Term
| Describe the 4 types of Caldwell-Moloy pelvises (Gynecoid, Platypelloid, Android and Anthropoid). |
|
Definition
Gynecoid = Round.
Platypelloid = Oval-R/L.
Android = Wedge.
Anthropoid = Oval-AP. |
|
|
Term
| What are the functions of Skene's and Bartholin's glands? |
|
Definition
|
|
Term
| What is the area where the fallopian tubes enter the uterus called? |
|
Definition
|
|
Term
| What are the 4 areas that surround the uterine cervix? |
|
Definition
| Anteror, posterior and 2 lateral fornices. |
|
|
Term
| Where do you find the internal and external os? |
|
Definition
| Internal is the end of the cervix that is closest to the uterus. External is the end of the cervix that is closest to the vagina. |
|
|
Term
| Describe the 3 layers of the uterus. |
|
Definition
Serosal layer = outermost layer.
Myometrium = firm, thick, intermediate smooth muscle layer.
Endometrium = inner mucosal lining. |
|
|
Term
| What are the connections of the uterosacral ligament? |
|
Definition
| attach the uterus to the sacrum |
|
|
Term
| What are the connections of the round ligament? |
|
Definition
| Attaches the uterus to the labium majora |
|
|
Term
| What are the connections of the Broad ligament? |
|
Definition
| Connects the uterus to the walls of the pelvis, the pelvic floor and the ovary. |
|
|
Term
| What are the attachments and function of the Cardinal ligament? |
|
Definition
| It attaches the cervix to the lateral pelvic wall at the ischial spine and also contains the uterine artery and uterine vein. |
|
|
Term
| :the lower, narrow portion of the uterus where it joins with the top end of the vagina (fusion of mullerian ducts |
|
Definition
|
|
Term
| What is a nulliparous (round) and a parous (transverse slit) Cervical Os indicative of? |
|
Definition
Nulliparous = No Hx of childbirth.
Parous = Hx of birth or abortion. |
|
|
Term
| What is the purpose of the Fallopian tubes? |
|
Definition
| Egg transport and it is the site of fertilization. |
|
|
Term
| What is the most common site of fertilization? |
|
Definition
| The ampula of the Fallopian tubes. |
|
|
Term
| What is the purpose of the ovary? |
|
Definition
|
|
Term
| What is a corpus albicans? |
|
Definition
| It is a shriveled corpus luteum |
|
|
Term
| :development of the breasts |
|
Definition
|
|
Term
| :the first development of axilla and pubic hair |
|
Definition
|
|
Term
| :the first menstrual period |
|
Definition
|
|
Term
| :an increase of adrenal androgens |
|
Definition
|
|
Term
| What is the average length of a females menstrual cycle? Duration of menses? Blood loss? Iron loss? |
|
Definition
Length = 28 +/- 7 days.
Duration = 5 days +/- 2 days.
Flow = 60 +/- 20 ml per day and 35-150 ml total.
Iron loss = 13 mg total. |
|
|
Term
| What phase of the menstrual cycle is variable? |
|
Definition
| The follicular phase is variable so if there is menstrual cycle changes it is in the follicular phase. The luteal phase is a fixed 14 days. |
|
|
Term
| What days are the follicular phase, ovulation and the luteal phase in a 28 day cycle. |
|
Definition
| Follicular phase is days 1-14, Ovulation is day 14, Luteal phase is days 15-28. |
|
|
Term
| How does the hypothalamus secrete GnRH? |
|
Definition
| q 90 minutes in a pulsatile fashion. |
|
|
Term
| What is the function of FSH in the follicular phase? Describe the cycle of FSH throughout the menstrual cycle and the effects of other hormones. |
|
Definition
| It stimulates the follicles in the ovary to grow and produce estrogen. As estrogen increases it shuts off FSH and triggers LH release from the anterior pituitary. FSH is triggered again at the end of menses by the lack of estrogen. |
|
|
Term
| What makes sure that only 1 egg is released during ovulation? |
|
Definition
| FSH stimulates the follicle to grow, release the egg and produce estrogen, as estrogen increases it causes a negative feedback inhibition of FSH, thus releasing only 1 egg. |
|
|
Term
| Which hormone stimulates the follicle to produce androgens (testosterone and androsteindione), which can be later converted to estrogen? |
|
Definition
|
|
Term
| What is the fate of the corpus luteum if there is no pregnancy? |
|
Definition
| It turns into the corpus albicans (fibrous scar tissue). |
|
|
Term
| What phase of the menstrual cycle is constant in length? |
|
Definition
| The luteal phase (12-14 days). |
|
|
Term
| What is responsible for keeping progesterone levels high after the corpus luteum stop producing progesterone (if there is implantation)? How do high levels of progesterone inhibit the release of another follicle? |
|
Definition
hCG is produced by the placenta during pregnancy and is responsible for keeping the levels of progesterone high.
High progesterone levels inhibit FSH and therefore inhibit the growth and release of a new follicle. |
|
|
Term
| What are the proliferative and secretory phases of the menstrual cycle? Describe the changes in the endometrium during each phase and what hormone influences those changes. |
|
Definition
Proliferative phase is aka the non-menstruating days of the follicular phase (typically days 7-14) and the secretory phase is aka the luteal phase.
