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Medicine (MD/DO)
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First Aid for the USMLE Step 2 CK (10th Ed.)
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Abnormalities of the Menstrual Cycle

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First Aid for the USMLE Step 2 CK (10th Ed.) | Medicine (MD/DO) School Study Aid

Abnormalities of the Menstrual Cycle
16 Picmonics to Learn | 32 mins
Kallman Syndrome
Mutation in KAL-1 or FGFR-1 Gene
Failure of GnRH Secreting Neurons
Delayed Puberty
Anosmia
Hypogonadism
Infertility
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2 mins
Turner Syndrome
Signs and Symptoms
Female (XO)
Short stature
Shield Chest
Cystic Hygroma (Webbing of Neck)
Lymphedema in Hands and Feet
Ovarian Dysgenesis
Streak Ovary
Decreased Estrogen
Increased FSH
Increased LH
Dysgerminoma
Bicuspid Aortic Valve
Preductal Coarctation of the Aorta
Horseshoe Kidney
Menopause before Menarche
Amenorrhea
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5 mins
Imperforate Hymen
Clinical Features
Often Asymptomatic until Puberty
Hematocolpos
Primary Amenorrhea
Lower Abdominal Pain
Diagnosis
Diagnosis by Clinical Impression
Management
Surgery
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2 mins
Androgen Insensitivity (Complete)
Defect in Androgen Receptor
Phenotypically Female
(46, XY)
Female External Genitalia
Rudimentary Vagina
Scant Sexual Hair
Testes Often in Labia Majora
Testes Surgically Removed to Prevent Malignancy
Increased Estrogen, Testosterone, and LH
Absent Uterus and Fallopian Tubes
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3 mins
21 Hydroxylase Deficiency
Pathophysiology
Decreased Cortisol
Increased 17 Hydroxyprogesterone
Decreased Aldosterone
Signs and Symptoms
Hypotension
Increased Renin
Hyperkalemia
Female Pseudohermaphroditism
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2 mins
17 Alpha Hydroxylase Deficiency
Decreased Cortisol
Decreased Sex Hormones
Increased Mineralocorticoids (DOC)
Hypertension
Hypokalemia
XY Externally Phenotypic Female
No Internal Reproductive Structures Due to Mullerian Inhibitory Factor
XX Externally Phenotypic Female
Sexual Infantilism
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2 mins
11 Beta-Hydroxylase Deficiency
Pathophysiology
Decreased Cortisol
Decreased Aldosterone
Increased Sex Hormones
Increased 11 Deoxycorticosterone (11 DOC)
Signs and Symptoms
Hypertension
Masculinization
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1 min
Polycystic Ovarian Syndrome (PCOS) Mechanism
Mechanism
Hyperinsulinemia Increases GnRH Pulse Frequency
Large Increase in LH
Small Decrease in FSH
Increased Androgen Production From Theca-Lutein Cells
Decreased Steroid Hormone-Binding-Globulin (SHBG) Causes Increased Free Testosterone
Obese Patients Have Increased Estrogen
Increased Risk of Endometrial Cancer
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2 mins
Polycystic Ovarian Syndrome (PCOS) Symptoms and Diagnosis
Symptoms
Most Common Cause of Infertility in Women
Amenorrhea
Acne
Hirsutism
Obesity
Diagnosis
Enlarged, Cystic Ovaries
LH:FSH Ratio of 3:1
"String of Pearls" on Ultrasound
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1 min
Polycystic Ovarian Syndrome (PCOS) Treatment
Weight Loss
Oral Contraceptives
Clomiphene Citrate
Anti-androgens
Cyclic Progesterone for Endometrial Protection
Metformin
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1 min
Endometriosis Symptoms and Treatment
Symptoms
Dysmenorrhea
Cyclic Pelvic Pain
Dyschezia
Dysuria
Dyspareunia
30-40% are Infertile
Treatment
Surgery
NSAIDs
OCPs
Progesterone (Progestins)
GnRH Agonists
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1 min
Endometriosis Characteristics
Endometrial Tissue Outside of Uterus
Glands and Stroma
Most Common in Ovary, Pelvis, Peritoneum and Bowels
"Chocolate Cyst" in Ovary
Adenomyosis
Theories
Retrograde Flow
Metaplastic Transformation
Mullerianosis
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2 mins
Pelvic Inflammatory Disease (PID)
Mechanism
Neisseria gonorrhoeae
Chlamydia Trachomatis
Symptoms
Cervical Motion Tenderness
Chandelier Sign
Salpingitis
Tubo-ovarian abscess
Hydrosalpinx
Complications
Ectopic Pregnancy
Infertility
Adhesions
Fitz-Hugh-Curtis Syndrome
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2 mins
Pelvic Inflammatory Disease (PID) Interventions
Antibiotics
No Intercourse for 3 Weeks
Semi-Fowler's Position
Analgesics
Monitor Temperature
Treat Partners
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2 mins
Endometritis
Postpartum
Postpartum Endometritis
Cesarean Birth
Fever
Uterine Tenderness
Acute
Acute Endometritis
Neutrophils
Pelvic Inflammatory Disease (PID)
Chronic
Chronic Endometritis
Plasma Cells
Idiopathic
Treatment
Gentamicin + Clindamycin
Ampicillin-Sulbactam
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3 mins
Dysfunctional Uterine Bleeding
Assessment
Bimodal Age Distribution
Painless Vaginal Bleeding
Amenorrhea
Menorrhagia (Heavy Menstrual Bleeding)
Metrorrhagia (Bleeding Between Menses)
Interventions
Balloon Thermotherapy
Hormone Medications
Dilation and Curettage (DandC)
Considerations
Monitor for Anemia
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3 mins

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