Menstrual dysfunction & breast health

Question 1

menorrhagia

Answer 1

regular normal intervals with excessive duration and volume of flow

Question 2

amenborrhea

Answer 2

absence of period

Question 3

dysmenorrhea

Answer 3

painful periods

Question 4

steps for heavy bleeding.

Answer 4

1. assess for family dxn or blood anormoalities
2. test preg, TSH, CBC
3. US
   - fibroid - refer for emobilizatino or fibroidetomy
   - polyp - send for plopectomy
4. still not normal? -
   10 mg medroxyprog acetate for 21 days per month for 3-6 months (does not protect against prengnacy btw) or insert levonorgertrel relaseing IU system or begin trail NSAID or estrogen therapy w/prog (estradiol valerate/dienogest) that vary 4 times through cycle ( aka OCP), antifibrinolytic
5. still not normal - biopsy

Question 5

oligomenorrhea

Answer 5

infreq uterine bleeding

Question 6

hypermenorrhea

Answer 6

estremely heavy flow, normal duration

Question 7

metorrhagia

Answer 7

periods occur closer together

Question 8

what labs for PCOS?

Answer 8

TSH, HCG, prolactin
LH, FSH and ratio
elevated levels of andorgens:DHEAS (adrenal tumor > 700), free and total testosterone (adrenal or ovarian tumor > 150), 17 OHP, cortisol, fasting blood glucose

Question 9

labs for amenorrhea?

Answer 9

1. TSH, prolactin, and HCG
2. may also immed do LH, FSH, testosterone
3. if a palpate mass do US or as alternative to assess endometrium (thickness >- 60 mm is ok estrogen!)

• low FSH, LH, and estradiol = hypogonadotropic hypogonadism
• low to normal FSH, LH, and estradiol indicates hypothalamic anemorrhea
• elevted FSH, LH and low estro indicate ovarian failure

Question 10

pelvic US indicated when?

Answer 10

To assess: 
uterus
cervix
ovaries
fallopian tubes
bladder

and help identify:
palpable masses such as ovarian cysts and uterine fibroids
ovarian or uterine cancers

Question 11

transvaginal US indicated when?

Answer 11

usually performed to view the endometrium and the ovaries.

also provides a good way to evaluate the muscular walls of the uterus, allows for a more in-depth investigation of the uterine cavity.

Three-dimensional (3-D) ultrasound permits evaluation of the uterus and ovaries in planes that cannot be imaged directly. These exams are typically performed to detect:
uterine anomalies
uterine scars
endometrial polyps
fibroids
cancer, especially in patients with abnormal uterine bleeding

Question 12

LH and FSH levels, and LH:FSH ratio of PCOS?

Answer 12

2:1 or higher

low - normal FSH levels

Question 13

progesterone challenge is what?

Answer 13

5-10 mg oral medroxyprogesterone 7-10 days or 300mg oral microionized progesterone 7-10 days or 100 - 200 mg prg in IM

if bleeding occurs in 2-7 days after cessation - endometrium ok and estrogen is being produced

no bleeding - consider oral conjugated estrogen 0.625 mg/day for 35 days to prime endometrium. then progstin days 26-35. if no bleeding – endometrium is scarred :(

Question 14

Tx PCOS?

Answer 14

screen glucose tolerance every 2 years
low dose COCs
spirinolactone

Question 15

Steps to evaluate dysfunctional uterine bleeding?

Answer 15

1. CBC, HCG,
2. STI screen, Pap,
3. endometial US
4. biopsy if irregular if over 35 with DUB to rule out enodmetrial cancer, consider in 18-35 if high risk for cancer
5. could look at andorgens if virilization noted on exam
6. prolactin if indicated (galacterrhea or oligo)
7. caogulation studies if indicated (PTT, etc)
8. TSH if indicated with symptoms

Question 16

steps to tx DUB by severity?

Answer 16

MILD - NSAID, MV
MODERATE - OCP, iron foods
HEAVY - 35 microgram OCP : one pill 4 times a day for 4 days one pill three times a day for 3, one pill twice a day for 2 weeks, then withdraw, slough 4-7 days. then cycle on pill per day 3-6 months.

Severe: emergency

Question 17

Uterine cancer S&S

Answer 17

irregular period, heavier flow, spotting, pain pelvic or during urination, discharge.

Question 18

diagnostic testing uterine cancer?

Answer 18

1. pelvic exam for abnormalities

2. pelvic US , thickness > 5 mm need sampling done. or biopsy.

Question 19

S&S breast cancer?

Answer 19

nonmobile painful bump, nipple discharge, change in aerola or adenopathy. simpling, retraction or inversion.

Question 20

mammogram done when?

Answer 20

50-74 biennial

over 30 + with lump do mammogram + US
under 30 just US
increased risk due MRI

Question 21

what is a fibroadenoma?

Answer 21

hyperplastic lesions during mearche . small pea or marble lie lump that is painless. well circumscribed, solitary, firm, mobile, and discrete, nontesnder with lympadenothy.

Question 22

Daignostic for fibroadenoma?

Answer 22

1. US (US + mammo > 30).

2. triple test eval for soolid lesion –> percutaneous biopsy noted if mass found as solid on imaging

Question 23

Tx fibroadenoma?

Answer 23

• surgical excision recomm if not feasible to do needle biopsy or if rapid growth or greater than 5 mm
• if benign and serial examination and imagnie at 6 month intervals for 1-2 years

Question 24

breast cyst diagnostics?

Answer 24

1. US for evaluation
2. US guided aspiration/fine needle biopsy if symptomatic
3. if looks high risk during US will be referred for needle biopsy during US