Gyn UWise Flashcards
What are the advantages of colpocleisis?
it is fast and can be done without general anesthesia, making it a good option for those who are poor surgical candidates and have no desire for future intercourse
What is danazol and what are it’s downsides?
it is an androgenic medication used to treat hormonal disorders including endometriosis but has androgen-baed side effects including weight gain, hair growth, etc
What is the most common indication for a ductogram?
bloody discharge from a single breast
How long after discontinuing breastfeeding may a women continue to produce milk?
up to two years
Why would you want to repeat prolactin levels in a women with elevated levels and a whitish discharge?
because any manipulation of the breast may artificially raise prolactin levels, which should instead be drawn after 24 hours without nipple stimulation
What is the most common cause of cyclic mastalgia in young women?
fibrocystic change and the accompanying hormonal responses
What follow up is indicated if a fine needle aspiration biopsy of a breast lesion reveals clear fluid? Bloody fluid?
- clear fluid requires re-examination in two months to ensure there has not been a recurrence
- bloody fluid requires an excisional biopsy
How is mastitis treated?
- use ibuprofen plus acetaminophen for analgesia
- begin IV or oral antibiotics depending on the severity
- continue breastfeeding
What role do fine needle aspiration and excisional biopsies play in the assessment of breast lesions?
- fine needle aspiration is used first because it is less invasive and if clear fluid is drained, there is no need for an excisional biopsy
- excisional biopsy is the follow up to FNA if there is a bloody aspirate or if FNA results are negative since there is a high false negative rate
Which risk factors are indications for breast MRI screening?
- those with a BRCA mutation or first-degree family member with such a mutation
- those with a more than 20-25% lifetime risk of breast cancer
- those with a history of radiation to the chest between ages 10-30
What are the possible risks or complications with a LEEP procedure?
- infection or bleeding
- cervical stenosis
- risk for preterm delivery
- persistent disease
What is considered the definitive treatment for those with endometriosis?
hysterectomy with bilateral salpingo-oopherectomy
Molar pregnancy is more common in which age groups and race?
more common amongst Asians and in those less than 20 or older than 40
What is the proper management of a molar pregnancy?
- CXR to assess for metastases
- uterine evacuation with suction dnc
- monitoring of B-hCG levels
How is a diagnosis of choriocarcinoma confirmed?
by evaluating the patient’s B-hCG levels
How long after a molar pregnancy until it is safe for a patient to become pregnant?
they should wait six months after B-hCG levels return to zero
Molar pregnancies are associated with what kind of ovarian cysts?
lutein cysts
Lichen sclerosis is a risk factor for what kind of vulvar malignancy?
squamous cell carcinoma
What is the typical appearance of a verrucous carcinoma of the vulva?
it has a cauliflower like appearance
What is the typical appearance of Paget’s disease of the vulva?
it is a white plaque-like lesion with poorly demarcated erythema, not a discrete mass as in squamous cell carcinoma
How should VIN III be treated?
with wide local excision
What is trichloroacetic acid a therapy for?
HPV-related condylomas
What is imiquimod a therapy for?
HPV-related condylomas
How would you treat multifocal VIN II?
with CO2 laser ablation
What is the most common symptom of leiomyomas?
heavy menstrual bleeding
What kind of leiomyoma is most likely to affect fertility?
submucosal
If GnRH agonists are withdrawn, what typically happens to fibroids?
they will resume their former growth potential
What would be an indication for myomectomy?
fibroids that are symptomatic to the point of disrupting the patient’s daily living or those that distort the uterine cavity to a sufficient degree as to disrupt fertility
Which one hormone level is most likely to support a diagnosis of PCOS?
testosterone level
What class of medications are known for causing hyperprolactinemia?
antidopaminergics, particularly psychotropics
What is the most appropriate first step in evaluation of a patient with menorrhagia and no other risk factors?
pelvic ultrasound
What size threshold indicates active rather than expectant management of a uterine polyp?
those more than 1.5 cm should not be simply observed
What is mid-cycle vaginal bleeding?
that at the time of ovulation, associated with the concurrent drop in estrogen levels
What is the best surgical approach when dealing with a submucosal fibroid?
submucosal, unlike intramural or subserosal, cannot be accessed laparoscopically and is instead removed hysteroscopically
Describe the sequence of sexual maturation during puberty in women.
thelarche, adrenarche, growth spurt, menarche,
What is the average age of thelarche in girls?
age 10
What weight must be achieved before menses will typically commence? What two other factors must be present for secondary sex development?
- typically 85-106 pounds
- sleep and optic exposure to light are also very important in the development of secondary sex characteristics
Partial deletions of the long arm of chromosome X are associated with what phenotypes/dysfunction?
premature ovarian failure
What are the main features of Kallmann syndrome?
olfactory tract hypoplasia and failure of the arcuate nucleus to secrete adequate GnRH, meaning patients have no sense of smell and no secondary sexual development
Mullerian anomalies most often co-occur with what other set of anomalies?
renal anomalies
What kind of ovarian tumor is known for producing estrogen?
a granulosa tumor
