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72 Cards in this Set
- Front
- Back
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What is menopause?
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amenorrhea for >12 consecutive months due to permanent cessation of ovarian activity |
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What is perimenopause?
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transition phase between normal ovarian cycles and menopause (anovulation). begins in mid-40s. defined by prolongation of the follicular phase (cycles become prolonged - >35 days). FSH raises >40 |
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What is premature ovarian syndrome? |
menopause (permanent anovulation) before the age of 40 |
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What is post-menopausal bleeding indicative of until proven otherwise? |
endometrial cancer**** |
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What are the effects of estrogen deprivation in menopause?
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atrophy of genitals - tx: topical estrogen cream osteoporosis cardiovascular effects - less NO production, thrombotic environment, foam cell formation from oxidated LDL |
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Describe the hormone levels of the menstrual cycle
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low estrogen at this time causes release of FSH from pituitary FSH causes follicular maturation, while estrogen aids in endometrial regeneration. increasing estrogen leads to LH surge LH surge seen a few days before ovulation ovulation stimulates high progesterone levels cycle begins again |
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Describe what is considered a "normal menstrual cycle"
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occurs ~ 1/month (q26-35 days) lasts a limited amount of time (3-7 days) heavy in the beginning but should not pass clots often preceded by premenstrual symptoms: cramps, breast tenderness, etc |
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What is dysmenorrhea?
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painful menses |
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Differential between primary and secondary dysmenorrhea
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secondary - with pelvic patho: fibroids, polyps, PID, adenomyosis, endometriosis |
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What is endometriosis?
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presence of endometrial tissue outside of the uterus, cause of secondary dysmenorhea |
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What are the SS of endometriosis?
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dysmenorrhea, painful intercourse, pelvic pain, menstrual irregularities, painful bowel movements |
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How is endometriosis treated?
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2nd line: denazole, GnRH agonist 3rd line: conservative sx for resection 4th line: definitive sx: hysterectomy, ovaries & tubes |
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What is premenstrual dysphoric disorder?
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severe form of PMS that affects patient functioning |
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What is a remnant follicle called? What does it replease?
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progesterone |
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What makes uterine bleeding "abnormal"
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large amount (>80 ml/pad) frequency: <21 days or >35 days |
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What is menorrhagia?
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heavy bleeding (but at regular intervals), and prolonged (>7days)
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what is metrorrhagia?
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periods at irregular intervals |
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what is menometrorrhagia? |
heavy, prolonged bleeding at irregular intervals, associated with anovulation |
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what is polymenorrhea? |
frequenct, regular intervals (<21 days apart)
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what is oligomenorrhea? |
infrequent, irregular intervals, bleeding >35 days apart |
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what is dysfunctional uterine bleeding?
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usually due to hypo-pit-ovarian axis dysfunction with estrogen dysregulation |
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list common causes of anovulation
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thyroid, PCOS, stress |
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How is anovulation investigated? |
bHCG, CBC, coagulation studies, TSH, prolactin, free testosterone
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Until proven otherwise, all abnormal uterine bleeding is _______________? |
endometrial cancer |
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How is menorrhagia treated? |
NSAIDs, tranexamic acid, denazole, OCP, progesterone |
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How is anovulatory dysfunctional uterine bleeding treated? |
OCP |
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How are fibroids treated? |
myomectomy, uterine artery embolization or hysterectomy
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How is adenomyosis treated? |
progesterone, OCP, IUD, hysterectomy |
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How is uterine or endometrial cancer treated? |
total hysterectomy |
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How is abnormal uterine bleeding investigated?
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bHCG, CBC, ferritin, pap test, TSH, prolactin, LH, FSH, transvaginal US or endometrial biopsy |
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What are the risk factors for developing fibroids?
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obesity Fhx blacks HTN |
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What are the SS of fibroids?
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pelvic pain menorrhagia obstructive symptoms infertility miscarriage pelvic mass |
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How are fibroids diagnosed? |
transvaginal US, MRI, sonohystograhy, |
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What is pelvic inflammatory disease? What infections/diseases are associated with PID?
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-inflammation of the endometrium, fallopian tubes, pelvic peritoneum, and contiguous structures -gonorrhea, chlamydia |
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What are the risk factors for developing PID?
