Ob/Gyn Flashcards
1
Q
What type of effects does Tobacco and Cocaine have on neonates when taken during pregnancy?
A
- Tobacco–> low birth wt
- Cocaine –> low birth wt 2/2 vasoconstrictive placental insufficiency
2
Q
Name Intrauterine Maternal factors that inhibit fetal growth? - 5
A
Includes Alcohol use
Always consider Gestational Dating may be inaccurate
3
Q
Name Intrauterine Placental abnormalities that inhibit fetal growth? - 3
A
Always consider Gestational Dating may be inaccurate
4
Q
Name Intrauterine Fetal abnormalities that inhibit fetal growth? - 4
A
Always consider Gestational Dating may be inaccurate
5
Q
What office tool (other than LMP) is used to estiamate gestational age?
A
Fundal height (palpate superior aspect of enlarged uterus)
6
Q
Name Factors that ⬆︎ Risk for Vertical transmission of HIV -6
A
- Unprotected Sex during pregnancy (chorioamnionitis and other STI ⬆︎HIV transmission)
- Advanced Maternal HIV viral load
- Membrane rupture > 4 hrs prior to delivery in Mother not on HAART
- Vaginal Delivery
- Breastfeeding
- Premature Delivery before 37 wks
7
Q
You’ve just discovered a positive rapid HIV test on pregnant pt in labor
Name Factors that ⬇︎ Risk for Vertical transmission of HIV -3
A
- HAART if viral load > 1000 copies
- C-section prior to onset of labor and rupture of membranes
- NO Breastfeeding
8
Q
What is the Ballard Tool?
A
Uses Physical and Neuromuscular signs to estimate gestational age
9
Q
What constitutes a FULL term infant?
A
≥ 37 wks gestation
10
Q
What clinical problems are associated with SGA (Small for Gestational Age)?-3 …and why?
A
- hypOglycemia (⬇︎ glycogen stores and gluconeogenesis)
- hypOthermia (⬆︎Surface area and ⬇︎SubQ insulation)
- Polycythemia presenting w/Respiratory distress (Chronic hypoxia)
11
Q
What are the major risk factors for Breast CA - 6
A
- 1st degree relative with breast CA
- Excess estrogen (menstruating outside of 12-45 y/o range vs utero DES vs HRT)
- Genetics (BRCA 1/2 mutation)
- Alcoholic
- Obesity
- Therapeutic radiation
Average Menopause onset = 51
12
Q
Guidelines for PAP Smear Cervical CA Screening - 3
A
- [Age 21 - 65 every 3 years (cytology only)] ≥ 3x
- [Age 30-65 can alternatively get Co-HPV Testing every 5 years] ≥ 2x
- Risk Groups (immunocompro/CIN2 or 3 hx/CA/utero DES pts/smoking) need more frequent screening
13
Q
Guidelines for Breast CA screening - 3
A
- 45-54 get mammograms every year
- > 55 cont mammograms every year OR switch to every 2 years
- 40-44 have the option
No mamm in pt < 40 unless known BRCA mutation
14
Q
What are characteristics of a breast lump that suggest malignancy - 5
A
- single
- solid (consider US to differentiate from cystic lesion)
- immobile
- >2 cm
- irregular borders
15
Q
Pregnancy and Breast stimulation are normal causes of nipple discharge
What are pathologic causes? - 5
A
- CA (Intraductal/Paget’s/DCIS/Mammary duct ectasia)
- Hormone imbalance
- Trauma
- Abscess
- Meds (Antidepressant/Antipsychotics/AntiHTN)
16
Q
Risk factors for Cervical SQC - 5
A
- Early Sexual Intercourse
- Large # of lifetime sex partners
- utero DES
- Smoking
- Immunocompro
17
Q
Dx for Menopause
A
No menstruation for 1 year straight!
