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WHNP Boards Gynecologic Disorders Exam Questions And Correct Answers
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WHNP Boards Gynecologic Disorders ExamQuestions And Correct Answers
When does PMS occur? - ANS - luteal phase
- 5 to 7 days before menses; resolves within 4 days of onset of menses
Etiology of PMS - ANS - Unknown etiology; multiorgan disorder
Suggested causes include:
- metabolic and endocrine disorders
- alterations in estrogen or progesterone levels
- withdrawal of endogenous endorphins
- fluid imbalance
- vitamin and mineral deficiencies
- altered carbohydrate metabolism
Differential dx of PMS - ANS - depression and/or anxiety
- bipolar affective disorder
- alcohol or substance abuse
- personality disorders
- chronic fatigue syndrome
- fibromyalgia
- diabetes
- brain tumor
- thyroid disease
,- hyperprolactinemia
- perimenopause
Diagnostic testing for PMS - ANSWER - documenting sx in diary for 2-3 months to
evaluate consistency of sx with ovulation or menses
- individual testing can include glucose tolerance and thyroid profile
- HORMONE LEVELS OF LITTLE VALUE
Options for nonpharmacologic tx of PMS - ANSWER - First line: self help strategies
(teach sx, reassurance, patience)
little evidence to show helpfulness of dietary revisions (such as less salt/sugar/caffeine)
Vitamin B6 (50-150mg/day): may be beneficial w/ continuous, not intermittent, use
Calcium carbonate supplements (1200-1600mg/day)
Chaste tree berry extract
Aerobic exercise 20-30 mins at least 4x wk
avoidance of physical or emotional triggers
- cognitive therapy, group therapy, relaxation, acupuncture, biofeedback
Medical management of PMS - ANSWER - Spironolactone during luteal phase to reduce
,swelling/bloating
- NSAIDs: can reduce fluid, back/breast/pelvic pain
- COCs, POPs
- SSRIs: shown to alleviate severe PMS; may choose to take only in luteal phase each
month
- Danazol: can help suppress ovulation
Gonadotropin-releasing hormone agonists: inhibit cyclic gonadotropin release (has
menopause like side effects); limit use for 4-6 months unless combined with combination
hormonal therapy
Premenstrual dysphoric disorder (PMDD) - ANSWER - at least 5 PMS-type sx severe
enough to disrupt normal functioning in most if not all cycles
- must include at least 1 of these sx: markedly depressed mood, marked anxiety, marked
affective lability, persistent and marked anger
when does PMDD occur? - ANS Luteal phase and resolves within 1 wk after menses
Treatment for PMDD - ANS - same therapeutic intervention as for PMS
- Meds w/ FDA approval for tx of PMDD include: drospirenone containing combination
hormonal contraceptives; SSRIs: fluoxetine, paroxetine, sertraline
- Anxiolytic drugs (alprazolam, buspirone): mixed results in PMDD tx studies; high
potential for drug dependence/abuse; use only short term
, Primary vs Secondary Dysmenorrhea - ANSWER - Primary: unassociated with
underlying pelvic pathology; rarely begins after age 20; associated with ovulatory
cycles; stimulated by prostaglandin release
- Secondary: underlying pelvic pathologic condition thought to by cause; may occur at
any age in menstruating women
Etiology/Incidence of Primary and Secondary Dysmenorrhea - ANSWER - Primary: seen
in 50-75% women, with 10-20% severe; prostaglandins stimulate contractile response
on smooth muscles
-Secondary-onset may be many yrs following menarche; most often in women >20 yrs of
age; organic disease is related
Symptoms of primary dysmenorrhea-ANWAR -Pain begins shortly before onset of
menses and usually lasts no longer than 2 days
-Described as colicky, crampy, spasmodic in lower abdomen, sometimes in lower back
and thighs
s/sx of secondary dysmenorrhea - ANSWER - Pain begins at anytime during cycle; may
notice change in duration and amoung of menstrual flow
- unlikely to be relieved by OTC measures
- sx often persist longer than primary
Differential dx for Dysmenorrhea - ANSWER - imperforate hymen
- endometriosis
- cervical stenosis
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