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TAV MDT List > GU Female MDT > Flashcards

GU Female MDT Flashcards

1
Q

Fibrocystic condition

Painful breast masses are often:

A

Multiple and bilateral

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2
Q

Fibrocystic condition

Pain often worsens during:

A

Premenstrual phase of the cycle

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3
Q

Fibrocystic condition

What is considered a causative factor?

A

Estrogen

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4
Q

Fibrocystic condition

Increased risk in women who:

A

Drink alcohol

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5
Q

Most frequent lesion of the breast

Most common age is 30-50

A

Fibrocystic condition

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6
Q

Symptoms:
-Breast pain or tenderness
-Discomfort worsens during premenstrual cycle
-Fluctuation in size of masses
-Multiple or bilateral
-No lymphadenopathy

A

Fibrocystic condition

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7
Q

Imaging for fibrocystic condition

A

Mammography

U/S (Used alone when patient is <30 y/o)

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8
Q

Diagnostic testing for fibrocystic changes

A

Core needle biopsy

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9
Q

All suspicious lesions should be biopsied by a:

A

General Surgeon

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10
Q

Treatment for mild to moderate discomfort from fibrocystic changes

A

NSAIDs

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11
Q

Patient education for fibrocystic changes

A

Avoid Trauma

Wear supportive bra night and day

Decreasing dietary fat intake

Consider eliminating caffeine

Vitamin E, 400IU Daily

Monthly self exam just after menstruation

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12
Q

Common benign neoplasm occurs most frequently in young women

Usually within 20 years after puberty

A

Fibroadenoma

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13
Q

Symptoms:
-Round/Ovoid
-Rubbery
-Discrete
-Relatively moveable
-Nontender mass 1-5 cm in diameter

A

Fibroadenoma

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14
Q

Imaging for Fibroadenoma

A

U/S

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15
Q

All breast masses should be referred to _________ for further evaluation and work up

A

General Surgery

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16
Q

Breast mass

Biopsy is negative, what is the next step of treatment?

A

No treatment is necessary

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17
Q

What may be necessary for large or rapidly growing fibroadenomas?

-Larger than 3-4 cm
-Rule out phyllodes tumor

A

Excision

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18
Q

Lesion of the breast

Produces a mass

Commonly seen after breast surgery/injections or trauma

A

Fat necrosis

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19
Q

Fat necrosis if untreated

A

Gradually disappears

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20
Q

Safest course when dealing with Fat necrosis

A

Biopsy

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21
Q

Fat necrosis is common after:

A

Segmental resection

Radiation therapy

Flap reconstruction after mastectomy

MVA

Assault

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22
Q

Female breast carcinoma

__ in eight American women

_____ most common cancer in women

_____ leading cause of cancer death

A

One

Second

Second

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23
Q

What is the most significant risk factor for female breast carcinoma?

A

Age

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24
Q

Risk rises rapidly until early 60’s, peaks in 70’s, then declines

A

Female breast carcinoma

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25
Q

Reproductive history associated with female breast carcinoma

A

Nulliparous or late first pregnancy (after age 30)

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26
Q

Menstrual history associated with female breast cancer

A

Early menarche (under 12)

Late menopause (after 55)

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27
Q

Most reliable means of detecting breast cancer before a mass can be palpated

A

Mammography

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28
Q

Most slow growing cancers can be identified by mammography at least ___ years before they are palpable

A

2 years

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29
Q

Mammography screening for women age 40-49

A

Shared decision making with patient

Suggested every 2 years

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30
Q

Mammography screening for women age 50-74

A

Every 2 years

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31
Q

Mammography screening age 75 and older

A

Only recommended if life expectancy is greater than 10 years

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32
Q

Imaging for High Risk female breast carcinoma patients

A

MRI

U/S

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33
Q

Female Breast Carcinoma

__% of patients with a (usually) painless lump

__% discovered by the patient

A

70%

90%

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34
Q

Rare symptoms associated with female breast carcinoma

A

Axillary mass or swelling

Back or joint pain

Jaundice

Weight loss

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35
Q

Signs

-Single, nontender, firm to hard mass with ILL-DEFINED margins
-Mammographic abnormalities and no palpable mass

A

Female breast carcinoma EARLY SIGNS

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36
Q

Signs:

-Skin or nipple retraction
-Axillary lymphadenopathy
-Breast enlargement, erythema, edema, pain
-Fixation of mass to skin or chest wall

A

Female breast carcinoma LATE SIGNS

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37
Q

Laboratory findings associated with female breast carcinoma

A

Increase Alkaline Phosphatase

Increase Serum Calcium

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38
Q

Imaging for female breast carcinoma

A

Mammography

U/S

MRI

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39
Q

Diagnostic procedure of choice in both palpable and image detected abnormalities

A

Core needle biopsy

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40
Q

Treatment for female breast cancer

A

Surgical resection (Mastectomy)

Radiation

Systemic Therapy (Chemo, Targeted, Bisphosphonates)

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41
Q

Most reliable indication of female breast carcinoma prognosis

A

Stage of cancer

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42
Q

Female Breast Carcinoma

Recurrences occur most frequently within the first ___ years

A

2-5 years

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43
Q

Female breast carcinoma

Patients are examined every 6 months for the first:

A

2 years

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44
Q

Female breast carcinoma

Patients are examined annually after:

A

2 years (first 2 years is every 6 mo)

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45
Q

A new primary breast malignancy will develop in ___% of patients

A

20-25%

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46
Q

If female breast carcinoma is metastatic, it will travel to:

A

Bone

Liver

Lungs

Brain

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47
Q

Incidence is only 1% of all breast cancer

A

Male breast carcinoma

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48
Q

Male breast carcinoma

Average age occurrence is:

A

70

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49
Q

What increases the risk of men with breast cancer?

