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Women's Health > Lecture 11: Menstrual and Uterine Disorders > Flashcards

Lecture 11: Menstrual and Uterine Disorders Flashcards

1
Q

Primary amenorrhea is classified by absence of menses by age () with impaired sexual development, or by age () with normal sexual development.

A
  • Age 13 if impaired development.
  • Age 15 if development was normal.
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2
Q

The MCC of primary amenorrhea is…

A

Abnormal chromosomes leading to gonadal dysgenesis.

Ovarian insufficiency

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3
Q

Absence of menses for > 3 cycles or 6 consecutive months in a previously menstruating patient is known as…

A

Secondary amenorrhea

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4
Q

The MCC of secondary amenorrhea is…

A

Pregnancy

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5
Q

Postpastum pituitary necrosis due to hypovolemia and leading to hypothalamic-pituitary dysfunction/amenorrhea is known as…

A

Sheehan’s syndrome

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6
Q

Premature ovarian failure occurs prior to the age of…

A

40

Menopause prior to 40.

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7
Q

T/F: PCOS can cause amenorrhea

A

True

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8
Q

Mullerian dysgensis is congenital absence of the () and the upper 2/3 of the ()

A
  • Uterus
  • Upper 2/3 of vagina

However, can still ovluate and have normal 2ndary sex characteristics

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9
Q

Uterine adhesions are usually due to …

A

Asherman’s syndrome

Dilation and curettage

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10
Q

In a patient showing primary amenorrhea with Positive 2deg sex characteristics, the labs you would order are… (1)

A

Pregnancy test

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11
Q

In a patient showing primary amenorrhea with negative 2deg sex characteristics, the labs you would order are… (4)

A
  • Prolactin
  • TSH
  • LH
  • FSH
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12
Q

In a patient showing primary amenorrhea with negative 2deg sex characteristics, and elevated LH/FSH, you would expect their ovaries to ()

A

Not produce estrogen!

Ovarian failure

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13
Q

In a patient showing primary amenorrhea with negative 2deg sex characteristics, and low LH/FSH, the next step in workup is…

A

MRI of the brain

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14
Q

The 3 labs you would order initially for workup of secondary amenorrhea are….

A
  • Pregnancy test (MCC!)
  • TSH
  • Prolactin

Abnormal TSH = thyroid dz
Abnormal prolactin = pituitary imaging

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15
Q

A progesterone challenge test that shows bleeding means the () is intact but progesterone is lacking.

Workup of secondary amenorrhea

A

Endometrium

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16
Q

In an estrogen + progesterone challenge test, lack of bleeding suggests that the endometrium is either () or ()

A

Unresponsive or blocked.

Bleeding = suspect hypogonadism

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17
Q

The presence of high FSH/LH with amenorrhea pretty much means…

A

Primary ovarian failure

The ovaries are not responding properly.

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18
Q

The presence of low FSH/LH with amenorrhea usually means () ovarian failure

A

Secondary

Pituitary is not releasing a proper amt

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19
Q

A patient with secondary amenorrhea has a negative pregnancy test, Normal TSH/Prolactin, and a Progesterone challenge test with no bleed. The next test to run is… ()

A

Estrogen Progesterone challenge test

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20
Q

The main hormone responsible for growing the endometrium is..

A

Estrogen

I think? Im p sure? I hope?

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21
Q

In a patient suffering from amenorrhea that desires to get pregnant, the two pharmacologics we could suggest are…

A
  • Letrozole/Femara (aromatase inhibitor)
  • Clomiphene citrate/clomid (SERM)
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22
Q

A woman with amenorrhea that does not desire to get pregnant should be put on… ()

A

OCPs

Combination to maintain bones, reduce atrophy, menopausal s/s

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23
Q

The MC type of dysmenorrhea is…

A

Primary dysmenorrhea (idiopathic)

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24
Q

Painful menstruation that inhibits normal activity and requires medication is known as..

