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CK_Gyn > OME/Books > Flashcards

OME/Books Flashcards

1
Q

Which HPV strains cause malignancy and which cause warts?

A

cancer - 16,18, 30’s (vaccine)

warts - 6,11

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2
Q

typical first symptom of cervical cancer

A

post coital bleeding

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3
Q

histology of most cervical cancer

A

affects epithelial layer, leads to squamous cell carcinoma

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4
Q

how to grade cervical cancer

A

CIN 1, 2, 3

how much of cervix is involved

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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

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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

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7
Q

what to do if ASCUS on pap?

A
  1. HPV DNA test
  2. q6month pap

if HPV DNA test positive, proceed to colpo

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8
Q

2 risk factors cervical cancer

A

HPV

!!smoking!!!

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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

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10
Q

When to give HPV vaccine

A

girls - 11-26

boys - 11-21

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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)
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12
Q

how to screen for endometrial cancer

A

THERE IS NONE

can only biopsy

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13
Q

core rx for endometrial cancer

A

remove mass (total abdominal hysterectomy) + remove source of estrogen (bilateral salpingoophorectomy)

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14
Q

common presentation of endometrial cancer

A

post menopausal bleeding

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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

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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

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17
Q

reproductive age woman with weight loss, palpitations, anxiety, sweating…normal thyroid gland, adnexal mass

A

struma ovarii (thyroid producing benign cystic teratoma)

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18
Q

MCC type ovarian tumor iiwoman over 30

A

epithelial (serous>mucinous)

poorer prognosis

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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
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20
Q

tumor marker ovarian cancer

A

CA-125

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21
Q

MCC type ovarian tumor pt under 30

A

benign cystic teratoma (dermoid cyst)

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22
Q

rx epithelial ovarian cancer

A

debulking (TAH+SBO) + chemo with platinum agents (cisplatinium/carboplatinum)`

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23
Q

types of ovarian germ cell tumor (4) + marker

A

dysgerminoma - LDH
endodermal sinus/yolk sac - AFP
teratoma - no marker
choriocarcinoma - bHCG

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24
Q

types of ovarian epithelial cell tumor (4)

A

serous
mucinous
epithelioid
Brenner’s

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25
Q

risk factor epithelial tumor of ovary

A

ovulation (multiple ovulations)

multiple pregnancies and OCPs protective

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26
Q

two genetic syndromes increase risk for ovarian tumor?

A

BRCA1/2

HNPCC

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27
Q

how to dx, stage, and track ovarian tumor

A

dx - TVUS
stage - CT
track - CA-125

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28
Q

How to minimize ovarian tumor risk in BRCA1 patients

A

yearly TVUS and CA-125

prophylactic TAH/SBO @ age 35

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29
Q

2 types of stromal cell (ovarian tumor)

A

granulosa - theca cell . - estrogen producing

sertoli-leydig - testosterone

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30
Q

features of benign vs not so benign adnexal mass

A

-smooth, small, no septations - simple cyst, no further work up

large septations, loculated - less likely benign

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31
Q

how does choriocarcinoma typically present

A

hyperemesis gravidarum

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32
Q

red lesion on vagina that is itching, dx and rx

A

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

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33
Q

3 vulvar cancers

A

SCC (can be HPV related)
melanoma
Paget’s

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34
Q

grape like mass in vagina; dx and what exposure to check for?

A

vaginal adenocarcinoma

DES exposure in utero

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35
Q

vulvar lesion, non-itchy, hx of multiple STIs, acetic acid changes color of lesion to white
dx and rx

A 
condyloma accuminata (HPV)
rx with imiquimod/podophyllin
vs excision for larger lesions
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36
Q

post menopausal vaginal itching, dyspareunia, porcelain white lesions, thinning of vulvar skin
dx and rx

A

lichen sclerosis
rx topical CORTICOSTEROIDS

not estrogen (vaginal atrophy, dryness)

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37
Q

how does complete mole form?

A

bad egg + single sperm that doubles it’s chromosomes (normal chromosome number but all from sperm)

“COMPLETELY without fetal parts”

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38
Q

increased bhcg can imitate what hormone

A

hyperthyroidism

can also cause hyperemesis gravidarum

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39
Q

How to dx molar disease

A

TVUS shows “snowstorm appearance”

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40
Q

how to monitor molar disease

A

after treatment with suction curretage , do serial bHCGs while on reliable OCPs for 12 months

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41
Q

how does an incomplete form?

