Womens Health Flashcards
The long term sequel are of chronic anovulation includes unopposed estrogen stimulation of the endometrium putting with PCOS women at 3xs risk for
Endometrial cancer
Also associated with increased lipid abnormalities
All women diagnosed with PCOS must be screened for
Diabetes
Hyperlipidemia
Treatment of women with PCOS should address 4 areas
1) chronic anovulation
2) androgen excess
3) insulin resistance
4) lipid abnormalities
First line of therapy for PCOS
Biguanide Metformin
PCOS patients suffering from infertility should be treated with🤔
Clomiphene ovulation induction
Combined oral contraceptive pills are an ideal first line treatment in patients who also desire conception
Dysrythmia almost universally associated with patients with anorexia nervosa
Sinus bradycardia
Regional analgesia in laboring patients increases the risk of?
Vacuum or forceps assisted delivery
Patients with diarrhea predominant OR MIXED presentation IBS should be tested for?
Celiac disease
A diagnosis of migraine with aura is considered an unacceptable risk for
Combined Oral contraceptives
Sevelamer is a synthetic agent of phosphate binders class works by?
Blocking intestinal absorption of phosphate, which lowers parathyroid hormone secretion
Uricosuric acid, cystine, calcium oxalate stones tend to form in?
Acidic urine
In patients with hyperthyroidism to avoid worsening of orbitopathy recommended treatment?
Treat with methimazole prior to radioactive iodine ablation
Treatment that leads to most effective weight reduction and long term management in morbidly obese
Bariatric surgery
The major source of serum BNP
The cardiac ventricles
Condition characterized by chronic anovulation and hyperandrogenism
PCOS
In women 30-65 years old, screening for cervical cancer with cervical cytology and HPV testing is recommended every
5 years
Anovulatory amenorrhea is abnormal uterine bleeding that typically results from
Endocrinopathy i.e.; PCOS
Mechanism of abnormal bleeding related to unopposed estrogen
Imaging recommended to evaluate the uterus in patient with history of abnormal uterine bleeding
Transvaginal US MORE ADVANCED IMAGINGthen
Saline infusion sonohysterography
Or
Hysteroscopy
Endometrium that is too thin because of heavy continuous bleeding. What is treatment?
estrogen followed by progestin
Treatment too thick endometrium
Goal of therapy?
Treat with Progestins or OCPs to reduce thickness of the endometrium
Abnormal uterine bleeding emergency management
IV conjugated estrogen- 25mg q 4hours until bleeding slows
Oral conjugated estrogen 10 mg/ day
Determination of adequate estrogen in amenorrhea is established by?
Progestin challenge test
5-10 mg medroxyprogesterone acetate po q day X 10 days
ANY. Bleeding within 2-7 days is positive
Anovulatory amenorrhea is amenorrhea in women with adequate estrogen (+ progestin challenge) occurs because
Progesterone is NOT being adequately produced in the LUTEAL phase
Treat with progestin 10 mg q day 7-10 days every month or OCPs
Amenorrhea with nL TSH, Prolactin, and NEGATIVE withdrawal bleed with progestin challenge ➡️ no bleed with both estrogen and progestin challenge
Outflow tract obstruction
Management of PCOS
HIRSUTISM?
OCPs
Spironolactone
Fin astride
Management of PCOS
Insulin resistance?
Metformin
Management PCOS
Infertility
Meds that promote ovulation induction?
Clomiphene
Metformin
Pioglitazone
Management of PCOS
Oligomennorhea and amenorrhea?
OCPs
Monthly progesterone
First test when evaluating premenopausal bleeding?
Endometrial biopsy
Single most important histological finding on endometrial biopsy
Cytological atypia
Management In reproductive women with Cytological atypia on EMB
High dose progestins, megace (megestrol) or depo provera for 3 months then rebiopsy
Management in reproductive women with no Cytological atypia but simple endometrial hyperplasia with abnormal bleeding
Progestin withdrawal for 6 months then rebiopsy
MPA (provera), megestrol (megace), levonorgestrel IUS (mirena- induces amenorrhea and may cause atrophy) or sequential HRT - prevents hyperplasia but no contraception
Irregular bleeding is common after HRT is initiated and improves within
6-12 months for most women
Preferred treatment for vaginal dryness/ atrophy of the vagina
Vaginal estradiol ring worn for 90 days
52 year old currently takes no meds refuses estrogen replacement therapy. What is considered most effective in relieving her menopausal symptoms?
Venlafaxine ( Effexor)
All pregnant women should be screened for anemia? What level of Hgb is considered iron deficiency anemia in first trimester?
First trimester- Hgb
USPSTF recommends ALL pregnant women be screened for
HIV
Hepatitis B
Syphilis
USPSTF recommends ALL pregnant women less than 25yo and with high risk sexual behaviors (>1sexual partner) be screened for
Chlamydia and gonorrhea
When should women with active recurrent genital herpes should be offered suppressive viral therapy at or beyond
36 weeks of gestation
Acyclovir 400 mg tid
Valcyclovir 500mg po bid daily
How long must OCPs be taken before they become effective
1 month
The imaging study for evaluation of pelvic mass is?
Ultrasound
The most common class of organisms associated with BV
Anaerobic bacteria
Women with ASC-US who test positive for high risk HPV SHOULD UNDERGO
Colposcopy
HPV types associated with genital warts
6&11
Which part of the cervix is most vulnerable today’s plastic changes
The squamocolumnar junction
Indications for estrogen therapy/ estrogen combined with daily or cyclic progestin/progesterone therapy
1) treatment mod- severe vasomotor symptoms
2) treatment mod to severe vulvar and vaginal atrophy
3) prevention of post menopausal osteoporosis
USPSTF recommends biennial (every other year) mammography for women ages
50-74
Stop screening at age 75
The American cancer society recommends along with mammography that screening breast MRIs be performed in 5 groups. What are the 5 groups?
Women BRCA1&2 gene mutations
Women 1st degree relatives w/BRCA1&2 gene mut who have not had genetic testing
Women who underwent radiation to chest aged 10-30 for hodgkins
Women lifetime risk
Women known hereditary breast cancer syndrome
What is the preferred initial test for a patient with painless post menopausal bleeding
Transvaginal ultrasonography
