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150 Cards in this Set

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Uterine Leiomyoma (Fibroids) -
What is it
MC benign gyn lesion
MC in Blacks and pts. > 35
smooth muscle cell tumors
responds to hormones
inc. during pregnancy
usu regresses after menopause
transform to leiomyosarcoma
is rare
Uterine Leiomyoma (Fibroids) -
Hx/PE
Usu asymp
may have -
abnorm uterine bleeding
pelvic pressure
dysmenorrhea
urinary freq.
pain

NT
irreg enlarged uterus
"lumpy bumpy"
Uterine Leiomyoma (Fibroids) -
Dx
US
Uterine Leiomyoma (Fibroids) -
Tx
If asymp -
manage expectantly
monitor growth
serial exams
US

if severe Sxs or
postmenopausal growth -
myomectomy or
hysterectomy

med therapies -
shrink tumors
tumors grow when meds stopped
use in perimenopausal
Infertility -
What is it
Inability after 1 year
female dysfunction (no. 1)
male dysfunction

female -
no. 1 = endometriosis
PID
cervix
uterine-tubal
ovulation prob
peritoneum
multiple factors
UNK
Infertility -
Dx
FSH
LH
TSH
prolactin
hysterosalpingography
semen analysis
Infertility -
Tx
Tx underlying cause

. endometriosis -
lap removal of implants
. clomiphene citrate
. Pergonal -
purified human FSH & LH
. GIFT, IVF
Menopause -
What is it
Due to end-organ ovarian
resistance to gonadotropins
median age 50-52

premature -
< 40
idiopathic premature
ovarian failure
assoc. with cigarettes

artificial -
after removal of ovaries
after irradiation of ovaries

postmenopausal -
lose protection from estrogen
inc. risk for osteoporosis
and heart dis.
Menopause -
Hx/PE
Menstrual irreg
sweating
sleep disturb
mood changes
dec. libido
dyspareunia
dysuria

vaginal dryness
dec. breast size
gen. tract atrophy
Menopause -
Dx
Inc. serum FSH - suggestive
1 yr without menses
Menopause -
Tx
HRT -
can relieve Sxs
help prevent osteoporosis
contraindications -
unDx vag bleeding
liver disease
acute vas thrombosis
h/o endometrial cancer
h/o breast cancer

progesterone/estrogen -
if still have uterus

estrogen alone -
if had TAHBSO

clonidine
topical estrogens
calcium
vit D
calcitonin
bisphosphonates
Contraception -
Rhythm Method
What is it
Use body temp and cervical
mucus consistency to predict
time of fertility
Contraception -
Rhythm Method
Side Effect
Unreliable
Contraception -
Coitus Interruptus
What is it
Withdraw before ejaculation
Contraception -
Coitus Interruptus
Side Effect
High failure rate
Contraception -
Diaphragm and Cervical Caps
What is it
Domed sheet of rubber or latex
placed over cervix
must be fitted by physician
must remain in vagina 6-8 hrs
after intercourse
Contraception -
Diaphragm and Cervical Caps
Side Effects
Possible allergy to latex
or spermicides
risk of UTI, TSS
Contraception -
Condoms
What is it
Latex sheath
Contraception -
Condoms
Side Effects
Possible allergy to latex
or spermicides
Contraception -
IUD
What is it
Plastic and/or metal device
placed in uterus
causes local sterile
inflammatory reaction
in uterine wall so that
sperm engulfed and destroyed
Contraception -
IUD
Side Effects
Inc. vag bleeding - copper IUD
uterine perforation
IUD migration
infection
inc. risk of PID
inc. risk of ectopic preg
Contraception -
OCPs
What is it
Suppress ovulation by
inhibiting FSH/LH
change consistency of
cervical mucus
make endometrium unsuitable
for implantation
Contraception -
OCPs
Side Effects
HTN
hepatic adenoma
weight gain
inc. risk of thromboembolism
nausea
acne
breast tenderness
mood changes
Contraception -
Levonorgestrel (Norplant) -
What is it
Taken off market 2002
progestin subdermal implant
suppresses ovulation
thickens cervical mucus
makes endometrium unsuitable
for implantation
effect lasts 5 yrs.
Contraception -
Levonorgestrel (Norplant) -
Side Effects
Irreg vag bleeding
weight gain
galactorrhea
acne
breast tenderness
headache
hard to remove
Contraception -
Postcoital morning-after pill
What is it
Progesterone +/- estrogen
take within 72 hrs of
unprotected sex
suppresses ovulation
discourages implantation
Contraception -
Postcoital morning-after pill
Side Effects
N/V
fatigue
breast tenderness
headache
dizziness
Contraception -
Medroxyprogesterone
(Depo-Provera)
What is it
IM injection given every 3 mos
suppresses ovulation
thickens cervical mucus
makes endometrium unsuitable
for implantation
Contraception -
Medroxyprogesterone
(Depo-Provera)
Side Effects
Irreg vag bleeding
depression
weight gain
breast tenderness
delayed restoration of
ovulation after discontinue
Contraception -
Surgical Sterilization
(Tubal Ligation, Vasectomy)
What is it
Tubes ligated, cauterized or
mechanically occluded
Contraception -
Surgical Sterilization
(Tubal Ligation, Vasectomy)
Side Effects
Essentially irreversible
bleeding
infection
failure
ectopic pregnancy
Intraductal Papilloma -
What is it
Common cause of
bloody nipple discharge
Fibrocystic Change -
What is it
Catchall term
spectrum of clinical findings
mastalgia
breast cysts
fibroadenoma
mastitis
hyperplasia
nodularity

