Kaplan High Yield Gyn Flashcards
pts with PMS/PMDD experience their symptoms during what part of the menstrual cycle?
luteal phase (2nd half)
time requirements to dx PSM/PMDD
- occurred for 2 consecutive cycles
- occurs during the luteal phase (2nd half of cycle)
- no sx during the follicular phase (1st half)
- causes dysfunction in life (work, relationships, family, etc)
tx options for PMS/PMDD
- dec consumption of caffeine, alcohol, cigarettes, chocolate
- inc aerobic exercise
- SSRIs (for severe sx)
menopause =
- age of onset
- dx
- tx
= cessation of menses
- 48-52
- dec estrogen, inc FSH (primary oocytes are less sensitive to FSH –> inc)
- hormone replacement therapy (= estrogen +/- progesterone)
contraindications to HRT
- hx of DVT, PE
- hx of endometrial or breast cancer (estrogen-dependent cancers)
poscoital bleeding is _________ until proven otherwise
-tests?
cervical cancer
-speculum exam/ pap smear to rule it out
types of uterine bleeding
- menorrhagia
- hypomenorrhea
- metrorrhagia
- menometrorrhagia
- oligomenorrhea
- postcoital bleeding
- heavy, long menses
- light menses; spotting
- intermenstrual bleeding; normal volume
- irregular time intervals, amount, and duration of bleeding
- long menstrual cycle (>35 days long)
- after intercourse
anovulatory bleeding: explain.
- production of estrogen by ovary –> stimulates growth of endometrium
- no corpus luteum is formed –> no progesterone is formed –> no withdrawal bleeding from endometrium
- endometrium outgrows it’s blood supply –> bleeding
women over 35 years should get an ________ if they have abnormal bleeding.
endometrial biopsy
anovulation tx
- OCPs
- cyclic progesterone
- D&C (for hypertrophic uterus that bleed)
- IV estrogen (for atrophic uterus that bleed)
- endometrial ablation
- hysterectomy
types of hysterectomy
- subtotal
- total
- radical
- body of uterus
- uterus + cervix
- for pelvic malignancies: uterus + cervix + top part of vagina + tissue on the side of the uterus
OCPS dec the risk of? inc the risk of?
- dec risk of: breast or endometrial cancer (estrogen-dependent carcinomas)
- inc risk of: thromboembolism
labial fusion causes
increased androgen
- endogenous (21-beta hydroxylase deficiency)
- exogenous
Lichen sclerosus px, risks for, tx
- white, thin skin from labial to perianal region
- inc risk of cancer in postmenopausal women
- tx: topical steroids
Lichen simplex chronicus px, tx
- chronic vulvar pruritis + hyperkeratosis (raised white lesion)
- tx: sitz bath, lubricants
Lichen planus px, tx
- pruritis, papule, purple, polygonal
- tx: topical steroids
Bartholin gland cyst definition, px, tx
=obstructed glands on 5/7 o’clock position of vulva
- px: pain, tenderness, dyspareunia, inflammation
- tx: I&D, marsupialization, excision
normal pH of vaginal canal? how is it kept this way?
- pH < 4.5
- Lactobacillus keeps it there
types of vaginitis?
- bacterial vaginosis (Gardnerella)
- candidiasis
- trichomonas (Trichomonas vaginalis)
bacterial vaginosis px, dx, tx
- px: gray-white discharge + fishy odor
- dx: Amsel criteria; pH>4.5 + clue cells on microscopy + positive whiff test with KOH + discharge
- tx: metronidazole or clindamycin
candidiasis px, dx, tx
- px: white cottage cheese discharge
- dx: pseudohyphae on microscopy with KOH
- tx: miconazole, clotrimazole, econazole, nystatin
trichomonas px, dx, tx
- px: green frothy discharge
- dx: motile flagellates on microscopy
- tx: metronidazole –for pt AND partner
Paget disease of the vulva definition, population, px, dx, tx, risk
- intraepithelial neoplasia
- postmenopausal women
- px: vulvar soreness + pruritis + red lesions with superficial white coating
- dx: biopsy
- tx: radical or modified vulvectomy (bilateral vs unilateral lesion)
- risk: concurrent colon or breast cancer
squamous cell carcinoma of the vulva px, dx, tx
- px: pruritis + bloody vaginal discharge + ulcerated lesion/ cauliflower-like lesion
- dx: biopsy
- tx: vulvectomy +/- lymphadenectomy
adenomyosis definition, px, risk factors, dx, tx
=invasion of endometrial glands into the mymetrium (muscle)
- px: dysmennorhea + menorrhagia
- risk factors: endometriosis, uterine fibroids
- dx: clinical, MRI
- tx: hysterectomy
endometriosis definition, px, dx
=implantation of endometrial tissue outside the uterine cavity; ovary, pelvic peritoneum commonly
- px: cyclical pelvic pain 1-2 weeks before menses + nodular uterus/ adnexal mass + infertility (secondary to scarring)
- dysmenorrhea + dyspareunia
-dx: direct visualization during laparascopy
endometriosis tx (mild, severe, infertile)
- mild: NSAIDs, OCPs
- severe: leuprolide, danazol –> dec FSH/LH
- infertile: hysterectomy +/- BSO
polycystic ovarian syndrome px, dx, tx
- px: amenorrhea/ irregular menses + hirsutism + obesity + acne + DB type 2
- dx: US of bilaterally enlarged ovaries with multiple cysts; inc free testosterone; inc androgens
- LH:FSH ratio > 3:1 (FSH is inhibited by peripheral estrogen production)
-tx: weight loss, OCPs, clomiphene, metoformin, spironolactone
