Download MCN 538 MODULE 1 FINAL SCRIPT 2026 FULLY SOLVED ANSWER COLLECTION and more Exams Gynecology in PDF only on Docsity!
MCN 538 MODULE 1 FINAL SCRIPT 2026
FULLY SOLVED ANSWER COLLECTION
◉ Vaginitis Caveats include: Answer: Exam before treatment; self-diagnosis not recommended; failure of OTC = evaluation; PAP not reliable for dx; probiotics not recommended for treatment or prevention; sex partner treatment not needed for BV or uncomplicated candidiasis ◉ Obsessive Compulsive Disorders Answer: Presence of obsessions/compulsions consuming >1hr/day or causing significant distress. Obsessions: persistent, inappropriate ideas/impulses. Compulsions: washing, checking, hoarding, counting; evolve into rituals. Onset in late adolescence/early adulthood. ◉ Treatment of Anxiety Disorders includes: Answer: Psychotherapy & pharmacotherapy; CBT 12-15 weeks; first-line medications: SSRIs or SNRIs. ◉ true or false: Stress Disorders like Acute stress or PTSD are reactions to trauma. PTSD triad: re-experiencing trauma, avoidance of associated stimuli, persistent anxious vigilance. Beta blockers cannot prevent PTSD establishment.
Answer: false. everything is true EXCEPT the last sentence. beta blockers CAN prevent PTSD establishment. ◉ Adjustment Disorders. when do symptoms begin and when do they resolve? Answer: Symptoms begin within 3 months of stressor; cause significant impairment; expected to resolve in 6 months unless stressor is chronic. ◉ Eating Disorders include anorexia and bulimia. what are they and how do we treat? Answer: Anorexia nervosa: refusal to maintain normal weight, fear of fat, may induce vomiting/diuretics/purgatives. Bulimia nervosa: normal/overweight, binge/purge cycles, no amenorrhea. Treatment: psychotherapy, medications; anorexia may require inpatient care. ◉ Mental Health Conditions include: Answer: Include ADHD, Anxiety Disorders, Bipolar Disorders, Depression, Eating Disorders, OCD, PTSD. ◉ Related Mental Health Concerns are risk of what problems? Answer: Risk of suicide, self-harm, sleep disorders.
- 55 - 60 yr: Culminating life structure middle adulthood, Structure provides the vehicle for realization of adulthoods major aspirations and goals
- 60 - 65 yr: Late Adults Transition, Profound reappraisal of the past & shift to a new era ◉ Mid-Life Transitions Answer: 40-45: mid-life individualization; coming to terms with end of youth. Entry Life Structure 45-50: launching middle adulthood. Age 50 transition 50-55: reappraise structure, further exploration, developmental crises common. Culminating 55-60: achieve major aspirations/goals. Late Adult Transition 60-65: reappraisal of past & shift to new era. ◉ what is the leading killer of women in US; with similar death rates for Black & White women. what are the risk factors? Answer: CVD. risk factors: smoking, lack of exercise, unhealthy diet; silent killer with symptoms often delayed. ◉ what are concerning Cardiac Symptoms in Women? Answer: Rapid fatigue, poor sleep, SOB, indigestion, body aches, general malaise; classic angina may appear as heavy substernal pain provoked by stress or activity and relieved by rest; dizziness, irregular HR, palpitations; chest pain less common than men.
◉ what are the Cardiac Labs & Imaging we should know? Answer: CBC, UA (albumin), electrolytes (K), TSH, BUN, creatinine, fasting glucose, lipid profiles, CRP, PT & aPTT. Cardiac biomarkers: CK/CK-MB, troponin (elevated 5-14 days; also nonischemic causes). Cardiac structure: sonography, Doppler, EKG. Cardiac function: 12- lead EKG, Holter, stress tests, MPI, MRI, CAC, catheterization. ◉ what is a Heart Murmur? Answer: Prolonged extra sounds systolic/diastolic; caused by disrupted blood flow; classified by timing, pitch, intensity, pattern, quality, location, radiation, respiratory variation. Flow murmurs: ejection/innocent. Mitral valve prolapse: click-murmur syndrome, usually asymptomatic; 2D echo assesses regurgitation/thickening. Antibiotic prophylaxis only for high-risk dental procedures. ◉ true or false: 50% of strokes are preventable Answer: false. 80% of strokes are preventable. ◉ what is the patho of Type 1 DM? Answer: Destruction of pancreatic beta cells → insulin deficiency; risk increased in first-degree relatives; common in children/adolescents but also adults; classic hyperglycemia: polydipsia, polyuria, weight loss, sometimes polyphagia. ◉ what is the patho of Diabetes Type 2?
