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PANCE > Women's Health-Gyn > Flashcards

Women's Health-Gyn Flashcards

1
Q

Follicular Phase =

A

aka Proliferative
Days 1-14 of cycle
**Estrogen predominant

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2
Q

Luteal Phase =

A

aka Secretory
Occurs after ovulation (aka after day 14)
**Progesterone predominant
-made by corpus luteum

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3
Q

When is the only time you do PAP before the age of 21?

A

When you are trying to rule out cervical causes of abnormal bleeding. IE: when there is post-coital bleeding

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4
Q

What is menorrhagia and what are ddx

A 
-Heavy menstrual bleeding
DDx: 
-Leiomyomas (not painful)
-Adenomyosis (Painful)
-Bleeding disorder
-hyperplasia/carcinoma
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5
Q

Ddx of intermenstrual bleeding

A
  • endometrial polyps
  • unscheduled bleeding w/ contraceptive use
  • endometrial hyperplasia or carcinoma
  • infection (pain, discharge)
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6
Q

Irregular bleeding ddx

A
  • *typically these women are not ovulating**
  • ovulatory dysfunction
  • common at extremes of repro age
  • endocrine disorders (thyroid, PCOS)
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7
Q

Indications for endometrial biopsy

A
  • post-menopausal (ie: any bleeding after menopause)
  • age >45
  • obesity (endogenous unopposed estrogen)
  • diabetes (increased risk of endometrial cancer)
  • break through bleeding on HT
  • infertility
  • family history of endometrial or colon cancer
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8
Q

Treatment of Abnormal uterine bleeding

A
  • NSAIDs (naproxyn, ibuprofen) start 1 day before menses
  • Hormonal manipulation (OCPS, progestin IUD)
  • Endometrial ablation
  • Hysterectomy
  • Acute bleeding
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9
Q

What increases risk of endometrial cancer?

A

Unopposed estrogen

-RF: age, obesity, nulliparity, late menopause, tamoxifen, PCOS, DM, HTN, genetics (lynch and BRCA genes)

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10
Q

Most common type of endometrial cancer

A

-atypical glandular cells on cytology = Adenocarcinoma

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11
Q

What is primary amenorrhea?

A
  • lack of menarche by age 16
  • no evidence of pubertal onset by 13
  • lack of menstruation w/in 2 years of onset of breast development
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12
Q

What is Sheehan Syndrome

A

-Pituitary infarct from post-pregnancy hemorrhage

Ex: Post partum woman breast feeding can’t make milk anymore

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13
Q

What labs to order to work-up secondary amenorrhea?

A
  • HCG
  • TSH
  • Prolactin
  • FSH
  • Progesterone challenge
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14
Q

Secondary Amenorrhea w/ Prolactin >200

A

-Pituitary adenoma (check MRI/CT of sella)

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15
Q

Secondary Amenorrhea w/ Prolactin <200

A

-Medications (antipsychotics, lithium, anticonvulsants)

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16
Q

Secondary Amenorrhea w/ high FSH

A

Ovarian failure

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17
Q

Secondary Amenorrhea w/ low or normal FSH

A

Hypothlamic pituitary ovarian abnormality

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18
Q

What does progesterone challenge do?

A

Checks to see if pt is ovulating

-if she does bleed = everything is functioning just not ovulating

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19
Q

Primary Dysmenorrhea

A

begins soon after menarche
-non-pathologic
Tx: NSAIDs, OCPs

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20
Q

Secondary Dysmenorrhea

A

new onset in an older woman

-organic cause

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21
Q

Most common cause of secondary dysmenorrhea =

A 
#1 = Endometriosis
other = cervical stenosis
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22
Q

Presentation of endometriosis

A

-Pain PRECEDES and lasts through menses
-dysparenia
-infertility
-pelvic pain
-abnormal bleeding
Dx via laparoscopy

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23
Q

Tx of Endometriosis

A

ABlation, excision especially if they want to conceive

-Meds = ocps, nsaids, progesterone only, gnrh agonists (lupron, danocrine)

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24
Q

Tx of PMS

A

SSRIs
(reg exercise, avoid sugar and Etoh, NSAIDS)
other = spironolactone

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25
Q

Risk factors for cervical cancer

A
  • early age of first coitus
  • multiple sexual partners
  • HPV 16, 18, 31, 33, 35
  • personal hx of cervical dysplasia
  • immunocomprised
  • smoking (more difficult for immune sys to clear infection)
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26
Q

