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PANRE > GYN OB > Flashcards

GYN OB Flashcards

1
Q

Absence of menstruation by age 16

A

Primary Amenorrhea

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2
Q

What is the lab workup for primary amenorrhea?

A
  1. Quantitative Beta-HCG (pregnancy exam) 2. FSH, LH, prolactin, TSH(T3/T4), 3. May consider genetic testing
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3
Q

What imaging studies are order for primary amenorrhea?

A

Abdominal/Pelvic U/s, MRI or CT to r/o out CNS, abdominal or pelvic mass

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4
Q

What are the causes for primary amenorrhea?

A
  1. Gonadal agenesis or dysgenesis
  2. GNRH Deficiency
  3. Constitutional pubertal delay
  4. Hyperprolactinemia
  5. Ovarian resistance syndrome (PCOS)
  6. Stress
  7. CNS Mass
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5
Q

What is the max age for failure of menarche onset in the presence of 2nd sex characteristics ?

A

15/16

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6
Q

What is the age for failure of menarche onset in the absence of 2ry sex characteristics?

A

13

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7
Q

What are the etiologies of 1ry amenorrhea with uterus present and breast present ?

A

Outflow obstruction

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8
Q

Outflow obstruction consists of ?

A

Transverse vaginal septum, imperforate hymen

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9
Q

What are the etiologies of 1ry amenorrhea with uterus absent and breast present ?

A 
Mullerian agenesis (46XX)
Androgen insensitivity (46XY)
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10
Q

What are the etiologies of 1ry amenorrhea with uterus present and breast absent ?

A

Elevated:FSH/LH=Ovarian Causes
1. Premature ovarian failure 2. Gonadal dysgenesis (Turner’s 45X0)

Normal /Low: FSH/LH=

  1. Hypothalamus-Pituitary Failure
  2. Puberty delay (ex athletes, illness, anorexia)
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11
Q

What is Dysfunction uterine bleeding?

A

abnormal uterine with no underlying cause -no organic or anatomic

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12
Q

What is the normal menstrual cycle

A

24-35 days

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13
Q

Heavy bleeding at normal intervals

A

menorrhagia

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14
Q

bleeding between cycles

A

metrorrhagia

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15
Q

Irregular intervals with excessive bleeding

A

menometrorrhagia

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16
Q

What is oligomenorrhea ?

A

Infrequent cycle >35years

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17
Q

What is polymenorrhea

A

frequent cycle <21 days

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18
Q

How is dysfunction uterine bleeding diagnosis?

A

Dx of exclusion

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19
Q

What is the treatment of DUB?

A

NSAIDS, OCP/IUD, ablation/sx if persistent

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20
Q

What is 2nd amenorrhea ?

A

Cessation of menses of 6 (3) months with previous normal menses or >6 months of pets with oliogmenorrhea

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21
Q

what is the MC of 2nd amenorrhea

A

Pregnancy

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22
Q

What is the evaluation of 2nd amenorrhea

A
  1. Quantitative Beta-HCG (pregnancy exam) 2. FSH, LH, prolactin, TSH(T3/T4)
  2. Progestin Challenge
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23
Q

Ectopic endometrial tissue outside of the uterus

A

Endometriosis

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24
Q

What is the MC site for endometriosis ?

A

Ovaries MC Site

Posterior cul de sac, broad and uterosacral ligaments, recto sigmoid colon, bladder

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25
Q

What are the risk factors of Endometriosis?

A

NULLIPARITY, fm hx, early menarche,

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26
Q

Onset age of endometriosis

A

<35

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27
Q

Most common cause of infertility >30

A

Endometriosis

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28
Q

Endometriosis triad classic presentation?

A

triad of cyclic premenstrual pelvic pain + dysmenorrhea +

dyspareunia; ± low back pain, dyschezia, spotting

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29
Q

What is definitive dx for endometriosis ?

A

laparoscopy

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30
Q

Overall Treatment for Endometriosis?

A

hormonal, NSAIDs, ablation, TAH & bilateral salpingo-oophrectomy (BSO)

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31
Q

Treatment for endometriosis if fertility is desired?

A

Conservative Laparoscopy with ablation to preserve uterus and ovaries

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32
Q

What medical treatment suppress ovulation ?

A

Progesterone,,

Leuprolide and danazol

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33
Q

What Suppress GnRH, causes endometrial tissue atrophy and suppress ovulation?