The proliferative phase is influenced by estrogen and causes a rapid increase in the endometrium thickness. The secretory phase is influenced by progesterone and it stabilizes the newly thickened endometrium with an increased blood supply. |
|
|
Term
| Describe the changes in the corpus luteum, progesterone, estrogen, prostaglandins and endometrium blood supply just prior to the onset of menstruation. |
|
Definition
| The corpus luteum degenerates into the corpus albicans, estrogen and progesterone levels fall rapidly, prostaglandin levels increase (causing headache, cramping and nausea) and the endometrium loses its blood supply leading to sloughing (menses). |
|
|
Term
| How do high levels of prolactin affect ovulation? |
|
Definition
| High levels of prolactin cause anovulation because it inhibits FSH and LH so the follicles do not mature and they are not released. |
|
|
Term
| :Abnormal production of breast milk (not from pregnancy or breast feeding) due to overproduction of prolactin |
|
Definition
|
|
Term
| What is the average length of perimenopause? What is the range and when is it officially over and considered menopause? |
|
Definition
| The average length is 4 years but the range is a few months to 10 years. It is officially over when a women has gone 12 months without menstruation. |
|
|
Term
| What tests should be ordered in patients that have inter-menstrual or postmenopausal bleeding? |
|
Definition
| Endometrial biopsy and D&C (Dilation and curettage) - Dilation and curettage (D&C) is a procedure in which the cervix of the uterus is expanded (dilated) so that the uterine lining (endometrium) can be removed with a spoon-shaped instrument called a curet or curette. The procedure is performed for a variety of reasons. Most commonly, this surgery is done in order to help determine the cause of abnormal uterine bleeding. It can also be done to help determine the degree of abnormality of the endometrium in cases of cancer or pre-cancerous cells that are detected by an in-office biopsy. |
|
|
Term
| What are the beneficial effects of Estrogen replacement therapy in menopausal women? When would you not want to give them ERT? What are the beneficial effects of progesterone replacement therapy in menopausal women? |
|
Definition
ERT is used as a prophylaxis against osteoporosis and colorectal cancer but a contraindication is breast cancer.
Progesterone replacement is protective against endometrial cancer if they have not have their uterus removed. |
|
|
Term
| What can menopausal women take in place of estrogen if they cannot take estrogen? |
|
Definition
| Medroxyprogesterone (Provera) - Progesterone |
|
|
Term
| What is the definition of primary amenorrhea? Secondary? Most common cause of secondary amenorrhea? |
|
Definition
Primary = No menstruation by age 16.
Secondary = Prior menstruation but have had 6 months of amenorrhea. MCC of secondary amenorrhea is pregnancy. |
|
|
Term
| What are some common causes of secondary amenorrhea other than pregnancy? Describe why these conditions cause amenorrhea. |
|
Definition
Polycystic ovarian syndrome (it causes relatively high and sustained levels of estrogen and androgen, a male hormone, due to an increased pulsatile rate of GnRH secretion which favors LH so less FSH is produced, leading to anovulation and a lack of menstruation. Estrogen is still high despite a lack of FSH bc DHEA is converted to estrogen).
Pituitary tumors that cause an overproduction of prolactin can lead to amenorrhea bc prolactin inhibits FSH, LH and GnRH so the follicles do not mature and they are not released (amenorrhea).
*Or anything else that can inhibit the production of FSH/LH. |
|
|
Term
| When should a workup for amenorrhea be initiated? |
|
Definition
| No period by age 14 if they lack signs of puberty, lack of menses by age 16 regardless and a lack of menses for 6 months in previously menstruating women. |
|
|
Term
| What is Ullrich-Turner syndrome? Typical S&S? Complications? |
|
Definition
Monosomy X.
S&S = short stature, lack of secondary sex characteristics, infertility and amenorrhea.
Complications = heart disease, hypothyroidism, ophthalmic problems, otologic problems, and cognitive problems. |
|
|
Term
| What is the typical work-up for amenorrhea? Interpretation of the results? |
|
Definition
| Pregnancy test, TSH (rule out hypothyroidism), prolactin levels (rule out hyperprolactinemia), FSH/LH levels and a Progesterone Challenge test (PCT) to check for bleeding (bleeding implies that the ovaries are working and producing estrogen). |
|
|
Term
| What is the interpretation and next step to a progesterone challenge test that has no bleeding with progesterone supplementation? What is the interpretation of this test if there is bleeding? No bleeding? |
|
Definition
It means that the ovary is not producing estrogen. Give estrogen for 21 days and then repeat the PCT.
If this test has bleeding then that means that there is hypogonadism. If there is still not bleeding then there is an anatomical problem with the uterus. |
|
|
Term
| What may high FSH and low LH levels be indicative of? What about high FSH and high LH levels? Low levels of FSH and LH? Low FSH and high LH? |
|
Definition
High FSH and low LH levels may be indicative of a pituitary tumor.
High FSH and high LH may signify primary ovarian failure.
Low FSH and LH levels may be indicative of secondary ovarian failure due to pituitary or hypothalamic dysfunction.
Low FSH and high LH = PCOS. |
|
|
Term
| What are the differences between abnormal uterine bleeding (AUB) and dysfunctional uterine bleeding (DUB) and the common causes of each? |
|
Definition
| Both involve variations in the menstrual cycle (frequency, duration, amount of flow or spotting) but DUB is typically hormonally mediated (MCCs = ovarian failure, or hypothalamic/pituitary dysfunction) and AUB has various causes (pregnancy, infection, malignancy, medications, etc). |
|
|
Term
| :Prolonged (>7 d) or excessive (>80 mL daily) uterine bleeding occurring at regular intervals |
|
Definition
|
|
Term
| :Uterine bleeding occurring at irregular and more frequent than normal intervals |
|
Definition
|
|
Term
| :Prolonged or excessive uterine bleeding occurring at irregular and more frequent than normal intervals |
|
Definition
|
|
Term
| :Uterine bleeding of variable amounts occurring between regular menstrual periods |
|
Definition
| Intermenstrual bleeding (spotting) |
|
|
Term
| :light flow at regular cycles |
|
Definition
|
|
Term
| :Uterine bleeding occurring at regular intervals of less than 21 days |
|
Definition
|
|
Term
| :Uterine bleeding occurring at intervals of 35 days to 6 months |
|
Definition
|
|
Term
| What are some common causes of Oligomenorrhea? |
|
Definition
| Low weight, PCOS, stress, hypothyroidism, hyperprolactinemia and perimenopause. |
|
|
Term
| What are some treatment options for menorrhagia? |
|
Definition
| Oral contraceptives bc they can help regulate menstrual cycles or oral progesterone bc it can help correct hormonal imbalances and reduce menorrhagia. (These are supraphysiologic levels that can be given as extended which will reduce the days and help regulate menses or continuous which will lead to a lack of menses). |
|
|
Term
| What must be ruled out in a women older than 30 with intermenstrual bleeding (spotting)? What procedures can be used to rule this out? |
|
Definition
Cancer or hyperplasia of the uterus.
