NUR 684- Test#3- Questions & Answers
Adenomyosis- diagnostics Correct Ans--U/S or MRI may rule out other pathology
-Endometrial biopsy for abnormal bleeding
Adenomyosis- management Correct Ans--NSAIDs for pain
-Hormone suppression
-Hysterectomy may be indicated & is curative
Most common cause of chronic pelvic pain? Correct Ans-Endometriosis
Endometriosis (define) Correct Ans-The presence of endometrial stroma and glands outside
the uterus
Endometriosis- common complaints Correct Ans--Dyspareunia
-Dysmenorrhea
-Menorrhagia
-Premenstrual spotting
-Infertility
-Pelvic pain
Endometriosis- less common S/S Correct Ans--Hematuria
,-Dysuria
-Difficult/painful defecation
-Diarrhea
-Rectal bleeding
-Low back pain
S/S of endometriosis usually occur when? Correct Ans-Before or during menses
Endometriosis- physical findings Correct Ans--Fixed, retroverted uterus
-Bilateral, fixed, tender adnexal masses
-Nodularity & tenderness of uterosacral ligaments
-Tenderness, thickening, & nodularity of rectal-vaginal septum
-Cervical motion tenderness associated with menses
Endometriosis/chronic pelvic pain- labs Correct Ans--STD testing (GC, CT, trich, RPR)
-CBC
-TSH
-ESR
Endometriosis- diagnostics Correct Ans-**Direct visualization with laparoscopy or
laparotomy reveals classic implants
,-Pelvic/transvaginal U/S
Endometriosis- classifications Correct Ans-Stage I: minimal
Stage II: mild
Stage III: moderate
Stage IV: severe
Endometriosis- 1st line pharmacologic treatment Correct Ans--Analgesics (NSAIDs = 1st
choice)
-Combination oral contraceptives
-Progestin-only contraceptives (DMPA)
Endometriosis- 2nd line pharmacologic treatment Correct Ans--GnRH agonist (ex. goserelin,
leuprolide, nafarelin)
^use limited to 6 months
-GnRH antagonist (ex. elagolix)
^high dose limited to 6 months; low dose 24 months
Endometriosis- surgery Correct Ans--Laser surgery
-Hysterectomy with bilateral salpingo-ophorectomy is curative
Endometriosis- nonpharmacologic treatments Correct Ans--PO melatonin
-Acupuncture
, -Heat application
-Pelvic floor physical therapy
Interstitial cystitis (first line treatment) Correct Ans-Amitriptyline
Amitriptyline- side effects Correct Ans--Hypotension
-Urinary retention
-Dry mouth
If cytoscopy reveals Hunner's lesions? Correct Ans-Corticosteroid injections
Ectopic pregnancy- physical findings Correct Ans--Cervical motion tenderness
-Adnexal tenderness
-Adnexal mass
Ectopic pregnancy- diagnostics Correct Ans-**Stat transvaginal ultrasound**
-Positive pregnancy test
-beta hCG test increases less than expected (doubles every 48 hours in viable pregnancies)
Ectopic pregnancy- treatment Correct Ans-**Methotrexate**
Adenomyosis- diagnostics Correct Ans--U/S or MRI may rule out other pathology
-Endometrial biopsy for abnormal bleeding
Adenomyosis- management Correct Ans--NSAIDs for pain
-Hormone suppression
-Hysterectomy may be indicated & is curative
Most common cause of chronic pelvic pain? Correct Ans-Endometriosis
Endometriosis (define) Correct Ans-The presence of endometrial stroma and glands outside
the uterus
Endometriosis- common complaints Correct Ans--Dyspareunia
-Dysmenorrhea
-Menorrhagia
-Premenstrual spotting
-Infertility
-Pelvic pain
Endometriosis- less common S/S Correct Ans--Hematuria
,-Dysuria
-Difficult/painful defecation
-Diarrhea
-Rectal bleeding
-Low back pain
S/S of endometriosis usually occur when? Correct Ans-Before or during menses
Endometriosis- physical findings Correct Ans--Fixed, retroverted uterus
-Bilateral, fixed, tender adnexal masses
-Nodularity & tenderness of uterosacral ligaments
-Tenderness, thickening, & nodularity of rectal-vaginal septum
-Cervical motion tenderness associated with menses
Endometriosis/chronic pelvic pain- labs Correct Ans--STD testing (GC, CT, trich, RPR)
-CBC
-TSH
-ESR
Endometriosis- diagnostics Correct Ans-**Direct visualization with laparoscopy or
laparotomy reveals classic implants
,-Pelvic/transvaginal U/S
Endometriosis- classifications Correct Ans-Stage I: minimal
Stage II: mild
Stage III: moderate
Stage IV: severe
Endometriosis- 1st line pharmacologic treatment Correct Ans--Analgesics (NSAIDs = 1st
choice)
-Combination oral contraceptives
-Progestin-only contraceptives (DMPA)
Endometriosis- 2nd line pharmacologic treatment Correct Ans--GnRH agonist (ex. goserelin,
leuprolide, nafarelin)
^use limited to 6 months
-GnRH antagonist (ex. elagolix)
^high dose limited to 6 months; low dose 24 months
Endometriosis- surgery Correct Ans--Laser surgery
-Hysterectomy with bilateral salpingo-ophorectomy is curative
Endometriosis- nonpharmacologic treatments Correct Ans--PO melatonin
-Acupuncture
, -Heat application
-Pelvic floor physical therapy
Interstitial cystitis (first line treatment) Correct Ans-Amitriptyline
Amitriptyline- side effects Correct Ans--Hypotension
-Urinary retention
-Dry mouth
If cytoscopy reveals Hunner's lesions? Correct Ans-Corticosteroid injections
Ectopic pregnancy- physical findings Correct Ans--Cervical motion tenderness
-Adnexal tenderness
-Adnexal mass
Ectopic pregnancy- diagnostics Correct Ans-**Stat transvaginal ultrasound**
-Positive pregnancy test
-beta hCG test increases less than expected (doubles every 48 hours in viable pregnancies)
Ectopic pregnancy- treatment Correct Ans-**Methotrexate**
