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Womens Health EOR > Gynecology > Flashcards

Gynecology Flashcards

1
Q

What is primary amenorrhea?

A

the absense of menses by age 13 without pubertal development
OR
the absence of menses by age 15 regardless of pubertal development

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2
Q

What is secondary amenorrhea?

A

the absense of menses for 3 months with previously regular cycles
OR
the absense of menses for 6 months with previously irregular cycles

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3
Q

What is the MCC of secondary amenorrhea?

A

Pregnancy

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4
Q

What is the suspected etiology of amenorrhea in a patient with an elevated prolactin?

A

Prolactinoma
get a brain MRI

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5
Q

What is the suspected etiology of amenorrhea in a patient with low FSH?

A

HPA failure
OR
pubertal delay (athletes, anorexia)

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6
Q

What is the suspected etiology in a patient with high FSH?

A

Ovarian causes
(premature ovarian failure, turners syndrome)

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7
Q

How do you treat amenorrhea?

A

Treat the underlying cause
* No desire to be pregnant: OCPs
* Desires pregnancy: cyclic progesterone

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8
Q

What is abnormal/dysfunctional uterine bleeding?

A

Unexplained, abnormal bleeding in a non-pregnant women
MC > 40 years old

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9
Q

What are common causes of AUB?

A

PALM-COEIN
* Polyp
* Adenomyosis
* Leiomyoma
* Malignancy & hyperplasia
* Coagulopathy
* Ovarian dysfunction
* Endometrial
* Iatrogenis (IUDs)
* Not otherwise classified
MCC: anovulatory

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10
Q

What labs should be ordered for AUB?

A

CBC, TSH, iron studies, PT/PTT, progesterone, prolactin, FSH

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11
Q

What testing should be done for AUB?

A
  • Initial: TVUS
  • Gold standard: D&C
  • R/o CA: endometrial bx
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12
Q

How do you treat AUB?

A
  • Levonorgestrel-releasing IUD: most effective longterm tx
  • NSAIDs/tranexamic acid: unable/unwilling to use hormonal therapy
  • Definitive: hysterectomy
  • Acute hemorrhage: high-dose IV estrogen, COCs or oral progestins
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13
Q

What is dysmenorrhea?

A

Painful menstruation that affects normal activities

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13
Q

What is primary dysmenorrhea?

A

painful menses that begins within 12 months of menarche due to increased prostaglandins

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14
Q

What is secondary dysmenorrhea?

A
  • Painful menses due to another disorder
  • MCC: PID & endometriosis
  • MC in 20-30 year olds
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14
Q

What are symptoms of dysmenorrhea?

A

Recurrent, crampy midline lower abdominal pain or pelvic pain 1-2 days before or at the onset of menses & gradually decreases over 12-72 hours

HA, N/V/D, fatigue, malaise

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14
Q

How is dysmenorrhea diagnosed?

A

Clinically
TVUS helpful

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15
Q

How is dysmenorrhea treated?

A
  • NSAIDs: started prior to pain onset and taken for 2-3 days
  • Combined OCPs
  • Laproscopy: indicated if unresponsive to 3 cycles of inital treatment to rule out secondary causes
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16
Q

What is first line treatment for vasomotor symptoms of menopause?

A

HRT
* No uterus: estrogen only
* Uterus present: estrogen + progestin

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17
Q

What is second line for vasomotor symptoms of menopause?

A

SSRIs
* Paroxetine
* Escitalopram
* Venlafaxine

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18
Q

How do you treat osteoperosis in menopause?

A
  • Calcium & vitamin D supplements
  • Bisphosphonates (alendronate)
  • DEXA scan at 65 and every 2 years
  • SERMs (Raloxifene): alterntative to estrogen replacement in menopausal women at risk of osteoporosis
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19
Q

How do you treat vaginal dryness?

A
  • Topical vaginal estrogens
  • Vaginal mositurizers
  • Lubricant
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20
Q

How do you treat stress incontience?

A
  • Kegal exercises
  • Estrogen replacement (if due to menopause)
  • Sling procedure
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21
Q

How do you treat urge incontinence?

