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First Aid Step 2 > Gyn and breast disorders > Flashcards

Gyn and breast disorders Flashcards

1
Q

First test to perform when woman presents with amenorrhea

A

Beta hCG

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2
Q

Term for heavy bleeding during and between menstrual periods

A

Menometrorrhagia

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3
Q

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, history of D and C

A

Asherman’s syndrome- scaring of uterus

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4
Q

Therapy for PCOS

A

Weight loss
OCP
Consider metformin

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5
Q

Meds used to induce ovulation

A

Clomiphene citrate

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6
Q

Dx step required in postmenopausal woman who presents with vaginal bleedings

A

Endometrial biopsy

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7
Q

Indications for medical Tx of ectopic

A

Pt stable, unruptured ectopic pregnancy of <6 wks gestation

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8
Q

Medical options for endometriosis

A

OCP
Danaxol
GnRH agonists

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9
Q

Lap findings endometriosis

A

Powder burns

Chocolate cysts

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10
Q

Most common location for ectopic

A

Ampulla of oviduct

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11
Q

How to Dx and follow leiomyoma

A

US

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12
Q

Natural Hx leiomyoma

A

Regress after menopause

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13
Q

PT has inc vaginal discharge and petechial patches in upper vagina and cervix

A

Trichomonal vaginitis

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14
Q

Tx for bacterial vaginosis

A

Oral or topical metronidazloe

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15
Q

Most common cause bloody nipple discharge

A

Intraductal papilloma

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16
Q

Contraceptive methods that protect against PID

A

OCP

Barrier contraception

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17
Q

Unopposed estrogen CI in which Ca?

A

Endometrial or estrogen receptor + brest cancer

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18
Q

Pt with recent PID and RUQ pain

A

Fitz Hugh Curtis syndrome

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19
Q

Breast malignancy presenting as itching, burning, erosion of nipple

A

Paget’s disease

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20
Q

Annual screening for women with strong FH og ovarian Ca

A

CA=125 and transvaginal US

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21
Q

50 yr woman leaks urine when laughing or coughing. Non surg Tx?

A

STRESS INCONTINENCE
Kegel
Estrogen
Pessaries

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22
Q

30 yo woman has unpredictable urine loss. Exam normal. Tx?

A

URGE INCONTINENCE
Antichol (oxybutynin)
Beta adrenergics (metaproterenol)

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23
Q

Lab values suggesting menopause

A

Inc FSH

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24
Q

Most common cause female infertility

A

Endometriosis

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25
Q

2 consecutive findings of ASUC on Pap smear. Follow up eval?

A

Colposcopy and endocervical curettage

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26
Q

Breast cancer type that inc future rusk of invasive CA in both breast

A

Lobular carcinoma in situ

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27
Q

Order of events of normal female puberty

A 
Adrenarche 
Gonadarche
Thelarche
Pubarche
Growth spurt
Menarche
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28
Q

Adrenal androgen production

A

Adrenarche

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29
Q

Activation of gonads by FSH and LH

A

Gonadarche

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30
Q

Appearance of breast tissue

A

Thelarche: 8-11

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31
Q

Appearance of pubic hair

A

Pubarche

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32
Q

Onset menses

A

Menarche: 10-16

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33
Q

Precocious puberty in boys

  • Age
  • Cause
A

<9

Adrenal hyperplasia

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34
Q

Isosexual precocious puberty cause (major)

A

CNS lesion

Trauma

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35
Q

Midcycle surge induces ovulation

Regulates chol conversion to pregnenolone in ovarian theca cells as initial step in estrogen synthesis

A

LH

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36
Q

Stimulates development of ovarian follicles

Regulates ovarian granulosa cell activity to control estrogen synthesis

A

FSH

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37
Q 
Stimulates endometrial proliferation
Aids follicle growth
Induce LH surge
High levels inhibit FSH secretion
Principal role in sexual development
A

Estrogens (estradiol)

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38
Q 
Stimulates endometrial gland development
Inhibits uterine contraction
Increases thickness cervical mucus
Inhibits LH and FSH secretion; maintains pregnancy
Decrease in levels leads to menstruation
A

Progesterone

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39
Q

Acts like LH after implantation of fertilized egg

Maintains corpus luteum viability and progesterone secretion

A

hCG

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40
Q

Necessary for pt who is XY but androgen insensitive

A

Must remove testicle- inc risk cancer

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41
Q

Length of time without menses to qualify as secondary amenorrhea

A

6 months

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42
Q

Dysmenorrhea: primary Sx begin when, secondary when?

