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OB-Gyne > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Established by genetic inheritance at the moment of fertilization

A

Chromosomal sex

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2
Q

Development of primary sex organs in response to genetic sex

A

Gonadal sex

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3
Q

Regulation by gonadal sex of the differentiation of the genital apparatus

A

Phenotypic sex

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4
Q

Establishment of gender role, gender identity, or sexual orientation

A

Psychological sex

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5
Q

Plano-convex mass adherent to the inner side of the nuclear membrane in somatic cells of genetic females

A

Barr body

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6
Q

Inactivation of one of the two copies of X chromosomes in females

A

Lyonization

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7
Q

Possible specimens for sex chromatin test

A

buccal smear, nerve cells, blood smear, vaginal smear

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8
Q

Present only in 15/100 of male cells and invariably absent in females; basis for the test used in screening for large populations in sports competitions

A

Fluorescent body/ Y body (Hair-root test)

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9
Q

Gold-standard for sex determination; required for patients undergoing gender-reassignment

A

Karyotyping

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10
Q

Composed of coelomic epithelial cells; develops into the female ovaries

A

Outer cortex of the primitive gonads

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11
Q

Composed of stromal mesenchyme surrounding cords of epithelial cells; develops into the male testess

A

Inner medulla of the primitive gonads

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12
Q

AOG when primitive gonads are present

A

4th-6th week

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13
Q

AOG when testes normally descend through inguinal ring

A

7-9 months

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14
Q

Testosterone secreted by Leydig cels induces differentiation of anlagen of external genitalia. What mechanism?

A

Classic Endocrine Mechanism

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15
Q

Action of MIF on Mullerian duct; action of Testosterone on Wollfian duct. What mechanism?

A

Local Paracrine Regulatory Mechanism

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16
Q

Portion of Y chromosome that determines genetic sex

A

SRY gene

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17
Q

Which structures arise from the Wolffian ducts?

A

Vas deferens, epididymis, seminal vesicles

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18
Q

Which structures arise from the Mullerian ducts?

A

Uterus, fallopian tube, cervix, upper vagina

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19
Q

Converts testosterone to dihydrotestosterone

A

5-alpha-reductase

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20
Q

Responsible for differentiation of Wollfian ducts to male internal genitalia at 9 to 10 weeks AOG; secreted by Leydig cells

A

Testosterone

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21
Q

Glycoprotein hormone secreted by Sertoli cells; induces dissolution of Mullerian ducts, inhibiting differentiation of female internal genitalia

A

Mullerian Inhibiting Factor / Anti-Mullerian Hormone

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22
Q

Common embryonic origin of male and female external genitalia

A

Anlagen

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23
Q

Embryonic origin of glans penis, corpus cavernosum, corpus spongiosum

A

Genital tubercle

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24
Q

Embryonic origin of clitoris and vestibular bulb

A

Genital tubercle

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25
Q

Fuse around urethral groove to form the ventral shaft of the penis

A

Genital folds

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26
Q

Embryonic origin of the labia minora

A

Genital folds

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27
Q

Embryonic origin of the scrotum and prepuce

A

Labioscrotal swelling

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28
Q

Embryonic origin of the labia majora

A

Labioscrotal swelling

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29
Q

Embryonic origin of the male urethra, Cowper’s glands, prostate gland

A

Urogenital sinus

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30
Q

Embryonic origin of the urethra, female vagina, Bartholin’s glands, Skene’s glands

A

Urogenital sinus

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31
Q

Pattern of secretion of gonadotrophs in males

A

Pulsatile, relatively constant and sustained (tonic release)

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32
Q

Pattern of secretion of gonadotrophs in females

A

Pulsatile but cyclic

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33
Q

Female: coarctation of the aorta, short stature, ovarian dysgenesis, shield chest, webbed neck, normal intelligence

A

Turner Syndrome (45, XO)

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34
Q

Male: testicular atrophy, eunochoid body shape, long extremities, gynecomastia, female hair distribution

A

Klinefelter Syndrome (47, XXY)

