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OBGYN EOR > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Workup for amenorrhea

A

Pregnancy test
FSH, LH
Serum prolactin
TSH

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2
Q

Primary amenorrhea

A

Failure of menarche onset (menstruation) by age 15 y/o in the presence of secondary sex characteristics

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3
Q

Secondary amenorrhea

A

Absence of menses for > 3 months in pt with previously normal menstruation
Or > 6 months in pt with oligomenorrhea

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4
Q

Amenorrhea: hypothalamus dysfunction

A

Anorexia
Exercise
Systemic disease (celiac dz)

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5
Q

Management of amenorrhea - hypothalamus dysfunction

A

Stimulate gonadotropin secretion

Clomiphene, Menotropin

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6
Q

Amenorrhea: pituitary dysfunction

A

Prolactin-secreting pituitary adenoma

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7
Q

Management of amenorrhea - pituitary dysfunction

A

Transsphenoidal surgery

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8
Q

Amenorrhea: ovarian disorder

A

Polycystic ovarian syndrome

Turner’s syndrome

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9
Q

Diagnosis of amenorrhea - ovarian disorder

A

Progesterone Challenge Test
10 mg medroxyprogesterone for 10 days
+ withdrawal bleeding –> ovarian dysfunction

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10
Q

Amenorrhea: Uterine disorder

A

Scarring of the uterine cavity

Asherman’s Syndrome

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11
Q

Diagnosis of amenorrhea - uterine disorder

A

Pelvic US

Hysteroscopy to diagnose and treat

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12
Q

Management of amenorrhea - uterine disorder

A

Estrogen treatment to stimulate endometrial regeneration

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13
Q

Normal menstrual cycle: cycle length and length of menstruation

A

24-38 days in cycle length

4.5-8 days of menstruation

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14
Q

Dysfunctional uterine bleeding - chronic anovulation

A

Due to disruption of the HPO axis
Extremes of age
Unopposed estrogen - irregular, unpredictable bleeding

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15
Q

Dysfunctional uterine bleeding - ovulatory

A

Ovulation with prolonged progesterone secretion

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16
Q

Dysfunctional uterine bleeding is a:

A

Diagnosis of exclusion

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17
Q

Workup for dysfunctional uterine bleeding

A

Pregnancy test
Hormone levels
Transvaginal US
Endometrial biopsy if US endometrial stripe > 4 mm

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18
Q

Management of dysfunctional uterine bleeding - acute severe bleeding

A

High dose IV estrogens or high dose OCPs

If IV estrogen fails, may do D and C

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19
Q

Management of dysfunctional uterine bleeding

A
  1. OCPs
  2. Progesterone
  3. GnRH agonists (leuprolide)
  4. Hysterectomy or endometrial ablation
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20
Q

Primary dysmenorrhea is not due to pelvic pathology, but:

A

Due to increased prostaglandins

Painful uterine muscle wall activity

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21
Q

Causes of secondary dysmenorrhea

A 
Endometriosis
Adenomyosis
Leiomyomas
Adhesions
PID
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22
Q

Diffuse pelvic pain right before or with onset of menses

May be associated with HA, N/V

A

Dysmenorrhea

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23
Q

Management of dysmenorrhea

A
  1. NSAIDs first line
  2. OCPs, progestins
  3. Laparoscopy if medications fails to r/o secondary causes
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24
Q

Premature menopause may occur sooner in pts with:

A

DM
Smokers
Vegetarians
Malnourished pts

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25
Q

Signs/Symptoms of menopause

A

Estrogen deficiency changes
Atrophic vaginitis
Decreased bone density

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26
Q

Ex of estrogen deficiency changes

A 
Menstrual cycle alterations
Vasomotor instability (hot flashes)
Mood changes
Skin/nail/hair changes
Increased risk of cardiovascular events
HLD
Osteoporosis
Urinary incontinence
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27
Q

Atrophic vaginitis

A

Thin, yellow discharge, vaginal pH >5.5, pruritus

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28
Q

Diagnosis of menopause

A 
FSH assay (>30 IU/mL)
Increased FSH, increased LH, decreased estrogen
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29
Q

