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Clin Med/Spec > Repro Exam > Flashcards

Repro Exam Flashcards

1
Q

when is Rhogam given?

A

28 weeks

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2
Q

when is the QUAD screen given?

A

second trimester

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3
Q

when is round ligament pain common?

A

second trimester

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4
Q

when is G/C tested for?

A

1st and 3rd trimester

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5
Q

when is GBS tested for?

A

35+ weeks

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6
Q

what is the first line treatment for N/V in pregnancy?

A

unisom

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7
Q

when is the GCT given?

A

24-28 weeks (first trimester if risk factors)

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8
Q

HA, vision changes, and RUQ pain are sx of what?

A

preeclampsia

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9
Q

how many weeks is considered a term pregnancy?

A

37

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10
Q

what is the standard for kick counts?

A

10 kicks/2 hrs

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11
Q

when is a fetal non-stress test performed?

A

after 28 weeks

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12
Q

what is considered post term (and labor should be induced)?

A

42 weeks and up

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13
Q

where is the most common place for the sperm and egg to meet?

A

ampulla

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14
Q

what are the risk factors for an ectopic pregnancy

A

1) previous ectopic
2) tubal surgery
3) endometriosis
4) hx pelvic infection
5) hx of infertility
6) IUD (if currently inserted)
7) smoking

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15
Q

what are the most common symptoms of an ectopic pregnancy

A

1) abd pain
2) missed LMP
3) vaginal bleeding

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16
Q

which should be included in the workup if you suspect an ectopic?

A

1) BHcg
2) CBC
3) type and screen
4) pelvic US

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17
Q

what does a bhcg tell you over a upreg?

A

quantity

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18
Q

what is the discriminatory zone and what is the lab range?

A

bhcg level at which an intrauterine gestational sac should be seen

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19
Q

at what value should a gestational sac be seen on US?

A

> 2000

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20
Q

at what point in a pregnancy should a gestational sac be seen?

A

4-5 weeks

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21
Q

at what point in a pregnancy should a yolk sac be seen?

A

5 weeks

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22
Q

at what point in a pregnancy should a fetal pole be seen?

A

6 weeks

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23
Q

at what point in a pregnancy should fetal heart motion (FHM) be seen?

A

6 1/2 weeks

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24
Q

how would you expect a bhcg value to change over 2 days?

A

should at least double

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25
Q

what is a heterotypic pregnancy?

A

extrauterine and intrauterine pregnancies occur simultaneously

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26
Q

how is a an ectopic dx?

A

1) adnexal mass c/w ectopic
2) free fluid in pelvis (ruptured ectopic)
3) hemodynamically unstable
4) bhcg > 1500-2000 w/o an intrauterine sac

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27
Q

what should you do if you suspect an ectopic but can’t prove it yet?

A

1) repeat bhcg in 48 hrs
2) repeat pelvic US
3) give ectopic precautions and bleeding precautions

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28
Q

how is an ectopic pregnancy managed medically?

A

Methotrexate (MTX)

check bhcg on day 1, 4, 7

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29
Q

how is an ectopic pregnancy managed surgically?

A

laparoscopic salpingectomy/salpingostomy

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30
Q

how do you know if a medically managed ectopic was a “success”?

A

15% in bhcg between day 4-7

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31
Q

how long should bhcg be followed after treating an ectopic?

A

until < 5 (considered negative)

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32
Q

when is surgical management for an ectopic used over medical?

A

1) evidence of rupture
2) hemodynamically unstable
3) CI to MTX

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33
Q

what must you remember to give a patient with an ectopic?

A

Rhogam!

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34
Q

what two supplements counteract MTX?

A

DHA and folic acid

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35
Q

for which surgical procedure to remove an ectopic must bhcg be followed and why?

A

salpingostomy

b/c need to make sure you removed all of the pregnancy

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36
Q

why must remnants from a surgical excision of an ectopic be sent to pathology?

A

to confirm chorionic villi

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37
Q

what is GTD?

A

gestational trophoblastic disease
lesions characterized by abnormal proliferation of placenta trophoblast (complete or partial hydatiform mole or placental site nodule)

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38
Q

what is GTN?

A

gestational trophoblastic neoplasia
malignant neoplasms arising from abnormal proliferation of placental trophoblast (choriocarcinoma, placental site trophoblastic tumor, epitheliod trophoblastic tumor, invasive mole)

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39
Q

which surgical procedure for an ectopic has more risk of recurrence and threat to fertility?

A

both the same!

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40
Q

what are the sx of GTD?

A

1) abnormal vaginal bleeding
2) uterine size > dates
3) hyperemesis gravidarum
4) bhcg > 100,000
5) hyperthyroidism
6) preeclampsia

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41
Q

what gives you morning sickness in pregnancy?

A

bhcg

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42
Q

how is a molar pregnancy (GTD) dx?

A

1) bhcg level > 100, 000
2) US
3) pathology = definitive

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43
Q

how does a complete mole look on US?

A

“snowstorm” appearance form hydropic villi w/o fetal parts

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44
Q

how does a partial mole look on US?

A

+/- fetal parts

enlarged cystic placenta

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45
Q

which type of mole confers a higher risk of GTN?

A

complete mole

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46
Q

why must a woman use contraception and be sure not to become pregnant after have a GTD treated?

A

if get pregnant - can’t tell if the bhcg is positive from the mole or a new pregnancy

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47
Q

how can you tell if GTD has progressed to GTN?

A

1) bhcg rise 10% over 2 weeks
2) bhcg plateau 10% over 3 weeks
3) bhcg positive at 6 month

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48
Q

what is the tx for low risk GTN?

A

single agent

MTX or Actinomycin-D

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49
Q

what is the tx for high risk GTN?

A

multi agent

EMA-CO (etoposide, MTX, actinomycin-D, cyclophosphamide, vincristine)

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50
Q

after a GTD is treated how is bhcg followed?

A

weekly until < 5

monthly for 6 mon

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51
Q

what is another name for the placenta?

A

chorion

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52
Q

what is another name for the sac?

A

amnion

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53
Q

how many days before split result in conjoined twins?

A

> 12

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54
Q

how many days before split results in monochorionic diamniotic twins?