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35
Q

Only possible detectable difference between triple X and normal females

A

Increased risk for menstrual irregularities and learning disorders

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36
Q

Genetic male lacking receptors for testosterone in target cells

A

Androgen Insensitivity Syndrome

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37
Q

Cause of androgen overproduction resulting in virilization and ambiguous genitalia in females

A

Congenital Adrenal Hyperplasia

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38
Q

Common enzyme deficiencies in CAH

A

21-hydroxylase; 11-beta-hydroxylase; 3-beta hydroxylase

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39
Q

Enzyme accumulation in 21-hydroxylase deficiency

A

17-hydroxyprogesterone

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40
Q

Most common gynecologic problem in prepubertal females; caused primarily by poor perineal hygiene

A

Vulvovaginits

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41
Q

Most common foreign body seen in pediatric gynecologic consults

A

Tissue paper

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42
Q

Pathognomonic sign of adhesive vulvitis

A

Translucent vertical line at the midline

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43
Q

Parchment-like appearance, hourglass pattern; common in prepubertal children and post-menopausal women

A

Lichen sclerosus

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44
Q

Epidermal atrophy; Hydropic degeneration of basal cells; Sclerotic strome; Dermal inflammation

A

Lichen sclerosus

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45
Q

Possible signs of sexual abuse detected during PE of a pediatric patient

A

Spiral fractures, cigarette burns, abrasions and bruises found at suspicious areas

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46
Q

Sequence of changes during female puberty

A

Thelarche - Pubarche - Growth Spurt - Menarche

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47
Q

Age of precocious puberty in males?

Age of precocious puberty in females?

A

9 in boys; 8 in girls

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48
Q

Precocious puberty with normal LH, FSH and estrogen; levels are increased with GnRH stimulation; usual cause is idiopathic or a CNS lesion

A

Central precocious puberty (GnRH dependent)

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49
Q

Precocious puberty with decreased LH and FSH but highly elevated estrogen; levels do not change with GnRH; most common etiologies are Granulosa Cell tumor and McCune-Albright syndrome

A

Peripheral precocious pubery (GnRH dependent)

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50
Q

Treatment of choice for idiopathic precocious puberty

A

GnRH agonist administered chronically until puberty

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51
Q

Precocious puberty, cafe au lait spots, polyostotic fibrous dysplasia

A

McCune-Albright syndrome

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52
Q

Requisites for diagnosis of premenstrual syndrome

A

Symptoms present in last 3 consecutive cycles; absent in pre-ovulatory phase; resolve with onset of menses; interfere with normal daily functioning

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53
Q

First step in workup of abnormal uterine bleeding

A

Pregnancy test

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54
Q

AUB work-up to check for disorders of coagulation, endocrine dysfunction or chronic disease

A

CBC with pc/dc; Coagulation profile; TSH; prolactin

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55
Q

AUB work-up to check for reproductive tract abnormalities or anatomic defects

A

Pelvic examination; Pelvic UTZ;

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56
Q

Indications for endometrial biopsy in the work-up of AUB

A

Post-menopausal; >35 years old; Obese; Hypertensive

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57
Q

DUB: post-menarchal; dysfunctional HPO axis; unstable, frequent, haphazzard; no elevation of body temperature; proliferative changes in endometrial biopsy

A

Anovulatory DUB

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58
Q

DUB: mid-reproductive life; due to local endometrial factors; orderly tissue breakdown; self-limited bleeding; mid-cycle body temperature elevation; secretory changes in endometrial biopsy

A

Ovulatory DUB

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59
Q

Treatment of choice for anovulatory DUB

A

Progestin

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60
Q

Treatment for acute excessive uterine bleeding in hemodynamically stable patients

A

Conjugated equine estrogen (CEE) 10mg/day in 4 doses for 14-21 days; medroxyprogesterone for 7-10 days

61
Q

Treatment for acute excessive uterine bleeding in hemodynamically unstable patients

A

IV estrogen (causes rapid proliferation of denuded endometrium)