A
  • Bladder training, kegals
  • Mirabegron (Beta-3 agonist, least sx)
  • Oxybutyin (antimuscurinic)
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22
Q

What is premensutral syndrome?

A

recurrent physical and emotional symptoms that develop during the 5 days before the onset of menses and subside within 4 days after menstruation begins

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23
Q

What is premenstural dysphoric disorder?

A

Severe PMS with functional impairment when anger, irritablity and internal tension are prominent

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24
Q

What are symptoms of PMS and PMDD?

A

Bloating, weight gain, constipation, anxiety, breast tenderness, depression, cravings, irritablity, mood swings, anger

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25
Q

How is PMDD diagnosed?

A

DSM-5 criteria
* Sx occur during the last week of the luteal phase of most menstrual cycles during the previous 12 months and remit within a few days after the onset of menstruation
* Total of 5 symptoms needed

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26
Q

How are PMS and PMDD treated?

A
  • Conservative: diet & exercise
  • 1st line: SSRIs – Fluoxetine, sertralin
  • Pain/cramping: NSAIDs
  • Bloating: Spironolactone
  • w/ contraception: OCPs with drospierenone
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27
Q

What are gonorrhea and chlamydia?

A

Neisseria gonorrhea
* gram negative diplococci

Chlamydia trachomatis
* gram negative
* MCC of cervicitis

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28
Q

What are the symptoms of gonorrhea and chlamydia?

A

Mostly ASX
* Female: mucopurulent discharge, post-coital bleeding, friable cervix, urinary sx
* Male: dysuria, urethral discharge

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29
Q

How are gonorrhea and chlamydia diagnosed?

A

NAAT
* Annually screening recommended by the CDC in sexually active women

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30
Q

How are gonorrhea and chlamydia treated?

A

Pregnant
* Gonorrhea only or coinfxn: azithroymycin 1g PO & ceftriaxone 500 mg IM
* Chlamydia: azithromycin 1 g PO
* Test of cure 4 weeks after tx

Not-Pregnant
* Gonorrhea: ceftriaxone 500 mg IM
* Chlamydia: doxycycline 100 mg BID x 7 days
* Retesting 3 months after tx

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31
Q

What are symptoms of herpes simplex cervicitis?

A

Vulvar burning & pruritus preceded by multiple vesicles on an erythematous base
* flu-like sx, malaise, myalgias, N/D, fever

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32
Q

How is HSV cervicitis diagnosed?

A
  • Gold standard: viral culture
  • Tzanck smear: multinucleated giant cells
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33
Q

How is HSV cervicitis treated?

A
  • Primary: valacyclovir 1g BID x 10 days
    —–Alt. acyclovir 400 mg TID x 7-10 days
  • Recurrent: topical lido + valcyclovir
  • Supressive: 500 mg once daily
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34
Q

What is condylomata acuminata?

A

Anogenital warts
* MCC HPV types 6 & 11
* MC STI worldwide

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35
Q

What are symptoms of condylomata acuminata?

A
  • Flat, dome-shaped, verrucous, and cauliflower-shaped warts soft to palpation
  • Single or multiple, MC fleshy-colored but can vary
  • Pap smear: Koilocytic squamous epithelial cells in clumps
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36
Q

How is condylomata acuminata treated?

A

Self: imiquimod, podophyllotoxin
Office: trichloroacetic acid, cryotherapy, surgery

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37
Q

What is HPV cervicitis?

A

Human papilloma virus
* Types 16 & 18
* MCC of cervical cancer
* RF: IC + sexually active

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38
Q

What are symptoms of HPV cervicitis?

A

postcoital bleeding, dyspareunia, large amounts of unusal dyscharge

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39
Q

How is HPV cervicitis diagnosed?

A

White, sharply demarcated lesion of the cervix after acetic acid is applied
* HPV viral typing

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40
Q

How is HPV cervicitis treated?

A

Surgical excision
* LEEP

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41
Q

How can HPV be prevented?