commonly seen in premenopause
from exaggerated response of
stroma to hormones
& growth factors
inc. cancer risk only if
cellular atypia
Fibrocystic Change -
Hx/PE
Cyclic,
premenstrual,
b/l breast pain,
tenderness, swelling

excessive tissue nodularity
Fibrocystic Change -
Dx
Fine-needle aspiration
cytologic exam
Fibrocystic Change -
Tx
Dec. caffeine and nicotine
vit E
progestins
danazol
tamoxifen
diuretics
Fibroadenoma -
What is it
MC breast lesion < 30
benign, slow-growing tumor
epithelial & stroma components
recurrence common

phyllodes tumor -
(cystosarcoma phylloides)
grows fast
large type of fibroadenoma
rarely malignant
Fibroadenoma -
Hx/PE
Round
firm, NT
mobile
solitary mass, discrete
Fibroadenoma -
Dx
Surgical excision -
tissue for Dx
Fibroadenoma -
Tx
Surgical excision
Breast Cancer -
What is it
MC cancer (incidence)
no. 2 in cancer death

risk factors -
gender
age
breast Ca 1st degree relatives
h/o breast cancer
1st fullterm preg after 35 y/o
h/o fibrocystic change with
cellular atypia
inc. exposure to estrogen -
nullparity
early menarche
late menopause

late menarche - dec. risk
BRCA-1 & BRCA-2 mutations -
early-onset familial breast
and ovarian cancers
Breast Cancer -
Hx/PE
Lump -
hard
irreg
not mobile
painless
possible nipple discharge

can be asymp and nonpalpable
MC location - upper outer quad
mets to -
lymph nodes
bones
brain
lung
liver

advanced disease -
skin changes:
dimpling
redness
ulceration
edema
axillary adenopathy
Breast Cancer -
Dx
■ Mammography -
↑ density
microcalcifications
irregular borders
■ US -
solid mass vs. benign cyst
■ tumor markers for recurrent-
CEA
CA 15-3
CA 27-29
■ estrogen receptor (ER)
progesterone receptor (PR)
HER2/neu status
■ metastatic disease -
↑ ESR
↑ alk phos
↑ calcium
CXR - pulmonary metas
CT - chest, abdomen, pelvis,
brain
bone scan
Breast Cancer -
Tx
■ All hormone receptor pos. -
tamoxifen
■ estrogen rec. neg - chemo
■ trastuzumab -
HER2/neu-expressive cancers
■ partial mastectomy and
axillary dissection
followed by radiation
■ modified radical mastectomy
(total mastectomy plus
axillary dissection)
■ contraindications to
breast-conserving therapy -
large tumor
multifocal tumors
subareolar location
fixation to chest wall
nipple involved
overlying skin involved
■ Invasive cancer requires
axillary dissection
■ stage IV -
radiation and hormones
mastectomy may required
■ ER- and PR+ - favorable
Ectopic Pregnancy -
What is it
Implants outside uter. cavity
MC site - ampulla

