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Ob/Gyn Dreams > Gynecology > Flashcards

Gynecology Flashcards

1
Q

OCPs up risk of what in RUQ

A

hepatic adenoma

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2
Q

delayed puberty definition

A

girls: > 12 w/o breast growth

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3
Q

tx: prolactinoma

A

cabergoline or bromocriptine
(try one then the other)
if neither work –> transsphenoidal resection

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4
Q

dx: syphilis

A

primary: dark field microscopy or direct florescence Ab testing (lesion tissue)

secondary/tertiary: RPR, VDRL; confirm with fluorescent treponemal Ab absorbed test (FTA-ABS)

Neurosyph (CSF): VDRL best

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5
Q

tx: syphilis

A

1/2: penicillin G (1 dose)

latent: 3 doses
neurosyphilis: continuous infusion

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6
Q

tx: fibroids

A 
GnRH agonists (shrinks them)
definitive: hysterectomy or myomectomy (depend on kid-wanting)
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7
Q

tx: body dysmorphic disorder

A

CBT, SSRI

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8
Q

Krukenberg tumor?

A

gastric CA throws mets to ovaries

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9
Q

mgmt: ASCUS

A

21 - 24: repeat pap in 12 mo

25+: HPV test
(+)–> colp
(-) –> repeat cyto in 3 years

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10
Q

RFs endometrial CA

A

unopposed estrogen use
DM
age
fam hx

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11
Q

21-hydroxylase deficiency – what are the junk like?

A

males: normal
females: ambiguous

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12
Q

tx: 21-hydroxylase def

A

initially: IV hydrocortisone

then glucocorticoid and mineralocorticoid therapy for life

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13
Q

tx: TSS

A

IV fluids

IV nafcillin + aminoglycoside (clinda)

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14
Q

trichomoniasis puts at risk for…

A

HIV and HIV transfer

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15
Q

management: bloody nipple discharge

A

apparently surgery

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16
Q

how does hypothyroidism –> galactorrhea?

A

low thyroid hormone –> increased TRH and TRH stimulates both TSH and prolactin from pituitary

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17
Q

normal vaginal pH

A

3.8 - 4.2

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18
Q

candida vaginal pH

A

normal

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19
Q

trichomoniasis vaginal pH

A

> 4.5

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20
Q

tender utero-sacral nodules

A

endometriosis

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21
Q

dx: endometriosis

A

laparoscopy (gun-powder lesions)

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22
Q

palpable testes in labia majora

A

androgen insensitivity syndrome

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23
Q

who do you screen for syphilis?

A

high risk: MSM, sex workers, risky business

+ preggos

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24
Q

mgmt: LSIL

A

21-24: no colp
HPV (-): repeat cyto + HPV in 1 year
HPV(+) or not done: colp

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25
Q

age of precocious puberty

A

7 in females

8 in males

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26
Q

risks of tamoxifen

A 
hot flashes (MC)
endometrial CA
DVTs
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27
Q

AEs: MTX

A 
hepatotoxicity
stomatitis (mouth ulcers)
pancytopenia
lung fibrosis
alopecia
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28
Q

MTX rescue

A

leucovorin

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29
Q

ddx hirsutism

A

PCOS
21-hydroxylase def
androgen secreting tumors (often ovarian)
Cushing syndrome

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30
Q

lady stuff + liver things

A

think Fitz-Hugh-Curtis

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31
Q

suspected orgs in osteomyelitis after UTI

A

klebsiella

pseudomonas

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32
Q

tx: syphilis (pt has severe PCN allergy)

A

primary: doxy x 14
secondary: doxy x 14
latent: doxy x 28
tertiary: ceftriaxone x 14
preggo: desensitize then PCN

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33
Q

hormones in PCOS

A

T up (or norm)
E up
LH (up or norm)/ FSH imbalance

34
Q

OCP AEs

A

DVT
HTN
hepatic adenoma
rare: stroke/MI

35
Q

tx: symptomatic bartholin cyst

A

I+D

Word catheter

36
Q

dx: endometriosis

A

laparoscopy (usually don’t need definitive dx)

37
Q

risks of endometriosis

A

infertility

38
Q

when do you use a pessary

A

stress incontinence (3rd line)

39
Q

explain the hormones in primary ovarian insufficiency

A

(a type of hypogonadotropic hypogonadism)
ovaries stop functioning –> estrogen down
amps up feedback @ hypothalamus –> increased GnRH and FSH

40
Q

explain the hormones in hypothalamic hypogonadism

A

usually they’re too skinny –> shuts down hypothalamus

less GnRH –> less FSH –> less estrogen

41
Q

explain the hormones in PCOS

A

(i think)
the ovaries are crap and not really ovulating –> estrogen down
hypothalamus goes nuts trying to help –> GnRH up (but not pulsatile)
this makes LH go up more than FSH (which is low/normal)
then also you’re making a bunch of androgens and they get converted to estrone which is an estrogen but doesn’t help so you get high (unhelpful) estrogen
Total: GnRH up, LH up, FSH low/norm, E up