Predominant estrogen after menopause

A

Estrone

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30
Q

Complications of menopause

A

Osteoporosis
Cardiovascular risk
Hyperlipidemia

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31
Q

Management of menopause - vasomotor insufficiency

A

Estrogen, progesterone
Clonidine
SSRIs
Gabapentin

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32
Q

Management of menopause - vaginal atrophy

A

Transdermal, intravaginal estrogen

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33
Q

Management of menopause - osteoporosis prevention

A 
Calcium + vitamin D
Weight bearing exercises
Bisphosphonates
Calcitonin
SERM (raloxifene, tamoxifen)
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34
Q

Risks of estrogen alone tx for menopause

A

Thromboembolism (CVA, DVT, PE)

Liver disease

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35
Q

Risks of estrogen + progestin tx for menopause

A 
Breast cancer (slightly increased risk)
Thromboembolism
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36
Q

Endometrium thickens under the influence of:

A

Estrogen

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37
Q

Enhances the lining of the uterus to prepare it for implantation

A

Progesterone

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38
Q

Physical, behavioral and mood changes with cyclical occurrence during the ________ phase of the menstrual cycle

A

Premenstrual Syndrome

Luteal phase

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39
Q

Severe PMS with functional impairment

A

Premenstrual Dysphoric Disorder (PMDD)

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40
Q

Signs/Symptoms of PMS:

A
  1. Physical: bloating, breast swelling/pain
  2. Emotional: depression, hostility, irritability, libido changes
  3. Behavioral: food cravings, poor concentration
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41
Q

Criteria for diagnosis of PMS:

A

1-2 weeks before menses (luteal phase)

Relieved within 2-3 days of the onset of menses

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42
Q

Management of PMS:

A
  1. Stress reduction, exercise, caffeine and salt restriction
  2. NSAIDs
  3. SSRIs
  4. OCPs
  5. Drospirenone-containing OCPs for PMDD
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43
Q

MC cause of cervicitis

A

Chlamydia

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44
Q

What organism causes LGV

A

Chlamydia

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45
Q

Painless genital ulcer + painful inguinal LAD

A

LGV

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46
Q

Diagnosis of chlamydia / gonorrhea

A

NAAT
Cultures
DNA probe

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47
Q

Management of chlamydia / gonorrhea

A

1 g Azithromycin PO
250 mg Ceftriaxone IM (co-tx for gonorrhea)

Can use doxycycline instead of azithromycin

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48
Q

Pt instructions for chlamydia / gonorrhea tx

A

Avoid sexual intercourse 7 days after treatment

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49
Q

Haemophilus ducreyi

A

Bacteria that causes chancroid

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50
Q

Soft, shallow, painful genital ulcer that may have foul discharge
Painful inguinal LAD

A

Chancroid

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51
Q

Diagnosis of chancroid

A

Clinical, culture

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52
Q

Treatment of chancroid

A

Azithromycin

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53
Q

HPV strains that cause genital warts

A

6, 11

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54
Q

Flat, pedunculated or papular flesh-colored growths

Cauliflower-like lesions

A

HPV
Genital warts
6, 11

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55
Q

Diagnosis of HPV

A

Whitening with 4% acetic acid application
Clinical diagnosis
+/- colposcopy, biopsy

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56
Q

Management of HPV (genital warts)

A 
Trichloroacetic acid
Podophyllin
Cryotherapy
Surgical removal
Outpt: podofilox, imiquimod
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57
Q

Genital ulcer disease caused by Chlamydia trachomatis

A

LGV

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58
Q

Diagnosis of LGV

A

NAAT (Chlamydia)

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59
Q

Tx of LGV

A

Doxycycline 100 mg PO BID x 21 days

Azithromycin effective as well

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60
Q

Pts with LGV should be also be tested for:

A

HIV and other sexually transmitted diseases

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61
Q

Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, nausea, vomiting, fever

A

Pelvic Inflammatory Disease

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62
Q

Physical exam sign of PID

A

+ chandelier’s sign - cervical motion tenderness to palpation and rotation

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63
Q

Diagnosis of PID

A

Clinical diagnosis
BhCG to r/o ectopic pregnancy
Cervical motion tenderness plus > 1 of the following:
+ gram stain, WBC > 10,000, pus on culdocentesis or laparoscopy, increased ESR or CRP
Pelvic ultrasound - may show abscess

