UW3 (13 Gyn) Flashcards
MenoPausal bleed
Endometrial biopsy indication?
Age > 45 + Anovulatory bleed
1° Dysmenorrhea
- Mechanism?
- Treatment? 2
↑ Prostaglandin
- NSAID
- OCP (1st if sexually active)
Breast discharge
- Most common cause?
- Diagnostic? 3
• papilloma
- bHCG @ bilateral
- Mammogram @ unilateral + Age > 30
- US @ unilateral + Age < 30
OCP (contraindication) 10
- 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
AdenoMyosis
- Symptoms?
- Treatment?
- Dysmenorrhea
- Menstrual bleeding (regular & heavy)
- Pelvic pain
- Diffuse globular uterus (uniform enlargement)
- Anemia = Fatigue / HR ↑
• Hysterectomy
DysMenorrhea (differential)
1) Fixed & Immobine uterus / Adenexal mass/nodule
2) Irregular menstruation
3) Irregular uterus
4) Irregular menses
1) Endometriosis
2) HypoThyroidism
3) LeioMyoma
4) Perimenopause
Breast Cancer
- Screening indication?
- High risk indication (needs counseling)? 5
• 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
Breast mass
Abnormal US/mamo management
- Age > 30?
- Age < 30? 2
• Cone biopsy
- Simple = Needle aspiration
- Complex/Solid = Cone biopsy
Ovarian HyperStimulation
- US findings? 2
- Cause / pathology?
- L+R enlarged ovaries
- Multiple follicles
- hCG injection for induction
- VEGF ↑ –> permeability ↑
PCOS
Treatment? 4
1) Weight↓
2) OCP
3) Progestin
4) Clomiphene (↑ ovulation
PMS
Treatment? 3
1) Fluoxetine
2) Other SSRI
3) OCP (E+P)
Cyclic intermittent abd pain “1° amenorrhea” Uterine enlargement Tender suprapubic mass Blue Intralabial mass
1) Diagnosis?
2) Cause?
3) Complication?
4) Treatment?
1) Imperforate hymen
2) Cause: Estrogen ↑ @ newborn
3) Complication: Intra-abdominal adhesion
4) Treatment: Hymenectomy
Urinary Incontinence
Diagnosis? Mechanism? Management?
1) Leak @ activity & valvalsa
2) Sudden onset / Freq ↑
3) Constant dribble / Incomplete empty / Nocturia
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
Vulvular
HypoPigmentation
Pruritus – erosion / excoriation
Plaque - Thin to Thick / Permeant thickening
Diagnosis?
Lichen Sclerosis
Vulvular Cancer
- Cause? 2
- Treatment? 2
- HPV infection
- Chronic inflammation
- Excision
- Radiation
Endometriosis
- Symptoms?
- PE?
- Common site? 2
- Treatment?
- 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)
OCP failure with anti-siezure meds
- Which meds? Why?
- Which meds have no effect?
- Phenytoin
- Carbamazepine
- Ethosuximide
- Phenobarbital
- Topiramate
- OCP metabolism ↑
- Gabapentin / Valproate
Infertility
Definition?
No conception @
1) 12m
2) > 6m @ F > 35
Nipple discharge
- Benign symptoms? 3
- Management? 4
- Bilateral
- Non-bloody
- Only @ manipulation
1) Physical exam
2) Mammo/US Biopsy
3) Prolactin+TSH treat
4) Reassure / Obs
If uncertain – duct excision
PID
1) Risk factors? 2
2) OP treatment?
3) IP treatment?
1) Multiple partner > Prior PID
2) OP: Ceftriaxone + Doxy
3) IP: Cefoxitin + Doxy
Raw burning pain @ void > 3m
Dyspareunia
Irritation
- Diagnosis?
- Treatment? 3
• VulvoDynia
- Behavioral
- Pelvic floor PT
- CBC
Uterine Sarcoma
- Symptoms? 4
- Risks?
- Treatment?