A

-Prostate cancer

-First degree relatives of men with breast cancer

-BRCA 2 mutation

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50
Q

Signs:
-Male patient usually presents with a painless lump
-Hard, ill defined, nontender mass beneath the nipple or areola
-Gynecomastia

A

Male breast carcinoma

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51
Q

Imaging for male breast carcinoma

A

Mammography

U/S

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52
Q

Treatment for male breast carcinoma

A

Modified radical mastectomy

Radiation

Adjuvant systemic therapy

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53
Q

Prognosis for 5 year survival

-Node negative disease __%
-Node positive disease __%

A

Positive 88%

Negative 69%

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54
Q

Serous nipple discharge most likely suggests

A

Benign fibrocystic changes (FCC)

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55
Q

Bloody nipple discharge most likely suggests

A

Neoplastic papilloma

Carcinoma

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56
Q

Nipple discharge

If there is bloody discharge, the bloody duct and mass if present should be:

A

Excised

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57
Q

Nipple discharge with an associated mass more likely suggests:

A

Neoplasm

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58
Q

Bilateral nipple discharge is most likely:

A

Non-neoplastic (Endocrine etiology)

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59
Q

Common causes of Nipple Discharge in non-lactating women

A

Duct ectasia (FCC)

Intraductal papilloma (FCC)

Carcinoma

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60
Q

Milky discharge in the non-lactating woman may occur from:

A

Hyperprolactinemia

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61
Q

Nipple discharge

What lab levels are used to rule out pituitary tumor?

A

Serum prolactin levels

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62
Q

What class drugs can cause elevated prolactin levels which lead to lactation in men and women?

A

Antipsychotic

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63
Q

Nipple discharge

Oral contraceptives or estrogen replacement may cause what type of discharge?

A

Clear, serous or milky discharge

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64
Q

Nipple Discharge

Purulent discharge is associated with:

A

Breast Abscess

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65
Q

Labs for nipple discharge

A

Cytological evaluation of discharge

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66
Q

Imaging for nipple discharge when localized is not possible or in the absence of a palpable mass

A

Mammography

U/S

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67
Q

Treatment for Nipple Discharge

A

Refer to a breast clinic, OB/GYN, or General Surgery

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68
Q

Most discharge is ______ especially if bilateral

A

Benign

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69
Q

Follow up for a patient with nipple discharge if there are no signs of malignancy

A

Re-examined every 3-4 months

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70
Q

Normal menstrual bleeding lasts an average of:

A

5 days

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71
Q

Range of days for normal menstrual bleeding:

A

2-7 days

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72
Q

Mean blood loss per menstrual cycle is:

A

40 ml

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73
Q

Blood loss over 80 ml

A

Menorrhagia

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74
Q

Bleeding between periods

A

Metrorrhagia

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75
Q

Bleeding that occurs more often than every 21 days

A

Polymenorrhea

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76
Q

Bleeding that occurs less frequently than every 35 days

A

Oligomenorrhea

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77
Q

Classifications of descriptive terms denoting the bleeding pattern

A

Heavy

Light

Menstrual

Intermenstrual

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78
Q

Etiologies of Abnormal Uterine Bleeding

A

PALM-COEIN

Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet classified

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79
Q

Structural etiologies of AUB

A

Polyp

Adenomyosis

Leiomyoma

Malignancy

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80
Q

In adolescents AUB is usually from:

A

Anovulation (not ovulating)

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81
Q

AUB-O

A

AUB from ovulatory dysfunction

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82
Q

Once regular menses is established, what is the most common cause of AUB?

A

AUB-O

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83
Q

AUB in women 19-39 is often the result of:

A

Pregnancy

Structural lesions

Anovulatory cycles

Hormonal contraceptives

Endometrial hyperplasia

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84
Q

AUB

Depending on the amount of blood, you could have signs of:

A

Anemia

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85
Q

AUB diagnosis depends on:

A

History of duration and amount of flow, associated pain, relationship to LMP

History of present illnesses

History of medications

History of coagulation disorders

Complete physical exam

Pelvic Exam

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86
Q

Labs for AUB

A

CBC

HCG

Thyroid function tests

Coagulation studies

Gonorrhea and chlamydia

Pap Smear

Endometrial Sampling

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87
Q

Imaging for AUB

A

Transvaginal US

Sonohysterography or Hysteroscopy

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88
Q

Treatment for AUB

ALL patients should:

A

Refer to OB-GYN

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89
Q

AUB can be secondary to:

A

Submucosal myomas

Infection

Early abortion

Thrombophilia

Pelvic neoplasm

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90
Q

AUB Treatment

A

Progestin (to oppose estrogen)

NSAIDs

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91
Q

AUB can cause:

A

Anemia

Infertility

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92
Q

Postmenopausal bleeding is _______ until proven otherwise

A

Cancer

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93
Q

Important tool in evaluating the etiology of bleeding

A

Transvaginal ultrasound measurement of the endometrium

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94
Q

Recurrent variable cluster of troublesome physical and emotional symptoms that develop during the 5 days before the onset of menses and subsides within 4 days after menstruation occurs

A

Premenstrual syndrome (PMS)

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95
Q

When emotional or mood symptoms predominate along with the physical symptoms and there is a clear junctional impairment with work or personal relationship

A

Premenstrual dysphoric disorder (PMDD)

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96
Q

PMS

Intermittently affects ___% of premenopausal women

A

40%

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97
Q

PMS primarily affects what age range?

