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Step 2 CK: Obstetrics & Gynecology > Female Reproductive System & Breast > Flashcards

Female Reproductive System & Breast Flashcards

1
Q

Diagnosis:

bilateral breast tenderness and swelling 24-72 hours post partum

A

Most likely: Breast engorgement

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2
Q

Treatment:

Breast engorgement

A

Nothing, breast engorgement typically resolves spontaneously.

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3
Q

What is the peak onset for breast engorgment?

A

3-5 days after delivery

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4
Q

Mechanism of Action:

Raloxifene

A
  1. Estrogen receptor ANTAGONISTin (1) breast & (2) vaginal tissue
  2. Estrogen receptor AGONIST in bone tissue

Raloxifene is a selective estrogen receptor modulator (SERM) and has mixed activity at the estrogen receptor.

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5
Q

Function:

Raloxifene

A

SERM used as first line therapy to prevent osteoporosis

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6
Q

What are the risks associated with raloxifene?

I. Increased risks
II. Decreased risks

A

I. Increased risk of thromboembolism

II. Decreased risk of breast cancer.

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7
Q

Diagnosis:

  1. skin or nipple retraction
  2. calcifications on mammography
A

This could be either (1) fat necrosis or (2) breast cancer. Be careful diagnosing!

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8
Q

Diagnosis:

Biopsy reveals fat globules and foamy histiocytes in a woman with nipple retraction and calcifications on mammography.

A

Fat necrosis

Note, fat necrosis looks similar to breast cancer on physical examination and mammography. Differentiate between the two by performing a biopsy.

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9
Q

Treatment:

Fat necrosis of the breast tissue

A

none

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10
Q

Diagnosis:

  1. Erythematous and edematous cutaneous plaque overlaying breast mass
  2. axillary lymphadenopathy
A

Inflammatory breast cancer

Note, inflammatory breast cancer is very rare!

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11
Q

Prognosis:

Inflammatory breast cancer

A

Poor prognosis! 25% of patients with inflammatory breast cancer will have metastatic disease at the time of presentation.

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12
Q

What is the work up for an asymptomatic women with a pelvic mass?

A
  1. Transvaginal ultrasonography

2. Cancer antigen (CA)-125 level

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13
Q

You have a post-menopausal patient with an elevated CA-125 level. What if any are your concerns?

A

You are concerned about ovarian cancer

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14
Q

When can asymptomatic pelvic masses be followed conservatively?

A
  1. US suggests a simple cyst
  2. CA-125 level is not elevated
  3. Mass is
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15
Q

How do you manage the finding of “atypical squamous cells in the following patients:

I. Women age 21-24
II. Women age >/= 25 yo
III. Women age >/= 25 yo who test positive for HPV
IV. Women age >/=25 yo who test negative for HPV

A

I. repeat cytology in 1 year
II. Human papillomavirus (HPV) DNA test
III. Colposcopy
IV. repeat Pap smear PLUS HPV test in 3 years

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16
Q

What is the most common pelvic tumor found in women?

A

uterine leiomyomas (fibroids)

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17
Q

Diagnosis:

Pelvic mass w/

  1. Constipation
  2. Urinary frequency
  3. Heavy, prolonged menstrual bleeding
A

Uterine leiomyoma (fibroid)

Note, fibroids do not typically present with bleeding between cycles or postmenopausal bleeding.

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18
Q

How can you identify structural abnormalities in the uterus or fallopian tubes or a patient with suspected infertility?

A

Hysterosalpingogram

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19
Q

Treatment:

HER2 positive breast cancer

A
  1. Trastuzumab
  2. Anthracycline chemotherapy

HER2 oncogene positivity predicts increased susceptibility of breast cancer to the above medications.

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20
Q

When do you perform an endometrial biopsy on a patient with abnormal uterine bleeding (AUB)?

A
  1. All postmenopausal women with AUB
  2. Women >/= 45
  3. Women
21
Q

Clinical Manifestation:

Menopause

A
  1. irregular or absent menses
  2. heat intolerance
  3. flushing
  4. insomnia
  5. night sweats
22
Q

Why should you check TSH and FSH levels in a patient presenting with absent menses, heat intolerance, insomnia, flushing and night sweats?

A

Menopause and hyperthyroidism have similar presentations. You need to use the TSH and FSH levels to differentiate the two.