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64
Q

Outpatient management of PID

A

Doxycycline + Ceftriaxone

+/- Metronidazole

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65
Q

Inpatient management of PID

A

IV doxycycline + 2nd gen ceph (cefoxitin or cefotetan)

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66
Q

Complications of PID

A

Fitz-Hugh Curtis Syndrome

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67
Q

Caused by spirochete Treponema pallidum

A

Syphilis

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68
Q

Forms chancre at the inoculation site and from there, goes to the regional lymph nodes before disseminating

A

Syphilis

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69
Q

Painless ulcer with raised indurated edges (usually begins as a papule that ulcerates)
Nontender regional lymphadenopathy

A

Primary Syphilis

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70
Q

Maculopapular rash involving palms/soles
Condyloma lata (wart-like, moist lesions involving mucus membranes and other moist areas)
Fever, lymphadenopathy

A

Secondary Syphilis

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71
Q

Gumma: non cancerous granulomas on skin and body tissues
Neurosyphilis: headache, meningitis, dementia
Tabes dorsalis: ataxia, areflexia burning pain, weakness
Argyll-Robertson Pupil: does not constrict/react to light
Cardio: aortitis, aortic regurgitation, aortic aneurysms

A

Tertiary syphilis

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72
Q

Clinical syndrome that occurs within the first year of infection: includes primary, secondary and early latent

A

Early syphilis

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73
Q

Asymptomatic infection + normal physical exam but positive serologic testing

A

Latent syphilis
Early latent if < 1 year (highly contagious)
Late latent if > 1 year

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74
Q

Congenital syphilis

A

Hutchinson teeth (notches on teeth)
Sensorineural hearing loss
Saddle-nose deformity
ToRCH syndrome

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75
Q

Diagnosis of syphilis

A
  1. Darkfield microscopy

2. RPR, FTA-Abs

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76
Q

Jarisch-Herxheimer reaction

A

S/E of penicillin rxn

Acute febrile response, myalgias, HA

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77
Q

A ________ reduction in the titer for syphilis within 6 months denotes adequate management

A

4-fold

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78
Q

All pts with syphilis should be tested for:

A

HIV

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79
Q

Signs/Symptoms of atrophic vaginitis

A

Thin, yellow discharge
Vaginal pH > 5.5
Pruritus
Recurrent UTIs

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80
Q

Tx of atrophic vaginitis

A

Transdermal, intravaginal estrogen
Ospemifene
Vaginal moisturizers

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81
Q

Copious vaginal discharge, watery grey-white “fish rotten” smell

A

Bacterial vaginosis

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82
Q

Malodorous vaginal discharge, frothy yellow-green discharge, strawberry cervix

A

Trichomoniasis

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83
Q

Thick curd-like/cottage cheese vaginal discharge

A

Candida vaginitis

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84
Q

Diagnosis of bacterial vaginosis

A 
Whiff test (fishy odor)
Microscopic: clue cells - epithelial cells covered with bacteria
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85
Q

Diagnosis of trichomoniasis

A

Mobile protozoa on wet mount, WBCs

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86
Q

Diagnosis of candida vaginitis

A

Hyphae, yeast and spores on KOH prep

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87
Q

Copious lactobacilli, large number of epithelial cells on microscope

A

Cytolytic

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88
Q

Management of BV

A

Metronidazole or Clindamycin

89
Q

Management of trichomoniasis

A

Metronidazole or Tinidazole

90
Q

Management of candida

A

Fluconazole, intravaginal antifungals

91
Q

Management of cytolytic vaginitis

A

Discontinue tampon usage, sodium bicarbonate (sitz bath)

92
Q

Most common non-skin malignancy in women

A

Breast cancer

93
Q

Second most common cause of cancer death in women

A

Breast cancer

94
Q

Risk factors for breast cancer

A 
BRCA 1 / 2
1st degree relative with breast CA
Age > 65 y/o
Increased number of menstrual cycles
75% have no risk factors
95
Q

Most common types of breast cancer

A
  1. Ductal carcinoma (MC)

2. Lobular Carcinoma

96
Q

Most common location of BC METS

A

Lung
Liver
Bone
Brain

97
Q

Chronic eczematous itchy, scaling rash on the nipples and areola. Lump often present.