A

Primary: beginning of menstruation Sx
Secondary: midcycle and increase until menstruation over

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43
Q

Most common cause female infertility

A

Endometriosis

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44
Q

Abnormal uterine bleeding defined as

A

35 d, last >7 d, >80 ml blood loss

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45
Q

Needed to Dx PCOS

A

3 of following:

  • Anovulation
  • Androgen excess
  • Polycystic ovaries on US
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46
Q

PCOS increased risk

A

Endometrial cancer 2/2 increased estrogen

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47
Q

Gardnerella, Trichomonas, Candida- which need to Tx partner

A

Trichomonas

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48
Q

Clue cells

A

Gardnerella

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49
Q

Motile

A

Trichomonas

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50
Q

Normal vag pH

A

Candida

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51
Q

Cause TSS

A

S, aureus

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52
Q

Causes cervicitis

A

GC or chlam

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53
Q

Thayer Martin agar

A

GC

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54
Q

Tx Cervicitis

A

Ceftriaxone for GC

Azithro or doxy-Chlam

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55
Q

Causes PID

A

GC/Chlam

Infrequent: bacteroides, E coli, streptococci

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56
Q

Chandelier sign

A

PID: palpate cervix during pelvic exam cause pt to jump off table

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57
Q

Pt with PID also has signs of sepsis or peritonitis - should suspect?
Tx?

A

Tubo-ovarian abscess

Inpt Tx with IV abx and IVF

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58
Q

1 vs 2 vs 3 syphilis

A

1: 3 wks after exposure - solitary chancre to painless ulcer
2: chancre heals, maculopapular rash palm and soles, condylama lata; relapses up to 30 yrs
3: gummas, tabes dorsalis, Argyll Robertson pupil

59
Q

Dx and Tx syphilis

After Tx, which test will remain +

A

Dx: VDRL, RPR; FTA-ABS, MHA-ABS (microhemagglutination), spirochetes on dark field (Cannot culture)
+ = FTA-ABS positive for life
Tx: Pen G, doxy, tetracycline; IV Pen G for tertiary

60
Q

Tx HPV

A 
Podophyllin
Trichloroacetic acid
5FU
alpha IFN
Cryo or laser
61
Q

Cause syphilis

A

Treponema pallidum

62
Q

Characterization of genital ulcers

A

Some Girls Love Licorice but Fellows Hate Candy

Syphilis, Granuloma inguinale, Lymphogranuloma venereum = painLess

PainFul= Herpes simplex, Chancroid

63
Q

Tx Chancroid
Dx
Cause

A

Ceftriaxone, erythromycin, azithromycin
Dx: gram stain (-) rods
Cause: Haemophilus ducreyi

64
Q

Tx lymphogranuloma venereum
Dx
Cause

A

Tetracycline, erythromycin, doxycycline
Immunoassay
Chlamydia trachomatis L1, L2, L3

65
Q

Tx granuloma inguinale
Dx
Cause

A

Doxy or TMP SMX
Giemsa stain Donovan bodies
Cause: Klebsiella granulomatis

66
Q

Tx uterine fibroid/leiomyoma

A

GnRH agaonist - temporary
Myomectomy
Hysterectomy

67
Q

CA 125

A

Endometrial Ca
Cervical Ca
Ovarian but only if pest menopausal

68
Q

Most common cause vaginal bleeding

A

Atrophic vaginitis

69
Q

ACUS Tx

A

HPV
Pap in 6 and 12 months
Repeat HPV in 12 months

70
Q

ASCH (ASUC, cannot exclude HSIL) Tx

A

HPV
Endocervical biopsy
Pap 6 and 12 months
REpeat HPV 12 months

71
Q

LSIL - CIN 1 Tx

A

Pap 6 and 12
HPV 12 months
LEEP or conization or laser ablation

72
Q

HSIL Tx - CIN 2 and 3 (include in situ) Tx

A

LEEP or conization or laser ablation

Repeat cytology q 6 months

73
Q

Benign ovarian mass: granulosa cells, occur first 2 weeks of cycle, may regress over menstrual cycle

A

Follicular cyst

Tx: observe

74
Q

Benign ovarian mass: theca cells - cystic or hemorrhagic

A

Corpus luteum cyst

Tx: observation, cystectomy if not regress

75
Q

Benign ovarian mass: from epi tissue, may resemble endometrial or tubal histology, cystic with serous or mucinous contents, may calcify= PSAMMOMA BODIES

A

Mucinous or serous cystadenoma

Tx: unilat salpingo-oophorectomy

TAH BSO if postmenopausal

76
Q

Benign ovarian mass: Spread of endometriosis to involve ovary

A

Endometrioma

Tx: OCP, GnRH agonist, progrestin, danazol - Sx
Cystectomy or oopherectomy because recur

