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rizk review > Gynecology > Flashcards

Gynecology Flashcards

1
Q

2 definitions of Primary Amenorrhea?

A

No menses by age of 16 yo; No secondary sex characteristics by age of 14 yo

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2
Q

Female presents with Primary Amenorrhea and shortening of 4th metacarpal bone – diagnosis?

A

Turner Syndrome

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3
Q

2 cardiac manifestations of Turner’s Syndrome?

A

Coarctation of aorta, Bicuspid aorta

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4
Q

1 renal manifestation of Turner’s Syndrome?

A

Horseshoe kidney

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5
Q

1 MSK manifestation of Turner’s Syndrome?

A

Lymphedema

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6
Q

Change to FSH/LH in Turner’s Syndrome?

A

Increased

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7
Q

Patient presents with primary amenorrhea; PE shows no palpable cervix, no uterus; Karyotype shows 46XX – diagnosis?

A

Mullerian agenesis

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8
Q

Patient presents with primary amenorrhea; PE shows no palpable cervix, no uterus; Karyotype shows 46XY – diagnosis?

A

Androgen Insensitivity Syndrome

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9
Q

2 PE manifestations of Androgen Insensitivity Syndrome?

A

Lack of pubic hair, Bilateral inguinal swelling

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10
Q

1st step of treatment in Androgen Insensitivity Syndrome?

A

Removal of testes … Increased risk for testicular CA

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11
Q

Timeframe needed for diagnosis of Secondary Amenorrhea?

A

6 months

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12
Q

1st step in workup up Secondary Amenorrhea?

A

β-HCG

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13
Q

3 cardinal features of PCOS?

A

Secondary amenorrhea, Hirsutism, Cystic ovaries

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14
Q

Lab value that suggests diagnosis of PCOS?

A

LH:FSH > 3

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15
Q

DOC for infertility in PCOS?

A

Clomiphene citrate

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16
Q

MOA of Clomiphene Citrate?

A

Estrogen-R antagonist in hypothalamus; Increases FSH/LH release … stimulates ovulation

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17
Q

DOC for metabolic syndrome in PCOS?

A

Metformin

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18
Q

How does prolactin cause amenorrhea?

A

Inhibits release of GnRH from hypothalamus; Decreases release of LH/FSH

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19
Q

In addition to amenorrhea, what is another clinical feature seen in setting of hyperprolactinemia?

A

Galactorrhea

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20
Q

Change to FSH. LH levels in setting of Premature Ovarian Failure?

A

Increased

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21
Q

Source of estrogen production in post-menopausal women?

A

Peripheral conversion of testosterone to estrogen

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22
Q

Enzyme responsible for peripheral conversion of androgen to estrogen?

A

Aromatase

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23
Q

Treatment of choice for atrophic vaginitis?

A

Estrogen

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24
Q

Which drug should be added to estrogen during treatment of atrophic vaginitis?

A

Progesterone

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25
Q

Value of adding progesterone to estrogen in setting of atrophic vaginitis?

A

Decreases risk of endometrial CA … (caused by unopposed estrogen exposure)

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26
Q

1st step in workup for older female who presents with hirsutism, amenorrhea, virilization?

A

CT scan to rule out adrenal/ovarian tumor

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27
Q

Dysmenorrhea is mediated by …

A

Prostaglandin F2α

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28
Q

Treatment of choice for dysmenorrhea?

A

NSAIDs, OCPs

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29
Q

Difference between Primary dysmenorrhea and Secondary dysmenorrhea?

A

Primary = occurs in absence of pathology; Secondary = occurs in presence of pathology

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30
Q

___ refers to mid-cycle pain due to ovulation

A

Mittelschmerz

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31
Q

When does Premenstrual Syndrome typically occur?

A

7-10 days before beginning of menstrual cycle

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32
Q

Treatment of choice for Premenstrual Syndrome?

A

Aerobic exercise, OCPs

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33
Q

Treatment of choice for severe Premenstrual Syndrome?

A

SSRI

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34
Q

1st test for diagnosis of endometriosis?

A

US, MRI

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35
Q

Definitive test for diagnosis of endometriosis?

A

Laparoscopy

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36
Q

Treatment for Endometriosis?

A

NSAIDs, Progesterone, GnRH agonists (continuous), Danazol

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37
Q

MOA of Danazol?

A

Testosterone agonist

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38
Q

AE of Danazol?

