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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
epithelial cell ovarian cancer path
epithelial trauma = ovulation | malignant
26
epithelial cell ovarian cancer pt
``` postmeno female null/low parity stage IIIb or worse (even w/ screen) - asx, seed peritoneally - renal failure, SBO, ascites BRCA1 or 2, HNPCC ```
27
epithelial cell ovarian cancer dx
NO screen 1st: TVUS then: CT - stage track: CA 125 best: bx
28
epithelial cell ovarian cancer tx
TAH + BSO | paclitaxel
29
epithelial cell ovarian cancer special
BRCA1 or 2 screen | - TVUS and CA-125 w/ ppx TAH+BSO @35
30
stromal cell ovarian tumors
granulosa theca - estrogen | sertoli leydig - testosterone
31
vaginal cancer - SCC
just like cervical cancer except no pap
32
vaginal cancer - adeno
DES exposure in mom while your patient in front of you was in mom's uterus 'grape-like' mass in vagina in a child
33
complete mole path
``` completely molar = no fetal parts completely chromosomal = 46, XX completely spermal =no egg genetics normal fertilization broken egg ```
34
complete mole pt
``` size-date discrepancy ß-hCG too high for dates hyperthyroidism (from ß-hCG) hyperemesis gravidarum adnexal mass (simple cyst) grape-like mass exiting cervix ```
35
complete mole dx
1st: U/S = snowstorm ****
36
complete mole tx
suction curettage
37
complete mole f/u
ß-hCG q week | OCP x1y
38
incomplete mole path
incompletely molar = some fetal parts incompletely chromosomal = t69, XXY abnormal fertilization = 2 sperm normal egg
39
incomplete mole pt
``` 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
incomplete mole dx
US snowstorm
41
incomplete mole tx
suction curettage
42
incomplete mole f/u
ß-hCG q1wk | OCP x1y
43
choriocarcinoma path
cancer of gestational contents
44
choriocarcinoma pt
s/p mole, miscarriage, or even normal pregnancy | increase ß-hCG (sxs as above)
45
choriocarcinoma dx
1st: TVUS best: biopsy = curettage then: stage CT
46
choriocarcinoma tx
``` surgical -TAH (I) - debulking (II) medical = "MAC" - MTX - actinomycin D - cyclophosphamide chemo = "MAC backbone" - advanced only ```
47
stress incontinence path
big/multiple births stretch cardinal ligament cystocele abd pressure on = bladder, not sphincter
48
stress incontinence pt
sneeze and pee no urge no nocturnal sxs
49
stress incontinence dx
physical = cystocele | Qtip test
50
stress incontinence tx
1st: lifestyle then PT, pessaries then surgery (sling/urethral bulking agents)
51
hypertonic bladder/motor urge path
spastic contractions | random detrusor contractions
52
hypertonic bladder/motor urge pt
+ urge + nocturnal sxs pee when spasms
53
hypertonic bladder/motor urge dx
``` physical = normal u/a = normal cystometry = spasms at all urinary volumes ```
54
hypertonic bladder/motor urge tx
oxybutynin | intermittent/indwelling catheter
55
hypertonic bladder/motor urge f/u
too much antispasmodics -> hypotonic
56
hypotonic bladder/overflow incontinence path
absent detrusor muscle contractions neural injury = trauma, MS, etc leaks before ruptures
57
hypotonic bladder/overflow incontinence pt
no urge to void + nocturnal sxs leak throughout day
58
hypotonic bladder/overflow incontinence dx
``` physical = normal .l. focal neurologic deficit u/a = normal cystometry = no spasms at any volume ```
59
hypotonic bladder/overflow incontinence tx
bethanechol | intermittent/indwelling catheter
60
irritative bladder path
inflammation | stones, UTI, cancer
61
irritative bladder pt
frequency, urgenc,y dysuria + urge no nocturnal sxs
62
irritative bladder dx
``` physical = normal u/a = dx -> urine cx ```
63
irritative bladder tx
UTI: FQ, bactrim, nitrofurantoin
64
irritative bladder f/u
stones and cancer (urology, medicine)
65
dermoid cyst/teratoma path
benign tumor of ovary
66
dermoid cyst/teratoma pt
``` young woman (teens) abdominal/adnexal mass weight gain ```
67
dermoid cyst/teratoma dx
u/s = complex cyst
68
dermoid cyst/teratoma tx
cystectomy (this cyst only)
69
dermoid cyst/teratoma f/u
likely to recur on the opposite side
70
endometrioma path
retrograde menses? estrogen responsive tissues endometrium outside the uterus
71
endometrioma pt
dysmenorrhea dyspareunia infertility
72
endometrioma dx
u/s = cyst dx lap with laser ablation OCP trial
73
endometrioma tx
1. pelvic pain: NSAIDs 2. axis: OCPs -> GnRh analogues -> danazol 3. dx lap with laser ablation
74
endometrioma f/u
chocolate cyst
75
ectopic pregnancy path
salpingitis (PID) = stricture early fertilization ampulla is mos common site
76
ectopic pt
amenorrhea/spotting abd pain UPT +
77
ectopic dx
UPT + ß-hCG >/= 2000 U/s = ectopic
78
ectopic tx
salpingostomy: no rupture salpingectomy: + rupture MTX +/- leucovorin - ß-hCG < 5000 - GS < 3cm - no heart tones
79
ectopc f/u
trend hCG to 0..risk of chorio
80
tubo-ovarian abscess path
PID = Gc/Chla | vaginal flora
81
TOA pt
``` abd/pelvic pain no other cause 1 of 3: - CMT - adnexal tenderness - uterine tenderness fever, leukocytosis + wbc on wet prep ^^^^^ ```
82
TOA dx
u/s = abscess, complex cyst
83
TOA tx
``` inpatient IV - cefoxitin + doxy + MTZ - clinda + genta drain - if abx fail ```
84
TOA f/u
drain if no improvement | cefoxitin + doxycycline are for PID
85
ovarian torsion path
ovary twists about the vascular supply and kills off the ovary weight of the cysts, twists around the suspensory ligament
86
ovarian torsion pt
spontaneous abdominal pain toxic (fever, leukocytosis) no good reason why
87
ovarian torsion dx
u/s with doppler = decreased flow
88
ovarian torsion tx
operate = untwist - pinks up: leave it in - stays grey: cut it out
89
simple cysts
``` single, fluid filled, homogenous cystic unilocular < 7cm resolved in 2 mo treat with OCP ```
90
complex cysts
``` 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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