62
Q

Irreversible complication of Danazol

A

Deepening of the voice

63
Q

Treatment for chronic ovulatory DUB for patient desiring contraception

A

OCP and levonogestrel-releasing IUD w or w/o NSAIDs and Tranexamic acid

64
Q

Menstrual pain associated with ovulatory cycles in the absence of pathologic findings; mediated by excess of prostaglandins; diagnosis of exclusion

A

Primary dysmenorrhea

65
Q

Excessive menstrual pain and cramping arising in the mid-reproductive years with identifiable anatomic pathology

A

Secondary dysmenorrhea

66
Q

Primary amenorrhea

A

No menses by 14 years in the absence of secondary sexual characteristics; No menses by 16 years if with secondary sexual characteristics

67
Q

Secondary amenorrhea

A

No menses for 3 months (if previous menses were regular); no menses for 6 months (if previous menses were irregular)

68
Q

Primary amenorrhea: no breasts ; low FSH and LH. Likely etiology?

A

CNS tumor (hypogonadotrophic hypogonadism)

69
Q

Primary amenorrhea: no breasts; high FSH and LH; normal karyotyping. Likely etiology?

A

Ovarian failure

70
Q

Primary amenorrhea: no breasts; high FSH and LH; abnormal karyotyping. Likely etiology?

A

Turner’s syndrome

71
Q

Hypogonadotropic hypogonadism with insufficient GnRH; anosmia

A

Kallman syndrome

72
Q

Primary amenorrhea: breasts present; uterus absent; abnormal karyotyping. Likely etiology?

A

Androgen insensitivity

73
Q

Primary amenorrhea: breasts present; uterus absent; normal karyotyping

A

Mullerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)

74
Q

Primary amenorrhea: breasts present; uterus present

A

Outflow obstruction

75
Q

Outflow tract abnormalities causing secondary amenorrhea

A

Imperforate hymen, Transvaginal septum, Vaginal agenesis

76
Q

CNS-hypothalamic causes of secondary amenorrhea

A

Decreased leptin, weight loss, anorexia nervosa, exercise, stress

77
Q

Hirsutism, amenorhea, obesity

A

Polycystic Ovarian Syndrome

78
Q

Pituitary cell destruction as a result of hypotensive episode during pregnancy

A

Sheehan syndrome

79
Q

Treatment for hyperprolactinemia

A

Bromocriptine, TCA, MAOI

80
Q

Cessation of ovarian function before the age of 40; may be caused by irradiation, chemotheraphy, autoimmunity

A

Premature ovarian failure

81
Q

Progesterone challenge test: withdrawal bleeding within 7 days. Possible causes?

A

Anovulation (most common); prolactinoma, hypothyroidism, endometrial CA with unopposed estrogen

82
Q

Progesterone challenge test: no withdrawal bleeding. Possible causes?

A

Outflow obstruction, inadequate estrogen (do EPCT)

83
Q

Indirect means of determining sufficient estrogen to produce endometrial growth that will slough after the progesterone level falls

A

Progesterone challenge test

84
Q

Intrauterine adhesions most frequently caused by endometrial curettage associated with pregnancy; cause of DUB

A

Asherman syndrome

85
Q

Timeframe required to diagnose menopause

A

12 months amenorrhea from final period; 3 months amenorrhea with elevation of gonadotropins

86
Q

Mean age of menopause for Filipinos

A

47-48 years

87
Q

Median age of onset and length of perimenopausal (climacteric) period

A

47.5 years; may take as long as 4 years

88
Q

Initial hormonal change signalling onset of menopause

A

Decreased ovarian inhibin production with increased pituitary FSH

89
Q

Less likely to develop hot flushes, osteoporosis; more likely to develop endometrial hyperplasia during menopause

A

Obese women

90
Q

More likely to develop hot flushes; more likely to develop osteoporosis; less likely to develop endometrial hyperplasia and cancer

A

Non-obese women

91
Q

Recommendations for prevention of osteoporosis during menopause

A

Calcium supplementation (1500mg/day)
Vitamin D supllementation (1500mg/day)
Weight-bearing exercises
Smoking cessation

