A

Age 15

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3
Q

What is the criteria for secondary amenorrhea?

A

No menses for ≥ 3 cycles or 6 consecutive months

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4
Q

What are the clinical features of amenorrhea?

A
  • Persistent absence of menses

- Neuroendocrine or anatomic abnormality

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5
Q

What are the dx test for amenorrhea?

A
  • Progesterone challenge Test
  • FSH/LH
  • Prolactin
  • TSH
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6
Q

What is the tx for amenorrhea if you want to get pregnant?

A

Ovulation induction

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7
Q

What is the tx for amenorrhea if you do not want to get pregnant?

A

Oral estrogen and progesterone

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8
Q

What does dysmenorrhea mean?

A

Painful menses, requires medication

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9
Q

What is primary dysmenorrhea classified as?

A

Painful uterine muscle activity

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10
Q

What is secondary dysmenorrhea classified as?

A

Identifiable cause

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11
Q

What are the clinical features of primary dysmenorrhea?

A
  • lower abdominal pain/SP pain
  • Intermittent pain
  • N/V/D
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12
Q

What are the clinical features of secondary dysmenorrhea?

A
  • Pain that last longer than menses

- gets worse B4 it gets better

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13
Q

What are the PE findings for primary dysmenorrhea?

A

Normal PE

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14
Q

What are the PE findings for secondary dysmenorrhea?

A
  • Asymmetrical/irregularly
  • Enlarged uterus
  • Tender-boggy uterus
  • Uterine motion restriction
  • Adnexal tenderness
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15
Q

What should a clinician do if pt has secondary dysmenorrhea?

A

Conduct diagnostic studied for suspected underlying disease

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16
Q

What is the tx for primary dysmenorrhea?

A
  • NSAIDs
  • Heat
  • Exercise
  • Psychotherapy
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17
Q

What is the tx for secondary dysmenorrhea?

A

Treat underlying disease

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18
Q

What does DUB mean?

A

Dysfunctional uterine bleeding

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19
Q

What does DUB include?

A
  • Pregnancy
  • Systemic Disease
  • Cancer
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20
Q

Who/what should alway be considered for DUB?

A
  • Women in child bearing years

- A complicated pregnancy

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21
Q

What establishes a dx of DUB?

A

Exclusion of all possible pathological causes

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22
Q

What is PE for DUB pelvic exam assessing for?

A
  • Masses
  • Irregular uterus
  • Adnexal tenderness
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23
Q

What are the dx lab test for DUB?

A
  • Pregnancy test
  • Pap test
  • CBC
  • TSH
  • Liver
  • FSH
  • Prolactin
  • Progesterone
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24
Q

What are the dx imaging test for DUB?

A
  • Pelvic US

- Endometrial biopsy

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25
Q

What is the tx for both adolescent/young and menopausal women with DUB?

A 
Adolescent/young: 
- estrogen oral contraceptives
Menopause: 
- Oral contraceptives, should not be unopposed estrogen
- DandC
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26
Q

What is PMS?

A

Cyclic occurrence of symptoms that interfere with life; consistent and predictable in relation to menses

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27
Q

What is psychoneuroendocrine disorder?

A
  • Biologic, psychological, social parameters
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28
Q

What are common sx of PMS?

A
  • HA
  • Breast tenderness/mastodynia
  • Pelvic pain
  • Bloating
  • Premenstrual tension
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29
Q

What are severe sx of PMS?

A
  • Irritability
  • Dysphoria
  • Mood lability
    (if these disrupts daily function then PMDD)
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30
Q

What are some other known sxs of PMS?

A
  • Clumsiness
  • Decreased energy
  • Sleep changes
  • Mood swings/behavioral changes
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31
Q

What is the dx criteria for PMS?

A

At least 1 of each:

  • Affective: depression, angry, outburst, irritability, confusion, social w/d symptom
  • Somatic: mastodynia, bloating HA
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32
Q

What is the tx for PMS?

A
  • Habit change: < Caffeine, Chocolate, ETOH, Na+
  • Behavioral: Stress management, CBT, exercise
  • Pharm: Fluoxetine, Sertraline, SSRIs, Hormonal intervention
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33
Q

What are functional cysts?

