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OB GYN > Test 3 Deck 6 > Flashcards

Test 3 Deck 6 Flashcards

1
Q

Chronic pelvic pain description?

A
  1. Noncyclic pain >6 months
  2. Localized to an atomic pelvis, anterior abdominal wall at or below the umbilicus
  3. Pain sufficiently severe to cause functional disability or lead to medical intervention
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2
Q

Patients w/ chronic pelvic pain are more likely to develop what?

A

IBS, vulvodynia, interstitial cystitis, depression, fribomyalgia, chronic fatigue syndrome, temporomandibular disorder, migraine

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3
Q

If a patient has a hx of ___ __ it makes them more likely to have chronic pelvic pain.

A

Sexual abuse

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4
Q

What is important to remember on a gynecological exam for chronic pelvic pain?

A

They may hurt. Let the patient know you can stop whenever and start w/ outer paplation w/ q tip. Then slide in a single digit to look for trigger points, regions of tenderness, and nodules. Rectals are indicated. You may see allodynia and hyperalgesia

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5
Q

What are some causes of chronic pelvic pain?

A

Pelvic adhesions (surgery)

Pelvic congestion syndrome (varicoceles)

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6
Q

What is the treatment for pelvic congestion syndrome?

A

OCP, ovarian vein embolization, or hysterectomy

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7
Q

What is the treatment for overall chronic pelvic pain?

A

Refer to GYN,

Antidepressants specifically TCA (amitryptyline)

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8
Q

What is the treatment for vulvodynia?

A 
Behavior therapy 
Topical lidocaine
Topical gabapentin
Antidepressants (TCA first line)
Anticonvulsants
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9
Q

Pt presents w/ rawness, itching, cutting pain in vulvar region. Lacks physical signs, has new onset insertional dyspereunia (and pain w/ tampon insertion/bathing). Light touch applicator on vulva elicited tenderness and it’ erythematous. Dx__ trx__

A

Localized provoked vulvodynia

Neuropathic pain meds
Topical lidocaine

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10
Q

Pushing around and hit a trigger point on outside?

A

Myofascial pain syndrome (muscle, but can be from chronic things like endometriosis, interstitial cystitis, or IBS)

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11
Q

Pt. Having trigger pain involving the levator ani muscles. Pt. Complaining of lower abdominal pain, low back pain, dysperenuia, and chronic constipation. What is the treatment?

A

Reduce spasm and trigger points. PT, massage, botulinum toxin, analgesics, muscle relaxants

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12
Q

Pt. Presents w/ complaint of pelvic girdle pain following pregnancy/ right around pregnancy. The pain is focused around the SI joints. You know this originates from injury or inflammation of pelvic and/or lower spine ligaments. DX__ trx__

A

Peripartum pelvic pain syndrome

PT, exercise, analgesics (NSAIDs/Tylenol)

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13
Q

Pt. Presents w/ sharp, severe, shooting pain in clitoris, vulva, rectum. Aggravated by sitting. Doesn’t awaken patient from asleep and is relieved by a nerve blockade. Dx___ trx___

A

Pudendal neuralgia

PT, gabapentin/TCA, botulinum toxin, pudendal nerve stimulation/ surgical nerve decompression

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14
Q

What is called when the uterus prolapses?

A

Procidentia

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15
Q

Pt. Presents w/ bulge symptoms. Complaint of feeling like sitting on a ball. The symptoms are exacerbated by posture, and relieved by supine position. The have been using their fingers to help the remove stool. Dx__ trx__

A

Pelvic organ prolapse

Minimal sx: watch
Corrections:
Estrogen
Kegel’s
Pressaries
Surgery
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16
Q

Pt. Presents w/ urinary frequency, urgency, and pelvic pain. You perform an exam and find mucosal changes (hunner ulceration) and reduced bladder capacity. they are triggered by alcohol, caffeine, smoking, spicy foods, citrus, fruits and juices (cranberry juice). DX___ dif. Dx__ trx__

A

Interstitial cystitis

Painful bladder syndrome

Pat education and avoidance of triggers

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17
Q

What are the different types of incontinence?

A

Stress (involuntary leakage w/ increased in intraabdominal pressure)

Urge (void and right before need to go bad)

Overflow (incomplete emptying)

Functional (mixed stress and urge)

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18
Q

Transient incontinence

A

DIAPPERS

Delirium/demmentia
Infection
Atrophic vaginitis/urethritis
Psychiatric disorders
Pharmacological disorders
Endocrine disease
Restricted mobility
Stool impaction
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19
Q

If you pee when you cough, sneeze or lift, what iincontinance is that associated w/?

A

Stress

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20
Q

If you pee, but you couldn’t make it to the toilet fast enough, what is that??

A

Urgent

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21
Q

What is the cause of stress urinary incontience?

A

Pelvic floor or urethra weakness

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22
Q

What is the cause of urge incontience?

A

Detrusor instability

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23
Q

Pt. Presents w/ stress and urge incontinence symptoms. They complain of frequency, hesitation, nocturia, and dribbling. DX__ causes__

A

Incomplete bladder emptying

Overdistension/ bladder outlet restriction (surgery/injury)

CA++ blockers
Alpha adrenergic agonists

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24
Q

What is the MC type of incontinence in women?

A

Mixed

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25
Q

What is the q-tip test?

A

Change in angle by >30 degrees to horizontal suggests hyper mobility

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26
Q

What is the treatment for incontiinence?

A

Pelvic floor strengthening

Kegel excersises 50-60 contractions a day
Isotonic 10 seconds

Biofeedback
Dietary changes
Addition of calcium glycerophphate my help reduce urgency

Schedule voiding
Estrogen replacement
Incontinence pessary
Surgery

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27
Q

What do anticholinergics do for incontinence?