A

Hirsutism

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39
Q

Epidemiology of Acute endometritis?

A

Post-partum female

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40
Q

3 aspects of clinical presentation of Acute endometritis?

A

Fever, Lower abdominal pain, Purulent cervical drainage

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41
Q

Etiology of Acute endometritis?

A

Retained products of conception

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42
Q

2 most common pathogens responsible for Acute endometritis?

A

Peptostreptococcus, Group B Strep … POLYMICROBIAL

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43
Q

Which type of WBC is most commonly found in Acute endometritis infiltrate?

A

PMNs

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44
Q

Which type of WBC is most commonly found in Chronic endometritis infiltrate?

A

Plasma cells + Lymphocytes

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45
Q

Presence of which WBC type is REQUIRED for diagnosis of Chronic endometritis?

A

Plasma cells

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46
Q

Pathogen responsible for Chronic Endometritis in setting of IUD use?

A

Actinomyces Israeli

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47
Q

Clinical presentation of Leiomyoma?

A

Uterine bleeding; Fe-deficiency anemia

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48
Q

Characteristic of Leiomyoma?

A

Estrogen-sensitive … increase in size during pregnancy

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49
Q

Leiomyoma represents growth of …

A

Smooth muscle

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50
Q

Epidemiology of Endometrial Carcinoma?

A

55 – 65 yo females

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51
Q

When does Endometrioid Carcinoma typically occur?

A

Peri-Menopausal

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52
Q

Etiology of Endometrioid Carcinoma?

A

Excessive estrogen exposure

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53
Q

Histologic appearance of Endometrioid Carcinoma?

A

Adenocarcinoma (glandular)

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54
Q

When does Serous Endometrial Carcinoma typically occur?

A

Post-Menopausal

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55
Q

Etiology of Serous Endometrial Carcinoma?

A

Endometrial atrophy

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56
Q

Clinical presentation of Serous Endometrial Carcinoma?

A

Post-menopausal vaginal bleeding

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57
Q

Most common type of Vaginal Neoplasm?

A

Squamous Cell

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58
Q

Risk factor for Squamous Cell Vaginal neoplasm?

A

HPV infection

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59
Q

In addition to Squamous Cell vaginal carcinoma, what is another type of vaginal carcinoma?

A

Clear Cell Adenocarcinoma

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60
Q

Risk factor for Clear Cell Vaginal Adenocarcinoma?

A

DES exposure in utero

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61
Q

Alternate name for Sarcoma Botryoids?

A

Embryonal rhabdomyosarcoma

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62
Q

Clinical presentation of Embryonal rhabdomyosarcoma?

A

Bunch of grapes protruding from vagina

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63
Q

Epidemiology of Embryonal rhabdomyosarcoma?

A

Females < 5 yo

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64
Q

Prognosis for Vulvar leukoplakia?

A

Precursor for squamous cell carcinoma

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65
Q

1st step of diagnosis for Vulvar leukoplakia?

A

Biopsy lesion

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66
Q

Prognosis for vulvar Lichen Sclerosis?

A

NO increased risk for squamous cell carcinoma

67
Q

Etiology of vulvar Squamous Cell carcinoma?

A

HPV infection

68
Q

Clinical appearance of Paget’s Disease of vulva?

A

Vulvar pruritis, Velvet red lesion

69
Q

Paget’s Disease of vulva represents which type of vulvar CA?

A

Adenocarcinoma

70
Q

Characteristic of vaginal discharge in setting of vulvovaginal candidiasis?

A

White, “cottage cheese” consistency

71
Q

Appearance of vulvovaginal candidiasis on wet prep?

A

Hyphae

72
Q

Epidemiology of vulvovaginal candidiasis? (3)

A

DM, ABX use, Immunosuppression

73
Q

Treatment of choice for vulvovaginal candidiasis?

A

-Azole … NO need to treat partner

74
Q

Treatment for Bacterial Vaginosis?

A

Metronidazole

75
Q

Appearance of vaginal discharge in setting of Trichomoniasis?

A

Yellow-Green

76
Q

Appearance of cervix in Trichomoniasis?

A

Strawberry cervix

77
Q

Treatment of choice for Trichomoniasis?

A

Metronidazole … TREAT the partner!

78
Q

AE of Metronidazole?

A

Disulfiram reaction, Metallic taste

79
Q

Which patient should be treated, even if asymptomatic … Gardnerella, Candida, Trichomonas?

