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MS3 - Women's Care > First Aid for the USMLE Step 2 CK: Gynecology > Flashcards

First Aid for the USMLE Step 2 CK: Gynecology Flashcards

1
Q

What order do thelarche, menarche, pubarche, and growth acceleration take place in female puberty?

A

1) Growth development
2) Thelarche
3) Pubarche
4) Menarche

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2
Q

The __________ triggers ovulation and stimulates the production of progesterone.

A

LH surge

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3
Q

The follicular phase comes ___________ the luteal phase.

A

before

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4
Q

The follicular phase is also called the __________ phase.

A

secretory

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5
Q

Which peaks first, estrogen of LH?

A

Estrogen (because of the FSH rise beforehand)

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6
Q

The corpus luteum can survive about __________ days without further LH or hCG.

A

10 - 14 days (the luteal phase, basically)

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7
Q

The change from _________ to ___________ causes the endometrial glands to become tortuous.

A

estrogen; progesterone

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8
Q

List the symptoms that characterize menopause.

A
  • Hot flashes
  • Vaginal atrophy (pruritus, vaginal dryness)
  • Insomnia
  • Anxiety/irritability
  • Poor concentration
  • Mood changes
  • Dyspareunia
  • Loss of libido
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9
Q

In menopause, the __________ levels rise before the _________.

A

FSH; LH

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10
Q

How does the lipid profile change during menopause?

A

The HDL goes down and the total cholesterol goes up.

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11
Q

What are some contraindications to HRT?

A
  • Breast cancer
  • Endometrial cancer
  • Thromboembolism
  • Liver disease
  • Triglyceridemia
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12
Q

What drugs are used to treat vasomotor symptoms of menopause?

A
  • Clonidine
  • Gabapentin
  • SNRIs
  • SSRIs
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13
Q

Combined HRT protects against ______________.

A

ovarian and endometrial cancer

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14
Q

Primary is defined by two possible scenarios: ______________.

A
  • Absence of menarche and secondary sexual features by age 14
  • Absence of menarche by age 16 with secondary sexual features
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15
Q

List four causes of primary amenorrhea without secondary sexual characteristics.

A
  • Kallman syndrome
  • Hypogonadism
  • Primary ovarian insufficiency (such as Turner’s)
  • Constitutional growth delay
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16
Q

Implanon contains what?

A

Progestin only

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17
Q

What are four advantages to Implanon?

A
  • Effective for 3 years
  • Immediate fertility once removed
  • Safe with breastfeeding
  • Lighter periods
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18
Q

What is the rate of perforation in IUDs?

A

About 1/1,000

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19
Q

Hormonal IUDs are effective for ________ years, while copper IUDs are effective for ________.

A

5; 10

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20
Q

What are two disadvantages of Depo (IM medroxyprogesterone)?

A
  • Irreversible infertility for up to ten months after discontinuation
  • Weight gain
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21
Q

How do you use the NuvaRing?

A

Three weeks continuously followed by one week without

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22
Q

One of the major downsides of progestin-only birth control is _______________.

A

that you need to strictly take it every day at the same time

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23
Q

What are some contraindications to estrogen-containing pills?

A
  • Undiagnosed vaginal bleeding
  • Estrogen dependent cancer
  • Liver failure
  • Breast cancer
  • History of clots
  • Tobacco use in someone older than 35
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24
Q

List some contraindications for IUDs.

A
  • Active pelvic infection
  • Structural abnormality
  • Gynecologic malignancy
  • Reaction to copper
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25
Q

What is in the morning-after pill?

A

Estrogen and progestin

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26
Q

In addition to pills, ___________ can also be used as emergency contraception (up to 7 days post coitus).

A

copper IUDs

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27
Q

The first step of working up amenorrhea is ______________.

A

a pregnancy test (even in primary amenorrhea)

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28
Q

A woman has secondary sexual characteristics, primary amenorrhea, and no pubic hair. Diagnosis?

A

CAIS

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29
Q

List two structural and two hormonal causes of primary amenorrhea in a woman with secondary sexual characteristics.

A

Structural:
•Imperforate hymen
•Müllerian agenesis

Hormonal:
•CAIS
• CAH

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30
Q

Give a differential for secondary amenorrhea.

A

It’s good to think of systems-based ways, so here is a top-to-bottom outline:
•Hypothalamus: neoplasms or functional disorders (like anorexia or stress)
• Pituitary: neoplasm
•Thyroid: hypothyroidism
•Uterine: pregnancy, Asherman syndrome, cervical stenosis
•Ovarian: premature ovarian insufficiency, PCOS

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31
Q

Those with PCOS have ___________ progesterone.

