Test 3 Deck 6 Flashcards
Chronic pelvic pain description?
- Noncyclic pain >6 months
- Localized to an atomic pelvis, anterior abdominal wall at or below the umbilicus
- Pain sufficiently severe to cause functional disability or lead to medical intervention
Patients w/ chronic pelvic pain are more likely to develop what?
IBS, vulvodynia, interstitial cystitis, depression, fribomyalgia, chronic fatigue syndrome, temporomandibular disorder, migraine
If a patient has a hx of ___ __ it makes them more likely to have chronic pelvic pain.
Sexual abuse
What is important to remember on a gynecological exam for chronic pelvic pain?
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
What are some causes of chronic pelvic pain?
Pelvic adhesions (surgery)
Pelvic congestion syndrome (varicoceles)
What is the treatment for pelvic congestion syndrome?
OCP, ovarian vein embolization, or hysterectomy
What is the treatment for overall chronic pelvic pain?
Refer to GYN,
Antidepressants specifically TCA (amitryptyline)
What is the treatment for vulvodynia?
Behavior therapy Topical lidocaine Topical gabapentin Antidepressants (TCA first line) Anticonvulsants
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__
Localized provoked vulvodynia
Neuropathic pain meds
Topical lidocaine
Pushing around and hit a trigger point on outside?
Myofascial pain syndrome (muscle, but can be from chronic things like endometriosis, interstitial cystitis, or IBS)
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?
Reduce spasm and trigger points. PT, massage, botulinum toxin, analgesics, muscle relaxants
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__
Peripartum pelvic pain syndrome
PT, exercise, analgesics (NSAIDs/Tylenol)
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___
Pudendal neuralgia
PT, gabapentin/TCA, botulinum toxin, pudendal nerve stimulation/ surgical nerve decompression
What is called when the uterus prolapses?
Procidentia
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__
Pelvic organ prolapse
Minimal sx: watch Corrections: Estrogen Kegel’s Pressaries Surgery
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__
Interstitial cystitis
Painful bladder syndrome
Pat education and avoidance of triggers
What are the different types of incontinence?
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)
Transient incontinence
DIAPPERS
Delirium/demmentia Infection Atrophic vaginitis/urethritis Psychiatric disorders Pharmacological disorders Endocrine disease Restricted mobility Stool impaction
If you pee when you cough, sneeze or lift, what iincontinance is that associated w/?
Stress
If you pee, but you couldn’t make it to the toilet fast enough, what is that??
Urgent
What is the cause of stress urinary incontience?
Pelvic floor or urethra weakness
What is the cause of urge incontience?
Detrusor instability
Pt. Presents w/ stress and urge incontinence symptoms. They complain of frequency, hesitation, nocturia, and dribbling. DX__ causes__
Incomplete bladder emptying
Overdistension/ bladder outlet restriction (surgery/injury)
CA++ blockers
Alpha adrenergic agonists
What is the MC type of incontinence in women?
Mixed
What is the q-tip test?
Change in angle by >30 degrees to horizontal suggests hyper mobility
What is the treatment for incontiinence?
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
What do anticholinergics do for incontinence?
Work on detrusor muscle
What does imipramine do for incontience?
Use for mixed
What can you use to treat for refractory urgency and anal incontinence?
Sacral neuomodulation (implantable system)
Percutaneous tibial nerve stimulation
What medications does someone w/ stress incontinence want to avoid?
Alpha antagonists
What medications does someone w/ overflow incontience want to avoid?
Alpha agonists
Anti-cholinergics
Ca++ blockers
Diagnosis of menopause?
No menses for 1 year
Cessation of menstruation prior to age 40?
Premature ovarian failure
How long does menopause transition take?
4-7 years
What stages are associated w/ reproductive stages of the reproductive aging workshop?
-5, -4, -3
At what stage does the menopausal transition begin?
-2 (early) -1 (late)
How can you tell the difference when the menopausal transition begins?
