Gyn Uworld Flashcards
what hormone are PCOS deficient in
progesterone
at risk for what with PCOS
endometrial carcinoma from increased estrogens causeing hyperplasia
unnopposed estrogen is increased risk for what
endometrial cancer
common age endometriosis
nulliparous age 25-35
medical Tx endometriosis
NSAIDs and OCPs
If Sx do not improve with NSAIDs and OCPS in endometriosis
next step
laparscopy
because is Dx and therapeutic when biopsying ablating or excising
25 yr old nulligravid
bimaanual shows tenderness in posterior vaginal fornix and decreased uterine mobility
no adenexal masses
thickening of uterosacral ligaments
endometriosis
common complication endometriosis
infertility
aromatase deficiency
rare genetic disorder cannot convert androgens to estrogens virilization XX child cliteromegaly delayed puberty osteoporosis
hormone levels in aromatase deficiency
high FSH and LH with low estrogen
mccune albright
cafe au lait
polyostotic fibrous dysplasia and auronomous endocrine hyperfunction
GnRH independed precocious puberty
kallmans syndrome
hypogonadotropic hypogonadism with anosmia
delayed puberty
low or absent LH and FSH
ruptured ovarian cyst signs
sudden onset severe unilateral lower abdomina pain after activity or sex
signs ovarian torsion
sudden onset severe lower abdominal pain on one side
nausea and vomiting
unilateral tender adenexal mass
enlarged ovary with decreased blood flow
ovarian torsion
best reccommendation for patient to avoid breast cancer
decrease alcohol intake
in postmenopasual women
next step after detecting adenexal mass
transvaginal US and serum CA-125
first steps for abnormal uterine bleeding in premenopausal woman
exclude pregnnancy
CBC coags, tSH
risk factors for endometrial cancer
>45 obesity DM unopposed Estrogen exposure PCOS early menarche/late menopause
why not go to transvaginal US in premenopausal women looking for endometrial strip
because differ in thickness depending on cycle
instead do Bx
older post menopasual patients transvaginal US is better test
when to do endometrial Bx in premenopausal patient
persistent Sx with negative lab results
risk factors for endometrial cancer
physiologic galactorrhea
bilateral and no blood
Sx fibroids
heavy menses with clots
constipation
urinary frequency, pelvic pain and heaviness
enlarged uterus on exam
Sx adenomyosis
dysmenorrhea, pelvic pain, menorrhagia and bulky globular tender uterus
how do tamoxifen and raloxifene work
estrogen agonist and antagonist activity
estrogen agonist in uterus– inc endometrial CA
tamoxigen is antagonist in breast
common side effect tamoxifen
hot flashes
inc risk for what with tamoxifen
endometrial cancer and DVT
flaty velvety wart like lesion
condyloma lata- secondary syphilis
lichen sclerosis
white thin and wrinkled skin over labia
elderly and have pruritis
vulvar lichen planus
middle aged women
hyperkeratotic erosive papulosquamous
pruritis, soreness and vaginal discharge
important factor for invasive ductal carcinoma
HER2neu
how to detect her2neu
FISH or immunohistochemical staining
what chemo is effective against her2neu+
trastuzumab and anthracycline
hormone levels of LH and FSH in PCOS
excess LH
little FSH
injury to pelvic floor muscles cna result in what
urethral hypermobility and urethral prolpase
get stress incontinence
cystocele
Dx test for urethral hypermobility
Q tip test checking the angle
Tx for stress incontinence
kegel exercises
urethral sling
boggy tender uniformly enlarged uterus
adenomyosis
initial workup if suspect adenomyosis
Pelvic US and MRI
definitive is with histo exam of uterus
bimanual and speculum shows dilated cervix with firm dark red round mass at os
prolapsing leimyoma uteri (fibroid)
most common Sx of submucous fibroid
heavy and prolonged menstrual bleeding
tx for woman with endometrial Bx showing complex hyperplasia without atypia
potent progestin to stop effects of estrogen
premature ovarian failure causes in women
chemo, radiation, autoimmune ovarian failure, turners, fragile X
hormone levels in premature ovarian failure
decreased Estrogen levels causing increased FSH and LH usuall FSH:LH >1
role of bhCG
maintenance of corpus luteum
cervical mucus in ovulatory phase
profuse, clear and thin
cervical mucus in post and pre ovulatory phase
scant opaque and thick
when is cervical mucus more basic
during ovulation >6.5
what stimulates prolactin
TRH and serotonin and GnRH
medications that cuase high prolactin
antipsychotics, TCAs and MAOIs
unilateral bloody nipple discharge