Can be ruled out using EMB (endometrial biopsy) of 3 locations, D&C (Dilation and curettage) or H-scope (hysteroscopy). |
|
|
Term
| What relations between estrogen and progesterone can lead to menorrhagia? |
|
Definition
| Too much estrogen or too little estrogen in relation to progesterone can lead to menorrhagia. |
|
|
Term
| :characterized by severe uterine pain/cramps during menstruation characterized by pain that is so severe it limits normal activities, or requires medication such as NSAIDS. |
|
Definition
|
|
Term
| What are the causes of primary and secondary dysmenorrhea? |
|
Definition
Primary = prostaglandin mediated.
Secondary = disease/structural abnormality within or outside the uterus. |
|
|
Term
| What can be used to treat primary Dysmenorrhea? Secondary? |
|
Definition
Primary = NSAIDs, oral contraceptives, vitamin B1 and fish oil. Can also use diet and exercise.
(Oral contraceptives are given at supraphysiologic levels that can be given as extended which will reduce the days and help regulate menses or continuous which will lead to a lack of menses).
Secondary = treat underlying cause. |
|
|
Term
| Describe what causes an anovulatory cycle and how it can lead to DUB. |
|
Definition
| Anovulatory cycle occurs when the ovum is not released so the corpus luteum does not form and does not produce progesterone. This leads to unopposed estrogen stimulation causing overgrowth of the endometrium which eventually outgrows its blood supply leading to necrosis. The end result is overproduction of uterine blood flow (DUB). |
|
|
Term
| :ectopic tissue similar to the lining of the uterus is found elsewhere in the body (commonly the ovaries, fallopian tubes and the pelvic sidewall) characterized most commonly by pelvic pain that is heightened during menstruation. |
|
Definition
|
|
Term
| What are some ways to diagnose and treat endometriosis? |
|
Definition
Can diagnose with laparoscopy (and treat while in there with laser vaporization) and also treat with GnRH agonists (Lupron) bc it negative feedback inhibits the production of LH/FSH, Danazol (a synthetic androgen, inhibits ovulation), continuous oral contraceptives (lead to a lack of menses and shrinks endometrial tissue) and pregnancy. Surgical removal of endometriosis is reserved for severe cases.
* Best oral contraceptives for endometriosis are continuous because in women with endometriosis that get pregnancy they are sometimes spontaneously cured simply due to 9 months without menses, continuous oral contraceptives for an extended period of time can cure endometriosis much in the same way. |
|
|
Term
| How can the GnRH agonist (Lupron) bc used to treat endometriosis? |
|
Definition
| It acts as a negative feedback inhibitor of FSH/LH production so the women do not menstruate (which is when they get most of the symptoms). |
|
|
Term
| Does endometriosis typically regress or get worse with menopause? |
|
Definition
|
|
Term
| Describe the DSM criteria for PMS diagnosis. |
|
Definition
| 5 or more dysmenorrhea symptoms of mood, somatic, cognitive or behavioral changes that are not due to other conditions and start up to 14 days before menses and are relieved within 4 days of the start of menses. |
|
|
Term
| What is the most common etiology of cycle dysfunction? |
|
Definition
| Almost always hormonal (GnRH, FSH/LH, Estrogen or Progesterone) |
|
|
Term
| Is DUB or AUB most commonly associated with anovulation? |
|
Definition
| Usually DUB because it is more hormonally mediated. |
|
|
Term
| What are the most common causes of DUB during adolescence? Reproductive years? Perimenopausal years? |
|
Definition
Adolescence = hypothalamic immaturity.
Reproductive = PCOS.
Perimenopausal = ovarian failure. |
|
|
Term
| How is DUB usually diagnosed? |
|
Definition
| It is usually a diagnosis of exclusion after all organic causes have been ruled out. |
|
|
Term
| What information is gained when evaluating a patient with DUB by knowing whether they are ovulatory or anovulatory? |
|
Definition
Ovulatory means that they hypothalamic pituitary axis is working.
Anovulatory means that it could be a problem in the hypothalamus, pituitary or ovary. |
|
|
Term
| What considerations must be taken before drawing FSH/LH levels? |
|
Definition
| you must know where they are in their cycle |
|
|
Term
| What imaging technique can give the size and shape of the uterus and is good for detecting the endometrial thickness and fibroids? |
|
Definition
|
|
Term
| How does high dose conjugated estrogen control acute bleeding episodes? |
|
Definition
| It induces endometrial growth but it does not treat the underlying cause. |
|
|
Term
| What is the most common cause of infertility in women in the US? |
|
Definition
|
|
Term
| What are the S&S of PCOS? Risk factors? |
|
Definition
S&S = Oligomenorrhea, increased facial hair, acne and acanthosis nigricans.
RF = overweight, DM, high trigs, low HDL and high BP. |
|
|
Term
| What is the classic triad of PCOS? |
|
Definition
| abnormal anovulatory cycles, hyperandrogenism and bilateral polycystic ovaries. |
|
|
Term
| Describe the etiology of the increased androgens and normal level of estrogens seen with PCOS even though FSH levels are low. |
|
Definition
| As a general rule, increase GnRH pulse frequency favors LH, decreased pulse frequency favors FSH. Therefore in PCOS, the pulse frequency of GnRH is accelerated, causing high LH to make more androgens and you would think less estrogen but the androgen (DHEA) is a precursor to estrogen and when the androgens start to backup due to overproduction, DHEA is converted to estrogen. |
|
|
Term
| Which hormone is stimulated by LH? FSH? Explain why the hormones produced from LH/FSH/corpus luteum will not work the same if they are given in supraphysiologic (oral contraceptive) levels. |
|
Definition
LH stimulates the theca cells of the ovaries to produce androgens (testosterone).
FSH stimulates the granulosa cells to produce estrogen.
Estrogen AND FSH are responsible for endometrial growth (estrogen and FSH must be present for endometrial growth bc FSH primes the uterus for estrogen).
When oral contraceptives are given the high levels of estrogen and progesterone trick the body into thinking it is pregnant so FSH/LH is chronically negative feedback inhibited due to the high levels of estrogen/progesterone. |
|
|
Term
| Describe the role of insulin in the increased testosterone seen with PCOS. |
|
Definition
| It works synergistically with LH to produce testosterone at the theca cells of the ovaries and it increases the amount of biologically active testosterone by inhibiting hepatic synthesis of androgen-binding globulin. |
|
|
Term
| What leads to the elevated insulin levels seen with PCOS? What actually causes the cysts seen with PCOS? |
|
Definition
Insulin resistance will increase the levels of insulin, common with PCOS due to type II diabetic risk factor.
