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Womans Health EOR > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What are types of barrier methods for birth control?

A

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

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2
Q

What is the fail rate for spermicides?

A

27%

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3
Q

How do OCPs work?

A

They prevent ovulation by inhibiting mid-cycle LH surge

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4
Q

When used correctly what is the failure rate for OCPs?

A

0.3% when used incorrectly its 9%

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5
Q

At what age and above do you not use combined estrogen and progesterone?

A

35 and older that are smokers

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6
Q

If you start an OCP after day 5 of menstrual cycle what prevention should you take to prevent pregnancy and why?

A

Should use barrier protection because OCP may not suppress ovulation for first cycle

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7
Q

What day should the pill be initiated on?

A

Should start the pill on the first sunday after the onset of Menses

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8
Q

What is the recommendations for quick start of OCP if last menstrual period was within last 5 day?

A

Start it right now and use backup contraception for 1 week

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9
Q

What is the quick start of OCP if menstrual period was greater than 5 days?

A
  1. you want to obtain a pregnancy test and if negative you can start it
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10
Q

Says someones last unprotected intercourse was >5days ago. Can you start oral contraceptive without fetal harm?

A

yes you can and just let them know urine pregnancy test not conclusive

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11
Q

Dose the transdermal patch have a greater fail rate when used wrong than OCP?

A

Nope the values are the same 0.3% failure when used right and 9% when used wrong

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12
Q

How often does the patch need to be changed?

A

weekly

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13
Q

what is needed for the first 7 days after starting the patch if started any day other than day 1 of the menstrual cycle?

A

non-hormonal back up contraception

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14
Q

What kind of hormones does the nuvaring contain?

A
  1. etonogestrel

2. Ethinylestradiol

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15
Q

When should the nuva ring be inserted?

A

on day 5 of the cycle or within 7 days of last OCP. Ring must remain in place for a minimum of 3 weeks.

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16
Q

Is the progestin only mini-pill safe in lactation?

A

yeah

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17
Q

What is the most effective form of birth control?

A

IUD

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18
Q

a Copper IUD is good for what group of women?

A

Women who cant have hormones but want to have kids later in life.

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19
Q

How often is Copper IUD replaced?

A

every 10 years

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20
Q

What hormones are contained in the mirena IUD? How often is it replaced?

A

Progesterone only. this is replaced ever 3-5 years

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21
Q

How soon should plan B be administered?

A

within 3 days of unprotected sex

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22
Q

If plan B cant be given within 3 days what can you prescribe that gives the patient an extra 2 days?

A

Ella (ulipristal)

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23
Q

What kind of IUD can you consider for emergency protection if within 5 days?

A

a copper IUD

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24
Q

What kid of drug interactions might you see with Plan B or Ella?

A

pop up with CYP3A4 inducers (carbamazepine, topiramate, St. John’s wort, etc).

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25
Q

What hormone is involved with Depo-provera?

A

Long-acting progesterone

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26
Q

Can the Depo shot be useful for stopping heavy bleeding

A

yeah, progesterone prevents the sheding of the uterine wall

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27
Q

How long does the depo shot last?

A

3 months

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28
Q

What kind of hormone is used in Nexplanon?

A

Long-acting progesterone

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29
Q

How long does the nexplanon stay in the upper arm?

A

3 years

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30
Q

What has a greater failure rate Nexplanon? or Tubal ligation?

A

Tubal ligation actually. So fuck that

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31
Q

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?

A

endometriosis

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32
Q

What is endometriosis?

A

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

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33
Q

What are the three Ds of endometriosis?

A
  1. Dyspareunia
  2. Dyschezia (difficulty pooping)
  3. Dysmenorrhea
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34
Q

How do you definitely diagnose endometriosis?

A

laparoscopy and then confirmed by biopsy

35
Q

Are these test, ultrasonography, barium enema, IV urography, CT, MRI specific and adequate for diagnosis?

A

No

36
Q

On PE in someone with endometriosis what would you expect to see the uterus look like.

A

The uterus is fixed and retroflexed on PE. Also Tender nodularity of cul de sac and uterine ligaments

37
Q

What is the treatment for endometriosis?

A

OCPS are first line medications

  1. Estrogen-progesteron OCP does ovarian suppression
  2. Progesteron analogs- medroxyprogesterone and levonorgestrel) - inhibit the growth of the endometrium
38
Q

How would GnRH antagonists help with endometriosis?

A

decrease estrogen

39
Q

How is infertility defined?

A

inability to conceive within 12 months of unprotected sex

40
Q

What is the difference between primary infertility verse secondary?

A

Primary- infertility in the absence of previous pregnancy

Secondary- infertility after previous pregnancy

41
Q

what is the most common cause of infertility?

A

Anovulation- this is amenorrhea and abnormal periods

42
Q

What are some other causes of infertility other than anovulation?

