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MS3 OBGYN > GYN > Flashcards

GYN Flashcards

1
Q

If a pap/colpo comes back ectocervical, what is the next step in management?

A

LEEP, Cryo

If stage IIA or , stage, resect, chemo

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2
Q

If a colpo comes back endocervical, what is the next stage in management?

A

Cone biopsy

If stage IIA or , stage, resect, chemo

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3
Q

What is the pathogenesis of endometrial cancer?

A

Progesterone is protective;
Estrogen exposure:
Age, nulliparity, obesity, PCOS, hormone replacement therapy

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4
Q

How does endometrial cancer present?

A

Post menopausal female with bleeding

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5
Q

How is endometrial cancer diagnosed?

A

Endometrial biopsy

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6
Q

How is endometrial cancer treated?

A

TAH-BSO +/- chemo for mets

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7
Q

What are the parhogeneses of vulvar cancer?

A

Squamous (HPV);

Melanoma

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8
Q

How does a patient present with vulvar cancer?

A

Vulva is black and itchy

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9
Q

How does a patient with Paget’s present?

A

Vulva is red and itchy

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10
Q

What are the subtypes of germ cell ovarian cancer?

A

Dysgerminomas: chemo, LDH;
Endometrial sinus: AFP;
Teratoma: struma ovarii;
Choriocarcinoma: beta-hcg

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11
Q

How does a patient with a germ cell ovarian cancer present?

A

Teenage girl with unilateral adnexal mass

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12
Q

How is a germ cell ovarian tumor treated?

A

Unilateral SO;

Conservative therapy to preserve fertility

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13
Q

What is your differential for premenarchal vaginal bleeding?

A

Sexual abuse;

consider doing speculum exam under anesthesia

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14
Q

What is your main differential for postmenarchal vaginal bleeding?

A

Endometrial cancer

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15
Q

What is your differential for bleeding in the reproductive age female?

A
  1. Pregnancy
  2. Anatomy
    3.
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16
Q

What is the management of major vaginal bleeding?

A
  1. 2 large bore ivs
  2. IVF boluses
  3. type and cross
  4. IV estrogen to shut off bleeding from the uterus
  5. surgical intervention ie intracavitary tamponade (balloon) or D&C or uterine artery embolization (interventional radiology) or TAH
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17
Q

What are the steps of abortion?

A

IUP threatened abortion –> inevitable –> incomplete –> complete

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18
Q

What are the characteristics of a threatened abortion?

A

Vaginal bleeding
No passage of contents
Closed os
live baby on u/s

Bedrest may save baby

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19
Q

What are the characteristics of an inevitable abortion?

A

Vaginal bleeding
No passage of parts
Open os
dead baby on u/s

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20
Q

What are the characteristics of an incomplete abortion?

A

Vaginal bleeding
Passage of parts
Open os
retained parts on u/s

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21
Q

What are the characteristics of a complete abortion?

A

Vaginal bleeding
Passage of parts
Open os
nothing on u/s

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22
Q

What are the characteristics of a missed abortion?

A

No vaginal bleeding
No passage of contents
Closed os
dead baby on u/s

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23
Q

What is the management of abortion?

A

Misoprostol in the first trimester, may have to induce delivery of a dead baby (pitocin);
D&C;
still give rhogam if mom is Rh (-)

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24
Q

What is the first step in the management of bleeding during pregnancy?

A

Transvaginal u/s

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25
Q

What is the management of an ectopic pregnancy that has ruptured?

A

Salpingectomy

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26
Q

What is the management of an ectopic pregnancy that has not ruptured?

A

Salpingostomy - can open tube, suck out pregnancy, close tube; or
methotrexate with or without leucovorin IF:
b-hCG

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27
Q

What is the management of a positive pregnancy test, vaginal bleeding, but nothing seen transvaginal u/s?

A
  1. read beta-quant for b-hCG in blood
    if b-hCG > 1500, should see IUP, if no, treat as ectopic
  2. If b-hCG IUP
    –if beta quant fails to double –> ectopic
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28
Q

What does PALM stand for in the differential of vaginal bleeding?

