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EORs > GYN > Flashcards

GYN Flashcards

1
Q

what days of cycle are optimal for fertilization

A

day 11-15

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2
Q

name the two phases (or 3)

A

follicular (proliferative)
luteal (secretory)

Follicular + menstruation
ovulation
luteal

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3
Q

Follicular phase

  • days
  • predominant hormone
A 
day 1 (menstruation) to day 14 (ovulation)
-new follicle is growing

HORMONES:
*GnRH–>FSH + LH–>follicle grows–>secreting estorgen–>provides (-) feedback to AP–>but then estrogen gets to a point where its very high and creates (+) feedback on FSH and LH—SURGE–. SURGE OF LH=OVULATION

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4
Q

what causes menstruation

A

progesterone withdrawal

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5
Q

what triggers ovulation

A

on day 11-14 a sugrge in LH occurs once dominant follicle is selected

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6
Q

corpus luteum

A
  • progesterone production

- —-> neg feedback on FSH + LH

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7
Q

Luteal PHase

-hormone and its role

A

PROGESTERONE

  • enhances endometrial lining to prepare it for implantation
  • once there is no implantation– corpus luteum degenerates into corpus albicans —-> steep decr in estrogen + Progesterone

***this drop of hormones leads to menstruation and star of new cycle

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8
Q

MCC of secondary amenorrhea

A

pregnancy

ALWAYS DO PT IN EVERY PATIENT

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9
Q

primary vs secondary amenhorrhea

A

PRIMARY

  • failure of menses to occur by age 15 (or 16) in presence of normal growth and secondary sexual characteristics
  • ->start evaluation at age 13 if no menses + absence of secondary charactersistics

SECONDARY
*absence of menses for 3 MO in a woman with previous menses
oR
6 months in a woman with hx of irreg cycles

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10
Q

causes of primary amenorrhea

A

Turners syndrome—- XO

hypothalamic-pituitary insufficiency 46 XX
*low FSH low LH

Androgen insensitivity: 46 XY
High testosterone… breast development only

Imperforate hymen: 46, XX, diagnosed on PE

anorexia

mullerian agensis– no uterus but has secondary sex charactersitcs

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11
Q

Turners syndrome

A

XO

webbed neck, broad chest, high FSH

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12
Q

causes of secnoadry amenhorrhea

-what hormones to always check

A

pregnancy
hypothyroid
weight changes
prolactinoma

**ALWAYS CHECK BHCG, TSH and Prolactin

***progesterone challenege test–> medroxyprogesterone 5-10 mg PO once a day or another progesterone for 7-10 days—— if bleeding occurs=anouvulatory cycles

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13
Q

MCC of primary amenorrhea

A

GONADAL DYSGENSIS

  • Turner syndrome– 45XO
  • Mullerian dysgenesis– 46XX
  • Androgen Insensitivity—46XY
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14
Q

a 35-year-old woman with concerns about heavy menstrual periods for the past year that occur at irregular intervals. She explains that sometimes her menses come twice a month but other times will skip two months in a row. Her menses may last 7 to 10 days and require 10 to 15 thick sanitary napkins on the heaviest days. PELVIC EXAM NORMAL NORMAL PAP no STIs

A

DUB

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15
Q

define DUB

A

excessive uterine bleeding with prolonged menses that is NOT CAUSED BY PREGNANCY OR MISCARRIAGE

**diagnosis of exlcusion

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16
Q

define Polymenorrhea

A

menses that occur more frequently (<21 days apart menses)

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17
Q

define hemorrhagic or hypermenorrhea

A

menses that involve more blood loss >7 days or >80 mL

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18
Q

menorrhagia

A

prolonged/heavy bleeding

>7 days or >80 ml at regular intervals

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19
Q

metrorrhagia

A

uterine bleeding that occurs frequently and irreguarly b/w cycles

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20
Q

menometrorrhaiga

A

more blood loss during menses and frequent and irregular bleeding b/w menses

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21
Q

oligomenorrhea

A

long intervals of >35 days

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22
Q

MCC of AUB/DUB

A

chronic anovulation
**corpus luteum does not form–>so noprogesterone formed—>unoppposed estrogen–>endometrial overgrowth–>irregular, unprediactable shedding

