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OBGYN Flashcards

1
Q

What are the 3 signs seen on the cervix during pregnancy

? ligament assists w/ holding fallopian tubes and ovaries?

A

Chadwick: early inc vascularity
Goodell: cervical softening due to edema
Hegar: isthmus/uterus softening

Broad ligament- contains arteries, veins and nerves

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2
Q

What part of the broad ligament are the fallopian tubes in?

What are the 4 parts of the fallopain tubes?

A

Mesosalpinx

Infundibulum
Ampulla
Isthmus
Interstitial/intramural

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3
Q

What arteries feed blood to the ovaries

Where do these arteries drain to?

A

Ovarian/Uterine arteries through medulla

L ovary- L renal vein
R ovary- IVC

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4
Q

What are the two parts of the pelvis

What is the term of the head position desired for delivery

A

True: immobile/constraining
False: above linea terminalis; supports pregnant uterus

Occiput anterior- back of baby head facing mother anterior

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5
Q

What are the 3 baby head presentation positions possible for birth

What are the 3 pelvic landmarks

A

Vertex- occiput anterior?
Sinciput
Brow

Interspinous diameter
Transverse inlet
Obstetrical conjugate- needs to be 11cm for delivery

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6
Q

What are the two hip categories favorable for vaginal delivery?

What two categories are not favorable?

A

Gynecoid, Arthropoid

Android, Platypelloid

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7
Q

What mother position may help increase pelvic outlet diameter?

Linea terminalis is AKA and includes ? structures

A

McRoberts maneuver: hyperflexion of legs in dorsal lithotomy, inc by 1.5-2cm

AKA Innominate line, separates false/true pelvis
Pubic crest
Pectineal line
Arcuate line
Sacral ala
Sacral promontory
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8
Q

What makes the bony pelvis

What part contains all of the abdominal organs?

A

Innominate bones
Sacrum

True/lesser pelvis

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9
Q

The false/greater pelvis is bound in what 3 locations

Where are the superficial vascular structures in the abdomen supplied w/ blood from and travel in ? direction

A

Lumbar vertebrae- post
Iliac fossae- laterally
Abdominal wall- ant

Femoral artery
Diagonal towards umbilicus

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10
Q

What vascular structures provide blood to the muscles and fascia of the anterior abdominal wall

What is the name of the c-section incision and what strucutres may be unintentionally hit?

A

External iliac vessels

Maylard
Inferior epigastric artery on lateral side of rectus belly

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11
Q

When entering through a Pfannenstiel incision, what is the risk?

Hypothalamus releases ?

Ant Pit releases ? to take affect on ?

A

Severing Iliohypogastric nerve, loss of sensation over lateral gluteal/hypogastric regions

GnRH

LH/FSH on ovaries

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12
Q

Ovaries release ? two hormones that conduct ? two functions

What is the only female organ not changed during pregnancy?

A

Estrogen: proliferative; helps endometrium grow
Progresterone: secretory; helps w/ glandular processes

Ovary

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13
Q

What are the 3 sources of gonad tissues

A

Mesothelium: lines posterior abdominal wall

Mesenchyme: embryonic CT

Primordial germ cell: earliest undiff sex cells

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14
Q

What is the sequence of differentiation of gonad development into ovaries

When does ovary/testis differentiation begin?

A 
Mesothelium
Gonad ridge
Gonad cord
Indifferent gonads
Ovary

Begins: 5w of gestation
Committed: 7w of gestation

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15
Q

? ducts develop into testes
? ducts develop into ovaries

Testes only develop from the ducts if ? is avail, otherwise ovaries develop

A

T: mesonephric/wolffian by 7wks
O: paramesonephric/mullerian by 12wks

TDF

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16
Q

How is the male phenotype made?

What hormone has no role in the gonad differentiation process?

A

Undifferentiated gonad + Y chromosome= TDF

Testes= MIF, T, DHT:
testes development, testosterone, mullerian inhibiting factor, fusion of labial folds, growth of phallus/prostate

Estrogen

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17
Q

What processes occur prior to gonadal differentiation?

Ovary can be histologically identified by ? wk but isn’t truly developed until ? wk

?wk does the cortical cords break down and into ?

A

Germ cells migrate to ridges/cords

10 and 12

16wk into premordial follicles

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18
Q

Primordial germ cells contain ? which derive from ? tissue

While still in a fetus, what replication process are the oogoniums doing?

A

Oogonium
Mesoderm, surface epithelium

Mitosis- diploid 46xx

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19
Q

By 20th wk of development, oogonium are committed and stop/rest at ? step of replication?

8-12wks of gestation, Hcg peaks and stimulates production of ? signaling the start of ?

A

Prophase I

Testosterone
Anti-mullerian hormone

Gonadal differentiation

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20
Q

What male/female organs are present at 9wks of development

11wks?

12wks?

A

Penis Clitoris Minora

Majora Scrotum

External urethra
M: Prepuce, scrotal raphe
F: Clitoris, mons, vaginal orifice

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21
Q

Define Didelphys

Define Bicornuate uterus

Define Bicornuate w/ rudimentary horn

Define Septate

Define Unicornuate

A

Inferior duct fails to fuse, single or double vagina

Duplicated upper uterus body

Slowed growth of one duct, no fusion

Failure of resorption, septum

One duct fails to develop; PT fertile but risk of preterm delivery/loss

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22
Q

Define Ovotesticular DSD

What is an example of this

What can cause this example

A

Chromatin +
Most 46XX w/ ovotestis
M or F w/ ambiguous genital

46XX:
+ ovary, ambiguous externals
Excess androgens= virilization (fusion, hypertrophy, sinus)
+ Wolf and Muller cells

Causes:
Impair Fetal Steroidgenesis- CAH (no 21 hydroxylase)
Mother took androgens
Luteoma: masculinizing tumor

