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Women's Health > ClinMed I > Flashcards

ClinMed I Flashcards

1
Q

2 leading causes f death in US women

A
  1. heart disease

2. cancer

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2
Q

cervical cancer screening ages 21-29

A

pap test q3 yr

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3
Q

cervical cancer screening ages 30-65

A

pap test and HPV q5 yr

OR pap test q3 yr

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4
Q

gonorrhea/chlamydia screening ages

A

=24 yrs

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5
Q

HPV immunization ages

A

=26 yo

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6
Q

routine screening for uterine and ovarian cancer

A

none

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7
Q

what pelvic measurement is used to approximate the obstetric conjugate?

A

diagonal conjugate

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8
Q

what measurement describes the smallest diameter a fetal head must pass?

A

obstetric conjugate

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9
Q

what is the most common pelvis shape?

A

gynecoid

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10
Q

what is considered the keystone of perineum

A

perineal body

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11
Q

what is the adnexa?

A

uterine tube + ovaries

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12
Q

what drapes over pelvic viscera?

A

parietal peritoneum

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13
Q

what nerve is responsible for innervation of vagina?

A

pudendal nerve

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14
Q

what is the site called where ectocervical and endocervical cells meet?

A

squamo-columnar junction

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15
Q

MC position of uterus

A

on top of bladder, with slight anteflexion and anteversion

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16
Q

what is adrenarche

A

maturational increase in adrenal androgen production (begins 6-8yrs)

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17
Q

what is gonadarche

A

maturation of neuroendocrine-gonadotropin-gonadal axis; marks onset of puberty

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18
Q

proliferative phase of the endometrium corresponds with what phase in the ovary?

A

follicular

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19
Q

secretory phase of the endometrium corresponds with what phase in the ovary?

A

luteal

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20
Q

what is perimenopause

A

time between normal ovarian function and ovarian failure; decreased number of ovarian follicles and estradiol production

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21
Q

how do you define menopause

A

absence of menses for > 1 year

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22
Q

what hormone triggers ovulation and where is it produced

A

LH, anterior pituitary

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23
Q

what hormone does the corpus luteum make?

A

progesterone primarily

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24
Q

what hormonal changes cause menses

A

withdrawal of progesterone

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25
Q

what hormone do the ovarian follicles make?

A

estrogen

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26
Q

why is estrogen without progesterone a problem?

A

the lining with proliferate (at risk for uterine cancer)

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27
Q

diagnosis of uterine fibroids via …

A

pelvic U/S

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28
Q

MC presentation of uterine fibroids

A

bleeding

but most are ASX

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29
Q

MC causes of bartholin’s gland abscess

A

n. gohorrhea or clamydia

but r/o adenocarcinoma in women over 40

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30
Q

major risk factor for endometrial cancer

A

increased estrogen exposure

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31
Q

definitive dx for endometriosis

A

laparoscopy

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32
Q

what might you find on PEx in a patient with adenomyosis?

A

tender, uniformly enlarged, boggy uterus

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33
Q

PCOS triad

A

amenorrhea
obesity
hirsutism

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34
Q

2 main menstrual irregularities with PCOS

A

amenorrhea (50%); oligomenorrhea (70%)

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35
Q

what do you do when a patient with PCOS says she doesn’t have a menses?

A

pregnancy test

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36
Q

what should you always order in a pt with acute pelvic pain

A

pregnancy test

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37
Q

what tumor marker is followed with ovarian cancer?

A

CA-125

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38
Q

which cancer has the highest mortality of all gyn cancers?

A

ovarian

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39
Q

3 ovarian cancer risk reduction strategies

A
  1. OCPs >5 years
  2. preg prior to 25
  3. prophylactic salpingo-oophorectomy
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40
Q

what is the MC gyn malignancy

A

endometrial

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41
Q

your pt is being given unopposed estrogen. why is this a big no no?

A

increases risk for endometrial cancer (proliferation without shedding)

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42
Q

OCPs are protective against what two cancers?

A

ovarian

endometrial

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43
Q

what’s a big red flag symptom for endometrial cancer?

A

abnormal uterine bleeding (esp postmenopausal)

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44
Q

what the main dx method for endometrial cancer?

A

endometrial biopsy

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45
Q

stage I endometrial cancer treatment

A

hysterectomy +/- post op radiation

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46
Q

HPV is a risk for what type of cancer?

A

cervical

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47
Q

early onset of sexual activity, high number of sexual partners, smoking, OCPs are all risk factors for what

A

cervical cancer

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48
Q

MC symptoms of cervical cancer

A

post coital bleeding and intermenstrual spotting

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49
Q

diagnosis cervical cancer is done via

A

colposcopy/biopsy

pap smear with cytology used for screening

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50
Q

what are 4 ways to reduce cervical cancer risk?

