MTB 1 Flashcards
What are PMS and PMDD - Presentation and difference
Premenstrual syndrome/dysphoric disorder
- Women 20’s-30’s
- Sx’s: HA, breast tenderness, pelvic pain, bloating
- lack of energy, irritable
- PMDD more severe - disrupts pt’s daily activities
Testing for PMS and PMDD
Menstrual diary
- Sx’s for 2 consecutive cycles
- Sx free in follicular phase (1st week)
- Sx’s present in luteal phase
Tx for PMS and PMDD
Decrease caffeine, alcohol, cigs, chocolate
Severe - SSRI
What is Mittelschmerz and how does it present
Midcycyle pain
Women w regular menstrual cycle
Not on OCPs
Lateralizes to overy that produces mature ovum - unilateral pain
When does Mittelschmerz occur
2 weeks after start
At time of ovulation
Menopause lab levels
Increased FSH
TX for menopause
HRT = short term sx relief and osteoporosis prevention
CI to HRT
Estrogen dependent carcinoma
Hx of DVT or PE
What are the Estrogen dependent carcinomas
Breast
Endometrial
HRT can lead to what type of carcinoma
Endometrial
What conditions do we see menorrhagia
Endometrial hyperplasia
Uterine fibroids
DUB
IUD
What is menorrhagia
Heavy and prolonged menstrual bleeding
What is metorrhagia
Intermenstrual bleeding
When do we see metorrhagia
Endometrial polyps
Endometrial/cervical cancer
Exogenous estrogen administration
What is menometrorrhagia
Irregular bleeding
- time intervals
- duration
- amount
Causes of menometrorrhagia
Endometrial polyps
Endometrial/cervical cancer
Exogenous estrogen administration
Malignant tumors
What is dysfunctional uterine bleeding (DUB)
Unexplained abnormal bleeding
Pts that are anovulatory
Ovary makes estrogen, but no corpus luteum to make progesterone
Continuous high estrogen
Test for DUB
R/O anovulation causes = hypothyroid, hyperPRL
EMB for women > 35
TX for EMB
OCPs
OCPs reduce risk for what
Endometrial cancer
Ovarian cancer
Ectopic pregnancy
What are types of emergency contraception
Copper IUD - place within 5 days
Hormonal contraceptive pills
What complication is ass’d with IUD
PID
What causes labial fusion
Excess androgens
MCC of labial fusion
21-B hydroxylase deficiency
What is Lichen sclerosis?
White, thin skin from labia to perianal area
Chronic inflamm condition in anogenital region
Presentation of Lichen sclerosis?
Pruritis
dyspareunia
dysurai
painful defacation
What does lichen sclerosis look like on PE
Porcelin white
Polygonal macules and patches w atrophic cigarette paper quality
Dx and tx of lichen sclerosis
Punch Bx to r/o cancer
Steroids
Cancer risk with lichen sclerosis
Post menopausal women have increased risk of cancer
Premalignant Vulvar SQCC
Lichen Planus Presentation and tx
30’s-60’s
Violet, flat papules
Tx steroids
Bartholin gland cyst location and presentation
Lateral sides of vulva - secrete mucus, become obstructed Pain Tenderness Dyspareunia PE: edema and deep fluctuant mass
Tx of Bartholin gland cyst
I&D
Culture fluid
What is normal vaginal pH
Below 4.5 (Lactobacillus maintains)
Bacterial vaginosis Pathogen Sx DX TX
Gardnerella
Fishy odor, gray white d/c, NO inflammation
KOH = clue cells
Metronidazole or clindamycin
Candidiasis
Sx
DX
TX
White, cheesy vaginal D/c
KOH = pseudohyphae
Miconazole, clotrimazole, econazole, nystatin
Trichomonas
Sx
DX
TX
Profuse, green, frothy d/c, inflammation, pruritis
KOH = motile flagellates
Metronidazole + partner
pH 5-6
Paget disease Presentation
Postmenopausal Caucasian women
Vulvar soreness and pruritus = red lesion w superficial white coating
Dx and TX for Paget Dz
Bx
Radical vulvectomy
What is adenomyosis
Invasion of endometrial glands into myometrium
Presentation of adenomyosis
35-50
Dysmenorrhea and Menorrhagia
PE: Uterus that is large, boggy, globular
Risk factors for adenomyosis
Endometriosis
Uterine Fibroids
Test for adenomyosis
Most accurate is MRI
Tx for adenomyosis
Hysterectomy
What is endometriosis
Implantation of endometrial tissue outside uterus (endometrial cavity)
MC location = ovary and pelvic peritoneum
Presentation for endometriosis
Women of reproductive age Dysmenorrhea = Abnormal bleeding Dyspareunia Dyschezia Infertility
what does endometriosis look like on direct visualization and on PE?
Rusty or dark brown lesions
“Chocolate cyst” = ovary cluster of lesions
PE: nodular uterus and adnexal mass
Tx for endometriosis
Analgesia
OCPs or continuous progesterone
Moderate - severe: Danazol or Leuprolide
- decrease FSH and LH
Leuprolide continuous or pulsatile suppresses estrogen?
Continuous
PCOS Dx test
Pelvic US = BL enlarged ovaries w multiple cysts
PCOS labs
Testosterone (free) = High
Androgens = High
Estrogen = High
LH: FSH > 3:1
Tx for PCOS
Wt loss
OCPs
Clomiphene
Metformin
Premature Ovarian Failure Presentation
Women < 40yoa w Primary hypogonadism Amenorrhea Hot flashes Vagina/breast atrophy Anxiety Depression, Irritability
Causes of Premature Ovarian Failure
Chemo Radiation AI Turners Fragile X
Pathophys of Premature Ovarian Failure
Impaired follicular development causes decreased estrogen = loss of feedback inhibition causes
HIGH FSH and LH
FSH>LH
Dx for Premature Ovarian Failure
Preg test
PRL and FSH levels
When does endometriosis occur in relation to menses?
Cyclical pain starts 1-2 wks before menses and ends w menses
Peaks 1-2 days before menses
MC site for endometriosis? Second?
MC - Ovary
2nd - cul-de-sac = uterosacral ligament nodularity,
