this week we began the gynecology section in CPD, taught by Dr. Windstar. we went over some of the anatomy and physiology from last year, then talked about diagnosis of various abnormalities: pelvic pain, pelvic mass, and abnormal bleeding disorders.
questions
introduction...
1. what is the characteristics of a normal menses in terms of color, how long the flow lasts, average blood loss?
2. what is menorrhagia?
3. how much blood does a saturated pad or tampon usually hold?
4. what is the connection between constipation and gynecological conditions?
5. what are rectoceles and cystoceles?
6. Skene's glands are palpated if what is suspected?
7. what are the 4 possible positions of the uterus?
8. what is the normal size of the uterus?
9. what is the normal size of a reproductive age ovary?
10. what is the normal size of a menopausal age ovary?
11. what is the most common place that endometriosis develops?
12. name three pregnancy tests.
13. what is the advantage to the serum qualitative test?
14. what is the serum quantitative test used for?
15. what is the normal pH of cervical secretions?
16. what is the most common imaging technique used when masses are suspected?
pelvic masses...
17. what are hematocolpos?
18. what is the most common benign neoplasm in women?
19. what are hydrosalpinges?
20. TVUS might be preferred over CT because...
21. what is the most common tumor marker elevated in ovarian cancer?
pelvic pain...
22. what are the four systems that must be assessed with the presentation of pelvic pain?
23. what might syncope or hemorrhagic shock suggest?
24. describe the quality of pelvic pain in adnexal torsion.
25. tenderness in the anterior abdominal wall might indicate...
26. describe the quality of pelvic pain in perirectal abscess.
27. what are some sources of pain that would require immediate referral to ER?
28. what are some concomitant symptoms that should always be asked when a patient presents with pelvic pain?
29. 70% of patients with chronic pelvic pain have...
30. what are some labs that would aid in the diagnosis of pelvic pain?
31. if source of pelvic pain cannot be determined with PE and labs, consider...
abnormal vaginal bleeding...
32. what is menorrhea?
33. what is polymenorrhea?
34. what is metrorrhagia?
35. what is oligomenorrhea?
36. what is amenorrhea?
37. how long after menopause does bleeding need to persist in order to be considered abnormal?
38. what are the common ages for anovulation and why?
what are the most common causes of abnormal vaginal bleeding for...
39. infants.
40. children.
41. women of reproductive age with syncope or hemorrhagic shock.
42. women of reproductive age with positive pregnancy test.
43. women of reproductive age with negative pregnancy test.
44. what are the labs and imaging tests that would aid in the diagnosis of abnormal vaginal bleeding?
45. what is a south american herb that can aid in estrogen imbalances?
female reproductive endocrinology...
46. how does weight affect onset of puberty?
47. how does blindness affect onset of puberty?
48. what is the most common cause of precocious puberty?
49. what is the average age of menarche in the US?
50. describe the levels of FSH and LH after birth and in early childhood.
51. what hormonal change triggers the beginning of the menstrual cycle?
52. what is the hormone that stimulates FSH and LH production and where is it produced?
53. what is the hormonal change that triggers ovulation?
54. corpus luteum makes which hormone?
55. why does body temperature rise during the luteal phase?
56. when do progesterone levels peak?
57. if implantation occurs, how long does the corpus luteum continue to produce progesterone?
58. what are the hallmarks of the endometrial proliferative stage? what stage of ovarian development does this correspond to?
59. what are the hallmarks of the endometrial secretory stage? what stage of ovarian development does this correspond to?
60. when during the lifetime is estrone (E1) highest? what demographic is it higher in?
61. when during the lifetime is estradiol (E2) highest? what is it produced by?
62. when is estriol (E3) highest? what is it produced by?
63. E3 is the breakdown product of...
amenhorrhea...
64. what is meant by primary and secondary amenhorrea?
65. what are causes of anovulatory amenhorrhea related to hypothalamic dysfunction?
66. what are causes of anovulatory amenhorrhea related to pituitary dysfunction?
67. what are causes of anovulatory amenhorrhea related to ovarian failure?
