ClinMed I Flashcards
2 leading causes f death in US women
- heart disease
2. cancer
cervical cancer screening ages 21-29
pap test q3 yr
cervical cancer screening ages 30-65
pap test and HPV q5 yr
OR pap test q3 yr
gonorrhea/chlamydia screening ages
=24 yrs
HPV immunization ages
=26 yo
routine screening for uterine and ovarian cancer
none
what pelvic measurement is used to approximate the obstetric conjugate?
diagonal conjugate
what measurement describes the smallest diameter a fetal head must pass?
obstetric conjugate
what is the most common pelvis shape?
gynecoid
what is considered the keystone of perineum
perineal body
what is the adnexa?
uterine tube + ovaries
what drapes over pelvic viscera?
parietal peritoneum
what nerve is responsible for innervation of vagina?
pudendal nerve
what is the site called where ectocervical and endocervical cells meet?
squamo-columnar junction
MC position of uterus
on top of bladder, with slight anteflexion and anteversion
what is adrenarche
maturational increase in adrenal androgen production (begins 6-8yrs)
what is gonadarche
maturation of neuroendocrine-gonadotropin-gonadal axis; marks onset of puberty
proliferative phase of the endometrium corresponds with what phase in the ovary?
follicular
secretory phase of the endometrium corresponds with what phase in the ovary?
luteal
what is perimenopause
time between normal ovarian function and ovarian failure; decreased number of ovarian follicles and estradiol production
how do you define menopause
absence of menses for > 1 year
what hormone triggers ovulation and where is it produced
LH, anterior pituitary
what hormone does the corpus luteum make?
progesterone primarily
what hormonal changes cause menses
withdrawal of progesterone
what hormone do the ovarian follicles make?
estrogen
why is estrogen without progesterone a problem?
the lining with proliferate (at risk for uterine cancer)
diagnosis of uterine fibroids via …
pelvic U/S
MC presentation of uterine fibroids
bleeding
but most are ASX
MC causes of bartholin’s gland abscess
n. gohorrhea or clamydia
but r/o adenocarcinoma in women over 40
major risk factor for endometrial cancer
increased estrogen exposure
definitive dx for endometriosis
laparoscopy
what might you find on PEx in a patient with adenomyosis?
tender, uniformly enlarged, boggy uterus
PCOS triad
amenorrhea
obesity
hirsutism
2 main menstrual irregularities with PCOS
amenorrhea (50%); oligomenorrhea (70%)
what do you do when a patient with PCOS says she doesn’t have a menses?
pregnancy test
what should you always order in a pt with acute pelvic pain
pregnancy test
what tumor marker is followed with ovarian cancer?
CA-125
which cancer has the highest mortality of all gyn cancers?
ovarian
3 ovarian cancer risk reduction strategies
- OCPs >5 years
- preg prior to 25
- prophylactic salpingo-oophorectomy
what is the MC gyn malignancy
endometrial
your pt is being given unopposed estrogen. why is this a big no no?
increases risk for endometrial cancer (proliferation without shedding)
OCPs are protective against what two cancers?
ovarian
endometrial
what’s a big red flag symptom for endometrial cancer?
abnormal uterine bleeding (esp postmenopausal)
what the main dx method for endometrial cancer?
endometrial biopsy
stage I endometrial cancer treatment
hysterectomy +/- post op radiation
HPV is a risk for what type of cancer?
cervical
early onset of sexual activity, high number of sexual partners, smoking, OCPs are all risk factors for what
cervical cancer
MC symptoms of cervical cancer
post coital bleeding and intermenstrual spotting
diagnosis cervical cancer is done via
colposcopy/biopsy
pap smear with cytology used for screening
what are 4 ways to reduce cervical cancer risk?
