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Women's Health > Women's Health Exam > Flashcards

Women's Health Exam Flashcards

1
Q

Mastoplasia

A

ropy thickening of tissues; often UOQ, persist throughout menstrual cycle

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2
Q

Allodynia

A

hypersensitivity to touch

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3
Q

Galactorrhea

A

abnormal breast discharge

usually benign

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4
Q

Gynecomastia

A

breast tissue swelling in boys/men
estrogen/testosterone imbalance
estrogen worsens
in alcoholic men

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5
Q

What changes occur in women >40 in breast anatomy?

A

more fat tissue than glandular

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6
Q

Milk secretion pathway

A

secretory cell of alveoli –> lactiferous ducts (lobules) –> lactiferous sinus –>excretory duct of each lobe –> nipple

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7
Q

Abnormal breast discharge, what Dx test

A

serum prolactin

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8
Q

How does cancer in cooper’s ligament present?

A

retraction of breast

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9
Q

What’s the lymphatic drainage of breast?***

A

75% axillae***
direct lymphatics to mediastinum
internal mammary vessels

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10
Q

What does Plan B do?

A

ton of progesterone

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11
Q

How prevalent is breast cancer?

A

1/8

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12
Q

What can sudden microcalcifications in the breast indicate?

A

breast cancer

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13
Q

Which patients get screening mammograms?

A

asymptomatic

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14
Q

What is the protocol for mammograms?

A

Screening Mammo Abnormal > Diagnostic Mammo > Breast U/S > Biopsy

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15
Q

What do breast ultrasounds do?

A

determine is mass is cyst or solid mass

precisely locate during procedure

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16
Q

Types of Mastodynia

A

Cyclic: menstruation

Non-cyclic: 40-50yo

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17
Q

Mastodynia Tx

A

spontaneously resolution 80-90%
1st line: NSAIDs
Refractory - severe cases (ex: tamoxifen)

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18
Q

Fibrocystic breast changes

A

50% menstruating women
benign: lump and pain
fibroadenomas, cysts, etc

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19
Q

What can caffeine cause?

A

mastodynia or fibrocystic changes

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20
Q

difference between cysts and cancer

A

cysts: well circumcised (defined edges), rolls around
cancer: fixed

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21
Q

Tietze’s Syndrome

A

costochondritis: inflammation of cartilage connecting rib to breastbone

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22
Q

What should you always keep on the Dx for fibrocystic changes?

A

breast cancer

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23
Q

What is the shortcoming of mammograms compared to U/S?

A

Cant differentiate cysts from solid mass

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24
Q

Galactocele

A 
well circumscribed milk cysts
no inflammation (red, hot, tender)
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25
Q

Most common tumor in the breast?

A

Carcinoma

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26
Q

2nd most common tumor in breast?***

A

fibroadenoma

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27
Q

Fibroadenoma

A

firm, benign, smooth
freely moving breast mass
most common tumor in women <30
fatty tissue lumps

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28
Q

Categories of fibroadenoma

A

Giant: >5cm
Juvenile: adolescents/young adults

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29
Q

Who gets fibroadenomas***

A

common in women 15-35

unknown cause

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30
Q

How to diagnose fibroadenomas?

A

biopsy (mammogram can’t differentiate)

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31
Q

Cystosarcoma phyllodes*

A

rapid growth*
necrosis - push into vasculature*
benign or malignant
destroys breast - needs to be caught early

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32
Q

Who gets cystosarcoma phyllodes more often

A

60+, genetically linked

can arise from fibroadenoma

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33
Q

intraductal papilloma

A

spontaneous UNILATERAL nipple discharge
masses RARE
usually benign but similar to carcinoma

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34
Q

fat necrosis

A

bruised/dead tissue in breast

can be delayed from trauma

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35
Q

Stellate lesion***

A

think cancer or fat necrosis***

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36
Q

Prolactinoma Dx***

A

keep prolactinoma on Dx but dont go to it first
order mammogram and blood tests first***
order MRI of pituitary if evidence (prolactinoma)

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37
Q

Most common cause of Mastitis and abscess***

A

Staph aureus*** –> SYSTEMIC symptoms

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38
Q

When is tamoxifen used?

A

severe cases of fibrocystic lesions

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39
Q

Paget’s Disease of Nipple

A

malignant ductal cells invading to epidermis

looks like psoriatic rash from nipple

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40
Q

Skin dimpling

A

tumor on Cooper’s ligament

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41
Q

Peau d’orange

A

edema of breast skin

causes: lymphatic blockage, mastitis

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42
Q

What is hallmark of inflammatory carcinoma of breast?

A

Peau d’orange (plug dermal lymphatics)

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43
Q

When does PMS occur

A

during LUTEAL phase of menstruation
to to 75% of women
interfering

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44
Q

PMDD

A

premenstruation dysphoric disorder
DEBILITATING
up to 10%

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45
Q

What is the ABCD classification (Abraham’s)

A

Diagnostic for PMS

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46
Q

Dx of PMS***

A

symptoms for at least 2 consecutive cycles!***

diagnosis of exclusions

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47
Q

What can anemia and hypothyroidism cause?

