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Quarter 4 > womens health > Flashcards

womens health Flashcards

1
Q

the 5 Ps of taking a history

A 
Partners
Practices (what type)
Prevention
Protection
Past hx of STI
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2
Q

Special populations STI

A 
Youth 15-24
MSM
Pregnant
HIV
Correctional facility
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3
Q

3 most common sx of Vaginitis

A

discharge
odor
pruritis/discomfort

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4
Q

3 mosts common causes of Vaginitis

A

Yeast infection, BV, Trich

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5
Q

Yeast infection

A

highest prev in reproductive years

C albicans

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6
Q

Yeast infection

A

Pruritis, vulvar soreness

White, thick, curd like, adherent to vaginal walls

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7
Q

Yeast infection risk factors

A

DM
Abx use
Inc estrogen levels
Immunosupp

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8
Q

Dx of Yeast infection

A

Wet mount 10% KOH: budding yeast, hyphae, or pseudohyphae

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9
Q

tx of Yeast infection

A

Oral Fluconazole (Diflucan) OR OTC topical azole (Clotrimazole)

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10
Q

Tx for Yeast infection in pregnant

A

Need to use topical (Clotrimazole or Miconazole)

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11
Q

BV

A

most common cause of discharge among women of childbearing age!***

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12
Q

BV

A

Malodorous, “fishy”, thin off white d/c

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13
Q

Dx criteria for BV

A 
Amsel's, need at least 3 of the following:
-thin, white, homo d/c
-CLUE CELLS
-ph >4.5
\+whiff test
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14
Q

Tx of BV

A

Metronidazole (Flagyl) 500 mg BID x 7 days

OR gel or clinda cream

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15
Q

What to avoid while taking Metronidazole (Flagyl)

A

drinking alcohol

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16
Q

Trich

A

most common non-viral STI in the world

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17
Q

Are sx common with Trich?

A

NO

most have minimal or no sx (70-85%)

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18
Q

Sx of Trich

A

Purulent, frothy, thin
malodorous d/c
POSTCOITAL BLEEDING
pain w/intercourse

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19
Q

Trich

A

flagellated protozoan

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20
Q

PE of Trich

A

“Strawberry cervix”

vaginal ph >4.5

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21
Q

Dx of Trich

A

NAAT: gold standard

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22
Q

Tx of Trich

A

Metronidazole (flagyl) 2g of one single dose

can do 500 mg BID if pregnant, much weaker dose

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23
Q

Chlamydia

A

most common reported BACTERIAL STD in AMERICA

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24
Q

Clinical sx and PE of Chlamydia and Gon are IDENTICAL

A

Cervicitis: change in d/c, intermenstrual/post intercourse bleeding OR sx related to urethritis

PE: mucupur endocervical d/c, FRIABLE cervix, erythema, edema

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25
Q

Dx of Chlam and Gon

A

NAAT

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26
Q

Complication of Chlam

A

Conjunctivitis of Neonate

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27
Q

Gonorrhea

A

2nd most common reportable communicable dz in AMERICA

concern with ABX RESISTANCE

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28
Q

Complications of Gonn

A

Transmissable to neonate during delivery

DGI (arthritis)

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29
Q

Tx of Chlamydia

A

Azithro or

Doxy

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30
Q

Tx of Gonorrhea (more)

A

Azithro AND

Ceftriazone (rocephin)

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31
Q

Screening for Gon/Chlam

A

Yearly for all sexually active women <25YO, AND

older with risk factors

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32
Q

PID

A

upper genital tract (ascending)

often a comp of Gon/Chlam or BV-assoc pathogens

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33
Q

PID

A

wide array of clinical sx

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34
Q

PID physical

A 
Abdominal tenderness (lower quadrants)
Uterine, adnexal, or CVA tenderness "chandelier sign"
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35
Q

A manifestation of PID (on boards!!!)