A

Trichomonas

80
Q

Definition of infertility?

A

Inability to conceive after 12 months of unprotected sex

81
Q

Three most common causes of female infertility?

A

Pelvic inflammatory disease, endometriosis, anovulatory cycles

82
Q

First step of management for infertility?

A

Male evaluation

83
Q

Etiology of anti-sperm antibodies?

A

Contact between sperm and serum via testicular trauma or vasectomy

84
Q

When should you screen lesbians for HPV?

A

If there is a history of male sexual contact

85
Q

Lesbians have a lower risk for which type of cancer?

A

Cervical

86
Q

Lesbians have an increased risk of which two types of cancer?

A

Breast, ovarian – Nulliparity

87
Q

When should females begin Pap smear screening?

A

21 years old

88
Q

How often should Pap smear screenings occur after the age of 21?

A

After three consecutive negative annual exams, repeat Pap smear every three years

89
Q

Which condition does not require repeated Pap smear screenings?

A

Hysterectomy

90
Q

After which age are Pap smears no longer required if history is negative?

A

70 years old

91
Q

Next step of work up for Pap smear that shows either high or low grade dysplasia?

A

Biopsy

92
Q

Next step of work up for Pap smear that shows atypia?

A

Check for history of HPV

93
Q

Next step of work up for Pap smear that shows atypia with negative HPV history?

A

Repeat cytology in one year

94
Q

Next step of work out for Pat spears that shows atypia with positive HPV history?

A

Colposcopy

95
Q

Two additional indications for colposcopy?

A

Any visible lesions on the cervix, cervical intraepithelial neoplasia (CIN)

96
Q

Definition of cervical dysplasia?

A

Cervical cells that show increased chromatin condensation, but have not yet penetrated the basal membrane of the epithelium

97
Q

What is the major complication of cervical conization as treatment for cervical dysplasia?

A

Bleeding

98
Q

Four lifestyle modifications that can lead to regression of cervical dysplasia?

A

Diet heavy in fruits and vegetables, condom use, smoking cessation

99
Q

Most common type of cervical cancer?

A

Squamous cell carcinoma

100
Q

Second most common type of cervical cancer?

A

Adenocarcinoma

101
Q

Which anatomic structure is frequently involved in cervical cancer?

A

Ureter

102
Q

Clinical manifestation of ureter involvement in the setting of cervical cancer?

A

Hydronephrosis, renal failure

103
Q

Is BRCA1 or BRCA2 more commonly responsible for ovarian cancer?

A

BRCA1

104
Q

Two types of cancer associated with Lynch syndrome?

A

Ovarian, colorectal

105
Q

Which pattern of ovulation is more associated with increased risk for ovarian cancer?

A

Nulliparity, early menarche

106
Q

Tumor marker associated with ovarian cancer?

A

CA – 125

107
Q

First step of workup for suspected ovarian mass?

A

Transvaginal ultrasound

108
Q

Which tumor markers are often elevated in the setting of germ cell ovarian tumors?

A

AFP, BHCG

109
Q

Which procedure is required for staging, diagnosis, treatment of ovarian cancer?

A

Laparotomy

110
Q

Definition of stage one ovarian cancer?

A

Ovarian cancer that is limited to the ovary

111
Q

Treatment of choice for stage one ovarian cancer?

A

Surgical excision

112
Q

Treatment of choice for stage 2–5 ovarian cancer?

A

Surgical excision, chemotherapy

113
Q

Which two chemotherapy drugs are indicated for treatment of ovarian cancer?

A

Cisplatin, paclitaxel

114
Q

___ refers to infection of breast parenchyma

A

Mastitis

115
Q

Which pathogen is most commonly responsible for mastitis?

A

Staph aureus

116
Q

Best advice for a breast-feeding mother who develops mastitis?

A

Continue breast-feeding

117
Q

Best treatment for mastitis?

A

Dicloxacillin, I&D

118
Q

What is the most common breast disorder in women 25–50 years old?

A

Fibrocystic change

119
Q

Characteristic of breast masses in fibrocystic change?

A

Estrogen sensitive, fluctuate with menstrual cycle

120
Q

Epidemiology of Fibroadenoma?

A

Females less than 35 years old

121
Q

Most common benign breast mass?

A

Fibroadenoma

122
Q

Prognosis of Fibroadenoma?

A

Always benign

123
Q

Clinical manifestation of Paget’s disease of the breast?