Average Menopause onset = 51
18
Q
S/S of Menopause - 4
A
- Menstrual irregularity in older female (heavy/last>1 week) = perimenopause
- Hot Flashes (last 30 sec - 10 min)
- Atrophic vaginitis –> Vaginal Dryness, dyspareunia, urinary sx, smooth vaginal mucosa
- Mood Swings
19
Q
What are risk factors for Osteoporosis? - 9
Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean
A
- ⬇︎Estrogen
- LOW BMI (malnutrition/malabsorption)
- Sedentary lifestyle
- Poor Ca+ intake (body needs 1000mg premenopausal and 1200mg post)
- Family or personal hx of osteoporotic fracture
- Smoking
- EtOH abuse
- White race
- Steroids
20
Q
Preventitive measures for Osteoporosis? - 4
Bone Mineral Density ≥ 2.5 SD below mean
A
- Dietary Ca+ intake 1200-2500 mg/day
- Dietary VitD intake 600 IU/day
- Sun > 10 min/day
- Weight bearing exercises (walking,jogging,dancing)
Only use supplements WHEN ABSOLUTELY NEEDED
21
Q
Guidelines for Osteoporosis screening - 2
Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean
A
- Women ≥65 = DEXA
- Women < 65 get DEXA if fracture risk is ≥ a 65 yo WHITE woman per FRAX score
Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean
22
Q
Guideliness for Chlamydia Screening (Women vs Men)-3
A
Women
- ALL sexually active women < 25
- Sexually active women > 25 if high risk
Men: Insufficient evidence :-(
23
Q
What are the major s/s of Pregnancy - 7
A
- Amenorrhea (this may be normal in teens)
- NV
- Breast TTP
- Urinary frequency
- [Hegar’s Uteral / Goodell’s Cervical Softening]
- Uteral Enlargement
Remember to screen sex active women < 25 for Chlamydia
24
Q
Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Gestational age (EGA) - 2 options?
A
22 weeks ; [Current Date - date of LNMP] = EGA
OR
serial testing of SERUM βhCG
( LNMP = last normal mentrual period)
25
Abortion is legal up to ____ weeks gestation ; How do you calculate Estimated Due Date (EDD) - 3?
**22** weeks ; [date of LNMP] + 1 year - 3 months + 1 week = EDD
## Footnote
* THIS IS KNOWN AS NAEGELE'S RULE and is [+/- 2 wk accuracy]*
* Use US to confirm BUT ONLY IN WOMEN \< 20 WKS GESTATION*
26
Which labs do you order initially for newly discovered Prenatal? - 6
1. CBC (detect anemias)
2. Blood Type & Screen (RH-D = RH neg, and **these women need anti-D Ig**)
3. Rubella IgG
4. Hep B surface antigen
5. RPR
6. HIV
27
What's the best way to diagnose ectopic pregnancy or miscarriage? - 2
1. *SERUM* βhCG level trend
2. Progesterone ( ectopic/miscarriage \< 5 - 25 \< healthy pregnancy) - not reliable tho
28
How much and When is [RhoGam Anti-RhD Ig] administered to pregnant women? - 4
1. 50mcg sometime during [\< 14 WG: 1st trimester]
2. 300mcg at 28 WG
3. unspecificied dose within 72 hrs after delivery
4. unspecificed dose with any episode of vaginal bleeding
## Footnote
*WG = Weeks Gestation*
29
Lab w/u for [1st trimester vaginal bleeding]
## Footnote
*Remember: this is 25-50% chance of miscarriage*
1. **Serum βhCG trend WITH Pelvic US**
2. CBC
3. Wet Mount for trichomonas
4. GC/Chlamydia PCR
5. Progesterone ( ectopic/miscarriage \< 5 - 25 \< healthy pregnancy) - not reliable tho
30
βhCG levels have to be ____ for pregnancy to be detected via trans*vaginal* US, and usually _____ when trans*abdominal* US can finally detect it
What are βhCG levels during:
A: Ectopic Preg/Miscarriage
B: Molar Pregnancy
βhCG levels have to be **1500-1800** for conclusive pregnancy detection via transvaginal US and usually **\>5000** when transabdominal US can finally detect it
A: Ectopic Preg/Miscarriage = low βhCG
B: Molar Pregnancy = \> 100,000 βhCG!!!