A

low

The high levels of estrogen from fat inhibit the release of FSH and ovulation does not occur. Thus, progesterone remains low.

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32
Q

What two conditions present with absent uterus?

A
  • CAIS (46, XY)

* Müllerian agenesis (46, XX)

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33
Q

What do a positive and negative progestin challenge indicate?

A
  • Positive (patient bleeds with progesterone withdrawal): PCOS or idiopathic anovulation
  • Negative (patient doesn’t bleed): premature ovarian failure or uterine abnormality
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34
Q

What features suggest primary dysmenorrhea?

A
  • Pain during the first three days of menstruation
  • Back pain
  • Absence of pathologic features on exam, lab workup, and history that would suggest other diagnosis (because primary dysmenorrhea is a diagnosis of exclusion)
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35
Q

True diagnosis of endometriosis and adenomyosis requires _______________.

A

laparoscopy to see lesions (in the case of endometriosis) and pathologic biopsy of the myometrium (in the case of adenomyosis); because this is costly and invasive, these diagnoses are usually made clinically

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36
Q

Although TAH is curative of endometriosis and adenomyosis, women who still want children can opt for _______________.

A

hysteroscopy with ablation of known lesions

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37
Q

Menorrhagia is ______________.

A

increased amount of blood

38
Q

Metrorrhagia is ______________.

A

bleeding between periods

39
Q

What things should you do to evaluate AUB?

A
  • ß-hCG to evaluate for pregnancy
  • CBC to assess anemia
  • PT/PTT and bleeding time to detect coagulopathy
  • Chlamydia and gonorrhea swab to test for cervicitis
  • TSH to test for hyperthyroidism
  • US to detect endometrial stripe thickness and uterine/ovarian masses
  • Pap test
40
Q

What should you do in acute heavy uterine bleeding?

A
  • High dose estrogen or progestin can stabilize the endometrium
  • If hormones fail, D&C can be done
41
Q

___________ can be given during menses to stop heavy bleeding.

A

Tranexamic acid

42
Q

____________ can help treat ovulatory and non-ovulatory bleeding.

A

Progestin IUDs and OCPs

43
Q

Describe the classic form of congenital adrenal hyperplasia.

A

Defective 21-alpha hydroxylase leads to lack of glucocorticoids and aldosterone with excess androgens. Presents with hypotension and virilization.

The nonclassic form presents with normal blood pressure and later virilization.

44
Q

What is cosyntropin?

A

Synthetic ACTH

You can give it to assess adrenal insufficiency. If the levels of cortisol fail to rise after administration of cosyntropin, then adrenal insufficiency is likely.

45
Q

Explain the Rotterdam criteria for PCOS diagnosis.

A

Must have at least two of the following:
•Oligo/anovulation
•Clinical or biochemical evidence of hyperandrogenism
• Polycystic ovaries

Important: metabolic syndrome and obesity are common comorbidities, but are not necessary for diagnosis.

46
Q

What other diseases do you need to rule out in diagnosing PCOS?

A
  • Adrenal tumor (secreting DHEA)
  • Cushing syndrome
  • Nonclassic CAH
  • Androgen-secreting ovarian tumors
47
Q

A woman has fever and a positive chandelier sign. What should you do to further evaluate?

A
  • Swab to test for C. trachomatous and N. gonorrhoeae (to narrow treatment)
  • Ultrasound to rule out tubo-ovarian abscess
48
Q

Although not necessary to diagnose PCOS, what other labs can be done to further the work up?

A
  • LH/FSH ratio greater than 2
  • TVU showing the “pearl necklace” sign in the ovary
  • Metabolic testing (i.e., glucose challenge, lipids)
49
Q

How should PCOS be treated?

A
  • Clomiphene and metformin can induce ovulation (in women seeking to conceive)
  • OCPs, progestin, and metformin can normalize ovulation
  • Diet, weight loss, and exercise can treat obesity and metabolic syndrome
  • Spironolactone can treat hirsutism
50
Q

What are the complications of PCOS (things you should be screening for!)?

A
  • Breast and endometrial cancer (due to unopposed estrogen)
  • Diabetes
  • Miscarriages
51
Q

Women who’ve had myomectomy should never have _____________.

A

a subsequent vaginal delivery (must be caesarian section)

52
Q

The two broad categories of clinical infertility are _______________.

A

primary infertility (in which the woman has never been pregnant) and secondary infertility (in which the woman has had a prior pregnancy)

53
Q

What percent of infertility cases are due to problems in the woman?

A

58%

54
Q

Bartholin cysts can cause what symptom?

A

Dyspareunia

55
Q

Bacterial vaginosis is caused by _____________.

A

Gardnerella vaginalis

56
Q

Thick white secretions that adhere to the vaginal wall are normal in what two physiologic states?

