Gyn Flashcards
What is the pathophysiology of primary dysmenorrhea
increased endometrial prostaglandin (PGF2 alpha) production → vasoconstriction/ischemia and stronger, sustained uterine contractions
State 5 main causes of secondary dysmenorrhea
Endometriosis Pelvic inflammatory disease (PID) Intrauterine device (IUD) Uterine leiomyoma Adenomyosis Psychological factors
Definition of primary and secondary amenorrhea
- Definition: the absence of menses (onset of menarche) at the age of 15 or older
- Absence of menses for more than 3 months (in women with previously regular cycles) or 6 months (in women with previously irregular cycles)
State some casues of primary amenorrhea
Patients with normal puberty
Anatomic anomalies: hymenal atresia, vaginal septum, Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
Competitive sports
Patients with growth delay and developmental retardation
Hypogonadism
Hypergonadotropic hypogonadism
Hypogonadotropic hypogonadism
Patients with virilization
Congenital adrenal hyperplasia (CAH)
Polycystic ovary syndrome (PCOS)
What are the structural causes of AUB
Structural causes: polyps, adenomyosis, leiomyomas, malignancy/hyperplasia (PALM)
What are the functional causes of AUB
Non-structural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified (COEIN)
Define menorrhagia
Bleeding volume > 80 mL and/or length of menstruation > 7 days
State some causes of spotting
- After ovulation
- Breakthrough bleeding: mid-cycle bleeding caused by hormone imbalances (usually after starting new OCP therapy)
- Estrogen breakthrough
- Progesterone breakthrough
- Estrogen withdrawal - Endometriosis
- Myomas, polyps, carcinomas, contact bleeding (e.g., in patients with cervical carcinoma or during gynecological examination)
- During pregnancy: may indicate imminent abortion
Gyna term for intermenstrual bleeding
Metrorrhagia
Menometrorrhagia- Heavy and irregular bleeding
Don’t forget to rule out endometrial cancer/hyperplasia, cervical cancer
Ovarian insufficiency
Oral contraceptive use
What is the point of doing a pelvic USS
can be considered to rule out structural anomalies (e.g., leiomyoma, adnexal mass); allows evaluation of endometrial thickness
Endometrial biopsy/Pipelle is used for
The patient is > 45 years of age OR
The patient is at high risk for endometrial cancer (risk factors include: age > 35 years, obesity, polycystic ovary syndrome, diabetes mellitus, tamoxifen therapy) or has failed medical management OR
Endometrial thickness is ≥ 4 mm in a postmenopausal patient
Acute AUB with haemodynamically stable- bleeding alot out what would you give
High-dose conjugated estrogen(High levels of estrogen trigger rapid growth of the endometrium and thereby stop sudden, heavy bleeding from the uterine surface. Conjugated estrogen therapy is contraindicated in women with breast cancer and/or those at a high risk of thrombosis)
1st line
High-dose conjugated estrogen OR
multi-dose regimens of OCs or oral progestins
2nd line
Oral or IV tranexamic acid acts within 2–3 hours of administration and should not be used in women at a high risk for thrombosis.
Pharmacological treatment for menorrhagia
tranexamic acid
oral contraceptives
progestin (PO, IV, or as an IUD)
Surgical indications for AUB
Severe bleeding/patient hemodynamically unstable
Patient unresponsive to hormonal treatment
Hormonal treatment contraindicated (e.g., breast or endometrial cancer)
Underlying medical condition requiring surgical repair
4 surgical procedures for AUB are
- Dilation and uterine curettage (D&C) with concomitant hysteroscopy-preserve FERTILITY- it is both Diagnostic and therapeutic
- Endometrial ablation
- Transcatheter uterine artery embolization
- Hysterectomy: reserved for women who do not respond to any other treatment
Why do young girls(age 10-12) have irregular bleeding
In girls with acute abnormal uterine bleeding and onset of menarche within the last year, anovulatory bleeding due to immaturity of the hypothalamic-pituitary-gonadal axis should be considered.
AUB and the woman wants to preserve fertility, what is the best surgical options
Dilation and uterine curettage (D&C) with concomitant hysteroscopy-preserve–> Diagnostic and therapeutic
Endometrial ablation leads to increased risk of
Ectopics
Pregnancy may still occur following endometrial ablation but is associated with a higher risk of ectopic pregnancies, miscarriage, and fetal and maternal complications. Following ablation, use of contraceptives is recommended to prevent pregnancy.