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23
Q

GS for diagnosis of AUB

A

uterine D/C

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24
Q

labs to order for DUB

A

bHCG
CBC, iron stuidies, PT, PTT,
TSH, progesterone, prolactin, FSH,
LFTs

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25
Q

how to confirm anovulatry cycle causing DUB

A

progestin trial– if the bleeding stops its from anovulation

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26
Q

TX for AUB

A

OCPs

NSAIDs

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27
Q

TX for AUB

A

OCPs

NSAIDs

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28
Q

TX for AUB

A

OCPs

NSAIDs

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28
Q

TX for AUB

A

OCPs

NSAIDs

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29
Q

TX for AUB

A

OCPs

NSAIDs

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30
Q

TX for AUB

A

OCPs

NSAIDs

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30
Q

TX for AUB

A

OCPs

NSAIDs

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30
Q

TX for AUB

A

OCPs

NSAIDs

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31
Q

a 19-year-old nulligravid college female who complains of dull, throbbing, cramping lower abdominal pain during menses for the past three years. She reports nausea and vomiting during menses but denies irregular or heavy periods, pain with intercourse, or abdominal pain outside of menses. Pain tends to peak 24 h after the onset of menses and subsides after 2 to 3 days. A pelvic exam is norma

A

dysmenorrhea

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32
Q

define dysmenorrhea

A

uterine pain around time of menses

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33
Q

difffernece b/w primary and secondary dysmenorrhea
RF for both
tx for both

A 
PRIMARY 
-no organic cause 
-pain from excess of prostaglandins 
-teens to early 20s--- declines with age 
-NO Pelvic pathology 
-N/V/D 
-HA 
"labor like pains"

RF

  • menarche before 12
  • nulliparity
  • smoking
  • fm hx
  • obesity

TX= NSAIDs, OCPs

SECONDARY from pathologic cause

  • endometriosis
  • adenomyosis
  • polyps
  • fibrids
  • PID
  • IUD
  • tumors
  • adhesions
  • cervical stenosis
  • lesions
  • psych
  • *pain will increase in severity until end
  • common in age 20-40s

tx=underlinyg cause

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34
Q

avg age for menopause

A

44-55

avg=51

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35
Q

perimenopause

A

transition period b/w reproductive capability and menopause

hallmark=irregular menses 3-5 years

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36
Q

onset of menopause <40 YO

A

premature ovarian failure

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37
Q

labs seen in menopause

A

elevated FSH >30 + low estradiol

**high FSH not requried tho its mainy about amenorrhea for 1 yr

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38
Q

tx for menopause
+uterus
-uterus

A

+uterus: HRT—-estrogen + progesterone
HRT=hormone replacement therapy
**Tibolone

-uterus----ERT (just estrogen)
ERT=estrogen replacement therapy 
or SERMS-----selective estrogen receptor modulators 
*******raloxifine 
******tamoxifen
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39
Q

why can you not use estrogen alone for woman in menopause with intact uterus?

A

incrs risk of endometrial CA

and DVT/PE

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40
Q

Risk of Tibolone or any HRT

A

BCA but its low

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41
Q

contraindication for HRT

A

hx of BCA

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42
Q

HRT effect on lipid profile

A

incrs HDL and TG levels

decrs LDL

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43
Q

contras for HRT

A 
high trigs 
undiagnosed vag bleeding
endometrial CA 
hx of bCA or estrogen sensitive CAs 
CVD hx 
DVT or PE
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44
Q

define premenstrual dysphoric disorder (PMDD)

A

repeated epsiode of significant depression and related s/s during week b4 menses
*****severe/debilitating PMS

DSM-5

  • at least 5 symptoms in final week b4 menses
  • that imrpove within few days after onset of menses
  • becomes absent or minimal week post menses

S/S:

  • marked lability—-mood swings, feeling suddenly sad or tearful, incrs sensitivity/rejection
  • marked irriability
  • depression
  • severe anxiety
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45
Q

tx for PMDD

A

SSRIs
-fluoxetine or sertraline

SNRIs
-venlafaxine

low dose OCPs + diuretics

GnRH—- only as third+ line

Benzos, TCAs,

SEVERE/REFRACTORY
-ovarianectomy

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46
Q

when do s/s o PMS occur in cycle

-when do s/s resole

A

luteal phase (1-2 wks before menses)

resole at onset of menses

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47
Q

tx for PMS

A

exercise
stress reduction

1st line- SSRIs if they dont want OCPs
OCPS will be first tho before SSRIs

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48
Q

mucopuruelnt discharge

gram neg diplococci

A

gonorrhea

MC women are asympto

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49
Q

tx gonorrhea

A

IM ceftriaxone 500 mg if <300 pounds
>300 piunds= 1 gram ceftri IM

***usually tx as co infection

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50
Q

urethritis, vulvovaginitis (vulvar and vaginal discomfort, pain, pruritus), and inflammation of the cervix; clear vaginal discharge

A

chlamydia

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51
Q

tx for chlamydia

A

doxycycline 100 mg BID 7 days

alternatives
-azitrhomycin 1 g PO x1 dose
OR
-levofloxacin 500g PO x 7 days

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52
Q

mc sti

A

chlamydia

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53
Q

GS dx for HSV

A

viral culture

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54
Q

tx for HSV

A

**valcyclovir

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55
Q

which type of HPV MC cause for cervical CA and anal CA

A

16 and 18

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56
Q

which type of HPV causes warts

A

6 and 11

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57
Q

Gardasil covers which HPV strains

A

6
11
16
18

31
33
45
52
58
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58
Q

> 90% of cervical cancer is associated with HPV types

A 
16
18
31
33
35
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59
Q

_____ is commonly seen in combination with condylomata acuminata

A

trichomonas

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60
Q

PAP shows koilocytic squamous epithelial cells in clumps

A

cervical warts from HPV

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61
Q

when does HPV vaccine start

A

9

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62
Q

oldest you can be to get HPV vaccine

A

45

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63
Q

painful sore on her vulva that first resembled a pimple. On examination, you find an ulcer with clearly demarcated borders, gray base, and foul-smelling discharge.

A

chancroid

YES its a STI

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64
Q

causative pathogen for chancroid

A

Haemophilus ducreyi

gram - ROD

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65
Q

in half of PT with chancroid there will also be?

A

marked lymphadenopathy in inguinal chain

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66
Q

tx for chancroid

A

single does IM ceftri 250 or azitrhomycin 1 grams PO x1 dose

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67
Q

serotypes of chlamydia tht cause chalmydia

A

D-K

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68
Q

serotypes of CT that cause lymphogranuloma venereum (LGV)

A

L1-3

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69
Q

RF for LGV

A

MSM– unprotected anal sex, HIV, HCV

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70
Q

painless genital ulcers or papules

A

lymphogranuloma vanereum

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71
Q

uni or bilat tender inguinal and or femoral lymphadenopathy

A

lymphogranuloma vanereum

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72
Q

strictures, fibroisis and fistulae of anogenital region

A

lymphogranuloma vanereum

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73
Q

tx for lymphogranuloma vanereum

A

doxycycline 100 mg PO BID for 21 days

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74
Q

PID involves what parts

A

infection ascending from cervix or vagina INTO ENDOMETRIUM AND/OR FALLOPIAN TUBES

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75
Q

tx for PID outpatient

A

ceftriaxone IIM 250 mg once + PO doxycycline 100 mg BID x14 days +/- PO Flagyl 500 mg BID x14 days

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76
Q

when to admit for PID

A

sevee n/v
if diagnosis is uncertain
ectopic preg and appendicity cant be ruled out

preg or pelvic abscess suspected

HIV+

cannot tolerate outpt meds

faiil to respond to outpt meds

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77
Q

inpatient tx for PID

A

IV second gen cephalosporin (cefoxitin or cefotetan) + IV Doxy—-then PO doxy for 14 days

clindamycin + gentamycin is alternative—– use this in pregnancy or pcn allergy—- then use PO doxy

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78
Q

sypgilis causative agent

A

spirochete Treponema pallidum

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79
Q

painless single ulcer (chancer)

