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PANCE review > Women's Health - GYN > Flashcards

Women's Health - GYN Flashcards

1
Q

Phases of menstrual cycle

A
  1. follicular phase - begins with menses, increased FSH
  2. ovulation
  3. luteal phase - corpus luteum forms
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2
Q

A surge in ____ causes dominant follicle to release its egg.

A

LH

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3
Q

High levels of what, are important in thickening uterine lining for implantation

A

estrogen

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4
Q

What do follicles and corpus luteum secrete?

A

follicles - estrogen

corpus luteum - progesterone

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5
Q

What hormone change specifically causes shedding of uterine lining?

A

dramatic drop in progesterone

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6
Q

What happens to corpus luteum if fertilization occurs?

A

keeps producing progesterone until placenta develops and takes over production

this all occurs if hCG present

corpus luteum degrades to corpus albicans

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7
Q

What is primary amenorrhea?

A

no menstruation by 16 years old even with normal development

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8
Q

What genetic condition common cause of primary amenorrhea?

A

Turner Syndrome

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9
Q

What is secondary amenorrhea?

A

no menstruation over a 6 month period

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10
Q

Most common cause of secondary amenorrhea

A

pregnancy!

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11
Q

Signs of polycystic ovarian syndrome

A

hirsutism
obesity
virilization

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12
Q

Possible causes of secondary amenorrhea

A 
Pregnancy (most likely)
Anorexia
Stress
Asherman syndrome – intrauterine adhesions and scarring
Polycystic ovarian syndrome
Tumor of hypothalamus or pituitary
Sheehan syndrome – damage to pituitary secondary to ischemia during childbirth
Hypothryoid
Hyperprolactinema
premature ovarian insufficiency
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13
Q

What is primary dysmenorrhea and what causes it?

A

painful menstruation without pathology; caused by excessive prostaglandin production

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14
Q

First and second line treatments for primary dysmenorrhea

A

1) NSAIDs - inhibit prostaglandins

2) OCs, IUD, Depo shot - prevent ovulation

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15
Q

Possible causes of secondary dysmenorrhea

A 
Endometriosis
PID
Pelvic pain
Cervicitis
Fibroids
IUD
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16
Q

When are PMS symptoms present and absent in cycle?

A

Occur in luteal phase

NO symptoms in follicular phase

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17
Q

Diet modifications to help PMS

A

Increase complex carbs, calcium, Vit D
Decrease salt
Avoid sugar, alcohol, caffeine

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18
Q

Medical treatment for PMS

A

SSRIs
Oral contraception
Diuretics – spironolactone during luteal phase
NSAIDs

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19
Q

Average age of menopause

A

51

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20
Q

Age of premature menopause

A

less than 40

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21
Q

Hallmark finding of menopause

A

hot flashes

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22
Q

What lab is diagnostic of menopause?

A

FSH > 30

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23
Q

What is main cause of endometrial cancer?

A

estrogen given without progesterone

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24
Q

What symptoms are improved with estrogen replacement therapy?

A

hot flashes, insomnia, and osteoporosis

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25
Q

ADRs of hormone replacement therapy for menopausal women?

A

breast cancer and CV disease

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26
Q

How can vaginal dryness and dyspareunia of menopause be treated?

A

vaginal estrogen cream

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27
Q

Menorrhagia

A

excessive, heavy menstrual flow

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28
Q

Metrorrhagia

A

bleeding or spotting between menses

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29
Q

Dysmenorrhea

A

menstrual pain which interferes with activities of daily living

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30
Q

Hypomenorrhea

A

extremely light menstrual flow

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31
Q

Oligomenorrhea

A

menstrual periods that occur greater than 35 days apart

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32
Q

Who is most likely to have dysfunctional uterine bleeding?

A

Menopausal woman

Very young woman

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33
Q

Abnormal bleeding from the uterus without any problems found in the uterus =

A

Dysfunctional Uterine Bleeding (DUB)

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34
Q

What blood work should be done for Dysfunctional Uterine Bleeding?

A

CBC
Iron studies
PT/PTT

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35
Q

Dysfunctional Uterine Bleeding treatment

A

Oral contraception
D&C
Endometrial ablation
Hysterectomy

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36
Q

African American female comes in with dysmenorrhea and bleeding in between periods. Pelvic U/S shows firm mass on uterus. Likely dx?