A

25-40

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98
Q

PMS

__% symptoms are severe

A

5-8%

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99
Q

Signs/Symptoms
-Bloating, breast pain, ankle swelling, sense of increased weight, skin disorders, irritability, aggressiveness, depression, inability to concentration, libido change, lethargy, food cravings

A

PMS

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100
Q

PMS

Work up for the patient includes

A

Support for both emotional and physical distress

Daily diary of all symptoms for 2-3 months
-Record severity of problems

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101
Q

PMS

If symptoms occur throughout the month rather in the two weeks before menses, she may have:

A

Depression or other mental health disorders

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102
Q

Treatment for mild to moderate PMS

A

Aerobic exercise

Reduction of caffeine, salt and alcohol

Increase Calcium (1200mg/day)

Vitamin D or magnesium

Increase complex carbohydrates

Alternative therapies (acupuncture/herbal)

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103
Q

Medications for PMS

A

Hormonal contraceptives

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104
Q

When mood symptoms predominate, what has been shown to be effective in relieving tension, irritability, and dysphoria?

A

SSRIs (Antidepressants)

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105
Q

SSRIs are contraindicated in:

A

Patients taken MOAI in the past 2 weeks

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106
Q

Results from:

-Pathogens
-Allergic Reactions
-Vaginal Atrophy
-Friction during coitus

A

Vaginitis

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107
Q

History taking for Vaginitis should include

A

Onset of LMP

Recent sexual activity (use of products)

Contraceptives, tampons, or douches

Changes in medications or use in antibiotics

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108
Q

Signs/Symptoms:

-Vaginal irritation
-Pain
-Unusual or malodorous DISCHARGE
-Bimanual exam shows inflammation, cervical motion tenderness, adnexal tenderness

A

Vaginitis

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109
Q

What predisposes patients to Candida infections?

A

Pregnancy

Diabetes

Antibiotics

Corticosteroids

Heat, moisture, occlusive clothing

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110
Q

Pruritus, vulvovaginal erythema, white curd-like discharge that is not malodorous

A

Vulvovaginal Candidiasis (Yeast infection)

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111
Q

Sexually transmitted protozoal flagellate

A

Trichomonas

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112
Q

Pruritus and a malodorous frothy, yellow-green discharge occur, along with diffuse vaginal erythema

Strawberry Cervix

A

Trichomonas

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113
Q

Polymicrobial disease that is not sexually transmitted, chronic in nature

Overgrowth of Gardnerella and other anaerobes

Increased malodorous discharge without obvious vulvitis or vaginitis

A

Bacterial Vaginosis (BV)

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114
Q

Labs for Vaginitis

A

KOH

Wet Prep

NAAT urine testing

Vaginal pH

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115
Q

Vaginitis KOH

Branched hyphae and budding yeast in:

A

Candidiasis

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116
Q

Vaginitis KOH

Positive whiff test (amine or fishy odor)

A

BV

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117
Q

Vaginitis Wet Prep

Motile flagella is found in:

A

Trichomonas

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118
Q

Vaginitis Wet prep

Clue cells is found in:

A

BV

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119
Q

NAAT urine testing is for:

A

Chlamydia and gonorrhea

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120
Q

Vaginal ph

Frequently greater than 4.5 in:

A

Trichomonas

BV

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121
Q

Treatment for vulvovaginal candidiasis

A

Fluconazole

150mg tab

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122
Q

Treatment for Trichomonas

A

Metronidazole

2g PO x1
500mg BID x7

TREAT BOTH PARTNERS

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123
Q

Treatment for BV

A

Metronidazole 500mg BID x7 days

Clindamycin vaginal cream 2%, 5g once daily x7 days

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124
Q

Treatment for Chlamydia

A

Doxycycline

100mg BID x 7 days

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125
Q

Treatment for Gonorrhea

A

Ceftriaxone

500 mg IM x 1 dose

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126
Q

What may cause the Bartholin duct to be obstructed?

A

Trauma or infection

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127
Q

Bartholin gland infection usually:

A

Resolves

Pain disappears

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128
Q

Signs/Symptoms

-Periodic painful swelling on either side of the introitus
-Dyspareunia
-Fluctuant swelling 1-4 cm in diameter later to either labium minus
-Tenderness is evident of active infection

A

Bartholin’s Gland Abscess

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129
Q

Labs for Bartholin’s Gland Abscess

A

Culture of drainage
-Chlamydia
-Gonorrhea
-Other pathogens

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130
Q

Treatment for Bartholin’s Gland Abscess

A

Manual aspiration or incision and drainage of abscess

Antibiotics if STI is suspected

Warm Soaks

Marsupialization (OB/GYN)

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131
Q

Bartholin’s Gland Abscess

Women under ___ years of age, asymptomatic cysts do not require therapy unless they’re large or cause problems with intercourse

A

Under 40

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132
Q

Bartholin’s Gland Abscess

Women over age __, biopsy or removal are recommended to rule out vulvar carcinoma

A

Over 40

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133
Q

Cervical dysplasia starts in _____ because of hormonal changes and pH of tissue

A

Puberty

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134
Q

Infection with HPV may lead to cellular abnormalities. Over a period of time this can lead to:

A

Cervical dysplasia or Cancer

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135
Q

All atypia (abnormal cells) must be observed and treated if:

A

Persistent or worsening

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136
Q

CIN

A

Cervical Intraepithelial Neoplasia (CIN)

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137
Q

Cervical dysplasia presumptive diagnosis is made by an ________ of an asymptomatic woman with no grossly visible cervical changes

A

Abnormal PAP smear

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138
Q

All visible abnormal cervical lesions should be referred to:

A

OB/GYN for biopsy and therapy

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139
Q

In immunocompetent women, cervical cancer screening should begin at age:

A

21

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140
Q

USPSTF recommends screening for cervical cancer in women aged 21-65 with cytology every ___ years

Or, 30-65 screening with a combination of cytology and HPV every __ years

A

3 years

5 years

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141
Q

Cervical cancer with HPV testing, alone or in combination with cytology in women younger than age 30 is not recommended because:

A

HPV can “go away” in younger women

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142
Q

USPSTF recommends against cervical cancer screening for women older than age ___ with no prior history

A

65

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143
Q

What puts you at a greater risk for Cervical Intraepithelial Neoplasm (CIN)?

