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Gynecology > Gynecological Diseases > Flashcards

Gynecological Diseases Flashcards

1
Q

What are premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD)? What are the symptoms?

A

PMS and PMDD begin when women are in their 20s and 30s. PMDD is a more severe version of PMS that will disrupt the pt’s daily activities.

Symptoms:

  • Headache
  • Breast tenderness
  • Pelvic pain and bloating
  • Irritability and lack of energy
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2
Q

What is the diagnostic criteria of PMDD?

A
  • Symptoms should be present for 2 consecutive cycles
  • Symptom-free period of 1 week in the first part of the cycle (follicular phase)
  • Symptoms must be present in the second half of the cycle (luteal phase)
  • Dysfunction in life
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3
Q

What is the treatment of PMS and PMDD?

A

Decrease consumption of caffeine, alcohol, cigarettes, and chocolate and should exercise. If symptoms are severe, use SSRIs.

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4
Q

What causes menopause? When does it occur? What is the first symptom? What happens on a hormonal level?

A

Menopause is the result of permanent loss of estrogen. It occurs in pts aged 48-52. It starts with irregular menstrual bleeding. The oocytes produce less estrogen and progesterone, and both LH and FSH start to rise.

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5
Q

What are the symptoms of menopause? How long do they last?

A
  • Menstrual irregularity
  • Sweats and hot flashes
  • Mood changes
  • Dyspareunia (pain during intercourse)

Symptoms usually last for an average of 12 months, but some women can experience symptoms for years.

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6
Q

What are the physical exam findings for menopause?

A
  • Atrophic vaginitis
  • Decrease in breast size
  • Vaginal and cervical atrophy
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7
Q

What is the diagnostic test for menopause? How is it treated?

A

Increased FSH is diagnostic.

Hormone replacement therapy (HRT) is short-term symptomatic relief (estrogen is given for hot flashes) as well as the prevention of osteoporosis.

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8
Q

What are the complications of hormone replacement therapy? What are the contraindications?

A

HRT is associated with endometrial hyperplasia and endometrial carcinoma.

Contraindications:

  • Estrogen-dependent carcinoma (breast or endometrial cancer)
  • History of pulmonary embolism or DVT
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9
Q

What are the types of abnormal uterine bleeding?

A
  • Menorrhagia
  • Hypomenorrhea
  • Metrorrhagia
  • Menometrorrhagia
  • Oligomenorrhea
  • Postcoital bleeding
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10
Q

What are the characteristics of menorrhagia?

A
  • Heavy and prolonged menstrual bleeding
  • “Gushing” of blood
  • Clots may be seen
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11
Q

What are the causes of menorrhagia?

A
  • Endometrial hyperplasia
  • Uterine fibroids
  • Dysfunctional uterine bleeding
  • Intrauterine device
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12
Q

What are the characteristics of hypomenorrhea?

A
  • Light menstrual flow

- May only have spotting

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13
Q

What are the causes of hypomenorrhea?

A
  • Obstruction (hymen, cervical stenosis)

- Oral contraceptive pills

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14
Q

What are the characteristics of metrorrhagia?

A

Intermenstrual bleeding

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15
Q

What are the causes of metrorrhagia?

A
  • Endometrial polyps
  • Endometrial/cervical cancer
  • Exogenous estrogen administration
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16
Q

What are the characteristics of menometrorrhagia?

A

Irregular bleeding in terms of:

  • time intervals
  • duration
  • amount of bleeding
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17
Q

What are the causes of menometrorrhagia?

A
  • Endometrial polyps
  • Endometrial/cervical cancer
  • Exogenous estrogen administration
  • Malignant tumors
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18
Q

What are the characteristics of oligomenorrhea?

A

Menstrual cycles > 35 days long

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19
Q

What are the causes of oligomenorrhea?

A
  • Pregnancy
  • Menopause
  • Significant weight loss (anorexia)
  • Tumor secreting estrogen
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20
Q

What are the characteristics of postcoital bleeding?

