2.1 Cs Exam4: Dysmenorrhea, Endometriosis, Pms

Front 1

this is a condition that has painful, crampy menstruation

Back 1

dysmenorrhea

Front 2

what is the difference between primary and secondary dysmenorrhea

Back 2

1- absence of pelvic pathology (typical 17-22 yr olds)
2- dt identifiable organic diseases (more common w/ age - late 20/30)

Front 3

this usually starts 1-2 days before menses and lasts over 12-72 hours., improves with advancing age and after childbirth

Back 3

primary dysmenorrhea

Front 4

what are some sx of primary dysmenorrhea

Back 4

crampy
headache
diarrhea
nausea and vomiting
normal pelvic exam
suprapubic or lower abdominal area

Front 5

what has the pathophysiology of dysmenorrhea been a/w?

Back 5

uterine contractions with ischemia
sloughing of endometrial cells release PGF2/PGE2 --> uterine ischemia via myometiral contraction and vasoconstriction

elevated levels of prostaglandins have been noted in pts

Front 6

what are some tx of primary dysmenorrhea

Back 6

heat
exercise, OMT, acupuncture
behavioral intervention

diet/vitamins
NSAIDS (decrease PG)
Oral contraceptives

Transdermal patch, pill

Front 7

when does secondary dysmenorrhea occur

Back 7

-may present after menarche
-Can occur before, after, or during menses

Front 8

what are some symptoms of secondary dysmenorrhea

Back 8

heavy /irregular menses
infertility
dyspareunia
vaginal discharge

Front 9

what are some common causes of secondary menses

Back 9

endometriosis
adenomyosis
leiomyoma
PID
ovarian cysts
pelvic congestion

Front 10

what is adenomyosis

Back 10

endometrial glands & stroma are present in the myometrium causing hypertrophy and hyperplasia of surrouding myometrium

***BOGGY and GLOBULAR uterus *** found on bimanual exam

Front 11

pelvic congestion is typical of what demographic

Back 11

multiparous women who have pelvic vein varicosities.

gets worse with fatigue, standing, and sex

Front 12

what are benign monoclonal tumors arising from smooth muscle cells of the myometrium called

Back 12

leiomyomata (fibroids)

Front 13

this type of cyst has teeth, hair, and sebum. usu occurs in younger pts

Back 13

dermoids

Front 14

where can you can growth of endometrial tissue occur with endometriosis?

Back 14

pelvic cavity
ovaries
uterosacral ligaments
pouch of douglas

Front 15

what is the demographic that endometriosis usu hit

Back 15

tall thin non blacks and non asians
~30 yo nulliparous and infertile

Front 16

what are some RF for endometriosis

Back 16

nulliparous
early menarche/late menopause
short menstrual cycles
prolonged menses

Front 17

what is the classic triad of endometriosis

Back 17

dyspareunia (pain with sex)
dysmenorrhea (recurrent painful periods)
dyschezia (painful defecation)

Front 18

what are some things you may find on PE of endometriosis

Back 18

tenderness of adnexal masses/pouch of douglass/uterosacral ligaments

palpable tender noduels
tender enalrged adnexal mass
thickening & induration of uterosacral ligaments

tenderness on bimanual exam*

Front 19

what is the ONLY DX TEST that can reliably rule out endometriosis. this is GOLD STANDARD

Back 19

laparoscopy

looks like gun shot lesions--> chocolate like material

Front 20

what are things you must consider when tx endometriosis

Back 20

severity of sx
extent of dz
desire for future fertility
age of pt
threat to GI and urinary tract or both

Front 21

what are some pharmacologic tx

Back 21

oral contraceptives
progestins
danazol (androgen agents)
gnrh analogues (suppress menses--> atrophy of endometriotic implants)
NSAIDS

Front 22

surgical tx of endometriosis?

Back 22

laparoscopy or open abd procedures
hysterectomy or bilateral oophoretectomy
laser/thermal ablation

*surgical excision of endometriosis

Front 23

When in the menstrual does PMS & PMDD occur?

Back 23

during luteal phase of menstrual cycle

Front 24

How is PMS diagnosed?

Back 24

*pt has 1 of the affective & somatic symptoms during the 5 days before menses in 3 prior menstrual cycles

*sx relieved w/i 4 days of onset of menses w/o reoccurence until day 12

*exclusion of other diagnoses (drugs, alcohol, prior depression or anxiety)

*pt suffers from social/economic dysfunction resulting from sx

Front 25

What are the affective & somatic sx?

Back 25

affective: (psychological, behavioral sx)

depression, angry outbursts, irritability, anxiety, confusion, social withdrawl

somatic: (physical sx)

breast tenderness, abdominal bloating, headache, extremity swelling

Front 26

DSMV criteria for PMDD:

Back 26

5 total symptoms, including 1 of the following;

-mood swings, sudden saddness, inc sensitivity to rejection

-hopelessness, depressed, self critical

-tension, anxiety, on edge

-anger, irritability

Front 27

T/F

To diagnose PMDD, the pt cannot suffer a psychiatric disorder

Back 27

FALSE

PMDD can occur superimposed, but NOT PMDD if it is an exacerbation of the disorder

Front 28

Both PMS & PMDD sxs are monthly cyclitic, have mood sx & physical sx.

How can PMDD be differentiated?

Back 28

PMDD also has marked social impairment

Front 29

Tx for moderated PMS

Back 29

SSRIs--> fluoxetine (sarafem), sertralline (zoloft)

during luteal phase only

(may add oral contraceptives (OC))

Front 30

Tx for PMDD

Back 30

(add progressively if sx don't improve)

1. SSRI (can add OC)

2. GnRH agonist

3. oophorectomy

Front 31

OMT can also be used to help w/ pain & sx in PMS/PMDD

What techniques?

Back 31

sacral rock (parasympathetic inhibition)

pelvic diaphragm release

pelvic diaphragm direct doming

HVLA (T10-L2)

direct doming of diaphragm (resp diaphragm)

supine thoracic inlet release

lymphatic drainage