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young age at first intercourse, multiple partners and high risk sexual activity, IUD insertion, prior PID, |
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What are the SS of PID? |
pelvic pain, lower abdo pain, abnormal discharge, painful intercourse, dysuria, abn uterine bleeing, adnexal tenderness, cervical motion tenderness, pus discharge from cervix |
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Who requires hospitalization for PID?
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pregnant women, abscess present, suspected poor abx compliance, severely ill, no response to outpatient te |
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How is PID treated?
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ofloxacin+metronidazole levofloxacine+metronidazole ceftriaxone+doxycycline/metronidazole |
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What are the SS of PCOS?
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ss: irregular menses, hirsuitism, clitoromegaly, acne, wt gain/obesity, pre DM, acanthosis nigricans |
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What are the 3 diagnostic clues of PCOS?
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2. anovulation 3. hyperandrogenism |
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How is PCOS treated?
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metformin, provera, OCP, spironolactone (+OCP), GnRH |
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What are the 4 types of gynecological malignancies?
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endometrial, ovarian, cervical, and vulvar cancer |
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Differentiate between type 1 & 2 endometrial cancer
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type 2: estrogen independent |
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How is a suspected endometrial cancer investigated/
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BIOPSY!! |
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How is endometrial cancer treated? |
surgically, chemo-radiation(if late stage) |
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What are the 3 types of ovarian cancers? (the good, bad & ugly)
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2. stromal tumors 3. epithelial tumors (carcinomas) |
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What is a teratoma?
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germ cell ovarian tumor that produces hair, teeth, etc. |
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What are the 5 types of epithelial ovarian tumors? Which is most common?
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endometrioid mucinous clear cell brenner |
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Which type of epithelial ovarian cancer is most often found bilaterally?
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serous ca.
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Which type of epithelial ovarian cancer will present with a large belly and look or pregnancy due to its large size?
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mucinous ca. |
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What is the RMI score used for? what 3 things does the equation contain?
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-uses ultrasound assessment, menopausal state, and gene marker (CA125) -if >200 = highly suspicious |
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What are the risk factors for cervical cancer?
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HPV, early onset sex, unprotected sex, no. sexual partners, smoking, immunocompromise |
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How is cervical cancer diagnosed?
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NOT by pap-test!! by colposcopy & biopsy |
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Which histological finding from a pap-smear does NOT warrant a colposcopy?
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ASC-US |
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What are SS of a potential cervical cancer?
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post-coital bleeding, menometrorrhagia, vag discharge, pelvic pain, bowel or bladder symptoms, flank pain, sciatica, lower limb edema |
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Describe the staging of cervical cancer?
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stage 2: upper vagina 3: lower vagina 4: bladder/bowel involvement or distant metastases |
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How is cervical cancer investigated?
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pap test, - colposcopy if abnormal & biopsy if visualized! |
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How is cervical cancer treated? |
excision, or ablation by laser, cautery or cryotherpay |
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Where is the first node that vulvular cancer speads?
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sentinel node |
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What is the pearl index of contraception?
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failure rate over one year of use (both for typical and perfect use) |
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How does the OCP work?
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inhibits LHS, thickens cervical mucous, thins out endometrial lining, inhibits tubal transport |
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What are the contraindications of OCP?
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previous DVT, smoking and >35yo, CVA, migraine headaches, breast cancer, preg, liver disease, DM, HTN, |
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When using the calendar method of contraception, how do you determine the fertile window?
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take shortest cycle and subtract 11, take longest cycle and subtract 18 |
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What is the infective agent in syphilis?
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trepomena pallidum |
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Describe the 3 stages of syphilis infection
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2. secondary: whole body rash, mucous patches 3. tertiary: no external symptoms, effects heart and brain |
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What causes gonorrhea? How is it treated?
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abx |
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What causes chlamydia?
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chlamydia trachomatis |
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Describe the vaginal discharge seen in the following: 1. gardnerella 2.trichomonas 3. foreign body 4. cervicitis 5. chlamydia 6. gonorrhea |
2. bubbly, frothy, white discharge 3. terrible odor 4. mucopurulent cervical discharge and tenderness 5. may not have discharge 6. green, mucopurulent discharge from cervix |
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What is the most common type of benign breast tumor?
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fibroadenoma
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What is the most common type of breast cancer?
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ductal carcinoma |
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How is a breast investigated?
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US, fine needle aspiration, core needle biopsy |
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What characteristics make a breast mass suspicious? |
hard, fixed, non-mobile, irregular, redness and dimpling of the skin, nipple inversion |
