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Mistakes > Lady Bits > Flashcards

Lady Bits Flashcards

1
Q

What causes stress incontinence in a nulliparous woman?

A

Leiomyomata uteri (mass effect)

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2
Q

Indications for endometrial biopsy >= 45 yo

A

AUB

Post-menopausal bleeding

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3
Q

Indications for endometrial biopsy < 45 yo

A

AUB +

Unopposed estrogen (Obesity, anovulation)
Failed medical management
Lynch Syndrome (HNPCC)
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4
Q

Indications for endometrial biopsy >= 35 yo

A

Atypical glandular cells on pap test

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5
Q

Initial workup for AUB in premenopausal women

A 
Endocrine Evaluation (TSH, Prolactin)
Pelvic Ultrasound
Possible endometrial biopsy
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6
Q

Endometrial stripe of <=4mm

A

Rules out endometrial cancer in postmenopausal women

Can’t reliably rule it out in premenopausal

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7
Q

Irregularly-enlarged uterus
Prolonged menstrual bleeding
Labor-like pain

A

Prolapsing leiomyoma uteri/Aborting submucous myoma

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8
Q

What causes cramping during the first few days of menses?

A

Prostaglandin release from sloughing endometrium causes uterine contractions

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9
Q

What distinguishes primary dysmenorrhea from secondary?

A

A normal physical exam

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10
Q

Treatment for primary dysmenorrhea

A

NSAIDs (1st Line)
They work as prostaglandin synthetase inhibitors
Hormonal contraception works well too

Most patients respond to these interventions within 3 months

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11
Q

Bulky globular tender uterus

Usually in women >35

A

Adenomyosis

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12
Q

Tenderness along uterosacral ligaments
Nodularity in the cul-de-sac
Adnexal enlargement
Pain precedes menses by a few days

A

Endometriosis

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13
Q

Virus Strains leading to Condylomata Acuminata

A

HPV 6 & 11

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14
Q

Clinical features of Condylomata Acuminata

A

Multiple pink or skin-colored lesions

Lesions range from smooth, flattened papules to exophytic/cauliflower-like growths

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15
Q

Treatment for Condylomata Acuminata

A

Chemical (Podophyllin resin, tricholoracetic acid)
Immunologic (Imiquimod)
Surgical (Cryotherapy, laser therapy, excision)

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16
Q

Prevention for Condylomata Acuminata

A

Vaccination

Barrier contraception

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17
Q

Virus Strains leading to high grade CIN & Cervical Cancer

A

HPV 16 & 18

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18
Q

Genital Lichen Planus

A

Pruritic, glassy, bright red erosions & ulcerations

Affects vulva & vagina

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19
Q

Lichen Sclerosus

A

Pruritic, white, thin wrinkled skin over labia

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20
Q

Molluscum Contagiosum

A

Caused by a poxvirus

Single or multiple small pearly painless nodules
Central dimples or pits
Do not bleed on contact

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21
Q

Trastuzumab

A

Monoclonal Ab for HER2+ Breast Carcinoma

Adverse effect: Cardiotoxicity (reversible w/ discontinuation of agent)
Asymptomatic LVEF decline most common
Overt heart failure can occur
Effect amplified when used in combination with cardiotoxic chemotherapy (Doxorubicin)

Precede administration with echocardiography for baseline, and follow at regular intervals throughout therapy

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22
Q

Side effect of Cisplatin and Carboplatin

A

Ototoxicity
Peripheral neuropathy

Precede administration with baseline audiometry testing

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23
Q

Side effect of Anastrozole and Letrozole

A

Osteoporosis

Precede administration with baseline bone marrow biopsy only if administering with antimetabolite chemotherapy (5FU or MTX)

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24
Q

Side effect of Bleomycin

A

Pulmonary fibrosis

Precede administration with baseline PFTs, follow them serially throughout treatment.

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25
Q

Side effect of TNF-Alpha Inhibitors

A

Reactivation of latent tuberculosis

Precede administration PPD

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26
Q

How often should sexually active women <25 undergo GC/Chlam testing?

