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Precision > Repro/Endo > Flashcards

Repro/Endo Flashcards

1
Q

Amenorrhea (FMLD)

A

Primary = Failure of menarche onset by age 15 (in the presence of secondary sex characteristics) or age 13 in the absence of secondary sex characterisitics)

Secondary = Absence of menses for >3mo in a patient with previously normal menstruation or >6mo in a patient who was previously oligiomenorrhea)

MCC of Secondary amenorrhea = Pregnancy

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2
Q

Amenorrhea secondary to gonadal dysgenesis, turner syndrome (dx + labs)

A

Karotyping = Definitive dx = 45 XO

Hormonal screening = low estrogen + high FSH + high LH

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3
Q

Bacterial vaginosis (FMLD)

A

Vaginal odor worse after sex +/- itching

> 50% may be asymptomatic

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4
Q

Bacterial vaginosis (Dx and labs)

A

Amslers criteria
1. Clue cells on saline smear
2. pH >4.5
3. Thin, water grey discharge
4. (+) whiff test, fishy odor with 10% KOH

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5
Q

Breast cancer (health maint + prevention)

A

Clinical breast exam age 20-39 ; every 3 years until age 40 then annually

Mammo = age 40 or 10 years prior to age of 1st deg relative was diagnosed

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6
Q

Breast mass (FMLD)

A

Palpable single nontender firm IMMOBILE mass

MC = Upper outer quadrant and findings on mammography

Stereotactic core-needle biopsy or open biopsy = most accurate in establishing diagnosis

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7
Q

Cervical cancer (scientific concepts)

A

HPV (Most common = 16,18,31,33,45,52,58)

3rd MC gynecologic cancer
(endometrial = #1, ovarian = #2)

MC Mets = Locally (vagina, parametrium, pelvic)

MC type = Squamous, clear cell carcinoma linked to DES

MC sx = Post-coital bleeding/spotting

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8
Q

Cervical cancer (Dx and labs)

A

Screening = Pap with cytology
Dx = Colpo with biopsy

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9
Q

Contraception (pharm tx)

A

Combination OCP (estrogen + testosterone) = prevents ovulation by inhibiting mid cycle LH surge, thicken cervical mucosa, thin endometrium

Progesin only = Safe during lactation, no estrogen SE

IUD = Most effective, increase risk of PID

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10
Q

Dysfunctional uterine bleeding (scientific concepts)

A

Abnormal uterine bleeding in the absence of pelvic pathology, pregnancy

Disruption in normal cyclic pattern of ovulatory hormonal stimulation to endometrial lining

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11
Q

Dysfunctional uterine bleeding (Clinical intervention)

A

Dx of exclusion

Workup shows no evidence of organic cause and negative pelvic exam, DUB is the dx

Workup includes: hormone levels, transvaginal ultrasound, endometrial biopsy

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12
Q

Endometrial cancer (scientific concepts)

A

Endometrial cancer is a cancer that arises from the endometrium (the lining of the uterus or womb).[1] It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body.[8] The first sign is most often vaginal bleeding not associated with a menstrual period.[1] Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain.

Endometrial cancer occurs most commonly after menopause

Risk factor = Family hx, increased # of ovulatory cycles, infertility, nulliparity, age over 50, BRCA genes, Peutz-jeghers, Turners, HTN, DM

Estrogen-dependent cancer

MC gynecological malignancy

MC type = adenocarcinoma

MC postmenopausal (50-60)

Combination OCPs are protective against both ovarian and endometrial

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13
Q

Endometrial cancer (FMLD)

A

Postmenopausal bleeding: endometrial stripe >4mm on transvaginal US

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14
Q

Endometrial cancer (Dx and labs)

A

Dx = biopsy, pelvic exam, D&C, transvaginal US, CT, MRI

Labs = CA-125 (seen in both endometrial + ovarian cancer)

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15
Q

Endometriosis (FMLD)

A

Classic Triad (3 D’s)
Dyspaurenia
Dysmenorrhea
Dyschezia

+/- pre-post menopausal bleeding

Infertility

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16
Q

Endometriosis (dx + labs)

A

PE = usually normal; adnexal tenderness

Laparoscopy with biopsy = Definitive

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17
Q

Endometritis (pharm tx)