A

one egg + 2 sperm

causes (69 XXY/XXX)

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42
Q

rising hcg despite good contraception

A

invasive molar disease/choriocarcinoma

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43
Q

when can choriocarcinoma occur?

A

molar pregnancy
after miscarriage
after NORMAL pregnancy even

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44
Q

how to dx chorio

A 
dx with TVUS
Bx with curretage
stage CT
surgical rx - TAH/Debulking
medical rx - MAC chemo
45
Q

MAC chemo for chorio?

A

methotrexate
actinomycin D
cyclophosphamide (refractory disease)

46
Q

what ligament contains vascular supply to ovary

A

suspensory ligament of ovary

47
Q

what ligament is affected by ovarian torsion?

A

suspensory ligament of ovary

48
Q

pathway to uterine artery from aorta

A

aorta, common iliac, internal iliac, uterine artery

49
Q

non surgical treatment for postpartum hemorrhage

A
  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
Q

which ligament connects uterus to side wall and and anterior/posterior boundary (bladder anteriorly, rectum posteriorly)

A

cardinal ligament

51
Q

large multiple births, stretching ligaments, leading to vaginal fullness/chornic backpain leading to prolapse of pelvic organs

A

pelvic floor relaxation

52
Q

three types of pelvic organ prolapse and their treatments

A
  1. cystocele - bladder, colporraphy
    rectocele - rectum, colporraphy
    uterine inversion - uterus, hysterectomy
53
Q

constipation that’s relieved by inserting two fingers in vagina/splinting

A

rectocele

54
Q

adnexal mass, unilocular, anechoic, homogenous, <10 cm

what to do next?

A

watch and wait to see if it grows, do not aspirate

likely a simple cyst

55
Q

adnexal mass, septations, multilocular, multiechoic, heterogenous, >10cm

what to do next?

A

remove it!

laparaoscopy>laparotomy

likely a complex cyst (teratoma, endometriosis, ectopic pregnancy, tubo ovarian abcess, cancer)

56
Q

rx teratoma in younger woman

A

CYSTECTOMY

not salpingoophorectomy unless she’s done having kids

57
Q

dysmenorrhea, dyspareunia, infertility, complex cyst on TVUS

A

endometrioma (causing endometriosis)

58
Q

how to dx endometrioma

A

diagnostic laparoscopy WITH LASER ablation (loo for chocolate cyst, blast it if you see it)

59
Q

how to dx endometriosis (without oma)

A

give OCP

if it resolves then that’s the dx!

60
Q

how to rx endometriosis

A

halt estrogen

give OCPs

61
Q

bhcg >2000

what to do next?

A

ultrasound

if in uterus = awesome
if not = ectopic :(

IF LESS THAN <2000, check again later

62
Q

bhcg<5000
gestational size <3cm
no fetal heart tones

what to do

A

ectopic! rx with methotrexate and leukovorin rescue (fertility sparing but most limited time)

63
Q

how to rx ovarian torsion

A

u/s with doppler!! to check flow

64
Q

abd pelvic pain, with cervical motion/adnexal/uterine tenderness which doesn’t improve with cef + doxy/metronidazole/gent

A

tuboovarian abscess

like PID

DRAIN THAT SHIT

65
Q

MCC etiology pre-menarchal vaginal bleeding

A

foreign body

but watch out for sexual abuse, precocious puberty

66
Q

MCC etiology reproductive age woman with vaginal bleeding

A

pregnancy

but watch out for dysfuctional uterine bleeding

67
Q

first medical treatment for large uterine bleed

A

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
Q

no passage of contents, closed os, live baby

A

intrauterine pregnancy

69
Q

bleeding, no passage of contents, os closed, live baby

A

threatened abortion

BED REST, and may be reversible

70
Q

no passage of contents, open os, deadbaby

A

inevitable abortion

71
Q

passage of fetal contents, open os, retained parts

A

incomplete abortion

72
Q

passage of fetal contents, closed os, no parts on ultrasound

A

complete abortion

73
Q

no passage of contents, closed cervical os, dead baby

A

missed abortion

74
Q

after spontaneous abortion diagnosed, what to do?

