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Gynecology Flashcards

1
Q

What is the order of female development? (4)

A
  • growth acceleration
  • Thelarche
  • pubarche
  • menarche
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2
Q

What is the order of male development? (4)

A
  • Testicular enlargement
  • Penile growth
  • Pubarche
  • facial hair
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3
Q

What is the follicular phase of menstruation? When in menstruation does it occur?

A

Starts with menstruation and end with LH surge

Occurs days 1- 13

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4
Q

What hormonal change triggers ovulation?

A

LH surge

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5
Q

What causes the LH surge in menstruation?

A

Increased frequency of GnRH pulsation leads to the growth of follicles, and increased estrogen production

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6
Q

On what day does ovulation occur? What happens hormonally on this day?

A

Day 14
Estradiol reaches a peak→ positive feedback to the pituitary gland → LH surge (smaller FSH rise) → rupture of the ovarian follicle and release of a mature ovum → travels to oviduct/uterus.

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7
Q

What do ruptured follicular cells differentiate into?

A

The corpus luteum.

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8
Q

When does breast development occur in females?

A

8 - 11 years.

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9
Q

How long can a corpus luteum survive without further LH or HCG simulation?

A

10 to 14 days.

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10
Q

What is the average onset of menopause?

A

51 years old.

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11
Q

What is the technical Definition of premature menopause?

A

Cessation of Menses before 40.

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12
Q

Increased FSH. Increase LH. Increased total cholesterol. (3)

A

Increased FSH.
Increase LH.
Increased total cholesterol.

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13
Q

True or false: multiple sexual partners and nulliparity are absolute contraindications to IUD use.

A

False

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14
Q

What are the adverse effects of estrogen replacement after menopause?

A

Increased risk of breast Cancer, and CV risks

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15
Q

What are the contraindications. Estrogen replacement after Menopause?

A
  • vaginal bleeding
  • breast CA
  • untreated endometrial cancer
  • h/o thromboembolism
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16
Q

What are the non-hormonal medications that can be given for menopausal symptoms? (3)

A

SRRIs, clonidine, and/or Gabapentin.

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17
Q

True or false: topical estrogen preparation for vaginal atrophy has the same contraindications a systemic hormone replacement therapy.

A

False

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18
Q

What are the key physical exam findings that are common for Turner syndrome?

A

Redneck repair.
Shield chest.
Streaked ovaries.
Aortic Coarctation

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19
Q

What is the definition of primary amenorrhea?

A

The absence of Menses by age 16 with secondary sexual development present

OR the absence of secondary sexual characteristics by age 14.

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20
Q

What is the most common cause of primary amenorrhea?

A

Primary ovarian insufficiency.

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21
Q

What are the risk factors for Central hypogonadism?

A

Undernourishment.

CNS tumor

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22
Q

What is the MOA, advantages, and disadvantages of: Implanon

A

MOA- Progestin only–Inhibits ovulation by increasing cervical mucus viscosity.

  • Advantage: Safe with breastfeeding
  • Disadvantage: Irregular periods.
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23
Q

What is the MOA, advantages, and disadvantages of: IUD with progestin

A
  • MOA: FB inflammation + local cervical mucus thickening
  • Advantage: Light periods
  • Disadvantage: Spotting x6 months
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24
Q

What is the MOA, advantages, and disadvantages of: Copper IUD (paragard)

A
  • MOA: FB inflammation
  • Advantage: 10 years
  • Disadvantage: increased cramping initially
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25
Q

What is a major adverse effect Of tubal ligation?

A

Besides being irreversible, there’s an increased risk of ectopic pregnancy.

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26
Q

What is the MOA, advantages, and disadvantages of: Depo shot

A
  • MOA: One progestin injection
  • Advantage: lighter periods
  • Disadvantage: weight gain and delayed fertility after removal
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27
Q

What is the MOA, advantages, and disadvantages of: ortho evra (the patch)

A
  • MOA: Combined weekly estrogen and progestin dermal patch
  • Advantage: Periods more regular
  • Disadvantage: thromboembolism
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28
Q

What is the MOA, advantages, and disadvantages of: nuvaring

A
  • MOA: Combined estrogen + progestin vaginal ring
  • Advantage: Period more reg, 3 weeks of continuous use
  • Disadvantage: increase vaginal d/c
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29
Q

What is the MOA, advantages, and disadvantages of: OCPs

A
  • MOA: Inhibits FSH/LH production
  • Advantage: Lighter menses, improve acne
  • Disadvantage: Daily compliance, thromboembolism risk
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30
Q

What is the MOA, advantages, and disadvantages of: progestin only pills

A
  • MOA: thicken cervical mucus
  • Advantage: Safe with breastfeeding
  • Disadvantage: require strict compliance and daily timing
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31
Q

What general type of contraception is safe to use when breastfeeding?