A

depression and lethargy

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48
Q

Hormonal changes during PMS and when*

A

prior to menses
estrogen/progesterone levels
Low endorphins - LUTEAL***

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49
Q

What can B6 deficiency cause?

A

impair estrogen metabolism–>fluid retention
low prostaglandins (moderate hormones)
affects serotonin and melatonin levels

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50
Q

What is serotonin produced from

A

Tryptophan

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51
Q

What can serotonin deficiency affect?

A

sleep
menstruation
carb metabolism

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52
Q

Normal metabolism and serotonin

A

eat carb –> tryptophan in brain –> serotonin release –> high serotonin –> protein craving –>eat protein –> lowers serotonin –> triggers carb craving

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53
Q

Abnormal metabolism and serotonin

A

insufficient serotonin release from tryptophan –> no craving for protein –> continued carb craving

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54
Q

What worsens PMS

A

saturated fat, sugar, caffeine

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55
Q

How can sugar and caffeine affect hormones?

A

deplete B vitamins and minerals (makes prostaglandins)

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56
Q

Tx of PMS

A 
Diet and exercise
vitamin supplement (E, B6, Zinc, C, Ca)
herbal supplement (primrose oil, Gringko, chasteberry, St. john's wort)
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57
Q

what drugs do St. John’s worts act like?

A

SSRIs

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58
Q

How can diuretics help PMS? (ex: HCTZ)

A

decrease fluid retention

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59
Q

Typical Antidepressants/NSAIDs for PMS***

A

Prozac
Zoloft
Serafem
Ibuprofen

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60
Q

Core symptoms of PMDD

A

Markedly depressed mood
anxiety, tension, “on edge”
DEBILITATING*** and destroys relationships

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61
Q

Standard test for PMS***

A

NONE

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62
Q

Drug Tx for PMS***

A

Oral contraceptives, antidepressants

but first counsel: diet, exercise, sleep

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63
Q

Dx for PMS***

A

Pt chart symptoms for 2 cycles

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64
Q

When during menstruation does PMS occur?

A

Luteal phase (1-2wks before menses)

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65
Q

DMS-5 diagnostic criteria for PMDD

A

1 year of symptoms

need 1: markedly depressed mood/anxiety/affect lability/anger

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66
Q

Difference between PMS and PMDD

A

PMDD: primarily mood
PMS: primarily physical

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67
Q

Why is Dx of PMDD difficult?

A

high comorbidity

take good Hx and find out relationship to menstruation

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68
Q

Acute Pelvic pain

A

<3 months

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69
Q

Most severe causes of acute pelvic pain and their complications if missed Dx***

A

ectopic pregnancy: death***

PID: infertility

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70
Q

Chronic Pelvic Pain

A

nonmenstural; >3-6months
common: 1/7 women
up to 70% multi-factorial
most common reproductive age

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71
Q

Differential Dx of Acute Pelvic pain***

A 
PREGNANCY***
ectopic pregnancy***
cervicitis***
PID***
CANCER***
appendicitis
UTI
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72
Q

Common causes of chronic pelvic pain

A 
endometriosis
pelvic adhesion (from surgery)
irritable bowel syndrome
interstitial cycstitis
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73
Q

Leiomyoma

A

uterine fibroids
can be anywhere in uterus
acute pain when disintegrate

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74
Q

Hydrosalpinx

A

obstructed fallopian tube with fluid accumulation

can cause acute pain

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75
Q

PID

A

Pelvic inflammatory disorder: general term for infection of uterus, fallopian tube, ovaries

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76
Q

Salpingitis

A

inflammation to fallopian tube

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77
Q

Ectopic pregancy

A

fertilization in fallopian tube

fatal if ruptures

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78
Q

vaginismus

A

involuntary contraction of pelvic muscles

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79
Q

Chandelier’s sign

A

cervical motion tenderness of PID during pelvic exam

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80
Q

loss of pelvic muscle support causes

A

cystocele

rectocele

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81
Q

What is a significant effect of chronic pelvic pain?

A

significant impact of woman’s daily functioning and relationship
(pain becomes illness)
(episodic or continuous)
(no obvious pathology)

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82
Q

pelvic congestion syndrome

A

varicose veins in pelvis

can cause chronic pelvic pain

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83
Q

chronic pelvic pain Dx

A

good history and physical exam!

