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GYN Flashcards

1
Q

What is endometrial hyperplasia?

A

abnormal proliferation of glandular and stromal elements of the endometrium
*premalignant!

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2
Q

Breast development, blind pouch and shortened vagina, normal ovaries, pelvic mass consistent with uterus
-Diagnosis?

A

Mayer-Rokitansky-Kuster-Hauser syndrome

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3
Q

Female genitalia externally and internally; no breast development
-Diagnosis?

A

Swyer’s syndrome

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4
Q

What are the 3 types of ovarian cancer?

A
  • germ (dysgerminoma, teratoma, choriocarcinoma)
  • stromal (granulosa-theca, sertoli-leydig)
  • epithelial (serous, mucinous, endometrioid, Brenners)
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5
Q

Post-coital bleeding, black, itching suggests what cancer?

A

cervical, vaginal, vulvar

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6
Q

Post-menopausal bleed suggests what cancer?

A

endometrial

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7
Q

What is the etiology of the following cancers?

  • cervical, vaginal, vulvar
  • endometrial
  • ovarian
  • choriocarcinoma
A
  • cervical, vaginal, vulvar: HPV
  • endometrial: estrogen
  • ovarian: ovulation
  • choriocarcinoma: gestational trophoblast
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8
Q

What is the treatment for endometrial cancer?

A

TAH + BSO

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9
Q

How does the treatment for endometrial cancer differ from endometrial cancer w/ mets?

A
  • endometrial cancer: TAH + BSO

- endometrial cancer w/ mets: TAH + BSO +/- radiation/ chemo

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10
Q

What is the difference in appearance of vulvar cancer and Paget’s?

A
  • vulvar SCC or melanoma: black and itchy

- Paget’s: red lesion and itchy

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11
Q

Pathology of endometriosis

A

retrograde menses –> fallopian tube

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12
Q

What is the treatment for a tubo-ovarian abscess?

A

IV cefoxitin + doxy + MTZ

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13
Q

What can cause cervicitis?

A

Gonorrhea, Chlamydia

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14
Q

What is the difference in treatment of PID for inpatient vs outpatient?

A
  • inpatient: cefoxitin + doxy; clinda/gent

- outpatient: IM ceftriaxone + doxy + MTZ

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15
Q

What is the difference between an inevitable, incomplete, complete, and missed abortion?

A
  • inevitable: no passage of contents, os open, U/S dead baby
  • incomplete: passage of contents, os open, U/S retained parts
  • complete: passage of contents, os closed, U/S nothing
  • missed: no passage of contents, os closed, U/S dead baby
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16
Q

What does PALM COEIN stand for?

A 
Causes of vaginal bleeding:
Polyp
Adenomyosis 
Leiomyoma
Malignancy
Coagulopathy
Ovarian dysfxn
Endometrium
Idiopathic
Not yet classified
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17
Q

How does adenomyosis present?

A

symmetric, smooth, boggy uterus

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18
Q

If a GnRH stimulation test results in increased LH, is the problem central or peripheral?

A

central

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19
Q

No secondary sex characteristics, female external genitalia, no uterus
-nml T, FSH, LH

A

mullerian agenesis (idiopathic loss of mullerian ducts)

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20
Q

Secondary sex characteristics, female external genitalia, no uterus

  • increased T, nml FSH, LH
  • U/S: testes
A

AIS (resistance to T)

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21
Q

No secondary sex characteristics, female external genitalia, +uterus

  • increased FSH, LH
  • U/S: streak ovaries
A

Turner’s Syndrome

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22
Q

What is the next step in working up secondary amenorrhea after checking TSH, UPT, and prolactin?

A

progesterone for withdrawal bleed (if pt bleeds, think PCOS)

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23
Q

Hirsutism

  • increased T, nml DHEA-S, LH:FSH >3:1
  • U/S: bilateral ovaries
A

PCOS

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24
Q

What is the treatment for PCOS?

A
  • exercise, wt loss
  • metformin
  • OCPs
  • clomiphine
  • spironolactone
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25
Q

Virilization

  • super increased T, nml DHEA-S
  • U/S: unilateral ovary
A

Sertoli-Leydig tumor

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26
Q

Virilization

  • nml T, super increased DHEA-S
  • CT/MRI: unilateral adrenal
A

Adrenal tumor

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27
Q

Hirsutism

-nml T, increased DHEA-S, 17OHP in urine

A

CAH

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28
Q

How do you treat CAH?

A
  • cortisol

- fludrocortisone

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29
Q

What drug can be given for hot flashes and mood swings of menopause?