Elevation of FSH
Early menopause transition does what to the menstrual cycles?
Variable cycle length (>7 days dif from normal)
What does late stage perimenopause (menopausal transition do to the period?
> = 2 skipped cycles and an interval of amenorrhea (>= 60 days)
How long is early post menopause?
4 years
Are you still able to become pregnant during early menopausal transition?
Yes
At what age can contraception be discontinued by all women?
55 y/o
What is the leading cause of death in women >50?
Cardiovascular disease
What is hormone therapy not recommended for?
Cardio protection
Horomone therapy reduces ___ cance risk, reduce __ fracture risk, but increase risk of cancer, stroke, blood clots, VTE, choleystitis, and possible ovarian cancer.
Colon, hip
When is hormone therapy indicated?
Vasomotor symptoms, vaginal atrophy, osteoporosis prevention and treatment
If the uterus is present what must you add to estrogen therapy?
Progestin to reduce the risk of endometrial cancer. Unopposed estrogen leads to endometrial hyperplasia
Estrogen CI:
- Undiagnosed vag bleeding
- Breast cancer
- Estrogen dependent neoplasia
- Thromboembolism
- Thromboembolic disease (stroke, MI)
- liver dysfunction
- Pregnancy
What are the Hormonee therapy preps that may be used if the pt. Has a uterus?
Estrogen + progestins
Estrogen+ based oxide emissions
What other medications besides hormone therapy may be used for vasomotor treatment?
CNS agents;
She really hit SNRIs (desvenlafaxine, and venlafaxine)
Who is screened for osteoporosis?
- > =65
- Or 1 or more risk factors
- Sustain fractures
What z-score would indicate evaluating for osteoporosis?
WHO criteria for osteoporosis?
Normal BMD 2.5 to -1
Osteopenia -1 to -2.5
Osteoporosis < -2.5
Secondary causes that may want you to consider screening for osteoporosis?
Hyperparathyroid Hyperthyroid Renal failure Hypercortisoolism Alcoholic
What vitamins are recommended for women >=51 for prevention of osteoporosis?
Calcium 1200 mg, Vit D 800-1000 IU
What is the treatment for osteoporosis?
Regular weight bearing Stop smoking Decrease alcohol Lower weight Minimize fall risks Ca 1200-1500 Vit D 800
Who get’s osteoporosis treatment?
- Total hip/femoral neck/spine t-scores <=-2.5
- Osteoporotic vertebral/hip fracture
- -1 - -2.5 w/ oe or more additional risk factors for fracture
What are good antiresporptive agents?
Estrogen, SERMs, bisphosphanates, dnosumab
What are good medicines to stimulate bone formation (anabolic agents)?
Recombinant parathyroid hormone
What are the long term safety concerns of bisphosphanates?
Osteonecrosis of the Jaw, and atypical femur fractures
What drug decreases bone resorption by blocking the function and survival, but not the formation of osteoclasts?
Bisphosphonates
What drugs are agonists at the bone level and prevent vertebral fracture
SERM (Raloxifene)
What drugs inhibit osteoclast development and activity?
Monoclonal antibodies (denosumab)
What drug can be used in lieu of estrogen that reduces the risk of vertebral fractures and decreases the rate of bone resorption?
Salmon calcitonin
What drug is the only drug that builds bone by iincreasing osteoblast number and activity/ can only be used for 18-24 months?
Recombinant parathyroid hormone
T-score to DEXA scan frequency?
- 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
Osteoporosis risk factors?
- > 65
- Vertbral compression fix
- Fragility fracture
- Fam hx
- System glucocorticoids >3 months
- Malabsorption
- Primary hyperparathyroid
- Falling
- Osteopenia on radiograph
- Hypogonadism
- Early menopause
- Anticonvulsant therapy
- Smoker
- Alcoholic
- Excessive caffeine
- Weight <57 kg
- > 10% weight loss at 25
- Chronic heparin therapy
