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Year 5 O&G > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Ovotesticular Disorder of Sexual Differentiation

A

Previously called “true hermaphrodite”
Ambiguous or normal male genitalia
Mullerian structures absent on side of functioning testes
Bicornuate uterus if ovary/sreak gonad

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2
Q

5 alpha reductase deficiency

A

“Penis at 12”

Ambiguous genitalia at birth, increased virilization at puberty

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3
Q

Hirsutism

A

Either exces androgens or increased skin sensitivity to androgens
CAH, androgen-secreting tumor, Cushings, acromegaly, drugs

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4
Q

Hypertrichosis

A

Excess hair growth in generalized non-sexual pattern

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5
Q

Tx-excess hair

A

Lose weight
Cosmetic methods: waxing, shaving, bleaching, etc
Diannette/Yasmin
Topical eflornithine

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6
Q

Candida-dx

A

Take sample from anterior fornix/lat vaginal wall

Gram stain, KOH prep

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7
Q

Tx Candida (pregnant and non-pregnant)

A

Fluconazole if not pregnant

Clotrimazole if pregnant

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8
Q

Dx Trichomonas

A

Wet prep microscopy of discharge (women).

Culture in males.

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9
Q

Tx trichomonas

A

Metronidazole 2g PO

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10
Q

Tx BV

A

2g mentronidazole PO or 400mg BD for 5 days

Or intravaginal gel

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11
Q

Chlamydia serotypes A-C

A

Cause trachoma

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12
Q

Chlamydia serotypes D-K

A

Genital chlamydia, ophthalmia neonatorum

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13
Q

Chlamydia L1-L3

A

LGV (rectal infection, proctitis)

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14
Q

Tx-chlamydia

A

Azithromycin
Can give doxycycline for several days but not in pregnancy and less compliance than single dose azithro hence why azithro is first line

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15
Q

LGV

A

Painless rapidly healing ulcers
May cause balanitis, proctitis, cervicitis
Secondary stage-inguinal buboes, 2/3 unilateral. Slow healing with scarring
Late stage-genital elephantiasis, genital ulcers, frozen pelvis

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16
Q

Tx-LGV

A

NAAT

2/52 doxy

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17
Q

Gonorrhea

A

Increased vaginal discharge, lower abdo/pelvic pain
Contact bleeding
Endocervical swabs
Cephs ok in preg…ceftriaxone 250mg IM
Always treat automatically for chlamydia as well…which is kind of insulting when you think about it…“You’re clearly a ho. Here, have ALL the antibiotics. We think you’ll need them.”

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18
Q

Secondary syphilis

A

Arthralgia, myalgia, HA, fever

Neuro involvement–aseptic meningitis, CN palsies, optic neuritis, acute nerve deafness

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19
Q

Tertiary syph

A

2-30 years later
Gumma-SKIN, bone, mucosa
Aortitis
Neurosyph incl Argyll Robertson pupils

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20
Q

Congenital syph

A

Intrauterine death, interstitial keratitis, VIII deafness, Hutchinson teeth

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21
Q

Chancroid

A 
Haemophilus ducreyi
Tropical
Multiple painful shallow ulcers
Regional LAD
Culture
Tx: 2g azithro
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22
Q

Donovanosis/Granuloma inguinale

A 
Klebsiella granulomatis
Africa, India, Australian Aboriginal communities
Painless nodule
Giemsa stain--intracellular inclusions
Tx-erythromycin
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23
Q

Herpes simplex (STI version)
Sxs
Dx
Tx

A 
Multiple small shallow painful ulcers
Febrile flu-like prodrome
Swab-electron microscopy
Primary outbreak-acyclovir
Recurrent-5 day course acyclovir 200mg 5x/day
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24
Q

Facial molluscum in an adult

A

HIV until proven otherwise

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25
Q

Tx-genital warts

A

Podophyllin, imiquimod

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26
Q

Tx-PID

A

Ofloxacin and metronidazole 14 days

If pregnant-IM ceftriaxone + erythromycin + metronidazole

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27
Q

RMC-causes

A

Anatomical: fibroids, uterine abnormalities, cervical incompetence
Genetic
Bleeding/Clotting: Antiphospholipid, FV Lieden
Infection (late): BV