A
  1. HPV vaccine
  2. pap smear/HPV testing
  3. smoking cessation
  4. counsel safe sex practices
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51
Q

pruritus is the most common complaint with what type of cancer

A

vulvar cancer

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52
Q

MC cell type of vulvar cancer

A

squamous

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53
Q

two main groups of female incontinence

A

stress UI
urgency UI

also mixed UI

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54
Q

your pt complains of involuntary loss of urine when they sneeze and also when they jump. what type of incontinence is this?

A

stress UI

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55
Q

pathophys of majority of urge urinary incontinence

A

idiopathic

56
Q

risk factors for stress incontinence

A 
obesity
childbirth
family history
age
previous pelvic surgery
57
Q

what are the two main categories of AUB?

A

anovulatory vs ovulatory

58
Q

MC secondary cause of amenorrhea

A

pregnancy

59
Q

primary amenorrhea is failure to menstruate by age ___ in presence of 2ndary sex characteristics OR by age ____ in absence of secondary sexual characteristics

A

15-16 in presence of 2ndary characteristics

OR

14 in absence of 2ndary characteristics

60
Q

4 main causes of primary amenorrhea

A
  1. chromosomal disorder
  2. mullerian genesis
  3. physiological delay
  4. PCOS
61
Q

secondary amenorrhea is defined as

A

cessation of regular menses for 3 cycles OR cessation of menses for 6 months

62
Q

if pt is post menopausal and has bleeding what TWO things must be done?

A

endometrial biopsy

pelvic US

63
Q

medical management for anovulatory AUB (3)

A
  1. OCPs
  2. medroxyprogesterone monthly
  3. levonorgesterel-releasing intrauterine system
64
Q

medical management ovulatory AUB (4)

A
  1. NSAIDs
  2. OCPs OR progesterone (oral or IUD)
  3. GnRH agonists
  4. tranexamic acid
65
Q

3 options for AUB for women who do NOT desire fertility

A
  1. endometrial ablation
  2. uterine artery embolization
  3. hysterectomy (definitive)
66
Q

three breast palpation techniques

A

circular
vertical strip
wedge

67
Q

limitations of mammograms

A

detects 85% of cancers, false positives

68
Q

what is the breast imaging reporting and database system called?

A

BI-RADS

0-5

69
Q

what can US differentiate between and who is it helpful in?

A

differentiate between solid mass and fluid filled cyst

helpful in younger women with denser breast tissue

70
Q

two categories of mastalgia

A

cyclic (typically bilateral) vs non-cyclic (unilateral, sharp)

71
Q

5 treatments for mastalgia

A
  1. supportive bra
  2. reduce or eliminate caffeine
  3. avoid sodium premenstrually
  4. NSAIDs
  5. evening primrose oil
72
Q

two categories of nipple discharge

A

pathologic: spontaneous, unilateral, bloody, associated with mass, often confined to one duct, age >40
physiologic: discharge only with compression, multiple duct involvement, often bilateral

73
Q

if you suspect physiologic nipple discharge, what is your work-up? (2)

A
  1. exclude coexisting abnormalities w exam and mammogram if women is > 35 yrs
  2. check prolactin level
74
Q

if pathologic discharge is suspected, what is your workup (2)

A
  1. diagnostic mammogram +/- US
  2. surgical referral for excision of duct

cytology is generally unhelpful

75
Q

intraductal papilloma – benign or malignant? discharge type? treatment?

A
  • benign
  • often bloody discharge
  • surgical excision
76
Q

ductal ectasia– benign or malignant? discharge type? treatment?

A
  • benign

- thick, stick discharge (often clear, brown, green), - warm compresses and abx can help

77
Q

breast abscess with often associated with what?

A

lactation

78
Q

bug MC responsible for non-lactating breast abscess

A

s. aureus

cellulitis can lead to abscess (needs I&D)

79
Q

what is the MC benign condition of the breast?

A

fibrocystic changes

80
Q

you get an FNA to eval fibrocystic changes. what would indicate you need to get a follow up biopsy?

A

need to exclude cancer if:

  1. no fluid or bloody fluid on aspiration
  2. mass persists after aspiration
81
Q

what med can be used for severe, persistent breast pain?

A

danazol

82
Q

if women >30 yrs with fibroadenoma, what do you need to consider as a ddx?

A

fibrocystic condition or malignancy

83
Q

age group that fibroadenoma is MC seen

A

teens to 30s

84
Q

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)?

A

1.monitor x 1-2 menstrual cycles
OR
2. aspirate

85
Q

your pt is less than 30, and she has a mass that persists or is suspicious. what should you start with?

A
  1. US

if negative –> observe 3-6 months
if suspicious –>consider diag mammo

86
Q

your pt is older than 30, and she has a mass. what do you do?

A

unilateral diag mammo & US (no reason to wait for imaging!)

if older than 40, and due for screening, can get bilateral

87
Q

what is the recommended for mammography screening?

A

ages 50-74, every 2 years (average risk)

Grade B

88
Q

for patients ages 40-49, what is the breast cancer screening recommendation?