A

Tubal disease
Male factor
Unexplained/multifactorial

43
Q

How can you dx infertility?

A

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

44
Q

What labs should you draw on a women greater than 35 with questions of infertility?

A
  1. TSH
  2. Prolactin
  3. LH
  4. FSH
45
Q

What medication can you use for infertility?

A

clomiphene citrate to hyperstimulate ovulation

46
Q

If you have decreased ovulation due to PCOS what medication can you give to increase oulation?

A

Metformin

47
Q

What medication helps to treat hyperprolactinemia?

A

Bromocriptine

48
Q

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?

A

Leiomyoma

49
Q

What is a leiomyoma?

A

uterine fibroids which are benign smooth muscle cell tumors

50
Q

What symptoms could you expect in someone with a leiomyoma?

A

Pelvic pressure and increased abdominal girth. Uterine mass

51
Q

What population is at most risk for leiomyomas?

A

Black women

52
Q

Where does a subserosal leiomyoma project?

A

projects into the pelvis, may be pedunculated

53
Q

Where is an intramural leiomyoma?

A

within the uterine wall (most common)

54
Q

a leiomyoma that projects into the uterine cavity is what kind?

A

submucosal

55
Q

How do you Dx leiomyoma?

A

with ultrasound and/or MRI

56
Q

what is the definitive tx for leiomyomas?

A

myomectomy, endometrial ablation, hysterectomy (most common surgical tx)

57
Q

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?

A

An ovarian cyst

58
Q

What kinds of symptoms can you see with an ovarian cyst?

A
  1. Bloating
  2. Lower abdominal pain
  3. dyspareunia
  4. lower back pain
59
Q

is a functional ovarian cyst a variant of the normal menstrual cycle?

A

yes

60
Q

What is the most common type of ovarian cyst?

A

Follicular cysts

61
Q

What are the three types of ovarian cysts?

A
  1. follicular- dominant follicle fails to rupture
  2. Corpus luteum- dominant follicle ruptures but closes again and doesn’t dissolve
  3. Theca lutein cysts- overstimulation of HCG produced by placenta so only seen in pregnancy
62
Q

What are the three main complications of ovarian cysts?

A

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)

63
Q

What is the initial imaging of choice for ovarian torsion?

A

pelvic ultrasound

64
Q

How do you Dx ovarian cysts?

A

Transvaginal ultrasound

65
Q

If Transvaginal ultrasound is indeterminate what imaging modality can you use to look again?

A

MRI and also if you plan on surgical resection

66
Q

What lab can you draw to look for ovarian cyst?

A

Serum CA-125 (in menopausal, postmenopausal individuals) ⇒Assists in ruling out ovarian cancer

67
Q

What is a definitive method for Dx ovarian cyst?

A

Histologic analysis via ultrasound-guided aspiration (definitive)

68
Q

Tx for simple cysts greater than 5cm but less than 7cm in premenopausal females?

A

they should be followed yearly

69
Q

Tx for simple cysts greater than 7cm?

A

further imaging with MRI or surgical assessment is mandated due to their large size, these cysts cannot be reliably assessed by ultrasound alone

70
Q

what should you do for Cysts that persist beyond two or three menstrual cycles or occur in postmenopausal women?

A

They should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy

71
Q

What are the five major types of incontinence?

A
  1. Urge
  2. Stress
  3. Overflow
  4. Functional
  5. Mixed
72
Q

Difference between urge and stress incontinence?

A

Urge occur at night and disrupts sleep whereas stress incontinence doesnt cause any nightly urine loss

73
Q

How do you tx urge incontinence?

A

bladder training exercises, if unsuccessful you can use anticholinergics (oxybutynin) and TCAs (imipramine)

74
Q

Weakness of the pelvic floor resulting in urination issues is classified as what?

A

Stress incontinence

75
Q

Tx for stress incontinence?

A

Kegel exercises to strengthen pelvic floor musculature

76
Q

impaired detrusor contractility results in what kind of urine incontinence?

A

overflow incontinence

77
Q

Describe overflow incontinence?

A

occurs when urinary retention leads to bladder distention and overflow of urine through the urethra.

78
Q

Pts with what disorders are at higher risk of overflow incontinence?

A

Diabetic pts and those with neurologic disorders

79
Q

Tx for overflow incontinence?

A

cholinergic agents (bethanechol) to increase bladder contractions

α-blockers (terazosin, doxazosin) to decrease sphincter resistance

80
Q

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?

A

Functional incontinence

81
Q

Tx for functional incontinence?

A

Scheduled voiding times

82
Q

What is the most common type of voiding issue?

A

Mixed which is a combo of stress and urge

83
Q

tx for mixed incontinence?

A

Lifestyle modifications and pelvic floor exercises are first-line

Womans Health EOR (10 decks)

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