Conditions/Diseases Flashcards

1
Q

Turner Syndrome Summary

A

Def: genetic abnormality in women

Cause: 45, XO chromosomes

Eval:

SS:
amenorrhea
delayed puberty
webbed neck
small stature
poor breast development
coarctation of aorta

Txt:
growth hormone
estrogen - during puberty
progestins - later to prevent endometrial hyperplasia

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

Excess Androgens Summary

A

Def: overproduction at adrenal glands, ovaries, extraglandular

Cause:
Polycystic Ovary Syndrome
Hormone secreting tumors
Adrenal disorders
- congenital adrenal hyperplasia
- cushing syndrome
Idiopathic Hirsutism
SS:
Hirsutism
Virilization
structural
- imperforate hymen
- transverse vaginal
- bicornate uterus
- mullerian agenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Follicular phase summary

A

Def: onset of menses to LH surge/ovulation

Duration: variable, 14 days

Activity:
FSH increase
- follicular growth of oocytes
- emerge dominant follicle (23 chromosomes)

Menstuation

  • first 3 - 7 days
  • blood/desquamated superficial endometrial tissue
  • prostaglandins cause cramping

Estradiol

  • maintain endometrium
  • start low and then increase to cause LH burst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ovulation summary

A

Def: release of oocyte

Activity:
LH surge cause ovulation
oocyte released from ovary
follicle becomes corpus luteum (release progesterone)

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

Luteal phase summary

A

Activity:
Progesterone secreted by corpus luteum
- suppress FSH and LH

Fertilization:

  • implanted zygote release human chorionic gonadotropin
  • sustains corpus luteum until placenta take over (9 - 10 weeks)

No Fertilization:
corpus luteum involutes 9 - 10 days
- cause increase FSH

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

Oogenesis summary

A

Cause: FSH stimulation

Activity:
several primary oocytes grow
- 1 or 2 resume meiosis I
* cause secondary oocyte

primary follicle develop granolas cells around secondary oocyte
- releases 2nd oocyte and become corpus luteum

corpus luteum secrete progesterone and estrogen to support 2nd oocyte if fertilized

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

Amenorrhea summary

A

def: absence of menstruation
primary - none by 13 yrs or 15yrs with 2nd sexual development

secondary
- no menstruation 3-6 months

cause:
preg
hypothalamic
ovarian
genital outflow obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anovulation summary

A

def: failure to ovulate

cause:
HPO
systemic disease
medications

SS:
constant estrogen levels
irregular, unpredictable bleed

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

Ovulatory bleeding summary

A
Metorrhagia
- bleed between cycles
Menorrhagia
- excessive bleed regular intervals
Menometrorrhagia
- frequent/excessive bleed
Polymenorrhea
- frequent bleed
Cause:
Obstetric
GU tract abnormal
HPO axis
anovulatory bleeding
meds
dysfunctional uterine bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fibroadenoma

A

Most common solid mass found in women of reproductive years (15-50)

Symptoms: firm, round, well circumscribed, mobile mass

Dgx: classic US appearance and/or needle bx

Tx: does not require excision, although most women prefer it

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

Mastitis/Abscess

A

Causes: pregnancy/lactation, injury, nipple piercing

Symptoms: pain, swollen, erythematous breast

Tx: Abx

Mammogram or US to r/o abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lobular carcinoma in situ

A

*Misnomer-NOT a cancer, but is a risk factor for developing invasive cancer
Risk may be increased as much as 20-30%
Tx: close observation, bilateral prophylactic mastectomy. tamoxifen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ductal carcinoma in situ

A

Abnormal appearing microcalcifications
Proliferation of malignant cells within ducts
Stage 0
Tx: lumpectomy/Radiation therapy, mastectomy, no lymph node dissection, no chemo, possibly tamoxifen

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

invasive ductal/lobular carcinoma

A

invades beyond the normal duct/lobule into surrounding tissue
lobular carcinoma can be more diffuse and difficult to detect by mammography because it grows linearly
most common sites of metastasis: Lung, Liver, Bone, Brain
Tx: all patients need axillary lymph node bx for staging; lumpectomy/chemotherapy, mastectomy, chemotherapy/hormone therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Inflammatory Breast Cancer

A

stage 3b, poor prognosis

Signs: swollen, usually nontender breast, erythema, peau d’orange, may not have dominant mass

