Gyn Flashcards
Absent or rudimentary uterus and upper vagina (“short vagina”)
Normal ovaries
Normal breast development
Normal axillary and public hair
Mullerian agenesis (Mayer-Rokitansky-Kuster-Hauser syndrome) 46XX
Don’t got tubes! But gonads ok
Absent uterus and upper vagina
Cryptorchid testes
Normal breasts
Minimal-absent axillary/pubic hair
Completely androgen insensitivity syndrome
46 XY
Just a woman with blind pouch vagina with hidden testes
Normal uterus and vagina
Streak ovaries
Breasts are variable
Normal axillary/pubic hair
45X
Persistent, eczematous or ulcerative rash on nipple->areola
+/- vesicles, bloody discharge, nipple retraction
Paget disease (Adenocarcinoma)
From migration of cancer cells from ducts to nipple surface
Palpable, mobile, rubbery, firm breast mass.
No nipple changes
Fibroadenoma
Unilateral bloody nipple discharge but no nipple lesions
Breast papilloma
Mobile, soft nontender, well-circumscribed mass behind labium majus
Can cause discomfort
Bartholin cysts
(the bartholin glands provide lubrication and are not palpable unless duct is blocked)
Can evolve into abscess (localized erythema, induration, fluctuancy, +/- fever)
Thin white crinkly skin over labia
or “thin dry, white plaque-like vulvar skin” with loss of labia minora
can have clitoral hood retraction
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!!
Bright red autoimmune ulcers and erosions around vulvovaginal area
Lichen planus
Leathery skin from chronic scratching
Lichen simplex chronicus
Recurrent mild and unilateral mid-cycle pain prior to ovulation. Lasts hours-days
Mittelschmerz
Sudden-onset, severe, unilateral lower abd pain, N/V. Unilateral, tender adnexal mass on exam
Ovarian torsion
Ultrasound: enlarged ovary with decreased or absent blood flow
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.
ruptured ovarian cyst
Primary amenorrhea with no breast development
What to get next?
FSH
If FSH decreased -> pituitary MRI
if FSH increased -> karyotype
Fishy odor
Clue cells
+Whiff test
Tx?
BV (gardnerella vaginosis)
tx: metronidazole or clinda
yellow-green frothy discharge
pH>4.5
motile tear-shaped organisms
trichomoniasis
tx: metronidazole. treat sexual partner too!
thick, cottage-cheese discharge
candida
+pseudohyphae. normal pH
tx: fluconazole
Precocious puberty in child
Or bleeding/endometrial hyperplasia in postmenopausal women
Large adnexal mass
Increased estrogen
Granuloma cell tumor of ovary
Ovarian tumor in women <30yo
Secretes LDH or B-hCG
Dysgerminoma
Mature teratoma (dermoid cyst)
Common, benign ovarian tumor that is not hormonally active
Serous cystadenoma
Benign ovarian neoplasm. Hormonally inactive and do not cause precocious puberty.
Ovarian tumor that produce androgens
Defeminization -> masculinization
-> flattening of breasts and scanty, irregular menstruation -> amenorrhea
Hirsutism, coarsening of facial features, voice depending, clitoral enlargement
Sertoli-Leydig cell tumors
Ovarian mass
Ultrasound shows hyperechoic nodules and calcifications
Mature dermoid cyst (teratoma)
Usually do not rupture, but do increase risk of torsion
Uterine cancer following pregnancy that tends to be metastatic on presentation (eg presents with lung nodules)
Choriocarcinoma