A

Progesterone only types

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32
Q

Besides the obvious, what are the major contraindications to the use of estrogen containing contraceptives?

A
  • Liver problems

- Tobacco use and over age 35

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33
Q

Active gynecological infection within what time frame is a contraindication to IUD placement?

A

within 3 months

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34
Q

What is kallmann syndrome?

A

a failure of the hypothalamus to release GnRH at the appropriate time as a result of the GnRH releasing neurones not migrating into the correct location during embryonic development

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35
Q

What is mullerian agenesis?

A

Absence of two-thirds of the vagina. as well as uterine abnormalities

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36
Q

What is the first step in the work of a primary secondary amenorrhea?

A

A pregnancy test.

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37
Q

What is the first step in the work of a primary or secondary amenorrhea?

A

A pregnancy test.

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38
Q

How do patients with complete Androgen insensitivity present?

A

Patients present with breast development, but are amenorrheic and lack pubic hair

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39
Q

If a young female patient presents with amenorrhea secondary to uterus absence, what labs should be obtained?

A

Karyotype, and serum testosterone

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40
Q

What lab result will be markedly elevated in patients with primary Ovarian insufficiency?

A

FSH

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41
Q

What is the technical definition of secondary amenorrhea?

A

The absence of Menses for six consecutive months in women who have passed menarche.

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42
Q

What are the major uterine causes of secondary amenorrhea?

A

asherman syndrome, cervical stenosis.

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43
Q

What are the major pituitary causes of secondary amenorrhea?

A

Adenoma, sellar masses, Sheehan syndrome.

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44
Q

What are two major ovarian causes of secondary amenorrhea?

A

PCOS, premature ovarian failure.

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45
Q

What thyroid problem can lead to secondary amenorrhea?

A

hypothyroidism

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46
Q

What lab tests should be obtained in patients with secondary amenorrhea who are not pregnant?

A
  • TSH

- Prolactin levels

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47
Q

What is the effect of prolactin menses?

A

Inhibits the release of GnRH

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48
Q

What are the following lab values like with constitutional growth delay:

  • GnRH
  • LH/FSH
  • Estrogen/progesterone
A
  • GnRH = ↓
  • LH/FSH = ↓
  • Estrogen/progesterone = ↓
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49
Q

What are the following lab values like with anatomic problems:

  • GnRH
  • LH/FSH
  • Estrogen/progesterone
A
  • GnRH = normal
  • LH/FSH = normal
  • Estrogen/progesterone = normal
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50
Q

What are the following lab values like with hypogonadotropic hypogonadism:

  • GnRH
  • LH/FSH
  • Estrogen/progesterone
A
  • GnRH = ↓
  • LH/FSH = ↓
  • Estrogen/progesterone = ↓
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51
Q

What are the following lab values like with hypergonadotropic hypogonadism:

  • GnRH
  • LH/FSH
  • Estrogen/progesterone
A
  • GnRH = ↑
  • LH/FSH = ↑
  • Estrogen/progesterone = ↓
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52
Q

What are the following lab values like with anovulatory problems:

  • GnRH
  • LH/FSH
  • Estrogen/progesterone
A
  • GnRH = ↑ or decreased
  • LH/FSH = normal
  • Estrogen/progesterone = ↓progesterone, ↑estrogen
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53
Q

What does a positive progestin challenge indicate in the workup of amenorrhea?

A

Due to noncyclic gonadotropic secretion

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54
Q

What does a negative progestin challenge indicated in the workup of amenorrhea?

A

Indicates uterine abnormalities or estrogen deficiency

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55
Q

What are the treatments for hypothalamic causes of amenorrhea in pts trying to conceive, and those who are not?