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84
Q

Dx method for severe abdominal w/o cause

A

abdominal laparoscopy

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85
Q

Tx for chronic pelvic pain

A

goal is NOT pain free but pain management –> be up front w/pt - hollistic
be careful w/NSAIDs dosage: can cause GI bleed and renal failure

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86
Q

Tx for neuropathic pain of chronic pelvic pain

A

antidepressants (SSRIs, TCAs)
gabapentin
pregabalin

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87
Q

Tx for CYCLIC pain of chronic pelvic pain

A 
oral contraceptives
intrauterine devices (IUD)
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88
Q

last resort of chronic pelvic pain

A

hysterectomy

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89
Q

Dyspareunia

A

painful intercourse

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90
Q

Most common cause of dyspareunia

A

vulvovaginitis

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91
Q

dysplasia

A

abnormal cell growth/development

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92
Q

hyperplasia

A

increase in number of cells

usually adaptive response to demand for increase tissue function

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93
Q

neoplasia

A

new cell growth

accelerate/uninhibited division/growth of abnormal cells

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94
Q

Benign vs Malignant neoplasia***

A

Benign: well-differentiated, slow, localized, clear demarcations
Malignant: poorly-differentiated, fast growth, invasive, unclear margins

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95
Q

Most cancers are?

A

Monoclonal! arise from single cell

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96
Q

carcinoma vs sarcoma

A

carcinoma: epithelial cell origin
sarcoma: connective tissue origin

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97
Q

direct spread vs metastasis

A

direct spread: invasion of surrounding tissue

metastasis: invasion of vessels/lymph

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98
Q

TNM classification of cancer***

A

Tumor: size of primary (T0-T4)
Nodes: number of Lymph nodes (N0-N4)
Metastasis: M0 none, M1 present
*lower the stage, better the prognosis

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99
Q

Strongest cause of Vaginal/Vulva cancer

A

HPV

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100
Q

Types of malignant vulva disorders

A

Vulvar intraepithelial Neoplasia (VIN): epithelial cells
Paget’s Disease: basal cell layer
Vulvar carcinoma: squamous cells

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101
Q

VIN III

A

involved all epithelial layers

aka “carcinoma in situ”

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102
Q

Classification of VIN

A

classify by depth and epithelial cell maturation, can become invasive:
VIN I: most mature, partial thickness, mild dysplasia
VIN II: moderate dysplasia
VIN III: least mature, full thickness, severe dysplasia

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103
Q

VIN and Vulvar cancer S/S

A

asymptomatic
chronic pruritus (itching), palpable lumps
progression more likely w/elder/immunocompromised

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104
Q

What is present in 1/3 of patients w/VIN and vulvar cancer?***

A

second malignancy (cervical or vaginal)***

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105
Q

Dx of VIN/vulvar cancer

A

Physical exam
vulvoscopy
biopsy

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106
Q

Tx of VIN

A

Surgical excision w/wide margins
look for additional cancers
has frequent recurrence (follow up)

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107
Q

Risk factors of vulvar cancer

A

multiple sex partners, HPV (worts), smoking

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108
Q

Difference between VIN occupying non-hairy cells and hairy cells

A

non-hairy: epithelial disease

hairy: greater depth of destruction

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109
Q

presentation of Paget’s disease of vulva

A

pruritus, vulvar soreness
eczematoid appearing lesion
looks like psoriasis

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110
Q

Extensive disease presentation of Paget’’s disease of vulva

A

Raised, velvety, weepy lesion

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111
Q

Tx of Paget’s disease of vulva

A

surgical wide excision (high recurrence) or complete vulvectomy

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112
Q

Nodal involvement of Paget’s disease of vulva

A

could be FATAL

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113
Q

What is present with 1/3 of patients w/Paget’s disease of vulva?***

A

second neoplasm (cervical or vaginal)

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114
Q

Paget’s disease of breast

A

rare breast cancer: starts on nipple, extend to areola

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115
Q

Late lesion of Vulvar cancer presentation

A

cauliflower-like, hard ulcerated area

usually delay reporting symptoms

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116
Q

What cells do vulvar cancer affect?

A

90% squamous cells

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117
Q

Tx of Vulvar cancer

A

excision
radical node dissection
irradiation
chemotherapy

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118
Q

Tx of stage IV vulvar cancer

A

radical vulvectomy, pelvic exenteration (remove all organs)
post surgical radiation
left w/colostomy, urinary diversion
LIFE CHANGING Dx

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119
Q

Most common vagina cancer

A

extension of cervical cancer

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120
Q

What cell type is affected in vaginal cancer?

A

85% squamous

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121
Q

Most common distant metastasis of vaginal cancer?

A

liver and lungs

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122
Q

15% of vaginal cancer in 17-21 yo’s get what?

