Female Reproductive System and Breast I Flashcards
Acute mastitis is due to bacterial infection of the breast, most commonly with […].
Acute mastitis is due to bacterial infection of the breast, most commonly with Staphylococcus aureus.
Adenomyosis typically causes dysmenorrhea and heavy menstrual bleeding in multiparous women > […] years of age.
Adenomyosis typically causes dysmenorrhea and heavy menstrual bleeding in multiparous women > 40 years of age.
new-onset dysmenorrhea in later reproductive years is classic
Adolescents with irregular menstrual bleeding due to anovulatory cycles may benefit from […] therapy.
Adolescents with irregular menstrual bleeding due to anovulatory cycles may benefit from progesterone therapy.
progesterone, which is normally secreted by the corpus luteum during ovulatory cycles, causes differentiation of the proliferative endometrium into secretory endometrium; withdrawal causes menstruation
An intrauterine pregnancy is typically seen on TVUS with beta-hCG levels > […] IU/L.
An intrauterine pregnancy is typically seen on TVUS with beta-hCG levels > 1500-2000 IU/L.
Androgen insensitivity syndrome is characterized by an absent uterus, cervix, and upper vagina due to normal production of […].
Androgen insensitivity syndrome is characterized by an absent uterus, cervix, and upper vagina due to normal production of anti-Mullerian hormone.
normal lower vagina because the fetal urogenital sinus defaults into external female genitalia due to a mutated androgen receptor
Androgen insensitivity syndrome is characterized by […] breast development.
Androgen insensitivity syndrome is characterized by normal breast development.
due to conversion of testosterone to estrogen
Antibiotic therapy for hospitalized patients with pelvic inflammatory disease includes IV […] or […] plus oral doxycycline.
Antibiotic therapy for hospitalized patients with pelvic inflammatory disease includes IV cefoxitin or cefotetan plus oral doxycycline.
an alternative broad-spectrum antibiotic regimen is IV clindamycin plus gentamicin; metronidazole is added when PID is complicated by tubo-ovarian abscess
Aromatase deficiency is associated with […] ovaries on ultrasound due to high concentrations of gonadotropins.
Aromatase deficiency is associated with polycystic ovaries on ultrasound due to high concentrations of gonadotropins.
Biopsy of breast tissue with fat necrosis typically reveals calcifications, foamy macrophages, and […].
Biopsy of breast tissue with fat necrosis typically reveals calcifications, foamy macrophages, and fat globules.
the presence of calcifications on mammography and a fixed mass on physical exam can mimic breast cancer
BRCA mutations result in significantly increased risk of […] and […] cancer.
BRCA mutations result in significantly increased risk of breast and ovarian cancer.
BRCA-positive individuals are recommended to have a […] to decrease incidence of ovarian cancer.
BRCA-positive individuals are recommended to have a prophylactic bilateral salpingo-oophorectomy to decrease incidence of ovarian cancer.
recommended as soon as childbearing is complete; may cause side effects from surgical menopause
Candida vaginitis is more common in patients with recent […] or […] use.
Candida vaginitis is more common in patients with recent corticosteroid or antibiotic use.
other risk factors include pregnancy and diabetes mellitus
Choriocarcinoma is a tumor with early, diffuse hematogenous spread, especially to the […].
Choriocarcinoma is a tumor with early, diffuse hematogenous spread, especially to the lungs.
presents as hemoptysis, shortness of breath, and/or chest pain; other common sites of metastasis include the vagina and brain
Common side effects of the injectable medroxyprogesterone contraceptive are vaginal bleeding/spotting and weight […].
Common side effects of the injectable medroxyprogesterone contraceptive are vaginal bleeding/spotting and weight gain.
Condylomata acuminata (genital warts) is associated with HPV strains […] and […].
Condylomata acuminata (genital warts) is associated with HPV strains 6 and 11.
Congenital aromatase deficiency in newborn females is characterized by […] internal genitalia and […] external genitalia.
Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
due to high levels of gestational androgens
Congenital […] deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
due to high levels of gestational androgens
Congenital aromatase deficiency in newborn females is characterized by […] internal genitalia and […] external genitalia.
Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
due to high levels of gestational androgens
Congenital […] deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.
due to high levels of gestational androgens
Daughters of women exposed to […] during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.
Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.
additionally, daughters and sons with in-utero exposure are at risk for genital tract anomalies
Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing […] of the vagina and cervix.
Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.
additionally, daughters and sons with in-utero exposure are at risk for genital tract anomalies
Does lichen sclerosus cause an increased risk for squamous cell carcinoma?
Yes, slightly increased risk.
During the luteal phase of menstruation, cervical mucus becomes more […] and less penetrable by sperm.
During the luteal phase of menstruation, cervical mucus becomes more thick (less watery) and less penetrable by sperm.
Empiric treatment for endometriosis consists of […] and/or […].
Empiric treatment for endometriosis consists of NSAIDs and/or OCPs.
laparoscopy is reserved for treatment failure, adnexal mass, or infertility
Evaluation of atypical glandular cells on Pap test in women > 35 years old includes colposcopy, […], and endometrial biopsy.
Evaluation of atypical glandular cells on Pap test in women > 35 years old includes colposcopy, endocervical curettage, and endometrial biopsy.
Evaluation of atypical glandular cells on Pap test in women > 35 years old includes colposcopy, endocervical curettage, and […].
Evaluation of atypical glandular cells on Pap test in women > 35 years old includes colposcopy, endocervical curettage, and endometrial biopsy.
Hormone replacement therapy is only indicated for the treatment of […] in women age < 60 who have undergone menopause within the past 10 years.
Hormone replacement therapy is only indicated for the treatment of vasomotor symptoms in women age < 60 who have undergone menopause within the past 10 years.
e.g. hot flashes, sleep disturbances; not indicated for chronic disease prevention (e.g. osteoporosis, coronary heart disease)
How can hypothyroidism lead to hyperprolactinemia?
Stimulation of prolactin secretion by TRH (thyrotropin-releasing hormone).
TRH is released in response to hypothyroidism.
How does bone density change in patients with hypothalamic amenorrhea?
Decreased (e.g. osteopenia)
due to estrogen deficiency secondary to loss of pulsatile GnRH secretion
If a patient has a history of CIN 2 or higher, Pap testing should continue for another […] years after detection.
If a patient has a history of CIN 2 or higher, Pap testing should continue for another 20 years after detection.
Indications for endometrial biopsy include abnormal uterine bleeding in women age
Indications for endometrial biopsy include abnormal uterine bleeding in women age obesity and/or anovulation.
due to increased risk for endometrial hyperplasia/cancer from unopposed estrogen; other indications in women < 45 include Lynch syndrome and failed medical management
Indications for endometrial biopsy include abnormal uterine or postmenopausal bleeding in women age > […].
Indications for endometrial biopsy include abnormal uterine or postmenopausal bleeding in women age > 45.
Infertility in patients age < 35 is defined as the failure to achieve pregnancy after […] of regular, unprotected sexual intercourse.
Infertility in patients age < 35 is defined as the failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse.
for women age > 35, infertility evaluation can begin after 6 months
Infertility in patients age > 35 is defined as the failure to achieve pregnancy after […] of regular, unprotected sexual intercourse.
Infertility in patients age > 35 is defined as the failure to achieve pregnancy after 6 months of regular, unprotected sexual intercourse.
for women age
Is weight gain an adverse effect associated with oral contraceptive pills?
No
adverse effects include breakthrough bleeding (most common), worsening of hypertension, increased risk of cervical cancer, and increased risk of venous thromboembolism
Just prior to ovulation, cervical mucus increases in quantity and becomes more […] and penetrable by sperm.
Just prior to ovulation, cervical mucus increases in quantity and becomes more watery and penetrable by sperm.
this change corresponds with the LH surge
Just prior to […], cervical mucus increases in quantity and becomes more watery and penetrable by sperm.
Just prior to ovulation, cervical mucus increases in quantity and becomes more watery and penetrable by sperm.
this change corresponds with the LH surge
Lack of menses is considered normal at age
Lack of menses is considered normal at age 15 if development of secondary sex characteristics has been appropriate.
typically occurs around Tanner stage 4
Lactational amenorrhea occurs due to high levels of […], which has an inhibitory effect on the production of GnRH.
Lactational amenorrhea occurs due to high levels of prolactin, which has an inhibitory effect on the production of GnRH.
thus LH and FSH production is also suppressed and ovulation does not occur
Lactational amenorrhea occurs due to high levels of prolactin, which has an inhibitory effect on the production of […].
Lactational amenorrhea occurs due to high levels of prolactin, which has an inhibitory effect on the production of GnRH.
thus LH and FSH production is also suppressed and ovulation does not occur
Lichen simplex chronicus presents as leukoplakia with […] vulvar skin.
