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Gynecology and obstetrics > NAGY GYN > Flashcards

NAGY GYN Flashcards

1
Q

Symptoms and diagnosis of ectopic Pregnancy

A

Symptoms:
- Signs of pregnancy (PPP)
- Irregular bleeding
- Abdominal pain
-Peritoneal signs

Diagnosis:
- hCG: doubles every day in pregnancy, does not in ectopic pregnancy (still increased)
- US

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2
Q

Symptoms of endometriosis

A

Symptoms:
- Dysmenorrhea
- Abdominal pain
- Problems with defacation
-Dyspareunia (painful intercourse)

Diagnosis:
- US
- Laparascopic visualization and removal!! (DX and TX?)

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3
Q

Uterine fibroids

A

Types:
- Intramural
- Submucosal
- Subserosal
- Broad ligamental fibroids (?)

Treatment:
- Individual factors are important, can be removed by laparoscopy, but hysterectomy is the only complete treatment

Complications:
- Problems with conception
- Infertility
- Can become very large

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4
Q

Bacterial vaginosis: etiology, symptoms, diagnosis, treatment

A

Etiology: Gardenella or another anaerobic bacteria. NOT an STD

Symptoms:
- Vaginal discharge
- Foul smell
- Dyspareunia

Diagnosis:
- KOH prep(potassium hydroxide), see clue cells

Treatment: Metronidazole

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5
Q

External female genitalia parts

A

Vulva:
- Labia minora and majora
- Clitoris
- Bartholin glands
- Perineum
- Fourchette

(Internal and external border: hymen)

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6
Q

Causes of primary amenorrhea

A
  • Müllerian agenesis
  • Androgen insensitivity syndrome
  • Primary hypogonadism; Turner syndrome
  • Secondary hypogonadism: Kallman syndrome and pituitary tumor
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7
Q

A postmenopausal woman has thickened endometrium on US. What do you do next?

A

Dilation and curettage, and histology.

It is suspect for corporal/endometrial cancer

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8
Q

What is Stein-Leventhal syndrome? And the metabolic disorder associated with it?

A
  • Another name for PCOS
  • Associated with insuline resistance/DM
  • Diagnostic criteria: anovulation, hyperandrogenism, > 10 follicles
  • Lab: increased LH:FSH ratio (3:1)
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9
Q

What are some genital malformations?

A
  • Mullerian agenesis/Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome)
  • Bicornuate uterus
  • Septate uterus
  • Vaginal atresia
  • Imperforate hymen
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10
Q

How to differentiate btw. Bartholin cyst and abscess?

A

Abscess will be painful

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11
Q

Benefits and risks of hormone contraceptives

A

Benefits:
- Decreased incidence of ovarian and enometrial cancer
- Decreased bone loss
- Treats dysmenorrhea
- Treats acne
- Decreases risks of trisomies with increasing age

Risks:
- Thrombosis, DVT/stroke (especially with other diseases/postpartum)
- Increased BP
- Weigth gain (edema, not true anymore)
- Depression

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12
Q

Treatment of complete uterine prolapse

A

Vaginal hysterectomy

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13
Q

Barrier and chemical contraceptive - what barriers do we have?

A
  • Female and male condoms
  • Pessaries: Cervical cups, Diaphragm
  • Sponges
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14
Q

What endocrinological change occurs in puberty?

A

Before puberty, GnRH release is continous, when we reach reproductive age, it becomes pulsatile.
- It increases in frequency and amplitude from the hypothalamus, stimulating the anterior pituitary to release LH and FSH

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15
Q

Female sex development

A
  • External genitalia develop from genital and urogenital folds
    -Muellerian duct (paramesonephric) gives rise to the upper vagina, cervix, uterus and fallopian tubes
  • Absence of Y-chromosome leads to total regression of Wolffian duct (mesonephric)
  • Ovaries develop from germinal epithelium
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16
Q

How to confirm intersexuality

A

(Not 100% sure answer)
- Karyotyping (check chromosomes)
- Secondary sex characteristics
- Check internal gonads
- Mental/psychological is the last stage

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17
Q

Treatment of PID and complications

A

Empirical AB therapy
- Outpatient: one single IM dose of ceftriaxone + PO doxycycline, add metronidazole if signs of vaginitis
- Inpatient. IV cephalosporin (cefoxitin, cefotaxime) + doxycycline, if tuboovarian abscess, add metronidazole

(How long?)

