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Online Med Ed > Gynecology > Flashcards

Gynecology Flashcards

1
Q

cervical cancer path

A

HPV infection -> 16, 18, 30s

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2
Q

cervical cancer pt

A

asx screen = pap (pre-cancer)
post-coital bleeding
reproductive age female

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3
Q

cervical cancer dx

A 
pap smear
- start screen @ 21, then q3y
- ASCUS: q1y Pap or HPV DNA
colposcopy
- ectocervical lesions
- endocervical lesions
staging
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4
Q

cervical cancer tx

A

ecto: local ablation (LEEP, cryo)
endo: cone biopsy
stage IIa or < : local resection
stage IIb or > : chemo + radiation

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5
Q

cervical cancer screen

A

pap smear

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6
Q

cervical cancer ppx

A

HPV vax 11-26

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7
Q

endometrial cancer path

A 
PROgesterone is PROtective
Estrogen Exposure
- old age
- nulliparity
- obesity
- PCOS
- HRT
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8
Q

endometrial cancer pt

A

postmeno female with postmeno bleeding

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9
Q

endometrial cancer dx

A

endometrial sampling or D&C (bx)

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10
Q

endometrial cancer tx

A

hyperplasia: progesterone
cancer: TAH + BSO
+/- radiation
+/- chemo

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11
Q

vulvar cancer path

A 
squamous cell (HPV)
melanoma (sun exposure)
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12
Q

vulvar cancer pt

A

black and itchy

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13
Q

vulvar cancer dx

A

1st and best = bx

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14
Q

vulvar cancer tx

A

vulvectomy and LN dissection

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15
Q

paget’s path

A

usually noninvasive

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16
Q

paget’s pt

A

RED and itchy

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17
Q

paget’s dx

A

1st and best = bx

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18
Q

paget’s tx

A

local resection (no need for vulvectomy)

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19
Q

germ cell ovarian cancer subtypes

A

dysgerminomas: chemo, LDH
endometrial sinus: AFP
teratoma: struma ovarii
chorio: ß-hCG

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20
Q

germ cell ovarian cancer path

A

nonmalignant

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21
Q

germ cell ovarian cancer pt

A

teenge girl with an adnexal mass

stage I

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22
Q

germ cell ovarian cancer dx

A

TVUS

best: biopsy

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23
Q

germ cell ovarian cancer tx

A

unilateral salpingo-oopherectomy (conservative)

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24
Q

epithelial cell ovarian cancer subtypes

A

serous
mucinous
endometrioid
brenner’s

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25
Q

epithelial cell ovarian cancer path

A

epithelial trauma = ovulation

malignant

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26
Q

epithelial cell ovarian cancer pt

A 
postmeno female
null/low parity
stage IIIb or worse (even w/ screen)
- asx, seed peritoneally
- renal failure, SBO, ascites
BRCA1 or 2, HNPCC
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27
Q

epithelial cell ovarian cancer dx

A

NO screen

1st: TVUS
then: CT - stage
track: CA 125
best: bx

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28
Q

epithelial cell ovarian cancer tx

A

TAH + BSO

paclitaxel

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29
Q

epithelial cell ovarian cancer special

A

BRCA1 or 2 screen

- TVUS and CA-125 w/ ppx TAH+BSO @35

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30
Q

stromal cell ovarian tumors

A

granulosa theca - estrogen

sertoli leydig - testosterone

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31
Q

vaginal cancer - SCC

A

just like cervical cancer except no pap

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32
Q

vaginal cancer - adeno

A

DES exposure in mom while your patient in front of you was in mom’s uterus
‘grape-like’ mass in vagina in a child

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33
Q

complete mole path

A 
completely molar = no fetal parts
completely chromosomal = 46, XX
completely spermal =no egg genetics
normal fertilization
broken egg
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34
Q

complete mole pt

A 
size-date discrepancy
ß-hCG too high for dates
hyperthyroidism (from ß-hCG)
hyperemesis gravidarum
adnexal mass (simple cyst)
grape-like mass exiting cervix
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35
Q

complete mole dx

A

1st: U/S = snowstorm **

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36
Q

complete mole tx

A

suction curettage

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37
Q

complete mole f/u

A

ß-hCG q week

OCP x1y

38
Q

incomplete mole path

A

incompletely molar = some fetal parts
incompletely chromosomal = t69, XXY
abnormal fertilization = 2 sperm
normal egg

39
Q

incomplete mole pt

A 
size-date discrepancy 
ß-hCG too high for dates
hyperthyroidism (from ß-hCG)
hyperemesis gravidarum
adnexal mass (simple cyst)
grape-like mass exiting cervix
40
Q

incomplete mole dx

A

US snowstorm

41
Q

incomplete mole tx

A

suction curettage

42
Q

incomplete mole f/u

A

ß-hCG q1wk

OCP x1y

43
Q

choriocarcinoma path

A

cancer of gestational contents

44
Q

choriocarcinoma pt

A

s/p mole, miscarriage, or even normal pregnancy

increase ß-hCG (sxs as above)

