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Clin med sem 2 > Uterus/FT > Flashcards

Uterus/FT Flashcards

1
Q

PCOS- pathophysiology

A

Most Common endocrinopathy in females

Insulin resistance?

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2
Q

PCOS- S/S & PE

A 
Abnormal menstrual cycle
Terminal hair - hirsutism 
acne
Alopecia
Acanthosis nigricans
Skin tags
Truncal obesity

Stein Leventhal Syndrome - anovulation/hyperandrogenism, oligomenorrhea/amenorrhea, hirsutism, obesity, enlarge polycystic ovaries, infertility

Anovulation

  • persistent high concentration of LH
  • low concentration of FSH
  • Low day 21 progesterone level
  • Sonographic follicular monitoring
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3
Q

PCOS- diagnosis

A

Rotterdam criteria - 2 of 3

  • Hyperandrogenism
  • ovulary dysfunction
  • polycystic ovaries

U/S
Ovary containing 12+ follicles sized 2-9mm OR
Ovary >10mL

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4
Q

PCOS- labs & imaging

A

Serum androgen - inc

LH - inc
FSH - dec
- inc ration 3:1

U/S - multiple cysts on ovaries

Lipids

A1C - insulin resistance

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5
Q

PCOS- treatment

A

OCP - irregular menses/acne
Metformin - hyperglycemia
Wt Loss
Clomiphene - ovulation stimulant

Chronically anovulatory

  • endometrial hyperplasia - progesterone - refer to GYN
  • Repeat U/S
  • endometrial biopsy
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6
Q

Dysmenorrhea- pathophysiology

A

Painful menstruation

Prevents nl activity and requires meds

Associated w/ ovulatory cycles
Prostaglandin activity

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7
Q

Dysmenorrhea- cause

A

Primary - excessive prostaglandin E2 secretion in menstrual fluid -> painful cramping
- starts 3-6m after menarche

Secondary - pathologic

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8
Q

Dysmenorrhea- S/S & PE

A

History

Primary

  • No specific findings
  • generalized pelvic tenderness
  • N/V, diarrhea
  • Fatigue, low back pain, HA
  • 1st day of menses

Secondary

  • Pain lasts longer than a menstrual period
  • starts before bleeding begins - worse throughout - persists after
  • > 25yo
  • blatting, menorrhagia, dyspareunia
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9
Q

Dysmenorrhea- labs & imaging

A

Labs - primary -> nl

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10
Q

Dysmenorrhea- treatment

A 
NSAIDs
Heat to abdomen
Oral contraceptives
Exercise
Transcutaneous electrical nerve stimulation 
Surgery
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11
Q

Abnormal Uterine Bleeding - in reproductive aged women- pathophysiology

A

Abnormal menstrual bleeding and bleeding due to causes - preg, systemic, cancer

If exclude everything -> dysfunctional uterine bleeding

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12
Q

Abnormal Uterine Bleeding - in reproductive aged women - cause

A 
PALM - COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy + Hyperplasia
Coag
Ovulatory Dysfunction
Endometrial 
Iatrogenic
Not otherwise classified
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13
Q

Abnormal Uterine Bleeding - in reproductive aged women - epidemiology

A

Any age

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14
Q

Abnormal Uterine Bleeding - in reproductive aged women - S/S & PE

A

Bleeding b/t periods, after intercourse, spotting anytime in menstrual cycle, bleeding heavier or for more days than normal, bleeding after menopause

Good Hx

  • LMP, LNMP
  • age of menarche/menopause
  • etc
PE
Speculum
Bimanual Exam 
Eval for other bleeding sites 
Pap
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15
Q

Abnormal Uterine Bleeding - in reproductive aged women - diagnosis

A 
Cytological exam 
- pap - cervical dysplasia
Hysteroscopy - GOLD
- direct visualization of endometrium 
D&C
- remove tissue from uterus
- diagnose and treat certain uterine conditions - heavy bleeding or clear uterine lining after miscarriage/abortion
- local anesthesia
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16
Q

Abnormal Uterine Bleeding - in reproductive aged women - labs & imaging

A 
"\Urine/Serum HCG
CBC
TSH
Hormone - prolactin, androgen, estrogen 
Endometrial biopsy ->45
- curette, cervical dilation not always needed
- small samples of tissue removed from endometrium
- looked at under microscope
- may need a D&C

Transvaginal U/S or Saline infusion sonohysterography

  • only if palpated mass on PE
  • persisting
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17
Q

Abnormal Uterine Bleeding - in reproductive aged women - treatment

A

Treat underlying problem

Mirena - IUD
OCA - estrogen + progestin
PO progestin
Tranexamic acid  - safe when trying to get preog
Myomectomy and uterine artery emboization 
Polypectomy
Hysterectomy
Endometrial ablation
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18
Q