Tx: preoperative chemotherapy first, mastectomy and axillary lymph node dissection, radiation, hormone therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Paget’s disease

A

signs: eczematous changes of the nipple
associated with underlying invasive cancer
dgx: with nipple bx
Tx: usually tx with mastectomy, if underlying cancer identified can do central lumpectomydysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lichen sclerosus summary

A

Def: inflammatory condition of the valva

Cause: autoimmune

SS:
vulvar pruitis
vulvar pain
dysuria
dyspareunia
white, wrinkled skin on labia

Eval:
punch biopsy

Txt:
Topical steroids (2-3 mths and then weekly)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lichen simplex chronicus summary

A

Def: lichenified skin reaction to chronic scratching

Cause: atopic dermatitis, cadidia, tinea

SS:
progressive pruritis
progressive burning
red papules form scaly plaques

Eval:
clinical

Txt:
underlying cause
antipruritis meds
topical steroids

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

Lichen planus summary

A

Def: inflammatory condition

Cause: autoimmune in older women

SS:
chronic pruritis
dyspareunia
post-coital bleeding
red/white, patchy, ulcerative lesions

Eval:
Clinical
Biopsy

Txt:
topical steroids
oral prednisones

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

Psoriasis summary

A

Def: genital involvement during menarche, pregnancy, menopause

Cause: autosomal dominant

SS:
pruritic
scaly, silvery patch on erythematous base

Eval:
Biopsy

Txt:
Topical steroids

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

Dermatitis Summary

A

Def: dry skin

Cause: eczema and seborrheic dermatitis

Eval:
Clinical

Txt:
offending agent
topical steroids

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

Vestibulitis summary

A

Def: localized vulvar pain without dermatitis

Cause: unknown

SS: severe pain on touch vulva
dyspareunia
small, reddened patchy areas

Eval:
light touch over vestibule recreate pain

Txt:
Topical lidocaine
notripyline
gabapentin
abstinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Bartholin gland cyst summary

A

Def: obstruction of bartholin glands

Cause: bacterial cause

SS:
asymptomatic
pain and tenderness
firm swelling of posterior vaginal introitus

Eval: clinical

Txt:
word catheter

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

Vulvar neoplasia summary

A

Def: cancer of vulva

Most common vaginal intraepithelial neoplasia (from another site)

SS:
irritation
pruritus
raised lesions

Eval:
Biopsy

Txt:
Excision

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

Vaginal Cancer summary

A

Def: squamous cell, adenocarcinoma, melanoma
Not common

Cause:
HPV
Vaginal Intraepithelial Neoplasia
Cervical cancer

SS:
asymptomatic
vaginal bleed

Eval:
pap
biopsy

Txt:
radiation
hysterectomy
upper vaginectomy

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

Benign Cervical Tumors summary

A

Nabothian cysts - squamous over columnar cells in cervix

Polyps - polypectomy if symptomatic

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

Cervical Cancer summary

A

Cause: HPV but if have won’t mean get cancer

SS:
precursor lesions by 10 yrs
asymptomatic
watery vaginal discharge
spotting

Eval:
Pap test
colposcopy
conization

Txt:
conization of cervix
hysterectomy
lymph node dissection
radiation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Uterine Leiomyoma Summary

A

Def: localized proliferation of smooth muscle cells

Cause:
Estrogen

SS:
masses in uterus
abnormal bleeding
Menorrhagia (anemia from it)

Eval:
clinical
US

Txt:
myomectomy
hysterectomy

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

Adenomyosis summary

A

Def: benign endometrial glands and stroma in uterine musculature

SS:
menorrhagia
dysmenorrhea
enlarged uterus

Eval:
MRI
histology

Txt:
hysterectomy

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

Endometrial polyps summary

A

Def: benign focal processes in perimenopausal women

SS:
abnormal bleeding
pelvic pain

Eval:
US

Txt:
polypectomy

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

Endometrial hyperplasia summary

A

def: proliferation of endometrial glands

Cause: excess estrogen exposure

SS:
abnormal uterine bleeding

Eval:
US

Txt:
Dilatation and Curettage
progestins
medroxyprogesterone
hysterectomy
32
Q

Endometrial cancer summary

A

Def: postmenopausal cancer

SS:
postmenopausal bleeding

Eval
biopsy
US

Txt:
Hysterectomy

33
Q

Benign ovarian cysts/tumors summary

A
SS:
asymptomatic
mass
pelvic pain
dyspareunia
dysmenorrhea
Eval:
pelvic exam
US
CBC
UPT

