Gynecology Flashcards
1
Q
What is the most sensitive test for multiple sclerosis?
A
MRI of head and orbits
Shows asymmetric white matter lesions.
2
Q
Normal progression of puberty
A
- Adrenarche (DHEA produced)
- Gonadarche (TSH, LH)
- Thelarche breast formation
- Pubarche: pubic hair growth
- Growth spurt
- Menarche: onset of menses.
- 13yo is average age.
3
Q
Precocious Puberty
A
Onset of puberty before average age.
- Central: d/t premature activation of Hypothalamic axis
- Peripheral: excess secretion of sex hormones.
- Dx
- High LH = central
- Low LH = peripheral
- High DHEA-S = adrenal hyperplasia.
- Tx
- (+) tumor = resection
- Central w/o tumor = continuous GnRH agonist (leuprolide)
- Peripheral = needs US to find source of excess estrogen.
4
Q
Primary ovarian insufficiency
A
Amenorrhea < 40yo
5
Q
ADR of estrogen
A
- weight gain
- Nausea
- Breast tenderness
- Headache
- Endometrial cancer
6
Q
ADR of progesterone
A
- Acne
- Depression
- HTN
7
Q
Non-hormonal options to treat menopause hot flashes
A
- Desvenlafaxine
- SNRI.
- Venlafaxine
- Clonidine
- good for BP control also
- Gabapentin
- good for RLS, insomnia, seizure.
- Time
- majority of women have resolution within a few months.
8
Q
Contraindications to IUD placement
A
- Active uterine infection
- (+) pregnancy, near future pregnancy desired.
- Uterine distortion.
- Uterine bleeding w/o known source
- Cu allergy, Wilson disease = should avoid Cu IDU.
- Breast cancer pt should avoid the Levonorgestrel IUD.
9
Q
Absolute contraindications to use the OCPs
A
- pregnancy
- H/o thromboembolism, DVT, PE
- (+) ER tumor
- Cerebrovascular disease CAD, stroke
- HTN uncontrolled.
- Smoking > 35yo
- Hepatic disease (hepatic adenoma)
- Migraine w/ aura
10
Q
Medications that reduce the effectiveness of OCPs?
A
- Antiepileptics
- phenobarbital, phenytoin, carbamazepine, topiramate, oxcarbazepine, primidone
- Abx
- rifampin, griseofulvin
- St. John’s Wort.
11
Q
Forms of emergency contraception
A
- Ethinyl estradiol/levonorgestrel pill
- high dose estrogen. ADR - HA, nausea
- Levonorgestrel
- Prevents ovulation
- Prevents fertilization (disrupts the fallopian tube motility and thickens cervical mucus)
- Copper IUD
- Progestin inhibitors
- Ulipristal
- Mifepristone
12
Q
Primary causes of dysmenorrhea
A
Inflammation and physical trauma d/t shedding of endometrial lining
13
Q
Secondary dysmenorrhea
A
Endometriosis, PID, fibroids, adenomyosis.
14
Q
Tx of dysmenorrhea
A
- NSAIDs
- OCPs
15
Q
What is PMS?
A
- Typically onset of Sxms (weight gain, HA, abd/pelvic pain, bloating) that starts 2-7d before menses.
- Tx
- NSAIDs
- exercise and relaxation
- SSRI
- OCPs.
16
Q
Causes of abnormal Uterine bleeding
A
PALM COIEN
- polyps
- adenomyosis
- leiomyomas
- malignancy
- coagulopathy
- ovulatory dysfunction
- Iatrogenic
- endometrial infection
17
Q
Evaluation of primary amenorrhea
A
18
Q
Secondary amenorrhea evaluation
A
19
Q
Progesterone withdrawal test
A
20
Q
Hormone abnormalities with PCOS
A
- LH:FSH (>2:1)
- high androgen
- high insulin
- high estrogen
- Low sex hormone binding globulin
21
Q
Clinical criteria for PCOS
A
2 of the 3.
- Cysts on ovaries (US)
- hyperandrogenism - high testosterone, DHEA-S
- acne, male pattern baldness, hirsutism
- Anovulation
Can also have: diabetes, obesity, infertility ,high risk endometrial cancer.