A

syphilis

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80
Q

erythematous rash invovling palms and soles

+/- condyloma lata

A

secondary syphilis

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81
Q

what can cause a false negative syphilis test

A

lyme disease

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82
Q

tx for syphilis

A

Benzathine PCN G 2.4 million units IM x1 single dose
-prim and sec disease

PCN allergic= doxycycline

IV PCN G for congenital and teritary syphilis

83
Q

ph for candida

A

acidic

<4.5

84
Q

tx for candida

A

PO Fluconazole (diflucan) 150 mg

then repeat dose in 7 days

85
Q

agent in BV

A

Gardnerella

anaerobic bacteria

86
Q

frothy, grayish white fishy smelling dsx

A

BV/Gardenerella

87
Q

clue cells

A

BV/Gardnerella

88
Q

epithelial cells with bacilli attached to their surfaces

A

clue cells

89
Q

ph for BV

A

basic

>4.5

90
Q

tx for gardnerella

A

metro 500 mg PO bid 7days
also metro gel
clindamycin cream

SECOND INE TX
-clindamycin PO 300 mg bid 7days

91
Q

greenish gray frothy vaginal discharge

A

trich

92
Q

petechiae on cervix

A

Trich

93
Q

mobile pear shaped protoxoa with flagella on wet mount

A

trich

94
Q

tx for trich

A

metro 2g PO x1 dose

tx partner too

95
Q

tx for atrophic vaginitis

A

conjugated estrogens vaginal creams for 3 wks then taper

can give oral HRT if no contraindications

non homronal vaginal crmeas too

96
Q

thin pale appearing mucosa on vaginal exam in a post menopausal woman

A

atrophic vaginitis

97
Q

causative agent for TSS

A

endotoxins from staph aureus

98
Q

caues for TSS

A

tampons

non-menstrual:

  • surgical and PP wound infections
  • contraceptive sponge use
99
Q

sudden onset of high fever + tachycardia +/- N/V/D +/- pharyngitis

A

TSS

100
Q

tx for TSS

A

surrpotive

aggresive IVF replacement + IV ABX—- clindamycin + vancomycin or linezolid

101
Q

mc malignancy in woan

A

BCA

102
Q

RF for BCA

A
  • incr age
  • BRCA 1 or 2
  • incr number of menstrual cycles: nulliparity, early menarche (b4 12), late menopause, late first full term preg >35yo
  • incr estrogen exposure: PP HRT, prolonged unopposed estrogen, obesity, ETOH
  • having endomertrial CA incrs risk of BCA and vice versa
103
Q

mc type of BCA

A

infiltrative ductal carcinoma

104
Q

eczematous nipple lesion scalling rash on nipples and areoa

A

pagets dz of nipple

105
Q

what is not cancerous but assoc with incr risk of invasive BCA

A

lobular carcinoma in situ

106
Q

BCA screening guidelines

A

baseline mammo every 2 years from 50-74

every 2 years starting at 40 if incr RFs——- start 10 yrs prior to the age of the 1st degree relative diagnosis

107
Q

clinical breast exam every ____ yrs

A

every 3 yrs 20-39 YO

then annual 40+

108
Q

common sites for BCA mets

A

bone—-vertebrae, ribs, pelvis, femur
lungs
liver
brain

TRICK: 2Bs and 2Ls

109
Q

red swollen warm itchy breast + nipple retraction

A

inflammatory BCA

110
Q

pea d’orange

A

assoc with poor prognosis

inflam BCA

111
Q

triad for cerv CA extension to the pelvic wall

A

Unilateral leg edema, sciatic pain, ureteral obstruction

112
Q

third MC type of CA

A

cervical

113
Q

postmenopausal vaginal bleeding

A

cervical CA

114
Q

MC type of cervical CA

A

squamous cells

115
Q

RF for cervical CA

A
  • multiple sex partners
  • early age of first intercourse
  • early first pregnancy
  • HPV +
116
Q

friable, bleeding cervical lesion

A

ca

117
Q

at wht age should pt get first PAP regardles of sexual activity

A

21 YO

or at the time of intercourse under 21 who have HIV infection or on chronic immunosupp tx for SLE or organ transplant

118
Q

when to discontinue pap testing

A

at age 65 who have had three consectiuve negative cytology tests or two consecutive HPV/pap co tests in last 10 yrs

119
Q

ASC-US

A

atypical squamous cells of undeterminted signifiance

120
Q

LSIL

A

low grade squamous intrapeithelial lesions

  • mild dysplia
  • CIN 1
121
Q

HSIL

A

high grade squamous intraepithelial lesions
mod-seveere dysplaisa
CIN 2-3, carcioma in situ

