Week 7 - Menstrual cycle & Uterus

Question 1

Symptoms of PMS and PMDD

Answer 1

Mastalgia, weight and appetite changes, emotional lability, and bloating.

Question 2

Treatment for PMS and PMDD

Answer 2

SSRIs – for PMD with predominantly emotional symptoms (Fluoxetine, sertraline, paroxetine)
‣ Continuous – daily dose
‣ Intermittent – begin daily with ovulation and continue to days 1-2 of menses
‣ Symptom onset dosing: begin with onset of symptoms stop with end of menses

Hormonal contraception – combined therapy with estrogen and progesterone – OC pills, the ring or hormonal patches

Anxiety medications like Xanax

Diuretics for fluid retention and bloating

Question 3

Primary dysmenorrhea

Answer 3

‣ strong, frequent uterine contractions are believed to cause hypoxia and even ischemia of the muscle, resulting in pain
‣ NSAIDS effective in treating symptoms

Question 4

Secondary dysmenorrhea

Answer 4

Caused by an underlying pathology, such as endometriosis (the most common cause), adenomyosis (the second most common cause), nonhormonal intrauterine devices, fibroids, and scarring from abdominal surgery or infection
‣ Diagnosed with symptoms, usually onset 2+ years after menarche, HPE, imaging

Question 5

S/S of primary and secondary dysmenorrhea

Answer 5

‣ painful cramping with menses. Patients also report backache, pain that radiates into the thighs, nausea and vomiting, diarrhea, sweating, headaches, fatigue, and sleeping disorders
‣ symptoms occur with ovulary cycles

Question 6

Abnormal Uterine Bleeding (AUB)

Answer 6

• bleeding that is atypical in frequency, regularity, duration, and timing in the absence of structural abnormalities

Question 7

Endometriosis

Answer 7

Growth or multiple growths (polyps) of endometrial tissue found outside of the uterine cavity

Question 8

Symptoms of endometriosis

Answer 8

‣ Dysmenorrhea
‣ Painful intercourse
‣ Rectal pain w/defecation
‣ Urgent micturition

Question 9

Risk factors for endometriosis

Answer 9

‣ Increased age
‣ Hereditary
‣ Caucasian
‣ Early menarche

Question 10

Uterine fibroids

Answer 10

benign tumors of the uterine myometrium

‣ Microscopic to very large, single or multiple
‣ Most common indication for hysterectomy

Question 11

Symptoms of uterine fibroids

Answer 11

‣ Menorrhagia
‣ Infertility
‣ Bowel/bladder complaints

Question 12

Risk factors for uterine fibroids

Answer 12

‣ Hereditary
‣ Obesity
‣ Black
‣ Primiparous status (giving birth to only one child)

Question 13

Adenomyosis

Answer 13

growth of endometrial tissue into the uterine myometrium (smooth muscle layer)

Question 14

Symptoms of Adenomyosis

Answer 14

‣ Menorrhagia
‣ Diffusely enlarged, tender, boggy uterus

Question 15

Treatment for adenomyosis

Answer 15

‣ gonadotropin-releasing hormone (GnRH) agonist,
‣ myomectomy,
‣ oral contraceptives,
‣ intrauterine device (IUDs

Question 16

Pelvic inflammatory disease

Answer 16

occurs in the upper female genital tract and includes any combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. Most commonly caused by gonorrhea or chlamydia

Question 17

S/S of PID

Answer 17

‣ abdominal, pelvic, and low back pain;
‣ abnormal vaginal discharge;
‣ intermenstrual or postcoital bleeding;
‣ fever
‣ nausea and vomiting
‣ urinary frequency

Question 18

Assessment for PID

Answer 18

Comprehensive history
‣ recent pelvic surgery,
‣ abortion, childbirth,
‣ dilation of the cervix
‣ insertion of an intrauterine device (IUD) within the past month.

Sexual history should be obtained,
‣ current or most recent sexual activity
‣ number of partners,
‣ method of contraception;
risk for STIS

Question 19

Amenorrhea

Answer 19

absence of menses – commonly caused by pregnancy, hypothalamic amenorrhea and PCOS

Question 20

Dysmenorrhea

Answer 20

defined as painful cramps that occur with menstruation

Question 21

Toxic Shock Syndrome

Answer 21

A rare, life-threatening complication of certain bacterial infections characterized by an acute onset characterized by fever, low blood pressure, a sunburn-like body rash, and end-organ damage.

Question 22

Signs and symptoms of Toxic Shock Syndrome

Answer 22

‣ a rapid onset of fever, hypotension, and rash
‣ Multisystem organ involvement in addition to less specific symptoms, such as myalgias, headache, and pharyngitis, which may then progress to organ dysfunction.

Question 23

Diagnosing Toxic shock syndrome

Answer 23

• Negative results on the following tests, if obtained:
  ‣ Blood or cerebrospinal fluid cultures (blood culture may be positive for Staphylococcus aureus)
  ‣ Negative serologies for Rocky Mountain spotted fever, leptospirosis, or measles

Clinical findings positive for:

‣ Fever: temperature greater than or equal to 102.0°F (greater than or equal to 38.9°C)
‣ Rash: diffuse macular erythroderma
‣ Desquamation: 1–2 weeks after onset of rash
‣ Hypotension: systolic blood pressure less than or equal to 90 mm Hg for adults or less than the fifth percentile by age for children younger than 16 years
‣ Multisystem involvement (three or more of the following organ systems):
‣ Gastrointestinal: vomiting or diarrhea at onset of illness
‣ Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal
‣ Mucous membranes: vaginal, oropharyngeal, or conjunctival hyperemia
‣ Renal: blood urea nitrogen or creatinine at least twice the upper limit of normal for laboratory or urinary sediment with pyuria (greater than or equal to 5 leukocytes per high-power field) in the absence of urinary tract infection\
‣ Hepatic: total bilirubin, alanine aminotransferase enzyme, or asparate aminotransferase enzyme levels at least twice the upper limit of normal for laboratory
‣ Hematologic: platelets less than 100,000/mm3
‣ Central nervous system: disorientation or alterations in consciousness without focal neurologic signs when fever and hypotension are absent

