OBGYN Reverse Flashcards
Sexual expression is determined by ? five factors
Masters and Johnson describe ? four stage sexual response cycle in 1966
Basson proposed ? revised sexual response cycle in 2001
Psychological Learned Environment Spiritual Social
Excitement Plateau Orgasm Resolution
Intimacy Stimuli Arousal Desire Enhanced intimacy
? is the biological component of the Sexual Response Cycle and what control this component
? carries that most weight of the cycle
Desire Phase is driven by ? hormone while Arousal Phase is driven by ? hormone
Sexual Drive- influenced by neuroendocrine
Motivation
Emotional willingness
D: testosterone, excited- T, suppressed- Serotonin
A: E2 from parasympathetic
Menopause sexual dysfunction is d/t ?
What are the three phases of sexual response
? underlying Dxs are comorbid w/ sexual d/os
Hypo-estrogen
Inc FSH= hot flashes
Desire (Libido)
Excitement (Arousal)
Orgasm (Climax)
Anxiety/Depression
Excitement/arousal is a reflex controlled by ? nerves and controlled by ? system
The excitement/arousal phase is enhanced by ? hormone and the lack of this is the MC ?
Orgasmic phase reflex is controlled by ? nerves and modulated by ?
T11-L2, S2-4; Parasympathetic
Estrogen; MCC of dysfunction of excitement phase
T11-L2, S3-4; Sympathetic
What are the four RFs for developing dyspareunia
Difference between fe/male sexual assault in military
? are the RFs for violence against women and when are the RFs lowest
Hx of abuse/PID
Age <50
Depression/Anxiety
Unwanted touch: MC to men
More likely reported/investigated- MC to women
Age 16-24y/o
Witnessing violence as child
Lowest: 65/> y/o
What are the support structures of the pelvis
What are the pelvic organs
Define Chronic Pelvic Pain
Perineum
Urogenital diaphragm
Levator ani
Vagina
Rectum Uterus Bladder Vagina
Non-cyclic pain lasting 6mon+ severe enough for functional disability/medical intervention
What is used for first line Tx of Chronic Pelvic Pain
How are neuropathic Sxs Tx
How are dysmenorrhea/dyspareunia Sxs Tx
What surgical options are available
Acetaminophen and NSAIDs
SS/NRI TCA Gabapentin
CoCs Progestin GnRH agonist
Hysterectomy Neurolysis
Define Vulvodynia
What is used for Tx
When does Localized Provoked Vulvodynia become a DDx
Vulvar discomfort x3mon w/out identifiable cause
Topical Lidocain/Gabapentin
Antidepressant- TCA (max 200mg Amitriptyline)
New onset insertion pain x 3mon
What are the two sub-classifications of Dyspareunia and the causes
Exam for dyspareunia mirrors the exam for ?
How is this condition Tx
Insertion: d/t vulv-odynia/itis, poor lube
Deep: pain d/t endometriosis, adhesions or bulky leiomyomas
Chronic Pelvic Pain
Vaginismus- desensitization, counseling
Atrophy- estrogen cream
Poor lube- lube and arousal
Structural- surgery
Pudendal Neuralgia is Dx w/ ? criteria
Define Cystocele, Rectocele, Enterocele, Procidentia
? is the 3rd MC indication for hysterectomy
Nantes: Pain along pudendal nerve path Worse w/ sitting No sensory loss Does not awaken Relieved w/ nerve block
C: bladder prolapse
R: rectum prolapse
E: bowel prolapse
P: uterus prolapse
Pelvic organ prolapse
Define Splinting/Digitation associated w/ pelvic organ prolapses
Which type of prolapse presents w/ urinary retention
What are the RFs for prolapse
Splint: manual bolstering improves Sxs
Digit: manual pressure aids w/ BMs
Cystocele
Inc abdominal pressure CT d/o Age- risk double each decade Vaginal delivery- 1.2x per delivery Elective forcep delivery Race: hispanic/white
Although unknown, Interstitial Cystitis and/or Painful Bladder Syndrome is potentially d/t ? two etiologies
These two Dxs are considered when
Pts w/ this condition but Dx w/ UTIs will present w/ ? c/c
Mast cell activation; Defected mucin layer
Unexplained chronic pelvic pain w/ voiding Sxs
Cranberry juice exacerbates pain
Define Hunner Ulcer
Define Glomerulations
What is first and second line Txs for Interstitial Cystitis/Painful Bladder Syndrome
What is the only FDA approved medication for Tx Interstitial Cystitis/Painful Bladder Syndrome
Red/brown lesion w/ radiating vessel to central scar causing bladder stiffening- Dx for interstitial cystitis