77
Q

Benign ovarian mass: originates as germ cell, composed of multiple dermal tissues - hair, teeth, sebaceous glands

A

Benign cystic teratoma (desmoid cyst)

Tx: cystectomy with attempted preservation of ovary
1-2% transform to malignant

78
Q

Benign ovarian mass: origin-granulosa, theca, Sertoli, Leydig cells’ secrete hormones of cell of origin
CAUSES: PRECOCIOUS PUBERTY or VIRILIZATION

A

Stromal cell tumor

  • granulosa or theca: precocious puberty
  • Sertoli-Leydig: virilization

Tx: unilat salpingo oopherectomy, TAH BSO if postmenopausal

79
Q

BRCA 1 and 2

A

Breast Ca

Ovarian Ca

80
Q

US: smooth lesion edges, few septa, cystic mass

A

Benign

81
Q

US: irregular, nodular, multiple septa, pelvic extension

A

Malignant

82
Q

Types ovarian Ca

A

Epi or germ cell

83
Q

Types cervical ca

A

SCC
Adeno
Mixed

84
Q

Nonbloody nipple discharge with noncancerous pathology- excise or no

A

Not needed

85
Q

Most common site breast cancer

A

Upper outer

86
Q

Problem with FNA

A

High false negative rate

87
Q

Malignant cells in ducts without stromal invasion, maybe calcification

A

DCIS

Higher risk of subsequent invasive cancer than DCIS

NO Sx

88
Q

Malignant cells in lobules without stromal invasion, no calcifications, can be multifocal, increased risk contralat malignancy

A

LCIS

No Sx

89
Q

Malignant cells in ducts with stromal invasion and calcification, fibrotic response in surrounding tissue

A

Infiltrating ductal
MOST COMMON INVASIVE

Firm mass, skin dimples, nipple retraction, peau d orange, nipple discharge

90
Q

Malignant cells in breast lobules with infiltration and less fibrous response; usu multifocal or bilat; slower mets; assoc HRT

A

Infiltrating lobular

Same Sx as infiltrating ductal

91
Q

Well circumscribed, rapid growth; soft

A

Medullary Ca

Better prognosis than ductal Ca

92
Q

Well circumscribed, slow growth, older women; gelatinous

A

Mucinous Ca

Better prognosis than ductal Ca

93
Q

Slow growing malignancy of well formed tubular structure invading stroma, pt in late 40s, excellent prognosis

A

Tubular Ca

94
Q

Subtype of ductal, rapid progression and angioinvasive, poor prognosis

A

Inflammatory

95
Q

Primary amenorrhea - caues if no secondary sexual characteristics

A

Constitutional growth delay= commonest
Primary ovarian insufficiency= Turner, rad/chemo
Central hypogonadism= undernourishment, stress, hyperprolactinemia, exercise, CNS tumor, Kallman’s (anosmia)

96
Q

Primary amenorrhea- causes if secondary sexual characteristics

A

Mullerian agenesis- absence of 2/3 vagina
Imperforate hymen
Complete androgen insensitivity

97
Q

Increased amount of time bewteen menses (35-90 d)

A

Oligomenorrhea

98
Q

Frequent menstruation <21 d

A

Polymenorrhea

99
Q

Increased flow or prolonged bleeding

A

Menorrhagia

100
Q

Bleeding between periods

A

Metrorrhagia

101
Q

Excessive and irregular bleeding

A

Menometrorrhagia

102
Q

Midcycle estrogen surge- secretions are?

A

Clear, elastic mucoid

103
Q

Luteal phase pregnancy - secretions are?

A

Thick, white, adhere to vaginal wall

104
Q

Criteria for Dx bacterial vaginitis

A

Need 3 of 4

  1. whitish gray discharge
  2. ph >4.5
    • amine/whiff test
  4. clue cells >20% on wet mount
105
Q

Causes acute pelvic pain

A

A ROPE

Appendicitis
Ruptured ovarian cyst
Ovarian torsion/abscess
PID
Ectopic
106
Q

2 types endometrial cancer

A

Endometroid (type I) and serous (type II)

107
Q

Endometrial cancer: most common, 2/2 unopposed estrogen, dx around 55 yrs, good prognosis

A

Endometroid - type I

108
Q

Endometrial cancer: not as common, unrelated to estrogen, p53 mutation, dx around 67 yrs, poor prognosis

A

Serous- type II

109
Q

Rx protective against endometrial and ovarian cancer

A

OCP

110
Q

Pelvis mass: mobile, cystic, unilateral, smooth = benign or malignant

A

Benign

111
Q

Pelvis mass: fixed, solid or firm, bilateral, nodular = benign or malignant

A

Malignant

112
Q

Adnexal mass: < 8 cm, cystic, unilocular, unilateral, calcifications = benign or malignant

