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PANCE REVIEW > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Key Points to the menstrual cycle

A

1) Follicular phase/Proliferative (14 days): presence of estrogen thickens the endometrium until a dominant follicle is produced-leads to ovulation
2) Luteal phase/Secretory phase: AFTER ovulation, progesterone prepares uterus lining for implantation, if the corpus leuteum doesn’t implant, then you will decrease both hormones and menstruation happens

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2
Q

On what days in the menstrual cycle does ovulation occur?

A

Days 12-14

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3
Q

What causes ovulation? (the release of the egg)

A

LH surge

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4
Q

Heavy or prolonged bleeding @ normal menstrual intervals

A

menorrhagia

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5
Q

Irregular bleeding between normal menstrual cycles

A

Metorrhagia

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6
Q

Infrequent menstruation

A

Oligomenorrhea

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7
Q

Painful menstruation

A

Dysmenorrhea

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8
Q

What is the cause of primary dysmenorrhea?

A

Non-pelvic etiology:

  • Caused by increased prostaglandin secretions which causes increased uterine wall contractility
  • Treat with NSAID
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9
Q

What is the cause of secondary dysmenorrhea?

A

A pelvic etiology:

-Caused by something such as endometriosis, leiomyoma, PID

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10
Q

At what point in the menstrual cycle do the symptoms of Premenstrual syndrome occur?

A
  • They occur in the luteal phase
  • They are relieved within 2-3 days of the onset of menses
  • Must be symptom free at least 7 days during the follicular phase

**Treat with SSRI

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11
Q

What is the definition of primary amenorrhea?

A
  • Failure of menarche onset before the age of 15 if 2ry sex characteristics present
  • Failure of menarche onset before the age of 13 if NO 2dy sex characteristics
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12
Q

Etiologies of primary amenorrhea

A

1) A uterus & breasts present and there is outflow obstruction
2) There is no uterus (Mullein agencies, androgen insensitivity)
3) Ovarian causes of too much FSH, LH-there would be no breasts present (premature ovarian failure, gonadal dysgenesis)
4) HPA axis failure causes low FSH. LH

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13
Q

What is the definition of secondary amenorrhea?

A

absence of menses for >3 months in a patient with previously normal menstruation

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14
Q

Etiologies of secondary amenorrhea

A

1) Pregnancy (MC)
2) Hypothalamus dysfunction ( low FSH, LH)
3) Pituitary dysfunction (high prolactin)
4) Ovarian dysfunction (PCOS, POF

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15
Q

Amenorrhea workup

A

1) pregnancy test
2) estrogen stimulation

3) Progesterone challenge test
- If withdrawal bleeding there is an ovarian issue
- If no withdrawal bleeding there is not enough estrogen or an outflow obstruction

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16
Q

What is the influence of estrogen and progesterone replacement on endometrial cancer?

A

Unapposed (only estrogen) replacement = INCREASED risk

Estrogen & Progesterone combo = protective

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17
Q

What is the best lab to order when menopause is suspected?

A

FSH! The levels will surge greater than 30

-Later you will see decreased estrogen

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18
Q

Consequences of menopause (loss of estrogen protection)

A

1) osteoporosis
2) increased lipids
3) increased cardiovascular risk

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19
Q

What is a leiomyoma?

A

Benign smooth muscle tumor of the uterus

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20
Q

MC presenting symptom of leiomyoma?

A

Bleeding

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21
Q

Treatment of leiomyoma

A

GhRH agonist (Leuprolide)

-Hysterectomy is definitive

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22
Q

What is the MC cause for a hysterectomy?

A

Leiomyoma

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23
Q

Cystocele

A

Prolapse of the posterior bladder into the anterior vagina

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24
Q

Rectocele

A

Prolapse of the rectum in the posterior vagina

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25
Q

Enterocele

A

Prolapse of the pouch of douglas into the upper vagina

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26
Q

Grading of Pelvic organ prolapse

A

I. descent into upper 2/3 of vagina
II. cervix aproaches introitus
III. outside introitus
IV. complete prolapse outside vagina

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27
Q

Pelvic organ prolaspe management

A
  • prevent with Kegal exercises
  • Pessaries
  • Ligament fixation surgeries
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28
Q

What is the triad of PCOS?

A

1) Amennorrhea
2) obesity
3) Hirstuism

*all from insulin resistance

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29
Q

Pathophysiology of PCOS

A

Abnormal HPA axis, leading increased insulin (insulin resistance) and increase LH leading to ovarian androgen production

-High testosterone and high LH levels found

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30
Q

Treatments for PCOS

A
  • OCP
  • Spirinolactone (tetragenic), decreases androgens
  • Clomiphene; if desiring pregnancy
  • Metformin
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31
Q

99% of cervical cancer is caused by what?

