GI/GU/OB/GYNE Flashcards

Question

Pt had a painful cyst, now its better. Think...

Answer 1

Rupture Do another sono and look for "Fluid in the Culdesac" fluid released from cyst will sink to basement of the pelvic cavity.

Answer 2

Ovarian torsion - a GYN 911 so PLAN AHEAD and PREVENT CYSTS with BCP

Answer 3

No, only for fluid filled. solids get referred + biopsied- could be cancerous

Answer 4

one full year without menses No going back. Bleeding after this year is NOT break thru bleeding - it is a significant risk of endometrial cancer. Refer for sono AND schedule biopsy asap

Answer 5

Annual Breast exams Bimanual exam every 5 yrs paps every 5

Answer 6

Ovarian Cancer Get a Sono ASAP. This one Mets to the lungs.

Answer 7

often NONE Vague bloating Vague 'not ok in there' Exam likely normal.... If tender, it's already advanced. If it's vague but pt or you feel something may possibly be amiss, get the SONO. Ovarian cancer is ONLY TREATABLE at VERY early stages. Sono will ID rice like solids in the abdominal cavity Biopsy confirms its rogue ovarian tissue CT is only for staging

Answer 8

Ovarian Cancer Marker Not specific, used more for tracking relapse Most insurances will not cover though Deb likes it for high risk females with BRCA1/2 or Primary relative with Ov Canc.

Answer 9

Bilateral Salpingo-Oophorectomy

Answer 10

Fibroids Though solid, they don't look like endometrial cancer on sono. EC is a thickening of the endometrial wall, not really a tumor. They can get so big as to be felt thru the belly and they can press on the ureters/urethra and cause backup, even Hydronephrosis. Rx is NSAIDS -Fe++ for anemia -Combo BCP if nonsmoker -Progestagin BCP if smoker days 1-25 -Ultrasound Fibroid Destruction -Radio Frequency Cauterization/Ablation of Uterine arteries. Renders Uterus unable to support fibroids and pregnancy -You can just excise them (Myomectomy) and preserve fertility Menopause shrinks them d/t lack of estrogen

Answer 11

Endometrial Thickening on sono, no tumor 1st sign is POSTmenopausal BLEEDING - do PAP + Pelvic (will be normal) - do Sono - Schedule Biopsy - ASAP!!!!!!! If early, biopsy may be (-). Schedule a D+C to clear out the ENTIRE endometrium so pathology can go over every inch of it for aberrant cells. SOMETHING is causing that bleeding. Mets to the peritoneal cavity and lymph nodes NOT to the lungs

Answer 12

Ovaries stop responding to gonadotropin, so it skyrockets, trying to elicit Estrogen and Prog. Gonadotropin increases FSH over 50 (normal is 32-35) LH rises Testosterone RISES - no longer suppressed by Estrogen Progesterone Plummets Estrogen Plummets, only estrone on board FSH is the one you test to confirm menopause.

Answer 13

E - no more than 400 units or CV at risk

Answer 14

Effexor XR Venlafaxine, an SNRI 37.5mg ONLY. If its going to work, it will work at that dose. Don't increase it

Answer 15

Premarin 50% equine estrone.... Prempro.. has progestegins with its estrogen No wonder premarin was causing cancer!!!

Answer 16

In chronic bacterial prostatitis (chronic urinary retention, boggy prostate) to obtain a prostatic secretion sample for culture This will NOT be possible in Acute prostatiasis, wherein the prostate will be a hot hard little apple and your pt will present with Fever Chills Dysuria and PERINEAL PAIN.

Answer 17

Pt will present with Fever Chills Dysuria and PERINEAL PAIN. ``` DRE may be refused - too painful Get a UA, should be + WBC PSA will be + in Ac Bact Prost so this test won't Dx Still, if (+) retest in 60 days ``` UTI bugs and GC are the most likely so, unless your pt is sexually inactive, cover both: Cephrtriaone 250mg IM with a script for either Cipro 500mg BID or Bactrim DS BID both orals for a FULL 28 days. This area is hard to penetrate with abx! If you suspect sepsis (hypotension, fever, swelling) hospitalize your patient and run Cephtriaxone with Gentamycin IV until stabilized.