A

Perihepatitis: Fitz Hugh Curtis Syndrome

inflammation of liver capsule and neighboring peritoneal surfaces

PID, RUQ pain, “violin string” lesions on liver

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36
Q

What to order if suspicous of PID

A 
Pregnancy test!!
Pelvic US (if unsure)
microscopy of d/c
NAAT (r/o Gon/Chlam)
HIV screen, syphillis screen
UA
CBC, ESR/CRP
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37
Q

Gold standard test for Gon/Chlam

A

NAAT

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38
Q

Criteria for presumptive clinical dz of PID

A

Sexual active young women
Pelvic/lower abd pain
Cervical motion, uterine, or adnexal tenderness
(“Chandelier”)

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39
Q

Tx for PID

A

Ceftriaxone (rocephin) AND

Doxy

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40
Q

Most common STI in the WORLD

A

HPV- condyloma acuminata, anogenital warts

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41
Q

most common types of warts

A

strand 6 and 11

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42
Q

Risk factors of HPV

A

sexual activity
smoking
immunosuppression

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43
Q

Tx of HPV (warts)

A

Cyto destructive: Podoflox
Immune med: Imiquimod, Sinecatechins
Surgical: cryotherapy, laser, electrocaut

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44
Q

Types of Herpes

A

Primary: person HAS pre-existing antibodies

Non primary first episode: start of HSV2 in person that had HSV1 antibodies, or vice versa

Recurrent: of genital

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45
Q

Tx of Herpes

A

FAV drugs
“cyclovir”
start within 72 hours

1st episode: 7-10 days
Recurrent: 1-5 days
suppression: BID, daily

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46
Q

Mullerian ducts give rise to:

A

Fallopian tubes
Uterus
Upper vagina

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47
Q

Normal female puberty: FSH/LH stimulates production of

A

Estradiol from ovaries

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48
Q

Estradiol –>

A

breast development and growth of skeleton

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49
Q

Average age of menses and menopause

A

menses: 12-13 YO
menopause: 51 YO

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50
Q

Avg menstrual cycle

A

24-38d

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51
Q

Amount of blood loss during menses

A

5-80mL

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52
Q

Primary amenorrhea

A

Failure to reach menses (never start)

by age 15 w normal growth and secondary charac (like breasts)
OR
by age 13 w/o secondary charac (so more than just menses is missing)

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53
Q

Secondary amenorrhea

A

Cessation of menses (stops after it once started)

Absence for more than 3 cycle intervals
OR
6 consecutive mo

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54
Q

Most common cause of Primary amenorrhea

A

Gonadal dysgenesis (ovarian dysfx)

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55
Q

Gonadal dysgenesis

most comm cause of Primary amenorrhea

A

Abnormal organ development

Hyper Hypogonadism (high FSH)

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56
Q

Turner syndrome

46 XO

A

Ovaries can’t respond to gonadotropins

Result: premature depletion of oocytes and follicles

Woman does NOT ovulate or have periods

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57
Q

Turner syndrome clinical sx

A

“shield chest”
webbed neck
widely spaced nipples
“Streak ovaries” and sexual infantilism

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58
Q

Swyer Syndrome

46 XY gonadal dysg

A

“Vanishing testes”
Fibrous streak gonad can’t secrete Anti’-M hormone or testosterone

Mutation of SRY gene

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59
Q

46XY Swyer

A

Gonads fail to diff into testes

Lack of Anti-M, testosterone, and DHT results in FEMALE INTERNAL and EXTERNAL genitalia

everything appears to be girl, but genetically a male

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60
Q

PCOS

rare cause of primary amenorrhea

A

Rare cause of primary amenorrhea

Hyperandrogenism- acne, hirsutism, acanthosis nigricans, obesity

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61
Q

Female athlete triad

A

Not enough calorie intake
Amenorrhea
Low bone density

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62
Q

Functional hypothalamic amenorrhea

A

HPO axis suppressed bc not eating enough

leading to abnormal GnRH secretion –> no follicle develop/ovulation –> Low estradiol secretion –> NO LH surge

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63
Q

Idiopathic Hypo Hypo

Congenital GnRH deficiency

A

if no smell, “Kallmann” synd

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64
Q

Pituitary causes of Primary amenorrhea

A

Micro/Macro-Adenoma (i.e. cushings)
Hyperprolactinemia (BUT this one is more associated w Secondary amenorrhea)

these two are most common

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65
Q

VERY COMMON causes of Primary: Outflow tract disorders

A

Uterine-Mullerian agenesis

  • 46 XX with no oviducts, uterus, or upper vagina. instead have a small pouch rather than full vaginal canal.
  • Normal gonadal function (estrogen = breast devel)
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66
Q

Rare cause of primary amenorrhea

A

Androgen Insensitivity Synd

Genetically male, looks femaile, high testosterone

Breasts, Absent upper vagina, uterus, and fallopian tubes on Pelvic US

Testes are STILLL THERE, intra abdominal or partially descended. Need to be removed d/t CA risk

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67
Q

Rare cause of Primary Amenorrhea

A

5-a-reductase deficiency
-46XY unable to convert DHT–>T

ambiguous genitalia at birth

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68
Q

17-a-hydroxylase deficiency

A

HTN and Lack of pubertal development

d/t decreased Cortisol synth and lack of sex steroids

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69
Q

Biggest cause of Secondary Amenorrhea

A

Pregnancy!

