FARR Gynecology Flashcards
The first test to perform when a woman presents with amenorrhea.
β-hCG; the most common cause of amenorrhea is pregnancy.
Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia.
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.
Asherman’s syndrome.
Therapy for polycystic ovarian syndrome.
Weight loss and OCPs.
Medication used to induce ovulation.
Clomiphene citrate.
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy.
Indications for medical treatment of ectopic pregnancy.
Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation.
Medical options for endometriosis.
OCPs, danazol, GnRH agonists.
Laparoscopic findings in endometriosis.
“Chocolate cysts,” powder burns.
The most common location for an ectopic pregnancy
Ampulla of the oviduct.
How to diagnose and follow a leiomyoma.
Ultrasound.
Natural history of a leiomyoma.
Regresses after menopause.
A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis.
Treatment for bacterial vaginosis.
Oral or topical metronidazole.
The most common cause of bloody nipple discharge.
Intraductal papilloma.
Contraceptive methods that protect against PID.
OCPs and barrier contraception.
Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor–
A patient presents with recent PID with RUQ pain
Consider Fitz-Hugh–Curtis syndrome.
Breast malignancy presenting as itching, burning, and erosion of the nipple.
Paget’s disease.
Annual screening for women with a strong family history of ovarian cancer.
CA-125 and transvaginal ultrasound.
A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?
Kegel exercises, estrogen, pessaries for stress incontinence.
A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?
Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.
Lab values suggestive of menopause.
↑ serum FSH.
The most common cause of female infertility.
Endometriosis.
Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?
Colposcopy and endocervical curettage.
Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.
Lobular carcinoma in situ
HRT has been shown to
↑ cardiovascular morbidity and mortality and may ↑ the incidence of breast and endometrial cancers. For this reason, clinicians should thoroughly review the risks and benefits of HRT before initiating treatment.
Contraindications to HRT include
vaginal bleeding, suspected or known breast cancer, endometrial cancer, and a history of throm- boembolism, chronic liver disease, or hypertriglyceridemia.
Non-HRT:
Venlafaxine and, less commonly, clonidine can be given to ↓ the frequency of hot flashes.
Secondary Dysmenorrhea DIAGNOSIS
I First step: Obtain a β-hCG to exclude ectopic pregnancy. I Second step: Order the following:
I A CBC with differential to rule out infection or neoplasm. I UA to rule out UTI.
I Gonococcal/chlamydial swabs to rule out STDs/PID.
I Stool guaiac to rule out GI pathology.
I Third step: Look for pelvic pathology causing pain (see Table 2.12-4).
Abnormal Uterine Bleeding AUD DIAGNOSIS
I First step: Obtain a β-hCG to rule out ectopic pregnancy. I Second step: Order a CBC to rule out anemia.
I Third step:
I Pap smear to rule out cervical cancer (which can present with bleed-
ing).
I TFTs to rule out hyper-/hypothyroidism and hyperprolactinemia.
I Obtain platelet count, bleeding time, and PT/PTT to rule out von
Willebrand’s disease and factor XI deficiency.
I Order an ultrasound to evaluate the ovaries, uterus, and endometrium.
Look for uterine masses, polycystic ovaries, and thickness of the endo-
metrium.
I If the endometrium is ≥ 4 mm in a postmenopausal woman, obtain
an endometrial biopsy. An endometrial biopsy should also be obtained if the patient is > 35 years of age, obese (BMI > 35), and diabetic.
PCOS
HISTORY/PE
I High BP.
I BMI > 30 (obesity).
I Stigmata of hyperandrogenism or insulin resistance (menstrual cycle dis-
turbances, hirsutism, obesity, acne, androgenic alopecia, acanthosis nigri-
cans).
Women with PCOS are also at ↑ risk for the following:
I Type 2 DM
I Insulin resistance
I Infertility
I Metabolic syndrome—insulin resistance, obesity, atherogenic dyslipidemia, and hypertension
PCOS Women who are not attempting to conceive:
Treat with a combination of OCPs, progestin, and metformin (or other insulin-sensitizing agents).
PCOS Women who are attempting to conceive:
Clomiphene +/− metformin is first-line treatment for ovulatory stimulation.
PCOS Symptom-specific treatment:
I Hirsutism: Combination OCPs are first line; antiandrogens
(spironolactone, finasteride) and metformin may also be used.
I Cardiovascular risk factors and lipid levels: Diet, weight loss, and ex-
ercise plus potentially lipid-controlling medication (e.g., statins).
Acute causes of pelvic pain—
A ROPE
Appendicitis
Ruptured ovarian cyst Ovarian torsion/abscess PID
Ectopic pregnancy
Toxic Shock Syndrome (TSS)
Caused by preformed S. aureus toxin (TSST-1); often occurs within five days of the onset of a menstrual period in women who have used tampons. The in- cidence in menstruating women is now 6–7:100,000 annually. Nonmenstrual cases are nearly as common as menstrual cases.
TSS HISTORY/PE
I Presents with abrupt onset of fever, vomiting, and watery diarrhea, with fever 38.9°C (102°F) or higher.
I A diffuse macular erythematous rash is also seen.
I Nonpurulent conjunctivitis is common.
I Desquamation, especially of the palms and soles, generally occurs dur-
ing recovery within 1–2 weeks of illness.
Fibroid Pharmacologic treatment:
I NSAIDs.
I Combined hormonal contraception.
I Medroxyprogesterone acetate or danazol to slow or stop bleeding.
I GnRH analogs (leuprolide or nafarelin) to ↓ the size of myomas, sup-
press further growth, and ↓ surrounding vascularity. Also used prior
to surgery.
HPV DNA is found in 99.7% of all cervical carcinomas.
HPV 16 is the most prevalent type in squamous cell carcinoma; HPV 18 is most preva- lent in adenocarcinoma.
Premenopausal women: ↑ CA-125 may point to
benign disease such
as endometriosis.
Postmenopausal women: ↑ CA-125 (> 35 units)
indicates an ↑ likeli-
hood that the ovarian tumor is malignant.
Causes of urinary incontinence without specific urogenital pathology—
DIAPPERS Delirium/confusional state Infection Atrophic urethritis/ vaginitis Pharmaceutical Psychiatric causes (especially depression) Excessive urinary output (hyperglycemia, hypercalcemia, CHF) Restricted mobility Stool impaction
Fibroadenoma
A benign, slow-growing breast tumor with epithelial and stromal components. The most common breast lesion in women < 30 years of age. Cystosarcoma phyllodes is a large fibroadenoma.
