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Gynecology > Kaplan > Flashcards

Kaplan Flashcards

1
Q

Adenomyosis Definition

A

ectopic endometrial glands and stroma located within the myometrium

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2
Q

Adenomyosis Diagnosis

A

enlarged symmetric tender uterus in the absence of pregnancy

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3
Q

Symptoms of Adenomyosis

A

Majority asymptomatic
Dysmenorrhea and menorrhagia
Uterus globular
Tenderness before and during menses

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4
Q

Management of Adenomyosis

A

Levonorgestrel

Hysterectomy

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5
Q

Leiomyoma vs Adenomyosis

A

Leimoyoma: asymmetric, firm, nontender
Adenomyosis: symmetric, soft tender

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6
Q

Menopause definition

A

Three continuous months of cessation of bleeding with elevated gonadotropins.

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7
Q

Most common gynecologic malignancy

A

endometrial carcinoma

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8
Q

DD of Postmenopausal bleeding

A

Endometrial carcinoma
Vaginal or endometrial atrophy
Postmenopausal hormone replacement therapy.

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9
Q

Mediating factor of most endometrial carcinomas

A

Unopposed estrogen

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10
Q

Risk Factors for Endometrial carcinoma

A

Obesity, HTN, Diabetes
Increased estrogen exposure
Late menopause
Chronic anovulation conidtions

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11
Q

Diagnosis Endometrial carcinoma

A

Endometrial biopsy
Hysteroscopy
Ultrasound measures the thickness of the endometrium

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12
Q

Staging of Endometrial carcinoma

A

Stage 1: limited to uterus
Stage 2: Extension to the cervix
Stage 3: outside of the uterus
Stage 4 spread further from the uterus

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13
Q

Endometrial atrophy treatment

A

Must give estrogen AND progesterone so no unopposed estrogen

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14
Q

Treatment of adenocarcinoma

A

Surgery: Total abdominal hysterectomy and bilateral salpingooophrectomy. and para-aortic lymphadenectomy with peritoneal washing. Consider radiation or chemo

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15
Q

Treatment of hyperplasia without atypia

A

Progestin. Only do hysterectomy if advancing to atypia or carcinoma

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16
Q

Precocious puberty

A

secondary sexual characteristics

Before age 8 in girls, 9 in boys

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17
Q

Progression of puberty in girls

A

Thelarche 9-10
Adrenarche 10-11
Growth 11-12
Menarche 12-13

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18
Q

Concerns in precocious puberty

A

Short stature from closing of epiphysis

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19
Q

Incomplete precocious

A 
Only one change
Thelarche
Adrenarche
Menarche
Likely from end organ sensitivity
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20
Q

Complete Gonadotropin Dependent Precocious Puberty

A

All changes are seen and the change is from the HPA.
80% idiopathic 6-7yrs
Others are CNS path

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21
Q

Management Complete Gonadotropin Dependent Precocious Puberty

A

CNS imaging to rule out.

Leuprolide (GnRH agonist) to suppress the HPA

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22
Q

CNS pathology causing Complete Gonadotropin Dependent Precocious Puberty

A 
Hydrocephalus
von Recklinghausen disease
Meningitis
Sarcoid
Encephalitis
All cause an increase in GnRH --> increase FSH--> estrogen
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23
Q

Gonadotropin independent

A

Estrogen production independent of gonadotropin secretion

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24
Q

Diseases causing Gonadoptropin independent

A

McCune Albright

Granulosa Cell Tumor

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25
Q

McCune Albright findings

A

syndrome-autonomous stimulation of aromatase enzyme production of estrogens by the ovaries

multiple cycstic bone lesions
cafeau lait
Rx is aromtase enzyme inhibitos

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26
Q

Diagnosis of Premenstural disorder

A 
Symptom diary over 3 periods:
absent in preovulatory phase
2postovulatory weeks
interfere with normal function
must resolve with onset menses
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27
Q

Symtpoms in Premenstrual syndrome

A

Fluid retention
Emotional
Musculoskeletal
Autonomic

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28
Q

Treatment of Premenstrual Symptoms

A 
SSRI
Yaz (drospirenone)
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29
Q

virilization

A

excessive male pattern hair growth in women PLUS other male signs clitorimegaly, baldness, lowering of voice, increasing muscle mass and loss of female body contour

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30
Q

Dehydroepiandrosterone sulfate

A

produced ONLY in the adrenal glands. Markedly elevated DHEAS is consistent with adrenal tumor

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31
Q

17OH progesterone

A

precursor to cortisol.