A

fibroids

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37
Q

Fibroid treatment

A

Watchful waiting

GnRH agonists help reduce size by causing hypogonadism (Depot Leuprolide, Nafarelin)

Surgery - myomectomy or hysterectomy

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38
Q

dyschezia =

A

difficulty evacuating bowels

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39
Q

Woman comes in with dysmenorrhea and pelvic pain related to her menstrual cycle. She also c/o dyschezia. Growth of tissue seen outside uterus on U/S. Likely dx?

A

endometriosis

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40
Q

Endometriosis treatment

A

NSAIDS
Oral contraception
GnRh agonist
Danazol to suppress menstruation

Surgical
Laparoscopic fulguration – destruction of tissue using high voltage electricity
Hysterectomy with bilateral salpingo oophorectomy

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41
Q

Best imaging for suspected endometriosis

A

exploratory laparoscopy

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42
Q

Risk factors for endometrial cancer

A 
postmenopause
FHX of colon cancer
obesity
never pregnant
DM
PCOS
HTN
Unopposed estrogen therapy
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43
Q

How is endometrial cancer dx’d?

A

endocervical and endometrial biopsy

*PAP smear usually negative

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44
Q

Post-menopausal woman with abnormal uterine bleed. What must be ruled out?

A

endometrial cancer

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45
Q

Treatment for metastatic and recurrent endometrial cancer

A

high dose progestins

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46
Q

Types of uterine prolapse

A

Cystocele – bladder herniating into vagina
Rectocele – rectume herniating into vagina
Enterocele – small intestine herniating into vagina

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47
Q

What causes uterine prolapse?

A

Ligaments and muscles which suspend the uterus are damaged or stretched often secondary to vaginal delivery though it may occur even to women without children

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48
Q

Treatment of ovarian cysts

A

Watchful waiting. Follow with U/S in premenopausal women with small cyst

Laparoscopic surgery for large cysts

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49
Q

Signs/sx’s of ovarian cancer

A

Nondescript GI sx’s
Pelvic pain
Pelvic pressure
Palpable mass on pelvic exam

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50
Q

Way to monitor progression of ovarian cancer?

A

CA 125 levels

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51
Q

Treatment of ovarian cancer

A

abd hysterectomy, bilateral salpingo oophorectomy and lymphadenectomy, and removal of any visible tumors

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52
Q

An obese woman comes in c/o amenorrhea and excessive hair growth. She has also had difficulties becoming pregnant. What is likely to be seen on pelvic u/s?

A

polycystic ovaries

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53
Q

What labs are part of PCOS work up?

A

FSH/LH - premature ovarian failure, hypogonadotropic hypogonadism
TSH - thyroid causes
DHEAS - adrenal neoplasm
Glucose tolerance test

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54
Q

Treatment of polycystic ovarian syndrome if patient still desires to get pregnant?

A

Clomiphene and Dexamethasone to stimulate ovulation

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55
Q

Treatment of polycystic ovarian syndrome if patient does not want to get pregnant?

A

Medroxyprogesterone acetate daily for 1st 10 days of each month to stimulate endometrial shedding

Oral contraception

Treat hirsutism with spironolactone, flutamide, or finasteride (all teratogenic!)

56
Q

Risk factors for ovarian cancer

A

no children
40-60 yo
Caucasian
+ FHX

57
Q

Way to manage PCOS without medication?

A

lose weight

58
Q

neoplasia vs dysplasia

A

Neoplasia – abnormal growth of cells

Dysplasia – abnormal development typically with an excess of immature cells

59
Q

Risk factors for cervical dysplasia and cancer

A

risky sexual activity
HPV exposure
long term oral contraception use
smoking

60
Q

Vaccine to prevent cervical cancer? When to give?

A

HPV vaccine (Gardasil) recommended for children 9-26 yo

61
Q

Schiller test of cervical

A

part of colposcopy; cervix covered with iodine and dysplastic cells that do NOT stain and should be biopsied

62
Q

What are abnormal findings on routine PAP smear?

A 
Mild cervical intraepithelial neoplasia (CIN-1)
Moderate dysplasia (CIN-2)
Severe dysplasia (CIN-3); most progress to cancer
63
Q

What is next step if abnormal Pap smear?

A

refer for colposcopy and possible tissue biopsy

64
Q

Most likely location of cervical cancer?

A

transformation zone of cervix

65
Q

_______ is when the cervix begins to dilate and efface before labor.

A

cervical incompetence

66
Q

Pap smear shows a friable cervix with mucopurulent discharge. Likely dx and cause?

A

cervicitis; typically caused by Chlamydia and Gonorrhea

67
Q

Symptoms of vaginitis

A

vaginal pruritus, pain, burning, unusual discharge

68
Q

Normal pH of vagina? How is this effected by bacteria?