Endometriosis
- main clinical features
- treatment options
Chronic pelvic pain that worsens before the onset of menses(cyclic pain)
Dyspareunia
Infertility–> many patients will only recognize they have endo when the doc tell them they have endometriosis
Rectovaginal tenderness and palpable adnexal masses (chocolate cysts) on palpation
Pharmacologic
Combination oral contraceptive pills (first-line)
GnRH analogs, danazol, NSAIDs, progestins
Surgical
Conservative: excision, cauterization, and ablation of lesions; removal of adhesions
Definitive: total abdominal hysterectomy (TAH)/bilateral salpingo-oophorectomy (BSO)
Why is endometriosis so concerning and must be treated early
Can lead to INFERTILITY
Adenomyosis
- main clinical features
- treatment options
Dysmenorrhea
Menorrhagia
Chronic pelvic pain
Uniformly enlarged uterus
Pharmacologic
NSAIDs (first-line)
Oral contraceptive pills, progestins
Surgical
Conservative: hysteroscopy → endometrial ablation/resection
Definitive: hysterectomy
Gyn term for fibroid/fibroma
Uterine leiomyoma Fibroid, Uterine fibromyoma
Treatment for uterine leiomyoma/fibroid
Treat only if symptomatic
Pharmacologic GnRH agonists, progestins, levonorgestrel-releasing IUD NSAIDs Antifibrinolytics Androgenic agonists (e.g., danazol)
What is the cut-off on USS for endometrial thickness, for you to be worried about cancer
4-5mm, then you should have a biopsy(hysteroscopy, D and C)
Diagnosis- pipelle(office procedure)
Hysteroscopy D&C
What are the 2 types of endometrial cancer, which one is most common
Type 1- 80-90% endometrial cancers
Type 2-clear cell, carcinosarcoma(MMMT)–> higher grade, worse prognosis–> No risk factors and healthy women get it–> VERY BAD luck
Genetic- Lynch Syndrome- HNPCC
Which hormone is protective against endometrial cancer
Progesterone–> Give Mirena(IUD) and pill is also protective
Risk factors for endometrial cancer are
COLDNUT
C-cancer(breast, bowel and ovarian)
O-Obesity
L-Late menopause
D-Diabetes Mellitus
Nulliparity
Unopposed estrogen
Tamoxifen use
Intermenstrual bleeding and post-coital bleeding must always rule out
Cervical cancer
Why is CST done every 5 years? are they trying to save money by not doing it every 2 years?
Does HPV equal cancer doc
Grows slowly
The body can get rid of the virus on its own
and looking at the virus itself no the cell changes
age of highest sexual encounters- 25
screening too early–> overtreatment
No having HPV means there is likely pre-cancerous changes that COULD/COULD NOT lead to cancer. Does that make sense?
HPV leads to pre-cancerous changes
Vulva itch in older woman, what should you rule out
Vulval cancer
lichen sclerosis-Lichen sclerosus is often mistaken for thrush so see your doctor if you are often itchy in the vulvar or anal area.
Gestational trophoblastic disease/neoplasia
- benign
- malignant
benign–> complete and partial(incomplete) mole
incomplete mole–> has the fetus appearance(use its one egg and 2 sperms)
GTN malignant–> invasive mole or persistent GTN
Choriocarcinoma
Placental-site trophoblastic trauma
What is the most common cause of premature menopause
- how do you diagnose the condition
- what is the treatment
Menopause occurring before the age of 40 is considered premature. A common cause of premature menopause is ovarian insufficiency. The diagnosis is confirmed by increased FSH levels occurring after more than three months of amenorrhea in a woman under the age of 40. Treatment involves hormone replacement therapy.
How long do you have to stay without a period to confirm menopause
The official date of menopause is the last appearance of menstrual blood, which is determined retroactively after 12 months of amenorrhea
Why is obesity a risk factor for endometrial cancer
Causes unopposed oestrogen. Some estrogens are produced by peripheral aromatase conversion of adrenal androgens in adipose tissue.
