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Primary Care > Repro > Flashcards

Repro Flashcards

1
Q

______ is defined as the abnormal presence of endometrial tissue w/in the myometrium (thick, muscular layer of the uterus).

A

Adenomyosis

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2
Q

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.

A

Leiomyoma

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3
Q

Secondary causes of dysmenorrhea (or PAINFUL MENSTRUATION) include:

A
  • Endometriosis
  • Adenomyosis
  • Leiomyoma
  • Adhesions
  • PID
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4
Q

____ is the MC secondary cause of dysmenorrhea in younger patients. ____ is more common with increasing age.

A

Endometriosis MC secondary cause

Adenomyosis w/ increasing age

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5
Q

Some defining terms…

A
  • 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
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6
Q

How is a diagnosis of Dysfunctional Uterine Bleeding (DUB) made?

A

DX OF EXCLUSION

W/u- hormone levels and transvaginal US

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7
Q

How is DUB treated?

A
  1. Acute, Severe Bleeding- High-dose IV estrogens or high dose OCPs (D&C if estrogen fails)
  2. OCPs- 1st line! regulates cycles, thins endometrial lining, and reduces menstrual flow (DECREASES endometrial cancer risk by reducing unopposed estrogen)
  3. GnRH agonists- Leuprolide cases temporary amenorrhea (if given in continuous fashion)
  4. Progesterone- orally or IUD
  5. SURGERY- If not responsive to medical treatment:
    - Hysterectomy- definitive
    - Endometrial ablation
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8
Q

_____ 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

A

Bacterial Vaginosis

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9
Q

____ 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

A

Trichomoniasis

*TREAT PARTNER TOO

**Can have perinatal complications and increased risk of HIV transmission

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10
Q

____ 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

A

Candida

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11
Q

_____ is a type of vaginitis that is an overgrowth of lactobacilli.

Discharge: non odorous

Treatment: D/C tampon use, Sitz bath or douche

A

Cytolytic Vaginitis

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12
Q

_____ is an ascending infection of the upper reproductive tract that may lead to sepsis, ectopic pregnancy, or infertility.

A

PID

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13
Q

PID is MC caused by what organisms?

A

GC/Chlam

*Increased risk w/ multiple sexual partners, unprotected sex, prior PID, 15-19y, nulliparous, IUD

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14
Q

What might you find on PE of someone w/ PID?

A
  • Lower abd tenderness
  • Fever
  • Purulent cervical d/c +/- bleeding
  • CHANDALIER SIGN: CERVICAL MOTION TENDERNESS
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15
Q

PID is primarily a clinical diagnosis. What are some other findings that would point you in that direction (think labs, PE)?

A

(+) gram stain, temp > 38C, WBC>10,000, increased ESR and CRP, CMT

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16
Q

How is PID treated?

A

Outpatient: Doxycycline + Rocephin + Flagyl

Inpatient: see p. 104

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17
Q

_____ 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.

A

FITZ-HUGH CURTIS SYNDROME

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18
Q

______ is the MC solid lesion of the breast in pts <40y.

A

Fibroadenoma

  • Benign, painless
  • PE: rubbery and mobile
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19
Q

____ is simple and fluid filled breast mass. Occurs in pts 30-50.

A

Cyst

  • They are often tender
  • Tx- aspiration v. observation
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20
Q

______ is a fibrotic tissue reaction that is found in patients with a history of trauma or surgery. It is a painful, tender mass/area.

A

Traumatic Fat Necrosis

*Tx- conservative v. excision, must R/O CANCER

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21
Q

_____ is a cystic enlargement of glands seen in patients 30-50y. There is associated nipple d/c and cyclic mastalgia.

A

Fibrocystic breast changes

*Tx- symptomatic= NSAIDs and cold compress

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22
Q

_____ is a wart-like tumor of the breast duct. Often occurs in menopausal women. May have clear or bloody d/c.

A

Intraductal papilloma

*Tx- Excision to r/o atypia or Ca

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23
Q

_____ is a complication of mastitis. Usually occurs in lactating women. Associated with pain- baby can’t latch. May have fever, cellulitis.

A

Breast abscess

  • Tx- Nurse, MRSA abx, Aspiration
  • *DDX- Inflammatory breast Ca
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24
Q

Malignancy primarily of mild ducts or lobules is otherwise known as _____.

A

Breast cancer

*2nd MC cause of cancer death (after lung)

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25
Q

RF for Breast Ca include:

A

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

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26
Q

_____ is the MC type of breast cancer.

A

Infiltrative Ductal Carcinoma

All types-

  1. Ductal Carcinoma:
    - Infiltrative
    - DCIS
  2. Lobular Carcinoma
    - Infiltrative
    - LCIS
  3. Medullary, mucinoid, papillary, metastatic, mammary Paget’s dz. of the breast
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27
Q

S/S of breast cancer:

A

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

28
Q

PE findings related to breast cancer:

A

Skin changes: color changes (asymmetric redness), skin retraction, ulceration

Changes in breast size and contour

Nipple inversion

Skin thickening

29
Q

______ is associated with chronic eczematous itchy, scaling rash on the nipples and areola.

A

Paget’s disease of the nipple

30
Q

______ is skin changes that look like the peel of an orange due to lymphatic obstruction. It is associated with a poor prognosis.

A

Peau d’ orange

31
Q

US is recommended as the initial modality to evaluate masses in women < ___ years.

A

40

32
Q

Staging based on TNM. What does this stand for?