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32
Q

Conditions with elevated 17OH progesterone

A

congenital adrenal hyperplasia
21-hydroxylase deficiency
(converted peripherally into androgens)

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33
Q

Where are androgens produced in the female body.

A

ovaries
adrenal glands
hair follicle

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34
Q

Testosterone production

A

ovary and adrenal glands.

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35
Q

Mild elevated testosterone

A

PCOS

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36
Q

Markedly elevated testosterone

A

Ovarian tumor

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37
Q

Abrupt onset virilization
Abdominal/flank mass
Increase DHEAS

A

Adrenal tumor

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38
Q

Abrupt onset virilization
Adnexal mass
Markedly increase testosterone

A

Ovarian tumor

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39
Q

Gradual onset hirsutism
Normal exam
increase 17-OH progesterone

A

Congenital Adrenal Hyperplasia

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40
Q

Treatment of CAH 21 OH deficiency

A

corticosteroids (suppresses ACTH)

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41
Q

Gradual onset hirsutism
Irregular Bleeding
Infertility
Increase testosterone and LH:FSH ratio 3:1

A

PCOS

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42
Q

Necklace of pearls on ultrasound

A

PCOS

Also bilateral enlarged ovaries

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43
Q

Management of PCOS

A

OCPs

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44
Q

Acanthosis nigricans

A

PCOS

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45
Q

most common cause of androgen excess in women

A

Idiopathic

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46
Q

Gradual onset hirsuitism
Normal exam
Normal DHEAS, testosterone and 17OH progesterone

A

Idiopathic

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47
Q

PCOS RX OCP mechanism

A

1) lower testosterone by lowering LH stimulation of ovarian follicle theca cells
2) increase SHBG thus decreasing free testosterone

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48
Q

Management of Idiopathic hirsuitism

A

Spironolactone

Eflornithine

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49
Q

Increased 5 alpha reductase

A

Idiopathic

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50
Q

Spironolactone MOA

A

decreases the activity of 5 alpha hydroxylase

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51
Q

Management of PCOS:
Irregular bleeding
Hirsuitism
Infertility

A

Irregular bleeding-OCP
Hirsuitism-OCP, Spironolactone
Infertility- Clomiphene or HMG and Metformin

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52
Q

Fecundability

A

Likelihood of conception occurring with one cycle of appropriately timed mud cycle intercourse

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53
Q 
Sperm details:
volume
pH
density
motility
morphology
A 
Sperm details:
>2ml
pH 7.2-7.8
>20 million/ml
>50% motility
sperm morphology >50%
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54
Q

intrauterine insemination

A

When low sperm count inject directly into the uterine cavity.

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55
Q

intracytoplasmic sperm injection

A

Can be used with IVF. For severely abnormal sperm.

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56
Q

Objective data in Anovulation

A

Basal body chart shows no rise in temp
Serum progesterone low
Endometrial biopsy shows proliferative histology

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57
Q

Correctable causes of anovulation

A

Hypothyroidism and hyperprolactinemia

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58
Q

Induction of ovulation

A

Clomiphene-tricks pituitary 9given for five days on the fifth day of menstrual period)
HMG- exogenous gonadatropins

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59
Q

Hyper stimulation of ovaries

A

most common side effect of ovulation induction. Ascities, SOB, hyper coagulation etc.

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60
Q

Indication for ovarian reserve testing

A

Woman over the age of 35 with infertility

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61
Q

What is being assessed when doing ovarian reserved testing

A

1) assesses # of follicles available for recruitment

2) Assesses health and quality of eggs in ovary

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62
Q

Ovarian Reserve Testing

A

Day 3 FSH-increase in FSH if follicle depletion
Anti-Mullerian hormone- produced by small astral ovarian follicles direct measure of the ovarian pool
Antral follicle count total number of follicles not observed during an early follicular phase on transvaginal sonogram

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63
Q

Treatment of unexplained infertility

A

60% will achieve conception in next three years.
Controlled ovarian hyper stimulation with clomiphene and IUI
IVF

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64
Q

Invasive Anovulation tests

A

Hysterosalpingogram
Chlamydia antibody
Laparoscopy

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65
Q

Premature menopause

A

idiopathic
post radiation
surgical oophrectomy

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66
Q

Most common cause of mortality in post menopausal women

A

Cardiac disease

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67
Q

Most common method of assessing calcium loss

A

urine hydroxyproline

Urine NTX N-telopeptide

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68
Q

Most common risk factor for osteoporosis

A

Positive family history

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69
Q

Treatment of osteoperosis

A

Bisphosphonates

SERMS

70
Q

Indications for Menopausal hormone therapy

A 
Vasomotor symptoms
Vaginal dryness
Premature menopause
Benefits:
Osteoporosis
CHD
71
Q

Risks of Menopausal hormone therapy

A

VTE
Stroke
Breast cancer

72
Q

Drugs that are SERMS

A

Tamoxifen

Raloxifene

73
Q

PID

A

spectrum of upper genital tract conditions ranging from acute bacterial infection to to massive adhesions and old inflammatory scaring.
Ascending infection

74
Q

Symtpoms of Cervicitis

A

friable cervix on exam with mucopurulent discharge.