Answer 18

Bile backs up the liver, damages the ducts. Test is for antimitochondrial Antibodies, which seem to attack the biliary hepatocytes Rx is

Answer 19

``` Primary: genital (usually) chancre w/in 3 weeks Secondary: Nonpruritic, non- tender truncal rash 2-10 weeks +/- malaise, low fever neck stiffness meninigitis possible Latency: asymptomatic, may last 25 years. Babies may be born in this stage if infected in utero, tertiary sxs being their first signs ``` ``` Tertiary: 'Gummas' the awful disfiguring lesions on face, head, body, bone. Dementia, Hearing loss vision loss 3-10 yrs out Valve vegetation+failure ``` Early Tests 1-2 weeks post chancre: VDRL + RPR only 78% sensitive @ primary stage FTA-ABS to confirm. This is the definitive serology ``` Pen G for all stages Doxy will do it too Probenecid (for gout) will keep penicillin from being excreted in the tubules, maintaining high serum concentrations ```

Answer 20

Progesterone No ovulation No luteal body No progesterone peak- adrenals do produce it but steady + low

Answer 21

A Krukenberg tumor refers to a malignancy in the ovary that metastasized from a primary site, classically the gastrointestinal tract, although it can arise in other tissues such as the breast. Gastric adenocarcinoma, especially at the pylorus, is the most common source. Krukenberg tumors are often (over 80%) found in both ovaries, consistent with its metastatic nature.

Answer 22

FSH stimulates the follicle to mature and produce estradiol The follicle also grows LH receptors The estridiol peak of the mature follicle stimulates the anterior pituitary to release LH which binds its receptors on the mature follicle and effects rupture/ovlation It is this rupture/ovulation that signals the creation of the luteal body, which is sustained by LH from the anterior pituitary for two weeks unless a zygote implants, at which point some other hormone directs the anterior pituitary to continue producing LH longer, to sustain the endometrial lining until the placenta can take over progesterone production in 3 months.

Answer 23

Before the skin keratinizes (in the 1st trimester) amniotic fluid freely diffuses across the baby's skin into the amniotic sac and it is essentially plasma. After keratinization of the skin around 14 weeks, the fluid can't cross the skin and so it is largely made up of fetal urine and lung secretions made by the fetal kidney and lung.

Answer 24

Graafian follicles can also called "mature vesicular follicles", "tertiary vesicular follicles" or "ripe vesicular follicles"

Answer 25

Ovarian Silent until untreatable Endometrial cancer is the most common, but ovarian is nearly always deadly.

Answer 26

Verted is just tilted posteriorly | Flexed is actually bent backwards

Answer 27

Endometrial tissue lying outside the uterus, obviously the result of endometriosis Chocolate cysts are endometriomas

Answer 28

Generalized Swelling This can happen to a fetus and is visible on ultrasound as subcutaneous tissue greater than 5mm thick It's a component of Hydrops Fetalis, a complication of Homozygous Thassalemia

Answer 29

Dermoid Cyst - filled with hair/blood/tissue Deb's little gremlin Usually found in women of child bearing age Usually benign but 30% are malignant so all of them get removed Malignancy risk increases if found in a girl as opposed to a woman of child bearing age.

Answer 30

Nabothian Cyst - essentially a cervical pimple. Epithelial cells grow over a cervical crypt and the mucus secreted by the crypt build up into a hard sometimes white sometimes clear cyst They are benign unless they get really big, often self resolve but can be frozen off or cauterized.

Answer 31

A Trisomy Developmental Disorder: will become the webbed neck

Answer 32

10-12 That corpus really hangs on a long time if there is implantation - really the entire first trimester!

Answer 33

Placenta Previa - Gestation can continue so long as mother isn't bleeding and baby isn't distressed, but is followed very closely. Usually C-Section. Vaginal birth is possible if at least 2 cm from the os but bleeding could be heavy. If all goes wrong, hysterectomy during C-Section is the fallback to stop the bleed.

Answer 34

Classic Liver Failure With or without jaundice

Answer 35

Cirrhosis - not sure why difficult to get an answer online but it was a sxs.

Answer 36

Trichonomiasis Strawberry Cervix See swimming flagellated protozoa on wet mount Give Flagyl

Answer 37

Bacterial Vaginosis Gardnerella Vaginosis (anaerobe) + Whiff test Give Flagyl (Metronidazole) or Clindamycin

Answer 38

Placenta Previa

Answer 39

Testicle is not attached to the scrotum so it can swing like a bell and it can TWIST High Risk for Testicular torsion

Answer 40

Renal Cell Carinoma

Answer 41

painful sexual intercourse

Answer 42

Nons are more aggressive testicular cancers Elevated Beta HCG in Seminoma- not so bad Elevated Alpha Feto Protein in Non-Seminoma- very aggressive

Answer 43

Lipase lifts first and last longer don't even bother with amylase. An elevated serum amylase is not pathopneumonic for anything in particular, if its salivary amylase think parotid gland inflammation but in that case you can probably SEE the problem.

Answer 44

Endometriosis, pain also can move down into the legs. Fibroids cause heavy bleeding but are typically painless, though very large fibroids can press on nerves and cause pelvic/lumbar issues

Answer 45

think FIBROIDS white women do get them but | 80% of african american women get fibroids of some sort in their life times.

Answer 46

Septic Arthritis Gout would have Uric acid crystals (-) Birefringence/sharp XLs Pseudo Gout XLs are Calcium (+) Birefringence and rhomboid XLS Acute Rheumatic Fever arthritis is usually migratory, presenting in varying joints. Strep Antibody test is a good idea here instead of aspirating fluid. Also, this is more likely in kids who had a sore throat that wasn't treated.

Answer 47

Hyaline membrane disease Chronic Lung Disease of Prematurity is a complication in about 20% of Hyaline Membrane Disease, so is less prevent then HMD

Answer 48

The entire sole In preterm, there will be a portion that is not creased, typically 1/3.

Answer 49

Basal - pearly pink clear/ulcerated papule, with telangectasias least worrisome Squamous Cell Red, scaly often ulcerates Arises from Actinic Keratosis and that looks like a dark ctr, Keratinized rough more metastatic Melanoma - black

Answer 50

