Gynecology Flashcards
What HPV strains cause cancer
16, 18, 30s
Risk Factors for Cervical cancer
HPV, Sex, STDs, Smoking
Cervical CA
Presentation
Dx, Tx
Asx Screening, post-coital bleeding Dx: Pap-smear, staging Tx: ASCUS-HPV DNA Ectocarcinoma-Local Ablation Endocarcinoma-Cone biopsy Stage IIa or less-resection Stage IIb or greater-debulking +/- chemo/rad
Stage I Cervical Cancer
contained in the cervix
Stage II Cervical Cancer
IIa- upper 2/3 of the vagina
IIb- involvement of the cardinal ligament
Stage III Cervical Cancer
IIIa- lower 1/3 of vagina
IIIb- Pelvic side wall
Stage IV Cervical Cancer
IVa- Adjacent organs
IVb- Distant mets
Endometrial Cancer Patient presentation/patient history
unopposed estrogen exposure or prolonged estrogen exposure Anovulation Age Nulliparity Obese Early Menarche/late Menopause HRT/SERM for breast CA
Endometrial CA warning sign
postmenopausal bleeding
Postmenopausal Bleeding
Dx, Tx
Dx: Bx
Tx: Hyperplasia-progesterone
CA:TAHBSO
+/- Chemo/rad (Paclitaxel, cisplatin, doxorubicin)
Ovarian Cancer-Germ Cells
Dysgerminoma, endodermal sinus, teratoma, choriocarcinoma
Dysgerminoma Tumor marker
LDH
Endodermal Sinus Tumor marker
AFP
Choriocarcinoma Tumor marker
B-HCG
Germ Cell tumors
Presentation
Dx, Tx
Teenage girls, adnexal mass, weight gain, usually stage I
Dx: Transvaginal ultrasound
Tx: Unilateral salpingoophrectomy
Ovarian Cancer- epithelial cell
Cystadenocarcinoma-Serous, Mucinous, Endometroid
Brenners
Epithelial Cell Tumors, Tumor Markers
CA-125
Epithelial Cell Tumors
Presentation
Dx, Tx
Postmenopausal woman nulliparous-there could be renal failure, SBO, Ascites Dx: Transvaginal ultrasound CT scan for staging Tx: TAHBSO Paclitaxel
BRCA1-HNPCC
Ovarian cancer screening
Risk factor for epithelial cancer -
screen with ultrasound and CA-125
Granulosa-Theca Cell Tumor
Presentation
Secrete Estrogen
Dx: Transvaginal Ultrasound
Sertoli-Leydig Cell Tumor
Presentation
Secretes Testosterone
Complete Hydatidiform Mole
Presentation
Dx, Tx
All sperm, Good fertilization with a bad egg
Presentation: Size-Date discrepancy
>100k B-Hcg
Hyperthyroidism
Hyperemesis gravidarum
Grape-like mass, adenexal mass
Dx: Transvaginal ultrasound-snow storm appearance
Tx: Suction curretage
afterwards-OCP for 12 months and monitor B-HCG
Incomplete Mole
Presentation
Dx, Tx
Fetal parts found
Egg Sperm Sperm fertilization
presentation, Dx, Tx and follow up are the same as complete mole
Choriocarcinoma
Presentation
Dx, Tx
Malignant, gestational contents Pt: high levels of B-HCG can occur after a miscarriage, molar or normal pregnancy Dx: Transvaginal ultrasound Bx with curretage Stage with CT Tx: Surgical-TAHBSO, Debulking Medical-Methotrexate, Actinomycin D, Cyclophosphamide
Post-partum Hemorrhage
Presentation
Tx
500c-after vaginal birth 1000cc-after c-section non-surgical: uterine massage oxytocin balloon tamponade
Teratoma
Presentation
Dx, Tx
usually benign young female in her teens Asx, Weight gain Dx: Ultrasound=enormous mass Tx: Cystectomy
Adenexal mass Simple Cyst
Presentation
Small, Consistent, unilocular, anechoic, homogenous
<3cm=watch and wait
