Gynecology Flashcards
What are the top 3 causes of vulvovaginitis symptoms?
- Bacterial vaginosis (21-29%)
- Vulvovaginal candidiasis (7-39%)
- Trichomonas (4-35%)
“Thick white discharge with itching” is the classic presentation for which vulvovaginitis condition?
Yeast infection
“Thin white discharge with fishy odor” is the classic presentation for which vulvovaginitis condition?
Bacterial vaginosis
“Yellow frothy discharge with increased odor” is the classic presentation for which vulvovaginitis condition?
Trichomonas
What is the normal vaginal pH range in a reproductive-aged female?
3.8-4.5
What vulvovaginal infection is associated with a pH < 4.5?
Yeast
What vulvovaginal infection is associated with a pH > 4.5?
BV or Trichomonas
How can lichen sclerosis and lichen planus be distinguished from one another?
Lichen sclerosis only involves the vulva whereas lichen planus involves both the vulva and vagina
What are the CDC recommendations for C/G screening?
- < 25 yo: annual screening
- > 25 yo: screen if new/multiple sexual partners or partners with known STD risk
What are the STI screening recommendations for pregnant women?
1st Trimester
- Syphilis
- C/G
- HIV
- Hep B
What are HIV screening recommendations for individuals age 13-64?
Screen at least once and repeat annually if high risk
What are STI screening recommendations for men who have sex with men?
Annual G/C screen
What are STI screening recommendations for those with a history of injection drug use or unsafe sex?
HIV screen annually
What is the most common infectious disease in the United States?
Chlamydia
What is the treatment for Chlamydia?
Azithromycin + Doxycyclin
+ Ceftriaxone for gonorrhea coverage
What is the treatment for Gonorrhea?
Ceftriaxone (+ Azithromycin and Doxycyclin for chlamydia coverage)
HSV-1 usually causes what type of herpes?
Oral
HSV-2 usually causes what type of herpes?
Genital
What is a common treatment for UTI?
Trimethoprim-Sulfamethoxazole
What is the 1st-line therapy for prolapse?
Pessary
How is endometriosis defined?
The presence of endometrial glands and stroma in any site outside of the uterus
What are the two classic symptoms of endometriosis?
- Dysmenorrhea
- Dyspareunia
What is the first-line therapy for the treatment of endomentriosis
Oral contraception (OCPs)
What is the definition of chronic pelvic pain?
Non-cyclic pain that last more than 6 months and localizes to the anatomic pelvis, the anterior abdominal wall at or below the level of the umbilicus AND is of sufficient severity to causes functional disability OR require medical care
What are some common gynecologic causes of chronic pelvic pain?
- PID
- Endometriosis
- Leiomyomas
What are two notable non-gynecologic causes of chronic pelvic pain?
- IBS
- Interstitial cystitis
What are the top risk factors for breast cancer?
- Age
- Personal hx of breast cancer
- Inherited BRCA 1/2
A straining Q-tip angle > 30 degrees from the horizon can be indicative of what?
Urethral hyper-mobility
What symptoms are classically present in a woman with ovarian torsion?
- Pelvic pain
- Adnexal mass
- Nausea/vomiting
What is the treatment for ovarian torsion?
Surgery immediately!
What does LEEP stand for?
Loop Electrosurgical Excision Procedure
What are some of the complications of LEEP?
- Increased bleeding
- Cervical stenosis
- Infection
- Persistent disease
What is the first sign of sexual development progression in a female?
Thelarche (Breast buds)
What is the minimum body weight range for menarche to begin?
85-106 pounds
What is the best initial treatment for polycystic ovary syndrome (PCOS)?
- Weight loss
- OCPs (to regulate periods, control androgen levels, and prevent endometrial hyperplasia)
What is the best treatment for polycystic ovary syndrome (PCOS) if a women wishes to conceive?
- Clomiphene citrate
- Metformin
Why does postpartum telogen effluvium (hair loss) occur?
During pregnancy estrogen levels are very high which causes synchrony of hair growth. Therefore, when the estrogen levels decrease after delivery (1-5 months), the hair loss occurs all at the same time rather than in phases under normal estrogen levels.
What is the mechanism by which OCPs reduce pain during menstruation?
Progesterone in OCPs causes endometrial atrophy. Since prostaglandins are released by the endometrium, less endometrium equals less prostaglandins = less pain
A fixed, nodular uterus might describe which condition?
Endometriosis
What is the first step in working up any female patient over the age of 45 with abnormal uterine bleeding (AUB)?
Endometrial biopsy (to rule out endometrial carcinoma)
What is the pathogenesis of adenomyosis?
Invasion of endometrial glands into the myometrium
Which FRAX scores indicate treatment in the setting of osteopenia/osteoporosis?
- 10-year risk of osteoporotic fracture > 20%
- 10-year risk of hip fracture > 3%
Why is an anti-mullerian hormone assay helpful in the workup of infertility?
In women of older age and AMA, it helps determine the ovarian reserve
What are two important timing criteria needed for the diagnosis of PMS or PMDD?
- A symptom-free week during the follicular phase
- Symptoms must be present in the luteal phase
Supplementation with which mineral/element has been shown to reduce the physical and emotional symptoms of PMS?
Calcium 1,200mg (remember, eating ice cream while on your period makes you feel better!)
Which race has a higher incidence of molar pregnancy?
Asian
Which age distribution is more likely to have a molar pregnancy?
Women > 40 or < 20 years old
Which type of molar pregnancy has a propensity to develop into a post-molar GTD?
Complete mole
Should you biopsy a lesion suspicious for choriocarcinoma/metastatic choriocarcinoma?
NO!! NEVER!
Why should you never biopsy a lesion suspicious for choriocarcinoma/metastatic choriocarcinoma?
Because choriocarcinoma is a highly vascular malignancy, so biopsy can cause a rupture. A positive beta-HCG is all you need!
Which type of leiyomyoma is most likely to lead to issues with fertility?
Submucosal
Dermoid cyst of the ovary is a synonym for what?
Mature cystic teratoma
Mature cystic teratoma can lead to what complication of the ovary?
Ovarian torsion
What are the most common ovarian neoplasm in women < 30 years old?
Germ cell tumor (think germ cell as in “young”)
