Lady Bits Flashcards
What causes stress incontinence in a nulliparous woman?
Leiomyomata uteri (mass effect)
Indications for endometrial biopsy >= 45 yo
AUB
Post-menopausal bleeding
Indications for endometrial biopsy < 45 yo
AUB +
Unopposed estrogen (Obesity, anovulation) Failed medical management Lynch Syndrome (HNPCC)
Indications for endometrial biopsy >= 35 yo
Atypical glandular cells on pap test
Initial workup for AUB in premenopausal women
Endocrine Evaluation (TSH, Prolactin) Pelvic Ultrasound Possible endometrial biopsy
Endometrial stripe of <=4mm
Rules out endometrial cancer in postmenopausal women
Can’t reliably rule it out in premenopausal
Irregularly-enlarged uterus
Prolonged menstrual bleeding
Labor-like pain
Prolapsing leiomyoma uteri/Aborting submucous myoma
What causes cramping during the first few days of menses?
Prostaglandin release from sloughing endometrium causes uterine contractions
What distinguishes primary dysmenorrhea from secondary?
A normal physical exam
Treatment for primary dysmenorrhea
NSAIDs (1st Line)
They work as prostaglandin synthetase inhibitors
Hormonal contraception works well too
Most patients respond to these interventions within 3 months
Bulky globular tender uterus
Usually in women >35
Adenomyosis
Tenderness along uterosacral ligaments
Nodularity in the cul-de-sac
Adnexal enlargement
Pain precedes menses by a few days
Endometriosis
Virus Strains leading to Condylomata Acuminata
HPV 6 & 11
Clinical features of Condylomata Acuminata
Multiple pink or skin-colored lesions
Lesions range from smooth, flattened papules to exophytic/cauliflower-like growths
Treatment for Condylomata Acuminata
Chemical (Podophyllin resin, tricholoracetic acid)
Immunologic (Imiquimod)
Surgical (Cryotherapy, laser therapy, excision)
Prevention for Condylomata Acuminata
Vaccination
Barrier contraception
Virus Strains leading to high grade CIN & Cervical Cancer
HPV 16 & 18
Genital Lichen Planus
Pruritic, glassy, bright red erosions & ulcerations
Affects vulva & vagina
Lichen Sclerosus
Pruritic, white, thin wrinkled skin over labia
Molluscum Contagiosum
Caused by a poxvirus
Single or multiple small pearly painless nodules
Central dimples or pits
Do not bleed on contact
Trastuzumab
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
Side effect of Cisplatin and Carboplatin
Ototoxicity
Peripheral neuropathy
Precede administration with baseline audiometry testing
Side effect of Anastrozole and Letrozole
Osteoporosis
Precede administration with baseline bone marrow biopsy only if administering with antimetabolite chemotherapy (5FU or MTX)
Side effect of Bleomycin
Pulmonary fibrosis
Precede administration with baseline PFTs, follow them serially throughout treatment.