Routine Gyn/ Female Patient Health Maintenance Flashcards
A pt comes in with no concerning PMH,complaints, or abnormal bleeding. Ultrasound shows an anechoic mass with no septae with thin walls as shown in the photo. What is recommended for this patient?
F/u exam.
Her findings are suggestive of a benign ovarian cyst. Management consists of follow-up examinations to monitor possible growth of the cyst, of which the majority resolve spontaneously. Treatment is only required if complications occur (e.g., ovarian torsion, ovarian cyst rupture).
What signs and findings would you observe with a patient in TSS-1?
-leukocytosis
-fever
-tachycardia
-low blood pressure
-along with a diffuse, erythematous rash
-skin peeling
-acute kidney injury (look at Cr and urea nitrogen)
-thrombocytopenia (low platelets!)
What organism causes TSS-1?
Staph a
For a self-palpated breast lumps in women, when do we recommend US over mammography as our next steps?
US is for women younger than 30 yo, for women over 40 yo we recommend mammography
A small, concentric, hypoechoic myometrial mass in a nulliparous woman of reproductive age is suggestive of
uterine leiomyoma
For a female of reproductive age presenting with signs of PCOS with no desire for children at this time, what is the first line therapy for her?
Combo OCPs
A combination oral contraceptive pill (COCP) containing ethinylestradiol and progestin is the first-line pharmacotherapy for patients with PCOS who currently do not wish to conceive. COCPs help regulate the menstrual cycle and, because of antiandrogenic effects, relieve symptoms of hyperandrogenism. In addition, progestin decreases the risk of endometrial hyperplasia and cancer, which are possible complications of PCOS (due to the increased levels of estrogen from aromatization of androgens). Besides pharmacotherapy, weight loss is the mainstay of treatment because obesity and the associated insulin resistance play an important role in the pathophysiology of PCOS.
_______________ a selective estrogen receptor modulator (SERM), is the drug of choice for osteoporosis in postmenopausal women who are at an increased risk of developing breast cancer (in this case, the history of breast cancer at a young age in a first-degree relative and nulliparity increase this patient’s risk). An adverse effect that is due to its estrogenic activity should be considered.
Raloxifene
This mediation prevents bone resorption by acting as an agonist on estrogen receptors in the bone. At the same time, it acts as an estrogen antagonist in the breast and endometrium.
raloxifene
What is the most severe adverse effects of raloxifene?
Thromboembolic events
Combo CHC’s decrease risk of what cancers?
COCPs can decrease the risk of ovarian cancer, possibly through reduced cell proliferation within the ovaries and fallopian tubes. They also reduce the risk of endometrial cancer; the progestin contained therein opposes estrogen-driven endometrial hyperplasia, which reduces the risk for the development of type 1 endometrial cancer.
What cancer risk is contraindicative for COCPs?
Combined oral contraceptives do not reduce the risk for breast cancer. However, there is controversy as to whether current OCPs actually increase the risk for breast cancer, and therefore should be used with caution in a patient with a high risk for breast cancer development (e.g., BRCA mutations).
COCP’s may also increase the incidence of hepatic adenomas.
_________________________is a common benign phenomenon in women of reproductive age that is caused by physiologic enlargement and rupture of the follicular cyst during ovulation, which leads to the release of small amount of intraperitoneal fluid and subsequent peritoneal irritation. The pain is self-limited and usually subsides within a few hours to two days.
Mittelschmerz
What is our firstline tx for mittelschmerz?
Reassurance and NSAIDs
What are the cardiovascular side effects of COCPs?
Hypertension and thromboembolism. Estrogen-containing oral contraceptives may also cause hyperlipidemia and a mild increase in the incidence of hepatic adenomas.
For women ages 30 to 65, what is the screening recommendations for cytology and high risk HPC testing (“co-testing)?
Co-testing every 5 years assuming that their last pap/cotest was clear, high risk HPV testing along every 5 years or cytology alone every 3 years is also acceptable
A 28 yo women comes in with HSIL cytology result on her pap/co test. What is recommended for her?
Colposcopy
Lower abdominal pain, adnexal tenderness, faver, cervical motion tenderness, and vaginal discharge are all indicative of…
PID
On a wet mount, a drop of KOH releases amines from the cells and a fishy odor can be noted if _________________ is present
bacterial vaginosis
Multinucleate giant cells and inflammation are microscopic findings consistent in a patient with
herpes
THe primary screening modality for breast cancer in women with average risk of developing BC is…
US
A patient with a high BMI and acanthosis nigrans should increase your suspicion for what physiologic concern?
Insulin resistance, acanthosis nigrans and high bmi are both consistent and associated with insulin resistance. A patient with that presentation should be tested for diabetes.
Women should be offered colorectal cancer screening starting at age ____
45
What are the options for colorectal screening?
Hemoccult testing, flexible sigmoidoscopy q5yrs, or colonoscopy q10yrs
What kind of incontinence: unprecipitated urine leakage, inability to empty the bladder
Overflow incontinence
The most common type of urethral carcinoma in women is
squamous cell carcinoma
Outpouching of the urethra that presents with recurrent UTIs, urethritis, urinary incontinence, and incomplete bladder emptying
Urethral diverticulum
What is first line therapy for bacterial vaginosis?
Metronidazole
This occurs secondary to pelvic floor dysfunction and weakness, most commonly in multiparous patients. This weakness causes herniation of the vaginal vault through the vagina and introitus. It presents with a heavy sensation in the pelvic area, incontinence, and constipation or difficulty initiating a bowel movement.
Vaginal vault prolapse
Common in multiparous patients due to weakness of the pelvic floor causing the bladder to infringe on the anterior vaginal wall. Pts present with stress incontinence.
Cystocele
Can be a consequence of gyn surgery or radiation therapy. It presents with asymptomatic urinary leakage from the vagina that is often worse with standing.
Vesicovaginal fistula
What are the major causes of dysmenorrhea?
Primary: Dx of exclusion, its pain with menses not attributed to underlying pathology. Pat presents with pain with menses that radiates to the lower abdomen and pelvis/lower back and thighs. It is accompanied by nausea, diarrhea, heafaches, and flushing. Its thought to be attributed to prostaglandin production by the endometrium (hence the use of nsaids).
Secondary: endometriosis, leiomyomas, adhesions, PID, adenomyosis.
What are the recommendation for pap and HPV testing?
Pap q3 years for 21-29 yo
Pap and HPV q5 years 30-65 (or q3 if no HPV testing done with it)