A

case by case (grade C)

89
Q

describe early findings of breast cancer

A

single, NONTENDER, FIRM mass (often ill defined margins) or mammographic abnormality with no palpable masses

90
Q

MC anatomic quadrant for breast cancer

A

upper lateral

91
Q

do ER/PR receptor positive or negative tumors have a more favorable course?

A

receptor-positive!

92
Q

describe two features of HER-2+ tumors

A
  1. more aggressive

2. susceptible to certain targeted therapies

93
Q

breast cancer arises from what 2 tissues

A

ducts or lobules

94
Q

inflammatory breast cancer is often mistaken for what?

A

infection

95
Q

how is paget’s dz diagnosed?

A

skin biopsy of erosive area

96
Q

what percentage of breast cancers are d/t genetic mutations?

A

5-10%

97
Q

what is the goal of adjuvant chemo for breast cancer?

A

cure; eliminate micrometastases

98
Q

what is a BIG no no for contraception containing estrogen?

A

NEVER EVER give to a smoker aged 35 or older

99
Q

risk of death increases by how much for each additional week of pregnancy beyond 8 weeks

A

38%

100
Q

when would RhIG (rhogam) be given in terms of IAB care?

A

after, if patient is Rh negative

101
Q

what is the strongest risk factor for abortion-related mortality?

A

gestational age

102
Q

untreated chlamydia or gonorrhea may lead to what?

A

pelvic inflammatory disease (PID)

103
Q

what is the leading infectious cause of infertility in the US?

A

STIs

104
Q

1, 2, 3 NEW STIs in the US

A

HPV
chlamydia
trichomoniasis

105
Q

1, 2, 3 NEW and EXISTING STIs in the US

A

HPV
HSV-2
Trich

106
Q

5 Ps of sexual history

A

partners, practices, prevention of pregnancy, protection, past hx

107
Q

most common genital ulcer in US?

A

HSV

108
Q

what’s the big difference between herpes and primary syphillis

A

herpes is painful, syphilis is not

109
Q

describes HSV lesions

A

painful ulcers (usually multiple); small grouped ulcers/vesicles on erythematous base

110
Q

what are two benefits of treating herpes with antivirals?

A

reduce transmission and heal quicker

111
Q

3 main diagnostic features of chancroid

A
  1. painful soft ulcerations (typically one)
  2. painful lymph nodes (50%)
  3. foul smelling discharge from ulcer
112
Q

what causes chancroid? is it bacterial, fungal, or viral?

A

haemophilus ducreyi

bacteria

113
Q

what’s an important follow up for chancroid?

A

treat sexual partner

114
Q

what causes syphilis? is it bacterial, fungal, or viral?

A

treponema pallidum

bacterial

115
Q

describe primary syphilis lesion

A

chancre: painless ulcer; raised oval ulcer w indurated edges; usually lasts 3-6 weeks

116
Q

when is syphilis contagious?

A

when it’s primary or secondary

117
Q

specific feature of secondary syphilis

A

bilateral symmetrical papulosquamous rash; involvement of palms and soles is common

118
Q

what STI is known as the great imitator?

A

syphilis

119
Q

is serology usually reactive with latent syphilis?

A

yes, despite mostly ASX

120
Q

3 major features of tertiary syphillis

A

gumma (granulomas on skin)
neurosyphilis (HA, meningitis, etc)
CV (aortitis)

121
Q

tx for syphilis

A

penicillin G IM

122
Q

what does HPV cause (3)

A

warts
cervical dysplasia
cancer

123
Q

most patients with HPV are ASX but some have what type of lesion?

A

condylomata: papillomatous, white, cauliflower-like growth

124
Q

tx for high risk HPV types

A

colposcopy/bx; surgical excision

125
Q

MC reported STI in US

2nd MC reported?

A

1st: chlamydia trachomatis
2nd: neisseria gonorrhea

126
Q

who should be tested for chlamydia?

A
  1. women 24 and younger
  2. new sex partner in last 60 days
  3. > 2 sex partners in past year
  4. based on PEx
127
Q

5 chlamydia complications

A
  1. PID (40% in untreated females)
  2. infertility (20% of PID)
  3. ectopic pregnancy
  4. perihepatitis
  5. perinatal transmission
128
Q

test of choice for gonorrhea and chlamydia dx?

A

NAAT

129
Q

is granuloma inguinale painful or painless ulcer

A

painless

130
Q

what two STIs are often found together?

A

chlamydia and gonorrhea

131
Q

pathogens of PID

A

N. gonorrhea, c. trachomatis

others

132
Q

cervical motion tenderness suggests what?

A

PID

aka chandelier sign

133
Q

what is fitz hugh curtis syndrome?

A

RUQ pain d/t perihepatitis (liver capsule involvement)

134
Q

what is strawberry cervix associated with?

A

trichomonas vaginitis

135
Q

do you have to treat bacterial vaginosis?

A

nope, 1/3 NON preggers will resolve on their own

Women's Health (3 decks)

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