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PANCE Review > Reproductive System > Flashcards

Reproductive System Flashcards

1
Q

Average age of menarche

A

Between 12 and 13

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2
Q

Nature of the menstrual cycle around menarche time

A

typically irregular, with anovulatory cycles, for the first 6 months to 1 year

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3
Q

2 phases of menstrual cycle

A

Follicular and luteal

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4
Q

Source of follicle stimulating hormone

A

pituitary gland

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5
Q

Ovarian follicle produces this hormone

A

estrogen

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6
Q

Effect of estrogen on uterus

A

Proliferation of uterine lining

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7
Q

Timing of lutenizing hormone spike

A

mid-cycle, around day 14

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8
Q

Action of lutenizing hormone on ovary

A

Release of ovum from follicle

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9
Q

The luteal phase of the menstrual cycle begins _____________

A

after release of the ovum, some time after day 14

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10
Q

After release of ovum, remnants of the follicle become the ________ and secrete _______

A

Corpus luteum, secrete progesterone

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11
Q

Action of progesterone on uterus during a natural menstrual cycle

A

maintains uterine lining in preparation for implantation of fertilized ovum

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12
Q

If fertilization occurs, the trophoblast synthesizes __________. This maintains _________

A

hCG, corpus luteum

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13
Q

If there is no fertilization, what does the corpus luteum do?

A

it degenerates, and progesterone levels start to drop

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14
Q

If progesterone levels drop, what happens to the endometrium?

A

It is sloughed off

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15
Q

As estrogen and progesterone drop near the end of the menstrual cycle, what hormone starts to increase?

A

FSH

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16
Q

As FSH rises near the end of the menstrual cycle, what happens in the ovary?

A

development of primary ovarian follicles, the start of a new follicular phase

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17
Q

This is a diagnosis of exclusion, when pathologic menorrhagia or metrorrhagia are ruled out.

A

Dysfunctional uterine bleeding

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18
Q

One likely cause of dysfunctional uterine bleeding

A

anovulation via disruption of hypothalamic-pituitary-gonadal axis, causing continuous estrogen stimulation of the endometrium that overgrows and sloughs off at irregular times in varying amounts

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19
Q

Common times to find dysfunctional uterine bleeding

A

near menarche and menopause

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20
Q

This is the gold standard way to determine if ovulation is occurring in the setting of dysfunctional uterine bleeding

A

Endometrial sampling

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21
Q

Definitive surgery, used in refractory cases of dysfunctional uterine bleeding

A

hysterectomy

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22
Q

First procedural treatment of choice in dysfunctional uterine bleeding (that has not responded to medical therapy)

A

Dilation and curettage

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23
Q

First line treatment for dysfunctional uterine bleeding (stable, non-hemorrhaging)

A

Oral contraceptives

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24
Q

Medical treatment for dysfunctional uterine bleeding, if bleeding is excessive

A

conjugated estrogens

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25
Q

If dysfunctional uterine bleeding is ovulatory, this medication can help to decrease menstrual blood loss

A

NSAIDs

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26
Q

Most common gynecologic cancer in the US

A

Endometrial cancer

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27
Q

Endometrial cancer, median age at diagnosis

A

60 years

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28
Q

4 most common types of endometrial cancer, listed with most common first

A

Adenocarcinoma–mucinous–clear cell–squamous cell

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29
Q

3 prognostic factors in endometrial cancer

A

Histologic grade–myometrial invasion–histologic type

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30
Q

6 risk factors for endometrial cancer

A

Nulliparity–Late menopause–Diabeetus–Obesity–Unopposed estrogen therapy–Tamoxifen use

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31
Q

Most common symptom of endometrial cancer

A

irregular bleeding

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32
Q

What does the pelvic exam typically show in endometrial cancer?

A

Pelvic exam is typically normal

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33
Q

Test of choice for endometrial cancer

A

endometrial biopsy

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34
Q

Use this diagnostic test to rule out fibroids, polyps, and endometrial hyperplasia when you suspect endometrial cancer

A

pelvic ultrasound

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35
Q

3 common treatments for endometrial cancer

A

total abdominal hysterectomy–bilateral salpingo-oophorectomy–radiation therapy

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36
Q

Define endometriosis

A

presence of endometrial tissue outside the endometrial cavity

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37
Q

most common sites for endometriosis (5)

A

ovary–pelvic peritoneum–round ligament–fallopian tubes–sigmoid colon

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38
Q

5 common symptoms of endometriosis

A

dysmenorrhea–dyspareunia–infertility–abnormal bleeding–chronic pelvic pain

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39
Q

Physical exam with disseminated endometriosis

A

uterosacral nodularity or a fixed retroverted uterus

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40
Q

Physical exam with ovary involvement in endometriosis

A

fixed adnexal mass

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41
Q

Definitive diagnosis of endometriosis

A

direct visualization with laparoscopy

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42
Q

Treatment goal in endometriosis

A

suppression and atrophy of endometrial tissue

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43
Q

Definitive surgical treatment in refractory endometriosis

A

hysterectomy with bilateral salpingo-oophorecomy, lysis of adhesions, removal of endometriosis lesions