risk -
h/o PID (most common)
prior ectopic pregnancy
tubal/pelvic surgery
DES exposure in utero
IUD
Ectopic Pregnancy -
Hx/PE
Classic triad -
amenorrhea
light vag bleeding
lwr abdom or pelvic pain

tender pelvic or adnexal mass

ruptured ectopic -
surgical emergency
sudden, sharp abdom pain
orthostatic hypotension
tachycardia
shoulder pain
shock
generalized abdominal and
adnexal tenderness with
rebound tenderness
Ectopic Pregnancy -
Dx
■ B-hCG -
levels lwr than normal preg
level takes > 2D to double
■ serum progesterone < normal
■ transabdom or transvag US
Dx - empty uterine cavity
and B-hCG of 6,500
■ culdocentesis -
> 5cc of nonclotting blood
identifies hemoperitoneum
not sensitive nor specific
Ectopic Pregnancy -
Tx
■ Serial B-hCG and US
■ expectant management if -
asymp
dec. B-hCG
small mass
no US evidence of bleeding
■ methotrexate -
stable, unruptured
■ all others, surgery -
salpingostomy
salpingectomy
salpingo-oophorectomy
■ RhoGAM if appropriate
Ectopic Pregnancy -
Complications
Inevitable loss of fetus
hemorrhagic shock
future ectopic pregnancy
infertility
maternal death
Rh sensitization
Vaginitis -
What Causes it
Vagina normally -
mixed bacterial flora
acidic envi (pH 3.5-4.5)
maintained by lactic acid-
producing lactobacilli

change in environment =>
overgrowth of other bacteria
can be bact., fungi, protozoa
Bacterial Vaginosis -
Hx/PE
Gray, fishy-smelling discharge
often pruritus and irritation
Bacterial Vaginosis -
Dx
pH > 4.5
saline smear - clue cells
KOH prep - positive whiff test
Bacterial Vaginosis -
Tx
PO metronidazole
Trichomonas -
Hx/PE
Profuse, malodorous,
yellow-green discharge
dysuria
dyspareunia
erythema
strawberry petechiae in
upper vagina/cervix
Trichomonas -
Dx
pH > 4.5
saline smear -
motile trichomonads
KOH prep - nothing
Trichomonas -
Tx
PO metronidazole
Tx partner
test for other STDs
Candidal Vaginitis -
Hx/PE
Thick, white discharge -
cottage-cheese texture
pruritus
with or without burning
erythematous, excoriated
vulva/vagina
Candidal Vaginitis -
Dx
pH - normal
saline smear - nothing
KOH prep - pseudohyphae
Candidal Vaginitis -
Tx
Topical antifungals
(miconazole)
po fluconazole
Vaginitis -
Dx
■ Det. vag pH with
nitrazine paper
■ micro exam of discharge -
saline (wet prep)
KOH
■ r/o STDs -
gram stain of discharge
Chlamydia Ag test
■ r/o UTI -
clean-catch UC and UA
Vaginitis -
Complications
Inc. risk of PID -
with bacterial vaginosis

preterm labor
ROM
Cervicitis -
What is it
N. gonorrhea
Chlamydia
co-infection common
infect cervical glandular
epithelium
cervix - red & bleeds easily
yellowish-green mucopurulent
discharge
discharge can be seen exuding
from endocervical canal
Cervicitis -
Dx
Cervical motion tenderness
(CMT)
no other signs of PID
Pelvic Inflammatory Disease -
What is it
Risk Factors
Microorg. ascend into:
endometrium - endometritis
uterine wall - myometritis
fallopian tubes - salpingitis
ovaries - oophoritis
parietal perit. - peritonitis

most causes -
gonorrhea & chlamydia

risk factors -
multiple sexual partners
unprotected or freq. sex
young age at 1st intercourse
mucopurulent cervicitis
prior PID
IUD
incidence decreases with -
OCPs
barrier contraception
Pelvic Inflammatory Disease -
Hx/PE
Lower abdominal pain
fever
chills
menstrual disturbances
purulent cervical discharge
cervical motion tenderness
adnexal tenderness
RUQ pain may indicate
perihepatitis
(Fitz-Hugh–Curtis syndrome)
Pelvic Inflammatory Disease -
Dx
Lower abdom, adnexal and
cervical motion tenderness
fever
inc. ESR
inc. CRP
WBC > 10,000
cervical swab pos. for
chlamydia or gonorrhea
US - pelvic abscess
Def. Dx - laparoscopy