A

4-8

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55
Q

how many days before split results in monochorionic monoamniotic twins?

A

8-12

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56
Q

how many days before split results in dichorionic diamniotic twins?

A

0-4

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57
Q

how can you tell if twins are fraternal or identical?

A

genetic testing at birth

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58
Q

what does the T sign on US tell you about twins?

A

monochorionic

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59
Q

what does the lambda sign on US tell you about twins?

A

dichorionic

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60
Q

what is the risk with monochorionic twins?

A

congenital anomalies (heart defects)

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61
Q

what is the risk with monochorionic diamniotic twins?

A

twin twin transfusion syndrome (TTTS)
twin anemia polycythemia sequence (TAPS)
twin reversed arterial perfusion (TRAP)

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62
Q

what is the risk with monochorionic monoamniotic twins?

A

cord entanglement/accident

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63
Q

when are DCDA twins delivered?

A

38 wks

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64
Q

when are MCDA twins delivered?

A

34-37 wks

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65
Q

when are MCMA delivered?

A

32-34 wks

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66
Q

at what point is mom of MCMA twins managed inpatient?

A

@ 24wks

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67
Q

how do you determine mode of delivery for twins?

A

depends on presentation of twin A

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68
Q

if twins are vertex-vertex, how are they delivered?

A

vaginally

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69
Q

if twins are vertex/breech or transverse, how are they delivered

A

vaginally or C section

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70
Q

if twin A is non-vertex how are they delivered?

A

C section

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71
Q

if twins are MCMA, how are they delivered?

A

C section

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72
Q

why would you screen for pregestational DM (GCT at 1st prenatal visit)?

A

1) BMI > 30
2) 1st degree relative with DM
3) hx of GDM in prior pregnancy
4) hx macrosomic infant
5) physical inactivity
6) A1C > 5.7

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73
Q

what guidelines are used in the US for GDM dx?

A

carpenter/coustan

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74
Q

how many times daily for glucose be checked in GDM?

A

4-5x

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75
Q

what are the benchmarks to follow for glucose in GDM?

A

fasting < 95
1 hr postprandial < 140
2hr postprandial < 120

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76
Q

how does the dose of insulin needed trend throughout pregnancy

A

increases b/c resistance increases as you go along

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77
Q

what risks do glyburide pose if used for GDM?

A

risk of macrosomia and hypoglycemia

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78
Q

how often are growth scans required in GDM?

A

q4wks

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79
Q

in addition to a growth scan, what does A2 GDM require for surveillance?

A

non-stress test (NST) wkly 28-32 weeks

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80
Q

what testing does a GDM mother get post partum?

A

75g OCTT at 6-12 wks postpartum

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81
Q

what is the definition of chronic HTN in pregnancy?

A

BP > 140/90

GA < 20wks

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82
Q

what characteristics do GHTN, pre-eclampsia, and eclampsia have in common?

A

BP > 140/90
x2 > 4hrs apart
GA > 20 wks

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83
Q

what is eclampsia?

A

condition where high blood pressure results in seizures during pregnancy

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84
Q

how is pre-eclampsia with severe features defined?

A

BP> 160/110

severe ft. = ptl < 100,000, pulm edema, headache, vision changes, oliguria

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85
Q

what is pre-eclampsia?

A

multisystem d/o caused by placental and maternal vascular dysfunction

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86
Q

what is treatment for pre-eclampsia?

A

delivery

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87
Q

how is GHTN differentiated from pre-eclampsia?

A

proteinuria

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88
Q

what BP meds are recommended in pregnancy?

A

labetolol, hydralazine, nifedipine, methyldopa

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89
Q

what are the fetal consequences of Rh incompatibility?

A

anemia, hydrops fetalis, death

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90
Q

when is Rhogam given?

A

28 wks
within 72 hrs of delivery if Rh positive
setting of any sensitizing event

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91
Q

what is considered preterm labor?

A

< 37wks

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92
Q

what is the definition of labor?

A

regular contractions and cervical changes

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93
Q

what are tocolytics?

A

prevent uterine contraction

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94
Q

what is betamethasone used for?

A

given to mothers in preterm labor for fetal lung maturity

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95
Q

what is magnesium sulfate used for?

A

cerebral palsy prevention

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96
Q

what are the stronger tocolytics?

A

nifedipine, indomethacin

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97
Q

what are CI to tocxolysis (where baby really just needs to come out)?

A

1) fetal distress
2) placental abruption
3) pre-eclampsia
4) intrauterine fetal demise
5) intrauterine infection
6) lethal fetal anomaly

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98
Q

how is a premature rupture of membranes dx?

A

sterile speculum exam

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99
Q

what is PROM?

A

premature rupture of membranes

ROM before onset of labor (contractions)

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100
Q

what is PPROM?

A

preterm premature rupture of membranes

ROM < 37 wks and before onset for labor

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101
Q

what is prolonged rupture of membranes?

A

ROM > 18 hrs

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102
Q

what is the “latency period”?

A

time between ROM and delivery

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103
Q

if a pregnancy is at term and the water breaks, how long is the latency period?

A

1-2 days

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104
Q

what labs must be checked after ROM?

A

gonorrhea, chlamydia, UA, urine culture, GBS

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105
Q

at what point in pregnancy must D&E be considered if there is a PROM?

A

< 24 wks

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106
Q

how is a PROM patient managed inpatient?

A

1) daily non-stress test
2) serial growth US
3) limit vaginal exams (d/t infection risk)

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107
Q

what type of cells make up the endocervix?

A

columnar epithelium

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108
Q

what type of cells make up the ectocervix?

A

nonkeratinizing squamous epithelium

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109
Q

how does the cervix change after menarche?

A

acidification –> ectocervis undergoes squamous transformation –> metaplastic changes radiate inward from the original squamocolumnar junction to new SCJ —> creates a transformation zone

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110
Q

when is ectropion seen?

A

OCPs, menarche (before squamous metaplasia)

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111
Q

why is ectropion prone to bleeding?

A

columnar cells are not meant for friction

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112
Q

what is a nabothian cyst?