A

adenocarcinoma (increase in metastasis)

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123
Q

Dx of vaginal cancer

A

Look and feel vaginal walls during pelvic exam
biopsy vaginal lesion
mandatory cervical biopsy
rule out vulvar cancinoma

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124
Q

Effects of chemotherapy on vaginal cancer***

A

HAS NOT BEEN SHOWN TO CURE***

use radiation therapy

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125
Q

What is cervical cancer strongly associated with?***

A

HPV***

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126
Q

Most common HPV serotypes associated with cervical cancer*

A

HPV Serotype 16, 18*

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127
Q

Most common gynecologic malignancy***

A

endometrial cancer***

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128
Q

Endometrial cancer TRIAD***

A

Obesity
HTN
DM

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129
Q

What increases risk of endometrial cancer

A

increased estrogen

nulliparity

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130
Q

Endometrial cancer Sx***

A

> 60% abnormal uterine bleeding***

uterus can be enlarged, hard, fixed

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131
Q

Menopausal or postmenopausal women w/abnormal bleeding***

A

MUST evaluate for endometrial cancer***

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132
Q

Uterine sarcoma derived from which tissue types?

A

leiomyosarcoma: from myometrial muscle

mesodermal and stromal sarcoma: from endometrial epithelium (can have teeth, bones, cartilage, etc)

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133
Q

Uterine sarcoma presentation

A

usually after 40yo

rapid enlargement of uterus or mass

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134
Q

Highest mortality rate of all gynecologic cancers

A

ovarian cancer (but only 5% of cancers in women)

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135
Q

Main risk factor of ovarian cancer

A

exposure to estrogen

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136
Q

Syndromes w/40% lifetime risk of developing ovarian cancer

A

Lynch II syndrome: cancer of colon, breast, endometrium, ovary w/HNPCC
Breast-ovarian cancer syndrome: BRCA1, 2 mutation

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137
Q

Types of ovarian cancer

A

epithelial
germ cell
sex chord and stromal
metastic

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138
Q

Primary mode of dissemination of epithelial ovarian cancer***

A

implantation on peritoneal surfaces***

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139
Q

Ovarian cancer presentation***

A

ASYMPTOMATIC UNTIL WELL ADVANCED***

symptoms don’t become apparent until tumor compress/invade adjacent structures, ascites develop, or evident metastasis

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140
Q

Sister Mary Joseph Nodule

A

metastatic implant in umbilicus

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141
Q

screening for ovarian cancer

A

bimanual exam best even though low sensitivity and specificity
palpable only with advanced disease…

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142
Q

Benign ovarian tumors***

A

tend to be cystic, smooth, unilateral, mobile

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143
Q

Malignant ovarian tumors***

A

tend to be solide, nodular, bilateral, immobile/fixed

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144
Q

What lab result is elevated in ovarian cancer?***

A

Ca-125 (postmenopausal women, advanced stage)

^serum tumor marker

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145
Q

Ovarian cancer prophylaxis in high risk women

A

recommend bilateral salpingo-oophorectomy by 40 yo

BRCA: surgery by 35 yo

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146
Q

Neuropeptide Y

A

stimulate pulsatile release of GnRH –> gonadotropin

but in absence of estrogen: inhibit gonadotropin release (undernutrition)

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147
Q

Angiotensin II

A

receptors in pituitary

influence EPI/NE in hypothalamus –> changes gonadotropin and prolactin release

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148
Q

Somatostatin

A

hypothalamic peptide

influence growth hormone, prolactin, TSH from pituitary

149
Q

Galanin

A

released in portal circulation of pituitary
increases LH
inhibited by: dopamine, somatostatin
stimulated by: TRH, estrogen

150
Q

Activin and Inhibin

A

produced by gonads
growth factor beta family
Inhibin: decreases FSH, +conversion: progesterone
Activin: increases FSH, + conversion: estradiol

151
Q

Follistatin

A

inhibit FSH synth and release
inhibit FSH response to GnRH
binds to activin to inhibit

152
Q

Melatonin

A

pineal gland
converted from tryptophan
inhibits GnRH
increase at night

153
Q

Leptin

A 
produced by adipose cells
INCREASE GnRH release in hypothalamus
negatively correlated w/DHEA
increased in obesity
role in implantation
154
Q

Kisspeptin (KISS1)

A

stimulate GnRH
KISS1 neurons innervate GnRH neurons in hypothalamus
mediates sex hormone feedback
role in initiating puberty

155
Q

Arcuate nucleus

A

secretes most of GnRH in hypothalamus

156
Q

Reproductive cycle vs Sexual cycle

A

Reproductive: after fertilization to birth
Sexual: occurs every month in absence of pregnancy (ovarian and menstrual cycles)

157
Q

Ovarian cycle vs Menstrual cycle

A

Ovarian: events in ovaries
Menstrual: concurrent events in uterus

158
Q

What inhibits and stimulates GnRH?***

A

Inhibits: DA/S, GABA, opioid Beta endorphin, CRH
Stimulates: EPI/NE, leptin, NPY, Galanin

159
Q

What happens when GnRH release rate and amplitude is decreased or increased?

A

Wont ovulate, FSH/LH not released! very specific

160
Q

estradiol effect on GnRH

A

Decreases amplitude of GnRH (neg feedback)

161
Q

Progesterone effect on GnRH

A

Decreases frequency of GnRH (neg feedback)

162
Q

Day 1 of menstrual cycle

A

first day of bleeding

163
Q

What hormones are in birth control pills?