A

HIV

Immunosuppression

Exposure to diethylstilbestrol (DES) in utero

Previous treatment for CIN 2, CIN 3, or cervical cancer

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144
Q

Diagnosis for Cervical Dysplasia is made by:

A

Papanicolaou Smear

Colposcopy

Biopsy

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145
Q

Diagnostic procedure with a colposcope, dissecting microscope with various magnification lenses, used to provide an illuminated, magnified view of the cervix, vagina, vulva, or anus

A

Colposcopy

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146
Q

Women with Atypical squamous cells of unknown significance (ASC-US) with a negative HPV must be followed up in _____ for a repeat Pap smear and HPV co-testing

A

1 year

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147
Q

If HPV screen is positive, what diagnostic procedure is indicated?

A

Colposcopy

148
Q

All patients with SIL or atypical glandular cells should undergo:

A

Colposcopy

149
Q

What is necessary for diagnosis and planning of treatment for Cervical Dysplasia?

A

Colposcopically directed punch biopsy and endocervical curettage

150
Q

Associated with a high percentage of all cervical dysplasia and cancers

A

HPV

151
Q

What can prevent cervical, vaginal, and vulvar cancers and low grade precancerous lesions caused by HPV?

A

Vaccination

152
Q

What vaccination for HPV is recommended for females and males ages 9 and older?

A

Gardasil

153
Q

HPV

In addition to vaccination, preventive measures include:

A

Limiting the number of sexual partners

Using a condom for coitus

Smoking cessation

154
Q

Cervical Dysplasia

Biopsies should precede treatment, except in cases of:

A

HSIL (High grade squamous intraepithelial lesions)

155
Q

Cervical Dysplasia

Treatment for High grade squamous intraepithelial lesion (HSIL)

A

Loop Electrosurgical Excision Procedure (LEEP)

156
Q

Treatment effective for noninvasive small lesion visible on the cervix

A

Cryosurgery

157
Q

Cervical Dysplasia

Treatment minimizes tissue destruction

Colposcopically directed

A

CO2 Laser

158
Q

Cervical Dysplasia

Treatment: Wire loop is used for excision

A

LEEP

159
Q

Cervical Dysplasia

Treatment for cases of severe dysplasia or cancer in situ

A

Conization of the cervix

160
Q

Most common benign neoplasm of the female genital tract

A

Leiomyoma (Fibroid) of the uterus

161
Q

Discrete, round, firm, often multiple uterine tumor composed of smooth muscle and connective tissue

May cause miscarriage and pregnancy complications because they interfere with implantation

A

Leiomyoma (fibroid) of the uterus

162
Q

Leiomyoma

Symptoms for which females seek treatment

A

Pelvic discharge

Abnormal uterine bleeding

Pain

163
Q

Labs for Leiomyoma (Fibroid)

A

CBC
-Iron deficiency anemia

164
Q

Imaging for leiomyoma

A

Transvaginal U/S

MRI with contrast

Hysterography / hysteroscope

165
Q

Leiomyoma

Imaging to confirm presence and monitor for growth

A

Transvaginal U/S

166
Q

Leiomyoma

Imaging to assess location within the muscle and blood flow to the tumor

A

MRI w/ contrast

167
Q

Contraceptive

Can help decrease bleeding associated with fibroids

A

LNG IUD

168
Q

Treatment for leiomyoma

A

NSAIDs

Hormonal therapies

169
Q

Complications from leiomyoma

A

Infertility

Anemia

Need for C-section delivery

Recurrence is common

Surgical complications

170
Q

Any patient with symptomatic (anemia, pain, AUB) fibroids should be:

A

Referred to gynecologist

171
Q

Disposition for a suspected torsion of fibroid and hemorrhage

A

MEDEVAC

172
Q

Carcinoma of the endometrium

Abnormal uterine bleeding is present in __% of cases

A

90%

173
Q

All post-menopausal bleeding require:

A

EVALUATION

174
Q

Carcinoma of the endometrium

Pap smear is frequently: ______

Pain is usually: _______

A

Negative

Late symptom

175
Q

Second most common cancer of the female reproductive tract

A

Adenocarcinoma of the endometrium

176
Q

Adenocarcinoma of the endometrium most often occurs at what age?

A

50-70

177
Q

Risk factors for adenocarcinoma of the endometrium

A

Obesity

Nulliparity (unopposed estrogen)

Diabetes

Polycystic ovaries with prolonged anovulation (unopposed estrogen)

Unopposed estrogen therapy

Extended use of tamoxifen (estrogen blocker for breast cancer)

Family history of colorectal cancer

178
Q

Labs for Adenocarcinoma of the endometrium

A

Biopsy of endometrial tissue

Pap smear

179
Q

Imaging for Adenocarcinoma of the endometrium

A

Vaginal U/S

Hysteroscopy

180
Q

Treatment for Adenocarcinoma of the endometrium

A

Surgery

Post-operative radiation

Chemotherapy

181
Q

Overall 5-year survival of Adenocarcinoma of the endometrium:

A

80-85%

182
Q

Adenocarcinoma of the endometrium

Strongest predictor of prognosis

A

Depth of cancer invasion into the myometriumis

183
Q

All patients with concern of endometrial carcinoma should be referred to:

A

GYN oncologist

184
Q

Ectopic growth of the endometrium outside the uterus, particularly in the dependent parts of the pelvis and in the ovaries

A

Endometriosis

185
Q

Principle manifestation of endometriosis

A

Chronic pain

Infertility

186
Q

Signs/Symptoms

-Dysmenorrhea
-Chronic pelvic pain
-Dyspareunia
-Abnormal uterine bleeding
-Infertility
-May be asymptomatic