The cysts are due to the follicles that do not completely mature or rupture so they continue to grow. |
|
|
Term
| What are some ovulatory/menstrual disorders seen with PCOS? What will be the result of the progesterone challenge test? |
|
Definition
Chornic anovulation, oligmenorrhea and DUB.
PCT will have bleeding after 5 days of progesterone administration and will also have withdrawal bleeding because estrogen present due to DHEA conversion and some FSH. |
|
|
Term
| What tests are the most cost effective for evaluation of PCOS? What will be the result of these tests? |
|
Definition
FSH/LH and androstenedione levels.
LH will be 2-3x higher than FSH and androstenedione will be elevated. |
|
|
Term
| What are some potential concerns of a patient with PCOS? Describe the levels of FSH, LH, Estrogen, Androgens and Progesterone with explanations. |
|
Definition
Concerns = Infertility and an increased risk of endometrial cancer.
FSH is decreased in comparison to LH due to the increased pulsatile rate of GnRH which favors LH, leading to increased levels of LH. Androgens are increased due to the increase in LH (which stimulates the production of androgens via the theca cells) but estrogen is normal despite a low FSH (which normally stimulates estrogen production via the granulosa cells) due to the conversion of the androgen (DHEA) to estrogen. Progesterone will be low though bc a lack of FSH leads to anovulation so there is no corpus luteum to secrete progesterone. |
|
|
Term
| What are the treatments for PCOS if fertility is not desired? |
|
Definition
| Progesterone cycling (to prevent endometrial hyperplasia due to no progesterone production due to no corpus luteum), oral contraceptives (treat menstrual irregularities and acne/hirsutism), spirinolactone (diuretic that also competes for androgen receptors) and flutamide (anti-androgen drug). |
|
|
Term
| What can be done to treat PCOS in women that want to have children? |
|
Definition
| Clomid (clomiphene citrate) (which binds to estrogen receptors and acts as estrogen but also has antiestrogen effects at the negative feedback receptors for estrogen, inhibiting the negative feedback of estrogen on the anterior pituitary and thus increasing the levels of FSH), gonadotropin regulation (slow it down so FSH production is favored or is at least equal and the follicle can be stimulated to mature and be released), Ovarian diathermy (laser is used to destroy parts of the uterus and can trigger ovulation), in Vitro fertilization or insulin sensitizers (metformin, Actos and Avandia). |
|
|
Term
| What phase of the menstrual cycle is typically symptom free for PMS? |
|
Definition
|
|
Term
| What are the treatment options for PMS? Which is the most effective? |
|
Definition
Treatment options = diet, exercise, anti-prostaglandins (NSAIDs), and SSRIs.
SSRIs are the most effective. |
|
|
Term
| What is the pathophysiology behind menopause? How does this relate to laboratory diagnosis? |
|
Definition
| The ovaries have a decreased response to FSH and LH and therefore do not ovulate and make less estrogen. This is seen on labs as an increased FSH and decreased estrogen levels. |
|
|
Term
| What is surgical menopause? What needs to be done for these patients? |
|
Definition
| It is surgical removal of both ovaries which leads to more severe symptoms. HRT is indicated STAT unless it is contraindicated. |
|
|
Term
| What is the most common etiology of premature menopause? |
|
Definition
| Chemotherapy/radiation damage to the ovaries. |
|
|
Term
| What is the average age of onset for perimenopause? Menopause? Average duration of perimenopause? |
|
Definition
Perimenopause = 46 years old.
Menopause = 51 years old.
Duration of perimenopause = 5 years. |
|
|
Term
| What are the typical S&S of perimenopause and menopause? |
|
Definition
| Hot flashes, difficulty sleeping, irregular bleeding, vaginal atrophy/dryness, mood changes, and exacerbation of psychiatric illness. |
|
|
Term
| What conditions of menopausal/perimenopausal women is often confused with a yeast infection? |
|
Definition
|
|
Term
| What are some possible ways to treat the vaginal atrophy/dryness seen with menopausal women? |
|
Definition
| Vaginal lubricants, estrogen replacement and sexual activity (sexually active women have less vaginal atrophy). |
|
|
Term
What are some common sequelae of menopause?
What is the number one cause of death for menopausal women? |
|
Definition
Osteoporosis, lipid changes (increased cholesterol/LDL and decreased HDL), and atherosclerotic diseases.
Number one cause of death is CAD. |
|
|
Term
| In what situation would you give estrogen only HRT or combined HRT to a menopausal women that wanted HRT? |
|
Definition
Estrogen only - is given ONLY if the women does not have a uterus.
Combined is given if the women has a uterus as unopposed estrogen can cause endometrial cancer but when given with progesterone it will not. |
|
|
Term
| What is the HRT of choice in menopausal women with a uterus? Without a uterus? |
|
Definition
With uterus = Estrogen + Progesterone (protects against endometrial cancer in addition to osteoporosis).
Without uterus = Estrogen alone (protects against just osteoporosis). |
|
|
Term
| What should be involved in the patient education of a menopausal women beginning continuous Estrogen/Progesterone replacement therapy? What are some examples of continuous Estrogen/Progesterone replacement drugs? |
|
Definition
They may have some initial bleeding but will eventually lead to no bleeding.
Examples = Prempro, Activella, Femhrt, Prefest and Combipatch. |
|
|
Term
| Describe the dosing regimen for combined cyclic hormone replacement therapy. What kind of patients is this therapy useful for? Why? |
|
Definition
Estrogen is given daily and progesterone is given 12-14 days per month.
This therapy is useful for perimenopausal women because it will regulate their bleeding patterns. |
|
|
Term
| What are some examples of combined cyclic HR drugs? |
|
Definition
| Daily estrogen (Premarin or Cenestin) and 12-14 days of progesterone (Provera or Prometrium). |
|
|
Term
| What drug would you give a peri-menopausal women that is still menstruating that may need contraception? |
|
Definition
|
|
Term
| What is the advantage to adding progesterone to HRT? |
|
Definition
| It protects the endometrium from endometrial cancer. |
|
|
Term
| What are the contraindications to HRT of estrogen or estrogen/progesterone? |
|
Definition
Contraindications =
Estrogen-dependent cancer.