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23
Q

46XY DSD

A

D/o of testicular development= dec production of T/MIS, causes low virilization
Chromatin -

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24
Q

Define Androgen Insensitivity Syndrome

Kallmann Syndrome

A

Genotype: male
Phenotype: female
Female genital Abdominal/inguinal testis
No masculinization, menses

Partial: point mutation on androgen receptor gene

Kallman: Hypo Hypo; anosmia
Dec FSH LH and E
SECONDARY Hypogonadism

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25
Q

Klinefelter Syndrome

Turner Syndrome

Why is it life saving to Dx infants w/ DSD early in life

A

47XXY 1* hypogonadism
Dec T, Inc LH/FSH

45XO 1* Hypogonadism
Hypergonadtropic hypogonadism
Dec E, Inc FSH/LH

Avoid Adrenal crisis- Na crisis at day 4-15, death due to HypoNa/HyperK

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26
Q

Define Gametogenesis

What type of replication occurs here?

A

Development of precursors into oocytes or spermatozoa

Meiosis I: diploid to haploid

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27
Q

How do they replicate and into ?

Where is the transition from dip to hap and mitosis to meiosis?

A 
Spermatogonia
Spermatogonium
1* spermatocyte
2* spermatocyte,
Spermatid
Sperm

1* to 2= dip to hap
1 to 2*= mitosis to meiosis I

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28
Q

During spermatogenesis, when do sperm cells go from diploid into haploid?

One 1* spermatocyte= ? mature, mobile sperm

A

1* spermatocyte, diploid
Meiosis I
2* spermatocyte, haploid

1 primary= 4 mature

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29
Q

Define Non-Disjunction

What is the last phase of spermatogenesis?

Why is this last phase important and where does it take place?

A

1* spermatocyte error at first meiotic division

Spermiogenesis: spermatid into spermatozoa

Golgi body into acrosome in Sertoli cells- enzymatic penetration of zona pallucida
Development of mitochondria in middle portion of sperm tail

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30
Q

What type of cells line the seminiferous tubules

What are the 3 functions of these cells?

A

Sertoli cells

Sperm development
Spermatogenesis regulation
Passive transport from seminiferous to epididymis

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31
Q

Sperm mature during ? phase of development?

Where do they mature and how long does it take?

A

Spermiogenesis

Seminiferious tubules x 3mon: 2mon process, 1mon maturation

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32
Q

What are the series of hormone events prior to ovulation?

LH stimulates ? cells to make ? two products

These products are taken up by ? cell and turned into ?

A

Inc estrogen causes LH surge= ovulation

Theca cells: Cholestterol + LH= Androstenedione, Testosterone

Granulosa cells: Androstenedione + FSH= Estrone, Estradiol

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33
Q

What is the name of the scar tissue the corpus luteum turns into after ovulation?

Corpus luteum grows during ? phase under the influence of ?

This product stimulates ? cells to produce ?

A

Corpus albicans 7-10 days later

Luteal, LH

Granulosa cells, progesterone

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34
Q

Changes/variations of a woman’s period is due to ? phase of the menstrual cycle

What are the two layers of the endometrium which covers ?

A

Follicular, luteal is regulated more strict/less fluctuant

Functionalis, Basalis
Myometrium

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35
Q

The constriction of the spiral arteries deprive the ? layer is what causes ?

What happens during the Proliferative phase

What does the Secretory Phase stimulate the release of

A

Functionalis
Period

Estrogen, arteries lengthen, endometrial growth maxes, glands are straight/narrow due to glycogen

Glycogen/mucus

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36
Q

Secretory phase is occurring because ?

What hormone is high at ovulation/ferning

A

Prepping to implant

Estrogen
Inc amount of alkaline mucus,
Dec viscosity/spinnbarkheit

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37
Q 
How many days after Ovulation for each to occur:
Fetilization
Entrance of Blastocyst 
Implant
Trophoblast and attach
Sync
hCG rescue
A

1 4 5 6 8 10

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38
Q

What are the two phases of fertilization

What happens at the end of these two phases

A

Acrosomal reaction: penetrating zona pellucida

Zona reaction: chemical change in solubility, impermeable

Fusion of oocyte/spem= completion of Meiosis II; Ootid->zygote

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39
Q

What hormones effect zygote/blastocyst transit through fallopian tube?

What is the name of the 16 cell structure that precedes a blastocyst entering a uterus

A

Estrogen + sticking
Progesterone - sticking

Prostaglandin E + tube relax
Prostaglandin F + tube motility

Morula

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40
Q

What are the two layers of the blastocyst

What hormone is produced and what’s it’s purpose

A

Embryoblast: forms embryo, amnion, cord
Trophoblast/chorion: forms placenta, hCG
Chorion: fetus portion of placenta

hCG 7-10 days post-fertilization, preserves CL until placenta halts menses
Cause of Morning Sickness

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41
Q

What are the 3 phases of implantation

Define Decidua and its function

Why is this structure important

A

Apposition Adhesion Invasion

Maternal side of placenta, establishes embryo implantation

Endometrium of pregnancy, separates at birth
Essential for maternal blood contact w/ trophoblast

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42
Q

What are the 3 parts of the decidua

Trophoblast differentiates into the Cyto/Synch blast by day ?

After implantation, these further differentiate into ?

A

Basal Capsul* Parietal

Day 8

Extra/Villous Trophobalsts:
Extra- anchor chorionic villi to uterus
Vill- chorionic gas, nutrient, hormone exchange

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43
Q

Define CV Sampling

How many vessels in the umbilical cord?

What is the maternal surface of the placenta called and divided into?

