Gynecology: Female Genitalia & Reproductive Tract Flashcards
Cervical cancer is strongly associated with what virus?
HPV: High risk strands 16.18; Low risk strands 6,11
What are some of the predisposing factors for cervical cancer?
HPV infection
Sext at a young age
Multiple Sex partners
Hx of STIs
Promiscuous male partners
Smoking
What methods are used to evaluate for cervical cancer?
Pap Smear
Colposcopy directed Biopsy
Upon a routine GYN exam on a post-menopausal woman you distinctly feel one of the ovaries. It feels hard, irregular and fixed. What do you presume this is?
Ovarian Cancer
What cancer marker is often positive in ovarian cancer?
CA-125 (elevated in ovarian cancer), Others to consider: AFP, LDH
What are some of the predisposing factors associated with ovarian cancer?
Excess Estrogen
-Nulliparity
-Early menarche/late menopause
Genetic Factors
-Mutations of BRCA 1 & 2 suppressor genes
-Turners Syndrome
-Family Hx of Cancer
Race: Caucasian
Postmenopausal estrogen therapy
Obesity (increased estrogen)
Talc or asbestos exposure
A female patient presents to the clinic with lower abdominal/pelvic pain. Upon questioning she describes it as a feeling of heaviness or dragging in the lower abdomen. She has had increased urinary frequency but a low urine output. Upon examination you feel palpable masses on the uterine wall. What is your primary suspicion?
Leiomyoma/Uterine Fibroids
What is the technical term for uterine fibroids?
Leiomyoma
How are uterine fibroids diagnosed?
Physical Exam: Bimanual Examination for uterine fibroids
Transabdominal/Pelvic or Transvaginal Ultrasound (confirm diagnosis- golden standard)
What is a homeopathic remedy to consider for fibroids in a woman who has profuse, bright red hemorrhages?
Phosphorous
The use of unopposed estrogen is associated with what type of female reproductive cancer?
Endometrial Carcinoma (Prolonged estrogen stimulations, unopposed by progesterone)
What populations is most affected by endometrial cancer?
Women 55-65 years old, postmenopausal women
What cells are affected in vulvar cancer?
90% Squamous Cell Carcinoma, others are melanomas, BCC, Paget’s disease, Bartholin’s gland carcinoma
What is the standard method of evaluating endometrial cancer
Endometrial biopsy
A patient presents with a palpable non-painful mass in the labia majora,; the mass occasionally bleeds and is itchy. There is some mild lymphadenopathy. What do you need to rule out?
Vulvar Cancer
Palpation of Bartholin’s gland: R/o an adenocarcinoma from the gland
What vulvar cancer in situ known as?
Bowen’s Disease : a very early form of squamous cell carcinoma
What are some of the predisposing factors associated with vulvar cancer?
Unclear, possibly related to HPV, HIV, vulvar intraepithelial neoplasia, lichen sclerosis, hx of cervical dysplasia or cigarette smoking
What are common causes of PID (Pelvic Inflammatory Disease)?
C. Trachomatis (Chlamydia)
N. Gonorrheae
Group B Strep
Gardnerella Vaginalis
What are the associated risk factors for PID?
Below the age of 30
Chlamydia & Gonorrhea Infection
IUD
Invasive procedures
Multiple sex partners
Low socioeconomic status
What are some of the sequelae of PID?
Infertility
Ectopic Pregnancy
Abscess
Chronic Pelvic Pain
Peritonitis
Bacteremia
Septic Arthritis
Infective endocarditis
What are the common signs and symptoms of toxic shock syndrome?
Sudden Fever
Malaise/Fatigue
Myalgias
Refractory hypotension: Circulatory collapse
Diffuse, red macular rash including palms and soles (Flaking)
Weakness (asthenia)
Neutrophilia
What is a common cause of endometrial hyperplasia?
High levels of estrogen: Unopposed Estrogen or estrogen dominance
Low levels of progesterone
PCOS
Estrogen Replacement Therapy
Irregular menstruation
Obesity
What are the common signs and symptoms of endometriosis?
Secondary dysmenorrhea
Menorrhagia
Cyclic Symptoms
Premenstrual and post-menstrual spotting
Dsypareunia
Infertility
Chronic pelvic pain
What is the only definitive way to diagnose endometriosis?
Laparoscopy
What is the most common causes of endometritis?
Post-partum and pelvic inflammatory disease
-Prolonged labor
-Caesarian Section
-Multiple Vaginal Examinations
What are the common signs and symptoms of endometritis?
Abdominal pain
Abnormal vaginal discharge that is foul-smelling (lochia)
Abnormal vaginal bleeding
Fevers
Chills
Uterine Tenderness
What is the typical presentation of a Bartholin cysts?
Unilateral (usually) or bilateral distention of labia majora
Non-tender on palpation (unless infected)
Pain when walking or sitting
Dyspareunia
What is the term for pain during intercourse?
