Gynecology Flashcards
Age of thelarche and menarche
thelarche: btwn 8-11
menarche: btwn 10-16
Tx of menopause
HRT (combined estrogen and progest)
Contraindicated: vaginal bleeding, breast cancer, hx thromboembolism, liver disease, hypertriglceridemia
Non-HRT: SSRI/SNRI, clonidine, gabapentin
workup, tx of primary amenorrhea
w/u: pregnancy test, bone age radiograph (constitutional delay?), FSH/LH, ultrasound for ovaries, karyotype if no uterus; prolactin, MRI if uterus
tx: (hypogonadism only) low dose estrogen 12-18mo, cyclic estrogen/ progesterone
Defn, workup of secondary amenorrhea
6 consecutive months, no menses (menarche passed)
w/u: pregnancy test, TSH, prolactin
progestin challenge: + challenge (bleeding on withdrawal): anovulation (eg PCOS)
-challenge (no bleeding): uterine or estrogen abn
signs hyperglycemia or hyptoension: dexa suppr to rule out CAH, cushing, addison
virilzation: testosterone, DHEAS, 17-hydroxyprog (PCOS, CAH, cushing, tumor)
noncyclical pain, menorrhagia, enlarged uterus: dx and tx
adenomyosis
tx: NSAID/OCP/ progestins
endometrial ablation, hysterectomy
Guidelines for endometrial bx in women with abnormal uterin bleeding
endometrium >4mm
>35yo with risk factors (obesity, DM)
Tx AUB: acute, ovulator, anovulator
Acute: high dose IV estrog, D&C w/in 12-24h
Ovulatory: NSAID, OCP, mirena
Anovulatory: Progestin x10d, desmopressin (vWF/ VIII), OCP, mirena
Newborn female infant with ambiguous genitalia and salt wasting
21-hydroxylase deficiency
Dx criteria and tx of PCOS
(req 2/3)
1. polycystic ovaries
2.oligo/anovulation
3/ clinical or biochemical evidence of hyperandrogenism (testosterone, DHEAS, DHEA)
Tx: OCP, progestin, metformin (if not trying to conceive)
clomiphene +/- metformin (trying to conceive)
Hirsutism: OCP, antiandrogen (spironolactone, finasteride), metformin
Fluctuant mass 1-4 cm at inferior portion labium nimus: dx and tx
bartholin cyst
If symptomatic: aspiration and I&D if symptomatic; word catheter insertion
Abx only if celluitis
Abx regimens for PID
Outpatient:
Regimen A: Ceftriaxone IM or Cefoxitin plus probenecid
+doxycycline x14d +/-metronidazole 14d
Regimen B: oxafloxicin or levofloxacin x14d +/- metronidazole 14d
Inpatient: cefoxitin or cefotetan plus doxy x14d
clindamycin + gentamicin x14d
Perhepitits, RUQ pian, abn liver fxn, shoulder pain with hx of PID
fitz hugh curtis
Abrupt onset of fever (>102), vomiting watery diarrhea, macular erythematous rash in female: dx and tx
TSS
Rapid rehydration
Antistaph (nafcillin, oxacillin, vanc)
corticosteroids to reduce severity/ fever
Tx leiomyoma
NSAID, OCP
medroxyprogestrone acetate or danazol to stop or slow bleeding
GnRH analogs (leuprolide or nafarelin) to decr size
myomectomy or hysterectomy or uterine artery embolization
Types of endometrial cancer and etiology
Type I (endometrioid): unopposed estrogen Type II (serous): unrelated to estrogen, p53 mut, older age; poor prognosis
Types of HPV assoc with diff types cancer
HPV 16: SCC
HPV 18: adenoca
vulva: pruritic or painful white, pigmented, raised, thickned, or ulcerated lesion: workup and tx
possible vulvar cancer: punch bx
Tx: topical chemo, laser abl, WLE, or vulvectomy
Inhibin producing ovarian mass
granulosa cell
LDH producing ovarian mass
dysgerminoma
AFP producing ovarian mass
endodermal sinus or embryonal carcinoma
criteria for tx of ovarian mass (by age)
premenarchal : >2cm-> close monitoring
Premenopausal: 8-10cm and complex/ unchanged: surgical exc
Postmenopausal: asymptomatic,
Presents as “a bunch of grapes” in the vagina of pediatric patient
sarcoma botyroides (rhabdomyosarcoma)
Etiologies + treatments precocious puberty
Central: leuprolide Peripheral: -ovarian cyst: none, will regress -CAH: glucocorticoids -Adrena/ovarian tumor: excision -Mccune albright: toamoxifen or ketoconazle/testolactone