122
Q

RF for cervical dysplasia

A

HPV 16 18 31

they can lead to CCA

123
Q

ASCUS or anything else

A

reflex HPV—
negative- then repeat in 1 yr
+ then send for colposcopy

124
Q

MC GYN Malignancy

A

endometrial CA

125
Q

fourth mc malignancy of women US

A

endometrial

126
Q

postmenopasual bleeding

A

cervical or endometrial CA

127
Q

mc type of CA for endometrial

A

adenocarcinoma

128
Q

RF for endometrial CA

A 
obesity 
nulliparity 
early menarche 
late menopause 
unopp estrogen

HTN
Gallbladder dz
DM
prior ovarian, endometrial or BCA

129
Q

do all women who have endometrial CA have abnormal pap?

A

no only 50%

130
Q

what is indicated in all postmenopausal women with vaginal bleeding

A

endometrial biopsy

131
Q

mc age group for ovarian ca

A

40-60

132
Q

ascites + abd pain

A

ovarian CA— advanced stage

133
Q

protective factors for ovarian CA

A

multiparity
OCPs
breast feeding

134
Q

RF for ovarian CA

A

nulligravidy or infertility
early menarche
late menopause
endometriosis

135
Q

mc type of ovarian CA

A

epithelial

136
Q

CA-125

A

ovarian CA

137
Q

BRCA gene 1

A

BCA

Ovarian CA

138
Q

RF for vaginal/vulvar CA

A

HPV infection, Smoking, Coexisting cervical carcinoma, In utero exposure to DES

139
Q

peak age for vaginal CA

A

60-65

140
Q

MC type of vaginal CA

A

squamous
—HPV

IF DES exposure then its adenocarcinoma

141
Q

MC location for vaginal CA

A

upper one third of the posterior vaginal wall

142
Q

how does vaginal CA present usually

A

changes in menses and/or Ab vag bleeding

143
Q

mc presentation for vulvar CA

A

vaginal pruritus

144
Q

mc type of vulvar CA

A

squamous

-HPV

145
Q

MC types for each CA

  1. breast
  2. ovarian
  3. cervical
  4. endometrial
  5. vaginal
  6. vulvar
A 
breast= ductal 
ovarian=epithelial 
cervical=squamous 
endometrial=adenocarcinoma 
vaginal and vulvar=squamous 
DES EXPOSURE=adenocarcinoma
146
Q

should pt with breast abscess cont to BF on affected side?

A

yes—— even in the setting of I&D

147
Q

a 32-year-old lactating female with breast pain, swelling, fever, chills, and a fluctuant mass of her left breast. The area directly above the lesion is warm, erythematous and tender to touch.

A

breast abscess

**progression from mastitis—s/s are same but addition of localized mass + systemic s/s infection

148
Q

tx for breast abscess

A

I&D
anti-staph abx
-Nafcillin/oxacillin IV or cefazolin + metronidazole
alt is vanco

dicloxacillin

  • cephalexin
  • clinda
  • MRSA=bactrim or clinda
149
Q

The most common type of noncancerous breast tumor that most often occurs in young women

A

firboadenoma

150
Q

dx for fibroandeoma

A

diagnostic mammo + US

-if indeterminant– FNA + pathology

<25 should be biopsied

151
Q

a 42-year-old woman with breast masses that changes in size, especially during her menstrual cycles. These masses are usually painful and pain radiates into the axillae. She reports that her breasts often feel full and heavy. Occasionally she has a small amount of greenish-brown nipple discharge. An ultrasound exam shows cystic masses within the breasts.

A

fibrocystic dz

152
Q

multiple bilateral breast masses

A

fibrocystic

153
Q

solitary mobile mass of breast

A

fibroadenoma

154
Q

breast cyst aspiration shows straw colored fluid with no blood

A

fibrocystic

155
Q

tx for fibrocystic

A

nsaids heat ice supporitve bra, decr caffeienc, fat, chocolate

OCPS

156
Q

a 45-year-old female complaining of pressure in the pelvis and vagina along with discomfort when straining. She also feels that her bladder hasn’t fully emptied after urinating.