23
Q

True vs. False

If a young women presents during menstruation with a breast mass it is ok to ask her to return after her menstrual period for reexamination?

A

True. It is ok to ask her to return after her period to assess for regression of the mass as long as there are no obvious signs of malignancy.

24
Q

When can emergency (postcoital) contraception be used?

A

Within 3-5 days of unprotected intercourse

25
Q

Mechanism of action:

Emergency (postcoital) contraception

A
  1. Delays ovulation

2. Impairs implantation to prevent pregnancy

26
Q

What is the most effective emergency contraceptive method?

A

Copper IUD-99% efficacy; you can give copper IUDs to nulliparous and adolescent patients.

27
Q

True vs. False

Emergency contraceptive pills (ulipristal, levonorgestrel and OCPs) are less effective than copper IUDs as a form of emergency contraception?

A

True, copper IUDs are 99% effective.

28
Q

When should screening for cervical cancer begin in women?

A

Cervical cancer screening should begin at age 21 in women regardless of the age of onset of sexual activity. The only exceptions are: (1) HIV + (2) SLE (3) organ transplant & (4) immunocompromised patients.

29
Q

True vs. False

Routine HPV testing is indicated for women

A

FALSE, women younger than 30 should not get routine HPV testing.

30
Q

What are the risk factors for the development of acquired hypogonadotropic hypogonadism?

A
  1. Excessive stress
  2. Eating disorders
  3. Excessive exercise
31
Q

Treatment:

Acquired hypogonadotropic hypogonadism

A

Pulsatile GnRH therapy

32
Q

Function:

Pulsatile GnRH therapy in patients with acquired hypogonadotropic hypogonadism

A

induction of ovulation

33
Q

What is the most accurate way to diagnose ectopic pregnancy?

A

Transvaginal ultrasound (TVUS) when beta-hCG levels are between 1,500-6,500 IU/L.

TVUS is better than transabdominal US when diagnosing an ectopic pregnancy.

34
Q

Clinical Manifestation:

  1. vulvar pruritus
  2. vulvar discomfort

in a postmenopausal women

A

Lichen sclerosus

35
Q

What is the necessary work up in a patient with suspected lichen sclerosus?

A

Biopsy is necessary to rule out vulvar SCC

36
Q

Physical examination:

porcelain-white atrophy of the vulva

A

Lichen sclerosus

Be sure to do a biopsy to rule out vulvar SCC.

37
Q

Treatment:

Lichen sclerosus

A

High-potency topical steroids

38
Q

Clinical Manifestation:

  1. sudden onset unilateral lower abdominal pain (usually right)
  2. nausea
  3. vomiting

in a woman of reproductive age

A

most concerning for ovarian and adnexal torsion

39
Q

Diagnosis:

Ovarian and adnexal torsion

A

Ultrasound using color Doppler

40
Q

Treatment:

Ovarian and adnexal torsion

A

Laparoscopic surgery

41
Q

What is the primary risk factor associated with ovarian and adnexal torsion?

A

ovarian enlargement (i.e. pregnancy or tumors)

42
Q

Clinical Manifestation:

Polycystic ovarian syndrome

A
  1. anovulation or oligo-ovulation
  2. androgen excess: male-pattern hair growth or acne
  3. ovarian cysts
43
Q

Diagnosis:

Endometriosis

A
  1. Laparoscopy
  2. Biopsy of implants

This is the only definitive way to diagnose endometriosis.

44
Q

When is laparoscopy and biopsy indicated in a patient with suspected endometriosis?

A

If a patient fails NSAID and hormonal contraceptive therapy they must undergo laparoscopy and biopsy.

45
Q

Pathophysiology:

Impaired fertility or infertility in endometriosis

A

Chronic inflammation and adhesion formation prevent fertility

46
Q

Epidemiology:

What portion of women with endometriosis have impaired fertility?

A

50%

47
Q

Epidemiology:

What portion of women with infertility have endometriosis?

A

25-50%

48
Q

What is the greatest risk factor for the development of clear cell adenocarcinoma of the vagina and cervix?

A

In utero exposure to diethylstilbestrol (daughters of women who received diethylstilbestrol during pregnancy)

49
Q

What are the obstetrics risk associated with in utero exposure to diethylstilbestrol?

A
  1. clear cell adenocarcinoma of the vagina and cervix (women)
  2. genital tract anomalies (women and men)

Step 2 CK: Obstetrics & Gynecology (15 decks)

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