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MS3 Year > GYN > Flashcards

GYN Flashcards

1
Q

Cervical cancer screening begins at? Prevention of cervical cancer?

A

21; HPV vaccine

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2
Q

3 most common cancers in women other than skin?

A

Breast, lung, colon

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3
Q

Etiology of cervical cancer?

A

HPV (think of cervical cancer like an STD - same risk factors)

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4
Q

GYN cancer with the highest mortality?

A

Ovarian

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5
Q

Mammogram breast cancer screening begins at?

A

50 according to USPSTF (or 40 from ACOG); family history = earlier

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6
Q

If you find ASCUS, what is the next step?

A

Do HPV DNA testing

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7
Q

What are excisional tx’s for cervical precancerous lesions?

A

local ablation: LEEP and cry

Cone

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8
Q

Women age 21-29 get what kind of HPV testing?

A

Reflex - only test for HPV if they have abnormal pap

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9
Q

Post-coital bleeding, dx?

A

cervical cancer (benign causes include: cervicitis, cervical polyp, cervical fibroid)

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10
Q

Tx of cervical cancer

A

Stage IIa or less: local resection

Stage IIb or more: chemo + radiation (usually platinum based chemo)

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11
Q

Risk factor for endometrial cancer? Name 8 things that contribute to that risk

A

unopposed estrogen; 1) age; 2) nulliparity; 3) obesity; 4) PCOS; 5) HRT; 6) tamoxifen; 7) early menarche; 8) late menopause

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12
Q

Surgical tx for endometrial cancer?

A

TAH + BSO

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13
Q

How do you diagnose endometrial cancer?

A

Biopsy: endometrial sampling or D+C

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14
Q

Post menopausal vaginal bleeding, what is the most common cause?

A

Vaginal atrophy! (not cancer)

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15
Q

How does a pt with cervical cancer typically present? Endometrial cancer? Ovarian cancer (3)?

A

post-coital bleeding; post menopausal bleeding; RF, SBO, ascites

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16
Q

Screening for ovarian cancer in BRCA1/2 mutations?

A

transvaginal U/S and Ca-125 with ppx TAH+BSO at 35

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17
Q

Detect choriocarcinoma by?

A

elevated B-HCG levels, persistent bleeding

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18
Q

Screening for ovarian cancer?

A

None (catches it too late)

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19
Q

Dysgerminoma - how to tx and track?

A

chemoreceptive + unilateral oophorectomy; use LDH to track; hCG can be elevated; often recur on contralateral side (seminoma equivalent for women)

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20
Q

Yolk sac tumor marker?

A

AFP (see Schiller-Duval bodies)

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21
Q

Post-menopausal female, small bowel obstruction, ascites, dx?

A

Ovarian cancer (can also present with weight gain and abdominal bloating)

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22
Q

If you find an adnexal mass, what’s the next step?

A

transvaginal U/S
(if simple cyst, can stop; if large, sepatated, loculated - complex cyst - use age and symptoms to determine if germ cell or epithelial)

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23
Q

How do you tx germ cell tumors? Epithelial ovarian tumors?

A

unilateral salpingo-oophorectomy; TAH + BSO and paclitaxel

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24
Q

Name 4 subtypes of epithelial cell ovarian cancer

A

1) serous; 2) mucinous; 3) endometrioid; 4) Brenner’s

these are all cystadenocarcinomas

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25
Q

Name 4 subtypes of germ cell ovarian cancer

A

1) dysgerminoma; 2) endometrial sinus/yolk sac; 3) teratoma; 4) choriocarcinoma

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26
Q

What is the risk factor for epithelial ovarian cancer?

A

Ovulation (epithelial trauma) - thing associated with it: nulliparity, post-menopausal female

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27
Q

Incomplete mole genetics?

A

69, XXY (1 egg, 2 sperm)

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28
Q

Complete mole genetics?

A

46, XX (85-90% of time) (via empty egg, 2 sperm)

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29
Q

What is seen on U/S of molar pregnancy?

A

snowstorm pattern

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30
Q

Grape-like mass exiting the cervix, +UPT, dx?

A

molar pregnancy

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31
Q

How do you tx a molar pregnancy?

