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gyn-menstrual disord

MC cause of ovarian insufficiency Turner Syndrome (single X). sx: underdeveloped breasts, shield chest, genital hypoplasia, webbed neck, cardio abnormalities, short stature
failure of the uterus, fallopian tubes and vagina to develop Mullerian agenesis
MC common cause for 2ndary amenorrhea pregnancy!
female athlete triad insufficient caloric intake, amenorrhea, and low bone density or osteoporosis
hyperprolactinemia can be a SE of what? (3) many dopamine-lowering meds, pituitary tumor or hypothyroidism
in a pt w/ 2nd amenorrhea (and - preg test and med review) order _____ and _____ levels as an initial work up TSH and prolactin
if prolactin is high, order_______ MRI of sella turcica
premature ovarian failure can be associated with? (4) radiation, chemo, infx, autoimmune process
should pts w/ premature ovarian failure be considered infertile? NO!
FSH values of _______ on 2 occasions confirms ovarian failure FSH >40 IU/mL
pts w/ POF should be tx with _______ until normal age of menopause to reduce risk of _______ and _________ hormones; osteoporosis and heart dz
PCOS is a multifactorial disorder that usually includes ________ hyperandrogenism
what are the Rotterdam Criteria? for PCOS (must have 2 of 3): clinical OR lab hyperandrogenism, oligo-ovulation or anovulation, polycystic ovaries
how do you test for lab hyperandrogenism? total testosterone >50 ng/mL (but if >200 ng/mL it suggests an androgen secreting tumor)
other common findings in pts w/ PCOS obesity, central adiposity, insulin resistance, acanthosis nigricans, skin tags, abnormal LH:FSH ratio where the LH is 2-3x the FSH
pts w/ PCOS are at higher risk for what? (4) T2DM, atherosclerosis, dyslipidemia, and cardiovascular dz
______ is a common cause of infertility PCOS
tx of PCOS? 1st line: weight loss and exercise, OCPs, Metformin, spironolactone (hirsutism)
pts w/ PCOS should be screened for _____ and ______ dyslipidemia and diabetes
4 causes for secondary amenorrhea PCOS, hyperprolactinemia, hypothalamic dysfunction, premature ovarian failure
______ and ______ are effective tx for PMS and PDD SSRIs and SNRIs
causes for menorrhagia (5) fibroids, adenomyosis, endometrial hyperplasia, von Willebrand dz, thrombocytopenia
spotting (metrorrhagia) can be caused by? (3) cervical polyps, cervical CA, infection
causes of AUB w/ anovulatory pattern (7) PCOS, thyroid dysfunction, hyperprolactinemia or med, uncontrolled DM, hypothalamic dysfunction/athlete triad, first 1-2 yrs after menarche or perimenopause, pregnancy
causes of AUB w/ ovulatory pattern (5) thyroid dysfunction, coag defects/bleeding disorder, fibroids, polyps, advanced liver disease
first 3 tests ordered for AUB? pregnancy, TSH, prolactin level
if the etiology of AUB can't be determined, pt has _________ DUB (dysfunctional uterine bleeding)
primary tx for anovulatory DUB hormonal therapy
occurs when simple proliferation advances to abnormal proliferation that involves glandular and stromal elements of the endometrium endometrial hyperplasia
endometrial hyperplasia is caused by continuous exposure to endogenous or exogenous ________ stimulation in the absence of ________ estrogen, progesterone
endogenous and exogenous source of estrogen? endogenous: obese women (commonly seen in PCOS) exogenous: HRT w/o progesterone
additional RF of endometrial hyperplasia? HTN and DM
which histologic variation has the highest and lowest chance of progressing to CA? highest=atypical complex hyperplasia lowest: simple hyperplasia
US can be utilized to evaluate _______ ______ endometrial stripe (<4mm in postmenopausal women)
test of CHOICE in endometrial hyperplasia endometrial biopsy
tx of endometrial hyperplasia hysterectomy (atypical complex hyperplasia) REFER ALL ATYPICAL PTS, progestin therapy (but relapse is common in atypical types after therapy stops), D&C (pts w/o atypical changes)
who should be evaluated for endometrial hyperplasia or CA? (4) >45yo w/ AUB, <45yo w/ AUB, anovulation and obesity, pts who fail to respond to med tx for AUB, certain findings on Pap
endometrial CA has a ______ prognosis good!
endometrial CA mostly occurs in _______ women postmenopausal
Type 1 endometrial CA is usually related to prolonged exposure to _______ w/o _______ estrogen, progesterone
Type 2 endometrial CA are not preceded by _______ ________ and have a ______ prognosis than Type 1 endometrial hyperplasia, worse!
gold standard for dxing endometrial CA? endometrial biopsy
tx for endometrial CA? total abd hysterectomy and bilateral salpingo-oophorectomy
f/u time for endometrial CA? every 3-6months for 2yrs, then annually after that
what does staging and grading mean? stage I-IV describes extend of CA spread. Grade describes the % of tumor that is solid
most common finding of endometrial CA? prognosis? adenocarcinoma, positive prognosis
Created by: rjerome09