A

Paget’s disease of the nipple

98
Q

Red, swollen, warm, itchy breast. Often with nipple retraction, peau d’ orange, usually not associated with lump

A

Inflammatory breast cancer

99
Q

Dx of breast cancer

A
  1. mammogram
  2. ultrasound
  3. biopsy, FNA
100
Q

Hormone therapy for breast cancer pts

A
  1. Tamoxifen (ER positive) - premenopausal
  2. Letrozole, anastrozole (ER positive) - postmenopausal
  3. Herceptin (HER2 positive)
101
Q

Timing for breast self-examinations

A

Immediately after menstruation or on days 5-7 of menstrual cycle

102
Q

Breast cancer prevention in high-risk patients

A

SERM: tamoxifen or raloxifene

Tamoxifen preferred

103
Q

Third most common gynecologic cancer

A

Cervical carcinoma

104
Q

Most common METS w/ cervical carcinoma

A

Local –> vagina, parametrium, pelvic lymph nodes

105
Q

Risk factors for cervical carcinoma

A

HPV, early sexual activity, increased number of partners, smoking, STIs, immunosuppression

106
Q

MC type of cervical carcinoma

A

Squamous (90%)

107
Q

Most common symptoms of cervical carcinoma

A

Post coital bleeding/spotting

Pelvic pain, watery vaginal discharge

108
Q

Diagnosis of cervicial carcinoma

A

PAP smear with cytology used for screening

Colposcopy with biopsy

109
Q

Management of pt > 25 y/o, with normal PAP screen but + HPV test

A

Cytology and HPV testing in 1 year OR

Genotype for HPV 16/18

110
Q

70% of _________ lesions regresses at 24 months but HPV + lesions have higher risk of progression into carcinoma

111
Q

Management of pt > 25 y/o with ASC-US PAP screen

A

HPV testing:
HPV (+) - colposcopy with biopsy
HPV (-) - repeat PAP and HPV in 1 year

112
Q

Management of pt 21-24 y/o with ASC-US or LSIL PAP screen results:

A

Repeat PAP in 1 year or HPV testing

113
Q

Management of pt < 32 with ASC-US PAP screen results:

A

Repeat PAP in 1 year

114
Q

Management of pt with ASC-H PAP screen results

A

Colposcopy and biopsy

Higher chance of cancer than ASC-US

115
Q

Most commonly associated with cellular changes seen with transient HPV infection

116
Q

Management of 25+ y/o pt with LSIL PAP screen results

A

Colposcopy with biopsy

117
Q

Includes CIN II, CIN III, and carcinoma in situ

118
Q

Management of HSIL

A

Colposcopy with biopsy in all ages
Excision of ablation mainstay of tx
Excision: LEEP, cold knife cervical conization
Ablation: Cryocautery, laser cautery, electrocautery

119
Q

CIN

A

Cervical Intraepithelial Neoplasia

Precursor for cervical carcinoma

120
Q

Highest risk for malignancy on the cervix

A

Transformation zone (squamocolumnar junction)

121
Q

Moderate dysplasia including 2/3 thickness of basal epithelium

122
Q

Severe dysplasia including > 2/3 - up to full thickness of basal epithelium

123
Q

Most common gynecologic malignancy in the US

A

Endometrial cancer

124
Q

4th most common non-skin cancer in women overall

A

Endometrial cancer

Breast –> lung –> colorectal –> endometrial

125
Q

Endometrial cancer is most commonly seen in what population?