A

An anatomical variation that arises from normal ovarian function

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34
Q

What are the two types of functional cysts?

A

Follicular and Corpus Luteum cysts

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35
Q

What causes a follicular cyst?

A
  • Follicle fails to rupture

- Ovulation does not occur

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36
Q

Causes of a follicular cyst results in what?

A
  • Lengthened follicular phase

- Transient 2nd amenorrhea

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37
Q

What causes corpus luteum cysts?

A

Abnormal changes in the follicle of the ovary after an egg is released the opening to seal off

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38
Q

What are the clinical features of functional cysts?

A
  • Secondary amenorrhea

- Mild-moderate unilateral lower abdominal pain

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39
Q

What is the PE findings for functional cysts?

A
  • Palpable, mobile, cystic adnexal mass
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40
Q

What are the dx test for functional cysts?

A
  • Pelvic US

- Unilocular simple cyst

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41
Q

What is the tx for functional cysts

A

Will spontaneously resolve in approx. 6 wks

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42
Q

What is the primary cause of PCOS?

A

Hyperandrogenism

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43
Q

What are clinical features of PCOS?

A
  • Hirsutism
  • Anovulation or oligo-ovulation
  • Infertility
  • Irregular menses
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44
Q

What is the PE findings for PCOS?

A
  • Excessive hair growth
  • Increased acne
  • Obesity
  • Metabolic Syndrome
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45
Q

What are the dx test for PCOS?

A
  • LH/FSH ratio: > 3x’s
  • Screen for DM
  • Lipids: >LDL
  • Estrodiol level
  • US
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46
Q

What is seen on the US in a pt with PCOS?

A

Necklace or sting of peals

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47
Q

What is the tx for PCOS?

A
  • Oral contraceptives
  • Metformin
  • Refer: Endocrinologist
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48
Q

What is a key point to keep in mind when you have a pt with PCOS?

A

Endometrial hyperplasia can become malignant

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49
Q

What is torsion?

A
  • Ischemic Condition, >50% occur on right side
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50
Q

What causes ovarian torsion?

A
  • Enlarged Ovary
  • Pregnancy
  • Tumors
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51
Q

What are the clinical features of ovarian torsion?

A
  • Sudden onset of severe unilateral lower abdominal pain

- May occur with exertion

52
Q

What is the hallmark PE finding in a pt with ovarian torsion?

A

Tenderness

53
Q

What are the dx test for ovarian torsion and what would you see?

A

Doppler Ultrasound

- lack of blood flow to the ovary

54
Q

What is the tx for ovarian torsion?

A

Surgery- medical emergency!!

55
Q

What is the MC cell type in ovarian cancer?

A

Malignant epithelial cells

56
Q

How do epithelial cells spread in ovarian cancer?

A

Spread by direct extension within the peritoneal cavity

57
Q

What cell would you find in a pt less than 20 with ovarian cancer?

A

Germ cells

58
Q

What cell would you find in an older pt with ovarian cancer?

A

Stromal cells

- “Functioning tumors”

59
Q

Why is the mortality rate of ovarian cancer so high?

A
  • 5th MC of all cancers in the US

- Difficulty detecting disease prior to dissemination

60
Q

What are some early warning signs/sxs of ovarian cancer?

A
  • Increased abdominal girth
  • Nausea or anorexia
  • Urinary Symptoms: Incontinence, Frequency, urgency
61
Q

What are the PE findings in a pt with a benign ovarian mass?

A
  • Mobile
  • Cystic
  • Smooth
  • Unilateral
62
Q

What are the PE findings in a pt with a malignant ovarian mass?

A
  • Fixed
  • Solid/firm
  • Nodular
  • Bilateral
63
Q

What are the dx test for ovarian cancer?

A
  • Elevated CA-125 levels are associated with ovarian cancer

- NOT used as a screening tool only to follow therapy response or evaluate recurrent disease

64
Q

If you were a primary care PA what would be the next step once you diagnose your pt with ovarian cancer?

65
Q

What is leiomyoma?

