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Clin Med- Repro > Green PANCE book- GYN > Flashcards

Green PANCE book- GYN Flashcards

1
Q

the absence of spontaneous menstruation by age 16 years

A

primary amenorrhea

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2
Q

in a woman who has previously menstruated, an absence of menses for 3 months if previous cycles were normal

A

secondary amenorrhea

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3
Q

if a woman has irregular menses, how long until secondary amenorrhea is defined?

A

6 months

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4
Q

Most common cause of secondary amenorrhea

A

Pregnancy

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5
Q

Beta-human chorionic gonadotropin (Beta-hCG)

A

first line test with amenorrhea (pregnancy test)

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6
Q

painful menstruation caused by excess prostaglandin and leukotriene levels leading to painful uterine contractions, N/V/D

*no pathologic abnormality

A

primary dysmenorrhea

peaks in late teens and early 20s

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7
Q

painful menstruation caused by an identifiable clinical condition, usually of the uterus or pelvis (i.e., endometriosis, adenomyosis, uterine fibroids, PID or IUD)

A

secondary dysmenorrhea

incidence increases with age

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8
Q

Management for primary dysmenorrhea

A
  • NSAIDs just before expected menses for 2-3 days

* OCPs, vitamin B, magnesium, etc.

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9
Q

Symptoms are associated with menstrual cycle and begin 1-2 weeks before menses and end 1-2 days after the onset of menses

*a monthly symptom free period during the follicular phase must exist

A

PMS

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10
Q

perimenopause lasts about….

A

3-5 years

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11
Q 
vasomotor symptoms
urogenital atrophy
accelerated bone loss
estrogen related CV protection declines
thin, less elastic skin
changes in sleep cycle
confusion, memory loss, etc.
A

Menopause

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12
Q

FSH of greater than 30 is diagnostic of…

A

Menopause

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13
Q

Increase risk of:
CV disease
Breast cancer
Cognitive changes

A

Negative impacts of hormone therapy in menopause

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14
Q

abnormal uterine bleeding in the absence of an anatomic lesion, usually caused by a problem with the hypothalamic-pituitary-ovarian hormonal axis

(other causes…polycystic ovarian, exogenous obesity, adrenal hyperplasia)

A

Dysfunctional uterine bleeding (DUB)

most common shortly after menarche and during perimenopause

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15
Q

Tx depends on severity of bleeding

can use…progestin, OCP

A

Dysfunctional uterine bleeding (DUB)

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16
Q

Leiomyomata

A

uterine fibroids

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17
Q

Uterine fibroids most commonly occur in the ____ decade and more common in black women and those with a family hx

A

fourth

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18
Q

women with fibroids have a fourfold increase in the risk of…

A

endometrial cancer

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19
Q

most women have no symptoms but do have a firm, enlarged, irregular uterine mass

  • some will have symptoms of pressure or fullness in pelvis
  • menorrhagia, metorrhagia, intermenstrual bleeding and dysmenorrhea common
A

Leiomyomata (uterine fibroids)

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20
Q

Most common presenting symptom of leiomyomata (uterine fibroids)

A

Bleeding

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21
Q

What is the management recommended in most leiomyomata cases?

A

Observation

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22
Q

Most common GYN cancer

post menopausal women make up 75%

A

Endometrial cancer

mean age=58

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23
Q

Adenocarcinomas make up __% of endometrial cancers

A

75

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24
Q

Prognosis of endometrial cancer depends on…

A

age
histologic appearance
extent of spread

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25
Q 
Obesity
Nulliparity
Infertility
Late menopause
Diabetes
Unopposed estrogen stimulation
HTN
Gallbladder dz
Chronic tamoxifen use
White women
A

Risk factors for endometrial cancer

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26
Q

Cardinal symptom is inappropriate uterine bleeding***

A

Endometrial cancer

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27
Q

Tx for endometrial cancer

A

Total hysterectomy combined with bilateral salpingo-oophorectomy

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28
Q

Condition in which endometrial tissue is found outside endometrial cavity
*most sites in pelvis or on ovary

A

Endometriosis

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29
Q

Most common in nulliparous women in late 20s-early 30s

*infertility is common

A

Endometriosis

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30
Q 
Dysmenorrhea
Deep thrust dyapareunia
Difficulty passing BM (dyschezia)
Intermittent spotting
Pelvic pain
Infertility
A

Endometriosis

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31
Q

Tender nodularity of the cul-de-sac and uterine ligaments and a fixed uterus

*can use combined OCPs or progestins

A

Endometriosis

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32
Q

prolapse of the uterus typically occurs after…

A

pregnancy, labor and vaginal delivery
*risk increases after menopause

(but may occur in nulliparas)