Txt:
Removal

34
Q

Malignant Ovarian Neoplasms Summary

A

Highest mortality rate

SS;
bloating, pain, satiety, eating issues
fixed solid mass

Eval:
US
histo

Txt:
Hysterectomy and Ovarial removal

Protective:
OCP use
breastfeeding
multiparity
tubal ligation
35
Q

Ovarian torsion summary

A

Def: twisting of ovary

SS:
new onset pelvic pain
N/V
adnexal mass

Eval:
US

36
Q

Candidiasis Vaginosis

A

Yeast Infection-candida albicans or glabrata

Predisposed by: DM, recent abx use, OCPs, pregnancy, CS therapy, occlusive clothing

SS: white, thick discharge, intense Pruritis, dysruria
vulvar/labial erythema, excoiation, edema, white discharge *often without odor

Dgx: characteristic s/s; *Normal pH, hyphae/spores on KOH, wet prep or culture

Tx: Oral fluconazole 150mg PO for 1 dose; vaginal hygiene

37
Q

Bacterial vaginosis

A

common cause of vaginal discharge in women of childbearing age
overgrowth of largely anaerobic bacteria (*mainly gardnerella vaginalis) and a decrease in lactobacilis

SS: nonirritating, discharge, thin, gray white/yellow discharge, foul vaginal odor

Dgx: Amsel criteria: must have 3 of these: abnormal discharge, *abnormal pH >4.5, positive whiff test with KOH, wet prep shows *clue cells
DNA probe

Tx: metronidazole 500mg PO bid fro 7 days

38
Q

Trichomoniasis vaginosis

A

STI

SS: persistent, profuse, frothy discharge, vulvar pruritis/foul odor, dysuria, inflamed labia, perineum, vagina, small petechiae (strawberry spots)

Dgx: wet mount shows increase in PMNs with *motile flagellate, KOH whiff, *pH >4.5
DNA probe, screen for other STIs

Tx: systemic metronidazole 2 gm PO x 1 or 500 mg PO bid for 7 days, must tx partner

39
Q

Human papillomavirus

A

Warts/condyloma acuminata types 6 and 11; very common STI

SS: numerous, discrete fleshy lumps, smooth velvety surface, symmetric, may coalesce into cauliflower like regions, may be hidden in rectum or vaginal canal
mass, pruritis, burning, bleeding

Dgx: visual inspection (may require acetic acid wash to visualize affected skin), pathology

Tx: often difficult
Surgical: cryotherapy, electrocautery, laser,surgery
Chemical destruction: TCA acid, topical podofliox, topical imiquimod
Expectant management

40
Q

Herpes simplex virus

A

type 2 > type 1
Primary (first) outbreak-most severe
SS: small, painful, grouped vesicles develop at site of contact>pustules>erosions/ulcers, erythema, swelling
dysuria, flu-like symptoms, lymphadenopathy

Secondary outbreak: less severe, fewer lesions, prodrome likely, heal faster

Dgx: clinical presentation, viral culture, tzanck smear, PCR, serology

Tx: primary: acyclovir 200mg PO 5 times/day x 7-10 days
relapse is common 3-5 days of tx

41
Q

Chlamydia

A

SS: often asx; mucopurulent discharge with cercitis, dysuria, postcoital bleeding, pelvic pain, fever, urethritis

Complications: PID: tubal occlusion, infertility, extopic pregnancy risk, increases with each infection

Dgx: DNA assay, cervical culture, screen annually

Tx: azithromycin 1 gm x 1; doxycycline 100mg bid x 7 days; treat partner and report

42
Q

Gonorrhea

A

SS: can be asx; copious mucopurulent discharge, dysuria, pelvic pain, fever, urethritis, usually affects other sites like oropharyngeal

Complications: PID

Disseminated: arthritis, tenosynovitis, dermatitis,

Dgx: DNA assay, culture, screening guidelines

Tx: ceftriaxone 250mg IM x 1 and azithromycin 1gm x1 for chlamydia

43
Q

Syphilis

A

Primary-painless, hard, indurated ulcer forms at site of inoculation (chancre)-hidden, chancre heals in 3-6 weeks without scar