A

forms on the cervix during squamous metaplasia
mucus trapping –> bleb formation
trapping what normally would get secreted

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113
Q

what is the MC benign cervical neoplasm?

A

cervical polyp

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114
Q

what is a cervical polyp?

A

hyperplastic endocervical fold of columnar epithelium

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115
Q

which is more likely to bleed - cervical polyp or nabothian cyst?

A

cervical polyp

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116
Q

why would a cervical polyp be removed?

A

bothersome to patient (bleeding)

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117
Q

how does cervical insufficiency differ from preterm labor?

A

preterm labor = painful

cervical insufficiency = painless

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118
Q

what can cervical stenosis lead to?

A

hematometra (retention of blood in uterus) and infertility

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119
Q

what is the MC STI?

A

HPV

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120
Q

what is the strongest factor that predisposes someone to HPV?

A

sexual partners

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121
Q

what percent of HPV cases regress in 2 years?

A

70-90%

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122
Q

when do paps start?

A

21

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123
Q

when are paps done from 21-29?

A

q3yrs

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124
Q

when is pap with HPV cotesting done?

A

30-65 y/o

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125
Q

when would you need a pap earlier than 21?

A

if you have HIV

start pap at time dx or once sexually active if congenitally acquired

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126
Q

what is colposcopy?

A

used to evaluate abnormal pap or persistent HPV infection

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127
Q

what is used during a colposcopy?

A

acetic acid (makes it white) & Lugol’s sol’n (makes it brown)

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128
Q

what is another name for cervical dysplasia?

A

cervical intraepithelial neoplasia

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129
Q

what is cervical dysplasia?

A

HPV-mediated abnormal growth of squamous epithelium

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130
Q

since cervical dysplasia can be potentially malignant, how is it classified?

A

by risk

  • CIN 1 = low risk
  • CIN2-3 = high risk
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131
Q

how is CIN characterized into high risk vs low risk?

A

1) cellular immaturity
2) cellular disorganization
3) nucelar abnormalities
4) increased mitotic activity

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132
Q

in terms of placement on the cervix, how is CIN grade determined?

A

CIN 1 = lower 1/3 of epithelium
CIN 2 = middle 1/3
CIN 3 = upper 1/3

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133
Q

what is the treatment for CIN2-3?

A

excision method - LEEP/cold knife cone

ablative method - cryotherapy

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134
Q

what is the downside of ablation?

A

harder to see if you got everything (nothing goes to path like with LEEP)

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135
Q

what is the most common gyn cancer in women in the world?

A

cervical

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136
Q

what are the histological types of cancer?

A

1) squamous cell carcinoma
2) adenocarcinoma
3) mixed cervical carcinoma and neuroendocrine tumors

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137
Q

what is the most common type of cervical cancer?

A

squamous cell carcinoma

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138
Q

what are the sx of cervical cancer?

A

1) abnormal bleeding
2) watery d/c
3) postcoital bleeding
4) venous/lymphatic/ureteral compression

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139
Q

why is adenocarcinoma of the cervix sneaky?

A

just b/c you removed the cancer from place on the cervix doesn’t mean that you don’t have it elsewhere (skip lesion)

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140
Q

what is the tx for stage IA cervical cancer?

A

radical hysterectomy

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141
Q

what is the tx for stage IB - IIA cervical cancer?

A

surgery and/or pelvic radiation

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142
Q

what is the tx for stage IIB - IVA cervical cancer?

A

radiation and chemo

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143
Q

what is the tx for stage IVB cervical cancer?

A

palliative care

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144
Q

what supplementation might a breast feeding baby need?

A

vitamin D

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145
Q

what in terms of immunity does a breastfeeding baby get from mom?

A

IgA

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146
Q

what are maternal benefits of breastfeeding?

A

1) decr postpartum depression
2) boosts maternal weight loss
3) uterine involution (oxytocin release, uterine contractions, minimizes hemorrhage)

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147
Q

what is colostrum? and when does it occur?

A

yellow milk containing fat, minerals, IgA

starts at 2nd day postpartum

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148
Q

what is mature milk composed of?

A

protein, lactose, water, fat

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149
Q

what maintains lactation?

A

decrease in estrogen and progesterone causes loss of PRL inhibition

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150
Q

how does the role of oxytocin differ from PRL in terms of breastfeeding?

A

oxytocin is responsible for the myoepithelial contraction within the alveoli

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151
Q

how does PRL affect the ovaries?

A

suppresses ovulation by inhibiting GnRH, LH, FSH

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152
Q

what are 4 problems with breastfeeding?

A

1) mastitis
2) suppression
3) mastitis
4) nipple problems
5) infant drug exposure

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153
Q

when is mastitis MC?

A

2-4 hours postpartum

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154
Q

what is the MC cause of mastitis?

A

staph aureus from infants pharynx

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155
Q

what medications can suppress lactation?

A

1) bromocriptine
2) pseudoephedrine
3) estrogen-containing contraceptives

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156
Q

what medication can boost lactation?

A

domperidone

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157
Q

when are NSAIDs contraindicated?

A

pregnancy but ok during breastfeeding!

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158
Q

why are NSAIDs CI in pregnancy?

A

can cause closure of the patent ductus arteriosus

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159
Q

what medications can impact a baby via breastmilk and how?

A

1) narcotics –> sedation

2) nitrofurantoin –> hemolytic anemia in G6PD deficient babies

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160
Q

what is the MC cause of maternal death?

A

hemorrhage (ante, intra, or postpartum)

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161
Q

what are the MC causes of 3rd trimester bleeding?

A

1) placenta previa
2) abruption
3) preterm labor

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162
Q

what is placenta previa?

A

placenta covering the cervix

doesn’t move up the uterus to where there is more muscle likes it’s supposed to

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163
Q

what is placenta accreta?

A

abnormal placental attachment to the myometrium

absent Nitabuch’s layer causing defective decidual formation

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164
Q

what is the decidua?

A

the endometrium during pregnancy

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165
Q

what is an accessory or “succenturiate” lobe?

A

small lobe of the placenta that often infarcts

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166
Q

what is the risk with a “succenturiate” lobe?

A

retained portion of the placenta after birth

can result in postpartum bleeding

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167
Q

what is required after a “succenturiate” lobe?