A

4.0 to 4.5

over 4.5 if bacteria present

69
Q

Cause of vaginitis with white cottage cheese discharge?

A

yeast infection

70
Q

Cause of vaginitis with foul-smelling frothy, yellow/green discharge?

A

Trichomonas vaginosis

71
Q

How is Candida dx’d?

A

KOH wet mount shows budding yeast and hyphae

72
Q

How is Trichomonas dx’d?

A

wet mount shows motile flagellates of protozoa

73
Q

Treatment of Candida vaginitis

A

Topical azoles

Oral fluconazole 150 mg oral tablet single dose

74
Q

Treatment of Trichomonas vaginosis

A

Metronidazole 2 g x one dose

All partners should be treated

75
Q

Cause of vaginitis with frothy, grey discharge and positive whiff test?

A

bacterial vaginosis

76
Q

What is seen on wet mount of bacterial vaginosis?

A

clue cells = epithelial cells covered in bacteria

77
Q

Treatment of bacterial vaginosis?

A

Metronidazole 500 mg BID x 7 days

Clindamycin

78
Q

Sign of HPV virus infection

A

vaginitis - pruritus, pain, burning

warty growths on vagina

79
Q

Treatment of HPV infection?

A

Remove painful warts:
Cryotherapy
Trichloroacetic acid
CO2 laser

Podofilax gel or Aldara cream

Surgical removal

80
Q

A 29 year old sexually active female presents to your office complaining of mucopurelent discharge. She has had several sexual partners over the past few weeks and here last period was three weeks ago. On physical exam the vagina appears normal however there is some bleeding from the cervix. What is the most likely cause of her infection?

A

Chlamydia or Gonorrhea infection causing cervicitis

81
Q

A 24 year old female presents to the ER complaining of strange foul smelling discharge per the vagina. You perform a wet mount and note that clue cells are present. The vaginal pH is 4.7. What is the best course of treatment.

A

Metronidazole 500 mg po BID x 7 day

82
Q

What causes most cases of Pelvic Inflammatory Disease?

A

Chlamydia and Gonorrhea

83
Q

PE findings of Pelvic Inflamm Disease?

A

Cervical motion tenderness

Purulent discharge

84
Q

Why would you do U/S to help dx abdominal pain as PID?

A

rule out appendicitis, ectopic pregnancy, ovarian torsion

look for abscess

85
Q

Culdocentesis

A

Placing a needle into rectovaginal space in order to culture fluid there; used to help dx PID

86
Q

What test is used to dx Gonorrhea and Chlamydia?

A

culture

NAAT

87
Q

Procedure to visualize abdominal and pelvic structures as well as obtain cultures?

A

Laparoscopy

88
Q

Treatment of PID

A

Mild - outpatient abx
Severe - hospitalize with IV abx
Surgery if unresponsive to treatment or pelvic abscess seen
Treat all sexual partners!

89
Q

Fibrocystic disease of breasts includes:

A

cysts, papillomatosis, adenosis, fibrosis, ductal epithelial hyperplasia

90
Q

Age for fibrocystic disease

A

30-50

91
Q

Sx’s of fibrocystic disease

A

palpable breast mass (usually multiple and bilateral)
+/- pain
Size changes with menstrual cycle
Nipple discharge

92
Q

Diagnostic imaging for breast masses

A 
Breast U/S
Mammogram
Biopsy
Fine-needle aspiration cytology
Gram stain or culture any discharge
93
Q

Most common breast lesion

A

Fibrocystic Disease

94
Q

Treatment of Fibrocystic Disease

A

Monitor
Aspiration of cysts reduce pain
Reduce caffeine?

95
Q

1-5 cm rubbery, movable, and non-tender breast mass is likely what?

A

fibroadenoma

96
Q

Treatment of fibroadenoma

A

Reassurance

Cryoablation

97
Q

Breast pathology commonly seen within 3 months of delivery or women who are nursing for the first time?

A

mastitis and breast abscess

98
Q

Common pathogen of in nipple discharge of mastitis

A

staph aureus

99
Q

Next step in non-lactating women with mastitis who does not respond to antibiotics?

A

incision and biopsy

100
Q

Treatment of mastitis and breast abscess

A

Abx to cover staph - Augmentin, Dicloxacillin

Mechanical emptying of breast

Abscess may need I&D

Ok to continue breastfeeding

101
Q

What is the most common female malignancy?

A

breast cancer

102
Q

2 types of breast malignancies? Which is more common?