Unexplained uterine bleeding.
Active liver disease.
History of DVT/PE.
Confirmed CVD.
Smoking. |
|
|
Term
| What 3 outcomes were found to be linked to ERT and estrogen/progesterone RT in the Women's Health Initiative study? |
|
Definition
| Coronary heart disease, breast cancer and strokes. |
|
|
Term
| :non-hormonal therapy for menopausal women that has anti-oxidant properties (against certain types of breast and prostate cancer. |
|
Definition
| Isoflavones (found in soy products and red clover). |
|
|
Term
| :non-hormonal therapy for menopausal women that contains high levels of omega 3 fatty acids, especially alpha-linoleic acid, which has been suggested to be beneficial for reducing inflammation leading to atherosclerosis, preventing heart disease and arrhythmia and is required for normal infant development. |
|
Definition
|
|
Term
| What are some common drugs that are known to disrupt sexual function in females? |
|
Definition
| Alcohol, SSRIs, antihypertensives (BBs, diuretics, etc), and steroids. |
|
|
Term
| What are the top 4 contraceptives methods used today? |
|
Definition
1. Female sterilization.
2. Oral contraceptive pills.
3. Male condoms.
4. Male sterilization. |
|
|
Term
| What is the fertility awareness method of contraception? |
|
Definition
| Avoidance of intercourse during the "fertile time" - typically days 8-19 of the menstrual cycle. |
|
|
Term
| Describe the MOA of a diaphragm. |
|
Definition
| It is a soft latex/rubber cup that covers the cervix and has spermicide placed into the inside of the diaphragm. |
|
|
Term
| What are some disadvantages of using a diaphragm as a method of contraception? |
|
Definition
| Must be fitted, increased risk of UTIs, must be left in place for at least 6 hours after intercourse and must insert more spermicide prior to subsequent sex. |
|
|
Term
| When must a patient replace their diaphragm? |
|
Definition
| Every 2 years, 20 lb weight change or after each pregnancy. |
|
|
Term
| Describe the efficacy of Cervical Caps vs Diaphragms in the use of contraception in nulliparous vs parous women. |
|
Definition
| They are about equal in nulliparous women but the Cervical caps are much less effective in parous women. |
|
|
Term
| What is the MOA for an IUD in contraception? |
|
Definition
| It is a small device inserted into the uterine cavity that prevents pregnancy by preventing fertilization, and interfering with implantation. |
|
|
Term
| Describe the length of efficacy for the 3 IUDs being used in the US (Paraguard, Mirena and Progestasert). |
|
Definition
Paraguard = 10 years.
Mirena = 5 years.
Progestasert = 1 year. |
|
|
Term
| What are some of the disadvantages to IUD use? |
|
Definition
| Risk of perforation, increase in the number of bleeding days and increased risk of PID during the first 20 days after insertion. |
|
|
Term
| What are some contraindications to IUD use? |
|
Definition
| Pregnancy, uterine fibroids/cancer, GU infection or current STD. |
|
|
Term
| Describe the length of hormone vs placebo use in traditional, continuous and extended use oral contraceptives. |
|
Definition
Traditional = 21 days of hormones and 7 days of placebo.
Continuous = 28 days of hormone and no days of placebo.
Extended = 24 days of hormone and 4 days of placebo. |
|
|
Term
| Describe the MOA for combined oral contraceptives. |
|
Definition
| It contains both estrogen and progesterone which suppresses ovulation by negative feedback inhibition of FSH/LH and thickens the cervical mucous so sperm have a harder time traveling through it. |
|
|
Term
| What are the contraindications to combined oral contraceptive use? |
|
Definition
| Smokers, HTN, DM, migraines and vascular disease (such as SLE). |
|
|
Term
| What are the contraindications to progesterone only contraceptive use? |
|
Definition
| Pregnancy, unexplained vaginal bleeding, atherosclerotic diseases, estrogen dependent cancers or liver tumors (metabolized there). |
|
|
Term
| What does ACHES of early warning signs of combined oral contraceptives stand for? |
|
Definition
Abdominal pain
Chest pain
Headache
Eye problems
Severe leg pain |
|
|
Term
| Describe the patient education for a patient taking combined oral contraceptives that is less than 24 hours late in taking a pill. More than 24 hours late? |
|
Definition
Less than 24 hours they should take the pill ASAP and take their next pill at the usual time and are still protected.
More than 24 hours late they should take the missed pill and the pill that is due at that time together and they are not protected for 7 days so use other methods of contraception. |
|
|
Term
| Describe the MOA for progestin only pills (Minipill) as a contraceptive agent. |
|
Definition
| It inhibits ovulation by negative feedback inhibition of FSH and it thickens/decreases the amount of cervical mucous making it difficult for sperm to travel. It also thins the endometrium for possible inplantation. |
|
|
Term
| What is the major advantage for the progesterone only pill (Minipill) for contraception? Disadvantages? |
|
Definition
Advantage = It can be taken by those that cannot take estrogen (due to DVT, heart disease or breast feeding mothers but progesterone still can not be given with estrogen dependent tumors).
Disadvantage = More break through bleeding and less effective than combination pills. |
|
|
Term
| What are the advantages to the Depo-Provera injection (progesterone only) method of contraception? Disadvantages? |
|
Definition
Advantages = works within 24 hours, works for 12 weeks and it can be taken in those that cannot take estrogen.
Disadvantages = Lots of side effects (weight gain, headaches, depression and bone loss). |
|
|
Term
| Should DepoProvera be used as a long term birth control method? |
|
Definition
| No, because it is associated with a significant loss of bone mineral density. It should only be used if other methods are inadequate. |
|
|
Term
| What is the major concern of oral contraceptive pills that are progesterone dominant? |
|
Definition
| Bone mineral density loss. |
|
|
Term
| What are the advantages of extended/continuous use contraception? |
|
Definition
| They are useful in women with menorrhagia and dysmenorrhea. |
|
|
Term
| What is significant about the oral contraceptive pill: Lybrel? |
|
Definition
| It is the first and only pill that is used for 365 days straight without any placebo, women will not have a period for an entire year. |
|
|
Term
| What is the MOA of the contraceptive: ORTHO EVRA? What are the common adverse effects of using this over a traditional oral contraceptive? |
|
Definition
It is a weekly patch that has a 21 day regimen and then 7 days of placebo/no patch.