tension/headache/backache, skin disorders, breast tenderness, tearfulness, sleep disturbances. ◉ what are some Common Interventions for PMS? Answer: NSAIDs for cramps, HA, muscle aches; concurrent treatment for anxiety/depression or fibromyalgia as needed; careful hx for other conditions/medications. ◉ what are some PMS Complementary & Alternative Therapies? Answer: Minerals (Mg, Ca, Chromium, Zn), Vitamins (B6, multivitamin, E), Herbs (evening primrose, chasteberry, St. John's Wort, Ginkgo Biloba), increased physical activity, nutritional changes, relaxation therapies. ◉ what are some herbs used to treat Primary Dysmenorrhea? Answer: - Dong Quai: inhibits uterine contractions, prostaglandin synthesis, anticoagulant properties; AE: bloating, appetite loss, possible antithrombotic/progesterone effects; caution with warfarin/HRT/OC or estrogen-dependent tumors. - Cramp Bark & Black Haw *Cramp bark: Hot water infusion of the bark from cramp bark, Hx of relieving menstrual cramps in the US, Smooth muscle relaxant properties in animals, Proanthocyanidins in the fruit have antioxidant, anti-inflammatory, & vasodilating activities
- Black Haw: Used for menstrual cramps, In vitro studies in rabbits have shown smooth muscle relaxing effects, No clinical studies have been done in humans
- Rose Hips: Used to treat dysmenorrhea in eastern cultures
- Guava: Popular Mexican phytomedicine rx for the treatment of dysmenorrhea, Primary action is antispasmodic, Also has antioxidant & anti-inflammatory activity, Distinct advantage: Does not have the adverse GI SE like w/ NSAIDs
- Other Herbs for Dysmenorrhea: o False unicorn: Native American's used in 19th century to treat dysmenorrhea o Black cohosh & chasteberry: treat dysmenorrhea but no studies documenting safety or effectiveness ◉ Hormonal Treatments and CNS Targeting Agents for PMS Answer: CHCs: prevent ovulation, may not prevent mood changes. Progesterone: sedative effect in high doses; mixed effectiveness. CNS: SSRIs most commonly used. ◉ Adolescent Development Erikson Answer: Identity vs Role Confusion (early adolescents), Intimacy vs Isolation (early adulthood); overlap may persist into early adulthood. ◉ what should you know about Adolescent Informed Consent?
Answer: NAAT recommended; urine or vaginal swab; swabs more sensitive; both acceptable. ◉ Cervical Cancer Screening in Adolescents should be done at what age? Answer: PAP smear not recommended until age 21. ◉ Menstrual Cycle Puberty Markers: thelarche, adrenarche, and first menses normal age ranges Answer: Thelarche (breast budding) or Adrenarche (sexual hair growth); average onset 9.7 yrs (range 7-13); first menses follows thelarche ~2 yrs later. ◉ Primary Amenorrhea Diagnosis meets what requirements? Answer: No adrenarche/thelarche by 13; no menses by 15; menses not started within 5 yrs of thelarche/adrenarche onset. primary amenorrhea differential dx should inclue: Dx: anatomical, genetic, hormonal, enzymatic, psychological. Examples: imperforate hymen, transverse vaginal septum, or in
- uterus but no breasts: ovarian estrogen deficiency (Turner's), enzyme deficiency, ovarian damage, breast present but congenital absence of uterus: Mullerian agenesis ◉ Menstrual Irregularities Early Puberty include what?
Answer: Average cycle: 21-45 days; up to 7 bleeding days; ACOG recommends evaluation if cycles >90 days apart, <21 or >45 days, lasting >7 days, heavy, frequent pad changes, or delayed menarche with risk factors. ◉ what is Toxic Shock Syndrome (TSS)? Answer: Caused by Staphylococcus aureus; associated with continuous tampon use, contraceptive sponge/diaphragm; peak occurence on day 4 of menses; symptoms: fever >102, diffuse rash like a sunburn, desquamation, hypotension, negative cultures. ◉ what are the criteria to dx TSS? Answer: Any 3: GI (vomiting/diarrhea)
- muscular (myalgia/CPK >2x)
- renal (BUN/Cr >2x)
- mucous membranes (hyperemia)
- hepatic (bilirubin/AST/ALT >2x)
- hematologic (PLT <100k)
- CNS (disorientation without fever/hypotension) ◉ how to Manage TSS? Answer: Antibiotics, vaginal irrigation, advise no tampon/vaginal contraceptive use (≥8 months).
Answer: Chronic low mood; patient may not perceive as depression; treatment pharmacotherapy effective; vulnerable to MDD including PTSD. ◉ what Bipolar 1-2? Answer: Bipolar 1: manic & depressive episodes, often undiagnosed for years, screening via M-3 checklist, MDO, WHO CIDI; treatment: psych referral, lithium. Bipolar 2: hypomania & depression, often misdiagnosed as unipolar depression, treatment: mood stabilization, avoid antidepressants alone. ◉ what is the Ovarian Cycle? Answer: Development of a dominant follicle resulting in ovulation and corpus luteum formation; divided into follicular and luteal phases. ◉ what is the Follicular Phase? Answer: GnRH pulses from hypothalamus → FSH & LH pulses from anterior pituitary → multiple follicles begin developing → estrogen rises → one dominant follicle emerges → other follicles undergo atresia → estrogen peaks ~24h before ovulation → LH surge triggers ovulation 24-36h later. ◉ what is the Luteal Phase?