Secondary-skin rash on palms and soles, flu like illness, condyloma lata, systemic, hepatitis, GI, musculoskeletal, renal, neuro, resolves 2-6 weeks to latent infection

Dgx: spirochete seen on dark microscopy, screening and confirmation serology

Tx: PenG 2.4 million units IM x1
*repeat titers at 3, 6, 12 and 24 months post tx to ensure eradication

44
Q

PID

A

acute ascending pelvic infection involving the upper genetial tract; often d/t gonorrhea and chlamydia

SS: often asx; low *bilateral abdominal pain, vaginal discharge, dysuria, dyspareunia, N/V/F/C, irregular bleeding
fever, abd tenderness, endocervical discharge, cervical motion tenderness, uterine tenderness

Dgx: clinical, imaging, laparoscopy

Labs: pregnancy test, UA, CBC, microsopy on vaginal discharge, STI testing

Tx: inpatient: doxycycline 100mg PO q12 hours plus cefoxin 2gm IV q6hours
outpatient: ceftriaxone 250mg IM x 1 plus doxy 100mg PO bid continue for 14 days

45
Q

Threatened Abortion

A

Def: vaginal bleeding through a closed cervical os, pregnancy may still be viable

S/s: vaginal bleeding, painless or mild suprapubic pain, closed cervical os, products of conception not visualized, uterine size appropriate for gestational age

Reassuring factors: serum hcG doubling every 48 hours, detectable cardiac activity

Adverse outcomes: preterm labor, premature rupture of membranes

Tx: Supportive management

46
Q

Inevitable abortion

A

Spontaneous abortion is imminent

S/s:vaginal bleeding, pelvic cramping, cervical os open, gestational products may or may not be visible, uterus may still be apropriately sied

Tx: supportive care, pain meds for cramping, f/u to make sure they did pass the products

47
Q

Complete abortion

A

Most common abortion

Def: a spontaneous abortion in which the entire contents of the uterus are expelled; common

48
Q

Incomplete abortion

A

Def: spontaneous abortion with retained products; common >12 weeks

S/s: heavy vaginal bleeding, severe cramps, cervical os open, retained products, uterus small for gestational age (we want this to be contracted to stop the bleeding)

Tx: surgical management-D&C = scraping of all tissue in uterus

49
Q

Missed abortion

A

Def: retention of a failed intrauterine pregnancy

S/s: mild vaginal bleeding/spotting, cervical os closed, products of conception not visable, uterus small for gestational age

Tx: surgery or meds to induce abortion

50
Q

Septic abortion

A

Def: spontaneous abortion complicated by uterine infection

Causes: staph aureus, gram neg bacilli, gram positive cocci

Risks: invasive procedures, foreign bodies, incomplete or illegal induced abortions

S/s: vaginal bleeding, pelvic tenderness, cervical os open, uterus tender and boggy, fever, chills, tachycardia, vaginal discharge, peritonitis, septicemia

Tx: stabilize pt, blood and endometrial cultures, broad spectrum abx (clinda, gentamicin, amp)
surgical management of DNC or may need hysterectomy

51
Q

Recurrent pregnancy loss

A

3 or more losses before 20 weeks

Causes: uterine abnormalities, chromosomal, endocrine, immunologic, hematologic

52
Q

Ectopic pregnancy

A

Implantation of the embryo outside the uterine cavity
MUST r/o in any woman of reproducing age with abd/pelvic pain or irregular bleeding
Hemorrhage from ectopic pregnancy is the leading cause of maternal death in first trimester

S/s: abd pain, abnormal uterine bleeding, pregnancy sx, dizziness, amenorrhea, abd tenderness, peritoneal signs, adnexal tenderness, cervical motion tenderness* (unilateral), adnexal mass, uterus normal size

Eval: UPT, hcG, transvaginal US, CBC

Tx: methotrexate, surgery is preferred

53
Q

IUGR summary

A

def: intrauterine fetal growth

cause:
HTN
diabetes
smoking

SS:
weight gain
fundal height low

Txt:
supplements
smoking cessation

54
Q

Premature rupture of membranes

A

Rupture of membranes before onset of labor
Generally followed by prompt onset of spontaneous labor and delivery