Hence more oestrogen in the body increased risk of endometrial cancer
State some clinical features of menopause
Autonomic symptoms
Increased sweating, hot flashes, and heat intolerance
Vertigo
Headache
Mental symptoms Impaired sleep (insomnia and/or night sweats) Depressed mood or mood swings Anxiety/irritability Loss of libido
Atrophic features
- Breast tenderness and reduced breast size
- Vulvovaginal atrophy
- Atrophy of the vulva, cervix, vagina (thin, pale, smooth epithelial layer, associated with vaginal dryness, pruritus, and dyspareunia; see atrophic vaginitis for details)
- May present with features that mimic a urinary tract infection (i.e., dysuria, urinary frequency and urgency)
Weight gain and bloating
Increased risk of coronary artery disease
What happens to Estrogen, progesterone and FSH
↓ Estrogen, ↓ progesterone, ↑↑ FSH
Hyperthyroidism and menopause present similarly. For this reason, serum TSH should be checked in all suspected perimenopausal cases with heat intolerance and disturbed sleep to determine the cause!
What are some contraindications for HRT/ERT(estrogen replacement therapy)
Risks
Cancer
Unopposed estrogen can result in endometrial hyperplasia → increased risk of endometrial cancer
Estrogen plus progestin therapy → increased risk of breast cancer
Cardiovascular disease: coronary heart disease, deep vein thrombosis, pulmonary embolism, stroke
Gallbladder disease
Stress urinary incontinence
Contraindications Undiagnosed vaginal bleeding Pregnancy Breast cancer/endometrial cancer Chronic liver disease Hyperlipidemia Recent DVT/stroke Coronary artery disease
Treatment for chlamydia
Azithromycin
doxycycline
or macrolides
What is the gold standard for chlamydia infection
NAAT
Nucleic acid amplification tests (NAAT): the gold standard
If the gonococcal infection is suspected with chlamydia, what is the treatment
If the gonococcal infection is suspected, combine azithromycin with ceftriaxone.
What are some complications of chlamydia infection
1) PID
2) Ectopic pregnancy
3) Infertility
4) Reactive arthritis
5) Perinatal transmission of infection to the newborn is a possible → risk of conjunctivitis, otitis media, and/or pneumonia
Intermenstrual bleeding can happen with PID- T/F
True
Fever, abdominal/pelvic pain, dyspareunia
Abnormal, intermenstrual bleeding
Fitz-Hugh-Curtis syndrome (perihepatitis with RUQ pain)
Extragenital manifestations of gonorrhea include
1) Pharyngitis (sore throat, pharyngeal exudate, cervical lymphadenitis)
2) Proctitis
3) Disseminated gonococcal infection–>
Clinical triad (arthritis-dermatitis syndrome) Polyarthralgias: migratory, asymmetric arthritis that may become purulent
Tenosynovitis: simultaneous inflammation of several tendons (e.g., fingers, toes, wrist, ankle)
Dermatitis: vesicular, pustular, or maculopapular lesions, possibly with a necrotic or hemorrhagic centre
Purulent gonococcal arthritis
Abrupt inflammation in up to 4 joints (commonly knees, ankles, and wrists)
Yellow greenish discharge, purulent particularly in the morning
Gonorrheal infection
Is disseminated gonococcal infection= reactive arthritis
Nope
Two herpes conditions seen in children are
Herpetic gingivostomatitis and herpetic whitlow.
HSV gingivostomatitis vs herpetic whitlow
herpetic gingivostomatitis- painful lesions of the oral and pharyngeal mucosa
Herpetic whitlow causes blisters on the fingers with pronounced regional lymphadenopathy.
HSV most common in adults
HSV-1
HSV-1 happens in the
near the oral, lips
DDx for HSV-1
Shingles (Herpes zoster) Aphthous ulcers Herpangina Hand, foot, and mouth disease Candidiasis Syphilitic chancre or chancroid
Genital herpes is HSV
HSV2
What are some characteristics of genital herpes
-Most patients are asymptomatic
-Genitals: redness, swelling, tingling, pain, pruritus
-Unusual discharge
-Painful lymphadenopathy in the groin area
-After several days, “punched-out” lesions may appear that later ulcerate.
Lesions may appear as single or disseminated, painful red bumps or white vesicles.
They are typically located on or around the genitals and anus.
Herpetic gingivostomatitis, who gets it
- what are some clinical features
Mainly in children (∼ 1–6 years), but also immunocompromised patients (e.g., agranulocytosis, HIV)
Prodrome (fever, malaise) often mistaken for teething in children.
Pharyngitis, cervical lymphadenopathy
Gingivitis; erythema and painful ulcerations on perioral skin and oral mucosa, especially on the inner cheek, soft palate, and tongue
Primary syphilis presents as
Painless chancre(primary lesion)
Which test offer screening for syphilis and which ones offer diagnosis
Nontreponemal tests are used for screening purposes, while treponemal tests confirm the diagnosis.