A

hysterectomy upon delivery of baby

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168
Q

what is abruptio placentae and how does it start?

A

premature separation of the placenta
initiated by hemorrhage into the decidua basalts which causes a decidua hematoma and decidua separation from the basal plate

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169
Q

what can abruptio placentae lead to and why?

A

DIC

b/c decidua separation from the basal plate causes further separation and bleeding which leads to DIC

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170
Q

what is uterine rupture and what is a major risk factor for it?

A

complete separation of all layers of the uterus

prior uterine scar

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171
Q

how is the source (baby or mom) of intrapartum hemorrhage determined?

A

Apt test

test specimen of the blood that comes out and turns a different color if its mom vs baby

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172
Q

what is the definition of postpartum hemorrhage

A

intrapartum and postpartum 24 hrs > 1000mL blood loss with delivery and s/sx of hypovolemia

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173
Q

what are causes of postpartum hemorrhage?

A

1) uterine atony
2) obstetric trauma
3) uterine inversion
4) abnormal placentation
5) coagulation d/o
6) DIC

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174
Q

what is sequelae of postpartum hemorrhage?

A

Sheehan, mortality, DIC, hypovolemic shock, end-organ failure

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175
Q

what is anaphylactoid syndrome?

A

amniotic fluid embolism
fetal antigens enter the mother and there is an inflammatory response that causes DIC and decrease of myocardial function

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176
Q

when should pitocin be given during labor?

A

before the end of stage 3 (before the end of placental delivery)

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177
Q

how is puerperal endometriosis start?

A

intraamniotic infection ascending from lower GI or GU tract

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178
Q

what are the risk factors for puerperal endometriosis?

A

prolonged labor and membranous rupture

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179
Q

what is usually the cause of puerperal endometriosis?

A

polymicrobial

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180
Q

what do you do if a woman goes into preterm labor and you haven’t swabbed her for GBS yet?

A

give abx (assume positive)

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181
Q

what is the SART?

A

sexual assault response team

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182
Q

what is a SANE?

A

sexual assault nurse examiner

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183
Q

what is PERK and when is it good for?

A

physical evidence recovery kit

good for up to 96hrs after assault

184
Q

which injuries are only seen within 24hrs of assault and why?

A

anogenital injuries b/c they heal very quickly

185
Q

what are the 2 MC places of injury in sexual assault?

A

fossa navicularis and posterior fourchette

186
Q

how do you handle a Nuvaring in an assault patient?

A

take out, swab and put back

187
Q

why is an HIV test not done in SANE exam?

A

don’t want to tell them same day they got assaulted that they also have HIV
also it wouldn’t be from assault it have been contracted earlier

188
Q

what is the MC dx in patients seeking evaluation of breast lumps?

A

fibrocystic changes

189
Q

what is the pathological agent in mastitis?

A

staph aureus

190
Q

what are the sx of mastitis?

A

induration, redness, swelling, pain, heat and edema

191
Q

what is fat necrosis?

A

firm nodule that can mimic CA

often hx of trauma causing damage to breast fat

192
Q

what is MC breast disorder?

A

fibrocystic changes

193
Q

what is the age range fibrocystic changes are dx?

A

20-40

194
Q

what is fibrocystic breast disease associated with?

A

hyperestrenism

195
Q

what are the non proliferative patterns of FCC?

A

1) cyst formation
2) fibrosis
3) adenosis

196
Q

what are the proliferative patterns of FCC?

A

1) sclerosing adenosis
2) epithelial hyperplasia
3) atypical hyperplasia
4) small duct papilloma

197
Q

what are the features of sclerosing adenosis?

A

1) small lesions
2) mammography calcifications
3) rarely palpable
4) proliferation of acini

198
Q

what FCC confers a moderately increased risk?

A

atypical ductal hyperplasia

atypical lobular hyperplasia

199
Q

what diseases can be associated with gynecomastia?

A

cirrhosis and functioning testicular tumor

200
Q

what are the stromal breast tumors?

A

fibroadenoma

phyllodes tumor

201
Q

what are the epithelial breast tumors?

A

large ductal papilloma

carcinoma

202
Q

what tumor causes bloody nipple d/c?

A

large duct papilloma

203
Q

Paget’s disease is a subtype of what?

A

DCIS

204
Q

what are the clinical features of invasive carcinoma?

A

1) fixed firm nodule
2) dimpling of skin
3) retraction of nipple

205
Q

what are the “special” histological breast carcinomas?

A

1) mutinous carcinoma
2) medullary carcinoma
3) papillary carcinoma

206
Q

what are the most common causes of infectious vaginitis?

A

1) bacterial vaginosis
2) vulvovaginal candidiasis
3) trichomoniasis

207
Q

what is the vulva?

A

external female sex organs

208
Q

what is the normal pH of a menstruating woman?

A

3.5 - 4.5

209
Q

generally, what type of bacteria reside in the vagina?

A

aerobic

210
Q

what do the lactobacilli do in the vagina?

A

1) produce lactic acid
2) inhibits growth of bacteria
3) maintains acidic environment

211
Q

specifically, what 3 types of bacteria are typically present in the vagina?

A

yeast and pathogenic bacteria in small amounts

lactobacilli

212
Q

what is the purpose of the lactic acid production in the vagina?

A

detrimental to the growth of pathogens

213
Q

what is physiologic discharge?

A

clear/cloudy odorless, non-adherent to walls

contains lactobacilli

214
Q

when does physiologic discharge MC occur?

A

1) ovulation
2) postcoitus
3) postmenses
4) pregnancy

215
Q

what can be examined on a wet mount?

A

1) BV (saline)
2) trichomonas (saline)
3) candida (KOH)

216
Q

where do you take the specimen from for a wet mount?

A

lateral wall of the vagina

217
Q

what is the BD Affirm VP III lab study?

A

used for bacterial vaginosis

DNA probe

218
Q

what does BD Affirm VP III test for?

A

Gardnarella vaginalis, Trichomonas vaginalis, Candida

219
Q

what is the MC vaginal infection in WOCBP?

A

BV

220
Q

what is the MC cause of vaginal d/c and odor?