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70
Q

PCOS

A

Androgen excess
Chronic amenorrhea or oligomenorrhea
Polycystic ovaries
Peripheral insulin resistance

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71
Q

Asherman synd

cause of Secondary amenorrhea

A

Scarring of endometrial lining caused by OBGYN procedure

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72
Q

Hx of weight loss, strenuous exercise, eating disorder?

Dx Sec Amenorrhea

A

Hypothalamic disorder

anorexia, exercise, stress induced

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73
Q

Hx of surgical procedure or infection

Dx Sec Amenorrhea

A

Asherman syndrome

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74
Q

HA, visual change, Galactorrhea

Dx Sec Amenorrhea

A

Infiltrating Pituitary dz/tumor

Sheehan synd

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75
Q

Illness, CA, infection, RA

Dx Sec Amenorrhea

A

Can simply be d/t systemic illness

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76
Q

When to start evaluating for Primary amenrrhea

A

No menses by:
age 15
age 13 AND no breast
No menses after 3 yrs of having breasts

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77
Q

Normal order of development for women

A

Breast
Pubic hair
Growth spurt
Menses

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78
Q

Tests to oder when working up Amenorrhea

A

Pregnancy test (hcG)
FSH
TSH
Prolactin

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79
Q

What to order if pt has Short stature and elevated FSH

A

Karyotype

Turner synd

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80
Q

What to order if pt has low/norm FSH, breasts, but NO uterus

A 
Karyotype (Mullerian agenesis)
Total Testosterone (Androgen Insens Synd)
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81
Q

What to order if pt has low/norm FSH, breast, AND uterus is present

A

Consider endocrine: PCOS, thyroid

If hyperandrogenism: order Total Testosterone and DHEA

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82
Q

What to oder it pt has low/norm FSH, NO BREAST

A

Recheck FSH, LH
Consider pituitary MRI

WE NEED TO CONSIDER MRI for tumor if pt has no breasts

83
Q

if FSH is high, consider

A

Primary ovarian insufficiency

ovaries are not responding like they should

84
Q

Amenorrhea tx

A

catered to etiology

85
Q

Primary ovarian insuff example

A

Turner syndrome

86
Q

Breast development is a marker of:

A 
Ovarian fx 
(except for Androgen insensitivity synd)
87
Q

4 tests to order when working up amenorrhea

A

Pregnancy
FSH
TSH
Prolactin

88
Q

Pt has breasts, what is next test

A

Uterus?
Yes: outflow obstruction
No: Karyotype

89
Q

Pt has NO breasts, what is next test

A

FSH/LH

Low: hypo hypo
High: Hyper hypo –> karyotype (Swyer, Premature failure, Turner)

90
Q

Secondary amenorrhea

A

> 3 mo if regular cycle

>6 mo if irregular cycle

91
Q

If evidence of hyperandrogenism, order

A

Total Testosterone

92
Q

Abnormal bleeding

A 
Abn quantity, duration, or schedule
<24 days
>38 days
duration>8 days
loss >80 mL
intermenstrual
93
Q

Most common causes of abnormal bleeding:

A

Anovulation
Structural pathology
Bleeding disorder
Uterine neoplasia

94
Q

PALM- COEIN for abn uterine bleeding

A 
PALM= structural causes
COEIN= non structural
95
Q

PALM causes of structural bleeding

A

Polyp
Adenomyosis
Leiomyoma (uterine fibroid)
Malignancy, endometrial hyperplasia

96
Q

COEIN cause of NONstructural bleeding

A 
Coagulopathy
Ovulatory dysfx
Endometrial
Iatrogenic (anticoags, birth control)
Not otherwise classified
97
Q

What to do first when you suspect abnormal bleeding

A

Confirm uterus is source
Exclude pregnancy
What is pattern, severity, and cause?