- HPV vaccine
- pap smear/HPV testing
- smoking cessation
- counsel safe sex practices
pruritus is the most common complaint with what type of cancer
vulvar cancer
MC cell type of vulvar cancer
squamous
two main groups of female incontinence
stress UI
urgency UI
also mixed UI
your pt complains of involuntary loss of urine when they sneeze and also when they jump. what type of incontinence is this?
stress UI
pathophys of majority of urge urinary incontinence
idiopathic
risk factors for stress incontinence
obesity childbirth family history age previous pelvic surgery
what are the two main categories of AUB?
anovulatory vs ovulatory
MC secondary cause of amenorrhea
pregnancy
primary amenorrhea is failure to menstruate by age ___ in presence of 2ndary sex characteristics OR by age ____ in absence of secondary sexual characteristics
15-16 in presence of 2ndary characteristics
OR
14 in absence of 2ndary characteristics
4 main causes of primary amenorrhea
- chromosomal disorder
- mullerian genesis
- physiological delay
- PCOS
secondary amenorrhea is defined as
cessation of regular menses for 3 cycles OR cessation of menses for 6 months
if pt is post menopausal and has bleeding what TWO things must be done?
endometrial biopsy
pelvic US
medical management for anovulatory AUB (3)
- OCPs
- medroxyprogesterone monthly
- levonorgesterel-releasing intrauterine system
medical management ovulatory AUB (4)
- NSAIDs
- OCPs OR progesterone (oral or IUD)
- GnRH agonists
- tranexamic acid
3 options for AUB for women who do NOT desire fertility
- endometrial ablation
- uterine artery embolization
- hysterectomy (definitive)
three breast palpation techniques
circular
vertical strip
wedge
limitations of mammograms
detects 85% of cancers, false positives
what is the breast imaging reporting and database system called?
BI-RADS
0-5
what can US differentiate between and who is it helpful in?
differentiate between solid mass and fluid filled cyst
helpful in younger women with denser breast tissue
two categories of mastalgia
cyclic (typically bilateral) vs non-cyclic (unilateral, sharp)
5 treatments for mastalgia
- supportive bra
- reduce or eliminate caffeine
- avoid sodium premenstrually
- NSAIDs
- evening primrose oil
two categories of nipple discharge
pathologic: spontaneous, unilateral, bloody, associated with mass, often confined to one duct, age >40
physiologic: discharge only with compression, multiple duct involvement, often bilateral
if you suspect physiologic nipple discharge, what is your work-up? (2)
- exclude coexisting abnormalities w exam and mammogram if women is > 35 yrs
- check prolactin level
if pathologic discharge is suspected, what is your workup (2)
- diagnostic mammogram +/- US
- surgical referral for excision of duct
cytology is generally unhelpful
intraductal papilloma – benign or malignant? discharge type? treatment?
- benign
- often bloody discharge
- surgical excision
ductal ectasia– benign or malignant? discharge type? treatment?
- benign
- thick, stick discharge (often clear, brown, green), - warm compresses and abx can help
breast abscess with often associated with what?
lactation
bug MC responsible for non-lactating breast abscess
s. aureus
cellulitis can lead to abscess (needs I&D)
what is the MC benign condition of the breast?
fibrocystic changes
you get an FNA to eval fibrocystic changes. what would indicate you need to get a follow up biopsy?
need to exclude cancer if:
- no fluid or bloody fluid on aspiration
- mass persists after aspiration
what med can be used for severe, persistent breast pain?
danazol
if women >30 yrs with fibroadenoma, what do you need to consider as a ddx?
fibrocystic condition or malignancy
age group that fibroadenoma is MC seen
teens to 30s
your pt is less than 30, and she has a mass that you suspect is a cyst (based on characteristics). what can you do (2)?
1.monitor x 1-2 menstrual cycles
OR
2. aspirate
your pt is less than 30, and she has a mass that persists or is suspicious. what should you start with?