intraductal papilloma
first step for workup of bloody nipple discharge of breast unilaterally
mammo to rule out carcinoma
next step to identify fibroids causing stress incontinence
US of pelvis
posterior acoustic enhavement of breast mass
fluid
aspiration of breast mass revealed clear fluid and mass disappeared. next step
return 2-4 months for follow up clinical breast exam
what is the reason for amenorrhea in crazy athlete
estrogen deficiency
hormones in female olympic athletes
decreased LH and GnRH
estrogen deficiency
most efficient emergency contraceptive
copper IUD
risk of amenorrhea from HPO axis suppression from extreme weight loss or exercise
decreased bone mineral density
first step for determining infertility
semen analysis
which side is more common for ovarian torsion
right
risk factors for ovarian torsion
pregnancy, ovulation induction for infertility, ovarian masses
Dx ovarian torsion
color doppler
antibiotics for lactational mastitis
dicloxacillin or cephalexin
first line test to assess fallopian tube patency
hysterosalpingogram
risk of PID later for pregnancy
fallopian tube scaring
obesity cause of infertiliy
anovulation from not enough progesterone
Tx for vaginismus
kegel exercises and gradual dilatation
first step for breast mass- non malignant like but patient has +FMH breast cancer
US
if breast US shows complex cyst or solid mass, next step
image guided core biopsy
OCP increase risk for what cancer
cervical
what liver disorder do OCP increase risk for
hepatic adenoma
heavy menses in young patient with first year of menses
anovulation
patient with new onset night sweats, insomnia and irregular menses.
in middle aged
check TSH and FSH
pagets is associated with what breast cancer
adenocarcinoma
chocolate appearing material in ovarian cyst
old blood
endometrioma
gold standard Dx endometriosis
laparoscopy
patient with high grade squamous epithelial lesion on cervix and is pregnant
repeat pap and colpo after delivery
when do you do a LEEP procedure
when >25 and have HGSIL of cervix
unless post menopausal or pregnant
common cause heavy menstrual bleeding
fibroids
proliferation smooth muscle in myometrium
what significantly decreases risk of ovarian CA in BRCA + patients
prophylactic BSO
ulcer in syphlis
painless that forms punched out base with raised indurated margins
non modifiable breast cancer risk factors
genetic mutation in first degree relative
swhite
>50 years old
early menarche or later menopause
Dx fibroids
pelvic US
normal increase bhCG in pregnancy
increase every 2 days
infertility definition in women >35 years old
trying for 6+ months
how to assess infertility due to aging
early follicular phase GSH level, clomiphene challenge test
inhibin B level
what increases risk for clear cell adenocarcinoma of vagina and cervix
in utero exposure to DES
males exposed inutero to DES
microphallus
cyrptorchidism
hypospadias
testicular hypoplasia
side effect tamoxifen
hyperplasia endometrium
21-24 year old with atypical squamous cells of undetermined significance on pap
next step
repeat cytology in 1 year
birth control for woman undergoing chemo for breast cancer
copper IUD
common side effet of OCPs
worsening HTN
5 alpha reductase deficiency
cannot convert testosterone to DHES
abiguous genitalia at birth
male internal urogenital tract from AMH
mullerian agenesis
no upper vagina, cervix or uterus otherwise notmal female developmen
normal pubic and axillary hair
female testosterone levels
what is HELPP
systemic inflammation and platelet consumption
next step in HELPP
delivery
Mg
anti HTN
suspect lichen sclerosis, next step
vulvar punch biopsy
risk with lichen sclerosis
vulvar squamous cell carcinoma
Tx lichen sclerosis
topical corticosteroids
need to do what before starting herceptin Tx
echo because risk of cardiotoxicity especially in those with low EF
best chance for pregnancy with premature ovarian failure
in vitro fertilizaiton using donor oocytes
CI to raloxifene and tamoxifen
VTE disorders like PE, DVT and retinal vein thrombosis
msot common Sx vaginal CA
vaginal bleeding and malodorous vaginal discharge
fat necrosis of the breast
fixed mass with skin or niple retraction and gives calcifications in spiculated pattern on mammo
fat globules and foamy macrophages on Bx
how does clomiphene work
estrogen analog that imporves GnRH release and RSH release improving chance of ovulation
when is HPV screening started
> 30
when to stop paps
> 65 if previous negative screens