``` A-Assymetrical B-Border, Uneven C-Color, not uniform D-Diamerer larger than pencil eraser E-Evolving appearance, color shape size ```

Answer 51

Notched teeth of Congenital Syphilis babies can go through Stage 1 and Early Stage 2 in utero. Latent stage 2 can last over a decade so congenital syphilis is often not picked up until latency ends. The teeth are a sign though.

Answer 52

Take it out. If fluid were clear and the mass decreased in size with each monthly scan, then you can leave it alone but get that bloody one out.

Answer 53

Incise and Drain it Reserve Abx for cases wherein surrounding tissue is inflamed

Answer 54

Cholestyramine, A Bile Salt Sequestrant, relieves the itch of cirrhosis

Answer 55

Bacterial Vaginosis Rx is Metronidazole

Answer 56

Pre-Ecclampsia Risk of Seizure- seizure is bad as it denies fetus oxygen so PREVENT IT with MgSO4 IV and get this lady to the ER

Answer 57

Complication of Pre-Eclampsia H- Hemolysis EL - Elevated Liver enzymes LP- Low Platelets Pt is usually already hypertensive and in the 3rd trimester. Somehow, the coagulation cascade gets activated and fibrin strands in the small vessels mainly of the LIVER start hacking RBCs to bits, creating the HEMOLYSIS. Platelets stick to the fibrin and suddenly we're low on PLATELETS and of course this creates a blockage in the vessels of the liver and thus tissue downstream becomes ischemic and LIVER ENZYMES RISE as hepatocytes die. Some say a D-Dimer in the setting of pre-eclampsia is diagnostic. Others say don't all it until you have CBC (for platelets), CMP for electrolytes, Coagulation Panel, Lactate Dehydrogenase (leaks out of damaged RBCs and indicates hemolysis) and LFTs Some say Lactate Dehydrogenase over 600 in the setting of pre-ecclampsia is diagnostic. Bottom line is baby needs to be delivered. MgSO4 and Fresh Frozen Plasma for the DIC and pRBC for the anemia might work but only for a bit. Get that baby out. 1% maternal mortality, HELLP occurs in +/- 15% of severe pre-eclamptic cases. Fetal prognosis depends on gestational age at the time HELLP develops.