A

Endometriosis

187
Q

Physical exam may show:

-Tender nodules in the cul-de-sac or rectovaginal septum
-Cervical motion tenderness
-Adnexal mass or tenderness

A

Endometriosis

188
Q

Definitive diagnosis of endometriosis is made only by:

A

Histology of lesions removed at surgery (Laparoscopy)

189
Q

Imaging for endometriosis

A

Transvaginal U/S (presence of pelvic or adnexal mass)

190
Q

Treatment for endometriosis

A

NSAIDs

Hormonal therapy

191
Q

Endometriosis treatment

Inhibit ovulation for ___ month preventing cyclic stimulation of endometriotic growths inducing atrophy

A

4-9 months

192
Q

Surgical treatment for endometriosis that reduces pain and promotes fertility

A

Laparoscopic ablation of endometrial implants

193
Q

Surgical treatment for endometriosis that is the definitive therapy for those with intractable pelvic pain, adnexal masses, or multiple previous ineffective conservative surgical procedures

A

Hysterectomy

194
Q

Complications of endometriosis

A

Infertility

Chronic pain

Reoccurrence

195
Q

Any patient suspected of having endometriosis should be referred to:

A

OB/GYN

196
Q

Polymicrobial infection of the upper genital tract

A

Pelvic Inflammatory Disease (PID)

197
Q

PID is commonly associated with:

A

Gonorrhea & Chlamydia

Endogenous organisms, including anaerobes

Influenzae

Enteric gram-negative rods

Streptococci

198
Q

Most common in young, nulliparous, sexually active women with multiple partners and is a leading cause of infertility and ectopic pregnancy

A

Pelvic Inflammatory Disease (PID)

199
Q

The use of ________ of contraception may provide significant protection from PID

A

Barrier Methods

200
Q

PID is more likely to occur when:

A

History of PID

Recent sexual contact

Recent onset of menses

Recent insertion of IUD

Partner has sexually transmitted disease

201
Q

Acute PID is highly unlikely when:

A

Recent intercourse has not taken place (within 60 days)

202
Q

Women with cervical motion pain, uterine, or adnexal tenderness should be considered to have _____ and be treated with _______

A

PID

Antibiotics

203
Q

Signs/Symptoms

-Lower abdominal pain
-Chills and fever
-Menstrual disturbances
-Purulent cervical discharge
-Cervical and adnexal tenderness
-Subtle or mild symptoms of postcoital bleeding, urinary frequency, low back pain

A

PID

204
Q

Labs for PID

A

Endocervical culture
-Chlamydia
-Gonorrhea
-Other pathogens

Pregnancy Test

205
Q

Imaging for PID

A

Vaginal U/S

Laparoscopy

206
Q

Imaging used to diagnose PID when diagnosis is not certain or if the patient has not responded to antibiotic therapy after 48 hours

A

Laparoscopy

207
Q

Early treatment of PID

A

Cefoxitin 2g IM and Doxycycline 100mg PO BID x14 days

Ceftriaxone 500mg IM and Doxycycline 100mg PO BID x14 days

Metronidazole 500mg PO BID x14 days

208
Q

Treatment for severe PID

A

Cefoxitin 2g IV Q6h and Doxycycline 100mg PO/IV Q12h

209
Q

Complications of PID

A

Tube-ovarian abscess

Long-term sequelae in 1 in 4 women

210
Q

PID

Risk of ______ increases with repeated episodes of salpingitis

10% after first episode
25% after a second episode
50% after a third episode

A

Infertility

211
Q

PID

MEDEVAC if you suspect:

A

Tube-ovarian abscess

Pregnant

Unable to tolerate outpatient regimen

Not responding to outpatient therapy within 72 hours

Severe illness (nausea, vomiting, high fever not controlled)

Surgical Emergency can not be ruled out

212
Q

Ovarian tumors are common. Most are ______.

A

Benign

213
Q

Leading cause of death from reproductive tract cancer

A

Malignant ovarian tumors

214
Q

Women with ___ gene mutation have increase risk for ovarian cancer

A

BRCA

215
Q

Most women with both benign or malignant ovarian neoplasms present with:

A

Symptomatic or nonspecific GI symptoms or pelvic pressure

216
Q

Women with advanced ovarian malignant disease may experience what kind of symptoms?

A

Abdominal pain

Bloating

Palpable abdominal mass with ascites

217
Q

Once an ovarian mass has been detected, it must be:

A

Categorized as functional

Benign neoplastic

Potentially malignant

218
Q

Labs for Ovarian mass

A

Tumor marks serum
-Cancer antigen 125

HCG

Lactate dehydrogenase

Alpha fetoprotein

219
Q

Imaging for Ovarian mass

A

Transvaginal ultrasound

220
Q

Treatment for malignant ovarian mass

A

Surgical evaluation by GYN oncologist

221
Q

Treatment for benign neoplasms in the ovaries

A

Tumor removal or unilateral oophorectomy

222
Q

Ovarian cancer is usually diagnosed after advanced disease ___% of the time

A

75%

223
Q

Ovarian cancer 5 year survival:

__% Early Disease

__% Local Spread

__% Distant Metastases

A

89%

26%

17%

224
Q

Malignant mass is suspected, what should be done?