Etiology: infection, low SES, 2nd and 3rd tri bleeding, low BMI, nutritional deficiencies, smoking, uterine over distension

Dgx: H and P, avoid digital exam, confirm with Amnisure, US, pH

Risks: Maternal intrauterine infection
Fetal umbilical cord compression and/or ascending infection

Tx: if at TERM: induce labor with oxytocin and intravaginal PGE2

55
Q

Shoulder dystocia

A

failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head
Turtle sign
Obstetric emergency-have pt stop pushing, McRoberts maneuver is used

56
Q

Decreased variability on EFM

A

fetal hypoxia, acidemia, drugs, fetal tachycardia, fetal CNS and cardiac abnormalities, prolonged uterine contractions, prematurity, fetal sleep

57
Q

Uterine prolapse

A

sagging of the uterus; various stages

S/s: pressure, feeling of something bulding, urinary incontinence, retention, cramping, low back pain

Tx: nothing, pessary, hysterectomy

58
Q

Cystocele

A

bladder becoming prolapsed first

S/s: pressure, feeling something bulging, urinary incontinence, retention, frequent UTIs

Tx: pessaries, Kegel exercises, double voiding; anterior colporraphy, burch suspension, sling procedures

59
Q

Rectocele

A

posterior part of pelvic wall is beginning to prolapse and bring the uterus with it

S/s: pressure, feeling something bulging, stool incontinence

Tx: pessaries, manual splinting, posterior colporraphy

60
Q

Fistulae

A

Abnormal connection between two organs (a hole that shouldn’t be there)

Cause: childbirth injuries (lacerations, necrosis), previous surgery, Crohn’s disease

S/s: incontinence, gas from the vagina, foul smelling discharge: all depends on where it is

Tx: easy to repair; Foley

61
Q

Menopausal transition summary

A

Def: time frame due to when menstrual cycle length changes to end of LMP

SS:
Stages:
-2 = variable cycle length diff from normal
-1 = > 2 skipped cycles and amenorrhea > 60 days
FSH increases
inhibin B decline
estadriol same
Intermenstrual interval increases to 40 - 50 days

Eval:
diary

Txt:
symptomatic

62
Q

Menopause summary

A

Def: permanent cessation of menstrual periods, > 12 months

Avg age 51 yrs

Criteria: FSH > 30 mlU/ml and cessation of menstrual period

Txt:
symptoms
osteoporosis prevention

63
Q

Postmenopause summary

A

Def: 12 months after LMP

Stage:
1 - First 5 years after the final menstrual period
* accelerated bone loss
2 - begin 5 years after final period to death
* vaginal symptoms

Txt:
Estrogen/Progesterone
SERMs

64
Q

Postmenopausal bleeding summary

A

Cancer until proven otherwise

Eval:
transvag US
Endometrial biopsy

65
Q

Osteoporosis summary

A

Def: decrease in bone mass with increased risk for fracture

Risks: 
Age
Sex
Fhx
caucasian/asian
alcohol
smoking
small build
low weight
sedentary
low calcium and vit D
Steroids
SS:
asymptomatic
fragility fracture
dowager's hump
height loss
Eval:
CBC
Vit D
Serum
Xray followed by CT
FRAX
DEXA T > -2.5
Txt:
Nonpharm
- Diet
- smoking
- alcohol
- weight bearing exercise
- fall prevention

Pharm

  • Vit D
  • Calcium
  • SERMS
  • Bisphosphonates
  • Calcitonin
  • Teriparatide
  • Denosumab
66
Q

Primary Amenorrhea

A

Absence of menses by age 15 with normal growth and development of secondary sex characteristics

Causes: chromosomal abnormalities, hypogonadism, absence of certain gyn organ, pituitary disease

67
Q

Premenstrual syndrome

A

Etiology: unknown

Cyclic occurrence for >2 months and symptom free >7 days
S/s: HA, fatigue, mastalgia, abdominal bloating, irritable, restless, low mood, tension
These diminish after onset of menses

Dgx: no objective test, solely based on documentation.
Keep a menstrual diary

Tx: SSRI, SNRI, anxiolytics, OCPs, NSAIDs, spironolactone
calcium, vit D, and B6
increase exercise, diet changes (decrease caffeine, EtOH, Na, chocolate, sugar)

68
Q

Premenstrual Dysphoric Disorder

A

More severe PMS-type syndrome; also known as late luteal dysphoric syndrome.

