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OB Gyn babies > Gyn > Flashcards

Gyn Flashcards

1
Q

Absent or rudimentary uterus and upper vagina (“short vagina”)
Normal ovaries
Normal breast development
Normal axillary and public hair

A 
Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome)
46XX

Don’t got tubes! But gonads ok

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2
Q

Absent uterus and upper vagina
Cryptorchid testes
Normal breasts
Minimal-absent axillary/pubic hair

A

Completely androgen insensitivity syndrome
46 XY

Just a woman with blind pouch vagina with hidden testes

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3
Q

Normal uterus and vagina
Streak ovaries
Breasts are variable
Normal axillary/pubic hair

A

45X

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4
Q

Persistent, eczematous or ulcerative rash on nipple->areola

+/- vesicles, bloody discharge, nipple retraction

A

Paget disease (Adenocarcinoma)

From migration of cancer cells from ducts to nipple surface

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5
Q

Palpable, mobile, rubbery, firm breast mass.

No nipple changes

A

Fibroadenoma

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6
Q

Unilateral bloody nipple discharge but no nipple lesions

A

Breast papilloma

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7
Q

Mobile, soft nontender, well-circumscribed mass behind labium majus
Can cause discomfort

A

Bartholin cysts
(the bartholin glands provide lubrication and are not palpable unless duct is blocked)

Can evolve into abscess (localized erythema, induration, fluctuancy, +/- fever)

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8
Q

Thin white crinkly skin over labia
or “thin dry, white plaque-like vulvar skin” with loss of labia minora
can have clitoral hood retraction

A

Lichen sclerosus
chronic inflammatory condition, can coexist with other autoimmune conditions

dx: punch biopsy to rule out SCC
tx: high-potency topical steroids on genitals!!

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9
Q

Bright red autoimmune ulcers and erosions around vulvovaginal area

A

Lichen planus

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10
Q

Leathery skin from chronic scratching

A

Lichen simplex chronicus

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11
Q

Recurrent mild and unilateral mid-cycle pain prior to ovulation. Lasts hours-days

A

Mittelschmerz

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12
Q

Sudden-onset, severe, unilateral lower abd pain, N/V. Unilateral, tender adnexal mass on exam

A

Ovarian torsion

Ultrasound: enlarged ovary with decreased or absent blood flow

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13
Q

sudden-onset, severe, unilateral lower abd pain immediately following strenous or sexual activity. second half of menstrual cycle.

can result in pelvic free fluid or hemoperitoneum if anticoagulated.

A

ruptured ovarian cyst

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14
Q

Primary amenorrhea with no breast development

What to get next?

A

FSH

If FSH decreased -> pituitary MRI
if FSH increased -> karyotype

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15
Q

Fishy odor
Clue cells
+Whiff test

Tx?

A

BV (gardnerella vaginosis)

tx: metronidazole or clinda

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16
Q

yellow-green frothy discharge
pH>4.5
motile tear-shaped organisms

A

trichomoniasis

tx: metronidazole. treat sexual partner too!

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17
Q

thick, cottage-cheese discharge

A

candida

+pseudohyphae. normal pH

tx: fluconazole

18
Q

Precocious puberty in child
Or bleeding/endometrial hyperplasia in postmenopausal women
Large adnexal mass
Increased estrogen

A

Granuloma cell tumor of ovary

19
Q

Ovarian tumor in women <30yo

Secretes LDH or B-hCG

A

Dysgerminoma

20
Q

Mature teratoma (dermoid cyst)

A

Common, benign ovarian tumor that is not hormonally active

21
Q

Serous cystadenoma

A

Benign ovarian neoplasm. Hormonally inactive and do not cause precocious puberty.

22
Q

Ovarian tumor that produce androgens
Defeminization -> masculinization
-> flattening of breasts and scanty, irregular menstruation -> amenorrhea
Hirsutism, coarsening of facial features, voice depending, clitoral enlargement

A

Sertoli-Leydig cell tumors

23
Q

Ovarian mass

Ultrasound shows hyperechoic nodules and calcifications

A

Mature dermoid cyst (teratoma)

Usually do not rupture, but do increase risk of torsion

24
Q

Uterine cancer following pregnancy that tends to be metastatic on presentation (eg presents with lung nodules)

A

Choriocarcinoma

25
Q

Ovarian masses
On ultrasound, bilateral multiseptated cystic masses
Induced by high hcg during pregnancy (eg molar pregnancy)

Can cause virilization

A

Theca lutein cysts

Should regress spontaneously

26
Q

Pregnant
Yellow ovarian masses (half are bilateral)
Virilization

A

Luteoma
(High risk of fetal virilization)

Should regress spontaneously

27
Q

RUQ pain with PID symptoms (fever, lower abd pain)

A

perihepatitis (fitz-hugh-curtis disease)

28
Q

How does tamoxifen/raloxifene work? (and what if risk of tamoxifen therapy?)

A

selective estrogen receptor modulator (SERM)

estrogen receptor antagonist in the breast
estrogen agonist in the uterus (thus associated with endometrial polyps in premenopausal women, and endometrial hyperplasia/cancer in postmenopausal women)

29
Q

Precocious puberty
Bone age > chronological age
Low basal LH
GnRH stim -> LH still low

A

Peripheral precocious puberty (GnRH independent)

  • ADRENAL things (CAH, adrenal tumors)
  • GONADAL things (gonadal tumors, ovarian cysts)
  • exogenous (estrogen, etc)
  • McCune albright (triad: cafe au lait spots, precocious puberty, bone probs)
30
Q

Precocious puberty
Bone age > chronological age
High basal LH

A

Central precocious puberty

  • Idiopathic
  • Hypothalamic lesions and other CNS tumors
31
Q

Precocious puberty
Bone age > chronological age
Low basal LH
GnRN stim -> LH rises

A

Central precocious puberty (GnRH dependent)

  • Idiopathic
  • Hypothalamic lesions and other CNS tumors
32
Q

Delayed/absent puberty
Anosmia
Low FSH, LH

A

Kallman syndrome

X-linked recessive defect in migration of fetal GnRH and olfactory neurons -> hypogonadotropic hypogonadism

33
Q

turmor in men
b-HCG elevated
AFP normal

A

seminoma

34
Q

tumor in men
AFP elevated
b-HCG can be elevated

A

nonseminomatous germ cell tumor (yolk sac, choriocarcinoma, embryonal carcinoma)

35
Q

Condyloma lata vs acuminata

A

Lata is secondary syphilis, is flat

Acuminata is hpv (warts); cauliflower like, usually asymptomatic but can bleed

36
Q

side effect of trastuzumab (herceptin)

A

cardiotoxicity

Get echo before starting

37
Q

side effect of cisplatin, carboplatin etc

A

ototoxicity

get baseline audiometry

38
Q

side effect of aromatase inhibitors (anastrozole, letrozole)

A

(used in tx of postmenopausal estrogen-receptor+ breast cancer)

increases risk of osteoporosis
get baseline bone density scans

39
Q

side effect of tamoxifen

A

increases risk of venous thromboembolism
maybe get test for factor V leiden

and endometrial cancer

40
Q

side effect of bleomycin

A

pulmonary fibrosis

get baseline PFTs

41
Q

side effect of TNA alpha inhibitors

A

reactivation of latent TB

get TB skin test

42
Q

how does obesity lead to premature puberty

A

increased insulin -> adrenal androgen production (->adrenarche), ovarian estrogen production (->thelarche)

increased leptin -> premature HPGA axis

OB Gyn babies (3 decks)

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