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44 Cards in this Set
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Q. What things are important to ask when taking a gyn history?
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1. Birth Control and Medication History
2. Pregnancy History |
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Q. What areas to examine on a well women’s exam?
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1. Breast
2. External Genitalia: Skene glands, Bartholin glands 3. Speculum Exam 4. Bimanual: Cervix 5. Rectovaginal |
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Q. The correct order of specimen collection during gyn exam?
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1. Wet Mount: Vaginal Discharge
2. Cultures: Good for determining vaginal symptoms such as pain, or burning 3. Pap Smear: Obtain a pap smear annually |
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Q. Which strains of HPV are high risk and low risk and what conditions each cause?
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Low-risk: 6,11, 42, 43, 44: genital warts.
High-risk: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68: Cancer precursors. |
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Q. Know what tests to order during a well women’s exam for a woman under 30?
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Under 30: ACOG: does not recommend HPV testing in women under 30 unless PAP is abnl.
ACS: women under 30 get PAP annually if using conventional cytology and pap every two years if using liquid based cytology. |
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Q. Know what tests to order during a well women’s exam for a woman over 30?
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ACOG: HPV screen with PAP, combine testing has greater than 99% negative predictive value, double negative=not likely to have high grade cervical disease with in the next 3 years.
ACS: women over 30 can PAP every 2-3 years if the 3 previous PAP test results are negative. USPSTF: cytology screening every 3 yrs up to age 65 |
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Q. Know when to refer for a colposcopy ASCUS?
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If > ASCUS on repeats then refer for colpo. If high risk positive refer for colposcopy. ASC-H-refer for colposcopy. LSIL: If high risk HPV and tx fails then repeat colposcopy. LSIL and Adolescence: If HSIL then colpo Repeat PAP in 4-6 months.
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Q. What glandular cells mean on a pap and what to do about it?
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AGC – Glandular
-Colposcopy with endocervical sampling -Endometrial sampling if >35 or <35 and has abnormal bleeding -Atypical endocervical or endometrial (uterine) cells present on pap, then do EMB (endometrial biopsy) -HPV testing |
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Q. Secondary Amenorrhea?
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Stops menstruating for 3 or more months in the absence of pregnancy, lactation
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Q. The causes of secondary amenorrhea?
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1. Disorders of vagina/uterus
2. Disorders or ovary 3. Disorders of anterior pituitary 4. Disorders of CNS |
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Q. The proper work up for the progesterone challenge?
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Give 10 mg and see if she bleeds.
If she bleeds; ANOVULATION If bleeding does not occur, then the patient most likely has outflow tract obstruction - either Asherman's syndrome or cervical stenosis. |
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Q. SXM of PCOS?
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1. Amenorrhea/ oligomenorrhea
2. HTN, hyperlipidemia |
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Q. 2 ways to treat PCOS?
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Menstrual regularity/ endometrial protection - get them back to normal cycle
Reduce androgens/treat symptoms of excess – low progesterone, helps with the signs of hyperandrogens |
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Q. 5 Causes of female infertility?
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Central (CNS) 40%
Tubal 30-50% Pelvic/peritoneal 5-10%: Contraception and Pregnancy History: IUD, DEPO shot Endometrial/uterine 2-3%: Low progesteron Cervical/mucus 2-3% Unexplained 10% |
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Q. 5 Causes of Male infertility?
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40-90% of cases are d/t deficient sperm production of unidentifiable origin
Varicocele (42%) Unexplained (22%) Obstructive azoospermia (14%) Undescended testis (3%) |
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Q. 3 ways to know how to determine if your patient is ovulating?
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-cervical mucus monitoring
-basal body temperature -home ovulation detection kits |
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Q. 6 hormonal patterns to PMS?
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1. Elevated plasma estrogens in the mid or late luteal phase
2. Decreases progesterone day 21 3. Elevated prolactin (inhibits progesterone) 4. Increased FSH 1 week prior to menses 5. Hypothyroidism 6. Elevated PGE2 (pro-inflammatory) |
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Q. The dietary patterns to lower PMS?
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1. Vegetarian
2. A lower-fat diet 3. Increase complex CHO 4. Low fat protein 5. No sugar 6. Legumes, fruit, veggies |
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Q. How to decrease PMS-A SXM?
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1. Decrease dairy and calcium
2. Decrease refined sugar and caffeine 3. Increase magnesium rich foods 4. B6, Vit E and ZN |
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Q. How to decrease PMS-C SXM?
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1. Hypoglycemic diet
2. Decrease sugar and caffeine and salt 3. Anti-inflammatory diet Mg, EPO, GLA, fish oil |
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Q. How to decrease PMS-D SXM?
