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IPAP > OB Cram > Flashcards

OB Cram Flashcards

1
Q

Cyst size for Premenopause women and management

A

3cm or less: norm variant
5cm or less: no Tx
5-7cm: repeat TVUS 12 wks, persistant= annual
+7cm: MRI/surg eval

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2
Q

Cyst size for Post-menopause women

A

1cm or less: norm variant
5cm or less: CA125 level, norm= repeat TVUS 12 wks, perisitant= annual
>7cm: MRI/surg eval

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3
Q

Risk factors for Endometrial CA

A

Nullparity
Obese
PCOS
Estrogen

White
Infertile
DM/CHTN/Gallbladder dz
Early menarche

Late
Irregular
North american/european
Tamoxifen

COC w/ smoking
Old

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4
Q

What is the primary driver of endometrial cancer risk

Paps stop at ? age

AGC Pap result management

A

Estrogen exposure length

65

Colpo and endocervical/metrial sampling
No concern for HPV status

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5
Q

Post menopause PT w/ HTN, DM and PCOS w/ vaginal bleeding x 2wks, what is next step?

When is endometrial ablation used for Tx

A

Hysteroscopy

AUB w/ reproduction complete
Endometriosis Tx concurrent w/ laproscopic exam

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6
Q

When is Uterine Artery Embolization used for Tx

A

AUB, acute menorrhagia if balloon tamponade fails

Leiomyomatas

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7
Q

Leiomyoma

A

MC pelvic tumor in women that are Estrogen dependent
Round/rubbery

Present: bleeding, pressure, pain, infertility

Dx: US

Tx: COCs (dec bleeding) UAE Hysterectomy

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8
Q

Adenomyosis

A

Endomettriosis in myometrium

Present: Heavy bleeding or Dysmenorrhea in parous women 40-50y/o

Dx: TVUS, MRI

Tx: Hysterectomy
Progestin IUD
Danadol
COC
GnRH agonist
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9
Q

Polyps

A

MC Sx: mentrorrhagia

Dx: TVUS, Sonohystography

Tx: if Sx/Large, remove

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10
Q

Endometrial Hyperplasia

A

From recurrent/chronic annovluation due to unopposed estrogen

MC presentation: AUB in post-menopause female +50

Dx:
Pre-Meno: biopsy, Gold Standard
Post-Meno: TVUS= Dx equivalent, <4mm= low risk

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11
Q

What classification of endometrial hyperplasia has the highest/lowest chance for progressing to Ca?

How are atypia cases Tx

A

Most: Complex hyperplasia w/ atypia
Less: Simple hyperplasia w/out atypia

Post menopause, no kids: hysterectomy w/ BSO
Pre-meno atypia, wants kids: progestin, EMB q3mon

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12
Q

How are endometrial hyperplasia cases w/out atypia Tx

A

Pre-meno: progestin or COC w/ q3-6mon EMB
Inc progesterone or refer to hysterectomy

Post-meno: COC/progestin w/ EMB q3-6mon

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13
Q

Endometrial Ca

A

MC Gyn Ca in US

MC Sx: vaginal bleeding
Sx: Pressure Irregular bleeding Girth Satiety Bloat

Dx: EMB
Post-Meno w/ stripe 5mm or more= biopsy
D&C if biopsy c/i or persistant bleeding w/ normal biopsy

Tx: Hysterectomy w/ BSO and lymph node staging
HT w/ progestin (Tamoxifen)

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14
Q

What Ca condition may require a hysterectomy as prophylaxis

PTs w/ this need to have ? screening procedure started at ? age

A

Lynch Syndrome

30-35y/o: EMB Q1-2yrs

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15
Q

How is endometrial Ca Tx if fertility is trying to be spared?

A

Dx hysteroscopy
D&C sample
Hormone Tx

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16
Q

Functional Cyst

A

> 3cm in woman of reproductive age

Sxs: dull pain, heaviness
Hemorrhagic cyst- inc Sxs

Dx: bimanual exam, US

Cyst + Pain= surg eval

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17
Q

MC epithelial benign neoplasm

What is the largest

? is MC benign ovarian neoplasm

A

Serous cystadenoma

Mucinous cystadenoma

Benign Cystic teratoma: Germ cell

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18
Q

PT w/ ovarian mass may have ? key Sxs

A

Weight loss
Ascites
Pleural effusions

Bimanual
US
CA-125- if Post-Meno
Dx w/ biopsy

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19
Q

Complex cyst management

Ovarian Torsion

A

Pre-Meno: TVS in 12wks, perisistent= MRI/surg eval
Post-Meno: surg eval

Twisted adnexal component: ovary and tube
Highest rate: adnexa 6-10cm
R more common, L protected by sigmoid

