Repro Flashcards
______ is defined as the abnormal presence of endometrial tissue w/in the myometrium (thick, muscular layer of the uterus).
Adenomyosis
A _____, also known as a fibroid, is a benign smooth muscle tumor that very rapidly becomes cancer. They can occur in any organ, but most often occur in uterus, small bowel, and esophagus.
Leiomyoma
Secondary causes of dysmenorrhea (or PAINFUL MENSTRUATION) include:
- Endometriosis
- Adenomyosis
- Leiomyoma
- Adhesions
- PID
____ is the MC secondary cause of dysmenorrhea in younger patients. ____ is more common with increasing age.
Endometriosis MC secondary cause
Adenomyosis w/ increasing age
Some defining terms…
- Amenorrhea: absence of menstrual period
- Cryptomenorrhea: light flow or spotting
- Menorrhagia: heavy or prolonged bleeding at normal menstrual intervals
- Metorrhagia: irregular bleeding between expected menstrual cycles
- Menometorrhagia: irregular, excessive bleeding between expected menstrual cycles
- Oligomenorrhea: infrequent menstruation
- Polymenorrhea: frequent cycle interval
How is a diagnosis of Dysfunctional Uterine Bleeding (DUB) made?
DX OF EXCLUSION
W/u- hormone levels and transvaginal US
How is DUB treated?
- Acute, Severe Bleeding- High-dose IV estrogens or high dose OCPs (D&C if estrogen fails)
- OCPs- 1st line! regulates cycles, thins endometrial lining, and reduces menstrual flow (DECREASES endometrial cancer risk by reducing unopposed estrogen)
- GnRH agonists- Leuprolide cases temporary amenorrhea (if given in continuous fashion)
- Progesterone- orally or IUD
- SURGERY- If not responsive to medical treatment:
- Hysterectomy- definitive
- Endometrial ablation
_____ is a type of vaginitis defined by VAGINAL ODOR that is worse after sex and described as “fishy.”
There is copious, grey-white discharge.
Micro: CLUE cells
Treatment: Flagyl
Bacterial Vaginosis
____ is a type of vaginitis that is sexually transmitted and is associated with pruritus, dysuria, and dyspareunia.
There is frothy, YELLOW-GREEN d/c and STRAWBERRY CERVIX.
Micro: Mobile protozoa
Treatment: Flagyl
Trichomoniasis
*TREAT PARTNER TOO
**Can have perinatal complications and increased risk of HIV transmission
____ is a type of vaginitis that is seen in DM, steroids, pregnancy, and abx abuse.
Discharge: thick, curd-like/cottage cheese
Micro: HYPHAE, yeast, and spore
Treatment: Fluconazole or intravaginal antifungals
Candida
_____ is a type of vaginitis that is an overgrowth of lactobacilli.
Discharge: non odorous
Treatment: D/C tampon use, Sitz bath or douche
Cytolytic Vaginitis
_____ is an ascending infection of the upper reproductive tract that may lead to sepsis, ectopic pregnancy, or infertility.
PID
PID is MC caused by what organisms?
GC/Chlam
*Increased risk w/ multiple sexual partners, unprotected sex, prior PID, 15-19y, nulliparous, IUD
What might you find on PE of someone w/ PID?
- Lower abd tenderness
- Fever
- Purulent cervical d/c +/- bleeding
- CHANDALIER SIGN: CERVICAL MOTION TENDERNESS
PID is primarily a clinical diagnosis. What are some other findings that would point you in that direction (think labs, PE)?
(+) gram stain, temp > 38C, WBC>10,000, increased ESR and CRP, CMT
How is PID treated?
Outpatient: Doxycycline + Rocephin + Flagyl
Inpatient: see p. 104
_____ is a complication of PID that is associated with hepatic fibrosis/scarring and peritoneal involvement. RUQ due to PERIHEPATITIS and adhesions on anterior surface of liver are common w/ this.
FITZ-HUGH CURTIS SYNDROME
______ is the MC solid lesion of the breast in pts <40y.
Fibroadenoma
- Benign, painless
- PE: rubbery and mobile
____ is simple and fluid filled breast mass. Occurs in pts 30-50.
Cyst
- They are often tender
- Tx- aspiration v. observation
______ is a fibrotic tissue reaction that is found in patients with a history of trauma or surgery. It is a painful, tender mass/area.
