repro Flashcards by Katie Bergstrom

treatment for DUB

oral contraceptives or progestin. may need D&C or hysteroscopy if cannot control it.

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menorrhagia

intervals normal, duration and flow excessive

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hypermenorrhea

cycles normal, excessive flow

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metrorrhagia

interval irregular, duration and flow excessive

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menometrorrhagia

interval irregular, duration and flow excessive and intermenstrual bleeding

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oligomenorrhea

interval over 45 days with normal flow

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polymenorrhea

interval less than 21 days, normal flow

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hypomenorrhea

cycles regular, flow decreased

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menopause symptoms

hot flashes, vaginal atrophy, insomnia, anxiety/irritability, poor concentration, mood changes, dyspareunia, loss of libido

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premature menopause age

before 40

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contraindications of HRT

vaginal bleeding, breast or endometrial cancer, hx of thromboembolism, liver disease, hypertriglyceridemia

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options for menopause tx other than HRT

SSRIs, SNRIs, clonidine, gabapentin, topical estrogens

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what causes dysmenorrhea?

uterine vasoconstriction, anoxia, sustained contractions mediated by an excess of prostaglandin

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common causes of secondary dysmenorrhea

endometriosis, adenomyosis, fibroids, adhesions, polyps, PID

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adenomyosis

endometrial tissue in the myometrium of the uterus

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endometriosis

functional endometrial glands and stroma OUTside the uterus

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triad of adenomyosis

noncyclical pain, menorrhagia, enlarged uterus

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workup of abnormal uterine bleeding

b-hcg, CBC to look for anemia, pap smear to r/o cervical cancer, US to look for uterine masses, polycystic ovaries, thickened endometrium. platelets/pt/ptt for won villebrands, TFTs to r/o thyroid disorders and hyperprolactinemia.
endometrial biopsy in postmenopausal woman/obese/if endometrium is over 4mm thick

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options of tx if medical management fails DUB

D&C, hysteroscopy/hysterectomy, endometrial ablation

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redness, tenderness, induration in breast during nursing

breast abscess. most common organism is s. aureus. need to do an US if suspect abscess not just mastitis and excision if doesn’t go away with antibiotics

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round or ovoid, rubbery, discrete, movable nontender mass in breast of young woman

fibroadenoma

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you suspect fibroadenoma. next step?

fine needle biopsy. no tx necessary or may use cryoablation

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painful, tender discomfort of breast. cyst-like structure that fluctuates in size and appearance or disappearance of mass and often cyclical

fibrocystic breast disease. most common in ages 30-50

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you suspect fibrocystic breast disease. next step?

mammography…US if less than 30yo. suspicious lesions need to be biopsied

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tx fibrocystic breast disease

not indicated although may aspirate if needed to alleviate pain and confirm cystic nature of mass

tx of mastitis

dicloxacillin 500mg poq6hrs for 10-14 days

risk factors for breast cancer

female, age, fhx, smoking, early menarche, late menopause, nulliparity, HRT, alcohol

mammogram recommendations

all patients 30 and older, annually definitely if any risk factors

most common breast CA

ductal carcinoma

risk factors for PID

young, nulliparous, sexually active women with multiple partners. nonwhite, douching, smoking

protection factors for PID

barrier or oral contraceptives

lower abdominal pain, chillis and fever, menstrual disturbances, purulent cervical discharge, positive chandelier sign

PID

you suspect PID. next step?

r/o ectopic pregnancy

tx PID

ceftriaxone 250 IM plus doxy 100mg BIDx10 plus metronidazole 500mg BID x 14d

hyphae and spores on KOH prep

candidiasis

tx candidiasis

diflucan 150mg po 1-3 days

motile organisms on wet prep

trichomonas

strawberry cervix

trichomonas

tx trichomonis

metronidazole 2g po 1 dose

clue cells

tx BV

metronidazole 500mg po BID x 7days

contraindications to OCP

MI, thromboembolic disease, cerebrovascular disease (smoking, HTN, over 35) carcinoma, HA, lactation--before 6 weeks postpartum

who is the progestin minipill good for?

smokers who are over 35 or clotting disorders, safe during lactation

other options for contraception similar to OCP

depo shot, implanon, patch, ring

contraindications for IUD

pregnancy, PID

IUD options

mirena (contains hormones, good for 5 years, reduces cramping and menstrual flow) copper (good for 7 years)

plan B

effective for up to 120 hours after intercourse.

cystocele

hernia of bladder wall into vagina, causing soft, anterior fullness and may be accompanied by urethrocele or sagging of urethra

rectocele

herniation of terminal rectum into posterior vagina due to vaginal childbirth, genetics, age, prior pelvic surgery

stages of rectocele

1--halfway to hymen 2--to hymen 3--halfway past hymen 4--maximum descent

clinical findings in cystocele or rectocele

sensation of bulge or protrusion in vagina, urinary or fecal incontinence, sense of incomplete emptying, dyspareunia

bleeding or cramping occurs, but pregnancy continues, cervix not dilated

threatened abortion

cervix dilated, membranes may be ruptured, but passage of products of conception has not yet occured. bleeding and cramping persist

inevitable abortion

products of conception completely expelled, os is closed

complete abortion

cervix dilated, some of products remain in uterus, mild cramps and bleeding persists

incomplete abortion

pregnancy ceased to develop, conceptus not yet expelled but sxs of pregnancy disappear. brownish discharge but not free bleeding

missed abortion

tx of missed abortion

cervical dilation follwed by aspiration

tx threatened abortion

bed rest, resumption of usual activities and abstinence

tx incomplete or inevitable abortion

removal of products remaining

workup of ectopic pregnancy

serial b-hcg, transvaginal US. laparoscopy surgical procefure of choice to confirm ectopic and permit removal or it

tx of ectopic

methotrexate IM if <3.5 cm and no active bleeding or fetal heart tones

CI to MTX treatment of ectopic

unstable patient

where does cervical cancer most likely take place?

transformation zone

HPV strains causing cervical cancer

16 and 18

gardasil protects against what strains of HPV?

6, 11, 16, 18

symptoms of cervical cancer

metorrhagia, postcoital spotting, cervical ulceration, discharge

screening recommendations for cervical cancer

start at age 21. pap smear with cytology once every 2 years, then if 30 and had 3 negatives can move to every 3 years, DQ at 70 if never had 3 normals in a row

ASCUS. net step?

HPV testing. if positive, colposcopy. if negative, repeat in 12 months

LSIL. now what?

colposcopy.

LSIL and negative colposcopy,

repeat at 6 and 12 months

tx CIN 1

pap smear at 6 and 12 months.

tx CIN 2 or 3

cryotherapy or laser ablation or LEEP or conization or hysterectomy