What are the 2 non-treponemal tests
Rapid Plasma Reagin (RPR): generally the test of choice
Venereal Disease Research Laboratory (VDRL)
What are the treponemal tests(2) and what do they detect
Detect specific antibodies to treponemal antigens
Treponema pallidum particle agglutination (TPPA)
Fluorescent treponemal antibody absorption test (FTA-ABS)
What are 2 tests that can directly test for the antigen for syphilis
1) Darkfield microscopy, may be combined with immunofluorescence
2) Polymerase chain reaction (PCR)
What is 1st line for treatment for syphilis
What if they are allergic to the mentioned 1st line drug
First-line therapy: benzathine penicillin G
Treat with doxycycline or ceftriaxone if allergic
Jarisch-Herxheimer reaction-what is that?
an acute, transient, systemic reaction to bacterial endotoxins and pyrogens that are released after initiation of antibiotic therapy
-occurs within 24 hours
If urethritis is suspected, what are the other infection you can think of
Acute cystitis
Epididymitis
Prostatiti
What are the two types of urethritis
Gonococcal and non-gonococcal
What are 3 of the most common causes of APH
Common causes of APH are bloody show associated with labor, miscarriage, placental previa, and placental abruption. Rare causes include vasa previa and uterine rupture.
Define APH
Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 20+ weeks of pregnancy and prior to the birth of the baby
During 3rd trimester
What are the most important causes of APH
The most important causes of APH are placenta praevia
and placental abruption, although these are not the most common.
PP and PA
Placenta and vasa previa which one occurs before rupturing of membranes and which one after
Placenta previa and vasa previa on the other hand typically manifest prior to rupture of membranes or after rupture of membranes respectively, with painless vaginal bleeding and fetal distress
PP- before
VP-after
Any APH what questioned should be asked during in history
-any miscarriage as well
Domestic violence
How can you classify APH
Spotting–> Stains, streaking, or spotting of blood
Minor Haemorrhage–> Less than 50mL
Major Haemorrhage–> 50-1000mL without signs of circulatory shock
Massive Haemorrhage–> Greater than 1000mL with or without signs of circulatory shock
What are the upper genital tract causes(uterine/placental)
1) Placental abruption
2) Vasa previa
3) Placenta previa
4) Abnormal placentation- accreta, increta and percreta
5) Uterine rupture
What are the upper genital tract causes(uterine/placental)
1) Placental abruption
2) Vasa previa
3) Placenta previa
4) Abnormal placentation- accreta, increta and percreta
5) Uterine rupture
What are the lower genital tract causes
Cervical- Cervicitis, ectropion and cancer
Vagina and others
Should we do a VE exam or a spec if APH is suspected
NOOOOO WE NEED TO RULE OUT PLACENTA PREVIA
Kleihauer test- what are we looking for and why should I order it
is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.
It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive childre
Kleihauer test- what are we looking for and why should I order it
Not really worth it for Rh+ women but definitely worth it for Rh- women
is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.
It is usually performed on Rh-negative mothers to determine the required dose of Rho(D) immune globulin (RhIg) to inhibit formation of Rh antibodies in the mother and prevent Rh disease in future Rh-positive childre
Define placenta previa
Placental location below the presenting part of the fetus
What is the hallmark for placenta previa bleeding
Painless
What is the considered a clear placenta previa
2cm away from os
What are the 3 P’s of cervical ectropion
1) Period
2) Pill
3) Pregnancy(a common cause of APH)
Define placental abruption
Separation of the placenta with associated bleeding from exposed bleeding
Hyperemesis gravidum- definition
Does not have a proper defintion, varies
1) Severe NV during pregnancy
2) Continued NVP despite oral anti-emetics
3) > 5% weight loss in the context of NV
4) Ketonuria
5) Electrolyte imbalance
DDX for NVP in pregnancy
Multiple pregnancies and GTN should be considered
Tell me some natural treatment for NVP
Ginger
Vitamin B6
4 signs of the placenta are separating from the wall
Umbilical cord lengthens
Gush of blood
The uterus is firming up and uterus
The uterus is rising up to the anterior abdomen
What is the cause of uterine inversion
Pulling on the umbilical cord prior to the 4 signs of placental separation
What thing should you consider in cord prolapse
Is the cord pulsating or not?