A

Infection post c-section = clinda + gentamicin

Group B strep coverage

Infection after vaginal delivery or chorioamnionitis = Amp + Gent

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18
Q

Enterocele (FMLD)

A

Pouch of douglas (small bowel) herniated into the upper vagina

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19
Q

Fibrocystic breast disorder (clinical intervention)

A

Ultrasound FNA reveales straw colored fluid (no blood)

Most spontanesouly resolve +/- FNA removal of fluid if symptomatic

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20
Q

Fragile X syndrome (dx + labs)

A

X-ray spine (scoliosis)

Echo = exclude MVP

Molecular testing + karotyping

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21
Q

Gestational diabetes (Dx and Labs)

A

1.Screening done at 24-28weeks = 50g 1hr glucola

  1. Confirmatory 3hr 100g GTT = gold standard; performed in morning after fasting
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22
Q

Gestational trophoblastic disease (molar pregnancy ) scientific concepts

A

2 MC risk factors = Prior molar pregnancy or extreme in maternal age like 20yo and 35yo

Eomplete egg with NO DNA fertilized by 1 or 2 sperm

46XXX all paternal chromosomes

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23
Q

Gestational trophoblastic disease (molar pregnancy ) Dx and labs

A
  1. Beta HCG elevated >100,000 very LOW serum alpha-fetoprotein
  2. US = Snowstorm appearance or “cluster of grapes”; Absence of fetal prats, heart sounds
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24
Q

Gynecomastia (clinical intervnetion)

A
  1. Supportive = depends on cause

Stop offending medsl observation if early in course will most likely resolve spontaneously

Idea tx should start within 6 mo of onset; Surgery if resistant

Limit ETOH consumption

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25
Q

Hydatidiform Mole (clinical intervention)

A

Surgical uterine evacuation is mainstay of tx to avoid choriocarcinoma

Trend weekly beta-HCG until undetectable

CXR to look for mets from possible choriocarcinoma

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26
Q

Hyperemesis gravidarum (pharm tx)

A

PO or IV fluids; Multivitamins; Bland diet = BRAT

Anitemeitcs = Doxylamine + Pyridoxine, diphenhydramine, zofran (cleft palate risk)

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27
Q

Hypothalmic amenorrhea (pharm tx)

A

Clomiphene (stimulate GnRH secretion from hypothalamus)

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28
Q

Hypothalmic amenorrhea (Dx + labs)

A

AKA when your hypothalamus causes your period to stop. Common causes include excessive exercise, stress and undereating

Normal/decreased FSH & LH

Decreased estradiol

Normal prolactin

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29
Q

Invasive mole (hx + pe)

A

Painless vaginal bleeding + preeclampsia before 20 weeks + hyperemesis

Uterine size and date discrepancies

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30
Q

Leiomyoma (clinical intervention)

A

Observation of asymptomatic

Myomectomy to preserve fertility

Hysterectomy = Definitive tx

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31
Q

Molar pregnancy (clinical intervention)

A

Surgical uterine evacuation (suction curettage)

  1. METS = Chemotherapy or methotrexate
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32
Q

Mucopurulent cervicitis (scientific concepts)

A

Depends on cause but start with obtaining culture

Empiric tx with Ceftriaxone + azithro + metronidazole +/- doxy while awaiting culture results

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33
Q

Ovarian cancer (clinical intervention)

A
  1. Early stage = TAH + lympadenectomy
  2. Surgery = Tumor debulking (serum CA-125 monitor tx progress)
  3. Chemo = Paclitaxel or Cisplatin Or Carboplatin
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34
Q

Ovarian cancer (FMLD)

A

MC in older, caucasian, nulliparous females
+/- sister mary joseph nodule
Ascites, abdominal distention, early satiety, changes in bowel habits, or fixed mass

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35
Q

Periop antibiotic prophy (pharm tx)

A

C-section up to 60 min prior

If ROM or in labor = Vaginal cleaning with povidine

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36
Q

PCOS (scientific concepts)

A

PCOS is due to insulin resistance (type 2 DM)

Associated with abnormal function of HPO axis = increase insulin and increase LH driven increase in ovarian androgen production