A

Breast pruritis

124
Q

Paget’s disease of the breast is associated with which type of breast cancer?

A

Intraductal carcinoma

125
Q

Which medical treatment is associated with an increased risk of breast cancer?

A

Radiation treatment for Hodgkin lymphoma

126
Q

Prognosis for fibrocystic change in price?

A

Benign

127
Q

What is the most significant risk factor for development of breast cancer?

A

Age

128
Q

Laterality of BRCA-related breast CA?

A

Bilateral

129
Q

BRCA1 is associated with increased risk of ___ CA

A

Ovarian

130
Q

2 other types of CA that are increased in patients with BRCA1 mutation?

A

Colon, Prostate

131
Q

BRCA2 is associated with increased risk of ___ CA

A

Ovarian, Breast

132
Q

Location of BRCA2 gene?

A

13q

133
Q

What type of breast CA is associated with BRCA1/BRCA2 mutation?

A

Inherited breast CA

134
Q

Do NOT discontinue mammography screening for …

A

Old age

135
Q

Patient presents with small breast lump, normal mammography 1 month ago – next step of workup?

A

Excisional biopsy … NOT needle biopsy

136
Q

Next step of workup for patient with nipple discharge?

A

Cytology exam

137
Q

42 yo female has HX of breast CA; Presents with small metastatic lesion in R femur only; Is mastectomy recommended?

A

No … mastectomy is NOT recommended for metastatic breast CA

138
Q

2 conditions in which axillary LN biopsy is NOT recommended?

A

Metastatic disease; Carcinoma in situ

139
Q

3 prognostic factors in breast CA?

A

Tumor, Lymph node involvement, Hormone receptors

140
Q

Management of non-invasive DCIS?

A

Local incision + Radiation … OR … Simple mastectomy

141
Q

Which medication will decrease local recurrence of DCIS after lumpectomy?

A

Tamoxifen

142
Q

Management of non-invasive LCIS?

A

Bilateral mastectomy

143
Q

Do DCIS or LCIS require lymph node evaluation?

A

NO

144
Q

Best treatment for invasive breast CA < 1 cm?

A

Lumpectomy + Radiation

145
Q

Best treatment for invasive breast CA > 1 cm?

A

Modified radical mastectomy + Adjuvant chemotherapy

146
Q

Added treatment for invasive breast CA that is Hormone Receptor (+)?

A

Tamoxifen for 5 years

147
Q

Best treatment for ALL invasive breast CA that is LN (+)?

A

Modified radical mastectomy + Adjuvant chemotherapy

148
Q

Best treatment for invasive breast CA that is LN (+) and HR (+)?

A

Add tamoxifen for 5 years

149
Q

Best treatment for invasive breast CA that is LN (+) and HR (-)?

A

No hormonal therapy

150
Q

2 potential treatments for estrogen/progesterone (+) tumors?

A

Tamoxifen, Aromatase inhibitors

151
Q

Which females should receive aromatase inhibitors in HR (+) breast CA?

A

Post-menopausal females

152
Q

Best treatment for HR (+) breast CA with visceral or bone metastasis?

A

Hormone therapy ONLY

153
Q

Best treatment for breast CA patients with painless lytic bone metastasis?

A

Bisphosphonates

154
Q

Best treatment for breast CA patients with painful lytic bone metastasis?

A

Radiation

155
Q

Suffix of Bisphosphonates used in treatment of breast CA with lytic bone lesions?

A

“-dronate“

156
Q

2 AEs associated with Tamoxifen?

A

Increased risk of endometrial CA; Uterine sarcoma

157
Q

1 added benefit of Tamoxifen?

A

Prevents bone loss

158
Q

Best workup for patient with breast CA treated with tamoxifen who experiences abnormal bleeding?

A

Endometrial biopsy

159
Q

Premenopausal female is treated with chemotherapy for HR (+) metastatic breast CA; Develops DVT – which chemotherapy drug was probably used?

A

Tamoxifen

160
Q

Shared AE of Tamoxifen and Raloxifene?

A

Increased risk of DVT

161
Q

Indication for Raloxifene?

A

Patients who have increased risk of breast CA … but not active breast CA

162
Q

Indication for Trastuzumab in breast CA?

A

HER2 (+) breast CA

163
Q

AE of Trastuzumab?

A

Cardiac toxicity

rizk review (19 decks)

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