Gynecology Flashcards
1
Q
What is the order of female development? (4)
A
- growth acceleration
- Thelarche
- pubarche
- menarche
2
Q
What is the order of male development? (4)
A
- Testicular enlargement
- Penile growth
- Pubarche
- facial hair
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
4
Q
What hormonal change triggers ovulation?
A
LH surge
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
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.
7
Q
What do ruptured follicular cells differentiate into?
A
The corpus luteum.
8
Q
When does breast development occur in females?
A
8 - 11 years.
9
Q
How long can a corpus luteum survive without further LH or HCG simulation?
A
10 to 14 days.
10
Q
What is the average onset of menopause?
A
51 years old.
11
Q
What is the technical Definition of premature menopause?
A
Cessation of Menses before 40.
12
Q
Increased FSH. Increase LH. Increased total cholesterol. (3)
A
Increased FSH.
Increase LH.
Increased total cholesterol.
13
Q
True or false: multiple sexual partners and nulliparity are absolute contraindications to IUD use.
A
False
14
Q
What are the adverse effects of estrogen replacement after menopause?
A
Increased risk of breast Cancer, and CV risks
15
Q
What are the contraindications. Estrogen replacement after Menopause?
A
- vaginal bleeding
- breast CA
- untreated endometrial cancer
- h/o thromboembolism
16
Q
What are the non-hormonal medications that can be given for menopausal symptoms? (3)
A
SRRIs, clonidine, and/or Gabapentin.
17
Q
True or false: topical estrogen preparation for vaginal atrophy has the same contraindications a systemic hormone replacement therapy.
A
False
18
Q
What are the key physical exam findings that are common for Turner syndrome?
A
Redneck repair.
Shield chest.
Streaked ovaries.
Aortic Coarctation
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.
20
Q
What is the most common cause of primary amenorrhea?
A
Primary ovarian insufficiency.
21
Q
What are the risk factors for Central hypogonadism?
A
Undernourishment.
CNS tumor
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.
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
24
Q
What is the MOA, advantages, and disadvantages of: Copper IUD (paragard)
A
- MOA: FB inflammation
- Advantage: 10 years
- Disadvantage: increased cramping initially
25
What is a major adverse effect Of tubal ligation?
Besides being irreversible, there's an increased risk of ectopic pregnancy.
26
What is the MOA, advantages, and disadvantages of: Depo shot
- MOA: One progestin injection
- Advantage: lighter periods
- Disadvantage: weight gain and delayed fertility after removal
27
What is the MOA, advantages, and disadvantages of: ortho evra (the patch)
- MOA: Combined weekly estrogen and progestin dermal patch
- Advantage: Periods more regular
- Disadvantage: thromboembolism
28
What is the MOA, advantages, and disadvantages of: nuvaring
- MOA: Combined estrogen + progestin vaginal ring
- Advantage: Period more reg, 3 weeks of continuous use
- Disadvantage: increase vaginal d/c
29
What is the MOA, advantages, and disadvantages of: OCPs
- MOA: Inhibits FSH/LH production
- Advantage: Lighter menses, improve acne
- Disadvantage: Daily compliance, thromboembolism risk
30
What is the MOA, advantages, and disadvantages of: progestin only pills
- MOA: thicken cervical mucus
- Advantage: Safe with breastfeeding
- Disadvantage: require strict compliance and daily timing
31
What general type of contraception is safe to use when breastfeeding?
Progesterone only types
32
Besides the obvious, what are the major contraindications to the use of estrogen containing contraceptives?
- Liver problems
| - Tobacco use and over age 35
33
Active gynecological infection within what time frame is a contraindication to IUD placement?
within 3 months
34
What is kallmann syndrome?
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
35
What is mullerian agenesis?
Absence of two-thirds of the vagina. as well as uterine abnormalities
36
What is the first step in the work of a primary secondary amenorrhea?
A pregnancy test.
37
What is the first step in the work of a primary or secondary amenorrhea?
A pregnancy test.
38
How do patients with complete Androgen insensitivity present?
Patients present with breast development, but are amenorrheic and lack pubic hair
39
If a young female patient presents with amenorrhea secondary to uterus absence, what labs should be obtained?