98
Q

Most common cause of Abn Uter Blee in 13-18 YO

A

Persistent anovulation d/t immature HPO axis

99
Q

Most common cause of Abn Uter Blee in 19-39 YO

A

Structural lesion (fibroid, leiomyoma, polyp)

100
Q

Most common cause of Abn Uter Blee (AUB) in over 40 YO

A

Anovulatory bleeding

Endometrial hyperplasia and CA

101
Q

Molimia sx

A

related to cycle

Breast tender, bloating, change in cervical mucus

102
Q

Menorrhagia

heavy

A

Think:
Structural lesion (polyp, hyperplasia, fibroid)
Coagulation disorder
Liver/Kidney failure

103
Q

Intermenstrual bleeding

A

d/t Cervical pathology (dyslasia or infection) or an IUD

104
Q

Perimenopause

A

Abn bleeding 5-10 years before menopause, common

Anovulation d/t declining # of Ovarian follicles

105
Q

Bleeding that is frequent, heavy, or prolonged should be evaluated with

A

EMB- Endometrial Biopsy to r/o Endometrial hyperplasia or CA

106
Q

Is bleeding AFTER menopause ever normal?

A

NO
Concerning for Endometrial CA

Do Pelvic US OR EMB- Endometrial biopsy

107
Q

Abn Uter Blee physical exam

A

Signs of bleeding disorder (skin, pallor, bruising)

Thyroid!

Hyperandrogen (acne, hirsutism, male balding)

108
Q

If anovulatory bleeding with AUB,

A

check CBC

then TSH, Prolactin, Androgen

109
Q

If ovulatory bleeding with AUB, suspect

A

CBC and other labs
Pelvic US
EMB-endometrial bx

110
Q

Intermenstrual bleeding, what tests?

A

Pap smear

Cervical cultures

111
Q

Who should get EMB- Endometrial Bx?

A

> 45YO with AUB

ANY postmenopausal women with uterine bleeding

112
Q

If you are younger than 45, when should you get EMB- Endometrial bx?

A

with Abnormal Uterine Bleeding (AUB) AND
Risk factor for unopposed estrogen
Persistent bleeding
Failed med tx for AUB

113
Q

Inpatient mgmt for Acute AUB

A

Admit if heavy and sx of hemodynamic instability

Tx: IV estrogen or possible Dand C

114
Q

Outpatient mgmt of AUB

A

COC (birth control)
Medroxyprogesterone (provera) , prog only
High dose estrogen
Tranexamic acid (non hormonal)

115
Q

Two most common outpatient tx for AUB

A

COC (monophasic pill w ethinyl estradiol)
AND
Medroxyprogesterone (provera)

116
Q

Most common Tx for CHRONIC AUB

A

Levonorgestral (mirena) IUD

117
Q

Tx for Chronic AUB (surgical options)

A

Endometrial ablation

Hyesterectomy (extreme cases)

118
Q

Other tx options for chronic AUB

A

Depo-provera
Estrogen/progestin
Tranexamic acid
NSAIDs

BUT keep in mind, Levonorgestrel (Mirena) IUD is most common!

119
Q

Anovulatory AUB

A

unpredictable bleeding

120
Q

Ovulatory AUB

A

regular cycle length + sx associated w ovulation

121
Q

Heavy AUB bleeding likely d/t

A

Fibroid
Adenoma
Coagulopathy

122
Q

Intermenstrual bleeding likely d/t

A

polyp
birth control
PID
cervical issue

123
Q

Irregular (anovulatory) bleeding likely d/t

A

PCOS
Thyroid
Hyperprolactinemia

124
Q

If pt is hemodynamically unstable with AUB, what is tx?

A

IV Estrogen

125
Q

Primary dysmenorrhea

A

Painful menses, No dz

17-22 YO common

126
Q

Secondary dysmenorrhea

A

Painful menses d/t PRESENCE of Dz

older women

127
Q

Prostaglandins are released from endometrium during cell lysis –>

A

uterine contractions and ischemia –> PAIN

128
Q

When do primary dysmenorrhea sx onset

A

few hours b4 or just after onset of menses

129
Q

Workup for primary amenorrhea

A

Pregnancy test

Consider pap smear and vaginal cultures, but not always nec

130
Q

Tx of Primary dysmenorrhea

A

1st line: NSAIDs!!!!