AEs = It has significantly more breast discomfort and dysmenorrhea. |
|
|
Term
| What is the only form of birth control that can be used during lactation? |
|
Definition
| Progesterone only forms of birth control. |
|
|
Term
| What is the MOA of Contraceptive Implants (Implanon)? Advantages? |
|
Definition
MOA: It contains progesterone only and it is a rod that is inserted under the skin into the inner, upper arm.
Advantages = it contains only progesterone so it can be used during lactation and in those that cannot have estrogen, it is effective for up to 3 years and it can be readily removed if pregnancy is desired sooner. |
|
|
Term
| What are some non-contraceptive benefits of combination oral contraceptives? |
|
Definition
| Decreased incidence of endometrial and ovarian cancer, ectopic pregnancy, PID, iron deficiency anemia, benign breast disorders, acne and bone density loss. |
|
|
Term
| What are the only 2 antibiotics that are proven to decrease oral contraceptive efficacy? |
|
Definition
| Rifampin and Griseofulvin. |
|
|
Term
| What is the MOA for the emergency contraception pills (Plan B, Preven and Paraguard)? Rank the order of efficacy. |
|
Definition
Plan B = high dose progesterone only pill.
Preven = combined estrogen/progesterone.
Paraguard = IUD insertion (only IUD that can be used for emergency contraception).
Paraguard is most effective and Plan B is more effective then Preven. |
|
|
Term
| How long have emergency contraceptive pills been shown to be effective after unprotected sex? |
|
Definition
| Up to 5 days but they are most effective the earlier they are taken. |
|
|
Term
| What is the normal pH of the vagina? |
|
Definition
|
|
Term
| What is the most common type of vaginal infection that occurs after antibiotic use? |
|
Definition
|
|
Term
| What are the 4 most common causes of vaginitis, in order of prevalence? |
|
Definition
| Gardnerella (bacterial), candidiasis, trichomoniasis and PID. |
|
|
Term
| What is the role of Acidophilus lactobacilli in the vagina? |
|
Definition
| It is the predominant organism of the normal vaginal flora and its produces lactic acid which is responsible for the acidic pH of the vagina and inhibition of Gardnerella, Candida and anaerobic bacteria. |
|
|
Term
| Describe the procedure for a wet mount preparation. What additional step lead leads to diagnosis of bacterial vaginitis (Gardnerella)? |
|
Definition
Take a sample from the lateral vaginal wall, place it in normal saline and then visualize it under low and high power objective lens.
Bacterial vaginitis (Gardnerella) can be detected by adding 10% KOH and doing the "whiff test" which will smell fishy. |
|
|
Term
| What are the typical bacteria responsible for bacterial vaginosis? |
|
Definition
| Gardnerella Vaginalis in combination with anaerobic bacteria. |
|
|
Term
| Describe the discharge seen with bacterial vaginosis. What about candida? Trichomoniasis? |
|
Definition
Bacterial = Thin milky grayish appearing, often pools at introitus, adheres to vaginal walls (spilled milk).
Candida = looks like cottage cheese.
Trichomoniasis = copious, thin, bubbly and pale green/gray. |
|
|
Term
| What is the hallmark of bacterial vaginosis on wet prep smear? |
|
Definition
| "Clue cells" - large squamous epithelial cells with numerous bacilli clinging to the cell surface and few WBCs noted. |
|
|
Term
| What is the best treatment for bacterial vaginosis? What about if they are pregnant? |
|
Definition
| Flagyl (metronidazole) x 7 days regardless of pregnancy. |
|
|
Term
| What is the most common presentation of an individual with bacterial vaginosis? |
|
Definition
| They are usually asymptomatic |
|
|
Term
| What are the characteristic symptoms of candida vulvovaginitis that separates it from other forms of vaginitis? |
|
Definition
| The burning and redness associated with candida. |
|
|
Term
| Describe the pH of the vagina in bacterial vaginitis, candida vaginitis, trichomoniasis and atrophic vaginitis. |
|
Definition
Bacterial will have a pH of 5-6.
Candida will have a pH that is 4-6.
Trichomoniasis will have a pH that is 5-7.
Atrophic will have a pH that is 6-7. |
|
|
Term
| How will candida vulvovaginitis appear on KOH wet prep smear? |
|
Definition
| It will show pseudohyphae. |
|
|
Term
| What are the topical and oral treatment options for candida vulvovaginitis? |
|
Definition
Topical = (the -azoles: Clotrimazole, Miconazole, Butaconazole or Terconazole).
Oral = Diflucan (fluconazole). |
|
|
Term
| What is the treatment for candida vulvovaginitis in a pregnant women? |
|
Definition
|
|
Term
| Describe how the vaginal mucosa and cervix may look with trichomoniasis. |
|
Definition
| There may be petechiae or strawberry patches on the vaginal mucosa and cervix. |
|
|
Term
| How is trichomoniasis diagnosed on wet mount smear? What other diagnostic tests can be used? |
|
Definition
There is a pear shaped organism with a tail that is found swimming around and there are lots of WBCs present.
Can also use pap smear and a trichonomiasis rapid antigen test. |
|
|
Term
| What is the recommended treatment for trichomoniasis? |
|
Definition
| Flagyl (metronidazole) or Tinidazole (newer w/ less GI SEs) 2g PO as a single dose. |
|
|
Term
| What is the treatment for trichomoiasis during pregnancy? |
|
Definition
| Flagyl (metronidazole) 2g as a single dose but only after the first trimester. |
|
|
Term
| What is the major risk for a pregnancy women taking Flagyl (metronidazole)? What considerations should be taken? |
|
Definition
| Fetal low birth weight, should wait until after the first trimester because the first trimester is development and the 2-3rd are growth. |
|
|
Term
| What percentage of women and men are asymptomatic with trichomoniasis? |
|
Definition
| 50% of women & 80% of men are asymptomatic |
|
|
Term
| What is atrophic vaginitis? How will this be seen on wet mount? What is the treatment? |
|
Definition
Genital atrophy due to lack of estrogen.
Wet mount will show parabasal cells, RBCs and WBCs.