More common; petechia/sub-mucosal hemorrhage (not unique to interstitial cystitis)
1st: Education, Behavior mod
2nd: PT Elmiron Amitriptyline Cimetidine Hydroxyzine
Elmiron- repairs bladder defects
What can be injected into bladder for Interstitial Cystitis/Painful Bladder Syndrome Txs
? MedHx makes females 2.5x more likely to be admitted to nursing homes than peers
What are the transient causes of incontinence
Lidocaine Heparin Dimethyl Sulfoxide
Incontinence
Delirium- MC in hospitalized Pts Infections Atrophic vaginitis/urethritis Pharm: A-blockers (women) A-agonists (men) Psych Excess output/Endocrine dz Restricted mobility Stool impaction
What are the three degrees of Stress Incontinence Severity
How is the bladder controlled by the nervous system
? type of receptors are more predominant in the bladder dome and ? type of receptors are more predominant in the bladder neck
1: only w/ severe stress (cough, sneeze, jump)
2: moderate stress (movement, stairs)
3: mild stress (standing)
Peripheral, Autonomic:
Sympathetic: A/B receptors
Parasympathetic: Muscarinic/Nicotinic receptors
Dome: muscarinic, b-adrenergic receptors
Neck: a-adrenergic receptors
What meds do Pts w/ incomplete/overflow bladder emptying and stress incontinence need to avoid
? is the MC type of incontinence seen in women
How is urethral hypermobility assessed for during stress incontinence exams
Overflow: A-agonsits, CCBs
Stress: A-antagonists
Mixed
Q-tip test, angle changes >30* to horizontal= hypermobility and possible stress incontinence
Most cases of incontinence can be Tx conservatively w/ ?
What medication can be added to incontinence Tx to dec urgency/frequency
? medications can be used to work at detrusor muscle level
Kegels: 50-60 contractions/day
Calcium glycerosphate
Anticholinergics- inhibit muscarinic receptors to blunt contractions
? is a combo drug used for mixed incontinence Tx
? is a combo anti-spasmodic drug used for urge incontinence Tx
Botulinum injections can be used for Tx ? types of incontinence
Imipramine: TCA w/ a-adrenergic and anticholinergic effects
Mirabegron: relaxes detrusor, increases bladder capacity
Idiopathic detrusor overactivity
Urge
Urge Incontinence Tx methods
Stress Incontinence Tx methods
Overflow Incontinence Tx methods
Schedule
Anticholinergic: Detrol, Ditropan
Kegels
Pessary/kegel Imipramine Topical estrogen Surgery Duloxetine
Intermittent catheterizations
Surgery
Most breast dzs arise from ? structures
Because of their location these growths are very sensitive to ? hormones
When does breast epithelial cells proliferate and why
Terminal duct-acinar (lobules)
Est/Progest/Prolactin
Luteal- fullness week prior to menses d/t water content
? is the MC benign breast tumor and MC breast d/o
How does this MC appear on PE and what type of f/u is needed
? Pt populations are these more common in and what happens w/ age/menopause
Tumor: fibroadenoma
D/o: fibrocystic changes
Well circumscribed, rubbery and mobile;
No FamHx of breast Ca; f/u 3-6mon
Adolescent/pre-menopause;
Calcify and spontaneously involute
Simple Cysts appear as ? on US and need ? management for Tx
Complicated Cysts appear as ? on US
Complex Cysts appear as ? on US
Sololucent, smooth margins
No special management unless
Recurrent- consider excise
Internal echoes, proteinaceous debris
Consider aspiration, culture, cytology
Abnormality doesn’t resolve w/ aspiration- core needle
Septa/intracystic mass usually papillaoma
Core needle biopsy and/or excise
Define Fibrocystic Breast Changes
What causes these changes
These changes are characterized by ? that is d/t ?
Ropy, nodular tissue d/t dilated ducts and dense collagen
Collagen stromal response to hormones/GF
Hyperplasia- low progesterone compared to estrogen
How will Fibrocystic Breast Changes present to clinic
How are these Tx
What baseline order needs to be started if Pt is >25y/o
Bilateral cysts w/ pain worse pre-cycle (late luteal phase)
Aspiration for pain, Danazol but high androgen s/e
Bloody/residual= biopsy
Baseline mammogram (cut off age for US/Mamm- 30)