TEST BANK Women's Health: A Primary Care Clinical Guide 5th Edition.
Test Bank For Women's Health: A Primary Care Clinical Guide 5th Edition By Diane Schadewald; Ursula A. Pritham; Ellis Quinn Youngkin PhD, RNC, WHCNP, ARNP; Marcia Szmania Davi 9780135458624 Full Chapt...
TEST BANK FOR WOMEN’S HEALTH: A PRIMARY CARE CLINICAL GUIDE (5TH EDITION )
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Test Bank: Women's Health: A Primary Care Clinical Guide, 5th
Edition by Diane Schadewald - Chapters 1-26, 9780135458624
| Rationals Included
What differentiates pelvic pain from abdominal pain?
1. Pain below the umbilicus is pelvic pain
2. Duration of pain
3. Gender specific
4. Age of the patient - ANSWER: 1. Pain below the umbilicus is pelvic pain
Primary amenorrhea may be diagnosed by age 15 years. What should be
present for this diagnosis? Select all that apply.
1. Normal growth
2. Presence of secondary sexual characteristics
3. Elevated testosterone level
4. Hyperprolactinemia - ANSWER: 1. Normal growth
2. Presence of secondary sexual characteristics
Primary Amenorrhea - ANSWER: Absence of menses by age 15 years (could consider earlier if
abnormalities
present)
• Often secondary to dysfunction in the hypothalamus, pituitary, ovaries, uterus,
or vagina
• Many causes
• Refer for dx, tx
DYSMENORRHEA - ANSWER: Painful cramping associated with menstruation secondary to excessive
uterine muscle contraction
• Most common GYN problem in adolescents and many adult females
• Get a good HISTORY!!!
• Primary vs. Secondary
Primary Dysmenorrhea - ANSWER: Absence of pelvic pathology but likely have a lot of prostaglandins
being
produced
• Usually starts in adolescence
• Pain starts 1-2 days prior to onset of menses, then resolves over the next 12-
72 hours
• May present with nausea, diarrhea, fatigue, dizziness, HA, back pain
• Improves with NSAIDs, hormonal contraceptives
• Improves with age and parity
Secondary Dysmenorrhea - ANSWER: Get a good history (medical and menstrual)
• Physical exam
Purpose: Rule out a secondary cause (pelvic pathology-endometriosis,
adhesions, fibroids, PID)
• Pelvic exam (consider deferral for young, non-sexually active adolescents
with mild symptoms)
• Consider pelvic US to look for adnexal masses, fibroids, other pelvic
pathology
Once Primary Dysmenorrhea is established... - ANSWER: Non-Pharm Management
, • Exercise improves symptoms
• Heat to the lower abdomen is as effective as oral analgesics for relief
Pharm Management - ANSWER: NSAIDs: 80-86% response rate
(Start at onset of menses for 1-2 days or for
duration of pain)
•Hormonal contraceptive therapy (OK for first line tx)
•If treatment with NSAIDs or hormonal contraceptives fails, try the other
•Consider treatment with both
•Consider secondary cause for failure of first and second line tx
Polycystic Ovarian Syndrome (PCOS) - ANSWER: Chronic, complex endocrine disorder associated with
oligo-ovulation and/or anovulation
•Characterized by formation of cysts in the ovaries (hence, "polycystic")
•Common endocrinopathy; affects 6.5
-8% of females
•Endocrine Society has a diagnostic
algorhythm; Rotterdam Criteria for diagnosis
If pregnancy not desired - ANSWER: To Treat Androgen Exces: Estrogen/progestin contraceptive (first
line
treatment) treats acne, hirsutism and protects the endometrium
OR drospirenone (
analogue of spironolactone) OR Both
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