A

Chorionic Villi- chromosomal abnormalities

AAV
V: oxy, high press R side
AA: de-ox, low press L side

Basal plate: divides into clefts/lobules (coutyledon)
Extends in intervillous space

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44
Q

Define Nitabuch Layer

What are the 3 abnormalities of this layer

What is the risk factor for these abnormalities

A

Maintains separation by fibrinoid degeneration of decdiuda basalis
Prevents placental invasion into uterus

P Accreta: adheres
P increta: invades
P percreta: perforates

Previous uterine surgery/c-section

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45
Q

How long after conception does it take for maternal blood flow to enter placenta

Placental growth is more rapid than the fetus during the first trimester, they are equal by ? wk and ? at birth

A

1mon: enters intervillous space from spiral arteries, bathes sync-blasts

17wks
1/6th of fetal weight

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46
Q

hCG levels are abnormally low during ? and high during ?

This is the hormone responsible for ? two downsides of pregnancy

A

Low: ectopic, spontaneous abortion
High: gestational trophoblastic neoplasia

N/V
Hyperemesis gravidarum

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47
Q

What part of the maternal/fetal blood transfer has higher pressure/values

Why does fetal gas exchange have a three fold advantage

A

Uterine artery

Fetal Hbg higher O2 affinity
Bohr effect: dec o2 affinity w/ dec pH
Fetus has higher Hgb

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48
Q

Chorionic villi drain nutrients/O2 from maternal blood using ? method

Fetal envirionment generally has ? pH level

Umbilical cord that wraps around a fetus’ neck is called a ?

A

Bohr effect

Acidic

Nuchal cord

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49
Q

What are the 3 modifications to fetal circulation that maintains R to L shunting

A

Duct Art: connect aorta and PA, diverts blood to brain/heart, away from lungs

FOvale: shunts oxygenated blood from RA to circulation

DVenosus: bypasses hepatic circulation; remnant is ligamentum venosum

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50
Q

Placenta previa is a risk factor for ? placental abnormality

End of video 2, labeling chart

What is the MC complaint to GYN?

A

P acreta

Check

Abnormal uterine bleeding

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51
Q

What Tanner Stage represents the onset of puberty and 2* characteristics?

What hormone controls breast development?

What hormone controls pubic hair development?

A

Stage 2, Thelarche

Estrogen

Androgen

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52
Q

During childhood, there’s no puberty due to low levels of ?

Puberty starts when the feed back inhibition of ? decreases

A

FSH LH Estradiol

Estradiol and GnRH

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53
Q

Define Thelarche and Adrenarche

What is the time span between onset of thelarche and onset of menarche

A

Thel: breast development; first
Adren: pubic hair growth

2.5yrs

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54
Q

What is the sequential acronym of puberty development stages

An earlier onset of puberty linked and due to ?

Menarche initiation can not start if female PTs weigh less than ?

A

TAPup Me
Thelarche Adrenarche Pubarche Peak growth velocity Menarche

Obesity, leptin as initiator hormone

106lbs/48kg

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55
Q

Tanner Breast Staging

Tanner Pubic Hair Staging

A

1: elevation of papilla
2: buds, areola diameter inc
3: enlargement, no separation
4: secondary mound
5: mature breast

2: sparse along labia
3: darker hair over pubes
4: dark/coarse hair
5: dark/coarse hair extends to thighs

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56
Q

What are the two types of precocious puberty and how are they Tx

A

Central, GnRH dependent: high LH/FSH inc estrogen levels
Tx w/ GnRH agonist- inhibits LH/FSH

Peripheral, GnRH independent: ‘precocity’; lack of HPO axis activation= low FSH/LH
Tx: ovarian tumor, CAH, exogenous exposure

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57
Q

What are the risks if Precocious Puberty goes UnTx

Continue Tx until ? age

A

Early growth plate closure
Psych distress

11/yo

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58
Q

What tests are done for girls w/ precocious puberty due to estrogen excess

What is the criteria for delayed puberty

What is the MC cause

A

Hand x-ray: bone age
FSH LH TSH
Pelvic sonogram
CNS MRI

No thelarche by 13 or,
No menarche by 16

Constitutional delay

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59
Q

What needs to be checked if PT presents w/ delayed puberty

How is it Tx

A

FSH/LH

Gonads: 1* hypogonadism; high FSH/LH (hypergonadotropic)
Hypothalamus: 2* hypogonadism; low FSH/LH (hypogonadotropic)

Monitor, possible gonad steroids

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60
Q

What are the 3 HyperHypo causes of Delayed Puberty

What are the 3 HypoHypo causes?

A

Turners, Gonad dysgenesis,
Premature Ovarian Failure
/AKA Primary Ovarian Insufficiency; cause of delayed puberty

CNS Adrenal Psychosocial

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61
Q

Disruption of the HPO axis can alter ? 3 functions of the menstrual cycle

How much blood loss is considered normal or excessive?

When are menstrual cycles the most irregular

A

Reproduction Ovulation Menstruation

20-60mL
+80mL bad

2yrs after menarche
3yrs before menopause

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62
Q

Females are born with ? ova, but only ? are present at start of puberty

How many ovulation are expected throughout life?

? hormone controls the follicular phase and ? effect does it have on the endometrium

A

1-2mill; <400K

400

Estrogen; proliferative

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63
Q

What is the whole purpose of the luteal phase?

“Progesterone withdrawal”= ?

A

Prep endometrium for implantation

Menstrual bleeding

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64
Q

What are the 3 forms of estrogen

Where are they secreted from

The 4 transmitters E+3/P respond to ?

A

Estradiol Estrone Estriol

Theca interna
Granulosa cells

Gonadotropins

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65
Q

What are 3 effects of FSH on ovary

Sequence of hormonal events leading to ovulation

Female who has an anovulatory menstrual cycle means there is no ? phase

A

E/P production
Inc LH receptors
Follicle maturation

Inc estrogen, LH surge, ovulation

Luteal

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66
Q

Why/how do females w/ an anovulatory menstrual cycle still have regular menses?

