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EOR Women's Health > GYN > Flashcards

GYN Flashcards

1
Q

MCC vulvovaginitis

A

Bacterial vaginosis

candida, trichomoniasis, atrophy

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2
Q

normal vaginal bacteria, pH (reproductive, puberty & menopause)

A

lactobacilli, anaerobic

reproductive pH: 3.5-4.7 (acidic)
puberty, menopause pH: 6-8 (neutral)

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3
Q

MCC bacterial vaginosis

A

Gardnerella vaginalis

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4
Q

Bact vaginosis Sx

A
  • grey/yellow discharge (milky, filmy)

- fishy odor

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5
Q

Dx Bact vaginosis

A 
grey discharge
pH > 4.5
clue cells (ground glass)
pos whiff test, fishy odor
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6
Q

Tx bact vaginosis, how long

A

flagyl (metronidazole) 500mg x 7 days

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7
Q

Tx bact vaginosis in pregnancy, refractory, recurrent

A

preg: flagyl after 37 wks
refractory: metronidazole x 14 days
recurrent: normal Tx

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8
Q

complications bact vaginosis

A

PROM, preterm delivery, PID, postop infections, HIV, HSV

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9
Q

2 MCC vulvovaginitis candidiasis

A
  1. C. albicans

2. C. galbrata

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10
Q

RF for candida vulvovaginitis

A

DM!!! pregnancy, obesity, immunosuppression, tight clothing/nylon, panty liners, corticosteroids, abx

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11
Q

Sx candida vulvovaginitis

A

cottage cheese discharge, pruritis, redness, pH normal 4-5

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12
Q

Dx candida vulvovaginitis

A

KOH pseudohyphae!

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13
Q

Tx candida vulvovaginitis

A

topical: terconazole, miconazole, clotrimazole, butoconazole, nystatin

oral: fluconazole (diflucan) x 1
q 72 hrs x 3
takes 24 hrs to improve Sx

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14
Q

can you prophylactically treat for recurrent candida with abx?

A

yes. fluconazole (diflucan)

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15
Q

Tx refractory/recurrent candidiasis (3)

A
  • fluconazole (diflucan)- 3 doses q 72 hrs
  • gentian violet stain
  • boric acid vaginal tablet x 14 days
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16
Q

Tx candidiasis in pregnancy

A

topical only

terconazole, miconazole, clotrimazole, butoconazole, nystatin

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17
Q

trichomonas Sx

A
  • yellow/grey discharge (bact vaginosis)
  • fishy odor (bact vaginosis)
  • pos whiff test (bact vaginosis)
  • frothy
  • pruritis
  • strawberry cervix!!!
  • pH >5 (bact vaginosis >4.5)
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18
Q

trichomonas culture media

A

modified diamond media

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19
Q

Tx trichomonas

A

metronidazole (flagyl) 500mg x 7 days
same as bact vaginosis

or 2g x 1

or tinidazole 2g x 1 (category D not in pregnancy!)

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20
Q

category of tinidazole

A

D

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21
Q

trichomonas (and bact vaginosis) in pregnancy

A

no Tx in 1st trimester

Tx after 37 wks

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22
Q

trichomonas in lactation

A

metronidazole 2g x 1

no breastfeeding x 24 hrs

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23
Q

complications trichomonas (and bact vaginosis)

A

PROM, preterm, PID, ectopic, HIV

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24
Q

atrophic vaginitis cause

A

decr estrogen

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25
Q

Tx atrophic vaginitis

A

estrogen

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26
Q

Sx atrophic vaginitis

A

pH > 4.7

dry, itch, burn, dyspareunia, thin, friable

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27
Q

painful lesions

A

herpes, chancroid

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28
Q

painless chancre

A

syphilis

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29
Q

syphilis Dx

A

VDRL, RPR,

confirm: FTA-ABS, darkfield

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30
Q

Tx syphilis

A

PCN G

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31
Q

Tx chancroid

A

azithromycin, ceftriaxone

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32
Q

chancroid organism

A

Haemophilus ducreyi

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33
Q

MC STD

A

chlamydia

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34
Q

Dx GC/chlamydia

A

NAAT, cervical swab

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35
Q

Tx chlamydia

A

azithromycin, doxycycline

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36
Q

Tx Gonorrhea

A

azithromycin AND ceftriaxone

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37
Q

Tx chlamydia in pregnancy

A

azithromycin

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38
Q

uretrhitis/cervicitis screening

A
  • sexually active < 25 y/o
  • mucopurulent cervicitis
  • pregnant
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39
Q