A

BV

221
Q

why is BV bad in pregnancy?

A

increased risk of preterm labor

222
Q

what causes BV?

A

incr in pH causes overgrowth of bacteria

223
Q

what is the pathogen MC identified in BV?

A

Gardnerella vaginalis

224
Q

are most women sx with BV?

A

only 50%

225
Q

which patients are at increased risk of getting BV?

A

STI patients and WSW

226
Q

is BV an STI?

A

no it is sexually associated

227
Q

how does douching affect the vagina?

A

makes it more alkalinic

228
Q

what are the risk factors for getting BV?

A

1) recent abx use
2) douching
3) unprotected sex

229
Q

what are the sx of BV?

A

1) increased d/c white, grey in appearance
2) fishy odor
3) odor worse with sex

230
Q

what are the signs of BV?

A

1) thin, white vaginal d/c
2) KOH whiff test
3) clue cells on wet mount
4) few lactobacilli on wet mount
5) ph> 4.5

231
Q

what is seen on a saline wet pre in BV?

A

Clue Cells - fuzziness with stippled borders

predominance of anaerobic organisms

232
Q

why is there not a lot of WBCs on a saline wet prep in BV?

A

not inflammatory

233
Q

what is the Amsel criteria?

A 
dx for BV
need 3/4
1) homogenous, thin, grayish-white d/c
2) pH > 4.5
3) positive whiff test 
4) clue cells on wet mount
234
Q

what is the recommended tx for BV in pregnancy?

A

oral metronidazole

235
Q

what is considered recurrent BV and what does it require that normal BV does not necessarily?

A

> 3 episodes/yr

1) consistent condom use
2) longer treatment period

236
Q

when is vulvovaginal candidiasis MC?

A

in WOCBP

237
Q

what is vulvovaginal candidiasis?

A

yeast infection

238
Q

if you see hyphae on slides but patient is asx do you need to treat? why?

A

no

b/c candidiasis is part of the normal vaginal flora

239
Q

what bacteria is the MC cause of vulvovaginal candidiasis?

A

Candida albicans

240
Q

what is the less common cause of vulvovaginal candidiasis that usually doesn’t cause sx?

A

Candida glabrata

241
Q

what are the sx of vulvovaginal candidiasis?

A

1) vulvar pruritis
2) vulvovaginal burning and irritation
3) cottage cheese d/c
4) dysuria
5) dyspareunia

242
Q

what are the signs of vulvovaginal candidiasis?

A

1) erythema of vulva and vaginal mucosa
2) vulvar edema
3) thick white d/c adherent to vaginal walls
4) pseudohyphae (tree-branch looking) on wet mount

243
Q

how is the pH affected in vulvovaginal candidiasis?

A

it isn’t

244
Q

what is the dx test for vulvovaginal candidiasis?

A

KOH prep

245
Q

what type of treatment is best for more severe very itchy vulvovaginal candidiasis? why?

A

vaginal imidazole (topical) b/c will take care of sx quicker than oral

246
Q

what is the oral medication for vulvovaginal candidiasis?

A

fluconazole

247
Q

what are the types of topical vulvovaginal candidiasis tx?

A

vaginal imidazole, miconazole, clotrimazone, terconazole

248
Q

what is recurrent vulvovaginal candidiasis?

A

> 4 episode/yr

249
Q

when and how do you tx vulvovaginal candidiasis in pregnancy?

A

only tx if sx
topical (clotimazole or miconazole)
no PO meds!

250
Q

what is the tx for candida glabrata? why?

A

boric acid intravaginally

b/c azoles won’t work for this type

251
Q

what is the MC non-viral STI?

A

trichomoniasis

252
Q

what are the sx of trichomoniasis?

A

1) yellow green vaginal d/c
2) vulvovaginal irritation
3) dyspareunia
4) dysuria
5) male partner asx

253
Q

what are the signs of trichomoniasis?

A

1) motile flagellated organisms on wet mount
2) copious frothy cervical-vaginal d/c
3) strawberry cervix
4) presence of other STIs

254
Q

what does a strawberry cervix look like?

A

punctate macular hemorrhages

255
Q

how is trichomoniasis dx?

A

saline wet mount - motile trichomonads

pear shaped

256
Q

what typically is present with trichomoniasis?

A

BV

257
Q

why can trichomoniasis not be dx on pap?

A

can easily get a false positive

258
Q

what is different about trichomoniasis compared to other STIs?

A

doesn’t progress to PID like other STIs

259
Q

what must patients not do during tx for trichomoniasis?

A

EtOH and abstinence

260
Q

what does trichomoniasis require that BV does not in terms of tx?

A

need to tx partner

261
Q

why is trichomoniasis bad with pregnancy?

A

preterm labor and low birth weight

262
Q

what are the bartholin glands for?

A

moisture and lubrication during sex

263
Q

how should the bartholin glands feel on exam?

A

non-palpable

264
Q

what is a bartholin gland cyst?

A

cyst that develops when main duct draining the gland is occluded

265
Q

what is the MC vulvovaginal tumor?

A

bartholin gland cyst

266
Q

what are the s/sx of a bartholin gland cyst?

A

painless vulvar mass detected on pelvic exam

may be uncomfortable if very large

267
Q

what does the drainage of a bartholin gland cyst look like?

A

clear, white fluid

268
Q

what are the s/sx of a bartholin gland abscess?

A

1) tender, erythematous, severe pain with mucopurulent drainage
2) warm, tender, fluctuant mass

269
Q

what should also be tested for with a bartholin gland abscess?

A

G/C

270
Q

what is a Word catheter?

A

balloon tipped device inserted after I&D

inflatable tip left in place for 4-6 wks

271
Q

how does the Word catheter tx a bartholin gland cyst?

A

promotes formation of epitheialized duct

272
Q

what is marsupialization?

A

surgical procedure that forms a new ductal orifice

273
Q

in which age group is vulvar cancer MC?

A

postmenopausal women

274
Q

what are the risk factors for vulvar cancer?

A

1) HPV 16, 18, 31
2) vulvar intraepithelial neoplasia (VIN)
3) lichen sclerosus - derm condition characterized by thin white patches of vulva with itching
4) hx cervical cancer
5) HIV infection

275
Q

what is the MC vulvar cancer?