S/s: Mood sx predominate (anxiety, affective lability, anhedonia-loss of interest, low mood), markedly intereferes with school or work or social life; STILL have a sx free period

Dgx: CC of irritability, tension, dysphoria, mood lability AND 5 out of 11 consistent sx

Tx: SSRIs-fluoxetine, sertraline, paroxetine; Alprazolam; OCPs

69
Q

Dysmenorrhea

A

the pain associated with onset of menses

S/s: uterine cramps, D, N, V, HA; most common complaint seen in OB/GYN

Primary: excess prostaglandins/contractions; assoc with ovulatory cycles
Secondary: pathologic cause present; etiology is from other gyn disease-mainly endometriosis/endometriosis

Dgx: hx-pain specific, no specific PE findings; could do US to r/o other pathologies

Tx: NSAIDs, hormones/OCPs/LARCs, surgical (TAH, cervical dilation, neurectomy), Adjuvent (heat, exercise, TENS)

70
Q

Acute pelvic pain-MC etiologies and eval

A

GYN-dysmenorrhea, endometriosis, mittelschmerz, ovarian torsion, ovarian cyst/abscess, PID

Pregnancy-related- ectopic

GI-appendicitis

GU-cystitis, nephrolithiasis

Evaluation: UPT, wet prep, chl/gon, CBC, ESR, FOBT, US, CT, laparoscopy

71
Q

Chronic pelvic pain-MC etiologies and eval

A

endometriosis, adenomyosis, adhesions, cystitis, IBS, vastibulitis, pelvic congestion

Eval: never dx without reason, lab studies, behavioral assessment, laparoscopy

72
Q

Endometriosis

A

abnormal growth of endometrial type tissue outside of uterus; commoly occurs in the ovaries

S/s: pain 1-2 weeks before menses, relieved at onset of menses, variety of sx: dysmenorrhea, dyspareunia, infertility, hematuria, dysuria

Dgx: careful hx, PE: retroverted, fixed uterus, enlarged ovaries, overt lesions
Only laparoscopy and histology can definitively dgx; US, MRI, colonoscopy, and cystoscopy

Tx: hormones/OCPs, pain meds, discuss future fertility, observation and counseling; unresponsive may require hyst-BSO

73
Q

Secondary Amenorrhea

A

absence of menses for more than 3 months in girls or women who previously had regular menstrual cycles or six months in girls or women who had regular menses

Causes: pregnancy, hypothalamic dysfunction (eating disorders, exercise, stress), systemic illness (DM, celiac, thyroid), ovarian disorders ( PCOS, premature ovarian failure)

74
Q

Polycystic ovarian syndrome

A

An intrinsic hypothalamic-pituitary axis abnormality in the ovary that leads to an increased release of GnRH; increase in LH and a higher LH:FSH ratio triggers an ovarian production of testosterone

S/s: irregularities, infertility, hypertension, central obesity, male pattern alopecia, hirsutism, acne vulgaris, acanthosis nigricans, insulin resistence and hyperinsulinemia

Rotterdam Criteria: Must have 2/3

  1. Oligo-ovulation or anovulation
  2. Clinical hirsutism or hyperandrogenism
  3. Morphologic polycystic ovaries

Dgx: Clinical, US for string of pearls, Labs

Tx: menstrual abnormalities-OCP and metformin
Infertility-Clomid
Hirsutism and Acne-estrogen-progestin contraception, anti-androgen, mechanical hair removal, topical retinoids, abx

75
Q

Abnormal Uterine Bleeding

A

vaginal bleeding of abnormal quantity, duration, and schedule
work up depends on age and reproductive hx

Causes: pregnancy, Polyp, Adenomyosis, Leiomyomas, Malignancy/hyperplasia; Coagulopathy, Ovulatory dysfunction, Endometrial polyps, Iatrogenic problems, Non-classified chronic endometritis

76
Q

Female Athlete Triad

A

disordered eating, menstrual irregularities, low bone mineral density

Dgx of exclusion: R/o pregnancy, premature ovarian failure, thyroid dysfunction, osteopenia, uterine outflow tract abnormalities

Tx: increasing caloric deficiency relative to energy expenditure; using OCP to regulate menses; tx of decreased bone density