75
Q

Symptoms Acute Salpingo-oophritis

A

Bilateral abdominal/pelvic pain
Mucopurulent cervical discharge
Cervical motion tenderness

76
Q

Minimal criteria for acute salpingo-oophoritis

A

Sexually active young woman
Pelvic or lower abdominal tenderness
Cervical motion uterine or adnexal tenderness

77
Q

Outpaitent treatment for acute salpingo-oophoritis

A

Ceftriaxone IM x1 ( gonorhhea)
Doxy BID 14 days
+/- metronidazole BID 14d for anerobes

78
Q

Inpatient treatment for acute salpingo-ooporitis

A

Cefotetam IV 12hr
Doxy PO or IV q12hr
Clinda + Genta IV q8hr for anerobes and gram neg

79
Q

Symptoms Chronic Salpingo-oophoritis

A

Bilateral abdominal/pelvic pain
No cervical discharge
Cervical motion tenderness

80
Q

Management of Chronic Salpingo-oophoritis

A

Mild analgesia
Lysis of tubal adhesions
Pelvic clean out

81
Q

Definition primary dysmenorrhea

A

recurrent, crampy lower abdominal pain
Associated with N/V/D
occurs with menstruation
No associated pelvic pathology

82
Q

Pathogensis primary dysmenorrhea

A

excess production of prostoglandin F2 alpha causes harsh and dysrhythmic pelvic contractions

83
Q

Treatment of primary dysmenorrhea

A

suppression of prostoglandins with NSAIDs

Can also use OCP,

84
Q

Common Sites of endometriosis

A

Ovary- chocolate cyst
Cul-de sac
uterosacral ligament nodularity

85
Q

Symptoms of endometriosis

A

Dyspareunia
Dyschezia
Infertility

86
Q

Investigative findings of endometriosis

A

WBC and ESR normal
CA-125 may elevate
Sonogram may show endometrioma

87
Q

Diagnostic test for endometriosis

A

Laparoscopy

88
Q

Therapy for endometriosis

A 
Use progesterone to encourage endometrial atrophy
Pregnancy
Pseudopregnancy (medroxyprogesterone acetate,OCP, depo)
Pseudomenopause (Danazol/Danocrine) (Leuprolide)
89
Q

Layers of endometrium

A

Functionalis zone- sloughs off with withdrawl of progesterone causing spiral artery spasm
Basalis zone

90
Q

Menstrual phase

A

First four days of menstrual cycle

Withdrawl of progesterone causing spasm of spiral arteries in functionalis zone causes sloughing off.

91
Q

Proliferative phase

A

Estrogen driven early division of basalis to make functionalis. lengthening of spiral arteries
***UNSTABLE-prolonged anovulation will cause bleeding

92
Q

Secretory phase

A

Glandular secretion of glycogen and mucous mediated by progesterone from corpus luteum
STABLE-only ceases when the corpus luteum involutes

93
Q

Role of Beta HCG in preg

A

Tells corpus luteum to continue to make progesterone

94
Q

inhibin

A

Controls the amount of FSH via feedback. Produced by granulosacells.

95
Q

LH surge

A

Dependent on a rise in estrogen

96
Q

Differential Diagnosis of premenarchial vaginal bleeding

A 
Most common-foreign body
ingestion of estrogen
Cancer of vagina or cervix
tumor of pituitary or adrenal
ovarian tumor
sexual abuse
precocious puberty
97
Q

Causes of abnormal Vaginal bleeding

A

Pregnancy
Anatmoic
Inherited Coagulopathy
Dysfunction uterine bleeding

98
Q

Anatomic lesions causing abnormal vaginal bleeding

A

Vaginal lesions-lacerations, varicosity, tumor
Cervical lesions- polyps, cervicits, tumors
Endometrial lesions- subcutaneous leiomyoma, polyps, hyperplasia, cancer
Myometrial lesions- adenomyosis

99
Q

Inherited coagulopathy leading to abnormal vaginal bleeding

A

von willibrand most common

can measure with a risotcetin assay

100
Q

Symptoms of Endometrial polyp/ leimyoma

A

predictable vaginal bleeding with intermenstrual bleeding
33YO
Nomral weight an height.

