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Gyn/OB > Gyn > Flashcards

Gyn Flashcards

Mangler fra uterine abnormalities

1
Q

Absolute CI for COC

A
  • Pregnancy and nursing
  • Thromboembolism
  • CAD
  • Hx of CVA
  • Smokers >15 cigarettes a day over 35 years
  • Unexplained vaginal bleed
  • Abnormal liver function
  • Severe cholesterol and TG increase
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2
Q

Relative CI for COC

A
  • Migraine
  • Seizure disorders
  • High risk for vascular disease and > 40y
  • HT
  • DM
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3
Q

What is the definition of infertility?

A

If no conceivement >12m, if female is >35y it is >6m

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4
Q

What is the fecundability?

A

Ability to conceive in one menstrual cycle. It is about 20-25% in the first months.

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5
Q

What is the most common ovulatory cause of infertility?

A

PCOS and advanced maternal age.

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6
Q

What is the primary cause of tubal factors of infertility?

A

PID. Others are salpingitis, tubal ligation, endometriosis, pelvic adhesion.

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7
Q

What test can be used to assess the ovarian reserve?

A
  1. CCCT- clomiphene citrate challenge test
  2. Basal FSH/estradiol testing
  3. Antral follicle count (AFC)
  4. Anti-Mullerian hormone assay (AMH)
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8
Q

Tx of infertility in PCOS

A

Clomid, metformin, weightloss, letrozole (femara)

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9
Q

Tx of infertility in POF

A

No tx, lack viable oocytes.

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10
Q

What is the most effective way of tx cervical cause of infertility?

A

IUI- Intrauterine insemination

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11
Q

Tx of tubal factor of infertility?

A
  • Tuboplasty with tubal reanastomosis

- IVF

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12
Q

Tx of uterine cause of infertility?

A

Operative hysteroscopy

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13
Q

SE of Clomid

A

Hot flash, abd distention, bloating, emotional lability, depression and visual changes. Multiple gestation.

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14
Q

What is ovarian overstimulation sd? (OHSS)

A

Major complication of OI with gonadotropins. Ovarian enlargement, torsion or rupture. May be complicated by ascites, pleural effusion, hemoconcentration, hypercoagulability, electrolyte disturbance, renal failure and death.

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15
Q

What causes labial fusion?

A

Exogenous androgen exposure. Most common is 21-alpha hydroxylase def. (CAH)

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16
Q

What causes imperforate hymen?

A

Failure os embryologic hymen to degenerate and canalize

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17
Q

Sx of imperforate hymen

A

Cryptomenorrhea, primary amennorrhea, cyclical pelvic pain, central pelvic mass

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18
Q

What is hematocolpos?

A

Vagina filled with blood

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19
Q

What is hematometria?

A

Uterus filled with blood.

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20
Q

Tx of imperforate hymen

A

Hymenectomy

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21
Q

What is vaginal atresia?

A

Developmental failure of the lower 2/3 of vagina. From urogenital sinus. Replaced with fibrous tissue.

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22
Q

Sx of vaginal atresia?

A

No vagina, “vaginal dimple”. Cryptomenorrhea, hematometria.

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23
Q

tx of vaginal atresia

A

Vaginal pull through procedure

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24
Q

What is other name of vaginal agencies?

A

Mayer-Rokitansky-Kuster-Hauser sd

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25
Q

What is MRKH?

A

Failure of Mullein ducts to develop, resulting in absence in fallopian tubes, uterus, cervix and upper 1/3 of vagina. Ovaries are present, hormones are normal

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26
Q

Tx of MRKH sd

A

Frank and Ingram procedures, Serial vaginal dilators, surgery to create a neovagina (McIndoe procedure). Psychosocial

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27
Q

What is lichen simplex chronicus

A

Epidermal thickening due to excess itching. Thick and lethery. Excoriations from frequent itching.

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28
Q

tx of lichen simplex

A

Topical corticosteroids, bethamethasone. Fitz bath. Antihistamines.

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29
Q

What is the indications for biopsy of vulvar lesion ?

A
  • Ulceration
  • Unifocal lesion
  • Uncertain suspicion
  • Unindentifiable lesion
  • Lesion that recur after tx
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30
Q

What is lichen sclerosus?