A

Are: induce ovulation with gonadotropins
Not: OCPs

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56
Q

What is the cause of secondary amenorrhea if the progesterone withdrawl tests is + and the LH levels are increased?

A

PCOS or premature menopause

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57
Q

What is the cause of secondary amenorrhea if the progesterone withdrawl tests is + and the LH levels are decreased?

A

Idiopathic anovulation

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58
Q

What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are increased?

A

Hypergonadotropic hypogonadism / ovarian failure

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59
Q

What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are decreased?

A

Either hypogonadotropic hypogonadism or endometrial/anatomic problem

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60
Q

What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are decreased?

A

Either hypogonadotropic hypogonadism or endometrial/anatomic problem

Differentiate with estrogen+progesterone withdrawl test

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61
Q

What is the definition of primary dysmenorrhea?

A

Menstrual pain associated with ovulatory cycles in the absence of pathologic findigs

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62
Q

What are the exam findings of primary dysmenorrhea?

A

None

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63
Q

What is the treatment for primary dysmenorrhea?

A

NSAIDs
Heat
OCPs/IUD

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64
Q

What are the major causes of secondary dysmenorrhea? (5)

A 
Endometriosis
Adenomyosis
Fibroids
Adhesions
PID
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65
Q

What are the labs to obtain in suspected cases of secondary amenorrhea? (4)

A
  • beta-hCG for prego
  • CBC to r/o neoplasm/infx
  • UA for UTI
  • GC/Chlamydia
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66
Q

True or false: uterine polyps are not painful

A

True

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67
Q

What is the basic pathophysiology of endometriosis and adenomyosis?

A

Endometriosis = Functional endometrial tissue outside the uterus

Adenomyosis = endometrial tissue within the myometrium of the uterus

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68
Q

What are the classic s/sx of endometriosis?

A
  • Cyclic pelvic pain with menstruation
  • Painful nodules
  • Restricted ROM
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69
Q

What are the classic s/sx of adenomyosis? (3)

A
  • Dysmenorrhea
  • Menorrhagia
  • Enlarged, boggy, symmetric uterus
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70
Q

How do you diagnose endometriosis?

A

Requires direct visual laparoscopy or laparotomy

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71
Q

How do you diagnose adenomyosis?

A
  • MRI can aid in diagnosis but is costly.
  • Ultrasonography is useful but cannot always distinguish between leiomyoma and adenomyosis.
  • Ultimately a pathologic diagnosis.
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72
Q

What are the classic appearance of endometriosis? (3)

A

Chocolate cysts
Powder burn appearance
Raspberry colored lesions

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73
Q

What are the pharmacologic, conservative surgical, and definitive surgical treatments for endometriosis?

A
  • Pharmacologic: Inhibit ovulation (OCPs or GnRH analogues)
  • Conservative: Excision and/or cautery/ablation
  • Definitive: TAH/BSO + lysis of adhesions
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74
Q

What are the pharmacologic, conservative surgical, and definitive surgical treatments for adenomyosis?

A
  • Pharmacologic: symptomatic (NSAIDs + OCPs)
  • Conservative: Endometrial ablation/resection
  • Definitive: Hysterectomy
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75
Q

What is the major complications associated with endometriosis?

A

Infertility

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76
Q

What is the rare but major complication associated with adenomyosis?

A

Endometrial carcinoma

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77
Q

Postmenopausal bleeding is what until proven otherwise?

A

Cancer

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78
Q

What is the most common cause of irregular vaginal bleeding and amenorrhea?

A

Pregnancy

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79
Q

What are the components of the PALM mnemonic for the structural causes of abnormal uterine bleeding?

A

Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia

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80
Q

What are the components of the COEIN mnemonic for the structural causes of abnormal uterine bleeding?

A
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
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81
Q

What is the technical definition of oligomenorrhea?

A

Increase in the length between menses (35-90 days between cycles)

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82
Q

What is the technical defintion of polymenorrhea?

A

Frequent menstruation (less than 21 day cycle)

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83
Q

What is the technical defintion of menorrhagia?

A

Increased amount of bleeding (over 80 mL of blood per cycle) or prolonged bleeding (more than 8 days)

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84
Q

What is the technical defintion of metrorrhagia?