Tx = topical estrogen or systemic if indicated. |
|
|
Term
| :acute salpingitis/peritonitis, bilateral lower abdominal/pelvic pain, vaginal discharge, fever, leukocytosis, inflammatory mass, gram negative diplocicci, nausea, vomiting, headache and general lassitude. |
|
Definition
|
|
Term
| How is PID diagnosed? Most common organism? What PE sign is indicative of PID? |
|
Definition
Diagnosed by Culdocentesis (a procedure that checks for abnormal fluid in the space just behind the vagina).
MC organism is Neisseria Gonorrhea.
PE will show Chandeliers sign (touch the cervix and they jump in pain towards to ceiling). |
|
|
Term
| What is the treatment for mild-moderate PID? Severe PID? |
|
Definition
Mild-moderate = Outpatient: doxycycline (covers chlamydia) and IM Cefoxitin (cephalosporin to cover gonorrhea).
Severe = Hospitalization: IV and PO doxycycline(chlamydia coverage) and IV cefoxitin (cephalosporin for gonorrhea coverage). |
|
|
Term
| What conditions mimics vulvovaginitis in that it has burning, erythema, blisters and discharge? |
|
Definition
| Contact Dermatitis (irritant or allergen exposure). |
|
|
Term
| What is the treatment for contact dermatitis of the vulvovaginal region? |
|
Definition
| 1% hydrocortisone topical cream |
|
|
Term
| What will vaginitis never cause, so if patients present with these symptoms, you should look for something else? |
|
Definition
| Vulvovaginitis never causes pelvic pain! Rarely causes bleeding. Look for something else! |
|
|
Term
| What type of biopsy is best for obtaining full-thickness skin specimens? |
|
Definition
|
|
Term
| :Dryness, scales and erythema are notable. Mimics many forms of vaginitis. Key history- chronic condition for months to years. |
|
Definition
|
|
Term
| :a chronic inflammatory dermatosis that results in white plaques with epidermal atrophy of the genitals and may progress to gradual obliteration of the labia minora and stenosis of the introitus and large, occasionally hemorrhagic blisters |
|
Definition
|
|
Term
| What is the treatment for Lichen Sclerosis et Atrophicus? When should they follow up? |
|
Definition
Topical steroids BID x1 month, QD x 1 month then PRN.
Follow up in 3 months. |
|
|
Term
| What are Bartholin's Cysts? |
|
Definition
| They are cysts of Bartholin's glands, normally responsible for lubrication of the vagina. |
|
|
Term
| What is the best screening test for cervical cancer? |
|
Definition
| Pap Smear - it allows for early detection. |
|
|
Term
| What are the recommendations for when to get a Pap Smear? |
|
Definition
| By age 21 or after you are sexually active. Repeat annually for 3 years and if normal, drop back to q 1-3 years. |
|
|
Term
| Where do 95% if cervical cancers occur? |
|
Definition
| The transition zone (squamocolumnar junction), right at the tip of the external os. |
|
|
Term
| What are the risk factors for cervical dysplasia? |
|
Definition
| HPV, multiple sexual partners, early sexual activity, early childbearing, DES exposure, oral contraceptives and cigarette smoking. |
|
|
Term
| Describe Class I-V Pap Smear results. |
|
Definition
I = normal.
II = cervical inflammation.
III = mild-moderate dysplasia.
IV = severe dysplasia or carcinoma in situ (CIS).
V = cancer or carcinoma in situ (CIS). |
|
|
Term
| Describe the CIN (Cervical intraepithelial neoplasia) classification of Pap Smear results (I-III and over III). |
|
Definition
I = mild dysplasia.
II = moderate dysplasia.
III = severe dysplasia or carcinoma in situ (CIS).
Anything over CIN III is suggestive of cancer. |
|
|
Term
| At what CIN or Class of Pap Smear result would you do a colposcopy(procedure to examine an illuminated, magnified view of the cervix)? |
|
Definition
|
|
Term
| What is the most common Sx of cervical dysplasia? |
|
Definition
|
|
Term
| What are the follow up procedures for an "abnormal" pap smear that could be due to an underlying infection? |
|
Definition
| Treat any underlying infection to make sure that is not the cause, repeat Pap in 3 months, then again in 6 months and annual colposcopies for 2 years. |
|
|
Term
| Describe the procedure of a Colposcopy. How is dysplasia seen? How may this be considered a treatment as well? |
|
Definition
A bright light on the end of the colposcope makes it possible for the gynecologist to clearly see the cervix and acetic acid is applied to the cervix and taken up by dysplastic cells, the whiter the uptake, the more dysplastic the cell. Biopsy according to the whitest areas.
This can be considered treatment because you can do cryosurgery on any abnormal cells while you are in there. |
|
|
Term
| What is the LEEP procedure? |
|
Definition
| Cervical dysplasia treatment in which a thin wire loop electrode which is attached to an electrosurgical generator which transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. |
|
|
Term
| What type of biopsy is typically done if the cervical dysplasia extends inside the cervix on colposcopy? What type of procedures can take this kind of biopsy? |
|
Definition
Cone biopsy.
A sample of tissue can be removed for a cone biopsy using:
A surgical knife (scalpel).
A carbon dioxide (CO2) laser
or LEEP |
|
|
Term
| Describe what uterine fibroids typically rely on to grow and when they typically regress. |
|
Definition
| They are typically dependent on estrogen for growth and they regress with menopause. |
|
|
Term
| What are the typical S&S of uterine fibroids? |
|
Definition
| Usually asymptomatic, most common presenting Sx is menorrhagia, also get pelvic pressure and progressively worsening pelvic pain. |
|
|
Term
| What is the typical treatment for a uterine fibroid? |
|
Definition
| Usually does not require treatment, just monitor. |
|
|
Term
| What are the surgical options for multiple uterine fibroids? |
|
Definition
| Hysterectomy (MC), embolization therapy (cut off the blood supply to the fibroid) and myomectomy (removal of just the fibroid). |
|
|
Term
| What is the most common type of endometrial cancer? Which type has the best prognosis? |
|
Definition
| Endometrioid tumors are the most common and have the best prognosis. |
|
|
Term
| What is the greatest risk factor for uterine(endometrial) cancer? |
|
Definition
|
|
Term
| What is the #1 symptom of uterine (endometrial) cancer? Tx? |
|
Definition
#1 Sx = Abnormal bleeding.
