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Clinical Prep > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Types of Breast CA

A

Infiltrative ductal
Infiltrative lobular
Paget dz of breast

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2
Q

Most common type of breast CA

A

INFILT DUCTAL carcinoma

  • assoc w/ METs to Axillar nodes
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3
Q

Ductal cancer of breast presenting as Eczematous nipple lesion

A

Paget dz of the breast

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4
Q

Pre-malignant breast lesion

A

Lobular carcinoma in situ

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5
Q

Clinical sx of breast CA

A

painless, hard fixed nodule

unilateral d/c

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6
Q

PE of breast CA nodule

A

most common in Upper Outer quadrant

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7
Q

Most common site of breast CA mets after Axillary lymphnodes

2 Bs and 2 Ls

A

Brain
Bone

Lungs
Liver

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8
Q

Peau d’orange

often no lump, just the weird skin appearance

A

a type of Inflammatory breast CA- red, swollen, warm

orange peel is d/t Lymphatic obstruction

Poor prognosis

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9
Q

Masses that are highly concerning on Mammogram

A

Microcalcifications

Spiculated

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10
Q

Women is older than 40, what do you use to evaluate breast mass?

A

Mammogram

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11
Q

Women is younger than 40, what do you use to evaluate breast mass?

A

Ultrasound

d/t breast density

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12
Q

Most accurate diagnostic test for Breast CA

A

Open biopsy

as opposed to Fine needle or Large needle

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13
Q

Tx for Early stage breast CA

A

Breast conservation therapy (Lumpectomy)
Sentinel node biopsy
Then, Radiation

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14
Q

What does a Sentinel node biopsy test for

A

the need for Axillary lymph node dissection or not

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15
Q

When is Tamoxifen used to treat breast CA?

A

Estrogen receptor positive tumors

best in Pre-menopausal women

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16
Q

Adverse effects of Tamoxifen

A

Vein clot

Endometrial CA

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17
Q

Is women is POST menopausal with breast CA, what therapy should we use?

A

Aromatase inhibitor Hormonal therapy

  • Letrozole
  • Anastrozole
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18
Q

When is Mammogram recommended?

A

starting at age 50

50-74, every 2 years

UNLESS 1st deg relative, then start at 10 yrs prior to age that family member was diagnosed, whichever is earlier

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19
Q

How often to get a clinical breast exam?

A

Every 3 years in women 20-40, then yearly after age 40

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20
Q

2 meds that can be used as Breast CA prevention in high risk individuals

Both are SERMS

A

Tamoxifen
Raloxifene

post menopausal or >35 with high risk

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21
Q

HPV Vaccine

A

Gardasil 9

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22
Q

What strains of HPV usually cause Cervical and Anal CA

A

16 and 18

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23
Q

What strains of HPV usually cause Genital warts

A

6 and 11

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24
Q

How many doses of Gardasil 9 (The HPV vaccine) should be given if you are YOUNGER than 15?

A

2 doses

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25
Q

How many doses of Gardasil should be given if you are older than 15?

A

3 doses

interval of 0,2,6 mo

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26
Q

Ranking of gynecologic CA

A 
#1- Endometrial
#2- Ovarian
#3- Cervical
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27
Q

Most common type of Cervical CA

A

Squamous cell

Risk: HPV, many sex partners, smoking

Age of dx: 40-50 yo

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28
Q

Most common sx of Cervical CA

A

Post coital bleeding

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29
Q

Pregnancy that ends before 20 weeks gestation

A

Spontaneous abortion

Cause: usually Chromosomal abnormality

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30
Q

Threatened abortion

A

Products of Conception intact
Cervical os is intact

Tx: supportive, observe at home, close f/u

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31
Q

POC intact, but Cervical Os is dilated

A

Inevitable

Tx: surgical evac vs Meds: Misopristol

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32
Q

How to treat Septic abortion

A

Remove remaining products

Abx: Levofloxacin + Metro

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33
Q

Who should receive anti-D Rh Immunoglobulin at the time of abortion???

A

Rh-Negative mothers

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34
Q

Normal amt of blood loss during menses

A

5-80 mL

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35
Q

Abnormal Uterine Bleeding

A

Bleeding of abnormal quantity, duration, or schedule

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36
Q

Most common cause of AUB

A

Anovulation, Fibroids, Bleeding disorder, and Uterine tumor

37
Q

PALM COEIN for AUB

A

Polyp
Adenomyosis
Leiomyoma
Malignancy

Coagulopathy
Ovulatory dysfx
Endometrial
Iatrogenic
Not otherwise classified
38
Q

Most common cause of AUB if you are 13-18 years old

A

Anovulation d/t immature HPO axis

39
Q

Most common cause of AUB if you are 20-40 years old

A

Structural lesion- uterine fibroid or polyp

40
Q

Most common cause of AUB if you are older than 40

A
  • Ovaries running out of follicles
  • Endometrial hyperplasia
  • CA
41
Q

Menorrhagia (heavy bleeding) is often associated with

A 
STRUCTURAL lesions (fibroid, endometrial polyp), or 
COAGULATION disorder
42
Q

Intermenstrual bleeding often d/t

A

Cervical dysplasia or infection

43
Q

Post-menopausal bleeding is always concerning for

A

ENDOMETRIAL CA

44
Q

Unopposed Estrogen is bad because

A

can lead to Endometrial Dysplasia

45
Q

Who should undergo Endometrial biopsy sampling?