A

suction curretage, follow hCG to 0 (also give OCP for 1yr)

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32
Q

How do you medically tx choriocarcinoma of the uterus?

A

low risk: methotrexate
high risk: EMA/CO (etoposide, methotrexate and dactinomycin, cyclophosphamide and vincristine)

or remember MAC backbone: methotrexate, actinomycin D (aka dactinomycin), cyclophosphamide

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33
Q

What do you do after molar pregnancy?

A

good birth control plan, and follow B-HCG to 0 (qwk)

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34
Q

How does a pt with a molar pregnancy present (6)?

A

1) size-date discrepancy; 2) B-HCG too high for dates (gt 100,000); 3) hyperthyroidism (from B-HCG); 4) hyperemesis gravidarum; 5) adnexal mass (simple cyst); 6) grape-like mass exiting cervix

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35
Q

How do you surgically tx choriocarcinoma?

A

for local disease: TAH

for more advanced: debulking - and add medical tx

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36
Q

DES exposure - dx?

A

clear cell adenocarcinoma (vaginal cancer)

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37
Q

Red lesion and itchy lesion on vulva, dx?

A

Paget’s (confirm w/bx)

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38
Q

Grape-like mass in vagina of a child - dx?

A

Rhabdomyosarcoma (sarcoma botryoides)

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39
Q

How do you tx melanoma on the vulva?

A

vulvectomy for large tumors and LN dissection

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40
Q

How do you tx page’s of the vulva?

A

local resection (no need for vulvectomy)

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41
Q

Hard, red, or black lesion and itchy on the vulva, dx?

A

squamous cell or melanoma

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42
Q

Which is associated with higher blood loss, surgical or medical abortion?

A

medical

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43
Q

___ is a common vulvar non-neoplastic disorder that results from chronic scratching and rubbing, which damages the skin and leads to a loss of its protective barrier. Clinical findings include thick, enlarged and rugs labia, with or without edema. Tx is?

A

lichen simplex chronicus; short course of high potency topical corticosteroids and antihistamines to control pruritus

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44
Q

Name 5 risk factors in the development of pelvic organ prolapse. Does C/S or vaginal delivery have a higher risk?

A

1) increasing parity; 2) increasing age; 3) obesity; 4) some CT disorders (Ehlers-Danlos); 5) chronic constipation
Vaginal delivery

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45
Q

Name 3 surgical options for PPH

A

1) uterine artery ligation; 2) internal artery ligation; 3) TAH; (also can consider embolization of arteries with IR)

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46
Q

Pelvic floor relaxation is usually due to stretched ___ due to multiple __. Patient can present with __, __ or on __ exam.

A

stretched cardinal ligaments (can’t keep things in place); large births; vaginal fullness, chronic back pain, speculum

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47
Q

What is the nonsurgical tx option for pelvic floor relaxation? What is the surgical tx?

A

Pessaries; 1) hysterectomy (uterine) 2) colporrhaphy (rectocele, cystocele)

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48
Q

What are the 4 grades for uterine prolapse?

A

Grade I: in vaginal canal
Grade II: at vaginal opening
Grade III: out of vagina but not inverted
Grade IV: inverted and out of the vagina

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49
Q

If there is rupture of an ectopic, you do what?

A

Salpingectomy

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50
Q

Dysmenorrhea, dyspareunia, infertility - dx?

A

Endometriosis

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51
Q

First line tx for fibroids?

A

OCPs and NSAIDs

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52
Q

How do you tx endometriosis?

A

OCPs (and NSAIDs)

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53
Q

How do you treat ovarian torsion?

A

Surgery to untwist the ovary

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54
Q

Sudden onset abdominal pain and n/v in an otherwise healthy woman, dx?

A

Torsion of the ovary

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55
Q

How do you tx a small simple cyst?

A

You don’t - observe only. Reimage in 12 wks if warranted (typically if it’s greater than 3cm)

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56
Q

If there is no rupture of an ectopic, you do what?

A

methotrexate if possible, if not, salpingostomy

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57
Q

How do you tx tubo-ovarian abscess? How do you tx PID?

