Women's Health Flashcards
What’s a typical body weight around the start of menarche?
> 90lbs
What is oligomenorrhea?
Delayed onset
What is polymenorrhea?
More frequent
What is menorrhagia?
Excessive flow
What is hypomenorrhea?
Scant flow
What is epimenorrhea?
Bleeding between periods
_______ form of estrogen before menopause
Estradiol
________ form of estrogen after menopause
Estrone
What is estriol?
Estriol byproduct of estrogen metabolism
What does estrogen do?
● Metabolizes fat for energy ● Natural diuretic ● Natural antidepressant ● Facilitate thyroid hormone interaction ● Relieves hormonal headache
What does progesterone do?
● Normalizes blood clotting ● Restores libido ● Maintains endometrium secretory functions ● Prevents endometrial Cancer ● Balances estrogen
What is endometriosis?
It is a hormone dependent disorder in which endometrial tissue are deposited in other parts of the body, like the kidneys intestines, and Fallopian tubes. It causes scarring, adhesions, abnormal cycles, infertility, and pain.
Pt is 20-40 yo female c/o abdominal pain. She reports having abnormal cycles and infertility. What is the diagnosis and treatment?
Endometriosis
Treatments: laser cautery
Endometriosis makes up~ 24% of all hysterectomies
What is the average age of menopause in the US?
51
What are some factors that might determine when someone gets menopause?
Nutrition, weight, genes, smoking
What is the cut off for premature menopause?
< 40 yo
Climacteric Change of Life starts ___ years before menopause lasts for ____ years after.
10-15 years before
10 years after
In menopause, Cyclic estradiol (increases/ decreases/ ceases) as directed from the hypothalamus.
Ceases
As ovarian production decreases, the hypothalamus sends proteins to stimulate serum_____ and ___ to rise dramatically and stay high for two years
FSH (E) and LH (P)
What. Are some musculoskeletal changes that follow menopause?
● Muscle weakness ● Backache / joint pain ● Bone thinning ● Bloating ● Headaches
True or false; caffeine and red wine can relieve the symptoms of menopause
False; they may cause heat flashes
Sorry, ladies.
The ovaries may refer pain to
T 12 and medial thigh
The Fallopian tubes may refer pain to
T11 and T12
The uterus may refer pain to
T10-L1, lower abdomen
The cervix may refer pain to
S2-4 and sacral base
The vagina may refer pain to
Low back and butt
The ureter and uterine ligament may refer pain to
Across lumbosacral area
The rectum and trigone may refer pain to
Sacral apex of bladder
Pain may be referred to T12 and the medial thigh by the
Ovaries
Pain may be referred to T11 and T12 by the
Fallopian tubes
Pain may be referred to T10-L1 and lower abdomen by the
Uterus
Pain may be referred to S2-4 and the sacral base by the
Cervix
Pain may be referred to low back and butt by the
Vagina, vag, vajayjay, crotch, hoo ha, chacha, nether region, downstairs
Pain may be referred to across the lumbosacral area by the
Ureter and uterine lig
Pain may be referred to sacral apex of the bladder by the
Rectum and trigone
What are some postural changes associated with pregnancy?
● Cervical, Thoracic, and Lumbar curves increase ● Rounded Shoulder ● Hyper-extended knees ● Pronated Feet ● Widen Base of Support
What are some postural dysfunctions common with pregnancy?
● Thoracic Outlet Syndrome ● Carpal Tunnel Syndrome ● Low Back Pain ● Lumbar or Sacral Root Irritation ● Public Separation ● Ilial Position Faults ● Occasional Parasthesias ● Worsening of Preexisting Conditions-Spondylolisthesis
True or false; during the first trimester, it is dangerous to have a patient lay on her back because the fetus is at risk of crushing the vena cava
False, second
Which hormone may cause pregnant women to become hypermobile?
Relaxin
True or false; pregnancy can cause women to have TMJ problems
True
Pt is a pregnant female c/o pain, paresthesia, numbness, and clumsiness with her hands. You observe atrophy in median distribution. What is her diagnosis?
Carpal tunnel syndrome
What do a +phalens and +tinel’s tests indicate?
Carpal tunnel
True or false; When carpal tunnel develops during pregnancy, the most common option is for the women to undergo surgery after they’ve given birth.
False; it usually resolves
What is thought to be the cause of carpal tunnel during pregnancy?
Elevation of the ribcage during pregnancy is thought to be a potential cause
Which disorder can be described as tenosynovitis or inflammation of the abd pollicis longus and extensor pollicis brevis tendon sheaths ?
De Quervain’s
How do you treat De Quervain’s disease?
Tx using ice, phono, ionto, bracing, retraining, rest and work toward stretching and strengthening
Thoracic outlet syndrome becomes symptomatic secondary to __________, causing a compression of the nerve bundle at the C8-T1 dorsal outlet
head and neck postural changes
What is the normal amount of separation between the rectus abdominus muscle?