92
Q

Benefits of hormone replacement therapy during menopause

A

Decreases vasomotor symptoms
Stabilizes trabecular bone formation
Acidifies vaginal pH, decreases atrophic vaginitis
Thickens vaginal epithelium, decreases dyspaerunia

93
Q

Risks of hormone replacement therapy during menopause

A

Increased risk for heart disease, breast cancer, stroke, endometrial cancer and gallbladder disease

94
Q

Risk of breast cancer increases after how many years of ERT

A

4 years

95
Q

Contraindications to ERT for menopause

A 
Undiagnosed vaginal bleeding
Active thrombophlebitis
Chronic impaired liver function
History of thromboembolic disease
Hormonally-dependent carcinoma
96
Q

Alternative for those with contraindications to ERT for menopause

A

Selective receptor modulators (SERM)

Raloxifene Tamoxifen

97
Q

Anterior pelvic organ prolapse

A

Cystocele

98
Q

Posterior pelvic organ prolapse

A

Rectocele

99
Q

Pelvic organ prolapse through Pouch of Douglas

A

Enterocele

100
Q

POP wherein entire uterus as well as the anterior and posterior vaginal walls extend outside the introitus at all times

A

Procidentia (Grade IV POP)

101
Q

Excess of nonsexual hair

A

Hypertrichosis

102
Q

Rapid onset of virilizing and hirsutism symptoms; elevated DHEAS levels; palpable abdominal mass

A

Androgen-producing tumor

103
Q

Gradual onset of virilizing and hirsutism symptoms; elevated 17-OHP; presents with premature pubarche, acne, accelerated bone age, menstrual irregularities

A

Late-onset CAH (21-hydroxylase deficiency)

104
Q

Gradual onset of symptoms; increased glucocorticoids and androgens; exhibits central obesity, dorsal neck pad, abdominal striae

A

Cushing’s disease (ACTH-secreting pituitary adenoma)

105
Q

Gradual onset of hirsutism after puberty with long duration; normal testosterone, DHEAS, 17-OHP; common in Mediterranean family background

A

Hair follicle androgen sensitivity (5-alpha reductase sensitivity)

106
Q

Management of androgen-producing tumors

A

Surgery

107
Q

Management of late-onset CAH

A

Glucocorditoids

108
Q

Management of Cushing’s disease

A

Surgery, hormone replacement

109
Q

Required duration of unprotected, frequent intercourse to consider infertility

A

12 months

110
Q

Management of hair follicle androgen sensitivity

A

Spironolactone

111
Q

Likelihood of conception occurring with one cycle of appropriately-timed midcycle intercourse; rate usually is 20%

A

Fecundity

112
Q

Ovulatory causes of female factor infertility

A 
PCOS
Advanced maternal age
Premature ovarian failure
Hyperprolactinemia
Hypothyroidism
113
Q

Tubal causes of female factor infertility

A

PID
Tubal ligation
Pelvic adhesions
Endometriosis

114
Q

Uterine causes of female factor infertility

A 
Congenital malformation
Submucosal fibroids
Uterine polyps
Asherman syndrome
Luteal phaes defect
115
Q

Cervical causes of female factor infertility

A

Cervical stenosis
Cervicitis
Unfavorable mucus

116
Q

Phase 1 workup for infertility

A

Ovulation documentation
Semen analysis
Ovarian reserve
Pelvic UTZ

117
Q

Normal semen analysis values

A 
Volume: 2-5mL
Concentration: >20 million/mL
Motility: >50% with forward progression
Normal forms: >30% with normal form
pH: 7.2-7.8
118
Q

Treatment for hypothalamic-pituitary failure causing male factor infertility

A

Human Menopausal Gonadotropins (hMG)

119
Q

Weak estrogen; competes with endogenous estrogen for binding sites; induces ovulation by further enhancing GnRH release

A

Clomiphene

120
Q

Alternative treatment for ovulation induction; reduces insulin resistance

A

Metformin

121
Q

Used for ovulation-induction when estrogen levels are low

A

hMG (or alternatively, GnRH)

122
Q

Characteristic of normal vaginal secretion during midcycle estrogen surge

A

clear, elastic, mucoid

123
Q

Characteristics of normal vaginal secretion during luteal phase / pregnancy

A

thick, white, adherent to vaginal wall

124
Q

Grayish-white discharge, fishy odor, (+)clue cells, pH >4.5, (+) whiff test. Common etiology and DOC?