*βhCG should double every 2 days in normal pregnancy for first 7 weeks*
31
Why are serial βhCG more important than point value βhCG?
[βhCG should **double** every 2 days x first 7 weeks] in normal pregnancy so tracking the velocity trend is important
32
What are the options for Mngmt of Miscarriage - 3
1. **Expectant**: Watch waiting for products of conception to expel naturally in 2-6 weeks
2. **Surgical**: Dilitation & Curettage (D&C) - cant be done during infection
3. **Medical**: 800mcg Vaginal Misoprostol - takes up to 2 weeks for expel
## Footnote
*ALL REQUIRE 1 WEEK FOLLOW UP*
33
Why is the TDaP given to ____ week gestation pregnant patients?
27-36 week ; Protects **BABY** from Pertussis
34
1st trimester is ___ weeks gestation
What are the 3 biggest questions to ask during history taking for these patients? Why?
\< 14 weeks
1. NV? - asking because this is treatable
2. Vaginal Bleeding?
3. Cramping?
35
2nd trimester is ___ weeks gestation
What are the 5 biggest questions to ask during history taking for these patients? Why?
14 - 27 weeks
1. Leakage of Fluid? -OOP
2. Vaginal Bleeding? -OOP
3. Cramping/contraactions? -OOP
4. Fetal Movement? -OOP
5. Anticipatory Guidance [Breastfeeding/Car seats/OCP]
**It is a medical emergency when Fetal Movement is not felt by 24 wks!**
36
2nd trimester is ___ weeks gestation
Fetal Movement should be felt when? ; **It is a medical emergency when Fetal Movement is not felt by \_\_\_\_**
14 - 27 weeks
## Footnote
**It is a medical emergency when Fetal Movement is not felt by 24 wks!**
37
3rd trimester is ___ weeks gestation
What are the 5 biggest questions to ask during history?
28 - 42 weeks
1. Leakage of Fluid?
2. Vaginal Bleeding?
3. Cramping/Contractions?
4. Fetal mvmnt?
5. S/S Preeclampsia (HTN/edema/Proteinuria)
41
What is the normal Fetal Heart Rate and variability of FHR?
110 - 160/min (w/variability of 6-25)
## Footnote
*Normal Fetus' should have a _reactive_ NST*
43
What does APGAR stand for? ; How is it done? ; How is it used?
**A**ppearance, **P**ulse, **G**rimace(reflex irritability), **A**ctivity(tone), **R**espiration
Performed at **1** and **5** min postpartum, All scaled from 0 to 2 and then added together
[\< 3 = Critical] / [4-6 = fair] / [7-10 = normal]
44
Why shouldn't you be alarmed if newborn loses weight 2 days after birth?
Newborns lose up to 10% of birth weight in first several days, **but by 2 weeks should return to original birth weight**
## Footnote
*Expect wt gain of ounce/day with maternal milk*
45
What are the advantages of Group Prenatal care? - 4
1. Educate/support each other
2. More efficient for provider to give **more education** (prenatal, labor preparedness, adequacy of prenatal care)
3. **⬇︎** Preterm delivery (especially in Blacks)
4. ⬇︎lethal low birth wts in infants that are Preterm --\> ⬇︎Racial disparities between black and white infant deaths
47
*For Antepartum patients, their NST (Non Stress Test) should be reactive*
What does this mean? Does this happen in pts in labor?
neuro intact fetus should have
two heart rate acclerations tht are at least **[15 bpm over 15 seconds in 20 min period]** ; THIS IS NOT REQUIRED FOR PTS IN LABOR
48
What are the 2 clinical features for diagnosing ACTIVE labor?
