GYNO NAGY FAVE Flashcards
➔ Etiology of cervical cancer:
◆ HPV 16, 18
➔ Hydatidiform mole, which lab?
◆ b-Hcg (highly increased in molar pregnancy)
➔ How do you treat vulvar benign lesions?
◆ Surgical excision
➔ In uterine prolapse, what type of surgery?
◆ Vaginal hysterectomy
➔ Pediatric gynecology, most common complaints?
◆ Infection, amenorrhea, precocious or delayed puberty
➔ Most common causes of infertility?
◆ Male: sperm disorders, erectile dysfunction
◆ Female: anatomical (PID, Asherman syndrome, endometriosis), ovulatory
dysfunction, abnormal cervical mucus
➔ Inflammatory disorders of vulva and vagina - most common vaginal infections?
◆ Bacterial vaginosis (Gardnerella, mycoplasma), trichomonas, candida
➔ Staging of ovarian cancer?
◆ Only high-risk group: US and CA-125
◆ Staging:
● I: confined to ovaries or FTs
● II: ovaries + pelvis or peritoneal involvement
● III: ovaries + spread to peritoneum outside the pelvis and/or mets to
retroperitoneal LNs
● IV: distant mets - liver, lung, pleural fluid
➔ Urinary incontinence types?
◆ stress, urge, overflow, neurogenic
➔ Gynecology operation techniques - conization?
◆ Cone-shaped portion of the cervix removed. Using scalpel, laser or
electrosurgical techniques. Can be diagnostic (HSIL) or therapeutic (CIN2+3
➔ Primary Amenorrhea- when do we begin evaluation?
◆ I said the ages in the notes (age 16 or 2 years after onset of puberty OR age 14 if
no puberty)
◆ but he did say nowadays people wait till 18. Mention both. He accepted my
answer as correct
➔ At which stage of cervical cancer can you see with the naked eye
IB
PUBERTY
◆ Tanner stages I-V.
◆ I didn’t say them exactly, just described how its based on breast development,
pubic hair growth, there was no need to be precise
➔ Types of Uterine Fibroids
◆ intramural, subserosal, submucosal, and don’t forget broad ligamental
fibroids!!
➔ Breast cancer- what is a radical mastectomy
◆ entire breast removed + axillary lymph node dissection
➔ Syphilis, how to treat:
◆ penicillin G 2,4 mill units
➔ Benign lesions of vulva - Mention some
◆ Lichen sclerosus (post-menopausal), Lichen Simplex Chronicus. He just moved
on before I could mention more.
➔ Screening of endometrial cancer - Who would you screen and how?
◆ High risk women with long term estrogen exposure (PCOS, HRT, family history).
◆ Do an transvaginal US and examine the endometrial wall thickness (should not
be more than 8 mm in total)
➔ How would you screen for ovarian cancer?
◆ High risk women - Measure of serum CA-125 + US examination of ovaries.
➔ What is enterocele?
◆ Part of the small intestine protrudes into vagina, due to wall weakness.
➔ Ectopic pregnancy - He gave a case: If you have a woman with absence of menses for 7
weeks and you examine the uterus and there is no intrauterine pregnancy. How would
you diagnose?
◆ Measure beta-hCG, if elevated, but not doubling every 2nd day - indicate ectopic
pregnancy. Next step will be to do a laparoscopy
➔ In the end he asked an extra question (he didn’t expect an answer to it, but wanted to
ask it to test me): Genital development (not a topic for this year) - What is the equivalent
of the prostate in a female?
◆ Prostate consists of glands and smooth m. It is equivalent to the upper ⅓ of
vagina.
➔ Common STDs?
◆ Chlamydia, gonorrhea, syphilis, genital herpes (HSV-2), genital warts (HPV)
➔ How often do you screen for infections?
IDFK=i dont fuckinknow
➔ What changes are seen in Puberty?
◆ accelerated growth (growth spurt)
◆ development of secondary sexual characteristics, axillary hair growth
◆ + I mentioned Tanner stages and briefly described them: pubic hair growth,
breast development
➔ Types of Endometrial Hyperplasia?
◆ Simple typical - increase in glands but normal glandular architecture
◆ Complex typical - crowded irregular glands
◆ Simple atypical - simple hyperplasia with presence of atypical cells
◆ Complex atypical - complex hyperplasia with presence of atypical cells. Highest
malignant potential (30%)
➔ What are the stages + At what stage is Cervical cancer observable?