A

estrogen and progesterone (balance each other; progesterone stops ovulation)

164
Q

Normal pH of vagina and what makes vagina more receptive to sperm?

A

vagina acidic

LH makes vagina more basic –> better for sperm

165
Q

What does LH do?

A

thickens mucus and makes vagina more basic

166
Q

Most fertile age of women

A

23-25

167
Q

Age most likely to have twins

A

mid to late 30s

168
Q

What does estrogen do in the beginning of follicular phase? (Day 1-7)

A

inhibit FSH/LH release, negative feedback

169
Q

What does estrogen do later in the follicular phase

A

triggers LH –> ovulation

becomes POSITIVE feedback

170
Q

What does LH before ovulation do?

A

stimulate follicle to secrete progesterone

171
Q

what does the low level of progesterone immediately before ovulation do?

A

FSH SURGE

positive feedback of estradiol in increasing LH

172
Q

What does FSH surge do?

A
  • matures oocyte to meiosis I
  • produce proteolytic enzymes for follicle release
  • increases LH receptors in ovaries to increase progesterone during luteal phase
173
Q

What does LH surge do?

A
  • follicular rupture: increase intrafollicular proteolytic enzymes
  • luteinization of granulosa and theca cells –> inc progesterone
  • influx blood vessel to follicle to prepare transition to corpus luteum
174
Q

What does the corpus luteum do after ovulation?

A

high secretion of estrogen and progesterone inhibits GnRH and gonadotrophs

175
Q

What happens as corpus luteum dies off?

A

hormones levels subside

176
Q

What happens to eggs by age 37?

A

90% depletion!

177
Q

What hormone stimulates completion of Meiosis I and produce secondary oocyte and 1st polar body? (stops right before fertilization)

A

FSH during ovulation

178
Q

What happens to the egg right after fertilization?

A

Meiosis II and release of second polar body

179
Q

What causes the corpus luteum to become corpus albicans?

A

if no secretion of hCG

180
Q

What state is the egg before menarche?

A

primary oocyte

181
Q

What hormone binds to granulosa cells?

A

FSH

182
Q

What hormone binds to thecal cells?

A

LH

183
Q

Antrum

A

develops around oocyte as follicle matures

184
Q

What hormone is at the highest concentration right before ovulation?

A

Estradiol

185
Q

What is the pregnancy hormone that inhibits LH, FASH?

A

progesterone - measured in ovulation kits

186
Q

When does oocyte degenerate?

A

12-24 hrs after ovulation of not fertilized

187
Q

Graafian follicle

A

only one egg becomes graafian follicle, prepares to ovulate

188
Q

What stage of meiosis is the ovulated egg stopped at?

A

Metaphase II

189
Q

Tunica albuginea

A

covers surface of ovaries

190
Q

What phase does corpus luteum become corpus albican in the absence of pregnancy?

A

premenstrual phase

191
Q

Two cell theory

A

Theca produce androgens and granulosa cells convert androgens to estrogen

192
Q

What hormone thickens endometrium and what triggers shedding?

A

estradiol thickens

progesterone sheds

193
Q

What level of progesterone indicates occurence of ovulation?

A

> 3ng/mL, secretory phase

194
Q

Estriol

A

pregnancy hormone

195
Q

Estrone

A

postmenopausal estrogen

196
Q

catechol estrogens

A

increase w/low body weight and hyperthyroidism

197
Q

What cell produces activin and inhibin?

A

granulosa cells

198
Q

What are true androgens?***

A

testosterone and dihydrotestosterone
only ones bind to androgen receptors
converted from DHEA and ANDROSTENEDIONE

199
Q

What hormone is implicated in CAH?

A

17-hydroxyprogesterone

200
Q

What test to order to check Menopause?***

A

FSH!!! will be HIGH

201
Q

embryonic age

A

first day of fertilization, ovulation age

202
Q

gestation age

A

2 wks longer than embryonic

203
Q

Paramesonephric duct

A

Mullerian, Female

204
Q

Mesonephric duct

A

Wolffian, Male

205
Q

Differentiation

A

Male development, active, requires androgen + MIF

206
Q

Development

A

Female development, passive

207
Q

What are three developmental defects?*** (identify them)

A

agenesis
lateral fusion defects
vertical fusion defects

208
Q

Agenesis

A

MRKH Syndrome

ex: mullerian duct doesnt develop –> no cervix, uterus, vagina, tubes

209
Q

Lateral fusion defects***

A

Mullerian ducts dont fuse –> various effects

210
Q

Didelphys

A

double uterus, can get pregnant

fusion failure

211
Q

complete uterus didelphys

A

2 cervix, uterus, vagina

212
Q

Bicornuate uterus

A

heart shaped uterus, normal pregnancy

partial fusion

213
Q

unicornuate uterus***

A

destruction of one mullerian duct
almost always MISSING KIDNEY AND URETER ON SAME SIDE***
pregnancy loss

