Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro > week three > Flashcards

week three Flashcards

1
Q

gonadal function is controlled by what? does it stay the same throughout an individual’s life?

A

controleld by hypothalmic pituitary axis, varies throughout an individual’s lifetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when would you test FSH/LH in a premenopausal female?

A

day 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

describe the testosterone peaks for the 3 types of rhythmicity below

seasonal
circadian
pulsatile

A

seasonal (months) - fall
circadian (hours) - AM
pulsatile (mins) - every 90-120

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what controls the types of rhythmicity of testosterone?

A

melatonin via:
- pineal gland inputs (seasonal)
- neural connectinos (circadian)
- suprachiasmatic nucleas (mammilian 24-hr clock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the broad 4 categories that may be the underlying cause of AUB.

A

Structural
Functional
Hormonal irregularities
Medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FIGO def acute AUB

A

Acute AUB - episode of bleeding in reproductive age pts, not pregnant, and bleeding warrants immediate intervention to prevent further loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

FIGO def chronic AUB

A

Chronic AUB - bleeding from uterus that is abnormal in duration, volume, and/or frequency present for last 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

FIGO def disturbacnes menstrual frequency

A

Disturbances of menstrual frequency - infrequent every 38 days over 6 months (adolescents > 45), frequent every 24 days (<21 adolescents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FIGO def irregular menstrual bleeding

A

Irregular menstrual bleeding (cycle variation > 20 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

FIGO def abnormal duration of flow

A

Abnormal duration of flow (<2 days, increased volume or blood loss interfering with pts QOL, light menstrual bleeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

mechanisms for the cessation of menses

A
  • combo of vasoconstriction, tissue collapse, and vascular stasis
  • damaged tissue released thrombin > promotes formation of fibrin and activates platelets > hemostasis
  • development of ovarian follicle, the resultant release of E2 heals and regenerates the endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

local mechanisms of hemostasis

A
  • uterine contractions are due to prostaglandins PGE2a and PGF2a
  • vasoconstriction due to thromboxane A2 (TXA2)
  • vasodilation due to PGI2 and PGE2a
  • endometrial prostaglandins produced from arachidonic acid
  • estrogen affects uterine vascular tone, prostaglandin formation, and endometrial nitric acid formation to aid in the cessation of menstruation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are important aspects of medical hx to cover in the visit and describe the menstrual hx questions that need to be covered as well.

A

Age
Length of time of problem
Is uterus the source of the bleeding
What is the bleeding pattern
Signs of ovulation present or not
Form of BC
Thorough menstrual hx
Sexual hx
Precipitating factors such as trauma
Pregnancy hx
Complete med hx
Risk of endometrial cancer
Determine if bleeding is nongenital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the common etiologies for HMB

A
  • uterine leiomyomas (usu submucosal)
  • adenomyosis (HMB, clots, dysmenorrhea)
  • cesarean scar defect
  • bleeding d/o
  • endometrial hyperplasia/cancer
  • IUD
  • endometrial polyps
  • endometritis or PID
  • arteriovenous malformation
  • disorders of local endometrial hemostasis (alterations in prostaglandins)
  • hypothyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the common etiologies for intermenstrual bleeding

A
  • endometrial polyps
  • unscheduled bleeding due to contraceptives
  • endometrial hyperplasia/cancer
  • endometritis or PID
  • previous endometrial trauma (C-section)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the common etiologies for irregular bleeding (ovulatory dysfunction)

A
  • occurs commonly at extremes of reproductive age (postmenarchal and menopausal transition)
  • PCOS
  • other endocrine d/o (thyroid dz, hyperprolactinemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What physical exams should be performed with amenoorrhea and what are you looking for?

A

Assess for anemia (pallor, conjunctival pallor, dec cap refill) and hematologic pathology (petechiae, puerperal, ecchymosis, mucosal bleeding)

Assess for clinical hyperandrogenism/hyperinsulinemia (hirsutism, obesity, acne, acanthosis nigricans)

Assess for liver dz (spider angioma, palmar erythema, hepatosplenomegaly, ascites, jaundice)

Thyroid assessment (AbN vitals, eye findings, tremors, changes in texture of skin, wt changes, goiter or nodules, abn DTRs)

Inspection of urethra (assess for caruncle or lesions)

Pelvic exam (looking for course of bleeding examining all lower genital tract, speculum exam to assess for infection, trauma, or foregin objects as well as palpating for masses, tenderness, and size/shape/consistency of reproductive organs

Vaginal-rectal exam (external inspection, DRE, fecal occult test, anoscopic exam)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common cause of AUB in adolescents and the 2nd most common cause?

A

Physiologic anovulation
Coagulopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the first dx to consider in childbearing age patients?

A

Pregnancy + related conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the work-up to consider in a pt with AUB after pregnancy testing?