A

Progesterone

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34
Q

Testosterone (induces pseudomenopause-suppresses FSH & LH, mid cycle surge)

A

Danazol

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35
Q

GnRH analog causes pituitary FSH/LH suppression and causes GnRh inhibition when given continuously

A

Leuprolide-used for ovulation suppression and shrinks uterus put to 50%, will rtc to size once medication therapy is stop.

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36
Q

Ectopic endometrial tissue within myometrium

A

Adenomyosis

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37
Q

triad of non-cyclical pain + menorrhagia + enlarged uterus

A

Adenomyosis

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38
Q

How is Adenomyosis diagnosis?

A

MRI, post-total abdominal hysterectomy (TAH) examination of uterus

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39
Q

What is treatment of Adenomyosis?

A

TAH - only effective therapy; NSAIDs & hormones for symptomatic relief

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40
Q

When does adenomysosis presents ?

A

Later in reproductive years

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41
Q

What is PE of adenomyosis ?

A

Tender “symmetrically” enlarged “Boggy uterus”; Symmetric soft and tender.

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42
Q

What is Leiomyoma ?

A

AKA Uterine Firboids, Fibromyoma; Uterine smooth muscle tumor, “Benign Bleeders”

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43
Q

What hormone is responsible for Leiomyoma ?

A

Estrogen: Growth related to estrogen production, regresses after menopause; May increase with pregnancy in size with the menstrual cycle.

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44
Q

Leiomyoma is most common on what age? What ethnicity?

A

In 30’s, especially >35; 5x more common in African Americans

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45
Q

Pelvic exam of Leiomyoma?

A

irregular, hard palpable mass(es)

non tender

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46
Q

What are Leiomyoma CM?

A

MC -Bleeding/menorrhagia and dysmennorrhea; May present with increase bladder frequency and urgency

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47
Q

How is Leiomyoma (AKA: Uterine Fibroids) DX?

A

Pelvic US

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48
Q

Medical Treatment for Leiomyoma (AKA: Uterine Fibroids)

A

hormones, inhibition of estrogen(decrease endometrial growth); Leuprolide and Progestins (causes endometrial atrophy)-decreases bleeding

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49
Q

Definitive Treatment for Leiomyoma (AKA: Uterine Fibroids)

A

TAH, Fibroids are the MC cause for hysterectomy

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50
Q

What surgical treatment is used if trying to perserve fertility for uterine fibroids ?

A

Myomectomy; Endometrial ablation, artery embolization-both may affect the ability to conceive

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51
Q

What is endometrial Hyperplasia?

A

Precursor to endometrial adenocarcinoma (type 1); endometrial gland proliferation cytologic atypia,

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52
Q

What hormone is responsible for Endometrial Hyperplasia

A

Unopposed estrogen (unopposed by progesterone)

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53
Q

Common causes/etiologies that results in endometrial hyperplasia?

A

Chronic anovulation, PCOS, perimenopause, obesity (conversion of androgen-estrogen in adipose tissue)

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54
Q

When is endometrial hyperplasia mc?

A

Postmenopausal women

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55
Q

Presentation of Endometrial Hyperplasia?

A

menorrhagia, metrorrhagia, postmenopausal bleeding

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56
Q

Endometrial Hyperplasia is diagnosis?

A

TVUS -ENDOMETRIAL STRIPE >/OR EQUAL 4MM (SCREENING TEST)

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57
Q

What is Endometrial Hyperplasia definitive diagnosis?

A

Endometrial BX

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58
Q

What is Endometrial Hyperplasia screening test?

A

TVUS with endometrial stripe >/or equal to 4mm

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59
Q

What is the tx for What is Endometrial Hyperplasia?

A

Hyperplasia without atypia: progestin

o Hyperplasia with atypia: TAH (if not sx candidate or if pt wishes to perceive fertility)

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60
Q

What is the MC benign gynecologic lesion?

A

Leiomyoma /Fibromyoma

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61
Q

4th most common female cancer (breast>lung>colon)

A

Endometrial Cancer

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62
Q

risk factors for the development of endometrial cancer

A

is an estrogen dependent cancer so the main risk factors are anything that increases estrogen exposure- nulliparity, chronic anovulation, PCOS, estrogen replacement therapy, late menopause, obesity, Tamoxifen. These along with DM, family history, previous h/o breast/ovarian cancer are the most commonly listed risk factors.

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63
Q

due to unopposed estrogen, hyperplasia

A

Type 1 adenocarcinoma (75%) of Endometrial cancer

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64
Q

unrelated to estrogen, p53 mutation in 90%

A

Type 2 serous (25%):Endometrial Cancer

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65
Q

Endometrial Cancer Presentation?