A

Bleeding between periods

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85
Q

What is the technical defintion of menometrorrhagia?

A

Excessive and irregular bleeding

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86
Q

What are the labs, besides a UPT/hCG, that should be obtained when working up dysfunctional uterine bleeding? (6)

A
  • CBC for anemia
  • Pap smear for CA
  • GC/Chlamydia
  • TFTs and prolactin for endocrine
  • Platelet, PT/PTT for coagulation
  • US
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87
Q

What is the first line treatment for all abnormal uterine bleeding to decrease the amount of blood lost?

A

NSAIDs

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88
Q

On US, if the endometrium of a postmenopausal woman is thicker than how many mm is a concern for CA warranted?

A

4 mm or more

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89
Q

What is the treatment for heavy uterine bleeding that needs stabilization?

A

high dose IV estrogen to stabilized the endometrial lining. This typically stops bleeding within 1 hour

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90
Q

What is the treatment for ovulatory bleeding? (3)

A
  • NSAIDs
  • Tranexamic acid
  • OCPs
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91
Q

What is the treatment for anovulatory bleeding? (3)

A

The goal is to convert proliferative endometrium to secretory endometrium (to ↓ the risk of endometrial hyperplasia/cancer):
■ Progestins × 10 days to stimulate withdrawal bleeding.
■ OCPs.
■ Progestin IUD

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92
Q

What are the highly effective options for treating menorrhagia?

A

progestin IUDs and OCPs

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93
Q

What is the treatment for dysfunctional uterine bleeding that is refractory to medical therapy? (3)

A

D+C
Hysterectomy
Endometrial ablation

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94
Q

Draw out the adrenal enzyme pathway.

A

Draw

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95
Q

Which hormones are under/overproduced with 21-hydroxylase deficiency?

A

Underproduced aldosterone and cortisol

Overproduced androgens

96
Q

Which hormones are under/overproduced with 11 beta-hydroxylase deficiency?

A

Underproduced aldosterone and cortisol (although 11 deoxycorticosterone has enough aldosterone-like effects)

Overproduced androgens

97
Q

What is hirsutism?

A

Male hair pattern

98
Q

What is virilization?

A

Frontal balding
Muscularity
Clitoromegaly
Deepening of the voice

99
Q

Which of the three types of congenital adrenal hyperplasia result in HTN?

A

11beta and 21 hydroxylase deficiencies (17alpha does not)

100
Q

What is cosyntropin?

A

Synthetic ACTH

101
Q

What are the labs like with salt wasting 2/2 CAH or aldosterone deficiency (Na, K, Renin)?

A

Decreased Na
Increased K
Increased renin

102
Q

What is the treatment for CAH?

A

Glucocorticoids and mineralocorticoid (e.g. fludrocortisone) if salt wasting is present

103
Q

What is the classic triad of s/sx for PCOS?

A
  1. Polycystic ovaries
  2. Oligomenorrhea/anovulation
  3. Hyperandrogenism
104
Q

The most severe form of PCOS involves what lab/PE findings?

A
  • Acanthosis nigricans
  • Hyperandrogenism
  • Insulin Resistance
105
Q

Why might total testosterone by normal in PCOS, but free testosterone be elevated?

A

Low sex hormone binding globulin

106
Q

What is the classic appearance of ovaries with PCOS?

A

Pearl necklace sign

107
Q

What happens to LH/FSH levels with PCOS?

A

Elevated in a 2:1 ratio

108
Q

What is the treatment for women with PCOS who are and are not trying to conceive?

A

Not trying to conceive = OCPs, progestin, and metformin

Trying to: Clomiphene

109
Q

What is the treatment for the hirsutism seen with PCOS?

A

Combination OCPs and antiandrogens

110
Q

What are the complications of PCOS? (3)

A
  • DM
  • Miscarriages
  • Increased risk of breast/endometrial CA
111
Q

Which are more common: male or female causes of infertility?

112
Q

A 28-year-old woman comes to clinic for a wellness exam. She describes that approximately 2 weeks after her menses, she experiences intense, sharp lower quadrant abdominal pain that lasts a couple of hours. The pain varies from the right to the left side each cycle. What is the name of this phenomenon?