PAP Screen criteria

A
  • age 21 regardless of age of onset of sexual intercourse
  • 21-29: screen w/ cytology alone every 3yrs HPV test not recommended
  • 30-65: screen w/ cytology and HPV testing every 5yrs (or cytology alone q 3yrs)
  • > 65: discontinue screen if 2neg paps in past 10yrs and no hx of CIN2+ w/in the last 20yrs
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27
Q

About Follicular Cysts

A

Failure of the fluid in an incompletely developed follicle to be reabsorbed
NORMAL usually found incidentally on US
-20-25mm in size, clear fluid filled cyst
-usually asymptomatic
Tx: self-limited

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28
Q

About Corpus Luteum Cysts

A

Normal after ovulation
-may or may not be painful
-Typical in 1st trimester of pregnancy
Tx: self-limited

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29
Q

About Endometriomas

A 
Associated w/ endometriosis
aka chocolate cyst
-benign
-palpable mass on ovary
-may or may not be painful
Dx & Tx: US and aspiration
30
Q

About Dermoids

A 
Benign germ cell tumor
-usually in young women
-asymp finding on bimanual exam
-CALCIFICATION on US/X-ray
Tx: remove to avoid torsion or bleeding
31
Q

Ovarian Torsion presentation and Tx

A

Most commonly caused by DERMOIDs
-sudden severe pelvic pain
US w/ doppler to look for blood flow
-surgery is necessary ASAP to preserve ovarian function

32
Q

What is Stein-Leventhal Syndrome

A

aka PCOS

  • Hyperandrogenism
  • Insulin Resistance
  • Anovulation
33
Q

Clinical Presentation of PCOS

A
  • Infertility
  • Chronic Menstrual Irreg (oligomen, endometrial cancer)
  • Hyperangdrogenism (acne, hirsuit, male pattern baldness)
  • Insulin Resistance (central adip, acanthosis, DM2, CVD)
34
Q

Lab Values in PCOS

A

-Estradiol = normal
LH/FSH 3:1
Free Testosterone >50
Insulin Resistance
Large cystic ovaries on US and physical exam

35
Q

Tx of PCOS

A

Metformin = tx of choice for insulin resistance

  • obesity = lifestyle changes
  • Endometrial protection = OCPs
  • Ovulation induction = weight loss, pharmacotherpay
  • Ovulation induction = weight loss, clomiphene
  • Dyslipidemia = weight loss, exercise, statins
36
Q

RF for ovarian cancer

A
  • Age (median = 60)
  • First degree relative
  • genetic synd
  • nulliparity
  • high fat diet/obesity

OCP use = protective

37
Q

Screening tests for Ovarian Cancer

A

Screen those w/ 1st degree relative hx

  • Pelvic exam
  • CA125 (>35 is abnormal)alot of things w/ this
  • Transvaginal US
38
Q

Where is the first place ovarian cancer spreads

A

Omentum

39
Q

What causes vagina and vulva cancer?

A

30-50% = HPV

Diagnosed on biopsy

40
Q

Normal Vaginal pH

A

<4.5

41
Q

About BV

A

Ph >4.5
-positive whiff test
-clue cells
Tx: Metronidazole 500mg BIDx 7 days

42
Q

About Candida Vagintiits

A

RF: abx, pregnancy, OCP use consider DM screen in recurrent
-KOH = hyphae
Tx: Conazole creams or fluconazole 150mg PO x 1

43
Q

About Trich

A

Caused by t. vaginalis
-pH > 6.0
-copious, frothy discharge
-punctate erythem vagin and cervix “strawberry”
Tx: Metronidzole 2g X 1 or 250-500 mg TID/BID x 7 days
treat partner and also test for other STDs

44
Q

How to screen for chlamydia

A

-all sexually active women 25 and younger and other asymp women at increased risk
NAAT-Genprobe intracervical swab
LCT/PCR in urine
Tx: Azithromycin 1gram once or Doxycycline 100mg BID

45
Q

Prsentation of PID

A 
pelvic pain
cervical motion tenderness
dysparenia
symp present around the time of menses
FEVER
46
Q

Labs in PID

A

elevated ESR, SBC
GC/chlamyd
hCG

47
Q

Tx of PID

A

Hospitalize for high risk

Outpatient = ceftriaxone + doxy + metronidazole

48
Q

PID Sequelae

A
  • chronic pelvic pain
  • dysparenia
  • infertility
  • ectopic pregnancy
49
Q

Most reliable birth control method?