A

misoprostol, oxybutinin, d+c

administer rhogam to RH neg mother

75
Q

rx molar pregnancy

A

evacuation
OCPs (to prevent pregnancy)
monitor bhcg to prevent choriocarcinoma

76
Q

ectopic on u/s rupture vs no rupture

A

rupture - salpingectomy

no rupture- salpingOSTOMY

77
Q

discriminatory zone for bhcg

A

1500-2000

if over, look for uterine pregnancy, if not treat like ectopic

78
Q

characteristic of normal bhcg

A

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
Q

primary amenorrhea, no uterus, (X.X), normal testosterone

A

mullerian agenesis

80
Q

primary amenorrhea, no uterus, elevated testosterone (X,Y)

A

androgen insensitivity

81
Q

primary amenorrhea, no FSH/LH, no mass in anterior pit, anomsmia, no secondary sex characteristics

A

kallman syndrome

82
Q

primary amenorrhea, no fsh/lh, mass around ant pituitary, no fsh/LH

A

craniopharyngioma/other endocrine mass

83
Q

X,0, broken ovaries,

A

turner

84
Q

FSH and LH in turner’s?

A

elevated?

no disinhibition by estrogen in broken ovaries

85
Q

streak ovaries

A

turner’s

86
Q

two cardiac manifestations turner’s

A

coarctation

bicuspid aortic valve

87
Q

female sex characteristics, female external genitalia, no uterus/tubes

dx and rx?

A

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
Q

rx androgen insensitivity

A

remove testes (orchiectomy) after puberty so SHE doesn’t develop testicular cancer

89
Q

webbed neck, broad spaced nipples, shield like chest, coarctation/bicuspid aortic valve, no secondary sex characteristics

A

turner’s

90
Q

how to monitor Turner’s patients

A

serial echocardiograms, surgically intervene if heart anomalies (coarctaiton, bicuspid aortic valve are present)

91
Q

how to separate mullerian agenesis and androgen insensitivity with LABS

A

check testosterone level

will be elevated in androgen, nml in mullerian

92
Q

MCC secondary amenorrhea

A

pregnancy

assess with UPT

93
Q

2nd MCC secondary amenorrhea

A

hypothyroidism

elevated TSH

94
Q

elevation in what hormone can lead to secondary amenorrhea?

A

prolactin (prolactin inhibits GnRH)

think prolactinemia/-oma

95
Q

how does hypothyroidism inhibit bleeding?

A

t4 normally inhibits TRH.

TRH inhibits bleeding by increasing production of PROLACTIN

96
Q

how to evaluate male infertility

A

ED? -> NPT testing/sildenifil

semen analysis for sperm count

97
Q

medication to induce ovulation

A

clompiphene (disinhibits GnRH)

pernogal (stimulates FSH/LH)

98
Q

infertility test to check woman’s ovarian reserve

A

early follicular FSH + estradiol level

99
Q

way to eval for infertility (ovulation)

A

basal body temp
midluteal progestrone
TSH, prolactin, androgens

100
Q

amenorrhea in lactating patient?

A

lactational amenorrhea (prolactin inhibits GnRH, so no FSH/LH production)

101
Q

rx PCP (AIDS looking patient with interstitial pneumonia)

A

TMP SMX with prednisone (if pulse ox<92)

102
Q

male tumor elevated AFP and bHCG

A

nonseminomatous germ cell tumor

103
Q

rx septic shock before vasopressors

A

AGGRESSIVE VOLUME RESUSITATION (0.9% SALINE)

104
Q

cardinal symptoms of acute COPD exacerbation (3)

A

increased dyspnea
increased sputum production (change in color/volume)
increased cough

105
Q

management acute COPD exacerbation

A

oxygen
inhaled bronchodilators
systemic glucocorticoids
ANTIBIOTICS (if greater than 2 cardinal symptoms)

106
Q

phenytoin can cause deficiency of WHAT?

A

FOLIC ACID

107
Q

patient started on anticoagulation gets thrombocytopenia, thrombosis or 50% drop in platelet countfrom baseline

A

HIT (usually from unfractionated heparin)

108
Q

rx chemo-induced nausea

A

serotonin receptor antagonists

CK_Gyn (4 decks)

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