A

inpatient IV cefoxitin + doxycycline + metronidazole (drain abscess if no improvement); cefoxitin + doxycycline

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58
Q

How do you tx a large dermoid cyst?

A

cystectomy

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59
Q

In addition to OCPs, how else can you shut down the HPO axis in a pt with endometriosis?

A

GnRH analogues and danazol

danazol will probably not be the answer ever due to androgen SEs

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60
Q

What are the 3 things that determine if you can use methotrexate for an ectopic pregnancy?

A

1) bHCG less than 5000; 2) gestational size less than 3cm; 3) no fetal heart tones

(then trend HCG to 0…due to risk of chorio)

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61
Q

A pt with tubo-ovarian abscess will present with abdominal/pelvic pain and at least 1 of these 3, and __ and __.

A

1) cervical motion tenderness; 2) adnexal tenderness; 3) uterine tenderness; fever and leukocytosis

+WBC on wet prep increases likelihood of TOA

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62
Q

Multiple sclerosis can induce what type of incontinence?

A

Overflow incontinence (due to neurogenic bladder - absence of detrusor contractions)

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63
Q

Q-tip test shows hyper mobility, dx?

A

Stress incontinence (hypermobility is of the urethra)

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64
Q

Sneeze and pee, dx?

A

Stress incontinence

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65
Q

Sudden urges to urinate at all times of the day, dx?

A

Urinary urgency, check for UTI (could be urge incontinence)

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66
Q

How do you diagnose urgency incontinence?

A

hx, bladder diary, in some cases cystometry (will show spasms of the bladder at all levels of urinary volumes)

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67
Q

Urgency, frequency, and dysuria - dx?

A

UTI

68
Q

In addition to physical exam, how can you diagnose a continuous leak due to fistula?

A

tampon test

69
Q

How do you tx stress incontinence (4)?

A

1st lifestyle, then PT and pessaries, then surgery (sling, urethral bulking agents - urethropexy = Burch procedure)

70
Q

How do you tx urge incontinence (2)?

A

Oxybutynin, intermittent/indwelling catheter

71
Q

How do you tx overflow incontinence (2)?

A

bethanechol, intermittent/indwelling catheter

72
Q

Urge and nocturnal incontinence: stress, overactive bladder, overflow, irritative bladder

A

stress: no to both
overactive bladder: urge+ nocturnal+
overflow: no urge, nocturnal+
irritative: urge+, no nocturnal

73
Q

Flagellated motile organisms, dx?

A

trichomonas

74
Q

Erythematous macular body rash, desquamating rash, dx?

A

Toxic shock (look for tampon in question stem)

75
Q

How do you tx tubo-ovarian abscess?

A

IV cefoxitin, doxycycline, and metronidazole, and/or drain if large

76
Q

How do you dx candida? How do you tx candida?

A

KOH prep shows pseudohyphae; Fluconazole topical or oral

77
Q

How do you tx purulent cervical discharge?

A

Ceftriaxone + azithromycin or doxy

78
Q

Clue cells, dx?

A

Bacterial vaginosis

79
Q

White thick vaginal discharge, dx?

A

Candida

80
Q

How do you tx toxic shock?

A

Nafcillin

81
Q

How do you tx trichomonas?

A

metronidazole po both partners!

82
Q

Which two infxns are always tx together (and frequently occur together)?

A

Gonorrhea and chlamydia

83
Q

How do you diagnose cervicitis?

A

Gc/Chla NAAT (NAAT=PCR), wet prep

84
Q

Pt has cervical motion tenderness and cervical discharge without s/s of PID, dx?

A

cervicitis

85
Q

T/F: there is no imaging or blood test that can confirm endometriosis

A

True (definitive dx is through laparascopic surgery)

86
Q

How do you tx a complex cyst?

A

If it is greater than 7cm you should remove it laparascopically. Don’t do aspiration are you might seed it

87
Q

Describe a simple cyst (6). How do you tx?

A

Single, fluid-filled, homogenous, cystic, unilocular, lt 7cm; can tx with OCPs

88
Q

Describe a complex cyst (4). How do you tx?