Lichen simplex chronicus presents as leukoplakia with thick, leathery vulvar skin.
versus the “paper thin” skin of lichen sclerosus
Mammary Paget’s disease is typically associated with an underlying […].
Mammary Paget’s disease is typically associated with an underlying adenocarcinoma (e.g. DCIS).
Menopausal women with vasomotor symptoms and contraindications to HRT are typically managed with non-hormonal therapy, such as […].
Menopausal women with vasomotor symptoms and contraindications to HRT are typically managed with non-hormonal therapy, such as SSRIs.
contraindications include history of coronary heart disease, thromboembolism, TIA/stroke, breast cancer, or endometrial cancer
Menopause before age 40 suggests […] insufficiency.
Menopause before age 40 suggests primary ovarian insufficiency.
also known as premature ovarian failure or hypergonadotropic hypogonadism; more common in women who smoke or those receiving chemotherapy/radiation
Methods for lactation suppression include a supportive bra, avoidance of nipple stimulation, application of ice packs to the breast, and administration of […].
Methods for lactation suppression include a supportive bra, avoidance of nipple stimulation, application of ice packs to the breast, and administration of NSAIDs.
NSAIDs are used to reduce pain and inflammation; medications are not recommended to suppress lactation (e.g. dopamine agonists)
Most current guidelines suggest routine screening mammography every two years beginning at age > […].
Most current guidelines suggest routine screening mammography every two years beginning at age > 50.
increased risk of cancer with increased age
Most current guidelines suggest routine screening mammography every […] years beginning at age > 50.
Most current guidelines suggest routine screening mammography every two years beginning at age > 50.
increased risk of cancer with increased age
Normal postvoid residual volume in women is
Normal postvoid residual volume in women is 150 mL.
< 50 mL in men; high PVR may be seen with overflow incontinence
One risk factor for endometrial cancer is […] due to increased peripheral conversion of androgens into estrone.
One risk factor for endometrial cancer is obesity due to increased peripheral conversion of androgens into estrone.
Oral contraceptives are associated with a […]-coagulable state.
Oral contraceptives are associated with a hyper-coagulable state.
thus should not be used in women age > 35 that use tobacco due to risk of myocardial infarction and stroke
Oral contraceptives are associated with decreased risk for […] and […] cancer.
Oral contraceptives are associated with decreased risk for ovarian and endometrial cancer.
due to chronic suppression of ovulation and suppressed endometrial proliferation, respectively
Oral contraceptives are associated with […] (blood pressure).
Oral contraceptives are associated with hypertension (blood pressure).
due to increased angiotensinogen synthesis by estrogen during first-pass metabolism; discontinuing use can correct the hypertension in most patients
Outpatient antibiotic therapy for patients with pelvic inflammatory disease includes IM […] plus oral […].
Outpatient antibiotic therapy for patients with pelvic inflammatory disease includes IM ceftriaxone plus oral doxycycline.
Ovarian cyst rupture is commonly precipitated by strenuous activity or […].
Ovarian cyst rupture is commonly precipitated by strenuous activity or sexual intercourse.
Pap smears with HPV co-testing are repeated every […] years beginning at age […].
Pap smears with HPV co-testing are repeated every 5 years beginning at age 30.
Pap smears without HPV co-testing are repeated every […] years beginning at age […].
Pap smears without HPV co-testing are repeated every 3 years beginning at age 21.
begin at age 21 regardless of age of onset of sexual activity in immunocompetent patients; at age 30, Pap tests with HPV co-testing may be done at repeated every 5 years if negative
Pap testing may be discontinued in patients age > 65 with no history of CIN 2 or higher and […] consective negative Pap tests or […] consecutive negative co-testing results.
Pap testing may be discontinued in patients age > 65 with no history of CIN 2 or higher and 3 consective negative Pap tests or 2 consecutive negative co-testing results.
patients with cervical cancer risk factors (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing
Pap testing may be discontinued in patients age > […] with no history of CIN 2 or higher and 3 consective negative Pap tests or 2 consecutive negative co-testing results.
Pap testing may be discontinued in patients age > 65 with no history of CIN 2 or higher and 3 consective negative Pap tests or 2 consecutive negative co-testing results.
patients with cervical cancer risk factors (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing
Patients with PCOS may have […] due to anovulation from failed follicular maturation.