Karyotype, and serum testosterone
40
What lab result will be markedly elevated in patients with primary Ovarian insufficiency?
FSH
41
What is the technical definition of secondary amenorrhea?
The absence of Menses for six consecutive months in women who have passed menarche.
42
What are the major uterine causes of secondary amenorrhea?
asherman syndrome, cervical stenosis.
43
What are the major pituitary causes of secondary amenorrhea?
Adenoma, sellar masses, Sheehan syndrome.
44
What are two major ovarian causes of secondary amenorrhea?
PCOS, premature ovarian failure.
45
What thyroid problem can lead to secondary amenorrhea?
hypothyroidism
46
What lab tests should be obtained in patients with secondary amenorrhea who are not pregnant?
- TSH
| - Prolactin levels
47
What is the effect of prolactin menses?
Inhibits the release of GnRH
48
What are the following lab values like with constitutional growth delay:
- GnRH
- LH/FSH
- Estrogen/progesterone
- GnRH = ↓
- LH/FSH = ↓
- Estrogen/progesterone = ↓
49
What are the following lab values like with anatomic problems:
- GnRH
- LH/FSH
- Estrogen/progesterone
- GnRH = normal
- LH/FSH = normal
- Estrogen/progesterone = normal
50
What are the following lab values like with hypogonadotropic hypogonadism:
- GnRH
- LH/FSH
- Estrogen/progesterone
- GnRH = ↓
- LH/FSH = ↓
- Estrogen/progesterone = ↓
51
What are the following lab values like with hypergonadotropic hypogonadism:
- GnRH
- LH/FSH
- Estrogen/progesterone
- GnRH = ↑
- LH/FSH = ↑
- Estrogen/progesterone = ↓
52
What are the following lab values like with anovulatory problems:
- GnRH
- LH/FSH
- Estrogen/progesterone
- GnRH = ↑ or decreased
- LH/FSH = normal
- Estrogen/progesterone = ↓progesterone, ↑estrogen
53
What does a positive progestin challenge indicate in the workup of amenorrhea?
Due to noncyclic gonadotropic secretion
54
What does a negative progestin challenge indicated in the workup of amenorrhea?
Indicates uterine abnormalities or estrogen deficiency
55
What are the treatments for hypothalamic causes of amenorrhea in pts trying to conceive, and those who are not?
Are: induce ovulation with gonadotropins
Not: OCPs
56
What is the cause of secondary amenorrhea if the progesterone withdrawl tests is + and the LH levels are increased?
PCOS or premature menopause
57
What is the cause of secondary amenorrhea if the progesterone withdrawl tests is + and the LH levels are decreased?
Idiopathic anovulation
58
What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are increased?
Hypergonadotropic hypogonadism / ovarian failure
59
What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are decreased?
Either hypogonadotropic hypogonadism or endometrial/anatomic problem
60
What is the cause of secondary amenorrhea if the progesterone withdrawl tests is - and the FSH levels are decreased?
Either hypogonadotropic hypogonadism or endometrial/anatomic problem
Differentiate with estrogen+progesterone withdrawl test
61
What is the definition of primary dysmenorrhea?
Menstrual pain associated with ovulatory cycles in the absence of pathologic findigs
62
What are the exam findings of primary dysmenorrhea?
None
63
What is the treatment for primary dysmenorrhea?
NSAIDs
Heat
OCPs/IUD
64
What are the major causes of secondary dysmenorrhea? (5)
```
Endometriosis
Adenomyosis
Fibroids
Adhesions
PID
```
65
What are the labs to obtain in suspected cases of secondary amenorrhea? (4)
- beta-hCG for prego
- CBC to r/o neoplasm/infx
- UA for UTI
- GC/Chlamydia
66
True or false: uterine polyps are not painful
True
67
What is the basic pathophysiology of endometriosis and adenomyosis?
Endometriosis = Functional endometrial tissue outside the uterus
Adenomyosis = endometrial tissue within the myometrium of the uterus
68
What are the classic s/sx of endometriosis?