A

venlafaxine (SSRI)

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30
Q

What is the first line treatment of lichen sclerosis?

A

high-potency topical steroid (clobestasol)

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31
Q

______________ is an inflammation of the cervix, the lower, narrow end of the uterus that opens into the vagina

A

Cervicitis

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32
Q

What are possible symptoms of cervicitis?

A

bleeding between menstrual periods, pain with intercourse or during a cervical exam, abnormal vaginal discharge

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33
Q

What are common causes of cervicitis?

A

STI (Chlamydia, gonorrhea)

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34
Q

Mixed gonadal dysgenesis has an increased risk of what type of cancer?

A

vulva

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35
Q

No menses. Breast and pubic hair normal. Vagina of normal length. Cervix and uterus are hypoplastic. What is the diagnosis?

A

gonadal dysgenesis

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36
Q

Which of the following is a confirmatory test for syphilis?

  • RPR
  • Serum antinuclear antibody assay
  • Quantitative VDRL
  • Serologic test for Treponema pallidum antibodies
  • Dark-field examination of vaginal fluid
A

serologic test for treponema pallidum

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37
Q

Painful vulvar swelling, multiple episodes of neisseria gonorrhea infection suggest…?

A

Bartholin’s duct abscess

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38
Q

How does molar pregnancy present?

A

like pre-E but in the first half of pregnancy (severe HTN, hyperreflexia, proteinuria, etc.)

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39
Q

Chronic anovulation is associated with an increased risk of…

A

endometrial cancer

40
Q

______________ tumors are associated with elevated AFP

A

Intradermal sinus (smooth palpable ovarian mass)

41
Q

What is the next step for a patient with endometriosis who has failed medical management?

A

laparoscopy

42
Q

What is the next step in management for a 21-24 year old with ASCUS and HPV+?

A

repeat cytology in 1 year

43
Q

What is the greatest risk factor for developing osteoporosis?

A

family history

44
Q

What is the diagnosis?

heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus

45
Q

What is the diagnosis?

dysmenorrhea, pelvic pain, heavy menses, bulky/globular and tender uterus

A

adenomyosis

46
Q

What is the diagnosis?

Hx obesity, nulliparity, or chronic anovulation; irregular, intermenstrual, or postmenopausal bleeding; nontender uterus

A

endometrial cancer/hyperplasia

47
Q

What is the diagnosis?

dyspareunia, dysmenorrhea, chronic pelvic pain, intertility

A

endometriosis

48
Q

Mature cystic teratomas arise from what cells?

49
Q

A large ovarian mass with thick septations, solid components, and peritoneal free fluid (ascites) suggests…

A

epithelial ovarian carcinoma

50
Q

Why is there abnormal uterine bleeding following menarche?

A

immaturity of the developing hypothalamic-pituitary-gonadal axis

51
Q

Vulvovaginal atrophy (menopausal GU syndrome) is due to…

A

estrogen deficiency

52
Q

Genitourinary syndrome of menopause presents with sxs including…

A

vulvovaginal dryness, irritation, pruritis, irritation, bleeding, incontinence

53
Q

What type of tumor is this?

complex ovarian mass, precocious puberty, AUB, post-menopausal bleeding

A

granulosa cell tumor

54
Q

What is the histopathology of granulosa cell tumors?

A

call-exner bodies

55
Q

Embryonal carcinomas secrete _____ and ______

56
Q

What type of birth control will decrease risk of ovarian and endometrial cancer?

57
Q

What is the correct order of sexual maturation?

thelarche, adrenarche, menarche

A

thelarche –> adrenarche –> menarche

58
Q

What is the diagnosis?

renal anomalies, absent uterus and cervix, normal ovaries and secondary sex characteristics

A

Mullerian agenesis

59
Q

What is the karyotype and testosterone level in patients with mullerian agenesis?

A

Karyotype: 46 XX

Testosterone level: normal female range

60
Q

What is the next step after identifying atypical glandular cells on a pap?

A

endometrial bx

61
Q

A granulosa cell tumor presents as…

A

precocious puberty

62
Q

What are some complications of suction D&C?

A
  • bowel and bladder injury
  • cervical laceration
  • uterine perforation
63
Q

What is the most sensitive test to confirm HSV?

64
Q

What is definitive treatment for endometriosis?

A

simple hysterectomy with bilateral salpingo-oophorectomy

65
Q

What does lubrication during intercourse depend on?

A

transudate of fluid across the vaginal mucosa

66
Q

Can vaginismus resolve on its own?

