NU 665D Final Exam Study Guide
1. Pedunculated fibroids: Fibroids attached to the uterus by a thin stalk or pedicle.
2. Signs and Symptoms of fibroids: Heavy or prolonged menstrual bleeding,bulk-related
symptoms, reproductive dysfunction, intermenstrual bleeding.
3. Physical exam findings for fibroids: Enlarged, irregular-shaped uterus ob-served during a
physical examination.
4. Screening/imaging for fibroids: Confirmed with pelvic ultrasound and salineinfusion
sonography to identify submucosal lesions and intramural myomas.
5. Myomectomy: Simple surgical removal of fibroids, best for patients desiringpregnancy.
6. Hysterectomy: Surgical removal of the uterus for patients who do not desirepregnancy.
7. Medication for fibroids: Includes NSAIDs, contraception, GnRH agonists, andSPRMs.
8. GnRH agonists side effects: Hot flashes, vaginal dryness, and osteopenia;goal is
shrinkage of uterine fibroids.
9. Risk factors for fibroids: Includes AA race, early menarche <10 years, obesity,and
prevalence during the fifth decade of life.
10. Management during pregnancy for fibroids: Monitor via ultrasound; no inva-sive
procedures recommended.
11. Signs and symptoms of endometriosis: Commonly reported bowel and blad- der symptoms
include perimenstrual tenesmus, diarrhea or constipation, dyschezia, dysuria, hematuria, nausea,
distention, and early satiety.
12. Diagnosis of endometriosis: Physical exam findings include bluish nodules in the vagina
and tenderness along the posterior uterine segment.
13. Treatment for endometriosis: Includes birth control to manage symptoms, with follow-up in
3-4 months for reassessment.
14. First line treatment for endometriosis: Combined oral contraceptives (COCs) are the first
line of treatment to manage symptoms.
15. Patient education for endometriosis: Counseling for conception after lysis of adhesions,
advising to try conceiving immediately following surgery.
16. Bacterial Sinusitis signs and symptoms: Symptoms last >10 days without improvement,
URI symptoms that initially improve then worsen, purulent nasal discharge, facial
pressure/pain, nasal congestion, fever, headache, cough, fatigue,and dental pain.
17. Physical exam findings for bacterial sinusitis: Tenderness over sinuses,purulent nasal
drainage, swelling or erythema over the affected area, decreasedtransillumination of sinuses.
18. First-line treatment for bacterial sinusitis: Amoxicillin-clavulanate (Aug- mentin) for 5-7
days; alternatives include Doxycycline or Levofloxacin for PCNallergy.
,19. Symptoms <10 days: Gradual symptom resolution, clear nasal discharge, nasal
congestion, post-nasal drip, mild facial discomfort, headache, low-grade fever(if any).
20. Physical Exam Findings: Clear to mucoid nasal discharge, mild sinus tender-ness, nasal
mucosa may appear erythematous or edematous, symptoms are less severe and self-limiting.
21. Treatment for Nasal Symptoms: Supportive care only: nasal saline spray or rinse,
analgesics (e.g., acetaminophen, ibuprofen), decongestants (pseu- doephedrine,
oxymetazoline — short term only), intranasal corticosteroids (e.g.,fluticasone).
22. Hyphema: Accumulation of blood in the anterior chamber of the eye, usually dueto blunt
trauma.
23. Signs and Symptoms of Hyphema: Eye pain, decreased visual acuity, photo-phobia,
visible pooling of blood in the anterior chamber, history of eye trauma.
24. Physical Exam Findings for Hyphema: Layered blood visible in anterior cham-ber, partially
or completely obscured pupil depending on severity, normal or in- creased intraocular
pressure, must perform visual acuity testing, refer to ophthal- mology immediately.
25. Management of Hyphema: Eye shield, bed rest, elevate head, avoid NSAIDs(risk of
bleeding), refer urgently.