Important to treat due to risk of complications:
- Fitz-Hugh-Curtis syndrome
- Tuboovarian abscess
- Infertility
- Ectopic pregnancy
- Chronic pelvic pain

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18
Q

Types of benign ovarian tumors

A

Epithelial
- Serous cystadenoma
- Mucinous cystadenoma
- Endometrioid

Gonadal stromal tumors
- Granulosa theca cell tumors
- Sertoli-Leydig cell tumors

Germ cell tumors
- Dysgermimoma
- Teratoma

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19
Q

Obstetric and gynecological evaluation in patient without complain

A
  • Bimanual examination
  • Pap smear
  • Breast exam
  • Speculum examination
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20
Q

How do diagnose stage 1 in corporal cancer?

A

Less or more than 50% of the myometrium? Diagnose with transvaginal-US, if more than 4 cm do dilation and curettage for biopsy.

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21
Q

Vulvodynia

A

Vulvar discomfort, most often descibed as burning pain, occuring in the absencse of relevant visible findings or a specific, identifiable neurological disorder.

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22
Q

Perimenopause diagnosis

A
  • Exclude pregnancy
  • FSH constantly increases
  • No follicles in ovaries on US
  • Vulvovaginal atrophy on physical exam
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23
Q

Classification of human sexuality

A

-Heterosexual
- Homosexual
- Bisexual
- Transsexual

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24
Q

What is Mayer-Rokitansky-Kuster-Hauser (MRKH syndrome)?

A

Mullerian agenesis

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25
Q

What is hydatidiform mole?

A
  • Snowstorm pattern on US
  • No fetus
    (- Abnormal growth of trophoblasts)
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26
Q

Endometrial (corporal) cancer screening

A

Only screen women with high risk by measuring endometrial thickness

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27
Q

How to check for fallopian stricture?

A

Hysterosalpingography (X-ray w/ dye in uterus to check openness and shape of fallopian tubes)

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28
Q

Difference between virulism and hirsutism

A
  • Hirsutism is a clinical presentation of virilization; the apperance of male secondary sex characteristics in a female
  • Hirsutism: dark hair on back, lip and chest.
  • Other symptoms of virilization: clitoromegaly, deep voice, male pattern hair loss, acne, increased muscle mass
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29
Q

What is radical vulvectomy?

A

Surgical removal of vulva and inguinofemoral lymph nodes

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30
Q

Screening of ovarian cancer

A
  • US : multilocular cysts, solid areas, metastases, ascites and bilateral lesions ( one point per)
  • Ca-125
  • HE4 (human epidydimis protein 4)
  • RMI: risk of malignancy index, if over 200 you should be suspiscious for malignancy. Based on:
    - US features
    - Menopausal status
    - Levels of Ca-125
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31
Q

Cause of pelvic pain

A
  • Dysmenorrhea
  • Endometriosis
  • PID
  • Ruptured ectopic pregnancy
  • Adnexal torsion
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32
Q

Possible locations of ectopic pregnancy

A
  • Fallopian tubes (ampulla)
  • Uterine horns
  • Cervix
  • Scar from prior C-section
  • Abdomen
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33
Q

Diagnosis of hydatidiform mole

A
  • b-HCG (very high)
  • Snowstorm or honeycomb (partial mole) pattern on US
  • Confirmation with biopsy
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34
Q

Histology of types of breast cancer

A
  • Ductal and lobular
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35
Q

Endometrial benign lesions that are not fibroids:

A
  • Adenomyosis
  • Endometrial polyps
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36
Q

Vulvar cancer treatment

A
  • VIN: local excision
  • Radical vulvectomy (+ inguinofemoral lymphadenectomy)
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37
Q

Symptoms of cervical cancer

A

Vaginal bleeding

38
Q

Cause of dysmenorrhea

A
  • Endometriosis
  • Idiopathic
39
Q

18 year old patient with primary amenorhea, 46XY, breast developed but no pubic hair. What is the diagnosis?

A

Genetically male - androgen insensitivity syndrome?

40
Q

Pearl index definition

A

Definition: number of unintended pregnancies in 100 women over 1 year of contraception use. Tells us about th efficacy of various contraceptive methods.

Condoms: 3-26 (depends on user knowledge)

It is much lower in OC than in condoms

41
Q

Diagnose a patient with:
Hirsutism, acne, obesity, amenorrhea, insuling resistance

A

Stein-Leventhal/PCOS

42
Q

If you see a single unicellular cyst on one ovary US, how would you treat it?