37
Q

PCOS (dx and labs)

A

High androgen levels

Pelvic exam

Blood test and US can confirm

Labs = Decreased FSH, Increased LH, increased testosterone, increased estrogen,

38
Q

Pre-eclampsia (Health maint + prevention)

A

RF= Nulliparity, control HTN

Educate pt to be aware of signs of HTN

Steroids to mature fetal lungs if >34wks

39
Q

Pregnancy hypertension (hx and pe)

A

New onset BP 140/90 AFTER 20 weeks gestation

NO proteinuria, edema, or end-organ dysfunction

40
Q

Normal findings, pregnancy (scientific concepts)

A

During pregnancy cardiac output INCREASES

CO peaks around 24 weeks

50% increase in the volume of plasma, 20% in RBC and WBC

41
Q

Pregnancy parturition (scientific concepts)

A

4 phases
0 = Inhibition
1= Myometrial activation
2- Stimulation
3= Inovulation

42
Q

Pregnancy, Rh Isoimmunization (clinical intervention)

A

RhoGam given if Rh negative @ 28wks

43
Q

Rectocele (clinical intervention)

A
  1. Prophy = Kegels + weight control
  2. Non-surgical = Pessaries + estrogen tx
  3. Surgical = Hysterectomy
44
Q

Transitional (gestational) HTN (FMLD)

A

HTN after 20 weeks gestation; no proteinuria

Resolves 12 weeks after postparum; clinically asx

45
Q

Uterine leiomyoma (clinical intervention)

A

Observation if asx

Medical tx = decrease estrogen
Surgical = myomectomy , endometrial ablation, or hysterectomy

46
Q

Acromegaly (Dx and labs)

A

Pituitary adenoma causing hypersecretion of GH after the closure of the epiphyses

Screening test = Exogenous (insulin like growth factor 1)

Confirmatory test = Oral glucose suppression test = increased FH levels in acromegaly

MRI of pituitary

47
Q

Acromegaly (clinical intervention)

A
  1. Transsphenoidal surgery + Bromocriptine (increases dopamine)
  2. Radiation therapy if IGF-1 levels are increased post surgery
  3. Octreotide = somatostatin analog that supresses GH
  4. Pegvisomant: GH antagonist may be added to octreotide
48
Q

Adrenal crisis (pharm tx)

A
  1. IV fluids (normal saline to correct hypotension + hypovolemia)
  2. Glucocorticoids (IV hydrocortisone if known addisons) or Dexamethasone (if unknown)

3.Reversal of electrolyte disorders

  1. Fludricortisone = synthetic mineralcorticoid similar to aldosterone
49
Q

Adrenal crisis (scientific concepts)

A

MCC = abrupt withdrawl of steroids

Shock = primary manifestation (decreased BP, hypovolemia)

50
Q

Adrenal insufficiency (pham tx)

A

Addisons disease

Addisons = Glucocorticoids + mineralocorticoids

Secondary cause = Only glucocorticoids

51
Q

Adrenal insufficiency (dx and labs)

A

Baseline 8am ACTH, cortisol, & renin levels

  1. HIgh dose ACTH (cosynotropinin) stimulation test - screening test
  2. CRH stimulation test = differentiates causes of adrenal insufficiency
52
Q

Aldosteronism, primary (scientific concepts)

A

Occurs independent of renin

MCC = adrenal hyperplasia

Conn syndrome = Adenoma (HTN, hypokalemia + metabolic alkalosis)

53
Q

Arthropathy, Charcot (joint) FMLD

A

Aka diabetic foot

Joint damage & destruction as a result of peripheral neuropathy from DM, peripheral vascular disease & or other disease

Repetitive microtrauma to foot with no sensation & autonomic dysfunction leads to bone resorption & weakening

MC area = Midfoot affected with pain and swelling

54
Q

Cushings (hypercortisolism) clinical intervention

A

3 causes; 3 different treatments

  1. Cushings disease (pituitary cause) = transsphenoidal surgery or radiation therapy if unresectable
  2. Ectopic ACTH secreting or adrenal tumor = tumor removal, ketoconazole may be used if inoperable
  3. Iatrogenic = steroid tx
55
Q

Diabetes insipidus (clinical intervention)

