Women's Health EOR Exam Topics Correct 100%

If pregnancy occurs, what happens to the corpus luteum? - ANSWER -blastocyte (maturing zygote) keeps corpus luteum functional (prevents sloughing by release of progesterone and estrogen) If egg is not fertilized - ANSWER Unfertilized egg: -follicle stops production of estrogen and progesterone Without estrogen and progesterone: -endometrium breaks down and menstrual flow occurs Abnormal Uterine Bleeding (AUB) - ANSWER Change in menstrual bleeding pattern Normal menstrual cycle - ANSWER -21-34 days 2 to 7 days -avg blood loss: 30ml-80mL (~2-3 TBSP) amenorrhea - ANSWER absence of menstruation Cryptomenorrhea - ANSWER light flow or spotting Menorrhagia (hypermenorrhea) - ANSWER profuse or prolonged bleeding during regular menstruation metrorrhagia - ANSWER bleeding between periods menometrorrhagia - ANSWER irregular, excessive bleeding between periods oligomenorrhea - ANSWER infrequent menstrual flow Polymenorrhagia - ANSWER abnormally frequent menstruation *21 days Causes of abnormal uterine bleeding - ANSWER -structural: fibroids, adenomyosis, endometrial polyp -nonstructural: coagulopathy, infection -ovulatory dysfunction: prolactinoma, PCOS, thyroid disorder, eating disorder, severe weight loss Etiologies of abnormal uterine bleeding - ANSWER -anovulation: without ovulation there is no progesterone leaving estrogen unopposed (endometrial overgrowth with irregular, unpredicted shedding) -ovulatory: prolonged progesterone secretion (increased blood loss from vessel dilation) Workup for abnormal uterine bleeding - ANSWER 1. hormone levels 2. transvaginal US 3. endometrial bx (if indicated) abnormal uterine bleeding tx - ANSWER threatened abortion - ANSWER -bleeding in the first 20 weeks' gestation -no products expelled -cervical os closed Inevitable abortion - ANSWER -bleeding or pain within 20 weeks gestation -+ cervical dilation -no passage of tissue incomplete abortion - ANSWER -Expulsion of the fetus with retained products of conception before 20 weeks' gestation -cervical os open complete abortion - ANSWER -passage of all products of conception before 20 weeks -cervical os closed missed abortion - ANSWER -products of conception are no longer viable but are retained in the uterus -cervical os closed septic abortion - ANSWER -infection of uterus during miscarriage -fevers and chills -MC S. aureus -cervical os open with purulent discharge risk factors for ectopic pregnancy - ANSWER -previous -tubal surgery -PID -smoking -advanced maternal age -abortion -infertility -IUD Follicular cyst - ANSWER -Most common ovarian mass -may occur cyclically -benign corpus luteum cyst - ANSWER -develops after ovulation has occurred -MC mass in pregnancy -benign dermoid cyst - ANSWER -cyst composed of displaced embryonic tissue (teeth, bone, cartilage, and hair) -typically found in an ovary -usually benign theca lutein cyst - ANSWER -bilateral -gonadotropin stimulation (ovarian enlargement) -associated with choriocarcinoma and moles Endometroid - ANSWER -endometriosis within ovary -chocolate cyst Trichomoniasis - ANSWER -infection caused by the Trichomonas vaginalis -flagellated, motile -malodorous -frothy, green discharge -pH5 Trichomoniasis treatment - ANSWER Metronidazole (Flagyl) lab findings in menopause - ANSWER -decreased estrogen -increased FSH HELLP syndrome - ANSWER -hemolysis -elevated liver enzymes -low platelets HELLP syndrome treatment - ANSWER -immediate delivery -magnesium sulfate for seizure control -control BP Gonococcal Treatment - ANSWER -Ceftriaxone 250 mg IM -Azithromycin 1 g PO OR doxycycline 100 mg BID x 7 days Tx for abnormal uterine bleeding - ANSWER -OCPs: regulates cycle, thins the endometrial lining and reduces menstrual flow -progesterone: only if estrogen is CI -GnRH agonist: Leuprolide causes temporary amenorrhea Tx for AUB if non-responsive to medical tx - ANSWER surgery: -hysterectomy: definitive -endometrial ablation dysmenorrhea - ANSWER painful menstrual flow primary dysmenorrhea - ANSWER painful menstruation associated with prostaglandin release in ovulatory cycles *not due to pelvic pathology; ~pain starts 1-2 years after onset of menarche secondary dysmenorrhea - ANSWER Painful menstruation related to pelvic pathology: endometriosis, adenomyosis, leiomyomas, adhesions, PID *increased incidence with age clinical manifestations of dysmenorrhea - ANSWER diffuse pelvic pain right before or with onset of menses -N&V -HA -colicky dull pain that radiates to lower back and legs Tx for dysmenorrhea - ANSWER 1. NSAIDs 2. Oral contraceptive pills 3. Laparoscopy: if meds fail premenstrual syndrome (PMS) - ANSWER physical, behavioral, and mood symptoms that develop just prior to onset of menstrual period *PMDD: severe PMS with functional impairment clinical manifestations of PMS - ANSWER -physical: bloating, breast tenderness, fatigue, muscle/joint pain -emotional: depression, irritability, libido changes -behavioral: food cravings, poor concentration, loss of motor senses Dx of PMS - ANSWER -sxs seen in luteal phase (7-14 days before menses) -no sxs in fillicular phase (week after period) Tx for PMS and PMDD - ANSWER aerobic exercise, stress reduction, reduction in alcohol, caffeine, sodium -NSAIDs, and vitamin supplements (B6, E, Mg, Ca) -SSRIs- for PMDD: fluoxetine, sertraline, citalopram -OCPs -GnRH primary amenorrhea definition - ANSWER -absence of menses by age 15 with secondary sexual characteristics OR -absence of menses without secondary sexual characteristics by age 13 primary amenorrhea causes - ANSWER -hypothalamic dysfunction: defect in gonadotropin production -gonadal dysgenesis: Turner syndrome (45XO), Mullerian agenesis (46XX), androgen insensitivity (46XY) -CNS lesion -anatomic malformation: transverse vaginal septum, imperforate hymen -puberty delay: athletes, anorexia secondary amenorrhea causes - ANSWER 1) pregnancy - MCC 2) hypothyroidism - TSH 3) prolactin - level 4) meds 5) HPO axis Secondary amenorrhea definition - ANSWER -absence of menses for 3 months (cycles) or 6 months (if irregular) that previously had period hypothalamus dysfunction in secondary amenorrhea - ANSWER disruption of GnRH secretion lowers levels of FSH and/or LH *anorexia, exercise, stress, nutritional deficiencies, systemic dz (Celiac) Workup for amenorrhea - ANSWER -pregnancy test -serum prolactin -FSH, LH -TSH tx for secondary amenorrhea caused by hypothalamic dysfunction - ANSWER stimulate gonadotropin secretion: Clomiphene, menotropin (Pergonal)