What are some risk factors of placental abruption
Previous placental abruption Hypertension Trauma Smoking Cocaine use Preterm premature rupture of the membranes
Bright red vaginal bleeding in the 3rd trimester think
Placenta previa
What is velamentous cord insertion in vasa previa
Abnormal cord insertion into chorioamniotic membranes, resulting in exposed vessels surrounded only by fetal membranes and not protective Wharton’s jelly.
What is bloody show
Associated regular uterine contractions and cervical changes
A small amount of blood or blood-tinged mucus that is usually passed prior to labor or in early labor.
What is the most common cause of placental abruption
HTN
Continuous, dark, vaginal bleeding in the 3rd trimester think
Placental abruption
If its placenta previa can you delivery vaginally
Vaginal delivery should never be attempted outside the operating room in a patient with placenta previa
A woman infected with choro will present as, what are the symptoms and what are the signs
Infected women typically present with
1) fever
2) purulent vaginal discharge
3) and malodorous amniotic fluid
The combination of maternal (> 120/min) and fetal tachycardia (> 160/min) is highly indicative of intrauterine infection
What are some symptoms of choro
- maternal-5
- fetal-1
Maternal Fever (> 38 °C or > 100°F) Tachycardia > 120/min Uterine tenderness, pelvic pain Malodorous and purulent amniotic fluid, vaginal discharge Premature contractions, PROM
Fetal tachycardia > 160/min in cardiotocography
What is a common cause of neonatal infection
GBS
What are the 2 most common cause of neonatal infections
Streptococcus agalactiae (GBS) and Escherichia coli are the most common causes of both early- and late-onset neonatal sepsis!
Congenital infections are caused by pathogens transmitted from mother to child during pregnancy (transplacentally) or delivery (peripartum). What are they?
TORCH infections
What does TORCH stand for
Toxoplasmosis Others (e.g., syphilis, varicella, parvovirus B19 infection, listeriosis) Rubella Cytomegaly (CMV) Herpes simplex virus (HSV) infection
Hemolytic disease of the newborn has to 2 conditions within it to cause HDFN what are they
-which one is worse
Rh incompatibility –> won’t affect the current pregnancy, but second one is worse
ABO incompatibility–> will affect the current pregnancy, however, will have a milder course of the disease progression
ABO incomp - Newborn infants may present with pallor, jaundice, and hepatosplenomegaly.
What is hydrops fetails
A fetal condition characterized by generalized edema and accumulation of fluid in serous cavities (e.g., pleural effusion, pericardial effusion, ascites).
Hydrops fetalis (only expected in cases of Rh incompatibility)
erythroblastosis fetalis is
HDFN
Hemolytic disease of the newborn, also known as hemolytic disease of the fetus and newborn, HDN, HDFN, or erythroblastosis fetalis,
Which HDFN is milder
ABO incompatibility usually has a significantly milder course of disease than Rhesus incompatibility!
Which coombs test will show positively in HDFN
Rh incompatibility
Which HDFN happens in the 1st trimester
ABO incompatibility
What diagnostic test can be pre-natal and post-natal to determine HDFN
Prenatal diagnosis
Imaging
Ultrasound: to determine hydrops fetalis
Doppler sonography of fetal blood vessels → increased flow rate indicates fetal anemia
Postnatal diagnosis
If newborn has signs of hemolysis, conduct Coombs test (either direct or indirect)
In Rh incompatibility: positive
In ABO incompatibility: weak-positive or negative
What is the treatment for HDFN prenatally and postnatally
Prenatal
Intrauterine blood transfusion
Postnatal
Anemia: iron supplementation and, if necessary, RBC transfusion
Hyperbilirubinemia: phototherapy; if necessary, exchange transfusion with red blood cells (→ see the treatment of neonatal jaundice)
In severe cases, IV immunoglobulin (IVIG) may be administered
What are the indications for Anti-D immunoglobulin (RhoGAM)
Further indications (in Rh negativity)
After miscarriage, ectopic pregnancy, or termination of pregnancy
Bleeding during pregnancy
Following invasive procedures (e.g., amniocentesis, chorionic villus sampling
What is the life-threatening progression of pre-eclampsia
HELLP syndrome
What is the pathophysiology of HTN in pregnancy
