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OB-GYN > GYNE > Flashcards

GYNE Flashcards

1
Q

In utero diethylstilbestrol (DES) exposure is associated with what malignancy of the cervix?

A

Clear cell carcinoma of the cervix (usually in women

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2
Q

What is the most common tumor found on the vulva?

A

Epidermal inclusion cyst, usually from occlusion of a pilosebaceous duct or a blocked hair follicle

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3
Q

What is the common denominator of the risk factors for endometrial hyperplasia?

A 
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)
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4
Q

What is the most common Mullerian anomaly, and what is its most common complication in pregnancy?

A

Septate uterus, recurrent first trimester loss

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5
Q

An ovarian cyst of what size is concerning for torsion?

A

> 4cm

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6
Q

Differentiate endometriosis from adenomyosis.

A

Endometriosis: ectopic endometrial tissue (most common sites ovary, pelvic peritoneum)
Adenomyosis: endometrial tissue invading the uterine myometrium

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7
Q

Bacterial vaginosis

A

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

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8
Q

Trichomoniasis

A

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

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9
Q

Genital herpes

A

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

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10
Q

Gonorrhea

A

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)

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11
Q

What is primary amenorrhea?

A

Absence of menarche by 16 years old or 4 years after thelarche

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12
Q

Normal menstrual cycle

A

Every 21-35 days, lasting 3-5 days, 30-50ml blood loss

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13
Q

What are the patterns of abnormal uterine bleeding?

A

PALM-COEIN.
PALM structural causes: polyps, adenomyosis, leiomyomas, malignancy/hyperplasia.
COEIN nonstructural causes: coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

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14
Q

Define menorrhagia, metrorrhagia, menometrorrhagia, oligomenorrhea and polymenorrhea.

A

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

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15
Q

What is the most common cause of postmenopausal bleeding?

A

Endometrial or vaginal atrophy.

NOT cancer!!!

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16
Q

When should cervical cancer screening start and how often should it be done?

A

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

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17
Q

When can cervical cancer screening be discontinued?

A

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.

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18
Q

Management of CIN I, II, III

A

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

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19
Q

How is cervical cancer diagnosed?

A

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.

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20
Q

How is cervical cancer staged?

A

Cervical cancer is the only gynecologic cancer that is still CLINICALLY STAGED. The others are surgically staged.

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21
Q

Chlamydia

A

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

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22
Q

Chancroid

A

Etio: Haemophilus ducreyi

23
Q

Condyloma acuminata

A

Etio: HPV 6 and 11

24
Q

Molluscum contagiosum

A

Etio: pox virus

25
Q

Crabs

A

Etio: Phthirus pubis

26
Q

Scabies

A

Etio: Sarcoptes scabiei

27
Q

Candidiasis

A

Etio: Candida albicans

28
Q

Urinary tract infection

A

Tx: TMP-SMX, Nitrofurantoin or a fluoroquinolone for 3-7d

29
Q

Smoking in gynecolgic malignancy

A

Increases risk of vulvar, vaginal and cervical cancer
Decreases risk of endometrial cancer (because it increases hepatic metabolism of estrogen)
Possibly increases risk of molar pregnancy

30
Q

Effect of combination OCPs on gynecologic malignancy

A

Decreases risk of endometrial cancer (protection conferred lasts 15 years after discontinuation) and ovarian cancer (suppresses ovulation)

31
Q

What is the most common gynecologic cancer and what is its most common type?

A

Endometrial cancer, endometriod adenocarcinoma (80%)

32
Q

What are the four origins of ovarian tumors and which is the most conmon?

A

Surface epithelial cell tumors (most common, 65% of all ovarian tumors and 90% of all ovarian cancer), germ cell tumors, sex cord-stromal tumors, metastatic tumors

33
Q

What is the most common malignant epithelial tumor of the ovary?

A

Serous cystadenocarcinoma of the ovary (large, cystic, and usually bilateral)

34
Q

Conditions associated with elevated CA-125

A

Gyne: epithelial ovarian CA, fallopian tube CA, endometrial CA, endocervical CA, normal/ectopic pregnancy, endometriosis, leiomyoma, PID
Non-Gyne: pancreatic, lung, breast, colon CA, pancreatitis, cirrhosis, peritonitis, recent laparotomy

35
Q

What is the most common type of germ cell tumor?

