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CREOG Flashcards

1
Q

Teratogen: Valproic Acid

A

folate antagonist–> spina bifida (NTDs), craniofacial defects (cleft palate), heart defects (ASD); okay to take when breastfeeding

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2
Q

Teratogen: Warfarin

A

nasal hypoplasia, chondrodysplasia (Shortened limbs), micro-ophthalmia, IUGR

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3
Q

Teratogen: Methimazole

A

cutis aplasia (congenital skin defect), esophageal or choanal atresia

(Therefore avoid in first trimester!, PTU Phirst and Meth next!)

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4
Q

Luteoma

A

ovarian tumors during pregnancy, typically bilateral, some can secrete androgens, manage expectantly, if large >5cm surgery

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5
Q

Granulosa cell tumor

A

Typically present as large unilateral mass, produce estrogen–> AUB, PMB, precocious puberty; DO EMB, Markers: inhibin/AMH, Call Exner bodies (coffee-bean nuclei

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6
Q

Sertoli-Leydig

A

Often produce androgens and associated with virilizing symptoms: hirsuitism, amenorrhea, abdominal pain (mean size 16cm at presentation), AFP may be elevated

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7
Q

Dysgerminoma

A

Mostly in adolescents and women in 20s, elevated LDH, fried-egg cells, solid and can present bilaterally, commonly present with abdominal pain, fever, vaginal bleeding and even ascites

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8
Q

Yolk sac tumor

A

Elevated AFP, present with LARGE adnexal mass, aggressive tumors often with hemorrhage or necrosis and rapid growth; Schiller-Duval bodies

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9
Q

Fibromas

A

Most common type of sex cord stromal tumor, benign, unilateral, generally in postmenopausal women; think Meig’s syndrome: fibromas + ascites + pleural effusion

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10
Q

Mullerian Agenesis (MRKH syndrome)

A

Normal ovaries, absence of vagina, cervix and uterus, coexisting urinary tract anomalies in 1/3 of women

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11
Q

Trisomy 13

A

Patau Syndrome: midline defects, microcephaly, holoprosencephaly, umbilcial hernia, omphalocele, cutis aplasia, polydactyly, rocker bottom feet, cardiac/renal defects

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12
Q

Trisomy 18

A

Edward Syndrome: clenched hands with overlapping fingers, cardiac anomalies (VSD, ASD, PDA)

Quad screen: all decreased

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13
Q

Trisomy 21

A

Endocardial cushion defects, flat facial profile, epicanthic folds

Quad screen: High hcg and inhibin A, low uE3 and AFP

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14
Q

Factor V Leiden

A

Testing is reliable during pregnancy and acute thrombosis; but not with anti-coagulation

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15
Q

Prothrombin G20210A mutation

A

Testing is reliable during pregnancy, during acute thrombosis, and with anti-coagulation

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16
Q

Protein C Deficiency

A

Only reliable during pregnancy, test not reliable during acute thrombosis or with anticoagulation

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17
Q

Protein S Deficiency

A

Not reliable in pregnancy, during acute thrombosis or with anticoagulation

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18
Q

Antithrombin deficiency

A

Only reliable during pregnancy, test not reliable during acute thrombosis or with anticoagulation

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19
Q

Normal semen analysis

A

15 million spermatozoa/ml, 39 million spermatozoa per ejaculate, 32% progressive motility, 40% total motility, 4% normal morphology, 58% vitality and 1.5 mL ejaculate

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20
Q

Central precocious puberty

A

GnRH dependent, caused by early activation of HPO axis; diagnosis is made by measuring LH levels before/after GnRH stimulation (stimulated LH levels >5-8) is diagnostic, Tx: GnRH analog

21
Q

Peripheral precocious puberty

A

GnRH independent; caused by excess estrogen or androgen, exposure from gonadal, adnexal or external sources, LH levels are in pre-adolescent range and do not respond to stimulation with GnRH; US is indicated to look for ovarian cysts and tumors

22
Q

Lynch Syndrome

A

IHC testing for women with endometrial cancer who are younger than 60. Test endometrial tissue. If MLH1 protein absent then assess for MLH1 promoter methylation (if methylation is absent then next step is germline DNA testing) If methylation is present–> not LS

23
Q

Cowden Syndrome

A

Associated with PTEN overexpression, associated with breast cancer, thyroid cancer, endometrial cancer, colon cancer and benign mucocutaneous lesions

24
Q

Li-Fraumeni Syndrome

A

Associated with TP53 mutations, associated with high risk of soft tissue sarcomas, leukemia, adrenocortical cancer, breast cancer and brain cancer