A

Gardnerella vaginalis. Metronidazole

125
Q

Pruritus, burning, erythema, cottage-cheese-like discharge, (+)hyphae, pH < 4.5. Common etiology and DOC?

A

Candida albicans. Fluconazole

126
Q

Green-yellow frothy discharge, pruritus, malodorous, (+)strawberry cervix, pH > 4.5. Common etiology and DOC?

A

Trichomonas. Metronidazole

127
Q

No discharge, (+)erythema and excoriations, pruritus, normal pH, (+)D-shaped eggs. Common etiology and DOC?

A

Enterobius vermicularis. Pyrantel pamoate

128
Q

Polymicrobial ascending infection of the upper genital tract; increased risk with STDs, IUD use and douching; (+)chandelier sign. Common etiologies?

A

C.trachomatis, N. gonorrhoeae, other endogenous aerobes and anaerobes

129
Q

Violin-string adhesions from chronic pelvic inflammation

A

Fitz-Hugh-Curtis syndrome

130
Q

Outpatient regimen for empiric PID treatment

A

Ceftriaxone 250mg IM SD, Doxycycline 100mg BID PO x 14 days, with or without Metronidazole 500mg BID PO x 14 days

131
Q

Indications for in-patient treatment of PID

A 
Surgical emergency not excluded
Pregnant
Poor response to oral regimen
Unable to follow outpatient regimen
Severe illness, nausea, vomiting, high-fever
Tubo-ovarian abscess
132
Q

In-utero exposure causes increased risk of clear cell adenocarcinoma

A

DES

133
Q

Double cervix usually arising from uterine didelphys with double vagina

A

Bicollis

134
Q

Mucous retention cyst of endocervical columnar cells; Most common cervical cyst. No treatment required.

A

Nabothian cyst

135
Q

Most common lesion of the cervix; associated with intermenstrual or post-coital spotting; not premalignant

A

Cervical polyp

136
Q

Exists between the squamous epithelium of the vagina and ectocervix and the columnar epithelium of the endocervix; site of collecting specimens for Pap smere

A

Transformation zone

137
Q

When to begin screening for cervical cancer

A

3 years after onset of sexual activity or at 21 years of age (whichever comes first)

138
Q

Pap smear: within normal limits. Intervention?

A

Continue routine testing

139
Q

Pap smear: inflammation without atypia.Intervention?

A

Treat inflammation

140
Q

Pap smear: inflammation with atypia. Intervention?

A

Treat inflammation first, then repeat pap smear

141
Q

Pap smear: atypical squamous cells of uncertain significance. Intervention?

A

Colposcopy and biopsy, OR repeat pap smear after 3 months

142
Q

Pap smear: Low Grade SIL (CIN 1, Koilocytosis). Intervention?

A

Colposcopy and biopsy

143
Q

Pap smear: High grade SIL (CIN 2, CIN 3). Intervention?

A

Colposcopy and biopsy

144
Q

Possible indications for diagnostic conization

A

T-zone difficult to evaluate
Uncertainty regarding disease presence
Extension to ectocervix
Biopsy suggestive of microinvasive disease

145
Q

Most frequent malignancies in females, in decreasing order

A

Endometrial CA
Ovarian CA
Cervical CA

146
Q

HPV strains which conver high risk for cervical CA

A

16, 18, 31, 33

147
Q

Most common histologic type of cervical CA

A

Squamous cell (85%-90%)

148
Q

Most common symptom of cervical CA

A

Vaginal bleeding

OB-Gyne (1 decks)

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