A

loculated, lobulated, multiple septations, , gt 7cm. If it is greater than 7cm you should remove it laparascopically. Don’t do aspiration are you might seed it

89
Q

___ is a chronic inflammatory condition of the bladder, which is clinically characterized by recurrent irritative voiding symptoms of urgency and frequency in the absence of objective evidence of another disease that could cause the symptoms

A

Interstitial cystitis

70% of women with IC have pelvic pain; women may also experience dyspareunia

90
Q

GnRH agonists work by __. Danazol, a 17-alpha-ethinyl testosterone derivative, suppresses ___.

A

down regulating the HPO axis (decreasing release of LH and FSH, and subsequent estradiol levels); mid cycle surges of LH and FSH

91
Q

Pelvic congestion syndrome is accuse of chronic pelvic pain in the setting of ___. The unique characteristics of the __ make them vulnerable to chronic dilatation with stasis leading to __.

A

pelvic varicosities; pelvic veins; vascular congestion
(will see enlared uterus with selective dilatation of ovarian and uterine veins - high estradiol concentrations inhibits reflex vasoconstriction of vessels)

92
Q

Dysmenorrhea and heavy menstrual bleeding with progression chronic pelvic pain are typic of ___. A boggy, tender, __ uterus on examination is also characteristic.

A

adenomyosis; uniformly enlarged

93
Q

Pts who desire lactation suppression should do these 3 things

A

1) wear a supportive bra; 2) avoid nipple stimulation; 3) use ice packs and analgesics (NSAIDs) to relieve associated pain

94
Q

Name 4 risks of combined estrogen-progestin contraceptives

A

1) venous thromboembolism; 2) HTN; 3) hepatic adenoma; 4) rarely stroke and MI

95
Q

What is the typical clinical presentation of ruptured ovarian cyst? U/S findings?

A

sudden onset, severe, unilateral lower abdominal pain immediately following strenuous activity or sexual activity; pelvic free fluid

96
Q

Name 5 causes of acute abdominal/pelvic pain in women

A

1) mittelschmerz; 2) ectopic pregnancy; 3) ovarian torsion; 4) ruptured ovarian cyst; 5) PID (+/- TOA)

97
Q

Name 3 causes of abnormal menstrual bleeding

A

1) fibroids; 2) adenomyosis; 3) endometrial cancer/hyperplasia

98
Q

You suspect a foreign body in a child’s vagina, next step?

A

exam under anesthesia

99
Q

Assessing bleeding post menopausal woman

A

history, physical exam (pelvic), U/S, endometrial bx if thickened endometrium

100
Q

Birth control to tx bleeding irregularities?

A

OCPs, levonorgestrel IUD

101
Q

Post-menopausal woman bleeding - what test do you get?

A

u/s (if endometrial stripe thickened, endometrial biopsy)

102
Q

Assessing bleeding in reproductive age

A

pregnancy, PALM-COEIN (polyp, adenomyosis, leiomyomata, malignancy, coagulopahty, ovulartory dysfunction, endometrial, iatrogenic, not otherwise specified)

103
Q

What is the most common cause of vaginal bleeding in premenarchal, reproductive, and menopausal women

A

pre: foreign body
repro: pregnancy
meno: vaginal atrophy

104
Q

Name 3 causes of vaginal bleeding in a premenarchal girl

A

1) foreign body; 2) sexual abuse; 3) precocious puberty

105
Q

Name 3 causes of vaginal bleeding in a menopausal woman

A

1) vaginal atrophy; 2) endometrial cancer/hyperplasia; 3) HRT

106
Q

How do you tx a missed abortion?

A

If gt 24 weeks - induce with oxytocin
If lt 24 wks - can use misoprostol
D&C if surgery is warranted

107
Q

No passage of contents, cervical os open, U/S shows a dead baby, dx?

A

inevitable abortion

108
Q

No passage of contents, closed os, dead baby, dx?

A

Missed abortion

109
Q

UPT is positive, u/s shows nothing, B-quant is 1000, dx and next step?

A

pregnancy of unknown location - check B-quant in 48 hours (if it doubles, IUP, if not, ectopic)

110
Q

Passage of contents, cervical os closed, no baby on u/s, dx?

A

Complete abortion

111
Q

Abdominal pain, UPT positive, next step?