A

Pap/HPV testing
Genital cultures/STI testing
CBC, ferritin, Lfts, PT, PTT
TSH, reflex T4
Luteal phase serum progesterone levels (day 21-23) for ovulation, anovulation, luteal phase defect
Prolactin, total + free salivary testosterone, DHEA, FSH/LH
Complete pelvic US/saline-infusion sonography (SIS)
Endometrial biopsy (EMB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the treatment goals for anovulatory cycles and AUB?

A

Correct the underlying primary etiology
Improve QOL
Prevent episode of acute uterine bleeding
Prevent or treat anemia
Establish regular bleeding pattern (or amenorrhea)
Prevent endometrial hyperplasia/carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

AUB in perimenopausal patients what is the most common cause? What must you be sure to r/o in this age pt?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What pts should undergo evaluation for endometrial hyperplasia or endometrial cancer?

A

ALL postmenopasual pts
Age 45-menopause: bleeding that is frequent (onset within <21 days), heavy or prolonged >5 day. Includes intermenstrual bleeding
<45: persistent (>6 mo) abn bleeding, occuring in one of the following setting: hx of unopposed estrogen exposure, failed medical management of bleeding, pts with high risk of endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

List the risk factors for endometrial cancer.

A

> 35
Anovulatory cycles - PCO
Obesity
Nulliparity
Tamoxifen therapy
DM
HTN
Fhx colon cancer
Long term unopposed estrogen therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What work-up should be considered to evaluate AUB and R/O cancer?

A

Transvaginal ultrasound (TVUS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

List the findings on endometrial biopsy and their risk of endometrial cancer

A

Hyperplasia without atypia <5%
Hyperplasia with atypia 30%
Adenocarcinoma in situ (AIS) 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why should treatment not be started until the etiology of AUB has been found out?

A

They will not want to workup the underlying etiology - could miss malignancy and other dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

List common botanicals used for hemostasis and for hormone regulation

A

Hemostatic - cranes bill, ladys mantle, greater periwinkle, yarrow, shepherd’s purse, cinnamon, fleabane, geranium; wise woman cinnamon erigeron tincture 5 qtts qid during heavy bleeding

Uterine tonics: blue cohosh, sabadilla, squaw vine, raspberry, dong quai, life root

Hormone regulation: chaste tree

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What nutraceuticals can be helpful for uterine bleeding?

A

Vit C
bioflavonoids
Vit A
Ground flax
Probiotics
DIM
Green tea extract
EPO
Iron citrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What common pharmaceuticals (with doses) are used for uterine bleeding when there is no malignancy?

A

Oral contraceptives
Oral progestins: MPA/Provera 10mg 14 days/mo, Megestrol/megace (40mg/day)
NSIAIDs: ibuprofen 600-1000 mg day 5 days month beginning day 1 of menses, anaprox 550-1100 mg day for 5 days a month
Mirena IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What surgical options are available for AUB

A

Endometrial ablation/transcervical endometrial resection (pregnancy CI after)
Hysteroscopy
Myomectomy
Hysterectomy (completed childbearing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the tx options for endometrial hyperplasia without atypia

A

Without atypia:
OMP 100-400 mg qhs, 3 wk on 1 off OR
Mirena IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the tx options for endometrial hyperplasia with atypia

A

With atypia:
Provera 10-20 mg qd x 5-10 days + D&C
Tx 6 weeks then biopsy
Mirena IUD
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Define primary amenorrhea and secondary amenorrhea

A

Primary: pt hasnormal secondary sexual characteristics but no menarche by 16 yrs (with no secondary sexual ahraacteristics and no menarche, dx an be made around 13/14)

Secondary: cessation of menses after at least 1 or more menstrual cycles for a min of 3 cycles of 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

List the most common etiologies of secondary amenorrhea.

A

Pregnancy
PCOS
Thyroid dysfunction
Hyperprolactinemia
Hypothalamic amenorrhea
Ovarian failure

36
Q

List the important aspects of history taking for secondary amenorrhea

A

Chronic diseases
Illicit drugs, trauma, CNS tumors, stress, wt change, diet/exercise changes, exercise hx, sig wt changes
Consider anorexia
Change in hair quality
Gynecologic hx

37
Q

What must be asked in gynecological history? (list them)

A

Sexual activity and form of BC
Galactorrhea or nipple d/c
Irregular periods since onset of menarche
Sx estrogen deficiency
Hx abnormal paps, STIs, procedures
Hx of births ending with bleeding
Post pill amenorrhea
Menstrual hx prior to OC hx

38
Q

What physical exam should be performed and what are you looking for?

