Gynecology Flashcards
What Tanner stage is a girl at with a bud with elevation of the breast and papilla and an enlarged areola?
Stage 2
What Tanner stage is a girl who presents with areola and papilla that form a secondary mound above the level of the breast?
stage 4
What Tanner stage is a girl who presents with a papilla that projects as the areola recesses?
stage 5
Tanner stage of darker, coarser and more curled pubic hair?
stage 3
Tanner stage of adult hair in type but not including the medial thighs?
stage 4
What imaging should be considered in a peripheral precocious puberty?
CT abdomen and pelvis
What is considered precocious puberty?
pubertal changes in girls younger than 8 and boys before 9
What is the treatment for central precocious puberty?
continuous GnRH agonist (leuprolide)
FSH stimulates the release of which hormone from the follicle?
Estradiol
How is menopause diagnosed? What labs are needed to diagnose it?
- 12 months of amenorrhea in a women >40yo
- none
What is premature ovarian failure?
-amenorrhea in a pt
What non-hormonal options can be used in the treatment of menopausal hot flashes?
-Desvenlafaxine (only drug FDA approved for hot flashes)
-Vanlafaxine
-Gabapentin (good for insomnia and restless leg syndrome)
-
When should a woman taking estrogen take progesterone as well? Why?
-any woman with a uterus should take BOTH if taking estrogen due to the increased risk of endometrial hyperplasia and cancer with unopposed estrogen
What meds are known for decreasing the effectiveness of combination OCPs through changes in liver metabolism?
- Antiepileptics
- ABX: Rifampin (and kinda Griseofulvin)
- St. John’s Wort
What are some adverse effects of progestin-only contraceptives?
- Breakthrough bleeding
- weight gain (3-5lbs)
- +/- osteoporosis
OCP use decrease the incidence of which types of cancer?
- endometrial
- ovarian
- colon
What are the 4 options for emergency contraception?
- ethinyl estradiol/levorgestrel
- levonorgestrel (plan B)
- Copper IUD
- Antiprogestins (ulipristal or mifepristone)
Which medication is 1st line for moderate to severe PMS or PMDD?
-SSRIs given just during the luteal phase for several days or used continuously
What is the most common cause of female infertility?
endometriosis
Which lab can be elevated in endometriosis?
CA 125
How do you definitively diagnose endometriosis?
-visualization on laparoscopy
What is the timing of symptoms of PMS and PMDD?
Several days before the onset of menstruation
What is the timing of pain in primary dysmenorrhea during the menstrual cycle?
-1st day of menstruation
What is the most common cause of irregular heavy uterine bleeding in a non-pregnant, premenopausal woman?
an ovulation
What is the most common cause of regular heavy menstrual bleeding in a non-pregnant, premenopausal woman?
Fibroids
What is the most common closing disorder that can cause menorrhagia?
von willebrand disease
When is an endometrial biopsy a necessary part of the workup for AUB?
- age >45yo
- persistent AUB >6 months
- Multiple risks for endometrial cancer
What is the definition of primary amenorrhea?
- 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
Amenorrhea in the setting of excessive exercise, stress and/or weight loss?
hypothalamic amenorrhea (can lead to increased risk of osteoporosis)
Amenorrhea with breast development, absent uterus and no pubic or axillary hair?
Androgen insensitivity syndrome (must remove testes)
Amenorrhea with breast development, absent uterus, with pubic/axillary hair?
Mullein agenesis
Amenorrhea with anosmia, no secondary sex characteristics?
Kallman syndrome (impaired migration of GnRH neurons)
Secondary amenorrhea with a h/o D&C for septic abortion?
Asherman syndrome (scarring and adhesions within uterine cavity following uterine surgery)
How can androgen insensitivity syndrome be distinguished from mullerian agenesis?
Androgen insensitivity:
- High testosterone
- no pubic/axillary hair
- 46XY
Mullerian agenesis:
- Low testosterone
- pubic/axillary hair present
- 46 XX
What is the treatment for a prolactin-secreting pituitary adenoma?
-DA agonist (bromocriptine)
What is the diagnostic criteria for PCOS?
2+:
- oligoovulation or an ovulation
- hyperandrogenism (increased testosterone and DHEA, acne, male patterned baldness, hirsutism)
- Polycystic ovaries on US (“string of pearls”)
What is the main complication to be aware of in PCOS?
Endometrial hyperplasia (2/2 unopposed estrogen)
Tx for bacterial vaginosis?
Metronidazole
Tx for trichomoniasis?
Metronidazole (treat partner too!)
Tx for vulvovaginal candidiasis?
- Oral fluconazole
- topical azole
What is the empiric tx for TSS?
Clindamycin and Vanco
What is the treatment for gonorrhea?
- IM ceftriaxone x1
- Azithromycin PO x1
- covers BOTH chlamydia and gonorrhea and resistant gonococcal strains
What might cause RUQ pain in a patient that presents with PID?
- Fitz-hugh-curtis syndrome (perihepatitis)
- -> adhesions from the peritoneum to the liver
Treatment of PID inpatient?
- Cefotetan/cefoxitin + doxycycline
- Clindamycin + gentamycin
Treatment of PID outpatient?
-IM ceftriaxone x 1 dose + doxycycline x 14 days
Classic presentation of endometrial hyperplasia/cancer? What is the best diagnostic step?
- postmenopausal bleeding
- endometrial biopsy
How does Tamoxifen work?
- Estrogen receptor antagonist in the breast
- agonist in the endometrium–> can lead to endometrial cancer
Risk for endometrial cancer?
- chronic anovulation (PCOS)
- Estrogen replacement without progesterone (unopposed estrogen)
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?
-Ultrasound
What is the next best step: 46yo obese woman with PCOS and infrequent but heavy periods?
-Endometrial biopsy
What is the next best step: 60 yo woman with postmenopausal bleeding?
Endometrial Biopsy
Diethylstilbestrol use during pregnancy is associated with what malignancy?
-clear cell adenocarcinoma of the vagina in the infant
What is the next step in a patient found to have HSIL?
- age 21-24 =colposcopy
- >25 yo= LEEP
A 21 yo female is found to have ASCUS on a pap…What is the next best step?
- repeat pap in 1 year
- If + ==> colposcopy
A 27 yo female is found to have ASCUS on pap…What is the next step?
- HPV testing
- If + –> colposcopy
What is the next best step in ASC-H?
Colposcopy (all ages)
What is the next best step for a patient with atypical glandular cells on pap?
- Endocervical sampling
- colposcopy
- Endometrial biopsy (>35yo or risk factors)
What tumor marker is elevated with epithelial ovarian tumors?
CA 125 (most common)
- serous
- mucinous
Which tumor markers are elevated in granulosa cell tumors?
Estrogen and inhibin
Which tumor markers are elevated in sertoli-leydig cell tumors?
testosterone
Risks for ovarian cancer?
- uninterrupted ovulatory cycles (nulliparity, no OCPs)
- FmHX (BRCA genes or Lynch syndrome)