214
Q

Most common type of developmental defect***

A

septate uterus***
indented fundus
failure of reabsorption of septum

215
Q

Vertical fusion defects

A

vagina and cervix abnormalities

216
Q

What should you check w/mullerian abnormalities?***

A

50% renal anomalies

12% skeletal

217
Q

CAH

A

ambiguous genitalia
too little cortisol so ACTH increased –> too much androgens
also little aldosterone

218
Q

hydrocolpos

A

distention of vagina w/fluid

219
Q

hematocolpos

A

accumulation of menstrual blood in vagina

220
Q

effects of imperforate hymen

A

hydrocolpos

hematocolpos

221
Q

Time of presentation w/reproductive defects

A

birth
puberty
pregnancy

222
Q

Acquired structural abnormalities***

A

fibroids
uterine adhesion
cervical insufficial, short cervix

223
Q

Uterine fibroids

A

leiomyomas
benign smooth muscle growths
most asymptomatic, can go away on their own

224
Q

incidence of uterine fibroids

A

3/4 of women in 30s!

225
Q

pedunculated fibroids

A

outpouching of wall, hangs

226
Q

Uterine adhesions

A

Asherman syndrome
scar tissue
can be asymptomatic

227
Q

cervical insufficiency

A

premature cervical opening during pregnancy
more likley bc of short cervix
tx: can suture during pregnancy

228
Q

Hirsutism

A

abnormal hair growth w/excessive androgens (female)

229
Q

Polycystic Ovarian Syndrome features

A

excessive androgens
ovulatory dysfunction
polycystic ovaries

230
Q

What is POS strongly associated with?

A

obesity

231
Q

POS onset***

A

progressive onset at puberty

NOT sudden

232
Q

Hormonal changes w/POS

A

Suppressed FSH, elevated LH
Inc insulin (insulin resistant)
theca over produce androgens

233
Q

What is PCOS at increased risk for?***

A

Endometrial cancer (3x)

234
Q

What is NOT typical of PCOs?***

A

true virilization!

235
Q

What is ovulatory bleeding suggested by?

A

premenstrual symptoms (mood, fluid retention, tender breasts)

236
Q

acanthosis nigricans

A

discoloration of skin folds from hyperinsulinemia

237
Q

What is NOT associated w/PCOS

A

true virilization
cliterohypertrophy
galactorrhea

238
Q

Rotterdam criteria for PCOS

A 
Need 2/3:
irregular menses
excessive androgen
polycystic ovaries
exclude all other
239
Q

Tx PCOS

A 
Weight loss
Oral contraceptives (infertile) --> suppress LH
240
Q

most common cause of pelvic relaxation?

A

childbirth

241
Q

episiotomy

A

surgical cut through levator ani during childbirth

242
Q

atrophic vaginitis

A

lose labial fold

skin looks white

243
Q

Genuine stress incontinence

A

leak urine

trauma, pelvic prolapse, drugs relax sphincter

244
Q

Detrusor instability/urge incontinence

A

losing all urine

overstimulation of detrusor

245
Q

Overflow incontinence

A

reduced sensation of full bladder, leaking

cant stimulate detrusor

246
Q

interstitial cystitis

A

chronic pain and pressure in bladder

247
Q

What does interstitial cystitis NOT have?

A

incontinence!

248
Q

How to definitive Dx leiomyoma?***

A

transvaginal ultrasound

249
Q

Triad of ectopic pregnancy***

A

amenorrhea
irregular vaginal bleeding
pelvic pain

250
Q

Dysfunctional uterine bleeding caused by?***

A

90% by anovulation

251
Q

How to Dx Dysfunctional Uterine Bleeding?

A

Hysteroscopy and endometrial biopsy

252
Q

Dysfunctional Uterine Bleeding Tx

A

NSAIDs, High dose estrogen, OCP

depends on underlying cause

253
Q

Dysfunctional Uterine Bleeding Tx adolescent

A

just watch if no anemia

254
Q

Biggest thing to rule out in secondary amenorrhea

A

pregnancy

255
Q

Number 1 cause of hypothalamic disorders*

A

systemic stresses: excessive weight loss, exercise, emotional distress

256
Q

What does hypothalamic disorders cause?

A

low GnRH

257
Q

Endometriosis

A

endometrial tissue outside of uterus
estrogen dependent, benign
in reproductive popu.