A

HPV 16, 18 MC

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32
Q

What is the MC type of cervical cancer?

A

squamous cell

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33
Q

MC presenting symptom for cervical cancer?

A

Post coital bleeding/spotting

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34
Q

How do you diagnose cervical cancer?

A

Colposcopy with bx

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35
Q

What strands of HPV does the Gardasil vaccine cover

A

HPV 6,11,16,18

  • given between 11-26 years old.
  • If under 15: get 2 doses 6 months apart
  • If over 15: get 3 doses over 6 months
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36
Q

What type of breast disease changes with menstruation?

A

Fibrocystic breast disease

37
Q

Hallmarks of fibrocystic breast disease

A

Fluid-filled breast cyst due to exaggerated response to hormones

  • MC in 30-50 y/o & MC breast disorder
  • Mobile and tender
  • Straw colored fluid on FNA
38
Q

Hallmarks of breast fibroadenoma

A

-Late teens to early 20s
-nontender, mobile, rubbery mass that DOES NOT change with menstruation
-

39
Q

Hallmarks of inflammatory breast cancer

A
  • Peau d’orange apperance due to lymphatic obstruction

- red swollen, warm itchy breast

40
Q

Neoadjuvant Endocrine Therapy for ER positive breast cancer?

A
  • Anti-estrogen: Tamoxifen
  • Aromatase Inhibitors: Letrozole, Anastrozole
  • Can also be used in high risk patients to prevent breast cancer
41
Q

Neoadjuvant Endocrine Therapy for HER2 positive breast cancer

A

Trastuzumab (Herceptin)

42
Q

MC causative organisms of Pelvic Inflammatory Dz

A

N. gonorrhoeae & Chlamydia

43
Q

Treatment of PID

A

Outpatient: Doxy + Ceftriaxone

Inpatient: Doxy + 2nd gen cephalosporin

44
Q

Diagnosis of PID

A

1) Abdominal tenderness
2) Adnexal tenderness
3) Cervical motion tenderness (Chandelier sign)

PLUS 1 of the following:

  • fever
  • WBC
  • positive gram stain
  • pus
  • ESR, CRP
45
Q

Hallmarks of bacterial vaginosis

A
  • Caused by an overgrowth of natural bacteria (Gardnerella vaginalis) as the PH increases
  • MC cause of vaginitis
    • Whiff test with fishy order and thing, grey watery discharge
  • Clue cells on microscope
  • Metronidazole x 7 days
  • Do not need to treat partner
46
Q

Hallmarks of Trichomoniasis vaginitis

A
  • Flagellated protozoa
  • Itching, erythema, dysuria
  • Malodorous frothy yellow green discharge, STRAWBERRY CERVIX
  • Treat with metronidazole and treat partner
47
Q

Hallmarks of Canndida vaginitis

A
  • Candida albicans overgrowth
  • Curd-like cottage cheese discharge
  • Hyphae yeast on KOH
  • Treat with 1 dose fluconizole
  • Can also use anti fungal creams such as clotrimazole
48
Q

Chlamydia hallmarks

A

MC cause of Cervicitis

  • Dysuria, mucopurulent cervix, frequency
  • Diagnose with Nucleic acid PCR
  • Treat with Azithromycin 1g x 1 dose OR doxycycline 100mg PO x 10 days
49
Q

Gonorrhea hallmarks

A
  • May be asx with vaginal discharge, dysuria, frequency
  • Dx with nucleic acid PCR
  • Tx is with Ceftriaxone 250 mg IM
50
Q

Chancroid Hallmarks

A
  • Caused by Haemophilus Ducreyi
  • Appear as a PAINFUL genital ulcer with inguinal lymphadenopathy
  • Treat with Azithromycin
51
Q

How does HPV present

A
  • Precursor to cervical cancer
  • Flat, pedunculate flesh-colored growths
  • “CAULIFLOWER LESIONS”
  • Cells whiten with 4% acetic acid application
52
Q

How do Oral contraceptive pills work?

A
  • Prevent ovulation by inhibiting the LH surge
  • Thickens cervical mucus
  • Thins endometrium
53
Q

Pros of OCP

A
  • controls dysmenorrhea

- Protects against osteoporosis, endometrial and ovarian cancer

54
Q

Cons and contraindications of OCP

A
  • Smokers over 35 y/o SHOULD NOT USE
  • Increased risk for gallstones, DVT/PE, fluid retention
  • Caution in diabetic
55
Q

What is the “mini pill”?

A

Progestin only birth control:

  • inhibits ovulation and thickens cervical mucosa
  • safe during lactation
  • can have menstrual irregularities
56
Q

2 examples long lasting progestins

A

1) Implanon (etonogestrel): implantable rod that lasts 3 years; increases osteoporosis
2) Depo Provera: injection lasting 3 months

57
Q

What is ortho evra?