A

Dermoid cyst overall. If malignant, dysgerminoma (50%)

36
Q

Most common ovarian malignancy in women

A

Germ cell tumors

37
Q

Management of germ cell tumors

A

Benign germ cell tumors: ovarian cystectomy or oophorectomy

Germ cell cancer: unilateral salpingooophorectomy if fertility still desired; if bilateral and not desirous for pregnancy, TAHBSO. All require adjuvant chemo (bleomycin, etoposide, cisplatin) EXCEPT stage Ia dysgerminoma and immature teratomas.

38
Q

Most common sex cord-stromal tumor and its characteristics

A

Granulosa-theca cell tumors (70%).
Slow growing. Produces estrogen and inhibin A/B; coffee bean nuclei; Call-Exner bodies (pathognomonic). Can cause endometrial hyperplasia due to estrogen stimulation.

39
Q

The triad of ovarian tumor, ascites, and right hydrothorax is known as

A

Meigs Syndrome

40
Q

Management of sex cord stromal tumors

A

Unilateral salpingooophorectomy or TAHBSO

41
Q

What is Latzko’s Triad?

A

Profuse watery discharge, pelvic pain, and pelvic mass. Pathognomonic for fallopian tube CA

42
Q

Managemt of ovarian epithelial tumors

A

TAHBSO, omentectomy, cytoreduction, bilateral pelvic and paraaortic lymph node sampling. Frequently recurs, so also need adjuvant chemotherapy (Cisplatin + Taxol)

43
Q

Tumor markers in germ cell cancers

A

LDH - dysgerminoma
hCG - choriocarcinoma
AFP - endodermal sinus/yolk sac tumor
AFP + hCG - embryonal carcinoma (encompasses the previous 2)

44
Q

Four major classifications of gestational trophoblastic disease (GTD)

A

Molar pregnancy (80%), persistent/invasive moles (10-15%), choriocarcinoma (2-5%), placental site trophoblastic tumor (PSTT, very rare)

45
Q

What is the most curable gynecologic malignancy?

A

Gestational trophoblastic disease (extremely sensitive to chemotherapy)

46
Q

In the absence of chronic hypertension, preeclampsia occurring prior to 20wks AOG is pathognomonic of what condition?

A

Molar pregnancy

47
Q

Management of molar pregnancy (complete or incomplete mole)

A

Dilation and curettage.
Follow up: serum hCG monitoring - 48 hr after evac, weekly until negative for 3 weeks. Then monthly for 6 months. Average time for normalization is 14 weeks for complete mole, 8 weeks for incomplete mole

48
Q

Diagnosis of complete mole

A

Sx: irreg/heavy vaginal bleeding in pregnancy, hyperemesis gravidarum, preeclampsia before 20wks AOG, hyperthyroidism
PE: uterine size larger than AOG, no FHT, theca lutein cysts
Dx: serum hCG >100,000 mIU/ml, confirm by pelvic UTZ (snowstorm pattern), bilateral theca lutein cysts. Definitive dx patho exam of intrauterine tissue (grape-like vesicles filling uterus in the absence of fetus villi)
Tx: dilation and curettage

49
Q

Diagnosis of incomplete mole

A

Sx: like a normal pregnancy, but usually vaginal bleeding in late first or early second trimester (spontaneous abortion of triploid karyotype fetus)
PE: size less than dates
Dx: pelvic UTZ shows fetus with multiple anomalies and IUGR, reduced AF, Swiss-cheese intrauterine tissue. Definitive dx is patho exam

50
Q

Treatment for malignant GTD (persistent/invasive mole)

A

Non-mets: single agent chemo with methotrexate or actinomycin D
Mets, low risk: same as non-mets
Mets, high risk: multiagent chemo

51
Q

What is the only GTD not sensitive to chemotherapy?

A

Placental site trophoblastic tumor (extremely rare), treated with hysterectomy and adjuvant chemo.
Has high levels of hPL

52
Q

Which gynecologic malignancy is known as “the great imitator”?

A

Choriocarcinoma

53
Q

Diagnosis and management of choriocarcinoma

A

Sx: late postpartum bleeding, irreg bleeding years after pregnancy
Dx: pelvic UTZ uterine mass with hemorrhage and necrosis, CXR or chest CT/MRI may show mets
Tx: nonmets or good prognosis, single agent chemo; poor prognosis, multiagent chemo

OB-GYN (2 decks)

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