101
Q

Management of coagulopathy

A

PT PTT CBC PC vWF antigen

102
Q

Findings in Dysfunctional Uterine Bleeding

A 
irregular, unpredictable bleeding without cramping
No prostoglandin release
Cervical mucous clear watery and thin
No increase in BBT
proliferative endometrium on biopsy
103
Q

Correctable causes of abnormal uterine bleeding

A

Hypothyroidism

Hyperprolactinemia

104
Q

Management of abnormal uterine bleeding

A

Administer progestin/progesterone
Cyclic MPA
OCP
Progestin Intrauterine system

105
Q

Other therapies for abdnormal uterine bleeding

A

NSAIDS
Tranexamic acid
Endometrial ablation
Hysterectomy

106
Q

Primary amenorrhea

A

menstrual bleeding has never occured
Age 14 with no menarche and no secondary sexual characteristics
Age 16 with no menarche and sexual characteristics

107
Q

Primary amenorrhea with breast and uterus

A

imperforate hymen
anorexia nervosa
excessive exercise
pregnancy

108
Q

Primary amenorrhea
breasts but no uterus
pubic and axilary hair present

A

Mullerian agenesis

109
Q

Primary amenorrhea
Breasts but no uterus
No pubic hair or axillary hair

A

Androgen insensitivity

110
Q

Primary amenorrhea
no breasts but uterine present
Increase FSH

A

Gondal dysgenesis

111
Q

Androgen insensitivity

A

46XY individuals who do not respond to androgens in system. Thus external genitalia develops as female.
Testes produce testosterone tht is not recognized

112
Q

Management of androgen insensitivity

A

teste removal at age 20 with estrogen replacement therapy

113
Q

streak gonads
elevated FSH
No secondary sexual characteristics

A

Turner Syndrome (Gonadal dysgenesis)

114
Q

Primary amenorrhea
no breasts but uterus
decreased FSH

A

HPA dysfunction

115
Q

Kallman syndrome

A

Failure to produce GnRH

Anosmia

116
Q

Diagnosis of Secondary Amenorrhea

A

No menstruation for 3months of previous regular menses

No menstruation for 6 months if previous irregular menses

117
Q

Most common cause of secondary amennorhea

A

Pregnancy

118
Q

Management of secondary amenorrhea

A 
beta HCG
TSH
Prolactin
Progesterone challenge test (positive if withdrawl bleeding diagnosis anovulation)
Estrogen-Progesterone challenge test
119
Q

Savage Syndrome

A

follicles are seen but do not respond to gonadotropins

120
Q

Asherman Syndrome

A

extensive uterine curretage and infection induced adhesions create out flow tract obstruction leading to secondary amenorrhea.

121
Q

Active ingredient in spermacide

A

nonoxynol-9: disrupts cell membranes

122
Q

Absolute CI to OCP use

A 
Pregnancy
Liver Disease
Smoker over age 35
Uncontrolled HTN, headache.
History of vascular disease (estrogen)
123
Q

Types of Combination Contraception

A

Oral-Yaz estrogen and progesterone
Vaginal ring-estrogen and progesterone
Transdermal patch- estrogen and progestin

124
Q

Progestin only

A

injectable is depo provera medroxyprogesterone acetate
Subcutaneous
Intrauterine Mirena

125
Q

IUS options

A

Mirena levonorgestrel-impregnanted
Skyla-
Copper T380A IUS

126
Q

Abortion Options

A

First tri- D&C and mifepristone
Second Tri- D&E or IOL with PGE1
Third Tri- hysterectomy

127
Q

Mifepristone MOA

A

Progesterone antagonist.

128
Q

Types of Abortion

A 
Missed
Threatened
Incomplete
Complete
Inevitable
129
Q

Consequences of Fetal Demise

A

DIC from release of tissue thromboplastin is rare

Grief resolution

130
Q

Mode of delivery for fetal demise

A

D and E if

131
Q

DIC panel

A

Platelet count
D-dimer
Fibrinogen
PT/PTT

132
Q

Risk Factors for ectopic

A

Infections (PID,IUD)
Post surgical (ligation)
Congenital (DES)

133
Q

Definition of Adnexa

A

Space between uterine wall and pelvic wall: ovary, oviduct, ureter, cardinal ligaments

134
Q

Specific Criteria for Diagnosis of Ectopic Pregnancy

A

Serum beta HCG is greater than 1500 with no signs of transvaginal intrauterine gestational sac.