A

This is called mittelschmerz, pain at ovulation due to progesterone production. It can switch sides depending on which ovary ovulates in a given cycle.

113
Q

What is the classic description of fibroids on exam?

A

Uterus is irregular and mobile

114
Q

Are fibroids hormonally sensitive?

115
Q

What are the s/sx of fibroids?

A
  • Bleeding (longer, heavier periods)
  • Mass effect (constipation, urinary frequency)
  • Pain secondary dysmenorrhea
  • Pelvic s/sx
116
Q

If a uterine mass continues to grow after menopause, what process should be suspected?

A

Malignancy

117
Q

What are the diagnostic tests in the workup of leiomyomas?

A
  • TVUS
  • MRI delineate mucosal vs submucosal
  • CBC to assess for anemia
118
Q

What are the three general treatment for leiomyomas?

A
  • Expectant if asymptomatic
  • Contraception
  • Surgery
119
Q

What are the pharmacologic treatments for leiomyomas?

A
  • OCPs
  • GnRH analogs to decrease size
  • NSAIDs for pain
120
Q

What are the surgical options for fibroid treatment in:

  • Women of childbearing years
  • Women who have completed childbearing
A

Childbearing = Abdominal or hysteroscopic myomectomy

Not-Total or subtotal hysterectomy

121
Q

What is an indication for emergent surgery for fibroids?

A

If pedunculated one torses on itself

122
Q

What is the difference between type I and II endometrial cancer?

A

type I = results from Atypical endometrial hyperplasia

type II = results from serous or clear cell histology

123
Q

A uterine lining that is found to be below (__) mm in thickness is unlikely to be endometrial CA.

124
Q

What is the difference in prognosis between type I and Type II endometrial cancer?

A

I has a relatively good prognosis, whereas II has a very poor one.

125
Q

What is the difference in etiology between type I and Type II endometrial cancer?

A 
I = unopposed estrogen stimulation or tamoxifen therapy
II = unrelated to estrogen--p53 mutation
126
Q

What is the treatment for endometrial cancer in women of childbearing age, or postmenopausal women?

A 
Childbearing = High dose progestins
Postmenopausal = radiation and TAH/BSO
127
Q

What strain of HPV is the most common cause of squamous and adenocarcinoma?

A 
Squamous = 16
Adenocarcinoma = 18
128
Q

What are the s/sx of cervical cancer?

A

Metrorrhagia
Postcoital bleeding
Cervical ulceration

129
Q

What is the recommendation for pap smear frequency?

A

21-30, q 3 years

30-65, same as above, or q5 years if HPV tested

130
Q

HSIL correlates with what CIN grades?

A

II and III

131
Q

LSIL correlates with what CIN grade?

132
Q

How long should women with DES exposure be screened for cervical CA?

A

As long as they do not have some other life-limiting condition

133
Q

In what two major populations do the screening for cervical cancer/HPV do not apply?

A

Pregnant women and adolescents

134
Q

What are the two options for treating a woman aged 21-24 who has ACSUS or LSIL on pap smear? What should follow for each of these?

A
  • Repeat cytology at 12 months. If same or worse, then colp

- Reflex HPV testing. If +,colp

135
Q

What should be done for treating a woman aged 21-24 who has HSIL on pap smear?

A

Colposcopy

136
Q

What are the two options for treating a woman aged 24+ who has ACSUS or LSIL on pap smear? What should follow for each of these?

A
  • Reflex HPV testing. if - repeat usually. If +, colp

- Repeat cytology at 12 months

137
Q

In terms of pap smears, what does ASCUS stand for?

A

Atypical squamous cell of undetermined significance

138
Q

In terms of pap smears, what does ASC-H stand for?

A

Atypical squamous cells–cannot exclude HSIL

139
Q

In terms of pap smears, what does LSIL stand for?

A

Low-grade intraepithelial lesion

140
Q

In terms of pap smears, what does AGC stand for?

A

Atypical glandular cells of undetermined significance

141
Q

In terms of pap smears, what does HSIL stand for?

A

High-grade squamous intraepithelial lesions

142
Q

What should be done for treating a woman aged 24+ who has ASC-H on pap smear? What should follow for each of these?

A

colposcopy, regardless of HPV status

143
Q

What should be done for treating a woman aged 21+ who has LSIL on pap smear, and HPV + and - respectively?

