Mehl. dysmenorrhea/endometriosis/adenomyosis 03-24 (1) Flashcards
M. Primary dysmenorrhea.
What is dysmenorrhea?
Dysmenorrhea = period pain.
M. Primary dysmenorrhea. what is it?
Primary dysmenorrhea = “normal period pain”; benign.
M. Primary dysmenorrhea. mechanism?
Mechanism is prostaglandin PGF2a hypersecretion.
M. Primary dysmenorrhea.
During menstruation, the endometrial cells release high levels of prostaglandins, which cause uterine contractions and pain. The prostaglandins can also make their way into the systemic circulation, leading to headache and nausea.
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M. This is the answer on USMLE for period pain under the age of 20. The Q can say, girl who is 17 has menstrual pain so bad she has to miss class + physical exam shows no abnormalities, Dx?
primary dysmenorrhea
M. Primary dysmenorrhea.
the answer can also be written simply as “prostaglandin secretion.”
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M. Primary dysmenorrhea.
The key detail regarding primary dysmenorrhea is that ?
the physical exam is normal
M. Primary dysmenorrhea. VS In endometriosis, the physical exam is??????
the physical exam is abnormal + is always over age 20.
M. Primary dysmenorrhea. Tx?
Treatment is NSAID.
OCP is wrong answer if listed alongside NSAID (on NBME).
M. Endometriosis. definition?
Growth of endometrial tissue outside the uterus.
M. Endometriosis. most common location?
Most common location is the ovary, but can also grow in other locations like the pouch of Douglas.
M. Endometriosis. mechanism?
Mechanism is thought to be retrograde menstrual flow through the Fallopian tubes + seeding onto the ovaries or peritoneum.
M. Endometriosis. CP?
Causes severe menstrual pain over age 20 + an ABNORMAL physical exam.
M. Endometriosis.
The abnormal physical exam can be any miscellaneous finding – i.e., there is no specific finding you have to memorize. They can say findings such as nodularity of the uterosacral ligaments, a fixed retroverted uterus (due to adhesions from lesions), or pelvic tenderness.
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M. In contrast, severe period pain + normal physical exam = Dx?
primary dysmenorrhea.
NOT ENDOMETRIOSIS
M. 3F + period pain so bad she has to miss work + normal physical exam = answer?
answer = prostaglandin secretion / primary dysmenorrhea.
M. 23F + period pain so bad she has to miss work + physical exam shows nodularity of the uterosacral ligaments = Dx?
answer = endometriosis.
M. Endometriosis.
Descriptors such as pain with defecation (due to pouch of Douglas lesions) or dyspareunia (pain during sex) are highly buzzy and pass-level but too easy, so are often omitted from NBME questions, as per my observation.
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M. Endometriosis. next best step?
USMLE wants diagnostic laparoscopy as next best step.
M. Endometriosis. Dx = short term?
NSAIDs and OCPs are short-term measures
M. Endometriosis. definitive Tx?
definitive Tx is laparoscopic removal of lesions.
M. Adenomyosis. definition?
Growth of endometrial tissue within the myometrium.
M. Adenomyosis. CP?
Presents as a diffusely enlarged uterus + vaginal bleeding in woman 30s-50s.
M. Adenomyosis. Pain?
May or may not be painful.
M. Adenomyosis.
Q will say woman had tubule ligation two years ago + now has uterus that is 8 weeks’ gestation in size + vaginal bleeding. Answer = adenomyosis. Student is confused and says “how can she be pregnant if she had tubule ligation?” She’s not. Use your head. It’s just how the Q can describe the incr. size.
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M. Adenomyosis. Tx?
NSAIDs + OCPs.
M. Adenomyosis. What can be used for Tx in theory?
Leuprolide can be used in theory, but I haven’t seen it assessed.
M. Ovulatory pain; can present as sharp adnexal pain mid-cycle. Dx?
Mittelschmerz
M. Mittelschmerz?
Ovulatory pain; can present as sharp adnexal pain mid-cycle.
M. Heavy periods (>80 mL; can present with clots); and/or menses lasting >7 days?
Menorrhagia
M. Menorrhagia?
Heavy periods (>80 mL; can present with clots); and/or menses lasting >7 days
M.
Mid-cycle bleeding (i.e., any bleeding between periods).
Slightly different from “breakthrough bleeding,” which refers to mid-cycle bleeding in women using hormonal contraception.??
Metrorrhagia
M. Metrorrhagia?
Mid-cycle bleeding (i.e., any bleeding between periods).
Slightly different from “breakthrough bleeding,” which refers to mid-cycle bleeding in women using hormonal contraception.
M. Persistent or recurrent pain during sex; no one specific etiology.?
Dyspareunia
M. Dyspareunia?
Persistent or recurrent pain during sex; no one specific etiology.
M. Dyspareunia specifically caused by involuntary contraction of the pelvic floor muscles, especially the pubococcygeus (PC), presenting as spasmodic pain during sex.?
Vaginismus
M. Vaginismus?
Dyspareunia specifically caused by involuntary contraction of the pelvic floor muscles, especially the pubococcygeus (PC), presenting as spasmodic pain during sex.