A

squamous cell carcinoma

276
Q

what are the sx of vulvar cancer?

A

1) vulvar lesion
2) pruritus
3) +/- vulvar bleeding
4) +/- vulvar pain

277
Q

what does a vulvar cancer lesion look like?

A

1) unifocal plaque
2) ulcer
3) mass on labia, clitoris, perineum

278
Q

what is the MC etiology of vaginal cancer?

A

secondary to another primary metastatic tumor (cervix MC)

279
Q

what is the etiology of clear cell adenocarcinoma of the vagina?

A

DES exposure in utero

280
Q

what is the MC site of vaginal cancer?

A

upper 1/3

281
Q

what is the MC form of vaginal cancer?

A

squamous cell carcinoma

282
Q

what are the sx of vaginal cancer?

A

painless vaginal and/or postcoital bleeding

283
Q

how can trichomonas be transmitted non-venereally (super rare)?

A

toilet seat
swimming pools
hot tubs

284
Q

where is milk produced?

A

lobules

285
Q

what is the difference between what makes up young breasts vs old breasts?

A

young - mainly glandular tissue

older - mainly fat tissue

286
Q

where is the majority of breast cancers?

A

upper outer quadrant (axillary tail)

287
Q

when should the breast exam be performed in the cycle?

A

one week post menses

288
Q

what is mastalgia?

A

breast pain

289
Q

when does cyclic mastalgia occur during the cycle?

A

during the luteal phase

290
Q

what is extramammary breast pain?

A

pain referred from an outside source to the breast

291
Q

what are causes of cyclic mastalgia?

A

1) hormonal changes w/menses
2) OCPs
3) fibrocystic breast disease

292
Q

what are causes of noncyclic mastalgia?

A

1) pendulous breasts
2) mastitis
3) inflammatory breast cancer
4) poorly fitting bra
5) pregnancy
6) ductal ectasia
7) chest wall causes

293
Q

what is ductal ectasia?

A

blocked lactiferous duct

294
Q

how is mastalgia dx?

A

1) clinical breast exam
2) examine lymph nodes
3) US
4) mammogram

295
Q

what are the sx of mastitis?

A

breast pain, swelling, warmth, redness

296
Q

what is the MC pathogen that causes mastitis?

A

staph aureus

297
Q

when do you tx mastitis?

A

sx > 12-24 hrs

298
Q

what are the characteristics of benign nipple d/c?

A

1) bilateral
2) multi ductal
3) milky

299
Q

what are the characteristics of pathological nipple d/c?

A

1) spontaneous
2) unilateral
3) uniductal
4) bloody, yellow or clear
5) stains clothes
6) persistent

300
Q

where should you press to try to express d/c?

A

apply pressure around the areola

301
Q

what labs should be tested to investigate nipple d/c?

A

1) TSH
2) PRL
3) B-hcg

302
Q

what is an FNA used for?

A

lymph node or breast cyst

303
Q

in what instances is an FNA used (in terms of cancer likelihood)?

A

low suspicion for cancer

304
Q

what is the downside of an FNA?

A

high false negatives and non-diagnostic samples

305
Q

what is a core needle bx used for?

A

larger tissue specimen

306
Q

what is a punch bx used for?

A

to distinguish between benign and malignant skin changes (Paget’s)

307
Q

what is the image of choice in women < 30 y/o with focal breast sx?

A

US

308
Q

what is a breast MRI used for?

A

1) screening for high risk women
2) evaluate suspicious findings
3) assess silicone implant integrity

309
Q

what is the BIRADS score?

A

suspicion of malignancy

310
Q

which BIRADS scores should be f/u with bx?

A

4 & 5

311
Q

in a < 30 y/o patient, how should an indeterminate exam be followed up?

A

breast ultrasound

312
Q

in a > 30 y/o patient, how should an indeterminate exam be followed up?

A

diagnostic mammogram +/- direct US

313
Q

how should a patient presenting with a breast mass which isn’t detectable on PE be followed up?

A

repeat the exam in 2-3 months

314
Q

what is the “triple assessment”?

A

1) CBE
2) imaging
3) pathology

315
Q

what is the difference between a simple cyst and a complex cyst?

A

simple - fluid filled and benign

complex - fluid + solid components w/small risk for malignancy

316
Q

are cysts painful or painless?

A

can be either

317
Q

how is a breast cyst managed?

A

US or mammogram

318
Q

when is a mammogram used for a breast cyst?

A

> 30 y/o or complex cyst

319
Q

what is the most common benign breast disease?

A

fibrocystic breast disease

320
Q

what are the sx of fibrocystic breast disease?

A

1) bilateral cyclic pain
2) breast swelling
3) palpable masses
4) lumpy heavy breasts

321
Q

which patients is fibrocystic breast disease MC in?

A

20-40 y/o

322
Q

how is fibrocystic breast disease dx?

A

US
FNA
mammogram > 30 y/o

323
Q

what is a fibroadenoma?

A

benign solid tumors containing glandular & fibrous tissues

324
Q

when is a fibroadenoma MC?

A

WOCBP

325
Q

when do fibroadenomas change?

A

during pregnancy or estrogen therapy

326
Q

what is the most common breast cancer?

A

ductal carcinoma

327
Q

what are the non-invasive malignant tumors of the breast?

A

DCIS

LCIS

328
Q

what are the invasive malignant tumors of the breast?

A

ductal carcinoma

lobular carcinoma

329
Q

what are the BRCA genes?

A

tumor suppressor genes

330
Q

which population is very likely to have the BRCA mutation?

A

Ashkenazi Jews

331
Q

aside from the mass itself, what are the other sx of breast cancer?

A

unilateral nipple discharge, dimpling, skin thickening, breast pain, eczematous changes

332
Q

what is the underlying problem with paget’s disease?

A

ductal carcinoma

333
Q

which disease presents with the peas d’orange appearance?

A

inflammatory breast disease

334
Q

what are the sx of inflammatory breast disease?

A

erythema
edema
peau d’ orange

335
Q

how does chemo help post surgery?