A

Chronic inflammatory disease, often in postmenopausal. Ass. w au.im ds. Vulvar/ anal pruritus. Dyspareunia. Crinckled cigarette paper. Figure of 8.

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31
Q

What is important when making dx og lichen sclerosus?

A

Take biopsy to exclude neoplasia. 4-6% develop vulvar cancer.

32
Q

tx of lichen sclerosus

A

Short term high potency steroid ointment. Clobetasol. Estrogen cream w concurrent atrophy. Surgery for unresponsive case.

33
Q

What is lichen planus?

A

atrophic inflammatory condition. Characterized by shiny white-purple papules, esp on labia minora. Is a systemic condition. Usually middle aged (30-60). sx is pruritus

34
Q

tx of lichen planus

A

Vaginal hydrocortisone suppositories. Discontinue irritants. Adhesions w vaginal dilators or surgery. Ass. w 3-4% risk of ca.

35
Q

what is a typical hx of pat w vulvar psoriasis

A
  • pruritus ass w lesions
  • ex w stress and menses
  • impr. w pregnancy and summer
  • often skin lesions elsewhere.
36
Q

What is gartners duct cyst?

A

Most common benign cystic lesion of vagina. Usually asx. Rarely mass effect. Asss w GU anomalies. Located on anterolateral wall of proximal vagina. Are remnants of mesonephric ducts of Wollfian system.

37
Q

Atrophic vaginitis

A

Thinning of vaginal epithelium due to decreased estrogen. Sx is pruritus, dyspareunia, dryness, burning, discharge. Very common in postmenopausal.

38
Q

tx of atrophic vaginitis

A

low dose estrogen cream

39
Q

What is transverse vaginal septum

A

Inproper fusion of Mullein ducts and urogenital sinus. Presents w primary menorrhea (cryptomenorrhea). If incomplete septa may have normal menses, but can cause dyspareunia.

40
Q

What is longitudinal vaginal septum

A

Often asx, noticed on PE. Ass. w uterine septum or uterine didelphys. May lead to OB complications

41
Q

What is epidermal inclusion cyst

A

Proliferation on epidermal cells within a circumcised area of the dermis. May result in plugging of pilosebaceous unit. Most are asx, but can cause pain/tenderness or bc infected (odor/pus). Flesh color, <1cm. Elective excision, I&D if infected.

42
Q

What is hidradenoma

A

Benign cyst of the apocrine sweat gland. Often hx of similar cyst. Feature of Hidradenitis suppurativa and Fox-Fordyce ds.

43
Q

Bartholins gland cyst

A

Obstruction and cystic dilatation of Bartholins duct. Reproductive age. Idiopathic. May be 2nd to trauma or inf. If large dyspareunia, pain. Unilateral, round ovoid at 4 or 8 o’clock. Age >40 biopsy!

44
Q

Tx of Bartholins gland cyst

A
  • Small: no mx

- Large: 1) word catheter 2) I&D w marsupialization

45
Q

Skenes gland cyst

A

Paraurethral glands located next to urethra meatus. Caused by chronic inflammation, obstruction and eventually cystic dilation of gland. Act as reservoir for Trichomonas

46
Q

Urethral carbuncle and prolapse

A

Small, red and fleshy. At distal urethral meatus. Postmenopausal, result of atrophy. Ectropion at posterior urethral wall. If bloody spotting use topical estrogen.

47
Q

What are the cervical cysts, and which need removal?

A

Nabothian (majority), mesonephric, and endometriosis. Do not need removement unless symptomatic or interfere w Pap-test.

48
Q

What is nebothian cyst

A

Clear to yellow/white elevation of endocervix/proximal ectocervix. Rarely >1cm. Contain mucus, block endocervical gland.

49
Q

What is mesonephric cyst

A

Remnant of Wolffian ducts. Extend deeper into cervical stroma. More commonly found on ectocervix

50
Q

How is endometriosis cyst on cervix

A

Red-purple. Ass w worsening w menses. Cyclic pelvic pain and dyspareunia.

51
Q

Cervical polyps

A

Most are asx. Almost always bening. Presents w postcoital bleed, inter menstrual bleed. Should be removed to prevent masking bleed from other source.

