Infertility and pelvic floor disorders

Question 1

what kind of history would you get on woman that has presence of excessive body and facial hair?

Answer 1

Hx of PCOS, menstrual irregularities, fertility history, insulin resistance, obesity, or acne. Med history use- valproic acid, testosterone, danazol, athletic performance drugs. If glactorrhea present, workup for hyperprolactinemia.

Question 2

WORKUP on hirsutism

Answer 2

random testosterone level, TSH, fasting glucose

Question 3

if testosterone is greater than 150, suspect…? What is used to diagnose?

Answer 3

ovarian (ultrasound) or adrenal tumor (CT)

Question 4

tx for hissutism

Answer 4

oral contraceptives- 6 months to show effect, eflornithine HCL cream, cosmetic measures- hydrogen peroxide, plucking, waxing, shaving, chemical depilatories, electrolysis, laser therapy

Question 5

the only FDA approved hirsutism treatment

Answer 5

vaniqa (eflornithine) HCL cream

Question 6

inability of a couple to conceive within 1 year=

Answer 6

infertility

Question 7

difference between infertility and sterility

Answer 7

infertility- can’t conceive. sterile- intrinsic inability to achieve pregnancy (vasectomy, hysterectomy)

Question 8

how can you have both fecundity and infecundity

Answer 8

fecundity- can reproduce, but inability to achieve live birth- infecundit

Question 9

likelihood of conception per month of exposure

Answer 9

fecundability

Question 10

primary and secondary infertility inc or dec?

Answer 10

primary infertility increasing with concurrent decrease in secondary infertility

Question 11

4 key aspects in lab and radiologic tests that are looked at in infertility

Answer 11

sperm, oocyte, transport, and implantaion of ova

Question 12

causes of infertility in women

Answer 12

fallopian tubal occlusion d/t PID (oocyte cannot be transported to uterus), ovulatory disorders (gonadal dysgenesis), endometriosis, HIV, toxic exposures, untreated cervicitis, untreated STD’s

Question 13

majority of cases in infertlity caused by

Answer 13

testicular pathology (varicocele) in 25-40% of cases and ovulatory dysfunction in 20-25% of cases

Question 14

male factors causing infertility

Answer 14

endocrine (pituitary failure), anatomic, abnormal spermatogenesis (chromosomal abnormalities, cryptorchidism), abnormal mobility (varicocele, absent cilia), and sexual dysfunction (impotence, retrograde ejaculation)

Question 15

molimina

Answer 15

premenstrual symptoms

Question 16

ovulatory factors causing infertility

Answer 16

follicular pool (less as you get older) and ovarian reserve (older eggs, less quality)- inverse relationship between fecundity and age

Question 17

confirmation of ovulation

Answer 17

serum progesterone assay, pelvic ultrasound (looks at follicular phase), urinary LH kit/serum LH assay (detects LH surge), basal body temp, endometrial biopsy

Question 18

serum progesterone assay detects…

Answer 18

progesterone in mid luteal phase or third week of cycle. 3 or more ng/MI consistent with ovulation

Question 19

List main 4 characteristics seen in PCOS

Answer 19

Chronic anovulation- amenorrhea, oligomenorrea, infertility. Hyperandrogenism- acne, hirsutism, seborrhea, acanthosis nigricans, metabolic syndrome. Polycistic ovaries on ultrasound causing ovarian enlargement Insulin resistance, also causes increased testosterone

Question 20

PCOS testing

Answer 20

Ultrasound- polycistic appearing ovaries, hCG to r/o pregnancy and GTD. FSH to exclude premature ovarian failure. TSH, testosterone increased. 2 hr glucose tolerance test for insulin resistance check. lipid panel to check metabolic syndrome. CMP to check liver function, electrolytes. 17-hydroxyprogesterone- r/o congenital adrenal hyperplasia

Question 21

vaginal ultrasound in PCOS

Answer 21

polycystic appearing ovaries, multiple small follicles around periphery, increased ovarian volume (enlarged ovaries), increased uterine lining thickness

Question 22

tx of PCOS

Answer 22

exercise and healthy eating imp for insulin resistance, Birth control pills, depot provera, mirena IUD, metformin, spironolactone for androgen excess hirsutism, ovulation induction with clomiphene

Question 23

Rotterdam consensus

Answer 23

2 of the following satisfied in PCOS: chronic anovulation, hyperandrogenism, or polycystic appearing ovaries by ultrasound

Question 24

4 types of pelvic organ prolapse

Answer 24

cystocele, rectocele, enterocele, uterine prolapse

Question 25

Patient presents with frequent UTI’s, urinary incontinence, sense of fullness or mass in vagina, dyspareunia. what type of pelvic organ prolapse do you suspect?

Answer 25

cystocele

Question 26

anterior wall of vagina and small bowel prolapse

Answer 26

enterocele

Question 27

patient presents with sense of fullness or mass in vagina,dyspareunia, constipation, fecal incontinence. what type of prolapse do you suspect?

Answer 27

rectocele

Question 28

patient presents with urinary problems, trouble having bowel movement, low back pain, sensation of heaviness of pulling in the pelvis, tissue protruding from vagina, sx less bothersome in morning and become worse as day goes on. Suspect

Answer 28

uterine prolapse

Question 29

chronic inflammation of bladder

Answer 29

interstitial cystitis

Question 30

25 year old presents with dysuria, frequency, urinary urgency. Above 60 yo will also have nocturia and urinary incontinence. Pain with full bladder but once pee, then pain resolves. dx?

Answer 30

interstitial cystitis

Question 31

Urinalysis and urine culture and cytology in interstitial cystitis

Answer 31

normal (unless chronic bacteriuria)

Question 32

the only FDA approved tx for interstitial cystitis

Answer 32

pentosan polysulfate

Question 33

complication of interstitial cystitis

Answer 33

severe continusous high bladder pressure assoc with renal damage

Question 34

first line tx for urge incontinence

Answer 34

aticholinergic agents- tolterodine, oxybutynin, solifenacin, darifenacin

Question 35

first line treatment for stress incontinence

Answer 35

pelvic floor rehabilitation, duloxetine may help but has not been approved, estrogen NOT recommended

Question 36

surgical management for urge incontinence

Answer 36

sacral nerve stimulation, percutaneous tibial nerve stimulation