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28
Q

Causes dyspareunia

A

Vaginismus
Failure arousal and/or lubrication
Chronic UTI/urethral causes
Uterine: adenomyosis, fibroids
Extrauterine: endometriosis, chronic pelvic infection, pelvic relaxation, adhesions, vaginal shortening, tumors
GI: chronic constipation, IBD, IBS
MSK: herniated disc, femoral or abdominal hernia

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29
Q

Post-coital bleeding

A

Uterine: neoplasia, endometrial hyperplasia, polyps, fibroids
Cervical: cervicitis, erosion, ectropion, neoplasia
Vaginal: infection, atrophy, trauma
Pregnancy
Hemorrhoids

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30
Q

Average age breast development (puberty)

A

11.5

Usually 8.5-12.5

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31
Q

When does menarche occur in relation to puberty?

A

~2.5 yrs after start puberty

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32
Q

First sign puberty in males

A

Testicular enlargement (>4mL)

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33
Q

When do males get growth spurt in puberty?

A

When testicular volume 12-15mL

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34
Q

Precocious puberty cut-offs

A

Females:

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35
Q

Gonadotrophin-dependent precocious puberty

A 
Premature activation HPA axis
Causes:
Idiopathic
Congenital (hydroceph)
Acquired-post-radiation, infection, surgery
Tumors e.g. microscopic hamartomas
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36
Q

Gonadotrophin-independent precocious puberty

A 
Excess sex steroids
Causes:
Adrenal tumors, CAH
Ovarian tumors (granulosa cell)
Testicular tumors (Leydig cell)
Exogeous sex steroids
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37
Q

Chronic pelvic pain

A

> 6/12
Not exclusively with menstruation or intercourse
?Estrogen mediated (rare after menopause)
Sxs suggestive of IBS, interstitial cystitis oft present, as are psych factors (depression, sleep disorders)
**Substantial number have hx childhood/ongoing sexual abuse

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38
Q

Chronic pelvic pain ddx

A 
Gynae: endometriosis/adenomyosis
Adhesions
IBS, interstitial cystitis
Pelvic organ prolapse
MSK pain
Nerve entrapment post-sx
Other surgical
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39
Q

Adenomyosis

A

Endometrial tissue in myometrium
Uterus becomes enlarged and boggy
Menorrhagia, dysmenorrhia
RF: multiparity

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40
Q

Indications for hysteroscopy

A 
PMB, IMB, PCB
Irreg menstruation
Persistent menorrhagia or discharge
Possible uterine malformations
Suspected Ashermans
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41
Q

Complications hysteroscopy

A

Perforation
Cervical damage if need to dilate
Ascent of any existing infection

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42
Q

Indications for laparotomy

A 
Suspected ectopics
Undx'd pelvic pain
?Tubal patency (lap and DYE)
Sterilization/reversal
Ovarian cystectomy
Tx endometriosis
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43
Q

Hysterectomy: abdo vs vaginal

A

Vaginal has quicker recovery
Can’t do vaginal if malignancy (need to remove ovaries, look at LNs)
May be safer to do abdo if larer than 12 wks
Abdo: Pfannenstiel incision

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44
Q

Indications for cystoscopy

A 
Hematuria
Recurrent UTI
Sterile pyuria
Short hx irritative sxs
Suspected bladder abnormality (fistula, diverticula, stones)
Assess bladder neck
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45
Q

Benign epithelial ovarian tumors

A

Serous cystadenoma
Mucinous cystadenoma
Brenner

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46
Q

Malignant epithelial tumors

A

Serous cystadenocarcinoma
Mucinous cystadenocarcinoma
Endometrioid
Clear cell

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47
Q

Benign germ cell ovarian tumors

A

Dermoid cyst

Mature teratoma

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48
Q

Malignant germ cell ovarian tumors

A

Immature teratoma

Dysgerminoma

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49
Q

Benign sex cord ovarian tumors

A

Granulosa cell
Sertoli-Leydig
Thecomas
Fibromas

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50
Q

Malignant sex cord ovarian tumors

A

Granulosa cell

Sertoli Leydig

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51
Q

RFs for ovarian cancer

A 
Increased hormone exposure (early menarche, late menopause, etc)
Nulliparity/infertility
Endometriosis
Genetic predisposition (BRCA)
**Majority have no known RFs
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52
Q