A

Postmenopausal

126
Q

Endometrial cancer is ________ dependent

127
Q

Risk factors for endometrial cancer

A

Increased estrogen exposure (nulliparity, PCOS)
Tamoxifen
HTN, DM

128
Q

Combination OCPs are protective against:

A

Ovarian and endometrial cancer

129
Q

Signs/Symptoms of endometrial cancer

A

Abnormal uterine bleeding

Postmenopausal bleeding

130
Q

Diagnosis of endometrial cancer

A

Endometrial biopsy: adenocarcinoma (80%)

Ultrasound: endometrial stripe > 4 mm

131
Q

Second most common gynecologic cancer

A

Ovarian cancer

132
Q

Highest mortality of all gynecologic cancer

A

Ovarian cancer

133
Q

Risk factors for ovarian cancer

A

+ family history
Increased number of ovulatory cycles
BRCA 1/2
Turner’s syndrome

134
Q

Abdominal fullness/distention, back or abdominal pain, early satiety, urinary frequency, irregular menses, menorrhagia, postmenopausal bleeding, constipation

A

Ovarian cancer

135
Q

Physical exam signs on ovarian cancer

A

Palpable abdominal mass
+/- ascites
Sister Mary Joseph’s node - METS to umbilical lymph node

136
Q

Diagnosis of ovarian cancer

A

Biopsy - 90% epithelial
Transvaginal US
Mammography to look for METS to breast

137
Q

Management of ovarian cancer

A

TAH-BSO + selective lymphadenopathy
Serum CA-125 levels used to monitor treatment progress
Chemotherapy

138
Q

Dermoid cystic teratomas

A

Most common benign ovarian neoplasm

139
Q

Management of dermoid cystic teratomas

A

Removal due to potential risk of torsion or malignant transformation

140
Q

Most common type of vaginal cancer

A

Squamous cell (95%)

141
Q

S/S of vaginal cancer

A

Asymptomatic
Changes in menstrual period
Abnormal vaginal bleeding
Vaginal discharge

142
Q

Management of vaginal cancer

A

Radiation therapy

143
Q

Most common type of vulvar cancer

A

Squamous cell (90%)

144
Q

Most common presentation of vulvar cancer

A

Pruritus (MC)
Vaginal itching, irritation
Post-coiting bleeding, vaginal discharge

145
Q

Red/white ulcerative, crusted lesions

A

Vulvar cancer

146
Q

Dx of vulvar cancer

147
Q

Management of vulvar cancer

A

Surgical excision, radiation therapy, chemotherapy

148
Q

Seen mostly in lactating women secondary to nipple trauma

A

Infectious mastitis

149
Q

Most common organisms in infectious mastitis

A

Staph aureus

Strep +/- candida

150
Q

Bilateral breast enlargement 2-3 days postpartum

A

Congestive mastitis

151
Q

Unilateral breast pain (especially in one quadrant) with tenderness, warmth, swelling, and nipple discharge

A

Infectious mastitis

152
Q

Bilateral breast pain and swelling, may have low grade fever and axillary lymphadenopathy

A

Congestive mastitis

153
Q

Management of infectious mastitis

A 
Supportive measures (warm compress, breast pump)
ABX: dicloxacillin, nafcillin, cephalosporin
Mother may continue to breast feed
154
Q

Management of congestive mastitis

A

If woman desires to breast feed: manually empty breast completely after breastfeeding
Local heat, analgesics, continue nursing

If woman does not desire to breast feed: ice packs, tight fitting bras, analgesics, avoid breast stimulation

155
Q

Management of breast abscess

A

I and D

Discontinue breastfeeding from affected breast

156
Q

Most common breast disorder

A

Fibrocystic breast disorder

157
Q

Usually multiple, mobile, well demarcated lumps in breast tissue. Often tender and bilateral

A

Fibrocystic breast disorder

158
Q

May increase or decrease in size with menstrual hormonal changes

A

Fibrocystic breast disorder

159
Q

Second most common benign breast disorder

A

Fibroadenoma

160
Q

Most common breast disorder in pts specifically late teens to early 20s

A

Fibroadenoma

161
Q

Smooth, well-circumscribed, nontender, freely mobile, rubbery lump in breast. Gradually grows over time and does not usually wax and wane with menstruation

A

Fibroadenoma

162
Q

Management of fibroadenoma

A

Observation, most small tumors resorb with time

Excision (not usually done)

163
Q

Intermittent pain with spontaneous resolution indicates ________ torsion

A

Partial ovarian torsion

164
Q

Acute, severe, unilateral abdominopelvic pain.