Postmenopausal bleeding- pathophysiology

A

Menopause - 12m of amenorrhea

  • FSH>30
  • estradiol <20
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19
Q

Postmenopausal bleeding- epidemiology

A

Exogenous hormones

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20
Q

PMS- S/S & PE

A

Mood symptoms - irritability, mood swings, depression, anxiety
Physical symptoms - bloating, breast tenderness, insomnia, fatigue, hot flashes, changes in appetite
Cognitive symptoms - confusing and poor concentration
Symptoms must occur in sec half of menstrual cycle - luteal phase

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21
Q

PMS- diagnosis

A

5days prior and 4 days after menses

S/S consistent

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22
Q

PMS- labs & imaging

A

CBC
TSH
Pregnancy

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23
Q

PMS- treatment

A

Do all mammograms post cycle

Psych hx

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24
Q

Premenstrual dysphoris disorder (PMDD)- diagnosis

A

5 or 11present

  • marked dpressed mood, feelings of hopelessness
  • marked anxiety, tension, feelings,
  • affective lability
  • persistent/marked anger
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25
Q

Premenstrual dysphoris disorder (PMDD)- treatment

A

SSRI - GOLD

  • Fluoxetine - Prozac
  • Sertraline - Zoloft
  • Paroxetine controlled-release - Paxil CR
  • daily 14d prior to menses

CBT
NSAID
Vit
Bromocriptine

OCA
Benzos
Spironolactone
Lifestyle mod - caffeine, dec ETOH, smoking etc, salt restriction, inc exercise

26
Q

Leiomyoma (Uterine Fibroid)- pathophysiology

A

Common, benign uterine tumor

Smooth muscle and connective tissue

Depend on estrogen

Classified by location - subserous, intramural, submucous, intraligamentous, pedunculated, parasitic

27
Q

Leiomyoma (Uterine Fibroid) - S/S & PE

A

Discrete, round firm uterine mass

Asymptomatic

Menorrhagia, metrorrhagia, intermenstrual bleeding, dysmenorrhea

Bleeding - most common presenting S/S

anemia

Infertility - distort uterine cavity

28
Q

Leiomyoma (Uterine Fibroid) - labs & imaging

A 
Pelvic U/S 
D&C
Saline Hysteroscopy
Hysterosalpingography - die injected into uterus and fallopian tubes 
Lapaorscopy
Pelvic MRI/CT
29
Q

Leiomyoma (Uterine Fibroid) - treatment

A

Observation - mild symptoms

Myomectomy or D&C - symptomatic

Depo-provera - medroxyprogesterone acetate
- 150mg IM every 28d
- can have bleeding at times
Danazol - synthetic modified testosterone - 400-800mg daily - put pt in amenorrhea, usually before surgery

Uterine arterial embolization or endometrial ablation - if they don’t want kids

Hysterectomy - final step

30
Q

Endometriosis- pathophysiology

A

Endometrial tissue found outside of endometrial cavity

Common locations

  • ovaries
  • uterosacral ligament
  • GI tract
  • lungs/brain

3 theories

  • Retrograde menstruation - reflux of endometrial cells -> peritoneum -> ovary
  • Vascular & lymphatic dissemination
  • Transformation of peritoneal cells -> endometrial cells

Genetic

  • 7-9% have 1st deg relative
  • HLA-B7 allele

Stimulated by hormones

31
Q

Endometriosis- cause

A

Early - implants are red, petechial lesions on peritoneal surface
Older - dark brown, blue, black implants
- filled w/ menstrual debris

Surround tissue - thick and scarred

Adhesions developed -> bowel obstruction

On ovaries - endometriomas ““Chocolate Cysts””

  • old menstrual blood
  • grow in several cm
  • erodes into underlying tissue
32
Q

Endometriosis - epidemiology

A

20-30
Infertile W

Fmhx
Early menarche
Long duration of menstrual flow 
Heavy bleeding
Shorter cycles
33
Q

Endometriosis- S/S & PE

A

3Ds - Dysmenorrhea, Dyspareunia, dyschezia

Asymptomatic -> severe pelvic pain
- deep pain from infiltrating lesions
Infertility

PE

  • tender nodules in posterior vaginal fornix
  • pain w/ uterine motion
  • Tender adnexal masses
  • nothing
34
Q

Endometriosis- diagnosis

A

Tissue biopsy - laparoscopy

- direct visualization

35
Q

Endometriosis- treatment

A 
Depends on severity, location, desire for prego
Observation 
NSAIDs - for discomfort
Surgery - conservative or definitive 
Med treatment
- OCP
- IUD
- Progesterone therapy 
- Danazol - 19-nortestosterone derivative
- GnRH agonist - lupron