Uterovaginal prolapse tx in primary care

A

Silicon-rubber based ring pessaries (act as artificial pelvic floor)

53
Q

Lichen sclerosis

A

Vulvar itch, white lesion, thin and crinkled skin
Labial contour slowly disappears and labial adhesions form
Tx with aqueous cream/1% hydrocortisone TDS for itching
2% Testosterone ointment BD/TDS 6/52

54
Q

Vulvar squam cell hyperplasia

A

Thickened asymm areas (white/grey)

55
Q

Lichen planus

A

Assoc with HCV, PBC
*Kobnerization phenomenon
Acute onset purple, polygonar pruritic papular eruption
Wickham’s striae
Dyspareunia, scar tissue. Can cause stenosis
Tx: topical ‘roids-vaginal suppositories

56
Q

Vulvar vestibulitis

A

Reproducible exquisite pinpoint pressure tenderness.
Unknown cause
Assoc with dyspareunia, pain on tampon insertion

57
Q

Most common cause primary amenorrhea

A

Turners

58
Q

Second most common cause primary amenorrhea

A

Mullerian agenesis (aka Rokitansky-Kuster-Howser syndrome)

59
Q

Cervical stenosis: sxs, comps, causes, tx

A

Sxs: cyclical dysmenorrhea, subfertility, abn vaginal bleeding, amenorrhea
Comps: Hydrometra, hematometra, pyometra
Causes: cervical sx, radiation, infection, neoplasia, atrophic change
Tx: surgical dilation cervix

60
Q

Tx-fibroids

A

Tranexamic acid, NSAIDs, progestogens oft ineffective if causing menorrhagia, but may be worth trying as first line
GnRH agonists + HRT to shrink (but can only use 6/12 and then they come back anyway)
TCRF=trans-cervical resection of fibroids (pre-treat with GnRH ag)
Uterine artery embolization

61
Q

Fibroids-sxs

A

50% no sxs
30% menstrual problems (dysmenorrhea, menorrhagia)
Rarely cause pain unless torsion
May be a cause of infertility (get in way of implantation)

62
Q

Types of fibroids

A

Intramural
Subserosal
Submucosal

63
Q

Fibroid size during pregnancy

A

Equally likely to grow, shrink, or stay the same during pregnancy

64
Q

Endometrial polyps-tx

A

Don’t need to remove if pre-menopausal unless sxs >3/12

Remove if post-menopausal (risk cancerous change)

65
Q

Endometritis

A

Oft secondary to STIs, as comp sx (esp CS and intrauterine procedures) or foreign tissue (IUDs, RPC).
Post-menopause oft due to malignancy

Tender uterus +/- pelvic and systemic infection
Pyometra: pus accumulation and can’t escape

66
Q

Vulval cancer-RFs

A 
VIN
Lichen sclerosis
Immunosuppression
Smoking
Paget's disease of vulva
67
Q

Exam findings-vulval carcinoma

A

Ulcer or mass, most commonly on labia majora or clitoris

Inguinal LNs may be enlarged, hard, immobile

68
Q

Premature menopause cutoff (age)

A
69
Q

Tx menopause

A 
Treat vasomotor sxs.
5mg norethisterone
SSRIs-hot flashes
Topical estrogens for vaginal atrophy
Bisphosphonates, raloxifene for osteoporosis
70
Q

Raloxifene

A

SERM

Decreases fractures post-menopause by 30-50%

71
Q

Denosumab

A

Monoclonal Ab to RANK-L. Decreases osteoclast activation.