Arterial hypertension with systemic vasoconstriction causes placental hypoperfusion → release of vasoactive substances → ↑ maternal blood pressure to ensure sufficient blood supply of the fetus
Why is there an increased risk of DVT in HTN in pregnancy
Systemic endothelial dysfunction causes placental hypoperfusion → ↑ placental release of factors → endothelial lesions that lead to microthrombosis
What are the consequences of vasoconstriction and microthrombosis in HTN pregnancy
Organ ischemia and damage
1) Preeclampsia: multiorgan involvement (primarily renal)
2) Eclampsia: predominantly cerebral involvement
3) HELLP syndrome: severe systemic inflammation with multiorgan hemorrhage and necrosis (particularly liver involvement)
Chronic hypoperfusion of the placenta leads to
Chronic hypoperfusion of the placenta → insufficiency of the uteroplacental unit and fetal growth restriction
When we pre-eclampsia most likely occur
34 weeks
What will you expect from HELLP syndrome, like what are the signs
Rapid clinical deterioration (DIC, pulmonary edema, acute renal failure, stroke, abruptio placentae)
Preeclampsia with severe features includes
Severe hypertension (systolic ≥ 160 mmHg or diastolic BP ≥ 110 mmHg)
Proteinuria, oliguria
Headache
Visual disturbances (e.g., blurred vision, scotoma)
RUQ or epigastric pain
Pulmonary edema
Cerebral symptoms (e.g., altered mental state, nausea, vomiting, hyperreflexia, clonus)
What is ddx for eclampsia/ Seizure disorder in pregnancy-4
1) Epilepsy
2) Encephalitis
3) Metabolic disorders (e.g., hypoglycemia, hyponatremia)
4) Hemorrhagic stroke
5) Ischemic stroke
6) Withdrawal syndromes
Differential diagnosis of HELLP syndrome-3
Causes of thrombocytopenia and liver impairment during pregnancy
Thrombotic microangiopathy (TTP, HUS)
Fulminant viral hepatitis
Acute fatty liver of pregnancy
Intrahepatic cholestasis of pregnancy
Intrahepatic cholestasis of pregnancy- treatment
First-line medication: ursodeoxycholic acid PO(UDCA)
An early therapy with ursodeoxycholic acid reduces the risk of preterm birth and stillbirth.
Position patient on left lateral decubitus position why in eclampsia patients
Prevent placental hypoperfusion through compression of the inferior vena cava and reduce the risk of aspiration in the mother
Cure for eclampsia
Delivery
Most common cause of IUGR
Placental insufficiency
What are some fetal signs and maternal signs of IUGR
Fetal signs
1) Small for gestational age (or with a birth weight below 10th percentile)
2) Decreased or absent fetal movements
Asymmetrical IUGR: disproportionate growth restriction
The dimensions of the head are normal while the body and limbs are thin and small.
Symmetrical IUGR: global growth restriction
The entire body is proportionally small.
The circumference of the head is proportional to the rest of the fetal body.
↑ Risk of neurologic sequelae
Maternal signs
Mostly asymptomatic
Small uterus (e.g., a smaller abdomen than in previous pregnancies)
Possible vaginal bleeding (e.g., placental abruption); preterm labor
Your notes
Methyldopa is
Methyldopa is a central alpha-2 agonist.
Antithyroid drugs for 1st trimester and then on?
First trimester: propylthiouracil
Second and third trimester: methimazole
Single most important test to perform in a woman who states she has amenorrhea now
Beta-hCG
Main cause of secondary amenorrhea
What are the 4 types of secondary amenorrhea and state an example for each
1) Pregnancy
2) Endocrine–> Hypothyroidism
3) Ovarian disorder(PCOS)
4) Central–>
- hypergonadotrophic hypogonadism
- hypogoandotropic hypogonadism
Hypergonadotropic hypogonadism (primary hypogonadism)- causes
insufficient sex steroid production in the gonads
Turner syndrome (females), Klinefelter syndrome (males),
Hypogonadotropic hypogonadism (secondary hypogonadism)- causes
Definition: insufficient gonadotropin-releasing hormone (GnRH) and/or gonadotropin release at the hypothalamic-pituitary axis
Kallmann syndrome
Eating disorders (functional hypothalamic amenorrhea)
Trauma to head
Infection
Genetic syndromes- Prader Willi
With AUB state your 1st line investigations
and what other 3 additionally test can be requested
CBC → rules out anemia
Platelet count, PT, PTT → rule out bleeding disorders
Beta-HCG → rules out pregnancy
Additional testing if required (e.g.,
1) thyroid function tests,
2) prolactin
3) serum iron)
