Other Flashcards
what is the recommended emergency contraceptive method
Plan B one-step within 3 days of unprotected sex
or
Ella (ulipristal) within 5 days
or
Copper IUD within 5 days
what injection is the long-acting contraceptive injection
Depo-Provera
a 24-year-old nulligravid woman presents to your office with an 18-month history of painful intercourse, difficulty defecating, and dysmenorrhea. These symptoms are cyclical and come and go with her menses. Her menses are regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.
what is the diagnosis
endometriosis
what are the three D’s of endometriosis
Dyspareunia, dyschezia and dysmenorrhea
what is dyschezia
difficulty in defecating
what is the definitive diagnosis for endometriosis
laparoscopy confirmed by biopsy
what is found on physical examination with endometriosis
uterus is fixed and retroflexed on physical exam
what are treatment options for endometriosis
NSAIDs
OCPs
Danazol
Depo Provera
GnRH agonist
surgery
how is infertility characterized
inability to conceive within 12 months of unprotected intercourse
what is the most common cause of infertility
anovulation
how is infertility diagnosed
PAP
hormonal levels
US
hyperosalpingogram
semen analysis
ovulation check
what is the treatment for infertility
based on the underlying cause
- may require. meds such as clomiphene citrate to hyperstimulate ovulation, surgery or IVF
- metformin increases ovulation and pregnancy rates when PCOS is the cause
- Bromocriptine to treat hyperprolactinemia
What are Leiomyoma’s
uterine fibroids - benign smooth muscle cell tumors
what are symptoms of leiomyomas
polymenorrhea
menorrhagia
intermenstrual bleeding and/or metorrhagia
pelvic pressure and increased abodminal girth
what populations are most commonly affected by leiomyoma
black women with a family history
how are leoimyomas diagnosed
Ultrasound and/or MRI - uterine mass present
what is the symptomatic management of leoimyomas
NSAIDs
OCPs
Danazol
Leuprolide
what are definitive management of leoimyomas
myomectomy
endometrial ablation
hysterectomy
what is the most common type of ovarian cyst
follicular cyst
what are examples of non-functional/neoplastic ovarian cysts
PCOS
endometriomas
dermoid cysts
ovarian serous and mucinous cystadenoma
what are complications of ovarian cysts
- hemorrhagic
- rupture
- torsion
what is the first imaging study of choice for a suspected ovarian torsion
abdominal and pelvic ultrasound
what is the prophylactic antibiotic therapy for sexual assault
Recephin 250mg followed by oral doxycyline BID for 7 days
Tetanus toxoid if indicated
option for emergency ccontraception
what are the major types of urinary incontinence
- urge incontinence (detrusor overactivity)
- stress incontinence (weakness of pelvic floor)
- overflow incontience (impaired detrusor contractility)
- functional incontinence
- mixed (combo of stress and urge
what is urge incontinence
detrusor overactivity
frequent small amounts of urine
what is the treatment of urge incontinence
bladder training exercises
if unsuccessful - anticholinergics (oxybutynin) and TCAs (impiramine)
what is stress incontinence
weakness of the pelvic floor
urine leakage due to abrupt increase in intra-abdominal presure
what is the treatment of stress incontinence
kegel exercises to strengthen pelvic floor musculature
vaginal estrogens
use of a pessary
surgery
what is overflow incontinence
impaired detrusor contractility - occurs when urinary retention leads to bladder distention and overflow of urine through the urethra
what is the treatment of overflow incontinence
intermittent self-catheterization is the best management
- cholinergic agents (bethanechol) to increase bladder contractions
- alpha blockers (terazosin, doxazosin) to decrease spincter resistance
what is functional incontinence
occurs in pts who have nromal voiding systems but who have difficulty reaching the toilet becaue of pysical or mental disabilities
what is the treatment of functional incontience
scheduled voiding times
what is first line for mixed incontience
lifestyle modifications and pelvic floor exercises
