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CPD Vocab II > Gyn 1 > Flashcards

Gyn 1 Flashcards

0
Q

Dyspareunia

A

Pain with intercourse

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1
Q

Anovulation

A

Menstrual cycle where ovaries do not release oocyte
Most common cause of abnormal bleeding (dt HPO disregulation)
Huge clots, lots of blood

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2
Q

Transsexual patients… remember:

A

Ask which pronoun they prefer.

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3
Q

Screen for domestic violence

A

Do you feel safe at home?
Inconsistent explanation for injuries
Psychiatric sxs
Unusual somatic complaints

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4
Q

Parts of gyn exam

A

Vitals; heart, lung lymph; breast exam; abdominal examination; pelvic exam

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5
Q

External genital exam

A

Lymph nodes, hair distribution, clitoral size, vulva and perineum, vestibule, abnormal pigmentation, discharges

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6
Q

If suspect gonorrhea or chlamydia…

A

Palpate Bartholin’s and Skene’s glands

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7
Q

Normal speculum findings

A

Cervix is pink, shiny, clear/white discharge

Vagina has proper ruggae, no masses, no lesions

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8
Q

Bimanual exam normal findings

A

6cm x 4cm

Mobile, smooth, NT

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9
Q

Abnormal bimanual and DDX

A

Irregularity in shape suggests uterine fibroids or tumor
Enlargement: pregnancy, malignancy, adenomyosis/endometriosis, myoma
Bogginess: pregnancy, malignancy, degenerating myoma,msarcoma, PID
CMT: PID, ovarian cysts, endometriosis, adhesions

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10
Q

Use small Pederson if…

A

If post menopausal or history of trauma

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11
Q

Normal ovary size

A

Reproductive age: 3x2x2

Menopausal: 1x0.7x0.5

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12
Q

Rectovaginal exam

A

Done in women >40 yrs women with suspicion of endometriosis or cancer

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13
Q

Tests to run!

A

Pregnancy, Pap smear, wet prep, cervical mucus inspection, genital culture, DNA probes, pH or cervical secretions, STI testing

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14
Q

Pregnancy tests

A

Urine beta hCG. Highly sensitive (but the least sensitive), 1+ week of conception
Serum qualitative beta hCG. More sens and specific
**Serum quantitative beta hCG, for miscarriages, ectopic pregnancy

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15
Q

PAP smear test

A

Examine cells for dysplasia or cancer
Can add on HPV or DNA, or GC/CT
May detect uterine cancer

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16
Q

Wet prep test

A

Microscopic exam of vaginal secretions to identify thrichomonas, BV, yeast

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17
Q

Cervical mucus inspection

A

Used in infertility, place mucus on slide, allow to dry, assess for crystallization/ferning…reflects levels of estrogen

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18
Q

Genital culture

A

Helps to identify bacteria and fungus

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19
Q

DNA probes /urine Aptima test

A

For GC, CT

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20
Q

pH of cervical secretions…

A

Normal= 3.5-4.5

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21
Q

STI testing

A

Herpes: viral PCR, serum IgG
HIV: blood
RPR for syphilis: serum
Hep B and C: serum

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22
Q

What imaging?

A

Ultrasound! Abdominal and transvaginal (TVUS)

Esp if pelvic mass

23
Q

Surgical procedures

A 
Laproscopy
Endometrial biopsy
Colposcopy (to closely examine cervix/vagina for dz, indicated if abnormal PAP)
Vulvar biopsy
Hysterectomy
24
Q

Hematocolpos

A

Obstruction (imperforate hymen or congenital malformation) causes accumulation of menstrual blood

25
Q

Masses in reproductive aged women

A

Pregnancy, fibroid/myoma, ovarian cysts, ectopic pregnancy, benign teratomas (most common), hydrosalpinges, endometriomas

post menopausal…cancerous

26
Q

Endometriosis vs adenomyosis vs fibroid

A

Endo: normal endometrium grows on the outside of the uterus (or even other places!)
Adenomyosis: normal endometrium grows into muscular wall of uterus
Fibroids: muscular tissues making a lump

27
Q

Adenomyosis

A

Glands of uterus infiltrate muscle tissue of uterus. Bleed like crazy! Cause of dysmenorrhea

28
Q

Pelvic pain DDX

A

GU, GI, reproductive, musculoskeletal

29
Q

Mittelschmerz

A

Sudden onset, sharp pain during ovulation

30
Q

PID

A

Not always related to STI…need immediate treatment.
Marked CMT and adnexal tenderness.
Common sequelae of GC/CT

31
Q

Sequelae from big cysts

A 
Adnexal torsion (if twists will -->necrosis)
Rupture can --> peritonitis
32
Q

Abdominal pain mantra

A

Are you having any nausea/vomiting/fever/chills?