- Cyclic pelvic pain with menstruation
- Painful nodules
- Restricted ROM
69
What are the classic s/sx of adenomyosis? (3)
- Dysmenorrhea
- Menorrhagia
- Enlarged, boggy, symmetric uterus
70
How do you diagnose endometriosis?
Requires direct visual laparoscopy or laparotomy
71
How do you diagnose adenomyosis?
- MRI can aid in diagnosis but is costly.
- Ultrasonography is useful but cannot always distinguish between leiomyoma and adenomyosis.
- Ultimately a pathologic diagnosis.
72
What are the classic appearance of endometriosis? (3)
Chocolate cysts
Powder burn appearance
Raspberry colored lesions
73
What are the pharmacologic, conservative surgical, and definitive surgical treatments for endometriosis?
- Pharmacologic: Inhibit ovulation (OCPs or GnRH analogues)
- Conservative: Excision and/or cautery/ablation
- Definitive: TAH/BSO + lysis of adhesions
74
What are the pharmacologic, conservative surgical, and definitive surgical treatments for adenomyosis?
- Pharmacologic: symptomatic (NSAIDs + OCPs)
- Conservative: Endometrial ablation/resection
- Definitive: Hysterectomy
75
What is the major complications associated with endometriosis?
Infertility
76
What is the rare but major complication associated with adenomyosis?
Endometrial carcinoma
77
Postmenopausal bleeding is what until proven otherwise?
Cancer
78
What is the most common cause of irregular vaginal bleeding and amenorrhea?
Pregnancy
79
What are the components of the PALM mnemonic for the structural causes of abnormal uterine bleeding?
Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
80
What are the components of the COEIN mnemonic for the structural causes of abnormal uterine bleeding?
- Coagulopathy
- Ovulatory dysfunction
- Endometrial
- Iatrogenic
- Not yet classified
81
What is the technical definition of oligomenorrhea?
Increase in the length between menses (35-90 days between cycles)
82
What is the technical defintion of polymenorrhea?
Frequent menstruation (less than 21 day cycle)
83
What is the technical defintion of menorrhagia?
Increased amount of bleeding (over 80 mL of blood per cycle) or prolonged bleeding (more than 8 days)
84
What is the technical defintion of metrorrhagia?
Bleeding between periods
85
What is the technical defintion of menometrorrhagia?
Excessive and irregular bleeding
86
What are the labs, besides a UPT/hCG, that should be obtained when working up dysfunctional uterine bleeding? (6)
- CBC for anemia
- Pap smear for CA
- GC/Chlamydia
- TFTs and prolactin for endocrine
- Platelet, PT/PTT for coagulation
- US
87
What is the first line treatment for all abnormal uterine bleeding to decrease the amount of blood lost?
NSAIDs
88
On US, if the endometrium of a postmenopausal woman is thicker than how many mm is a concern for CA warranted?
4 mm or more
89
What is the treatment for heavy uterine bleeding that needs stabilization?
high dose IV estrogen to stabilized the endometrial lining. This typically stops bleeding within 1 hour
90
What is the treatment for ovulatory bleeding? (3)
- NSAIDs
- Tranexamic acid
- OCPs
91
What is the treatment for anovulatory bleeding? (3)
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
92
What are the highly effective options for treating menorrhagia?
progestin IUDs and OCPs
93
What is the treatment for dysfunctional uterine bleeding that is refractory to medical therapy? (3)
D+C
Hysterectomy
Endometrial ablation
94
Draw out the adrenal enzyme pathway.
Draw
95
Which hormones are under/overproduced with 21-hydroxylase deficiency?
Underproduced aldosterone and cortisol
| Overproduced androgens
96
Which hormones are under/overproduced with 11 beta-hydroxylase deficiency?
Underproduced aldosterone and cortisol (although 11 deoxycorticosterone has enough aldosterone-like effects)
Overproduced androgens
97
What is hirsutism?
Male hair pattern
98
What is virilization?
Frontal balding
Muscularity
Clitoromegaly
Deepening of the voice
99
Which of the three types of congenital adrenal hyperplasia result in HTN?
11beta and 21 hydroxylase deficiencies (17alpha does not)
100
What is cosyntropin?
