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Clin Med > WH > Flashcards

WH Flashcards

1
Q

Adenomyosis

A
  • benign tumor
  • migration of glands from basel layer of endometrium into myometrium
  • middle aged, porous women w/ severe dysmenorrhea & menorrhagia & symmetrically enlarged uterus
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2
Q

adenocarcinoma

A

most common uterine cancer!!!

risks: nulliparity, obesity, late menopause, unopposed estrogen stim, tamoxifen
- POSTMENOPAUSAL BLEEDING

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3
Q

All women w/ postmenopausal bleeding MUST

A

be evaluated for uterine cancer

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4
Q

estrogen-dependent uterine CA

A

younger, perimenopausal women

menstruating, younger pts

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5
Q

estrogen-independent uterine CA

A

older, postmenopausal

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6
Q

surgical mgmts of uterine cancers

A
  • TAH total abdominal hysterectomy
  • BSO b/l salpingooophorectomy
  • PLND pelvic LN dissection
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7
Q

multi. white lesions of vulva

A

vulva intraepithelial neoplasia

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8
Q

tx vulva melanoma

A

radical vulvectomy (maybe with lymphadenectomy)

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9
Q

DES exposure

A
  • moms get increased risk breast CA

- daughters get increased risk of clear cell adenocarcinoma vagina/cervix and breast CA and fertility problems

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10
Q

tx recurrent cervical ca

A

pelvic exenteration - take it all out, and vagina

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11
Q

colpo tissue biopsy –which info?

A

gives you CIN/dysplasia info

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12
Q

pap smear gives you what info

A

CELLS on pap give you bethesda classification (ASC-US,LGSIL, etc)

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13
Q

invasive CA of vagina is usually…

A

squamous cell carcinoma

HPV plays role

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14
Q

Two categories of AUB

A
  1. structural/organic

2. anovulatory dysfunction (usually DUB)

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15
Q

AUB tx

A

cyclic progestins (medroxyprogesterone acetate) or combined OCPs

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16
Q

estrogen dominates which part of cycle?

which type of feedback

A

follicular (proliferative)

estrogen-negative feedback

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17
Q

midcycle feedback

A

estrogen positive feedback (LH surge cause ovulation)

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18
Q

progesterone dominates which phase

A 
luteal phase (secretory)
progesterone-neg feedback
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19
Q

hypothal releases

A

GnRH acts on ant pit

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20
Q

ant pit releases

A

FSH & LH to act on ovary to produce estrogen & progesterone

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21
Q

secondary dysmenorrhea

A

older 20s, pain not just with period, structural issue like PID, fibroids, endometriosis

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22
Q

primary dysmenorrhea

A

from early adolescence, hormone-induced increase in prostaglandins

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23
Q

tx dysmenorrhea

A

NSAIDs, OCP

consider secondary if these don’t work

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24
Q

which phase is sx free with pms

A

follicular phase, sx restricted to luteal phase

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25
Q

DUB

A

excessive uterine bleeding w/o organic cause

  • *usually issues in hypothalamic-pituitary-ovarian hormonal axis causing ANOVULATION
  • -heavy bleeding usually issues of endometrial overgrowth b/c estrogen stimulation w/o adequate progesterone
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26
Q

intermenstrual bleeding

A

b/t periods

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27
Q

polymenorrhea

A

frequent bleeding = bleeding

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28
Q

oligomenorrhea

A

scant bleeding = bleeding >35days

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29
Q

menorrhagia

A

prolonged/excessive bleeding at regular intervals

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30
Q

metrorrhagia

A

uterine bleeding at irregular intervals

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31
Q

menometrorrhagia

A

prolonged uterine bleeding at irregular intervals

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32
Q

Characteristics of AUB w/ ovulatory cycle

A

regular intervals, mittelschmerz, biphasic BBT, serum LH >25

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33
Q

characteristics of AUB w/ anovulatory cycle

A

irregular intervals, no ovulatory pain, monophasic, no LH surge, estrogen unopposed causing heavy bleeding

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34
Q

sx ovarian cysts/masses

A

unilateral pain, fullness in pelvis/bloating

UNILATERAL PAIN

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35
Q

what size of unchanging ovarian cyst warrants surgery

A

> 5cm

also if cyst wall has papillary vegetation, any adnexal mass >10cm, solid ovarian lesions, suspect torsion or rupture

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36
Q

Brenner tumor

A

benign ovarian tumor

-solid, firm, white

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37
Q

which cancer is often detected late?

