Miscellaneous Flashcards
What are types of barrier methods for birth control?
Male condom- 20% fail rate
Female Condom- 21% fail rate
Diaphragm- 15% failure rate- must remain in place for 6-24 hours after intercourse, requires pelvic exam and fitting
What is the fail rate for spermicides?
27%
How do OCPs work?
They prevent ovulation by inhibiting mid-cycle LH surge
When used correctly what is the failure rate for OCPs?
0.3% when used incorrectly its 9%
At what age and above do you not use combined estrogen and progesterone?
35 and older that are smokers
If you start an OCP after day 5 of menstrual cycle what prevention should you take to prevent pregnancy and why?
Should use barrier protection because OCP may not suppress ovulation for first cycle
What day should the pill be initiated on?
Should start the pill on the first sunday after the onset of Menses
What is the recommendations for quick start of OCP if last menstrual period was within last 5 day?
Start it right now and use backup contraception for 1 week
What is the quick start of OCP if menstrual period was greater than 5 days?
- you want to obtain a pregnancy test and if negative you can start it
Says someones last unprotected intercourse was >5days ago. Can you start oral contraceptive without fetal harm?
yes you can and just let them know urine pregnancy test not conclusive
Dose the transdermal patch have a greater fail rate when used wrong than OCP?
Nope the values are the same 0.3% failure when used right and 9% when used wrong
How often does the patch need to be changed?
weekly
what is needed for the first 7 days after starting the patch if started any day other than day 1 of the menstrual cycle?
non-hormonal back up contraception
What kind of hormones does the nuvaring contain?
- etonogestrel
2. Ethinylestradiol
When should the nuva ring be inserted?
on day 5 of the cycle or within 7 days of last OCP. Ring must remain in place for a minimum of 3 weeks.
Is the progestin only mini-pill safe in lactation?
yeah
What is the most effective form of birth control?
IUD
a Copper IUD is good for what group of women?
Women who cant have hormones but want to have kids later in life.
How often is Copper IUD replaced?
every 10 years
What hormones are contained in the mirena IUD? How often is it replaced?
Progesterone only. this is replaced ever 3-5 years
How soon should plan B be administered?
within 3 days of unprotected sex
If plan B cant be given within 3 days what can you prescribe that gives the patient an extra 2 days?
Ella (ulipristal)
What kind of IUD can you consider for emergency protection if within 5 days?
a copper IUD
What kid of drug interactions might you see with Plan B or Ella?
pop up with CYP3A4 inducers (carbamazepine, topiramate, St. John’s wort, etc).
What hormone is involved with Depo-provera?
Long-acting progesterone
Can the Depo shot be useful for stopping heavy bleeding
yeah, progesterone prevents the sheding of the uterine wall
How long does the depo shot last?
3 months
What kind of hormone is used in Nexplanon?
Long-acting progesterone
How long does the nexplanon stay in the upper arm?
3 years
What has a greater failure rate Nexplanon? or Tubal ligation?
Tubal ligation actually. So fuck that
a 24-year-old nulligravid woman comes to your office with an 18-month history of painful intercourse, difficulty defecating, and dysmenorrhea. These symptoms are cyclical and come and go with her menses. Her menses are regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.
What is this patient most likely presenting with?
endometriosis
What is endometriosis?
this is when endometrial tissue grows on the outside of the uterus. most commonly the ovaries, then can also grow on fallopian tubes, cul-de-sac and uterosacral ligaments
What are the three Ds of endometriosis?
- Dyspareunia
- Dyschezia (difficulty pooping)
- Dysmenorrhea
How do you definitely diagnose endometriosis?
laparoscopy and then confirmed by biopsy
Are these test, ultrasonography, barium enema, IV urography, CT, MRI specific and adequate for diagnosis?
No
On PE in someone with endometriosis what would you expect to see the uterus look like.
The uterus is fixed and retroflexed on PE. Also Tender nodularity of cul de sac and uterine ligaments
What is the treatment for endometriosis?
OCPS are first line medications
- Estrogen-progesteron OCP does ovarian suppression
- Progesteron analogs- medroxyprogesterone and levonorgestrel) - inhibit the growth of the endometrium
How would GnRH antagonists help with endometriosis?
decrease estrogen
How is infertility defined?
inability to conceive within 12 months of unprotected sex
What is the difference between primary infertility verse secondary?
Primary- infertility in the absence of previous pregnancy
Secondary- infertility after previous pregnancy
what is the most common cause of infertility?
Anovulation- this is amenorrhea and abnormal periods
What are some other causes of infertility other than anovulation?
Tubal disease
Male factor
Unexplained/multifactorial
How can you dx infertility?
Ovulation tracking:
Menstrual diary
Luteal phase (day 21) progesterone level - if the progesterone level is l
less than 3 ng/ml on day 21 then you know that the patient did not
ovulate.
