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Ob/Gyn > Gyn Differentials And Steps > Flashcards

Gyn Differentials And Steps Flashcards

0
Q

Bartholin’s duct cyst/abscess – management?

A
  1. If pt over 40, biopsy
  2. If one-2 cm, leave untreated
  3. I&D with word catheter, or marsupialization
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1
Q

Ddx - vulvar lesion?

A

Non-neoplastic - Crohn’s, erythema multiforme, bulbous pemphigoid, plasma cell vulvitis

Neoplastic - SCC, BCC, melanoma, Paget’s

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2
Q

Differential diagnosis for abnormal bleeding without pelvic mass?

A

Endometrial polyps, endometrial hyperplasia, endometrial cancer, adenomyosis

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3
Q

Differential diagnosis for pelvic mass or uterine enlargement?

A

Uterine - pregnancy, adenomyosis, gliomyosarcoma, fibroids

Ovary – cyst, neoplasm, TOA

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4
Q

Indications for surgical intervention for fibroids?

A
  1. Growth – rapid, after menopause, >12 weeks gestation
  2. Bleeding - abnormal, secondary amenorrhea, and anemia
  3. Urinary frequency or retention
  4. Infertility
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5
Q

Endometrial hyperplasia - diagnosis?

A
  1. Endometrial biopsy

2. If equivocal D&C, unless under 30

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6
Q

Endometrial hyperplasia - tx?

A

Medical:

  1. Progestin for 3 months
  2. Repeat biopsy
  3. Repeat progestin if needed
Surgical:
1. If without atypia, D&C
2. If atypical complex
 a. hysterectomy 
 B. If want to keep fertility, curettage, long term progestin, ovulation induction
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7
Q

Management of a cystic adnexal mass?

A
  1. Postmenopausal with cyst greater than 2 cm – exploratory laparotomy
  2. Reproductive age
    a. Less than 6 cm – observe for two months then repeat US
    b. 6-8 cm – observe if unilocular, explore if multilocular or solid on ultrasound
    c. Greater than 8 cm – cystectomy
  3. Palpable cyst postmenopausal – oophorectomy
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8
Q

Management of endometriosis?

A
  1. Pseudopregnancy - NSAIDs, OCP, Provera (use these patients who are not seeking to conceive)
  2. Pseudo-menopause – danazol (androgen derivative), Lupron
  3. Conservative surgical therapy – ablation of visible endometriosis
  4. Definitive surgical therapy – total hysterectomy, Salpingo-oophorectomy, lysis of adhesions,
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9
Q

Patient presents with increasingly heavy menses and pressure on the bladder. Physical exam shows diffusely enlarged uterus which is mildly tender. Diagnosis?

A
  1. Pelvic ultrasound initially
  2. MRI to confirm

Hysterectomy

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10
Q

Differential for adnexal mass?

A 
Ovarian cyst
Ectopic pregnancy
PID
TOA
Endometriosis
Fibroids
Ovarian neoplasm
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11
Q

Management for uterine prolapse?

A
  1. Kegels
  2. In postmenopausal women, Estrogen replacement to improve tissue tone
  3. Vaginal pressaries
  4. Surgical - colporrhaphy (repair fascial defect)
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12
Q

Evaluation for incontinence?

A
  1. UA, urine culture
  2. Standing stress test
  3. Cotton swab test (for hypermobile bladder neck) – indicates stress incontinence
  4. Cystometrogram – Distinguishes between genuine stress incontinence and detrusor instability
  5. Uroflowmetry – for patients complaining of hesitancy, incomplete bladder emptying
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13
Q

Treatment for stress incontinence?

A
  1. Kegel
  2. Pessaries
  3. Alpha adrenergic agents (pseudoephedrine) to increase sphincter tone
  4. Estrogen to increase sphincter tone
  5. Surgery to return hypermobile bladder original position
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14
Q

Treatment of detrusor instability?

A
  1. Behavior modification (bladder training, Kegel, hypnosis, psychotherapy)
  2. Anticholinergics
  3. Beta-adrenergic agonists
  4. Smooth muscle relaxants
  5. Tricyclic antidepressants
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15
Q

Diagnosis of total incontinence?

A
  1. Methylene blue dye instilled in the bladder leaks if vesicovaginal fistula
  2. Indigo Carmine IV will leak if you ureterovaginal fistula
  3. Cystourethroscopy to identify number and location of fistulas
16
Q

Total incontinence – treatment?

A
  1. Surgery – obstetric fistula can be repaired immediately but surgical facilities must wait 3 to 6 months
  2. If waiting period, give antibiotics and estrogen
17
Q

Differential for primary amenorrhea?

A
  1. Outflow tract abnormalities – imperforate hymen, transverse vaginal septum, vaginal agenesis, uterine agenesis
  2. End organ disorders – ovarian agenesis, ovarian failure, turners
  3. Central disorders – Kallmann syndrome, hypothalamic (compression, TB, radiation, sarcoidosis)
  4. Pituitary – surgery/radiation , hemosiderosis
18
Q

Causes of primary gonadal failure?

A
  1. Enzyme defects
  2. Testicular regression syndrome
  3. True hermaphrodite
  4. Gonadal dysgenesis – turners, Swyers
  5. Ovarian resistance – savages
  6. Postinfection (mumps).
  7. radiation/chemotherapy

Ob/Gyn (64 decks)

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