A

age >45 years with AUB

AND

Any post-menopausal women with AUB

46
Q

Acute mgmt of AUB

A

Admit and give IV Estrogen

47
Q

Outpatient Mgmt of AUB

Hormonal Treatment

A

COC birth control
Medroxyprogesterone (Provera)
High dose Estrogen

or

Tranexamic acid (Lysteda) non hormonal

48
Q

Chronic tx for AUB

A

Levonorgestral (Mirena) IUD is great option

49
Q

Primary dysmenorrhea

A

Painful periods

50
Q

Secondary dysmenorrhea

A

Painful menses but d/t a PELVIC disease

something is wrong

51
Q

What causes cramping and pain during/before periods?

A

Prostaglandins are released during cell lysis, causing Uterine contractions and ischemia –> Pain

52
Q

How to diagnose Primary Dysmenorrhea (pretty much “period pain”)

A

CLINICAL diagnosis

  • Pregnancy test
  • consider Pap or Vaginal culture
53
Q

Tx for Primary Dysmenorrhea (period pain)

A

NSAIDs are 1st line

Birth control next: COC, Depo-provera, Mirena, IUD

54
Q

Secondary dysmenorrhea

older women, age 30-40

A

associated w some underlying problem

often also have sx of: Pain w sex, Infertile, or AUB

55
Q

The song describing all of what can cause Secondary Dysmenorrhea

A 
Endometriosis
Adenomyosis
Adhesions
PID
Leiomyoma
56
Q

Tx of Secondary dysmenorrhea

A

Treat underlying cause

Hormone therapy with COC
Pelvic surgery for complicated cause

57
Q

3 types of Vaginitis

A

Candidiasis
BV
Trich

58
Q

Tx for Vulvovaginal Candidiasis

A

Oral Fluconazole
OR
Topical Clotrimazole

59
Q

If pregnant pt has Vulvovaginal Candidiasis, tx is

A

TOPICAL Clotrimazole or Miconazole

60
Q

Most common cause of Vaginitis in women of childbearing age

A

BV

  • Thin d/c
  • “Fishy odor” +whiff test
  • Clue cells
  • pH >4.5

This is Amsel’s Criteria

61
Q

Tx for BV

A

Metronidazole (Flagyl)

62
Q

Most common NONVIRAL STI worldwide

A

Trich

many have minimal or NO sx

Flagellated protozoan

63
Q

Post coital bleeding
“Strawberry cervix”
Gold standard test: NAAT

A

Trich

64
Q

Tx for Trich

A

Metronidazole (Flagyl)

Same as BV

65
Q

Most commonly reported Bacterial infection in the US

A

Chlamydia

most are asymptomatic

66
Q

Clinical sx of Chlamydia

A

Cervicitis: change in d/c, intermenses or Post sex bleeding

Urethritis: dysuria, urinary frequency

67
Q

Classic PE finding of Chlamydia

A

Mucopurulent endocervical d/c
Cervix friability
Redness, swelling

68
Q

Tx for Chlamydia

A

Azithromycin
or
Doxy (but avoid this if pregnant)

69
Q

Gonorrhea has pretty much same sx and PE of chlamydia,

something we worry about specifically in GONORRHEA though is

A

DGI: Disseminated Gonococcal Infection

70
Q

Tx for Gonorrhea

A

Azithromycin
+
Ceftriaxone (Rocephin)

71
Q

Menopause

A

when periods stopped for AT LEAST 12 months in a row

72
Q

Perimenopause or Menopausal Transition- typically 4 years before last period

A 
Irregular period
Hot flash/night sweats
Mood sx- anxiety, depression
Vaginal dryness
Lipid and bone changes
73
Q

Lab suggestive that Perimenopause is happening

A

high FSH

FSH >25 is highly suggestive

74
Q

Median age of Menopause

A

51.5 years

75
Q

When is menopause abnormal?

A

If it occurs before 40 YO

Premature ovarian failure

76
Q

Post menopause

A 
Hot flashes stop within 4-5 years of onset
Vaginal dryness
Inc risk of: 
-Osteoporosis
-Heart dz
-Dementia

Anxiety and Depression

77
Q

Hormone therapy for Post-menopause

A

Estrogen (only those who have had hysterectomy)
OR
Estrogen with Progestin (most)

78
Q

Guideline for Hormone replacement therapy for Post-menopause

A

No longer than 5 years

Not after 60 YO

79
Q

Risk of Hormone Replacement Therapy

A

Increased risk of CLOT

and BREAST CA

80
Q

Osteoporosis is considered a T-score of

A

< -2.5

81
Q

What age to start screening for Osteoporosis

A

65

82
Q

1st line therapy for Osteoporosis

A

Bisphosphonates

SE: upper GI tract, Osteonecrosis of the jaw

83
Q

Anterior compartment pelvic organ prolapse

A

Cystocele (bladder)

84
Q

Posterior compartment pelvic organ prolapse

A

Rectocele

85
Q

Risk factors of prolapse

A

Delivering big babies
Older age
Obesity
Chronic dz (Constipation, COPD)

86
Q

What ethnicity is at highest risk of Pelvic organ prolapse?

A

Hispanic women

87
Q

Most effective procedure for prolapse, but can’t have sex anymore

A

Obliterative procedure

88
Q

POP is almost never urgent/emergent, UNLESS

A

Urinary retention
Obstructive nephropathy

What to do?

  • place catheter
  • Urogyn consult for pessary or surgery

Clinical Prep (41 decks)

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