Question 24

Treatment for Toxic Shock Syndrome

Answer 24

‣ Broad spectrum antibiotics -clindamycin (bacteriostatic and not bacteriocidal), penicillin 14 day course

Question 25

Polycystic Ovarian Syndrome

Answer 25

condition in which the ovaries produce an abnormal amount of androgens (male sex hormones) that are normally present in small amounts. If not enough hormones needed to ovulate are present the ovaries can develop small cysts.

Question 26

Symptoms of PCOS

Answer 26

‣ Missed periods, irregular periods, or very light periods.
‣ Ovaries that are large or have many cysts.
‣ Excess body hair, including the chest, stomach, and back (hirsutism)
‣ Weight gain, especially around the belly (abdomen)
‣ Acne or oily skin.
‣ Male-pattern baldness or thinning hair.
‣ Infertility.

Question 27

Assessment for PCOS

Answer 27

‣ Most common cause of hyperandrogenism, occurs in approximately 80% of women with androgen excess
‣ Clinical and/or biochemical evidence of hyperandrogenism
‣ Oligo-anovulation
‣ Polycystic ovaries
‣ Exclusion of other etiologies

Diagnosis of exclusion. If history, physical examination, and laboratory testing rule out all other possible causes of hyperandrogenism, the most likely diagnosis is PCOS

Question 28

Cervical Cancer Staging

Answer 28

SIL – squamous intraepithelial lesions
CIN – cervical intraepithelial neoplasia

‣ CIN 1 – low grade, involves lower 1/3 of layer of cervical cells
‣ CIN 2 (high grade) moderately severe, 2/3 thickness of cervical layer affected by abnormal cells
‣ CIN 3 – (high grade) – full thickeness of cervical layer affected by abnormal cells. AKA carcinoma in situ. Dysplasia becomes cancer when it invades the basement membrane.

Question 29

Cervical cancer screening guidelines

Answer 29

‣ Under age 21 – no screening
‣ Age 21-29 – Screen with cervical cytology every 3 years
‣ Age 30-65 – screen every three years with cytology along, screen every 5 years with cervical cytology and HPV testing
‣ Over age 65 – no screening

Question 30

Cervical cancer prevention

Answer 30

HPV vaccine, two doses starting at age 9-12 given 6-12 months apart

Question 31

PMS diagnostic symptoms

Answer 31

i. 1 affective + 1 somatic symptom
ii. Symptoms occur 5 days prior to menstrual flow
iii. Relief w/in 4 days of completion of menses
iv. No symptoms until return of luteal phase
v. Symptoms have occurred for 3 continous cycles
vi. PMDD ruled out
vii. Negative impact on social or economic function

Question 32

PMDD diagnostic criteria

Answer 32

PMDD diagnosis requires at least 5 symptoms from the following list, with at least 1 of those symptoms from the first four symptoms listed.

1. Depressed mood or hopelessness
2. Anxiety or tension
3. Lability
4. Increased or persistent anger, irritability or interpersonal conflicts
5. Decreased pleasure or interest
6. Difficult concentrating
7. Lethargy
8. Change in appetite
9. Insomnia or hypersomnia
10. Feeling overwhelmed or out of control
11. Breast tenderness or swelling
12. Abdominal bloating
13. Headache
14. Joint muscle or pain
15. Weight gain
16. Extremity swelling

Question 33

Vaginitis

Answer 33

inflammation of the vagina characterized by an increased vaginal discharge containing numerous white blood cells

Question 34

Cause of vaginitis

Answer 34

Occurs when the vaginal environment is altered, either by microorganisms or disturbance that allows pathogens to proliferate

Question 35

Vulvovaginitis

Answer 35

General term for a collection of vulvar and vaginal symptoms, such as itching, burning, irritation, and sometimes dysuria or dyspareunia.

Inflammation of the vulva and vagina, may be caused by vaginal infection or copious amounts of leukorrhea

Question 36

Bacterial vaginosis

Answer 36

Happens when here is a change in the pH of the vagina either due to reduction in lactus bacteria or invasion or overgrowth of pathogenic bacteria

Question 37

S/S of Bacterial Vaginosis

Answer 37

• thin greyish white adherent discharge
• fishy smell – may be worse with intercourse
• mild/no itching
• difficulty urinating
• may be mostly asymptomatic
• vaginal walls may be pink or pale but not erythematous

Question 38

Diagnosing BV

Answer 38

3 of 4 symptoms must be present for diagnosis

• white, thin adherent vaginal discharge
• pH 4.5 or greater
• Positive whiff/KOH test
• Clue cells on microscopic examination (more than 20 percent of epithelial cells are clue cells)

Question 39

Management of Bacterial Vaginosis

Answer 39

Metronidazole 500mg BID for 7 days or 0.75% vaginally inserted daily for 5 days

Question 40

Vulvovaginal candidiasis S/S

Answer 40

itching, burning, irritation, and sometimes dysuria or dyspareunia caused by candida

• Thin or thick, curd like, resembles cottage cheese
• No smell
• Swelling, erythema and itching
• Dysuria with severe cases

Question 41

Treatment for vulvovaginal cadidiasis

Answer 41

• OTC topical azoles
• 1 dose 150mg of PO fluconazole