A

Surgical evaluation by GYN oncologist

225
Q

Polycystic ovarian syndrome (PCOS) - common endocrine disorder affecting ___% of reproductive age women

A

5-10%

226
Q

Symptoms:

-Chronic anovulation with abnormal menses

-Polycystic ovaries

-Hyperandrogenism

A

Polycystic Ovarian Syndrome

227
Q

PCOS is associated with :

A

Hirsutism

Obesity

Increased risk for diabetes and cardiovascular disease

228
Q

Increased risk of endometrial cancer secondary to unopposed estrogen secretion is caused by:

A

Polycystic Ovarian Syndrome

229
Q

Signs/Symptoms

-Menstrual disorder (amenorrhea to menorrhagia)
-Infertility
-Skin disorders (secondary to increased androgens)
-Insulin resistance

A

Polycystic Ovarian Syndrome (PCOS)

230
Q

Labs for Polycystic Ovarian Syndrome (PCOS)

A

FSH

LH

Prolactin

TSH

Hemoglobin A1C

Lipid Profile

231
Q

Imaging for PCOS

A

Transvaginal U/S

232
Q

Treatment for PCOS

A

Weight loss and exercise

Metformin therapy

-Attempting fertility: Ovarian stimulation with medications/surgery

-Not attempting fertility: Combined Contraceptive

-Treatment for hirsutism

233
Q

PCOS

Increase Risk of:

A

-Infertility
-Cardiovascular disease
-Diabetes mellitus
-Endometrial cancer
-Ovarian torsion

Regular monitoring of lipids, glucose and Hgb A1C (metabolic syndrome)

234
Q

Any patient suspected of having PCOS should be referred to:

A

Physician supervisor or GYN

235
Q

A type of sexual pain disorder with recurrent or persistent genital pain associated with sexual intercourse that is not associated with lack of lubrication or vaginismus

A

Dyspareunia

236
Q

Most common cause of dyspareunia (painful intercourse) in premenopausal women

A

Vulvodynia

237
Q

Dyspareunia is characterized by what symptoms?

A

Sensation of burning

Pain

Itching

Stinging

Irritation

Rawness

NO PHYSICAL EXAM FINDINGS

238
Q

Sexual pain disorder with recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina

A

Vaginismus

239
Q

Vaginismus interferes with sexual intercourse and results from:

A

Fear

Pain

Sexual violence

Negative attitudes towards sex

240
Q

Labs for dyspareunia

A

UA

Gonorrhea and Chlamydia

KOH

Wet Prep

241
Q

Imaging for dyspareunia

A

Transvaginal U/S

242
Q

Treatment for vaginismus

A

Sexual counseling and education
-Education on using lubrication

Botox injections in refractory cases

243
Q

Treatment for vulvodynia

A

Topical anesthetics

Tricyclic antidepressants

SSRIs

Gabapentin

Physical therapy

244
Q

Any patient with concerns of dyspareunia or vaginismus should be referred to:

A

Physician supervisor or GYN

245
Q

Couple is said to be infertile if pregnancy does not result after ____ of normal (2x/week) sexual activity with no contraceptives

A

1 year

246
Q

__% of couples experience infertility at some point

A

25%

247
Q

Infertility

Male partner contributes ___%

A

40%

248
Q

Initial testing of infertility includes:

A

Private consultations with each partner

Pertinent history

GYN history

Basic labs

249
Q

Labs for infertility

A

CBC

Gonorrhea testing

Chlamydia testing

TSH

Semen analysis

250
Q

Infertility

In the absence of identifiable causes ___% will achieve pregnancy within 3 years

A

60%

251
Q

Infertility

Couples who do not achieve pregnancy within ___ years may be offered ovulation induction (IVF)

A

3 years

252
Q

Women over the age of ___ are given a more aggressive approach to for fertility

A

35

253
Q

__% of the 213 pregnancies in 2012 were unintended

A

45%

254
Q

Mechanism of action:

Suppression of ovulation by inhibition of GnRH, LH, FSH, and the mid-cycle LH surge.

A

Combined Oral Contraceptives (COC)

255
Q

Effects the endometrium rendering less suitable for implantation

Thickening of cervical mucus to prevent penetration by sperm

Impairment of normal tubal motility

A

Progestin

256
Q

The failure rate for COC’s if using them perfectly

A

0.3%

257
Q

Typical failure rate for COC’s

A

8%

258
Q

COC’s are ideally started on:

A

First day of the menstrual cycle

259
Q

COC

If an active pill is missed at any time, and no intercourse occurred in the past 5 days, what should be done?

A

Two pills taken immediately

Backup method used for 7 days

260
Q

COC

If intercourse occurred in the previous 5 days while missing a pill, what should be done?

A

Emergency contraception should be used immediately

Pills restarted the following day

Backup method used for the next 5 days

261
Q

Contraceptive Advantages:

-Lighter menses
-Improvement of dysmenorrhea symptoms
-Decreased risk of ovarian and endometrial cancer
-Improvement in acne
-Functional ovarian cysts are less likely
-Frequency of developing myomas is lower
-Beneficial effect on bone mass

A

Combined Oral Contraceptives

262
Q

Contraindications for what contraceptive?

-Pregnancy
-Thromboembolic disorders
-Stroke/CAD
-HTN >160/100
-Breast Cancer
-Undiagnosed vaginal bleeding
-Age >35 and smoking >15 cigarettes daily
-Migraine with aura

A

Combined Oral Contraceptives (COCs)

263
Q

Contraceptive that is highly dependent on consistent use

Must be taken with precise accuracy within 3-hour window every day

A

Progestin Minipill

264
Q

What contraceptive is recommended in patients who are >35, who smoke, have DVT, thromboembolic disorders, and diabetes with vascular disease?

A

Progestin Minipill

265
Q

What contraceptive can cause the following:

-Bleeding irregularities
-Ectopic pregnancies are more frequent
-Side effects like weight gain and mild headache

A

Progestin Minipill

266
Q

Injectable progestin (DMPA) is given SubQ or IM every __ months

A

3 months

267
Q

Nexplanon, single rod progestin implant is effective for:

A

3 years

268
Q

Transdermal contraceptive patch, Ortho Evra, is applied consecutively for
___ weeks and ___ weeks off.