consider -
B-hCG
RPR/VDRL
HIV
LFTs
Pelvic Inflammatory Disease -
Tx
Don't wait on culture results
treat partner

outpatient (3 options) -
cefoxitin + probenecid × 1dose
ceftriaxone IM × 1 dose and
doxycycline × 14 days
ofloxacin × 14 days and
metronidazole × 14 days

admit -
■ if surgical emergency can't
be ruled out
■ tubo-ovarian abscess -
admit for at least 24 hours
■ pregnant
■ don't improve after
48-72 hrs. of outpt. Tx
■ severe illness, n/v, hi fvr
■ immunodeficient
■ noncompliant
■ cefoxitin or cefotetan and
doxycycline × 14 days.
Pelvic Inflammatory Disease -
Complications
Ectopic pregnancy
chronic pelvic pain
infertility
repeated infections
Fitz-Hugh-Curtis syndrome

pelvic/tubo-ovarian abscess -
severe pain
hi fever
n/v
signs of sepsis
peritoneal signs
adnexal mass
admit -
IV ABx
hydration
drainage or TAHBSO
Toxic Shock Syndrome -
What is it
Acute illness
caused by preformed S. aureus
toxin (TSST-1)
90% women of childbearing age
in 5 days of onset of menses
tampon use
nonmenstrual almost as common-
organisms from:
nasopharynx, bones,
vagina, rectum, wounds
Toxic Shock Syndrome -
Hx/PE
■ Abrupt onset -
fever, vomiting, diarrhea
■ can => hypotensive shock
■ diffuse macular erythematous
rash (sunburn-like)
■ nonpurulent conjunctivitis
■ desquamation of palms and
soles within 1–2 weeks
Toxic Shock Syndrome -
Dx
BC - neg
Toxic Shock Syndrome -
Tx
Admit
rehydration
remove source of toxin
antistaph ABx -
nafcillin, oxacillin
manage renal or
cardiac failure
Menorrhagia -
What is it
Cause
↑ amount of flow
> 80 mL per cycle

or

prolonged bleeding
flow lasts > 8 days

causes -
leiomyoma
endometrial hyperplasia
endometrial polyps
endometrial cancer
cervical cancer
pregnancy complications
Oligomenorrhea -
What is it
MCC
↑ length of time
between menses
35–90 days between cycles
MCC - pregnancy
Polymenorrhea -
What is it
Cause
Frequent menstruation
< 21-day cycle
cause - anovulation
Metrorrhagia -
What is it
Causes
Bleeding between periods

causes -
endometrial polyps
endometrial cancer
cervical cancer
pregnancy complications
exogenous estrogen
Menometrorrhagia -
What is it
Causes
Excessive and irregular
bleeding

causes -
endometrial polyps
endometrial cancer
cervical cancer
pregnancy complications
exogenous estrogen
Postmenopausal Bleeding -
What is it
Causes
Uterine bleeding > 1 year
after menopause

causes -
vaginal atrophy
exogenous hormones
cancer
Abnormal Uterine Bleeding -
Dx
Distinguish ovulatory
from anovulatory d/o
thorough menstrual Hx -
bleeding freq., vol, duration
bimanual exam
pap smear

ovulatory -
transvag US
sonohysterogram
D&C with hysteroscopy

anovulatory -
B-hCG
CBC
coag profile
FSH
LH
TSH
prolactin
endometrial Bx

any postmenopausal woman with
uterine bleeding -
endometrial BX
to r/o endometrial cancer
Abnormal Uterine Bleeding -
Tx
Treat underlying d/o

ovulatory -
NSAIDs +/- OCPs

anovulatory -
OCPs
cyclic progestin
(medroxyprogesterone)
high-dose IV estrogen
D&C
endometrial ablation
hysterectomy - last resort
Amenorrhea -
What is Primary Amenorrhea
No menses by 16 y/o
no secondary sexual
characteristics by 14 y/o
Primary Amenorrhea -
Causes
Mullerian anomalies
vaginal agenesis
imperforate hymen
testicular feminization
ovarian failure
Turner's
Kallmann's
anorexia
excess exercise
weight loss
stress
tumor
infection
Amenorrhea -
What is Secondary Amenorrhea
No menses for 3 cycles
if h/o irreg cycles -
no menses for 6 mos.
Secondary Amenorrhea -
Causes
Asherman's syndrome
cervical stenosis
pregnancy
polycystic ovarian syndrome
anorexia
excess exercise
weight loss
stress
Amenorrhea -
Dx
Explain
PE
B-hCG

primary -
uterus?
breast?