A

Annually (in addition to routine Pap testing)

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27
Q

HELLP Syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelets

From abnormal placentation
Triggers systemic inflammation
Activates coagulation & complement cascades

Circulating platelets rapidly consumed
Microangiopathic hemolytic anemia damages liver

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28
Q

Hepatic Failure in third trimester or early postpartum

A

Acute Fatty Liver of Pregnancy

Comes with:
Prolonged PT & aPTT
Hypoglycemia
Encephalopathy

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29
Q

Intrahepatic Cholestasis of Pregnancy Treatment

A

Ursodeoxycholic Acid

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30
Q

Treatment for Lactational Mastitis with no reason to suspect MRSA

A

Continue nursing every 2 - 3 hours, both breasts
(Milk stasis is how the bacteria ascended from baby’s nares)
NSAIDS
Dicloxacillin or Cephalexin

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31
Q

Treatment for Lactational Mastitis with recent Hx of antibiotic use, residence in long term care facility or incarceration

A

Suspect MRSA

Continue nursing every 2 - 3 hours, both breasts
(Milk stasis is how the bacteria ascended from baby’s nares)
NSAIDs
Clindamycin, TMP-Sulfa, Vancomycin

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32
Q

Side Effects of Medroxyprogesterone injections for long-term contraception

A

Weight Gain!!!!!

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33
Q

Short Stature
Primary Amenorrhea
Absent Thelarche

A

Turner Syndrome

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34
Q

What are the gonadotropin levels like in Turner Syndrome?

A

High LH
High FSH

Streak ovaries provide no thelarche or feedback

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35
Q

Findings on light microscopy of patient with cervicitis from GC/Chlam

A

No organisms! NAATS is better test!

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36
Q

Clinical features of Granulosa Cell Tumor of the Ovary

A

Large adnexal mass

Children - Precocious Puberty
Postmenopausal - Bleeding/endometrial hyperplasia

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37
Q

Diagnostic findings of Granulosa Cell Tumor

A

Elevated Estrogen

Ovarian Mass & Thickened Endometrium on Ultrasound

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38
Q

Dysgerminoma

A

Ovarian tumor occuring in women <30

Secretes LDH or Beta-hCG

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39
Q

Mature Teratoma

A

Dermoid Cyst

Common, benign ovarian tumor
Not hormonally active

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40
Q

Serous cystadenomas

A

Most common benign ovarian neoplasm

Hormonally inactive

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41
Q

Sertoli-Leydig Cell Tumors

A

Produce androgens
Cause defeminization, then masculinization

Women of childbearing age experience:
Breast flattening
Scanty, irregular menstruation ending in amenorrhea
Hirsutism
Coarsened facial features
Deepend voice
Clitoral enlargement
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42
Q

Single most important prognostic consideration in the treatment of patients with breast cancer

A

Tumor burden (TNM Staging)

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43
Q

Features of a fibroadenoma

A 
Rubbery
Mobile
Well-circumscribed
Outer quadrant of breast
Pre-menstrual tenderness (fluctuating estrogen &amp; progesterone levels)
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44
Q

Management of adolescent patient with suspected fibroadenoma

A

Re-examine over at least one menstrual cycle

If it decreases in size and/or tenderness after the period, patient can be reassured

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45
Q

Management of non-adolescent patient with suspected fibroadenoma

A

Ultrasound

Excisional biopsy should be considered if patient is adult and has a very large mass

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46
Q

Most common beast mass in women age 35 - 50

A

Simple breast cyst
Indistinguishable from fibroadenoma (more likely if patient is adolescent) on physical exam
FNA diagnoses and resolves the cyst

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47
Q

Most common cause of vaginal bleeding in neonatal period

A

Maternal withdrawal of estrogen

Pregnancy is like the follicular phase of menstruation
Estrogen crosses placenta and builds fetal endometrial lining
Following delivery, neonate’s endometrium sloughs
Typically within first 2 weeks of life, may last days

Temporary breast buds & external genitalia engorgement may occur too. Brief. Physiologic. Normal.

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48
Q

Nodules resembling grapes protruding from the vagina in an infant

A

Rhabdomyosarcoma

Specifically Sarcoma Botryoides

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49
Q

In a patient with well-developed secondary sexual characteristics, how old can amenorrhea be considered normal?

A

Up to 16

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50
Q

In a patient with sexual characteristics absent, how old can work-up for amenorrhea be delayed

A

No later than 14

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51
Q

Patient with primary amenorrhea and no breast development. What hormone do you look at?