Synthetic ACTH
101
What are the labs like with salt wasting 2/2 CAH or aldosterone deficiency (Na, K, Renin)?
Decreased Na
Increased K
Increased renin
102
What is the treatment for CAH?
Glucocorticoids and mineralocorticoid (e.g. fludrocortisone) if salt wasting is present
103
What is the classic triad of s/sx for PCOS?
1. Polycystic ovaries
2. Oligomenorrhea/anovulation
3. Hyperandrogenism
104
The most severe form of PCOS involves what lab/PE findings?
- Acanthosis nigricans
- Hyperandrogenism
- Insulin Resistance
105
Why might total testosterone by normal in PCOS, but free testosterone be elevated?
Low sex hormone binding globulin
106
What is the classic appearance of ovaries with PCOS?
Pearl necklace sign
107
What happens to LH/FSH levels with PCOS?
Elevated in a 2:1 ratio
108
What is the treatment for women with PCOS who are and are not trying to conceive?
Not trying to conceive = OCPs, progestin, and metformin
Trying to: Clomiphene
109
What is the treatment for the hirsutism seen with PCOS?
Combination OCPs and antiandrogens
110
What are the complications of PCOS? (3)
- DM
- Miscarriages
- Increased risk of breast/endometrial CA
111
Which are more common: male or female causes of infertility?
Females
112
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?
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
What is the classic description of fibroids on exam?
Uterus is irregular and mobile
114
Are fibroids hormonally sensitive?
Yes
115
What are the s/sx of fibroids?
- Bleeding (longer, heavier periods)
- Mass effect (constipation, urinary frequency)
- Pain secondary dysmenorrhea
- Pelvic s/sx
116
If a uterine mass continues to grow after menopause, what process should be suspected?
Malignancy
117
What are the diagnostic tests in the workup of leiomyomas?
- TVUS
- MRI delineate mucosal vs submucosal
- CBC to assess for anemia
118
What are the three general treatment for leiomyomas?
- Expectant if asymptomatic
- Contraception
- Surgery
119
What are the pharmacologic treatments for leiomyomas?
- OCPs
- GnRH analogs to decrease size
- NSAIDs for pain
120
What are the surgical options for fibroid treatment in:
- Women of childbearing years
- Women who have completed childbearing
Childbearing = Abdominal or hysteroscopic myomectomy
| Not-Total or subtotal hysterectomy
121
What is an indication for emergent surgery for fibroids?
If pedunculated one torses on itself
122
What is the difference between type I and II endometrial cancer?
type I = results from Atypical endometrial hyperplasia
| type II = results from serous or clear cell histology
123
A uterine lining that is found to be below (__) mm in thickness is unlikely to be endometrial CA.
4mm
124
What is the difference in prognosis between type I and Type II endometrial cancer?
I has a relatively good prognosis, whereas II has a very poor one.
125
What is the difference in etiology between type I and Type II endometrial cancer?
```
I = unopposed estrogen stimulation or tamoxifen therapy
II = unrelated to estrogen--p53 mutation
```
126
What is the treatment for endometrial cancer in women of childbearing age, or postmenopausal women?
```
Childbearing = High dose progestins
Postmenopausal = radiation and TAH/BSO
```
127
What strain of HPV is the most common cause of squamous and adenocarcinoma?
```
Squamous = 16
Adenocarcinoma = 18
```
128
What are the s/sx of cervical cancer?
Metrorrhagia
Postcoital bleeding
Cervical ulceration
129
What is the recommendation for pap smear frequency?
21-30, q 3 years
| 30-65, same as above, or q5 years if HPV tested
130
HSIL correlates with what CIN grades?
II and III
131
LSIL correlates with what CIN grade?
I
132
How long should women with DES exposure be screened for cervical CA?
As long as they do not have some other life-limiting condition
133
In what two major populations do the screening for cervical cancer/HPV do not apply?
Pregnant women and adolescents
134
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?
- Repeat cytology at 12 months. If same or worse, then colp
| - Reflex HPV testing. If +,colp
135
What should be done for treating a woman aged 21-24 who has HSIL on pap smear?
