NU664 EXAM 2 STUDY GUIDE
QUESTIONS AND CORRECT
ANSWERS
Provera challenge: no bleeding occurs, what do you do ANSW✅✅oral-conjugated estrogen for 35
days in combination with a progestin
Provera challenge: continued failure ANSW✅✅endometrial scarring is likely -
hysterosalpingogram can confirm
Provera challenge: why is it used ANSW✅✅to confirm presence of estrogen and intactness of the
outflow tract (uterus, vagina)
ordered prior to additional hormone testing
Dysmenorrhea: subjective (primary) ANSW✅✅crampy, achy, dill, midline pain, radiation to
back/legs/abdomen
pain beginning hours-days before menses and persist for 24-48 hours
PMS symptoms ANSW✅✅n/v, fatigue, dizziness, diarrhea, nervousness, and HA
Secondary Dysmenorrhea: definition ANSW✅✅changes to timing or intensity of pain plus
prescence of pelvic pathology
Secondary Dysmenorrhea: SXS ANSW✅✅dyspareunia, HMB, IMB, postcoital bleeding, irregular
cycles, urinary complaints, diarrhea, vaginal discharge
Secondary Dysmenorrhea: key differentiating factor ANSW✅✅presence of symptoms of pain and
bleeding that persist beyond the normal menstrual cycle
, primary dysmenorrhea: exam findings ANSW✅✅normal, mild tender uterus
Secondary dysmenorrhea: exam findings ANSW✅✅depends on etiology
Secondary dysmenorrhea: exam findings - endometriosis ANSW✅✅normal exam with nodularity,
thickening, or focal tenderness on uterosacral ligament, cervical stenosis, fixed ovaries or uterus,
adnexal fullness
Secondary dysmenorrhea: exam findings - adenmyosis ANSW✅✅enlarged uterus, soft and tender
with normal mobility
Secondary dysmenorrhea: exam findings - leiomyomas ANSW✅✅uterus enlarged, firm, irregular
shape
Secondary dysmenorrhea: exam findings - infection ANSW✅✅discharge, cervical motion
tenderness, adnexal tenderness, fever, and uterine tenderness
how to dx endometriosis ANSW✅✅laparoscopy is gold standard
lifestyle changes for dysmenorrhea ANSW✅✅exercise - increase endorphins and suppress
prostaglandin release which leads to decreased endometrial proliferation and shunts blood away
from the uterus which reduces pelvic congestion and pain
diet - reduce salty foods, increase fiber and fresh fruits/vegetables and water
heating pads to decrease muscle spasms
relaxation - massage, yoga
weight loss - obesity produces more estrogen
dysmenorrhea first line medication ANSW✅✅NSAIDS - analgesic effect and decrease volume of
menstrual flow, continue use for 2-5 days when symptoms persist is more effective than episodic
use
QUESTIONS AND CORRECT
ANSWERS
Provera challenge: no bleeding occurs, what do you do ANSW✅✅oral-conjugated estrogen for 35
days in combination with a progestin
Provera challenge: continued failure ANSW✅✅endometrial scarring is likely -
hysterosalpingogram can confirm
Provera challenge: why is it used ANSW✅✅to confirm presence of estrogen and intactness of the
outflow tract (uterus, vagina)
ordered prior to additional hormone testing
Dysmenorrhea: subjective (primary) ANSW✅✅crampy, achy, dill, midline pain, radiation to
back/legs/abdomen
pain beginning hours-days before menses and persist for 24-48 hours
PMS symptoms ANSW✅✅n/v, fatigue, dizziness, diarrhea, nervousness, and HA
Secondary Dysmenorrhea: definition ANSW✅✅changes to timing or intensity of pain plus
prescence of pelvic pathology
Secondary Dysmenorrhea: SXS ANSW✅✅dyspareunia, HMB, IMB, postcoital bleeding, irregular
cycles, urinary complaints, diarrhea, vaginal discharge
Secondary Dysmenorrhea: key differentiating factor ANSW✅✅presence of symptoms of pain and
bleeding that persist beyond the normal menstrual cycle
, primary dysmenorrhea: exam findings ANSW✅✅normal, mild tender uterus
Secondary dysmenorrhea: exam findings ANSW✅✅depends on etiology
Secondary dysmenorrhea: exam findings - endometriosis ANSW✅✅normal exam with nodularity,
thickening, or focal tenderness on uterosacral ligament, cervical stenosis, fixed ovaries or uterus,
adnexal fullness
Secondary dysmenorrhea: exam findings - adenmyosis ANSW✅✅enlarged uterus, soft and tender
with normal mobility
Secondary dysmenorrhea: exam findings - leiomyomas ANSW✅✅uterus enlarged, firm, irregular
shape
Secondary dysmenorrhea: exam findings - infection ANSW✅✅discharge, cervical motion
tenderness, adnexal tenderness, fever, and uterine tenderness
how to dx endometriosis ANSW✅✅laparoscopy is gold standard
lifestyle changes for dysmenorrhea ANSW✅✅exercise - increase endorphins and suppress
prostaglandin release which leads to decreased endometrial proliferation and shunts blood away
from the uterus which reduces pelvic congestion and pain
diet - reduce salty foods, increase fiber and fresh fruits/vegetables and water
heating pads to decrease muscle spasms
relaxation - massage, yoga
weight loss - obesity produces more estrogen
dysmenorrhea first line medication ANSW✅✅NSAIDS - analgesic effect and decrease volume of
menstrual flow, continue use for 2-5 days when symptoms persist is more effective than episodic
use