52
Q

Cervical stenosis

A

Narrowing/obliteration of cervical canal. May be congenital(segmental Mullein hypoplasia) or acquired( inf/ atrophy/ scarring). Sx may be mild or cryptomenorrhea, 2nd dysmenorrhea, infertility, OB complications, enlarged uterus

53
Q

dx of cervical stenosis

A

inability to pass 1-2cm probe into uterine cavity.

54
Q

tx of cervical stenosis

A

cervical dilation, misoprostol, leaving catheter

55
Q

what is the most common ca in women?

A

Breast cancer

56
Q

what is the effect of estrogen on breast

A

Promote ductal development and fat deposition

57
Q

what is the effect of progesterone on breast

A

Promote lobular-alveolar development

58
Q

what is the effect of prolactin on breast

A

Milk production

59
Q

What is the effect of oxytocin on breast

A

Let down of milk

60
Q

When is nipple discharge concerning?

A
  • bloody or serosanguius
  • unilateral
  • ass w mass
  • persistent
  • from a singe duct
61
Q

Most common cause of bloody discharge from nipple

A

Intraductal papilloma or sometimes invasive papillary cancer

62
Q

Galactorhea causes

A
  • pregnancy
  • pit.adenoma
  • hypothyroidism
  • stress
  • meds: OCP, antiHT, psychotropics
63
Q

Serous discharge form nipple

A
  • normal menses
  • OCP
  • fibrocystic change
  • early pregnancy
64
Q

yellow-tinged nipple discharge

A

fibrocystic change or galactocele

65
Q

Green and sticky nipple discharge

A

duct ectasia

66
Q

purulent nipple discharge

A

mastitis, breast abscess

67
Q

Ovarian cause of female infertility?

A

PCOS and advanced maternal age. Others are POF, hypothalamic amenorrhea, hyperprolactinemia.

68
Q

Uterine factors of female infertility?

A
  • Congenital malformation
  • Submucosal fibroid
  • Uterine polyps
  • Intrauterine synechiae (Asherman)
69
Q

Cervical factors of infertility?

A

Mullerian duct abnormalities, cervical stenosis, cervicitis or chronic inflammation.

70
Q

what is endometriosis?

A

Presence of endometrial glands and stroma outside the normal location, excluding adenomyosis. Hormonally dependent on estrogen.

71
Q

What are the theories og pathophysiology of endometriosis

A
  • Exact MoA has not been discerned
  • Retrograde menstruation/Sampson
  • Lymphatic/varscular spread/Halban
  • Coelomic metaplasia/Meyer (progenitor cells)
  • Induction theory( exposure to estrogen cause transformation of tissue)
  • Immune dysfunction
72
Q

Where is the most common site of endometriosis?

A

Ovary and pelvic peritoneum

73
Q

risk factors for endometriosis

A
  • 1st degree relative
  • genetic mutation
  • anatomic defect
  • Au.imds: SLE, asthma, hypothyroidism, chronic fatigue sd, fibromyalgia, allergy
  • Environment: TCDD/dioxins, caffeine, alcohol
  • Nulliparity
  • Early menarche
  • Prolonged menses
  • Mullerian anomalies
74
Q

presentation of endometriosis

A
  • Cyclical or chronic pelvic pain , peak 1-2d before mens
  • dysmenorrhea
  • dyspareunia (esp deep)
  • dysuria
  • defacatory pain
  • infertility
75
Q

how is PE in endometriosis

A

Speculum is usually normal, occasionally blue or powder-burn red lesion.
Bimanual: Uterosacral nodularity and tenderness. Fixed retroverted uterus. Enlrarged cystic adnexal mass. Fixed firm posterior cul de sac.

76
Q

what is gold standard in endometriosis dx

A

Laparoscopy

77
Q

mx of endometriosis

A
  • Pseudopregnancy: NSAID, COCs, progestins
  • Pseudomenopause: Androgen/danazol, GnRH analog/leuprolide/nafarelin
  • Aromatase inh./ anastrozole, used w COCs or GnRH agonist
  • Surgical: lesion ablation, resection of endometrioma, presacral neurectomy, hysterectomy w BSO (definite, done w child)

Gyn/OB (4 decks)

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