A

Gardasil-9
* Ages 9-14: 2 doses at 0, 6-12 months
* > 15: 3 doses at 0, 2 and 6 months

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42
Q

What is trichomoniasis?

A

Trichomonas vaginalis
* flagellated protozoan
* sexually transmitted
* can affect fertility!

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43
Q

What are symptoms of trichomoniasis?

A

Frothy yellow-green discharge worse with menses
* itching, dysuria, post-coital bleeding
* men usually asx

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44
Q

What are physical exam findings of trichomoniasis?

A

Friable Cervix
* Strawberry cervix

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45
Q

How is trichomoniasis diagnosed?

A

Saline wet mount: flagellated motile trichomonads
* pH > 5

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46
Q

How is trichomoniasis treated?

A

Metronidazole
* Screen/treat partners
* Retest in 2 weeks
* Prevention: spermicidal agents

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47
Q

What is bacterial vaginosis?

A

Gardnerella vaginalis
* MCC of vaginitis
* Due to lack of lactobacilli
* Not sexually active, but MC in sexually active women with new/multiple partners

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48
Q

What are symptoms of bacterial vaginosis?

A

Thin, milky discharge with a fishy odor
* Worse after sex and during menses
* Vaginal pH > 4.5

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49
Q

How is bacterial vaginosis diagnosed?

A
  • Amine whiff test (KOH prep)
  • Clue cells on wet mount (most reliable)
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50
Q

How is bacterial vaginosis treated?

A

Metronidazole 500 mg BID x 7 days
* Alt: clindamycin

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51
Q

What is candidiasis?

A

Candida albicans
* RF: DM, steriods, pregnancy, recent abx use

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52
Q

What are symptoms of candidasis?

A

Thick, white, “cottage-cheese” discharge + itching
* Dyspareunia, beefy red vaginal mucosa

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53
Q

How is candidiasis diagnosed?

A

KOH: budding hyphae, yeast & spores

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54
Q

How is candidiasis treated?

A

Fluconazole 150mg PO x1

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55
Q

What is PID?

A

Ascending infection of the uterus, ovaries and fallopian tubes
* Mixed etiolgoy: chlamydia (MC), gonorrhoeae, BV

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56
Q

What are symptoms of PID?

A

Pelvic or lower abdominal pain, often bilateral and worse during sex
* abnormal vaginal discharge, fever, bleeding, N/V

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57
Q

What are physical exam findings of PID?

A

Cervical motion tenderness with chandelier sign

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58
Q

How is PID diagnosed?

A

Mostly clinical
* NAAT for chlamydia or gonorrhea

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59
Q

How is PID treated?

A
  • Outpatient: ceftriaxone + doxycycline + metronidazole
  • Inpatient (pregnant, severe): IV ceftoxin + doxycycline
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60
Q

What are complications of PID?

A
  • Chronic pelvic pain due to adhesions
  • infertility
  • tubo-ovarian abscess
  • ectopic pregnancy
  • Fitz Hugh-Curtis syndrome
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61
Q

What is chancroid?

A

Haemophilus ducreyi
* Painful anogenital ulcers
* gram negative coccobacillus
* sexually transmitted
* MC in undeveloped countaries

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62
Q

What are symptoms of chancroid?

A

Tender erythematous papules with a ragged border and purulent base that become pustules then painful ulcers with soft irregular margins
* Marked unilateral inguinal lymphadenopathy
* In women: dysuria, dyspareunia, abnormal discharge, rectal bleeding, painful defecation

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63
Q

How is chancroid diagnosed?

A
  • Rule out other causes: RPR/VDRL, PCR
  • Gram stain
  • Chocolate agar culture
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64
Q

How is Chancroid treated?

A

Ceftriaxone 250mg IM x 1
OR
Azithromycin 1g PO x1

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65
Q

What is lymphogranuloma venereum?

A

Painless genital ulcer
* Due to chlamydia trachomatis, esp. serotypes L1, L2, and L3
* MC in undeveloped countries (tropical areas)

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66
Q

What are symptoms of lymphogranuloma venereum?

