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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?
1. Birth Control and Medication History
2. Pregnancy History
Q. What areas to examine on a well women’s exam?
1. Breast
2. External Genitalia: Skene glands, Bartholin glands
3. Speculum Exam
4. Bimanual: Cervix
5. Rectovaginal
Q. The correct order of specimen collection during gyn exam?
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
Q. Which strains of HPV are high risk and low risk and what conditions each cause?
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.
Q. Know what tests to order during a well women’s exam for a woman under 30?
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.
Q. Know what tests to order during a well women’s exam for a woman over 30?
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
Q. Know when to refer for a colposcopy ASCUS?
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.
Q. What glandular cells mean on a pap and what to do about it?
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
Q. Secondary Amenorrhea?
Stops menstruating for 3 or more months in the absence of pregnancy, lactation
Q. The causes of secondary amenorrhea?
1. Disorders of vagina/uterus
2. Disorders or ovary
3. Disorders of anterior pituitary
4. Disorders of CNS
Q. The proper work up for the progesterone challenge?
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.
Q. SXM of PCOS?
1. Amenorrhea/ oligomenorrhea
2. HTN, hyperlipidemia
Q. 2 ways to treat PCOS?
Menstrual regularity/ endometrial protection - get them back to normal cycle
Reduce androgens/treat symptoms of excess – low progesterone, helps with the signs of hyperandrogens
Q. 5 Causes of female infertility?
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%
Q. 5 Causes of Male infertility?
40-90% of cases are d/t deficient sperm production of unidentifiable origin
Varicocele (42%)
Unexplained (22%)
Obstructive azoospermia (14%)
Undescended testis (3%)
Q. 3 ways to know how to determine if your patient is ovulating?
-cervical mucus monitoring
-basal body temperature
-home ovulation detection kits
Q. 6 hormonal patterns to PMS?
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)
Q. The dietary patterns to lower PMS?
1. Vegetarian
2. A lower-fat diet
3. Increase complex CHO
4. Low fat protein
5. No sugar
6. Legumes, fruit, veggies
Q. How to decrease PMS-A SXM?
1. Decrease dairy and calcium
2. Decrease refined sugar and caffeine
3. Increase magnesium rich foods
4. B6, Vit E and ZN
Q. How to decrease PMS-C SXM?
1. Hypoglycemic diet
2. Decrease sugar and caffeine and salt
3. Anti-inflammatory diet
Mg, EPO, GLA, fish oil
Q. How to decrease PMS-D SXM?
1. Decrease sugar and caffeine and salt
2. Increase fish
3. Increase tryptophan foods
B6, Vit E and ZN
Q. How to decrease PMS-H SXM?
1. NO salt, caffeine or nicotene
2. No methylxanthines-tea, chocolate, coffee
3. No alcohol
Q. 4 types of PMS?
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
Q. What is PMDD?
PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life.
Q. How to treat PMS?
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
Q. 5 Causes of migraines?
1. Hormones, especially estrogen
2. Serotonin
3. Abnormal platelet function
4. Release of substance P
5. Triggers – Hx!!
Q. What is AUB and what causes it?
Abnormal uterine Bleeding: Menstrual cycle disruptions, disruptions of endometrial surface, abnormal angiogenesis, clotting abnormalities.
Cause: Pregnancy bleeding.
Anovulatory or Oligoovulatory, trauma, disorder of homeostatis
Q. Dysfunctional Uterine Bleeding definition and Cause?
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
Q. What is Ovulatory DUB?
Symptoms of menorrhagia but unrelated to:
1. Systemic coagulopathy
2. Pharmaceutical agents
3. Any structural anomalies
Q. What is Anovulatory/ Oligoovulatory DUB?
Occurs secondary to anovulation or oligoovulation. Due to estrogen stimulation w/o opposing progesterone
Q. What is Heavy Menstrual Bleeding?
80 ml/mo
Q. What are 4 consequences of heavy menstrual bleeding?
1. Anemia
2. Fatigue
3. Quality of life compromised
4. May also have cramps and pelvic pain
Q. SXM of Subserosal Uterine Leiomyomas?
NO BLEEDING
Q. SXM of Intramural Uterine Leiomyomas?
Cause bleeding. Causes deformed wall Myomectomy or hysterectomy
Q. SXM of pedunculated Uterine Leiomyomas?
Submucsal or subserosal. Cause bleeding. Can be resected hysteroscopically if less than 5mm
Q. 5 causes of Post-menopausal AUB?
1. Exogenous estrogen 30%
2. Atrophic Endometritis/ vaginitis 30%
3. Endometrial cancer 15%
4. Endo/cervical polyps 10%
5. Endo hyperplasia 5%
Q. What tests you would run for menorrhagia /DUB?
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
Q. Cause of Acute Pelvic Pain?
IMPORTANT: Pregnancy complications-ectopic (must rule out 1st)
2. Ovarian Cysts rupture
Q. Cause of Chronic Pelvic Pain (>6 months)?
1.Endometriosis
2. Adenomyosis
3. Ovarian cysts
Q. what tests to order to work-up acute pelvic pain?
Amylase, and LIPASE
Q. what is Primary Dysmenorrhea?
Pelvic Pain without demonstrable causes. Not chronic pelvic pain, only at menses.
Q. Definition of Interstitial cystitis?
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
Q. How to treat Interstitial Cystitis?
Antihisamines
Tricyclic Antidepressants
Analgesics
Q. What health conditions are linked to environmental chemicals?
Ovarian cysts and Endometriosis, HPV (toxinsIS cant repair itself), infertility, migraines,