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Boards 2 > Gynecology > Flashcards

Gynecology Flashcards

1
Q

What is the most sensitive test for multiple sclerosis?

A

MRI of head and orbits

Shows asymmetric white matter lesions.

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2
Q

Normal progression of puberty

A
  1. Adrenarche (DHEA produced)
  2. Gonadarche (TSH, LH)
  3. Thelarche breast formation
  4. Pubarche: pubic hair growth
  5. Growth spurt
  6. Menarche: onset of menses.
    1. 13yo is average age.
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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.
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4
Q

Primary ovarian insufficiency

A

Amenorrhea < 40yo

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5
Q

ADR of estrogen

A
  • weight gain
  • Nausea
  • Breast tenderness
  • Headache
  • Endometrial cancer
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6
Q

ADR of progesterone

A
  • Acne
  • Depression
  • HTN
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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.
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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.
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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
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10
Q

Medications that reduce the effectiveness of OCPs?

A
  • Antiepileptics
    • phenobarbital, phenytoin, carbamazepine, topiramate, oxcarbazepine, primidone
  • Abx
    • rifampin, griseofulvin
  • St. John’s Wort.
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11
Q

Forms of emergency contraception

A
  1. Ethinyl estradiol/levonorgestrel pill
    1. high dose estrogen. ADR - HA, nausea
  2. Levonorgestrel
    1. Prevents ovulation
    2. Prevents fertilization (disrupts the fallopian tube motility and thickens cervical mucus)
  3. Copper IUD
  4. Progestin inhibitors
    1. Ulipristal
    2. Mifepristone
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12
Q

Primary causes of dysmenorrhea

A

Inflammation and physical trauma d/t shedding of endometrial lining

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13
Q

Secondary dysmenorrhea

A

Endometriosis, PID, fibroids, adenomyosis.

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14
Q

Tx of dysmenorrhea

A
  1. NSAIDs
  2. OCPs
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15
Q

What is PMS?

A
  • Typically onset of Sxms (weight gain, HA, abd/pelvic pain, bloating) that starts 2-7d before menses.
  • Tx
    1. NSAIDs
    2. exercise and relaxation
    3. SSRI
    4. OCPs.
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16
Q

Causes of abnormal Uterine bleeding

A

PALM COIEN

  • polyps
  • adenomyosis
  • leiomyomas
  • malignancy
  • coagulopathy
  • ovulatory dysfunction
  • Iatrogenic
  • endometrial infection
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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
  1. Diet/ Exercise
  2. OCP
    1. if trying to avoid pregnancy
  3. Clomiphene
    1. if trying to get pregnant - induces ovulation.
  4. Cyclic progestins to protect against endometrial hyperplasia.
  5. spironolactone to tx hirsutism.

Metformin is 2nd line

23
Q

Tx of pelvic organ prolapse

A
  1. Observation is asymptomatic
  2. pelvic floor muscle exercise
  3. pessary
  4. 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
Q

Lymphogranuloma venereum

A

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
Q

Granuloma Inguinale (Donovanosis)

A

Klebsiella granulomatis

  • Pt
    • painless, ulcer w/ beefy-red base
  • Dx
    • Intracellular G(-) rods = Donovan bodies
  • Tx
    • azithromycin
27
Q

Leiomyoma

A
  • Pt
    • Heavy/prolonged periods
    • PELVIC Pressure and discomfort. no pain
    • Recurrent miscarriages
  • Dx
    • US. Bx is not needed
28
Q

Treatment of Leiomyomas

A
  • 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
Q

Adnexal mass Ddx

A
  • Physiological ovarian cyst
    • graafian cyst
    • corpus lutein cyst
  • endometrioma
  • ectopic preg
  • tuboovarian abscess
  • ovarian tumor
30
Q

Granulosa cell tumor

A
  • High estrogen, High inhibin
  • Pt
    • precocious puberty
    • Abnormal uterine bleeding.
31
Q

Sertoli-Leydig cell tumors

A
  • High testosterone
  • Pt
    • virilization
32
Q

Dysgerminoma

A

High LDH.

Presents in adolescent w/ abd pain/mass

33
Q

Yolk sac tumor

A

High AFP

Presents in adolescent w/ abd pain and mass

34
Q

Teratoma

A

High AFP

Presents in adolescent w/ abd pain and mass

35
Q

Embryonal tumor

A

High AFP + hCG

Presents in adolescent w/ abd pain and mass

36
Q

Medications that cause gynecomastia

A

STACKED

  • Spironolactone
  • THC- marijuana
  • Alcohol (chronic)
  • Cimetidine
  • Ketoconazole
  • Estrogen
  • Digoxin
37
Q

Breast Abscess

A
  • 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
Q

Fibrocystic changes

A
  • 35-50yo
    • Multiple, bilateral breast masses - painful.
    • Hormone sensitive
  • Tx
    • reduce intake of caffeine and fat
    • OCP if above fails.
39
Q

Fibroadenoma

A
  • 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
Q

Intraductal Papilloma

A

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
Q

Phyllosed Tumor

A
  • Pt
    • F >50
    • large, bulky tumor w/ leaf-like projections
  • Tx
    • monitor closely for malignant changes.
    • surgical resection if symptomatic
42
Q
A

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