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ER Exam 2 > Menarche > Flashcards

Menarche Flashcards

1
Q

Why can dehydration initiate signs of labor in a pregnant patient?

A

Oxytocin and Vasopressin (ADH) have similar structures, ADH will get upregulated in a dehydrated patient and will bind to oxytocin receptors and simulate labor

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2
Q

If a patient’s ovaries were being visualized by laproscopy and a yellow cyst was seen, what could this be if it was physiologically normal?

A

Corpus Luteum

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3
Q

When would you repeat an ultrasound for an ovarian cyst?

A

6 weeks from initial US to “catch” the patient in a different stage of her cycle

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4
Q

An intact coagulation pathway is important for what phase of the menstrual cycle?

A

Secretory phase

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5
Q

When should females have their initial reproductive health visit?

A

Ages 13-15

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6
Q

When does ACOG recommend 1st Pap test?

A

21 yrs old

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7
Q

What Gardasil HPV genotypes cause genital warts?

A

6, 11

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8
Q

What Gardasil HPV genotypes cause cervical CA?

A

16, 18

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9
Q

What is the median age of menarche?

A

12.43

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10
Q

How long after thelarche does menarche occur?

A

2-3 years

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11
Q

Primary menorrhea is characterized by

A

Absence of menarche by 13 years old w/o secondary sexual development

OR by the age of 15 with secondary sexual development

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12
Q

What is the difference in cycle ranges in the first gynecologic year as compared to the 3rd gynecologic year?

A

21-45 days to 21-35 days

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13
Q

Endocrine causes of menstrual irregularity

A

Poorly controlled DM

PCOS

Cushing’s Dz

THyroid dysfunction

Premature ovarian failure

Late-onset CAH

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14
Q

Acquired causes of menstrual irregularity

A

Stress-related hypothalamic dysfunction

Medication

Exercise

Eating disorders

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15
Q

What is the mean blood loss per menstrual period?

A

30cc

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16
Q

Define: Primary amenorrhea

A

No menstruation by 13 y/o w/o secondary sex development or by age 15 with secondary sex development

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17
Q

Define: Secondary amenorrhea

A

Absence of menses for 6 months or more

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18
Q

Define: Polymenorrhea

A

Abnormally frequent menses at intervals at <21 days

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19
Q

Define: Menorrhagia

A

Hypermenorrhea

>80 mL and >7 days at regular intervals

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20
Q

Define: Metrorrhagia

A

Irregular episodes of uterine bleeding

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21
Q

Define: Menometrorhagia

A

Heavy and irregular uterine bleeding

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22
Q

Define: Intermenstrual bleeding

A

Scant bleeding at ovulation for 1 or 2 days

23
Q

Structural causes for abnormal bleeding in reproductive-aged women

A

P: Polyp

A: Adenomyosis

L: Leiomyoma

M: Malignancy and hyperplasia

24
Q

Nonstructural causes for abnormal bleeding in reproductive-aged women

A

C: Coagulopathy

O: Ovulatory dysfunction

E: Endometrial

I: Iatrogenic

N: Not yet classified

25
Q

How does an endometrial polyp appear on ultrasound?

A

Focal thickening of endometrial stripe

Saline hysterosonography and hysteroscopy

26
Q

What is adenomyosis?

A

Extension of endometrial glands and stroma into uterine musculature

Associated with endometriosis

27
Q

What are uterine leiomyomas?

A

Fibroids - benign tumors derived from smooth muscle of myometrium

Most common neoplasm

28
Q

Risk factors for developing fibroids

A

Increasing age during reproductive years

African American

Nulliparity

Family hx

29
Q

Sx of leiomyoma

A

Mostly asymptomatic but may have:

Pelvic/low back pain

Urinary frequency

Prolonged or heavy bleeding

Increased incidence of infertility

30
Q

Common causes of endometrial hyperplasia

A

Persistent unopposed estrogen via:

PCOS

Granulosa theca cell tumors

Obesity

Exogenous estrogens w/o progestins

Tamoxifen

31
Q

What are the incidences of malignancy secondary to endometrial hyperplasia?

A

Simple without atypia - 1%

Complex w/o atypia - 3%

Simple w/ atypia - 9%

Complex w/ atypia - 27%

32
Q

What category does Von Willebrand disease fall under for abnormal bleeding?

A

Non-structural cause - Coagulopathy

33
Q

What category does PCOS fall under for AUB?

A

Nonstructural cause - ovulatory dysfunction

34
Q

What category do IUDs and exogenous hormones fall under for AUB?

A

Nonstructural cause - Iatrogenic

35
Q

When is a speculum exam for AUB most strongly indicated?

A

Post-coital bleeding

36
Q

Lab tests for AUB

A

Pregnancy (blood or urine)

CBC

Von willebrand’s profile, PTT/PT

TSH

Chlamydia

37
Q

Diagnostic imaging for AUB

A

Transvaginal sonography

Saline infusion sonohysterography

MRI

Hysteroscopy

38
Q

Indications for AUB in post menopausal women

A

Sample with spotting or bleeding

Endometrial lining >4mm

39
Q

Indications for AUB in age 45 to menopause

A

Any AUB, including intermenstrual bleeding, menorrhagia

40
Q

Indications for AUB <45y/o

A

Bleeding in the setting of unapposed estrogen exposure

41
Q

AUB treatment with synthetic progesterone

A

Have pt take synthetic progesterone to simulate a menstrual cycle and coordinate endometrial sloughing

42
Q

AUB treatment with OCPs

A

Have pt take OCPs 3 weeks and stop taking 1 week to coordinate regular menstrual cycle

43
Q

What are the surgical options for AUB treatment?

A

Polypectomy

Myomectomy

Dilation and Currettage

Uterine endometrial ablation

Hysterectomy

44
Q

What is Novasure?

A

Bipolar mesh that uses radiofrequency to perform ablation and burn the uterine lining away

Takes 90 seconds

45
Q

Major routes of hysterectomy

A

Total abdominal hysterectomy

Vaginal hysterectomy

Laparoscopic assisted vaginal hysterectomy

da Vinci assisted hysterectomy

46
Q

What is the average age of puberty onset?

A

12.4 years

47
Q

Factors determining puberty onset

A

Race: African American and hispanic girls begin earlier

Cities or higher than sea level

Obesity (leptin)

Must be around 106 pounds

48
Q

What are the stages of normal pubertal development?

A

Thelarche (breast development)

Adrenarche/Pubarche - pubic/axillary hair development

Growth: Max height velocity, occurs 2 years older than girls 1 year before menses

Me: Menses, pulsatile GnRH from hypothalamus triggering HPO axis

49
Q

What is Tanner stage 1?

A

Preadolescent

Breast development: Elevation of papilla

Absent pubic hair

50
Q

Tanner stage 2

A

Breast: Breast bud stage, elevation of breast and papilla as a small mound with enlargement of areolar region

Pubic: Sparse hair along labia, slightly pigmented

51
Q

Tanner stage 3

A

Breast: Further enlargement of breast and areola without separation of their contours

Pubic: Hair spreads sparsely over junction of pubes, dark and coarse

52
Q

Tanner stage 4

A

Breast: Projection of areola and papilla to form a secondary mound above the level of the breast

Pubic: Adult-type hair, no spread to medial surface of thighs

53
Q

Tanner stage 5

A

Breast: Mature, projection of papilla only, resulting from recession of the areola to the general contour of the breast

Pubic: Adult-type hair with spread to medial thighs

ER Exam 2 (16 decks)

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