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PSP > Pelvic Pain > Flashcards

Pelvic Pain Flashcards

1
Q

Speculum exam

A

. Insert 45 degree angle for nulliparous women
. Insert w/ no angle for multiprous women
. Apply downward pressure
. Advance to top of vagina
. Open speculum until cervix comes into view
. Check for vaginal mucosa (has rugae), discharge, lesions/ulcers, cervix shape, size, lesions, and discharge

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2
Q

What can ectropion cervix be confused w/?

A

. Friable cervix or erosion

. Means there is columnar epithelium around hole and squamous epithelium around rest

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3
Q

Cervical cancer screening and risks

A

. Liquid based cytology
. Risks: HPV, multiple sexual partners, smokers, immunosuppression, age, SES, herpes, diethylstilbestrol exposure during pregnancy

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4
Q

Positions of uterus

A 
. Anteverted
. Midposition
. Anteflexed
, retroflexed
. Retroverted
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5
Q

Common gynecologic complaints

A 
. Pelvic pain
. Abnormal discharge/odor
. Abnormal uterine bleeding 
. Dysmenorrhea
. Dyspareunia
. Post coital pleading 
. Dysuria 
. Vulvar lesions 
. Vulvar itchiness
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6
Q

Causes of RLQ pelvic pain

A 
. Appendicitis 
. Ectopic pregnancy
. Ovarian cyst
. Turbo-ovarian abscess
. Ovarian torsion 
. PID
. Nephrolithiasis
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7
Q

Causes of LLQ pelvic pain

A 
. Diverticulitis 
. Ectopic pregnancy 
. Ovarian cyst
. Turbo-ovarian abscess
. Ovarian torsion 
. PID
. Nephrolithiasis
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8
Q

Causes of central pelvic pain

A 
. Endo 
. Cramps 
. PID
. Cystitis 
. Painful bladder syndrome
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9
Q

Endometriosis

A

. Endometrial implants outside uterus

. Pain from inflammation and bleeding from implants

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10
Q

Pelvic inflammatory disease (PID)

A

. Ascending infection (chlamydia, gonorrhea, endogenous microorganisms) into uterus, Fallopian tubes, and ovaries
. Can lead to turbo-ovarian abscess
. Inc. risk future infertility
. Inc. risk ectopic pregnancies

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11
Q

Ectopic pregnancy

A

. Improperly implanted pregnancy
. Most common in Fallopian tube
. Can occur cornual, at C-section scar, abdominal, pelvic, cervical, or ovarian
. Risk factors: PID, prior ectopic pregnancy, tubal surgery, IUD, assisted reproductive technology

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12
Q

Ovarian cysts

A

. Usually benign
. Follicular cysts most common
. Hemorrhagic cysts
. Small, less than 6 cm, resolve on own

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13
Q

Ovarian torsion

A

. Ovary twists on own pedicle
. Obstructs blood flow to ovary through ovarian a.
. Risk factors: ovarian cyst over 5cm, malignancy, ovulation induction treatment

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14
Q

STI infection screening guidelines

A

. Chlamydia and gonorrhea: pregnancy, yearly under 25 and sexually active, 25 y/o w/ new sexual partner, NAATs on vagina, cervix, and urine
. Syphillis: in pregnancy, if high relish sexual behaviors, HIV+
. HIV: pregnancy, when requesting STI screening, can opt-out
. Hep B: pregnancy, high risk behaviors, HIV
. Hep C:, high risk behaviors, HIV+, born btw 1945-1965
. Genital herpes: not recommended

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15
Q

Premenstrual syndrome

A

. Painful cramping due to prostaglandin release

. 70% experience primary dysmenorrhea in lifetime

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16
Q

Hemorrhagic cysts

A

. Follicular cysts that tear a little and fill with blood

. Can be more painful

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17
Q

Normal Vaginal discharge

A

. Fluctuates w/ changes in hormones
. Egg-white during ovulation
. Thicker during second half of menstrual cycle when progesterone is high

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18
Q

Abnormal vaginal discharge

A

. Weird odor, irritation
. Not associated w/ changes in menstrual cycle
. Most common causes: bacterial vaginosis, trichomonas, and candidiasis

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19
Q

Bacterial vaginosis

A

. Bacterial overgrowth: Gardnerella vaginalis
. Symptoms: unpleasant odor, thin discharge, burning w/ intercourse
. Itchiness and irritation
. Discharge gray or white thin discharge, fishy
. Lab evaluation: Wet mount for clue cells, KOH, whiff test, pH over 4.5

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20
Q

Trichomonas

A

. Sexually transmitted protozoan
. Symptoms: malodorous discharge, pain w/ intercourse, pain w/ urination, itchiness
. Discharge: yellowish-green frothy
. Labs: wet mount for trichomonas

21
Q

Vulvovaginal candidiasis

A

. Overgrowth of yeast (candida albicans)
. Symptoms: puritis, vaginal pain, pain w/ urination, pain w/ intercourse
. Discharge: white and curdy
. Labs: KOH shows branching hyphae

