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Step 2/Level 2 > Gynecology > Flashcards

Gynecology Flashcards

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1
Q

What Tanner stage is a girl at with a bud with elevation of the breast and papilla and an enlarged areola?

A

Stage 2

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2
Q

What Tanner stage is a girl who presents with areola and papilla that form a secondary mound above the level of the breast?

A

stage 4

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3
Q

What Tanner stage is a girl who presents with a papilla that projects as the areola recesses?

A

stage 5

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4
Q

Tanner stage of darker, coarser and more curled pubic hair?

A

stage 3

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5
Q

Tanner stage of adult hair in type but not including the medial thighs?

A

stage 4

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6
Q

What imaging should be considered in a peripheral precocious puberty?

A

CT abdomen and pelvis

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7
Q

What is considered precocious puberty?

A

pubertal changes in girls younger than 8 and boys before 9

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8
Q

What is the treatment for central precocious puberty?

A

continuous GnRH agonist (leuprolide)

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9
Q

FSH stimulates the release of which hormone from the follicle?

A

Estradiol

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10
Q

How is menopause diagnosed? What labs are needed to diagnose it?

A
  • 12 months of amenorrhea in a women >40yo

- none

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11
Q

What is premature ovarian failure?

A

-amenorrhea in a pt

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12
Q

What non-hormonal options can be used in the treatment of menopausal hot flashes?

A

-Desvenlafaxine (only drug FDA approved for hot flashes)
-Vanlafaxine
-Gabapentin (good for insomnia and restless leg syndrome)
-

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13
Q

When should a woman taking estrogen take progesterone as well? Why?

A

-any woman with a uterus should take BOTH if taking estrogen due to the increased risk of endometrial hyperplasia and cancer with unopposed estrogen

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14
Q

What meds are known for decreasing the effectiveness of combination OCPs through changes in liver metabolism?

A
  • Antiepileptics
  • ABX: Rifampin (and kinda Griseofulvin)
  • St. John’s Wort
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15
Q

What are some adverse effects of progestin-only contraceptives?

A
  • Breakthrough bleeding
  • weight gain (3-5lbs)
  • +/- osteoporosis
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16
Q

OCP use decrease the incidence of which types of cancer?

A
  • endometrial
  • ovarian
  • colon
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17
Q

What are the 4 options for emergency contraception?

A
  • ethinyl estradiol/levorgestrel
  • levonorgestrel (plan B)
  • Copper IUD
  • Antiprogestins (ulipristal or mifepristone)
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18
Q

Which medication is 1st line for moderate to severe PMS or PMDD?

A

-SSRIs given just during the luteal phase for several days or used continuously

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19
Q

What is the most common cause of female infertility?

A

endometriosis

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20
Q

Which lab can be elevated in endometriosis?

A

CA 125

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21
Q

How do you definitively diagnose endometriosis?

A

-visualization on laparoscopy

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22
Q

What is the timing of symptoms of PMS and PMDD?

A

Several days before the onset of menstruation

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23
Q

What is the timing of pain in primary dysmenorrhea during the menstrual cycle?

A

-1st day of menstruation

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24
Q

What is the most common cause of irregular heavy uterine bleeding in a non-pregnant, premenopausal woman?

A

an ovulation

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25
Q

What is the most common cause of regular heavy menstrual bleeding in a non-pregnant, premenopausal woman?

A

Fibroids

26
Q

What is the most common closing disorder that can cause menorrhagia?

A

von willebrand disease

27
Q

When is an endometrial biopsy a necessary part of the workup for AUB?

A
  • age >45yo
  • persistent AUB >6 months
  • Multiple risks for endometrial cancer
28
Q

What is the definition of primary amenorrhea?

A
  • absence of menses and secondary sex characteristics by the age 13
  • if secondary sex characteristic are present, the absence of menses by the ago 15
29
Q

Amenorrhea in the setting of excessive exercise, stress and/or weight loss?

A

hypothalamic amenorrhea (can lead to increased risk of osteoporosis)

30
Q

Amenorrhea with breast development, absent uterus and no pubic or axillary hair?

A

Androgen insensitivity syndrome (must remove testes)

31
Q

Amenorrhea with breast development, absent uterus, with pubic/axillary hair?

A

Mullein agenesis

32
Q

Amenorrhea with anosmia, no secondary sex characteristics?

A

Kallman syndrome (impaired migration of GnRH neurons)

33
Q

Secondary amenorrhea with a h/o D&C for septic abortion?

A

Asherman syndrome (scarring and adhesions within uterine cavity following uterine surgery)

34
Q

How can androgen insensitivity syndrome be distinguished from mullerian agenesis?

A

Androgen insensitivity:

  • High testosterone
  • no pubic/axillary hair
  • 46XY

Mullerian agenesis:

  • Low testosterone
  • pubic/axillary hair present
  • 46 XX
35
Q

What is the treatment for a prolactin-secreting pituitary adenoma?

A

-DA agonist (bromocriptine)

36
Q

What is the diagnostic criteria for PCOS?

A

2+:

  • oligoovulation or an ovulation
  • hyperandrogenism (increased testosterone and DHEA, acne, male patterned baldness, hirsutism)
  • Polycystic ovaries on US (“string of pearls”)
37
Q

What is the main complication to be aware of in PCOS?

A

Endometrial hyperplasia (2/2 unopposed estrogen)

38
Q

Tx for bacterial vaginosis?

A

Metronidazole

39
Q

Tx for trichomoniasis?

A

Metronidazole (treat partner too!)

40
Q

Tx for vulvovaginal candidiasis?

A
  • Oral fluconazole

- topical azole

41
Q

What is the empiric tx for TSS?

A

Clindamycin and Vanco

42
Q

What is the treatment for gonorrhea?

A
  • IM ceftriaxone x1
  • Azithromycin PO x1
  • covers BOTH chlamydia and gonorrhea and resistant gonococcal strains
43
Q

What might cause RUQ pain in a patient that presents with PID?

A
  • Fitz-hugh-curtis syndrome (perihepatitis)

- -> adhesions from the peritoneum to the liver

44
Q

Treatment of PID inpatient?

A
  • Cefotetan/cefoxitin + doxycycline

- Clindamycin + gentamycin

45
Q

Treatment of PID outpatient?

A

-IM ceftriaxone x 1 dose + doxycycline x 14 days

46
Q

Classic presentation of endometrial hyperplasia/cancer? What is the best diagnostic step?

A
  • postmenopausal bleeding

- endometrial biopsy

47
Q

How does Tamoxifen work?

A
  • Estrogen receptor antagonist in the breast

- agonist in the endometrium–> can lead to endometrial cancer

48
Q

Risk for endometrial cancer?

A
  • chronic anovulation (PCOS)

- Estrogen replacement without progesterone (unopposed estrogen)

49
Q

What is the next best step: 38 year old healthy woman presents with heavy periods and is found to have an enlarged uterus on exam?

A

-Ultrasound

50
Q

What is the next best step: 46yo obese woman with PCOS and infrequent but heavy periods?

A

-Endometrial biopsy

51
Q

What is the next best step: 60 yo woman with postmenopausal bleeding?

A

Endometrial Biopsy

52
Q

Diethylstilbestrol use during pregnancy is associated with what malignancy?

A

-clear cell adenocarcinoma of the vagina in the infant

53
Q

What is the next step in a patient found to have HSIL?

A
  • age 21-24 =colposcopy

- >25 yo= LEEP

54
Q

A 21 yo female is found to have ASCUS on a pap…What is the next best step?

A
  • repeat pap in 1 year

- If + ==> colposcopy

55
Q

A 27 yo female is found to have ASCUS on pap…What is the next step?

A
  • HPV testing

- If + –> colposcopy

56
Q

What is the next best step in ASC-H?

A

Colposcopy (all ages)

57
Q

What is the next best step for a patient with atypical glandular cells on pap?

A
  • Endocervical sampling
  • colposcopy
  • Endometrial biopsy (>35yo or risk factors)
58
Q

What tumor marker is elevated with epithelial ovarian tumors?

A

CA 125 (most common)

  • serous
  • mucinous
59
Q

Which tumor markers are elevated in granulosa cell tumors?

A

Estrogen and inhibin

60
Q

Which tumor markers are elevated in sertoli-leydig cell tumors?

A

testosterone

61
Q

Risks for ovarian cancer?

A
  • uninterrupted ovulatory cycles (nulliparity, no OCPs)

- FmHX (BRCA genes or Lynch syndrome)

Step 2/Level 2 (18 decks)

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