Basal body temperature: No mid-cycle basal
body temperature increase
What labs should you draw on a women greater than 35 with questions of infertility?
- TSH
- Prolactin
- LH
- FSH
What medication can you use for infertility?
clomiphene citrate to hyperstimulate ovulation
If you have decreased ovulation due to PCOS what medication can you give to increase oulation?
Metformin
What medication helps to treat hyperprolactinemia?
Bromocriptine
a 39-year-old African American woman with abnormally heavy menstrual bleeding along with increased pelvic pressure. She denies pain and is not using any hormonal contraception. She uses multiple sanitary pads per day. On pelvic examination, there is an enlarged uterus with asymmetric contours. The uterus is non-tender to palpation. What does this patient most likely have?
Leiomyoma
What is a leiomyoma?
uterine fibroids which are benign smooth muscle cell tumors
What symptoms could you expect in someone with a leiomyoma?
Pelvic pressure and increased abdominal girth. Uterine mass
What population is at most risk for leiomyomas?
Black women
Where does a subserosal leiomyoma project?
projects into the pelvis, may be pedunculated
Where is an intramural leiomyoma?
within the uterine wall (most common)
a leiomyoma that projects into the uterine cavity is what kind?
submucosal
How do you Dx leiomyoma?
with ultrasound and/or MRI
what is the definitive tx for leiomyomas?
myomectomy, endometrial ablation, hysterectomy (most common surgical tx)
a 22-year-old nulligravida presents with pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her β-hCG urine test is negative. She has never been on oral contraceptives. On pelvic examination, unilateral tenderness on the left side and a palpable cystic mass approximately 4 to 5 cm in size are present. What does she likely have?
An ovarian cyst
What kinds of symptoms can you see with an ovarian cyst?
- Bloating
- Lower abdominal pain
- dyspareunia
- lower back pain
is a functional ovarian cyst a variant of the normal menstrual cycle?
yes
What is the most common type of ovarian cyst?
Follicular cysts
What are the three types of ovarian cysts?
- follicular- dominant follicle fails to rupture
- Corpus luteum- dominant follicle ruptures but closes again and doesn’t dissolve
- Theca lutein cysts- overstimulation of HCG produced by placenta so only seen in pregnancy
What are the three main complications of ovarian cysts?
Hemorrhagic: more common with follicular and corpus luteal cysts
Rupture: release contents into peritoneal cavity, frequently after sexual intercourse
Torsion: ovary twists around suspensory ligament, cuts of blood supply to the ovary (risk if the cyst is > 5 cm)
What is the initial imaging of choice for ovarian torsion?
pelvic ultrasound
How do you Dx ovarian cysts?
Transvaginal ultrasound
If Transvaginal ultrasound is indeterminate what imaging modality can you use to look again?
MRI and also if you plan on surgical resection
What lab can you draw to look for ovarian cyst?
Serum CA-125 (in menopausal, postmenopausal individuals) ⇒Assists in ruling out ovarian cancer
What is a definitive method for Dx ovarian cyst?
Histologic analysis via ultrasound-guided aspiration (definitive)
Tx for simple cysts greater than 5cm but less than 7cm in premenopausal females?
they should be followed yearly
Tx for simple cysts greater than 7cm?
further imaging with MRI or surgical assessment is mandated due to their large size, these cysts cannot be reliably assessed by ultrasound alone
what should you do for Cysts that persist beyond two or three menstrual cycles or occur in postmenopausal women?
They should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy
What are the five major types of incontinence?
- Urge
- Stress
- Overflow
- Functional
- Mixed
Difference between urge and stress incontinence?
Urge occur at night and disrupts sleep whereas stress incontinence doesnt cause any nightly urine loss
How do you tx urge incontinence?
bladder training exercises, if unsuccessful you can use anticholinergics (oxybutynin) and TCAs (imipramine)
Weakness of the pelvic floor resulting in urination issues is classified as what?
Stress incontinence
Tx for stress incontinence?
Kegel exercises to strengthen pelvic floor musculature
impaired detrusor contractility results in what kind of urine incontinence?
overflow incontinence
Describe overflow incontinence?
occurs when urinary retention leads to bladder distention and overflow of urine through the urethra.
Pts with what disorders are at higher risk of overflow incontinence?
Diabetic pts and those with neurologic disorders
Tx for overflow incontinence?
cholinergic agents (bethanechol) to increase bladder contractions
α-blockers (terazosin, doxazosin) to decrease sphincter resistance
Say a patient has normal voiding systems but has difficulty reaching the bathroom due to physical or mental disabilities. What kind of urine incontinence do they have?
Functional incontinence
Tx for functional incontinence?
Scheduled voiding times
What is the most common type of voiding issue?
Mixed which is a combo of stress and urge
tx for mixed incontinence?
Lifestyle modifications and pelvic floor exercises are first-line