A
  • If HPV -, then repeat cotesting at 12 months

- If HPV +, then colp

144
Q

What should be done for treating a woman aged 21+ who has LSIL on pap smear, and there is no access to HPV testing, or it is equivocal?

145
Q

What should be done for treating a woman aged 30+ who has LSIL and HPV positive?

146
Q

What should be done for all women who have AGC on pap smear? What if they’re 35+?

A

Colp for all, and if 35+ then endometrial sampling

147
Q

What should be done for treating a woman aged 21-24 who has ASC-H or HSIL on pap smear, and HPV + and - respectively?

A

Colp and treat for CA

148
Q

What is the treatment for noninvasive CIN I preceded by ASC-H or LSIL if repeat testing shows:

  • HPV and cytology-
  • HPV or cytology +
  • If HSIL?
A

Cotesting at 12 and 24 months.:

  • if HPV and cytology -, resume routine screening
  • If HPV + or abnormal cytology, colp
  • If HSIL, LEEP
149
Q

What is the treatment for noninvasive CIN II-III?

A

Ablation (cryotherapy or lasers)

  • LEEP
  • if young, can follow for 6-12 months
150
Q

If a woman has noninvasive CIN I, II, or III, undergoes excisional therapy, and has negative margins, what should be done next?

A

Pap smear at 12 months and/or HPV testing

151
Q

If a woman has noninvasive CIN I, II, or III, undergoes excisional therapy, and has positive margins, what should be done next?

A

Pap smear at 6 months, consider repeat endocervical curettage

152
Q

What is the treatment for invasive CIN with microinvasive CA, what should be done?

A

Cone bx and close f/u

153
Q

What is the treatment for invasive CIN with stages IA2, IB1, or IIA, what should be done?

A

may be treated with either radical hysterectomy with concomitant XRT and chemo, or with radiation therapy plus chemo alone

154
Q

What are the two major risk factors for developing vulvar cancer?

A

HPV infx

Lichen sclerosis

155
Q

What are stages 0 -IV of vulvar cancer?

A 
0 = in situ
I = Confined to cervix
II = Disease spread beyond cervix, but not to pelvic wall or lower 1/3 of vag
III = disease spread to pelvic wall or lower 1/3 of vag
IV = invades bladder, rectum, or mets
156
Q

What are the usualy s/sx of vulvar cancer?

A

Pruritus or ulceration of the mass

157
Q

What are the early lesions of vulvar cancer? Late?

A

Early = White, pigments, raised, thickened, nodular or ulcerative

Late = Large, cauliflower like or hard ulcerated area in the vulva

158
Q

What is the treatment for high grade VIN?

A

topical chemo, wide excision, or vulvectomy

159
Q

What is the treatment for invasive VIN?

A
  • Radical vulvectomy and regional lymph node dissection

- wide local excision

160
Q

What is the classic description of lichen sclerosis?

A

Atrophic and paper like skin

161
Q

What type of vaginal cancer usually affect younger women and postmenopausal women respectively?

A 
young = Adenocarcinoma or DES
Old = squamous
162
Q

What are the s/sx of vaginal cancer?

A

-abnormal vaginal bleeding or d/c

163
Q

What is the treatment for vaginal cancer?

A
  • Local excision

- vaginectomy if spread

164
Q

OCPs taken for 5+ years decrease the risk for ovarian CA by what percent?

165
Q

What is the most common type of gynecologic cancer?

A

Endometrial

166
Q

True or false: any palpable ovarian or adnexal mass in a premenarchal or postmenopausal women is highly suggestive of a neoplasm

167
Q

What are the s/sx of ovarian cancers?

A

Usually asymptomatic, but can present with pelvic pain or GI symptoms

168
Q

What is the tumor marker that is common to ovarian cancers?

169
Q

What benign disease may elevated CA-125 indicate in a premenopausal women?

A

Endometriosis

170
Q

A CA-125 level above what threshold in a postmenopausal woman is strongly suggestive for a malignant CA?

171
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: mobile

172
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: bilateral

173
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: nodular

174
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: multilocular appearance on US

175
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: calcification on US

176
Q

Is the follow characteristic suggestive of malignant or benign ovarian pathology: associated ascities

177
Q

An ovarian mass that is over how many cm is suggestive of Cancer?