A
  • Pregnancy

* Luteal phase

57
Q

How are the ulcers from HSV different from those in H. ducreyi?

A
  • HSV: shallow, painful, multiple

* H. ducreyi: deep, painful, single

58
Q

What organisms cause PID (by incidence)?

A
  • N. gonorrhoeae (1/3)
  • C. trochomatis (1/3)
  • Endogenous aerobes/anaerobes (1/3)
59
Q

What is the chandelier sign?

A

CMT that makes the patient “jump for the chandelier”

60
Q

Explain the mnemonic A ROPE for acute pelvic pain.

A
  • Appendicitis
  • Ruptured ovarian cyst
  • Ovarian torsion
  • PID
  • Ectopic pregnancy
61
Q

What are the diagnostic criteria for PID?

A
  • Pelvic pain

* Uterine, cervical, or adnexal tenderness

62
Q

What are two important components of treating toxic-shock syndrome?

A
  • Antibiotics against S. aureus

* Rehydration

63
Q

A woman presents with fever, vomiting, diarrhea, nonpurulent conjunctivitis, desquamating rash on the palms and soles, and a macular erythematous rash. What is the likley diagnosis?

A

Toxic shock syndrome (clindamycin and vancomycin)

64
Q

Bacterial cultures typically show __________ in toxic shock syndrome.

A

nothing (because the syndrome is caused by a preformed toxin)

65
Q

Although most fibroids are asymptomatic, they can present with the following symptoms: _________________.

A
  • Dysmenorrhea
  • Heavy periods
  • Dyspareunia
  • Firm, nontender, enlarged and irregular uterus
66
Q

Myomas can be in three places: ______________.

A

subserosal, intramural, and submucosal

67
Q

You’ve done a physical exam on a woman with suspected fibroids. What three tests/labs/images might you order next?

A
  • TVU
  • MRI (often just used in preparation for surgery)
  • CBC (to assess for anemia)
68
Q

How should you manage an asymptomatic fibroid patient?

A

Yearly pelvic exams and CBCs

69
Q

List three medications that can treat the bleeding from fibroids.

A
  • Medroxyprogesterone acetate (also Megace)
  • Leuprolide
  • Danazol
70
Q

What are the two kinds of endometrial cancer?

A
  • I: endometrioid

* II: serous, papillary, and squamous

71
Q

True or false: both kinds of endometrial cancer are associated with estrogen exposure.

A

False

Only type I is.

Type II is associated with the p53 mutation.

72
Q

Which endometrial cancer presents at an older age?

A

Type II

73
Q

Go through the treatment options for endometrial cancer.

A
  • Women who may want future children: high-dose progestins
  • Women who don’t want future children: TAH BSO with radiation
  • Women with advanced cancer: TAH BSO with radiation and chemotherapy
74
Q

Cervical cancer has two tissue subtypes. List each and the type of HPV that is most common in each.

A
  • Squamous (16)

* Adenocarcinoma (18)

75
Q

What are the most common symptoms of cervical cancer?

A

Metrorrhagia and postcoital bleeding

76
Q

How do LSIL and HSIL correlate with CIN?

A
  • LSIL = CIN I

* HSIL = CIN II and III

77
Q

For ASC-US and LSIL in women younger than 24, ACOG recommends ____________.

A

repeat cytology in one year

78
Q

For HSIL and ASC-H, ACOG recommends ____________.

A

colposcopy

79
Q

For ASC-US and LSIL in women older than 24, ACOG recommends ____________.

A

DNA testing

80
Q

What should you do for AGC?

A

Colposcopy with endocervical sampling

81
Q

If you do a colposcopy for HSIL or ASC-H and it is negative, then ___________.

A

do colposcopy and cytology every 6 months for two years or until negative

82
Q

How should you treat CIN I on colposcopy?

A

Repeat cotesting at 12 and 24 months

83
Q

How should you treat CIN II and III on colposcopy?

A

LEEP or cone excision

84
Q

A common cause of death in cervical cancer is ______________.

A

uremia from blocked ureters

85
Q

B in the staging of cervical cancer means ___________.

A

lateral growth

86
Q

Lynch syndrome raises the risk of which gyn cancers?

A

Ovarian and endometrial

87
Q

CA-125 is associated with which type of ovarian cancer?

A

Epithelial cell

88
Q

Elevated CA-125 in a premenopausal woman can be caused by ___________________.

A

endometriosis

89
Q

What pelvic masses produce AFP?

A

Choriocarcinoma and endodermal sinus

90
Q

Granulosa cell tumors secrete ____________.

A

inhibin

91
Q

Dysgerminoma produces _______________.

A

LDH

MS3 - Women's Care (47 decks)

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