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33
Q

symptoms vary but usually worse after prolonged standing or late in the day and relieved by lying down

vaginal fulless, lower abdominal aching, low back pain

A

uterine prolapse

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34
Q

Non surg: wt reduction, smoking cessation, pelvic exercises

OR surgical treatment

A

uterine prolapse

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35
Q

Most common ovarian growth

*usually functional and can include follicular, corpus luteum, theca lutein

A

cysts

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36
Q

May present as asymptomatic masses with pain and menstrual delay or with hemorrhage because of rupture

A

Ovarian cysts

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37
Q

Mobile, simple and fluid filled seen by pelvic ultrasonography

A

Ovarian cysts

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38
Q

In premenopausal women with cysts smaller than 8cm, how do you manage?

A

Observe for 1-2 cycles (persistent cysts warrant further investigation)

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39
Q

Large or persistant cysts may require…

A

laproscopic eval

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40
Q

Cysts in postmenopausal women are considered…

A

Malignant

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41
Q

Most common cause of androgen excess and hirsutism

*bilaterally enlarged polycystic ovaries, amenorrhea or oligomenorrhea and infertility

A

Polycystic ovary syndrome (PCOS)

42
Q

Normal puberty and adolescence, followed by progressively longer episodes of amenorrhea

*increased risk for endometrial hyperplasia and carcinoma

A

PCOS

43
Q

Ultrasonography may have characteristic “string of pearls” or “oyster ovaries”

A

PCOS

44
Q

Labs may show elevated androgen levels, increased LH/FSH ratio, lipid abnormalities and insulin resistance

A

PCOS

45
Q

High risk in older women (57-63), nulliparous, white and have a positive family history

*long term OCP use may be protective because of the suppression of ovulation

A

Ovarian cancer

46
Q

Breast and ovarian cancer (BOC) syndrome

Hereditary nonpolyposis colorectal cancer (HNPCC) syndrome

A

2 forms of hereditary ovarian cancer

47
Q

80% of ovarian cancers are ______ tumors

A

epithelial

48
Q

Lack of specific symptoms
May present with…
ascites, abdominal distention, early satiety, change in bowel habits or a fixed mass

A

Ovarian cancer

49
Q

Sister Mary Joseph nodule (a metastatic implant in the umbilicus) can be associated with

A

Ovarian cancer

50
Q

BRCA1 associated with 5%
Associated with p53 tumor suppressor gene

  • transvaginal or abdominal ultrasonography to diagnose
  • chemo and radiation to treat
A

Ovarian cancer

51
Q

HPV types 16, 18, 31 and 33 are strongly linked to…

A

Cervical cancer

52
Q

HPV exposure in addition to….

  • early age at first intercourse
  • early childbearing
  • multiple sex partners
  • high risk sex partners
  • history of STDs
  • low socioeconomic status
  • AfroAmericans
  • Cigarette smoking

all increase risk of….

A

Cervical Intraepithelial Neoplasia (CIN)

53
Q

Atypical changes at the __________ zone of the cervix initiate CIN, the pre-invasive phase of cervical cancer

A

transformation

54
Q

the pre-invasive phase of cervical cancer

A

cervical intraepithelial neoplasia (CIN)

CIN-1= mild dysplasia
CIN-2= moderate dysplasia
CIN-3=severe dysplasia
CIS= carcinoma in situ

55
Q

CIN most commonly occurs in women in their…

A

20s

cervical cancer after age 40

56
Q

Usually have abnormal pap without symptoms

May cause abnormal vaginal bleeding and vaginal discharge

A

Cervical cancer

57
Q

Can mild cervical lesions resolve spontaneously?

A

YES

58
Q

Loop electrosurgical excision procedure (LEEP) can be used as treatment in…

A

Preinvasive cervical neoplasia

59
Q

All boys and girls age ______ should receive Gardasil (3 injections over 6 months)

A

11-12 yo

60
Q

Protrusion of pelvic organs into or out of vagina

*may occur in isolation but usually combined

A

Pelvic organ prolapse

61
Q

May result from excessive stretching of pelvic fascia, ligaments, and muscles during pregnancy, labor and delivery

*occurs from increased intra-abdominal pressure

A

Pelvic organ prolapse

62
Q

_____ vaginal prolapse includes cystocele or cystourethrocele

A

Anterior

63
Q

______ prolapse includes enterocele and rectocele

A

Posterior

64
Q 
0= no descent
1= descent between normal position and ischial spines
2= descent between ischial spines and hymen
3= descent within hymen
4= descent through hymen
A

Pelvic organ prolapse grading

65
Q

tx= pelvic floor exercises, vaginal pessaries and surgical treatment

A

Pelvic organ prolapse

66
Q

Neoplasia in this area are the rarest of GYN neoplasms

A

vulva and vagina

67
Q

most vulvar malignancies are SQUAMOUS CELL carcinomas and occur mostly in…

A

post menopausal women

68
Q

Usually seen in women who are…
Obese with HTN, diabetes and arteriosclerosis
Chronic hx of vulvar itching

A

Vulvar cancers

69
Q

Local excision, topical 5-fluorouracil and laser therapy are used for early..