22
Q

Menarche

A

. Average age 12.5
. 21-35 days btw menses
. Irregular in first 2 yrs
. Up to 80mL blood normal

23
Q

Dysmenorrhea

A

. Pain w/ cycle
. Primary: inc. prostaglandins causing cramping, 70% have this
. Secondary: endo, PID, polyps, or adenomyosis

24
Q

Premenstrual syndrome

A

. Fatigue common

.5 days before menses and resolve w/in 4 days of start of menses

25
Q

Amenorrhea

A

. Absence of periods
. Primary: never had period
. Secondary: stopped due to pregnancy, lactation, menopause, low body weight, or PCOS

26
Q

Abnormal uterine bleeding

A

. Polymenorrhea: less than 21 days btw cycles
. Oligomenorrhea: over 35 days btw cycles
. Menorrhagia: excessive menstrual flow
. Metrorrhagia: bleeding btw cycles
. Postcoital bleeding: polyps, cancer, chlamydia

27
Q

Weird bleeding structural causes

A 
PALM
. Polyps
. Adenomyosis
. Leiomyoma
. Malignancy
28
Q

Weird bleeding nonstructural causes

A 
COEIN
. Coagulopathy
. Ovulatory dysfunction
. Endometrial 
. Iatrogenic
. Not yet classified
29
Q

Menopause

A

. Lack of menses for 12 months
. Normal after 40
. Average is 51.5 y/o
. Vasomotor symptoms through perimenopause and beyond

30
Q

Postmenopausal bleeding

A

. Any bleeding after diagnosis of menopause
. Warning sign for endometrial cancer
. Most common cause is atrophy

31
Q

Abnormalities of vulva and vagina

A

. Epidermoid cyst
. Yellowish appearance
. Blocked opening of gland
. Resolved w/ compress or Sitz bath

32
Q

Condyloma acuminatum

A

. Warty lesions
. HPV 6 and 11
. Cauliflower like appearance
. Will resolve on own, but can use cream

33
Q

Syphilis

A

. Chancre: about 21 days after exposure, painless ulcer, resolves w/o treatment
. Condyloma Latum: secondary syphilis, large, raise, oval or round, gray or white Papules

34
Q

Genital herpes

A

. HSV 1 or 2
. Traditionally HSV 1 is oral and HSV 2 is genital
. Large cross over now btw types
. Shallow, painful ulcers
. More frequent recurrence w/ HSV 2
. Culture these and send PCR for diagnosis

35
Q

Vulvar carcinoma

A

. Normal appearing vulva w/ chronic itchiness or irritation
. Can have hyperpigmentation, erythema, or ulceration
. HPV associated

36
Q

Bartholin gland cyst

A

. Gland gets blocked and fills w/ fluid
. Sitz baths
. Incision and drainage
. Word catheter drains them (stick balloon inside of cyst and leave catheter in for 6 weeks so fluid can drain out)

37
Q

Bartholin gland abscess

A

. Gland gets infected
. More erythematous and drains purulent fluid
. Causes: trauma, gonococci, anaerobes, and C. Trachomatis
. treat w/ I&D and antibiotics

38
Q

Cervicitis

A

. Purulent or yellow drainage from external cervix
. Typicall from C. Trachomatis or N. Gonorrhoeae
. Cervix friable

39
Q

Diethylstilbestrol exposure in utero

A

. Given to women btw 1938-1971 to dec. risk of miscarriage
. Columnar epithelium covers cervix
. Inc. risk of clear cell carcinoma of cervix (not HPV associated)
. Girls from women that took it have its

40
Q

Cervical cancer

A

. People 50% not screened before diagnosis
. 10% hadn’t been screened in over 5 yrs
. Gardasil-9 : cover 9 strains of HPV shot btw 9-12 y/o (can be given up to 45 y/o), 2 step if under 15, 3 step if over 15
. 90% effectiveness for invasive cervical cancer
. 93.6% effective for high grade neoplasia

41
Q

Cervical cancer screening ages under 21

A

Not recommended

42
Q

Cervical cancer 21-29 screening

A

. Every 3 yrs

. When high risk HPV, used as reflex test only when pap result is ASC-US

43
Q

Cervical cancer screening 30-65

A

. Co-testing w/ pap and HPV every 5 yrs
. Cytology alone every 3 yrs
. Option to use as reflex test in co-tested patients whose pap is neg. but HPV is pos.

44
Q

Cervical cancer screening over 65

A

. Discontinued if patient has adequate neg. prior to screening results and no history of CIN2+
. Continue age-based screening in patient w/ history of CIN2, CIN3, or adenocarcinoma in Situ

45
Q

Cystocele

A

. Ant. Portion

. Bladder starts to bulge and fall into area of vagina

46
Q

Rectocele

A

. Post. Side of vagina bulging out

47
Q

Carnuncle

A

. Columnar cells start growing outside of urethra

48
Q

Adenomyosis

A

. Blood vessels from stroma of uterus invade into myometrium

PSP (35 decks)

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