A

cystocele

157
Q

dx for cystocele

A

POP-Q
-pelvic organ prolapse quantification—- mesured extent and location of defects

US or MRI

158
Q

prophlaxs for cystocele

A

kegels

estrogen tx after menopause

159
Q

a 50-year-old female with pelvic pressure reports and a sensation of a mass present in the vagina. She reports chronic constipation and a sensation that the rectum is not completely emptied following a bowel movement. Occasionally, she experiences episodes of fecal incontinence.

A

rectocele

160
Q

pelvic pressure + bowels s/s

A

rectocele

161
Q

sudden onset of sharp and usually unilateral lower abdominal pain,

A

ovarian torsion

70% also have N/V

162
Q

dx test of choice for ovarian torsion

gold standard

A

abd US with doppler flow

GS= laparoscopy

163
Q

a 63-year-old, G5P5, Hispanic woman with a three-day history of increased pelvic pressure and a “bulge” that is felt in her vagina when she coughs. Additionally, she complains of incomplete emptying of her bladder, constipation and has noticed a recent worsening of lower back pain.

A

uterine prolapse

**many kids is key

164
Q

how do OCPS prevent ovulation

A

inhibits the mid cycle LH surge
thicken cervical mucus
thins endometrium

165
Q

what are OCPS protective factor for?

A

ovarian and endometrial CA

acne

166
Q

contras to OCPS

A

> 35 + smoker

hx of blood clots, BCA, migraines WITH aura

167
Q

a 24-year-old nulligravid woman comes to your office with an 18-month history of painful intercourse, difficulty defecating, and dysmenorrhea. These symptoms are cyclical and come and go with her menses. Her menses are regular and heavy, requiring 10 to 15 thick pads on the days of heaviest flow. She denies ever being diagnosed with a sexually transmitted infection (STI). She and her husband have been engaging in regular intercourse without contraception for 1 year in an attempt to conceive. On pelvic examination, you find a normal-sized, immobile, retroverted uterus with nodularity and tenderness on palpation of the uterosacral ligaments.

A

endometriosis

168
Q

mc sites for endometriosis tissue to be implanted

A

ovaries
FTs
cul-de-sac
uterosacral ligaments

169
Q

dyspareunia define

A

painful sex

170
Q

dyscheciz define

A

difficult defacating

171
Q

dysmenorrhea define

A

painful periiods

172
Q

three Ds for endometriosis

A

dyschezia
dysmenorrhea
dyspareunia

173
Q

def dx for endometriosis

A

laparoscopy

Imaging tests (eg, ultrasonography, barium enema, IV urography, CT, MRI) are not specific or adequate for diagnosis

174
Q

fixed and retroverted uterus

A

endometriosis

175
Q

tx for endometriosis

-1st

A 
nsaids 
OCPs 
Danazol (steroid)----inhibs mid cycle surge of FSH + LH 
Depo shot 
GnRH 
Surigcal

FIRST LINE=OCPs

  • estrogen does the ovulation suppresion
  • progesterone analogs will inhibit growth of endometrium
176
Q

difference b/w primary and secondary infertility

A

primary= infertility in absence of previous pregnancy

secon=infert after a previous pregnancy

177
Q

mcc of infertility

A

annovulation—-amenorrhea and abnormal periods

178
Q

what does it mean when a luteal phase progeterone level is less than 3

A

she did not ovulate

179
Q

if PCOS is the cause of infertility what can we give pt to help with ovulation

A

metformin—increases ovulation

180
Q

tx for hyperprolactinemia causing infertility

A

bromocpriptine

181
Q

fixed and retroverted uterus

A

endometriosis

182
Q

mc benign GYN tumor

A

leiomas

183
Q

list types of leiomas

-which is MC

A

intramural–within uterine wall (MC)
submucosal–projects into uterine cavity
subserosal–projects into uterine cavity–can be pedunculated
parasitic–

184
Q

a 39-year-old African American woman with abnormally heavy menstrual bleeding along with increased pelvic pressure. She denies pain and is not using any hormonal contraception. She uses multiple sanitary pads per day. On pelvic examination, there is an enlarged uterus with asymmetric contours. The uterus is non-tender to palpation.