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44
Q

3 conservative surgical treatments in endometriosis

A

ablation–electrocauterization–excision of visible endometriosis

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45
Q

4 medical treatments for endometriosis

A

oral contraceptives–medroxyprogesterone–danazol–GnRH

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46
Q

Side effects of danazol (4)

A

acne–edema–weight gain–hirsutism

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47
Q

Side effects of GnRH (2)

A

hot flashes–decreased bone density

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48
Q

Define adenomyosis

A

extension of endometrial glands and stroma into the musculature

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49
Q

Typical adenomyosis patient

A

parous woman, late 30s to early 40s

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50
Q

Adenomyosis comes with an increased risk of these 2 disorders

A

endometriosis–leiomyoma

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51
Q

2 most common symptoms of adenomyosis

A

dysmenorrhea–menorrhagia (though may be asymptomatic)

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52
Q

physical exam in adenomyosis

A

enlarged uterus with soft consistency

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53
Q

definitive diagnosis of adenomyosis

A

hysterectomy

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54
Q

this diagnostic test may help to identify adenomyosis

A

MRI

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55
Q

The only definitive treatment in adenomyosis

A

hysterectomy

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56
Q

This med may help in mild adenomyosis

A

analgesics

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57
Q

Another name for uterine fibroids

A

Leiomyoma

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58
Q

What are uterine fibroids?

A

local proliferation of smooth muscle cells of uterus

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59
Q

Leiomyoma is more common in this population

A

African-American women

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60
Q

Leiomyomas typically occur in women of what age range?

A

childbearing age

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61
Q

Most common symptoms of leiomyoma

A

abnormal uterine bleeding–pressure–infertility (though most patients are asymptomatic)

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62
Q

Physical exam in leiomyoma

A

nontender, irregular, masses on bimanual or abdominal exam, enlarged uterus

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63
Q

Diagnosis of leiomyoma

A

Pelvic ultrasound: hypoechoic areas among normal myometrial material

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64
Q

Leiomyoma treatment

A

Treatment is typically not required. If severe pain, infertility, growth: medroxyprogeterone, danazol, GnRH agonists. Surgical treatment includes myomectomy and hysterectomy.

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65
Q

Endometritis vs Endomyometritis

A

endomyometritis is an infection of the endometrium that invades into the myometrium

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66
Q

Most common causes of endometritis

A

C-section–vaginal delivery–dilation and evacuation or curettage–IUD insertion

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67
Q

3 S/Sx endometritis

A

Fever–uterine tenderness on bimanual exam–leukocytosis

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68
Q

Treatment of severe endometritis / endomyometritis

A

IV Clindamycin or gentamicin

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69
Q

Treatment of mild endometritis

A

cephalosporins

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70
Q

Treatment of chronic endometritis

A

doxycycline

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71
Q

Uterine prolapse is most common in this population

A

multiparous women

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72
Q

6 disorders that may predispose a woman to uterine prolapse

A

childbirth injury–pelvic tumors–sacral nerve disorders–obesity–asthma–ascites

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73
Q

Physical exam in uterine prolapse

A

descent of the cervix to the lower third of the vagina or through the introitus with bearing down or straining

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74
Q

4 treatments of uterine prolapse

A

Kegel exercises–vaginal pessary–estrogens–surgery

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75
Q

Two types of functional ovarian cysts

A

follicular and corpus luteum

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76
Q

Ovarian cysts most commonly occur between what two life events?

A

puberty and menopause

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77
Q

This behavior increases the risk of ovarian cysts

A

smoking

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78
Q

Symptoms of follicular cysts

A

Typically asymptomatic–large cysts can cause pelvic pain, dyspareunia

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79
Q

Larger follicular cysts can lead to this dangerous condition

A

ovarian torsion

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80
Q

Follicular cysts tend to be less than _____ in size

A

8 cm

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81
Q

Follicular cysts and Lutein cysts: which tends to be larger and more firm on palpation

A

Lutein

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82
Q

3 typical symptoms of lutein cysts

A

pelvic pain, amenorrhea, delayed menses

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83
Q

Physical exam for ruptured ovarian cyst

A

pain on palpation, acute abdominal pain, rebound tenderness

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84
Q

Presentation of polycystic ovarian disease (6)

A

anovulation, oligomenorrhea, amenorrhea, hirsutism, obesity, enlarged ovaries

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85
Q

Test of choice for workup of ovarian cysts

A

Pelvic ultrasound

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86
Q

Treatment of premenarchal patient with ovarian cyst greater than 2 cm

A

exploratory laparotomy

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87
Q

Treatment of reproductive age woman with ovarian cyst less than 6 cm

A

observe for 6 weeks

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88
Q

Treatment of reproductive age woman with cyst greater than 8 cm

A

exploratory laparotomy

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89
Q

Treatment of postmenopausal woman with palpable cyst

A

exploratory laparotomy

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90
Q

Treatment of woman with polycystic ovarian disease, desiring fertility

A

clomiphene citrate

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91
Q

Third most common cancer of female genital tract

A

Ovarian cancer

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92
Q

Primary means of spread for ovarian carcinoma

A

direct exfoliation of malignant cells

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93
Q

2 genes that increase risk of ovarian cancer

A

BRCA1, BRCA2

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94
Q

This common medication may have some protective effect from ovarian cancer

A

oral contraceptives

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95
Q

History risk factors for ovarian cancer (3)