25
Puetz-Jeghers Syndrome
STK11 gene mutations; hamartomatous polyps throughout GI tract, mucocutaneous hyperpigmentation of the mouth, lips, eyes, nose and genitalia; increased risk of breast, ovarian, uterine, pancreatic, lungs, stomach,, colon and ovarian sex cord tumors
26
Vulvar Cancer Staging: I
Stage I: confined to vulvar/perineum IA: lesion 2cm or less and with stromal invasion of 1 mm or less IB: lesion more than 2 cm or any size with stromal invasion of more than 1 mm
27
Vulvar Cancer Staging: II
Tumor of any size with extension to adjacent perineal structures (distal third of urethra, distal third of vagina, anal involvement)
28
Vulvar Cancer Staging: III
IIIA: 1 or 2 LN each less than 5 mm; one lump node met grater than or equal to 5mm IIIB: 3 or more LN each less than 5mm or two ore more LN > or equal to 5mm IIIC: positive inguinal lymph nodes
29
Vulvar Cancer Staging: IV
IVA: extension to proximal 2/3 of urethra, proximal 2/3 of vagina, bladder mucosa or rectal mucosa IVB: + pelvic LN
30
Endometrial Cancer Staging: I
IA: limited to endometrium or less than half of myometrium IB: one half or more of myometrium
31
Endometrial Cancer Staging: II
Invades stromal connective tissue of cervix, NO endocervical glandular involvement
32
Endometrial Cancer Staging: IIIA and IIIB
IIIA: involves serosa and/or adnexa IIIB: vaginal or parametrial involvement
33
Endometrial Cancer Staging: IIIC
Lymph node mets IIIC1: involves pelvic lymph nodes, IIIC2: involves para-aortic lymph nodes (with or without positive pelvic lymph nodes)
34
Cervical Cancer Staging: IA
IA1: stromal invasion 3mm or less IA2: stromal invasion greater than 3mm and less than or equal to 5mm
35
Cervical Cancer Staging: IB
IB1: invasive carcinoma > 5mm depth of stromal invasion and 2cm or less IB2: >2cm and less than or equal to 4cm IB3: >4cm
36
Cervical Cancer Staging: II
IIA: Involves 2/3 of vagina IIA1: less than or equal to 4cm IIA2: >4cm IIB: with parametrial involvement
37
Cervical Cancer Staging: III
IIIA: involves lower 1/3 of vagina IIIB: extension to pelvic wall IIIC1: Pelvic LN IIIC2: Para-aortic LN
38
Cervical Cancer Staging: IV
IVA: spread to adjacent pelvic organs IVB: spread to distant organs
39
Ovarian Cancer Staging: I
IA: limited to one ovary or tube IB: both ovaries or tubes IC3: malignant cells in ascites or peritoneal washings
40
Ovarian Cancer Staging: II
IIA: extension/implants on uterus IIB: extension/implants on other pelvic tissues
41
Ovarian Cancer Staging: III
IIIA1: + retroperitoneal lymph nodes IIIA2: microscopic extrapelvic (above the pelvic brim) peritoneal involvement
42
Ovarian Cancer Staging: IV
IVA: pleural effusion w/ positive cytology IVB: liver or splenic mets, transmural involvement of intestine, inguinal LN and LN outside the abdominal cavity
43
Relative contraindications to MTX
Adnexal mass >4cm in diameter, + fetal cardiac activity, bhcg of 6000-15000
44
When to screen for bone density before age 65
history of a fragility fracture, body weight <127lbs, medical causes of bone loss, parental medical hx of hip fracture, current smoker, alcoholism, RA
45
When to FRAX
In women <65. Those with FRAX 10-year risk of major osteoporotic fracture of 9.3%--> do DEXA
46
Clinical factors of FRAX
age, sex, bmi, previous fragility fracture, parental hip fracture, current smoking status, steroid use, etoh intake >3 drinks, RA and other secondary causes of osteoporosis
47
When to start treatment for osteoporosis?
When there is a 3% risk of hip fracture or a 20% risk of a major osteoporotic fracture
48
Raloxifene
Better suited for younger postmenopausal woman with osteoporosis who is at low risk of hip fracture and stroke by virtue of her age and who is often concerned about breast cancer and osteoporosis
49
Diagnosing gestational diabetes
1-hr 50g glucose load, >130 is abnormal. Then move to 3-hr 1000g glucose load: normal is fasting <95, 1-hour <180, 2-hour <155 and 3-hour <140.

CREOGS (1 decks)

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