A
  • Watchful waiting is usually enough
  • Can be removed surgically if there is a risk for torsion or rupture
43
Q

How do you diagnose cervical cancer?

A

Pap smear

44
Q

Treatment of choriocarcinoma? Prognosis? 5 year survival rate?

A
  • Methotrexate
  • Good prognosis
  • 95% survival rate
45
Q

Conization in pregnant women?

A

??

46
Q

Basis of cancer therapy

A

Surgery, radiotherapy and chemotherapy, combination of all

47
Q

Types of breast cancer surgery

A
  • Lumpectomy
  • Quadrantectomy
  • Mastectomy
  • Radical mastectomy
48
Q

Treatment of infertility

A
  • Ovarian follicle stimulation
  • Retrieve egg via US guidance
  • Mix sperm and egg
  • Incubation
  • Transfer 2-5 embryos into uterus; preferably cleavage or blastocyst stage
  • Best to do on day 20-24 of menstrual cycle ??
49
Q

Stage 3 of cervical cancer

A

3A: Lower third of vagina is involved
3B: Whole parametrium infiltrated
Tx: Chemoirradiation

50
Q

Diagnosis of postmenopause

A

Consistently elevated FSH

51
Q

Treatment of cervical cancer

A

Depends on the stage

  • Transabdominal hysterectomy
  • Radical hysterectomy (uterus, cervix + parametrium and LNs)
  • Radical trachelectomy (fertility perserving, large part of cervix is removed and some lymph nodes)
  • Chemoirradiation, palliative chemo, RT or surgery
52
Q

Symptoms of perimenopause

A
  • Hot flashes
  • Night sweats
  • Mood swings
  • Vaginal dryness
  • Loss of libido
53
Q

What infections cause painless lymphadenopathy with genital lesions, and what causes painful lymphadenopathy?

A

Painless: syphilis ( painless ulcer and painless lymphadenopathy)
Painful: lymphogranuloma venerum

54
Q

Symptoms of genital herpes

A
  • Vesicles on genitals: painful, pruritus, discharge, dysuria,
  • Sometimes systematic symptoms: fever, malaise, lymphadenopaty
55
Q

Choricarcinoma follow up

A

b-HCG

56
Q

Secondary amenorrhea; what is the progestin test?

A
  • Give progestin, and then withdraw it
  • If there is withdrawal bleeding then the diagnosis is PCOS/Anovulation
  • If there is no bleeding, further diagnostic tests should be done
57
Q

Causes of secondary amenorrhea

A
  • Pregnancy (Normal)
  • Menopause (Normal)
  • Lactation (Normal)
  • Hypothyroidism
  • Drugs (antidopaminergic)
  • Pituitary tumors
58
Q

Treatment of ectopic pregnancy

A
  • Laparascopy
  • Salpingostomy
  • Salpingectomy
59
Q

What does a functional ovarian cyst look like?

A
  • Look: Unilateral, uniloculated, simple cell inside, no papillary protrusion into the cyst
  • Types: follicular, corpus luteum, theca-lutein cyst
60
Q

How to differentiate malginant from benign ovarian cysts?

A
  • MRI
  • US
  • Ca-125
  • Biopsy
61
Q

Dysfunctional uterine bleeding in a 42 year old woman. What do you do?

A

D&C

62
Q

40 year old woman with dysmenorrhea. What do you do?

A

D&C

63
Q

Types of endometrial hyperplasia?

A
  • Simple typical: increase in glands but normal glandular structure
  • Complex typical: crowded irregular glands
  • Simple atypical: simple hyperplasia with presence of atypical cells
  • Complex atypical: complex hyperplasia with presence of atypical cells. Highest malignant potential (30%)
64
Q

What are the stages of cervical cancer? At what stage is it observable?

A

1: Confined to Cervix
- 1A: microscopically visible (Tx; TAH)
- 1B: macroscopically visible (Tx; TAH + pelvic LND)
2: Invades beyond uterus, to upper vagina and perimetrium, but not beyond pelvic wall (Tx; TAH + pelvic LNDs)
3: Invades lower 1/3 of vagina (3A) or pelvic wall (3B)
4. Invades bladder/rectum or distant metastasis (Tx: palliative chemo, RT, surgery)

65
Q

What are the changes seen in puberty?