A

positive family history, history of uninterrupted ovulation, breast cancer

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96
Q

3 types of ovarian carcinoma, listed most to least common

A

Epithelial tumors, germ cell, sex cord stroma

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97
Q

Most women with epithelial ovarian carcinoma are (this age)

A

in their 50s

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98
Q

Most patients with germ cell carcinoma are (this age)

A

1-25

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99
Q

Diagnosis aid for epithelial ovarian carcinoma

A

CA-125

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100
Q

Notable factor of sex cord stroma ovarian cancer

A

hormone producing

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101
Q

Treatment for epithelial ovarian carcinoma

A

Surgery, cisplatin-based chemo

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102
Q

Treatment for germ cell ovarian carcinoma

A

Surgery, multidrug chemo

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103
Q

Treatment for sex cord stroma ovarian carcinoma

A

surgery

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104
Q

5 year survival rate for epithelial ovarian carcinoma

A

less than 20%

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105
Q

5 year survival rate for germ cell ovarian carcinoma

A

60-85%

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106
Q

5 year survival rate for sex cord stroma ovarian carcinoma

A

90%

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107
Q

Physical exam in ovarian carcinoma

A

solid, fixed, bilateral (?), nodular mass, possibly with ascites

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108
Q

Symptoms of ovarian carcinoma

A

often asymptomatic until disease is advanced, may present with vague lower abdominal pain and abdominal enlargement

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109
Q

Test of choice when ovarian carcinoma is suspected

A

Pelvic ultrasound (malignant masses tend to be greater than 8 cm, solid, multilocular, bilateral)

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110
Q

Tumor markers noted in ovarian carcinoma

A

Ca-125, alpha-fetoprotein, hCG

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111
Q

Primary causative agent of cervical cancer

A

HPV 16, 18, 31

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112
Q

Behaviors correlated with a higher risk of cervical cancer

A

early onset of sexual activity, increased number of sexual partners

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113
Q

Two most common types of cervical cancer, listed with most common first

A

squamous cell carcinoma, adenocarcinoma

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114
Q

This type of adenocarcinoma is linked to in utero exposure to diethylstilbestrol (DES)

A

Clear cell carcinoma

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115
Q

Classic presentation of cervical cancer, and other common symptoms

A

postcoital bleeding (classic), abnormal vaginal bleeding, watery discharge, pelvic pain

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116
Q

physical exam in cervical cancer

A

mass in cervix palpated on bimanual exam

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117
Q

Recommended frequency of Pap smears (It is now more complicated, but remember, the PANCE is kinda behind, and so is the review book)

A

Every 2 years beginning at age 21, then every 3 years from age 30

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118
Q

Treatment of microinvasion cervical carcinoma, when patient would like to maintain fertility

A

cone biopsy

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119
Q

Treatment of invasive cervical carcinoma, if not spread beyond cervix, uterine corpus, and vagina

A

Radical hysterectomy

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120
Q

These two treatments in cervical cancer have been found to be effective against “bulky stage” disease

A

Cisplatin-based chemo and radiation

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121
Q

6 most common infectious agents in cervicitis

A

Chlamydia trachomatis–Neisseria gonorrhoeae–Herpes simplex virus–Candida albicans–Trichomonas vaginalis–Gardnerella vaginallis

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122
Q

Primary symptom in acute cervicitis

A

purulent vaginal discharge

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123
Q

thick creamy vaginal discharge organism

A

Gonorrhea

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124
Q

thin gray vaginal discharge organism

A

Gardnerella

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125
Q

white, curd like vaginal discharge organism

A

Candida

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126
Q

Purulent vaginal discharge organism

A

Chlamydia

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127
Q

Foamy, greenish white vaginal discharge organism

A

Trichomonas

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128
Q

4 other symptoms in cervicitis (other than vaginal discharge)

A

leukorrhea, infertility, pelvic discomfort, dyspareunia

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129
Q

Cervicitis physical exam

A

acutely inflamed, edematous cervix with purulent discharge

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130
Q

motile flagellated whatnots on wet mount in cervicitis

A

Trichomonas vaginalis

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131
Q

Spores or hyphae with KOH prep in cervicitis

A

Candida

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132
Q

Clue cells in cervicitis

A

Gardnerella vaginalis

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133
Q

Intracellular diplococci in cervicitis

A

Neisseria gonorrhoeae

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134
Q

Trichomonas vaginalis cervicitis treatment

A

metronidazole

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135
Q

Candida cervicitis treatment

A

nystatin, miconazole, or clotrimazole

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136
Q

Gardnerella cervicitis treatment

A

metronidazole

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137
Q

Gonorrhea cervicitis treatment

A

ceftriaxone

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138
Q

Chlamydia cervicitis treatment

A

doxycycline or azithromycin

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139
Q

How long does it take cervical intraepithelial neoplasia 1 to become cervical cancer?

A

7 years

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140
Q

How long does it take CIN II to become cervical cancer?

A

4 years

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141
Q

If CIN I discovered, what is the plan?

A

colposcopy every 3 to 4 months

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142
Q

If CIN II is discovered, what is the plan?