A

Vitals
Rapid bounding pulse (hyperthyroid)
Slow pulse (hypothyroid, anorexia)
HTN: PCOS, cushing’s syndrome
Hypotension, hypothermia, reduced subcutaneous fat: anorexia

BMI: obesity (PCOS), underweight

Thyroid exam

Parotid gland (swelling), erosion of enamel (eating d/o)

Skin:
Soft moist skin - hyperthyroidism
Dry skin w mild hirsutism - hypothyroidism or hypoestrogenism
Acanthosis nigricans - insulin resistance, PCOS
Striae - cushing syndrome
Hirsutism/acne - PCOS
Lanugos - nutritional disorder, anorexia

Breast exam (development, hyperprolactinemia)

Abdominal exam (hepatosplenomegaly - chronic systemic dz)

Pelvic exam:
Signs of estrogen influence (rugae, tissue color, cervical mucus)
Dec pubic hair, vaginal rugae, thinning mucosa - hypoestrogenism - POF/POI
Inc hair extending up thighs/umbilicus - PCOS
Ovarian masses
Collection of menstrual blood collecting in uterus due to cervical stenosis - hematometr

39
Q

list likely causes that should be investigated if normogonadotropic amenorrhea is present. What labs indicate this?

A

Normogonadotropic if FSH normal LH is low normal - hypothalamic amenorrhea, chronic disease, rapid wt loss, malnutrition, psych d/o, rec drug use

40
Q

list likely causes that should be investigated if hypogonadotropic amenorrhea is present. What labs indicate this?

A

Hypogonadotropic if FSH/LH < 5 IU/L - constitutional delay of growth/puberty, kallmann’s syndrome

41
Q

list likely causes that should be investigated if hypergonadotropic amenorrhea is present. What labs indicate this?

A

Hypergonadotropic if FSH >20, LH >40 IU/L - perform karyotype analysis, POF, turners syndrome

42
Q

What is the lab work that is necessary to identify the underlying cause of a pts. secondary amenorrhea and to r/o other DDX’s?

A

Pregnancy test
Thyroid studies
Prolactin levels
FSH + estrogen
CBC, UA, CMP

43
Q

What additional testing is important for young pt’s with athletic amenorrhea?

A

BMD levels/DEXA

44
Q

What are the underlying causes of hypothalamic amenorrhea and what is the best treatment approach for the first 3-6 months? What treatment should be initiated after 6 months if not the pt. continues to have amenorrhea?

A

Low estradiol, due to anorexia, female athletic triad
Functional - severe chronic disease, rapid wt loss, malnutrition, psych d/o, rec drug use, stress
PCOS

Treatment:
First 3-6 mo: treat cause, inc caloric intake/reduce exercise , stress management, CBT

After 6 mo: hormone therapy to avoid potential bone loss and CVD development

45
Q

List some common botanicals that are used to treat secondary amenorrhea

A

Vitex
Black cohosh
Rhodiola
Maca root

46
Q

What botanical is useful for hyperprolactinemia

A

Vitex

47
Q

what hormone would be elevated in someone with PCOS?

testosterone
progesterone
estrogen
FSH/LH

A

testosterone

48
Q

what hormones are preferred to be tested around day 3?

A

FSH/LH
Estrogen/oestradiol

49
Q

what hormones are preferred to be tested around day 21?

A

progesterone to look for signs ovulation has occurred

50
Q

what day of the cycle would you test for pregnancy?

A

around day 14
continuous if hx of repeat miscarriages

51
Q

difference between pregnancy urine testing and serum testing

A

Urine testing (qualitative)
Serum testing (quantitative)

52
Q

downside of serum hormone testing

A

doesnt account for pulsatility, cant be used to monitor topical HRT

53
Q

downside of urine hormone testing

A

one point in time
ineffective to monitor topical HRT
not well validated

54
Q

downside of saliva hormone testing

A

can only test steroid hormones
saliva contamination

55
Q

describe the appearance of squamous epithelial cells on a wet prep

A

Large flat cells
Square to trapezoid shape
Abundant cytoplasm
Small usually central nucleus (about size of a WBC)

56
Q

describe the appearance of WBC on a wet prep

A

Medium sized
Round to oval shape
May appear granular
Segmented nuclei may be present

57
Q

describe the appearance of RBC on a wet prep

A

Small round cells
Clear to faint yellow/green

58
Q

describe the appearance of bacteria on a wet prep

A

Tiny colorless rods (bacilli)
Cocco-bacilli or cocci
May be in chains, pairs, or clusters

59
Q

describe the appearance of yeast on a wet prep

A

Small round to ovoid cells (about the size of RBCs)
May see budding or pseudohyphae

60
Q

describe the appearance of trichomonas on a wet prep

A

Pear shaped
Flagellated motile protozoa
Dead ones resemble WBCs

61
Q

describe the appearance of clue cells on a wet prep

A

Squamous epithelial cells coated with cocco-bacilli (Gardnerella/others)
Indistinct cell membranes
“Furry” looking