A

Dysmenorrhea

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25
Q

The primary hormone? associated with dysmenorrhea is…

A

Prostaglandins during ovulation

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26
Q

The hallmark symptom of dysmenorrhea is…

A

PAIN

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27
Q

Generally, dysmenorrhea pain begins () relative to menses onset and recurs with () menstrual cycles

A
  • Begins at onset/1-2 days prior
  • Recurs with most/all menstrual cycles
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28
Q

Physical pelvic exam of dysmenorrhea will usually show…

A

No significant pelvic disease.

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29
Q

First line pharm treatment for dysmenorrhea

A

NSAIDs (Naproxen/Advil)

Reduce prostaglandins.

Take prior or at onset of S/S.

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30
Q

The first line NON-pharm tx for dysmenorrhea is…

A

Continuous heat to abdomen

Same efficacy as advil, better than tylenol

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31
Q

Erythema ab igne can occur in dysmenorrhea because…

A

Chronic use of heat pads

Toasted skin syndrome

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32
Q

A patient suffering from dysmenorrhea tries NSAIDs and heat, which both don’t work. You should now suggest…

A

Contraceptives (oral or IUDs)

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33
Q

The highest incidence of PMS and PMDD occurs between the ages of…

A

late 20s to early 30s

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34
Q

PMS becomes PMDD when there is clear…

A

Functional impairment

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35
Q

The primary non-pharm tx for mild-mod PMS/PMDD include changing (), () therapy, and supplements, specifically ()

A
  • Changing eating habits (complex carbs, avoid caffeine/chocolate/alcohol/salt)
  • CBT
  • Chasteberry

CCC

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36
Q

Cyclic edema in PMS/PMDD can be treated with…

A

Spironolactone

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37
Q

The primary use of bromocriptine, a dopamine agonist, in PMS/PMDD is for…

A

Breast pain

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38
Q

For more severe PMS/PMDD, the first-line treatment is…

A

SSRIs

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39
Q

Second-line tx for more severe PMS/PMDD is…

A

Hormonal contraceptives containing drospirenone

Yaz, Yasmin, Beyaz

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40
Q

For PMS/PMDD that is severe and refractory to SSRIs and hormones, our last resort is to use (meds) or definitive (surgery)

A
  • GnRH agonists (medical menopause)
  • Definitive: Bilateral oophorectomy +/- hysterectomy
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41
Q

You would expect endometrial cells in a postmenopausal patient to be an abnormal finding unless they were currently taking…

A

MHT

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42
Q

Generally, contact bleeding/postcoital bleeding is suggestive of ()

A

Cervical cancer

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43
Q

A transvaginal US needs be performed with a () bladder

A

Empty bladder

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44
Q

Typically, the initial imaging for evaluating dysfunctional uterine bleeding would be a….

A

Pelvic US

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45
Q

The gold standard for evaluating dysfunctional uterine bleeding is…

A

Hysteroscopy

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46
Q

In a pre-menopausal patient with dysfunctional uterine bleeding, no serious pathology, and no impact of QOL, we would recommend either () or ()

A
  • Observation
  • Hormone therapy
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47
Q

In a premenopausal patient with an active uterine hemorrhage, the TOC is…

A

IV estrogen

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48
Q

Definitive tx of dysfunctional uterine bleeding in a premenopausal woman is…

A

Hysterectomy

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49
Q

T/F: A postmenopausal patient with 12 months of amenorrhea that now presents with dysfunctional uterine bleeding needs investigation.

A

True

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50
Q

The MCC of postmenopausal uterine bleeds is…

A

Exogenous hormones

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51
Q

The MCC of a lower GU tract postmenopausal bleed is…

A

Vaginal atrophy

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52
Q

The primary differences between first and 2nd gen endometrial ablations is that 2nd gen does not require () and takes () time

A
  • 2nd gen does not require direct hysteroscopic guidance
  • Also 2nd gen is faster
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53
Q

A majority of patients will experience () menstrual flow after an endometrial ablation

A

Decreased menstrual flow

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54
Q

The primary contraindication to endometrial ablation is…

A

Patient wants kiddos later

Very dangerous to have kids after this

Also you cant do this if theyre currently pregnant lol

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55
Q

T/F: you need pre-op abx before an endometrial ablation

A

False

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56
Q

The first tool used for 1st gen endometrial ablation is…

A

Nd-YAG laser

57
Q

The main caveat of using rollerball ablation is that it cannot reach () lesions

1st gen endometrial ablation

A

Intracavitary

58
Q

The 1st gen endometrial ablation technique with the highest rate of perforation is…

A

Endometrial resection

59
Q

What is the primary advantage and disadvantage of Hysteroscopic thermal ablation?

2nd gen endometrial ablation

A
  • Pro: Can use with anatomically abnormal uterus
  • Con: Higher burn risk

Its like boiling your uterus

60
Q

The primary advantage of using radiofrequency thermal ablation is…

2nd gen endometrial ablation

A

No endometrial prep required

61
Q

Thermal + RF Thermal ablation, aka Minerva, shows () rates of normal or no menstrual flow post procedure

A

Higher rates

62
Q

Cryoablation of the endometrium typically causes () pain

63
Q

The MC GYN diagnosis that leads to hospitalization in women aged 15-44 is…

A

Endometriosis

64
Q

The 6 RFs for endometriosis are…

A
  • (+) FHx
  • Early Menarche
  • Nulliparity
  • Long flows
  • Heavy flows
  • Short cycles

AKA the most menstrual cycles

65
Q

The MC symptom of endometriosis is…

A

Dysmenorrhea

Pelvic pain, dyspareunia, infertility

66
Q

T/F: Symptom severity does not correlate with endometriosis extent

67
Q

The constant pelvic pain in endometriosis is usually worse () menses

A

Just before menses

68
Q

Classically, a patient with endometriosis will have () nodules in their posterior vaginal fornix, or they will have ()

A
  • Tender nodules
  • They could also just have nothing
69
Q

The initial imaging for endometriosis is…

A

TVUS

Checking for rectum or rectovaginal septa

70
Q

Definitive dx of endometriosis is done via

A

Surgery w/ biopsy

71
Q

Powder burn and chocolate cysts are most commonly associated with what condition?

A

Endometriosis

72
Q

The primary goal in treating endometriosis is…

A

Symptom relief

Plus restoring fertility

73
Q

In a patient with endometriosis presenting with minimal symptoms, we would first suggest (meds)

A

NSAIDs/Hormones

Combo or progestin only

74
Q

In a patient with mild endometriosis and is not responding well to hormones, the next hormonal tx options are (3)

A
  • GnRH agonists/antagonists
  • Danazol
  • Aromatase inhibitors
75
Q

What is Danazol’s MOA?

A

Inhibit gonadotropin release and enzymes that produce estrogen

Testosterone derivative that acts like progestin.

Relieves pain!

76
Q

Leuprolide is a GnRH (agonist/antagonist), whereas Orilissa is a GnRH (agonist/antagonist)

A
  • Leuprolide = Agonist
  • Orilissa = Antagonist

Both should only be used up to 6 months. Orilissa low dose = 24 m

77
Q

The two STDs MC associated with PID are…

A

Gonorrhea and chlamydia

Usually polymicrobial

78
Q

Overall, the highest risk patient for PID is..

A

Young, nulliparous, sexually active woman with multiple partners

79
Q

The leading cause of infertility and ectopic pregnancy is…

80
Q

The cardinal symptom of PID is…

A

Lower abd pain

81
Q

Specifically, RUQ pain associated with PID is most suggestive of () syndrome

A

Fitz-Hugh-Curtis Syndrome

82
Q

The classic sign of PID is known as …

A

Chandelier’s sign (Cervical motion tenderness

83
Q

T/F: A patient with PID has an elevated temp.