<10cm=repeat imaging
Adenexal mass Complex Cysts
Presentation
Big, Septations, Loculated, Multi-Echoic
heterogenous
>10cm=remove
Endometriosis
Presentation
Dx, Tx
Pt: Dysmenorrhea, Dyspareunia, Infertility Dx: U/S=cyst (endometrioma) OCP trial=endometriosis Dx Lap with laser ablation Tx: NSAIDs (pelvic Pain) OCPs
Ectopic Pregnancy
Presentation
Dx, Tx
RF-stricture or PID Pt: Amenorrhea/spotting Abdominal pain UPT (+) Dx: UPT(+) B-HCG >2000 Empty uterus on US Tx: Salpingosotmy if no ruputre salpingectomy if ruptured Methotrexate +/- leucovorin
When do you use methotrexate +/- leucovorin
B-HCG <5000
Gestational size <3 cm
No fetal heart tones
not using folate
Tubo-Ovarian Abscess
Presentation
Dx, Tx
Abdominal or pelvic pain no other cause + 1 of 3 1. CMT 2. ADT 3. UT possible fever and leukocytosis white cells on a wet prep Dx: U/S abscess Tx: Inpatient IV 1. Cefoxitin+Doxy+MTZ 2. Clindamycin+gentamicin
Stress Incontinence
Presentation
Dx, Tx
Sneeze and pee
No urge or nocturnal symptoms
Tx: kegel
Surgery
Hypertonic, Overactive Bladder
Presentation
Dx, Tx
(+) Urge and nocturnal symptoms Leaking with contractions Dx: Physical is normal U/A normal decreased cystometry Tx: Oxybutynin
Irritative Bladder
Presentation
Dx, Tx
Caused by inflammation, stones, CA, UTI Frequency, urgency, Dysuria (+) urge no nocturnal symptoms Dx: U/A=WBCs Tx: UTI=ABx Stones=Imaging CA=imaging
Fistula
Presentation
Dx, Tx
Continuous leak normal function Dx: Physical=fistula Tampon Test Tx: Fistulotomy
Causes of vaginal bleeding in the premenarchal age
Foreign body
sexual abuse
precocious puberty
Causes of vaginal bleeding in the reproductive age
Pregnancy, Anatomy, AUB, Cervical CA
Causes of vaginal bleeding in the postmenopausal age
vaginal atrophy
endometrial CA
HRT
Vulvovaginitis-Candida
Presentation
Dx, Tx
DM, Steroids, Abx Thick white discharge adherent to the vaginal wall no odor Wet prep-hyphae Tx= Topical antifungal oral fluconazole
Vulvovaginitis-Bacterial
Gardenerella
Presentation
Dx, Tx
Copious thin white discharge
Fishy odor
wet prep-clue cells
Tx: MTZ
Vulvovaginitis-Trichomonas
Presentation
Dx, Tx
Yellow-green discharge Frothy Strawberry Cervix Wet-prep: Flagella, motile Tx: MTZ, treat both partners
Cervicitis
Presentation
Dx, Tx
Inflammation of the cervix usually caused by NG/CT (+) CMT, discharge, no PID NG/CT PCR gonorrhea- GNR diplococci Chla-NOS many WBCs Tx=NG=Ceftriaxone CT=Doxyxycline/azithromycin
PID
Presentation
Dx, Tx
- Pelvic/abdominal pain
2.no other cause
1 of 3:
1.CMT - ADT
- UT
Dx: Transvaginal ultrasound
Tx: inpatient-
cefoxitin+Doxy
Clindamycin+Gentamycin
Outpatient-
Ceftriaxone+doxy+MTZ
Threatened abortion Features
No passage of contents
closed cervical os
live baby on U/S
Inevitable abortion features
No passage of contents
Open cervical os
Dead baby on U/S
Incomplete abortion features
Passage of clots or fetal parts
Open cervical os
Retained fetal parts on U/S
Complete abortion features
passage of contents
Closed cervical os
Nothing on U/S
Causes of vaginal bleeding
PALM COEIN
Polyps
Adenomyosis
Leiomyomas
Malignancy