26. Diagnostic Testing for Menopause: FSH (Follicle-Stimulating Hormone): In- creased
during menopause due to decreased ovarian function; FSH > 40 mIU/mL is suggestive of
menopause.
27. Estradiol Levels in Menopause: Decreased levels are seen during menopausedue to reduced
ovarian production; in postmenopausal women, estradiol levels typically fall to less than 20
pg/mL.
28. Menopause Diagnosis Support: If a woman presents with symptoms sugges- tive of
menopause (e.g., hot flashes, irregular periods, and night sweats), FSH > 40 mIU/mL and
estradiol < 20 pg/mL would support the diagnosis of menopause.
29. Hormone Replacement Therapy (HRT) Risks and Benefits: Should be dis- cussed with
patients before starting treatment; benefits include relief from vasomotorsymptoms (hot flashes,
night sweats) and prevention of bone loss; risks include increased risk of DVT/PE, breast
cancer, stroke, and endometrial cancer in certainpopulations.
30. HRT Prescribing Guidelines: Lowest effective dose should be used; shortestduration
possible to manage symptoms; ongoing monitoring (e.g., breast exams, mammograms).
31. Contraindications for HRT: History of DVT/PE, abnormal mammograms, sus-pected
BRCA mutations, acute liver disease, endometrial cancer.
32. Caution in Certain Conditions with HRT: Dyslipidemia: HRT may worsen lipid profiles;
seizure disorders: anticonvulsants can increase estrogen clearance; thyroid issues: monitor TSH,
T3, and T4 levels.
33. SSRIs for Menopause Symptom Management: Effective for managing vaso- motor
, symptoms (hot flashes); paroxetine (7.5 mg/day) is a commonly used option; citalopram (20
mg/day) is also effective.
34. SSRIs to Avoid for Hot Flashes: Avoid sertraline and fluoxetine (no effect on hot flashes
and can interfere with tamoxifen).
35. Gabapentin for Night Sweats: Used for night sweats and sleep difficulties; dosing: start at
100 mg 1 hour before bedtime and increase by 100 mg every 3 nights until relief (max 900
mg/day).
36. Black Cohosh Indications: Commonly used for hot flashes, night sweats, mood swings, and
vaginal dryness in menopausal women.
37. Black Cohosh Mechanism of Action: Thought to have phytoestrogenic prop- erties, may
mimic estrogen effects in the body, although it does not bind to estrogen receptors in the same
way as synthetic estrogen.
38. Efficacy of Black Cohosh: Studies have shown moderate effectiveness in re-ducing
vasomotor symptoms (e.g., hot flashes); results can vary, and more researchis needed to
determine long-term safety and effectiveness.
39. Gastrointestinal upset: Symptoms such as nausea and bloating.
40. Possible hepatotoxicity: Liver damage in some individuals, especially whentaken in
high doses or over extended periods.
41. Caution for liver disease: Should be used with caution in individuals with liverdisease or
those taking hepatotoxic medications.
42. Estroven: A combination supplement commonly used for menopausal symp-tom relief,
including hot flashes, night sweats, and mood swings.
43. Mechanism of Action of Estroven: The soy isoflavones and red clover pro-vide
phytoestrogens, which mimic estrogen in the body.
44. Efficacy of Estroven: Limited evidence supporting effectiveness for symptomrelief;
some studies suggest soy isoflavones may help reduce hot flashes.
45. Side Effects of Estroven: Gastrointestinal symptoms, headaches, breast ten-derness, and
mood changes.
46. Caution for Estroven: Use caution if there is a history of breast cancer orhormone-
sensitive conditions.
47. Remifemin: An herbal remedy containing black cohosh, marketed for thetreatment of
hot flashes, night sweats, and mood disturbances.
48. Mechanism of Action of Remifemin: Believed to exert phytoestrogenic ef-fects, though
the exact mechanism is not fully understood.
49. Efficacy of Remifemin: Some studies suggest it can help reduce hot flashes,but evidence
for long-term effectiveness is insufficient.