Define criteria for 1* Amenorrhea

A

Estrogen break through- loses ability to maintain endometrium

No menses by 16 w/ normal 2* characteristics
No menses by 14y/o and no 2* characteristics
No menses by 3yrs of thelarche

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67
Q

Define Criteria for 2* Amenorrhea

All causes of 2* amenorrhea can also cause ?

A

Cessation of menses x 3mon and previously regular

Primary amenorrhea

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68
Q

PT w/ AIS would have ? type of amenorrha

Hypergonadotropic Hypogonadism can be causes by what two d/os?

A

Primary

Turners
46XX and 46XY

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69
Q

Define Hypothatlamic Amenorrhea

What can cause this

A

Low GnRH/FSH secretion
Non-ovulatory

Stress/exercise
Weight loss
Celiac Dz

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70
Q

Define Kallman syndrome

What is the first and second MC cause of 2* amenorrhea

A

Congenital GnRH deficiency w/ anosmia

1st: Pregnancy
2nd: anovulatory cycles
Functional hypothalamic amenorrhea

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71
Q

What effect would hyperprolactinemia have on a PT?

After initial exam and labs, what test is done for assessing amenorrhea

A

Dec GnRH, low LH/FSH

Progesterone withdrawal test: give exogenous progesterone

+ bleeding= estrogen developed endometrium or; PT outflow tract in tact

  • bleed= unsure if proliferative phase occurred or if estrogen is functional
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72
Q

What are the primary tests ordered for amenorrhea evaluation

What are the 3 radiological tests ordered

A

hCG FSH Prolactin Estradiol TSH/fT4

Transvaginal US: PCOS, uterine agenesis, ovarian tumor

Hysterosalpingogram- mullerian anomalies/uterine adhesion
MRI: mullerian anomalies, hypothalamic pituitary Dz

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73
Q

If progesterone challengne test doesn’t cause bleeding, what is the next step

A

E/P challenge
+ bleed= FSH check
FSH >40: ovarian failure
FSH>5: stress, CNS tumor, Sheehan (post-partum necrosis/ischemia)

-bleed= obstruction/Ashermann

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74
Q

Frequent menstrual bleeding is a cycle that is ? days while infrequent cycles is ? days

Amenorrhea is a menstrual cycle absent for ? months or more and irregular bleeding is a cycle varying more than ? days

A

<21
>35

6mon
>20 days

75
Q

How many days is classified as prolonged or shortened menstrual bleeding

How much blood is considered heavy or light flow

A

> 8 days
<2 days

> 80cc
<5cc

76
Q

What is the MC complaint seen in GYN?

A

Abnormal uterine bleeding

PALM COINE
Structure:
Polyp Adenomyosis Leiomyoma Malignancy/hyperplasia
Non-structural:
Coagulopathy Ovulatory dysfunction Iatrogenic Not classified Endometrial

77
Q

What is the magic number of double endometrium thickness?

How is acute menorrhagia Tx if the PT is stable?

How are they Tx if unstable or don’t respond to non-surg Tx in first 24hrs

A

4mm

Combo OCP
Medroxypreogesterone acetate
Both @ higher dose than for contraception

Surgery:
D&amp;C
Balloon tamponade
Uterine artery embolization
Hysterectomy
78
Q

How is chronic recurrent menorrhagia Tx

A

Stable:
1: Normalize prostaglandins, not effective if taking NSAID

2: Coordinate sloughing- medroxyprogesterone, combo OCP

3: Endometrial suppression-
Progestin only OC
Extended cycle OC
DMPA
Levonorgestrel- most effective

4: Antifibrinolytic therapy- for PTs w/ fibrinolytic activity
Tranexamic acid

79
Q

When are PTs surgical candidates for abnormal uterine bleeding?

Dysmenorrhea is a ? mediated problem causing

A

Failed medical therapy
Child bearing completed

Prostaglandin- inc severity= inc prostaglandin levels
Back pain, N/V/D, HA

80
Q

When are prostaglandins highest

How is primary dysmenorrhea Tx

A

First 2 days of menstruation

NSAIDs
Possible combo w/ OCPs, progestin only (Levo, Depo, Nexplanon)

81
Q

PTs w/ migraine and aura can’t get ? type of OCPs

What is the MC location for endometrial tissue to be found in PTs w/ endometriosis

This is a cause of _ dysmenorrhea

A

Estrogen containing

Pelvic peritoneum
Ovaries, Uterosacral ligament

2*

82
Q

What are the Sxs of endometriosis

This condition may cause the uterus to take on ? shape

A

Dysmenorrhea
Dyspareunia
Dyschezia
Chronic pelvic pain

Retroverted

83
Q

If endometrial tissue is found in the thorax, where is it MC found

How is endometriosis Dx and what imaging is not recommended

A

R side w/ chest/shoulder pain

Laparoscopy, allows simultaneous Tx w/ ablation
US- lacks sensitivity

84
Q

How can endometriosis be differentiated from dysmenorrhea

How is mild endometriosis Tx

A

Endometriosis occurs 1-2 days prior to menses

NSAIDs
Cyclic hormones: Progesterone/OCPs
NSAID + OCP failure=referral

85
Q

What androgen analog is used during endometriosis Tx to inhibit LH/FSH

What is the GnRH agonist used?

How is severe recalcitran Dz cases Tx

A

Danazol- adverse acne/hair growth

Leuprolide- initiates pseudomenopause

Total hysterectomy w/ bilateral salpingo-oophorectomy

86
Q

What NSAIDs are used during endometriosis Tx

Endometriosis frequently co-exists w/ ? and ?