PID organisms, location

A

GC, chlamydia

cervix–> salpinx–> pelvic cavity

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40
Q

PID age

A

15-29 y/o

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41
Q

PID RF

A

untreated GC/chlamydia, IUD

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42
Q

PID Sx

A

-mucopurulent discharge
-HIGH FEVERS (>101 F, 38 C)
-GC/chlamydia labs
-incr WBC, ESR, CRP
pelvic pain/cramping, dyspareunia, post-coital bleeding, vaginal bleeding

  1. CERVICAL MOTION TENDERNESS
  2. ADNEXAL FULLNESS/MASS/TENDERNESS
  3. UTERINE TENDERNESS
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43
Q

DDx PID

A

appendicitis, ovarian torsion, ectopic, pyelonephritis, ruptured ovarian cyst

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44
Q

Tx PID outpatient

A

ceftriaxone AND doxycycline x 14 days

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45
Q

don’t use what to Tx PID?

A

fluoroquinolones

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46
Q

Tx PID inpatient

A

IV abx x 48 hrs

cefoxitin + doxycycline

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47
Q

complications PID

A
  • perihepatitis (Fitz-Hugh-Curtis syndr)- scar liver
  • infertility!! (fallopian tubes scar)
  • ectopic
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48
Q

bartholin gland normal size, location

A

< 1 cm, 5 and 7 o’clock

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49
Q

Sx bartholin gland infection

A

pain with walking & intercourse

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50
Q

organisms of Bartholin gland infection (and PID)

A

GC, chlamydia

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51
Q

Tx bartholin gland infection

A

I&D, catheter afterward

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52
Q

stages of uterine prolapse

A 
0= none
IV= complete
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53
Q

procidentia

A

uterine prolapse, cervix passes beyond vulva

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54
Q

Tx uterine prolapse

A

1st line: pessary
pelvic floor exercise
surgery: hysterectomy, ligament fixation, sacral hysteropexy, colpocleisis (no vagina lumen)

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55
Q

MC type incontinence

A

stress MC

urge MC in elderly

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56
Q

stress incontinence

A

incr abdom pressure, decr fascia integrity

  • worse with cough/laugh
  • loss in sm spurts
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57
Q

urge incontinence

A

detrusor overactivity

  • leak without incr abdom pressure
  • urgency, frequency
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58
Q

incontinence that can result after bladder surgery

A

urge

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59
Q

urge incontinence Tx

A

lifestyle changes
habit training

medication
-antimuscarinics: 
oxybutinin (avoid in elderly)
Vesicare, Enablex (good in elderly)
-Anticholinergics: imipramine
-myrbetriq (avoid in uncontrolled HTN)
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60
Q

stress incontinence Tx

A
  • 1st line: pelvic floor exercise
  • lifestyle modification: stop smoking, wt loss, no caffeine

-surgery: slings (TENSION-FREE VAGINAL TAPE), retropubic colposuspension (Burch procedure), bulking agents (around bladder neck)

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61
Q

overflow incontinence

A

detrusor inactivity, neurogenic problems (MS)
urethra obstuction
-constant dribbling

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62
Q

watery vaginal discharge, fishy odor, grey discharge, pH 5.0, clue cells, one partner
treatment?

A

metronidazole 500mg x 7days

(bact vaginosis)- DDx: trichomonas

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63
Q

crampy abdominal pain, chills, nausea, 101 F temp, mucopurulent discharge, cervical motion tenderness, adnexal discomfort
treatment?

A

ceftriaxone 250mg x 1
AND doxycycline 100mg x 14 days
(PID)

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64
Q

dyspareunia, vaginal pain worse with activity, afebrile, no abdom pain, 4cm mass 5o’clock
organism?

A

C. trachomatis

bartholin gland infection

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65
Q

elderly with urine leakage, urgency, frequency

Tx?

A

Vesicare

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66
Q

benign vulvar disease: cigarette paper skin, onion skin, atrophic, figure 8 around perineum, itching

A

Lichen sclerosus

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67
Q

benign vulvar disease: whickham straie, pruritis, demarcated edges

A

lichen planus

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68
Q

benign vulvar disease: hyperplastic, erythematous, lichenification, itch that rashes

A

lichen simplex chronicus

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69
Q

VIN risk factors

A

HPV, smoking

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70
Q

VIN Tx

A

excision, laser ablation

imiquimod, 5-fluorouracil topical

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71
Q

MC type vulvar cancer

A

SCC

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72
Q

PRURITIS, ulcerative red/white lesion on post 2/3 labia majora
what am i?