178
Q

What is the treatment for an ovarian mass in a premenarchal woman?

A

Masses over 2 cm in diameter require close clinical f/u and often surgical removal

179
Q

What is the treatment for an ovarian mass in a premenopausal woman?

A
  • Observation is suspected benign

- Surgical removal is suspicious or over 10 cm

180
Q

What is the treatment for an ovarian mass in a postmenopausal woman?

A
  • Closely f/u with US

- if palpable, remove

181
Q

What is the surgical treatment of choice for ovarian cancer?

A

TAH/BSO with omentectomy and pelvic and paraaortic lymphadenectomy

182
Q

XRT is particularly effective for what type of ovarian cancers?

A

Dysgerminomas

183
Q

Postop chemotherapy is routine for for ovarian cancers in what women?

A

routine for all women except for women with early stage or low grade ovarian cancer

184
Q

What is the screening test for ovarian cancer in women with a BRCA mutation? What is the prophylactic treatment?

A

Annual US and CA-125 testing

Prophylactic = bilateral oophorectomy by age 40

185
Q

What are the s/sx of pelvic organ prolapse, besides the feeling of a prolapsing uterus?

A

fecal/urinary Incontinence, dyspareunia, and/or incomplete voiding

186
Q

How do you assess the degree of pelvic organ prolapse in a woman?

A

Have them in lithotomy position, and have them valsalva

187
Q

What is the treatment for pelvic organ prolapse?

A
  • High fiber diet and weight reduction
  • Pessaries
  • surgery
188
Q

What are the components of the DIAPPERS mnemonic for causes of urinary incontinence?

A 
Delirium
Infx
Atrophic urethritis/vaginitis
Pharmaceutical
Psych
Excessive urinary output
Restricted mobility
Stool impaction
189
Q

What tests are used to differentiate causes of urinary incontinence in women?

A

UA
Voiding diary
US
CrCl for renal causes

190
Q

Describe total urinary incontinence. (s/sx, mechanism, and treatment)

A
  • Uncontrolled loss at all times and in all positions
  • Loss of sphincteric efficiency
  • Surgical treatment
191
Q

Describe stress urinary incontinence. (s/sx, mechanism, and treatment)

A
  • Increased abdominal pressure causes urination
  • Laxity of pelvic floor musculature
  • Kegels or vaginal vault suspension surgery
192
Q

Describe urge urinary incontinence. (s/sx, mechanism, and treatment)

A
  • strong, unexpected urge to void that is unrelated to position
  • Detrusor hyperreflexia or sphincter dysfunction 2/2 inflammatory conditions
  • Anticholinergics or TCAs
193
Q

Describe overflow urinary incontinence. (s/sx, mechanism, and treatment)

A
  • Chronic urinary retention
  • Chronically distended bladder with increased intravesical pressure that just exceeds outlet resistance
  • Urethral cath, timed voiding
194
Q

What is the most common cause of pediatric vaginitis?

A

-Group A strep infx

195
Q

What are the major noninfectious causes of pediatric vaginitis?

A

contact dermatitis and eczema

196
Q

Bunches of grapes in a peds vagina = ?

A

Sarcoma botryoides

197
Q

What is the general etiology of central precocious puberty?

A

Early activation of the hypothalamic GnRH production

198
Q

What is the general etiology of peripheral precocious puberty?

A

Results from GnRH independent mechanisms

199
Q

If there are secondary sexual characteristics in a girl under 8 years, what tests should be done to r/o central causes of precocious puberty?

A
  • GnRH stimulation test

- bone age determination

200
Q

What are causes of central precocious puberty?

A

Anything that affects the hypothalamus/pituitary:

  • Tuberous sclerosis
  • CNS infx/trauma
  • hydrocephalus
201
Q

What are causes of peripheral precocious puberty? (6)

A
  • CAH
  • ADrenal tumors
  • McCune albright syndrome
  • gonadal tumors
  • exogenous estrogen
  • ovarian cysts
202
Q

What is the first line therapy for central causes of precocious puberty?

A

Leuprolide (GnRH agonist)

203
Q

What is the treatment for peripheral precocious puberty 2/2 ovarian cyst?