A

3 stages
1. painless genital ulcers or papules
2. unilateral or bilateral tender inguinal and/or femoral lymphadenopathy (buboes)
3. strictures, fibrosis, and fistulae of the anogenital area

67
Q

How is lymphogranuloma venereum diagnosed?

A

NAAT
* Rule out other causes

68
Q

How is Lymphogranuloma venereum treated?

A

Doxycycline 100 mg PO BID x 21 days
* Alt. erythromycin 500 mg PO QID x 21 days
* +/- I&D

69
Q

What is syphilis?

A

Treponema pallidum

70
Q

What are symptoms of syphilis?

A

3 stages following a 3 week incubation period
1. painless genital ulcer (chancre) for 3 to 6 weeks
2. nonpruritic maculopapular rash on palms and soles or condyloma latum (painless, flat, gray, wart-like lesions), lymphadenopathy, fatigue/malaise for 2 to 6 weeks
3. major vessel changes, neurosyphilis, gummas (painless, soft, tumor-like masses that can form in the skin, bones, liver, or any other organ)

71
Q

How is syphilis diagnosed?

A

RPR/VDRL confirmed by the treponemal antibody-absorption test (FTA-ABS)

72
Q

How is syphilis treated?

A

Pen G IM

73
Q

What is the most common type of breast cancer?

A

Infiltrating ductal carcinoma

74
Q

What are symptoms of breast cancer?

A

Hard, nontender, immobile breast mass with irregular boarders
* Pagets (ductal CA): eczematous nipple lesion
* Inflammatory: peau d’orange

75
Q

How is breast cancer diagnosed?

A

Inital test:
* > 40: mammogram: group microcalcification & spiculated high-density masses
* < 40: ultrasound
Initial procedure: large needle core bx

76
Q

How is breat cancer treated?

A
  • Early stages I, IIA, IIB: lumpectomy + receptor tx if needed
  • Stages IIB-IIIA & triple negative: chemo then surgery, then radiation
  • Stage IV (metastatic): pallative care
77
Q

Medications for estrogen receptor + breast cancer

A
  • Premenopause: Tamoxifen
  • Postmenopausal: Letrozole, anastrozole
78
Q

Medications for HER2+ breast cancer

A

Trastuzumab after surgical excision + chemo

79
Q

What are the screening recommendations for breast cancer?

A

Mammogram every 2 years for women 50-74 years old

80
Q

What is the MC type of cervical cancer?

A

Squamous Cell Carcinoma

81
Q

What is the most important risk factor for cervical cancer?

A

HPV, primarily types 16 & 18 but also 31 & 33

82
Q

What are symptoms of cervical cancer?

A
  • Early: post-coital bleeding
  • Late: back pain, anorexia, weight loss
83
Q

How is cervical cancer diagnosed?

A
  • Friable, bleeding cervical lesion on exam
  • Biopsy and colposcopy definitive
84
Q

How is cervical cancer treated?

A

Resect and/or chemotherapy and radiation
* Stage 1: conservative, simple, or radical hysterectomy
* Stage 2 +: chemo +/– radiation

85
Q

What are the cervical cancer screening guidelines?

A
  • 21-29: pap q3yrs
  • 30-65: pap + HPV q5yrs
  • > 65 or hystrectomy: no screening
86
Q

What follow-up testing is required for a cervical pap histology of ASC-US or LSIL?

A

HPV testing
* positive & > 25: colposcopy
* negative or < 25: retest in 1 year

87
Q

What follow-up testing is required for a cervical pap histology of HSIL?

A

Colposcopy
* Outside cervix – LEEP or cryotherapy
* Inside cervix – cone biopsy

88
Q

How can cervical cancer be prevented?

A

HPV vaccine

89
Q

What is endometrial cancer?

A
  • MC gyn cancer in the US
  • MC type: adenocarcinoma
  • MC in postmenopausal women
90
Q

What are risk factors for endometrial cancer?

A
  • Age
  • Lynch syndrome
  • PCOS
  • Tamoxifen
91
Q

What is a protective factor against endometrial and ovarian cancer?

