Unit 10 - 3 Scheme

Front 1

menopause definition

Back 1

amenorrhea > 6-12 mo

Front 2

hot flashes

Back 2

instabiity of CNS (to occur at thermoregulatory set point in hypothalamus); 2 to dec estrogen

this is the most common symptom in postmenopausal patients

how many times per day do you feel hot flashes? <3 = prob dont treat

Front 3

symptoms of vaginal atrophy

Back 3

dyspareunia (painful intercourse) and vulvar/vaginal itching

Front 4

relevant P/FMH

Back 4

breast cancers, cardiovascular dz, strokes; this cna determine whether pt is candidate for estrogen replacement

Front 5

postmenopausal vaginal bleeding?

Back 5

ALWAYS considered pathological

if pts on anticoagulants this could account for the bleeding

Front 6

CI in estrogen replacement therapy

Back 6

thromboembolic dz;

Front 7

osteoporosis

Back 7

44 million pts suffer from this (3rd most prevalent in US)

estrogen replacement can help maintain bone mass; often these pts are asymptomatic

Front 8

history of breast cancer

Back 8

remind for routine mammography screening;

estrogen replacement can inc risk for this

Front 9

physical exam for amenorrhea

Back 9

vitals, general appearance, cardiovascular exam, thyroid exam, breast exam/mammography

Front 10

how to diagnose menopause

Back 10

lack of period for 12 mo (clinical dx)
estrogen, FSH, TSH not necessary (however if premature ovarian menopause would indicate these)

Front 11

how to tx vasomotor symptoms of menopause?

Back 11

SSRIs, SNRIs, gabapentin, progestins, clonidine

not for every p tthough,

if the symptoms are debilitating = short term hormonal replacement therapy

Front 12

HRT

Back 12

should never be introduced in late menopause (older patients); only useful during the transitional period

Front 13

menopause 'zebras'

Back 13

pheochromocytoma, carcinoid syndrome

both of these can mimic menopausal symptoms (hot flashes, flushing, etc); however these will NOT create menstruation problems

Front 14

discuss lifestyle changes in postmenopausal womens

Back 14

exercise, suplementation of calcium/vit D and cholesterol screening

discuss sexual problems (dyspareunia; thick about lubricants, estrogen cream o rother vaginal creams)

Front 15

which type of x ray should you use to osteoporosis in the back

Back 15

AP/lateral

pt needs loss of 30-40% of bone mineral density to detect Xray so it's not specific; but specific for complications;

first considered compression fracture (did you notice you've gotten shorter?)

Front 16

DXA scan

Back 16

dual energy x ray absorptionmetry; gold standard for detection of osteoporosis/osteopenia but not sensitive to detect compression fracture

Front 17

age at menarche and osteoporosis

Back 17

if pt has exposure to estrogen for a shorter period of time = late menarche, early menopause = higher risk of osteoperosis

Front 18

osteoporotic fractures

Back 18

pt has fallen from standard position and fractures while in a normal person this would not lead to a fracture

hip fractures, vertebral fractures (mc), wrist fractures

Front 19

osteoporosis tests to consider

Back 19

serum calcium level, 24 hr urine calcium

25-OH vitamin D

parathyroid hormone level (if calcium abnormaly high = primary hyperparathyroidism)

Front 20

how to prove osteoporosis

Back 20

DXA scan; but even if it doesnt show anything she still has an osteoporotic fracture anad still prob has osteoporosis

Front 21

risk factors for osteoporosis

Back 21

estrogen loss after menopause, small frame, Asian/white, smoking, family hx of osteoporosis

Front 22

age to start screening for menopause

Back 22

>65 female, >70 male w/o risk factors

w/ risk factors pt qualifies after age 50!

Front 23

T score = diff btwn pts bone mass and estimated theoretical peak

Back 23

Osteopenia between -1 to - 2.5, osteoporisis,, severe T score below -2.5, osteoporisis < -2.5 score + hx of fracture

Front 24

T score -1.8 in hip

Back 24

osteopenia; but if lower T score somewhere else she has osteoporosis

Front 25

T score of -3.3 in arm

Back 25

osteoporosis

Front 26

prevention/tx of vitamin D

Back 26

calcium and vitamin D

bisphosphanates (inhibit osteoclastic activity)
estrogen
raloxifene (SSRI)
teriparatide (human recombinant parathyroid hormone -> an ANABOLIC drug that stim bone formation when given as subcutaneous injection)

Calcitonin

Front 27

questions to ask about regarding pelvic floor problems

Back 27

how many pregnancies (babys head sits on pelvi floor)
gynecologic surgery
menopause? risk for pelvic abnormalities
ask about voiding patterns (under age 60 void every 4-5 hrs per day, no waking at night to void)

over age 60 = every 3-4 hrs, awakens once or more to avoid
with aging bladder capacity is less bladder overactivity = more contraction, more urine left in bladder

Front 28

why can't some pts get all their urine out

Back 28

desensis of the anterior compartment; cistercele (urinary bladder going down), urethrocele (urethra going donw)

pressure/discomfort in your vagina? lump coming down? back pain

Front 29

problems with bowel movements?

Back 29

any kind of inc intrabdominal pressure can worsen symptoms of pelvic floor abnormaliies/urinary incontinence

Front 30

chronic cough from smoking

Back 30

can aggravate urinary stress incontinence

Front 31

vaginismus

Back 31

too much contraction of the pelvic floor musculature

Front 32

cystocele

Back 32

bladder protrudes into vagina

visualize with MRI; assessing pubeococcyceal line;

Front 33

utreothrocele

Back 33

bladder and urethra both prolapse below the pubeococcyceal line

Front 34

rectocele

Back 34

rectum protrudes into vagina

Front 35

detrusor = bladder muscle used to void

Back 35

uterine prolapse can prevent voiding

Front 36

how to assess residual volume in pt

Back 36

ask pt ot go to the bathroom then catheterize the pt

you can also do an ultrasound

Front 37

cystometry

Back 37

pt says when she first feels the urge to urinate vs when she feels she must urinate

Front 38

reccomendation for how to delay desire tou rinate and improve pts urinary incontinence

Back 38

kegel exercises can strengthen the abdominal floor

Front 39

pessary

Back 39

ring that can prevent cystocele