Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
11 Cards in this Set
- Front
- Back
% of reproductive age women who will get endometriosis:
What % of pelvic pain and infertility patients have endometriosis? Pain results from: |
3-10%
5-20% pelvic pain, 20-40% infertility stimulation of implants from E/P, fribrous peritoneum prevents blood from escaping, pain from inflammation, pressure, adhesions, relationship to nerves |
|
Major S/S of endometriosis:
PE findings: Imaging study to better evaluate adenomyosis: |
may be asymptomatic
chronic pelvic pain, dysmenorrhea, mentrual pain, dyspareunia, infertility often normal tender cul-de-sac, uterosacral ligament tenderness, fixed/retroverted uterus, adnexal masses MRI |
|
Gold standard of eval:
Relationship of pain to size of masses: Classic appearance of endometriosis: non-classical appearance: 50% of endometriomas are located where? |
laparoscopy w/ biopsy/confirmatory histo
no correlation red spots, dark blue, black, brown, "powder burns", cystic clear vesicles, white/yellow spots, nodules, "pockets" ovaries |
|
Non-surgical tx:
What should you be careful of? Pain meds? Effect of OCP's? Effect of Danazol? |
avoid, be careful of narcotic use
use NSAID's, PG inhibitors use continuous OCP's - 6-12 mo., no placebos - can result in decidual changes in tissue, but is NOT curative inhibits gonadotropin release at hypothal - no FSH/LH surge, hypoestrogenic effect - prevents endometrial growth |
|
What is leuprolide?
Why do you need to limit its use? Conservative surgical tx? |
GnRH agonist - continuous administration suppresses gonadotropin release
limit 6 months - hypoestrogenic effects - add norethindrone, can extend use to 1 year lyse adhesions, remove all endometriomas - restore anatomy, laparoscopically |
|
When should you use definitive surgical management?
|
severe disease, S/S
complete child bearing failed conservative management |
|
Define infertility:
% US couples affected: Three circumstances to check after 6 months: Two major etiologies: |
inability to achieve pregnancy after 12 months of unprotected sex
10-20% advanced age, irregular cycles, high risk populations sperm disorders, ovulation disorders |
|
Pertinent male PE findings:
female PE findings: Normal ranges for sperm eval: |
penis deformities, testicular descent, testicular size (mass)?, vericocele, hydrocele
thyroidmegaly, mass; abd/pelvic mass/tenderness, uterine immobility, enlargement, uterosacral nodules, tenderness, cervical abnormalities count - >20 million/mL motility - >50% morphology - >60% normal |
|
Explain the luteal phase defect:
gold standard for dx: Reasonable initial screening test: |
insufficient progesterone effect on uterine lining
endometrial biopsy, >2 day difference between dating by pathology and time of ovulation hysterosalpingogram |
|
Basic workup guidelines:
When should you jump to the HSG/laparoscopy? What drug can initiate ovulation? Effect of metformin? ASRM guidelines for ART: |
don't over test, W/U can usually be done over 2-4 cycles, time tests appropriately
After normal sperm counts/ovulation Clomid - clomiphene citrate increases ovulation rate no more than 2 embryos tx'ed in patients <35 y/o |
|
4 types of ART:
|
IVF - in vitro
GIFT - gamete intrafallopian tx ZIFT - zygote intrafallopian tx ICSI - intracytoplasmis sperm injection |