A

Combined estrogen + progestin

92
Q

What are symptoms of endometrial cancer?

A

heavy, prolonged, frequent menses or postmenopausal bleeding

93
Q

How is endometrial cancer diagnosed?

A

Initial: TVUS - thickened enometrial stripe > 4 mm
Definitive: endometrial bx

94
Q

How is endometrial cancer treated?

A
  • Stage 1: TAH-BSO
  • Stage 2: TAH-BSO + lymph node excision + radiation
  • All others: TAH-BSO + lymph node excision + radiation + chemo
95
Q

What are the types of ovarian cancer?

A

Most deadly gyn cancer
* Epithelial (MC): > 50 years old
* Stromal: any age
* Germ cell: ages 15-19

96
Q

What are symptoms of ovarian cancer?

A

ASX until late disease
* pain, bloating, earily satiety, anorexia, weight loss

97
Q

What are physical exam findings of ovarian cancer?

A

Palpable abdominal/ovarian mass
* solid, fixed, irregular
* ascities

98
Q

How is ovarian cancer diagnosed?

A

Initial: TVUS
Labs: CA-125, AFP, LHD, hCG, testosterone

99
Q

How is ovarian cancer treated?

A
  • Stage I: TAH-BSO + selective lymphadenectomy & omentectomy
  • Stages II-TV: surgical removal followed by chemo
  • Monitoring: serum CA-125
100
Q

What is the MC type of vaginal and vulvar cancers?

A

Squamous cell carcinoma

101
Q

What are risk factors for vaginal and vulvar cancer?

A
  • HPV subtypes 16, 18 & 31
  • Smoking
102
Q

What are symptoms of vaginal cancer?

A
  • MC 60-65 years old
  • Usually secondary to another cancer
  • Changes in menstration, abnormal vaginal bleeding
103
Q

How is vaginal cancer diagnosed?

A

Direct visualization of lesion/mass/plaque/ulcer on the upper 1/3 of the posterior vaginal wall (MC site)

104
Q

How is vaginal cancer treated?

A

Radiation

105
Q

What are symptoms of vulvar cancer?

A
  • Peak incidence at 50 years old
  • Single pruritic lesion on labia majora (MC site)
  • Pagets: red and white ulcerative lesions
106
Q

How is vulvar cancer diagnosed?

A

Bx & histology
* Acetic acid or staining with toluidine blue may help direct optimal biopsy location

107
Q

How is vulvar cancer treated?

A

Vulvectomy and lymph node dissection
* Pagets: Local resection

108
Q

What is a breast abscess?

A

local pus collection in breast tissue
* MCC: staph aureus
* MC in primigravida breastfeeding

109
Q

What are symptoms of a breast abscess?

A

Unilateral painful inflammation of breast
* +/- fever, malaise

110
Q

What are physical exam findings of a breast abscess?

A

Unilateral tender indurated fluctuant mass

111
Q

How do you diagnosis a breast abscess?

A

Mostly clinical
* US to clarify cellulitis vs abscess if needed
* Severe: blood culture for ABX selection

112
Q

How do you treat a breast abscess?

A

US guided needle aspiration + ABX + contuine breastfeeding
* Nonsevere: dicloxacillin, cephalexin
* MRSA: bactrim, clindamycin
* Severe: vanco

113
Q

What is a fibroadenoma?

A

Benign solid tumor
* hormone dependent
* MC in young adults & adolescence
* MC in AA

114
Q

What are symptoms of fibroadenoma?

A

painless, slow growing mass that does NOT significantly change size with menses

115
Q

What are physical exam findings of a breast fibroadenoma?

A

Solid, firm, rubbery, mobile lesion ~2.5 cm

116
Q

How is fibroadenoma diagnosed?

A

Clinical
* US: solid, well-circumscribed, avascular mass
* Definitive: FNA – fibrous tissue & collagen in a “swirl”

117
Q

How is fibroadenoma treated?

A

Observation, repeat US in 3-6 months
* Excision

118
Q

What is fibrocystic breast disease?

