OME/Books Flashcards
1
Q
Which HPV strains cause malignancy and which cause warts?
A
cancer - 16,18, 30’s (vaccine)
warts - 6,11
2
Q
typical first symptom of cervical cancer
A
post coital bleeding
3
Q
histology of most cervical cancer
A
affects epithelial layer, leads to squamous cell carcinoma
4
Q
how to grade cervical cancer
A
CIN 1, 2, 3
how much of cervix is involved
5
Q
When to begin cervical cancer screening
A
start at 21 and have every 3 years (Pap smear), stop at 65 if tests have been normal
at 30, if you have Pap smears + co-testing, you can have every 5 years
exception: HIV, screen every year
6
Q
what to do if pap grossly abnormal?
A
colposcopy to see if lesions are ecto (outer) or endo….if ecto positive, do LEEP/cryo/ablation, if endo, do cone biopsy
7
Q
what to do if ASCUS on pap?
A
- HPV DNA test
- q6month pap
if HPV DNA test positive, proceed to colpo
8
Q
2 risk factors cervical cancer
A
HPV
!!smoking!!!
9
Q
When to do resection vs. debulking/chemo for cervical cancer
A
IIB or less - resection/ablation curative (involves cardinal ligament)
IIB or more - debulking and chemo with platinum based agent
10
Q
When to give HPV vaccine
A
girls - 11-26
boys - 11-21
11
Q
risk factors for endometrial cancer
A
ESTROGEN EXPOSURE!
- anovulation
- age
- nulliparity
- obesity (increases peripheral conversion of estrogen)
- early menarche/late menopause
- drugs (OCPs/tamoxifen for breast cancer/hormone replacement therapy with estrogen)
12
Q
how to screen for endometrial cancer
A
THERE IS NONE
can only biopsy
13
Q
core rx for endometrial cancer
A
remove mass (total abdominal hysterectomy) + remove source of estrogen (bilateral salpingoophorectomy)
14
Q
common presentation of endometrial cancer
A
post menopausal bleeding
15
Q
most common cause of post menopausal bleeding
A
vaginal atrophy
BUT MUST WORK UP FOR ENDOMETRIAL CANCER with endometrial biopsy or D+C
16
Q
what to give patient with precancerous endometrial hyperplasia who is of reproductive age and wants to preserve fertility?
A
progesterone
progestrone is “PROtective” and stops estrogen production
17
Q
reproductive age woman with weight loss, palpitations, anxiety, sweating…normal thyroid gland, adnexal mass
A
struma ovarii (thyroid producing benign cystic teratoma)
18
Q
MCC type ovarian tumor iiwoman over 30
A
epithelial (serous>mucinous)
poorer prognosis
19
Q
signs of ovarian cancer
A
malignant ascites to omentum, small bowel, lymphatics repeat bouts of SBO (from ascities) weight loss elevated CA-125 renal failure
20
Q
tumor marker ovarian cancer
A
CA-125
21
Q
MCC type ovarian tumor pt under 30
A
benign cystic teratoma (dermoid cyst)
22
Q
rx epithelial ovarian cancer
A
debulking (TAH+SBO) + chemo with platinum agents (cisplatinium/carboplatinum)`
23
Q
types of ovarian germ cell tumor (4) + marker
A
dysgerminoma - LDH
endodermal sinus/yolk sac - AFP
teratoma - no marker
choriocarcinoma - bHCG
24
Q
types of ovarian epithelial cell tumor (4)
A
serous
mucinous
epithelioid
Brenner’s
25
risk factor epithelial tumor of ovary
ovulation (multiple ovulations)
multiple pregnancies and OCPs protective
26
two genetic syndromes increase risk for ovarian tumor?
BRCA1/2
| HNPCC
27
how to dx, stage, and track ovarian tumor
dx - TVUS
stage - CT
track - CA-125
28
How to minimize ovarian tumor risk in BRCA1 patients
yearly TVUS and CA-125
| prophylactic TAH/SBO @ age 35
29
2 types of stromal cell (ovarian tumor)
granulosa - theca cell . - estrogen producing
| sertoli-leydig - testosterone
30
features of benign vs not so benign adnexal mass
-smooth, small, no septations - simple cyst, no further work up
large septations, loculated - less likely benign
31
how does choriocarcinoma typically present
hyperemesis gravidarum
32
red lesion on vagina that is itching, dx and rx
paget's disease of vagina
(biopsy and wide local excision)...generally does not invade, good prognosis
SCC and melanoma are usually black and itchy, not red
33
3 vulvar cancers
SCC (can be HPV related)
melanoma
Paget's
34
grape like mass in vagina; dx and what exposure to check for?