A

U/S and quantitative beta hCG

112
Q

Passage of contents, cervical os open, retained parts on u/s, dx?

A

Incomplete abortion

113
Q

Name 5 differential diagnoses for dysmenorrhea. Which 2 are associated with dyspareunia?

A

1) primary dysmenorrhea (pain during menses); 2) endometriosis (pain peaks before menses); 3) fibroids; 4) adenomyosis; 5) pelvic congestion (dull pelvic ache that worsens with standing)

endometriosis and pelvic congestion

114
Q

Asymmetric uterine masses, often present with pelvic pressure or abnormal uterine bleeding - dx?

A

fibroids

115
Q

How do you tx PCOS?

A

OCPs and metformin

116
Q

Fat, hairy, infertility, dx?

A

PCOS

117
Q

Severe vaginal bleeding w/o risk of DVT/PE?

A

IV estrogen

118
Q

First step to tx a bleeding fibroid?

A

OCPs and NSAIDs

119
Q

There is an image of a U/S of the ovaries with lots of little circles, dx?

A

PCOS

120
Q

How do you diagnose PCOS?

A

1) Anovulation AND either
2) biochemical: LH/FSH gt 3:1, inc testosterone and DHEAS
OR
3) imaging - u/s follicles
Will see hyperandrogenism too

121
Q

How do you tx fibroids if she wants kids? If she doesn’t want kids? If they are too big for surgery?

A

myomectomy; TAH; leuprolide to help shrink

122
Q

List 9 possibile causes of abnormal vaginal bleeding

A 
Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovarian dysfunction
Endometrium
Iatrogenic/IUD
Not yet classified
123
Q

Evaluation steps for secondary sex characteristics before 8?

A

obtain wrist XR (bone age), FSH, LH, and estradiol (for eval of Precocious puberty)

124
Q

In precocious puberty work up, if GnRH stimulation test results in increased LH you have __ precocious puberty. Next step is __. If you have no change in LH, you have __ precocious puberty. Next step is__.

A

central; MRI brain (look for anterior pituitary tumor vs constitutional GnRH secretion); peripheral; U/S abdomen, adrenals, ovaries, and 17-OH progesterone test (look for CAH, adrenal or ovarian tumor, or ovarian cyst)

125
Q

How do you tx central precocious puberty?

A

GnRH agonist (leuprolide) for prevention of premature epiphyseal plate fusion OR resect AP tumor if they have one

126
Q

Delayed puberty is defined by (2)?

A

absence of secondary sex characteristics by 13, or the absence of menses by 16

127
Q

T/F: growth hormone can help activate delayed puberty

A

false

128
Q

Development of axillary hair or breast buds before what age warrants investigation?

A

8 (some research suggests younger for African Americans)

129
Q

Central precocious puberty is dx’ed by what test?

A

GnRH stimulation test (will show LH up)

130
Q

17-OH progesterone can help identify?

A

CAH (it is part of newborn screening, but can have late onset)

131
Q

No breast development and can’t smell, dx?

A

Kallmann syndrome

132
Q

Shield-shaped chest, broad spaced nipples, web neck; dx?

A

Turner syndrome (X,O)

133
Q

What do you do with a pt who has androgen insensitivity syndrome?

A

Remove testes after puberty (due to risk of testicular cancer)

134
Q

First test for primary amenorrhea?

A

UPT

135
Q

Karyotype of mullerian agenesis?

A

XX (idiopathic loss of mullerian ducts)

136
Q

Primary amenorrhea: HPO axis intact and uterine anatomy intact, dx (4)?

A

1) pregnancy; 2) anorexia; 3) weight loss; 4) imperforate hymen

137
Q

Primary amenorrhea: HPO axis intact and uterine anatomy not intact, dx (2)?

A

Mullerian agenesis (XX, normal testosterone) and androgen insensitvity syndrome (XY female appearing, increased testosterone)

138
Q

Primary amenorrhea: HPO axis not intact and uterine anatomy intact, dx (3)?

A

Craniopharyngioma, Kallmann syndrome, Turner syndrome

first two have no FSH, LH; Turners has increased FSH, LH

139
Q

What 3 tests should you order in diagnosing primary amenorrhea?