A

Ibu/ketoprofen
Naproxen/Na
Mefenamic acid

Adenomyosis and Fibroids

87
Q

S/Sxs of PMS

Criteris for Pre-Menstrual Dysmorphic D/o

A

Fatigue Mood Tender Bloat

5 Sxs w/ significant Psych/Social impairment

88
Q

Mood swings of PMS coincide w/ ? phase

Why are there mood swings w/ PMS

A

Luteal: dec serotonin

Impact on CNS: Serotonin Noradrenaline GABA

89
Q

Why is there bloating/weight gain during PMS

PMDD Dx requires a Sx free period of 7 days that coincides w/ ?

A

Progesterone (antimineralcorticoid) + estrogen (+ RAAS)= altered E+ balance

First half of cycle x 3 cycles
Follicular phase- onset of menses

90
Q

What are the top two PE Sxs of PMS

What is the top behavioral health Sx

A

Fatigue Bloating

Labile mood

91
Q

How is PMS/PMDD Tx

What anovulatory agent is used second line and why is this step done?

A

SSRIs: Fluoxetine Sertraline Paroxetine
Cramp/HA: NSAID
Bloat: Diuretic (HCTZ, spironolactone)

Combo OCPs
GnRH agonist- Leuprolin
Places body in false menopause to relieve Sxs

92
Q

When are Sxs of PMS/PMDD worse

What is the definition of menopause

A

End of cycle during switch of p/e

Dx at 12mon after final menses
Avg age: 52

93
Q

Menopause transition is AKA ?

Define Premature Ovarian Failure

What is the acronym for the Sxs of menopause

A

Perimenopause/Climacteric

No menses <40y/o due to high FSH/low E/P

FSHIUL
Flashes Sad HA Insomnia Urinary sxs Libido

94
Q

The vasomotor Sxs of menopause can start as early as ? before FMP

How is estrogen a cardio protector?

This protection is gone and equal to male risk factors by age ?

A

2yrs

High HDL, Lower TC

70

95
Q

Hormone therapy can be beneficial to PTs but loses the protection if started ?

PTs on hormone therapy need to be evaluated every ?

Don’t give ? type of estrogen to females w/ uterus due to ? risks

A

Over 60y/o
+10yrs after FMP

Q6-12mon

Unopposed, endometrial hyperplasia, neoplasia, endometrial cancer

96
Q

What estrogen combo hormone therapy can be given to females w/ uterus

? part of hormone therapy causes females to be at inc risk for DVTs

A

Estrogen + Beazedoxifine

Estrogen

97
Q

What is the SHATTERED Family acronym for

A

Osteoporosis Risk factors

Steroid 
Hyperthyroid/Ca/parathyroid
Alcohol/tobacco
Testosterone, low
Thin, low BMI
Early menopause
Renal/liver failure
Erosive bone dz
Diet low in Ca/DM-1
FamHx
98
Q

When do women get DEXA scans

When do perimenopausal women get DEXA scans

A

+65y/o
One or more RF for osteoporosis
Sustained Fxs

Specific RFs
Low BMI <18.5
Meds accelerating bone loss

99
Q

What is a normal DEXA criteria?

Define T Score

Define Z score

A

Normal: +2.5–1.0
Penia: -1–2.5
Porosis:

100
Q

When is osteoporosis medical therapy started?

What meds are used to prevent, treat or both

Which ones work faster at vertebrae than hip?

A

T score < -2.5
Vertebral/hip Fx
-1 - 2.5 w/ 1+ RF

Prevent: estrogen, Vit D
Treat: denosumab, calcitonin/PTH 2nd line
Both: SERM, bisphosphonates

Prevention

101
Q

MOA of bisphosphonates

What are the a/e of using?

A

Inhibit osteoclast resorption
Take on empty stomach and stay upright x 30min due to esophageal erosion

Osteonecrosis of jaw
Atypica femur Fx
Prolonged use is worse
Take drug holidays

102
Q

Loss of estrogen increases ? activity

Loss of ?” of height needs to have a compression Fx considered

Where is most Ca lost from

A

Osteoclast

> 1.5”

Trabecular bone of spine, femoral neck

103
Q

What initial labs are ordered to work up amenorrhea

Why is primary ovarian failure a concern?

A

hCG FSH/LH TSH Prl

Estrogen= leads to severe osteoporosis

104
Q

What microbe causes Erythrasma

What does it look like under a woods lamp

How is it Tx

A

Corynebacterium

Red

Local: clindamycin
Wide: erythromycin

105
Q

Normal vaginal pH is ?

Why is this level needed?

What are two causes of non-inflammatory vaginitis

A

4.5

Lactobaccili- creates lactic acid and hydrogen peroxide as defenses

BV- gardnerella
Candidiasis

106
Q

What is the MC cause of vaginal d/c

What is the criteria used for Dx

A

BV- grey/milky d/c w/ fishy odor

Amsel’s Criteris:
pH >4.5 D/c Odor Clue

107
Q

How is vaginal pH tested

How is BV Tx

A

Nitrazine paper turns blue

Metronidazole
Clindamycin cream
Alt: Secnidazole, Tinidazole, Clindamycin ovules

108
Q

How are recurrent BV infections Tx

A

No prior extended Tx:
Vaginal Metrogel, Clindamycin
PO Metronidazole Tinidazole

Prior Hx of Tx:
Same as above x 2wks then,
Suppression therapy w/ Metronidazole gel x 1wk
Metronidazole PO x 2wks
Tinidazole x 6mon
109
Q

What are the adverse outcomes of unTx BV in pregnancy

What is the 2nd MC cause of vaginitis

A

PROM
Pre-term delivery
Intra-amniotic infection
Post-partum endometritis

Candidiasis albicans or Glabrata- resistant to -azoles

110
Q

What are the RFs for a candidiasis infection

How is it Tx

A 
ImmSupp
DM
Environmental
Estrogen
ABX use

Clotrimazole x 7 days**
PO Metronidazole x 1 dose

111
Q

Chronic recurrent candidiasis infections are a ? issue

What can cause these repeats?