A

Benign

113
Q

Adnexal mass: > 8 cm, solid/ cystic and solid, multilocular, bilat, ascites = benign or malignant

A

Malignant

114
Q

CA-125 tumor marker ovarian cancer

A

Epithelial

115
Q

AFP tumor marker ovarian cancer

A

Endodermal sinus

116
Q

AFP, hCG tumor marker ovarian cancer

A

Embryonal Ca

117
Q

hCG tumor marker ovarian cancer

A

Choriocarcinoma

118
Q

LDH tumor marker ovarian cancer

A

dysgerminoma

119
Q

Inhibin tumor marker ovarian cancer

A

Granulosa cell

120
Q

Causes of urinary incontinence without specific urogenital pathology

A

DIAPPERS

Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psych (esp depression)
Excessive urinary output (hyperglc, hyperCa, CHF)
Restricted mobility
Stool impaction
121
Q

Uncontrolled loss of urine at all times and in all positions - loss of sphincter efficiency, fistula

A

Total

122
Q

Urinary incontinence after increased intra-abdominal pressure (coughing, sneezing. lifting) - urethral sphincter insufficiency due to lax of pelvic floor mm
Tx

A

Stress

Kegel, pessary, vaginal vault suspension surgery

123
Q

Urinary incontinence that is strong, unexpected urge to void that is unrelated to position or activity. Due to detrusor hyperreflexia or sphincter dysfunction due to inflammation or neurogenic
Tx

A

Urge

Tx: antichol or TCA, biofeedback

124
Q

Urinary incontinence due to chronic urinary retention. Chronically distended bladder with inc intravesical pressure that just exceeds the outlet resistance, allowing a small amt of urine to dribble out
Tx

A

Overflow

Tx: placement of urethral catheter in acute settings; Tx underlying disease; timed voided

125
Q

Peds, bunch of grapes in vagina

A

Sarcoma botryoides - rhabdomysarcoma

126
Q

Uncommon fibroepithelial breast tumors -capable of a diverse range of behavior.

  • Similar to benign fibroadenomas, although with a propensity to recur locally following excision without wide margins.
  • Tumors that metastasize distantly, sometimes degenerating histologically into sarcomatous lesions that lack an epithelial component
A

phyllodes tumor

127
Q

Tumor markers recurrent breast cancer

A

CEA
CA 15-3
CA 27-29

128
Q

Breast cancer stages

A

I; <2 cm
II: 2-5 cm
III: axillary LN
IV: distant mets

129
Q

Testing to do if sexual assault

A 
HIV
Syphilis
HSV
HBV
CMV
Pregnancy
GC and chlam
BAC, urine tox
130
Q

Endometrial glands within uterine musculature

A

Adenomyosis

131
Q

Phenotypically normal female with absence of axillary and pubic hair, primary amenorrhea

A

Androgen insensitivity syndrome

NO UTERUS

132
Q

Normal breast development and a uterus, primary amenorrhea

A

Prolactin level to R/O pituitary adenoma
-Prolactin high: MRI
Normal: give progesterone and evaluate same as for secondary amenorrhea

133
Q

Side effects OCP

A 
Glc intolerance
Edema
Weight gain
Cholithiasis
Benign liver adenoma
Melasma
N/V, HHA
HTN
134
Q

Mammogram vs US when Dx breast mass

A

Mammo > 30 yrs

US <30 because breast too dense for mammo

135
Q

Women post menopause and new breast mass

A

MUST CONSIDER CANCER

136
Q

3 D endometriosis

A

Dysmenorrhea
Dyspareunia
Dyschezia

137
Q

Location endometriosis

A

Ovaries
Broad or uterosacral ligament
Peritoneal surface

138
Q

Location endometriosis

A

Ovaries
Broad or uterosacral ligament
Peritoneal surface

139
Q

Gold standard Dx endometriosis

A

Lap with visualization

140
Q

Benefits HRT

A

Decreased osteoporosis
Reduces hot flashes and GU Sx
Decreased risk colorectal Ca

141
Q

Benefits HRT

A

Decreased osteoporosis
Reduces hot flashes and GU Sx
Decreased risk colorectal Ca

142
Q

Absolute CI to HRT

A 
Unexplainred vag bleeding
Acute liver disease
CAD
Thromboembolism HX
CAD
Hx endometrial or breast cancer
Pregnancy
143
Q

If do not have a uterus, which hormone do you not need

A

Progesterone

First Aid Step 2 (22 decks)

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