Colposcopy
136
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?
- Reflex HPV testing. if - repeat usually. If +, colp
| - Repeat cytology at 12 months
137
In terms of pap smears, what does ASCUS stand for?
Atypical squamous cell of undetermined significance
138
In terms of pap smears, what does ASC-H stand for?
Atypical squamous cells--cannot exclude HSIL
139
In terms of pap smears, what does LSIL stand for?
Low-grade intraepithelial lesion
140
In terms of pap smears, what does AGC stand for?
Atypical glandular cells of undetermined significance
141
In terms of pap smears, what does HSIL stand for?
High-grade squamous intraepithelial lesions
142
What should be done for treating a woman aged 24+ who has ASC-H on pap smear? What should follow for each of these?
colposcopy, regardless of HPV status
143
What should be done for treating a woman aged 21+ who has LSIL on pap smear, and HPV + and - respectively?
- If HPV -, then repeat cotesting at 12 months
| - If HPV +, then colp
144
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?
Colp
145
What should be done for treating a woman aged 30+ who has LSIL and HPV positive?
Colp
146
What should be done for all women who have AGC on pap smear? What if they're 35+?
Colp for all, and if 35+ then endometrial sampling
147
What should be done for treating a woman aged 21-24 who has ASC-H or HSIL on pap smear, and HPV + and - respectively?
Colp and treat for CA
148
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?
Cotesting at 12 and 24 months.:
- if HPV and cytology -, resume routine screening
- If HPV + or abnormal cytology, colp
- If HSIL, LEEP
149
What is the treatment for noninvasive CIN II-III?
Ablation (cryotherapy or lasers)
- LEEP
- if young, can follow for 6-12 months
150
If a woman has noninvasive CIN I, II, or III, undergoes excisional therapy, and has negative margins, what should be done next?
Pap smear at 12 months and/or HPV testing
151
If a woman has noninvasive CIN I, II, or III, undergoes excisional therapy, and has positive margins, what should be done next?
Pap smear at 6 months, consider repeat endocervical curettage
152
What is the treatment for invasive CIN with microinvasive CA, what should be done?
Cone bx and close f/u
153
What is the treatment for invasive CIN with stages IA2, IB1, or IIA, what should be done?
may be treated with either radical hysterectomy with concomitant XRT and chemo, or with radiation therapy plus chemo alone
154
What are the two major risk factors for developing vulvar cancer?
HPV infx
| Lichen sclerosis
155
What are stages 0 -IV of vulvar cancer?
```
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
What are the usualy s/sx of vulvar cancer?
Pruritus or ulceration of the mass
157
What are the early lesions of vulvar cancer? Late?
Early = White, pigments, raised, thickened, nodular or ulcerative
Late = Large, cauliflower like or hard ulcerated area in the vulva
158
What is the treatment for high grade VIN?
topical chemo, wide excision, or vulvectomy
159
What is the treatment for invasive VIN?
- Radical vulvectomy and regional lymph node dissection
| - wide local excision
160
What is the classic description of lichen sclerosis?
Atrophic and paper like skin
161
What type of vaginal cancer usually affect younger women and postmenopausal women respectively?
```
young = Adenocarcinoma or DES
Old = squamous
```
162
What are the s/sx of vaginal cancer?
-abnormal vaginal bleeding or d/c
163
What is the treatment for vaginal cancer?
- Local excision
| - vaginectomy if spread
164
OCPs taken for 5+ years decrease the risk for ovarian CA by what percent?
29%
165
What is the most common type of gynecologic cancer?
Endometrial
166
True or false: any palpable ovarian or adnexal mass in a premenarchal or postmenopausal women is highly suggestive of a neoplasm
True
167
What are the s/sx of ovarian cancers?
Usually asymptomatic, but can present with pelvic pain or GI symptoms
168
What is the tumor marker that is common to ovarian cancers?
CA-125
169
What benign disease may elevated CA-125 indicate in a premenopausal women?
Endometriosis
170
A CA-125 level above what threshold in a postmenopausal woman is strongly suggestive for a malignant CA?