A

vulvar lesions

surgical excision is required for most vaginal neoplasms

70
Q

What diagnostic can distinguish between solid and cystic breast masses

A

Ultrasonography

71
Q

Mastodynia (matalgia)

A

breast tenderness

72
Q

Breast infection/breast abscess most often caused by staph aureus (primarily occurs in lactating women)

*unilateral tenderness, heat, significant fevers, chills and other flu like symptoms

A

Mastitis

usually 1 quadrant or lobule of breast is affected

73
Q

tx= penicillinase resistant antibiotic and hot compresses

A

Mastitis

74
Q

Most benign condition of breasts…include cysts, papillomatosis, fibrosis, adenosine and ductal epithelial hyperplasia

A

Fibrocystic changes

75
Q

Diagnostic and therapeutic procedure to do if you suspect cysts

A

Fine needle aspiration

76
Q

Round, firm, smooth, discrete mobile and nontender..benign

A

Fibroadenomas

77
Q

Most common cancer in women, Second leading cause of death in women

increased risk with...
Nulliparity
Early menarche
Late menopause
Long term estrogen or radiation
Delayed childbearing
A

Breast cancer

78
Q

Does breast cancer increase the risk of endometrial cancer (and vice versa)

A

YES

79
Q

Infiltrating ductal carcinomas

A

make up the majority of breast cancers

the remainder are lobular carcinomas

80
Q

_____ disease is a ductal carcinoma presenting as an eczematous lesion of the nipple

A

Paget

81
Q

The majority (2/3) of ductal carcinomas are estrogen receptor…

A

positive!

82
Q

Single, nontender, firm, immobile mass

  • 45% occur in UPPER OUTER QUADRANT
  • 25% under nipple and areola
A

breast cancer

83
Q

Best SCREENING tool for breast cancer?

A

Mammograms

84
Q

Lumpectomy with sentinel node biopsy if preferred for….

A

early stage breast cancer

85
Q

______ is used to treat women with estrogen receptor positive disease and post menopausal women

A

Tamoxifen

86
Q

Lactational amenorrhea may be effective in delaying contraception for….

A

6 months after birth (if the woman is breast feeding exclusively and amenorrhea is maintained)

87
Q

What is the failure rate for the calendar method of contraception

A

35%

88
Q

predicts the day of ovulation based on average menstrual patterns

*are based on the relative constancy (14 days) of the luteal phase

A

calendar method

89
Q

what happens to the temperature of the vagina 24-36 hours after ovulation

A

temperature drops, then rises and plateaus for the rest of the cycle

90
Q

most effective reversible means of pregnancy prevention

A

oral hormonal contraceptives

91
Q

ethinyl estradiol or mestranol

A

estrogen component of OCP

92
Q

withdrawal bleeding occurs _____ days after the last active OCP pill

A

3-5 days

93
Q

most useful in lactating women, women over 40, those who cannot tolerate estrogen

A

Progestin only pills (“mini pills”)

94
Q

What should the first test be when evaluating infertility

A

Semen analysis

95
Q

Clomiphene citrate can be used in…

A

“infertile” women to promote ovulation

96
Q

Acute salpingitis
IUD related pelvic cellulitis
Tubo ovarian abscess
Pelvic abscess

A

pelvic inflammatory disease (PID)

97
Q
  • usually polymicrobial

* most bacterial!

A

PID

98
Q

Lower abdominal and pelvic pain, typically bilaterally

Nausea, HA, lower back pain
+/- fever

A

PID

99
Q

Exam reveals lower abdominal and pelvic pain and cervical motion tenderness (chandelier sign)

Purulent discharge and inflammation of Bartholin or Skene glands may be present

A

PID

100
Q

most common causes of PID

A

Chlamydia

Gonorrhea

101
Q

This diagnostic is helpful in differentiation acute and chronic inflammation of PID

A

transvaginal ultrasonography

102
Q

Mild dz treated outpatient with antibiotics, antipyretics, analgesics and bed rest

Severe dz should be hospitalized for IV abx and possibly surgery

A

PID

Clin Med- Repro (11 decks)

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