A

3 weeks and 1 week off

269
Q

Contraceptive

Ring users may experience an increase incidence of:

A

Vaginal discharge

270
Q

Contraceptive devices that are highly effective with failure rates similar to those achieved with surgical sterilization

A

Intrauterine Devices

271
Q

IUD pelvic infections are increased for the first ____ following insertion

A

1 month

272
Q

Copper IUD can cause:

A

Heavier menstrual periods

Bleeding between periods

More cramping

273
Q

Treatment for a patient who’s missing IUD strings

A

Pelvic U/S

GYN referral

274
Q

Male condom types

A

Latex

Polyurethane

Animal Membrane

275
Q

Failure rates of couples who use condoms perfectly ___%

__% become pregnant after 1 year

A

18%

2%

276
Q

Female condom types

A

Polyurethane

Synthetic nitrile

277
Q

Calendar method

Length of menstrual cycle has been observed for at least __ months

A

8 months

278
Q

Basal body temperature

Body temperature must be taken at:

A

Upon awakening, before any activity

279
Q

Basal body temp

A slight drop of temperature occurs ___ hours before ovulation:

A

12-24

280
Q

Basal body temp

A rise of 0.4C occurs:

A

1-2 days after ovulation

281
Q

Basal Body temp

Risk of pregnancy increases starting __ days prior to ovulation

A

5 days

282
Q

Basal body temp

Risk of pregnancy peaks at:

A

Day of ovulation

283
Q

Basal body temp

Risk of pregnancy is zero by:

A

Day after ovulation

284
Q

Emergency contraceptives should be started as soon as possible and within:

A

120 hours (5 days)

285
Q

Emergency contraceptive that is more effective than levonorgestrel, especially between 72 and 120 hours, particularly for overweight women

A

Ulipristal 30 mg

286
Q

Naturally occurring miscarriage

A

Spontaneous Abortion

287
Q

Electively performed abortion

A

Induced

288
Q

DoD funds abortions ONLY if:

A

Endangered life of service member if the fetus were carried

Pregnancy is a result of an act of rape or incest

289
Q

Vasectomy

Which part of the male anatomy is severed and sealed through a scrotal incision under local anesthesia?

A

Vas Deferens

290
Q

Vasectomy

Semen analysis __ months after procedure to confirm sterility

A

3 months

291
Q

Female sterilization is often achieved with:

A

Tubal ligation

292
Q

Intentional sexual contact characterized by the use of force, threats, intimidation or abuse of authority or when the victim does not or cannot consent

A

Sexual Assault

293
Q

Treatment for Sexual assault victims

A

MEDEVAC

294
Q

Ships that are capable of receiving a sexual assault victim

A

LHA/LHD

CVN

295
Q

All urine or blood pregnancy tests rely on the detection of:

A

HCG

296
Q

Signs/Symptoms:

-Amenorrhea
-Nausea and vomiting
-Breast tenderness and tingling
-Urinary frequency and urgency
-Weight Gain

A

Pregnancy

297
Q

“Quickening” perception of first movement noted at ___ week of pregnancy

A

18th

298
Q

Pregnancy

Softening of the cervix occurs around __ week

A

7th

299
Q

Cervix becomes bluish to purple due to increased blood supply at the 7th week of pregnancy

A

Chadwick sign

300
Q

Pregnancy

Uterine fundus is palpable above the pubic symphysis by ____ weeks from the LMP. Reaches the umbilicus by ____ weeks

A

12-15

20-22

301
Q

Pregnancy

Fetal heart tones can be heard by doppler at ___ weeks of gestation

A

8-10

302
Q

Labs for pregnancy

A

HCG

303
Q

Imaging for pregnancy

A

Transvaginal U/S

304
Q

Treatment for pregnancy

A

MEDEVAC

Referral to Obstetrics

305
Q

Pregnant service members can serve aboard a ship until ___ week of pregnancy, while in port or during short underway periods

A

20th week

306
Q

Pregnancy service members aboard ships require a medical evacuation in less than __ hours

A

6 hours

307
Q

Patient education for pregnant females

A

Prenatal vitamins

Decrease caffeine to 0-1 cup

Use only medications prescribed or authorized by an OB provider

308
Q

__% clinically recognized pregnancies terminate in spontaneous abortion

A

20%

309
Q

Abortion

-Bleeding or cramping occurs, but pregnancy continues
-The cervix is not dilated

A

Threatened abortion

310
Q

Abortion

-Products of conception are completely expelled
-Pain ceases, but spotting may persist
-Cervical os is closed, some blood in the vaginal wall

A

Complete Abortion

311
Q

Abortion

-Cervix is dilated
-Some portion of the products of conception remains in the uterus
-Only mild cramps are reported
-Bleeding is persistent and often excessive

A

Incomplete Abortion

312
Q

Abortion

-Pregnancy has creased to develop, but the conceptus has not been expelled
-Sx of pregnancy disappear
-Brownish vaginal discharge but no active bleeding
-Pain does not develop. Cervix is semi firm and slightly patulous
-Uterus becomes smaller and irregularly softened
-Adnexa are normal
-Women may be indicated for abortifacient and curettage

A

Missed Abortion

313
Q

If HCG is low or falling during pregnancy, this indicates:

A

Abortion

314
Q

Abortion

All tissues recovered should be sent to:

A

Pathology

315
Q

Imaging for abortion

A

Transvaginal U/S

316
Q

Treatment for abortion

A

-Stabilize patient
-MEDEVAC
-Products of conception put in a specimen bottle
-Analgesics

317
Q

Any female with vaginal bleeding, positive HCG and abdominal pain is _______ until proven otherwise

A

Ectopic Pregnancy

318
Q

Ectopic pregnancy occurs __% of first trimester pregnancies

A

2%

319
Q

Risk factors for Ectopic Pregnancy include a history of:

A

Infertility

Pelvic Inflammatory Disease

Ruptured Appendix

Prior Tubal Surgery

320
Q

One of the most common causes of maternal death during the first trimester

A

Undiagnosed or undetected ectopic pregnancy

321
Q

What increases the chances of ectopic?