A

Transdermal birth control patch

-applied weekly for 3 weeks with 1 week off

58
Q

What is the most effective form of contraception (other than sterility and abstinence) ?

A

Intrauterine devices:

1) Mirena: lasts 5 years
2) Paraguard: copper IUD, lasts 10 years

59
Q

Clomiphene

A

Partial estrogen receptor agonist (stimulates ovulation via hypothalmus)

-Induces ovulation in patients with Infertility and PCOS

60
Q

Leuprolide

A

GnRH analog:

  • If given PULSATILE; treats infertility
  • If given CONTINUOUS; treats fibroids, prostate cancer, DUB, PMS
61
Q

How long after conception can a serum b-hcg be positive?

A

5 days

62
Q

How long after conception can a urine b-hcg be positive?

A

14 days

63
Q

What is Goodell’s sign?

A

Cervical softening due to increased visualization at 4-5 weeks gestation

64
Q

What is chadwicks sign?

A

bluish coloration of the cervix at 8-12 weeks gestation

65
Q

How do you estimate the date of deliver?

A

Naegele’s rule:

7 days after start of LMP subtract 3 months

66
Q

Triple screening measured at 15-20 weeks (2nd trimester)

A
  1. alpha-feto protein
  2. B-hcg
    3) estradiol
67
Q

A 2nd trimester screening test with the following results indicate what dx?

AFP: low
B-hCG: High
Estradiol: Low

A

Down Syndrome (Trisomy 21)

68
Q

A 2nd trimester screening test with the following results indicate what dx?

AFP: High
B-hCG: n/a
Estradiol: n/a

A

Open neural tube defects such as spina bifida

69
Q

A 2nd trimester screening test with the following results indicate what dx?

AFP: Low
B-hCG: Low
Estradiol: Low

A

Trisomy 18: often born stillborn or die within first year

70
Q

When is gestational diabetes screened for?

A

24-28 weeks

71
Q

When are fetal heart tones heard on doppler?

A

10-12 weeks

72
Q

Who gets RhoGAM and when is it given?

A

RH - mothers who are unsensitized

Given @ 28 weeks, and within 72 hrs after childbirth

73
Q

What is the definition of a spontaneous abortion ?

A

loss of pregnancy before 20 weeks

74
Q

What is the MC cause of first trimester bleeding?

A

Threatened abortion

75
Q

Hallmarks of threatened abortion

A
  • Pregnancy may be viable
  • Bleeding or spotting
  • Nothing is expelled
  • Bed rest and monitor B-hCG
76
Q

Hallmarks of an inevitable abortion

A
  • nothing is expelled
  • progressive cervical dilation, possible ROM
  • D&C if 1st trimester
  • D&E (evacuation) if after 1st trimester
77
Q

Hallmarks of incomplete abortion

A
  • some contents expelled
  • dilated cervix
  • heavy bleeding with retained tissue
  • Give ptocin, D&E
78
Q

Hallmarks of a complete abortion

A
  • all contents expelled

- give rhogam if indicated

79
Q

Hallmarks of missed abortion

A

Fetal demise but still retained in uterus

  • nothing expelled
  • closed cervical os
  • misoprostol, D&E
80
Q

What is placenta previa?

A

Abnormal placental placement on or close to the cervical os

81
Q

How does placenta previa present?

A

PAINLESS 3rd trimester bleeding, do an u/s to determine placenta placement

-You then need to monitor fetal heart rate and induce steroids for lung development if past 24 weeks. If complete previa you must do C-section

82
Q

What is a placental abruption ?

A

Premature separation of placenta from uterine wall

83
Q

How does placental abruption present?

A

Severe PAINFUL distended uterus with dark red profuse 3rd trimester bleeding

  • The fetal heart rate is likely to to be bradycardia and in distress
  • Immediate delivery is needed
84
Q

Average length of menstrual cycle

A

24-38 days with 4.5-8 days of menstruation

85
Q

Etiologies of dysfunctional uterine bleeding

A

1) chronic anovulation (90 %)
- unopposed estrogen without ovulation means no progesterone is produced, which means the uterus will shed irregular and unpredictably as overgrowth occurs rather than when progesterone should have stimulated it to.

2) ovulatory
- Prolonged progesterone secretion after ovulation causes increased endometrial vessel dilation and prostaglandins

86
Q

Workup of dysfunctional uterine bleeding

A

Diagnosis of exclusion!!

-must find no organic cause even after all the following has been evaluated:

Hormone levels, TVUS, endometrial bx (if >4mm)

87
Q

Treatment for acute/ severe dysfunctional uterine bleeding

A
  1. high dose IV estrogens

2. hysterectomy is definitive

88
Q

Treatment for anovulatory and ovulatory causes of dysfunctional uterine bleeding

A

OCP

PANCE REVIEW (15 decks)

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