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20
Q

Steroid hormones cause maleness

A

DHEA: adrenal- weak

Androstenedione: adrenal, ovary- weak

T: adrenal, ovary, adipose- potent

DHT: follicle, genital skin- most potent

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21
Q

Hypertrichosis

Hirsutism

Virilization

A

Genetic variant, not due to androgens

Terminal hair in male patterns, due to androgens

Acne, baldness, hypertrophy, due to androgens

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22
Q

PCOS

A

Inc androgens and estrogen

Sxs: Hirsutism AUB PCOs Infertile Obese

Dx: hyperandrogen, olio/anovulation

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23
Q

Ovarian Hyperthecosis

A

Leutenized theca cells

Balding Hypertrophy Deep voice

Inc insulin resistance
Acanth Nigrans

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24
Q

HAIRAN

A

Hyper Androgen Insulin Resistant Acanth Nigrican

Hyperandrogen
Severe insulin resistance

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25
Q

How is hirsutism scored

How is idiopathic hirsutism Dx

How is it Tx

A

Ferriman Gallwey system

Normal androgen, menses
Inc 5-AReductase
Mild PCOS ?

Ovulation: COC, Metformin
Hair: COC, Spirinolactone Flutamide Eflornithine

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26
Q

RFs for ovarian Ca

A

FEP BLOWN PEN
FamHx
Early menarche
Post meno HT

Breast Ca
Late meno
Old
White
NA/Ne

PID
Ethnic
Nullparity

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27
Q

RFs for cervical neoplasm

A

ALE MET SPICE
Age
Low status
Ethnic

Multiple partners
Early coitus
Tobacco/diet

Screening low/poor
Parity
ImmSupp
Cervical HPV
Exog hormones
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28
Q

Cervical Stenosis causes

Txs

A

CIN Tx
Hypoestrogen

Dilator
Vaginal estrogen

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29
Q

Nabothian Cyst

A

Columnar cells trapped under squamous- secrete mucus

Not Tx unless pain- cautery/excise

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30
Q

HPV 6,11 causes ?

HPV 16,18 causes

If these last longer than ?mon, risk increases

A

Genital warts
Laryngeal papillomas

Cervical Ca
16- most oncogenic; anogenital, oropharyngeal cancer

6mon into squamous intraepithelial lesion

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31
Q

Pap smear algorithm by ages

A

<21: no screen
21-29: Pap Q3yrs, reflex if +
30-65: Co-test Q5yrs, Pap Q3yrs
>65: 3 consecutive negatives

Post Hyst w/ CIN2 Dx in past 20yrs: annual vaginal swabs x 20yrs past Dx date

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32
Q

ASCUS

A

21-24: Pap 12mon
25-29: Reflex HPV
- HPV: Cotest 3 yrs
+ HPV: Colpo

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33
Q

LSIL

A

21-24: Pap 12mon
25-29: Colpo
-HPV: Pap/CoTest 12mon
+HPV: Colpo

Pregnant: Colpo

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34
Q

ASC-H

A

21-24: Colpo
25-29: Colpo
-HPV: Colpo
+HPV: Colpo

No CIN2: Colpo/Cyto Q6mon x 2yrs

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35
Q

HSIL

A

21-24: Colpo
25-29: Exc/colpo
-HPV: Exc/colpo
+HPV: Exc/colpo

No CIN2: Colpo/Cyto Q6mon x 2yrs

36
Q

AGC

A

Atypical: Sampling, no pathology= colpo

Other sub-cats: Colpo and Sampling if +35y/o w/ bleeding/anovulation

37
Q

Unsat Cytology

A

No/-HPV: Cytology 2-4mon

+HPV: Colpo/Cytology 2-4mon

38
Q

No EC/TZ

A

21-29: routing screen
+30: -HPV- routine screen
+30: +HPV- Cytology/genotyping 1yr

39
Q

PTs >30y/o w/ negative cytology but are HPV +

A

Cotest 1yr, ASC/HPV += Colpo
ASC/HPV- = Cotest 3yrs

DNA Typing: 16,18= colpo
Neg for 16,18= cotest 1yr

40
Q

Exophytic cervical cancer arises from ?

Endophytic cervical cancer arises from ?

A

Ectocervix

Endocervix

41
Q

What meds may be used for cervical Ca Tx during pregnancy but usually result in loss

How often are they f/u w/

How long ar PTs w/ cervical/vaginal cuff pap f/u w/?

A

Cisplatin w/ cicristine
Paclitaxel

Q3mon x 2yrs
Q6mon x 5yrs post Tx
Annually

Annually x 20yrs post-Tx

42
Q

What is NOT a RF for vulvar cancer?