Over 75% squamous cell occluded by bacteria = clue cell

Atypical clue cells: long rods coating cells - indicates cytolytic

62
Q

normal levels of squamous epithelial cells on wet prep

A

0-30/hpf

63
Q

normal levels WBC on wet prep

A

< 10/hpf

64
Q

normal levels RBC on wet prep

A

0-5/hpf

65
Q

normal levels bacteria on wet prep

A

1+ to 2+, rods should predominate

66
Q

normal levels yeast on wet prep

A

trace to 1+

67
Q

normal levels trichomonas on wet prep

A

none

68
Q

normal levels clue cells on wet prep

A

trace may be normal

69
Q

indications for elevation in squamous epithelial cells on wet prep

A

extreme inc in # may indicate tissue irritation

70
Q

indications for elevation in WBCs on wet prep

A

Increased # indicate infection or inflammation
No or small increase with BV

71
Q

indications for elevation in RBCs on wet prep

A

May see crenated or ghost cells

72
Q

indications for elevation in bacteria on wet prep

A

> 2+ may indicate infection
Absence of rods (lactobacilli) may indicate imbalance of flora

73
Q

indications for elevation in yeast on wet prep

A

> 1+ may indicate infection and imbalanced flora

74
Q

indications for elevation in trichomonas on wet prep

A

STI

75
Q

indications for elevation in clue cells on wet prep

A

> 1+ may indicate imbalanced flora

If > 1 in 10 SQE cells/hpf = clue cells, can dx BV

76
Q

what feature on wet prep can be dx of BV

A

If > 1 in 10 SQE cells/hpf = clue cells, can dx BV

77
Q

what organism must be kept at a certain temp and how soon must they be examined?

A

trichomonas - kept at body temp (37C) and examined within 30 mins or they will die

78
Q

what are some underlying conditions that can cause secondary amenorrhea

A

functional hypothalmic amenorrhea
PCOS
ovarian failure/insufficiency
thyroid dysfunction

79
Q

what are the major sequelae of PID and what percentage of women with 1 episode acute PID will experience sequelae?

A

25%
- ectopic pregnancy
- chronic pelvic pain
- tubal factor infertility (TFI)

80
Q

sx of PID

A

BL lower abdominal or pelvic pain*
Deep dyspareunia or pain w jarring movement
Onset of pain shortly after menses
Cramping
Dysuria
Fever/chills (50%)
Back pain
N/V
Abnormal d/c or bleeding
Vaginal itching and odor
Abnormal uterine or postcoital bleeding
Less common - RUQ pain fitz high curtis syndrome

81
Q

signs PID

A

Infected cervix
DC contains large # of WBCs > 10/hpf wet prep
Abdominal tenderness in lower quadrants commonly with rebound tenderness and hyporesonant bowel sounds
CMT, uterine tenderness, and/or unilateral or bl adnexal pain

82
Q

T or F: you should wait until you have a cause and firm diagnosis to begin tx of PID

A

FALSE - Initiate tx in all sexually active young omwen and women at risk for PID with uterine, adnexal, or CMT in bimanual exam with no other apparent cause - prevent long term sequelae

83
Q

what are common causative organisms PID

A

CT
GC
Aerobic/anaerobic bacteria:
- genital mycoplasma
- bacteroides
- prevotella species
- peptostreptococcus species
- BV
- e coli
- aerobic streptococci
- actinomyces (women with IUD)
Non genital pathogens
- h influenzae

84
Q

RF PID

A

STI/hx STI (esp GC/CT)
Sex during menses
Previous episode PID
14-25
<15 first sexual encounter
High # sex partners
New/multiple partners
Lower socioeconomic status
Nulliparous
Non white ethnicity (black women)
Alcohol use
Women > 35 with copper IUD
Recent IUD insertion
Nonbarrier contraceptives
Oral contraceptives
Cervical ectopy
BV
Douching

85
Q

what labs/tests should you run for ALL pts suspected PID

A

Pregnancy test
Wet prep
GC/CT
HIV
Syphilis

86
Q

what are dx tools for PID?

A

Endometrial biopsy* Laparoscopy *
TVUS
CT
MRI

87
Q

what is some naturopathic tx for PID? can these be used alone?

A

MUST BE USED AS SUPPORTIVE ONLY, USE CDC PROTOCOL
Rest
Modified fast
Probiotics 3x day
Vaginal lactobacillus crispatus
Alternating sitz
Hot vinegar packs
Castor oil packs
Vit C u
Anti inflammatories
Immune stimulating botanicals (mahonia, echinacea, garlic, myrrh)
Homeopathy

Repro (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions