Female Reproductive System and Breast Flashcards
Lab confirmation of premature ovarian failure.
less than 40years with amenorhea for >3mo and elevated FSH levels
describe HELLP
severe HTN + proteinuria + labs
systemic inflammation and activation of coag systme and complement cascade. platelets consumed and MAHA –> hepatocellular necrosis
Acute abdominal/pelvic pain in women:
recurrent mild and unilateral mid-cycle pain prior to ovulation. pain lasts hours to days.
dx and U/s findings
mittelschmertz
no u/s findings
Acute abdominal/pelvic pain in women:
amenorrhea, abd/pelvic pain and vaginal bleeding. psotive beta-hCG
dx and U/s findings
ectopic pregnancy
no intrauterine pregnancy seen
Acute abdominal/pelvic pain in women:
sudden onset, severe, u/l lower abd pain; N/V.
u/l tender adnexal mass on exam
dx and U/s findings
ovarian torsion
enlarged ovary with decreased or absent blood flow
Acute abdominal/pelvic pain in women:
sudden onset, severe, u/l lower abd pain immediately following strenuous or sexual activity
dx and U/s findings
ruptured ovarian cyst
pelvic free fluid
Acute abdominal/pelvic pain in women:
fever, chills, vaginal discharge, lower abd pain and cervical motion tenderness
dx and U/s findings
PID
+/- tubo-ovarian abscess
HPI: intense pruritis, dyspareunia, pain with defecation
PE: pale thin tissue and perianal thickening with fissures, spares vagina
lichen sclerosus - vulvar premalignant lesion
possible lichen sclerosus dx - then what?
vulvar punch bx for definitive dx of vulvar SqCCa
HPI: vulvovaginal dryness
PE: decreased vaginal diameter, loss of vaginal elasticity/rugae, thinning vulvar skin/loss of minora
atrophic vaginitis
tx of lichen sclorosis v. atrophic vaginitis
lichen - high potency topical steroids
atrophic - low dose topical estrogen
Acute: SOB, obstipation/constipation with vomiting, abd distension
Subacute: pelvic/abd pain, loating, early satiety
epithelial ovarian Carcinoma
Tx of chlamydia +/- gonorrhea
Tx for PID
Empiric: azithro + ceftriaxone
Confirmed chlamydia: azithro
Confirmed gonorrhea: azithro + ceftriaxone
PID: ceftriaxone and doxycycline
four non-modifiable risk factors for breast cancer
- age
- genetics or first degree relative with breast cancer
- white race
- early menarche or later menopause
soft, mobile nontender cystic mass usually asx , found at 4 or 8 o’clock position at base of labium majora
dx
tx
bartholin duct cyst
tx: asx - no intervention
sx - i/d
name two competitive inhibitors of E binding.
Indications for each
AE for both
Tamoxifen - breast cancer treatment
Raloxifene - postmenopausal osteoporosis
AE - hot flashes, venous thormboembolism, endometrial hyperplasia and carcinoma (tamoxifen)
complications of PID (four)
tuboovarian abscess
perihepatitis
ectopic pregnancy
infertility
Absolute CI to combined hormonal contraceptives
Migraine WITH aura BP >160/100 >15 cigs/day and >35y Hx of VTE Hx of stroke or ischemic heart disease Breast cancer Cirrhosis, liver cancer maojor surgery with prolonged immobilization <3wks postpartum
best emergency contraception option for 0-120 hours
copper IUD
Definition of infertility on <35 v >/=35
<35 is 12mo
>/=35 is 6mo
U/S findings of hyperechoic nodules and calcifications in a premenopausal women with adnexal fullness on PE and otherwise asx.
dermoid cyst (mature cystic teratoma) B9 germ cell tumor.
modifiable breast cancer risk factors (4)
alcohol
HRT
nulliparity
increased age at first brith
FSH in menopause
increased
T and E levels in PCOS
increased
SOB, obstipation/constipation, vomiting, abd distention. askx adnexal mass
CA-125 incr
Epithelial ovarian Ca
Multiparous >40y, dysmenorrhea, heavy menstrual bleeding. progression to chronic pelvic pain.
PE: boggy, tender, uniformly enlarged uterus
adenomyosis
tx of endometriosis
NSAIDs +/- OCPs
or
Laparoscopy
At what age is optimal fertility?
18y
normal internal genetalia, ambiguous external/virilizaiton (clitoromegaly), undetectable serum estrogen levels
Dx
congenital aromatase deficiency
HPI: postmenopausal bleeding
Imaging: U/S = thickened endometrium
Dx and path:
Dx: granulosa cell tumor of the ovary
path: estrogen secreting = endometrial hyperplasia or carcinoma, which causes postmeno bleeding
tx for pts who desire lactation suppression
ice packs and ANALGESICs
PCOS who wants to have children.
weight loss first, then if unsuccessful –> clomiphene citrate to induce ovulation