A

1) urine pregnancy test; 2) wrist xray; 3) u/s of the uterus

140
Q

Why does hypermagnesemia cause hypocalcemia?

A

due to temporary suppression of PTH secretion

141
Q

First test for secondary amenorrhea?

A

UPT

142
Q

What medications should you look for in secondary amenorrhea?

A

Anti-psychotics (dopamine antagonists increase prolactin)

143
Q

What tests should you get to assess secondary amenorrhea, and in which order?

A

UPT, then TSH, prolactin, FSH

144
Q

A woman stops bleeding, runs a lot, training for a marathon, dx?

A

hypothalamic causes

145
Q

A woman with multiple elective abortions/D&Cs has amenorrhea, dx?

A

Asherman’s syndrome

146
Q

If a woman has savage syndrome, what would the following tests show: progestin challenge, E+P challenge, FSH and LH, U/S

A 
savage = unresponsive ovaries
progestin negative (since no estrogen phase on endometrium)
E+P induces bleed 
FSH, LH both increased
U/S would show follicles
147
Q

Name 3 hypothalamic causes of 2ndary amenorrhea. Name 3 AP causes.

A

1) stress; 2) anorexia; 3) exercise

1) adenoma; 2) Sheehan; 3) apoplexy

148
Q

Name 3 ovarian causes of 2ndary amenorrhea. Name 2 endometrial causes.

A

1) savage syndrome; 2) premature ovarian failure; 3) menopause
1) asherman syndrome; 2) ablation

149
Q

What’s the difference btwn primary and secondary amenorrhea?

A

Primary has never had a period while 2ndary has in the past

150
Q

In 2ndary amenorrhea, once TSH, UPT, and prolactin have all been ruled out, what are the next tests (and the order)

A

Think about HPO Axis problems: 1) progesterone challenge; 2) E+P challenge; 3) FSH, LH and FSH/LH; 4) MRI; 5) DOE = hypothalamus

151
Q

In 2ndary amenorrhea, once TSH, UPT, and prolactin have all been ruled out and you bleed with a progesterone challenge, what’s the dx? Don’t bleed w/P or E+P challenge?

A

PCOS; Asherman’s or ablation

152
Q

How do you tx vaginal atrophy?

A

vaginal estrogen creams

153
Q

What are symptoms of menopause (4)?

A

hot flashes, vaginal atrophy, irritability, and mood swings

154
Q

How do you tx hot flashes?

A

venlafaxine

155
Q

What is primary care for women after menopause?

A

Ca + Vit D, dexa at 65

If CAD put on statin

156
Q

3 things necessary for fertility?

A

1) ovulation; 2) normal anatomy; 3) normal semen

157
Q

How do you tx infertility from anovulation?

A

clomiphene

158
Q

Infertility and fibroids, desires children, next step?

A

myomectomy

159
Q

What is the ovarian androgen? Adrenal androgen?

A

Testosterone; DHEA-S

160
Q

How do you dx a tumor in a young woman causing virilization?

A

U/S

161
Q

How do you dx congenital adrenal hyperplasia?

A

17-OH-progesterone in the urine

162
Q

What are 3 ways you can tell if a woman is ovulating?

A

1) basal temp rises 1 degree on ovulation; 2) endometrial bx day 14-28 showing secretory uterus; 3) can measure progesterone level at day 22

163
Q

What is the order of puberty development?

A

Tits, pits, mits, lips

breast, axillary hair, growth spurt, menarche

164
Q

What are six causes of precocious puberty (think about each level)?

A

1) Hypothalamus constitutionally on; 2) AP LH/FSH secreting tumor; 3/4) Ovary: cyst, granulosa theca tumor; 5/6): adrenals: CAH, tumor

165
Q

__ syndrome is characterized by premature menses before breast and pubic hair development

A

McCune-Albright syndrome

166
Q

__ anomalies occur in 25-35% of pts with mullerian agenesis.

A

renal

167
Q

What are the 3 D’s of endometriosis?

A

Dysmenorrhea (painful periods), dypareunia (painful sex), and dyschezia (painful defecation)

MS3 Year (18 decks)

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