Gynecology Flashcards
OCPs decrease risk of what type of cancer?
ovarian, endometrial
what causes labial fusion?
excess androgens
most common enzymatic cause of labial fusion?
21-B hydroxylase deficiency
marsupialization of bartholin gland cyst?
suture gland to keep open and prevent from forming another cyst in patients where this has become a recurrent problem
treatment for bacterial vaginosis?
metronidazole or clinda
if trichomonas is diagnosed….who needs treatment?
both partners
red unilateral vulvar lesion with superficial white coating in a postmenopausal caucasian female
paget disease
squamous cell carcinoma of the vulva presents as?
Itching, bloody vaginal discharge, postmenopausal bleeding. small ulcerated lesion to large cauliflower like lesion.
invasion of endometrial glands into the myometrium? risk factors? presents as?
adenomyosis: endometriosis and uterine fibroids are risk factor. presents with dysmenorrhea and menorrhagia with a large, globular, boggy uterus.
what is the most accurate test for adenomyosis? only definitive way to diagnose?
MRI; laporoscopic
what is the definitive treatment for adenomyosis?
hysterectomy
dysadvantage of implanon (progestin only implant)
irregular periods
First step in work up of primary or secondary amenorrhea is always a?
pregnancy test
Asherman syndrome
adhesions or fibrosis of endometrium. particularly associated with D+C.
medical therapy for prolactinoma
bromocriptine
cabergoline
Causes of abnormal uterine bleeding:
PALM-COEIN-
P: polyp
A: adenomyosis
L: leiomyoma
M: malignancy/hyperplasia
C: coagulopathy O: ovulatory E: Endometrial I: iatrogenic N: not classified
When should you do an endometrial biopsy on premenopausal women?
> 35, risk factors for endometrial carcinoma like obesity, diabetes and AUB
Treatment of acute-heavy bleeding of uterus? What if that treatment is contraindicated?
high dose estrogen IV and then transition to OCP or progestin when stable
Give progestin alone
If acute uterine blood loss has not stopped in 12-24 hours - what is management?
D+C
Firstline treatment of abnormal uterine bleeding during ovulation?
NSAIDS- reduce blood loss
Treatment for anovulatory bleeding?
progestin X 10 days to stimulate withdrawal bleeds
OCPS
Projestin IUD
which CAH presents with hypotension?
21-hydroxylase
which CAH presents with hypertension?
11Bhydroxylase and 17-hydroxylase due to accumulation of deoxycorticosterone
Treatment for CAH
glucocorticoids
Add mineralocorticoid if salt wasting
Rotterdam criteria
2/3 needed to diagnose PCOS
- PC ovaries on US
- oligo/anovulation
- clinical or biochem evidence of hyperandrogens
woman says that 2 weeks after her period she has intense sharp lower quad abd pain that lasts a few hours and alternates sides with each cycle. what is this?
mittelschmirz- pain at ovulation due to progesterone production.
+ chandelier sign =
cervical motion tenderness
patient has cervical motion tenderness and fever. you start abx. what is next step in management?
pelvic ultrasound to rule out out tubo-ovarian abscess
definition of infertility
inability to conceive after 12 months of nml reg sex
Is bacterial vaginosis an infection?
NO- its a shift in flora
“strawberry petechia” on upper vagina/cervix?
trichomonas
If there are many WBCs and no organisms on smear of vaginal fluid- suspect?
chlamydia
Criteria for diagnosis of bacterial vaginosis?
3/4 needed:
- abnml white/grey discharge
- vaginal pH >4.5
- whiff test
- clue cells > 20% of slide
multiple shallow painful ulcers on genitals?
HSV
deep painful ulcers with irregular borders?
chancroid. hemophylus ducrey
important side effect of metronidazole?
disulfuram reaction when you drink alcohol with it. (flushing, n/v)
why are blood cultures negative in TSS?
caused by preformed toxin
empiric abx for TSS?
clinda and vanc
If a uterine mass continue to grow after menopause…suspect?
malignancy (fibroids shrink after menopause)
guardisil vaccine protects against which types of HPV?
6+11 (90% of warts) and 16+18 ( 70% of cerv cancer)
Give the recommendations for cervical cancer screening for the following ages: 21-29 30-65 65 > DES exposure/immunocompromised
21-29: pap every 3 years
30-65: pap every 3 years or pap/HPV cotest every 5
65: stop if prior tests were negative.
DES/ImmunoC- continue to screen
What do you do for women 21-24 with ASC-US or LSIL?
ASC-H, HSIL, atypical glandular cells?
repeat cytology at 12 months (preferred). If (-), repeat again at 12 months. If (-)X2- resume normal screening.
If ASC-US >, colposcopy.
OR reflux HPV test. If (-) -> normal screening. If (+) resume algorithm above.
If ever ASC-H, HSIL, atypical glandular cells -> colposcopy right away
If >24 with ASC-US what do you do?
Reflex HPV test. If (-) cotest in 3 years. If (+)-> colpo (preferred)
OR retest in 12 months and if (-) routine screen
HSIL and > 24 years old?
immediate LEEP excision (not if pregnant)
HPV types for vulvar cancer?
16,18,31
frequency of female genital tract cancers in order?
endometrial > ovarian > cervical
deaths of female genital tract cancer?
ovarian > endometrial > cervical
marker for dysgerminoma
LDH
marker for granulosa cell tumor
inhibin
marker for embryonal carcinoma
AFP, B-hcg
marker for endodermal sinus
AFP
most common infectious cause of vulvovaginitis in kids?
GAS
differential diagnosis of breast mass?
fibrocystic disease, fibroadenoma, mastitis/abscess, fat necrosis, breast cancer
most common breast lesion in women < 30?
fibroadenoma
Phylodes tumor
difficult to distinguish from fibroadenoma. however usually larger and on histology will see classic “leaflike appearance) - papillary projections
Common cancers that met to bone? BLT with Pickle on top
breast, lung, thyroid, prostate
first step of mass in women > 30? women < 30?
> 30- mammogram
<30, US
All ER/PR + patients should receive ____ for therapy if premenopausal OR _____ if postmenopausal?
tamoxifen; aromatase inhibitor
All Her2/neu cancers should receive?
Trastuzumab
ER + and PR + is assocaited with _____ prognosis?
favorable
mimicker of breast cancer that occurs after trauma? what will biopsy show?
fat necrosis. coarse (not micro) calcifications and foamy macrophages
