Gynecology Flashcards
First step in evaluation of primary amenorrhea?
What is the second step, depending on the outcome of the first?
First step: Pelvic exam and/or US to assess for presence of a uterus
If present, next step is FSH (primary ovarian failure vs. central)
If absent, next step is karyotype (mullerian agenesis XX vs. AIS XY)
Labs to get for secondary amenorrhea after pregnancy has been ruled out
Prolactin, TSH, FSH
Female with normal internal genitalia, external virilization, high FSH/LH, and undetectable estrogen?
Aromatase deficiency (will also be elevated androgen)
When is endometrial biopsy needed for AUB?
- Any woman over 45 (or postmenopausal)
- Younger women with unopposed estrogen (obseity, anovulation)
(Also Lynch syndrome)
Common AEs of OCPs
- Hypertension
- VTE
- Hepatic adenoma
Most effective form of emergency contraception
Copper IUD
Levanorgestrel/plan B and ulipristal are other options
Treatment for infertility in PCOS
Clomophene citrate (SERM that is antiestrogen at hypothalamus)
What can differentiate endometriosis from adenomyoses
Heavy menstrual bleeding seen in adenomyosis only
(Will also see boggy, tender, enlarged uterus).
(Adenomyosis usually seen in older multiparous women, endometriosis in younger nulliparous women)
Differences in involvement in lichen sclerosis and atrophic vaginitis
Lichen sclerosis is skin only: vulvar and perianal skin. Vagina is spared
Atrophic vaginitis is vulva and vagina
Treatment for lichen sclerosus
- High-potency topical steroids
2. Punch biopsy to rule out SCC
What complications can atrophic vaginitis lead to?
Incontinence and recurrent UTIs (decreased urethral closure pressure and compliance)
Vaginal pH of different vaginal infections
BV and Trich: both abnormally alkalina, >4.5
Candida: normally acidic, <4.5
DIfference between BV and Trich discharge
BV is off-white and fishy odor.
Trich is frothy and yellow-green.
(Both are thin, malodorous, with alkalin (>4.5) pH)
Treatment for Candidal vaginitis
Oral fluconazole (or topical intravaginal nystatin)
Work-up for atypical glandular cells on pap
- Colposcopy
- Endocervical curettage
- Endometrial biopsy if over 35 (could be endometrial cancer)
Complications of cervical conization
Cervical stenosis or cervical incompetence
Initial tests for a postmenopausal woman with ovarian mass
US and CA-125
(CA-125 nonspecifc (also fibroids and endometriosis), but in postmenopausal woman ovarian cancer is more likely and others are less likely, increasing specificity somewhat)
(Get and MRI/CT if either abnormal)
What, if anything, is produced by granulosa cell ovarian tumors
Estrogen (get an endometrial biopsy in a postmenopausal woman)
What, if anything, is produced by dysgerminoma ovarian tumors?
LDH or HCG
What, if anything, is produced by Sertoli-Leydig ovarian tumors
Androgens
Breast dimpling and pitting with itching
Inflammatory breast cancer
AEs of SERMs
- Hot flashes (CNS antiestrogen)
- Thromboembolism
- For tamoxifen only, endometrial cancer
Main toxicity of trastuzumab
Cardiomyopathy, usually reversible
Screening for BRCA-positive woman without mastectomy
Annual mammograms and MRI
Unilateral bloody discharge with no associated mass or lymphadenopathy on exam or imaging. Next step?
Likely intraductal papilloma. But still need biopsy to rule out infiltrating ductal carcinoma.
Fixed breast mass with skin retractions with fat globules and foamy histiocytes on biopsy
Fat necrosis