What microbe causes Erythrasma and how does it appear under a Woods lamp

How is it Tx

A

Breast Ca

Corynebacterium- red

Wide: Erythromycin
Local: Clindamycin

43
Q

? etiology of vaginitis may be mobile when viewed

What is the predominant microbe and what defenses does it make?

What are the two non-inflammatory causes of vaginitis

A

Trichomonas

Lactobacilli- hydrogen peroxide, lactic acid

BV, Candidiasis

44
Q

What is the MC cause of vaginal d/c

This MC cause is due to ?

A

BV

Over growth of anaerobes: Gardnerella
Ureaplasma
Mobiluncus
Mycoplasma
Prevotella
45
Q

Name of criteria for Dx BV

One of these criteria is tested with a paper named ?

Med Txs

A

Amsel- pDOC

Nitrazine paper- blue

Metronidazole 500mg PO BID x 7 days
Clindamycin 5g intravaginally x 7 days

46
Q

How is recurrent BV Tx

A 
1st recurrence, no Tx:
Vaginal Metrogel or,
PO Metronidazole
PO Tinidazole
Vaginal clindamycin
- ALL x 2wks

Recurrent Recurrent:
Treat acute infection
Suppress w/ Metronidazole gel or Tinidazole

47
Q

UnTx BV + Pregnancy can lead to ? 4 adverse events

What is the strain of fungus resistant to -azoles

A

Premature rupture of membrane
Preterm delivery
Amniotic infection
Post-partum endometritis

C Glabrata

48
Q

Difference of pH between BV and Candidiasis infection

RFs for candidiasis infection

What PT population is more likely to acquire non-albicans fungal ifections

A

BV= pH >4.5
C: pH <4.5, more acidic

ID ADOPT
ImmSupp Diaphragm ABX DM OCPs Pregnant Tight

Women w DM2

49
Q

What are the two preferred med for treating candidiasis infections

Chronic candidiasis is linked to PTs w/ ? 2 things

How is recurrent VVC Tx

A

Clotrimazole
Metronidazole

Mannose binding lectin
Inc IL-4

PO Fluconazole
Suppressive Therapy:
PO Fluconazole 100-200mg wkly x 6mon

50
Q

How are fungal infections of non-albican species Tx

Trichomoniasis

A

Boric acid 600mg
PO Fluconazole 200mg

Musty/Frothy green/yellow d/c
Strawberry cervix
pH >4.5
NAAT- gold standard

51
Q

Trichomoniasis Tx

How are BV/Trichomnoas co-infections Tx

A

Metronidazole 2g PO x once
Metronidzaole 500mg BID x 2wks
Tinidazole

Tx the BV

52
Q

Lichen Sclerosis

A

Post Menopause woman- inflamed dermis w/ paper appearance

Dx Biopsy

Tx: Topics CCS- Clobetasol
Severe- retinoids
Phototherapy/5-aminolevulonic acid

53
Q

Lichen Simplex Chornicus

A

Itch Scratch Cycle, no wax/wane

Tx: lubricant, PO antihistamine
Unresolved 1-3wks= biopsy

54
Q

Atopic Dermatitis

A

Allergy/eczema Hx

Tx w/ Steroids/Immodulators (Tacrolimus)

55
Q

Psoriasis

A

Silver scales that are red in folds
Autoimmune T Cell reaction

Uncommon on Mons Pubis/labia
Koebnerization- vulva Trauma

Tx: emollient, steroid
Maintenance: Dovonex

56
Q

Lichen Planus

A

Male and female involvement
Autoimmune d/o of T-cells
Drug induced: BB NSAID Mehtyldopa PCN Quinine
Gingival involvement

Erosive- MC
5PS- polygon

Tx: Clobetasol, vaginal hydrocotrisone

57
Q

Intertrigo

A

Friction between skin folds causing burn, itch, hyperpigmentation

Tx: corn starch
Nystatin, Clotrimazole

58
Q

What is the MC cause of vaginal irritation post-menopause

A

Atrophic vaginitis

Tx: estrogen

59
Q

Barthlin Cyst

A

Occur in duct= no pain
CA concern if >40y/o

ASx= no Tx unless >40

DONT DO I&D

Tx: word catheter, marsupilizaiton- after two failed catheters

60
Q

Barthalin Abscess

A

Microbial or G/C

Tx: ABX if recurrent or high risk: Pregnant Cellulitis Systemic ImmSUpp
TMP/SMX
Amox/Clav
2nd Gen ceph

61
Q

TSS

Vulvar Ca more common in ?

A

Exotoxin from Staph A 2 after surgery/menses onset

Older
HIV infected

62
Q

Most Vulvar Cas are ?