A

FSH

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52
Q

Patient with primary amenorrhea and no breast development with a low FSH. What do you order next?

A

Pituitary MRI

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53
Q

Patient with primary amenorrhea and no breast development with a high FSH. What do you order next?

A

Karyotype

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54
Q

When does the cervix physiologically secrete mucus?

A

Late follicular phase, close to ovulation

Mucus is clear, elastic, thin, like an uncooked egg white
Increase in quantity may be perceived as “discharge”

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55
Q

Asherman Syndrome

A

Intrauterine adhesions caused by uterine curettage

Presents with:
Amenorrhea & cyclic pelvic pain due to endometrial destruction & obstructed menstrual flow

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56
Q

How often should a woman > 30 with no history of abnormal pap be screened for cervical cancer?

A

Every 3 years

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57
Q

In an asymptomatic, average-risk patient without ovarian mass, why not do CA-125 screening?

A

False elevations of CA-125 can be caused by conditions such as endometriosis & leiomyomata

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58
Q

Indications for hospitalization for PID

A 
Pregnancy
Failed outpatient treatment
Inability to tolerate oral meds
Noncompliant with therapy
Severe presentation (High fever, vomiting)
Complications (TOA, perihepatitis)
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59
Q

After aspiration/drainage of simple breast cyst, how soon should patient have follow up visit?

A

2 - 4 months for clinical breast examination

If symptoms did not recur, annual screening may resume

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60
Q

Complex multiloculated adnexal mass
Thick walls
Internal debris

A

Tubo-Ovarian Abscess

Complication of PID in reproductive-age women
Presents with fever, abdominal pain
Comes with leukocytosis, elevated CRP & CA-125

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61
Q

Normal internal genitalia
External virilization
Undetectable serum estrogen levels

A

Aromatase deficiency

Transient masculinization of mother that resolves after delivery.
Female infant has normal internal genitalia nad ambiguous external genitalia due to high levels of gestational androgen
Adolescence shows delayed puberty, osteoporosis, undetectable estrogen (so no breasts)

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62
Q

At what level of Beta-hCG should an IUP be detectable on TVUS?

A

1500 - 2000

If beta-hCG is lower and no IUP is seen, re-measure hCG again in 2 days, repeating TVUS once beta-hCG is within range.

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63
Q

Risk factors of breast cancer

A

1 in 8 women have a lifetime risk in the USA

Increases with increased lifetime estrogen exposure:
Chronological age
Nulliparity
Obesity
Prolonged HRT
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64
Q

What is the role of hCG in normal pregnancy?

A

Secreted by syncytiotrophoblast

Preserves corpus luteum during early pregnancy to maintain progesterone secretion until placenta can take over.

Production of hCG begins ~8d after fetilization
Levels double every 48 hours until they peak at 6 - 8 weeks gestation
Alpha-subunit is common to hCG, TSH, LH & FSH

65
Q

How do you treat vesicovaginal fistula?

A

Catherization in the immediate postop period

Surgical correction if you miss that window

66
Q

All patients with HSIL (regardless of if they are pregnant or not, regardless of HPV status) should be evaluated how?

A

Colposcopy!

If efidence of invasive cancer is found, proceed to LEEP, regardless of pregnancy status

67
Q

When do you do HPV testing in a gynecological visit?

A

ASCUS & LSIL

If positive, progress to colposcopy

68
Q

Medications that commonly cause urinary incontinence in the elderly

A

Alpha-adrenergic antagonists (urethral relaxation)
Anticholinergics, opiates, CCBs (urinary retention/overflow)
Diuretics (excess urine production)

69
Q

Reversible causes of urniary incontinence

A

DIAPPERS

Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals (alpha blockers, diuretics)
Pscyhological (depression)
Excessive urine output (DM, CHF)
Restricted Mobility (Postsurgery)
Stool impaction
70
Q

Ideal time to examine a breast for masses

A

5 - 10 days after menses (follicular phase)

71
Q

Fibroadenoma vs Fibrocystic changes

A

Fibroadenoma is one well-circumscribed lesion

Fibrocystic changes are multiple, small, cyclically tender masses (diffuse breast nodularity)

72
Q

If lactation mastitis progresses to abscess

A

Needle aspiration
Antibiotics (Dicloxacillin, cephalexin)

Continue breastfeeding

73
Q

Fluctuant, tender, palpable mass in the setting of lactation mastitis

A

It progressed to an abscess!