45
Q

choriocarcinoma dx

A

1st: TVUS
best: biopsy = curettage
then: stage CT

46
Q

choriocarcinoma tx

A 
surgical
-TAH (I)
- debulking (II)
medical = "MAC"
- MTX
- actinomycin D
- cyclophosphamide
chemo = "MAC backbone"
- advanced only
47
Q

stress incontinence path

A

big/multiple births
stretch cardinal ligament
cystocele
abd pressure on = bladder, not sphincter

48
Q

stress incontinence pt

A

sneeze and pee
no urge
no nocturnal sxs

49
Q

stress incontinence dx

A

physical = cystocele

Qtip test

50
Q

stress incontinence tx

A

1st: lifestyle
then PT, pessaries
then surgery (sling/urethral bulking agents)

51
Q

hypertonic bladder/motor urge path

A

spastic contractions

random detrusor contractions

52
Q

hypertonic bladder/motor urge pt

A

+ urge
+ nocturnal sxs
pee when spasms

53
Q

hypertonic bladder/motor urge dx

A 
physical = normal
u/a = normal
cystometry = spasms at all urinary volumes
54
Q

hypertonic bladder/motor urge tx

A

oxybutynin

intermittent/indwelling catheter

55
Q

hypertonic bladder/motor urge f/u

A

too much antispasmodics -> hypotonic

56
Q

hypotonic bladder/overflow incontinence path

A

absent detrusor muscle contractions
neural injury = trauma, MS, etc
leaks before ruptures

57
Q

hypotonic bladder/overflow incontinence pt

A

no urge to void
+ nocturnal sxs
leak throughout day

58
Q

hypotonic bladder/overflow incontinence dx

A 
physical = normal .l. focal neurologic deficit
u/a = normal
cystometry = no spasms at any volume
59
Q

hypotonic bladder/overflow incontinence tx

A

bethanechol

intermittent/indwelling catheter

60
Q

irritative bladder path

A

inflammation

stones, UTI, cancer

61
Q

irritative bladder pt

A

frequency, urgenc,y dysuria
+ urge
no nocturnal sxs

62
Q

irritative bladder dx

A 
physical = normal
u/a = dx -> urine cx
63
Q

irritative bladder tx

A

UTI: FQ, bactrim, nitrofurantoin

64
Q

irritative bladder f/u

A

stones and cancer (urology, medicine)

65
Q

dermoid cyst/teratoma path

A

benign tumor of ovary

66
Q

dermoid cyst/teratoma pt

A 
young woman (teens)
abdominal/adnexal mass
weight gain
67
Q

dermoid cyst/teratoma dx

A

u/s = complex cyst

68
Q

dermoid cyst/teratoma tx

A

cystectomy (this cyst only)

69
Q

dermoid cyst/teratoma f/u

A

likely to recur on the opposite side

70
Q

endometrioma path

A

retrograde menses?
estrogen responsive tissues
endometrium outside the uterus

71
Q

endometrioma pt

A

dysmenorrhea
dyspareunia
infertility

72
Q

endometrioma dx

A

u/s = cyst
dx lap with laser ablation
OCP trial

73
Q

endometrioma tx

A
  1. pelvic pain: NSAIDs
  2. axis: OCPs -> GnRh analogues -> danazol
  3. dx lap with laser ablation
74
Q

endometrioma f/u

A

chocolate cyst

75
Q

ectopic pregnancy path

A

salpingitis (PID) = stricture
early fertilization
ampulla is mos common site

76
Q

ectopic pt

A

amenorrhea/spotting
abd pain
UPT +

77
Q

ectopic dx

A

UPT +
ß-hCG >/= 2000
U/s = ectopic

78
Q

ectopic tx

A

salpingostomy: no rupture
salpingectomy: + rupture
MTX +/- leucovorin
- ß-hCG < 5000
- GS < 3cm
- no heart tones

79
Q

ectopc f/u

A

trend hCG to 0..risk of chorio

80
Q

tubo-ovarian abscess path

A

PID = Gc/Chla

vaginal flora

81
Q

TOA pt

A 
abd/pelvic pain
no other cause
1 of 3:
- CMT
- adnexal tenderness
- uterine tenderness
fever, leukocytosis
\+ wbc on wet prep ^^^^^
82
Q

TOA dx

A

u/s = abscess, complex cyst

83
Q

TOA tx

A 
inpatient IV
- cefoxitin + doxy + MTZ
- clinda + genta
drain
- if abx fail
84
Q

TOA f/u

A

drain if no improvement

cefoxitin + doxycycline are for PID

85
Q

ovarian torsion path

A

ovary twists about the vascular supply and kills off the ovary
weight of the cysts, twists around the suspensory ligament

86
Q

ovarian torsion pt

A

spontaneous abdominal pain
toxic (fever, leukocytosis)
no good reason why

87
Q

ovarian torsion dx

A

u/s with doppler = decreased flow

88
Q

ovarian torsion tx

A

operate = untwist

  • pinks up: leave it in
  • stays grey: cut it out
89
Q

simple cysts

A 
single, fluid filled, homogenous
cystic
unilocular
< 7cm
resolved in 2 mo
treat with OCP
90
Q

complex cysts

A 
loculated, lobulated, multiple septations
solid, mixed
multilocular
>/= 7cm
won't resolve
already on OCP at dx

Online Med Ed (18 decks)

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