258
Q

three forms of endometriosis

A

pelvis endometriosis
ovarian endometrioma
deeply infiltrating endometriosis

259
Q

most common symptoms of endometriosis

A

dysmenorrhea
dyspareunia
chronic pelvic pain

260
Q

Gold standard endometriosis Tx

A

hysterectomy, but permanent

261
Q

Endometriosis Dx

A

1st line: U/S

Gold standard: laparoscopy

262
Q

Tx goal for endometriosis

A

relief pain and reserve fertility bc most found in reproductive women

263
Q

Adenomyosis

A

ectopic endometrial tissue grow down into myometrium

perimenopausal women

264
Q

Gold standard Tx for adenomyosis

A

hysterectomy (also 1st line)

265
Q

What is a common change in squamous cells of vulva, vagina, cervix?

A

HPV

266
Q

What cell type does vulva neoplasia target?

A

squamous

267
Q

What age group is affected by vulvar cancer?

A

postmenopausal

268
Q

What vulvar disease looks like psoriasis?

A

Paget’s disease

269
Q

Psoriasis of vulva Tx

A

Steroids

270
Q

Verrucous Carcinoma

A

cauliflower lesions

chewing tobacco

271
Q

Invasive Squamous Cell Carcinoma

A

induration, thickened skin, ulceration

hurts

272
Q

Sarcoma S/Sx

A

rapidly expanding and painful

273
Q

possible dx for inflammed vulvar lesions

A

Fungi
Folliculitis: staph.
Cancer
reactive vulvitis: physical/chem irritation

274
Q

Leukoplakia

A

white lesions
hyperkeratosis
avascularity

275
Q

What is mandatory for white/dark lesions

A

BIOPSY

276
Q

Vitiligo v Lentigo

A

Vitiligo: white
Lentigo: dark, freckle
benign

277
Q

Nevi

A

moles

278
Q

Wet mount

A

KOH
fungus
yeast

279
Q

Vaginal pH of bacterial vaginosis or Trich?

A

> 5.0

280
Q

Vaginal pH of fungal infection or physiological discharge?

A

<4.5

281
Q

Do postmenopausal women get yeast infections?

A

No but can get atrophic vaginitis

282
Q

Atrophic vaginitis

A

vaginal inflammation from thinning of tissue, decreased lubrication
from low estrogen

283
Q

Lichen planus (psoriasis)

A

inflammatory, autoimmune

mucous mem.

284
Q

erosive lichen planus and Tx

A

glassy, bright red erosions on vulva, vagina
can bleed, yellow discharge
Tx: testosterone/corticosteroid cream, tacrolimus

285
Q

lichen sclerosis

A

vulva, no vagina

286
Q

Candida vaginitis

A

thick, curd-like vaginal discharge

itching

287
Q

intertrigonal candida

A

skinfolds

288
Q

Tx for Candidas albicans, tropicalis, glabrata

A

a: PO diflucan (hyphae and buds)
t: Terazol (hyphae)
g: nystatin, azole resistant (buds)

289
Q

Organism that common causes BV

A

Gardnerella vaginalis

290
Q

recurrent candida Tx

A

nystatin

291
Q

What is BV similar to?*

A

Trich but same Tx

292
Q

Dx criteria for BV

A

Clue cells
ph >4.5
“whiff” test
thin homogenous discharge

293
Q

Flora change in BV

A

shift from lactobacilli to anaerobic

294
Q

BV Tx

A

metronidazole

clindamycin

295
Q

“strawberry cervix”

A

trichomonas (women more symptomatic)

5%

296
Q

Trichomonas SSx

A

copious discharge, can be frothy

50% irritation, dysuria

297
Q

Trich Tx

A

Metronidazole

298
Q

Fitz Hugh Curtis Syndrome

A

GC or chlamydia move from fallopian tube to diaphragm; RUQ pain

299
Q

Leiomyoma v. adnexal masses

A

Leiomyoma: central/uterine
Adnexal: more lateral

300
Q

Uterine sarcoma

A

Uterine malignancy - not common (endometrial ca more common)

301
Q

Leiomyoma are dependent on what hormone?

A

estrogen

302
Q

Classifications of leiomyoma (in to out)

A

submucous
intramural
subserous

303
Q

What is significant about ovaries 5 years after menopause?

A

should not be palpable!

304
Q

functional v. complex cysts in the ovaries

A

function: fluid filled, benign
complex: multi-chamber, solid/semi-solid; more likely malignant

305
Q

What test to order in all post-menopausal ovarian cysts?

A

ca-125

306
Q

Types of functional ovarian cysts

A

follicular

luteal

307
Q

Infertility***

A

failure of a couple to conceive
<35yo: after 12 months trying
>35yo: after 6 months

308
Q

fecundability

A

probability of achieving pregnancy in 1 month

309
Q

3 most common causes of infertility

A

ovulatory disorders
fallopian tube problems
sperm/semen problems

310
Q

oligoovulation

A

infrequent

311
Q

What can scarring of ducts from STI PID cause?

A

tubal occlusion - infertility

312
Q

1/5 women w/PID (infections) gets what?

A

infertility

313
Q

Why shouldn’t patients “douche”?