Answer 58

BRCA stands for BR (breast) CA (cancer). They are two genes that, if mutated, increase the risk of developing breast cancer in over 40's. Their mutation is a familial marker for this risk heralding increased screening and testing for its owner. BRCA1 mutations are slightly more specific to breast cancer and ovarian cancer BRCA2 mutations are slightly more specific for breast cancer and prostate cancer. Thus would a male whose mother and maternal grandmother had breast cancer be wise to get tested and followed for both breast cancer and prostate cancer.

Answer 59

``` Atypical Squamous Cells of Undetermined Significance ``` Mildly Concerning For young women, repeat the test in 12 months to see if the atypical cells are still there, if so, then colposcopy In older women go straight to Colposcopy: Under strong light and microscopic lenses the cervix is treated with acetic acid highlight suspicious lesions not otherwise visible to the naked eye. Then the cervical canal is curettaged (scraped) and the scrapings "the clot" are removed to be examined by cytology. Biopsies are "bitten out" of the cervix at any suspicious looking spots to be examined for cancer cells by cytology.

Answer 60

Cervical IntraEpithelial = CERVICAL CANCER Neoplasia CIN I - May be cleared by your immune system, retest 6 mo CIN II - Confined to the epithelium, get it off with biopsy CIN III - Cervical Cancer In Situ, LEEP it out with electrical c cauterization (recall that sausage teaching demo - YIKE!!! CIN II + CINIII usually caused by HPV 16 + 18

Answer 61

stop labor MgSO4 Terbutaline Nifedapine

Answer 62

Pds longer than 8 days

Answer 63

6 hrs post coitus

Answer 64

PMS Give Fluoxitine 2mg only in days 21-28 or... put this woman on progesterone from 12-26

Answer 65

Symphysis Pubis

Answer 66

1) Vaginal Bleeding of unknown etiology (could be cancer) 2) Liver Disease (Estrog provokes cholestasis, transdermal might be an option though as it bypasses liver) 3) Hypercoagulable state (DVT extra likely) 4) Endometrial Cancer still has uterus 5) Breast Cancer

Answer 67

Interestingly, even pregnancy can incite cholestasis and when BCP came on the market, Jaundice was an unexpected side effect seen in some early users. Hepatic Osteodystropy - Bone loss d/t liver Dz Osteoporosis is a leading effect of Hepatic Disease. Unconjugated Bilirubin (which would rise if the liver were diseased and unable to conjugate it for excretion) DEPRESSES OSTEOBLAST activity. Less bone laid down. Liver damage also causes hypogonadism by interfering with gonadotropic hormone release from the Hypothalamus and FSH/LH from the ant pit. This decreases estrogen production in the ovary and testosterone in the testes. Estrogen in women and Testosterone in men suppress RANK in the bones. Without them, both sexes are subject to increased osteoclast creation and activity: More bone reabsorbed. With unconjugated bilirubin suppressing osteoblast activity and hypogonadal decreases in estrogen/testosterone allowing increased osteoclast activity, the pt with liver disease is in for a double whammy in the bone loss department. The liver breaks down estradiol to estrone and then to estriol. If the liver doesn't work and estradiol is introduced into the portal system either naturally, from functioning ovaries, or unnaturally by ingestion of oral synthetic estradiol, and the liver is diseased, it is unable to break the estradiol down to its less active metabolites and the estradiol continues circulating and endometrial proliferation continues unchecked - this can be the cause of endometrial cancer.

Answer 68

Every 48 hrs