A

Postmenopausal bleeding: abnormal vaginal bleeding; Pre or perimenopausal -menorrhagia or metrorrhagia

66
Q

Endometrial Cancer is dx?

A

endometrial biopsy

67
Q

Endometrial Cancer Treatment if trying to perceive fertility?

A

high dose progestin(stops estrogen from being unopposed, limits endometrial growth)

68
Q

Endometrial Cancer Tx for postmenopausal ?

A

TAH/BSO, ± radiation/chemotherapy depending upon

staging

69
Q

Endometrial Cancer Tx for stage 1?

A

TAH/BSO +/- post op radiation therapy

70
Q

Endometrial Cancer Tx for stage II/III?

A

TAH-BSO + lymph node excision+/- post op radiation therapy

71
Q

Endometrial Cancer Tx for stage IV (advanced)

A

systemic chemotherapy

72
Q

What are the screening guidelines for endometrial cancer for asymptomatic women?

A

No current screening guidelines

73
Q

MC age for endometrial cancer?

A

50-60; perimenopausal 25%

74
Q

What hormone is dependent for Endometrial cancer

A

estrogen

75
Q

HPV 16 =? what type of cancer

A

Squamous cell 90%

76
Q

HPV 18

A

adenocarcinoma 10%

77
Q

Cervical cancer risk factors?

A

Sex =risk ; HPV, early onset of sexual activity, increase # of partners, smoking, CIN, DES exposure, immunosiuppresions, STI’s

78
Q

S/S of cervical cancer

A

Post-coital spotting/bleeding, metrorrhagia

79
Q

Cervical cancer dx?

A

biopsy cytology

80
Q

Cervical cancer prevention ?

A

HPV vaccine against 6, 11, 16,18

81
Q

What is the 3rd MC gynecologic Cancer ?

A

cervical cancer

82
Q

Cervical cancer is associated to which virus?

A

HPV 99.7% especially 16, 18

83
Q

When is HPV vaccine CI?

A

Immunospressed, pregnant and lactating

84
Q

ACOG guidelines for ages 21-29?

A

every 3 years (pap smear)

85
Q

ACOG guidelines for ages 30-65?

A

Q 3 years or Pap + HPV testing Q 5 years

86
Q

ACOG guidelines for age >65?

A

Stop screening if negative (within the last 10 years)

87
Q

Atypical squamous cells of undetermined significance (ASC-US):

A

21-24 yo: repeat PAP in 1 yr or HPV test
o ≥25 yo: HPV test or repeat PAP in 1 yr
§ HPV positive → colposcopy
§ HPV negative → repeat PAP & HPV in 3 yrs

88
Q

Atypical squamous cells, cannot exclude HSIL (ASC-H):

A

All nonpregnant women → colposcopy

o Higher risk of cancer than ASC-US

89
Q

Low-grade squamous intraepithelial lesion, includes cervical intraepithelial
neoplasia I [CIN I] (LSIL

A 
Most common cause: transient HPV infection
o 25-29 yo: colposcopy with biopsy
o ≥30 yo: HPV testing
§ HPV negative → repeat cytology in 1 yr
HPV positive → colposcopy with biopsy
o Progression to cancer: 7 yrs
90
Q

High-grade squamous intraepithelial lesion, includes CIN II, III & carcinoma in
situ (HSIL

A

Colposcopy with biopsy in all ages

91
Q

Atypical glandular cells of undetermined significance (AGC

A

Colposcopy with biopsy in all ages

92
Q

Malignant transformation is most common at what site in the cervix?

A

squamocolumnar junction

93
Q

Common Causes for Cervicitis?

A

MC is infections and other causes;
STI: Neisseria gonorrheae , Chlamydia, HSV, syphilis, Trichomonas
● Non-infectious: Trauma, XRT exposure

94
Q

Cervicitis clinical presentation and s/s?

A

S/S: Pain, vaginal discharge, bleeding, dyspareunia
● PE: Cervical discharge, odor, “strawberry cervix” (Trich), absence of other
PID signs

95
Q

Cervicitis treatment?

A

Tx: Week of abstinence after treatment started AND:
○ Gonorrhea/Chlamydia: Always treat for both
■ Ceftriaxone 250mg IM x1 + azithromycin 1g PO x 1 or Doxy
BID x7d
○ Syphilis: Pen G IM
○ Trichomonas: Metronidazole
○ HSV: Acyclovir; 1 st episode 7-10 days; recurrent episodes 5 days

96
Q

What is vaginal cancer?

A

Rare, usually 2° to another cancer
● 95% squamous cell carcinoma
● Diethylstilbestrol (DES) exposure ↑ risk for clear cell carcinoma

97
Q

Symptoms of vaginal cancer?