A

T= TUMOR SIZE

N= NODES (AXILLARY)

M= METS

33
Q

Adjunctive therapy for breast cancer includes:

A
  1. Radiation- External beam or brachytherapy (internal)
  2. Anti-Estrogen (Tamoxifen): used in ER positive. Binds and blocks estrogen receptor in breast tissue.
  3. Aromatase Inhibitor (Letrozole, Anastrozole): used in POST-MENOPAUSAL ER positive women. Reduces production of estrogen.
  4. Monoclonal Ab treatment (Herceptin): used in HER2 (+)
    - ADR- Cardiotoxicity
34
Q

Neoadjuvant treatment for breast cancer includes:

A
  1. Chemotherapy- used in stage II-IV and inoperable dz. Especially ER (-) (can also be adjuvant treatment)
    * Ex: Doxorubicin, Cyclophosphamide, Fluorouracil, Docetaxel
  2. Tamoxifene or Raloxifene can be used in postmenopausal or women >35y with high risk.
    * Treatment usually used for 5 years!!
35
Q

Pelvic organ prolapse is MC after ____.

A

Childbirth

36
Q

Types of pelvic organ prolapse include:

A
  1. Cystocele: posterior bladder herniating into the anterior vagina
  2. Enterocele: pouch of Douglas (small bowel) into the upper vagina
  3. Rectocele: distal sigmoid colon (rectum) herniates into the posterior distal vagina
37
Q

Grades of Pelvic Organ Prolapse:

A

I: descent into upper 2/3 of vagina
II: cervix approaches introitus
III: outside introitus
IV: entire uterus is outside vagina- complete prolapse

38
Q

Treatment of Pelvic Organ Prolapse involves:

A
  1. Prophylactic- Kegels, weight control
  2. Nonsurgical- Pessaries, estrogen (improves atrophy)
  3. Surgical- Hysterectomy; Uterosacral or sacrospinous ligament fixation
39
Q

S/s of Menopause are:

A

Estrogen deficiency causing- menstrual cycle alterations, vasomotor instability (hot flashes), mood changes, increase in cardiovascular events, HYPERlipidemia, osteoporosis, and dyspareunia

40
Q

How is Menopause diagnosed?

A

FSH MOST SENSITIVE!
-INCREASE IN SERUM FSH > 30 IU/ML

(decreased LH and estrogen- Estrone predominates)

41
Q

Treatment of Menopause…

A
  1. Hot flashes: estrogen, progesterone, Clonidine
  2. Vaginal atrophy: transdermal/transvaginal estrogen
  3. Osteoporosis prevention: Calcium + Vitamin D, wt bearing exercise, bisphosphonates, calcitonin, estrogen (+/- progesterone), SERM
  4. 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 ??

42
Q

Serum b-hCG can detect pregnancy as early as __ days after conception.

Urine b-hCG can detect pregnancy as early as __ days after conception.

A

Serum- 5 days

Urine- 14 days

43
Q

Fetal heart tones are heart around __ to __ weeks.

A

10-12 weeks (Normal 120-160bpm)

44
Q

Pelvic US can detect fetus around __ to __ weeks.

A

5-6 weeks

45
Q

Fetal movement occurs between __ to __ weeks.

A

16-20

46
Q

Remember GPAL…

A

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

47
Q

To estimate date of delivery do LMP + 9 months + 7 days

A

Nagele’s Rule (really Lucy’s rule because I switched the equation around)

48
Q

Normal IUP can be visualized by transvaginal US when b-hCG is > ______ and by transabdominal US when b-hCG is > ______.

A

Transvaginal US- >1800-2000

Transabdominal US- >3500-5000

  • Serial quantitative b-hCG should double Q24-48hrs
  • *In ectopic- fails to double
49
Q

What type of contraception inhibits ovulation?

A

Progestin only!

*Pills, Implanon, Depo Provera shot, Mirena

**Safe during lactation :)

50
Q

What are some Pros and Cons to OCPs?

A

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

51
Q

Osteoporosis is an ADR associated with _____ (type of birth control).

A

Implanon

52
Q

_____ is left effective in overweight patients.

A

Patch

53
Q

____ must be removed before intercourse and replaced within 3 hours.

A

Nuvaring

54
Q

____ associated with most types of cervical cancer.

A

HPV

*45 is avg age of dx

55
Q

Types of cervical cancer…

A
  1. Squamous- 90%

2. Adenocarcinoma- 10%

56
Q

S/S of cervical cancer:

A

MC= POST COITAL BLEEDING/SPOTTING

*Dx: Colposcopy with biopsy, pap smear with cytology for screening

57
Q

Treatment of cervical cancer…

A

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

58
Q

Gardasil vaccine recommended to those aged __ to __.

A

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.
59
Q

Spontaneous abortion is defined as occurring before __ weeks.

A

20

  • MC weeks 1-7
  • *Etiology= MC is fetal chromosomal abnormality
60
Q

____ 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.

A

Threatened

*Tx- supportive, RhoGAM if indicated

61
Q

____ abortion is when NO POC is expelled and there is progressive cervix dilation. Pregnancy is not salvageable.

A

Inevitable

*Tx-
1st Trimester= D&C
2nd Trimester= D&E

62
Q

____ abortion is when SOME POC is expelled and SOME RETAINED. Cervical Os is dilated. There is HEAVY bleeding.

A

Incomplete

  • Tx-
  • May be allowed to finish
  • 1st= D&C; D&E after
  • Pitocin
  • RhoGAM if indicated
63
Q

___ abortion is when ALL POC is expelled. Cervical Os is usually closed.

A

Complete

*Tx- RhoGAM if indicated

64
Q

____ abortion leads to fetal demise but it still remains in uterus. No POC is expelled. Cervical Os is closed.

A

Missed

*Tx-
1st Trimester= D&C
2nd Trimester= D&E
-Misoprostol

65
Q

___ 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.

A

Septic

*Tx- D&E to remove POC and broad ABX +/- Hysterectomy if refractory

Primary Care (12 decks)

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