35 units
171
Is the follow characteristic suggestive of malignant or benign ovarian pathology: mobile
Benign
172
Is the follow characteristic suggestive of malignant or benign ovarian pathology: bilateral
Malignant
173
Is the follow characteristic suggestive of malignant or benign ovarian pathology: nodular
Malignant
174
Is the follow characteristic suggestive of malignant or benign ovarian pathology: multilocular appearance on US
malignant
175
Is the follow characteristic suggestive of malignant or benign ovarian pathology: calcification on US
benign
176
Is the follow characteristic suggestive of malignant or benign ovarian pathology: associated ascities
Malignant
177
An ovarian mass that is over how many cm is suggestive of Cancer?
8 cm
178
What is the treatment for an ovarian mass in a premenarchal woman?
Masses over 2 cm in diameter require close clinical f/u and often surgical removal
179
What is the treatment for an ovarian mass in a premenopausal woman?
- Observation is suspected benign
| - Surgical removal is suspicious or over 10 cm
180
What is the treatment for an ovarian mass in a postmenopausal woman?
- Closely f/u with US
| - if palpable, remove
181
What is the surgical treatment of choice for ovarian cancer?
TAH/BSO with omentectomy and pelvic and paraaortic lymphadenectomy
182
XRT is particularly effective for what type of ovarian cancers?
Dysgerminomas
183
Postop chemotherapy is routine for for ovarian cancers in what women?
routine for all women except for women with early stage or low grade ovarian cancer
184
What is the screening test for ovarian cancer in women with a BRCA mutation? What is the prophylactic treatment?
Annual US and CA-125 testing
| Prophylactic = bilateral oophorectomy by age 40
185
What are the s/sx of pelvic organ prolapse, besides the feeling of a prolapsing uterus?
fecal/urinary Incontinence, dyspareunia, and/or incomplete voiding
186
How do you assess the degree of pelvic organ prolapse in a woman?
Have them in lithotomy position, and have them valsalva
187
What is the treatment for pelvic organ prolapse?
- High fiber diet and weight reduction
- Pessaries
- surgery
188
What are the components of the DIAPPERS mnemonic for causes of urinary incontinence?
```
Delirium
Infx
Atrophic urethritis/vaginitis
Pharmaceutical
Psych
Excessive urinary output
Restricted mobility
Stool impaction
```
189
What tests are used to differentiate causes of urinary incontinence in women?
UA
Voiding diary
US
CrCl for renal causes
190
Describe total urinary incontinence. (s/sx, mechanism, and treatment)
- Uncontrolled loss at all times and in all positions
- Loss of sphincteric efficiency
- Surgical treatment
191
Describe stress urinary incontinence. (s/sx, mechanism, and treatment)
- Increased abdominal pressure causes urination
- Laxity of pelvic floor musculature
- Kegels or vaginal vault suspension surgery
192
Describe urge urinary incontinence. (s/sx, mechanism, and treatment)
- strong, unexpected urge to void that is unrelated to position
- Detrusor hyperreflexia or sphincter dysfunction 2/2 inflammatory conditions
- Anticholinergics or TCAs
193
Describe overflow urinary incontinence. (s/sx, mechanism, and treatment)
- Chronic urinary retention
- Chronically distended bladder with increased intravesical pressure that just exceeds outlet resistance
- Urethral cath, timed voiding
194
What is the most common cause of pediatric vaginitis?
-Group A strep infx
195
What are the major noninfectious causes of pediatric vaginitis?
contact dermatitis and eczema
196
Bunches of grapes in a peds vagina = ?
Sarcoma botryoides
197
What is the general etiology of central precocious puberty?
Early activation of the hypothalamic GnRH production
198
What is the general etiology of peripheral precocious puberty?
Results from GnRH independent mechanisms
199
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?
- GnRH stimulation test
| - bone age determination
200
What are causes of central precocious puberty?
Anything that affects the hypothalamus/pituitary:
- Tuberous sclerosis
- CNS infx/trauma
- hydrocephalus
201
What are causes of peripheral precocious puberty? (6)
- CAH
- ADrenal tumors
- McCune albright syndrome
- gonadal tumors
- exogenous estrogen
- ovarian cysts
202
What is the first line therapy for central causes of precocious puberty?