72
Q

HRT

A

Estrogen alone if hysterectomy
E + P if still have uterus

E can be given PO, transdermally, PV, SC (implant)
P can be given PO, transdermally, IUS
Tibolone: E, P, androgenic effects. Perimenopausal women who want amenorrhea. Treats vasomotor, psych, libido sxs and preserves bone mass

73
Q

Urodynamic stress incontinence

A

Exclude OAB
>10% all women
Urethral sphincter weakness
Bladder slips below pelvic floor–no compresion
Prolapse may co-exist but not always related

74
Q

RF-stress incontinence

A

Pregnancy, vaginal delivery
Obesity
Age (post-menopausal)
Previous hysterectomy

75
Q

Tx-stress incontinence

A

Weight loss
Tx cough
Decrease excess fluids

Conservative: pelvic floor exercise (1st line for 3/12). 8 contractions TDS. Vaginal cones or sponges to alleviate incont
Med: duloxetine
Sx: when conservative failed. Tension free vaginal tape, trans-obturator tape=first line

76
Q

OAB

A

Urgency with or without urge incontinence. Usually with frequency or nocturia in absence proven infection
Detrusor overactivity
35% of female incont
Usu idiopathic. May be post-USI sx, MS, spinal cord injury

77
Q

OAB-history

A 
Urgency, urge incontinence
Frequency, nocturia
Stress incont commonly co-exists
Sometimes leaks at night, during orgasm
Hx childhood enuresis or fecal urgency comm
78
Q

OAB-tx

A

Conservative: decrease fluids/caffeine, review drugs
BLADDER TRAINING-timed voiding with systemic delay in voiding and positive reinforcement. >6/52 + anticholinergics
Med: anticholinergics, estrogens, botulinum A toxin
Sx: neuromodulation, sacral nerve stimulation

79
Q

incontinence Ix

A

Stand and cough (over pad)-immediate loss urine=stress

Cystometry: fill bladder with 50mL H20–volume at first urge. Look for reflux

80
Q

Urethrocele

A

Prolpase lower anterior vaginal wall, involving urethra only

81
Q

Cystocele

A

Prolapse upper anterior vaginal wall, involving bladder

82
Q

Urethrocystocele

A

Prolapse involving both bladder and urethra

83
Q

Apical prolapse

A

Prolapse uterus, cervix, upper vagina

84
Q

Enterocele

A

Prolapse lower posterior vaginal wall involving anterior wall rectum

85
Q

RF-prolapse

A

Vaginal delivery (Esp large infant), prolonged 2nd stage, instrumetal deliveries
Congenital-EDS (collagen fuckery)
menopause (collagen again)
Iatrogenic-pelvix sx

86
Q

Cervical ectropion

A

Columnar epith extends a bit farther.
Easy bleeding (post-coital, smears, colposcopy)
Indistinguishable from early cervical cancer so need to do smear
Common in high estrogen states, e.g. on the pill

87
Q

Bartholin cyst

A

Cyst (usu U/L) in lower vestibule

Arises due to inflamm and obstruction of gland, usu in women reproductive age

88
Q

Condyloma

A

Genital warts. HPV 6, 11 (covered by Gardasil quadrivalent vaccine)
Koilocytic change

89
Q

Extramammary Paget’s disease

A

Malignant epith cells in epidermis vulva
Erythematous, pruritic, ulcerated vulvar skin
Carcinoma in situ
Must distinguish from melanoma

90
Q

Clear cell adenocarcinoma of vagina

A

Complication of female fetuses exposed to DES

91
Q

Exocervix-histology

A

Lined by squamous epith

92
Q

Endocervic-histology

A

Lined by columnar epith

93
Q

High risk HPV

A

16, 18, 31, 33 and more

16 and 18 covered by Gardasil vaccine

94
Q

CIN-histology

A

Koilocytic change, disordered cellular maturation, nuclear atypia, increased mitotic activity

95
Q

Referral for colposcopy

A

Borderline and mild tested for HPV. if positive for high risk–referral
Moderate and severe-automatic referral
Three inadequate smears

96
Q

Cervical carcinoma

A

Average age 40-50
Presents as PCB or cervical discharge
RF: High risk HPV, smoking, immunodeficiency
80% are squamous cell; 15% adenocarc