Traumatic Fat Necrosis
*Tx- conservative v. excision, must R/O CANCER
_____ is a cystic enlargement of glands seen in patients 30-50y. There is associated nipple d/c and cyclic mastalgia.
Fibrocystic breast changes
*Tx- symptomatic= NSAIDs and cold compress
_____ is a wart-like tumor of the breast duct. Often occurs in menopausal women. May have clear or bloody d/c.
Intraductal papilloma
*Tx- Excision to r/o atypia or Ca
_____ is a complication of mastitis. Usually occurs in lactating women. Associated with pain- baby can’t latch. May have fever, cellulitis.
Breast abscess
- Tx- Nurse, MRSA abx, Aspiration
- *DDX- Inflammatory breast Ca
Malignancy primarily of mild ducts or lobules is otherwise known as _____.
Breast cancer
*2nd MC cause of cancer death (after lung)
RF for Breast Ca include:
BRCA 1 and BRCA 2
-1st degree relative, age >65, hormonal–> increased risk with more menstrual cycles, increased estrogen in postmenopausal women on HRT and OCPs, obesity, and ETOH
_____ is the MC type of breast cancer.
Infiltrative Ductal Carcinoma
All types-
- Ductal Carcinoma:
- Infiltrative
- DCIS - Lobular Carcinoma
- Infiltrative
- LCIS - Medullary, mucinoid, papillary, metastatic, mammary Paget’s dz. of the breast
S/S of breast cancer:
Mass: Painless, hard, FIXED, lump +/- axillary LAD (MC in upper, outer quadrant)
Unilateral Nipple D/C: +/- blood, purulent, or green
METs to lung, liver, bone, brain
PE findings related to breast cancer:
Skin changes: color changes (asymmetric redness), skin retraction, ulceration
Changes in breast size and contour
Nipple inversion
Skin thickening
______ is associated with chronic eczematous itchy, scaling rash on the nipples and areola.
Paget’s disease of the nipple
______ is skin changes that look like the peel of an orange due to lymphatic obstruction. It is associated with a poor prognosis.
Peau d’ orange
US is recommended as the initial modality to evaluate masses in women < ___ years.
40
Staging based on TNM. What does this stand for?
T= TUMOR SIZE
N= NODES (AXILLARY)
M= METS
Adjunctive therapy for breast cancer includes:
- Radiation- External beam or brachytherapy (internal)
- Anti-Estrogen (Tamoxifen): used in ER positive. Binds and blocks estrogen receptor in breast tissue.
- Aromatase Inhibitor (Letrozole, Anastrozole): used in POST-MENOPAUSAL ER positive women. Reduces production of estrogen.
- Monoclonal Ab treatment (Herceptin): used in HER2 (+)
- ADR- Cardiotoxicity
Neoadjuvant treatment for breast cancer includes:
- Chemotherapy- used in stage II-IV and inoperable dz. Especially ER (-) (can also be adjuvant treatment)
* Ex: Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxel - Tamoxifene or Raloxifene can be used in postmenopausal or women >35y with high risk.
* Treatment usually used for 5 years!!
Pelvic organ prolapse is MC after ____.
Childbirth
Types of pelvic organ prolapse include:
- Cystocele: posterior bladder herniating into the anterior vagina
- Enterocele: pouch of Douglas (small bowel) into the upper vagina
- Rectocele: distal sigmoid colon (rectum) herniates into the posterior distal vagina
Grades of Pelvic Organ Prolapse:
I: descent into upper 2/3 of vagina
II: cervix approaches introitus
III: outside introitus
IV: entire uterus is outside vagina- complete prolapse
Treatment of Pelvic Organ Prolapse involves:
- Prophylactic- Kegels, weight control
- Nonsurgical- Pessaries, estrogen (improves atrophy)
- Surgical- Hysterectomy; Uterosacral or sacrospinous ligament fixation
S/s of Menopause are:
Estrogen deficiency causing- menstrual cycle alterations, vasomotor instability (hot flashes), mood changes, increase in cardiovascular events, HYPERlipidemia, osteoporosis, and dyspareunia
How is Menopause diagnosed?
FSH MOST SENSITIVE!
-INCREASE IN SERUM FSH > 30 IU/ML
(decreased LH and estrogen- Estrone predominates)
Treatment of Menopause…
- Hot flashes: estrogen, progesterone, Clonidine
- Vaginal atrophy: transdermal/transvaginal estrogen
- Osteoporosis prevention: Calcium + Vitamin D, wt bearing exercise, bisphosphonates, calcitonin, estrogen (+/- progesterone), SERM
- HRT:
-Estrogen ONLY:
Benefits= most effective symptomatic treatment!