A
  • MC benign breast disorder
  • Exaggeration of normal changes in breast tissue due to cyclic levels of estrogen
119
Q

What are symptoms of fibrocystic breast disease?

A

Cyclic bilateral breast pain + fluctuation in size
* Sx peak before menses

120
Q

What are physical exam findings of fibrocystic breast disease?

A

multiple, nodular, mobile, smooth round/ovid lumps bilaterally of varying sizes

121
Q

How is fibrocystic breast disease diagnosed?

A
  • Initial: US w/ biopsy
  • Mammogram, aspiration
122
Q

How is fibrocystic breast disease treated?

A

Supportive
* NSAIDs, OCPs

123
Q

What is mastitis?

A

Infection of the breast
* MC in lactating women in the 1st 12 weeks postpartum
* MCC: staph aureus

124
Q

What are symptoms of mastitis?

A

Unilateral firm, red, tender, swollen area of the breast
* sore, cracked nipples or visable fissure
* fever, myalgia, chills, malaise, flu-like sx

125
Q

How is mastitis treated?

A

NSAIDs, hot compress, emptying of breast, contuine breastfeeding
~~~

~~~
> 24 hrs: ABX
* Dicloxacillin, cephalexin
* MRSA: bactrim, clnidamycin
* Severe: canvo

126
Q

What are symptoms of uterine prolapse?

A

vaginal bulge/fullness
* pelvic pressure, constipation
* urinary & sexual dysfunction
* worse with prolonged standing, better with lying down

127
Q

What are the stages of uterine prolapse?

A
  1. Uterus is in the upper 2/3 of the vagina
  2. Uterus is at the opening of the vagina
  3. Uterus has protruded out of the vagina
  4. Uterus is completely out of the vagina
128
Q

How is uterine prolapse treated?

A
  • Conservative: kegels, pessaries, PT
  • Surgery
129
Q

What is ovarian torsion?

A

Complete/partial rotation of ovarian ligamental supports resulting in ischemia
* RF: ovarian mass

130
Q

What are symptoms and physical exam findings of ovarian torsion?

A
  • Sx: acute onset of unilateral pelvic pain + N/V
  • PE: palpable adnexal mass
131
Q

How is ovarian torsion diagnosed?

A
  • US w/ doppler: decreased blood flow
  • Definitive: direct visualization at the time of surgical exploration
132
Q

How is ovarian torsion treated?

A

Laproscopy w/ detorsion

133
Q

What are ovarian cysts?

A

Fluid-filled sac within the ovaries, MC related to ovulation
* Can be functional or neoplastic
* Functional: follicular (MC), corpus luteum

134
Q

What are symptoms of ovarian cysts?

A

ASX (functional) or pelvic pain
* amenorrhea, delayed menses

135
Q

What are symptoms of a ruptures ovarian cyst?

A

abrupt, unilateral, sharp, focal pain that occurs during sex or with strenous physical activity

136
Q

How are ovarian cysts diagnosed?

A

Ultrasound
* Follicular: smooth, thin-walled, unilocular
* Corpus luteal: complex, thick, peripheral vascularity
* Rupture: adnexal mass + pelvic fluid

137
Q

How are ovarian cysts treated?

A

OCPs, cystectomy
* Most spontaneously resolve within a few weeks

138
Q

What is endometriosis?

A

The presense of endometrial tissue outside of cavity, MC in the ovary
* estrogen-stimulated inflammatory respone
* MC in ages 25-35

139
Q

What are symptoms of endometrosis?

A

Dysmenorrhea, dyspareunia, dyschezia
* cyclic pelvic pain peaking 1-2 days before menses
* Sx improve with pregnancy and after menopause

140
Q

What are physical exam findings of endometriosis?

A

fixed retroverted uterus
* tenderness in the posterior vaginal fornix

141
Q

How is endometriosis diagnosed?

A

Inital: Ultrasound
Definitive: Laparoscopy with biopsy
* “powder burn”
* “chocolate cyst” if ovaries

Endometrioma on US: ground glass

142
Q

How is endometriosis treated?

