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NM 701 Gynecologic Health > Module 5 Study Guide > Flashcards

Module 5 Study Guide Flashcards

1
Q

What symptoms are associated with AUB-P (polyps)?

A

Light bleeding between periods and bleeding after sex

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2
Q

What type of patient is more likely to have AUB-A (adenomyosis)?

A

Multip >40

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3
Q

What is the most likely cause of structural AUB?

A

Leiomyoma (fibroid)

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4
Q

A patient presents with sudden change is bleeding. What should we be most concerned for?

A

Malignancy and hyperplasia

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5
Q

Your postmenopausal patient presents to the office for bleeding. What is our biggest concern/differential?

A

Malignancy and hyperplasia

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6
Q

Why do adolescents and perimenopausal patients often have AUB? Is it normal?

A

Irregular ovulation. It is often normal

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7
Q

At what point after menarche would we start to be concerned about AUB?

A

After 2-3 years. Before then, the HPO axis is immature and ovulation is irregular

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8
Q

What type of bleeding is associated with adenomyosis?

A

Menorrhagia-bleeding >7 days

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9
Q

A teen presents with heavy bleeding, what should we assess for?

A

Physical exam annd ROS for coagulopathy. Referal and/or labs as needed

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10
Q

A patient presents for bleeding between periods. What should we assess for?

A

STDs, infection (endometritis) and polyps

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11
Q

Your patient presents with AUB, sleep disturbances and temp. intolerance. What is your primary differential?

A

Thyroid disorder

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12
Q

Your patient presents with AUB, headaches and galactorrhea. What is are your primary differentials?

A

Prolactin secreting tumor or hypothyroidism

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13
Q

You prescribe COC to a patient with prolonged menstrual bleeding. What should you educate them to return for evaluation for?

A

Bleeding that does not stop within 48 hours

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14
Q

When should we evaluate a teen for primary amenorrhea secondary sex characteristics absent or present?

A

-Absence=14 y/o
-Present=16 y/o

Evaluate anyone who has not reached menarche by 15 or who have not had a menses w/in 3 years of thelarche

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15
Q

When should we investigate secondary amenorrhea?

A

No menses for 3 cycles or 6 months, whichever occurs first

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16
Q

How should you assess a patient with primary amenorrhea without secondary sex characteristics?

A

Measure FSH and LH levels

17
Q

How should you assess a patient with primary amenorrhea with secondary sex characteristics?

A

Perform ultrasonography of the uterus. If uterus present, check for outflow obstruction. If not present, check genetics

18
Q

What initial labs should be done on someone with secondary amenorrhea?

A

Pregnancy test-if negative then:
-TSH and prolactin

19
Q

What should you do if your patient with secondary amenorrhea has a negative pregnancy test and normal TSH and prolactin levels?

A

A progestin challenge test

20
Q

What does it mean if the patient has withdrawal bleeding when given a progestin challenge test?

A

Estrogen is present and they do not have an outflow tract obstruction

21
Q

List causes of secondary amenorrhea.

A

Pregnancy
Asherman syndrome
Cervical stenosis
Hormonal contraception
Thyroid disorder
PCOS
Pituitary tumor
Premature ovarian failure
Menopause
Hypothalamic/CNS disorders

22
Q

Describe the progestin challenge tests and its results.

A

Progestin is given for 7-10 days. Bleeding only occurs if sufficient circulating estrogen and a patent outflow tract exist. Bleeding should occur within 7-10d of completion of progesterone.

Bleeding is considered a positive result

23
Q

If PCT is given and pt experiences withdrawal bleeding, what conditions are still included as differentials?

A

-PCOS - withdrawal bleed
-Excess adipose tissue - withdrawal bleed - estrogen produced in part by adipose tissue

24
Q

If PCT is given and pt doe not experience withdrawal bleeding, what conditions are still included as differentials?

A

Galactorrhea - no withdrawal bleed - prolactin high → low estrogen

Prolactinoma - no withdrawal bleed, high prolactin → inhibited estrogen

Ovarian insufficiency - no withdrawal bleed - ovaries d/n produce estrogen

25
Q

What conditions cause clinical hyperandrogenism?

A

PCOS most common
Congnital adrenal hyperplasia
Hyperthecosis
Nonclassical adrenal hyperplasia
Androgen producing tumors
Adrenal or ovarian tumor

26
Q

How will you assess and diagnose PCOS?

A

History, PE, and indicated dx testing - by exclusion
If other causes of hyperandrogenism ruled out → PCOS dx
Syndrome, no single dx criteria sufficient
Rotterdam and PCOS society criteria most widely used

27
Q

What is first line Pharm treatment for PCOS?

A

COCs or antiandrogens (spironolactone, finasteride, flutamide)

28
Q

What red flags indicate the need for immediate referral in hyperandrogenic women?

A

Sudden onset or rapid progression of virilization

29
Q

What is the first-line treatment for lichen sclerosis?

A

high or very high potency topical steroid ointment

30
Q

What is the first-line treatment for lichen sclerosis?

A

high or very high potency topical steroid ointment

31
Q

How should we respond to a nabothian cyst?

A

Refer for electrocautery, excision, atypical bleeding, or unsure of benign nature

32
Q

What are the most common symptoms associated with endometriosis?

A

Dysmenorrhea
Deep dyspareunia
Sacral backache during menses

33
Q

What is the gold standard for diagnosis of endometriosis?

A

laparoscopy w/ histology of biopsy

34
Q

Explain the difference between endometriosis and adenomyosis.

A

Adenomyosis is a vairant of endo. where endometrial cells are located within the myometrium

35
Q

What symptoms are associated with adenomyosis?

A

May be asymptomatic or experience
-Menorrhagia
-Dysmenorrhea
-Dyspareunia
-Pelvic pain
May have diffusely enlarged, boggy, and/or tender uterus that is asymmetrical w/o firm nodularity of fibroids

36
Q

What symptoms are associated with fibroids?

A

May be asymptomatic or
Uterine bleeding, pelvic pain or pressure, and dyspareunia

37
Q

What symptoms are associated with an ovarian torsion?

A

Acute pain

38
Q

What endometrial thickness level allows us to rule out endometrial cancer?

A

thickness <3 mm

NM 701 Gynecologic Health (12 decks)

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