A

Mirena/Skyla IUD > Paraguard > Nexplanon

50
Q

Depo Negatives

A
  • 6% failure rate

- weight gain, menstrual irreg, depression, BB: lowers bone density, fertility delay

51
Q

Progesterone only mini pill indications

A

tx of choice for breastfeeding women

52
Q

Progesterone only mini pill contraindications

A

DVT
Liver Dz
Breast cancer

53
Q

Advantages of combo hormonal therapies

A
  • reduce risk of endometrial and ovarian cancer
  • decrease dysmenorrhea
  • improves acne
54
Q

Disadvantages of combo hormonal therapies

A
  • pills must be taken daily
  • no protection from STIs
  • CVD: thromboembolism, stroke, MI
55
Q

Contraindications to combo hormonal therapies

A
  • DVT/PE, CVA, CAD, Afib
  • severe HTN or vascular/heart disease
  • Migraine w/ Aura
  • 35 years or older and smoker (>15 cig/day)
  • Breast cancer
  • complicated DM
  • *Competes w/ seziure meds
  • liver dz
  • gall bladder dz
  • lower efficacy in obese ts
56
Q

What counts as infertility?

A

35 yrs who fail to conceive after 6 mo

57
Q

Menopause is defined as

A

12mo of amenorrhea

58
Q

How do you dx menopause

A

Check FSH and LH

FSH >30-40 (FSHincreases a lot; LH is low)

59
Q

Presenting complaints of menopause

A
  • vasomotor symp
  • vaginal atrophy
  • depressive symp, insomnia, irritability, lack of concentration
60
Q

Hormonal replacement for menopause

A

Estrogen only = no uterus
Estrogen and Progesterone = if uterine intact
(lowest dose for shortest amount of time)

61
Q

Benefits of HRT

A
  • osteoporosis prevention
  • lipid improvement
  • may decrease onset of DM
  • reduces colon cancer risk
62
Q

Osteoporosis occurs where?

A

In trabelucar bone

63
Q

T scores

A

1.0 to -1.0 = normal
-1.0 to -2.5 = osteopenia
< -2.5 = osteoporosis

64
Q

Most common pathogen in mastitis

A

s. aureus
- most common reason for fever after immediate peurperium in nursing mothers
* if occurs in non-lactating women, consider cancer*

65
Q

Causes of galactorrhea

A
  • psychotropics
  • cimetidine
  • TCA
  • OCP
  • Depo
  • CNS lesion (measure prolactin)
  • Medical conditions (hypothyroidism)
66
Q

Fibrocystic breast dz

A

-more painful just before menses and w/ consume of caffeine

Tx: avoid trauma, wear sports bra, NSAIDs, acetaminophen, OCPs, danocrine/lupron

67
Q

Fibroadenoma

A
  • *most common etiology of breast lump**
  • young women
  • benign solid mass
  • typically painless or minimally painful
68
Q

What do ALL palpable masses get?

A
  • Mammogram
  • US
  • consider biopsy
69
Q

RF for breast cancer

A

> 70% have no RF

  • age
  • family hx in 1st degree relative
  • Modest increased risk = nulliparity, 1st preg after 30, menarche at 50, alcohol, obesity, and or high fat diet, tobacco use
70
Q

Mammogram Schedule

A
  • every 1-2 years starting at age 40
  • every 1 year after age 50
  • Women w/ BRCA1 or 2 may have annual or semiannual clinical breast exams along w/ annual mammography beginning at age 25-35.
71
Q

Most common type of breast cancer

A

Infiltrating ductal carcinoma

most lethal = inflamm

72
Q

Paget Dz of breast

A
  • infiltrating intraductal carcinoma in the nipple and ducts of the nipple
  • 1st symp = itching or burning of the nipple, therefore usually treated as eczema

PANCE (18 decks)

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