Pregnancy

  • dec/improved symptoms
  • doesn’t cure

Hysterectomy

36
Q

Endometriosis- prognosis

A

Dec risk

  • > 4hr/wk exercise
  • higher parity
  • longer duration of lactation
37
Q

Adenomyosis- pathophysiology

A

Endometrial tissues exist w/in and grows into muscular wall of uterus

38
Q

Adenomyosis - epidemiology

A

Middle age, severe dysmenorrhea, hx of childbearing, symmetrically enlarged uterus, menorrhagia

39
Q

Adenomyosis - S/S & PE

A 
Asymptomatic
Severe dysmenorrhea
Abdominal pressure + bloating
Symmetrically enlarged uterus - can palpate
Heavy bleeding
40
Q

Adenomyosis - diagnosis

A

Pelvic US
MRI
Hysterectomy - DEFINITIVE
- look at cells under microscope

41
Q

Adenomyosis- treatment

A

NSAIDs
Hormones
Hysterectomy

42
Q

Uterine Prolapse- pathophysiology

A

Post pregnancy, labor, vaginal delivery

43
Q

Uterine Prolapse- cause

A

Any condition that inc intra-abdominal pressure

- obesity, chronic cough, heavy lifting, pelvic tumors, ascites, constipation

44
Q

Uterine Prolapse- epidemiology

A

> 50% post menopause

White women

45
Q

Uterine Prolapse- S/S & PE

A 
Vaginal fullness
Lower abdo pain
Low back pain
""falling out"" sensation
Relief w/ lying down

W/ - cystocele, rectocele, enterocele

46
Q

Uterine Prolapse- diagnosis- grade

A

Graded 0-4
Grade 0 - no prolapse
Grade 1 - Descent >1cm above hymen
Grade 2 - Descent to hymen
Grade 3 - protrudes but no less than 2cm total vag length
Grade 4 - total eversion of lower genital tract

47
Q

Uterine Prolapse- treatment

A

Pessary
Refer to GYN
Wt reduction, smoking cessation, kegels
Surgery

48
Q

Functional Cysts- pathophysiology

A

Monthly follicle keeps growing

49
Q

Follicular Cyst- pathophysiology

A

Most common functional cyst

Failure in ovulation - 2nd to disturbances in release of pituitary gonadotropins
- failure to ovulate and fluid fails to be reabsorbed

3-8cm

Lined by inner layer of granulosa cells and outer layer of theca interna cells

50
Q

Follicular Cyst- S/S & PE

A

Asymptomatic

Large cysts - aching pelvic pain, dyspareunia, occasional abnormal uterine bleeding

Complications - ovarian torsion and bleeding
- >6cm - turn on stalk -> torsion

51
Q

Follicular Cyst- treatment

A 
Watch and Wait 
- disappear spontaneously in 60d w/out treatment 
Reeval in 6w by U/S 
Benign vs Mal
Sugery eval
OCP - help establish nl rhythm
52
Q

Corpus Luteum Cyst- pathophysiology

A

Thin walled uniocular cysts from after ovulation when corpus luteum fails to regress

3-11cm

Less common

53
Q

Corpus Luteum Cyst- epidemiology

A

Amenorrhea

Delayed menstruation

54
Q

Corpus Luteum Cyst- S/S & PE

A

Localized pain, tenderness
Amenorrhea
Delayed menstruation

55
Q

Corpus Luteum Cyst

A

Watch and Wait
- regress in 1-2m
OCP - recom, but maybe not beneficial
Laparoscopy or laparotomy - required to control hemorrhage to perform detorsion of ovary

56
Q

Ovarian Torsion- pathophysiology

A

2nd to enlarged ovary by mass

57
Q

Ovarian Torsion - S/S & PE

A

Severe abdominal pain
Pelvic pain
N/v

58
Q

Ovarian Torsion- treatment

A

Surgical Emergency

59
Q

Hydrosalpinx- pathophysiology

A

Distally blocked fallopian tube, filled w/ fluid

Distended -> sausage appearance

60
Q

Hydrosalpinx- cause

A

Hematosalpinx - filled w/ blood
Pyosalpinx - filled w/ pus

PID
Endometriosis
surgery
Ruptured appendix

61
Q

Hydrosalpinx- S/S & PE

A

Asymptomatic
Pelvic pain
Abd pain
Infertility

62
Q

Hydrosalpinx- labs & imaging

A

U/S
Hysterosalpingogram
Laparoscopy

Clin med sem 2 (30 decks)

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