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Gyn > MTB 1 > Flashcards

MTB 1 Flashcards

1
Q

What are PMS and PMDD - Presentation and difference

A

Premenstrual syndrome/dysphoric disorder

  • Women 20’s-30’s
  • Sx’s: HA, breast tenderness, pelvic pain, bloating
  • lack of energy, irritable
  • PMDD more severe - disrupts pt’s daily activities
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2
Q

Testing for PMS and PMDD

A

Menstrual diary

  • Sx’s for 2 consecutive cycles
  • Sx free in follicular phase (1st week)
  • Sx’s present in luteal phase
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3
Q

Tx for PMS and PMDD

A

Decrease caffeine, alcohol, cigs, chocolate

Severe - SSRI

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4
Q

What is Mittelschmerz and how does it present

A

Midcycyle pain
Women w regular menstrual cycle
Not on OCPs
Lateralizes to overy that produces mature ovum - unilateral pain

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5
Q

When does Mittelschmerz occur

A

2 weeks after start

At time of ovulation

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6
Q

Menopause lab levels

A

Increased FSH

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7
Q

TX for menopause

A

HRT = short term sx relief and osteoporosis prevention

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8
Q

CI to HRT

A

Estrogen dependent carcinoma

Hx of DVT or PE

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9
Q

What are the Estrogen dependent carcinomas

A

Breast

Endometrial

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10
Q

HRT can lead to what type of carcinoma

A

Endometrial

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11
Q

What conditions do we see menorrhagia

A

Endometrial hyperplasia
Uterine fibroids
DUB
IUD

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12
Q

What is menorrhagia

A

Heavy and prolonged menstrual bleeding

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13
Q

What is metorrhagia

A

Intermenstrual bleeding

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14
Q

When do we see metorrhagia

A

Endometrial polyps
Endometrial/cervical cancer
Exogenous estrogen administration

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15
Q

What is menometrorrhagia

A

Irregular bleeding

  • time intervals
  • duration
  • amount
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16
Q

Causes of menometrorrhagia

A

Endometrial polyps
Endometrial/cervical cancer
Exogenous estrogen administration
Malignant tumors

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17
Q

What is dysfunctional uterine bleeding (DUB)

A

Unexplained abnormal bleeding
Pts that are anovulatory
Ovary makes estrogen, but no corpus luteum to make progesterone
Continuous high estrogen

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18
Q

Test for DUB

A

R/O anovulation causes = hypothyroid, hyperPRL

EMB for women > 35

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19
Q

TX for EMB

A

OCPs

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20
Q

OCPs reduce risk for what

A

Endometrial cancer
Ovarian cancer
Ectopic pregnancy

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21
Q

What are types of emergency contraception

A

Copper IUD - place within 5 days

Hormonal contraceptive pills

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22
Q

What complication is ass’d with IUD

A

PID

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23
Q

What causes labial fusion

A

Excess androgens

24
Q

MCC of labial fusion

A

21-B hydroxylase deficiency

25
Q

What is Lichen sclerosis?

A

White, thin skin from labia to perianal area

Chronic inflamm condition in anogenital region

26
Q

Presentation of Lichen sclerosis?

A

Pruritis
dyspareunia
dysurai
painful defacation

27
Q

What does lichen sclerosis look like on PE

A

Porcelin white

Polygonal macules and patches w atrophic cigarette paper quality

28
Q

Dx and tx of lichen sclerosis

A

Punch Bx to r/o cancer

Steroids

29
Q

Cancer risk with lichen sclerosis

A

Post menopausal women have increased risk of cancer

Premalignant Vulvar SQCC

30
Q

Lichen Planus Presentation and tx

A

30’s-60’s
Violet, flat papules
Tx steroids

31
Q

Bartholin gland cyst location and presentation

A 
Lateral sides of vulva - secrete mucus, become obstructed
Pain
Tenderness
Dyspareunia
PE: edema and deep fluctuant mass
32
Q

Tx of Bartholin gland cyst

A

I&D

Culture fluid

33
Q

What is normal vaginal pH

A

Below 4.5 (Lactobacillus maintains)

34
Q 
Bacterial vaginosis
Pathogen
Sx
DX
TX
A

Gardnerella
Fishy odor, gray white d/c, NO inflammation
KOH = clue cells
Metronidazole or clindamycin

35
Q

Candidiasis
Sx
DX
TX

A

White, cheesy vaginal D/c
KOH = pseudohyphae
Miconazole, clotrimazole, econazole, nystatin

36
Q

Trichomonas
Sx
DX
TX

A

Profuse, green, frothy d/c, inflammation, pruritis
KOH = motile flagellates
Metronidazole + partner
pH 5-6

37
Q

Paget disease Presentation

A

Postmenopausal Caucasian women

Vulvar soreness and pruritus = red lesion w superficial white coating

38
Q

Dx and TX for Paget Dz

A

Bx

Radical vulvectomy

39
Q

What is adenomyosis

A

Invasion of endometrial glands into myometrium

40
Q

Presentation of adenomyosis

A

35-50
Dysmenorrhea and Menorrhagia
PE: Uterus that is large, boggy, globular

41
Q

Risk factors for adenomyosis

A

Endometriosis

Uterine Fibroids

42
Q

Test for adenomyosis

A

Most accurate is MRI

43
Q

Tx for adenomyosis

A

Hysterectomy

44
Q

What is endometriosis

A

Implantation of endometrial tissue outside uterus (endometrial cavity)
MC location = ovary and pelvic peritoneum

45
Q

Presentation for endometriosis

A 
Women of reproductive age
Dysmenorrhea = Abnormal bleeding
Dyspareunia 
Dyschezia
Infertility
46
Q

what does endometriosis look like on direct visualization and on PE?

A

Rusty or dark brown lesions
“Chocolate cyst” = ovary cluster of lesions
PE: nodular uterus and adnexal mass

47
Q

Tx for endometriosis

A

Analgesia
OCPs or continuous progesterone
Moderate - severe: Danazol or Leuprolide
- decrease FSH and LH

48
Q

Leuprolide continuous or pulsatile suppresses estrogen?

A

Continuous

49
Q

PCOS Dx test

A

Pelvic US = BL enlarged ovaries w multiple cysts

50
Q

PCOS labs

A

Testosterone (free) = High
Androgens = High
Estrogen = High
LH: FSH > 3:1

51
Q

Tx for PCOS

A

Wt loss
OCPs
Clomiphene
Metformin

52
Q

Premature Ovarian Failure Presentation

A 
Women < 40yoa w Primary hypogonadism
Amenorrhea
Hot flashes
Vagina/breast atrophy
Anxiety
Depression, Irritability
53
Q

Causes of Premature Ovarian Failure

A 
Chemo
Radiation
AI 
Turners
Fragile X
54
Q

Pathophys of Premature Ovarian Failure

A

Impaired follicular development causes decreased estrogen = loss of feedback inhibition causes
HIGH FSH and LH
FSH>LH

55
Q

Dx for Premature Ovarian Failure

A

Preg test

PRL and FSH levels

56
Q

When does endometriosis occur in relation to menses?

A

Cyclical pain starts 1-2 wks before menses and ends w menses
Peaks 1-2 days before menses

57
Q

MC site for endometriosis? Second?

A

MC - Ovary

2nd - cul-de-sac = uterosacral ligament nodularity,

Gyn (3 decks)

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