A

can force bacterial vagination infections into upper resp tract

314
Q

asthenozoospermia

A

reduce sperm motility

315
Q

Teratozoospermia

A

abnormal sperm morphology

316
Q

azoospermia

A

no sperm

317
Q

aspermia

A

no semen

318
Q

Is heat induced infertility reversible?

A

potentially

319
Q

OTC urinary ovulatory kits test for?

A

LH –> predict LH surge –> ovulation

320
Q

ovulation serum test detects?

A

serum progesterone level (ovulation: >3ng/ml)

321
Q

Bodily signs of ovulation

A

increased temp by 1 F

cervical mucus thinner

322
Q

What infections are not considered STIs but increase rate of transmission of other STIs/HIV?

A

BV and candidiasis

323
Q

Ulcers: What STIs should you test for?

A

herpes and syphilis

324
Q

What infection is not protected by condoms?

A

HSV, HPV

325
Q

Rash of palms/feet: what do you think of?

A

Mono, rocky mountain spotted fever, Lyme, syphilis

326
Q

Tabes dorsalis

A

from neurosyphilis, demyelination of spinal nerves

327
Q

Jarisch-Herxheimer Reaction

A

fever, headache, myalgia 24hr after starting PCN tx of syphilis

328
Q

Most reported bacterial infection in US

A

Chlamydia

329
Q

Gonorrhea Tx

A

2 Abiotics: treat both gonorrhea and chlamydia

ceftriaxone, azithromycin

330
Q

What can you not ingest before/after BV Tx (metronidazole)

A

alcohol 24-72hrs

331
Q

Trichomonas and BV Tx

A

metronidazole

332
Q

Most common STI that doesnt have to be reported?

A

HPV

333
Q

What are the 5 P’s to ask in GYN visit?

A 
Partners
Pregnancy
Protection
Practices
Past History
334
Q

Chadwick’s sign

A

cyanosis of cervix; early pregnancy

335
Q

How is the endometrium thickened after menses?

A

mitosis of stratum basalis in proliferative phase

336
Q

How does the endometrium thicken after ovulation?

A

gland secretion and fluid accumulation in secretory phase

337
Q

Climacteric

A

transition when ovarian function wanes

338
Q

post menopausal bleeding

A

6 months after cessation of menses

339
Q

polymenorrhea

A

cycle shorter than 24 days

340
Q

oligomenorrhea

A

cycle longer than 25 days

341
Q

hypomenorrhea

A

bleeding less than 3 days

342
Q

hypermenorrhea

A

bleeding >7 days

343
Q

gravidity

A

pregnancy

344
Q

primigravida

A

experienced first pregnancy

345
Q

Multipara

A

delivered 2+ times

346
Q

parturient

A

in labor

347
Q

puerpera

A

just gave birth

348
Q

What to rule out w/Chancroid by Haemophilus ducreyi

A

must rule out Syphilis and HSV

NOT chancre

349
Q

HSV SSx

A

painful blisters on genitals (butts, thighs)
more likely recurrent than zoster
Raw burning “cut”

350
Q

Tzanck Smear

A

look for multinucleated cells in HSV, VZV

351
Q

LGV = lymphogranuloma venereum

A

elephantiasis, enlarged inguinal lymph nodes

352
Q

Congenital syphilis presents with?

A 
hutchinson teeth
saddle nose
frontal bossing
(eat away bones)
chancre
353
Q

What to check for w/new onset dementia?

A

Syphilis

354
Q

chancroid

A

purulent base, bleeds easily

355
Q

disseminated gonococcal infection has pain where?

A

joints and tendon

356
Q

What to check w/PID

A

pregnancy
chlamydia
gonorrhea

357
Q

condyloma lata v condyloma accuminata

A

lata: flat, syphilis
accuminata: HPV

358
Q

Reiter’s disease

A

reactive arthritis

359
Q

colposcopy v LEEP

A

colposcopy: small biopsy
leep: take whole cervix out

360
Q

monophasic v multiphasic combo OCP

A

mono: constant doses
multi: varying doses
fertility returns quickly after discontinuation

361
Q

How do combined OCPs work?*

A

mimicking early pregnancy (estrogen, progesterone)

362
Q

OCP side effects last for how long?

A

1st 3 months

363
Q

Depo-Provera

A

3 months effective
injectable
very good and no estrogen
cant be on >2yrs

364
Q

Pros of Depo-Provera

A

3 months effective
injectable
very good and no estrogen
cant be on >2yrs

365
Q

Cons of Depo-Provera***

A

return to fertility in 12-18 months

366
Q

emergency contraception mechanism

A

inhibits/delays ovulation:
Combo OCP
copper IUD (Paragard): within 5 days
plan b very effective: best w/in 12hrs

367
Q

Types of IUD

A 
Paragard = copper, 10yrs, spermacidal
LNG = mirena, 5yrs, cervical mucus and endome. atrophy, suppress ovulation
368
Q

Pro of IUD

A

immediate return to fertility after removal

Women's Health (1 decks)

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