74
Q

Sexually active young woman who doesn’t use contraception with lower abdominal pain, RUQ pain & a negative pregnancy test

A

PID progressed to Fitz-Hugh Curtis

75
Q

Sjogren Syndrome

A

Autoimmune disorder
Inflammation of the exocrine glands

Can occur isolated or with other autoimmune disease

76
Q

Dry mucous membranes
Dental caries
Dry eyes
Cough

A

Sicca Syndrome

From impaired function of salivary & other exocrine glands in Sjogren Syndrome

77
Q

Extraglandular features of Sjogren Syndrome

A 
Raynaud Phenomenon
Arthritis
Cutaneous Vasculitis
Respiratory Manifestations
Significant risk for non-Hodgkin Lymphoma
78
Q

Respiratory Manifestations of Sjogren Syndrome

A

Nonallergic Rhinitis
Bronchiectasis
Large & Small Airway Disease w/ impaired mucociliary clearance
Interstitial Lung Disease

79
Q

AUB that normally follows menarche

A

Initial menstrual cycles are irregular and anovulatory

Due to immaturity of developing HPA
Inadequate quantities & proportions of GnRH
Leads to inadequate release of LH & FSH
Ovulation skips a cycle & menstruation lacks its regular periodicity.
Between cycles, you get breakthrough bleeding because the endometrium built up too much.

80
Q

Initial workup for AUB

A

Administer exogenous progesterone

If bleeding ensues, we can exclude primary ovarian insufficiency, endometrial abnormalities (like adhesions) & outlet tract abnormalities (like imperforate hymen).

81
Q

Treatment of AUB in adolescents early in their development

A

If bleeding is disruptive, heavy or leads to anemia:
Progestin-only or Estrogen/Progestin OCPs

Anovulation resolves 1 - 4 years postmenarche

82
Q

Hormonal abnormalities in PCOS

A

Excess LH Secretion

Excess Androgen

83
Q

Hyperechoic nodules & calcifications on ultrasound of adnexa

A

Dermoid ovarian cyst (mature cystic teratoma)

Treatment = Removal of cyst

84
Q

First line study to assess palpable breast mass in women >= 30

A

Mammography

Ultrasound can provide added characterization of it
Tissue biopsy is required to confirm

85
Q

Progesterone’s normal role in menstrual cycle

A

Stabilizes endometrial proliferation
Causes differentiation into secretory endometrium

Cyclic withdrawal of progesterone causes menstruation

86
Q

First line treatment of PCOS to restore menstruation in obese patients

A

Weight Loss decreases peripheral estrogen conversion

If unsuccessful, Clomiphene Citrate is second line

87
Q

Clomiphene Citrate

A

SERM

Blocks estrogen receptors at hypothalamus
Inhibits negative feedback of pulsatile GnRH secretion
Normalizes LH & FSH levels
Creates an LH Surge

Restores ovulatory cycle, even in the presence of excess estrogen

88
Q

Adverse Effects of SERMs

A

Hot Flashes
Venous Thromboembolism
Endometrial hyperplasia & carcinoma (Tamoxifen only)

89
Q

History of Cancer
Amenorrhea
Signs of Estrogen Deficiency

A

Ovarian failure 2/2 Chemo

LH & FSH are high (Lack of Feedback)

90
Q

Diagnostic workup of unilateral and/or bloody nipple discharge without presence of palpable breast mass

A

Mammogram (Often normal in intraductal papilloma)

Ultrasound (May show dilated duct in intraductal papilloma)

91
Q

Diffuse breast erythema
Edema
Peau d’Orange

A

Inflammatory Breast Cancer

Mammogram reveals Mass, Calcification, Parenchymal Distortion

92
Q

Fixed palpable breast mass
Irregular borders
Oft bilateral

A

Lobular Breast Carcinoma

93
Q

Eczematous nipple changes that include the areola

+/- Bloody discharge

A

Paget Disease of the Breast

94
Q

Oral levonorgestrel

A

Plan B (Progestin)