A

Bleeding after intercourse

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21
Q

What are the causes of postcoital bleeding?

A
  • Cervical cancer
  • Cervical polyps
  • Atrophic vaginitis
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22
Q

What diagnostic tests are done for abnormal uterine bleeding?

A
  • CBC to see if hemoglobin and hematocrit have dropped
  • PT/PTT to evaluate for coagulation disorder
  • Pelvic ultrasound to visualize any anatomical abnormality
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22
Q

Why does anovulation cause dysfunctional uterine bleeding?

A

The ovary produces estrogen, but no corpus luteum is formed. Without the corpus luteum, progesterone is not produced, which prevents the usual withdrawal bleeding. The continuously high estrogen continues to stimulate growth of the endometrium. Bleeding occurs only once the endometrium outgrows the blood supply.

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23
Q

How is dysfunctional uterine bleeding diagnosed?

A

There is no specific test for DUB, so:

  • Rule out systemic causes of anovulation, such as hypothyroidism and hyperprolactinemia.
  • Endometrial biopsy must be done in women over 35 to rule out endometrial carcinoma.
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24
Q

What is the treatment of dysfunctional uterine bleeding?

A

Oral contraceptive pills for:

  • Adolescents and young women who are anovulatory
  • Women over 35 who have a normal endometrial biopsy

For acute hemorrhage, D&C is done to stop the bleeding.

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25
Q

How is dysfunctional uterine bleeding treated if patients have anemia, are not controlled with OCPs, or report that their lifestyle is compromised?

A

Endometrial ablation or hysterectomy

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26
Q

Do female condoms protect against disease?

A

Yes, they offer some protection against HIV and STDs.

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27
Q

Does a vaginal diaphragm without the jelly?

A

No; the diaphragm is ineffective without the contraceptive jelly.

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28
Q

When do you insert a vaginal diaphragm and when do you remove it?

A

Insert it 6 hours before intercourse and remove it 6 hours after intercourse.

29
Q

What are the disadvantages of using a vaginal diaphragm?

A
  • Need to be fitted properly (can change with weight or pregnancies)
  • Proper use of a diaphragm requires advance preparation
  • Improper placement or dislodging of diaphragm reduces efficacy
30
Q

What are OCPs comprised of? How are they taken?

A

Most commonly a combo of progesterone and estrogen.

The pill is taken for 21 days then a placebo is taken for 7 days during menstruation.

31
Q

What are the benefits of OCPs? What is the disadvantage?

A

OCPs reduce the risk of ovarian carcinoma, endometrial carcinoma, and ectopic pregnancy.

OCPs slightly increase the risk of thromboembolism.

32
Q

How does a vaginal ring work? How does it compare to OCPs in benefits and efficacy?

A

A vaginal ring is inserted into the vagina for 3 weeks; it releases both estrogen and progesterone on a constant basis. When the ring is removed, withdrawal bleeding will occur.

The vaginal ring has similar side effects and efficacy to OCPs.

33
Q

How does a transdermal patch work? How does it compare to OCPs in benefits and efficacy?

A

A transdermal patch is a combo of estrogen and progesterone, applied for 7 days. At the end of the week, a new one is placed. 3 weeks of patches is followed by one week without patches, during which the pt will experience withdrawal bleeding.

The side effects and efficacy are similar to OCPs.

34
Q

What is the option form IM injection for contraception? For how long is it effective?

A

Depot medroxyprogesterone acetate is an IM injection at is effective for 3 months.

35
Q

What are the two types of IUDs used for contraception? How long do they last for? What must be done before placement? What is the major complication?

A

The two types are copper and levonorgestrel. The IUD is implanted in the uterus and provides contraception for 10 years. Genital cultures must be done before placement.

The major complication is pelvic inflammatory disease when the IUD is placed.

36
Q

What are the surgical sterilization options for men and women? Are there any complications?

A

Women: Tubal ligation; the risk of pregnancy is low, but if it occurs, there is an increased incidence of ectopic pregnancy.