42
Q

tx: disseminated GC

A

IV ceftriaxone, switch to oral cefixime when clinically improved

43
Q

mgmt: pap –> atypical glandular cells

A

could be cervical or endometrial adenocarcinoma

who: > 35 or < 35 w/ RFs (obese, anovulation)
mgmt: colp, endocervical curettage and EMB

44
Q

breast: peau d’orange

A

inflammatory breast carcinoma

45
Q

breast: firm, mobile spherical, palpable mass (young woman)

A

fibroadenoma (benign)

46
Q

breast: unilateral nipple discharge w/o skin changes or other sx

A 
intraductal papilloma (benign)
even if discharge is bloody
47
Q

breast: fever, diffuse warmth, erythema

A

mastitis

48
Q

breast: dimpling/contour changes

A

infiltrating ductal carcinoma or lobular breast carcinoma

or inflammatory breast carcinoma

49
Q

breast: diffuse erythema, edema and dimpling

A

inflammatory breast carcinoma

50
Q

mammography: microcalcifications

A

ductal carcinoma in situ

51
Q

breast: diffuse nodularity with b/l mastalgia

A

fibrocystic changes

52
Q

breast: fixed, palpable mass with irregular borders

A

lobular breast carcinoma

53
Q

ages for HPV vaccine

A

female: 11 - 26
males: 9 - 21 (9 - 26 for MSM or HIV)

54
Q

psych med –> infertility

A

dopa blockers

55
Q

workup: primary amenorrhea

A

uterus?

yes –> FSH (increased –> karyotyping; decreased –> MRI)

no –> karyotype, serum T (XX, normal –> abnormal mullerian; XY, normal –> androgen insensitivity syndrome)

56
Q

definition abnormal uterine bleeding

A 
heavy
> 7 days
more often than every 21 days
less often than every 35
any post meno bleeding
57
Q

when do you do an EMB: > 45 yo

A

any abnormal uterine bleeding

58
Q

when do you do an EMB: < 45 yo

A

abnormal uterine bleeding + (any of following)

  • unopposed estrogen exposure
  • failed medical mgmt
  • lynch syndrome (HNPCC)
59
Q

needs to stop paps

A

65 or hysterectomy w/o CIN 2+
AND
3 neg paps/2 co-tests

60
Q

PCOS a/w

A

metabolic syndrome (DM, HTN)
OSA
NASH
endometrial hyperplasia/CA

61
Q

painful genital ulcers

A 
HSV
haemophilus ducreyi (has big LNs too)
62
Q

painless genital ulcers

A

treponema pallidum
chlamydia trachomatis
granuloma inguinale (klebsiella granulomatis)

63
Q

when to get CA-125 for ovarian cancer dx

A

post meno and see a mass on U/S (it’s more specific in post meno)
high –> get MRI or CT

64
Q

workup: secondary amenorrhea

A
  1. beta hCG
  2. prior uterine procedure? –> hysteroscopy
  3. check prolactin, TSH, FSH
    - up prolactin –> brain MRI
    - up TSH –> hypothyroid
    - up FSH –> premature ovarian failure
65
Q

OCPs down risk of what CA

A

ovarian

endometrial

66
Q

talk through hormones in irregular teen periods

A

not enough GnRH –> less GSH/LH –> not really ovulating

67
Q

PCOS @ risk for what cancer

A

endometrial

68
Q

tx: septic pelvic thrombophlebitis

A

anticoagulation

broad spectrum antibiotics

69
Q

urinary problems post menopause

A

GU syndrome of menopause

E deficiency –> atrophy of vagina and urethral epithelium –> UTIs, incontinence (stress and urge)

70
Q

pelvic U/S: ovarian mass w/ thickened endometrium

A

granulosa cell tumor

71
Q

female: high T and androstenedione, no estradiol or estrone

A

aromatase deficiency

72
Q

morbid obesity effect on girl hormones

A

–> anovulation
ovaries still make E –> normal FSH/LH
they just don’t make progesterone

73
Q

ovarian tumor making E

A

granulosa cell tumors

74
Q

ovarian tumor making beta hCG

A

dysgerminoma

75
Q

ovarian tumor making androgens

A

sertoli-leydig

76
Q

ovarian tumor making LDH

A

dysgerminoma

77
Q

pain from endometriosis vs pain from dysmenorrhea

A

endometriosis usually hurts a couple days before menses, not first couple days of menses

78
Q

b/l cordlike thickening of breasts

A

fibrocystic changes

79
Q

tx: fibrocystic changes

A

NSAIDs or OCPs

80
Q

chemo effects on lady hormones

A

transient amenorrhea

ovarian failure happens earlier

81
Q

pain worse with bladder filling or sex and relieved by voiding

A

interstitial cystitis

82
Q

effects of E on thyroid things

A

up TBG

need more levo if hypothyroid

Ob/Gyn Dreams (2 decks)

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