◆ I: confined to cervix
● IA: microscopically visible (Tx: TAH)
● IB: macroscopically visible (Tx: TAH + pelvic LND)
◆ II: invades beyond uterus, to upper vagina (Tx: TAH + pelvic LND) and
perimetrium, but not beyond pelvic wall
◆ III: invades pelvic wall or lower ⅓ of vagina
◆ IV: invades bladder/rectum or distant mets (Tx: palliative chemo, RT, surgery)
➔ 40 yo woman with dysmenorrhea. Test?
◆ D&C
➔ Dysfunctional uterine bleeding in a 42 year old woman, what to do
◆ D&C
➔ Normal causes of secondary amenorrhea
◆ pregnancy, menopause, lactation
➔ How to differentiate malignant from benign ovarian cysts
◆ MRI, US, CA-125, biopsy
➔ Functional ovarian cyst: what does it look like
◆ unilateral, uniloculated, simple cell inside, no papillary protrusion into cyst
◆ Types: follicular, corpus luteum cyst, theca-lutein cyst
➔ Ectopic preg: treatment
◆ Laparoscopy - Salpingostomy, salpingectomy
➔ Causes of secondary amenorrhea
◆ Pregnancy, menopause, lactation, hyperthyroidism, drugs
antidopaminergic), pituitary tumors (prolactinoma
➔ Secondary amenorrhea - what is the progestin test?
◆ Give progestin and then withdraw it. If there is withdrawal bleeding then the
diagnosis is PCOS/anovulation. If there is no bleeding, further diagnostic tests
should be done
➔ Choriocarcinoma follow up
◆ b-hCG
➔ Symptoms of genital herpes
◆ Vesicles on genitals, with pain, pruritus, discharge, dysuria. Sometimes systemic
symptoms - fever, malaise, lymphadenopathy
➔ What infections cause painless lymphadenopathy with genital lesions and what causes
painful lymphadenopathy
◆ Painless: syphilis (painless ulcer and painless lymphadenopathy)
◆ Painful: lymphogranuloma venerum
➔ Symptoms of perimenopause
◆ Hot flashes, night sweats, mood swings, vaginal dryness, loss of libido
➔ Treatment of cervical cancer
◆ Depends on stage
● Transabdominal hysterectomy
● Radical hysterectomy (uterus, cervix + parametrium and LNs)
● chemoirradiation, palliative chemo, RT, surgery
➔ Which lab do you measure in postmenopausal for dx.
◆ FSH (consistently elevated)
➔ Stage III of cervical cancer
◆ Lower third of vagina involved (IIIA) or whole parametrium infiltrated (IIIB)
◆ Tx: chemoirradiation
➔ What lab marker would you use to dx PCOS?
◆ I mentioned hyperandrogenism, so high androgens. He said yes, but he wanted
to hear that LH/FSH ratio is 3:1
➔ Treatment of Infertility: What would you do? What is IVF and how is it performed? At
what time is best?
◆ Ovarian follicular stimulation - retrieve egg via US guidance - mix sperm and egg
- incubation - transfer 2-5 embryos into uterus in cleavage or blastocyte stage
◆ Best to do on day 20-24 of menstrual cycle (according to google)
➔ Types of breast cancer surgery:
◆ Lumpectomy, quadrantectomy, mastectomy, radical mastectomy + I described
shortly what each are
➔ Basics of cancer therapy
◆ I just said surgery, RT and chemo and that in most cases today you do a
combination of the above mentioned and he moved on
➔ This is the question I couldn’t answer and he didn’t say what was correct: he said the
topic was about D&C and conization- there is a pregnant women who they need to
do a conization procedure on, what would be different in this procedure compared to
doing it on a nonpregnant women, what should they focus on? (PS: I took a long
time to think about it so I couldn’t even say my answer before he said that was too
much time so he wouldn’t accept my answer, just so people know to not take too
long to think- he wants an answer pretty quickly :))
◆ Risk of bleeding and premature birth in the pregnant woman?
➔ Treatment of choriocarcinoma? Prognosis? 5 year survival rate?
◆ Methotrexate, good prognosis, 95%
➔ How do you diagnose cervical cancer
◆ Pap smear
➔ If you see a single unicellular cyst on one ovary US what is it and how would you
treat it?