A

abnormal vaginal bleeding, vaginal discharge, typically asymptomatic

98
Q

Treatment for vaginal cancer?

A

Xray therapy, surgery

99
Q

What is vulvar cancer?

A

90% squamous cell

● Risks: HPV 16, 18, 31

100
Q

S/S of vulvar cancer ?

A

pruritus (MC presentation), pain, red/white ulcerative lesion; post-coital bleeding (20%)

101
Q

Vulvar Cancer dx?

A

Biospy

102
Q

Most common cause of vaginitis

A

Bacterial Vaginosis

103
Q

BV organism?

A

Gardnerella vaginalis

104
Q

BV s/s?

A

Discharge: thin, homogenous, grayish-white, fishy odor, odor worse after sex, +/-pru

105
Q

How is BV dx? What type of cells?

A

Dx: + whiff test on potassium hydroxide (KOH) prep,CLUE CELLS on wet mount

106
Q

BV treatment?

A

metronidazole PO/PV (SAFE in pregnancy), clindamycin PO/PV

107
Q

What are BV complications?

A

Pregnancy-PROM, preterm labor, chorioamnionitis

108
Q

Trichomoniasis PE ?

A

“Strawberry cervix” on exam

● Discharge: copious, yellow-green, frothy, malodorous; PH >5

109
Q

Trichomoniasis microscopic?

A

motile trichomonads (protozoa) on wet saline prep

110
Q

Trichomoniasis tx?

A

metroniadazole

111
Q

Does trichomoniasis needs treatment for sexual partner?

A

True

112
Q

Fungal Vaginitis organism?

A

Candida albicans

113
Q

Risk factors of candida albicans?

A

diabetes mellitus (DM), recent antibiotic or steroid use, pregnancy

114
Q

Candida PE?

A

Discharge: thick, white, “cottage cheese” texture with no odor

115
Q

Candida microscopic?

A

hyphae, yeast on KOH prep

116
Q

What is Bartholin Cyst / Abscess?

A

Duct obstruction → enlarged gland

117
Q

What causes Bartholin Cyst / Abscess?

A

infections(E. coli, Staphylococcus auerus, Neisseria gonorrhoeae) or trauma

118
Q

S/S of Bartholin Cyst / Abscess?

A

Infectious: tenderness, redness, unilateral mass

o Non-infectious: non-tender, unilateral mass

119
Q

DX of Bartholin Cyst / Abscess?

A

cultures, cbc

120
Q

TX of Bartholin Cyst / Abscess?

A

Infectious: incision & drainage (I & D) with Word catheter, warm
compresses, antibiotics may be warranted
o Non-infectious: self-limited, usually no treatment required (consider biopsy
for age >40 yo)

121
Q

What uterus disorder may presents <35 y/o ?

A

Endometriosis and Leiomyoma

122
Q

What are Ovarian Cysts?

A

Common in reproductive years, usually unilateral
● Follicular - associated with ovulation
● Corpus luteum - may be hemorrhagic upon rupture

123
Q

Dx of Ovarian cysts?

A

U/S, r/o pregnancy

124
Q

TX of Ovarian cysts?

A

NSAIDs, most resolve on their own, repeat U/S, may need surgery if recurrent
● BEWARE: large cysts > 5 cm can lead to ovarian torsion
o Emergent surgical detorsion

125
Q

When is a emergent surgical detorsion for an ovarian cyst done/required?

A

> 5 cm can lead to ovarian torsion

126
Q

Highest mortality of all gynecologic cancers

A

Ovarian Cancer

127
Q

Risks of Ovarian Cancer?

A

Risks: ↑ # of ovulatory cycles, BRCA1 & 2, FHx, Lynch II syndrome (hereditary
nonpolyposis colorectal cancer [HNPCC])

128
Q

What decreases risk of Ovarian cancer?

A

OCPs taken >5 yrs

129
Q

S/S of ovarian cancer?

A

S/S appear late in disease, vague pain/pressure, bloating, early satiety,
constipation

130
Q

PE of ovarian cancer ?

A

Solid fixed abdominal mass on exam, ascites

o Sister Mary Joseph node: metastasis to umbilical lymph nodes

131
Q

Dx of Ovarian Cancer?

A

U/S, CT
o 90% are epithelial tumors
o Tumor marker CA-125

132
Q

TX of Ovarian Cancer?

A

TAH/BSO + post-op chemotherapy

133
Q

Prevention in ovarian cancer?

