1. imaging (ovarian cysts on ultrasound 2. LH/FSH > 3:1

- exercise wt loss - metformin (also helps with ovulation) - OCPs/clomiphene if fertility wanted - anti-androgens like sprironolactone

OME/Books 2 Flashcards by Christian Bernardo

fat, hairy woman, male pattern distribution

hirsutism (moderate androgen elevation)

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hirsutism + clitormegaly, deep voice, male muscle pattern

virilization (severe androgen elevation)

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two types of androgens and where they are produced in woman

testosterone - ovaries (u/s)

DHEA-S - adrenal glands CT/MRI

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hisurtism, moderately elevated testosterone, normal DHEA-S, bilteral ovaries finding on imaging

PCOS

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2 ways to dx PCOS

imaging (ovarian cysts on ultrasound

2. LH/FSH > 3:1

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rx PCOS

exercise wt loss
metformin (also helps with ovulation)
OCPs/clomiphene if fertility wanted
anti-androgens like sprironolactone

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virilization, very elevated testosterone, DHEAS normal, unilateral ovary

Sertoli leydig tumor of ovary

find tumor on u/s and resect (unilateral oophorectomy)

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virilization, very elevated DHEAS, normal testosterone, unilateral adrenal

adrenal tumor

dx with adrenal vein sampling (confirm laterality) then cut out one of the adrenal glands)

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elevated DHEAS, no change in testosterone, hirsutism, bilateral adrenal glands on CT/MRI, elevated 17 hydroxyprogesterone in urine

CAH

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definitive test for CAH

17 oh progesterone in urine

accumulates in the absence of 21 beta hydroxylase (body is trrying to make more cortisol and aldosterone, so hypertrophies)

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rx CAH (21 b hydroxylase)

cortisol
fludrocorticosne (repletes aldosterone)

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hirsut, normal everything

familial hirsutism

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underlying pathophys menopause

ovarian failure (decreased estrogen, no fertilitY)

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T:F menopause is protective against UTI

FALSE, menopausal women are more vulnerable to UTI

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after how many missed cycles can you dx menopause

cessation of cycles for more than 12 consecutive cycles

CLINICAL DX

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when you’re having early menopause symptoms what labs can you get?

elevated FSH!!!

FSH elevated in menopause

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risk of systemic HRT for menopausal symptoms

increased risk breast cancer

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rx hot flashes

SSRI (venlefaxine)

estrogen creams

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what screenings should be given to postmenopausal womens

fasting lipids

bone scan at 65 (supplement with vit D and Ca), recommend exercise

risk factors breast cancer (3)

increased estrogen (early menarche, late menopause, HRT, obesity)
radiation (hx of radiation for lymphoma then gets breast cancer)
genetic (BRCA1/2)

how to dx possible breast cancer

mammogram
core needle biopsy

(better than FNA, less invasive than exicisional)

how to approach breast mass in patient <30

wait a few cycles
if it persists, do U/S
if it shows mass (no fluid), do FNA
if bloody do mammogram/biopsy

how to locally treat breast cancer

stage with sentinel lymph node, if positive do axillary lymph dissection

radiation + surgery

note: breast conserving therapy = radical mastectomy

systemic chemo for breast cacner

doxorubicin (watch out for CHF)
cyclophosphamide
paclitaxel

her/neu positive breast cancer treatment

trastuzumab

estrogen/progesterone positive breast cancer

youn g- selective estrogen receptor (i.e. tamoxifen), raloxifene) modifiers old - aromatase inhibitors

risks tamoxifen

increase risk DVT and endometrial cancer (estrogen blocker in breast, estrogen AGONIST in uterus)

side effect of trastuzumab

REVERSIBLE CHF unlike doxorubicin, which causes irreversible CHF

adolescent female, asymptomatic 1 cm non tender mobile rubbery breast mass

fibroadenoma

27 year old complains of breast pain which increases with menses; lumpy bumpy breast

fibrocystic changes

34 eyar old woman complains of unilateral serosanguineous nipple discharge from breast, no mass

intraductal papilloma must r/o malignancy

rx fibrocystic changes

avoid caffeine tight fitting bra OCPs/progestin

T/F evaluation breast cancer stops after negative mammogram

NO NEED A BIOPSY IF THERE'S A MASS

inheritance of BRCA1

autosomal dominant

MCC cause of digital clubbing (3)

1. lung malignancy 2. CF 3. right to left cardiac shunts

lower abdomoinal pain, intercycle spotting, fever, breathing wrose with inspiration, pleurtic chest pain

PID with perihepatitis (fitz hugh curtis0

post op patient develops sudden onset hypotension, syncope, new RBBB, JVD

right heart strain + syncope in post op patient = massive PE

longest acting non hormonal contraception and disadvantage?

copper IUD but disadvantage is it may increase bleeding

non IUD long acting reversible contraceptive

skin implants (explenon, implanon)

good contraception option for person who doesn't want that long of an effect but also has poor compliance

depo-provera (injection every 3 months)

risk of hormonal contraception

increase risk of DVT/PE

what three things together increase risk of DVT when on contraception

1. estrogen 2. smoking 3. age>35

which contraception protect against STI?

barrier methods condom/diaphragm

patient comes in with fever, severe infection, WBC count 45, LAP score high, neutrophil predominance (metamyelocytes>myelocytes)

leukomoid reaction CML has elevated WBC count, but has low LAP and immature neutrophils (myelocytes>metamyelocyes

levornogestrel requirement

use within 72 hours of intercourse | will not abort current pregnancy