22
Q
Management of PCOS
A
- Diet/ Exercise
- OCP
- if trying to avoid pregnancy
- Clomiphene
- if trying to get pregnant - induces ovulation.
- Cyclic progestins to protect against endometrial hyperplasia.
- spironolactone to tx hirsutism.
Metformin is 2nd line
23
Q
Tx of pelvic organ prolapse
A
- Observation is asymptomatic
- pelvic floor muscle exercise
- pessary
- surgery
24
Q
Chancroid
A
Haemophilus ducreyi
- Pt
- painful ulcer w/ purulent base.
- painful inguinal LAD.
- Dx
- G(-) rods w/ school of fish pattern
- Tx
- Ceftriaxone
- azithromycin
25
Lymphogranuloma venereum
*Chlamydia L1-L3.*
* Pt
* H/o tropical region or Male-with-male sex
* painless ulcer; spontaneous resolution
* **unilateral inguinal LAD**
* Dx
* NAAT
* Tx
* doxycycline
26
Granuloma Inguinale (Donovanosis)
*Klebsiella granulomatis*
* Pt
* painless, ulcer w/ beefy-red base
* Dx
* **_Intracellular G(-) rods_** = Donovan bodies
* Tx
* azithromycin
27
Leiomyoma
* Pt
* Heavy/prolonged periods
* **PELVIC Pressure and discomfort.** no pain
* Recurrent miscarriages
* Dx
* US. Bx is not needed
28
Treatment of Leiomyomas
* Hysterectomy is definitive
* GnRH agonist (3-6mo prior to surgery) to reduce size of fibroid.
* Myomectomy
* if woman wants to continue child bearing
* OCP, progestin, Levonorgestrel
* risk of increasing fibroid size. Controls bleeding.
* Endometrial ablation
* uterine artery embolization
29
Adnexal mass Ddx
* Physiological ovarian cyst
* graafian cyst
* corpus lutein cyst
* endometrioma
* ectopic preg
* tuboovarian abscess
* ovarian tumor
30
Granulosa cell tumor
* High estrogen, High inhibin
* Pt
* precocious puberty
* Abnormal uterine bleeding.
31
Sertoli-Leydig cell tumors
* High testosterone
* Pt
* virilization
32
Dysgerminoma
High LDH.
Presents in adolescent w/ abd pain/mass
33
Yolk sac tumor
High AFP
Presents in adolescent w/ abd pain and mass
34
Teratoma
High AFP
Presents in adolescent w/ abd pain and mass
35
Embryonal tumor
High AFP + hCG
Presents in adolescent w/ abd pain and mass
36
Medications that cause gynecomastia
STACKED
* Spironolactone
* THC- marijuana
* Alcohol (chronic)
* Cimetidine
* Ketoconazole
* Estrogen
* Digoxin
37
Breast Abscess
* Pt
* starts as mastitis. Diabetics and smokers.
* Painful breast mass w/ large area (25-30%) of breast warm and tender.
* Purulent drainage from nipple.
* Dx
* leukocytosis w/ bands.
* Tx
* incision and drainage
* Abx
* Dicloxacillin
* Bactrim (MRSA+)
* Metronidazole (+) anaerobes
* Continue breastfeeding/pumping
38
Fibrocystic changes
* **35-50yo**
* Multiple, bilateral breast masses - painful.
* Hormone sensitive
* Tx
* reduce intake of caffeine and fat
* OCP if above fails.
39
Fibroadenoma
* Most common breast mass **F \< 30yo**
* Pt
* Solitary firm, mobile breast mass
* Can increase in size w/ estrogen exposure.
* Dx
* US to determine cyst from solid mass
* FNA, CNB, Excision
* F/U ultrasound w/ diagnostic mammography (\>35yo)
* Tx
* May no be required
* Surgical excision or cryotherapy if symptomatic
40
Intraductal Papilloma
Benign lesion of ductal tissue, that rarely becomes malignant.
* Pt
* serous nipple discharge +/- blood discharge
* Tx
* surgical excision and pathology for cancer r/o.
41
Phyllosed Tumor
* Pt
* F \>50
* large, bulky tumor w/ leaf-like projections
* Tx
* monitor closely for malignant changes.
* surgical resection if symptomatic
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