Delays ovulation
Efficacy decreases over the course of 72 hours
Should be administered as soon as possible after intercourse

95
Q

Ulipristal

A

Emergency Contraception (Antiprogestin)

Delays follicular rupture
Inhibits ovulation
Impairs implantation
More effective than levonorgestrel
Can be taken up to 5 days after intercourse

Difficult to obtain in some settings

96
Q

Medical emergency contraceptives

A 
Oral levonorgestrel (progestin) - give within 3 days
Ulipristal (antiprogestin) - give within 5 days
97
Q

Most effective emergency contraceptive

A

Copper IUD

98
Q

Misoprostol

A

Prostaglandin analog

Used with mifepristone (Progesterone blocker) for medical abortion
Stimulates uterine contractions

99
Q

Risk factors for Rectovaginal Fistula

A

Poor intrapartum care
Long second stage of labor
(leads to ischemic pressure necrosis of rectovaginal septum)
Third or Fourth degree laceration

100
Q

Presentation of Rectovaginal Fistula

A

Incontinence of flatus (through vagina)
Incontinence of fecal material (through vagina)
Malodorous brown/tan discharge

101
Q

Diagnosis of Rectovaginal Fistula

A

Visual exam:

Dark red, velvety rectal mucosa on posterior vaginal wall

102
Q

Treatment of Rectovaginal Fistula

A

Surgical repair

103
Q

Lichen Sclerosus

A

Chronic inflammatory condition of anogenital region
Can affect women of any age
Can have autoimmune pathogenesis
Often coexists with other autoimmune conditions (DMI, Thyroid abnormalities)
Extragenital involvement is possible
“Figure of 8” pattern when perianal skin is involved too

104
Q

Symptoms of Lichen Sclerosus

A

Intense pruritus
Dyspareunia
Dysuria
Painful defectaion

105
Q

Porcelain-white polygonal patches w/ atrophy of normal genital structures
“Cigarette Paper” skin (thin, white, crinkled)

A

Lichen Sclerosus

106
Q

Diagnosis of Lichen Sclerosus

A

Can be clinical

Punch biopsy is recommended for definitive diagnosis

107
Q

Lichen Sclerosus can lead to

A

Vulvar Squamous Cell Carcinoma

108
Q

Treatment of Lichen Sclerosus

A

High potency topical corticosteroids
Clobetasol is ultrapotent & first-line

It is not known whether corticosteroids can prevent scarring and squamous cell carcinoma

If you apply more than once daily, you increase adverse effects, including skin atrophy, discoloration, striae

109
Q

Fixed Mass
Skin or Nipple retraction
Calcification on mammography
Ultrasonography demonstrates hyperechoic mass

Biopsy shows fat globules & foamy histiocytes

A

Fat necrosis

Often mass is excised due to concerning findings of calcifications on mammography in constellation with fixed irregular mass on physical exam

After excision, routine annual screening for breast cancer may resume normally.

110
Q

Treatment of asymptomatic bartholin cyst

A

Observation

It may resolve on its own

111
Q

Treatment of symptomatic bartholin cyst

A

Incision & Drainage

Placement of Word catheter

112
Q

Hallmarks of Endometriosis

A

Dysmenorrhea
Dysparunia
Dyschezia

Also pelvic pain & infertility

113
Q

First-line empiric treatment for endometriosis

A 
NSAIDs
Combined OCPs (suppression of ovulation may result in atrophy of endometriomas)

Laparoscopic evaluation for those who fail conservative treatment or have adnexal masses or infertility

114
Q

Vaginal pain on insertion
No dysmenorrhea
No dyschezia

A

Vaginismus (involuntary contraction of vaginal musculature interfering with sexual intercourse)

Try vaginal dilators

115
Q

Pathophys of Hypogonadotropic Hypogonadism

A

Excessive stress, weight loss or chronic illness leads to decrease in amplitude & frequency of GnRH pulses.
Pituitary LH & FSH production decreases
Ovarian estrogen production decreases
Ovulation doesn’t occur
Oligomenorrhea/amenorrhea & infertility ensue

Physical exam is typically normal (maybe low BMI)

116
Q

Treatment of hypogonadotropic hypogonadism

A

Management of underlying cause

Reduce stress, gain weight, manage illness

117
Q

At what Tanner Stage should menses be expected?