vaginal adenocarcinoma
| DES exposure in utero
35
vulvar lesion, non-itchy, hx of multiple STIs, acetic acid changes color of lesion to white
dx and rx
```
condyloma accuminata (HPV)
rx with imiquimod/podophyllin
vs excision for larger lesions
```
36
post menopausal vaginal itching, dyspareunia, porcelain white lesions, thinning of vulvar skin
dx and rx
lichen sclerosis
rx topical CORTICOSTEROIDS
not estrogen (vaginal atrophy, dryness)
37
how does complete mole form?
bad egg + single sperm that doubles it's chromosomes (normal chromosome number but all from sperm)
"COMPLETELY without fetal parts"
38
increased bhcg can imitate what hormone
hyperthyroidism
can also cause hyperemesis gravidarum
39
How to dx molar disease
TVUS shows "snowstorm appearance"
40
how to monitor molar disease
after treatment with suction curretage , do serial bHCGs while on reliable OCPs for 12 months
41
how does an incomplete form?
one egg + 2 sperm
| causes (69 XXY/XXX)
42
rising hcg despite good contraception
invasive molar disease/choriocarcinoma
43
when can choriocarcinoma occur?
molar pregnancy
after miscarriage
after NORMAL pregnancy even
44
how to dx chorio
```
dx with TVUS
Bx with curretage
stage CT
surgical rx - TAH/Debulking
medical rx - MAC chemo
```
45
MAC chemo for chorio?
methotrexate
actinomycin D
cyclophosphamide (refractory disease)
46
what ligament contains vascular supply to ovary
suspensory ligament of ovary
47
what ligament is affected by ovarian torsion?
suspensory ligament of ovary
48
pathway to uterine artery from aorta
aorta, common iliac, internal iliac, uterine artery
49
non surgical treatment for postpartum hemorrhage
1. uterine massage
2. meds: oxytocin, 3. balloon tamponade
if these fail...go to surgery!! (uterine artery ligation, then internal iliac artery ligation...then hysterectomy if those don't work)
50
which ligament connects uterus to side wall and and anterior/posterior boundary (bladder anteriorly, rectum posteriorly)
cardinal ligament
51
large multiple births, stretching ligaments, leading to vaginal fullness/chornic backpain leading to prolapse of pelvic organs
pelvic floor relaxation
52
three types of pelvic organ prolapse and their treatments
1. cystocele - bladder, colporraphy
rectocele - rectum, colporraphy
uterine inversion - uterus, hysterectomy
53
constipation that's relieved by inserting two fingers in vagina/splinting
rectocele
54
adnexal mass, unilocular, anechoic, homogenous, <10 cm
what to do next?
watch and wait to see if it grows, do not aspirate
likely a simple cyst
55
adnexal mass, septations, multilocular, multiechoic, heterogenous, >10cm
what to do next?
remove it!
laparaoscopy>laparotomy
likely a complex cyst (teratoma, endometriosis, ectopic pregnancy, tubo ovarian abcess, cancer)
56
rx teratoma in younger woman
CYSTECTOMY
| not salpingoophorectomy unless she's done having kids
57
dysmenorrhea, dyspareunia, infertility, complex cyst on TVUS
endometrioma (causing endometriosis)
58
how to dx endometrioma
diagnostic laparoscopy WITH LASER ablation (loo for chocolate cyst, blast it if you see it)
59
how to dx endometriosis (without oma)
give OCP
| if it resolves then that's the dx!
60
how to rx endometriosis
halt estrogen
| give OCPs
61
bhcg >2000
what to do next?
ultrasound
if in uterus = awesome
if not = ectopic :(
IF LESS THAN <2000, check again later
62
bhcg<5000
gestational size <3cm
no fetal heart tones
what to do
ectopic! rx with methotrexate and leukovorin rescue (fertility sparing but most limited time)
63
how to rx ovarian torsion
u/s with doppler!! to check flow
64
abd pelvic pain, with cervical motion/adnexal/uterine tenderness which doesn't improve with cef + doxy/metronidazole/gent
tuboovarian abscess
like PID
DRAIN THAT SHIT
65
MCC etiology pre-menarchal vaginal bleeding
foreign body
but watch out for sexual abuse, precocious puberty
66
MCC etiology reproductive age woman with vaginal bleeding
pregnancy
but watch out for dysfuctional uterine bleeding
67
first medical treatment for large uterine bleed
after 2 large IVs + fluids, type and screen...TRY IV ESTROGEN (stops uterine bleeding)..if that doesn't work..surgery (D+C, or balloon tamponade)
68
no passage of contents, closed os, live baby
intrauterine pregnancy
69
bleeding, no passage of contents, os closed, live baby
threatened abortion
BED REST, and may be reversible
70
no passage of contents, open os, deadbaby
inevitable abortion
71
passage of fetal contents, open os, retained parts
incomplete abortion
72
passage of fetal contents, closed os, no parts on ultrasound
complete abortion
73
no passage of contents, closed cervical os, dead baby
missed abortion
74
after spontaneous abortion diagnosed, what to do?