Answer: After ovulation, corpus luteum develops → produces progesterone → suppresses further follicular growth → secretory endometrial changes → basal body temperature rises → phase length ~14 days → if no pregnancy, corpus luteum deteriorates ~9- 11 days post-ovulation → progesterone & estrogen drop → menstruation triggered. ◉ what parts are included in the Uterine (Endometrial) Cycle? Answer: Endometrium responds to ovarian steroid changes → prepares for implantation → if no pregnancy → endometrium sloughs → menstruation occurs. includes proliferative phase, secretory phase, and menses ◉ what is the Proliferative Phase? Answer: Corresponds to follicular phase; estrogen thickens endometrium, increases blood flow, and forms progesterone receptors. ◉ what is the Secretory Phase? Answer: Corresponds to luteal phase; progesterone differentiates endometrium, secretes proteins to support implantation if fertilization occurs. ◉ what are Fibroadenomas?
◉ Thelarche thru tanner stages 1-5 include what? Answer: Breast budding; Tanner stages: 1-Prepubertal, 2-Sub- areolae bud, 3-Elevation/enlargement of areola, 4-Secondary mound forms, 5-Mature breast with recession of secondary mound. ◉ Pubarche thru tanner stages 1-5 include what? Answer: Appearance of pubic hair; Tanner stages: 1-No/fine hair, 2- Sparse fine straight, 3-Long dark curly, 4-Adult quality but not spread to thighs, 5-Adult quality & distribution with medial thigh spread. ◉ what is Menarche? Answer: Onset of menstruation; hips widen; occurs typically between ages 8-16; sequence influenced by health, genetics, nutrition. ◉ Physical Growth Spurt occures during _________ simultaneous with thelarche and pubarche; timing variable, typical onset around age 8. Answer: adolescence ◉ Reproductive Cycle Documentation should include what? Answer: Recorded in women of reproductive age by age of menarche, length of cycle, number of bleeding days, and pain/symptoms associated with menses.
◉ Average Age of Menarche Answer: 12.5 years. ◉ Normal Menstrual Cycle Length Answer: 24-35 days. ◉ Normal Blood Loss per Menstrual Cycle Answer: 20-80 mL; average pad/tampon holds ~5 mL. ◉ period Symptom Documentation should include what? Answer: Includes intermenstrual bleeding, spotting, pain, dyspareunia, pressure, bloating, dysmenorrhea. ◉ Emergent Symptoms of Ovarian Cysts include? Answer: Pain with fever & vomiting, sudden severe abdominal pain, fainting, dizziness, weakness, rapid breathing. ◉ Oligomenorrhea means? Answer: Menses occurring at intervals >35 days. ◉ Polymenorrhagia means?
◉ what is Primary Dysmenorrhea? Answer: Onset within a year of menarche, spasmodic cramping in lower abdomen radiating to groin/thighs, lasts up to 36 hours. ◉ what is Secondary Dysmenorrhea? Answer: Onset in adulthood; associated with pathology such as fibroids or endometriosis. ◉ what are some Factors Reducing Dysmenorrhea? Answer: Advancing age, parity, oral contraceptive use. ◉ what are some factors that Increase Dysmenorrhea? Answer: Family history, stress, low BMI/obesity, smoking, low SES, sexual abuse, PMS, early menarche, long cycle, heavy flow. ◉ what is the treatment for Dysmenorrhea? Answer: NSAIDs (ASA, ibuprofen, naproxen, ketoprofen), hormonal contraception (CHC or long-acting progestin), referral if unresponsive. ◉ what is used for Nonhormonal Management of Vasomotor Symptoms of dysmenorrhea?
Answer: SSRIs/SNRIs (fluoxetine, paroxetine, venlafaxine, desvenlafaxine), gabapentin. ◉ what is used for Hormonal Management of Menopausal Symptoms? Answer: Estrogen + progestin (if uterus intact), estrogen only (if hysterectomy), vaginal estrogen, DHEA suppositories. ◉ what is the STRAW Criteria? Answer: criteria that classify a woman's reproductive life into distinct stages based on changes in her menstrual cycle and hormone levels. The most current version is STRAW + 10, which identifies three main phases—reproductive, menopausal transition, and postmenopause—each with sub-stages ◉ the HPG axis is established in A, Dormant in B, reactivates in ___C____. It involves GnRH, FSH/LH ____D____ feedback which leads to the LH surge, producing ovulation and the corpus luteum formation. Answer: A. utero B. childhood C. puberty D. positive feedback
