Obgyn Exam 4

Front 1

Define Menopause

Back 1

amenorrhea for 12 consecutive months for which there is no pathologic of physiologic cause

Front 2

what is the phase in the agin women marking the transition from reproductive to nonreproductive called?

Back 2

Climacteric

Front 3

what is the definition of perimenopause?

Back 3

period immediately prior to the menopause and the first year after menopause

Front 4

LImited follicular maturation leads to ? *

Back 4

either a decreased cycle interval or lapses of cycles with oligomenorrhea

Front 5

Menses usually cease between what ages? *

Back 5

50 and 52 yo. reduces level of estrogen in follicles not sufficient to induce endometrial proliferative changes of menstruation

Front 6

In menopause, FSH levels rise? *

Back 6

10-20 fold above usual cycle leves

Front 7

Is there any estrogenic activity after menopause?

Back 7

* yes, for many years after but at much reduced levels

Front 8

What is the principal estrogen in postmenopausal women? *

Back 8

estrone

Front 9

Where/ how is Estrone produced? *

Back 9

produced from androstenedione via extraglandular and extrahepatic aromatization.

Front 10

Most of androstenedione (used in the production of estrone) is from?*

Back 10

the adrenal gland

Front 11

In obesity, there is an increased conversion of androstenedione to what? due to the ability of fat cells to do what? *

Back 11

androstenedione to estrone.
due to ability of fat cells to aromatize androgens

Front 12

how do we define premature menopause (premature ovarian failure)? *

Back 12

permanent amenorrhea before 35 yo

Front 13

causes of premature loss of oocytes and premature menopause*

Back 13

"ham laggs"
Hysterectomy
Alkylating CA chemotherapy
Mumps -- inflammatory reaction affecting the ovaries
Low body weight -- less adipocytes
Autoimmune disorder -- antibodies against thyroid, adrenal glands, ovarian endocrine tissues and even RA
Gonadotropin- Resistant ovary syndrome (Savage syndrome)
Genetic predilection
Smokin

Front 14

describe the effect of decreased estrogen on the vagina*

Back 14

Atrophic vaginitis
pruritus of vulvovaginal area
dyspareunia
stenosis
*vagina becomes smaller
Vaginal epitherlim becomes pale, thin, and dry

Front 15

what happens to the pelvic tissues and ligaments that support uterus and vagina with a decrease in estrogen levels? *

Back 15

lose their tone, predisposing to prolapse of the uterus

Front 16

what happens to the bladder and urethra in the absence of estrogen?
specifically urethral changes

Back 16

atrophic changes.
urethral changes lead to dysuria, urinary frequency, urgency and incontinence.
Increased frequency of cystitis (UTIs)

Front 17

what are the sx of menopause? *

Back 17

JF HIP SLID + HF
1. Hot flashes / Flush
2. Joint and mm pain
3. Fatigue
3. HA
4. Insomnia
5. Palpitations
6. Sexual dysfunciton
7. Loss of sense of well being
8. Irritability, nervousenss
9. Depression

Front 18

the hallmark of the menopausal woman is ? *

Back 18

the hot flash or flush

Front 19

characterized by sudden reddening of skin over the head, neck and chest accompanied by feeling of intense body head and perspiration lasting few seconds or several minutes*

Back 19

Flush

Front 20

Flushes are more likely to occur when in the day?*

Back 20

at night. more frequent and severe at night or during stress

Front 21

how long do vasomotor symptoms last in a menopausal woman?

Back 21

1-2 years or up to 5

Front 22

Flush coincides with surge of what?*

Back 22

FH and LSH

Front 23

Do patients kjnow when a flush is starting?

Back 23

yes

Front 24

Estrogen therapy decreases frequency and sensitivity of ? *

Back 24

flushes

Front 25

Increased endogenous estrogen my lead to increased bleeding in perimenopausal /menopausal women. What are 3 causes of increased levels? *

Back 25

1. increased levels of precursor androgens (endocrine tumors, liver disease, stress)
2. increased aromatization of androgenic precursors associated with obesity, hyperthyroidism, liver disease
3. increased secretion of estrogen from ovarian tumors

Front 26

what is the mechanism by which DUB occurs in perimenopausal women, most commonly in their 40-55 yo age range. *

Back 26

Function of estrogen excess, not deficiency. There is estrogen being produced that is not associated with normal ovarian ovulation but rather another source and therefore there is no progesterone opposing it.

Front 27

Endometrial Neoplasia and any abnormal bleeding that occurs in a woman over 35 yo must be evaluated with? *

Back 27

D & C or endometrial bx to r/o organic disease

Front 28

what is the therapy for abnormal perimenopausal bleeding most likely associated with unopposed estrogen secretion?*

Back 28

Intermittent progestin (medroxyprogesterone acetate) every month provides estrogen antagonism and helps regulate patient.