misoprostol, oxybutinin, d+c
| administer rhogam to RH neg mother
75
rx molar pregnancy
evacuation
OCPs (to prevent pregnancy)
monitor bhcg to prevent choriocarcinoma
76
ectopic on u/s rupture vs no rupture
rupture - salpingectomy
| no rupture- salpingOSTOMY
77
discriminatory zone for bhcg
1500-2000
if over, look for uterine pregnancy, if not treat like ectopic
78
characteristic of normal bhcg
doubles every 48 hours
so if suspecting ectopic and discriminatory hcg<1500, wait and see if it doubles over 48 hours...IF NOT IT'S AN ECTOPIC
79
primary amenorrhea, no uterus, (X.X), normal testosterone
mullerian agenesis
80
primary amenorrhea, no uterus, elevated testosterone (X,Y)
androgen insensitivity
81
primary amenorrhea, no FSH/LH, no mass in anterior pit, anomsmia, no secondary sex characteristics
kallman syndrome
82
primary amenorrhea, no fsh/lh, mass around ant pituitary, no fsh/LH
craniopharyngioma/other endocrine mass
83
X,0, broken ovaries,
turner
84
FSH and LH in turner's?
elevated?
| no disinhibition by estrogen in broken ovaries
85
streak ovaries
turner's
86
two cardiac manifestations turner's
coarctation
| bicuspid aortic valve
87
female sex characteristics, female external genitalia, no uterus/tubes
dx and rx?
mullerian agenesis OR androgen insensitivity
same on outside (female), different on inside (mullerian has ovaries, androgen insens has testes)
no upper 1/3rd vagina so surgically elevate vagina to make sex less painful
88
rx androgen insensitivity
remove testes (orchiectomy) after puberty so SHE doesn't develop testicular cancer
89
webbed neck, broad spaced nipples, shield like chest, coarctation/bicuspid aortic valve, no secondary sex characteristics
turner's
90
how to monitor Turner's patients
serial echocardiograms, surgically intervene if heart anomalies (coarctaiton, bicuspid aortic valve are present)
91
how to separate mullerian agenesis and androgen insensitivity with LABS
check testosterone level
| will be elevated in androgen, nml in mullerian
92
MCC secondary amenorrhea
pregnancy
| assess with UPT
93
2nd MCC secondary amenorrhea
hypothyroidism
| elevated TSH
94
elevation in what hormone can lead to secondary amenorrhea?
prolactin (prolactin inhibits GnRH)
| think prolactinemia/-oma
95
how does hypothyroidism inhibit bleeding?
t4 normally inhibits TRH.
| TRH inhibits bleeding by increasing production of PROLACTIN
96
how to evaluate male infertility
ED? -> NPT testing/sildenifil
| semen analysis for sperm count
97
medication to induce ovulation
clompiphene (disinhibits GnRH)
| pernogal (stimulates FSH/LH)
98
infertility test to check woman's ovarian reserve
early follicular FSH + estradiol level
99
way to eval for infertility (ovulation)
basal body temp
midluteal progestrone
TSH, prolactin, androgens
100
amenorrhea in lactating patient?
lactational amenorrhea (prolactin inhibits GnRH, so no FSH/LH production)
101
rx PCP (AIDS looking patient with interstitial pneumonia)
TMP SMX with prednisone (if pulse ox<92)
102
male tumor elevated AFP and bHCG
nonseminomatous germ cell tumor
103
rx septic shock before vasopressors
AGGRESSIVE VOLUME RESUSITATION (0.9% SALINE)
104
cardinal symptoms of acute COPD exacerbation (3)
increased dyspnea
increased sputum production (change in color/volume)
increased cough
105
management acute COPD exacerbation
oxygen
inhaled bronchodilators
systemic glucocorticoids
ANTIBIOTICS (if greater than 2 cardinal symptoms)
106
phenytoin can cause deficiency of WHAT?
FOLIC ACID
107
patient started on anticoagulation gets thrombocytopenia, thrombosis or 50% drop in platelet countfrom baseline
HIT (usually from unfractionated heparin)
108
rx chemo-induced nausea
serotonin receptor antagonists