A

4

118
Q

Premenarchal patients age < 15 with normal breast & pubic hair development require what evaluation?

A

None until they reach 15 and nothing has changed!

119
Q

Preferred diagnostic modality for suspected gynecological tumors

A

Ultrasound

120
Q

Phyllodes Tumor

A

Rare breast mass

Unilateral
Smooth
Painless
Mobile firm breast lump of variable size

121
Q 
Female Phenotype
Normal Ovaries
Abnormal Vagina (short)
Absent Uterus
A

Mullerian Agenesis

aka Mayer-Rokitansky-Kuster-Hauser Syndrome

122
Q 
46 XY Genotype
Male internal genitalia
Female (or undermasculinized) external genitalia
Experience masculinization at puberty
Lack breast development
A

5-Alpha-Reductase Deficiency

Can’t convert Testosterone to Dihydrotestosterone (DHT)

123
Q 
46 XY Genotype
External Female Genitalia
Minimal-to-Absent Body Hair
Breast Development
Cryptorchid gonads
A

Complete Androgen Insensitivity Syndrome

Peripheral tissues unresponsive to androgen
Testosterone is aromatized to estrogen, patient develops phenotypically female, with cryptorchid testes

Orchiectomy after puberty

124
Q

Why do we wait until after puberty to remove cryptorchid gonads from patients with Androgen Insensitivity Syndrome?

A

Risk of Dysgerminoma or Gonadoblastoma is 1 - 5% AFTER puberty.

Risk of malignancy before puberty is outweighed by benefits of gonad-stimulated puberty (attaining adult height)

125
Q

Which type of breast cancer do BCRA2 carriers tend to have?

A

Estrogen Receptor (+)

126
Q

Patient with breast cancer wants contraceptives. What do you give her?

A

Copper IUD

Pregnancy is contraindicated in breast cancer patients
So is hormonal birth control

127
Q

Fever
Hypotension
Diffuse maculopapular rash including palms and soles
Desquamation 1 - 3 weeks after disease onset
Vomiting/Diarrhea
AMS w/o focal neuological signs

A

Toxic Shock Syndrome

Staph Aureus or GAS
Exotoxin release acting as superantigens

Remove foreign body, give fluids & MRSA coverage

128
Q

At what age does Pap testing begin in immunocompetent patients?

A

21 years old, regardless of age of coitarche

129
Q

Dysmenorrhea
Heavy Menstrual Bleeding
Starts later in reproductive years
Progresses to chronic pelvic pain

Boggy, tender, uniformly enlarged uterus

A

Adenomyosis

Endometrial glands are trapped within myometrium
Typically multiparous women > 40

130
Q

Athlete’s Triad of Hypothalamic Amenorrhea

A

Amenorrhea
Osteoporosis
Eating Disorder

131
Q

Hypothalamic Amenorrhea

A

Relative caloric deficiency 2/2 inadequate intake compared to energy expended.

GnRH, FSH/LH & Estrogen are all low

These women are at risk for estrogen deficiency conditions:
Infertility
Vaginal Atrophy
Breast Atrophy
Decreased bone mineral density (Stress Fractures)

132
Q

Primary Ovarian Insufficiency is associated with

A

Concomitant Autoimmune Disorder

OR

Turner Syndrome

133
Q

When do you look at a CA-125?

A

When pelvic ultrasonography reveals an ovarian mass in a postmenopausal patient, and you would like to classify it as malignant or benign.

134
Q

Ovarian mass in a postmenopausal patient
Ultrasound shows simple cyst
CA-125 is normal

A

Observe

135
Q

Ovarian mass in a postmenopausal patient

Ultrasound shows large size, septations or solid components

A

Undergo further imaging (MRI/CT) to assess extent of disease

136
Q

Ovarian mass in a postmenopausal patient

CA-125 is elevated

A

Undergo further imaging (MRI/CT) to assess extent of disease

137
Q

Recurrent oral aphthous ulcers (painful)
Systemic Manifestations
Genital Ulcers (Painful)

A

Behcet Syndrome

Thought to be a vasculitis

138
Q

Multiple deep ulcers (Painful)
Base has grey-to-yellow exudate
Organisms clump in long parallel strands (“School of Fish”)

