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Flashcards in 17 GYN Deck (56)
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1

You see an adnexal mass on U/S
how to think about it in:

-premenstrual
-reproductive age
-postmenopausal

-ovarian CA (germ cell) until proven otherwise
-Simple cyst, vs complex cyst (many possibilities)
-ovarian CA (epithelial) until proven otherwise

2

Types of incontinence (3) main ones
-dx
-tx

1. stress--'sneeze and pee,' no nocturia. multiple births. Give pessary, surgery

2. urge (hypertonic)--urge and nocturia. Antispasmodic--anticholinergic (oxybutynin)

3. overflow (hypotonic)--no urge, yes nocturia. Neurogenic cause (trauma, diabetes, MS). Bethanechol/doxazosin, cath.

3

Structural abnormality causing vaginal bleeding
-DDx
-differences on exam
-how to workup

fibroids--asymmetric enlarged uterus
polyps--normal
adenomyosis--symmetric enlarge uterus

Start with transvag U/S. Best MRI
Possible bx if r/o CA

4

MTX for ectopic, criteria (4)

1. B-HCG <8000
2. <3cm
3. no fetal heart tones
4. no folate supplementation

No rupture.

5

"grape-like" structure in vagina

2 things:
-Vaginal adenoCA from DES use in mom

-molar pregnancy can also have grape-like mass in vagina

6

Cervical CA screening
-immunocompetent, different ages
-immunocompromised

q3y 21-29
q3y or q5 PAP +HPV testing, 30-65
65 stop if no abnormal screens before

start at sex onset

7

MCC pre-menarchal bleeding in young girl

foreign body

do speculum exam under anesthesia

8

vulva: "porcelain-white" lesions, itchy
think what, do what

Think lichen sclerosis
Bx to r/o SCC
steroids

9

spontaneous abortion, completed.
-do what for patient (4)

-U/S to make sure all products gone
-track B-HCG to 0
-give OCPs
-give Rhogam

10

TOA
-how to tx

Give Abx first (Amp-Gent-MTZ)
GNR: Amp-Gent, or Cipro
Anaerobes: MTZ, or Clinda

surgery not always necessary

11

Red vulvar lesion

Pagets.
Bx to confirm, then Local resection

12

abortion types (5)
os
passage of products
U/S

Vag Bleeding
threatened--os closed, no passage, live baby
inevitable--os open (or about to), no passage, dead baby
incomplete--os open, yes passage, retained parts
complete--os closed, yes passage, empty uterus

Missed--os closed, no passage, dead baby still inside

13

Primary amenorrhea
-how to approach, DDx, big picture

Think 2 things: Does pt have functional axis, and does she have the anatomy to bleed from (uterus)?

yes, yes--imperforate hymen, anorexia, stress
yes, no--mullerian agenesis, AIS
no, yes--Turners, Kallmans, Craniopharyngeoma

Physical exam for axis (breast buds, axillary hair)
U/S for anatomy, looking for uterus

14

Choriocarcinoma
-where to find mets

lung, brain

15

Endometriosis
-3 sxs to know

-dyspareunia
-dysmenorrhea
-infertility!

16

post-menopausal female with ascites, but no liver dz.
Think what

epithelial ovarian CA

17

Couple can't have a child
-when is it considered 'infertility'
-describe workup

infertility: >1y trying
blame man first (test for ED, semen)
then woman: bad mucus, anovulation, anatomy, endometriosis

18

Pt with Postmenopausal bleeding. you get endometrial sample. Do what for:

-simple hyperplasia, atypia
-complex atypia, dysplasia, or adenocarcinoma

-conservative, tx with Progesterone

-TAH-BSO. If mets add chemo

19

Choriocarcinoma
-how to dx
-tx (2)

elevated B-HCG, look at U/S
stage with CT
worry about liver/brain mets!

1. suction curretage (not D+C)
2. If mets, 'MAC" MTX, actinomycin, cyclophosphamide

20

Vulvar lesion:
what is use of acetic acid?

Put it on, if lesion turns white, it is HPV condyloma acuminatum.

Many tx: imiquimod, cryo, etc

21

Simple vs complex ovarian cyst
-what is difference
-tx
-what if already on OCPs

Simple: smooth, fluid filled, <7 cm.
Complex: loculated, >7cm, already on OCPs, not resolved in 2 months

Simple: rU/S in 3-4 mo, Should resolve.
OCPs don't really help, as previous thought

Complex: CT
If simple cyst found and pt already on OCPs, go straight to CT. Higher risk for malig. This is not simple cyst anymore, it is complex.

22

Rectocele
-what does this cause

rectum falls foward into vaginal space
-constipation. Pt can push finger into vagina to press on rectum to push stool. (Transvag digital compression)

23

menopause
perimenopause
menopausal transition

definitions

average age menopause
when too early

3 common sxs

What labs

1. 1 year+ after last menses occured
2. time period from onset of menstrual iregularity to start of menopause
3. same as perimenopause

average: 51. too early:40

hot flashes, vaginal dryness, mood swings

High FSH is dx, somewhat high LH

24

menopausal woman with hot flashes
-possible to tx? what to avoid

can use Venlafaxine (SNRI)
-avoid hormone replacement therapy (endometrail CA)

25

CAH
congenital adrenal hyperplasia
-what test
-which type MCC, how present

screening test: 17 OH Progesterone

21 OH-lase def. neonate with hypoNa, hyperK, hypotension. Both aldo and cortisol shunted.

26

Secondary amenorrhea,
-how to do full workup after first step of r/o 4 initial causes

Test the HPO axis, going backwards.

1. Progestin challenge (can endometrium bleed?)
If bleed, then anovulation

2. E+P challenge
If bleed, normal uterus.
If no bleed, then endometrial dysfxn (eg Ashermans)

3. LH, FSH
If high, then ovarian dysfxn--menopause or Savage (check for follicles on U/S)
If low, then central issue--pit problem, MRI

27

Fibroids
-tx options (3)

1. If mom wants to get pregnant, do surgery (myomectomy)
2. TAH if mom does not want to get pregnant
3. Leuprolide to shrink if too big for surgery

28

Pap smear comes back:
-ASCUS
-Abnormal

-do what

ASCUS: get HPV test or rPAP in 3 mo if age21-24. If either abnormal, do colpo

Abnormal: do colpo

29

Post partum hemorrhage
-management
-what blood vessels to ligate, what order?

1. massage
2. meds--oxytocin, transfuse
3. surgery (ex-lap)
-uterine a 1st to ligate
-then, internal iliacs
-then, TAH!

30

Missed abortion
-how to remove dead baby/products?

<24 weeks: D+C/suction
>24 weeks: induce