Men: Vasectomy (ligation of the vas deferens)

37
Q

What causes labial fusion? What is the MCC? What is the treatment?

A

Labial fusion occurs when excess androgens are present. This can occur with extraneous androgen administration or by increased androgen production. The MCC is 21-B hydroxylase deficiency.

The treatment is reconstructive surgery.

38
Q

Describe lichen sclerosis. What age group is typically affected? What is the treatment?

A

White, thin skin extending from the labia to the perianal area. Any age can be affected; however, if postmenopausal, there is an increased risk of cancer.

Treatment is topical steroids.

39
Q

Describe squamous cell hyperplasia. What age group is typically affected? What is the treatment?

A

Patients with chronic irritation develop hyperkeratosis (raised white lesion). It can happen at any age, esp. in pts who have had chronic vulvar pruritis.

Treatment is with sitz baths or lubricants to relieve the pruritis.

40
Q

Describe lichen planus. What age group is typically affected? What is the treatment?

A

Violet, flat papules. It happens to pts in their 30s-60s.

Treatment is topical steroids.

41
Q

Where are Bartholin glands located? What are the symptoms of a Bartholin gland cyst? What is seen on PE?

A

The glands are located on the lateral sides of the vulva. The secrete mucus and can become obstructed, leading to a cyst or abscess that causes pain, tenderness, and dyspareunia. PE shows edema and inflammation of the area with deep fluctuant mass.

42
Q

What is the treatment of Bartholin gland cysts?

A

Incision and drainage. During I&D, the fluid released should be cultured for STDs.

If cysts continue to recur, then marsupialization should be done. Marsupialization is a form of I&D in which the open space is kept open with sutures, allowing the space to remain open, which decreases the risk of a recurrence.

43
Q

What are the risk factors for vaginitis?

A

RFs include anything that increases the vaginal pH, such as:

  • Antibiotic use (Lactobacillus normally keeps the pH below 4.5)
  • Diabetes
  • Overgrowth of normal flora
44
Q

What are the symptoms of vaginitis?

A

Itching, pain, abnormal odor, and discharge.

45
Q

What are the three types of vaginitis? What pathogen is associated with each?

A

Bacterial vaginosis - Gardnerella
Candidiasis - Candida albicans
Trichomonas - Trichomonas vaginalis

46
Q

What are the distinct symptoms of bacterial vaginosis? How is the diagnosis made? What is the treatment?

A

Sx: Grey-white vaginal discharge with fishy odor
Dx: Saline wet mount shows clue cells
Rx: Metronidazole or clindamycin

47
Q

What are the distinct symptoms of candidiasis? How is the diagnosis made? What is the treatment?

A

Sx: White, cheesy vaginal discharge
Dx: KOH prep shows pseudohyphae
Rx: Miconazole or clotrimazole, econazole, or nystatin

48
Q

What are the distinct symptoms of trichomonas? How is the diagnosis made? What is the treatment?

A

Sx: Profuse, green frothy vaginal discharge
Dx: Saline wet mount shows motile flagellates
Rx: Treat both pt AND partner with metronidazole

49
Q

What is the most common nonviral STD?

A

Trichomonas vaginalis

50
Q

Who is the typical pt in Paget’s disease? What is the presentation?

A

Paget disease is an intraepithelial neoplasia that most commonly occurs in postmenopausal white women.

It presents as a red lesion with a superficial white coating with symptoms of vaginal soreness and pruritis.

51
Q

How is Paget disease diagnosed? How is it treated?

A

Dx: Biopsy
Rx: Radical vulvectomy for bilateral lesion; modified vulvectomy for unilateral lesion.

52
Q

What is the most common type of vulvar cancer?

A

Squamous cell carcinoma

53
Q

What are the symptoms of squamous cell carcinoma of the vulva? What is seen on PE?

A

Sx: Pruritis, bloody vaginal discharge, and postmenopausal bleeding

PE: Ranges from a small ulcerated lesion to a large cauliflowerlike lesion

54
Q

How is SCC of the vulva diagnosed? How is it staged?