1. Pedunculated fibroids: Fibroids attached to the uterus by a thin stalk or pedicle.
2. Signs and Symptoms of fibroids: Heavy or prolonged menstrual bleeding,bulk-related
symptoms, reproductive dysfunction, intermenstrual bleeding.
3. Physical exam findings for fibroids: Enlarged, irregular-shaped uterus ob-served during a
physical examination.
4. Screening/imaging for fibroids: Confirmed with pelvic ultrasound and salineinfusion
sonography to identify submucosal lesions and intramural myomas.
5. Myomectomy: Simple surgical removal of fibroids, best for patients desiringpregnancy.
6. Hysterectomy: Surgical removal of the uterus for patients who do not desirepregnancy.
7. Medication for fibroids: Includes NSAIDs, contraception, GnRH agonists, andSPRMs.
8. GnRH agonists side effects: Hot flashes, vaginal dryness, and osteopenia;goal is
shrinkage of uterine fibroids.
9. Risk factors for fibroids: Includes AA race, early menarche <10 years, obesity,and
prevalence during the fifth decade of life.
10. Management during pregnancy for fibroids: Monitor via ultrasound; no inva-sive
procedures recommended.
11. Signs and symptoms of endometriosis: Commonly reported bowel and blad- der symptoms
include perimenstrual tenesmus, diarrhea or constipation, dyschezia, dysuria, hematuria, nausea,
distention, and early satiety.
12. Diagnosis of endometriosis: Physical exam findings include bluish nodules in the vagina
and tenderness along the posterior uterine segment.
13. Treatment for endometriosis: Includes birth control to manage symptoms, with follow-up in
3-4 months for reassessment.
14. First line treatment for endometriosis: Combined oral contraceptives (COCs) are the first
line of treatment to manage symptoms.
15. Patient education for endometriosis: Counseling for conception after lysis of adhesions,
advising to try conceiving immediately following surgery.
16. Bacterial Sinusitis signs and symptoms: Symptoms last >10 days without improvement,
URI symptoms that initially improve then worsen, purulent nasal discharge, facial
pressure/pain, nasal congestion, fever, headache, cough, fatigue,and dental pain.
17. Physical exam findings for bacterial sinusitis: Tenderness over sinuses,purulent nasal
drainage, swelling or erythema over the affected area, decreasedtransillumination of sinuses.
18. First-line treatment for bacterial sinusitis: Amoxicillin-clavulanate (Aug- mentin) for 5-7
days; alternatives include Doxycycline or Levofloxacin for PCNallergy.
,19. Symptoms <10 days: Gradual symptom resolution, clear nasal discharge, nasal
congestion, post-nasal drip, mild facial discomfort, headache, low-grade fever(if any).
20. Physical Exam Findings: Clear to mucoid nasal discharge, mild sinus tender-ness, nasal
mucosa may appear erythematous or edematous, symptoms are less severe and self-limiting.
21. Treatment for Nasal Symptoms: Supportive care only: nasal saline spray or rinse,
analgesics (e.g., acetaminophen, ibuprofen), decongestants (pseu- doephedrine,
oxymetazoline — short term only), intranasal corticosteroids (e.g.,fluticasone).
22. Hyphema: Accumulation of blood in the anterior chamber of the eye, usually dueto blunt
trauma.
23. Signs and Symptoms of Hyphema: Eye pain, decreased visual acuity, photo-phobia,
visible pooling of blood in the anterior chamber, history of eye trauma.
24. Physical Exam Findings for Hyphema: Layered blood visible in anterior cham-ber, partially
or completely obscured pupil depending on severity, normal or in- creased intraocular
pressure, must perform visual acuity testing, refer to ophthal- mology immediately.
25. Management of Hyphema: Eye shield, bed rest, elevate head, avoid NSAIDs(risk of
bleeding), refer urgently.