Risks= INCREASED RISK of ENDOMETRIAL CANCER, VTE, and liver disease
-Estrogen + Progesterone:
Benefits= decreased risk of osteoporosis, VTE, and dementia
Risks= increased risk of breast ca ??
Serum b-hCG can detect pregnancy as early as __ days after conception.
Urine b-hCG can detect pregnancy as early as __ days after conception.
Serum- 5 days
Urine- 14 days
Fetal heart tones are heart around __ to __ weeks.
10-12 weeks (Normal 120-160bpm)
Pelvic US can detect fetus around __ to __ weeks.
5-6 weeks
Fetal movement occurs between __ to __ weeks.
16-20
Remember GPAL…
G- Gravida= # of times pregnant
P- Para= # of births (>20 weeks), including viable or nonviable (stillbirth)
A- Abortus= # of pregnancies lost for whatever reason (miscarriages, abortions)
L- Living= # of living children
To estimate date of delivery do LMP + 9 months + 7 days
Nagele’s Rule (really Lucy’s rule because I switched the equation around)
Normal IUP can be visualized by transvaginal US when b-hCG is > ______ and by transabdominal US when b-hCG is > ______.
Transvaginal US- >1800-2000
Transabdominal US- >3500-5000
- Serial quantitative b-hCG should double Q24-48hrs
- *In ectopic- fails to double
What type of contraception inhibits ovulation?
Progestin only!
*Pills, Implanon, Depo Provera shot, Mirena
**Safe during lactation :)
What are some Pros and Cons to OCPs?
Pros: Protection against- osteoporosis, ovarian cysts, ovarian ca, endometrial ca; improves acne, less PID and ectopic
Cons: smokers have to stop at >35 y, Gallstones, increased fluid retention, increased risk of DVT and PE
Osteoporosis is an ADR associated with _____ (type of birth control).
Implanon
_____ is left effective in overweight patients.
Patch
____ must be removed before intercourse and replaced within 3 hours.
Nuvaring
____ associated with most types of cervical cancer.
HPV
*45 is avg age of dx
Types of cervical cancer…
- Squamous- 90%
2. Adenocarcinoma- 10%
S/S of cervical cancer:
MC= POST COITAL BLEEDING/SPOTTING
*Dx: Colposcopy with biopsy, pap smear with cytology for screening
Treatment of cervical cancer…
Stage 0, Carcinoma in Situ= Excision, Ablation, or TAH-BSO (total hysterectomy and bilateral salpingo-oophorectomy)
Stage I, Microinvasion= Surgery: TAH-BSO; Radiation (+/- Chemo- Cisplatin)
Stage II-IVa (local METS)= Radiation (XRT) + Chemo b (Cisplatin +/- 5FU)
IVb (Distant METS)= Palliative radiation therapy, chemotherapy
Gardasil vaccine recommended to those aged __ to __.
11 to 26
- Schedule:
- <15y= 2 doses at least 6 months apart
- > 15y= 3 doses with 2nd dose given 2 months after first and then 3rd dose given 3-4 months later.
Spontaneous abortion is defined as occurring before __ weeks.
20
- MC weeks 1-7
- *Etiology= MC is fetal chromosomal abnormality
____ abortion is MC cause of 1st trimester bleeding. No POC is expelled, cervical OS is closed, and pregnancy MAY BE VIABLE or abortion may follow.
Threatened
*Tx- supportive, RhoGAM if indicated
____ abortion is when NO POC is expelled and there is progressive cervix dilation. Pregnancy is not salvageable.
Inevitable
*Tx-
1st Trimester= D&C
2nd Trimester= D&E
____ abortion is when SOME POC is expelled and SOME RETAINED. Cervical Os is dilated. There is HEAVY bleeding.
Incomplete
- Tx-
- May be allowed to finish
- 1st= D&C; D&E after
- Pitocin
- RhoGAM if indicated
___ abortion is when ALL POC is expelled. Cervical Os is usually closed.
Complete
*Tx- RhoGAM if indicated
____ abortion leads to fetal demise but it still remains in uterus. No POC is expelled. Cervical Os is closed.
Missed
*Tx-
1st Trimester= D&C
2nd Trimester= D&E
-Misoprostol
___ abortion is when retained POC becomes INFECTED. Cervical Os is closed and there is CMT. May have foul brown d/c, uterine tenderness, and spotting–>heavy bleeding.
Septic
*Tx- D&E to remove POC and broad ABX +/- Hysterectomy if refractory