A

Scarring of fallopian tube

322
Q

Signs/Symptoms

-Severe lower quadrant pain (Sudden, stabbing)
-Backache
-Adnexal tenderness
-Shock 10% of the time

A

Ectopic

323
Q

Ectopic pregnancy

HCG qualitative will be:

A

Greatly lower than expected

324
Q

Imaging for ectopic:

A

Transvaginal ultrasound

325
Q

Treatment for Unstable Ectopic

A

MEDEVAC

Surgical (Laparoscopy)

326
Q

Medical treatment for a stable patient with an early ectopic

A

Methotrexate 50mg IM

327
Q

Ectopic

Repeat tubal pregnancy occurs in __% of cases

A

10%

328
Q

Causative agent for Mastitis

A

Staph aureus

329
Q

Mastitis is rare in:

A

Nonlactating breast

330
Q

Mastitis

Biopsy is indicated in:

A

Nonlactating breast when non-responsive to antibiotics

331
Q

Signs/Symptoms

-Frequently begins within 3 months after delivery
-Starts with an engorged breast and a sore or fissured nipple
-Unilateral Cellulitis (Red, tender, and warm)
-Fever and Chills

A

Mastitis

332
Q

Lab findings in Mastitis

A

CBC: Leukocytosis

333
Q

Imaging for Mastitis

A

Breast U/S
-Evaluate for abscess

334
Q

Antibiotic Treatment for MSSA Mastitis

A

Cephalexin

Clindamycin

335
Q

Antibiotic Treatment of MRSA Mastitis

A

Trimethoprim/sulfamethoxazole

Clindamycin

336
Q

Treatment for Mastitis

A

Antibiotics

Regular emptying of breast (nursing is safe for infant)

NSAIDs (MOTRIN is safe in lactation)

337
Q

Follow-up for Mastitis

A

48 hrs to ensure improvement

338
Q

Mastitis

In the absence of improvement within ___ hours of initiating antibiotics patients should be referred to supervising physician of or GYN for further evaluation

A

72 hours

339
Q

Failure of menarche to appear

A

Amenorrhea

340
Q

Absence of menses for 3 consecutive months in women who have passed menarche

A

Secondary Amenorrhea

341
Q

Terminal episode of naturally occurring menses

Usually after 6 months of amenorrhea

A

Menopause

342
Q

Most common cause of secondary amenorrhea in premenopausal women

A

Pregnancy

343
Q

Etiologies of Amenorrhea

A

Pregnancy

Hypothalamic-Pituitary causes

Hyperandrogenism

Uterine Causes

Premature ovarian failure

Menopause

344
Q

Functional amenorrhea

A

Hypothalamic-Pituitary causes
-Low levels of GnRH affecting FSH & LH levels

345
Q

Early menopause

A

Before age 45

346
Q

Premature menopause

A

Before age 40

347
Q

Menopause normal age

A

48-55

348
Q

Further work up for Amenorrhea

A

HCG

FSH
LH
TSH
Prolactin
Testosterone (hirsutism or virilization is present)

349
Q

Imaging for amenorrhea

A

Transvaginal US
-Confirm Pregnancy
-Identify PCOS or uterine abnormalities

MRI (pituitary tumor is suspected)

350
Q

Women with premature menopause have a:

__% increased risk of coronary disease

__% increased risk for stroke

__% increased overall mortality

A

50%

23%

12%

351
Q

Adnexal torsion is an ischemic condition almost always associated with:

A

Ovarian Enlargement (masses or cysts)

352
Q

Ovarian enlargement causes the ovary to:

A

Twist
-Blocks blood flow

353
Q

__% of torsions occurs on the right side

A

70%

354
Q

Signs/Symptoms

-Sudden onset severe unilateral lower abdominal pain
-May develop after episodes of exertion or athletics

Nausea and vomiting

Possible palpable adnexal mass

A

Ovarian torsion

355
Q

Labs for ovarian torsion

A

HCG

CBC (Leukocytosis is found with necrosis)

356
Q

Imaging for Ovarian torsion

A

Transvaginal U/S with Doppler

357
Q

Treatment for ovarian torsion

A

MEDEVAC

SURGERY

358
Q

Torsion ovarian conservation surgery

A

Cystectomy

359
Q

Surgery for ovarian torsion with gross necrosis

A

Oophorectomy

360
Q

Indications to perform a urethral catherization

A

Diagnostic or therapeutic drainage of bladder

Reliable and frequent assessment of urine output

361
Q

Contraindications for urinary catheter

A

Known or suspect urethral injury
-High riding / free-floating prostate
-Blood at the urethral meatus
-Perineal hematoma

362
Q

Female urethra lies in the:

A

Superior fornix of the vulva

363
Q

Female catheter

Cleanse the enter area with ___ swabs soak in antiseptic

Clean the labia (front to back) with __ swabs

Clean the urethral meatus with __ swabs

A

4-5

2

2

364
Q

Female catheter

Advance the catheter until urine returns, then advance it ___ cm further

A

4-5cm (1-2in)

365
Q

Most common mistake in catheterization of the female bladder is to:

A

Mistake the urethra for the vagina

366
Q

Male Catheter

Sterilize the glans and urethral meatus with __ swabs dipped in antiseptic

A

3-4

367
Q

Male Catheter

Advance the catheter to the ___ of the tube even if urine is obtained earlier

A

Hilt

TAV MDT List (12 decks)

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