A
  • AKA fibroids or myoma
  • Benign tumor
  • MC’ly found in AA women
66
Q

Where does leiomyoma derive from?

A

Smooth muscle cells

67
Q

What are the clinical features of leiomyoma?

A
  • Progressively heavier menstrual flow
  • Iron-deficiency anemia
  • C/O something pressing down
  • Sensation of pelvic mass
68
Q

What is the PE finding for leiomyoma?

A

Uterus feels “hard or solid”, “lumpy-bumpy”

69
Q

What are the dx test for leiomyoma?

A
  • US: will confirm
  • CT/ MRI: see large myomas
  • Hysteroscopy
70
Q

What is the tx for leiomyoma?

A
  • 1st: treat sxs
  • Reassurance
  • Meds: progesterone, GnRH agonist
  • Surgical intervention
71
Q

Endometriosis usually occurs during what years?

A

Reproductive yrs

72
Q

What is the MC site for endometriosis?

73
Q

What is retrograde menstruation caused by endometriosis?

A
  • Transport of endometrial cells during menstruation
  • Fragments pass through fallopian tubes to the pelvic cavity
  • Once in pelvic tissue implants on peritoneal surfaces growing into endometrial lesions
74
Q

Endometrial glands and stroma are located where to the uterine cavity?

75
Q

What are the clinical features of endometriosis?

A
  • Progressive Dysmenorrhea
  • Progressive Dyspareunia
  • Dyschezia
76
Q

What is the PE finding in a pt with endometriosis?

A
  • Painful uterine motion
  • Uterus may be fixed and retroverted d/t cul-de-sac adhesions
  • Adnexal tenderness
77
Q

What is the dx test for endometriosis, and what is seen?

A
  • Direct Visualization
  • Dark brown, blue or black cysts
  • Scarring/adhesions
  • Chocolate cysts on the surface of the ovary
78
Q

What is the tx for endometriosis?

A
  • Pregnancy counseling
  • Hormonal contraception
  • GnRH agonist (Lupron)
  • Surgery
79
Q

What is the difference between adenomyosis and endometriosis?

A
  • Adenomyosis is the growth of endometrial cells inside the uterine musculature
  • Tissue cont. to act as it normally would: thickening, breaking down and bleeding.
80
Q

When does sxs adenomyosis start?

A

Childbearing years

81
Q

What are clinical features of adenomyosis?

A
  • Prolonged menstrual bleeding
  • Dysmenorrhea menses
  • Cramping throughout menses
  • Pass large clots
82
Q

What is the PE finding in a pt with adenomyosis?

A

Tender “boggy” uterus

83
Q

What is the tx for adenomyosis?

A
  • NSAID
  • Combined oral contraceptives
  • Endometrial ablation
84
Q

What is a pelvic organ prolapse (POP)?

A

Defect in pelvic supporting structures - results in relaxation

85
Q

What are the supporting structures affected by pelvic organ prolapse (POP)?

A
  • Ant. vaginal prolapse (cystocyle)
  • Post. vaginal prolapse (retrocele)
  • Uterine prolapse
86
Q

What are the causes of pelvic organ prolapse (POP)?

A
  • Age
  • Increasing parity
  • Obesity
  • Pelvic surgeries
  • Menopause
87
Q

What are the clinical features of pelvic organ prolapse (POP)?

A
  • Sensation of vaginal fullness
  • “Something is falling out”
  • “Sitting on a ball”
88
Q

What is the PE finding in a pt with pelvic organ prolapse (POP)?

A

Having the pt cough or strain to reveal a soft, reducible mass bulging into the vagina.

89
Q

What is the dx test for pelvic organ prolapse (POP)?

A

Pelvic exam

90
Q

What is the tx for pelvic organ prolapse (POP)?

A
  • Pelvic floor exercises
  • Topical Estrogen
  • Surgical intervention
  • Pessary
91
Q

What carcinoma is MC’ly seen in Type 1 endometrial cancer?

A

Adenocarcinoma 85%

92
Q

Type 1 endometrial cancer is MC’ly seen in who?

A

Younger women

93
Q

Type 2 endometrial cancer is MC’ly seen in who?