A

rarely does (requires dilators)

67
Q

The 3 D’s (dysmenorrhea, deep dyspareunia, and dyschezia (pain w/ defecation)) are suggestive of…

A

endometriosis

68
Q

Endometriosis should be treated with

A

NSAIDs and OCPs (may relieve pain by ovulation suppression, which may result in atrophy of endometrial tissue)

69
Q

A soft, mobile, contender, well-circumscribed mass behind the labium majus suggests…

A

a bartholin gland cyst

70
Q

What is the appropriate follow-up for for these low grade paps?

  • ASCUS/HPV-
  • ASCUS/HPV+
  • LSIL/HPV-
  • LSIL/HPV+
A
  • ASCUS/HPV-: 3 year co-test
  • ASCUS/HPV+: colpo
  • LSIL/HPV-: 1 year co-test
  • LSIL/HPV+: colpo
71
Q

What is the appropriate follow-up for the following?

  • CIN I/LSIL
  • CIN II/LSIL
  • CIN II/HSIL
  • CIN III/HSIL
  • Cancer
A
  • CIN I/LSIL: co-test 1 year –> co-test 3 year –> routine
  • CIN II/LSIL: co-test 1 year –> co-test 3 year –> routine
  • CIN II/HSIL: LEEP, cryo, expectant management
  • CIN III/HSIL: LEEP, cryo, expectant management
  • Cancer: cold knife cone
72
Q

What is Mittelschmerz and how does it present?

A

ovulation pain, presents with unilateral lower abdominal pain

73
Q

What is the only indication for use of hormone replacement therapy?

A

reduction of vasomotor sxs

74
Q

A teenage girl with really heavy menses may have…

A

a clotting disorder (fibroids are more common for women in their 30-40s)

75
Q

How is lichen sclerosis treated?

A

topical steroids

76
Q

When is an endometrial biopsy indicated in a woman <45 years old?

A

AUB + unopposed estrogen (obesity, anovulation), failed medical management, or Lynch syndrome

77
Q

How should suspicion for epithelial ovarian cancer be worked up in a woman…

  • with sxs?
  • without sxs?
A
  • with sxs: ex lap

- w/o sxs: CA-125

78
Q

RUQ pain, fevers, chills, vomiting, irregular menstrual periods

79
Q

Inflammatory mucocutaneous eruptions of the skin, scalp, nails, vulva, etc.

A

lichen Planus

80
Q

What is colpocleisis?

A

vagina is surgically obliterated

-used with patients who have vaginal prolapse but are poor surgical candidates because it can be done quickly

81
Q

How can you definitively diagnose endometriosis?

A

exploratory surgery and biopsies

82
Q

How do you recommend a woman with endometriosis get pregnant via fertility treatment?

A

ovarian stimulation (w/ or w/o artificial insemination)

83
Q

What is the definitive treatment for a patient with pelvic pain due to endometriosis?

A

hysterectomy with bilateral salpingo-oophorectomy

84
Q

Secondary sex characteristics present, Ovaries present; No uterus or cervix; Possible RENAL anomalies

A

mullerian agensis

85
Q

What are some causes of secondary dysmenorrhea?

A

endometriosis, adenomyosis, uterine fibroids, infection

86
Q

Severe menstrual cramping, heavy bleeding, inter menstrual spotting w/ normal gyn exam is most likely…

A

endometrial polyp

87
Q

Hormone replacement therapy increases the risk of what cancer?

88
Q

What vitamin supplement improves sxs of PMS?

89
Q

What is the recommended surgical approach to an early endometrial cancer?

A

total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic LAD

90
Q

What imaging is helpful to assess the extent of ovarian cancer?

91
Q

What are the hallmarks of endometriosis? (“3 D’s”)

A

dysmenorrhea, dyspareunia, dyschezia (pain w/ defecation)

92
Q

What is first line therapy for vulvar lichen sclerosis?

93
Q

What are some risk factors for endometrial cancer?

A

obesity, PCOS/chronic anovulation, nulliparity, early menarche or late menopause

94
Q

What is Meig’s syndrome?

A
  • ovarian fibroma
  • ascites
  • right pleural effusion
95
Q

What is secreted with each tumor?

  • endodermal sinus tumor
  • embryonal carcinoma
  • granulosa cell tumor
  • Sertoli-Leydig tumor
A
  • endodermal sinus tumor: AFP
  • embryonal carcinoma: AFP, bHCG
  • granulosa cell tumor: estrogen, inhibin
  • Sertoli-Leydig tumor: testosterone

OBGYN (5 decks)

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