N/V, possible elevated WBC and low-grade fever

A

Ovarian torsion

165
Q

Diagnosis of ovarian torsion

A

Clinical suspicion, may have adnexal mass

TUS with doppler flow studies

166
Q

Management of ovarian torsion

A

Surgical emergency, laparoscopy, laparotomy

167
Q

Uterine herniation into the vagina

A

Uterine Prolapse

168
Q

Risk factors for pelvic organ prolapse

A

Childbirth (especially traumatic)
Multiple vaginal births
Obesity
Repeated heavy lifting

169
Q

Posterior bladder herniating into the anterior vagina

170
Q

Pouch of Douglas (small bowel) into the upper vagina

A

Enterocele

171
Q

Distal sigmoid colon (rectum) herniates into posterior distal vagina

172
Q

Pelvic or vaginal fullness, heaviness, “falling out” sensation, lower back pain, vaginal bleeding, urinary frequency, urgency, stress incontinence

A

Pelvic organ prolapse

173
Q

Management of pelvic organ prolapse

A
  1. Kegel exercises, weight control
  2. Pessaries, estrogen treatment
  3. Hysterectomy, uterosacral or sacrospinous ligament fixation
174
Q

S/E of implanon

A

Osteoporosis

175
Q

Adverse effect of spermicide

A

Slightly increased risk of HIV (causes microabrasions)

176
Q

Type of endometrial tissue that is present outside the uterine cavity in endometriosis

A

Stroma and gland

177
Q

Risk factors for endometriosis

A

Nulliparity
Family history
Early menarche

178
Q

Classic triad of endometriosis

A

Cyclic premenstrual pelvic pain
Dysmenorrhea
Dyspareunia

179
Q

25% of all causes of female infertility

A

Endometriosis

180
Q

Diagnosis of endometriosis

A

Tender adnexal masses
Laparoscopy with biopsy (definitive)
Raised, patches of thickened, discolored, scarred or “powder burn” appearing plants of tissue

181
Q

Endometriosis involving ovaries large enough to be considered a tumor, usually filled with old blood appearing chocolate-colored

A

Endometrioma

182
Q

Management of endometriosis

A
  1. OCPs + NSAIDs
  2. Progesterone
  3. Leuprolide
  4. Danazol (induces pseudomenopause)
  5. Conservative laparoscopy with ablation if fertility desired
  6. TAH-BSO if no desire to conceive
183
Q

Failure to conceive after 1 year of regular unprotected sexual intercourse

A

Infertility

184
Q

Diagnosis of infertility

A

Hysterosalpingography - evaluates tubal patency or abnormalities

185
Q

Management of infertility

A
  1. Clomiphene - induces ovulation
  2. Intrauterine insemination
  3. In vitro fertilization (especially if fallopian tube defect is present)
186
Q

Benign uterus smooth muscle tumor

A

Leiomyoma (Fibroids)

187
Q

Most common benign gynecologic lesion

A

Leiomyoma (Fibroids)

188
Q

Growth of fibroids is related to _________ production

A

Estrogen

Therefore, fibroids regress after menopause - if it grows after menopause, think of other causes

189
Q

Fibroids are 5x more common in:

A

African-Americans

190
Q

Types of fibroids

A
  1. Intramural
  2. Submucosal
  3. Subserosal
  4. Pedunculated
  5. Parasitic
191
Q

Most common presentation of uterine fibroids

A

Bleeding, dysmenorrhea
Abdominal pressure/pain
Bladder frequency, urgency

192
Q

Large, irregular, hard palpable mass in the abdomen or pelvis

A

Uterine fibroids

193
Q

Diagnosis of uterine fibroids

A

Ultrasound - heterogenic masses with shadowing

194
Q

Management of uterine fibroids

A

Observation - most do not need tx
Leuprolide (shrinks uterus)
Progestins - decreases bleeding

Hysterectomy - MC cause for hysterectomy
Myomectomy
Endometrial ablation

195
Q

Types of ovarian cysts

A

Follicular - when follicles fail to rupture and continue to grow
Corpus luteal cysts - fail to degenerate after ovulation
Theca lutein - excess hCG causes hyperplasia