secondary -
prolactin
TSH
CT or MRI
progestin challenge
estrogen-progest. challenge
FSH/LH

■ inc. prolactin?
inhib rel. of FSH and LH
causes -
pituitary tumor,
hypothyroidism,
dopamine antag
if neg. - progestin challenge

■ progestin challenge -
bleeding - prob is anovulation
causes -
hypothalamic dysfunction
polycystic ovarian syn
ovarian tumor
adrenal tumor
no bleeding -
estrogen-progest. challenge

■ est-progesterone challenge -
bleeding - functional uterus,
inadequate estrogen stim
no bleeding - Asherman's

■ FSH/LH
hypo - Sheehan's
hyper - 17-hydroxylase def.,
gonadal agenesis
Amenorrhea -
Tx
Tx underlying cause
if low estrogen -
HRT
Ca2+ supplements
Dysmenorrhea -
What is it
Pain during menses that -
requires meds
prevents normal activity

primary -
no structural gyn d/o
start < 20 y/o
tends to dec. with age
due to uterine contractions
probably mediated by PGE
Tx - NSAIDs and OCPs

secondary -
pelvic pathology
MC - endometriosis
adenomyosis
myomas
pelvic congestion
PID
ovarian cysts
cervical stenosis
pelvic adhesions
Endometriosis-
What is it
Functional endometrial tissue
(glands and stroma)
implanted outside uterus
women of reproductive age

common sites -
ovaries
cul-de-sac
uterosacral ligament

due to -
implant via retrograde menses
vascular and lymph dissem
metaplasia

risk factors -
family Hx
nulliparity
infertility
Endometriosis-
Hx/PE
Hx -
premenstrual pain
dyschezia
chronic pelvic pain
dyspareunia
abnorm bleeding
infertility

PE -
tender, nodularity along
uterosacral ligament
fixed, retroverted uterus
tender, fixed adnexal masses
Endometriosis-
Dx
Definitive Dx -
direct visualization via
laparoscopy or laparotomy

implants -
rust-colored
dark brown "powder burns"
raised blue raspberry lesions"

severe -
adhesions surround implants

ovary may have -
endometrioma (chocolate cysts)

pain severity -
doesn't always correlate with
extent of disease
Endometriosis-
Tx
Options -
OCPs or progestin
danazol or GnRH agonists
lap ablation
TAH-BSO
lysis of adhesions
Vulvar Cancer -
What is it
Risk Factors
4th MC gyn malignancy
usu occurs after menopause -
(peaks in 60s)
squamous cell ca (90%)

risk factors -
diabetes
obesity
HTN
vulvar dystropy
HPV-16
HPV-18
Vulvar Cancer -
Hx/PE
Asymp in early stages
vulvar pruritis (MC)
erythematous or
ulcerated vulvar lesion
palpable vulvar mass
Vulvar Cancer -
Dx
Definitive Dx -
Biopsy
Vulvar Cancer -
Tx
Wide local excision
regional lymph node dissection
radiation -
dec. tumor
metas
recurrence
Cervical Cancer -
What is it
Risk Factors
3rd MC gyn malignancy
squamous cell ca (most)
adenoca (most of remaining)

results from cervical
intraepithlial neoplasia (CIN)
if untreated => invasive ca
spreads -
directly
blood
lymphatics to -
pelvic lymph nodes
para-aortic lymph nodes

Risk factors -
HPV 16, 18 and 31
early onset of sex
multiple sex partners
immune compromised
tobacco
STDs
Cervical Cancer -
Hx/PE
Hx -
usu asymp
if asymp, usu Dx by -
Pap smear, colposcopy and Bx

if symp -
postcoital bleeding is
usu 1st Sx
menorrhagia
metrorrhagia
pelvic pain
vag discharge