Tx = surgical removal, chemo and radiation. |
|
|
Term
| What is the etiology of follicular, lutein and theca-lutein ovarian cysts? |
|
Definition
Follicular = follicle is not released and leads to estrogen production.
Lutein = the corpus luteum fails to degenerate after 14 days and leads to progesterone production.
Theca-lutein = ovarian cyst that is due to increased levels of beta-hCG. |
|
|
Term
| What is the best initial diagnostic test for ovarian cysts? |
|
Definition
|
|
Term
| What are the typical Sx of ovarian cancer? |
|
Definition
| Vague GI symptoms due to METS bc they are usually asymptomatic until its metastasizes. |
|
|
Term
| What is the most common type of ovarian cancer? What is the screening test for ovarian cancer? |
|
Definition
Serous cystadenocarcinoma.
There is no effective screening test but CA-125 can be used as a biomarker for ovarian cancer. |
|
|
Term
| What are the S&S for cervical polyps? |
|
Definition
| Leukorrhea, postcoital bleeding, postmenopausal bleeding, menorrhagia and bloody discharge. |
|
|
Term
| What is the most common type of cervical cancer? Most common risk factor? Prognosis? |
|
Definition
Squamous cell carcinoma.
Most common risk factor is HPV.
Prognosis is very good if caught early. |
|
|
Term
| What is the most common Sx of vulvar carcinoma? What diagnostic study is typically done to diagnose vulvar carcinoma? Prognosis? |
|
Definition
Vulvar pruritis is MC Sx.
Toluidine blue staining with incisional biopsy can diagnose vulvar carcinoma. CT is done to rule out METS, if there is METS to the pelvic nodes then the prognosis is poor. |
|
|
Term
| What is the treatment for vulvar carcinoma? |
|
Definition
| Vulvectomy with presurgery radiation if advanced. Chemotherapy is not useful. |
|
|
Term
| What is the most common type of vaginal cancer? What is linked to clear cell carcinoma of the vagina? |
|
Definition
It is rare but the most common type is squamous cell carcinoma.
Clear cell carcinoma of the vagina is linked with DES exposure of her mother during pregnancy. |
|
|
Term
| Where do you predominately find HSV 1 and 2? |
|
Definition
HSV1 = oral herpes.
HSV2 = genital herpes. |
|
|
Term
| Describe the progression of the symptoms with Genital Herpes. |
|
Definition
| 2-5 days after the infection they will get burning, fever, myalgia, and malaise which will last for 1-2 days. They will then get vescicles and ulcerations for 7-14 days and 5-7 for subsequent outbreaks. |
|
|
Term
| What are some methods of diagnosing Genital Herpes? |
|
Definition
| culture, serology, HSV specific glycoprotein (G1 or G2), and IgG specific assays. |
|
|
Term
| Describe the treatment regimen for Genital Herpes primary episode and recurrent episodes (with duration of treatment). |
|
Definition
Treat with the (-virs) - Acyclovir, valcyclovir, famcyclovir, etc.
Primary = treat for 7-10 days.
Recurrent = 5 days except 3 with Valcyclovir. |
|
|
Term
| What is the primary site for chlamydia and gonorrhea infection in a female? |
|
Definition
| Cervix - mucopurulent cervicitis. |
|
|
Term
| What are the treatment options for chlamydia infection? |
|
Definition
| Azithromycin 1g single dose or doxycycline for 7 days. |
|
|
Term
| What are the recommended treatments for chlamydia infection during pregnancy? |
|
Definition
| Erythromycin or amoxicillin for 7 days. |
|
|
Term
| What is the etiology of Lymphogranuloma Venereum? Describe the primary and secondary phases. What are the treatment options? |
|
Definition
It is caused by chlamydia trachomatis.
Primary phase is genital ulcers and discharge.
Secondary phase is ascending vaginal and cervical infection which migrates to inguinal lymph nodes (forming “bubos”).
Tx = Doxycycline, erythromycin or tetracycline. |
|
|
Term
| What is the treatment for Neisseria gonorrhea? |
|
Definition
| Cephalosporins (Cefixime, Ceftriaxone, Ciprofloxacin, etc) |
|
|
Term
| Which classes of antibiotics want to be avoided in pregnancy? |
|
Definition
| No quinolones or tetracyclines |
|
|
Term
| What is the etiology of condyloma lata? Condyloma acuminata? |
|
Definition
Lata = syphilis.
Acuminata = HPV. |
|
|
Term
| What are the drug treatment options for HPV? Surgical treatments? |
|
Definition
Drugs = acids, podophyllin, Condylox, 5FU, Aldara and Interferon.
Surgical = cryotherapy, laser, electrodessication, and excision. |
|
|
Term
| What is the causative organism of Syphilis? Describe primary, secondary and tertiary syphilis. What are the primary concerns of a pregnant mother with syphilis? |
|
Definition
Cause = treponema pallidum.
Primary = painless "chancre" sore.
Secondary = constitutional symptoms, lymphadenopathy, condyloma lata, and "money spots" on the palms and soles that spread to the trunk.
Tertiary = damage to CNS, heart and great vessels and "gummas" may develop.
Concerns of a mother with syphilis is that it can cross the placenta and cause death to the fetus. |
|
|
Term
|
Definition
|
|
Term
| What is the causative agent for Chancroid? |
|
Definition
|
|
Term
| What is the causative organism of Granuloma inguinale (Donovanosis)? What is the typical presentation? |
|
Definition
Klebsiella granulomatis.
Typical presentation is a painless, beefy red, friable ulcer. |
|
|
Term
| Describe the differences between monophasic, biphasic and triphasic oral contraceptive pills? |
|
Definition
Monophasic pills contain the same amount of estrogen and progestin in all of the active pills in a pack.
Biphasic/triphasic pills contain different dosages of progestin or estrogen throughout the pill pack. Compared with monophasics, these pills reduce the total hormone dosage a woman receives and are thought to better match the body’s natural menstrual cycle. Biphasic pills change the level of hormones once during the menstrual cycle.
Triphasic pills contain three different doses of hormones in the active pills (changing every seven days during the first three weeks of pills). |
|
|
