Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

R3 Orals > Gyn > Flashcards

Gyn Flashcards

1
Q

Definition of infertility

A

inability to conceive x1y (can start eval >35yo at 6mo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What age does fertility start to decline?

A

32yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How dos NSAID use affect fertility?

A

negatively affects ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does cig use affect fertility?

A

rapid follicular depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How does obesity affect fertility?

A

ovulatory dysfxn - increased peripheral conversion of andrgogen to estrogen, therefore estrogen down-regulates FSH > decreased follicular development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Normal length of cycle

A

21-35d (although 25-35d x3-7d = likely ovulating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does basal body temp work?

A

post-ovulation, progesterone increases body temp 0.4-0.8 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do OPK tests work?

A

Measure urinary LH, LH surge lasts 48-50h. Ovulation normally occurs next day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does testing progesterone work for testing for ovulation?

A

Test at day 21 (or 7d after ovulation) tells you if corpus luteum is making progesterone to prepare endometrial lining

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are day 3 tests

A

estadiol and FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do day 3 tests work?

A

Inhibin normally inhibits FSH from being made. In decreased ov. fxn, granulosa cells make less inhibin > therefore more FSH is made. >10 is abnormal. estradiol is measured to decrease false neg (60-80 abnl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does AMH tell you?

A

Plays role in follicular recruitment, correlates with AFC. Can be falsely high in PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a normal antral follicle count?

A

10-20 total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What part of the cycle should HSG be performed?

A

Day 5-10 of cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is sperm affected by age?

A

decrease in motility and morphology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prevalence of infertile couples?

A

10-15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for hyper-prolactinemia?

A

bromocriptine (dopamine agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MOA of Clomid

A

SERM, blocks estrogen receptors in hypothalamus> increase in FSH> more follicles stimulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MOA of letrazole

A

aromatase inhibitor> blocks conversion of androgens to estrogen> increase in FSH> more follicle stimulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does ovarian drilling work?

A

Destroys ovarian stroma that is producing androgens. Decreased peripheral conversion of androgen to estrogen, increase FSH > more follicles stimulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Treatment for chronic cervicitis

A

Doxycycline 100mg BID x 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What value of mid-luteal progesterone indicates ovulation?

A

> 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

4 Most common bacteria of acute cystitis

A

E. Coli (75-95%), Klebsiella pneumoniae, Proteus miribilis, Staphylococcus saprophyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If you have one UTI, what are your chances of having another within 1 year?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the positive predictive value of having symptoms of a UTI?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What makes a UTI complicated?

A 
Diabetes
Pregnancy
Immunocompromise
Symptoms > 7d
Post-menopausal hematuria
Recurrent UTI's
Recent GU surgery
Urologic abnormalities
Recent hospitalization
Fever (100.4)
Ab/pelvic pain, n/v
Persistent symptoms despite treatment >3d
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What amount of CFU/ml is diagnostic of UTI?

A

10 to the 5, 10 to the 2 if from catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is leukocyte esterase?

A

chemical released from WBC in urine, high negative predictive value, can be falsely positive with contamination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is nitrite?

A

Metabolite of gram negative bacteria
NOT PRODUCED BY PSEUDOMONAS (or gram + like staph, strep, enterococcus)
False positive with pyridium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lifetime probability of woman getting UTI?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Non-ABX ways to prevent UTI’s

A

Cranberry inhibits binding, methenamine > formaldehyde (bacteriostatic), vaginal estrogen in postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How long should treatment for Pyelonephritis be? And how soon would you expect clinical improvement?

A

14 days, expect response in 48-72h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

ABX options for recurrent UTI’s, and how much will this decrease the risk of recurrence?

A

Daily macrobid, cipro, or bactrim x6-12 mo
Or post-coital
Decrease recurrence risk by 95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is one option for PO treatment for pyelo?

A

Augmentin x 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What part of a vulvar lesion should you biopsy?

A

hypo/hyperpigmented: thickest part

ulcerative: border

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Which dermatosis is characterized by the itch scratch cycle?

A

Lichen simplex chronicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do you treat lichen simplex chronicus?

A

Break itch-scratch cycle. Remove irritants. Topicl low potency CD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How is the diagnosis of lichen simplex chronicus made?

A

Clinical diagnosis.

Biopsy if no improvement after 1-3 weeks of treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

How does lichen sclerosus present?

A

Asymptomatic, just labial changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What population does lichen sclerosus affect?

A

Postmenopausal women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How does lichen sclerosus present?

