reproductive Flashcards
describe dysfunctional bleeding
abnormal uterine bleeding that occurs less than 21 days or >36 days or in
excessive amounts w/clots lasting > 7 days
with dysfunctional bleeding what must be ruled out
anatomical endometrial lesion must be ruled out
Ovulatory bleeding
Normal variant - “migelschmertz”
Normal (23-39 days {mean 29}, 2-7 days w/most blood loss in 1st few days)
Menorrhagia (normal in timing, excessive in amount &duration)
Intermenstrual (occurs between regular menses)
Ovulatory bleeding causes
fibroids Ca of the cervix endometrial Ca polyps, erosions , infection foreign bodies
what is anovulatory
disturbance w/in hypothalamic- pituitary-ovarian axis
when can you see an anovulatory state
Seen typically w/mild dysfunc;on of above w/irregular menses from situa-onal stress, wt. loss, exercise training
PCOs Presents
Irregularperiods:oligomenorrhea(<9menses/yr)oramenorrhea(nomensesfor3or
more consecu;ve months) infer;lity
Physical signs of PCOs
Hirsutism, obesity, amenorrhea, acne, DUB, Acanthosis Nigricans, HTN
Ovarian androgen overproduc;on is linked to
insulin resistance
Complications of PCOs
ncreased risk of T2DM r/t obesity, insulin resistance, impaired glucose tolerance,& dyslipidemia predispose to CHD
Nonalcoholic steatohepatitis
Mood disorders (depression & anxiety)
diagnostic test for ovulation evaluation
FSH (>40 ovarian failure),
LH, Prolactin,
serum progesterone,
testosterone
S/S of Menorrhagia
H/o prolonged heavy menses > 7 days •
Usual cycle interval
S/S Intermentstrual Bleeding:
mid cycle bleeding that is unpredictable • Regular ovulatory menses
s/s of Anovulatory Bleeding:
Menstruation that occurs without ovulation
Evidence of hyperandrogenemia –
Body build, hair distribution
Diagnostic labs with annovulatory bleeding
evaluation – B-hCG – CBC – Thyroid, prolac;n, cortisol – Testosterone – Endometrial Bx- >35, severely obese, abn. blg >5 yrs
s/s of Amenorrhea
absence of menstrual bleeding
Types of Ammenorrhea
Primary-
– No bleeding by the age of 14 in the absence of 2nd sex characteristics
no bleeding by age 16 regardless of the presence of normal G & D w/ 2nd sex characteristics
Secondary- previously menstruating & misses 3 cycles
Primary Ammenorhea is due to
result of gene;c disorders or premature loss of follicles
secondary Ammenorhea is due to
Secondary- lack of gonadatropin s;mula;on to normal ovaries
ammenorheia is associated with
elevated prolactin and galactorrhea.
Menopause is
Permanent cessa;on of menstrua;on following the decline of
ovarian estrogen production
Peri-menopause is
the period extending from immediately before to after the menopause (45-55 yrs), transi;on lasts 4 years, marked by altered ovarian functi on
S/S of menopause
irregular menses, hot flashes, dyspareunia r/t vaginal dryness, night sweats, dry skin or hair, joint stiffness, urinary changes, H/A, irritability, insomnia, depression, loss of sense of well being,
Diagnostic test for menopause is
Pap smear: – Endometrial bx – Mammogram yearly after 40 – Cholesterol baseline data rpt q 5 yrs – BS – baseline data – TSH, T4 – Prolactin , FSH – Pregnancy test – FOB annual exam for women>40 – Sigmoidoscopy q 5 yrs after 50
vaginal discharge
Bacterial vaginosis (BV) (gardnerella) caused by change in normal flora = overgrowth of anaerobic bacteria
Candida infections occur when
natural flora (candida albicans & nonalbicans candida) proliferate
Trichomoniasis caused by protozoan trichomonas vaginalis & is considered a
a sexually transmitted disease
S/S of Bacterial Vaginosis:
Increased vaginal discharge, vaginal burning aoer intercourse, strong “fishy” odor, no associated symptoms of inflammation
S/S of Candidiasis:
C/o itching (severe), burning w/urina;on, dysparuenia or burning w/intercourse, discharge is thick, white & curd-like
s/s of Trichomoniasis
Foul-smelling yellow-green discharge, external itching,
burning, dyspareunia & postcoital bleeding,
what is the incubation period for Trichomoniasis
4-28 days average 1 week
external genitaila with Trih
excoriated,
erythema, edema,
ulcerations,
lesions
vaginal mucosa with Trich
may notice red papules
vaginal mucosa with BV is
normal may have coaty white discharge
Cervix with Tich is
strawberry – like appearance
Discharge with Trich is
greenish,
yellow,
malodorous,
frothy
discharge with BV is
grayish,
fishy,
musty odor
Discharge with Candidiasis
thick,
odorless,
white,
curd-like
Vulvovaginitis: Diagnostic Test
pH (normal: 3.8 - 4.5)
Ph with BV
> 4.5
Ph with Cadidiasis
<4.5
Ph withTrich is
> 5
NS wet mount with candidiasis is
negative
NS wet mount for BV
Clue cells > 20
NS wet mount for Trich is
highly motile, oval cells
KOH for Candidiasis
pseudohypae, budding yeast
KOH for BV
yields + whiff test
BV can increase a women susceptibility to
other STDs, such as herpes simplex virus (HSV), Chlamydia and gonorrhea
HIV
Trich can increase a women susceptibility to
HIV
Chlamydia:
Definition
chlamydia trachoma.s a bacterial agent causing sexually transmiged
disease of the reproductive tract mucous membranes
Is Chlamydia reported to the CDC
Yes
Chlamydia: Pathogen
Chlamydia Trachomatis
Chamydia complications in men
NGU –nongonococcal urethritis
Acute epididymitis, pain, & rare sterility
Gonorrhea:
– Diagnostic tests
Wet prep : increased WBCs, decreased normal flora
• Gram stain: identification of intracellular gram – diplococci provides immediate dx
Balanitis:
infection frequent in uncircumcised males Mucocutaneous candidiasis fungal infection
inflammation of the urethra not caused by gonococcal infection
NGU
Chlamydia trachomatis
NGU can lead to
Reiter’s syndrome
urethritis
conjunctivitis
lesions of the skin and mucous membranes
NGU is the most common
STD in men