1. **Strong Regular** Contractions **every 3-5 min**
2. Cervix Dilation \> 6 cm during contractions
## Footnote
*Fetal Heart Tracing is IRRELEVANT to diagnosing active labor*
49
*Criteria for PreEclampsia is **Gestational HTN** + **Proteinuria***
What is the pathologic evolution of PreEclampsia? How do you evaluate for this?-3
**PreEclampsia** --\> [**SEVERE PreEclampsia** (HA + vision changes)] --\> **HELLP** and at anytime, **Eclampsia** is possible
1. LFTs
2. Renal Function (spot Urine protein/Creatinine ratio)
3. CBC (look for thrombocytopenia & hemoconcentration)
50
*Criteria for PreEclampsia is **Gestational HTN** + **Proteinuria***
How do you clinically diagnose _SEVERE_ PreEclampsia? - 6
**PreEclampsia** --\> [**SEVERE PreEclampsia** (HA + vision changes)] --\> **HELLP** and at anytime, **Eclampsia** is possible
ANY **ONE** OF THE FOLLOWING:
1. Systolic \> 160
2. Diastolic \> 110
3. RUQ pain
4. Doubling of LFTs
5. 100 \> Platelets \> 1.1 mg/dL
6. Pulmonary Edema
51
*Pregnant pt is a Jehovah's Witness and doesn't want blood during L & D*
What are steps to ⬇︎ Maternal Blood Loss? - 3
1. Give Pitocin after birth to help placenta detach faster
2. Uterine massage after placenta detaches to stop blood vessels from pumping
3. Clamp umbilical cord **EARLY** **(2 min after delivery**)
52
What are the Stages of Labor - 4
**1st:**
A: Latent Phase = Strong Regular Contractions q3-5 min
B: ACTIVE Phase = Cervix is now 6 cm Dilated, [growing @ 1-2 cm/hr] and effacing
**2nd**: 10 cm FULLY DILATED Cervix
**3****rd:** Baby is Delivered and then Placenta is Delivered
https://www.youtube.com/watch?annotation\_id=annotation\_563008&feature=iv&src\_vid=Xath6kOf0NE&v=ZDP\_ewMDxCo
53
*Criteria for PreEclampsia is **Gestational HTN** + **Proteinuria***
How do you clinically diagnose Gestational HTN? - 6
1. NO previous HTN
2. \> 20 wks gestation
3. **Systolic \> 140**
4. **Diastolic \> 90**
5. At least 2 readings taken \> 6 hrs apart
6. BP taken in seated or semi-reclined position
54
*Criteria for PreEclampsia is **Gestational HTN** + **Proteinuria***
How do you clinically diagnose Proteinuria for pregnant women - 3
1. ≥300 mg protein on 24 hr urine
OR
2. ≥ 30 mg/dL on dipstick
OR
3. At least 1+ on dipstick
* Must occur at least 2 times at least 6 hours apart*
55
*Criteria for PreEclampsia is **Gestational HTN** + **Proteinuria***
Which demographic are at greater risk for this?
Af American Women
## Footnote
*greater risk of having PreEclampsia, it being severe and suffering placental abruptio and Eclampsia*
58
What are Late Decelerations in Fetal Heart Rate?-2 ; What does this possibly indicate?
Decelerations in FHR that
1. Begin AFTER Contraction starts
2. Nadir is AFTER peak of contraction
= Hypoxemia during contractions 2/2 Utero-Placental insufficiency
59
What does *Early* Decelerations indicate? Is this normal or abnormal?
Head compression when fetus is low in pelvis; **NORMAL**
60
How do you manage FHR Late Decelerations? - 4
1. Continuous Fetal Heart Monitoring
2. Turn pt on side to ⬆︎ IVC venous return
3. O2 face mask
4. IV fluid bolus
61
What are alternatives to Epidural for L&D pain mngmt? - 4
1. Water Immersion
2. Intradermal sterile water injections
3. Self Hypnosis
4. Acupuncture
62
What are the 4 major causes of Postpartum Hemorrhage? - 4
The 4 T's!