Caogulopathy Ovarian Dysfunction Endometrium Iatrogenic=IUD Not yet Classified
Fibroids (leiomyoma)
Presentation
Dx, Tx
benign growths that are responsive to estrogen Pt: Asx nodularity Anemia/bleeding Pain, infertility Dx: Transvaginal ultrasound Tx: OCPs=IUD if kids=myomectomy no kids=TAH
PCOS
Presentation
Dx, Tx
Pt: Fat and hairy Metabolic Syndromes (HTN,DM,HLD) Menometorrhagia Infertility Dx: 1. Anovulation AND 2.Biochemical (DHEAS, increased Testosterone) OR 3. Follicles on U/S Tx: Metformin OCPs Clomiphene Spironolactone
Puberty Ages
Tits (breasts) 8
Pits (axillary) 9
Mits (growth spurt) 10
Lips (menarche) 11
What defines precocious puberty
No menarche by 15
No secondary sex characteristics by 13
Craniopharyngioma/Kallmans
Presentation
Dx, Tx
either a problem with hypothalamus or the anterior pituitary - no FSH/LH Pt: no secondary sex characteristics there are uterus and tubes Dx: decreased FSH/LH MRI differentiates the two diseases Tx: give estrogen and progesterone possible resection if there is a tumor
Mullerian Agenesis
Presentation
Dx, Tx
(x,x) karyotype Pt: Secondary sexual characteristics with female genitalia no uterus or tubes Dx: Karyotype Normal testosterone, FSH, LH Tx: Elevate the vagina
Androgen Insensitivity syndrome
Presentation
Dx, Tx
(x,y) resistance to testosterone Pt: secondary sexual characteristics external sexual characteristics no uterus or tubes Dx: Karyotype Increased testosterone, normal FSH, LH Tx: elevate vagina after puberty-orchiectomy
Turner Syndrome
Presentation
Dx, Tx
Webbed neck, Broad spaced nipples, Shield like chest, Coarctation, Bicuspid Aortic Valve
secondary sexual characteristics
uterus and female genitalia present
Dx: Karyotype (x,o) increased FSH and LH
U/S-Streak ovaries
Tx: Estrogen and progesterone
F/U echocardiogram
Causes of secondary amenorrhea
Pregnancy MC Hypothyroidism 2nd MC Prolactin Medications HPO Axis
Secondary Amenorrhea Diagnostic Tests
Progesterone Challenge
Estrogen & Progesterone
FSH & LH
MRI
Progesterone challenge positive
Bleeding indicated PCOS
Estrogen and progesterone positive (bleeding)
Check FSH & LH
Check FSH/LH ratio
increased-ovarian problem
normal/decreased-brain do MRI
Hostile Mucous indications
(-) Fern sign
(-) Sperm
< 6cm smush test
Normal Mucous indications
(+) fern, sperm
> 6cm Smush
PCOS
Presentation
Dx, Tx
Hirsuitism Increased testosterone Normal DHEAS Bilateral Ovaries LH/FSH= >3:1 follicles on US Tx: Exercise and weight loss metformin OCPs Clomiphene
Sertoli-Leydig Tumor
Presentation
Dx, Tx
Virilization Very High levels testosterone DHEAS-Normal Unilateral Ovary US shows tumor Tx: Resection
Adrenal Tumor
Presentation
Dx, Tx
Virilization Testosterone Normal DHEAS very increased Unilateral Adrenal CT/MRI Adrenal Vein Sampling Tx: Resection Make sure to do the adrenal vein sampling before surgery
CAH
Presentation
Dx, Tx
Hirsuitism Testosterone Normal DHEAS elevated Bilateral Adrenals CT/MRI 17-OH progesterone in the urine Tx: Cortisol fludrocortisone
When should you perform a DEXA scan
All get DEXA @ 65 60 if a smoker Bisphosphonates Give vitD and calcium if VitD deficient-50ku promote exercise