A

ovarian ca
40-60yo, stage 3
HIGH MORTALITY

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38
Q

most ovarian tumors are ..

A

epithelial

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39
Q

TANNER stages for boobs

A

I: flat
II: bud, surrounding glandular tiss
III: elevated breast, widened areola
IV: larger breast, secondary mound of areola/nipple
V: adult size breast, flat areola, projecting nip

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40
Q

witch’s milk

A

neonatal production of milk from influence of maternal hormones

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41
Q

when to do breast exams

A

follicular phase, 5-9days after period

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42
Q

most breast CA found where

A

upper, outer quadrant

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43
Q

mastitis

A

benign, usually from breastfeeding

  • pain, inflammation, infection
  • use warm compresses, abx, keep breastfeeding
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44
Q

galactorrhea in woman not lactating, worry…

A

pituitary adenoma
check d/c for fat droplets
if prolactin levels high need MRI

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45
Q

unilateral nipple d/c more likely to

A

be a disease than b/l nipple d/c

46
Q

fibrocystic changes

A

cysts or stromal tissue, hyperplasia

-from decrease progesterone relative to estrogen

47
Q

mammary duct ectasia

A

(dilation)
blockage of duct w/ inflammation
-thicky cheesy material
-nipple retraction

48
Q

polythelia

A

may nips

49
Q

fibroadenoma

A

most common benign breast tumor

-sharply circumcised, freely mobile, rubbery

50
Q

risks for breast CA

A
  • woman, age
  • genetics BRCA 1/2
  • nulliparity
  • unopposed estrogens
51
Q

breast CA feels/signs

A
  • stony hard, fibrotic
  • skin retraction, dimpling
  • nipple retraction
  • lymph block–>LAD –> peau d’orange
52
Q

Breast CA high risk screening guidelines

A

-lifetime risk >20% or BRCA mutation:

begin screening 25yo OR 5-10yrs younger than fam dx

53
Q

risk of male developing breast CA

A
  • klinefelter’s highest risk b/c more estrogen
  • orchitis or undescended testis
  • BRCA2
54
Q

Two types of carcinoma in situ

A
  • confined to ducts/lobules
  • Ductal carcinoma in situ, more pre-invasive
  • Lobular
55
Q

Paget’s breast CA

A

rare, scaly eczematous lesion of areola and nipple

-HER2/neu overexpression

56
Q

Inflammatory breast CA

A
  • ductal CA
  • peau d’orange from lymph block
  • dx LATE stage, moves quickly and aggressively
57
Q

how many lumps benign

A

80%

58
Q

soujourn time

A

16 months - time for CA to metastasize

survival goes down to 21% w/ distant metastasis

59
Q

Problem when you take out multiple lymph nodes

A

permanent lymphedema that is painful, restricts movement

-any woman with breast CA and axillary dissection is at risk for this

60
Q

SERMS can be given to..

A

estrogen and progesterone positive patients

61
Q

what are BRCA1/2 mutations and how are they transmitted

A

autosomal dominant so each child has 50/50 chance of getting it
-they are tumor suppressor genes

62
Q

why not pap before age 21

A

b/c 90% HPV

63
Q

how often to pap if no indications or prior abnormalities,

but still get…

A

every 3 years for women 21-29
(and 30-65)
BUT still get annual pelvic and bimanual exam

64
Q

> 65yo or hysterectomy w/ cervix removal…how often to pap

A

no screening but still get yearly pelvic exam

-if reason for hysterectomy was vaginal cancer, you’d pap the vaginal cuff

65
Q

you can stop doing screenings in 65yo pt if..

A

If no abnormalities w/in 20 yrs. NO pos prior screening, NO hx CIN2

66
Q

how often to screen if hx of abnormal paps?

A

If treated in pas for CIN2/3, CA then annual screening for at least 20 YEARS b/c risk for persistent/recurrent dz

67
Q

what bethesda classification is bad bad bad

A

AGC - Atypical Glandular Cells
need colpo
if >35 need endometrial biopsy

68
Q

in which bethesda classification is colpo usually unnecessary

A

ASC-US

69
Q

which bethesda classifications need colpo

A

ASC-H, LGSIL, HGSIL, AGC

70
Q

dysplasia progresses rapidly in which pts?

A

HIV+

also immunocomp

71
Q

DES increases what risk in pts exposed in utero (daughters)?

A

increased risk of vaginal cancer

72
Q

What’s the gold standard to dx cervical dysplasia & cancer?

A

Colposcopy - get tissue biopsy to diagnose

not screening tool

73
Q

what level of hormone indicative of menopause?