A

True, often PO temp is > 38.3C/101F

84
Q

T/F: Labs and imaging will always show if someone has PID

85
Q

Initial imaging for PID suspicion is a …

A

TVUS

Can also add on laparoscopy

86
Q

Per CDC guidelines, a Dx of PID is treated empirically. The Dx requires () and one or more of ()

A
  • Pelvic/lower abd pain with NO OTHER CAUSE
  • Either cervical motion/uterine/adnexal tenderness
87
Q

A pregnant patient presenting with PID needs empiric tx. You would choose (PO/IV) abx and tx her (IP/OP)

A

Admit her and tx with IV/PO abx (see below for details)

Pregnancy is an admit condition.

88
Q

The 3 drugs used in empiric tx of PID are…

A
  • Rocephin
  • Doxy
  • Metro

All 14d!

89
Q

The classic patient for a tubo-ovarian abscess is a…

A

Young, low-parity, hx of pelvix infection

90
Q

The method of choice to search for a tubo-ovarian abscess is…

91
Q

Tubo-ovarian abscesses that are unruptured are treated with…

A
  • Rocephin
  • Doxy
  • Metro

Similar to inpt PID but 4-6 weeks!

92
Q

A patient presenting with a ruptured tubo-ovarian abscess needs immediate (surgery)

A

Total abdominal hysterectomy + Bilateral salpingo-oophorectomy

and some fluids and abx

93
Q

In a postmenopausal pt with a tubo-ovarian abscess we suspect that they may also have a concurrent ()

A

Malignancy

94
Q

Cystocele is also known as…

A

Anterior vaginal prolapse

95
Q

A patient presents to your office with a feeling of discomfort down there. She describes it like something is falling out or its like im sitting on a ball. She is also coughing a lot and says she needs to strain hard when poopin. She probably has a ()

A

Pelvic organ prolapse

96
Q

What does it mean to splint your bladder or vagina/perineum?

A

Gotta push their fingers against that organ so they can pee/poop

if this is on the exam viv is gunna give me $5

97
Q

Dx of pelvic organ prolapse is usually done…

A

Clinically.

Only need imaging if you suspect something else

98
Q

Generally, the conservative tx for pelvic organ prolapse is…

A

Pessary

Requires provider to fit and check.

Can also do Kegels or topical estrogen

99
Q

T/F: After surgical mesh/repair of a pelvic organ prolapse, it will not recur again.

100
Q

Adenomyosis is (symmetrical/asymmetrical) enlargement of the endometrium

A

Symmetrical

101
Q

The top two RFs for adenomyosis is…

A
  • Parity
  • Age (40-50)
102
Q

Adenomyosis is characterized by growths within what layer of the endometrium?

A

Myometrium

103
Q

The preferred imaging modality for adenomyosis is…

A

TVUS

Focal thickening, heterogenous texture

104
Q

Symptomatic relief of adenomyosis is achieved with (OTC meds), OCPs, and (procedure)

A
  • NSAIDs for pain
  • Endometrial ablation/resection somewhat helpful
105
Q

Definitive tx of adenomyosis is with

A

Hysterectomy

106
Q

The MC benign neoplasm of the female genital tract is….

A

Leiomyomas

Myomas, fibroids, fibroid tumors

107
Q

Although most leiomyomas are asymptomatic, the MC presenting S/S are (2)

A
  • Abnormal uterine bleeding
  • Pelvic pressure/pain
108
Q

Presence of a leiomyoma is confirmed via () and its location is confirmed via ()

A
  • US to confirm presence.
  • Hysterography/hysteroscopy to confirm if its cervical vs submucous
109
Q

For a patient presenting asymptomatic with a leiomyoma, the preferred management is…

A

Observation with annual exams.

110
Q

If a leiomyoma is symptomatic, the pharm therapy for it is (2)

A
  • NSAIDs
  • Hormonal therapy (contraceptives, GnRH agonists)
111
Q

The 3 surgical treatments for leiomyomas are….