A

vulvar cancer

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73
Q

vulvar cancer MC site

A

labia majora

posterior 2/3

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74
Q

Tx vulvar cancer

A

excision, vulvectomy, L issection

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75
Q

location of inclusion cysts

A

posterior

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76
Q

causes of inclusion cysts

A

TRAUMA, GYN procedures, childbirth

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77
Q

Gartner duct cyst location

A

anterior

lateral walls of vagina

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78
Q

causes of Gartner duct cyst

A

residual from fetal development

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79
Q

VAIN risk factors

A

HPV

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80
Q

VAIN associated with what?

A

cervix, vulva neoplasia

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81
Q

VAIN Sx

A

asymptomatic!

82
Q

VAIN Tx

A

vaginectomy, laser ablation, excision

5-fluorouracil

83
Q

MC type of invasive vaginal cancer

84
Q

pediatric invasive vaginal cancer

A

sarcoma botryoides

85
Q

cervical polyps risk factor

A

multiparous

86
Q

Tx cervical polyps

A

remove, send for Bx, ablation/liquid nitrogen at base

87
Q

causes of cervical stenosis

A

TRAUMA, procedures (colposcopy), infections, cervical cancer

88
Q

cervical ectopy

A

columnar epithelium rolled out of os

89
Q

transformation zone

A
  • b/t squamo-columnar junction

- fastest growing cells = oncogenic susceptible

90
Q

cervical ectopy- spatula or brush?

91
Q

risk factors for CIN

A

HPV!!, smoking

mult sex partners, early age intercourse (<17), HIV, organ transplant (kidney), STD, DES, Hx CIN

92
Q

HPV types linked to CIN

A

6, 11, 16, 18, 31, 45

93
Q

progression of cervical disease

A

normal–> HPV–> CIN 1–> 2–> 3–> invasive CA

94
Q

pathognomonic for HPV

A

koilocytosis

-infected cells have halo appearance

95
Q

PAP screening when to start?

A

21 y/o

within 3 yrs of sex

96
Q

PAP screening when to stop?

A

65-70 y/o

  • no Hx abnorm
  • normal last 3 PAPs
  • no abnormals x 10 yrs
97
Q

PAP screening frequency?

A

-high risk twice annually then q year
-21-29 y/o: 3 annual neg smears–> q 2-3 yrs
>30 y/o: q 3-5 yrs if neg HPV

98
Q

abnormal PAP. now what?

A

HPV reflex test

99
Q

HPV test everyone at what age?

100
Q

dysplastic tissue on colposcopy test looks like?

A

green filter, acetic acid wash

-dysplastic tissue: whitish

101
Q

must visualize entire squamo-columnar junction (ectopy) for adequate colposcopy. if can’t visualize, do what?

A

endocervical currettage

102
Q

PAP smear result is ASCUS, what now?

103
Q

PAP- ASCUS, HPV pos, next step?

A

colposcopy

104
Q

PAP- ASCUS, HPV neg, next steps?

A

repeat PAP in 6 mo, if abnorm then colposcopy, if normal do normal screening

105
Q

colposcopy, no CIN, now what?

A

repeat PAP in 6 mo, 12 mo

HPV in 12 mo

106
Q

colposcopy, CIN pos, now what?

A

treatment
CIN 1: cryo/liquid nitrogen
CIN 2, 3: conization, LEEP

107
Q

when to treat PAP results?

A

CIN pos, HSIL

108
Q

PAP- LSIL now what?

A

colposcopy

109
Q

PAP- ASCH now what?

A

colposcopy

110
Q

contraindications to HPV vaccine

A

yeast allergy, pregnancy

111
Q

CIN 2/3 conization- if margins not clear, now what?

A

repeat conization

112
Q

CIN 2/3 conization- if margins include HSIL, now what?

A

hysterectomy

113
Q

PAP screening schedule after conization procedure

A

q 6 mo x 2 yrs

114
Q

cervical cancer RF

115
Q

types of cervical cancer

A

SCC, adenocarcinoma

116
Q

staging cervical cancer I-IV

A

I- cervix only
II- + vagina
III- + pelvic wall
IV- +beyond pelvis

cervix- vagina- pelvis- beyond

117
Q

HPV vaccine covers which types?

