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59 Cards in this Set

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postmenopausal women comes into your office w/ bleeding. what do you suspect? what do you do?
vaginal atrophy, exogenous hormones, endometrial ca (usu d/c w/ cervical ca)
Req endometrial biopsy (EMB)
to disting b/w anovulatory frm ovulatory, what char of bl do you ask on hx? do on pe?
hx: duration, amt, freq
pe: bimanual, pap for screen cervical ca
if ovulatory, what dx tools use? what suspect?
gold standard u/s w/ hysteroscopy
transvaginal us
sonohysterogram
if ovulatory, and showing excessive bl >80ml/cycle or prolong bl >8d, what is it?
menorrhagia
what are some causes of menorrhagia
leiomyoma
adenomyosis
endometrial hyperplasia/ca
primary bl d/o
preg complication
if ovulatory, and bl b/w periods, what is it?
metorrhagia
what are some causes of metorrhagia?
endometrial polyps
endometrial/cervical ca
preg complications
exogenous estrogen
what do you call bl during and b/w periods?
menometrorrhagia
what are some causes of menometrorrhagia?
same as metrorrhagia:
endometrial polyps
endometrial/cerival ca
preg complications
exogenous estrogen
what defines freq periods?
q3wks (21d)
what is freq periods called?
polymenorrhea
what is a cz of polymenorrhea?
anovulation
if suspect anovulation, what tests do?
b-hcg, cbc, coag, FSH/LH/TSH/prolactin
anovulation is related to secondary amenorrhea (no period 3 cycles or 6 mo w/ prior cycles). secondary amenorrhea can be cz by anatomical abn, ovarian/uterine dysfunc, or central regulatory d/o. what dyfunc or d/o do you suspect? (test for bhcg, endocrine)
ovarian/uter dysfunc: preg, ovarian failure, polycystic ovarian syndrome
central: hypothalamic dysfunc (anorexia, excercise, wgt loss, stress), pit dysfunc (sheehan, panhypopituitarism), hyperprolactinism
how many wks is infreq menstruation?
>5wks (35d)
what is infreq menstruation called?
oligomenorrhea
what are some causes of oligomenorrhea?
preg (most common)
hypothal-pit-gonadal-axis disrupt
systemic dz (neurosarcoid)
what is unusu low menstrual flow and duration, reg freq, called?
hypomenorrhea
what are cz of hypomenorrhea common in atheltes and anorexics?
hypogonadotropic hypogonadism (anorexic, athlete)
what common female medication is common w/ hypomenorrhea?
OCP
what syndrome is common in hypomenorrhea after surgery or infection? why?
asherman's syndrome
scarring of os (obstruct flow?)or uterus (cannot hyperplasia)
T or F
hypomenorrhea can occur d/t outlet obstruction
T
T or F
dysfunctional uterine bl is a dx of exclusion
T
T or F
Dysfunc ut bl is abn menstrual bl when no path found
T
what is the cz 90% in DUB?
anovulation
tx for anovulatory d/o
OCP*
cyclic progestin 10mg/d for 10d/mo (methoxyprogesterone)
what are the options for controlling profuse bl?
HI DOSE IV ESTROGEN*
D/C*
endometrial ablation
hysterectomy (last resort)
how tx dub?
nsaids +/- nsaids
how do you define primary amnorrhea?
(age w/o menses or second sec char; age w/o menses +/- second sec char)
14 w/o menses or second sex
16 w/o menses w/w/o second sex
primary amenorrhea d/t anatomical abn, such as...
testicular feminization
mullerian anomalies
vaginal agenesis
imperforate hymen
dev, vag, hymen
secondary amenorrhea d/t anatomical abn, such as...
asherman's synd
cervical stenosis (scar os)
secondary amenorrhea d/t ovarian/uterine dysfunc, such as...
preg!
ovarian failure
PCOS
primary amenorrhea d/t ovarian/uterine dysfunc, such as...
constitutional dev delay
ovarian failure
gonadal dysgenesis (turner)
steriodogenic enz defect
nat, ov, enz-ov
primary amenorrhea d/t central reg d/o, such as...
hypothal dysfunc (kallmann's synd, anorx, exercise, wgt loss, stress, tumor, infect)
PRImary pit dysfunc (RARE)
secondary amenorrhea d/t central reg d/o, such as...
hypothal dysfunc (anor, excess exercise, wgt loss, stress)
pit dysfunc (sheehan**, panhypopit)
hyperprolactinemia
pt comes to you with amenorrhea, what can you assess on PE?