**T**one (Uterine aTony)
**T**rauma (Perineal vs Cervix lacerations vs Uterine inversion)
**T**issue (retinaed/invasive placental tissue)
**T**hrombin (rare bleeding DO)
63
How long should women breastfeed their newborns?
AT LEAST 6 months, followed by [BF + complementary foods up until 12 mo.] (Remember: breast milk may take 2-3 days postdelivery to release)
## Footnote
*avoid pacifiers/educate women & partners/feed only on demand/immediate skin2skin contact postdelivery = good breastfeeding techniques*
64
What are the 4 biggest things to assess during Postpartum checkup?
1. Help at home?
2. Rx (Prenatal viamins, other meds)
3. Diet
4. Mood
65
*Naegle's Rule is the most accurate for determining gestation*
When can you use Ultrasound to determine gestation? - 4
1. Only in Women **\< 20 wks gestation** OR...
2. For discrepancy \> 1 wk between US and another method during 1st trimester
3. For discrepancy \> 2 wk between US and another method during 2nd trimester
4. For discrepancy \> 3 wk between US and another method during 3rd trimester
(the earlier the better!)
66
When is Fundal height used for gestational dating? What are the rules? - 2
[28-42 wks: **3rd** trimester] ;
1. At 20 wks gestation, Fundus should be at Umbilicus. It goes ⬆︎ by 1 cm every week after
2. After 20 wks, fundal ht in cm correlates with wks gestation
67
What is the relationship between Pregnant Women and Hot tubs?
They need to **avoid them**! Maternal heat exposure --\> Miscarriage & Neural tube defects
68
Which foods should Pregnant women avoid? - 5
1. Raw Eggs (Salmonella)
2. Unpasteurized Milk (toxo and listeria)
3. Soft Cheeses (listeria)
4. Raw Fish/Shellfish
5. Unwashed fruits/vegetables (toxo and listeria)
69
What Dietary supplements should Pregnant Women take? - 2
1. [Folic Acid 0.4 - 0.8 mg/day]
2. [Iron 30 mg/day]
70
During Fetal development, what happens at...
4 weeks?
7 weeks?
27 weeks?
4 weeks = Neuro tube closes
7 weeks = Heart starts to beat and fetus moves!
27 weeks = Fetus opens eyes & detects light
71
What are the minimum things to check during Prenatal f/u? - 3
1. Maternal wt
2. Maternal BP
3. Fetal HR (heard at 10-12 wks gestation)
72
Which Prenatal Vaccinations should be given? - 3
1. **FLU** [Dead IM]
2. [RhoGam Anti-RhD Ig] @ [\<14 WG:1st trimester] + [28 WG] + [within 72 hrs after delivery] + [with any episodes of vaginal bleeding] (if indicated)
3. Rubella **after delivery**
## Footnote
*WG = Weeks Gestation*
73
What is Hyperemesis Gravidarum?
**Persistent** NV during pregnancy
## Footnote
*Normal NV Starts 4WG until 20WG*
74
What are Dietary measures women with Hyperemesis Gravidarum can take? - 4
1. Frequent but small meals
2. **Bland** solid foods high in carbs, low in fat
3. Salty morning foods
4. Sour liquids \> Water
75
When can a fetus have its sex determined via US?
[**18WG**: 2nd trimester]
76
Name the major risk factors for Placental previa? - 4
1. \> 35 yo
2. Smoking
3. Prior Pregnancy (especially if with twins!)
4. Previous Uterine surgery like C-section
77
What are the 4 types of HTN in pregnancy?
