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UW3 (2020) > UW3 (13 Gyn) > Flashcards

UW3 (13 Gyn) Flashcards

1
Q

MenoPausal bleed

Endometrial biopsy indication?

A

Age > 45 + Anovulatory bleed

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2
Q

1° Dysmenorrhea

  • Mechanism?
  • Treatment? 2
A

↑ Prostaglandin

  1. NSAID
  2. OCP (1st if sexually active)
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3
Q

Breast discharge

  • Most common cause?
  • Diagnostic? 3
A

• papilloma

  • bHCG @ bilateral
  • Mammogram @ unilateral + Age > 30
  • US @ unilateral + Age < 30
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4
Q

OCP (contraindication) 10

A
  • Migraine
  • Age > 35 + Cig > 15/d
  • BP > 160/100
  • Heart disease
  • DM + Organ damage
  • History of VTE / CVA
  • Breast cancer
  • Liver cancer
  • Anti-Phospho Lipid
  • Postpartum < 3w
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5
Q

AdenoMyosis

  • Symptoms?
  • Treatment?
A
  • Dysmenorrhea
  • Menstrual bleeding (regular & heavy)
  • Pelvic pain
  • Diffuse globular uterus (uniform enlargement)
  • Anemia = Fatigue / HR ↑

• Hysterectomy

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6
Q

DysMenorrhea (differential)

1) Fixed & Immobine uterus / Adenexal mass/nodule
2) Irregular menstruation
3) Irregular uterus
4) Irregular menses

A

1) Endometriosis
2) HypoThyroidism
3) LeioMyoma
4) Perimenopause

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7
Q

Breast Cancer

  • Screening indication?
  • High risk indication (needs counseling)? 5
A

• F 50-74 @ q2y

  • 1° relative breast cancer > 2
  • Breast cancer in family > 3
  • 1° relative L+R breast cancer
  • Breast cancer in male relative
  • Ashkenazi Jew + FH breast/ovarian cancer
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8
Q

Breast mass
Abnormal US/mamo management

  • Age > 30?
  • Age < 30? 2
A

• Cone biopsy

  • Simple = Needle aspiration
  • Complex/Solid = Cone biopsy
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9
Q

Ovarian HyperStimulation

  • US findings? 2
  • Cause / pathology?
A
  • L+R enlarged ovaries
  • Multiple follicles
  • hCG injection for induction
  • VEGF ↑ –> permeability ↑
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10
Q

PCOS

Treatment? 4

A

1) Weight↓
2) OCP
3) Progestin
4) Clomiphene (↑ ovulation

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11
Q

PMS

Treatment? 3

A

1) Fluoxetine
2) Other SSRI
3) OCP (E+P)

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12
Q 
Cyclic intermittent abd pain
“1° amenorrhea”
Uterine enlargement
Tender suprapubic mass
Blue Intralabial mass

1) Diagnosis?
2) Cause?
3) Complication?
4) Treatment?

A

1) Imperforate hymen
2) Cause: Estrogen ↑ @ newborn
3) Complication: Intra-abdominal adhesion
4) Treatment: Hymenectomy

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13
Q

Urinary Incontinence

Diagnosis? Mechanism? Management?

1) Leak @ activity & valvalsa
2) Sudden onset / Freq ↑
3) Constant dribble / Incomplete empty / Nocturia

A

1) Stress
Sphincter tone ↓ / HyperMobile
Pelvic floor exerc / Pessary / Urethral sling

2) Urge
Detrusor ↑
Bladder train / Anti-Muscarinic

3) Overflow
Detrusor ↓ / Outlet obstruction
Intermittent Cath / Correct cause

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14
Q

Vulvular
HypoPigmentation
Pruritus – erosion / excoriation
Plaque - Thin to Thick / Permeant thickening

Diagnosis?