A
  • Accelerated growth
  • Development of secondary sexual characteristics, axillary hair growth,
  • Tanner stages for pubic hair growth and breast enlargement

Stages of development:
- Gonadarche (acrivation of gonads)
- Adrenarche (increase in androgen production)
- Thelarche (apperance of breast tissue)
- Menarche (first menstrual bleed, non ovulatory)
- Spermache (first sperm production, nocturnal sperm emissions)
- Pubarche (apperance of pubic hair, axillary hair, odor and acne)

66
Q

How often do you screen for infections``

A

?==

67
Q

Common STDs?

A

Chlamydia, gonorrhea, syphilis, genital herpes (HSV-2), genital warts (HPV)

68
Q

What is the equivalent of prostate in a female?

A

Upper 1/3 of vagina, consist of glands and smooth muscle

69
Q

Case: woman with no menses for 7 weeks, after uterine examination you dont find any intrauterine pregnancy. What do you do?

A
  • Measure b-HCG, if not doubeling every day it is an indication of ectopic pregnancy
  • Laparoscopy is the therapy
70
Q

What is enterocele?

A

Small bowel prolapse.

Occurs when the small intestine (small bowel) descends into the lower pelvic cavity and pushes at the top part of the vagina, creating a bulge. Due to wall weakness.

71
Q

Benign lesions of the vulva

A
  • Lichen Sclerosus (post-menopausal)
  • Lichen Simplex Chronicus
72
Q

Treatment of syphilis

A

2,4 mill units of Penicillin G

73
Q

Radical mastectomy

A

Removal of the whole breast + axillary lymph node dissection

74
Q

At what stage of cervical cancer can you see it with your naked eye?

A

1a2

75
Q

When to begin evaluation of primary amernorrhea?

A

Usually wait until 18 nowadays. (Nagy)

Textbook answer:
Age 16
2 years after onset of puberty
14 if no puberty

76
Q

What is conization?

A

Cone shaped portion of the cervix is removed. Using scalpel, laser or electrosurgical techniques.

Can be diagnostic (HSIL) or therapeutic (CIN2+3)
- Or both at the same time

77
Q

Types of urinary incontinence

A
  • Stress
  • Urge
  • Overflow
  • Neurogenic
78
Q

Staging of ovarian cancer

A

Screening of high risk group: Ca-125 and US

1: Confined to ovaries or FT’s
2: Ovaries + pelvic or peritoneal involvement
3: Ovaries + spread to peritoneum outside the pelvis and/or metastasis to retroperitoneal LNs
4: Distant metastasis to e.g liver, lung and pleural fluid

79
Q

Most common vaginal infections

A
  • Bacterial vaginosis (Gardenella or mycoplasma)
  • Trichomonas
  • Candida
80
Q

Most comom causes of infertility

A

Male: sperm disorders, erectile dysfunction
Female: anatomical (PID, Asherman syndrome, endemetriosis), ovulatory dysfunction, abnormal cervical mucus

81
Q

Etiology of cervical cancer

A

HPV 16 and 18

82
Q

Treatment of benign vulvar lesions

A

Surgical excision

83
Q

In uterine prolapse, what type of surgery?

A

Vaginal hysterectomy

84
Q

Most common complaints in pediatric gynecology?

A
  • Infection (bad diaper-washing)
  • Amenorrhea
  • Precocious or delayed puberty
85
Q

Endometriosis drugs

A
  • Make a pseudopregnancy with oral contraceptives
  • Make a pseudomenopause with Leuprolide
86
Q

Urinary incontinence and dx

A

Irritative: due to cystitis, tumor or foreign body –> urinanalysis
Stress: Cough test
Urge: tx is anticholinergics
Overflow/Neurogenic: tx is cholinergics

87
Q

Mayer-Rokitansky-Kuster-Hauser Syndrom

A

Mullerian Agenesis
Failiure of mullerian ducts to develop

88
Q

Pap-smear (Papanicolau classification)

A
  1. Improper sample
  2. Normal
  3. WBC and superficial cells on the slide
  4. Unsure
  5. Atypical cells, suspicious for malignancy
  6. True malignancy
89
Q

Bethesda

A

Reporting cervical or vaginal cytological Pap smear.

1- Quality of the slide
2- General description ( positive or negative)
3- Detailed description (HSIL OR LSIL)
4- Recommendations

90
Q

Marsupialization of Bartholins cyst

A

Cyst is opened at the edges, sutured and forms an open pocket so that it can drain. Heals by itself.

91
Q

Asherman syndrome

A

Adhesions and fibrosis in the uterine cavity.

Reversible infertility.

Endometrial ablation also causes this.

Gynecology and obstetrics (2 decks)

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