PE -
cervical discharge
cervical ulceration
pelvic mass
fistulas
Cervical Cancer -
Dx
■ Bx all lesions
■ colposcopy and
endocervical curettage if -
dysplasia (on Pap smear),
squamous intraepithelial
neoplasia (on Pap smear)
or 2 consec findings of
atyp squamous cells of
undet signif (ASCUS)
■ pelvic exam under anesthesia
■ CXR
■ IVP
■ staging -
clinical
based on invasion into
adjacent structures and
metastases
CT/MRI can't be used to stage
Cervical Cancer -
Tx
■ Carcinoma in situ -
finished childbearing - TAH
wish to keep uterus -
cervical conization
ablation of lesion:
cryotherapy
laser
■ invasive -
. all stages -
radiation & chemo
less radical surgeries
. early stages -
radical hysterectomy
lymph node dissection
■ advanced disease or
bulky tumors -
radiation +/- chemo
Cervical Cancer-
Staging of CIN
CIN I -
mild dysplasia
low-grade squamous
intraepithelial lesion (LSIL)

CIN II -
moderate dysplasia
high-grade squamous
intraepithelial lesion (HSIL)

CIN III -
severe dysplasia or
carcinoma in situ
high-grade squamous
intraepithelial lesion (HSIL)
Endometrial Cancer -
What is it
Risk Factors
MC gyn malignancy
strong association with
high levels of
unopposed estrogen
ages 50-70
usu adenoca

mets to:
direct - cervix
intraperitoneal seeding
blood - lungs, vagina
lymphatics -
aortic node
pelvic node

risk factors -
unopposed estrogen
diabetes
HTN
nulliparity
family Hx
Endometrial Cancer -
Examples of Unopposed Estrogen
Estrogen replacement therapy
chronic anovulation
early menarche
late menopause
ovarian granulosa cell tumors
polycystic ovarian syndrome
obesity
tamoxifen
Endometrial Cancer -
Hx/PE
postmenopausal bleeding
menorrhagia
metrorrhagia
lwr abdom pain
cramping

uterus -
fixed, immobile if
spread to adnexa & peritoneum

signs of mets -
hepatosplenomegaly
lymphadenopathy
abdom masses
Endometrial Cancer -
Dx
Pap smear - not very sensitive
ECC
EMB
D&C - if sample inadeq
US to r/o -
fibroids
polyps
endometrial hyperplasia

grade - key prognostic factor
staging -
surgical
peritoneal fluid cytology
abdom exploration
TAH-BSO
pelvic & para-aortic nodes
Endometrial Cancer -
Tx
High dose progestins - stage I
chemo -
doxorubicin
cisplatin
advanced & recurrent dis.
adjuvant radiation -
cervical & extrauter. spread
Ovarian Cancer -
What is it
Risk Factors
2nd MC gyn malignancy
leading cause of U.S. gyn
ca deaths
MC - postmenopausal
OCPs - protective effect

risk factors -
fam h/o breast or ovarian ca
chronic uninterrupted ovulate-
nulliparity
delayed childbearing
infertility
late menopause

categorize by site of origin -
■ epithelial cell -
MC
serous cystadenoca
■ germ cell -
dysgerminoma
■ sex cord-stromal tumors
Ovarian Cancer -
Hx/PE
Hx -
Usu asymp until advanced -
abdom pain
bloating
pelvic pressure
urinary freq.
early satiety
constipation
vag bleeding
systemic Sxs

PE -
solid, fixed nodular
pelvic mass
ascites
pleural effusion
Ovarian Cancer -
Dx
Pelvic US
CT or MRI
surgical staging -
TAH-BSO
omentectomy
tumor debulking

monitor -
CA-125
aFP
LDH
hCG
Ovarian Cancer -
Tx
Radiation - dysgerminomas
postsurgical chemo -
carboplatin
paclitaxel
epithelial cell tumors
Ovarian Cancer -
Prevention
■ 2 first degree relatives -
annual screening
CA-125
transvag US
■ after childbearng -
prophylactic oophorectomy
■ OCPs may help dec. risk
Polycystic Ovarian Syndrome -
What is it
Oligomenorrhea
cause unknown
Sxs of -
androgen overproduction
inc. circulating androgens
excess LH
b/l polycystic ovaries
chronic anovulation
infertility
obese
hirsute
ages 15-30
association -
insulin resistance
DM
inc. risk of endometrial ca
Polycystic Ovarian Syndrome -
Hx/PE
Hx -
hirsutism
obesity
amenorrhea
infertility