68. what are causes of anovulatory amenhorrhea related to other endocrine dysfunction?
69. what is ovulatory amenhorrhea?
70. what are examples of anatomical abnormalities that might cause ovulatory amenhorrhea?
answers
1. medium/dark red
3-7 days of bleeding
30mL blood loss
2. greater than 80mL blood loss during a cycle or bleeding for more than 7 days.
3. 5-15mL.
4. constipation can cause more estrogen to return from the GI back into the blood stream, via beta glucoronidase, causing an estrogen dominance state.
5. rectoceles are bulges of the posterior vaginal wall and cystoceles are bulges of the anterior vaginal wall due to wall laxity.
6. chlamydia.
7. retroverted, retroflexed, anteverted, anteflexed.
8. 6cm * 4cm.
9. 3 * 2 * 2cm.
10. 1 * 0.7 * 0.5cm.
11. pouch of douglas.
12. urine ßHCG
serum qualitative ßHCG
serum quantitative ßHCG
13. more specific and sensitive than urine.
14. miscarriage or ectopic pregnancy.
15. 3.5-4.5
16. ultrasound: transvaginal or abdominal.
17. accumulation of blood in the vagina due to imperforate hymen.
18. fibroids / leiomyomas.
19. uterine tubes filled with fluid due to blockage at the distal end.
20. because of the radiation from a CT.
21. CA-125.
22. gyn, GI, GU, MS.
23. ruptured ectopic pregnancy, ovarian cyst.
24. severe, colicky, unilateral pain which reaches peak intensity in seconds or minutes.
25. bladder / urethral pain due to a lower urinary disorder.
26. painful defecation, localized tender mass.
27. ectopic pregnancy
tubo-ovarian abscess
ovarian cyst rupture or torsion
appendicitis
bowel perforation
28. fever, chills, nausea, vomiting, dizziness, dyspnea, night sweats.
29. endometriosis.
30. UA
wet prep
CBC
pregnancy test
31. TVUS, laparoscopy.
32. see question 2.
33. menses that are too frequent (less than 21 days before menses).
34. bleeding that occurs not in relation to menses (including spotting).
35. infrequent menses (more than 35 days between menses)
36. no menses.
37. 6 months.
38. puberty and perimenopause due to the lack of progesterone.
39. in utero stimulation of endometrium via placental estrogens.
40. trauma, precocious puberty / premature menses, urethral meatus prolapse.
41. see question 23.
42. spontaneous abortion, ectopic pregnancy, gestational trophoblastic disease, endometritis.
43. hormonally related cause, or structural abnormality.
44. pregnancy, CBC, ferritin, TVUS, EMB, coagulation tests, vulvar biopsy, pap smear.
45. maca.
46. overweight girls have earlier puberty and underweight girls have later puberty.
47. earlier onset for unknown reasons.
48. hypothyroidism.
49. 12.5.
50. very high at birth but low in childhood.
51. drop in estrogen and progesterone.
52. GnRH, produced in the hypothalamus.
53. spike in LH.
54. progesterone.
55. because of the thermogenic effects of progesterone.
56. about day 21.
57. until the placenta takes over.
58. endometrial vascularization and proliferation, fertile mucous from cervix. corresponds to follicular phase.
59. stabilization and formation of secretory elements in endometrium. corresponds to luteal phase.
60. highest during menopause, obese women.
61. highest in childbearing years, produced by follicles.
62. pregnancy, placenta.
63. E1 and E2 in the liver.
64. primary: period never started. secondary: menses stop for over 3 months.
65. anorexia nervosa
excess exercise
66. galactorrhea
benign pituitary adenoma
67. autoimmune disorders
chemotherapy, pelvic irradiation
methyltrexate
68. cushing's
hypo/hyperthyroid
obesity
PCOS
69. a rare form of amenhorrhea that is marked by normal ovulation but abnormal anatomy.
70. acquired endometrial lesions
cervical stenosis
imperforate hymen
male pseudohermaphroditism
transverse vaginal septum
vaginal and uterine aplasia
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