A

Lichen Sclerosis

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15
Q

Vulvular Cancer

  • Cause? 2
  • Treatment? 2
A
  • HPV infection
  • Chronic inflammation
  • Excision
  • Radiation
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16
Q

Endometriosis

  • Symptoms?
  • PE?
  • Common site? 2
  • Treatment?
A
  • Dysmenorrhea
  • cPelvic pain unilateral
  • Dyspareunia
  • Dyschezia (pelvic pain @ BM)
  • Tender adnexal mass
  • Pain @ lateral cervical movement
  • Uterus – fixed & immobile

1) Ovary
2) Cul-de-sac

1) NSAID
2) OCP
3) MedroxyProgesterone / GnRH (Leuprolide) / Androgen (Danazol)
4) Resection (TAH-SBO)

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17
Q

OCP failure with anti-siezure meds

  • Which meds? Why?
  • Which meds have no effect?
A
  • Phenytoin
  • Carbamazepine
  • Ethosuximide
  • Phenobarbital
  • Topiramate
  • OCP metabolism ↑
  • Gabapentin / Valproate
18
Q

Infertility

Definition?

A

No conception @

1) 12m
2) > 6m @ F > 35

19
Q

Nipple discharge

  • Benign symptoms? 3
  • Management? 4
A
  • Bilateral
  • Non-bloody
  • Only @ manipulation

1) Physical exam
2) Mammo/US  Biopsy
3) Prolactin+TSH  treat
4) Reassure / Obs
If uncertain – duct excision

20
Q

PID

1) Risk factors? 2
2) OP treatment?
3) IP treatment?

A

1) Multiple partner > Prior PID
2) OP: Ceftriaxone + Doxy
3) IP: Cefoxitin + Doxy

21
Q

Raw burning pain @ void > 3m
Dyspareunia
Irritation

  • Diagnosis?
  • Treatment? 3
A

• VulvoDynia

  • Behavioral
  • Pelvic floor PT
  • CBC
22
Q

Uterine Sarcoma

  • Symptoms? 4
  • Risks?
  • Treatment?
A
  • Abnormal bleed
  • Pelvic pain/pressure
  • Uterine mass
  • Ascites
  • Pelvic radiation
  • Tamoxifen
  • PostMenopause

• Hysterectomy

23
Q

Emergency contraception? 4

A

1) Copper IUC
2) Ulipristal
3) Levonorgestrel
4) OCP

24
Q

Copper IUD

Contraindication? 4

A
  • Pelvic infection
  • Wilson’s disease
  • Organ transplant failure
  • Abnormal uterine cavity
25
Q

Breast cyst

  • Simple indication?
  • Complex indication?
  • Management?
A
  • Simple = benign
  • Thin wall
  • Fluid filled
  • No septation
  • Complex
  • Thick wall
  • Solid
  • Septations

1) Complex = biopsy
2) Simple
a. Asymptomatic = observation
b. Tender / Symptom = FNA
3) FNA
a. Non-bloody = reassure + US 4-6w
b. Non-bloody + persist/recur = biopsy
4) Bloody = Biopsy

26
Q

Sexual Assault PEP

5 diseases? Treatment?

A
  • Chlamydia = Azithromycin
  • Gonorrhea = Ceftriaxone
  • Trichomoniasis = Metronidazole
  • HIV = Tenofovir / Emtricitabine / Raltegravir
  • Hep B= Vaccine / IVIG
27
Q

Urge incontinence

  • Cause?
  • Treatment? 4
A

• Detrusor muscle ↑

  • Timed void / bladder training
  • Life style (Weight ↓/ Smoke ∅ / Alcohol ∅ / Caffeine ∅)
  • Anti-Muscarinic (Tolterodine / Solifenacin / Oxybutynin)
  • Alternative (Botulinum toxin / Precut tibial nerve stim)
28
Q

Gonorrhea / Chlamydia

  • Screening?
  • Treatment?
  • Follow up?
A
  • Sexually active / Age < 25
  • Q1y NAAT
  • Empiric = Ceftriaxone + Azithromycin
  • G = Ceftriaxone + Azithromycin
  • C = Azihthyromycin / Doxycycline
  • Test & treat partner
  • No sex x7d after tx completion
29
Q

Progetin subdermal implant

  • Effects?
  • Side effects?
  • Contraindication?
A

• FSH ↓ / LH ↓

  • Random bleeding
  • Weight ↑
  • Headaches

• Progestrin ⊕ breast cancer

30
Q

Condylomata Accuminata

1) Cause?
2) External treatment?
3) Internal treatment?
4) Treatment @ pregnancy?
5) Pregnancy management/ follow up?