A

destruction or excision of the lesions, cryotherapy or laser, loop electrosurgical excision procedure (LEEP)

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143
Q

What’s the deal with incompetent cervix

A

fetal membranes are exposed to vaginal flora and risk of trauma, infection, and premature rupture of membranes is higher

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144
Q

What two history factors predispose a woman to incompetent cervix

A

surgery or cervical trauma

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145
Q

Common presentation and timing of incompetent cervix

A

painless dilation and effacement of cervix, possibly with bleeding, vaginal discharge, or rupture of membranes, often during second trimester of pregnancy

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146
Q

Treatment of incompetent cervix

A

strict bed rest–placement of a cerclage, a suture placed vaginally to close the cervix

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147
Q

Definition of a cystocele

A

descent of a portion of the posterior bladder wall and trigone into the vagina, typically due to trauma of parturition (childbirth)

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148
Q

symptoms of small cystocele

A

none

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149
Q

symptoms of large cystocele

A

vaginal pressure, protruding mass, urinary incontenence, aggravated with prolonged standing, coughing, or straining

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150
Q

cystocele physical exam

A

relaxed vaginal outlet, thin-walled, smooth bulging mass involving the anterior vaginal wall, may project through the introitus with straining

151
Q

cystocele treatment (4)

A

Kegel exercises–vaginal pessary–estrogen therapy–surgery seldom indicated

152
Q

If surgery is needed for cystocele, what is the most effective procedure?

A

anterior vaginal colporrhaphy

153
Q

peak incidence time for vaginal neoplasia

A

women in their 50s

154
Q

most common type of vaginal neoplasia

A

epithelial

155
Q

Exposure to this medication increases risk of clear cell adenocarcinoma of the vagina

A

diethylstilbestrol (DES)

156
Q

common symptoms of vaginal neoplasia

A

many asymptomatic–vaginal discharge–bleeding–vaginal pruritis

157
Q

peak incidence time for vulvar neoplasia

A

women in their 60s

158
Q

vulvar neoplasia symptoms

A

vulvar pruritis, vulvodynia (vulvar pain)

159
Q

treatment of choice in vulvar neoplasia

A

wide local excision with regional lymphadenectomy

160
Q

additional treatment (over surgery) in vulvar neoplasia with metastasis

A

pelvic radiation

161
Q

definition of rectocele

A

herniation of rectum into vaginal vault

162
Q

cause of rectocele

A

injury of endopelvic fascia of the rectovaginal septum

163
Q

symptoms of small rectoceles

A

typically asymptomatic

164
Q

symptoms of large rectoceles

A

vaginal pressure, rectal fullness, incomplete evacuation

165
Q

rectocele physical exam

A

soft, thin-walled rectovaginal septum projecting into vagina

166
Q

treatment of rectocele (3)

A

increasing fluids, laxatives, surgery: posterior colpoperineorrhaphy

167
Q

most common organism in yeast vaginitis

A

Candida albicans

168
Q

3 predisposing factors for yest vaginitis

A

antibiotic use, diabetes mellitus, decreased cellular immunity

169
Q

What proportion of all vaginitises are caused by Candida albicans?

A

20-25%

170
Q

symptoms of yeast vaginitis

A

vulvar and vaginal pruritis, burning, dysuria, dyspareunia, vaginal discharge

171
Q

physical exam in yeast vaginitis

A

vulvar edema and erythema with a thick white vaginal discharge

172
Q

yeast vaginitis treatment

A

topical azoles, or oral fluconazole

173
Q

What proportion of all vaginitises are caused by Trichomonas vaginalis?

A

15-20%

174
Q

Clinical manifestations of Trichomonas vaginitis (5ish)

A

profuse, stanky yellow or green, frothy discharge–vulvar edema–erythema–pruritis–strawberry appearance of cervix

175
Q

Treatment of Trichomonas vaginitis

A

metronidazole for 7 days

176
Q

Risk factors for Gardnerella vaginalis

A

low socioeconomic status, IUD usage, multiple sexual partners, smoking

177
Q

What proportion of all vaginitises are caused by Garderella vaginalis

A

40-50%

178
Q

Clinical manifestations of Gardnerella vaginitis

A

may be asymptomatic–profuse nonirritating discharge with a fishy odor

179
Q

Burning vaginitis, thick white vaginal discharge, dysuria, dyspareunia, pruritis

A

think Candida

180
Q

Stinky yellow or green, frothy vaginal discharge, edema, erythema, pruritis, strawberry appearance of cervix

A

think Trichomonas

181
Q

Profuse nonirritating vaginal discharge with a fishy odor, which worsens with KOH

A

think Gardnerella

182
Q

Wet prep of Gardnerella

A

clue cells: vaginal squamous epithelial cells covered with G. vaginalis, making them look granular

183
Q

Gardnerella vaginitis treatment

A

metronidazole or clindamycin

184
Q

Define primary amenorrhea

A

absence of menses in a woman who has not undergone menarche by age 16

185
Q

3 major categories of causes of primary amenorrhea

A

Outflow obstruction–End-organ disease–Central regulatory disease

186
Q

4 types of outflow obstruction in primary amenorrhea

A

Imperforate hymen–Transverse vaginal septum–Vaginal agenesis–Testicular feminization