196
Q

S/S of ovarian cysts

A 
Most asymptomatic until they rupture, undergo torsion or become hemorrhagic - LLQ/RLQ pain
Menstrual changes (AUB), dyspareunia
197
Q

Diagnosis of ovarian cysts

A

Pelvic US
Follicular: smooth, thin-walled unilocular
Luteal: complex
Order hCG to r/o pregnancy

198
Q

Management of ovarian cysts

A

< 8 cm: rest, NSAIDs, repeat US after 6 weeks
OCPs +/- prevent recurrence but do not treat existing ones
> 8 cm or cyst in postmenopausal pt: laparoscopy or laparotomy possible

199
Q

Functional incontinence

A

Problem that keeps the pt from quickly getting to the bathroom

200
Q

Urine leakage due to increased intraabdominal pressure

A

Stress incontinence

201
Q

Risk factors for stress incontinence

A

Childbirth
Surgery
Postmenopausal estrogen loss

202
Q

Increased intraabdominal pressure from sneezing, coughing, laughing –> urine leakage

A

Stress incontinence

203
Q

Management of stress incontinence

A
  1. Kegel exercises
  2. Alpha agonists - midodrine, pseudoephedrine
  3. Surgery
  4. Anti-continence devices
  5. Estrogen cream or vaginal ring
204
Q

Urine leakage accompanied or preceded by urge

A

Urge incontinence

205
Q

Detrusor muscle overactivity, involuntary detrusor musucle contraction

A

Urge incontinece

206
Q

S/S of urge incontinence

A

Urgency, frequency, small volume voids, nocturia

207
Q

Management of urge incontinence

A
  1. Bladder training (timed voiding, decreased fluid intake)
  2. Anticholinergics: oxybutynin
  3. TCAs
  4. Mirabegron (beta agonst) - relaxes bladder
  5. Surgical - botox injection
  6. Diet - avoid spicy foods, citrus, chocolate, caffeine
208
Q

Urinary retention (incomplete bladder emptying)

A

Overflow incontinence

209
Q

Underactive bladder due to DM, multiple sclerosis, autonomic dysfunction, spinal injury

A

Overflow incontinence

210
Q

S/S of overflow incontinence

A

Small volume voids, frequency, dribbling

Increased void residual > 200 mL

211
Q

Management of overflow incontinece

A

Bladder atony - intermittent or indwelling catheter first line
BPH - alpha blockers - tamsulosin

212
Q

Triad of polycystic ovarian syndrome

A
  1. Amenorrhea
  2. Obesity
  3. Hirsutism (androgen excess)
213
Q

PCOS is due to:

A

Insulin resistance

214
Q

S/S of increased androgen effect in PCOS

A

Hirsutism - coarse hair growth on midline structures (face, neck, abdomen)
Acne
+/- male pattern baldness

215
Q

Complications/comorbidities of PCOS due to insulin resistance

A 
Type II DM
Obesity
HTN
Atherosclerosis
Endometrial carcinoma due to infertility
216
Q

Bilateral, enlarged, smooth, mobile ovaries on bimanual examination
Acanthosis nigricans

A

Polycystic ovarian syndrome

217
Q

Cysts are immature follicles with arrested development due to abnormal ovarian function

A

Polycystic ovarian syndrome

218
Q

Diagnosis of PCOS

A

R/o other disorders: TSH, prolactin levels, ovarian tumors, Cushing’s syndrome (dexamethasone suppression test)
GnRH agonist stimulation test: rise in serum hydroxyprogesterone
Lipid panel: checking insulin resistance
Glucose tolerance test
Pelvic US: string of pearls (bilateral enlarged ovaries with peripheral cysts)

219
Q

Management of PCOS

A

OCPs - mainstay
Spironolactone - teratogenic (must be used w/ OCPs)
Leuprolide
Clomiphene (if desiring children)
Metformin in pts with abnormal LH:FSH ratios may improve menstrual frequency by reducing insulin
Lifestyle changes; diet, exercise, weight loss
Surgical: wedge resection

OBGYN EOR (1 decks)

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