SM02 Mini4

Question 1

why is it importnat to talk about sex w/patients?

Answer 1

• talking about sex history helps improve overall health
• reduce disease & death by preventing & treating STDs, HIV, & hepatitis
• improve patients’ mental health & well-being thru identifying & tx of sexual problems
• improvement in physician-patient relationship

Question 2

barriers in taking sexual hx

Answer 2

• time
• reimbursement concerns
• privacy
• confidentiality
• provider discomfort
• unfamiliarity w/content or language

Question 3

5 Ps of sexual hx

Answer 3

1. partners: type & number
2. practices: type of sexual contact
3. protection from STDs
4. past hx of STDs
5. prevention of pregnancy

Question 4

questions for how to determine cause of infertility

Answer 4

• is ovulation occurring?
• is there adequate sperm w/adequate moltility?
• are Fallopian tubes patent?
• is uterine cavity ok?
• is there any pelvic disease
  
  • pelvic inflammatory dz can damage hair cells

Question 5

classic workup for infertility

Answer 5

• documentation of ovulation
• semenanalysis of partner
• hysterosalpingogram evaluates uterine cavity & Fallopian tubes
• diagnostic hysteroscopy to evaluate for pelvic disease

Question 6

how should the endometrium appear on ultrasound around the time of the LH surge?

Answer 6

trilaminar

Question 7

cause of luteal phase defect

Answer 7

probably abnormal formation of cellular adhesion molecules (CAMs), ex. integrins, & abnormal hormonal response of endometrium to estrogen & progesterone

Question 8

what studies are included in a semenanalysis?

Answer 8

sperm density (#/volume)

sperm motility

sperm morphology

Question 9

oligozoospermia

Answer 9

decreased # of spermatozoa in semen

Question 10

aspermia

Answer 10

complete lack of sperm

Question 11

hypospermia

Answer 11

reduced seminal volume

Question 12

azoospermia

Answer 12

absence of sperm cells in semen

Question 13

teratozoospermia

Answer 13

increase in sperm w/abnormal morphology

Question 14

asthenozoospermia

Answer 14

reduced sperm motility

Question 15

WHO criteria for normal sperm parameters

Answer 15

2010

1.5mL ejaculate

15million sperm/mL

32% motility

4% strict morphology by Kruger criteria

Question 16

how is sperm chromatin so tightly packed compared to somatic cells?

Answer 16

histones are replaced by protamines that allow DNA to form toroidal structures

Question 17

what causes Asherman’s Syndrome?

Answer 17

vigorous curettage of uterus or manual extraction of the placenta

ligher or more painful periods develop after such a procedure

may see uterine adhesions

Question 18

what is the difference between an polyp & a fibroid?

Answer 18

polyps are soft & of endometrial origin

fibroids are hard muscular growths

Question 19

other than the pelvis, where can signs of pelvic inflammatory disease be found?

Answer 19

perihepititis can be caused by PID

adhesions around the liver

Question 20

adenomyosis

Answer 20

endometrium grows into the pelvic wall

Question 21

tests to estimate ovarian reserve

Answer 21

• day 3 of menstrual cycle FSH <9IU/dL & estradiol <60pg/dL
• Clomid challenge test
• antral follicle count
• anti-Mullerian hormone
• inhibin B

Question 22

health risks for PCOS pt

Answer 22

**pt is estrogen replete**

endometrial hyperplasia

CV dz

HTN

diabetes

lipid abnormalities

obesity

sleep apnea

Question 23

treatment for infertility of PCOS pt

Answer 23

induce ovulation w/clomiphene citrate

Question 24

health risks for exercised induced hypothalamic amenorrhea

Answer 24

hypogonadotrophic hypogonadism→ very estrogen deficient

CV plaque formation

oesteoporosis

stress fracture

dysparunia