187
Q

2 types of end-organ disease causes for primary amenorrhea

A

Ovarian failure–Gonadal agenesis

188
Q

2 types of central regulatory disease causes for primary amenorrhea

A

hypothalamic disorders–pituitary disorders

189
Q

Define secondary amenorrhea

A

the absence of menses for 3 menstrual cycles or 6 months in a woman who previously had normal menses

190
Q

Leading cause of secondary amenorrhea

A

Pregnancy

191
Q

4 categories of causes of secondary amenorrhea

A

Anatomic–Ovarian dysfunction–Hyperprolactinemia–hypothalamic disorders

192
Q

2 anatomic causes of secondary amenorrhea

A

Asherman syndrome, Cervical stenosis

193
Q

2 ovarian dysfunctional causes of secondary amenorrhea

A

Premature ovarian failure, polycystic ovarian disease

194
Q

4 medications that can cause secondary amenorrhea via hyperprolactinemia

A

Dopamine agonists–tricyclic antidepressants–MAO inhibitors

195
Q

2 hyperprolactinemic causes of secondary amenorrhea

A

Primary hypothyroidism–pituitary tumor

196
Q

3 hypothalamic causes of secondary amenorrhea

A

Stress–Anorexia nervosa–weight loss

197
Q

Causes of primary amenorrhea in women with breasts and uterus (2)

A

Testicular feminization–Müllerian agenesis

198
Q

Causes of primary amenorrhea in women with breasts but no uterus (1)

A

Congenital abnormalities

199
Q

Causes of primary amenorrhea in women with a uterus, but no breasts (2)

A

Gonadal agenesis–Enzyme deficiency in testosterone synthesis

200
Q

Causes of primary amenorrhea in women with neither breasts nor uteruses (3)

A

Gonadal failure/agenesis–Hypothalamic-pituitary axis dysfunction–Hypothalamic, pituitary, or ovarian dysfunction

201
Q

First step in diagnosis of secondary amenorrhea

A

pregnancy test

202
Q

Next two lab tests after a pregnancy test in secondary amenorrhea

A

TSH and prolactin

203
Q

If prolactin is normal in secondary amenorrhea, this test is next

A

Progesterone challenge: if the patient has withdrawal bleeding, estrogen levels are adequate and outflow tract is patent

204
Q

Treatment of primary amenorrhea in women with a functional uterus and congenital abnormalities

A

Surgery to allow menses flow

205
Q

Treatment of primary amenorrhea in women without a uterus

A

Estrogen replacement to effect breast development and prevent osteoporosis

206
Q

Treatment of secondary amenorrhea (2)

A

treat underlying cause–if progesterone challenge is positive, treat with oral contraceptives to prevent endometrial hyperplasia

207
Q

Define dysmenorrhea

A

pain and cramping during the menstrual cycle that interferes with normal daily activities

208
Q

Primary vs secondary dysmenorrhea

A

Primary has no obvious cause (may be due to high levels of prostaglandins)–Secondary dysmenorrhea is due to endometriosis, fibroids, cervical stenosis, or pelvic adhesions

209
Q

Symptoms of primary dysmenorrhea (4)

A

pain on first or second day of menstruation, headache, nausea, vomiting

210
Q

Physical exam in primary dysmenorrhea

A

no abnormalities are typically noted except generalized tenderness in lower abdomen / pelvis

211
Q

Symptoms of secondary dysmenorrhea due to cervical stenosis

A

scant menses, severe cramping pain that is relieved with increased menstrual flow

212
Q

Physical exam, secondary dysmenorrhea due to cervical stenosis

A

scarring of external os

213
Q

typical history in patients with secondary dysmenorrhea due to pelvic adhesions

A

pelvic infections or prior pelvic surgery

214
Q

Treatment of primary dysmenorrhea

A

NSAIDs and oral contraceptive pills

215
Q

Treatment of cervical stenosis

A

cervical dilation

216
Q

Treatment of pelvic adhesions with dysmenorrhea

A

NSAIDs, oral contraceptive pills, possibly surgery

217
Q

Somatic complaints in PMS

A

breast swelling and tenderness, bloating, headache, fatigue, constipation

218
Q

Emotional complaints in PMS

A

irritability, depression, anxiety, libido changes

219
Q

Behavioral complaints in PMS

A

food cravings, poor concentration, sensitivity to noise

220
Q

This is necessary to confirm the diagnosis of PMS

A

symptom free follicular phase (about 1 week)

221
Q

Treatment of PMS (3)

A

NSAIDs, oral contraceptive pills, maybe antidepressants

222
Q

General age range of menopause in the US

A

between 48 and 52

223
Q

If menopause occurs before this age, it is considered premature

A

40

224
Q

2 major risks that increase with menopause

A

coronary artery disease, osteopenia/osteoporosis

225
Q

4 major symptoms of menopause

A

Vasomotor flushing, sweats, mood changes, depression

226
Q

physical exam in menopause (4)

A

decreasing breast size–vaginal, urethral, and cervical atrophy

227
Q

Lab result in menopause

A

elevated FSH

228
Q

Benefits of hormone replacement therapy in menopause

A

decreased risk of hip fracture, symptom improvement

229
Q

Risks of hormone replacement therapy in menopause (4)

A

cholestatic hepatic dysfunction, increased incidence of estrogen dependent neoplasm, increased risk of thromboembolic events, undiagnosed vaginal bleeding (?)

230
Q

using progesterone in combination with estrogen therapy for menopause decreases these two risks

A

endometrial hyperplasia and cancer

231
Q

This breast lesion may develop with acute mastitis

A

breast abscess

232
Q

A large portion of breast abscesses are related to this physiologic function

A

lactational

233
Q

This is the most common bacterium in lactational breast abscesses

A

Staphylococcus aureus

234
Q

Most common bacterial etiology in subareolar breast abscesses

A

mixed infection, including anaerobes, staphy, strep

235
Q

Presentation in breast abscess

A

painful, erythematous mass in breast with occasional drainage through skin or nipple duct

236
Q

Bad complication of subareolar breast abscess

A

fistula

237
Q

Abx in lactational abscesses

A

nafcillin, cefazolin, vancomycin

238
Q

abx in subareolar abscess

A

broad-spectrum abx

239
Q

non-druggy treatment of breast abscesses

A

Incision and drainage, rule out carcinoma with biopsy

240
Q

This proportion of American women will develop breast cancer during their lifetime

A

1:9

241
Q

Most cases of breast cancer are diagnosed in this age range

A

after age 40

242
Q

7 risk factors for breast cancer

A

Increasing age–Family history of gynecologic malignancies–first degree relative with breast cancer–personal history of breast cancer–exposure to ionizing radiation before age 30–significant alcohol use–BRCA1/2 gene

243
Q

5 ways to reduce the risk of breast cancer

A

Early pregnancy–prolonged lactation–chemical or surgical sterilization–exercise–low fat diet

244
Q

This complaint is rarely a symptom of breast cancer

A

Breast pain

245
Q

Breast cancer common presentation (4)

A

mass–skin changes–nipple discharge–symptoms of metastatic disease

246
Q

4 qualities of mass that is suspicious of breast cancer

A

nontender, irregular, firm, immobile

247
Q

Half of all breast cancers occur in this part of the breast

A

upper outer quadrant

248
Q

Best time to do self breast exam

A

5 days after menses

249
Q

notable skin changes in breast cancer (4-5)

A

dimpling, edema, peau d’orange, nipple retraction or discharge

250
Q

nonspecific (metastatic) symptoms common in breast cancer (5)

A

anorexia, weight loss, fatigue, dyspnea, bone pain

251
Q

Who should get a mammogram and how frequently

A

ages 50-74, every 1-2 years

252
Q

3 mammogram findings suggestive of carcinoma

A

spiculated mass–asymmetric local fibrosis–microcalcifications with a linear, branched pattern

253
Q

Another imaging method used with breast mass

A

ultrasound to distinguish fluid-filled cysts from solid masses

254
Q

definitive diagnosis of breast cancer

A

needle biopsy, FNA, or excisional biopsy

255
Q

If FNA is negative in a breast mass. . .

A

an excisional biopsy should be done

256
Q

4 types of invasive breast cancer

A

infiltrating ductal carcinoma–invasive lobular carcinoma–paget’s disease of nipple–inflammatory breast carcinoma

257
Q

2 types of noninvasive breast cancer

A

ductal carcinoma in situ–lobular carcinoma in situ

258
Q

DCIS breast cancer common age

A

50s

259
Q

LCIS breast cancer common age

A

40s

260
Q

DCIS mammogram results

A

clustered microcalcifications

261
Q

LCIS mammogram results

A

not seen on mammogram

262
Q

DCIS diagnosis

A

needle or excisional bipsy

263
Q

LCIS diagnosis

A

frequently incidentally on biopsy for other condition

264
Q

DCIS treatment

A

Surgical excision

265
Q

LCIS treatment

A

Local excision

266
Q

4 surgical options for breast cancer

A

Wide local excision or lumpectomy–Simple mastectomy–modified radical mastectomy–radical mastectomy

267
Q

This surgical option can be used if breast tumor is less than 4 cm and is not fixed to underlying tissue

A

wide local excision or lumpectomy

268
Q

4 qualities of a simple mastectomy

A

removal of breast tissue–removal of nipple-areolar complex–removal of skin–no axillary node dissection

269
Q

5 qualities of a modified radical mastectomy

A

removal of breast tissue–removal of nipple-areolar complex–removal of skin–removal of pectoralis fascia–removal of axillary lymph nodes

270
Q

6 qualities of radical mastectomy

A

removal of breast tissue, nipple-areolar complex, skin, axillary lymph nodes, pectoralis major and minor

271
Q

Use for chemo in breast cancer

A

control micrometastases

272
Q

indications for chemo in breast cancer

A

lymph node positive or high risk lymph node negative

273
Q

3 chemotherapy agents in breast cancer

A

cyclophosphamide, methotrexate, 5-fluorouracil (CMF) (cure my floppies?)

274
Q

most common hormone therapy in breast cancer

A

tamoxifen

275
Q

overall 5 year disease-free survival rate in breast cancer

A

94%

276
Q

prognosis in patients with estrogen and progesterone receptor positive cancer

A

more favorable than others

277
Q

define breast fibroadenoma

A

benign tumors most commonly noted in women younger than 40 years of age

278
Q

breast fibroadenoma physical exam (6)

A

round, well circumscribed, rubbery, nontender, mobile, firm lesion

279
Q

breast fibroadenomas never have (2)

A

axillary involvement or nipple discharge

280
Q

breast fibroadenomas may change with these events

A

menstural cycle, pregnancy

281
Q

breast fibroadenoma size

A

1-5 cm

282
Q

Breast fibrocystic disease is common in women in this age

A

between 30 and 40

283
Q

Breast fibrocystic disease etiology

A

exaggerated stromal response to hormones

284
Q

breast fibrocystic disease presentation

A

breast swelling, pain, tenderness

285
Q

breast fibrocystic disease physical exam

A

multiple, well demarcated, mobile masses, may involve both breasts

286
Q

breast fibrocystic disease never has (2)

A

axillary lymph node involvement or nipple discharge

287
Q

decreasing intake of ____ and _____ may reduce symptoms of breast fibrocystic disease

A

nicotine and caffeine

288
Q

treatment for severe breast fibrocystic disease

A

danazol, an androgen

289
Q

mastitis is typically seen in these women, and caused by this

A

lactating women, skin flora or oral flora of infant

290
Q

mastitis organism enters breast through

A

erosion or crack in nipple

291
Q

mastitis clinical presentation (6)

A

fever, chills, malaise–red, tender, warm breast mass

292
Q

mastitis treatment

A

dicloxacillin

293
Q

mastitis possible complication

A

breast abscess

294
Q

patients with mastitis should do this

A

continue to breastfeed or use breast pump to prevent accumulation of infected material

295
Q

This is a serious complication in women infected with N gonorrhoeae and C trachomatis

A

Pelvic inflammatory disease

296
Q

PID increases risk for these two bad things

A

infertility, ectopic pregnancy

297
Q

Age with highest incidence of PID

A

15-19 year old women

298
Q

4 risk factors for PID

A

smoking, nonwhite ethnicity, unmarried, IUD (only if insertion during STD infection)

299
Q

primary symptom of PID

A

abdominal or pelvic pain (bilateral or unilateral, burning, cramping, or stabbing)

300
Q

other symptoms of PID (other than pelvic pain) (5)

A

vaginal discharge–abnormal bleeding–dyspareunia–GI symptoms–urinary symptoms

301
Q

PID physical exam (4)

A

lower abdominal tenderness–cervical motion tenderness (Chandelier’s sign)–purulent cervical discharge–fever

302
Q

PID lab results

A

elevated white count, cultures

303
Q

definitive diagnosis of PID

A

laparoscopy

304
Q

PID treatment (3)

A

hospitalize–broad spectrum cephalosporins (cefotetan, cefoxitin)–doxycycline (clinda and genta may be used if allergic to cephalosporins)

305
Q

4 methods of ovulation assessment

A

basal temperature–menstrual cycle tracking–evaluation of cervical mucus–monitoring for premenstrual or ovulatory symptoms

306
Q

Failure rate of periodic abstinence as a method of contraception

A

20-40%

307
Q

Define coitus interruptus

A

A spell Harry Potter uses to render his enemies instantly flaccid. No. Withdrawal of the penis from the vagina before ejaculation

308
Q

Failure rate of coitus interruptus

A

15-25%

309
Q

Define lactational amenorrhea

A

After delivery, ovulation is delayed due to hypothalamic suppression of ovulation secondary to nursing and lactation

310
Q

Failure rate of lactational amenorrhea as a contraceptive method

A

15-55%

311
Q

How can the failure rate of lactational amenorrhea be reduced to 2%?

A

Method not used for more than 6 months, breast-feeding is the only form of nutrition for the infant

312
Q

Least effective category of contraception

A

natural methods

313
Q

Failure rate of male condom with perfect use and normal use

A

perfect: 2%–normal: 10-15%

314
Q

Failure rate of female condom

A

15-20%

315
Q

This is the only method of contraception that protects against HIV transmission

A

Condoms

316
Q

Disadvantage of female condom

A

more costly than male condoms

317
Q

How long must a diaphragm be in place after intercourse, and what is a special consideration for a diaphragm

A

6-8 hours, spermicide must also be used

318
Q

failure rate of diaphragm as contraceptive

A

5-20%

319
Q

If a diaphragm is left in place for too long. . .

A

the patient could become colonized with S. aureus and develop toxic shock syndrome

320
Q

common side effects of contraceptive diaphragm

A

bladder irritation and cystitis

321
Q

Contraceptive diaphragm logistics

A

must be fitted and replaced every 5 years or when patient gains or loses more than 10 pounds

322
Q

3 special considerations regarding cervical cap contraception

A

can be left in place for 1-2 days–must be fitted–requires use of spermicide

323
Q

failure rate of cervical cap contraception

A

5-20%

324
Q

mechanism of action of spermicide

A

disrupt cell membrane of sperm, act as a mechanical barrier of sperm to cervical canal

325
Q

When and how to use spermicide

A

placed in vagina 30 minutes BEFORE intercourse. May be used alone, but more effective in conjunction with condoms, diaphragms, or cervical caps.

326
Q

failure rate of spermicide

A

3-20%

327
Q

Common side effect of spermicide

A

vaginal irritation

328
Q

Failure rate of IUDs

A

1-3%

329
Q

6 absolute contraindications to IUD use

A

Current pregnancy–Abnormal vaginal bleeding–Gynecologic cancer–Acute cervical or uterine infection–History of PID (according to board review book, but not true)–Uterine fibroids with distortion of uterine cavity (not in review book, but in more reliable sources)

330
Q

4 relative contraindications to IUD use

A

Nulliparity–prior ectopic pregnancy–history of STD–moderate to severe dysmenorrhea (all 4 are according to review book, but aren’t entirely true)

331
Q

Hormones used in contraception

A

Progesterone alone or progesterone and estrogen

332
Q

Hormonal contraception MOA

A

interfere with pulsatile release of FSH and LH, suppress ovulation, change endometrium to not allow for implantation

333
Q

Hormonal contraception failure rate

A

thoretically 1%, actually about 3%

334
Q

Ways that hormonal contraception effectiveness may be decreased (6 drugs)

A

PCN, tetracycline, sulfonamides, rifampin, phenytoin, barbiturates

335
Q

Hormonal contraception increases risk of (4ish)

A

increased coagulability, so: thromboembolus, PE, stroke, MI

336
Q

Which hormone in hormonal contraception is directly related to coagulability

A

estrogen (higher estrogen=higher coagulability)

337
Q

7 absolute contraindications to oral contraceptive pills

A

Thromboembolism–PE–MI–stroke–Breast/endometrial cancer–hepatic tumor or abnormal liver function–Smokers over 35

338
Q

4 relative contraindications to oral contraceptive pills

A

Uterine fibroids–Lactation–Diabetes mellitus–hypertension (according to review book, other sources don’t mention fibroids)

339
Q

5 things that oral contraceptive pills decrease the risk of

A

ovarian cancer–endometrial cancer–ectopic pregnancy–anemia–PID

340
Q

Depo-provera duration of action

A

3 months

341
Q

Depo-provera hormone

A

progestin

342
Q

depo-provera mechanism of action

A

suppression of ovulation, thickening of cervical mucus, makes endometrium unsuitable for implantation

343
Q

depo-provera failure rate

A

0.3%

344
Q

4 common side effects of depo-provera

A

irregular vaginal bleeding–depression–breast tenderness–weight gain

345
Q

long term use side effects of depo-provera

A

loss of bone mineral density–osteoporosis–fracture

346
Q

how long after discontinuation of depo-provera might normal ovulation be delayed

A

up to 18 months

347
Q

Failure rate of tubal sterilization

A

0.2-0.4%

348
Q

Success rate of tubal sterilization reversal

A

40-80%

349
Q

How long should contraception be used after vasectomy?

A

4-6 weeks

350
Q

failure rate of vasectomy

A

less than 1%

351
Q

success rate of vasectomy reversal

A

60-70%

352
Q

hormones in emergency contraception

A

ethinyl estradiol and/or levonorgestrel

353
Q

MOA emergency contraception

A

inhibition or delay in ovulation and insufficient corpus luteum function

354
Q

failure rate of emergency contraception

A

15-25%

355
Q

emergency contraception is most effective when used. . .

A

within 72 hours of intercourse

356
Q

What does emergency contraception do in an established pregnancy

A

no effect on fetal development

357
Q

Percentage breakdown of causes of infertility (male, female, unidentifiable)

A

male: 40%, female: 40%, unidentifiable: 20%

358
Q

4 categories of causes of male infertility

A

Endocrine, Anatomic defects, abnormal sperm production or motility, sexual dysfunction

359
Q

3 risk factors for male infertility

A

exposure to chemicals, radiation, excessive heat

360
Q

4 endocrine causes of male infertility

A

Hypothalamic dysfunction, anabolic steroids, thyroid disease, hyperprolactinemia

361
Q

2 anatomic defect / abnormal spermatogenisis causes of male infertility

A

varicocele, cryptorchidism

362
Q

history questions for male infertility (5)

A

previous pregnancies fathered by patient, chemical or toxin exposure, history of STDs, mumps, trauma to genitalia

363
Q

physical exam for male infertility (3)

A

sx of testosterone deficiency, varicocele, patency of urethral meatus

364
Q

lab tests for male infertility (5)

A

semen analysis, thyroid, testosterone, prolactin, fsh

365
Q

5 categories of female infertility causes

A

cervical, uterine, tubal, peritoneal, ovulatory

366
Q

2 cervical causes of female infertility

A

cervical stenosis, cervicitis

367
Q

3 uterine causes of female infertility

A

malformations, leiomyoma, Asherman’s syndrome

368
Q

3 tubal causes of female infertility

A

PID, tubal ligation, endometriosis

369
Q

2 peritoneal causes of female infertility

A

adhesions, endometriosis

370
Q

5 ovulatory causes of female infertility

A

pituitary insufficiency, hyperprolactinemia, polycystic ovarian disease, ovarian tumor, thyroid disease, obesity

371
Q

diagnostic tests for female infertility (9)

A

laparoscopy, eval for evidence of ovulation, endometrial biopsy, progestin challenge, FSH, LH, prolactin, thyroid function, pelvic examination

372
Q

ovulation induction drug

A

clomiphene citrate

373
Q

major side effect of clomiphene citrate

A

multiple-gestation pregnancy

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