1. Chronic HTN (present **before** 20 WG and persist beyond 12 weeks postpartum)
2. Gestational HTN (≥140 systolic or 90 diastolic BP without proteinuria in women after 20 WG)
3. PreEclampsia
4. Eclampsia
78
What complications do pregnant women with [**SEVERE** Gestational HTN] and/or PreEclampsia have? - 3
1. PreTerm Delivery ( \< 37 WG)
2. SGA infants (Small for Gestational Age)
3. Placental Abruptio
## Footnote
*Women with mild Gestational HTN do NOT have these complications*
79
What complications do pregnant women with Gestational DM have? - 6
1. PreEclmapsia
2. Fetal Macrosomia
3. Birth Trauma
4. C-sections requirement
5. Neonatal mortality
6. neonatal hypOglycemia, hyperbilirubinemia
80
Gestational DM is determined via _______ test. According to the the Carpenter Coustan criteria, how is this interpreted?
[**3-hour glucose tolerance test**] (measure pt BP after fasting and then 1,2,3 hrs after 100 gram glucose oral load);
**at least 2** of:
1. Fasting BG ≥ 95
2. 1 hour BG ≥ 180
3. 2 hour BG ≥ 155
4. 3 hour BG ≥ 140
81
What are the common pregnancy rashes?-3 ; How do you treat them? -2
Topical Emollients and Steroids
## Footnote
*Do not confuse with Cholestasis which --\> whole body itching*
82
When is Group B Strep screening done for pregnant women?
35-37 WG via rectovaginal swab
83
Postpartum contraception can be started when? What are the postpartum contraception options? - 5
Start **after 6 weeks** postpartum for expulsion & breastfeeding purposes..
1. Progestin pills
2. [DepoProvera Injectable Progestin]
3. Progestin implant
4. [Mirena Levonorgestrel IUD]
5. Copper IUD *(can be inserted immediately postpartum if needed)*
84
Postpartum **depression** affects women during what time periods? What 2 methods are used to screen for this?
within 1st year \> first 3 mo ;
1. [PHQ2 --(if both +)--\> PHQ9]
2. Edinburgh Postnatal Depression Scale
*Screen prenatal, postnatal and well child*
85
Give brief descriptions that differentiate Postpartum
Blues vs Depression vs Psychosis
* Blues = onset right after birth, peaking at postpartum day 5 and subsiding PPD10, worst w/lactation
* Depression = onset right after birth - 6 months later. **Traditional s/s**. Previous Depression hx is RF
* Psychosis = RARE but onsets RAPIDLY after birth
86
At Postpartum visits, what 3 things should be talked about? What is the postpartum f/u for vaginal delivery? C-section?
Mood/Contraception/Breastfeeding
Vaginal delivery f/u = 6 wks postpartum
C-section = 2 wks postpartum
87
What is the DDx for Vaginal Bleeding and/or discharge in pregnant women? - 7
1. **Placenta Previa** (Spontaneous bleeding after 20 WG)
2. Placental Abruptio
3. Bacterial Vaginosis
4. Candidiasis
5. UTI
6. Cervical Trauma
7. PROM (premature rupture of membranes) = fetal membrane rupture prior to labor. Preterm PROM --\> premature birth
88
Home pregnancy test can detect Urine βHCG at levels of ____ while serum blood βHCG can be detected at levels of \_\_\_\_.
What is the pattern of βHCG? - 4
≥25 ; 5 mIU/mL
## Footnote
1st: βhCG doubles every 2 days for first 7 weeks
2nd: peaks at 12 weeks
3rd: rapidly declines until 22 weeks
4th: gradually rises again until delivery
89
*You have a pt who's **newly became pregnant***
What are the initial studies to be ordered? - 9
1. Blood Type/Rh status
2. Hgb/Hct (detects anemia)
3. GC Chlamydia
4. HIV
5. Hep B and C
6. Varicella hx
7. Herpes hx (active labia lesions during pregnancy is ctd)
8. PAP smear
9. UA (detects proteinuria)
90
What is Prenatal Maternal Quad Serum screening? When is this performed?
