GYNE Flashcards
In utero diethylstilbestrol (DES) exposure is associated with what malignancy of the cervix?
Clear cell carcinoma of the cervix (usually in women
What is the most common tumor found on the vulva?
Epidermal inclusion cyst, usually from occlusion of a pilosebaceous duct or a blocked hair follicle
What is the common denominator of the risk factors for endometrial hyperplasia?
Unopposed estrogen stimulation. Risk factors mnemonic: ENDOMETRIUM Excess exogenous estrogen use w/o progesterone Nulliparity Diabetes mellitus Obesity Menstrual irregularity Elevated BP Tamoxifen use Rectal cancer Infertility history Unopposed estrogen Menopause late (>55 yo)
What is the most common Mullerian anomaly, and what is its most common complication in pregnancy?
Septate uterus, recurrent first trimester loss
An ovarian cyst of what size is concerning for torsion?
> 4cm
Differentiate endometriosis from adenomyosis.
Endometriosis: ectopic endometrial tissue (most common sites ovary, pelvic peritoneum)
Adenomyosis: endometrial tissue invading the uterine myometrium
Bacterial vaginosis
Etio: polymicrobial; most common organism present is Gardnerella vaginalis
Sx: profuse non-irritating discharge with malodorous fishy amine odor
Dx: 3 of the ff: thin white homogeneous discharge coating vaginal walls, (+) whiff test, pH >4.5, clue cells on microscopic exam
Tx: metronidazole 500mg BID x 7d or Clindamycin 300mg BID x 7d
Trichomoniasis
Sx: yellow-green frothy malodorous discharge, strawberry cervix, vulvar erythema/edema/pruritus
Dx: flagellated motile T. vaginalis on wet mount
Tx: metronidazole 2g once. If recurrent, metronidazole 500mg BID x 7d. If still persistent, Tinidazole/Metronidazole 2g x 5d, consult with specialist and T vaginalis susceptibility
Genital herpes
Etio: majority HSV-2 BUT 80% of primary infection is HSV-1
Sx: multiple vesicles that evolve into painful genital ulcers
Dx: multinucleate giant cells on Tzanck smear, HSV IgG on serology
Tx: NO CURE. For primary infection, acyclovir 200mg 5x/d for 7-10d
Gonorrhea
Etio: Neisseria gonorrhea
Sx: mucopurulent cervicitis
Dx: NAAT (dx for both gonorrhea and chlamydia)
Tx: uncomplicated, Ceftriaxone 125mg IM once or Cefixime 400mg oral once. Also give Azithromycin 1g orally once or Doxycycline 100mg BID x 7d for Chlamydia coinfection (unless ruled out by NAAT)
What is primary amenorrhea?
Absence of menarche by 16 years old or 4 years after thelarche
Normal menstrual cycle
Every 21-35 days, lasting 3-5 days, 30-50ml blood loss
What are the patterns of abnormal uterine bleeding?
PALM-COEIN.
PALM structural causes: polyps, adenomyosis, leiomyomas, malignancy/hyperplasia.
COEIN nonstructural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified
Define menorrhagia, metrorrhagia, menometrorrhagia, oligomenorrhea and polymenorrhea.
Menorrhagia: regular menstrual cycle with excessive duration (>7d) or volume (>80ml).
Metrorrhagia: bleeding between regular cycles.
Menometrorrhagia: excessive or prolonged bleeding at irregular intervals.
Oligomenorrhea: periods >35d apart.
Polymenorrhea: regular periods
What is the most common cause of postmenopausal bleeding?
Endometrial or vaginal atrophy.
NOT cancer!!!
When should cervical cancer screening start and how often should it be done?
All women should begin cervical CA screening at age 21 regardless of risk factors, including age of onset of sexual activity.
21-29 yo: Pap smear every 3 years
30 above: Pap smear + HPV test then if both negative, every 5 yrs; if Pap smear alone, every 3 yrs
When can cervical cancer screening be discontinued?
Women over age 65-70, if they’ve had 3 or more consecutively normal Paps, haven’t had CIN II or higher in the past 20 yrs, or if a woman has had a TAH for benign indications and doesn’t have history of CIN II or higher.
Women with history of CIN II or III, s/p TAH, with 3 consecutive negative screening tests prior or after the TAH.
Management of CIN I, II, III
CIN I - repeat Pap every 6mo for 1 yr or high risk HPV screen in 1 yr, if persistent for 2 yrs, do LEEP (loop electrosurgical excision procedure).
CIN II - Same as CIN I for young women, LEEP for older
CIN III - LEEP
How is cervical cancer diagnosed?
By tissue biopsy. Pap smears are NOT sufficient to diagnose cancer! UTZ and CT scan may be done to confirm PE findings and define extent of disease.
How is cervical cancer staged?
Cervical cancer is the only gynecologic cancer that is still CLINICALLY STAGED. The others are surgically staged.
Chlamydia
Etio: Chlamydia trachomatis
Sx: usually asymptomatic. L-serotype causes lymphogranuloma venereum
Cx: PID, infertility, increased risk of ectopic pregnancy
Dx: NAAT
Tx: Azithromycin 1g oral single dose or Doxycycline 100mg BID x 7d
LGV: doxycycline 100mg BID x 3 weeks
