OnlineMedEd: Gynecology - "Vaginal Bleeding 3"

Question 1

Go through PALM-COEIN.

Answer 1

Structural: 
• Polyps
•Adenomyosis
•Leiomyoma
•Malignancy

Functional: 
•Coagulopathy
•Ovulatory dysfunction
•Endometriosis
•Iatrogenic (IUD) 
•Not yet classified

Question 2

Which disorder presents with a boggy uterus?

Answer 2

Adenomyosis

Question 3

How can you differentiate between adenomyosis and fibroids on PE?

Answer 3

• Fibroids –nodular, irregular mass in the suprapubic area

* Adenomyosis –smooth, regular mass in the suprapubic area

Question 4

Fibroids are __________-responsive.

Answer 4

estrogen

This is why they regress during menopause.

Question 5

The only diagnostic test needed for a fibroid is _______________.

Answer 5

transvaginal ultrasound

MRI can differentiate between leiomyoma and leiomyosarcoma, but the yield is so low that MRIs are not routinely done. Biopsies can also differentiate, but because they induce lots of bleeding they are also not usually done.

Question 6

List the two medical options for fibroids.

Answer 6

• NSAIDs (for pain)

* OCPs (to limit estrogen)

Question 7

If a woman wants kids but needs a fibroids removal, you should do a ____________.

Answer 7

myomectomy

If children are not desired, then you can do a TAH.

Question 8

If a woman with fibroids doesn’t want surgery but also doesn’t want kids, you can ______________.

Answer 8

give leuprolide

Question 9

Abnormal uterine bleeding is normal in what populations?

Answer 9

Those near menarche and those near menopause (when the estrogen/progesterone ratio is out of whack).

Question 10

Explain the diagnosis of abnormal uterine bleeding.

Answer 10

This is a diagnosis of exclusion. Once you’ve ruled out every other cause (via history, exam, CBC, TSH, prolactin, ultrasound, and MRI) you can diagnose “abnormal uterine bleeding”. It can be caused by stress or weight loss.

Question 11

How is abnormal uterine bleeding (the diagnosis of exclusion) treated?

Answer 11

With OCPs or IUDs (to lessen the bleeding) and NSAIDs (to control pain and lessen bleeding, too –because the lack of prostaglandins decreases uterine motility).

Question 12

Diagnosis is essentially hirsutism with ___________.

Answer 12

metabolic syndrome (HTN, HLD, and obesity)

Question 13

Examiners love to test that the ___________ ratio should be greater than 3 in those with PCOS.

Answer 13

LH:FSH

Question 14

Elevated _________ levels can indicate PCOS.

Answer 14

DHEAS

Question 15

____________ can induce ovulation in those with PCOS.

Answer 15

Metformin

Also clomiphine

Question 16

What can treat hirsutism in PCOS?

Answer 16

Spironolactone