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MTB (3) 1 Flashcards

1
Q

What are cervical cultures in PID

A

Negative

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2
Q

WHat does sonogram show for PID

A

BL cystic pelvic masses

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3
Q

Management of Chronic PID

A

Lysis of tubal adhesions

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4
Q

Presentation of Tuboovarian Abscess (TOA)

A

Ill-appearing woman
Severe, lower abdominal pelvic pain
Back pain, Rectal pain
Systemic Si’s - N/V, fever, tachy

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5
Q

Labs for Tuboovarian Abscess

A

WBC and ESR = high

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6
Q

Tuboovarian Abscess sonogram

A

Unilateral pelvic mass

Pus on culdocentesis

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7
Q

What is a culdocentesis

A

Fluid extraction from rectouterine pouch posterior to vagina via needle

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8
Q

Management for Tuboovarian Abscess

A
  1. Admit to hospital
  2. IV Clindamycin and IV genta micin
  3. If no response or rupture -> Exploratory lapartomy
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9
Q

Primary Dysmenorrhea Presentation

A

Recurrent, crampy, lower abdominal pain
N/V/D during menstruation
Sx’s begin 2.5 yrs after menstruation

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10
Q

Pathophysiology of Primary Dysmenorrhea

A

Excessive endometrial PGF2 - causes uterine CTX adn acts on GI smooth muscle

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11
Q

Management for Primary Dysmenorrhea

A

NSAIDS

OCPs (combination)

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12
Q

MCC of Secondary Dysmenorrhea

A

Endometriosis
Adenomyosis
Leiomyoma

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13
Q

What is primary amenorrhea

A

Absence of menses age 14 w/out secondary sexual development

Or age 16 WITH secondary sexual development

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14
Q

WU for primary amenorrhea

A
  1. PE and US
    - Breasts present or absent? Estrogen production
    - Uterus present or absent?
  2. Karyotype, testosterone, FSH
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15
Q

What is mullerian agenesis

A

Normal female secondary sexual traits
Normal estrogen/testosterone
Absence of Mullerian duct derivatives -fallopian tubes, uterus, cervix, upper vagina

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16
Q

Management of mullerian agenesis

A

Reconstructive surgery to elongate vagina for sexual intercourse

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17
Q

WU for primary amenorrhea w breasts absent

A

FSH and Karyotype

18
Q

Androgen Insensitivity Presentation

US

A

No pubic or axillary hair
Male genotype
US - testes produce normal estrogen (F) and testosterone (M) levels

19
Q

Management for Androgen Insensitivity

A

Remove testes before 20
Risk of testicular cancer
Estrogen replacement

20
Q

Turner syndrome Karyotype
Presentation
Labs

A

45, XO
Absent secondary sexual traits
Streak gonads
High FSH

21
Q

Management of Turner’s

A

Estrogen and progesterone replacement for development of secondary sexual characteristics

22
Q

Hypothalamic-Pituitary Failure
Presentation
Labs

A

No sexual characteristics
Normal uterus on US
FSH LOW

23
Q

Kallman syndrome

A

Hypothalamic - pituitary failure + Anosmia

Hypothalamus not producing GnRH

24
Q

Tx for Hypothalamic-Pituitary Failure

A

Estrogen and progesterone replacement for development of secondary sexual characteristics

25
Q

What is secondary amenorrhea

A

Regular menses replaced with absence of menses - 3 months
OR
Irregular menses replaced by absence of menses - 6 months

26
Q

WU of secondary amenorrhea

A
  1. B-hCG
  2. TSH to R/O hypothyroid (Hi TRH = Hi PRL)
  3. PRL - meds, AP’s = anti-Da = Hi PRL
    - CT/MRI r/o tumor
  4. Progesterone Challenge
  5. Estrogen Challenge
27
Q

Pituitary tumor

A

CT/MRI

  • tumor < 1cm = Bromocriptine
  • Tumor > 1cm = Surgery
28
Q

What does withdrawl bleeding in progesterone challenge test mean?

A

Anovulation

29
Q

What cancer are PCOS pts at risk for and why?

A

Endometrial cancer

Unopposed estrogen b/c no corpus luteum to make progesterone

30
Q

Testosterone level in PCOS

A

Increased total and free = mildly elevated
- Increased LH - increased theca cell production of androgens - hepatic production of SHBG suppressed =increased testosterone

31
Q

Tx for PCOS

A
  1. OCPs - irregular bleeding, hirsutism
  2. Spironolactone - suppresses hair follicles
  3. Clomiphene citrate - infertility
  4. Metformin- ovulation/insulin resistance
32
Q

Rapid onset hirsutism + virilization + NO FHX

A

Adrenal/ovarian tumor

33
Q

How to differentiate adrenal and ovarian tumor

A 
Adrenal = High DHEAS
Ovarian = High testoserone
34
Q

Next step in management adrenal/ovarian tumor after labs

A

US - adnexal mass

CT - adrenal mass

35
Q

CAH - 21-OH deficiency Presentation

A 
Gradual onset hirsutism + NO Virilization
2nd or 3rd decade
Menstrual irregularities
Anovulation
Precocious puberty + short stature
36
Q

Labs in CAH - 21-OH deficiency

TX

A

Elevated serum 17-hydroxyprogesterone

Corticosteroid replacement

37
Q

What is the T score in osteoporosis

38
Q

MOA of bisphosphonates

A

Inhibit osteoclastic activity

39
Q

Benefits of HRT

A

Decrease osteoporotic Fx

Decrease rate of colorectal cancer

40
Q

Risks of HRT

A

Increased risk of
DVT
MI
Breast cancer if tx > 4yrs

41
Q

Next step if pt unable to conceive, semen analysis is low

A

Repeat in 4-6 wks

42
Q

Infertility WU

A
  1. Semen analysis
  2. Anovulation WU
  3. Fallopian tube abnormalities

Gyn (3 decks)

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