A 
Ductal carcinomas (85%)
Lobular carcinomas (15%)
103
Q

How is invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS) treated?

A

IDC: Mastectomy or lumpectomy with radiation

DCIS: increased risk of IDC and therefore requires lumpectomy or mastectomy followed by radiation

104
Q

How is invasive lobular carcinoma (ILC) and lobular carcinoma in situ (LCIS) treated?

A

ILC: Lumpectomy or mastectomy

LCIS: monitor; not cancer but does increase risk of developing cancer

105
Q

What is Paget’s Disease?

A

cancerous skin cells around nipple that indicate underlying breast cancer

106
Q

Risk factors of breast cancer

A 
Advanced age (avg 60)
Nulliparity
Older at first pregnancy
Early menarche  50
Long term estrogen exposure
Genetics
FHX
Caucasian
107
Q

Gene that is involved in breast cancer?

A

BRCA 1 or 2

108
Q

PE of breast mass that is malignant

A

firm, poorly defined, immobile, non-tender

most often in upper outer quadrant

may have overlying peau d’orange (orange peel skin)

109
Q

Mammogram recommendations for breast cancer screening

A

every 2 years after age 50 if no risk factors

stop at age 75

110
Q

Imaging if cancer has become metastatic

A

CT

PET scan

111
Q

How can estrogen-receptor positive breast cancer be treated medically?

A

Tamoxifen - estrogen receptor antagonist

112
Q

Procedures and therapies to treat breast cancer

A

Lumpectomy
Mastectomy
Chemo/radiation
Tamoxifen

113
Q

Main sign of pituitary prolactinoma

A

galactorrhea

114
Q

Lab work-up of galactorrhea

A

Prolactin levels

hCG

115
Q

Meds that can reduce galactorrhea

A

Cabergoline and bromocriptine

116
Q

What is gynecomastia?

A

male developing female breasts

117
Q

Possible causes of gynecomastia?

A 
endocrine d/o
chronic liver or kidney disease
neoplasm
medications
puberty
118
Q

What imbalances in hormones are seen in gynecomastia?

A

low testosterone
increased estradiol
+/- elevated prolactin

119
Q

genetic disorder that causes gynecomastia in men?

A

Klinefelter’s syndrome

120
Q

Gynecomastia treatment

A

generally self-limiting
stop offending meds
treat underlying cause
surgical removal

121
Q

Gram stain for Gonorrhea

A

G- diplococci

122
Q

Breast exam shows multiple well defined masses which are tender

A

fibrocystic disease

123
Q

Basics of why are synthetic estrogen and progestin combinations used as contraceptives?

A

suppress ovulation

124
Q

What is Minipill?

A

progesterone only oral contraceptive

not as effective as combination pills but have different side effect profiles

125
Q

Non-contraceptive benefits of OCPs

A

Improve benign breast disease
Decrease anemia
Improve dysmenorrhea, acne, and hirsutism
Decrease development of myomas
Decrease risk of endometrial cancer and ovarian cysts

126
Q

ADRs of oral contraception

A

Increased risk of stroke, DVT, and breast cancer

127
Q

ADRs of IUD

A

uterine perforation

increased risk of ectopic pregnancy and pelvic infection

128
Q

Clinical definition of infertility

A

inability to conceive after 1 year of sexual activity without use of contraceptive

129
Q

Female causes of infertility

A 
Problems with ovulation
Cervical Problem
Infection (Chlamydia)
Scarring of tubes or uterus
Endometriosis
130
Q

Male causes of infertility

A

Smoking or alcohol
Recreational or rx’d drug use
Scrotal hyperthermia
Abnormal spermatogenesis

131
Q

Lab work to find cause of infertility

A

Semen analysis
FSH, LH, TSH, progesterone and estrogen levels
Ovulation prediction tests

132
Q

Imaging to find cause of infertility

A

pelvic u/s
hysterosalpingography
laparoscopy

133
Q

Infertility treatment

A

Clomiphene citrate 50-100 mg to promote ovulation

Resolve any infections or endocrine disorders

Surgical - fulguration of endometriosis, disruption of scarring and adhesions

Artificial insemination
In vitro fertilization

134
Q

The theoretical failure rate of oral contraception is _____ but the typical failure rate is _____.

A

0.3%, 8.0%

135
Q

A patient calls to tell you that she has missed her pill yesterday. Upon further questioning she has not had intercourse in the past week. What is her best course of action?

A

recommendation is to take both pills today and use a barrier method for 7 days

PANCE review (18 decks)

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