Gynecology Flashcards
normal female development
growth acceleration->thelarche–>pubarche–>menarche
men development
testicular enlargement–>penile growth–>pubarche–>facial hair
premature menopause
cessation of the menses before age 40
2 Dysmenorrhea DDX
endometriosis adenomyosis fibroids adhesions PID
adenomiosis triad
menorrhagia, enlarged boggy symmetrical uterus
AUB(abnormal uterine bleeding)
PALM COEIN
PALM(structural causes) -polyps -Adenomyosis -Leiomyoma -Malignancy COEIN(nonstructural) -Coagulopathy -Ovulatory dysfunction -Endrometrial -Iatrogrenic -Not yet classified.
endometrial biopsy indication
- endometrium is >4mm in postmenopausal woman
- in the patient is >35years of age with risk factors for endometrial hyperplasia(obesity,diabetes)
rotterdam criteria
PCOS (2/3)
- polycystic ovaries(via ultrasound)
- oliog. and/or anovulation
- clinical and/or biochemial evidence of Hyperandrogenism
many WBCs and no organism on saline smear, suspect?
Chlamydia
suspicious breast mass first step in workup
before 30 mammogram
most accurate test for adenomyosis
MRI
postcoital bleeding
cervical cancer until proven otherwise
dysfunctional uterine bleeding treatment
OCP
DUB with acute hemorrage treatmetn
- fluid until stable
- D &C
labial fusion
excess androgens
bartholin gland cyst
I and drainage if persist marsupialization
bilateral cancer in vaginal treatment
radical vulvectomy
only definitive treatment for adenomyosis
hysterectomy
endometriosis pain synmtomatology
pain start 1 to 2 weeks before menstruation , peaks 1 to 2 days before mesntruation, PAIN ENDS WITH MESNTRUATION
treatment for endometriosis in satisfacty childbearing female
hysterectomy and bilateral salpingo-oophorectomy
male normla development
testicular enlargement–>(9-14y)–>penile growth—>pubarche—->facial hair
MOST effective emergency contraceptive method
Copper T IUD(99% effective) used within 7 days of unprotected sex
1amenorrhea/delayed puberty
- absence of menses by age 16 with 2 sexual develop present.
- absence of 2 sexual characteristics by age 14
absence of 2 sexual characteristic
MEANS NO ESTROGEN
1 amenorrhea with absence of 2 sdexual characteristic
- TURNER
- CENTRAL HYPOGONADISM
- undernourishment,stress,hyperprolactinemia or exercise
- CNS tumor
- Kallman syndrome(anosmia)
- constutional growth delay
1 amenorrhea with 2 sexual characteristics(estrogen prodcution but other anatomic or genetic problem)
- mullerian agenesis(absence 2/3 of vagina)
- imperforated hymen(hematocolpos
- complete androgen insensitivity
- congenital adreanl hyperplasia:virilization with amenorrha or oligomenorrhea
first step en 1 and 2 amenorrhea
pregnancy test
1 amenorrhea
CHECK pag 339 firts aid CK
2 amenorrhea definition
absence of menses for 6 months in women who have passed menarche.
2 amenorrhea causes
- pregnancy
- ovary:PCOS, premature ovarian failure
- hypothalamus
- Neoplasm
- Functional hypothalamic amenorrhea(nutrition,exercise,stress)
- systemic disease
- Pituitary:adenoma,sellar mases,sheehan syndrome
- thyroid
- uterine:asherman syndrome,cervical stenosis.
2 amenorrhea workup
1-.pregnancy test
2-. TSH and prolactin
3-.Progestin challenge
*if positive(withdrawal bleed):anovulation
*if negative(no bleed):uterine abnormality or estrogen deficiency
premature ovarian failure treatment
if uterine present —> OCP
2 dysmenorrhea DDx
- endometriosis
- adenomyosis
- fibroids
- adhesion
- PID
most common cause of infertility in women
PCOS
increase DHEA
signs of hyperandrogenism
adrenal tumor
indication for drainage of tubo-ovarian/pelvic abscess
persist after antibiotic
-larger than 4-6cm
more mortal gynecologic neoplasm
ovarian
HPV 16
squamous cell carcinoma
HPV 18
adenocarcinoma
ASCUS or LSIL before 24y
repeat cytology at 12 months
ASCUS or LSIL after 24 Y
ASk for HPV DNA test
if positive COLPOSCOPY
direc to colposcopy
ASC-H
HSIL
HPV DNA +
indication por cervical ablation or incision
CIN II and CIN III
+ margin: papa in 6m
- margin: pap in 12 m
microinvasice carcinoma treatmetn
cone biopsy
precocious puberty
-secondary sexual characteristics in a child before 8 years
ASK FOR GnRH
causes of peripheral precocious puberty
CAH adrenal turmors McCune-Albright syndrome gonadal tumors exogenous estrone,OCP ovarian cyst
centra precocious puberty treatment
Leuprolide
breast cancer
stages
stageII:more than 2 cm
StageIII:nodal involvement
stageIV: mets
OCP absolute contraindication
- migraine with aura
- more than 15 cigarretes/days over 35y
- 2 stage hypertention
- history DVP
- stroke or ischemic heart disease
- Breast cancer
- cirrhosis and liver cancer
- major surgery with prolonged immobilization
epithelial carcinoma
increased CA-125
ASCUS with HPV DNA negative …next best step
repead co-testing in 3 years
breast cancer treatment during pregnancy
CX, no radiatiation, and no chemo during first trimester
next step if sperm analysis comes out abnormal
repeat the test
