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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
Q

what to do in life threateneing vaginal bleed

A 
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
Q

what to monitor in life threat vag bleed

A

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
Q

spontaneous abortion progression

A

IUP threatened–>inevitable–>incomplete–>complete

28
Q

IUP

passage of contents
Os
U/S

A

no

closed

live baby

29
Q

threatened preg

passage of contents
Os
U/S

A

no

closed

live baby

30
Q

inevitable abortion

passage of contents
Os
U/S

A

no

closed

open

dead baby

31
Q

incomplete abortion

passage of contents
Os
U/S

A

+ POC

open

retained parts

32
Q

complete abortion

pasage of contents
Os
U/S

A

+ POC

closed

nothing

33
Q

missed abortion

passage of contents
Os
U/S

A

no

closed

dead

34
Q

ectopic pregnancy dx

A

UPT + and vaginal bleeding

get TVUS

if have ectopic then get U/S and B hcg quant

35
Q

treatment if dx of ectopic

A

if have fallopian tube rupture
-salpingectomy

if no rupture and stable
-salpinogostomy

also can use methotrexate with leucovorin

36
Q

treat molar preganancy

A

evacu with curretage

OCP and monitor b-HCG for a year

37
Q

if ectopic maybe suspected and get U/S and still cannot tell then what?

A

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
Q

structural and nonstructural causes of vaginal bleeding

A

PALM (structural) COEIN (nonstructural)

Polyps
Adenomyomas
Leiomyomas,
Malignancy

Coagulopathy
Ovarian dysfnct
endometrium
iatrogenic
not yet classified
39
Q

endometrial tisue grows into myometrium, symmetrical, smooth, boggy =

A

adenomyosis

40
Q

fibroids is a _____ _____ uterus

A

assymetric nodular

41
Q

fibroids

path

pt
dx
tx

A

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
Q

fibroids if subserolsal can cause ____ order ___ imaging

A

visceral obstruction, get KUB

43
Q

abnormal uterine bleeding

dx

path

tx

A

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
Q

path of PCOS

A

annovulation

atretic follicles that produce testosterone

45
Q

stromal cell tumor types

A

granulosa theca —>estrogen

sertoli leydig–> testosterone

46
Q

adenexal mass get ____ and see that is smooth/small and no septations what do you do

A

US

stop

47
Q

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

A

complex cyst

GCT, and tx: USO

epithelial cell cancer
TAH + BSO + paclitaxel

48
Q

stress incontinence:

path
pt
dx
tx:

A

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
Q

hypotonic overflow

path
pt
dx
tx

A

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
Q

hypertonic motor urge, OAB (overactive bladder)

path:
pt
dx
tx

A

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
Q

irritated bladder

path
pt
dx
tx

A

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
Q

continuous leak, fistula

path
pt
dx
tx

A

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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