Measures 4 chemical markers for fetal anomalies and down syndrome- 81% accuracy (QUAD = **BUAD**):
1. **β**HCG
2. **U**nconjugated EsTriol
3. **A**FP
4. **D**imeric inhibin A - *only in QUAD screen*
Performed [15-21 WG: 2nd Trimester]
91
When is routine ultrasound for fetal anomalies performed?
[18-21 WG: 2nd trimester]
92
Desribe the 3 components of a physical exam for abnormal uterine bleeding
1. **Pelvic**: Look for vulvar/vaginal lesions, assess size & mobility of uterus since fixed uterus=uterine CA
2. **Neck**: Assess Thyroid since thyroid dz--\>uterine bleeding
3. **Skin**: Look for abnormal bruises (bleeding DO) and jaundice (liver dz--\>bleeding DO)
93
Risk factors for Endometrial CA -7
1. Excess Estrogen (HRT, neoplasm, [menstruation **outside** of 12-52])
2. Tamoxifen
3. Obesity
4. Anovulation/abnormal menstruation
5. Nulliparity
6. Other Disease (HTN, DM, Breast CA)
7. Age \> 35 yo
## Footnote
*Smoking and Progestin OCP ⬇︎Endometrial CA Risk*
94
Osteoporosis etx
⬇︎ Trabeculae bone density despite NORMAL mineralization
95
Name the most common locations for osteoporotic fractures? - 4
1. Hip
2. Vertebrae
3. Distal Radius
4. Proximal Humerus
96
Based on DEXA, when is a pt classified as having Osteoporosis? What about Osteopenia?
**OSTEOPOROSIS = Bone Mineral Density (T-score) ≥ 2.5 SD BELOW mean** of Bone Mineral Density in Young health person
osteopenia = BMD Tscore between 1 - 2.5 BELOW mean
*Normal = 0-1 below mean*
97
DDx for Abnormal uterine bleeding - 8
1. **CERVICAL POLYPS** **= MOST COMMON** **IN postpartum/PERImenopausal**
2. Endometrial Hyperplasia
3. Hormone-producing Ovarian tumors
4. Endometrial CA
5. Endometrial Proliferation 2/2 estrogen stimulation (Premenopausal)
6. Thyroid disease
7. Steroids
8. SSRIs
98
What tools are used for diagnosing AUB (Abnormal Uterine bleeding) in women, and why?
1. Transvaginal US = evaluates endometrial thickness (\<5mm = ok), leiomyoma fibroids, ovaries
2. Endometrial biopsy = gold standard for AUB in women w/high risk for endometrial CA
3. CBC = looks for anemia/thrombocytopenia
4. TSH = Thyroid dz --\> AUB
5. FSH & LH = In menopause, FSH/LH⬆︎ due to lack of inhibin
99
What are the Benefits-3 and Risk-4 of Estrogen Hormone Replacement Therapy?
## Footnote
*There is no right answer for whether women should use HRT*
**Pros**
1. Prevents Osteoporosis
2. ⬇︎Menopausal sx (Atrophic vaginitis, Hot flashes)
3. ⬆︎Cognitive/mental status
**Cons**:
1. ⬆︎Breast CA risk if combined Estrogen/Proges is used \>3 years
2. ⬆︎Endometrial CA risk with Excess Estrogen
3. STARTING HRT \> 60 yo--\> CAD
4. HRT ⬆︎Stroke risk within first 2 years of use
100
Osteoporosis tx - 4
1. Bisphosphonates (Bone resorption inhibitors)
2. Calcitonin
3. Estrogen HRT
4. PTH synthetic - **cant use for \> 2 years**
101
What are *alternative* treatments for postmenopausal sx? - 4
1. Yoga
2. Acupuncture
3. Tai Chi
4. Qi Gong