A

Work on detrusor muscle

28
Q

What does imipramine do for incontience?

A

Use for mixed

29
Q

What can you use to treat for refractory urgency and anal incontinence?

A

Sacral neuomodulation (implantable system)

Percutaneous tibial nerve stimulation

30
Q

What medications does someone w/ stress incontinence want to avoid?

A

Alpha antagonists

31
Q

What medications does someone w/ overflow incontience want to avoid?

A

Alpha agonists
Anti-cholinergics
Ca++ blockers

32
Q

Diagnosis of menopause?

A

No menses for 1 year

33
Q

Cessation of menstruation prior to age 40?

A

Premature ovarian failure

34
Q

How long does menopause transition take?

A

4-7 years

35
Q

What stages are associated w/ reproductive stages of the reproductive aging workshop?

A

-5, -4, -3

36
Q

At what stage does the menopausal transition begin?

A

-2 (early) -1 (late)

37
Q

How can you tell the difference when the menopausal transition begins?

A

Elevation of FSH

38
Q

Early menopause transition does what to the menstrual cycles?

A

Variable cycle length (>7 days dif from normal)

39
Q

What does late stage perimenopause (menopausal transition do to the period?

A

> = 2 skipped cycles and an interval of amenorrhea (>= 60 days)

40
Q

How long is early post menopause?

A

4 years

41
Q

Are you still able to become pregnant during early menopausal transition?

A

Yes

42
Q

At what age can contraception be discontinued by all women?

A

55 y/o

43
Q

What is the leading cause of death in women >50?

A

Cardiovascular disease

44
Q

What is hormone therapy not recommended for?

A

Cardio protection

45
Q

Horomone therapy reduces ___ cance risk, reduce __ fracture risk, but increase risk of cancer, stroke, blood clots, VTE, choleystitis, and possible ovarian cancer.

A

Colon, hip

46
Q

When is hormone therapy indicated?

A

Vasomotor symptoms, vaginal atrophy, osteoporosis prevention and treatment

47
Q

If the uterus is present what must you add to estrogen therapy?

A

Progestin to reduce the risk of endometrial cancer. Unopposed estrogen leads to endometrial hyperplasia

48
Q

Estrogen CI:

A
  1. Undiagnosed vag bleeding
  2. Breast cancer
  3. Estrogen dependent neoplasia
  4. Thromboembolism
  5. Thromboembolic disease (stroke, MI)
  6. liver dysfunction
  7. Pregnancy
49
Q

What are the Hormonee therapy preps that may be used if the pt. Has a uterus?

A

Estrogen + progestins

Estrogen+ based oxide emissions

50
Q

What other medications besides hormone therapy may be used for vasomotor treatment?

A

CNS agents;

She really hit SNRIs (desvenlafaxine, and venlafaxine)

51
Q

Who is screened for osteoporosis?

A
  1. > =65
  2. Or 1 or more risk factors
  3. Sustain fractures
52
Q

What z-score would indicate evaluating for osteoporosis?

A
53
Q

WHO criteria for osteoporosis?

A

Normal BMD 2.5 to -1
Osteopenia -1 to -2.5
Osteoporosis < -2.5

54
Q

Secondary causes that may want you to consider screening for osteoporosis?

A 
Hyperparathyroid
Hyperthyroid
Renal failure
Hypercortisoolism
Alcoholic
55
Q

What vitamins are recommended for women >=51 for prevention of osteoporosis?

A

Calcium 1200 mg, Vit D 800-1000 IU

56
Q

What is the treatment for osteoporosis?

A 
Regular weight bearing
Stop smoking
Decrease alcohol
Lower weight
Minimize fall risks
Ca 1200-1500
Vit D 800
57
Q

Who get’s osteoporosis treatment?

A
  1. Total hip/femoral neck/spine t-scores <=-2.5
  2. Osteoporotic vertebral/hip fracture
  3. -1 - -2.5 w/ oe or more additional risk factors for fracture
58
Q

What are good antiresporptive agents?

A

Estrogen, SERMs, bisphosphanates, dnosumab

59
Q

What are good medicines to stimulate bone formation (anabolic agents)?

A

Recombinant parathyroid hormone

60
Q

What are the long term safety concerns of bisphosphanates?

A

Osteonecrosis of the Jaw, and atypical femur fractures

61
Q

What drug decreases bone resorption by blocking the function and survival, but not the formation of osteoclasts?

A

Bisphosphonates

62
Q

What drugs are agonists at the bone level and prevent vertebral fracture

A

SERM (Raloxifene)

63
Q

What drugs inhibit osteoclast development and activity?

A

Monoclonal antibodies (denosumab)

64
Q

What drug can be used in lieu of estrogen that reduces the risk of vertebral fractures and decreases the rate of bone resorption?

A

Salmon calcitonin

65
Q

What drug is the only drug that builds bone by iincreasing osteoblast number and activity/ can only be used for 18-24 months?

A

Recombinant parathyroid hormone

66
Q

T-score to DEXA scan frequency?

A
  • 2 to -2.5 q 1 year
  • 1.5 to -2 q 3-5 year as
  • 1.01 to -1.5 q 10-15 years
  • 1 or higher q 15 years
67
Q

Osteoporosis risk factors?

A
  1. > 65
  2. Vertbral compression fix
  3. Fragility fracture
  4. Fam hx
  5. System glucocorticoids >3 months
  6. Malabsorption
  7. Primary hyperparathyroid
  8. Falling
  9. Osteopenia on radiograph
  10. Hypogonadism
  11. Early menopause
  12. Anticonvulsant therapy
  13. Smoker
  14. Alcoholic
  15. Excessive caffeine
  16. Weight <57 kg
  17. > 10% weight loss at 25
  18. Chronic heparin therapy

OB GYN (9 decks)

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