135
Q

Management of Unruptured ectopic

A

HCG6000: laparoscopy with Rhogam

Possible Salpingectomy if childbearing over

136
Q

What period is most susceptable to tetratogens

A

Weeks 3-8

137
Q

thin greyish-white discharge
pH above 4.5
Whiff test

A

Bacterial Vaginosis

138
Q

Clue Cells

A

Bacterial vaginosis

139
Q

Treatment of BV

A

metronidazole

Clindamycin

140
Q

Vaginal discharge >4.5
Itching and burning
strawberry cervix

A

Trichomonas Vaginitis

141
Q

frothy green discharge

A

Trichomonas Vaginitis

142
Q

What can you not use when taking metronidazole

A

alcohol

143
Q

RF for candida infection

A 
DM
systemic antibiotics
pregnancy 
obesity
decreased immunity
144
Q

treatment of candida

A

systemic fluconazole

vaginal azole creams

145
Q

normal vaginal pH infection

A

Candida

146
Q

excessive, thin watery vaginal discharge

A

Physiologic discharge

Estrogen dominance

147
Q

whitish focal/diffuse area on vulva

firm and cartilaginous

A

Squamous Hyperplasia

148
Q

treatment squamous hyperplasia

A

fluoridated corticosteroid cream

149
Q

bluish-white papule like parchment paper

A

lichen sclerosus

150
Q

Treatment of lichen sclerosus

A

Clobetasol cream

151
Q

white, red or pigmented multi focal lesions

A

Vulvar intraepithelial neoplasia

152
Q

fullthickness vuvlvar dysplasia

A

vuvlar carcinoma in situ

153
Q

Mittleschmertz

A

Pain during OVULATION from rupture and blood in pertineum

154
Q

Ovarian Hyperthecosis

A

increase in LH production of androgens

Leads to peripheral production of estrogen

155
Q

Presentation of Ovarian Hyperthecosis

A

More severe hirsutism than PCOS

Can also occur in postmenopausal women

156
Q

Differential of Prepubertal Complex Pelvic Mass

A

Germ Cell tumors
Dysgerminoma -LDH levels
Choriocarcinoma- beta HCG
Endodermal sinus- AFP

157
Q

Management of mass in prepuberty

A

Simple- laparoscopy and cystectomy

Complex mass- Laparotomy with Unilateral S&O

158
Q

DD of complex mass in premenopausal

A 
Dermoid Cyst
Benign cystic teratoma
Endometrioma
tubo-ovarian abcess
ovarian cancer
159
Q

Solid pelvic mass
negative beta HCG
increase LDH

A

dysgerminoma

160
Q

Pelvic mass in reproductive years
negative beta HCG
Calcifications on ultrasounds

A

Benign Cystic teratoma (aka dermoid cyst)
All germ layers
GI histology-carcinoid syndrome
Thyroid tissue-strumma ovari

161
Q

Sudden onset severe lower ab pain

adnexal mass

A

ovarian torsion

162
Q

Management of ovarian torsion

A

Laparoscopy/otomy tountwist
Cystectomy for revitalization
Unilateral S&O if necrotic

163
Q

Differential of Postmenopausal Pelvic Mass

A 
GI lesion
Urinary tract lesion
Ovarian tumor
-Epithelial
-Germ Cell
-Sex Cord Stromal
164
Q

Postmenopausal woman
Pelvic mass
Increased CEA/ CA-125

A

Serous carcinoma

165
Q

Epithelia ovarion tumors

A 
Serous
Mucinous
Brenner
Endometriod
Clear Cell
166
Q

Germ Cell tumors

A

Dysgerminoa
Endodermal sinus
teratomas
choriocarcinoma

167
Q

Sex Cord Stromal Tumor

A 
Granulosa/Theca
Sertoli Leydig
Fibroma
Thecoma
Stromal luteoma
Pregnancy luteoma
168
Q

Postmenopausla pelvic mass
Masculinization
Increase testosterone

A

Sertoli Leydig Cell

169
Q

Metastatic Ovarian tumors

A

Endometrium
GI
breast
Krukenberg

170
Q

Krukenberg

A

mucin secreting tumors origniationg from the stomach or breast
Usually bilateral

171
Q

ascites
pleural effusion
benign ovarian fibroma

A

Meigs syndrome

Gynecology (1 decks)

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