A 
The anatomical causes of bleeding
Polyps -- uterus feels normal
Adenomyosis -- symmetric, smooth and boggy
Leiomyoma -- assymetric nodular uterus
Malignancy
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29
Q

What do you give to shrink a fibroid in preparation for surgery?

A

Leuprolide

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30
Q

What is the pathology behind PCOS?

A

Anovulation

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31
Q

How does a patient with PCOS present?

A 
Fat and hairy;
metabolic syndrome - HTN, dyslipidemia, diabetes;
infertibility;
no control over highly variable periods;
hx of anovulation
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32
Q

How is PCOS diagnosed?

A
  1. Hx of anovulation AND either:
  2. imaging of multiple follicles, or
  3. biochemical evidence of manliness (elevated DHEAS, testosterone, or LH:FSH > 3:1)
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33
Q

What is the treatment for PCOS?

A

Must push her into ovulation

  1. Metformin stimulates ovulation
  2. OCPs if she doesnt want pregnancy
  3. Clomifen for ovulation
  4. Spironolactone to reduce androgens
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34
Q

What is the management for unexplained vaginal bleeding in a reproductive age female?

A

If no other differential item pans out, try NSAIDs to stop bleeding, then OCPs to regulate cycle, then surgery to clean out endometrium

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35
Q

What is the arterial supply to the ovaries?

A

The aorta directly supplies both ovaries, contained in the suspensory ligaments to the ovaries

36
Q

What is the venous drainage of the ovaries?

A

Ovaries –> vena cava on the right;

On the left - adrenal, renal and ovarian vein come together before entering the vena cava

37
Q

What is a complete molar pregnancy?

A

Complete molar pregnancies have only placental parts (there is no baby), and form when the sperm fertilizes an empty egg. Because the egg is empty, no baby is formed. The placenta grows and produces the pregnancy hormone, hCG. Unfortunately, an ultrasound will show that there is no fetus, only a placenta.

38
Q

What is a partial molar pregnancy?

A

Partial Mole occurs when the mass contains both the abnormal cells and an embryo that has severe birth defects. In this case the fetus will be overcome by the growing abnormal mass rather quickly.

39
Q

How often do you get a pap if you’re HIV+?

A

Every year

40
Q

If you’re having normal pap smears, when is it okay to stop pap smears?

41
Q

What is the next step for a grossly abnormal pap?

A
  1. Ectocervical inspection and biopsy

2. Endocervical curettage

42
Q

What are the most common causes for postmenopausal vaginal bleeding?

A

Vaginal atrophy and trauma

43
Q

What is the treatment for endometrial hyperplasia in the reproductive age female?

A

High dose progesterone (for precancer)

44
Q

What meds are the basis for chemo for endometrial cancer?

A

carboplatin and paclitaxel

45
Q

What are the common patients that present with endometrial cancer?

A
  1. old and obese
  2. old and on HRT or SERM
  3. young and PCOS
  4. granulosa-theca tumor that stimulates estrogen production
46
Q

Dysgerminomas arise from

A

germ cells in the ovary;

good prognosis

47
Q

Track dysgerminomas with what tumor marker?

48
Q

Endometrial sinus tumors are tracked with what tumor marker?

49
Q

What are the three types of endometrial cell tumors?

A 
Serous
Mucinous
Endometroid
(all above cystadenocarcinoma)
Brenners
50
Q

What is the pathogenesis of the cystadenocarcinomas? (Epithelial ovarian cancers)

A

“trauma” = ovulation

51
Q

How does epithelial ovarian cancer present?

A

Stage IIIb or worse;
Peritoneal seeding common;
renal failure, SBO, or ascites common

52
Q

How are epithelial ovarian cancers diagnosed and tracked?

A
  1. transvaginal u/s
  2. CT to stage
  3. track with CA-125
53
Q

What is the treatment for epithelial cell ovarian cancer?

A

TAH + BSO;

chemo with paclitaxel

54
Q

What is the special consideration for ovarian cancer prevention for BRCA1/2 people?

