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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
Hematocolpos
Obstruction (imperforate hymen or congenital malformation) causes accumulation of menstrual blood
25
Masses in reproductive aged women
Pregnancy, fibroid/myoma, ovarian cysts, ectopic pregnancy, benign teratomas (most common), hydrosalpinges, endometriomas *post menopausal...cancerous*
26
Endometriosis vs adenomyosis vs fibroid
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
Adenomyosis
Glands of uterus infiltrate muscle tissue of uterus. Bleed like crazy! Cause of dysmenorrhea
28
Pelvic pain DDX
GU, GI, reproductive, musculoskeletal
29
Mittelschmerz
Sudden onset, sharp pain during ovulation
30
PID
Not always related to STI...need immediate treatment. Marked CMT and adnexal tenderness. Common sequelae of GC/CT
31
Sequelae from big cysts
``` Adnexal torsion (if twists will -->necrosis) Rupture can --> peritonitis ```
32
Abdominal pain mantra
Are you having any nausea/vomiting/fever/chills?
33
Menorrhagia
Excessive duration (>7days) and/or amount (>80mL) of bleeding per cycle
34
Pelvic pain related to menses
Dysmenorrhea, endometriosis, Mittelschmerz
35
Pain unrelated to menses
PID, ruptured ovarian cyst, ruptured ectopic pregnancy, acute degeneration of uterine fibroid, adnexal torsion, adhesions, uterine or ovarian cancer, spontaneous abortion
36
Review all the systems:
Gyn, GI, GU, musculoskeletal (diastasis of pubic symphysis)
37
Pelvic pain that may require surgery
Tubo-ovarian cyst (assoc w PID); ectopic pregnancy; ruptured/torsion of ovarian cysts, appendicitis, bowel perforation
38
Red flags on PE for pelvic pain
``` Syncope or hemorrhagic shock Peritoneal signs Post-menopausal vaginal bleeding Fever/chills Sudden, severe pain with N/V, diaphoresis, agitation ```
39
Post menopausal bleeding
Vaginal bleeding >6 mos (12 mos) after last normal menses...likely cancer
40
DUB
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
AUB
May be structural, inflammatory, other gyn disorder, rarely due to bleeding disorder
42
Risk factors for endometrial cancer
Obesity, DM, HTN, prolonged unopposed estrogen use, PCOS, >35 years
43
Red flags for abnormal vaginal bleeding
Hemorrhagic shock, premenarchal and postmenopausal vaginal bleeding, vaginal bleeding in pregnant patients
44
Abnormal bleeding labs
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
Key points of abnormal vaginal bleeding
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
Tanner stage I
Prepubertal
47
Tanner stage II
Palpable sub areolar breast buds, presentable pubic hairs
48
Tanner stage III
Engagement and elevation of whole breast, sexual pubic hairs
49
Tanner stage IV
Areolar mounding (transient), progression of pubic hair on pubis, not to medial surface of thighs
50
Tanner stage V
Mature breast contour, mature female escutcheon (inverted triangle pattern)
51
Follicular phase/endometrial proliferative phase
During menses estrogen and progesterone are lo...FSH/LH rise Endometrium increases to 11mm late in follicular phase
52
Ovulation phase
Strong LH surge and slight FSH surge...oocyte released
53
Luteal phase/ endometrial secretory phase
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
Run CBC with abnormal bleeding
Check if anemic or hypovolemic
55
Abnormal vaginal bleeding: pos pregnancy test
Spontaneous abortion, ectopic preg, gestational trophoblastic dz, endometritis secondary to retained products of conception
56
AUB, negative pregnancy test
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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