Patients with PCOS may have infertility due to anovulation from failed follicular maturation.
due to imbalance of LH and FSH hormone levels
Patients with polycystic ovarian syndrome have increased risk of […] carcinoma.
Patients with polycystic ovarian syndrome have increased risk of endometrial carcinoma.
due to unregulated endometrial proliferation from unopposed estrogen stimulation
Patients with suspected premenstrual syndrome (PMS) should record a […] to aid in diagnosis.
Patients with suspected premenstrual syndrome (PMS) should record a symptom/menstrual diary to aid in diagnosis.
symptoms typically occur 1-2 weeks before menses (luteal phase) and resolve after menses (follicular phase)
Placental […] deficiency can present with maternal virilization during pregnancy.
Placental aromatase deficiency can present with maternal virilization during pregnancy.
fetal androgens can cross the placenta
Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo […] prior to surgical exploration.
Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo further imaging (e.g. CT, MRI) prior to surgical exploration.
helps assess for the presence of metastatic disease which can guide surgical exploration
Potential complications of cervical conization include cervical […], cervical incontinence, and preterm delivery.
Potential complications of cervical conization include cervical stenosis, cervical incontinence, and preterm delivery.
Potential complications of cervical conization include cervical stenosis, cervical incontinence, and […] delivery.
Potential complications of cervical conization include cervical stenosis, cervical incontinence, and preterm delivery.
Premature ovarian failure is characterized by […] FSH and LH levels.
Premature ovarian failure is characterized by increased FSH and LH levels.
due to lack of feedback inhibition from estrogen
Primary genital herpes is associated with high risk for recurrence, with […] frequent recurrences over time in immunocompetent individuals.
Primary genital herpes is associated with high risk for recurrence, with less frequent recurrences over time in immunocompetent individuals.
treatment with antiviral medications (e.g. acyclovir) can speed resolution of outbreaks and decrease recurrences
Progestin-containing IUDs work by […] cervical mucus and impairing implantation.
Progestin-containing IUDs work by thickening cervical mucus and impairing implantation.
Raloxifene is a SERM that acts as an estrogen receptor […] in breast and […] in endometrium.
Raloxifene is a SERM that acts as an estrogen receptor antagonist in breast and antagonist in endometrium.
also has agonist activity in bone, which helps prevent osteoporosis without increasing risk of endometrial cancer (versus tamoxifen)
Recurrent vulvovaginal candidiasis in a patient warrants evaluation for underlying […].
Recurrent vulvovaginal candidiasis in a patient warrants evaluation for underlying diabetes mellitus.
Risk factors for cervical cancer include early onset of sexual activity, high-risk HPV infection, immunosuppression, and […] use.
Risk factors for cervical cancer include early onset of sexual activity, high-risk HPV infection, immunosuppression, and tobacco use.
Selective estrogen receptor modulators increase the risk for venous thromboembolism by increasing […] resistance.
Selective estrogen receptor modulators increase the risk for venous thromboembolism by increasing protein C resistance.
due to estrogen agonist activity
Stress urinary incontinence is often associated with urethral […]-mobility.
Stress urinary incontinence is often associated with urethral hyper-mobility.
characterized by urethral angle of > 30 degrees from horizontal with an increase in abdominal pressure (Q-tip test); SUI may also be caused by decreased urethral sphincter tone
Tamoxifen is a selective estrogen receptor modulator associated with increased risk of […] hyperplasia/cancer.
Tamoxifen is a selective estrogen receptor modulator associated with increased risk of endometrial hyperplasia/cancer.
due to estrogen agonist activity in endometrial tissue
Tamoxifen is a SERM that acts as an estrogen receptor […] in breast and […] in endometrium.
Tamoxifen is a SERM that acts as an estrogen receptor antagonist in breast and agonist in endometrium.
also has agonist activity in bone which helps prevent osteoporosis, though not used for osteoporosis due to risk of endometrial cancer (versus raloxifene)
The “three D’s” of endometriosis are […], deep dyspareunia, and dyschezia.
The “three D’s” of endometriosis are dysmenorrhea, deep dyspareunia, and dyschezia.
other possible symptoms include chronic pelvic pain and infertility (resection of endometriosis improves conception rates)
The “three D’s” of endometriosis are dysmenorrhea, […], and dyschezia.
The “three D’s” of endometriosis are dysmenorrhea, deep dyspareunia, and dyschezia.
other possible symptoms include chronic pelvic pain and infertility (resection of endometriosis improves conception rates)