A

Dx: Biopsy

Staging:
0 - Carcinoma in situ
I - Limited to vaginal wall 2 cm
III - Tumor spreading to lower urethra or anus, unilateral lymph nodes present
IV - Tumor invasion into bladder, rectum, or bilateral lymph nodes
IVa - Distant metastasis

55
Q

How is SCC of the vulva treated?

A
  • Unilateral lesions without lymph node involvement: Modified radical vulvectomy
  • Bilateral involvement: Radical vulvectomy
  • Lymph nodes involved: Lymphadenectomy
56
Q

When do women typically get adenomyosis? What are the risk factors?

A

Between the ages of 35-50.

RFs:

  • Endometriosis
  • Uterine fibroids
57
Q

What is the presentation of adenomyosis?

A

Sx: Dysmenorrhea and menorrhagia

PE: Uterus is large, globular and boggy

58
Q

What is the most accurate test for adenomyosis? What is the treatment?

A

MRI is the most accurate test.

Hysterectomy is the only definitive treatment. It is also the only way to diagnose adenomyosis definitively.

59
Q

What are the most common sites of implantation in endometriosis? What is the typical age of pts with endometriosis?

A

The ovary and pelvic perineum are the most common sites.

EM occurs in women of reproductive age and is more common if a first-degree relative (mother or sister) has it.

60
Q

What is the presentation of endometriosis?

A

Sx:

  • Cyclical pelvic pain that starts 1-2 weeks before menstruation and peaks 1-2 days before menstruation. The pain ends with menstruation.
  • Dysmenorrhea
  • Dyspareunia

PE: Nodular uterus and an adnexal mass.

61
Q

How is endometriosis diagnosed?

A

Visualization via laparoscopy is the only way to diagnose it. Direct visualization of the endometrial implants looks like rusty or dark brown lesions. On the ovary, a cluster of lesions called an endometrioma looks like a “chocolate cyst.”

62
Q

How is endometriosis with mild Sx treated?

A
  • Analgesia is done with NSAIDs.
  • Mild Sx: OCPs are used to interrupt the menstrual cycle and stop ovulation.
  • Moderate to severe Sx: Either danazol or leuprolide acetate is used; these are used to decrease FSH and LH.
63
Q

What are the adverse effects of danazol? Of leuprolide?

A

Danazol is an androgen derivative that is associated with acne, oily skin, weight gain, an hirsutism.

Leuprolide is a GnRH agonist and when given continuously suppresses estrogen. It is associated with hot flashes and decreased bone density.

64
Q

Is surgery an option for endometriosis?

A

Surgical treatment is considered for pts who have severe symptoms or are infertile. Surgery attempts to remove all of the endometrial implants and adhesions, as well as to restore pelvic anatomy.

Pts who have completed their childbearing may undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy.

65
Q

When does polycystic ovarian syndrome (POS) occur in women?

A

It occurs in women of reproductive age.

66
Q

What is the presentation of POS?

A
  • Amenorrhea or irregular menses
  • Hirsutism and obesity
  • Acne
  • Type 2 diabetes due to increased insulin resistance
67
Q

What blood tests are done for POS? What imaging study is used? What does each show?

A
  • Elevated free testosterone
  • Elevated LH and decreased FSH, with LH:FSH ratio > 3:1
  • Pelvic ultrasound will show bilaterally enlarged ovaries with multiple cysts present
68
Q

Explain the serum hormone findings in POS

A

Free testosterone will be elevated due to high androgens.the high androgen level and obesity lead to an increase in estrogen formation outside the ovary. This stimulates LH secretion while inhibiting FSH secretion, leading to an LH to FSH ratio > 3:1.

69
Q

What is the treatment of POS?

A
  • Weight loss decreases insulin resistance.
  • OCPs control the amounts of estrogen and progestin in the body. This both controls the androgen levels and prevents endometrial hyperplasia.
  • Clomiphene and metformin may be used in pts who wish to conceive.

Gynecology (1 decks)

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