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Gyn > MTB (3) 2 > Flashcards

MTB (3) 2 Flashcards

1
Q

MCC of nipple discharge

A

Intraductal Papilloma

- Bloody

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2
Q

Workup discharge that is what?

A

Unilateral
Spontaneous
Bloody
Ass’d with a mass

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3
Q

Workup for Intraductal Papilloma

A

Mammogram

Surgical duct excision

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4
Q

When do we do cytology for nipple discharge

A

Never

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5
Q

Workup for BL, milky nipple discharge?

A

Prolactinoma

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6
Q

How does fibrocystic dz of breast present

A

BL
Painful Breast lumps
Pain varies w menstrual cycle
Simple cyst with sharp margins, collapses on FNA

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7
Q

Tx for fibrocystic dz

A

OCPs

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8
Q

Presentation of fibroadenoma

A

Discrete, firm, nontender, highly mobile breast nodule

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9
Q

FNA of fibroadenoma

A

Epithelial stromal elements

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10
Q

Workup for pt with breast mass

A

Breast exam
US or Mammography
FNA Bx

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11
Q

First step in workup of a palpable mass that feels cystic

A

US

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12
Q

Invasive Ductal carcinoma

A

> 2cm

HER2 = prognostic factor

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13
Q

How to check for HER2 expression

A

FISH

IHC

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14
Q

Tamoxifen increases risk of what

A

Endometrial cancer

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15
Q

Tamoxifen benefits

A

Decrease serum cholesterol, CV risk
increased bone density = decreased Fx
d

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16
Q

Causes of enlarged uterus

A

Pregnancy
Leiomyoma
Adenomyosis

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17
Q

Leiomyoma Presentation

A 
Smooth muscle growth of myometrium
AA female
Childbearing age
Secondary dysmenorrhea and menorrhagia
\+/- sx's of rectal, ureter or bladder compression
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18
Q

Workup for Ovarian mass

A

B-HCG
US
Laparoscopy/Laparotomy if complex of > 7 cm

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19
Q

Leiomyoma on pelvic exam

A

Enlarged
firm
asymmetric
NONtender uterus

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20
Q

What is the difference b/t leiomyoma and adenomyosis

A

Leio - Asymmetrically enlarged and NON tender

Adeno - Symmetric and tender

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21
Q

How do simple ovarian cysts present

A

Asymptomatic unless torsion

22
Q

Dx test for simple cyst

A

US shows fluid-filled simple cyst

23
Q

Management of simple cyst

A

F/U in 6-8 weeks + steroid contraception for PPX

Laparoscopic removal if > 7 cm or steroid did not prevent

24
Q

What seizure medication is ass’d w PCOS

A

Valproic acid

25
Q

Postmenopausal woman with severe hirsutism and virilization

A

Ovarian hyperthecosis - nests of luteinized theca cells in ovarian troma
High levels of androgens

26
Q

Management of ovarian hyperthecosis

A

OCPs (both E and P) = suppress androgens by lowering LH of theca cells
Decrease free androgens = stimulate SHBG

27
Q

How does a luteoma of pregnancy present

A

Incidental finding on c-section or postpartum tubal ligation

Fetal and maternal hirsutism and virilization

28
Q

Theca Lutein cysts - what are they?
Labs?
In whom?

A

Benign neoplasms
High FSH and B-hCG
Twins/molar pregnancies

29
Q

Theca Lutein cysts Management

A

Spontaneously regress

30
Q

Postmenopausal woman w abdominal distension, ovarian mass - first step?

A

CT to assess mass and confirm ascites (peritoneal seeding)

31
Q

If ascites present w ovarian mass postmenopausal woman, next step?

A

Laparotomy, oophorectomy, surgical staging

32
Q

9 yo girl with R adnexal pain and complex cystic mass on US?

A

Germ cell tumor

MC malignant - dysgerminoma

33
Q

Germ cell tumor markers

A

LDH
B-hCG
a-FP

34
Q

67 yo woman w progressive wt loss, distended abdomen, and L adnexal mass

A

EPithelial tumor = MC ovarian cancer in postmenopausal women

MC malignant = serous

35
Q

Tumor markers for Epithelial tumor of ovarian cancer

A

CA-125

CEA

36
Q

58 yo w postmenopausal bleeding. EMB - endometrial hyperplasia. Pelvic US shows R ovarian mass

A

Granulosa-theca stromal tumor

Secretes estrogen causing causing endometrial hyperplasia

37
Q

48 yo c/o increased facial hair and deepening of voice. Adnexal mass on exam

A

Sertoli-Leydig cell stromal tumor

Secretes testosterone

38
Q

64 yo presents w hx of gastric ulcer, recent worsening dyspepsia, wt loss, abd pain. Adnexal mass is found

A

Mets gastric cancer

Krukenberg tumor

39
Q

Tumor marker for krukenberg

A

Mucin producing tumor from stomach

40
Q

TX for ovarian masses

A 
Sonogram/CT = postmenopausal
Bx via laparoscopy for simple cysts
Tumor markers
Cystectomy - benign
Premenstrual - Salpinoophorectomy (SO)
Postmenopausal - TAH, BSO, post op chemo
41
Q

What is workup for pt with ASCUS

A

Do HPV testing:
Negative -> Repeat pap 6 mos
Positive -> Colposcopy

42
Q

What imaging study is done for cervical cancer

A

None. Only gyn cancer that is not staged clinically

43
Q

What is management for invasive cervical cancer

A

Simple hysterectomy

Modified radical hysterectomy

44
Q

WU for pregnant patient and abnormal pap?

A

Same as non-pregnant

Except endocervical curettage

45
Q

WHo gets HPV vaccine

A

All females 8-26

Men 11-22

46
Q

DDx for Pelvic pain

A

Cervicitis
Acute salpingoophoritis
Chronic PID
Tuboovarian abscess

47
Q

WU for Pelvic pain

A
  1. Pelvic Exam
  2. Cervical Culture
  3. Labs: ESR, WBC
  4. Sonogram
48
Q

Pt c/o cervical motion tenderness + lower pelvic pain after menstruation

A

Acute Salpingoophoritis

49
Q

Labs for Acute Salpingoophoritis

A

Positive cultures

High ESR and WBC

50
Q

Tx for Acute Salpingoophoritis

A

ABX

Gyn (3 decks)

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