Question 1

A 35-year-old woman without a previous history of dysmenorrhea reports lower pelvic pain and irregular bleeding between periods. What is the initial action in managing this patient?&#10;A) Obtaining a pelvic transvaginal ultrasound with saline infusion&#10;B) Ordering a CBC, erythrocyte sedimentation rate, and cultures&#10;C) Performing an abdominal, pelvic, and rectovaginal examination&#10;D) Prescribing a trial of nonsteroidal anti-inflammatory medications (NSAIDs)

Accepted Answer

Performing an abdominal, pelvic, and rectovaginal examination is the initial action in managing this patient as it helps in identifying any anatomical abnormalities or reproductive issues that may be causing the symptoms. A pelvic transvaginal ultrasound may be indicated after the physical examination, but it is not the initial action. Ordering CBC, erythrocyte sedimentation rate, and cultures may also be helpful, but they are not the initial action. Prescribing NSAIDs may provide symptomatic relief, but it is not the initial action as the underlying cause needs to be identified first.

Question 2

An adolescent female reports crampy pelvic pain radiating to the back, sacrum, and inner thighs during the first 2 days of each menstrual period, associated with nausea and loose tools. She asks about what causes these symptoms. What will the provider tell her?

A) Excess prostaglandins, vasopressin will cause these symptoms.
B) Mechanical cervical obstruction and severe uterine flexion are likely causes.
C) Nulliparity and her young age are correlated with these symptoms.
D) The most likely cause at her age is anovulatory menstrual cycles.

A

Accepted Answer

The symptoms described are consistent with primary dysmenorrhea, which is caused by excessive production of prostaglandins during menstruation. Vasopressin may also be a contributing factor. Mechanical cervical obstruction and uterine flexion are causes of secondary dysmenorrhea, which is typically seen in women who have previously had normal periods. Nulliparity and young age are not necessarily correlated with dysmenorrhea. Anovulatory menstrual cycles can cause menstrual irregularities but are not the most likely cause of the symptoms described.

Question 3

A patient diagnosed with primary dysmenorrhea has taken nonsteroidal anti-inflammatory medications (NSAIDs) and COX-2 inhibitors without getting relief from symptoms. What will the provider suggest?&#10;A) A combined oral contraceptive (OCP)&#10;B) Complementary therapies&#10;C) Intrauterine (IUD) device implantation&#10;D) Narcotic analgesics as needed

Accepted Answer

Primary dysmenorrhea is caused by excess production of prostaglandins during menstruation. NSAIDs and COX-2 inhibitors can effectively reduce prostaglandin synthesis and provide relief in most cases. However, if these medications are not effective, the provider may suggest a combined oral contraceptive pill. OCPs work by suppressing ovulation and reducing prostaglandin production, thereby alleviating dysmenorrhea symptoms. Complementary therapies and narcotic analgesics may also be considered, but OCPs have been shown to be the most effective treatment for primary dysmenorrhea. IUD implantation is generally not recommended for the sole purpose of treating dysmenorrhea.

Deck 142: Dysmenorrhea