A

No intervention necessary, as it will resolve with cyst regression

204
Q

What is the treatment for peripheral precocious puberty 2/2 CAH?

A

Glucocorticoids

205
Q

What is the treatment for peripheral precocious puberty 2/2 adrenal or ovarian tumors?

206
Q

What is the treatment for peripheral precocious puberty 2/2 McCune-Albright syndrome

A
  • Antiestrogens (e.g tamoxifen)

- Estrogen synthesis blockers (e.g. ketoconazole or testosterone)

207
Q

What are the classic s/sx of McCune-Albright syndrome? (3)

A
  • precocious puberty
  • Cafe-au-lait spots
  • bony abnormalities (polyostotic fibrous dysplasia)
208
Q

What is a leuprolide stimulation test? What are the two outcomes?

A

Give leuprolide and check LH response:

  • If +, then central causes of precocious puberty
  • If -, then peripheral cause
209
Q

What exposures are associated with breast cyst development?

A

Caffeine use and trauma

210
Q

What is the order of the diagnostic workup of a breast mass?

A
  1. Return after menstruation. If unchanged, proceed
  2. US
  3. FNA
  4. Excisional bx if no fluid obtainable
  5. Mammography
211
Q

True or false: there is no increased risk of breast cancer with simple breast cysts

212
Q

What is the treatment for breast cysts?

A

OCPs
Decrease caffeine
Reassurance

213
Q

What are two common causes of bloody nipple discharge?

A

intraductal papilloma and duct ectasia

214
Q

What are the four major causes of proliferative breast lesions that do NOT have atypia?

A
  • Fibroadenomas
  • Ductal hyperplasia
  • Intraductal papillomas
  • Sclerosing adenosis
215
Q

True or false: there is no increased risk of breast cancer with proliferative breast lesions that do not have atypia, like fibroadenomas

A

False–slight increase

216
Q

What is the most common breast lesion in women under 30 years?

A

Fibroadenoma

217
Q

What are the s/sx of fibroadenomas?

A

Round, rubbery, discrete, mobile mass 1-3 cm. Usually TTP, but not always

218
Q

True or false: fibroadenomas are usually solitary lesions

219
Q

Do fibroadenomas change in size with menstruation?

A

No, but do decrease in size with menopause

220
Q

What are phyllodes tumors? What is the classic histologic appearance?

A

They are typically large, fast-growing masses that form from the periductal stromal cells of the breast. 10% are malignant

Leaflike appearance

221
Q

What percent of breast cancers appear in the upper, outer quadrant of the breasts?

222
Q

What are the four cancers that commonly met to bone?

A 
Breast
Lung
Thyroid
Prostate
("BLT with Pickle on top")
223
Q

The first step in the workup of a new breast mass in a postmenopausal woman is what?

224
Q

What are the mammogram findings of breast cancer? (4)

A

Increased density with microcalcifications, irregular borders, spiculated mass

225
Q

What is a major disadvantage to a FNA for breast masses?

A

High false + rate

226
Q

What are the three major tumor markers for breast cancer?

A

CA-15-3
CA 27-29
CEA

227
Q

What labs are classically elevated in metastatic breast cancer? (3)

A

Alk phos
ESR
Ca

228
Q

What is the chemotherapy for HER2-NEU receptor + breast cancer?

A

Trastuzumab

229
Q

What is the chemotherapy for estrogen receptor + breast cancer? (2)

A

Tamoxifen or aromatase inhibitor

230
Q

What are the contraindications to a breast sparing surgery for breast cancer? (5)

A
  • CA affixed to chest wall
  • Subareolar location
  • multifocal tumors
  • prior XRT to the chest
  • involvement of the nipple
231
Q

What defines stages II, III, and IV breast cancer?

A 
II = over 2 cm in size
III = nodal involvement
IV = mets
232
Q

Which it more prognostically significant for breast cancer: the grade or the stage?

233
Q

ER+ and PR + breast cancer holds a good or bad prognosis?

A

Good if both +

234
Q

What lung manifestation may appear with metastatic breast cancer?

A

malignant pleural effusion

235
Q

What are the labs that should be obtained post sexual assault?

A
  • STDs
  • Pregnancy
  • Blood EtOH levels, urine drug

A1 (32 decks)

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