A

Cigarette paper lesions
Labial regression
Urethral obstruction
Introitus stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do you cure lichen sclerosis?

A

There is no cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the treatment for lichen sclerosis?

A

Potent topical CS > taper

  1. 05% clobetasol ointment
  2. 05% halobetalol ointment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Which dermatosis increases the risk of vulvar squamous cell carcinoma?

A

Lichen sclerosus (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How does lichen planus present?

A

Itchy and painful, vuvlvar + oral lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Classic finding of lichen panus

A

Wickham striae

Parabasal cells in vaginal discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How do you treat lichen planus?

A

high potency topical corticosteroid ointment

48
Q

What is the skin change from friction in moist areas called?

A

Intertrigo

- dry out with cornstarch

49
Q

What is the function of bartholin gland?

A

Makes mucus to lubricate vulva

50
Q

What bacteria is most common in a bartholin gland abscess?

A

E. coli

51
Q

Where is the bartholin gland located?

A

inferior labial majora or vestibule

52
Q

If a postmenopausal woman has an enlarged bartholin gland what should you suspect?

A

Malignancy

53
Q

Definition of vulvodynia

A

6 months of vulvar pain, diagnosis of exclusion

54
Q

Likely pathophysiology of vulvodynia?

A

local stimulus to trauma causing a maladaptive nervous system response

55
Q

Treatment of vulvodynia

A

topical lidocaine
topical gabapentin
TCA Antidepressants
Anticonvulsants

56
Q

Typical population of desquamative inflammatory vaginitis

A

perimenopausal white women

57
Q

How does desquamative inflammatory vaginitis present?

A

Copius discharge, vaginal burning, dyspareunia that is refractory to typical vaginitis treatment

58
Q

What is the microscopic finding of desquamative inflammatory vaginitis?

A

Parabasal cells and polymorphonuclear cells

59
Q

How do you treat desquamative inflammatory vaginitis?

A

2% vaginal clindamycin cream in vaginal hydrocortisone x4-6 weeks

60
Q

What type of cancer does DES in utero cause?

A

Vaginal clear cell adenocarcinoma

61
Q

What is a Gardner duct?

A

Remnant of mesonephric (Wolfian) Duct

62
Q

Risk factors for POP

A 
increased parity, vaginal deliveries
Menoause- hypoestrogenism
Chronically increased ab pressure (CPOD, obese)
Pelvic floor trauma
race (latina/white)
Connective tissue disorder
Spina bifida
63
Q

Muscles of levator ani

A

Iliococcygeus
Puborectalis
Pubococcygeus

64
Q

Stages of POP

A 
0= none
1= TVL-2
65
Q

Different types of POP

A 
Distention= smooth; no loss of fascial attachments
Displacement= ruggated; loff of fascial attachments
66
Q

Levels of vaginal support

A

Level 1= cardinal/uterosacs
Level 2= Lateral vagina> ATFP
Level 3= perineal body

67
Q

2 majr parts of continence

A

Urethral contraction and detrusor relaxtion

68
Q

Which nerves and receptors are responsible for urethral contraction?

A

Pudendal and pelvic nerves (alpha rec)

69
Q

Which nerves and receptors are responsible for bladder relaxation? And bladder contraction?

A

relaxation: Sympathetic nervous system (beta rec)
contraction: parasympathetic (ACh muscarinic)

70
Q

Which nervous system is responsible for detrusor contraction?

A

Parasympathetic NS; ACh- muscarinic

71
Q

How does voiding work?

A

Decreased sympathetic NS, increased para-sympathetic NS > detrusor contraction, urethral relaxation

72
Q

Theories of SUI

A

Lack of support vs. sphincter deficiencies

73
Q

How does SUI present in urodynamic testing?

A

Leak in absence of detrusor contractions

74
Q

Which nerves are responsible for bulbcavernosus reflex?

A

S2-S4

75
Q

How do TVT and TVT-O compare in terms of risk?

A

TVT higher risk of voiding dysfxn

TVT-O higher risk of nerve injury

76
Q

How do oxybutynin, tolterodine, fesoterodine work?

A

Anti-cholinergics, block detrusor activity

77
Q

How do vesicare and trospium work?

A

Selective anti-muscarinics,block detruser but should have less side effects than normal anti-cholinergics

78
Q

How does mirabegron work?

A

beta 3 agonist, causes detrusor relaxation

79
Q

What nerves are moduated in PTNS?

A

L4-S3

80
Q

What causes endometrial hyperplasia and what is this a precursor to?

A

Estrogenic stimulation

Precursor to adenocarcinoma (type 1)

81
Q

What is the best way to sample endometrial lining when concern for ECa?