1. uterus->NO: karyotype (testic femin), mullerian agenesis, steroid enz defect, pure gonadal dysgenesis or anorchia
2. (yes uterus) no patent vagina: imperforate hymen, transverse vag septum, vaginal agenesis
3. (yes ut, yes pat vag) yes breast: w/u second amenor
no breast: w/u progestin neg second amenor
uterus: yes or no
if yes, patent vagina: yes or no
if yes, breasts: yes or no
does prolactin stim or inh release of LH/FSH?
inhibit
what can cz hyperprolactin?
pit tumor, hypothyroid, dopamine antagonist (dop inh prolactin)
what lab tests/imaging to eval cz of hyperprolact? if neg, what tests perform?
TSH-hypothy
CT/MRI-pit tumor
if neg--progestin challange
what is done in a progestin challenge? what defines pos test? if neg, what test do?
5d course of progesterone
if withdrawl bl: pos test, which means +estrog, +outflow tract, =anovulation
(if nonhirsute--hypothal, if hirsute--pcos, cush, r/o ov/adr tumor)
if neg (no bl): r/o asherman's, do estrogen-progest challenge
estrogen-progest challenge: if bl--where is the prob?
if not bl--what suspect?
if bl: func uterus, but inadeq estrogen stim (prob follicle or HPAxis)
if no bl: asherman's
hypogonadotrophin (lh/fsh)suggest HPA or gonadal failure?
HPA (ie Sheehan)
hypergonadotrophin (lh/fsh) suggest HPA or gonadal failure?
gonadal failure (17-hydroxlase defic, gonadal agenesis)
define dysmenorrhea
menstrual pain, req meds, prev nml activity
Primary amenorrhea:
cz?
occur at age?
tx?
no organic cz, pos frm hi PGs & leukotrienes, psych
under 20
NSAIDS, OCP
Secondary amenorrhea:
cz?
ENDOMETRIOSIS* (most common)
adenomyosis (endometrial glands and stroma w/in myometrium)
myoma
pelvic congestion
PID
ovarian cyst
cervical stenosis
pelvic adhesions
Defin endometriosis
endometrial glands/stroma outside of uterus
Common sites of endometriosis
OVARIES*
cul-de-sac
uterosacral ligament
Possible etiologies of endometriosis
retrograde menstruation
vasc/lymphatic
metaplasia
T or F
endometriosis typically found in women of repro age
T
RF for endometriosis
+fam hx, null, inferile
Sx of endometriosis
premenstrual pain (stop at menstruation)
DYSCHEZIA* (pain defecate)
CHR PELVIC PAIN
DYSPAREUNIA
INFERTILITY
abn bl
PE may reveal...
(uterus, uterosacral lig, adnex)
NODULARITY ALONG UTEROSACRAL LIG
FIXED, RETROVERT UTERUS
tender, fixed adnex mass
DDx of endometriosis
(pelvic pain
pos missed period,
past STD
past surg
abn bl
appy, adn torsion,
ect preg
PID
pelvic adehsions
tumor
other: corpus luteum cyst
definitive dx can be made w/ direct visualization of endometrial tissue via what tool?
LAPAROSCOPY*
laparotomy
implants appear as?
rust-colored to dk br "POWDER BURNS" or
raised blue "RASPBERRY LESION"
in sev dz, may be surround by adhesions
"CHOCOLATE CYSTS": ovaries w/ endometriosis (old bl)
T or F
pain severity correlates w/ extent of dz
FALSE!!***
it DOES NOT ALWAYS CORRELATE w/ dz***
what are the medical options to endometriosis?
OCP**
progestin (suppress ov and menstruation) and DANAZOL**
GnRH agonist (suppress estrogen prod)
what are the surgical options of endometriosis?
LAPAROSCOPIC ABLATION of implants
sev recur dz: TAHBSO w/ lysis adhesions