- US
if negative –> observe 3-6 months
if suspicious –>consider diag mammo
your pt is older than 30, and she has a mass. what do you do?
unilateral diag mammo & US (no reason to wait for imaging!)
if older than 40, and due for screening, can get bilateral
what is the recommended for mammography screening?
ages 50-74, every 2 years (average risk)
Grade B
for patients ages 40-49, what is the breast cancer screening recommendation?
case by case (grade C)
describe early findings of breast cancer
single, NONTENDER, FIRM mass (often ill defined margins) or mammographic abnormality with no palpable masses
MC anatomic quadrant for breast cancer
upper lateral
do ER/PR receptor positive or negative tumors have a more favorable course?
receptor-positive!
describe two features of HER-2+ tumors
- more aggressive
2. susceptible to certain targeted therapies
breast cancer arises from what 2 tissues
ducts or lobules
inflammatory breast cancer is often mistaken for what?
infection
how is paget’s dz diagnosed?
skin biopsy of erosive area
what percentage of breast cancers are d/t genetic mutations?
5-10%
what is the goal of adjuvant chemo for breast cancer?
cure; eliminate micrometastases
what is a BIG no no for contraception containing estrogen?
NEVER EVER give to a smoker aged 35 or older
risk of death increases by how much for each additional week of pregnancy beyond 8 weeks
38%
when would RhIG (rhogam) be given in terms of IAB care?
after, if patient is Rh negative
what is the strongest risk factor for abortion-related mortality?
gestational age
untreated chlamydia or gonorrhea may lead to what?
pelvic inflammatory disease (PID)
what is the leading infectious cause of infertility in the US?
STIs
1, 2, 3 NEW STIs in the US
HPV
chlamydia
trichomoniasis
1, 2, 3 NEW and EXISTING STIs in the US
HPV
HSV-2
Trich
5 Ps of sexual history
partners, practices, prevention of pregnancy, protection, past hx
most common genital ulcer in US?
HSV
what’s the big difference between herpes and primary syphillis
herpes is painful, syphilis is not
describes HSV lesions
painful ulcers (usually multiple); small grouped ulcers/vesicles on erythematous base
what are two benefits of treating herpes with antivirals?
reduce transmission and heal quicker
3 main diagnostic features of chancroid
- painful soft ulcerations (typically one)
- painful lymph nodes (50%)
- foul smelling discharge from ulcer
what causes chancroid? is it bacterial, fungal, or viral?
haemophilus ducreyi
bacteria
what’s an important follow up for chancroid?
treat sexual partner
what causes syphilis? is it bacterial, fungal, or viral?
treponema pallidum
bacterial
describe primary syphilis lesion
chancre: painless ulcer; raised oval ulcer w indurated edges; usually lasts 3-6 weeks
when is syphilis contagious?
when it’s primary or secondary
specific feature of secondary syphilis
bilateral symmetrical papulosquamous rash; involvement of palms and soles is common
what STI is known as the great imitator?
syphilis
is serology usually reactive with latent syphilis?
yes, despite mostly ASX
3 major features of tertiary syphillis
gumma (granulomas on skin)
neurosyphilis (HA, meningitis, etc)
CV (aortitis)
tx for syphilis
penicillin G IM
what does HPV cause (3)
warts
cervical dysplasia
cancer
most patients with HPV are ASX but some have what type of lesion?
condylomata: papillomatous, white, cauliflower-like growth
tx for high risk HPV types
colposcopy/bx; surgical excision
MC reported STI in US
2nd MC reported?
1st: chlamydia trachomatis
2nd: neisseria gonorrhea
who should be tested for chlamydia?
- women 24 and younger
- new sex partner in last 60 days
- > 2 sex partners in past year
- based on PEx
5 chlamydia complications
- PID (40% in untreated females)
- infertility (20% of PID)
- ectopic pregnancy
- perihepatitis
- perinatal transmission
test of choice for gonorrhea and chlamydia dx?
NAAT
is granuloma inguinale painful or painless ulcer
painless
what two STIs are often found together?
chlamydia and gonorrhea
pathogens of PID
N. gonorrhea, c. trachomatis
others
cervical motion tenderness suggests what?
PID
aka chandelier sign
what is fitz hugh curtis syndrome?
RUQ pain d/t perihepatitis (liver capsule involvement)
what is strawberry cervix associated with?
trichomonas vaginitis
do you have to treat bacterial vaginosis?
nope, 1/3 NON preggers will resolve on their own