A
  • Myomectomy
  • Hysterectomy
  • Uterine artery embolization
112
Q

Your 45 year old patient presents with a new onset leiomyoma with no symptoms. She seems like she is about to go through menopause. You should counsel her that her leiomyoma will () after menopause.

A

It will usually regress sponatenously.

113
Q

The MC GYN malignancy is…

MC in white woman, but they also have higher survival rates

A

Endometrial cancer

114
Q

Although endometrial cancer can occur as young as 20-30, it typically has a peak onset at (age)

115
Q

The primary underlying etiology for endometrial cancer is…

A

Endometrial hyperplasia.

Long-term estrogen, which stimulates the endometrium!

116
Q

The MCC of endogenous overproduction of estrogen is…

A

Obesity

Metabolic syndrome

PCOS = no progesterone to counteract

117
Q

What drug can cause abnormally high levels of estrogen/increase risk of endometrial cancer?

118
Q

Generally, estrogen enhances the endometrium. In order to counteract it, the mainstay of therapy is…

A

Progesterone

119
Q

The primary medication we use to reduce risk of endometrial cancer is…

A

Combo OCPs!

We need that progesterone

120
Q

Lifestyle modifications to reduce endometrial cancer are primarily (2)

A
  • Smoking (NOT CESSATION)
  • lower animal fat diet

Smoking reduces estrogen, so it actually reduces risk

121
Q

The MC symptom of endometrial hyperplasia is…

A

Abnormal uterine bleeding

122
Q

Simple hyperplasia without atypia of the endometrium is expected to regress (spontaneously/with progestin) 80% of the time

A

Spontaneously

123
Q

T/F: Endometrial hyperplasia with atypia is considered cancer

A

False, it is premalignant

It could become caner

124
Q

If endometrial hyperplasia with atypia undergoes () but it fails/relapses, the next step in management is ()

A
  • Progestin therapy
  • Hysterectomy
125
Q

The majority of endometrial ccancers are seen in younger patients, have favorable prognoses, and are usually low-grade mean they are (type 1/2) endometrial caner

A

Type 1 endometrial cancer

126
Q

Type 2 endometrial cancer is unique in that estrogen ()

A

Estrogen has no effect.

127
Q

The classic patient with endometrial cancer is…

A

Obese, nulliparous, infertile, HTN, DM, white woman

128
Q

The MC cell type of endometrial cancer is…

A

Adenocarcinoma

129
Q

The endometrial cancer cell type that is rarest and NOT associated with hyperestrogenic states is…

A

Clear cell carcinoma

130
Q

The mainstays of preventing endometrial cancer include:

  • Reduce exposure to exogenous (1)
  • Using (2)
  • Avoiding any syndrome that induces (3)
  • Wt control/exercise
  • Control of (2 chronic conditions)
  • Prophylactic TAH/TVH +/- BSO
A
  1. Exogenous estrogen
  2. Using progesterone
  3. Anovulation (think PCOS)
  4. DM and HTN
131
Q

The MC symptom of endometrial cancer is..

Also often the most important and earliest!

A

Abnormal bleeding

Always workup any postmenopausal bleed

132
Q

Cervical os stenosis leading to blood/detritus build-up is known as…

A

Hematometra

133
Q

Generally, a physical exam of endometrical cancer early on will show…

A

Probably nothing

134
Q

In a post-menopausal pt with abnormal bleeding, your initial imaging choice would be… ()

135
Q

What endometrial thickness is highly suspicious of endometrial cancer in a postmenopausal patient?

136
Q

In order to definitively diagnose endometrial cancer, you need a ()

A

Biopsy of endometrial tissue

137
Q

The extra definitive diagnostic procedure for endometrial cancer is (), which must be done inpatient with anesthesia.

A

D&C

Bigger sample.

138
Q

The mainstay of treating endometrial cancer is…

A

Surgery

Gotta take it all out ):

139
Q

The 2 adjunct chemo agents used for endometrial cancer are…

A
  • Doxorubicin
  • Cisplatin

Women's Health (15 decks)

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