A

1) HPV infection
2) Podophyllin
3) TrichloroAcetate
4) Podophyllin
5) No vertical transmission / No tx @ delivery / Vaginal delivery

31
Q

Contraception (side effects)

1) Estrogen+Progestrin ? 3
2) DMPA ? 4
3) Progestrin SD implant ? 1
4) IUD progastrin? 2
5) IUC copper? 2

A

1) Breakthrough bleed / Breast tenderness / Nausea
2) Irregular bleed / Amenorrhea / Bone loss (reversible) / Weight ↑
3) Irregular bleeding
4) Irregular bleeding / Amenorrhea
5) Dysmenorrhea / Heavy menses

32
Q

Functional HypoThalamic Amenorrhea

1) Symptoms?
2) Risks?
3) Complications?
4) Effects / Labs?
5) Treatment?

A

1) Amenorrhea / Breast atrophy / Anovulatory infertility / Vaginal atrophy
2) Athlete / Stress / Anorexia
3) Fracture risk / Cholesterol ↑ / Triglyceride ↑
4) Calory ↓ / GnRH ↓ / LH ↓ / FSH ↓ / Estrogen ↓
5) ↑ caloric intake / Calcium & Vitamin D / Estrogen

33
Q

Female normal puberty

  • Thelarche (breast)
  • Menarche
  • Constitutional delay
A
  • Age 8-12
  • Age < 15 + 2° sex
  • Delayed bone age
  • Age > 12
  • Short
  • No breast development
34
Q

Pre-Puberty
Spotting
Vaginal discharge & odor
Intermittent bleeding

  • Diagnosis?
  • Common cause?
A
  • Vaginal Foreign Body

* Toilet paper

35
Q

Vaginal spotting (differential)

1) Development of: Breast / Axillary & Pubic hair
2) Bloody & mucoid discharge / Grape structure protrusion
3) Dysuria / Red & purple mass
4) Anti biotic use / Immunocompromised / Vulvular pruritus / Thick & white discharge

A

1) Precocious puberty
2) Sarcoma Botyroides
3) Urethral prolapse
4) Candidiasis

36
Q

Breast Mass = Single, Rubbery, Mobile, Well circumscribed, Upper outer quadrant

  • Diagnosis?
  • Symptoms associated with menstruation?
A

• FibroAdenoma

  • Tender before menstruation
  • Improve after menstruation
37
Q

Most common breast mass @ adolescent

A

FibroAdenoma

38
Q

Tamoxifen (complication)

  • Post menopause? 2
  • Pre menopause? 2
A
  • Endometrial hyperplasia & cancer
  • Uterine sarcoma
  • Endometrial polyp
  • Abnormal uterine bleeding
39
Q

Cervical cancer / HSIL

Management? 2

A
  • Colposcopy

* LEEP @ ( Age > 25 / Not pregnant & Don’t want kids anymore)

40
Q

PAP / Cervical cancer

Screening?

A
  • Age 21 – 65 q3y

* If age 30-65, cytology + HPV q5y

41
Q

Gestational TrophoBlastic Neoplasia

  • Common metastasis location?
  • Labs to check?
  • Imaging study? 2
  • Treatment?
  • Follow up?
A

• Lung > Vagina

  • bHCG ⊕
  • US pelvis / XR chest
  • Methotrexate
  • Hysterectomy

• bHCG monitor

UW3 (2020) (19 decks)

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