Dyspareunia
A women comes to the clinic with pain on urination, mild pelvic pain, incontinence and pain on intercourse. She is multiparous. On GYN exam you ask her to strain as if passing stool and you notice a bulging through the vaginal wall anteriorly. What is going on?
Cystocele: Prolapsed bladders, drops in vaginal canal
What is a bulging from the posterior vaginal wall called?
Rectocele
What is colpocele?
Prolapse of uterus in vagina
What are the 4 main classifications of vaginitis?
Bacterial Vaginosis
Candidal Vaginitis
Atropic Vaginitis
Trichomoniasis Vaginitis
Inflammatory
Foreign Body
A fishy vaginal odor is associated with what types of vaginitis?
Bacterial Vaginosis (Gardnerella Vaginalis)
Trichomoniasis
Pruritus, burning, redness, excoriations and friable tissue are associated with what vaginitis?
Candidal vaginitis: vaginal burning, itching, redness, edema
What would you see on a wet mount/KOH prep with vulvovaginal candidiasis?
Hyphae, spores
Pseudohyphae, Yeast Buds, WBCs, Lactobacilli
What herbs are indicated for vulvovaginal candidiasis?
Allium Sativa
Boric Acid ( not an herb but effective)
What drugs are used to treat vaginal candidiasis?
Antifungal Creams: Miconazole, Clotrimazole, Fluconazole
A microscopic report comes back for the lab with these findings: Low lactobacilli, low WBCs, low RBCs, no pathogens seen. These findings are associated with what type of vaginitis?
Atropic Vaginits
Creamy, thin, or watery discharge with white plaques adhering to the vaginal wall is associated with what type of vaginitis?
Candidiasis
Erythema, friable cervix, abdominal pain, and swollen lymph nodes are associated with what type of vaginitis?
Trichomoniasis
- Low
- Low
- Low
- Elevated bacteria, clue cells
- <4.5 (very acidic)
- Elevated
- 5-7
- Elevated
- Motile Trichomonads
What is the term for pain during ovulation?
Mittelschmerz
Lower abdominal or pelvic pain that occurs at midway point a women’s menstrual cycle
What are the common signs and symptoms of ovarian cysts?
Pelvic pain
-Radiates to lower back and thighs
-Before menstruation or afterwards
Dyspareunia
Irregular menstruation
“Fullness” in abdomen
Ruptured cyst results in sudden, unilateral sharp pelvic pain
How are ovarian cysts diagnosed?
Ultrasound
What are some common risk factors for PCOS?
Obesity
Insulin Resistance
Family Hx of diabetes
Genetic
What are the common signs and symptoms of polycystic ovarian syndrome?
Menstrual Irregularities: Oligomenorrhea
Abnormal uterine bleeding
Obesity (50%)
Androgenization: Hirsutism, acne, male pattern baldness
Polycystic Ovaries
Insulin Resistance
Endometrial Hyperplasia
What are the three diagnostic criteria for PCOS?
Need 2 of 3 to make diagnosis
Oligomenorrhea/irregular menses for 6 months
Clinical or lab evidence of hyperandrogenism
-Blood Test: LH:FSH Ratio >2; LH chronically high
Polycystic ovaries on Ultrasound
What is one of the best treatments for PCOS?
Diet Modification: Increase fiber, unsaturated fatty acids, proteins, and decrease refined sugar and saturated fats
Exercise: Weight Loss
Avoid Cigarette Smoking
Low dose OCPs medroxyprogesterone to suppress ovarian steroidogenesis
LH-release Hormone Analogues
Spironolactone: Diuretic helps lower androgens
Metformin: help improve insulin sensitivity
In the conventional model, what is a common treatment for PCOS?
Oral contraceptives
The results of a patient’s PAP Smear come back as HSIL. Describe what this means.
This means that it is likely there is a high grade lesion which has an increased chance of progressing to cervical cancer
What is the next step of a patient has an abnormal pap (+) high risk HPV?
Colposcopy of the cervix w/ biopsy
What is the description for a normal PAP smear?
Negative intraepithelial lesion or malignancy
What is CIN I?
Cervical Intraepithelial Neoplasm I (CIN I): Mild cervical dysplasia involving the lower third of the epithelium
What is CIN II?
Moderate dysplasia involving the lower two thirds of the epithelium
What is CIN III?
Severe dysplasia/carcinoma in situ (CIS) involving full thickness of the epithelium
What diagnostic technique is used when a patient has an abnormal pap?
Colposcopy (microscope) & Biopsy of the cervix
Do nabothian cysts progress to cancer?
No, they are benign cervical lesions.
What are the common signs and symptoms of lichen sclerosus?