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1. Decrease sugar and caffeine and salt
2. Increase fish 3. Increase tryptophan foods B6, Vit E and ZN |
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Q. How to decrease PMS-H SXM?
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1. NO salt, caffeine or nicotene
2. No methylxanthines-tea, chocolate, coffee 3. No alcohol |
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Q. 4 types of PMS?
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PMS-A (anxiety)- High Estrogen and Low Progesterone
PMS-C (Cravings)-Low Magnesium and PGE1 PMS-D (depression): High Progesterone and Low estrogen PMS-H (hyperhydration): High sodium retention and aldosterone |
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Q. What is PMDD?
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PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life.
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Q. How to treat PMS?
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SOY
EXERCISE HERBS: Vitex agnus castus, Angelica Sinensis, Taraxicum root SUpplements: 1. Calcium D-Glucarate 500mg tid 2. Diindolylmethane (DIM) 3. Progesterone, B6, Milk Thistle |
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Q. 5 Causes of migraines?
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1. Hormones, especially estrogen
2. Serotonin 3. Abnormal platelet function 4. Release of substance P 5. Triggers – Hx!! |
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Q. What is AUB and what causes it?
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Abnormal uterine Bleeding: Menstrual cycle disruptions, disruptions of endometrial surface, abnormal angiogenesis, clotting abnormalities.
Cause: Pregnancy bleeding. Anovulatory or Oligoovulatory, trauma, disorder of homeostatis |
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Q. Dysfunctional Uterine Bleeding definition and Cause?
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Definition: Excessive uterine bleeding with no demonstrable organic cause
Causes: Hormonal IMPORTANT: ANOVULATION from estrogen breakthrough bleeding. This is the #1 cause. Estrogen withdraw bleeding (midcycle spotting) 2. Progesterone breakthrough bleeding (norplant) 3. Progesterone withdraw bleeding (OCP) 4. Luteal phase defect. 5. Unopposed estrogen stimulation |
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Q. What is Ovulatory DUB?
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Symptoms of menorrhagia but unrelated to:
1. Systemic coagulopathy 2. Pharmaceutical agents 3. Any structural anomalies |
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Q. What is Anovulatory/ Oligoovulatory DUB?
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Occurs secondary to anovulation or oligoovulation. Due to estrogen stimulation w/o opposing progesterone
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Q. What is Heavy Menstrual Bleeding?
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80 ml/mo
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Q. What are 4 consequences of heavy menstrual bleeding?
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1. Anemia
2. Fatigue 3. Quality of life compromised 4. May also have cramps and pelvic pain |
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Q. SXM of Subserosal Uterine Leiomyomas?
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NO BLEEDING
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Q. SXM of Intramural Uterine Leiomyomas?
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Cause bleeding. Causes deformed wall Myomectomy or hysterectomy
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Q. SXM of pedunculated Uterine Leiomyomas?
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Submucsal or subserosal. Cause bleeding. Can be resected hysteroscopically if less than 5mm
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Q. 5 causes of Post-menopausal AUB?
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1. Exogenous estrogen 30%
2. Atrophic Endometritis/ vaginitis 30% 3. Endometrial cancer 15% 4. Endo/cervical polyps 10% 5. Endo hyperplasia 5% |
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Q. What tests you would run for menorrhagia /DUB?
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1. Exam- External, speculum, bimanual
2. Labs- CBC, CMP, TSH, Prolactin, PT, PTT, Platelet, ferritin, bHCG, Pap, E2 and FSH day 3 of cycle 3. Pelvic U/S:Fibroids, Endometrial Polyps, Endometrial thickening |
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Q. Cause of Acute Pelvic Pain?
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IMPORTANT: Pregnancy complications-ectopic (must rule out 1st)
2. Ovarian Cysts rupture |
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Q. Cause of Chronic Pelvic Pain (>6 months)?
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1.Endometriosis
2. Adenomyosis 3. Ovarian cysts |
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Q. what tests to order to work-up acute pelvic pain?
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Amylase, and LIPASE
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Q. what is Primary Dysmenorrhea?
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Pelvic Pain without demonstrable causes. Not chronic pelvic pain, only at menses.
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Q. Definition of Interstitial cystitis?
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A painful multifactorial syndrome of unknown etiology characterized by chronic suprapubic pressure and/or pain and/or perineal pain, urinary urgency and frequency but no urinary tract infection is seen
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Q. How to treat Interstitial Cystitis?
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Antihisamines
Tricyclic Antidepressants Analgesics |
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Q. What health conditions are linked to environmental chemicals?
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Ovarian cysts and Endometriosis, HPV (toxinsIS cant repair itself), infertility, migraines,
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