◆ probably a Follicular Cyst and watchful waiting is usually enough, but can be
removed surgically if there’s risk for torsion or rupture. (he didn’t seem super
stoked about my answer but accepted it lol not sure what else he wanted me
to say)
➔ They give you the symptoms of PCOS and you have to name the disease
◆ Hirsutism, acne, obesity, amenorrhea, insulin resistance
➔ Pearl index definition and the index for condom
◆ Def: Number of unintended pregnancies in 100 women over 1 year of
contraception use. Tells us the efficacy of various contraceptive methods.
◆ For condoms: 3-26 (much lower for hormonal contraception)
➔ 18 year old pt with primary amenorrhea, 46XY, breast developed, but no pubic hair -
what is the diagnosis?
◆ Genetically male - so Androgen insensitivity syndrome?
➔ Cause of dysmenorrhea
◆ Endometriosis, idiopathi
➔ Symptom of corporal cancer
◆ Vaginal bleeding
➔ Vulvar cancer treatment:
◆ local excision (in VIN), radical vulvectomy (+ inguinofemoral lymphadenectomy)
➔ Name endometrial benign lesions that are not fibroids
◆ adenomyosis (and he moved on haha)
◆ Endometrial polyps?
➔ Histology of types of breast cancer:
◆ I shortly explained about ductal and lobular carcinoma
➔ Diagnosis of hydatidiform mole:
◆ b-HCG (very high), snowstorm or honeycomb pattern on US. confirm with biopsy
➔ Possible locations of ectopic pregnancy
◆ Fallopian tubes (ampulla), uterine horns, cervix, scar from prior C-section,
abdomen
➔ Cause of Pelvic pain?
◆ Dysmenorrhea, endometriosis, PID, ruptured ectopic pregnancy, adnexal
torsion
➔ Ovarian cancer, how to screen. Etiology
◆ US, CA125, also HE4 Human epididimys protein 4 (best for premenopausal
women). Compare to CA125.
◆ RMA: Risk of malignancy index. If over 200 → suspicious for malignancy
● US features
● menopausal status
● levels of CA125
Radical vulvectomy, what is it
◆ Surgical removal of vulva + inguinofemoral LNs
➔ Virulism and hisutism difference
◆ Hirsutism is a clinical presentation of virilization = the appearance of male secondary sex characteristics in a female. ◆ Other symptoms of virilization can be: ● Clitoromegaly ● Deep voice ● Male pattern hair loss ● Acne ● Increased muscle mass
➔ How to check for fallopian stricture:
◆ Hysterosalpingography
➔ Endometrial cancer screening:
: Not feasible to test everyone, only ones with high
risk. Measure endometrial thickness (tot 8 mm)
➔ Hydatiform mole:
◆ see snowstorm pattern on US, no fetus
➔ Mayer Rokitansky Kuster Hauser syndrome - what is it?
◆ Mullerian agenesis
➔ Stein Leventhal Syndrome, what is it & Diagnostic criteria.
◆ PCOS. Dx criteria (Anovulation, hyperandrogenism, >10 follicles)
◆ Which lab values? Incr LH:FSH ratio (3:1)
➔ Classification of human sexuality
◆ Heterosexual, homosexual, bisexual, transsexual, etc. ??
I THINK ACTUALLY ITS: phenotype, karyotpye, genitals, how the patient feels
➔ Perimenopause diagnosis.
◆ Exclude pregnancy, FSH consistently increased. No follicles in ovaries on US.
Vulvovaginal atrophy on physical exam.
➔ Benign lesions of vagina and vulva: What is vulvodynia (he had this lecture)
◆ “Vulvar discomfort, most often described as burning pain, occurring in the
absence of relevant visible findings or a specific, identifiable neurologic disorder”
➔ Stage 1 of corporal cancer, how to diagnose?
◆ Myometrium 50%, diagnose with US and D&C
➔ Obstetric & gynecological evaluation - What kind of examination do you perform on a
female without any complaint?
◆ Vaginal inspection, speculum examination and Bimanual pelvic examination,
breast exam. Pap smear
➔ Types of benign ovarian tumors
◆ Epithelial - serous cystadenoma, mucinous cystadenoma, endometrioid
◆ Gonadal stromal tumors - Granulosa theca cell tumors, Sertoli-Leydig cell tumors
◆ Germ cell tumors - dysgermimoma, teratoma
➔ Treatment of PID, how long and why
◆ Empirical antibiotic therapy
● Outpatient: one single IM dose ceftriaxone + po doxycycline. Add po
metronidazole if signs of vaginitis
● Inpatient: IV cephalosporin (cefoxitin, cefotaxime) + doxycycline. If
tuboovarian abscess, add metronidazole.