A
  1. Central DI = Desmopressin/DDVAP; Carbamazepine)
  2. Nephrogenic (kidney doesnt detect ADH) = sodium/protein restriction use HCTZ and indoemthicin
  3. If symptomatic = hypotonic fluid (pure water orally)
56
Q

Diabetes insipidus (Dx and Labs)

A
  1. Fluid deprivation test = Established the diagnosis of DI, continued production of DILUTE URINE (urine osmo <200 and low specific gravity <1.005)
  2. Desmopressin (ADH) stimulation test = Differentiate between nephrogenic and central

If central = reduction in urine output indicating response to adh

If nephrogenic = continued production of dilute urine - no response to ADH

57
Q

Diabetic hypoglycemia (FMLD)

A

Acute altered mental status; complication of DM

MCC = Too much insulin, too little food intake, excess exercise

Autonomic: sweating, tremors, palpitations, nervousness, tachycardia

CNS: HA, confusion, slurred speech, diziness

58
Q

Diabetic hypoglycemia (clinical intervention)

A

Mild <60mg/dl = 10-15g fast carb, fruit juice, hard candy = RECHECK every 15 minutes

Severe/unconscious = <40mg = IV bolus of D50 or inject glucagon SQ

59
Q

DKA (pharm tx)

A

SIPS

Saline
Insulin (reg)
Potassium repletion
Search for underlying cause and treat it

INITIAL treatment = Isotonic normal saline

60
Q

Diabetic nephropathy (Dx and labs)

A

Mircroalbuminuria = first sign of diabetic nephropathy; increased BP accelerates kidney deterioration

Albuminuria, anemia, acidosis

Kidney bx = Kimmelsteil -Wilson (nodular glomerulosclerosis = PINK HYALINE AROUND CAPILLARIES FROM PROTEIN LEAKAGE)

61
Q

Graves Disease (Pharm tx)

A

Aka Hyperthyroidism

MC = Radioactive iodine
If not pregnant = Methimazole or PTU
If pregnant = PTU in 1st trimester then methimazole

62
Q

Gynecomastia (pharm tx)

A
  1. SERM (hormone tx = Tamoxifen)
  2. Aromatase inhibitors blocks estrogen synthesis (anastrozole or letrozole)
  3. Androgens used in hypogonadism (DHEA)
63
Q

Hyperaldosteronism (Dx and labs)

A
  1. Labs = Hypokalemia with met alkalosis
  2. Aldosterone: renin ratio screening
  3. Definitive test = SALINE INFUSION TEST
  4. CT/MRI - look for mass
    5.EKG shows hypokalemia (u wave)
64
Q

Hyperparathyroidism (FMLD()

A

signs of hypercalcemia

Bones, stones, abdominal groans, psych moans

Decreased DTR

65
Q

Hyperplasia, congenital adrenal (FMLD)

A

Autosomal recessive disorder

Deficient in enzyme in synthesis of cortisol, aldosterone, or bone

Sex of neonate is unclear because of genital ambiguity

66
Q

Hyperprolactinemia (Pharm tx)

A

Stop offending drug
Dopamine agonists (Bromocriptine, cabergoline)

67
Q

Hyperthyroid (scientific concepts)

A
  1. Graves disease = MCC; autoimmune
  2. Toxic multinodular goiter (plummer dz) autonomous functioning nodules; MC in elderly
  3. Toxic adenoma = one autonomous functioning nodule
  4. TSH secreting pituitary adenoma
68
Q

Hypoparathyroidism (dx and labs)

A

Caropedal spasms, trosseaus and chovsteks sign, increased DTR

Triad: Hypocalcemia, decreased PTH, increased phosphate

69
Q

Hypopituitarism (scientific concepts)

A

Pituitary destruction or deficicent hypothalamic pituitary stimulation

Congenital
Or
Acquired (tumor, infiltrative disease, bleeding into pituitary like Sheehans), pituitary infarction, XRT

70
Q

Hypothyroidism (myxedema) Dx and Labs

A

Decreased T3/T4
Increased TSH

Sx = bradycardia, hypothermia, hypoventilation, hypotensive, hypoglycemia, hyponatremia, delayed T3/T4

