Womens Reproductive Health Flashcards
After age 60 is hypertension more common in men or women
Women
Is T2DM higher in men or women
Women
PCOS involves a triad of:
Insulin resistance, anovulation, and increased androgens
Autoimmune disorders are more common in
Women
What percentage of pregnancies are planned
Less than half
How often should the average women get a Pap test?
Every 3 years
The most common gyne malignancy is
Uterine cancer
Highest risk for uterine cancer is in
Obese, low parity women
MB Breast Screening Program recommends mammograms starting at age
50
50-69YO women should have a mammogram how often?
Every 2-3 years
What age do paps start in MB?
21
Cervical cancer is seen in women
20+
Commonest causes of mortality for a 19YO woman
Accidents and complications from HIV, followed by suicide
Which vaccination can reduce a woman’s risk of cervical cancer?
HPV vaccine
Uterine cancer presents with
Abnormal bleeding
Elevated risks in older mothers are
Genetic abnormalities, miscarriage, infertility, hypertension, gestational diabetes
A 60 YO woman should get a mammogram every
2-3 years
What nerve provides motor and sensory innervation to the perineal structures?
Pudendal nerve (S2-S4)
Pessaries are
Prosthetic devices used to prop up the vagina by providing intravaginal support
Large uterine fibroids may cause what sx
Pelvic pain, difficulties with micturition and defecation, backache and pain in the leg
Where does the distal ureter course in relation to the uterine artery?
Ureter under the artery - water under the bridge
Ovarian torsion presents as
Severe, constant, unilateral pelvic pain
Diagnosing suspected ovarian torsion
Diagnostic laparoscopy
Atypical endometrial hyperplasia can be a precursor to
Endometrial cancer
Most cases of endometrial cancers are due to
Prolonged unopposed estrogen exposure
Chronic HPV infection is a risk factor for
Cervical adenocarcinoma
Diethylstilbestrol exposure in utero increases risk of
Clear cell carcinoma of the cervix and vagina
Cervical Leiomyoma presents as
Protruding cervical mass with heavy bleeding
Uterine leiomyoma presents with
Bulk symptoms and heavy bleeding
Choriocarcinoma typically presents with
Vaginal bleeding, elevated B-hCG levels, enlarged uterus
Complete mullerian agenesis presents as
Amenorrhea and a blind vaginal pouch due to congenital absence of the uterus and cervix
Foreign body in the vagina can present as
Abdo pain, foul smell, discharge, bleeding
Sarcoma botryoides (a form of rhabdomyosarcoma) presents during infancy as
Polypoid of grapelike mass protruding from the vagina, associated with vaginal discharge and bleeding
Imperforate hymen usually presents as
Pubertal patients with cyclical abdo pain, amenorrhea, and hematocolpos
Treatment of a symptomatic bartholins duct cyst
Incision and drainage with possible word catheter placement
Which HPV strains cause condylomata accuminata
11 and 16
Cluster headache onset is often during
Sleep
Location of cluster headache
Behind one eye
Tension headache location
Bilateral band around the head
Duration of cluster headache
Less than 2 hrs, multiple times followed by remission
Corneal edema/cloudiness, fixed mid dilated pupil, conjunctival redness is a signs of
Acute angle closure glaucoma
Florescein staining of the eye is usually performed to detect
Corneal abrasions or herpetic keratitis
HPV vaccine indications
All female and male patients age 11-26
Signs of acute inhalant intoxication
Transient euphoria and loss of conciousness
Chronic abuse of nitrous oxide can result in
B12 deficiency and polyneuropathy
What acid base disturbance can result due to hypoventilation?
