OBGYN Flashcards
How long is the average menstrual cycle?
28 days
How many phases are there of the uterus and what are the called?
Mensuration, proliferative, and secretory phase
How many phases are there of the ovum?
Follicular phase and the luteal phase
What is the primary hormone in the follicular phase?
FSH and LH
What does FSH do?
It stimulates growth of the follicle and production of estrogen by stimulating granulosa cells to make aromatase which converts androsteidone (from theca cells) to estrogen.
Why are anovulatory cycles a problem?
They mean that unopposed estrogen is exposed to the uterine lining. Because there is no corpus luteum no progestrone is produced.
What are causes of secondary amenorrhea?
Pregnancy, Prolactinoma, hypothyroidism, menopause (hypergonadotrpic hypogonadism)
What is the criteria in order to diagnose a patient with amenorrhea?
The patient with regular cycles has no periods for greater than 3 months. OR in a person with irregular periods greater than 6 months.
What is oligomenorrhea?
Menstrual cycles greater than 35 days long or less than 9 cycles in a year.
What is menorrhagia?
Heavy and prolonged menstrual bleeding
hypomenorrhea
spotting
Metorrhagia
Bleeding between menstrual periods
What are some of the causes of abnormal uterine bleeding.
Remember the pneumonic PALM. Polyp, adenomyosis, Leiomyata, and Malignancy.
How do we diagnose pregnancy?
urine bHCG and transvagial ultrasound
If FSH and estradiol is low in a patient with amenorrhea what diagnosis would you suspect?
primary ovarian insufficiency
If a patient has amenorrhea what should work up for this patient look like?
BHCG, prolactin, TSH, FSH, estradiol
If estradiol is low to normal in patient with amenorrhea, but the patient has no signs of virilization what is the next step in work up?
progesterone withdrawal test
If estradiol is low to normal in patient with amenorrhea and the patient has large clitormegaly, hair growing underneath the chin, what diagnosis would you suspect?
PCOS
If a progestrone withdrawl test is done in a patient with amenorrhea and has withdrawl bleeding what is the reason for amenorrhea?
progesterone deficiency
If a progesterone withdrawal test is done in a patient with amenorrhea and has no withdrawal bleeding what is the next step in management?
Get a progesterone and estrogen test
If a patient with amenorrhea has withdrawl bleeding after a progestrone and estogen test what is the likely diagnosis?
hormonal deficiency
What is PCOS?
Due to problems of progress and or regression of the follicles the follicles become cystic.
What are common associations of PCOS?
Insulin resistance, acanthosis nigracans, obesity, weight gain, and type 2 diabetes
What is the diagnosis of PCOS?
It’s a diagnosis of exclusion, typically we rule out cushing, 21 hydroxylase, IGF-1 etc
What is treatment for PCOS in a patient that doesn’t currently want children ?
OCP
What is the treatment of PCOS in a patient that wants children?
clomephine or letrzole (usually used in women with a BMI over 30)
what is the mechanism of action of letrozole?
It inhibits aromatase
What are the risks associated with taking OCP’s?
Increased risk of coagulopathies, hypertension, and benign hepatic tumors
Medroxyprogestrone acetate
Hormonal depot or the injection
What are the two types of IUD’s
Levonorgestrel and cooper
What is a vasectomy?
Cut the vas deferens
What is a tubal ligation?
Female sterilization
How do OCP’s work?
They work by inhibiting LH surge due to estrogen feedback to the hypothalamus and pituitary.
How does progesterone work?
By increasing the cervical mucus production
What are the absolute contraindications of OCP’s?
*Patient >35 with smoking history
* History of thromboembolism or
coagulation disorders
* History of liver disease
* history of coronary artery disease
* migrane aura
*breast cancer
* SLE
* Valvular heart disease
This emergency contraception should be inserted 5 days after unprotected sex?
Cooper IUD and uliprastil
This emergency contraception can be used up to 3 days after unprotected sex?
Levenorgestrel
What is primary dysmenorrhea?
Menstrual pain that has lasted a year and usually occurs around the time of menstruation and is typically do to prostaglandin production.
Dysmenorrhea, dyspareunia, urgency frequency, dysuria, constipation. Physical exam shows mass in the left adnexa. What is the most likely diagnosis?
Endometriosis
What is the management for patients with endometriosis?
OCP’s and NSAIDs
What is the diagnostic exam for endometriosis?
Laprascopy
What are Leiomyomas?
Fibroids, masses of the smooth muscle.
cyclic pelvic pain, menorrhagia, dysmenorrhea, urinary frequency, constipation, with an asymetrical large uterus?
Fibroids
Fever, nausea, abnormal vaginal discharge, dysparuneia, with cervical motion tenederness.
PID
How do we diagnose PID?
If you suspect PID, which is a clinical diagnosis. Keep in mind that these patients tend to be sexually active females. Pelvic exam should routinely be performed microscopy of vaginal discharge. NAAT test, pregnancy test, and screen for STD’s.
What are risk factors for PID?
Risky sexual activity, previous infection or STD/STI’s, age <25
What is pre-menstural syndrome?
Either behavioral or physical symptoms that occur around menses
What is post-menstural dysmorphic disorder?
More prominent anger and irritability around mensuration
How we diagnose a women as being in menopause?
It’s a clinical diagnosis and can be confirmed with low levels of estrogen and high levels of and high levels of FSH and LH.
A patient with itching and burning, frequency, dyspareunia. What is the next step in management?
Vaginal discharge analysis (ph), microscopy,
A patient with itching and burning, frequency, dyspareunia. With discharge analysis showing a ph < 4.5 and yeast and hyphae on microscopy has?
Candida
Patient with itching and burning, frequency, dyspareunia with malodorous discharge. With a ph >4.5 with clue cells has?
Gardnerella