A

Host issue w/ 4 repeats/year

Dec mannose binding lecting
Inc of IL-4

112
Q

What is used for recurrent VVC Tx

What is used for suppression therapy?

A

PO Fluconazole: day 1 4 and 7

After completing Tx regime:
PO Fluconazole x 6mon

113
Q

What meds are used for non-albican species of VVC

What med can be used for external irritaiton/inflammation

A

Boric acid x 2wks
Fluconazole Q72hrs

Mild potency steroid

114
Q

What is the 3rd MC cause of vaginal d/c

How is it Dx

A

Trichomoniasis- frothy green/yellow d/c w/ musty odor

Frothy d/c
Strawberry cervix
pH >4.5
Trichomonads on wet prep (mobile w/ flagella)
NAAT* gold standard
115
Q

How is Trichomoniasis Tx

How are PTs w/ BV and Trichomonas infections Tx

A

Metronidazole 2g PO or,
500mg BID x 2wks if compliant PT
Tinidazole 2g x once

Tx BV
Test of Cure at 1mon and 6on

116
Q

What are the causes of vulvar pruritis w/ white lesions

What are the causes of pruritis w/ red lesions

A

Dystrophies:
Lichen sclerosus
Squamous hyperplasia

Dermatoses:
Contact/Atopic dermatitis
Psoriasis
Vestibulitis
Lichen planus
117
Q

Define Squamous Hyperplasia

Define Lichen Sclerosus

A

Vulvar pruritis that used to be called leukoplakia
Lichen simplex chronicus

Inflammation of dermis in post-menopause w/ wax/wane itching/late burning
Skin appears paper/crinkled

118
Q

Lichen Sclerosus has an increased risk for PTs to develop ?

How is it Tx

A

Squamous Ca of vulva

Topical CCS- Clobetasol
Retinoids if unremitting
Phototherapy and 5-aminolevulinic acid if severe

119
Q

Define Lichen Simplex Chronicus

How is it Tx

A

Non neoplastic alteration of vulvar skin due to chronic irritation from itch/scratch cycle
MC at L Majora

Lube: petroleum jelly, veg oil
Sitz bath
PO antihistamine
Wear cotton gloves at night
Topical steroid

Unresolved in 1-3wks= biopsy

120
Q

Atopic Dermatitis

How is it Tx

A

Hx of allergy/eczema w/ atypical location
Scaly patches w/ fissuring

Topical steroids
ImmunModulators- Tacrolimus

121
Q

Where is Psoriasis uncommonly seen in females?

Define Koebnerization

How is it Tx

A

Mons pubis
Labia

Trauma on vulva as inticing factor

Emollient/Steroids
Dovonex after

122
Q

What meds can cause Lichen Planus

How does it appear

A

NSAIDs BB Methyldopa PCN Quinine

Cutaneous and mucosal surfaces w/ red erosion/white border
D/c Pruritis Burning
Post-intercourse bleeding

123
Q

What are the 3 variants of Lichen Planus

What does it look like

How is it Tx

A

Erosion Papulosquamous Hypertrophic

Purple erosive pruritic polygon papules/plaques- can affect gingiva

Clobetasol
Vaginal hydrocortisone
Suppository

124
Q

How does Intertrigo present

How is it Tx

A

Crease friction from bacterial/fungal infection
Burning/itching
Hyperpigmentation

Corn starch
Mild steroid: inflammation
Antifungal: Nystatin/Cotrimazole

125
Q

What is the MC cause of vaginal irritation after menopause?

How does it present

How is it Tx

A

Atrophic vaginitis

Clear/yellow/blood tinged d/c w/ dysparunia
Loss of rugae/pale mucosa

Topical estrogen

126
Q

Bartholin cyst is a concern for CA in women over ? y/o

If the cyst is located ?, the PT presents w/ no pain

How are these Tx

A

40

Cyst in duct

ASx= none, unless >40
Don’t do I&D
Word catheter
Marsupialization after 2 failures

127
Q

What usually follows a bartholin cyst

Women w/ this follow on presentation need ? screening

A

Abscess- polymicrobial w/ correlation to G/C infection

STD panel: G/C

128
Q

When are ABX used for Barthlin abscess Tx

What ABX are used

A 
Recurrent/High risk PT:
Pregnant
Cellulitis
Systemic infection
ImmSupp

TMP/SMX
Amox/Clav

129
Q

What microbe causes Toxic Shock Syndrome

When does it start and how does it present

How/why do PTs die of this

A

Staph A

2days after surgery/onset of menses
Macular rash w/out pain/itch

ARDS, DIC or HOTN leading to myocardial failure

130
Q

What are the major criteria for Dx Toxic Shock

What are the minor criteria

A 
HOTN
OHOTN syncope
BP <90
Macular erythroderma
Temp >38.8*C
Skin desquamation 1-2wks later
3 needed: 
Diarrhea/Vomit
Membrane erythema
Elevated Cr
Inc platelet count/bilirubin
AMS
131
Q

What increases the chances of vulvar Ca?

These are usually caught and Dx in ? stage

A

Age, HIV

1 or 2

132
Q

Vulvar Ca is usually ? type

What is the 2nd MC type

A

Squamous on Hart line

Malignant melanoma, poor prognosis

133
Q

What are the risk factors of vulvar Ca in women <55y/o

What risk factors affect >55y/o

Women have a 35x inc risk of Ca if they have ? 2 RFs

A

HPV, smoking
Same risk as cervical Ca

15% have HPV
Long standing lichen sclerosis

Smoker + HPV

134
Q

How does Vulvar Ca usually present

What procedure is done for exam?

