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MED ED > Gynecology > Flashcards

Gynecology Flashcards

1
Q

how do you treat trichamonas

A

MTZ PO, make sure both partners are taking it at the same time bc of ping-pong effect

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2
Q

which organisms are the main cause of vulvovaginitis

A

candida
bacterial vaginalis
trich

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3
Q

treatment of candida

A

OTC topical antifugal

flucanazole

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4
Q

treatment of bacterial vaginosis

A

MTZ

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5
Q

treatment of trich

A

MTZ

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6
Q

which organisms cause cervicitis

A

gonn/chla and organisms that can cause vulvovaginitis

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7
Q

what will the pt present with if have cervicitis

A

CMT +
d/c +
no sx of PID

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8
Q

what bacteria cause PID

A

1/3 chlamydia
1/3 gonn
1/3 normal vaginal flora

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9
Q

diagnosing PID

A

pelvic or abdominal pain
no other cause
1 of the following 3
-CMT, adnexal tenderness, uterine tenderness

also see
fever, EBC on wet prep, d/c +

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10
Q

treatment of PID

inpt: severe
outpt:

A

inpt: cefoxatine + doxy IV
- or: clindamycin and gentamycin

outpt: ceftriaxone + doxy + azithromycin

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11
Q

vulvar cancer types

A

SCC
melanoma
pagets disease

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12
Q

scc of vulva and melanoma

appearacne and treatment

A

black and itchy

vulvectomy and LN dissection

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13
Q

paget’s disease of vulva appearance and treament

A

red lesion and itchy

wide local resection, try to preserve vulva

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14
Q

adenocarcioma of vagina

appearance and cause

A

grape like mass IN vagina

DES exposure (mom had while pregnant)

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15
Q

types of ovarian cancer

A

Germ cell tumor
stromal cell
epithelial cell

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16
Q

types of germ cell tumors

treat or track or other association

A

dysgerminoma: chemo, follow with LDH

endometrial sinus tumor: follow with AFP

teratoma, can cause struma ovarii

choriocarcinoma: B-HCg

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17
Q

what pts will you usually see germ cell tumor of ovaries in
-symptoms?
-dx
tx

A

young teenage girls with adenxal mass with weight gain

  • often asx
  • mainly stage I with no invasion

Dx: TV US
Tx: Unilateral salpingoophrectomy (USO)

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18
Q

epithelial cell ovarian cancer types

A

serous
mucionous
endometroid
-these 3 are cystadenocarcinomas

then also brenner’s

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19
Q

what is the main cause of epithelial cell ovarian cancer

presents what stage

can lead to what

A

trauma (incrased ovulations bc ruptured follicles can turn to this
incrased age, post menopaus
no pregnancies and no OCPs

-often malignant at stage IIIb
-present like this bc asx until later
peritoneal seeding can lead to
RF, ascites, SBO

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20
Q

ovarian epithelial cell cancer genetics

A

BRAC1/2 and HNPCC

if positive for this then can do prophylactic TAH and BSO at age 35

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21
Q

ovarian epithelial cell cancer dx and tx

A

dx: TV US, then CT to stage, then CA-125 to track
tx: TAH with bilateral salp ooph (BSO) + paclitaxel

22
Q

causes of vaginal bleeding pre menopause

dx

A

foreign body
sexual abuse
precocoius puberty

dx: speculum exam under ansethesia

23
Q

causes of vaginal bleeding repro age

dx:

A

Pregnancy
Anatomy
Dysfunctinal uterine bleed
Cervical cancer

dx: UPT

24
Q

causes of vaginal bleeding in pts who are post menopausal

and dx

A

vaginal atrophy
endometrial cancer
HRT

enometrial bx

25
what to do in life threateneing vaginal bleed
``` 2 large bore IVs IVF bolus type and cross, transfuse IV estrogen **** shuts off acute bleed surgical intervention -balloon, D + C (preferred), uterine artery embolization, TAH ```
26
what to monitor in life threat vag bleed
change in hemoglobin, could be normal with loss of both plasma and RBCs reaccess after you give IVF, if under 7 then bad orthostatics
27
spontaneous abortion progression
IUP threatened-->inevitable-->incomplete-->complete
28
IUP passage of contents Os U/S
no closed live baby
29
threatened preg passage of contents Os U/S
no closed live baby
30
inevitable abortion passage of contents Os U/S
no closed open dead baby
31
incomplete abortion passage of contents Os U/S
+ POC open retained parts
32
complete abortion pasage of contents Os U/S
+ POC closed nothing
33
missed abortion passage of contents Os U/S
no closed dead
34
ectopic pregnancy dx
UPT + and vaginal bleeding get TVUS if have ectopic then get U/S and B hcg quant
35
treatment if dx of ectopic
if have fallopian tube rupture -salpingectomy if no rupture and stable -salpinogostomy also can use methotrexate with leucovorin
36
treat molar preganancy
evacu with curretage OCP and monitor b-HCG for a year
37
if ectopic maybe suspected and get U/S and still cannot tell then what?
get beta quant if over 1500 and do not see IUP then treat like ectopic if less than 1500 repeat in 48 hrs, if it doubles then IUP -if falls then ectopic and treat as such
38
structural and nonstructural causes of vaginal bleeding
PALM (structural) COEIN (nonstructural) Polyps Adenomyomas Leiomyomas, Malignancy ``` Coagulopathy Ovarian dysfnct endometrium iatrogenic not yet classified ```
39
endometrial tisue grows into myometrium, symmetrical, smooth, boggy =
adenomyosis
40
fibroids is a _____ _____ uterus
assymetric nodular
41
fibroids path pt dx tx
path: benign growth of myometrium, estrogen responsive pt: asx nodularity, anemia or bleeding, can be painful, can cause infertility dx: TV US tx: meds, OCP = IUD, and NSAIDs for pain surgery: if want kids then myomectomy (scoop fibroids) - dont want kids TAH - continuous GnRH thearpy to shrink then cut if too big at first (leuprolide)
42
fibroids if subserolsal can cause ____ order ___ imaging
visceral obstruction, get KUB
43
abnormal uterine bleeding dx path tx
dx: diagnosis of exclusion - CBC, TSH, prolactin - US, MRI path: anovulation, no progesterone tx: 1) OCP = IUD 2) NSAIDs, actually reduce bleeding in uterus 3) ablation 4) TAH
44
path of PCOS
annovulation | atretic follicles that produce testosterone
45
stromal cell tumor types
granulosa theca --->estrogen | sertoli leydig--> testosterone
46
adenexal mass get ____ and see that is smooth/small and no septations what do you do
US | stop
47
TVUS shows large septations and loculated adenexal mass then what young, large mass, asx then ____ and ___ tx older female, asx, with RF, SBO, ascites then ____ and ___ tx
complex cyst GCT, and tx: USO epithelial cell cancer TAH + BSO + paclitaxel
48
stress incontinence: path pt dx tx:
path: big, multiple births = stretches the cardinal ligament = cystocele, increased abdominal pressure pt: sneeze and pee - no urge, no nocturnal sympts dx: PE: cystocele, + Q tip test tx: kegal ---> pessary surgery, (MMK and buch)
49
hypotonic overflow path pt dx tx
path: absent detrusor contraction - no sensation to void, or signal to relax sphincter and contract bladder disconnected from brain = neurognic bladder - MS, trauma, antispasmodics - "leak and explode" pt: no urge, +nocturnal sx, regularity through day dx: PE = distended bladder cystomtomy = dx tx: bethanocol---> if doesn't work, intermittent vs chronic indwelling cath
50
hypertonic motor urge, OAB (overactive bladder) path: pt dx tx
path: random spasms of detrusor muscle pt: +urge and +nocturnal symptoms dx: PE = normal, U/A = normal, cystometry decreased (increased spasms) tx: antispasmodics like oxybutynin
51
irritated bladder path pt dx tx
path: inflammaiton, stone, cancer, UTI Pt: frequency, urge, dysuria, no nocturnal PE = normal U/A -WBC = infection, RBC = cancer or stone tx: UTI = abx stones: image and capture cancer, image and surgery
52
continuous leak, fistula path pt dx tx
path: inflammation/radiation, surgery, cancer, IBD (crohns) pt: constant, cont leak, normal fnct dx: PE, see fistula, tampon test to see where blue dye ends up tx: surgery

MED ED (4 decks)

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