A

Chancroid

H. Ducreyi

139
Q

Multiple small grouped ulcers (Painful)
Shallow w/ erythematous base
Multinucleated giant cells & Intranuclear inclusions (Cowdry Type A)

A

Herpes Simplex 1/2

140
Q

Extensive & progressive ulcerative lesions (Painless) without lymphadenopathy
Base may have granulation-like tissue
Deeply staining gram-negative introcytoplasmic cysts (Donovan bodies)

A

Granuloma Inguinale (Donovanosis)

Klebsiella Granulomatis

141
Q

Single, indurated, well-circumscribed ulcer (Painless)
Clean base
Bilateral inguinal lymphadenopathy
Thin, delicate, corkscrew-shaped organisms on darkfield microscopy

A

Syphilis

Treponema Pallidum

142
Q

Small & shallow ulcers (Painless)
Large, painful, coalesced inguinal lymph nodes (“Buboes”)
Intracytoplasmic inclusion bodies in epithelial cells & leukocytes

A

Lymphogranuloma Venereum

Chlamydia Trachomatis

143
Q

Most common cancer in the vagina

A

Metastatic direct spread from cervix, vulva, or endometrium

144
Q

Type of cancer in primary vaginal cancer

A

Squamous Cell Carcinoma (commonly upper 1/3)

Diagnose: Biopsy
Symptoms: Bleeding, malodorous vaginal discharge
Risk factors: Smoking, HPV

145
Q

Evaluation of refractory endometriosis

A

Laparoscopy

146
Q

Definition of Menopause

A

Absent menses for 12 months

147
Q

Management of uncomplicated ovarian cyst rupture with no fever, hypotension, tachycardia or signs of hemoperitoneum/infection

A

Outpatient analgesics

148
Q

Patient presents for infertility & endometriosis is diagnosed. How do we improve her fertility?

A

Surgical resection of endometriomas

149
Q

When was DES widely used?

A

1938 - 1971

It’s a synthetic estrogen given for prevention of Spontaneous Abortion, Premature Delivery & Postpartum Lactation Suppression

150
Q

Effects of in-utero exposure to DES

A

Women are at risk of:
Clear Cell Adenocarcinoma of vagina & cervix (40-fold risk increase)

Men are at risk of:
Cryptorchidism
Microphallus
Hypospadias
Testicular hypoplasia
151
Q

Irregular polypoid mass on anterior vaginal wall

A

Clear Cell Adenocarcinoma of the Vagina & Cervix

Think DES exposure in-utero

152
Q

When do we stop Pap testing?

A

Age 65 or Hysterectomy

PLUS

No history of CIN2 or higher

AND

3 consecutive negative Pap tests OR 2 consecutive co-testing results

153
Q

What malignancy are PCOS patients most likely to develop?

A

Endometrial

Chronic anovulatory cycles lead to decreased progesterone secretion (no corpus luteum), and overproliferation of endometrium

Treat with cyclic progesterone, combined OCPs or progesterone IUD to reduce cancer risk

154
Q

What syndrome are adrenocortical malignancies associated with?

A

Li-Fraumeni

155
Q

Malodorous, thin white vaginal discharge

In absence of inflammation

A

Bacterial Vaginosis

Amine odor on KOH whiff test
Clue Cells on microscopy

Treat with metronidazole or clinda

156
Q

What causes anovulation in PCOS?

A

High estrone (increased peripheral conversion & decreased sex hormone binding globulin) provides negative feedback to the hypothalamus, so GnRH is not released.

FSH is low, so follicle doesn’t mature
LH is low, so follicle doesn’t release

157
Q

Gonadotropin levels in Primary Ovarian Insufficiency

A

GnRH is elevated
FSH is elevated
Estrogen is low

Failure is at the level of the ovaries, so the rest of the pathway is trying to rev them up.

158
Q

Origin site of Epithelial Ovarian Carcinoma

A

Ovary
Fallopian Tube
Peritoneum

Can start with any of these! Metastasizes all over abdomen regardless of primary origin.

159
Q

Definition of preeclampsia

A

New-onset hypertension
And/or
Signs of end-organ damage at >= 20 weeks gestation

Mistakes (8 decks)

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