A

in women who are BRCA 1 positive - annual U/S, CA-125 screening
● Consider prophylactic oophorectomy when childbearing complete

134
Q

Diagnostic triad: polycystic ovaries + oligo-/anovulation + evidence of
hyperandrogenism

A

PCOS

135
Q

PCOS cause ?

A

Exact cause not known, but associated with ban function of hypothalamus-pituitary -ovarian axis(increase insulin and increase LH-Driven -Increase in ovarian androgen production. Insulin resistance common
● Obesity, acanthosis nigricans

136
Q

DX of PCOS?

A

testosterone, dehydroepiandrosterone sulfate (DHEA-S), LH:FSH ratio >2x
normal
o Rule out other causes of hyperandrogenism
o U/S optional - may show “string of pearls

137
Q

TX of PCOS:

A

OCPs, antiandrogens

138
Q

What has increase risk of infertility and endometrial cancer?

A

PCOS

139
Q

Pelvic Organ Prolapse?

A

Weakness of pelvic floor musculature due to vaginal birth, previous surgery,
obesity
● Uterine: herniation into vagina
● Cystocele: posterior bladder into anterior vagina
● Enterocele: small bowel into upper vagina
● Rectocele: rectum into posterior vagina

140
Q

S/S of Pelvic organ prolapse

A

pelvic fullness, “falling out” sensation, urinary frequency/incontinence

141
Q

DX of Pelvic organ prolapse?

A

bulging mass on exam with Valsalva

142
Q

TX of Pelvic organ prolapse?

A

Kegel exercises, pessaries, surgery(hysterectomy; Uterosacral or sacrospinous ligament fixation?

143
Q

Pelvic Inflammatory Disease (PID)?

A

Polymicrobial infection; associated with STIs

144
Q

Risk factors for PID?

A

Multiple sex partners, unprotected sex, prior PID, age 15-19, nulliparous, IUD placement

145
Q

S/S and PE for PID?

A

S/S: pain, fever, purulent cervical discharge, “chandelier sign” on exam
● Dx: high suspicion from exam, U/S for abscess, cervical motion tenderness, adnexal tenders plus +grain stain, temperature >38 C, WBC >10,000, pus on culdocentesis

146
Q

Treatment for PID?

A

doxycycline + ceftriaxone to cover chlamydia & gonorrhea

147
Q

Complications for PID?

A

infertility, Fitz-Hugh-Curtis syndrome (right upper quadrant [RUQ]
pain, perihepatitis)
Toxic

148
Q

Fitz-Hugh Curtis syndrome?

A

hepatic fibrosis/scarring & peritoneal involvement. May radiate to the right shoulder. Infertility, turbo ovarian abscess, ectopic pregnancy and chronic pelvic pain ?

149
Q

Toxic shock Syndrome etiology?

A

exotoxins produced by Staphylococcus aureus

150
Q

Most Common cause of Toxic Shock Syndrome?

A

tampon use

151
Q

S/s of Toxic Shock Syndrome?

A

abrupt onset of high fever, vomiting, diarrhea, diffuse macular red rash

152
Q

DX of Toxic Shock Syndrome?

A

clinical, labs, organism isolation is not required

153
Q

Tx of Toxic Shock Syndrome?

A

hospital admission, aggressive rehydration, anti-staphylococcal antibiotics (clindamycin + vancomycin (mrsa)

154
Q

What is mastitis?

A

Infectious (unilateral; lactating women 2° nipple trauma) vs congestive (bilateral;
2-3d postpartum)
● Staphylococcus aureus is the most common infectious agent

155
Q

TX for mastitis?

A

anti-staphylococcal antibiotics, warm compresses, continue to breast feed

156
Q

Breast abscess:

A

rare, fluctuant, needs I & D, stop breast feeding from affected side

157
Q

What is dx for Fibrocystic changes?

A

U/S, straw colored fluid on fine needle aspiration (FNA)

158
Q

What is tx for fibrocystic changes

A

usually none needed

159
Q

What is fibrocystic changes?

A

Most common benign breast disorder
● Cysts, ductal epithelial hyperplasia, fibrosis
● Associated with caffeine use
● S/S: cyclic breast tenderness in luteal phase, multiple mobile masses which
fluctuate in size due to hormone levels

160
Q

Fibroadenoma?

A

Most common benign breast lesion <30 yo
● S/S: round, rubbery, mobile, nontender mass on exam, no cyclical fluctuation in
size

161
Q

Dx of fibroadenoma?

A

U/S, FNA to distinguish from cyst

162
Q

Tx of fibroadenoma?

A

± excision

PANRE (15 decks)

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