A

Older women

94
Q

Type 1 endometrial cancer is associated with what?

A

Estrogen exposure

95
Q

Type 2 endometrial cancer is associated with what?

A

Endometrial atrophy

96
Q

What is the MC clinical feature of endometrial cancer?

A

abnormal vaginal bleeding

97
Q

What clinical feature would a menopausal woman have that would indicate endometrial cancer?

A

Intermittent spotting

98
Q

What clinical feature would a premenopausal woman have that would indicate endometrial cancer?

A
  • Excessive flow

- Possible lower abdominal pain

99
Q

What are PE findings in a pt with early and late-stage endometrial cancer?

A
  • Usually unremarkable
  • Early stages: normal uterus
  • Late stages: enlarged uterus
100
Q

What is the dx test and tx for endometrial cancer?

A

Dx: Endometrial bx
Tx: Hysterectomy

101
Q

Does type 1 endometrial cancer have a poor for favorable prognosis?

102
Q

Does type 2 endometrial cancer have a poor for favorable prognosis?

103
Q

What is menorrhagia?

A

Heavy (80 ml) or prolonged flow (7 days)

- “gushing” or “open faucet” bleeding

104
Q

What causes menorrhagia?

A
  • Myoma
  • Pregnancy complication
  • Adenomyosis
  • IUD
  • Endometrial hyperplasia
105
Q

What is metrorrhagia?

A

Intermittent bleeding

- bleeding occurring b/w menses

106
Q

What causes metrorrhagia?

A
  • IUD
  • Endometrial/cervical cancer
  • Endometriosis
  • Polyps
107
Q

What is polymenorrhea?

A

Menses occurring too frequently, <21 days

108
Q

What causes polymenorrhea?

A

Luteal phase defect

109
Q

What is menometrorrhagia?

A

Bleeding occurring at irregular intervals

- Amount and duration can vary

110
Q

What causes menometrorrhagia?

A

Any condition that causes intermenstrual bleeding

111
Q

What is oligomenorrhea?

A

Menses > 35 days apart

- Bleeding usually decreases in amount

112
Q

What causes oligomenorrhea?

A

Prolonged follicular phase

113
Q

What defines infertility?

A

Failure of a couple to conceive after 12 months of frequent, unprotected intercourse
- affects reproductive ages 15-44 yo

114
Q

What are the 3 categories affecting fertility?

A
  • Female factors (65%)
  • Male factors (20%)
  • Unexplained or other conditions (15%)
115
Q

How do you dx a male with infertility?

A
  • Get hx
  • Semen analysis: if abnl refer to urology and edno
  • Infx disease panel: if intrauterine insemination or in vitro fertilization
116
Q

How do you dx a female with infertility?

A
  • Hx, confirm ovulation
  • PE: asses cervix, uterus, adnexa
  • Pelvic US
  • Hysterosalpingogram
  • Saline sonogram
  • Laparoscopy
  • Infx disease panel
117
Q

What is natural menopause?

A

12 months of amenorrhea

- age approx. 51 yo

118
Q

What is induced menopause?

A

Permanent cessation of menstruation after bilateral oophorectomy or ablation of ovary function

119
Q

What is premature menopause?

A

Menopause occurring before the age of 40

- natural or induced

120
Q

What is perimenopause?

A

Menstrual cycle and hormonal changes that occur a few yrs before and 12 months after the final menses

121
Q

What hormones are still being produced by ovarian stroma during menopause?

A
  • Androgens: testosterone and androstenedione

- Testosterone is a major product

122
Q

What hormone declines after menopause?

A

Testosterone but remains 2x higher in menopausal women with intact ovaries

123
Q

What is the predominant endogenous estrogen in postmenopausal women?

124
Q

What are S/Sx of menopause?

A
  • Atrophic vaginitis
  • Sleep disturbances
  • Hot flashes/flushes
  • Osteoporosis
  • Atrophic urethritis
  • Mood/memory changes
  • Skin, hair, nails changes
125
Q

What is the tx for menopause?

A
  • Estrogen therapy
  • Combined Estrogen/Progestin therapy
  • Natural remedies

OBGYN (5 decks)

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