Since primary vaginal carcinomas are rare, found cases are usually ? Ca

A

Pruritis w/ lesion

Vulvoscopy- coposcopic exam of vulva w/ biopsy

Metastatic to vagina

135
Q

What are the types of vaginal Ca

A

Squamous- HPV, bleeding

Adenocarcinoma- metastatic, DES exposure

Mesenchymal

136
Q

What is the MC type of vaginal malignancy in kids under 5y/o

What may be the most rare form?

A

Rhabdomyosarcoma (mesenchuymal tumor)

Leiomyosarcoma

137
Q

What is the MC Complaint of PTs w/ vaginal Ca

What is the MC region?

What if the Ca is on the anterior wall

What if it’s on the posterior wall?

A

Vaginal bleeding

Upper third of wall

Dysuria Urgency Hematuria

Constipation

138
Q

What are the four types of benign cervical dzx

A

Polyp Cervicitis Nabothian cyst Stenosis

139
Q

S/Sxs of Cervical stenosis

How is it Tx

A

Contracting scar issue on endocervical canal blocks os=

Dysmenorrhea Infertility Amenorrhea

Dilators
Vaginal estrogen x 4wks if Post-monopause

140
Q

Cervical os needs to be at least _mm for blood to exit

Define Nabothian cyst

A

5mm

Columnar cell trapped under squamous during metaplasia, continue secreting mucus
Rarely Sx= no Tx
If Sx= cautery/excision

141
Q

How does cervicitis present

What can cause it

What part of the cervix creates mucus

A

Bleeding cervical epithelium

G/C HSV Trichomonas BV

Endocervix from glandular columnar cells

142
Q

SCJ can regress into endocervix during what 3 low estrogen times?

Immature metaplastic cells in the T-zone are vulnerable to the oncogenic effects of ?

What other 2 RFs increase these chances

A

Menopause
Lactation
Progestin only OCPs

HPV

Early intercourse and 1st pregnancy

143
Q

What is the primary method of detecting pre-cancers

Cervical Ca is not considered to be sensitive to ?

A

Colposcopy

Estrogen

144
Q

What are the risk factors for cervical neoplasms

A

Age, inc
Low status
Ethnicity

Male w/ multiple partners
Early coitus
Tobacco/diet

Parity
ImmSupp
Exogenous hormones
Cervical HPV
Screenings poor
145
Q

HPV vaccine is ? prevention while Pap screenings are ?

What lab/pap finding is a “surrogate” for cervical Ca

A

Vaccine- primary
Pap- secondary

CIN 3: squamous epithelial lesion

146
Q

What are the different grades of CIN

A

1: mild; abnormal cells in lower 1/3, HPV, most regress
2: moderate; abnormal cells to middle 1/3
3: severe; abnormal cells to upper 1/3

Carcinoma in situ- full thickness involvement

147
Q

HPV is the MC STI in the US, what type is the most oncogneic worldwide

What are the low risk strands of HPV

Where does the infection reside in the body

A

16: ano/oropharyngeal cancers

6 and 11- genital warts, laryngeal papillomas

Basal cells

148
Q

Since HPV can spontaneously resolve, what is it’s key factor to develop in Ca?

PTs w/ HPV 16/18 w/ lesions lasting longer than 6mon develop ?

A

Persistence

Squamous Intraepithelial lesion

149
Q

Define Pap Co-Testing

Define Reflex Testing

A

Pap Cyto sample tested for HPV in PTs +30y/

<30y/o w/ abnormal cells on Pap trigger additional tests

150
Q 
What Pap screenings are needed for the following ages:
<21
21-29
30-65
>65
Post-Hysterectomy
A

<21: no screening

21-29: Q3yrs w/ Reflex testing

30-65: Co-test Q5yrs, only Pap=Q3yrs

> 65= 3 consecutive neg Paps

Post-Hys, no CIN2 past 20yrs:
+ cervix= continue screening
- cervix= no screening
CNI2+ Dx in 20yrs= vaginal swabs x 20yrs past Dx

151
Q

Co-test/Reflex test only give you ? data

HPV HR DNA test gives you ?

A

Presence of HPV

Sub type of HPV

152
Q

HPV results are given using ? criteria

What info is given

A

Bethesda

Specimen type
Adequacy
Interpretation
Description ancillary testing
Notes/recommendations
153
Q

What are the 5 categories of resutls that can come back on a pap smear

A

ASCUS- atypical squamous cells undetermined significance

LSIL- low grade squamous intraepithelial lesion

ASC-H- atypical squamous cells, can’t exclude HSIL

HSIL- high grade squamous intraepithelail lesion

AGC- atypical glandular cells

154
Q

+HPV PTs are managed the same as ?

How are they managed

A

LSIL

Colsposcopy

155
Q

What is the next step for:
>30y/o LSIL, -HPV

LSIL but no HPV test

LSIL w/ +HPV

PT w/ ASC-H

PT w/ HSIL

A

Repeat Co-test in 1yr

Colposcopy

Colposcopy

Colpo regardless of HPV

Loop or Colpo

156
Q

Pap is a ? tool, Colpo is a ? tool

Colpo offers what 3 tools

What has to be done prior to procedure

A

Screen, Dx

Biopsy Sampling Visualization

Qualitative pregnancy test

157
Q

If Colpo is unsat due to T-zone can’t be seen, whats then ext step

Cervical Ca is #_ of malignancy in females

A

4, usually from HPV

LEEP- loop electrosurgical excision procedure
CKC- cold knife cone

158
Q

How often are Cervical Ca Pts f/u

How often are cervical/vaginal cuff paps performed

A

Q3mon x 2yrs
Q6mon until 5yrs Post-Tx
Annually

Annually x 20yrs post-Tx

159
Q

What are the estrogen dependent abnormalities of the uterus?

