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Reproductive System
Part II
| Question | Answer |
|---|---|
| absence of menses who has no menarche by 16 | amenorrhea |
| imperforated hymen, transverse vaginal septum, tesicular feminization, ovaries, gonadal agenesis (no growth during fetal), gonadal agenesis hypothalmic, pituitary | primary amenorrhea Three varieties (outflow obstructed, end-organ, central regulatory |
| absence of menses for 3 cycles or 6 months in women who had them. DON"T FORGET LEADING CAUSE | pregnancy! Secondary amenorrhea |
| asherman, cervical stenosis, polycystic ovarian, premature ovarian failure, hypothyroid, meds, STRESS, WT LOSS, anorexia | secondary reasons for amenorrhea |
| amenorrhea and no uterus, no breasts = what is the work up? | karyotype, testosterone, FSH. Consider congenital, (if no breasts: gonadal failure, hypothalamus dys) |
| amenorrhea and uterus, yes breasts - what dx? | testicular feminizaiton, mullerian agenesis |
| amenorrhea workup? | pregnancy test. TSH, prolactin (hypohtyroid/hyperprolactin) |
| if amenorrhea, TSH normal, not pregnant and prolactin normal, what should you check next? | progesterone (especially for withdrawal bleeding (OC), estrogen ok, patent cervix) |
| adminster estrogen to effect breast development and prevent osteoporosis | tx for primary amenorrhea (no uterus) |
| + progesterone challenge test treatment (amenorrhia secondary) | OC - prevents endometrial hyperplasia |
| progresterone challenge test (rarely used) | administer progresterone for amenorrhea Provera. withdrawal bleeding = anovulation (estrogen works/uterus lining works/cervix works). no withdrawal bleeding = (estrogen doesn't work, signals for estrogen doesn't work, cervix doesn't work) |
| pain, cramping during menses - interpheres with daily life. (no obvious cause - high level prostaglandins), (2nd: fibroids, cervical stenosis, pelvic adhesion, endometriosis) | dysmenorrhea (1 and 2) |
| pain occurs on first or second day of menstration, HA, N/V, tender on pelvis/abd, | dysmenorrhea priamry |
| scant menses, severe cramping, pain relieveed with increased menstrual flow (scared external os) | cervical stenosis |
| hx of pelvic infection, prior pelvic sugery | pelvic adhesion |
| tx for dysmenorrhea (uncomfortable menses) | NSAIDS and OC - treatment of choice |
| treatment for cervical stenosis | cervical dilation |
| pelvic adhesions treatmnet? | NSAIDS, OC, surgery to lyse adhesion |
| occurs during second half of the menstrual cycle with somatic(breast swelling, bloating, HA, fatigue, constipation), emotional (frustrated, depressed, anxious, libido changes) behavioral (food, concentration low, sensitive to noise) | PMS |
| dx for PMS | pt have symptom free follicular phase for 1 week. PMS occurs during luteal phase... two weeks before your period. progesterone is high, FSH, LH is low, estrogen is constant. |
| Antidepressant, NSAIDS, oC | PMS |
| denoted by final menstruation and marks the end of reproduction. ages 48-52. diminished estrogen that leads to increased FSH, LH. | menopause |
| SE of menopause | lipid profile, vascular endothelium, INCREASED risk of CVA, loss of bone resorption (osteopenia, osteoporosis), Flushing, sweats, mood changes, depressoin, decreased breasts, vaginal atrophy, elevated FSH |
| TX for menopause | estrogen/progestorone combo tx. (SE: estrogen neoplasm, emoblic events, vaginal bleeds) progesterone reduces endometrial ca. |
| PID infectious agents | chlamdia and gonnorhea |
| risk of PID | infertile, ectopic pregnancy (15-19) STI very risky. (IUDs, cigarettes, unmarried, nonwhite), Contraceptives help |
| abdominal pelvic pain, b/l or u/l - burning, cramping, stabbing. vaginal discharge, abn bleeding, dyspareunia, GI or UT sx. with FEVER. | PID |
| cervical motoin tenderness (Chandelier's sign) and purulent discharge | PID |
| Labs: elevated WBC count, US not helpful, laparoscopy definite diagnosis. cultures obtained. clue cells noted on wet mount (potential for other bacteria) | PID |
| PID treatment | hospital, borad-spectrum cephalosporin (cefoxitin, doxycycline) Clindamycin, gentamicn if allergic to Cephalosporins |
Created by:
jamieseals
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