Women <55y/o vulvar Ca RFs

Women >55y/o vulvar Ca RFs

A

Squamous on vestibule
Malignant melanoma- poor prognosis

HPV, smoking
Same RFs as cervical Ca

Non-smoker
No STD Hx
Long lasting Lichen Sclerosis

63
Q

35 x bigger risk of vulvar Ca risk if ? combo

How is this Ca Tx

A

Smoker and +HPV

Wide local incision- microinvasive Stage 1A
Vulvar resection if lymph/adenopathy is present
Chemo

64
Q

MC complaint of vaginal Ca

MC region involved

If its on anterior wall, ? Sxs

A

Bleeding

Upper 1/3 of wall

Dysuria Urgency Hematuria

65
Q

During childhood, what 3 hormones are low

What hormone is suppressing the HPO axis from 4-10y/o

A

FSH LH Estradiol

Estradiol, suppresses GnRH

66
Q

Sequence of puberty changes

What variant can occur but is a normal variant

A

TAPuP Me

Thelarche Adrenarche Pubarche Peak growth MenarchePubarche being first

67
Q

What is the onset of puberty

Define Central Precocious Puberty

Define Peripheral Precocious Puberty

A

Pulsatile GnRH causes AntPit to release FSH/LH

Dependent, Isosexual
High FSH LH Est

Independent, Iso or Heterosexual
Low FSH LH, High Est

68
Q

Peripheral precocious can lead to ?

What labs are ordered

A

Tumors
CAH
Cushing
Exogenous androgens

Hand x-ray
FSH LH TSH
Pelvic sonograph
CNS MRI

69
Q

Criteria for delayed puberty

What D/os fall under 1* hypogonadism

A

No thelarche by 13
No menses by 16

Turners
Kleinfelter
POI

70
Q

How much blood is usually lost during a period?

When are cycles most irregular

A

20-60mL

2yrs after menarche
3yrs before menopause

71
Q

3 functions of menstrual cycle

What phase of the menstrual cycle is variable

A

Reproduction
Ovulation
Menses

Follicular

72
Q

Acronym for phases and hormones

3 effects of FSH on ovary

A

PSL- prog sec luteal
Ester Pro Life

Recruit follicle
E/P production
Inc LH receptors

73
Q

What phases are present and absent in anovulatory menstrual cycle

MC cause of 2* amenorrhea

A

+ proliferative
- luteal

Pregnancy
2nd: anovulatory

74
Q

Criteria for 1* amenorrhea

Define 2* amenorrhea

A

No menses by 16
No menses by 14, absent 2* characteristics
No menses w/in 3 yrs of thelarche

No menses x 3mon who were having menses

75
Q

1* amenorrhea includes ?

What are the first 3 steps for investigating amenorrhea

A

Turner
46XX
47XY

Estrogen?
US
FSH levels:
Inc= gonad failure
Dec= function/structure issue
76
Q

Define Functional Amenorrhea

What can cause this

A

Abnormal GnRh
Low FSH

Female athlete triad

77
Q

What causes Functional Hypothalamic Amenorrhea

What are the primary tests ordered for amenorrhea

What images are ordreed

A

10% weight loss
Malnourished
Leptin deficient
Stress

hCG FSH Prolactin Estradiol TSH

US Saline sonography
MRI

78
Q

Frequency of bleeding

Regularity

Duration

Flow

A

Frequent: <21 days
Infrequent: 35 days

Amenorreha; absent 6mon
Irregular: >20 day variation

Prolonged; >8 days
Short: <2 days

Heavy: >80cc
Light: <5cc

79
Q

PALM COINE acronym for AUB

A

Polyp
Adenomyosis
Leiomyoma
Malignancy/hyperplasia

Coagulopathy
Ovulatory d/f
Endometrial
Iatrogenic
Not classified
80
Q

AUB Acute

A 
Stable: COC: medroxyprogesterone
Unstable: D&amp;C
Balloon tamponade
UAE
Hysterectomy
81
Q

AUB Chronic Tx

A

NSAIDs

One reset:
Medroxy
COCs

Suppression:
Progestin
COC
Depo
Levonorgestrel**

Antifibrinolytic:
Tranexamic acid

82
Q

Prostaglandins play part of ? dysmenorrhea

Tx

A

Primary

NSAIDs
COCs
Progestin OCPs

83
Q

Dexa scan

Score ranges

A

+65y/o
1 RF for osteoporosis
Sustained Fxs
ALL perimenopausal women

Normal: 2.5 - -1
Penia: -1 - -2.5
Porosis:

84
Q

Z score

T score

A

Results to same age
<2.0= Dx eval for 2* cause of porosis

Results to healthy PT 20-35

85
Q

When is therapy started for osteoporosis

A

T -2.5 or less
Vertebral/hip Fx
-1 - -2.5 w/ RFs

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