33
Q

Menorrhagia

A

Excessive duration (>7days) and/or amount (>80mL) of bleeding per cycle

34
Q

Pelvic pain related to menses

A

Dysmenorrhea, endometriosis, Mittelschmerz

35
Q

Pain unrelated to menses

A

PID, ruptured ovarian cyst, ruptured ectopic pregnancy, acute degeneration of uterine fibroid, adnexal torsion, adhesions, uterine or ovarian cancer, spontaneous abortion

36
Q

Review all the systems:

A

Gyn, GI, GU, musculoskeletal (diastasis of pubic symphysis)

37
Q

Pelvic pain that may require surgery

A

Tubo-ovarian cyst (assoc w PID); ectopic pregnancy; ruptured/torsion of ovarian cysts, appendicitis, bowel perforation

38
Q

Red flags on PE for pelvic pain

A 
Syncope or hemorrhagic shock
Peritoneal signs
Post-menopausal vaginal bleeding 
Fever/chills
Sudden, severe pain with N/V, diaphoresis, agitation
39
Q

Post menopausal bleeding

A

Vaginal bleeding >6 mos (12 mos) after last normal menses…likely cancer

40
Q

DUB

A

Dysfunctional unterine bleeding. Problem with HPO axis…can yield to Anovulation –> no progesterone –> unopposed estrogen –> stimulation of endometrial glands –> sloughs irregularly, incompletely, excessive or long

41
Q

AUB

A

May be structural, inflammatory, other gyn disorder, rarely due to bleeding disorder

42
Q

Risk factors for endometrial cancer

A

Obesity, DM, HTN, prolonged unopposed estrogen use, PCOS, >35 years

43
Q

Red flags for abnormal vaginal bleeding

A

Hemorrhagic shock, premenarchal and postmenopausal vaginal bleeding, vaginal bleeding in pregnant patients

44
Q

Abnormal bleeding labs

A

Pregnancy test! CBC, ferritin, thyroid panel, prolactin, TVUS/sonohysterogram, EM biopsy, PT/PTT/vWF, vulvar biopsy, Pap smear, FSH/LH

If suspect PCOS…serum testosterone, DHEAS, fasting glucose

45
Q

Key points of abnormal vaginal bleeding

A

Always exclude pregnancy!
DUB..most common cause of abnormal bleeding during reproductive years
Vaginitis, forgiven bodies, trauma, sexual abuse common causes
Post menopausal bleeding needs to be evaluated for cancer

46
Q

Tanner stage I

A

Prepubertal

47
Q

Tanner stage II

A

Palpable sub areolar breast buds, presentable pubic hairs

48
Q

Tanner stage III

A

Engagement and elevation of whole breast, sexual pubic hairs

49
Q

Tanner stage IV

A

Areolar mounding (transient), progression of pubic hair on pubis, not to medial surface of thighs

50
Q

Tanner stage V

A

Mature breast contour, mature female escutcheon (inverted triangle pattern)

51
Q

Follicular phase/endometrial proliferative phase

A

During menses estrogen and progesterone are lo…FSH/LH rise

Endometrium increases to 11mm late in follicular phase

52
Q

Ovulation phase

A

Strong LH surge and slight FSH surge…oocyte released

53
Q

Luteal phase/ endometrial secretory phase

A

Body temp rises due to thermogenic properties of progesterone
Progesterone peaks day 21 ideal implantation time
Endometrium ~14mm thick
Mature squamous cells are shed…provides glycogen for lactobacillus

54
Q

Run CBC with abnormal bleeding

A

Check if anemic or hypovolemic

55
Q

Abnormal vaginal bleeding: pos pregnancy test

A

Spontaneous abortion, ectopic preg, gestational trophoblastic dz, endometritis secondary to retained products of conception

56
Q

AUB, negative pregnancy test

A

DUB: brain lesion, drugs, hypothyroidism, adrenal/ovarian tumors

Structural: vaginal disorders, cancer, adenosis, trauma, cervical CA, uterine fibroids/endometritis/polyps, ovarian tumors

CPD Vocab II (9 decks)

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