+ supportive- exercise, stop smoking, heat, yoga

2nd line pharm: Birth control (COC, Depo provera, IUD)

131
Q

Consider laparoscopy or GnRH analog tx in Primary Amenorrhea if

A

Resistant cases

132
Q

When to f/u or Refer out with primary amenorrhea

A 
pain worsening each cycle
last longer than first 2days
meds not working
increasingly heavy
pain with FEVER
abnormal d/c
pain unrelated to menses
133
Q

Secondary dysmenorrhea

A

bc of a disease

may be worse during menses

134
Q

Secondary dysmen sx often associated with other sx like

A

Dyspareunia (pain w sex)

Infertility or AUB

135
Q

Secondary dysmenn sx usually age

A

30-40

136
Q

Common cause of secondary dysmenn (a disease)

A 
Endometriosis
Adenomyosis
Adhesions
PID
Fibroids
137
Q

Tx of Seconday dysmen

A

Underlying cause
COC
Pelvic surgery perhpas

138
Q

PMS relationship to

A

LUTEAL phase
occurs i most cycles
resolve w onset of mense

139
Q

PMDD

A

PMS w more severe emotional sx

140
Q

PMDD possible cause

A

abnormal Serotonin response

141
Q

Not enough Serotinin in Luteal phase

A

PMS, and other sx caused by:
Progesterone increases MAO
which reduces Serotinin availability

142
Q

PMS diagnostic criteria

A

1-4 sx that are physical, behavioral, or psychological OR

> 5 sx that are physical or behavioral

at least ONE sx during Luteal phase
Sx remit at menses

143
Q

PMDD

DSM5 criteria

A

At least one must be present:

  • mood swing, sudden sad, sens to rejection
  • hopelessness, depressed
  • anger/irritable
  • tension,anxiety

AND

at least one of these (together totallying 5)

  • cant concentrate
  • appetite change
  • anheydonia
  • fatigue
  • overwhelmed
  • sleep changes
  • breast tender, wt gain, bloating
144
Q

PMDD Criteria ctd

A

must be present in most cycles over the PREVIOUS YEAR

145
Q

Non pharm tx for PMS

A 
decrease salt, caffeine
exercise
calcium, MG
stress reduce
CBT
146
Q

Pharm tx of PMDD

A

First line tx: SSRI (fluoxetine (prozac), sertraline (zoloft) escitalprom (lexapro)

147
Q

Fluoxetine and Sertraline are best tx for

A

PMDD

both are SSRIs

148
Q

Menopause

A

permanent cessation of menses for 12 months in a row

149
Q

Perimenopause (transition to menopause)

A

4 years before Final Menstrual Period (FMP)

150
Q

Clinical sx of Perimenopause (menopausal transition)

the time period b4

A

Irregular menses
Hot flashes/night sweats

Anxiety/depression
Vaginal dryness
Change in lipid/bone

151
Q

FSH value is suggestive of Perimenopause (transitional period b4)

A

FSH > 25

152
Q

Menopause before age ___ is abnormal

A

40 YO

153
Q

Labs to suggest you are officially Menopausal

A

FSH > 70

154
Q

Postmenopause sx

A

Hot flashes (usually stop within 4-5 YEARS of onset)
Vaginal dryness
Inc risk Osteoporosis, CVD, and Dementia
Anxiety/Depression

155
Q

Vasomotor (hot flashes)

A

Usually in upper body, face, neck, chest
1-5 min
Narrowing of Thermoregulatory zone

156
Q

Who has hot flashes the worst in menopause?

A

African american

What about the least? Asians

157
Q

Tx for Hot flashes

A 
Lifestyle
Estrogen vs. Estrog/Prog
SSRI, SNRI
Clonidine
Gabapentin
Herbal
158
Q

NOT recommended for hot flashes

A

Prog only meds
Testosterone
Compounded bio-identical hormones

159
Q

Most effective tx for Menopausal sx

A

Systemic Hormone Therapy (HT)

160
Q

Estrogen only

A

for Women who have had Hysterectomy

161
Q

Why do we usually give the Progesterone component of the Estrog/Prog combo therapy?

A

to protect the uterus from Hyperplasia and Endometrial CA

162
Q

Estrog/Prog combo

A

Women w intact uterus

163
Q

How long to give Hormone Therapy?

A

Lowest dose for shortest possible amt of time.

No more than 5 years and not beyond age 60

164
Q

Do not use Hormone Therapy

A

For more than 5 years

for Woman >60 YO

165
Q

SE of Hormone Therapy

A

Tender breasts
Vaginal bleeding
Bloating
HA

166
Q

Risk of Hormone Therapy

A

Clots and Breast CA

167
Q

Lower risk of clots when using Estrogen only if you use what route

A

Transdermal

168
Q

Different than combo therapy, Estrogen alone does not raise a risk of what

A

no risk of CVD or Breast CA

still clots though

169
Q

CONTRA to Hormone Therapy

A 
Breast CA
CHD
Previous Clot or Stroke
Active Liver dz
Unexplained vag bleed
High risk Endomet CA
TIA
170
Q

Testosterone is not recommended for vasomotor sx, but what can it HELP with?