A

Prophylactic TAH + BSO at 35

55
Q

What are the stromal tumors of the ovary?

A
  1. Granulosa theca cell tumors –> produce estrogen

2. Sertoli-Leydig tumors –> produce testosterone

56
Q

What is a simple cyst seen on u/s?

A

Smooth, small, w/o septations

57
Q

What is a complex cyst seen on u/s?

A

large, septations, loculated;

must biopsy

58
Q

What is the treatment for SCC or melanoma of the vulva?

A

Vulvectomy + LN dissection

59
Q

What is the treatment for Paget’s disease of the vulva?

A

Usually wide local resection

60
Q

What are the kinds of vaginal cancer?

A
  1. SCC - HPV

2. Adenocarcinoma - grape like mass in the vagina - DES exposure in utero

61
Q

What is the differential for a complex ovarian cyst seen on u/s?

A
  1. teratoma
  2. endometrioma
  3. ectopic pregnancy
  4. tubo-ovarian abscess
  5. cancer
  6. torsion
62
Q

What is the treatment for teratoma?

A

Remove cyst only - conservative tx to preserve fertility

63
Q

What’s the treatment for endometriosis w/o chocolate cysts?

A

Trial of OCP;
treat pelvic pain with NSAIDs;
can use leuprolide

64
Q

What is the pathology behind ectopic pregnancy?

A

Early implantation, can be from stricture or PID

65
Q

What is the most common location of ectopic pregnancy?

66
Q

When can you use methotrexate with leucovorin rescue?

67
Q

What is the pathology behind ovarian torsion?

A

Cyst –> suspensory ligament twists;

suspensory ligament contains uterine artery and vein

68
Q

How is ovarian torsion diagnosed?

A

vaginal u/s with Doppler (to see decreased blood flow)

69
Q

What is the pathology behind tubo-ovarian abscess?

A

PID (gc/chlamydia or vaginal flora)

70
Q

What is the treatment of tubo-ovarian abscess?

A

Treat as PID;
patient will likely be toxic, and/or have leukocytosis - need inpatient tx with cefoxitin w/ doxy and metronidazole, or clindamycin + metronidazole;
drain surgically if patient does not improve

71
Q

What is a major suggestion that a patient has a tubo-ovarian abscess?

A

White cells on wet prep

72
Q

What is the pathology behind stress incontinence?

A

Stretching of the cardinal ligaments from multiple births, cystocele

73
Q

What’s the presentation of stress incontinence?

A 
Sneeze and pee (increase in intraabdominal pressure;
no nocturnal symptoms;
no urgency (u/a and cystometry are normal and not needed)
74
Q

What is the treatment for stress incontinence?

A

Kegels, then pessaries, then surgery (sling or colposuspension)

75
Q

What is the pathology behing overactive bladder?

A

Hypertonic bladder with random spasms of detrusor muscle

76
Q

How will a patient with OAB present?

A

Nocturnal symptoms;
Leaking;
Urgency
Dx made on cystometry (can see spasms)

77
Q

What is the treatment for OAB?

A

Oxybutinin

78
Q

What is the pathology behind hypotonic/overflow/neurogenic bladder?

A

No sensation of needing to void, or no message to void;

common in MS, trauma, antispasmodics

79
Q

How does overflow bladder present?

A 
Leaking at critical pressure;
No urge;
Nocturnal symptoms;
distended bladder;
possible focal neurological deficit
80
Q

How is overflow bladder diagnosed?

A

Cystometry;

treat with bethanacol, if chronic, catheter…

81
Q

What is the pathology behind irritative bladder?

A

Inflammation from stones, cancer, or UTI

82
Q

How does irritative bladder present?

A

Frequency, urgency, dysuria, no nocturnal symptoms

83
Q

How is irritative bladder diagnosed?

A

u/a - wbc if uti, rbc if cancer or stones

84
Q

Give two common reasons fistulas occur.

A

Inflammation;

Radiation

85
Q

What is an easy way to diagnose fistula?

A

Tampon test

MS3 OBGYN (2 decks)

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