Pruritis
White, parchment-like paper appearance to skin
Tearing and bleeding of skin
Genital soreness
Dysuria; Dyspareunia
Atrophy of clitoral blood
Lichen sclerosus is a risk factor for what gynecological malignancy?
Vulvar cancer
A patient presents with a beefy red rash on the vulva with satellite lesions. What do you suspect, what type of evaluation would you do and what would you expect to see?
Suspect vulvar candidiasis
Perform KOH prep of skin scrapings
Expect to see hyphae or yeast buds
What should you consider in a patient present with amenorrhea?
Pregnancy
Menopause
Early stage of lactation
Endocrine Dysfunction (Cushing Syndrome)
Strenuous exercise, weight loss
OCP usage
Hypothalamic Dysfunction
Pituitary Dysfunction
What herbs may be indicated for amenorrhea?
Alteris Farinosa
Angelicia Sinensis
Caulophylum Thalictroides
Chamalirium luteum
Vitex agnus-castus
What are the serum FSH levels typically associated with menopausal symptoms?
Increased levels of FSH (>30/35 IU/L) on day 3 of cycle and LH; (FSH > LH)
What are the serum estrogen and progesterone levels typically associated with menopausal symptoms?
Low estrogen (deficiency) and progesterone
What herbs are indicated for menopause?
Cimicifuga racemosa
Angelicia sinensis
Trifolium Prantense
What other class of herbs may be useful in treating menopause symptoms?
Adaptogens
What nutrients are used to treat menopause?
Soy Isoflavones, flax seeds
What homeopathic remedy would you consider for menopausal hot flashes when the woman has flushes of heat that prevent from falling asleep?
Sulphur
What is excessive menstrual flow called?
Menorrhagia
What herbs are indicated for menorrhagia?
Caulophylum thalictroides
Capsella bursa-pastoris
Chamaelirium luteum
Cinnamon zeylancium
Geranium maculatum
Glycyrrhiza glabra
Mitchella repens
What nutrients could be used to treat menorrhagia?
Iron, Vitamin A, Vitamin C
What are some of the risk factors associated with menorrhagia?
Obesity
Estrogen dominance
PCOS
Prolonges progestin
Coagulation Disorders
Iron Deficiency
What type of contraception can be associated with menorrhagia?
*IUD, will typically resolve in 3 days
OCPs, Progestin therapy
Menstrual bleeding that occurs at an inappropriate time in the menstrual cycle is known as what?
Metrorrhagia, abnormal uterine bleeding that happens between periods
What is the term for greater than 35 days between menstrual cycles?
Oligomenorrhea, light or infrequent menstruation (cycle is >35 days) in women of childbearing age
What herbs are indicated for PMS?
Angelica sinensis
Borago officinalis
Cimicifuga racemosa
Dioscorea villosa
Leonorus Cardiaca
Oenotheria biennis
Ricinis communis (Caster oil topically)
Viburnum opulus
Viburnum prunifolium
Vitex agnus-castus
What nutrients are used to treat PMS?
Essential Fatty Acids
Vitamin E
B6
Magnesium
Calcium
Avoid sodium, simple sugars, caffeine, and alcohol
What might be the history in a person who is having diffculty conceiving?
Age
STI
Cervical/Uterine Abnormalities
Medications/Drugs
Hormonal Imbalance
Immunologic Incompatibility
Metabolic Disorders
Nutrition and Lifestyle
Ovulation Failure
Tubal Obstruction
What is the definition of infertility?
Inability to conceive after one year of trying (in women less than 35 years old)
What are some of the ovulatory disorders that could cause infertility?
PCOS
*Primary ovarian insufficiency
Premature menopause
*Hypothalamic amenorrhea
Ovarian Cancer
Luteal insufficiency
*Corpus luteum Defect
What are some of the tubal disorders that could cause infertility?
PID
Ectopic Pregnancy
Endometriosis
Tubal occlusion/dysfunction
Abdominal/Pelvic Surgery
What are some of the cervical disorders that could cause infertility?
Cervical stenosis
Excessive Cervical Mucus
Uterine Fibroids
What are some of the other disorders that could contribute to infertility?
Obesity or being underweight
Abnormal vaginal flora
Alcohol or increased caffeine intake
Heavy metal toxicity
Uterine Malformations
Intrauterine Adhesions
Endometriosis
What are some of the causes of male infertility?
What are some of the findings of male infertility?
How is male infertility diagnosed?
What are some of the structural abnormalities that could lead to male infertility?
A deficiency of what mineral might be contributing to male infertility?
Zinc
What herbs may be indicated for infertility in general?
Vitex agnus-castus
Angelica sinensis
Caulophylum thalictroides
Chamaelirium luteum
Cimicifuga racemosa
Leonurus cardiaca
Medicago sativa
Mitchella repens
Smilax officinalis
Verbena officinalis
Lepidium meyenii
What amino acids are indicated for infertility?
Arginine
L-carnitine