A

6, 11 (genital warts)

16, 18 (cervical cancer)

118
Q

Gardasil

A

HPV vaccine

119
Q

when to give HPV vaccine

A

12-26 y/o females

12-21 y/o male

120
Q

breastfeeding and HPV vaccine

121
Q

vulvar pruritis DDx

A

lichen(s)
psoriasis
vulvar carcinoma
dermatitis

(not bartholin gland cyst)

122
Q

leiomyomata aka

A

uterine fibroids

prolif muscle cells, estrogen sensitive

123
Q

Sx leiomyomata

A

menorrhagia (incr bleeding), Fe def anemia

dysmenorrhea

124
Q

leiomyomata what population

125
Q

Dx leiomyomata

A

pelvic US

-uterus “bulky” large

126
Q

Tx leiomyomata

A
  • progesterone supplement (decr bleeding)
  • GnRH, danazol (decr estrogen)- b/c estrogen sensitive
  • myomectomy
  • endometrial ablation
  • uterine artery/fibroid embolization
  • hysterectomy (definitive Tx)
127
Q

MC site endometriosis

128
Q

causes of endometriosis

A
  • retrograde menstruation
  • vascular/lymph dissemination
  • coelomic metaplasia (multipotential cells in peritoneal cavity–> endometrial tissue)

unopposed estrogen

129
Q

endometrioma aka

A

chocolate cysts, hemosiderin deposits

130
Q

Sx endometriosis

A

dysmenorrhea, dyspareunia, chronic pelvic pain, infertility

131
Q

Dx endometriosis

A

laparoscopy direct visualization, tissue Bx

132
Q

Tx endometriosis

A
  • OCP (progesterone), NSAIDs, danazol, GnRH
  • cauterization, hysterectomy, oophorectomy

(decr estrogen, incr progesterone)

133
Q

can endometriosis recur?

134
Q

MC genital tract cancer

A

endometrial cancer (uterine cancer)

135
Q

MC Sx endometrial cancer

A

abnormal bleeding, postmenopausal bleeding

136
Q

simple hyperplasia- what tissue

A

glandular & stromal tissue

137
Q

complex hyperplasia- what tissue

A

glandular only

138
Q

Braxton Hicks contractions

A

“false labor”, sporadic uterine contractions

2nd-3rd trimester

139
Q

goodell’s sign

A

indication of pregnancy

-softening of the vaginal portion of the cervix from increased vascularization

140
Q

hegar’s sign

A

softening and compressibility of the lower segment of the uterus

141
Q

Chadwick’s, Goodell’s, Hegar’s sign

A

Chadwick: vagina, “C”olor change, a dark blue to purplish-red congested appearance of the vaginal mucosa, an indication of pregnancy.

goodell: cervix, “G”ooey/softening, softening of the cervix; a sign of pregnancy.
hegar: lower uterus, “H”ey it hurts to touch, softening of the lower uterine segment; indicative of pregnancy.

(alphabetical out to in)

142
Q

postmenopausal bleeding - always think what?

A

endometrial cancer

hormone therapy; endometrial atrophy, polyps, hyperplasia

143
Q

Dx endometrial cancer

A

transvaginal US, endometrial Bx is definitive

144
Q

endometrial cancer findings on transvaginal US

A

> 5mm endometrial stripe in POSTMENOPAUSAL women

145
Q

RF for endometrial CA

A

long term estrogen use!! nulliparity, PCOS, older age, infertility, tamoxifen, late age menopause, early menarche

146
Q

endometrial cancer types

A

adenocarcinoma, endometrioid

147
Q

type I endometrial CA

A

MC endometrial CA, estrogen dependent, favorable prognosis

148
Q

type II endometrial CA

A

estrogen independent, poor prognosis

149
Q

endometrial CA Tx

A

hysterectomy, pelvic washings (look for spread)

150
Q

is endometrial CA high risk of recurrence?

151
Q

f/u of endometrial CA pts

A

pelvic speculum exam
q 3-4 mo x 3-4 yrs
then q 6 mo

152
Q

uterine fibroid degeneration leads to this, Sx: post menopausal bleeding, distant mets

A

uterine sarcoma

Tx: hysterectomy

153
Q

ovaries not palpable in premenopausal women…

A

more concerning vs. postmenopausal

154
Q

ovaries palpable in postmenopausal women…

A

maybe malignant

155
Q

simple ovarian cyst benign if what size?

156
Q

CA-125 elevation suspicious when?

A

always, especially postmenopausal

157
Q

most ovarian enlargements?