97
Q

Limitation pap smear

A

Doesn’t pick up adenocarcinoma

98
Q

Asherman syndrome

A

Secondary amenorrhea due to loss basalis and scarring. Often from overaggressive dilation and curettage

99
Q

Anovulatory cycle

A

Estrogen-driven proliferative phase without subsequent progesterone-driven secretory phase. (NB unopposed estrogen)
Common cause dysfunctional uterine bleeding, esp during menarche and menopause

100
Q

Endometrial hyperplasia

A

As consequence unopposed estrogen
Postmenopausal uterine bleeding
Most important predictor for progression to endometria carcinoma is cellular atypia

101
Q

Endometrial carcinoma

A

Most common invasive carcinoma of female genital tract
*Post-menopausal bleeding
75% from hyperplasia pathway
25% sporadic pathway–more aggressive

102
Q

Unopposed estrogen–causes

A

PCOS/anovulatory cycles
Obesity
Estrogen replacement

103
Q

PCOS

A

5% women of reproductive age
Increased LH:FSH
Increased LH induces excess androgens from theca cells causing hirsutism
Androgen converted in adipose to estrone (unopposed estrogen(
Classic presentation: obese young woman with infertility, oligomenorrhea, hirsutism.
Some pts have insulin resistance and may develop TII DM 10-15 years later

104
Q

Management ovarian cyst in post-menopausal woman

A

Risk assessment: pre or post-menopausal, CA 125, simple?

If simple,

105
Q

Treatment endometriosis

A

Danazol 3-6m
Triptorelin up to 6/12

Lap

106
Q

1st line HMB

A

Mirena

107
Q

2nd line HMB

A

Tranexamic acid, mefanamic acid

Mefanamic has more side effects

108
Q

1st line severe PMS

A 
SSRIs
Vit B6
Diet and exercise
CBT
yasmin or Cilest
109
Q

Management of significant and symptomatic prolapse

A

Surgery

110
Q

Festoterodine

A

Urge incontinence

111
Q

Solifenacin

A

Urge incontinence

112
Q

OAB management

A

Start trial therapy and reassess before urodynamic studies
Bladder diary and bladder retraining
Oxybutynin

113
Q

Causes and Ix for vesicovaginal fistula

A

Causes: worldwide is obstructed labor. First world is pelvic surgery
Ix: Methylene blue into bladder, then speculum into vagina

114
Q

Emergency contraception options

A

1.5mg levonorgesterol. Up to 72 hrs
Ulipristal up to 5 days
Copper coil up to 5 days

115
Q

Rokitansky’s

A

Mullerian agenesis
Ovaries fine
No Fallopian tubes or uterus; may have shortened vagina

116
Q

Indications for colposcopy

A 
Three borderline
Three insufficient
Two mild
Borderline or mild + high-risk HPV
Any moderate or severe
117
Q

Wertheim’s hysterectomy

A

Cervical cancer

Removes uterus, upper 1/3 vagina, parametrium

118
Q

Subtotal hysterectomy

A

Leaves cervix

119
Q

Cytoreduction surgery

A

Debulking.

Can be used before chemo

120
Q

Meig’s syndrome

A

Pleural effusion (classically on right) and ovarian fibroma

121
Q

RMI calculation

A

concerning things on USS x CA 125 x 3 (if post-menopausal)

122
Q

Most common adverse effect POP

A

Irregular bleeding

123
Q

Length of contraception after menopause

A

50: 12 months

124
Q

Primary dysmenorrhea

A

No pelvic pathology
Increased prostaglandins
Up to 50% women

125
Q

Secondary dysmenorrhea–causes

A

Endometriosis, adenomyosis, PID, IUD, fibroids

126
Q

Cerazette

A

3rd generation POP

Can take up to 12 hours late (as opposed to three hours with earlier pills)

127
Q

proliferative phase

A

Aka follicular phase

128
Q

Secretory phase

A

Aka luteal phase

Year 5 O&G (2 decks)

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