Front 29

what is the main health hazard associated with menopause? *

Back 29

osteoporosis

Front 30

define osteoprosis*

Back 30

increaed porosity of bone. usually axial skeleton

Front 31

most of the loss in osteoporosis occurs to what part of the bone? *

Back 31

occurs to trabecular bone with thinning of the cortex

Front 32

osteoporosis is associated with decreased levels of what hormones? *

Back 32

estrone and androstenedione levels

Front 33

______ women are at much greater risk for rapid onset of osteoporosis*

Back 33

oophorectomized

Front 34

exercise and proper diet have beneficial effect on bone integrity and _____ therapy can retard osteoporosis *

Back 34

estrogen

Front 35

*average of _____ of women with hip fx _____ within 4 months of fx from complications

Back 35

16%, die

Front 36

Approx. ____% of white women over 60, not treated, will have ______ fractures

Back 36

25%, spinal compression fractures

Front 37

* Approx. 32% of white women with inadequate osteoporosis prevention develop what kind of fractures?

Back 37

develop one ore more hip fx

Front 38

osteoporosis induced fractures occur where? *

Back 38

humerus
upper femur
distal forearm
vertebral body
ribs

Front 39

which osteoporosis treatment can lead to jaw osteonecrosis and sever bone, joint, and or mm pain

Back 39

Bisphosphonates

Front 40

what is the SERM drug used for osteoporosis?

Back 40

Evista, increases bone density and prevents fx

Front 41

what osteoporosis med is a recombinatn human PTH that stimulates bone formation by increasing vertebral bone mineral density?

Back 41

Forteo

Front 42

which osteoporosis med has a black box warning about increased risk of osteoscaroma?

Back 42

Forteo

Front 43

which osteoporosis drug inhibits proliferation, differetntiation and mtuaration of pre-osteoclases into acative bone-resorbing cells? thus decreasing bone remodeling and increasing bone mineral density?

Back 43

prolia

Front 44

_____ is effective in reducing bone density loss but not as good as bisphosphonates and raloxifene (evista). Used in combo with Vit. D

Back 44

Calcium 1200-1500 mg/d

Front 45

how much supplemental calcium should be prescribed? *

Back 45

1200-1500 mg/day

Front 46

what types of calcium supplement preps have the highest concentration of elemental calcium (40%) they are also inexpensive and easy to take but less soluable and need gatric acid for absorption

Back 46

Calcium carbonate and calcium phosphate

Front 47

____ increases calcium absorption from intestine and should be included in regimen for osteoporosis

Back 47

Vit D min of 800 IU

Front 48

the women's health initiative did a study on the use of HRT what is their recommendation for use of HRT? *

Back 48

use of HRT should be monitored closesly and should be limited to the shortest duration consistent with tx goals and risks for individuals and periodically evaluated.

Front 49

There is a black box warning that estrogen or combo HRT are NOT indicated for prevention of what?

Back 49

CHD or other cardiovascular disease

Front 50

FDA recommendation for indications and usage of estrogen include what?

Back 50

treatement of moderate to severe vasomotor sx associated w/ menopause (hot flashes) and vulvar and vaginal atrophy associated with menopause. (if only rx for the vaginal atrophy use topical)

Front 51

Can estrogen therapy help vaginal relaxation?

Back 51

no! doesn't respond

Front 52

what are the 3 indications for using MHT?

Back 52

1. relief of moderate to severe vasomotor sx of menopause
2. relief of mod to severe sx of vulvoaginal atrophy associated with Menopause
3. tx of significant postmenopausal osteoporosis if non-estrogen therapy is not an option

Front 53

What are the contraindications to MHT?

Back 53

1. acute liver dz
2. chronic impaired liver fnx
3. acute vascular thrombosis - DVT
4. neuro-opthalmologic vascular dz
5. CAD
6. Cancer (estrogen dependent neoplasia)

Front 54

When would we use progestin only as therapy?

Back 54

Medroxyprogesterone acetate is effective for sx relief of hot flashes/vasomotor sx in women with contraindication to estrogen

Front 55

define urinary incontinence

Back 55

involuntary loss of urine as a result of an incompetent urethral closure mechanism during an increase in intraabdominal pressure (coughing, sneezing) MC type of incontinence

Front 56

what is the MC type of incontinence?

Back 56

stress urinary incontince

Front 57

what are causes of stress urinary incontinence?

Back 57

strictly anatomic
distortion of the normal antomic urethrovesical relationship
alteration n the cirfular muscular arrangement.

Front 58

How do we dx stress incontinence?

Back 58

* take detailed hx to differentiate from other causes of involuntary loss of urine
1. voiding pattern
2. stressors that evoke loss of urine
3. use of meds
4. hx of uti, urologic surery, OB trauma, CNS or spinal cord disorders

Front 59

what is the bladder neck elevation test? and what is another name for it?

Back 59

Place finger on each side of urethra as patient strains. if this relieves incontinence, then bladder neck elevation may be good tx option.

Other name: Marchetti test

Front 60

Do patients with stress incontinence often suffer from more than one disorder?

Back 60

yes

Front 61

what tx should we try first in stress incontinence?

Back 61

non surgical

Front 62

when patients failure to respond to therapy or no organic cause can be found for incontinence, what should be obtained next?

Back 62

psychiatric consult. (emotional, anxiety, and depression can be cause)