A

prevents recurrence

336
Q

when is hormonal therapy given in breast cancer?

A

after surgery, chemo, radiation

337
Q

when the ACS guidelines suggest offering mammogram to women?

A

40-44 y/o

338
Q

when is annual mammogram screening recommended?

A

45-55

339
Q

when is biennial mammogram screening recommended?

A

> 50

340
Q

how can Turner’s syndrome patients have a child?

A

use an egg donor

can bear a child b/c they have a uterus but not capable of conceiving on own

341
Q

why would you get shoulder pain with ectopic pregnancy?

A

irritation of the diaphragm

referred pain via the phrenic nerve

342
Q

where do ovarian cysts develop?

A

ovary or fallopian tube

343
Q

what can be the sx of an ovarian cyst?

A

1) pelvic pain
2) pelvic fullness
3) dyspareunia
4) bloating
5) torsion

344
Q

what are the signs of an ovarian cyst?

A

adnexal fullness and CMT

345
Q

what is contained in the cortex of the ovary?

A

follicles/eggs

346
Q

where do the most common ovarian cysts arise?

A

follicle

347
Q

what are the most common types of ovarian cysts?

A

simple cysts
corpus luteal cysts
endometrioma

348
Q

what is a simple cyst?

A 
serous water fluid filled 
composed of granulosa cells 
thin walled
always benign
can become 5-7 cm
349
Q

what is a complex cyst?

A 
can be filled w/blood or mucous
solid component
internal debris 
thick walled
septations
papilla
have a lower threshold of suspicion
350
Q

which cysts are related to ovulation?

A

simple cysts and corpus luteal cysts

351
Q

which cysts can produce estrogen?

A

simple cyst

352
Q

which cysts can produce progesterone?

A

corpus luteal cyst

353
Q

what does a corpus luteal cyst tell you about a woman’s cycle?

A

either she is ovulating or she is pregnant but you can’t see it yet

354
Q

what is a “chocolate cyst”?

A

ectopic growth of endometrial tissue

355
Q

what must you do for a chocolate cyst? why?

A

wait and watch
remove laparoscopically
OCP

these usually do not resolve on their own

356
Q

what is CA-125?

A

blood test used to indicate malignancy

used to monitor response to therapy

357
Q

what is theca lutein cyst?

A

luteinized follicular cyst

358
Q

how do theca luteal cysts form?

A

hyperstimulation from hcg

359
Q

how are theca lutein cysts resolved?

A

source of hcg removed

360
Q

which cysts do not resolve on their own and should be followed?

A

medullary and germ cell tumors

361
Q

what is a mature cystic teratoma (dermoid cyst)?

A

germ cell tumor containing ectoderm, mesoderm, and endoderm

362
Q

what is a cyst adenoma?

A

serous and mucinous

363
Q

when are ovarian cysts suspicious for malignancy?

A

1) hyperechoic
2) nodular
3) papillary projection
4) presence of ascites
5) blood flow in solid component
6) peritoneal mass

364
Q

what does a CA-125 value not tell you?

A

how severe the disease is

365
Q

what is the MC gyn malignancy?

A

endometrial

366
Q

what is the most common cause of gyn CA deaths?

A

ovarian cancer

367
Q

what are the s/sx of ovarian cancer?

A

1) pelvic mas
2) pelvic pain
3) abdominal fullness
4) back pain
5) constipation
6) diarrhea
7) early satiety

368
Q

what is the MC ovarian cancer?

A

epithelial cell

369
Q

when are germ cell tumors MC?

A

in pediatrics

370
Q

what are sx of a granulosa theca tumor?

A

precocious puberty
irregular heavy bleeding
postmenopausal bleeding

371
Q

what are the sx of sertoli-leydig tumors?

A

can be masculinizing in adolescence

372
Q

what is the problem with large cysts?

A

can cause ovarian torsion

373
Q

what are the sx of ovarian torsion?

A

1) severe pain
2) N/V
3) low grade fever

374
Q

what are the risk factors for ovarian torsion?

A

1) pregnancy
2) ovarian cysts
3) neoplasms

375
Q

what is the MC cause of infertility?

A

PCOS

376
Q

what is the other name for PCOS?

A

Stein-Leventhal syndrome

377
Q

what are the s/sx of PCOS?

A

1) oligomenorrhea
2) amenorrhea
3) obesity
4) infertility
5) hyperandrogenism
6) insulin resistance

378
Q

why is PCOS a misnomer?

A

they don’t have any cysts

they have an incr number of antral follicles

379
Q

what is used to dx PCOS?

A

Rotterdam criteria

380
Q

what is the Rotterdam criteria and how many are needed for PCOS dx?

A

1) oligo or anovulation
2) clinical signs of hyperandogenism
3) polycystic ovaries (string of pearls)

381
Q

when does the ovarian reserve decrease the most?

A

after 35 y/o

382
Q

how is infertility defined?

A

inability to conceive after 1 yr

383
Q

if a woman is <35 and has regular periods, at what point should she be referred to a fertility clinic?

A

no pregnancy after 1 yr

384
Q

if a woman is 35-39 and has regular periods, at what point should she be referred to a fertility clinic?

A

no pregnancy after 6 months

385
Q

if a woman is 40+ and has regular periods, at what point should she be referred to a fertility clinic?

A

no pregnancy after 3 months

386
Q

what is an SIS?

A

saline infusion sonohysterography

387
Q

what is SIS used for?

A

infusion of saline into the uterus allows better visualization of the uterus

388
Q

on day 3 of menses what would elevated estrogen and FSH point toward?

A

decreased ovarian reserve

389
Q

what is a hysterosalpingogram?

A

insertion of contrast dye into the uterus and fallopian tubes and an X-ray to check contour and tube patency

390
Q

what are causes of male infertility?

A

1) varicocele
2) infection
3) ejaculation issues
4) cryptorchidism
5) hormone imbalances
6) chromosomal abnormalities

391
Q

what is the best timing for sex when trying to conceive?

A

1-2 days prior to ovulation and 1 day after

392
Q

what do ovulation predictor kits (OPK) do?

A

detect LH surge (which precedes ovulation)

393
Q

when does body temperature increase in the cycle?