A
  • Definitve: TAH-SBO
  • Medical: NSAIDs, OCPs, Danazol
  • Complications: infertility
143
Q

What is infertility?

A

Failure to concieve after 1 year of regular unprotected sex
* MCC: Anovulatory cycles
* In males: abnormal spermatogenesis

144
Q

How is infertility diagnosed?

A

Hysterosalpingography
* to evaluate tubual patency & abnormalities
* progesterone levels

145
Q

How is infertility treated?

A

Letrozole
* PCOS: clomiphene citrate
* Fallopian tube defect: IVF

146
Q

What is leiomyoma?

A

Uterine fibroids
* Benign smooth muscle tumors that grow in reponse to estrogen
* MC benign gyno tumor
* MC location: intramural
* MCC of AUB

147
Q

What are risk factors for leiomyoma?

A

AA, > 35 years, HTN, nulliparity, FHx, early menarche < 10 years

148
Q

What are symptoms of leiomyoma?

A

ASX or DUB
* MC: heavy/prolonged menses
* Infertility, pelvic pain, anemia

149
Q

What are physical exam findings of leiomyoma?

A

Nontender irregular enlarged mobile uterus

150
Q

How is leiomyoma diagnosed?

A

US: heterogenic hypoechoic mass or masses

151
Q

How is leiomyoma treated?

A

Observation, TX if SX
* NSAIDs, traneximic acid
* OCPs, GNRH agonist (leuprolide, natarein)
* Myomectomy: preserve fertility
* Hysterectomy: definitve

152
Q

What is PCOS?

A

Gonadotropic dysregulation with increased LH
* a/w endometrial cancer due to excess estrogen
* MCC of infertility

153
Q

What are symptoms of PCOS?

A
  • bilateral enlarged cystic ovaries
  • insulin resistance
  • hyperandrogenism
  • amenorrhea or oligomenorrhea
154
Q

How is PCOS diagnosed?

A

Rotterdam criteria (2/3)
* hyperandrogenism
* ovulatroy dysfunction
* cystic ovaries on US

US: string of pearls
Increased LH:FSH & testosterone

155
Q

What is STAT?

A

Have you been
* Slapped
* Threatened
* or Thrown

155
Q

What is adenomyosis?

A

Extension of endometrial tissue into myometrium
* increased estrogen stimulates hyperplasia of basalis layer

155
Q

How do you treat PCOS?

A

OCPs & lifestyle changes for weight loss
* Metformin, spironolactone, clomiphene citrate

155
Q

What is HITS?

A

Does your partner
* Hit
* Insult
* Threaten
* or Scream at you

155
Q

What is RADAR?

A

Remember to
* Ask
* Document
* Assess
* and Refer

156
Q

What are symptoms and physical exam findings of adenomyosis?

A

Sx: ASX, dysmenorrhea, menorrhagia, chronic pelvic pain
PE: diffusedly enlarged symmetrically soft or “boggy” uterus

157
Q

How is adenomyosis diagnosed?

A

US then MRI

158
Q

How is adenomyosis treated?

A

NSAIDs, levonorgestrel releasing IUD
* Definitive: hysterectomy

159
Q

How do you treat cystitis?

A

Nitrofurantoin
* avoid in 1st trimester and at term
* alt. fosfomycin
Bactim, ciprofloxacin

160
Q

What is a tubo-ovarian abscess?

A

inflammatory mass involving the fallopian tubes, ovaries or occasionally other pelvic organs
* most occur as a complication of PID

161
Q

What are symptoms of a tubo-ovarian abscess?

A

acute lower abdominal pain, vaginal discharge, fever, chills
* ruptured: leaking contents into abdominal cavity, acute abdomen, sepsis

162
Q

How is tubo-ovarian abscess diagnosed?

A

Mostly clinically with the presence of an inflammatory adrenxal mass on TVUS or CT

163
Q

How is tubo-ovarian abscess treated?

A

IV cefoxitin + doxycycline +/- drainage
* Ruptured: immediate surgical exploration

Womens Health EOR (2 decks)

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