A

uterine fibroids aka leiomyoma

185
Q

inital TOC for leiomyomas

A

transvaginal US

186
Q

focal heterogenic hypoechoic mass of masses with shadowing on transvag US

A

fibroids

187
Q

tx for firboids

A
  1. medical
    - NSAIDs
    - OCPS
    - Danazol
    - Leuprolide– can be used to shrink before surgery
  2. DEFINITIVE:
    - myomectomy–to preserve fertility
    - endometrial ablation
    - Hyerestcomy— mc
188
Q

what type of ovarican cysts is mc

A

follicular—follicle fails o rupture and continues to grow

189
Q

22-year-old nulligravida presents with pelvic pain and irregular menstrual bleeding. She denies sexual activity, and her β-hCG urine test is negative. She has never been on oral contraceptives. On pelvic examination, unilateral tenderness on the left side and a palpable cystic mass approximately 4 to 5 cm in size are present.

A

ovarain cyst

190
Q

list three types of functional ovarian cysts

A

follicular– MC–dominat follicle fails to rupture

corpus luteum—– usually 2-3 cm, can get as big as 10 cm–dominant follicle ruptures but closes again and doesnt dissolve

Theca Lutein cysts– overstimulation of HCG prod by placenta so only seen in preggo

191
Q

list non-functional ovarian cysts

A

also called neoplastic cysts

  • PCOS
  • endometriomas aka chocolate cysts
  • dermoid cysts aka teratomas
  • ovarian serious and mucinous cystadenoma
192
Q

US shows a cyst that is smooth, thin walled and unilocular

A

follicular

193
Q

US shows a yst that is complex, thick walled and with peripheral vascularity

A

corpus luteum

194
Q

anechoic unilocular fluid filled cysts are low or hgh risk for malignancy

A

low

195
Q

solid, nodular, thick septation cysts are low or high risk for malignancy

A

high

196
Q

what labs to order if concerned baout ovarian CA

A

ca-125
beta HCG
alpha-fetoprotein

197
Q

three main complications from ovarian cysts

A
  1. hemorrhagic
    - mc with follicular and coprus luteum cysts
  2. rupture
    - releases contents into peritoneal cavity
    - mc after sex
  3. torsion
    - ovary twists around suspensory ligaments
    - cuts off blood suppy to the ovary
    - this is a risk if cyst is >5 cm
198
Q

waxing and waning pain

A

ovarian torsion
+/- N/V
low grade fever

199
Q

first imaging choice for ovarain torsion

A

US

CT is more $$$$$$ and will give same results as US

200
Q

simple cyst in a premenopausal woman is b/w 5-7 cm what is tx

A

follow up yearly

201
Q

simple cyst grearer than 7cm tx/plan

A

further imaging with MRI

surgical assessment

202
Q

rophylactic antibiotic therapy for rape victim

A
  1. Rocephin 250 mg followed by PO doxy twice daily x7 days
  2. tetanus toxoid if indicated
  3. emergency contraception
  4. councesling
203
Q

list typses of incontinence

A

urge

stress

ovrflow

functional

mixed

204
Q

urge incontinence

A

detrusor overactivity
-frequent small amts of urine

MC in old,
-assoc with UTI

***at night + disrupts sleep

tx=bladder training exercised
if unsuccessful
1. oxybutin—– anticholingeric
2. imipramine–TCA

205
Q

stress incontienence

A

pelvic floor weakness
-urine leaks due to abrupt incr in intra abd pressure—- cough, sneeze, laugh, bending or lifting

  • **multiple deliveries
  • **NO URINE LOSS AT NIGHT

tx

  • kegel
  • vaginal estrogen
  • pessary
  • surgery
206
Q

urine loss at night

A

urge incontience

207
Q

overflow incontience

A

impaired detrusor contractility
-urinary retention leads to bladder distention and overflow of urine

  • common in DM and neurlogic disordrs
  • elevated postvoid residual volume*******

tx

  • self cath best one
  • MEDS
    1. cholinergic agents— bethanechol to incr bladder contractions
    2. alpha blockers to decr sphincter resistance
208
Q

functional incontiencne

A

normal voiding systems but who have difficulty reaching toilet bc of physical or mental disability

209
Q

mc type of incontience

A

mixed
urge + stress

tx=life style mods
pelvic flor exercies

EORs (15 decks)

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