A

FSH >30

(FSH & LH both increase) and estrogen decreases

74
Q

define menopause

A

End of reproductive life 50-52yo.
amenorrhea for 1 year
FSH >30

75
Q

menopause effects on body systems

A 
everything goes to hell.
smaller vagina,uterus, ovaries
you dry out
get atrophic  
decreased libido, now that you can have sex without worrying about making a child, you don't want to have sex anymore. cool.
76
Q

what causes vasomotor sx in menopause

A

hot flashes from peripheral vasodilation from estrogen withdrawal

77
Q

premature menopause

A
78
Q

premenopause

A

cycle changes in 40s

79
Q

peri-menopause

A

lasts 5-10yrs

shitty sx from estrogen deficiency - hot flashes

80
Q

peri-menopause cycle changes

A

shorter follicular phase, fewer follicles to stimulate

luteal phase unchanged

81
Q

when do endometrial biopsy in perimenopause/menopausal transition

A

if inter menstrual bleeding or obese women with menometorrhagia

82
Q

Tx for hot flashes

A

estrogen hormonal therapy

WITH CONTINUOUS PROGESTERONE IF HAVE UTERUS

83
Q

When is best time to initiate HRT (hormonal replacement therapy after menopause)

A

initiate therapy as close to end of menses as possible to lower risks
(probably wouldn’t start >5yrs after menopause)

84
Q

if a patient has a uterus…

A

NO UNOPPOSED ESTROGEN

85
Q

Absolute contraindications to HRT

A
  • estrogen-dependent neoplasia
  • undiagnosed abnormal genital bleeding
  • active thromboembolic dz
  • recent MI/CVA
  • liver dz
  • gallstones
86
Q

tx for vasomotor sx

A

estrogen/prog for hot flashes

also SSRIs, gabapentin, clonidine

87
Q

tx loss of libido

A

flibnserin, test or test/est, vaginal estrogen therapy if it’s cause your vag is dry

88
Q

decrease uterine bleeding with

A

OCP or progestin intrauterine device

89
Q

pregnancy can occur during the menopausal transition sooooooooo

A

contraception needed in perimenopausal

90
Q

complications of uterine bleeding

A
  • pregnancy
  • postmenopausal bleeding needs endometrial biopsy to R/O cancer
  • increased osteoporosis from lack estrogen
  • increase atherosclerosis
91
Q

menopausal changes that can lead to sexual dysfunction

A

decreased genital blood flow, genital sensation, lubrication, vaginal dryness and discomfort during penetration

92
Q

two types of libido disorders

A

sexual interest and sexual aversion

93
Q

types of sexual arousal d/o

A
  1. subjective - no sexual arousal
  2. genital - no genital arousal
  3. combined sexual & genital
  4. persistent arousal - genital arousal without sexual interest
94
Q

dyspareunia

A

pain w/ entry/intercourse

95
Q

vaginismus

A

can’t let stuff in the vagina even if you want it

96
Q

noncoital sexual pain

A

genital pain from sexual stimulation

97
Q

vulvodynia

A

vulva pain

98
Q

tx sexual dysfxn in premenopausal women

A

switch from OCP to nonhormonal or higher androgen amount

99
Q

tx post-menopausal sexual dysfunction

A
  • estrogen (vaginal or systemic)
  • testosterone
  • combined est/test
  • dilators
100
Q

vulvitis tx

A

topical steroids

101
Q

vulvar lichen sclerosis

A

initial erythema then develop white plaques

-high rate of SCC so bx

102
Q

vulva lichen simplex chronicus

A
  • benign thickening & hyperkeratosis from chronic irritation
  • always itches, burns, pain
103
Q

vulvovaginal lichen planus

A

rare mucocutaneous dermatosis w/ sharply marginated flat-topped papules on skin and less sharply marginated white plaques on oral & genital mucous membranes

104
Q

herpes vulvovagnitis transmission

A

most during asymptomatic viral shedding

105
Q

causes of vaginitis/vaginosis

A

BV (Gardnerella), candida, trich

106
Q

tx BV

A

flagyl

107
Q

tx candidiasis

A

azoles

108
Q

tx trich

A

systemic flagyl

109
Q

bartholin’s cyst/abscess tx

A

stab incision & hemostat to break up locations

NO ABX

110
Q

tx gonorrhea

A

rocephin

-NO quinolone or TCN if preg

111
Q

tx chlamydia

A

azithromycin or doxy

amox if preg

Clin Med (1 decks)

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