- Abnormal bleed
- Pelvic pain/pressure
- Uterine mass
- Ascites
- Pelvic radiation
- Tamoxifen
- PostMenopause
• Hysterectomy
Emergency contraception? 4
1) Copper IUC
2) Ulipristal
3) Levonorgestrel
4) OCP
Copper IUD
Contraindication? 4
- Pelvic infection
- Wilson’s disease
- Organ transplant failure
- Abnormal uterine cavity
Breast cyst
- Simple indication?
- Complex indication?
- Management?
- 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
Sexual Assault PEP
5 diseases? Treatment?
- Chlamydia = Azithromycin
- Gonorrhea = Ceftriaxone
- Trichomoniasis = Metronidazole
- HIV = Tenofovir / Emtricitabine / Raltegravir
- Hep B= Vaccine / IVIG
Urge incontinence
- Cause?
- Treatment? 4
• Detrusor muscle ↑
- Timed void / bladder training
- Life style (Weight ↓/ Smoke ∅ / Alcohol ∅ / Caffeine ∅)
- Anti-Muscarinic (Tolterodine / Solifenacin / Oxybutynin)
- Alternative (Botulinum toxin / Precut tibial nerve stim)
Gonorrhea / Chlamydia
- Screening?
- Treatment?
- Follow up?
- Sexually active / Age < 25
- Q1y NAAT
- Empiric = Ceftriaxone + Azithromycin
- G = Ceftriaxone + Azithromycin
- C = Azihthyromycin / Doxycycline
- Test & treat partner
- No sex x7d after tx completion
Progetin subdermal implant
- Effects?
- Side effects?
- Contraindication?
• FSH ↓ / LH ↓
- Random bleeding
- Weight ↑
- Headaches
• Progestrin ⊕ breast cancer
Condylomata Accuminata
1) Cause?
2) External treatment?
3) Internal treatment?
4) Treatment @ pregnancy?
5) Pregnancy management/ follow up?
1) HPV infection
2) Podophyllin
3) TrichloroAcetate
4) Podophyllin
5) No vertical transmission / No tx @ delivery / Vaginal delivery
Contraception (side effects)
1) Estrogen+Progestrin ? 3
2) DMPA ? 4
3) Progestrin SD implant ? 1
4) IUD progastrin? 2
5) IUC copper? 2
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
Functional HypoThalamic Amenorrhea
1) Symptoms?
2) Risks?
3) Complications?
4) Effects / Labs?
5) Treatment?
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
Female normal puberty
- Thelarche (breast)
- Menarche
- Constitutional delay
- Age 8-12
- Age < 15 + 2° sex
- Delayed bone age
- Age > 12
- Short
- No breast development
Pre-Puberty
Spotting
Vaginal discharge & odor
Intermittent bleeding
- Diagnosis?
- Common cause?
- Vaginal Foreign Body
* Toilet paper
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
1) Precocious puberty
2) Sarcoma Botyroides
3) Urethral prolapse
4) Candidiasis
Breast Mass = Single, Rubbery, Mobile, Well circumscribed, Upper outer quadrant
- Diagnosis?
- Symptoms associated with menstruation?
• FibroAdenoma
- Tender before menstruation
- Improve after menstruation
Most common breast mass @ adolescent
FibroAdenoma
Tamoxifen (complication)
- Post menopause? 2
- Pre menopause? 2
- Endometrial hyperplasia & cancer
- Uterine sarcoma
- Endometrial polyp
- Abnormal uterine bleeding
Cervical cancer / HSIL
Management? 2
- Colposcopy
* LEEP @ ( Age > 25 / Not pregnant & Don’t want kids anymore)
PAP / Cervical cancer
Screening?
- Age 21 – 65 q3y
* If age 30-65, cytology + HPV q5y
Gestational TrophoBlastic Neoplasia
- Common metastasis location?
- Labs to check?
- Imaging study? 2
- Treatment?
- Follow up?
• Lung > Vagina
- bHCG ⊕
- US pelvis / XR chest
- Methotrexate
- Hysterectomy
• bHCG monitor