Respiratory acidosis
What type of contraception is preferred in postpartum breastfeeding mothers
Progestin only
Bilateral nipple discharge workup
Pregnancy test, galactorrhea evaluation
Unilateral nipple discharge workup
Ultrasound +/- mammogram
Workup for galactorrhea
Prolactin and TSH levels, pregnancy test
Thelarche is
The onset of breast development
The first sign of puberty in most girls is
Thelarche
Adrenarche is the onset of
Body odor, pubic hair, etc
Treatment for asymptomatic pelvic organ prolapse
Reassurance and observation
Obesity is a major risk factor for endometrial hyperplasia because
Adipose tissue increases peripheral conversation of androgens to estrone - increased estrogen levels and causing unopposed uterine exposure
Ideal contraception in hypertensive patient
Copper containing IUD
Chronically elevated estrone levels can have what effect on menstrual cycle
Anovulation and abnormal uterine bleeding
What effect do copper IUDs have on periods?
They usually get heavier and more painful
Primary dysmenorrhea is due to
Excessive prostaglandin production
First line treatment for primary dysmenorrhea is
NSAIDs
Leiomyomata uteri is also known as
Uterine fibroids
Uterine fibroids are located in
Uterine myometrium
Chlamydia treatment
Doxycycline
Gonorrhea treatment
Ceftriaxone
Screening for intimate partner violence should occur for who
All women of childbearing age
A female fetus gets masculinization by abnormal levels of testosterone in
Congenital adrenal hyperplasia
Effects of in utero estrogen exposure will wane by what age?
6 months
Protruding vaginal mass after delivery, with mother in shock but not overtly bleeding may indicate
Vaginal hematoma (uterine artery)
Follicular, lutein, and polycystic sclerotic ovaries are all what type of conditions?
Functional, benign
A cyst that produces estrogen
Follicular cyst
A cyst that produces progestin
Lutein cyst (can delay menses)
Theca lutein cysts are associated with high levels of
B HCG
Dysmenorrhea
Painful periods
Menstrual cycle normal length
24-38 days
Duration of menstrual flow normal
4.5-8 days
Normal volume of blood loss in menstruation
5-80mL
FSH high, estrogen low
Primary ovarian insufficiency
Significant hypotension from maternal blood loss lowering the BP and causing necrosis in the anterior pituitary gland
Sheehans syndrome
Low estrogen differential
POI, thyroid, prolactin, tumour
Medical management patient with fibroids
Progestin only (controls bleeding), combined HC, GnRH (instant menopause)
Tumour markers in gyne malignancies
CA125, CEA, LDH, AFP, BHCG
TAH BSO
Total hysterectomy and bilateral salpingoophorectomy
PALM and COIEN for abnormal bleeding
Polyp, adenomyosis, leiomyoma, malignancy
Coagulopathy, ovulatory issue, endometrial, iatrogenic, not yet classified
Endometrial tissue invading myometrium, bulky painful heavy uterus with heavy bleeding
Adenomyosis
Medical treatment of adenomyosis
Levonorgestrel containing IUD
Contraindications to OCPs
Stroke risk with pseudo tumour cerebri or migraines with aura
Treating lichen sclerosis
Steroid cream, maybe estrogen therapy
A tumour that has bone in it
Dermoid cyst
Total vs subtotal hysterectomy
Whether the patient keeps their cervix or not
Dermoid cysts arise from what type of cell
Primordial germ cell - all three germ layers
Treating condyloma accuminata
Laser, cryotherapy, podophyllin
How long after puberty does menarche occur
2 years after
Ca125 is a tumour marker for
Ovarian cancer
VIN in young women
Usual VIN, warty or basaloid
VIN in older women
Differentiated (d vin)
Vulvar cancer can spread via lymph to
Inguinal nodes
Vulvar cancer can spread via blood to
Lung, liver, bone
Cervical cancer types
- Squamous cell carcinoma, 2. Adenocarcinoma
Mucopurulent cervicitis can be caused by
Gonorrhea, chlamydia
Profuse, frothy vaginal discharge
Trichomonas
Pruritic discharge, not STI
Candida
Foul and fishy discharge
BV
Treating for gonorrhea and chlamydia
Oral cefixime and azithromycin
Treating pelvic inflammatory disease
Ceftriaxone, doxycycline, metronidazole
Treating BV
Metranidazole