May have -
virilization
acne
DM
HTN
acanthosis nigricans

PE -
enlarged cystic ovaries
Polycystic Ovarian Syndrome -
Dx
Serum LH/FSH ratio > 3
inc. serum androstenedione
inc. DHEA
US
Polycystic Ovarian Syndrome -
Tx
weight reduction
clomiphene citrate
metformin
OCPs
Spontaneous Abortion (SAB) -
What is it
Risk Factors
Nonelective termination
at < 20 wks. GA
common cause of 1st tri blding
most 1st tri - fetal factors
most 2nd tri - mat. factors

risk factors -
advanced mat. age
advanced pat. age
increased gravidity
prior SAB
minority status
Spontaneous Abortion (SAB) -
Hx/PE
Hx -
ask h/o:
abortions
infections
familial genetic abnorm

PE -
vaginal bleeding
passage of tissue
open or closed cervical os
Spontaneous Abortion (SAB) -
Dx
B-hCG
establish GA
transvag US - assess viability
CBC
blood type
Spontaneous Abortion (SAB) -
Tx
Ensure hemodynamically stable
give Rhogam (if appropriate)
uterine evacuation
Threatened Abortion -
Sxs
Minimal bleeding
possible abdom pain
no POC expelled

(POC=
products of contraception)
Threatened Abortion -
PE/US
Closed internal cervical os
normal US
Threatened Abortion -
Tx
Avoid heavy activity
pelvic and bed rest
Inevitable Abortion -
Sxs
Profuse bleeding
severe cramping
Inevitable Abortion -
PE/US
Open internal cervical os
Inevitable Abortion -
Tx
Emergent D&C
Incomplete Abortion -
Sxs
Some POC expelled
Incomplete Abortion -
PE/US
Open internal cervical os
retained fetal tissue on US
Incomplete Abortion -
Tx
Emergent D&C
Complete Abortion -
Sxs
Minimal bleeding
minimal cramping
all POC expelled
Complete Abortion -
PE/US
Closed internal cervical os
empty uterus on US
Missed Abortion -
Sxs
No uterine bleeding
no POC expelled
Missed Abortion -
PE/US
Closed internal cervical os
no fetal cardiac activity
retained fetal tissue on US
Missed Abortion -
Tx
Evacuate uterus
D&C
Septic abortion -
Sxs
Fever
chills
peritoneal signs
often recent h/o
therapeutic abortion
Septic abortion -
PE/US
Hypotension
hypothermia
oliguria
resp distress if in shock
inc. WBC
Septic abortion -
Tx
Evacuate uterus
D&C
IV ABx
Intrauterine fetal demise -
Sxs
Mom may report absence of
fetal movements
Intrauterine fetal demise -
PE/US
Uterus small for GA
no fetal heart tones
or movement on US
Intrauterine fetal demise -
Tx
Induce labor
evacuate uterus to avoid DIC
Urinary Incontinence -
Risk Factors
Older age
pelvic relaxation
obstructed labor
traumatic delivery
menopause
chronic cough
straining
ascites
large pelvic tumors
Urinary Incontinence -
Causes
DIAPPERS

Delirium
Infection (UTI)
Atrophic urethritis/vaginitis
Pharmaceutical
Psych causes
(esp. depression)
Excess urine output
(hyperglycemia,
hypercalcemia,
CHF)
Restricted mobility
Stool impaction
Urinary Incontinence -
Dx
UA and UC -
to exclude UTI
Serum Cr -
to exclude renal dysfunction
Cystogram -
fistulas
bladder neck abnorm
Stress Incontinence -
What is it
Sphincter insufficiency
laxity of pelvic floor muscles
common in multiparous women
or after pelvic surgery
Stress Incontinence -
Hx
Activities that
↑ intra-abdominal pressure -
coughing,
sneezing,
lifting
not common in supine position
Stress Incontinence -
Tx
Kegel exercises
surgery -
place bladder neck in
correct anatomical position
Urge Incontinence -
What is it
Detrusor hyperreflexia
or sphincter dysfunction
due to bladder -
inflammatory conditions
neurogenic disorders
Urge Incontinence -
Hx
Preceded by strong,
unexpected urge to void
unrelated to position
or activity
Urge Incontinence -
Tx
Anticholinergics
TCAs
Overflow Incontinence -
What is it
Dribbling of urine from
overly full bladder
Volume is usually small
Overflow Incontinence -
Hx
Chronic urinary retention
Overflow Incontinence -
Tx
Catheter - if acute
Tx underlying disease
timed voiding