26. Diagnostic Testing for Menopause: FSH (Follicle-Stimulating Hormone): In- creased
during menopause due to decreased ovarian function; FSH > 40 mIU/mL is suggestive of
menopause.
27. Estradiol Levels in Menopause: Decreased levels are seen during menopausedue to reduced
ovarian production; in postmenopausal women, estradiol levels typically fall to less than 20
pg/mL.
28. Menopause Diagnosis Support: If a woman presents with symptoms sugges- tive of
menopause (e.g., hot flashes, irregular periods, and night sweats), FSH > 40 mIU/mL and
estradiol < 20 pg/mL would support the diagnosis of menopause.
29. Hormone Replacement Therapy (HRT) Risks and Benefits: Should be dis- cussed with
patients before starting treatment; benefits include relief from vasomotorsymptoms (hot flashes,
night sweats) and prevention of bone loss; risks include increased risk of DVT/PE, breast
cancer, stroke, and endometrial cancer in certainpopulations.
30. HRT Prescribing Guidelines: Lowest effective dose should be used; shortestduration
possible to manage symptoms; ongoing monitoring (e.g., breast exams, mammograms).
31. Contraindications for HRT: History of DVT/PE, abnormal mammograms, sus-pected
BRCA mutations, acute liver disease, endometrial cancer.
32. Caution in Certain Conditions with HRT: Dyslipidemia: HRT may worsen lipid profiles;
seizure disorders: anticonvulsants can increase estrogen clearance; thyroid issues: monitor TSH,
T3, and T4 levels.
33. SSRIs for Menopause Symptom Management: Effective for managing vaso- motor
, symptoms (hot flashes); paroxetine (7.5 mg/day) is a commonly used option; citalopram (20
mg/day) is also effective.
34. SSRIs to Avoid for Hot Flashes: Avoid sertraline and fluoxetine (no effect on hot flashes
and can interfere with tamoxifen).
35. Gabapentin for Night Sweats: Used for night sweats and sleep difficulties; dosing: start at
100 mg 1 hour before bedtime and increase by 100 mg every 3 nights until relief (max 900
mg/day).
36. Black Cohosh Indications: Commonly used for hot flashes, night sweats, mood swings, and
vaginal dryness in menopausal women.
37. Black Cohosh Mechanism of Action: Thought to have phytoestrogenic prop- erties, may
mimic estrogen effects in the body, although it does not bind to estrogen receptors in the same
way as synthetic estrogen.
38. Efficacy of Black Cohosh: Studies have shown moderate effectiveness in re-ducing
vasomotor symptoms (e.g., hot flashes); results can vary, and more researchis needed to
determine long-term safety and effectiveness.
39. Gastrointestinal upset: Symptoms such as nausea and bloating.
40. Possible hepatotoxicity: Liver damage in some individuals, especially whentaken in
high doses or over extended periods.
41. Caution for liver disease: Should be used with caution in individuals with liverdisease or
those taking hepatotoxic medications.
42. Estroven: A combination supplement commonly used for menopausal symp-tom relief,
including hot flashes, night sweats, and mood swings.
43. Mechanism of Action of Estroven: The soy isoflavones and red clover pro-vide
phytoestrogens, which mimic estrogen in the body.
44. Efficacy of Estroven: Limited evidence supporting effectiveness for symptomrelief;
some studies suggest soy isoflavones may help reduce hot flashes.
45. Side Effects of Estroven: Gastrointestinal symptoms, headaches, breast ten-derness, and
mood changes.
46. Caution for Estroven: Use caution if there is a history of breast cancer orhormone-
sensitive conditions.
47. Remifemin: An herbal remedy containing black cohosh, marketed for thetreatment of
hot flashes, night sweats, and mood disturbances.
48. Mechanism of Action of Remifemin: Believed to exert phytoestrogenic ef-fects, though
the exact mechanism is not fully understood.
49. Efficacy of Remifemin: Some studies suggest it can help reduce hot flashes,but evidence
for long-term effectiveness is insufficient.