What are fibroids AKA

A

Adenomyosis
Leiomyomata
Endometrial hyperplasia

Leiomyomata- MC pelvic tumor of women

160
Q

What is a common presenting Sxs of fibroids

What is the preferred Dx

These commonly lead to ? Tx

A

Bleeding

US

Hysterectomy

161
Q

What is used to reduce/slow bleeding from leiomyomas

Define Adenomyosis

What is the first image ordered?

A

Contraceptives
IUD

Endometriosis w/in myometrium, usually ASx

US

162
Q

What is the gold standard Tx for Adenomyosis

What meds may be tried prior to Tx

A

Hysterectomy

GnRH agonist Danazol IUD COC

163
Q

What is the MC Sx of Polyps

How are they viewed?

A

Metrorrhagia

US, sonohysterography

164
Q

How does endometrial hyperplasia present

Who is is MC seen in

How is it Dx

A

Abnormal uterine bleeding

Post-menopause women

Biopsy- gold standard

165
Q

How is endometrial hyperplasia classified for malignancy potential

Trans-Vag US is the first Dx step for endometrial hyperplasia only in ? PTs

A 
Greatest= complex hyperplasia w/ atypia
Least= simple hyperplasia w/out atypia

Post-menopause, 4mm or less= low risk

166
Q

How are PTs w/ endometrial hyperplasia w/ atypia but want to retain fertility managed?

How are PTs w/ endometrial hyperplasia w/out atypia managed

A

Progestin w/ endometrial biopsy q3mon
Then hysterectomy and salpingectomy

Pre-Meno:Low progestin x 6mon or
COC w/ endometrial biopsy
Post-Meno: SAME

167
Q

What is the MC Gyn in Ca

What are the MC presentations

A

Endometrial Ca

Vaginal bleeding
Pelvic pressure
Early satiety

168
Q

How is endometrial Ca Tx

Define Lynch Syndrome

A

Hysterectomy w/ bilateral salpingoophrectomy and lymph node staging

Multiple Ca, usually sentinel
Tx w/ prophylactic hysterectomy

169
Q

How is endometrial Ca Dx

What would be seen on TVUS

A

Endometrial Biopsy

Post-Meno: 4mm or small, ok
5 or more, biopsy

170
Q

What tumor marker may be seen in endometrial cancer

This responds to ? hormone

A

CA125, monitor tool
May help w/ ovarian masses in Post-Meno PTs

Progestin- Tamoxifen

171
Q

What are the two types of functional ovarian masses

Define endometrioma

A

Follicular cyst- follicle doesn’t rupture, >3mm
Lutein cyst- corpus luteum doesn’t regress

Metaplastic ovarian mass from endometriosis

172
Q

How doe functional cysts present

How are they dx and Tx

A

Pain Dull sensation Heavy

Bimanual exam, US

Tx w/ surgery

173
Q

What are sizes of simple cysts and f/u

A 
Pre-Men:
3 or less: norm variant
5 or less: no Tx
>5 <7: repeat TVUS 12wks, persists= annual TVUS
>7: MRI/surg eval

Post-Meno:
1 or less: norm variant
5 or less: Norm CA125= repeat US 12wks, persists= annual TVUS
7 or more: MRI, surg eval

174
Q

What steroid hormones cause male-ness

A

DHEA- adrenal gland; weak

Androstenedione- adrenal gland and ovary, weak

T- adrenal gland, ovary and adipose, potent

DHT- follicles and genital skin, most potent

175
Q

Define Hypertrichosis

Dfeine Hirsutism

Dfein Virilizaiton

A

Non-sexual hair not due to androgens

Terminal thick male pattern hair on female, due to androgens

Acne Male baldness Deep voice
Due to androgens

176
Q

PCOS

Dx req’s ? 2 things

What are the 5 MC presentations

A

High androgen/estrogen

Hyperandrogenism
Oligo/anovulation

Hirsutism
Abnormal bleeding
PC ovary
Infertility
Obesity
177
Q

What is NOT a required finding for Dx of PCOS

Define Ovarian Hyperthecosis

How do they present

A

Poly cystics ovaries

Sever PCOS- nest of lutenized theca cells in ovarian stroma

Balding Hypertrophy Deep voice
Acanthosis nigrans

178
Q

HAIRAN Syndrome

A

Hyper Androgenic Insulin Resistant Acanthosis Nigricans

PCOS variant w/ severe insulin resistance

179
Q

What causes idipathic hirsutism

How is PCOS Tx

A

Variant
Inc 5-alpha reductase activity
Mild form of PCOS

COCs: progestin only or Clomiphene if pregnancy desired
Metformin

180
Q

How is the hirsutism of PCOS Tx

A 
Androgen blockers:
Spirinolactone, Flutamide
5-alpha reductase:
Finasteride
Eflornithine- slows growth
181
Q

What causes the most deaths than any other Gyn malignancy

Why is this so deadly

A

Ovarian cancer

No screenings

182
Q

What is the primary mechanism of ovarian cancer

What are some protective steps that can be done

A

Uninterrupted ovulation

Breast feeding
OCPs
Ligation/hysterectomy
Diet high fiber, low fat

183
Q

What factors can falsely elevate CA125

What PE finding + a pelvic mass is indicative of ovarian cancer

What pulm finding is concern

A

Premenopause w/ endometriosis, fibroids

Ascites

Pleural effusion

184
Q

What lab findings will be seen in PTs w/ ovarian Ca

How is ovarian cancer staged

What does BRCA mutation do to prognosis

A

Thrombocytosis
HypoNa

Surgery

Improves, better response to chemo

IPAP (212 decks)

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