A

after ovulation

394
Q

how long can sperm survive in repro tract?

A

2-3 days

395
Q

how long is the window for eggs to be fertilized?

A

24 hrs

396
Q

what is clomid used for? and what type of drug is it?

A

first line for ovulatory d/o

SERM

397
Q

what is femara used for? and what type of drug is it?

A

suppresses estrogen production

AI

398
Q

what is ART?

A

assisted reproductive technology

399
Q

what is OHSS?

A

ovarian hyperstimulation syndrome

400
Q

what can be a complication of OHSS?

A

3rd spacing - bloating, abdominal fullness, n/v/d, weight gain, decreased urine output, excessive thirst, pleural effusion, SOB, chest pain, electrolyte imbalance

401
Q

what is polymenorrhea?

A

incr in frequency of bleeding

402
Q

what is menorrhagia?

A

incr in the amount of bleeding

403
Q

what is oligomenorrhea?

A

decrease in the frequency of bleeding

404
Q

what is metromenorrhagia?

A

irregular intervals of bleeding

405
Q

what is menometrorrhagia?

A

irregular intervals of bleeding with excessive amounts of bleeding

406
Q

what are the structural causes of AUB?

A 
PALM
polyp
adenomyosis
leiomyoma
malignancy &amp; hyperplasia
407
Q

what are the non-structural causes of AUB?

A 
COEIN
coagulopathy 
ovulatory dysfunction
endometrial 
iatrogenic 
not yet classified
408
Q

what is a concerning menses account?

A

soaking two or more pads/hour for >2 hours

409
Q

which imaging studies can also be used as a treatment?

A

1) hysterosalpingogram
2) laparoscopy
3) hysteroscopy

410
Q

in postmenopausal women, what should be the thickness of the uterus?

A

thin (or else concerning)

411
Q

which procedure is done in the office setting - endometrial bx or hysteroscopy?

A

endometrial bx

412
Q

what is the age you MC see endometrial polyps?

A

> 50

413
Q

what are the sx of endometrial polyps?

A

1) intermenstrual bleeding
2) post-coital bleeding
3) post-menopausal bleeding

414
Q

how are endometrial polyps dx?

A

US or hysteroscopy

415
Q

when should an endometrial polyp be removed?

A

menopausal or causing sx

416
Q

what is adenomyosis?

A

barrier between endometrium and myometrium breaks allowing endometrial cells to invade the myometrium

417
Q

what is the age you MC see adenomyosis?

A

30-50

418
Q

how does adenomyosis differ from endometriosis?

A

the ectopic endometrial tissue does not respond to hormones

419
Q

what are the sx of adenomyosis?

A

1) heavy menstrual bleeding
2) noncyclic pelvic pain
3) progressive dysmenorrhea

420
Q

how does the uterus feel on PE in adenomyosis?

A

boggy and globular with symmetrical uterine enlargement

421
Q

what is leiomyosis?

A

benign proliferation of smooth muscle cells of the myometrium

422
Q

what is the MC benign uterine tumor?

A

leiomyoma

423
Q

what is esp bad about pedunculated and subserosal fibroids?

A

can sit on other organs and cause sx

424
Q

which leiomyoma is assoc with infertility?

A

submucosal fibroid

425
Q

what are the s/sx of a leiomyoma?

A 
HMB
pelvic pain or pressure
infertility 
compressive sx
enlarged, firm, nontender uterus
426
Q

how is hyperplasia of the endometrium dx?

A

endometrial bx

427
Q

what is the cardinal sx of malignancy?

A

AUB

428
Q

what does the pap show which is concerning for malignancy?

A

atypical glandular cells

429
Q

what are the type I endometrial malignancies called?

A

endometroid

430
Q

what are the type II tumors called?

A

serous and clear cell

431
Q

what is leiomyosarcoma?

A

fibroid that has progressed to cancer

rapidly growing mass with vaginal bleeding and pain

432
Q

what is the prognosis for leiomyosarcoma?

A

poor

433
Q

what is anovulatory AUB?

A

excess estrogen in absence of progesterone

incomplete sloughing of the endometrium

434
Q

what is ovulatory AUB?

A

prolonged progesterone secretion

causes irregular shedding of the endometrium

435
Q

what is the triad that can be found in a later stage chlamydia infection?

A

urethritis, uveitis, arthritis

436
Q

what is the MC form of chronic prostatitis - bacterial or abacterial?

A

abacterial

437
Q

what is the major hormone contributing to BPH?

A

DHT

438
Q

what is the gold standard for treating BPH

A

TURP

439
Q

what is the MC malignancy in men in the US?

A

prostate carcinoma

440
Q

where does prostate cancer normally arise?

A

peripheral zone of the posterior prostate

441
Q

on histology, what does prostate cancer look like?

A

one layer of basal cells and cherry nucleolus

442
Q

what is the Gleason grading used for and what is it based on?

A

staging of prostate cancer

based on architectural parameters

443
Q

what on a bone scan would be pathognomonic for prostate cancer?

A

osteoclastic bony mets

444
Q

which cells support spermatogenesis?

A

sertoli cells

445
Q

when does cryptorchidism need to be treated by in order to prevent atrophy?

A

2 y/o

446
Q

what is not performed before a surgery on a testicular mass?

A

bx

447
Q

what is the age range MC for testicular cancer?

A

25-45

448
Q

what are the type of testicular germ cell tumors?

A

seminoma and non-seminoma

449
Q

what is the most common germ cell tumor of the testicles

A

classic seminoma

450
Q

what does a seminoma look like on gross exam?

A

solid tan bulky mass

451
Q

what is a highly malignant testicular tumor and why?

A

choriocarcinoma

b/c it mets very early

452
Q

what is ITGCN?

A

Intratubular germ cell neoplasia - precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults

453
Q

what is the hormone producing tumor in the testicles?

A

stromal tumor and leydig cell tumor

454
Q

are stromal tumors and leydig cell tumors usually malignant or benign?

A

benign

455
Q

what is the MC testicular neoplasm in men > 60?

A

aggressive non-Hodgkin

Clin Med/Spec (11 decks)

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