A

hysteroscopy is best

then in office EBx = D&C

82
Q

What progestin therapy can be used for endometrial hyperplasia?

A

Provera 10mg x 12-14 days/month or 100 mg megace same way or IUD

83
Q

If using progestin therapy for hyperplasia, how often should you sample the lining?

A

q 3-6 months

84
Q

How is hyperplasia classified?

A

WHO schema outdated, now EIN schema

  • benign
  • pre-malignant
  • malignant
85
Q

If pre-malignant on biopsy, what percentage will have concurrent ECa on hyst specimen?

A

40%

86
Q

In a patient with PMB, what ES warrants a EBX?

A

> 4mm or if bleedinr recurrent/persistent

87
Q

What is the most commonly diagnosed gyn malignancy?

A

ECa

88
Q

At what stage does ECa normally present?

A

70% type 1, stage 1 at dx

89
Q

mean age of ECa dx?

A

63 yo

90
Q

What is type 1 endometrial cancer?

A

Endometrioid
75% of cases
normally low grade at dx
white women

91
Q

What is type 2 endometrial cancer?

A

Clear Cell, pap serous, Carcinosarcoma
high grade with risk of extra-uterine spread at time of dx
women of color

92
Q

What percentage of ECa is Pap serous, and what percentage of death d/t ECa does this cause?

A

10% of all ECa are pap serous, they cause 40% of ECa deaths

93
Q

Risk factors for endometrial cancer

A 
age
north american/northern european
high education/income/white
nulliparity- h/o infertility
early menarche, late menopause
Tamoxifen
Obesity (T2DM, HTN)
Lynch syndrome
94
Q

What is Cowden syndrome? genes and cancers

A

genes: PTEN
Cancers: thyroid, breast, endometrial

95
Q

What is lynch syndrom? genes and cancers

A

genes: MLH1, MSH2, PMS2, MSH6
Cancers: colorectal, ovarian, type 1 endometrial

96
Q

What can cause increased estrogen?

A

obesity
chronic anoulation (PCOS)
estrogen producing tumors (granulosa cell)

97
Q

How much does increased estrogen increase the risk of ECa?

A

20x the risk

98
Q

How is ECa staged?

A

surgically: hyst-BSO, para-aortic LN, pelvic LN, washing

99
Q

When are LND not needed?

A

grade 1
grade 2 if <50% myometrium
if tumor <2 cm

100
Q

Stages of ECa

A

I: confined to uterus
IA: <50% myometrium
IB: >50% myometirum

II: cervical stroma

IIIA: serosa/adnexa
IIIB: vaginal/parametrium
IIIC: pelvic/para-aortic LN

IVA: bladder/bowel mucosa
IVB: distant mets

101
Q

How often is Surveillance after surgery for ECa?

A

first 2 years: every 3-6 months
then 3 years of q 6 months
then annually

102
Q

When do patients need adjuvant radiation?

A

if 70+ yo with one of the following:
if 50+ yo with 2 of the following:
any age with all three of the following:

+LVSI
grade 2 or 3
outer 1/3 of myometrium

103
Q

What chemo do we use?

A

carboplatin and paclitaxel

104
Q

How do we screen for VIN?

A

We don’t!

105
Q

What are risk factors for VIN?

A

HPV
Smoking
Immunocompromised

106
Q

What are the two different types of VIN?

A

Differentiated: starts from Lichen sclerosis
Usual: HPV associated

107
Q

Who needs a biopsy of a wart?

A

all post-menopausal women, those refractory to topical treatment

108
Q

If vulvar cancer is suspected, what is the treatment?

A

Wide local excision with margins of 0.5-1 cm

109
Q

If vulvar cancer is not suspected, but patient has VIN what is the treatment?

A

Laser ablation, excision, topical imoquimod

110
Q

How does laser ablation for VIN work?

A

Burn around lesion 0.5-1 cm

Use colposcope to see

111
Q

How deep does laser need to burn for VIN?

A

In hair bearing areas: 3mm into subcutaneous fat

In non-hair bearing: into dermis (2mm)

112
Q

How do patient’s use imiquimod for VIN?

A

Apply weekly x 12-20 weeks, with colpo q 406 weks

not FDA approved

113
Q

What is one factor that makes colposcopy of vulva difficult?

A

Keratinization

114
Q

What is the recurrence rate of VIN?

A

9-50%

115
Q

What surveillance is needed after treatment of VIN?

A

Appointment in 6 months, then 12 months, then annually

R3 Orals (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions