U-Wise REI and Neoplasia Flashcards by Robby Skinner

Normal puberty sequence

Thelarche –> adrenarche (hair growth) –> growth spurt –> Menarche

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Body weight needed for menses to begin

85-106 pounds

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Treatment of true precocious puberty

GnRH agonist

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Normal menarche range

9-17

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Look for what else in mullerian agenesis

Renal abnormalities

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Labs for secondary ammenorrhea

FSH/LH, TSH, Prolactin

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First test in suspected cushings

Overnight dexamethasone suppression test

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What causes postpartum hair loss

Loss of high levels of estrogen in pregnancy

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What is hyperthecosis

More severe form of PCOS (balding, clit enlargement, deepening of the voice)

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Progestin converts endometrium from what to what

Proliferative to secretory

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Test for heavy periods that began three months ago in G3P3 42 year old

Pelvic US to look for things like polyps or submucosal fibroids

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Most common clotting disorder to manifest at menarche

VW disease

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When is observation not recommended for a uterine polyp

When > 1.5 cm

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Why is free T elevated in PCOS

Sex hormone binding globulin is decreased by elevated androgens

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Best tx for submucosal fibroid to preserve fertility

Hysteroscopic myomectomy

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How do COC help dysmenorrhea

Progesterone induces endometrial atrophy –> prostaglandins made in endometrium so less made to cause pain

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Who gets GC test

All sexually active patients 25 years and younger

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Young pts with persistent dysmennorhea despite treatment should get what

Laparoscopy

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Boggy uterus and heavy bleeding? non surgical tx?

Adenomyosis

GnRH agonists, but problem recurs after cessation of treatment

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Dysmenorrhea + palpable abnormality

Secondary amenorrhea

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Women over 40 with heavy bleeding and clear fibroids should still have

Endometrial biopsy to rule out cancer

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Fibroids path description

Well-circumscribed, non-encapsulated myometrium

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Premature ovarian failure at what age

Under 35

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Ca requirement per day in menopausal women

1200 mg

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Risk factors for osteoporosis

Hx of fracture as an adult, low body weight, smoking | *Start these patients on bisphosphonates*

HRT risks

breast ca, MI, CVA, VTE

What do menopausal ovaries continue to produce

Androgens --> gets converted to estrogen in fat

Test to help confirm PCOS

Testosterone levels | once dx is made, progesterone levels can help determine ovulation

Imapramine can cause

Hyperprolactinemia

Hypothyroidism can cause

Hyperprolactinemia

Hypothalamic amenorrea levels

Normal FSH, low estrogen | *Check estrogen levels*

What is a clomiphene challenge test

Give on days 5-9 of cycle and check FSH on days 3 and 10 --> To help determine ovarian reserve

Vit def associated with increased in PMS

A, E, abd B6 | Also Calcium and magnesium

What can help determine if its PMS vs crazy

Prospective symptom calendar

PMS symptoms but all the time think?

Hypothyroidism

Hysterectomy would only relieve what part of PMS

bleeding and cramping

Molar pregnancy risks

Under 20 or over 40 | Asian races who consume less beta-carotene and folic acid

Recurrent risk for 1 molar pregnancy? two?

1: 1-2% 2: 10%

3 findings that can be diagnostic of a mole when together

Enlarged uterus, vaginal bleeding, and Beta-hCG > 1,000,000

Two odd manifestations of molar pregnancy

Tachycardia from hyperthyroidism | HTN from pre-eclampsia

Standard tx for molar pregnancies

Suction curettage

Complete mole features

Empty egg by single sperm (46xx) Trophoblastic proliferation and hydropic degeneration More likely to go on to GTD

Partial mole features

69XX- Present with marked villi swelling Not as bad, typically documented as missed abortions in older patients

How long to try and get pregnant after molar pregnancy

6 months after negative b-hCG levels (need to follow hcg to ensure no spontaneous regression)

Tx for invasive vulvar cancer

Radical vulvectomy and groin node dissection

90% of vulvar cancers are

Squamous cell (most often thought to be from chronic itch-scratch cycle of lichen sclerosis)

Think white "crinkled tissue paper" on vagine

Lichen sclerosis

Multi centric brown-pigmented papules on perineum likely

Vulvar intraepithelial neoplasia from HPV

Finding of mass in bartholin gland highly suspicious of

Malignancy (esp in post menopausal women) Excisional biopsy *new ones in old ladies*

Fiery red and itchy vulva in older woman

Paget's dz

ASCUS w/ neg HPV follow up

Pap smear in 3 years

What is needed for colposcopy to be satisfactory

Visualization of the entire lesion --> if its not do cervical conization *also do if biopsy is sig diff than colposcopy*

Micro invasive cervical Ca invades

When can women stop having Paps after 65

if they do not have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row, or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past five years

Most common symptom with fibroids

Menorrhagia

3 mechs that submucosal fibroids may use causing recurrent abortions

1. Focal endometrial vascular disturbance 2. Endometrial inflammation 3. Secretion of vasoactive substances

What stimulates growth of fibroids

Estrogen

When is bariatric surgery indicated for BMI under 40

> 35 with serious weight related health problem

GnRH tx in large fibroids when

Usually to reduce size and increase hct before surgery

When is myomectomy for fibroids indicated

In younger patients who's fertility is compromised by fibroids who are large enough to distort uterine cavity

Largest modifiable risk factor for endometrial Ca

Obesity

Next step after atypical cells on endometrial biopsy

D and C

Most common site of distant spread in endometrial Ca

Lungs

Best test for identifying spectrum of dz in ovarian Ca

CT abdomen/pelvis

Chemo for ovarian Ca

Taxmen and Platinum

Most common ovarian tumor found in women of all ages

Dermoid tumor (teratoma)

Prophylactic what to all rape victims

Contraception and antibiotics

Best place to have domestic abuse infro

Office restroom (most private)