2 cm at level of umbilicus
2 cm above umbilicus
THERE IS NO SEPARATION BELOW THE UMBILICUS
True or false; 2 cm is a normal amount of separation in the rectus abdominus at the level and below the umbilicus
FALSE! ABOVE and at the level. NOT BELOW. ZERO BELOW.
How do you examine a diastasis recti?
● Position pt in supine with knees bent
● She raises her head and shoulders until her neck is about 8 inches from the supporting surface
● The chin should be tucked and the arms stretched out
● The PT checks for a bulge in the central abdominal area, which is evident when the muscles have parted
● If present, it is defined by the number of fingers that
can be inserted horizontally into the the gap at the level of the umbilicus and 2 inches above and below
True or false; treat diastasis recti with trunk rotation to strengthen the obliques to compensate for the weak rectus.
FALSE AVOID TRUNK ROTATION UNTIL THERE IS NO SEPARATION
Why not treat diastasis recti with jackknifing or double leg lifts-possibility?
increasing separation between rectus abdominus muscles or injuring lower back
When treating diastasis recti Ther ex is aimed at…
increasing the strength of the TA while protecting the Rectus.
What are the causes of costal rib pain during pregnancy?
● incr. mobility of rib articulations
● flaring of lower ribs and widening of subcostal angle
● A-P and transverse diameters of thorax widen by 2cm
● circumference incr. by 6cm
● diaphragm elevated 4cm
● normal neurovascular bundle may be stretched over an elevated 1st rib
●diaphragmatic crura may add stress to anterior longitudinal ligament in lumbar area, esp. at L1 & L2
True or false; To assess SI joint pain in a pregnant female, you should assess BOTH the anterior AND posterior innominate for malpositioning.
True
Posterior innominate correction requires an _______ _________ force
Anterior torsion
Anterior innominate correction requires a ________ _______ for correction
Posterior torsion
True or false; a good treatment for women with SI joint pain is ambulation with widely Abducted legs on uneven terrain
False
True or false; a good treatment for women with SI joint pain is frog kicks
False
True or false; a good treatment for women with SI joint pain is splits
False
True or false; a good treatment for women with SI joint pain is climbing the stairs with more than one step at a time
False
True or false; a good treatment for women with SI joint pain is to educating them to swing one leg out at a time when getting up
False
Which test will assess for symphysis pubis?
March test
How do you examine a patient to assess for symphysis pubis?
● Tenderness over Symphysis
● Ends of some will be separated
● May feel several CM
● Shift when pt shifts wt
If a patient has symphysis pubis, they should avoid which action?
Hip abduction
Why might a pregnant woman’s back hurt?
● Added wt ● Poor muscle tone ● Increased lordosis ● Changes in COG ● Loose pelvic ligs.
True or false; the piriformis may lengthen during pregnancy due to relaxin
False, it shortens, causing the waddling gait
(Midline/ Mediolateral) episiotomy heals easier
Midline
(Midline/ Mediolateral) episiotomy increases risk for sphincter damage
Midline
(Midline/ Mediolateral) episiotomy increases risk for asymmetrical tissue
healing and scarring
Mediolateral
Incontinence occurs during pregnancy and after delivery due to…
weakness and pressure on the bladder
What are the verbal instructions for pelvic floor contractions?
● Long=hold 10-15 sec ● Short=hold 3sec ● 10 reps 3-5x/day ● Avoid valsalva ● Have pt use stop test once per week as it tests the external sphincter
To which part of the body might you provide a Thiele’s massage?
Coccyx
Which orthosis relieves pressure from pregnancy and increased blood flow
The baby hugger orthosis
Valves in veins swell, causing __________ filling with distension
retrograde
True or false; knee and patella dysfunction may occur, resulting in instability and chrondromalacia secondary to relaxin AND preexisting condition
True
Which nerve palsie is caused by compression
of the fetal head before birth or during delivery?
Obturator L3-4
Which nerve palsie is caused by Psoas m hemorrhage, pelvic trauma, or compression in the pelvic cavity?
Femoral L2-3
Which nerve palsie iscaused by compression of the stirrups used in delivery?
Peroneal L4-5
Feet are more likely to be (supinated/pronated), so strengthen the medial compartment and toe (flexors/ extensors)
Pronated
Flexors
What is the goal of exercising during pregnancy?
Goal is to maintain maternal and fetal physiologic reserve
During pregnancy, flood volume increases ___%
40
Initially during pregnancy, blood CO2 increases ___%
20
During pregnancy, pulse increases around ___bpm
15
Duringpregnancy, vital capacity increases ____%
None, it remains unchanged, 0%
During pregnancy, basal O2 consumption increases ___%
20%
During pregnancy, metabolic demands increase around _____cal
300
Vigorous maternal exercise can increase fetal HR ______ bpm. Max exercise can cause ___________.
5-15
fetal bradycardia
If you’re having twins, exercise may be relatively contraindicated after _____weeks
24
