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OB/GYN > vaginal bleeding > Flashcards

vaginal bleeding Flashcards

1
Q

what age is average menarche and menopause

A

11 and 51

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2
Q

what is the most common cause of premenarchal bleeding

A

foreign object due to self insertion

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3
Q

what is the most common cause of reproductive age bleeding?

A

pregnancy

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4
Q

what is the most of postmenopausal bleeding

A

vaginal atrophy (especially after sex)

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5
Q

what is important to consider in premenarche

A

sexual abuse

precocious puberty

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6
Q

what is important to consider in postmenopasusal

A

endometrial cancer

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7
Q

what is important to consider in reproductive age

A 
think PAD (pregnancy, anatomy, abnormal uterine bleeding) 
Don't rule out cervical cancer but this is decreasing
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8
Q

How do we do a speculum exam on a minor and why

A

under anesthesia because its dramatic

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9
Q

How to shut off acute bleeding of the uterus

A

IV estrogen

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10
Q

what is an absolute indication for significant uterine bleeding

A

hemoglobin < 7

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11
Q

what is a mechanical method for hemorrhaging

A

intracavitary tamponade

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12
Q

what is the most absolute cure for hemorrhaging

A

total hysterectomy

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13
Q

what are the stages of abortion?

A

IUP-threatened-inevitable-incomplete-complete

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14
Q

IUP definition

A

closed os, ultrasound shows live baby, no passage of contents.

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15
Q

threatened abortion defined

A

closed os, no passage of contents, live baby.

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16
Q

inevitable abortion definition

A

no passage of contents, dead baby, open os

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17
Q

incomplete abortion definitino

A

passage of contents (some), retained parts, open os baby always dead.

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18
Q

complete abortion

A

passage of contents is complete, closed os, no baby on ultrasound

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19
Q

missed abortion

A

no passage of contents, dead baby, closed os. mom missed the death of baby and usually doesnt know that this happened.

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20
Q

what to do with missed abortion

A

misprostol (1st trimester), induce delivery pitocin, d and c.

21
Q

what do we give Rh negative mothers

A

RhoGAM

22
Q

what are fibroids

A

leiomyoma are benign growths of the myometrium and respond to estrogen. They DO NOT cause cancer. highly vascular

23
Q

how to fibroids present

A

anemia, pain, infertility, visceral obstruction.

24
Q

how to diagnose firboids

A

transvaginal ultrasound, but the best is MRI. MRI is never gotten.

25
Q

treatment of fibroids

A

medicine: OCP/IUD. NSAIDs for pain.
surgery: fertility is the question. if she wants kids then do myomectomy which is usually not effective long term. Hysterectomy is usually best.
can give leuprolide to shrink d

26
Q

what is leuprolide

A

a GnRH analog that decreases testosterone and estradiol production.

27
Q

when is AUB

A

reproductive age woman only

28
Q

first line therapies for AUB

A

1) NSAIDs (can actually reduce bleeding because of their negative impact on prostaglandin
2) OCP/IUD
3) ablation or hysterectomy

29
Q

why is PCOS important for AUB

A

because this is classic anovulation which causes a predominantly estrogen++ system and also makes testosterone. Thus she becomes him.

30
Q

where does testosterone in PCOS come from

A

atretic follicles.

31
Q

how does PCOS present/diagnose

A

fat, hairy woman. metabolic syndrome. dyslipidemia, diabetes, infertility, hypertension. menometrorrhagia (no system control)
need hyperandrogenism (DHEAs, testosterone, LH/FSH ratio > 3:1
imaging for follicles

32
Q

what is the biochemical test and result that suggests PCOS

A

LH/FSH ratio >3:1

33
Q

what is the treatment for PCOS

A 
weight loss and exercise can produce results, but never by themselves. 
METFORMIN is the treatment 
OCPs and IUDs
Clomiphine for helping with pregnancy. 
spironoleptone.
34
Q

why metformin for PCOS

A

pushes PCOS into ovulation

35
Q

what are the causes of AUB

A

PALM-COEIN: polyp, adenomyosis, leiomyomas, malignancy, coagulopathy, ovulapathy, endometrial issues, iatrogenic (IUD), not yet specified.

36
Q

what is a fibroid?

A

benign growth within the endometrium. nodular, asymmetric

37
Q

what are the different types of fibroids?

A

subsereosal, submucosal, transmural, abdominal, peduculated

38
Q

what is adenomyosis

A

endometrial growth, proliferatio of glandular tissue. SYMMETRIC. smooth and boggy

39
Q

Polyps are what?

A

peduculated mass in the uterus

40
Q

do fibroids cause cancer?

A

NO.

41
Q

are fibroids estrogen responsive>?

A

Yes. they may change with cycles. proliferate under cycles

42
Q

what is the patient experience of fibroids

A

asymptomatic lump, anemia/bleeding (highly vascular), painful, may cause infertility.

43
Q

what is a complication of large fibroids

A

visceral obstruction

44
Q

what is the diagnostic step for fibroids?

A

works: transvaginal ultrasound…MRI is best

best test is Biopsy.

45
Q

treatment of fibroids

A

meds: oral contraceptives (or IUD). NSAIDs for pain.
surgery: does the patient want kids? wants kids: myomectomy (scooping out fibroids). hysterectomy –satisfaction rate is HIGH.
leuprolide (gNRH) to shrink the fibroids.

46
Q

what does ovulation do?

A

switches axis to progesterone to stop proliferation of the endometrium

47
Q

what does estrogen do?

A

builds the endometrium. if there is no ovulation, then the endometrium will continue to build until it becomes avascular and eventually sheds–AUB

48
Q

when is AUB normal?

A

during menarche and menses

49
Q

treatment for AUB

A

medical: OCP (IUD also) –take over the cycle.
NSAIDs can reduce bleeding.
have a predominant prostaglandin effect in the uterus, thus they slow down bleeding
surgery: ablation and hysterectomy.

OB/GYN (39 decks)

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