OB/GYN Flashcards
Define Primary Amenorrhea
What are 4 possible causes
Define Secondary Amenorrhea
13y/o, no menses or 2* development
15y/o, no menses w/ 2* development
Pregnancy
HPO abormals
Imperforate hymen
Gonad dysgenesis
No menses x 3mon after previous normal cycles or,
No menses x 6mon w/ Hx of abnormal cycles
MCC of Secondary Amenorrhea
What are four other etiologies
Pregnancy
Endometrial atrophy (Ashermans)
Premature ovary failure (FSH >40)
Pituitary dysfunction (Sheehans)
Drug/Diet/Stress
How is Amenorrhea Tx
Define Dysmenorrhea
Primary Dysmenorrhea usually begins ? and is associated w/ ?
No pregnant wish- OCPs
Cyclic progesterone 10mg x 10 days
Pain w/ or preceding menses x 1-3days, peaks 24hrs after onset, lasts 2-3days
After menarche; prostaglandins
Define Secondary Dysmenorrhea
What is used for First and Second line Tx
Define Dysfunctional Uterine Bleeding
New onset in older women w/ structural cause
1st: NSAIDs
2nd: contraception
Excessive bleeding w/out organic cause
Define Polymenorrhea
Define Hypermenorrhea
Define Menorrhagia
Menses <21d apart
> 7d or >80mL
Prolonged, >7d/>80mL
Define Metrorrhagia
Define Menometrorrhagia
DDx for Dysfunction bleeds in Pts <16y/o
Bleeding frequently and irregularly between menses
More blood loss during menses w/ frequent/irregular bleeding between menses
Pregnancy
Anovulation
OCP break through
Dyscrasis
DDx for Dysfunction bleeds in Pts 16-40y/o
DDx for Dysfunction bleeds in Pts >40y/o
Pregnancy Anovulation OCP break through STI/PID Endometriosis Ca
Pregnancy
Anovulation
OCP break through
Endometrial Ca
? is gold standard to Dx Dysfunctional Uterine Bleeding
What are the two goals of Tx
How is this Tx
Uterine dilation and curettage
Causing cyclic bleeds
Protect endometrium
Progesterone therapy
Estrogen
NSAIDs
GnRH agonists
Define Premenstrual Syndrome
Sxs coincide w/ ? part of cycle
What ACOG criteria is needed for Dx
Imbalance of E/P w/ excess prostaglandins
Luteal phase: 1-2wks prior to menses
1 Sx x 5d before and stops w/in 4d of onset:
Somatic: physical
Affective: mood
? is used as first line PMS Tx
What else can be used
What is 3rd line therapy
What is reserved for last line
SSRIs
Drospirenon/ethinyl estradiol (Yazmin)
GnRH agonist
Surgery: Bo/Bs
? is the MCC of androgen excess and hirsutism
These Pts have ? trifecta of c/c
What causes this condition
PCOS
Bilat-cystic ovaries
Amen/Oligo-rrhea
Infertile
Ant-Pit creating excess LH (double of FSH)
Insulin resistance
Pts w/ PCOS are at risk for ? two future issues
Half of these Pts are ? w/ ? issue
How is PCOS Dx
Endometrial hyperplasia/carcinoma
Hirsute w/ truncal obesity
US w/ string of pearl sign
Inc LH/FSH ratio
Insulin resistance
How is PCOS Tx
? is used for Tx the hirsutism
? is used for infertility
Weight reduction
Androgen lowering: OCPs
Clomiphene citrate
Metformin
What are the two types of ovarian cysts
Functional:
Follicular- MC
Corpus luteum >3cm
Theca lutein; bilateral and cystic d/t hCG
Non-functional:
PCOS
Everything else
Corpus luteum cysts can develop into ? cysts
These usually develop on ? side
What is a common c/c
Hemorrhagic
Right, inc pressure from IVC
Pain after sex
Incidental ovarian cysts are f/u how often
How are these Tx based on size
US at 5cm;
5-7cm and pre-menopause: q12mon
>7cm: MRI or surgical assessment
<5cm: observe
>5cm: laparoscopy
Surgery: Sx, malignant, hemorrhagic, torsions
? tumor marker is elevated/found w/ ovarian Ca
When using the Risk of Malignancy Index, a score greater than ? need referral to Gyn/Onc
Ca-125
> 200
RMI= US score x menopause score x Ca-125 level
Cysts that are present at ? two unique times need further eval
How are they further eval’d
? is the 1st and 2nd MC Gyn cancer
Greater than 3 cycles,
Post-menopause
US and laparoscopy
1st: endometrial
2nd: ovarian
? is the leading Gyn cause of death
? type make up 90% of tumors
? type are found in Pts <10y/o
Ovarian Ca
Epithelial, mid-50s
Germ cell tumor
? are RFs for ovarian Ca
? can decrease this risk
How are these Dx
Nulligravidity
Early menarche
Late menopause
Endometrosis
OCP use x 5yrs
TV-US
Blood: Ca-125
? are the MC adnexal masses in pre-menopausal women
Premenopausal women w/ adnexal masses of ? size can be observed
Postmenopausal women w/ adnexal masses ? size can be observed
Follicular/Copus luteum cysts
<10cm
<3cm and Ca-125 is not elevated
Dermoid cysts are AKA ?
Where are ectopic pregnancies MC found
RFs for ectopic pregnancy
Teratomas
Ampulla
Gestation diabetes Abortion PID Ectopic pregnancy OCPs
? is the leading cause of maternal death during first trimester
These are more common in ? two populations
How are these Dx
Ectopic rupture
> 35y/o
Non-white ethnicity
Quant b-hCg
TV-US
Define Ring of Fire Sign
How are these Tx in unruptured/stable Pts
What are the criteria to use this Tx
Hypervascular lesion w/ peripheral vasculature on Doppler suggesting ectopic pregnancy
Methotrexate
hCG <5K
Ectopic <3.5cm
Hemodynamic stable
No R/L/P Dz
How are ectopic pregnancies Tx if rupture has occurred
Laparoscopic salpingostomy
