Menstrual Disorders Flashcards

1
Q

Primary Amenorrhea is? (2)

A

1) No period by 15 e/t 2° characteristics N

2) No period by 13 and no 2° characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary Amenorrhea caused by? (5)

A

1) Gonadal dysgenesis from chromosome abnormality
2) Hypothalamic hypogonadism
3) No mullerian duct as embryo, no women parts
4) Transverse vag septum, imperf hymen
5) Pituitary dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Primary Amenorrhea: Hypothalmic/Pituitary Disorders caused by? (4)

A

1) Functional: Low GnRH secretion due to low nutrition, excess exercise, stress
2) Congenital: Low GnRH from hypogonad
3) Hyperprolactinemia
4) Infiltrate/tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Kallmann’s Synd is?

A

hypogonadotropic hypogonadism with loss of sense of smell (anosmia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Primary Amenorrhea: Ovarian Disorders caused by? (2)

A

1) Gonadal dysgenesis (e.g. Turner’s)

2) Polycystic Ovary Synd (U causes 2° amenor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Primary Amenorrhea: Receptor Abnormalities/Enzyme Deficiencies?

A

Androgen Insensitivity Synd:
Male w/ outer vagina,
no uterus/fallop tubes,
high testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Primary Amenorrhea: Initiate eval when? (3)

A

1) 15yo w/o bleeding
2) 13yo w/o breast development (thelarche)
3) 13yo w/o bleed within 2 yrs of breasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Primary Amenorrhea: Hx questions? (11)

A

1) Timeline of puberty
2) FHx age of menarche
3) Height compared to family
4) Neonate/childhood health
5) Sxs of virilization (male char)
6) Stress, wgt ∆, diet, exercise, illness
7) Galactorrhea
8) Anosmia
9) HA, visual ∆, fatigue, polyuria/dipsia
10) Hx of head trauma
11) Sex activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Primary Amenorrhea: Physical exam should always include?

A

Cardiac, pulmonary, pelvic, breasts

Along w/ vitals, general, skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Primary Amenorrhea: Labs? (6)

A
hCG (ALWAYS)
FSH/LH
Karotype
Prolactin
TSH
Testost
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

High FSH indicates?

Low/N FSH indicates?

A

gonadal dysgenesis

hypo/hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Primary Amenorrhea: Possible Imaging?

A

Pelvic sonogram

CT or MRI (pituitary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

2° Amenorrhea is?

A

Previous menstruaters w/ no period for 3 cycles or 6 consecutive months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2° Amenorrhea: Caused by? (5)

A

1) PREGNANCY
2) Ovarian dysf
3) Hypothalamic dysf
4) Pituitary dysf
5) Uterine dysf

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2° Amenorrhea: Hypothalamic/Pituitary Disorders caused by?

A

1) Fxn’l hypothalamic (same as w/ primary, celiac)
2) Puititary dz
3) Hyperprolactinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2° Amenorrhea: Hx questions? (11)

A

1) Bleed hx
2) Pregnancies
3) Meds
4) PMH/recent illness
5) Weight ∆
6) Exercise
7) Skin ∆s (oil, acne, hair)
8) Galactorrhea
9) E2 deficiency sxs
10) Endocrine ROS
11) Asherman sxs (intrauterine adhesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2° Amenorrhea: Physical exam should include?

A

same as primary

+ HEENT (parotid swelling, enamel erosion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

2° Amenorrhea: Labs?

A

same

+ progestin challenge if other labs are N

19
Q

Progestin challenge test is?

A

Assess E2:

pt takes medroxyprogestone x 10 d,
if E2 levels are N, pt will bleed w/ withdrawl of med

if no bleed = hypoE2, pregnancy, uterine defects

20
Q

2° Amenorrhea: Imaging?

A

Pelvic sonogram
CT adrenal gland
CT/MRI pituitary

21
Q

Polymenorrhea is?

A

frequent bleeds <24 days apart

22
Q

Menorrhagia is?

A

heavy or prolonged at N intervals

23
Q

Menometrorrhagia is?

A

heavy and irregular

24
Q

Metrorrhagia is?

A

irregular

25
Q

Abnormal Uterine Bleeding (AUB) caused by?

A

PALM COEIN

Polyp
Adenomyosis
Leiomyosis
Malig/Hyperplasia

Coagulopathy
Ovulatory dysf
Endometrial
Iatrogenic (caused by tx)
Not classified
26
Q

Dysfunctional Uterine Bleeding is?

A

Dx of exclusion

Use when all other P causes are r/o

27
Q

AUB initial eval includes? (3)

A

1) confirm blood from uterus
2) confirm pre- or postmenopausal
3) exclude pregnancy

28
Q

AUB 2° eval includes? (5)

A

1) Determine bleeding pattern
2) Is endometrial sample needed?
3) Is coag eval needed?
4) Bleeding related to contraception method?
5) Concurrent factors to bleeding?

29
Q

AUB hx questions? (9)

A

1) Age of menarche
2) Bleed hx
3) Bleed pattern/amount
4) Molimina sxs (premenstrual sxs)
5) Birthcontrol
6) Meds
7) Hx/FHx of bleed dis
8) Weight ∆
9) Anemia sxs

30
Q

AUB physical exam purpose?

A

r/o all possible causes for bleeding

31
Q

AUB labs? (4) and (4 possibles)

A

hCG
CBC
Fe
Pap/Cx

(P)
coag
TSH
LFT
FSH
32
Q

AUG imaging/studies? (2)

A

pelvic sonogram

endometrial bx

33
Q

AUG management?

A

E2
endometr ablation
hysterectomy

34
Q

Dysmenorrhea: Primary is?

2° is?

A

no identifiable cause

organic pelvic dz

35
Q

Primary Dysmenorrhea: Begins?

Pain description?

Pain location?

Assoc sxs?

Pelvic exam results?

A

at onset of menst, lasts 12-72 hrs

intermitt cramping

low abd, (P) low back/up thighs

N/V/D, HA, fatigue

N pelvic

36
Q

Primary Dysmenorrhea: Tx for resistant cases?

A

CCB (nifedipine)

37
Q

2° Dysmenorrhea: Management?

A

Treat cause

COC help in most cases

38
Q

PMS is?

A

physical, mood, behavioral ∆s that occur in relationship to LUTEAL PHASE, resolve w/ menses

39
Q

Premenstrual Dysmorphic Dis (PMDD) is?

A

PMS w/ severe emotional sxs

40
Q

PMS diagnostic criteria?

A

1) 1 or more somatic and affective sxs 5 days before menses
2) sxs resolve w/i 4 days of meses
3) not caused by meds
4) dysfxn in social or economic life

41
Q

PMDD diagnostic criteria?

A

slide 62

42
Q

Non pharm mgmt for PMSs?

A

↓ salt, caffeine, EtOH
↑ exercise
↑ Ca2+/Mg

43
Q

Pharm mgmt for PMSs?

A

NSAIDs
Spironolactone (bloating)
SSRI
(P) ovulation suppression