A

functional ovarian cysts-

follicular, corpus luteal, late luteal, theca lutein

158
Q

ovarian cyst Sx

A

asymptomatic usually, assoc with menstrual abnormalities, pain sometimes

159
Q

DDx ovarian cyst pain

A

UTI, ovarian torsion, renal calculi, appendicitis, IBD, diverticulitis (LLQ)

160
Q

follicular ovarian cyst Sx

A

unilateral pelvic pain, palpable mobile adnexal mass

incr estradiol levels (prevents ovulation= follicle fails to rupture)

161
Q

ovarian cyst rupture Sx

A

acute pelvic pain, peritoneal irritation

162
Q

Tx follicular cyst

163
Q

follicular ovarian cyst definition

A

follicle fails to rupture, becomes fluid filled

164
Q

corpus luteal cyst size, definition

A

follicle turns into corpus luteum, becomes enlarged, progesterone incr

corpus luteum > 3cm

165
Q

Sx corpus luteal cyst

A

ameorrhea!! lower quadrant pain, missed menses, neg pregnancy test

mimics ectopic!

166
Q

luteal phase cyst definition

A

spontaneous hemorrhage into cyst

167
Q

luteal phase cyst RF

A

anticoagulants, bleeding disorders

168
Q

luteal phase cyst rupture

A

acute pain, luteal phase
blood in peritoneum

Tx: surgical resection

169
Q

theca lutein cysts seen when, Tx?

A

pregnancy

regress without Tx

170
Q

Tx benign ovarian neoplasms

A

surgery b/c potential for malignancy, ovarian torsion

171
Q

3 classes of benign ovarian neoplasms

A

epithelial, germ, stromal cell tumors

172
Q

3 types of epithelial cell tumors

A

serous cystadenoma, mucinous cystadenoma (huge), Brenner cell tumor

173
Q

serous cystadenoma

A

malignant potential

174
Q

mucinous cystadenoma

A

low malignant potential, huge!

175
Q

Brenner cell tumor

176
Q

MC of all benign tumors!!

A

germ cell tumor (ovarian)

177
Q

germ cell tumor type

A

benign cystic teratoma (dermoid cyst)

178
Q

dermoid tissue

A

sweat gland, fat, bone teeth

179
Q

stromal cell tumor types

A

granulosa thecal cell tumor (F), Sertoli-Leydig cell tumor (M)

180
Q

MC GYN cancer, high mortality!

A

ovarian cancer

mortality- slough directly into peritoneum- widespread

181
Q

RF ovarian cancer

A
  • age 50-60 y/o, white
  • BRCA 1 & 2
  • HNPCC (hereditary nonpolyposis colorectal CA), Lynch syndr
  • Hx cancer of uterus/breast/colon
182
Q

decr risk ovarian CA by lots

A

OCP x 5 yrs

183
Q

Sx ovarian CA

A

early satiety (unable to eat normally), urinary incontinence, very vague Sx (fatigue, indigestion)!

184
Q

ovarian cancer and CA-125

A

not a screening tool

young: pos = uterine leiomyomata, PID, endometriosis, preg
old: pos = likely malignant

185
Q

Dx ovarian CA

186
Q

Dx adnexal mass

187
Q

histology of ovarian cancer

A

epithelial

188
Q

germ cell tumors age group

189
Q

staging ovarian CA

A

I- ovaries
II- pelvis
III- outside pelvis (nodes, liver, bowel)
IV- distant mets

190
Q

Tx ovarian cancer

A

SURGERY!

chemo: Taxol, carboplatin, cisplatin

191
Q

primary dysmenorrhea cause, age

A
  • incr prostaglandins during menstruation
  • prostaglandin F2alpha, prostaglandin E2

teens/20s- decr with age

192
Q

secondary dysmenorrhea causes, age

A

clinically identifiable cause: endometriosis, adhesions, leiomyomata, adenomyosis, polyps, IUD, infection, cervical stenosis

incr age

193
Q

prostaglandin F2alpha purpose

A

smooth muscle contraction

uterine: cramping
extrauterine: emesis, diarrhea

194
Q

prostaglandin E2 purpose

A

menorrhagia

195
Q

Tx primary dysmenorrhea

A

NSAIDs (block prostaglandin synthesis
ibuprofen 800 mg TID
naproxen 500 mg BID

topical heat, OCP (consistent levels)

196
Q

chronic pelvic pain definition

A

noncyclic pain > 6mo

197
Q

main causes of chronic pelvic pain

A

PID, IBS, interstitial cystitis, endometriosis, adhesions, psychogenic

198
Q

leiomyomata Tx main overall goal

A

block estrogen

199
Q

right sided pelvic pain, several days, menstrual irregularities, movable 5cm right adnexal mass palpated

A

functional ovarian cyst

200
Q

what causes pain assoc with primary dysmenorrhea?

A

prostaglandin F2alpha

EOR Women's Health (4 decks)

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