A

Improve sexual function for postmenopausal women

171
Q

Bio-identical hormones

A

plant derived hormones similar to those produced by body

often advocates recommend salivary testing

172
Q

SSRIs used for Menopause

A

SSRI:

Paroxetine
Citalopram
Escitalpram

173
Q

SRNIs used for menopause

A

Venlaxafine (effexor)

Desvenlafaxine (pristiq)

174
Q

Loss of estrogen with menopause often leads to

A

Vulvovaginal and bladder-urethral atrophy

vaginal dryness, pain w sex, itching
sexual dysfx

urinary frequency
recurrent UTI

175
Q

Treating solely Vulvovaginal atrophy

A

Estrogen- local (cream, ring, tablet)

176
Q

Ospemifene rx for

A

Dyspareunia d/t vulvar atrophy

a SERM

177
Q

Risk factors for Osteoporosis

A

Older age
Female

White or Asian
Long term steroids
Low body weight
Excessive alc intake
Cig smoking
FH Osteoporosis
Vit D def
Secondary osteoporosis
178
Q

How much Ca and Vit D should you have to prevent osteoporosis?

A

1200 Ca

800 Vit D

179
Q

Diagnosing Osteoporosis

A

DEXA gives you a T score
OR
Fragility Fracture

180
Q

Fragility Fracture

A

Spine, hip, wrist, humerus, rib, pelvis

from STANDING HEIGHT or less

181
Q

Osteoporosis Dx with T Score

A

< or equal to -2.5

182
Q

Low bone mass (osteopenia)

A

T score:

between -1 and -2.5

183
Q

T score:

Greater than -1.0

A

Normal

184
Q

When to screen normal healthy women for Osteoporosis?

A

65 YO

185
Q

Usually start bone screening at 65YO, but if women has risk factors, screen earlier:

A 
Hx of fragility fracture
weight <127
Med cause of bone loss
Parental med hx of Hip fx
Smoker
Alcoholism
RA
FRAX calculator 10 yr risk is >9.3%
186
Q

Candidates for Pharm therapy for Osteoporosis

A

Post menopause hx of HIP or VERTEBRAL fracture

T score

187
Q

1st line therapy for Osteopenia

A

Bisphosphonates

zoledronic acid, risedronate, alendronate

188
Q

Other tx for Osteoporosis

A

SERMS
(Evista/Raloxifene)
reduce risk of Breast CA

189
Q

Monitoring for Osteoporosis

A

Normal T score: 5-15 yrs
Osteopenia (-1.5 to -2): 5 years
Bad osteopenia (-2 to -2.49): 1 year

190
Q

Monitoring after you legit have Osteoporosis, for tx reasons

A

1-2 years after starting tx, then every 2 yrs after

191
Q

Anterior compartment POP

A

Cystocele (bladder)

192
Q

Posterior compartment POP

A

Rectocele

193
Q

Prolapse sx

A 
Heaviness, pressure
Urinary sx
Defecatory sx
Splinting
Pain and irritation
194
Q

Risk factors for Prolapse

A

Vaginal births
Obesity
Chronic dz (constipation, COPD)

195
Q

Racial effect on Prolapse

A

Hispanic women highest risk

African american lowest risk

196
Q

Conservative mgmt of prolapse

A

Pessary (donut thing)

Kegel exercises

197
Q

Surgical tx of prolapse

A

for those who have sx or declined conservative mgmt

198
Q

Advantage of Pessary:
safe
effective

A

Disadvantage of Pessary:
odor, d/c, vagina ulcer
have to remove for sex

199
Q

Surgery for Prolapse, can take ligament from:

A

Sacrospinous

Uterosacral

200
Q

Sacrocolpopexy surgery

A

Attach vagina or cervix to Anterior longitudinal ligament of the SACRUM

201
Q

Anterior and posterior repair surgery of prolapse both do what?

A

PLICATION TO VAGINAL TISSUE TO MIDLINE e to reduce Bulging bladder or Bulging rectum

202
Q

Obliterative procedures

A

Best, safe, effective

but can never have sex again

203
Q

When is Prolapse emergent?

Almost never, but exceptions are:

A

Urinary retention
Obstructive Nephropathy

UroGyn consult for Pessary or Surgery

Quarter 4 (10 decks)

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