Leuprolide (GnRH agonist)
203
What is the treatment for peripheral precocious puberty 2/2 ovarian cyst?
No intervention necessary, as it will resolve with cyst regression
204
What is the treatment for peripheral precocious puberty 2/2 CAH?
Glucocorticoids
205
What is the treatment for peripheral precocious puberty 2/2 adrenal or ovarian tumors?
Surgery
206
What is the treatment for peripheral precocious puberty 2/2 McCune-Albright syndrome
- Antiestrogens (e.g tamoxifen)
| - Estrogen synthesis blockers (e.g. ketoconazole or testosterone)
207
What are the classic s/sx of McCune-Albright syndrome? (3)
- precocious puberty
- Cafe-au-lait spots
- bony abnormalities (polyostotic fibrous dysplasia)
208
What is a leuprolide stimulation test? What are the two outcomes?
Give leuprolide and check LH response:
- If +, then central causes of precocious puberty
- If -, then peripheral cause
209
What exposures are associated with breast cyst development?
Caffeine use and trauma
210
What is the order of the diagnostic workup of a breast mass?
1. Return after menstruation. If unchanged, proceed
2. US
3. FNA
4. Excisional bx if no fluid obtainable
5. Mammography
211
True or false: there is no increased risk of breast cancer with simple breast cysts
True
212
What is the treatment for breast cysts?
OCPs
Decrease caffeine
Reassurance
213
What are two common causes of bloody nipple discharge?
intraductal papilloma and duct ectasia
214
What are the four major causes of proliferative breast lesions that do NOT have atypia?
- Fibroadenomas
- Ductal hyperplasia
- Intraductal papillomas
- Sclerosing adenosis
215
True or false: there is no increased risk of breast cancer with proliferative breast lesions that do not have atypia, like fibroadenomas
False--slight increase
216
What is the most common breast lesion in women under 30 years?
Fibroadenoma
217
What are the s/sx of fibroadenomas?
Round, rubbery, discrete, mobile mass 1-3 cm. Usually TTP, but not always
218
True or false: fibroadenomas are usually solitary lesions
True
219
Do fibroadenomas change in size with menstruation?
No, but do decrease in size with menopause
220
What are phyllodes tumors? What is the classic histologic appearance?
They are typically large, fast-growing masses that form from the periductal stromal cells of the breast. 10% are malignant
Leaflike appearance
221
What percent of breast cancers appear in the upper, outer quadrant of the breasts?
60%
222
What are the four cancers that commonly met to bone?
```
Breast
Lung
Thyroid
Prostate
("BLT with Pickle on top")
```
223
The first step in the workup of a new breast mass in a postmenopausal woman is what?
Mammogram
224
What are the mammogram findings of breast cancer? (4)
Increased density with microcalcifications, irregular borders, spiculated mass
225
What is a major disadvantage to a FNA for breast masses?
High false + rate
226
What are the three major tumor markers for breast cancer?
CA-15-3
CA 27-29
CEA
227
What labs are classically elevated in metastatic breast cancer? (3)
Alk phos
ESR
Ca
228
What is the chemotherapy for HER2-NEU receptor + breast cancer?
Trastuzumab
229
What is the chemotherapy for estrogen receptor + breast cancer? (2)
Tamoxifen or aromatase inhibitor
230
What are the contraindications to a breast sparing surgery for breast cancer? (5)
- CA affixed to chest wall
- Subareolar location
- multifocal tumors
- prior XRT to the chest
- involvement of the nipple
231
What defines stages II, III, and IV breast cancer?
```
II = over 2 cm in size
III = nodal involvement
IV = mets
```
232
Which it more prognostically significant for breast cancer: the grade or the stage?
Stage
233
ER+ and PR + breast cancer holds a good or bad prognosis?
Good if both +
234
What lung manifestation may appear with metastatic breast cancer?
malignant pleural effusion
235
What are the labs that should be obtained post sexual assault?
- STDs
- Pregnancy
- Blood EtOH levels, urine drug