Treating syphilis
Benz G
Treating candidiasis
Topical azole, fluconazole PO
Treating lymphogranulonum venereum
Oral doxycycline
Bicillin (Benzathine penicillin G) treats
Syphilis
Most ectopic pregnancies are located in the
Ampulla
Rh negative women with pregnancy require
Rh immune globulin AKA WinRho, RhoGAM
Longer lifetime estrogen exposure increases risks of
Breast cancer
Mammography is recommended
Every 2-3 years for women 50-74
Signs of breast cancer
Mass, nodes in armpits, nipple changes
Estrogen ad progesterone receptor positive tumours in breast
Better prognosis (endocrine therapy)
HER2 status is associated with what prognosis
Poor prognosis
Treat HER2 cancers with
Trastuzumab
Treat ER PR positive breast cancers with
Aromatase inhibitors and CDK4/6 inhibitors
Treat triple negative breast cancers with
Chemotherapy
Cystocele
Bulging of bladder into the upper anterior vaginal wall
Rectocele
Weakness in the rectovaginal septum, bulging or descent toward posterior vaginal wall
Enterocele
Bulding of the rectum into the pouch of Douglas (usually with loops of bowel)
The baden walker system is used to grade
The clinical severity of pelvic prolapse in women
Stress incontinence
Occurs with increased intraabdominal pressure
Urgency incontinence
Urge with voiding, like you might not make it, caused by involuntary detrusor muscle over activity
Overflow incontinence defn
Continuous leakage with residual urine after emptying, due to detrusor under activity or bladder outlet obstruction
Treating mastalgia
NSAIDS - oral vs topical
Lactating vs non lactating mastitis treatment
Lactating - cloxacillin, non lactating - Amox clav
Post menopause, ovaries secrete mostly
Andosenedione and testosterone
Key feature of perimenopause
Menstrual irregularity
Contraindications for menopausal estrogen therapy
Unexplained vaginal bleeding, acute liver dysfunction, estrogen dependent cancer, coronary heart disease, previous stroke
Unilateral spontaneous bloody nipple discharge with mass workup for
Malignancy
What workup should a patient have prior to starting Trastuzumab
Echocardiogram to assess baseline function (to compare further reassessments to)
Common side effects of cisplatin and carboplatin
Ototoxicity
What workup should be obtained before using aromotase inhibitors (anastrozole, letrozole)
Baseline bone density scans
Tamoxifen increases the risk of
VTE
Bleomycin can cause
Pulmonary fibrosis
Trastuzumab risky side effect
Cardiotoxicity
No cervical change for more than 4 hrs with adequate contractions
C section
Adequate contractions are defined as more than
200mV units in ten minute interval
Vaginal delivery is contraindicated in patients with
Classical vertical cesarean delivery or abdominal myomectomy with uterine cavity entry
Intrauterine infusion to decreased cord compression and resolve variable decels
Amnioinfusion
Amnioinfusion is contraindicated in
Previous uterine surgery
Terbutaline is a
Tocolytic
Laboring patients at high risk of uterine rupture require
Laparotomy and cesarean delivery
What shot should all pregnant patients get
Flu shot
Normal internal genitalia, external virilization, undetectable serum estrogen in female is
Aromatase deficiency
Ambiguous external genitalia, normal internal female organs, electrolyte abnormalities
Congenital adrenal hyperplasia (21hydroxylase deficiency)
Hypogonadotropic hypogonadism with anosmia and low LH/FSH
Kallmans syndrome
Cafe au lair, polyostotic fibrous dysplasia, and autonomous endocrine hyper function (precocious puberty)
Mccune Albright syndrome
Cervical insufficiency clinical features
More than 2 prior painless second trimester losses, painless cervical dilation
Treatment for cervical insufficiency is
Cerclage placement
Thrombosis of the deep pelvic or ovarian veins, that becomes infected
Septic pelvic thrombophlebitis
Management of cervical intraepithelial neoplasia 3 in non pregnant women
LEEP, cold knife conization, cryoablation
Mechanism of hypertension caused by some OCPs
Increased angiotensinogen synthesis by estrogen during hepatic first pass metabolism