71
Q

Hypothyroidism (myxedema) FMLD

A

Myxedema crisis = Extreme form of hypothyroidism

Sx = fatigue, cold intolerance, weight gain, constipation, dry skin, mylagia, menstrual irregularities, goiter, bradycardia, delayed DTR

72
Q

Klienfelter syndrome (dx and labs)

A

47XXY karyotype

Low serum tesosterone

73
Q

Klienfelter syndrome (dx and labs)

A

47XXY karyotype

Low serum tesosterone

74
Q

Klinefelter syndrome (FMLD)

A

Patients appear normal until puberty

Tall, thin,stature, long limbs

In adulthood = scoliosis, ataxia, developmental delays, hypogonadism, small testicles, infertility, scarce pubic hair

75
Q

Pheochromocytoma (scientific concepts)

A

Catecholamine secreting adrenal tumor (Chromaffin cells)

Secretes Epi + Norepi

90% benign; may be associated with MEN type 2

76
Q

Pituitary adenoma (FMLD)

A

In females = Hypogonadism, amenorrhea, galactorrhea, HA, visual changes

In men = Hypogonadism, decreased libido, infertility, HA, visual changes

77
Q

Pituitary adenoma (pharm tx)

A

Prolactinoma = Dopamine agonists (cabergoline, bromocriptine)

Somatotroph adenoma = Somatostatin analog (octreotide, lanreotide)

78
Q

Primary adrenal insufficiency (scientific concepts)

A

Addisons disease

Adrenal gland destruction (lack of cortisol and aldosterone)

Etiologies:
1. Autoimmune (MC)
2.Infection (MCC worldwide) like TB, HIV, fungal, CMV
3.Vascular (thrombosis or hemorrhage in adgren gland known as Waterhouse-fredrichsen)
4.Metastatic disease or medications (ketoconazole, rifampin, phenytoin, barbituates)

79
Q

Primary hyperaldosteronism (Scientific concepts)

A

Renin-independent (autonomous)

Conn syndrome = adrenal adosteronoma in the zona glomerulosa

80
Q

Primary hyperparathyroidism (clinical intervention)

A
  1. Surgery = Parathyroidectomy
  2. Vitamin D/Ca supplementation if this is a secondary problem
  3. Tx of hypercalcemia if symptomatic (IV fluids, furosemide)
81
Q

SIADH (dx and labs)

A

Syndrome of inappropriately HIGH ADH

  1. Isovolemic hypotonic hyponatremia = decreased BUN
  2. Urine = Increased urine osm
  3. Dx made in absence of renal, adrenal, pituitary, thyroid disease, or diuretic use
82
Q

SIADH (pharm tx)

A

Moderate = ADH receptor antagonists (conivaptan, tolvaptan)

Chronic = Demeclocycline (tertracycline)

83
Q

SIADH (clinical intervention_

A

Tx underlying cause when possible

Fluid restriction

If severe hyponatremia = IV hypertonic saline

Avoid rapid correction to prevent central pontine myelinolyusis

84
Q

SIADH/malignancy (FMLD)

A

Neuro sx of hyponatremia and cerebral edema = confusion, lethargy, disorientation, seizures

Normovolemic, hypotonic, hyponatremic = Decreased serum osmolarity

85
Q

Subacute thyroiditis (clinical intervention)

A

Aspirin (no anti-thyroid drugs)

86
Q

Thyroglossal duct cysts (FMLD)

A

Often presents as midline neck cysts closely associated with hyoid bone

Asx but can have symptoms

Mass will elevate with tongue protrusion or swallowing

87
Q

Thyroidtoxicosis (FMLD)

A

Thyrotoxicosis is condition due to excess thyroid hormone of any cause

Increased T3 + T4 with decreased TSH

Sx = anxiety, emotional lability, weakness, tremor, palpitations, heat intolerance, weight loss, a.fib

Can progress into coma, hypotension

MCC = Event like surgery, trauma, infection, illness, pregnancy

88
Q

Type 1 DM (Scientific concepts)

A

Pancreatic beta cell destruction

Patient no longer able to produce insulin; MC in childhood

Type 1A = Autoimmune beta cell destruction triggered by 1 or more environmental factors

Type 1B = Nonautominnue beta cell destruction

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