◆ Need to treat due to risk of complications: Fitz-Hugh-Curtis sy, tuboovarian
abscess, infertility, ectopic pregnancy, chronic pelvic pain
➔ How to confirm intersexuality (disorder of sex development) - 4 steps ??? Guessing the
answers here:
◆ Karyotyping - check chromosomes
◆ Secondary sex characteristics
◆ Check internal gonads
◆ Mental/psychological is the last stage
➔ Female sex development
◆ External genitalia develop from genital and urogenital folds (from urogenital
membrane)
◆ Muellerian (paramesonephric) duct gives rise to upper vagina, cervix, uterus and
FTs. Absence of Y chromosome leads to total regression of Wolffian
(mesonephric) duct
◆ Ovaries develop from germinal epithelium
➔ Endocrinology of female reprod system during, before and after reproductive stage of
life: - What is the changes that occur during puberty?
◆ Pulsatile (!) GnRH release, increased in freq and amplitude from the
hypothalamus, stimulting the ant pituitary to release LH and FSH.
➔ Barrier and chemical contraceptive - what different barriers do we have?
◆ female and male condoms, pessaries, cervical cups and sponges. diaphragm
➔ Symptoms, signs and screening of corporal cancer: - What is the screening method for
corporal cancer
◆ I said that there is really no screening method for corporal/uterine/endometrial
cancer, but TV-US is an alternative and measure the endothelial lining. I said that
if it’s > 4 mm its suspective. He then corrected me, because thats the
measurment for one, meaning that the cut off is 8 mm!
➔ Normal and abnormal position of the vagina - What is the treatment for complete uterine
prolaps?
◆ Vaginal hysterectomy
➔ Benefits and risk of hormone contraceptives ( he wanted the list from the Nagy favorites
file)
◆ Benefits: ● decreased incidence of ovarian and endometrial cancer ● Decreased bone loss ● Treats dysmenorrhea ● Treats acne ● Decreases risk of trisomies with increasing maternal age ◆ Risks ● Thrombosis, DVT/stroke ● Increased BP ● Weight gain ● Depression
➔ How can you differentiate btw Bartolins cyst vs abscess?
◆ Abscess will be painful
➔ What are some genital malformations
◆ I said Mullerian agenesis - then he also wanted the
Mayer-Rokitansky-Kuster-Hauser name.
◆ Other: bicornuate uterus, septate uterus and he was happy. Transverse vaginal
septum, vaginal atresia, imperforate hymen
➔ What is Stein-Leventhal syndrome? What is the metabolic disorder associated with it?
◆ PCOS. Insulin resistance/DM
➔ A postmenopausal woman have thickened endometrium on US - What do you do next?
◆ D&C –> histo
➔ Causes of primary amenorrhea
◆ Anorexia, weight loss, pregnancy, imperforate hymen
◆ Mullerian agenesis, androgen insensitivity syndrome
◆ Primary hypogonadism (hypergonadotropic hypogonadism): Turner sy.
◆ Secondary hypogonadism (hypogonadotropic hypogonadism): Kallman sy
(impaired GnRH release + anosmia); pituitary tumor (craniopharyngioma)
➔ External female genitalia parts
◆ Vulva: labia minora and majora, clitoris, vulvovaginal (Bartholin) glands,
perineum, fourchette
➔ Bacterial vaginosis
◆ Symptoms: vaginal discharge, foul smell, dyspareunia
◆ What causes it? Gardnerella or other anaerobic bacteria
◆ Is it an STD: No
◆ Diagnosis: KOH prep, see clue cells
◆ Treatment: Metronidazole
➔ Uterine fibroids
◆ What are the types
◆ How can you remove them? Laparoscopy, hysteroscopy in case of
submucosal fibroids
◆ Complications: problems with conception, infertility, can grow to a large size
➔ Symptoms of endometriosis
◆ Dysmenorrhea, abdominal pain, problems with defecation, dyspareunia
◆ Dx: US, laparoscopic visualization
➔ Ecoptic pregnancy
◆ Symptoms: signs of pregnancy (e.g. breast enlargement), irregular bleeding,
abdominal pain and peritoneal signs if ruptured.
◆ Diagnosis: take bhCG, do US.
◆ How does bHCG change during normal pregnancy: doubles every other day.
Is it elevated bu does not double in ectopic pregnancy.
