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OB/Gyn > gyn procedures > Flashcards

gyn procedures Flashcards

1
Q

LSIL - LEEP procedure indicated?

A

no f/u with repeat pap in 6 months

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2
Q

indications for cold knife conization

A

+ endocervical curettage, HSIL lesion too big for LEEP, lesion extends into endocervical canal beyond vision, r/o invasive cancer

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3
Q

cervical cancer tx

A

radical hysterectomy

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4
Q

IUD for endometriosis

A

Levonorgestrel IUD

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5
Q

thelarche

A

breast budding

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6
Q

adrenarche

A

hair growth

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7
Q

menarche

A

onset of menses

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8
Q

order of puberty

A

thelarche, adrenarche, growth spurt, menarche

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9
Q

weight required for menses

A

85-105 lbs

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10
Q

Noonan’s syndrome - physical chracteristics

A

short stature, webbed neck, heart defects, abnormal faces and delayed puberty

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11
Q

Noonan’s syndorme - karyotype

A

normal

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12
Q

Turner syndrome - karyotype

A

XO

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13
Q

Turner syndrome - physical characteristics

A

pterygium colli, shield chest and cubitus valgus

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14
Q

Rokitansky-Kuster-Hauser Syndrome

A

vaginal/uterine agenesis

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15
Q

Kallmann syndrome

A

olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH

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16
Q

Kallmann syndrome - tx for no puberty

A

pulsatile GnRH therapy

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17
Q

true precocious puberty

A

diagnosis of exclusion, sex steroids increased by hypothalamic, pituitary, gonadal axis with increased pulsatile GnRH secretion

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18
Q

precocious puberty - CNS causes

A

tumors (astrocytoma, glioma, germ cell tumors secreting hCG), hypothalamic hamatomas, injury (surgery, trauma, radiation, inflammation, abscess), congenital (hydrocephalus, arachnoid cysts, suprasellar cysts)

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19
Q

McCune Albright

A

premature menses BEFORE breast/pubic hair development

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20
Q

true precocious puberty - tx

A

if not within several months o expected puberty, GnRH agonist to suppress axis (non-pulsatile = suppression)

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21
Q

congenital adrenal hypoplasia - mechanism

A

21-hydroxylase type results in the adrenal being unable to produce adequate cortisol as a result of a partial block in the conversion of 17-hydroxyprogesterone to desoxycorticosterone, with the accumulation of adrenal androgens

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22
Q

congenital adrenal hypoplasia - outcome

A

precocious adrearche

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23
Q

congenital adrenal hypoplasia - tx

A

steroid replacement

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24
Q

congenital adrenal hypoplasia, premature adrenarche, some then develop ___ in adlescence

A

PCOS

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25
Q

normal ages for menarche

A

9 - 17

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26
Q

pt with uterine agenesis, look for __

A

Renal anomalies occur in 25-35% of females with Mullerian agenesis

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27
Q

most common lower genital tract malformation

A

imperforate hymen

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28
Q

short vagina and pelvic mass on exam

A

iperforate hymen/vaginal or cervical agenesis

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29
Q

weight loss - hypothalamic dysfunction - lack of pulsatile GnRH - pituitary doesnt secrete LH/FSH

A

hypothalamic pituitary dysfunction

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30
Q

causes of hypothalamic-pituitary amenorrhea

A

functional (weight loss, obesity, excessive exercise), drugs (marijuana and tranquilizers), neoplasia (pituitary adenomas), psychogenic (chronic anxiety and anorexia nervosa), and certain other chronic medical conditions

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31
Q

PCOS tx

A

OCPs

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32
Q

PCOS desiring pregnancy - tx

A

clomiphene

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33
Q

most common cause of amenorrhea

A

pregnancy

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34
Q

Mayer-Rokitansky-Kϋster-Hauser syndrome - aka…

A

Mullerian agenesis - congenital absence of vagina (absence of allopian tubes/uterus), ovaries are present and functioning (secondary characteristics of puberty occur at appropriate time)

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35
Q

Asherman’s syndrome - causes

A

endometritis or curettage

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36
Q

Sheehan’s syndroe - cause

A

postpartum hemorrhage, pituitary apoplexy

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37
Q

initial laboratory assessment for a patient with amenorrhea and no other symptoms or findings on physical exam

A

prolactin

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38
Q

if elevated prolactin - order

A

brain MRI

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39
Q

if first round of labs are normal - order…

A

17-hydroxyprogesterone, LH, FSH

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40
Q

short duration hirsutism, high DHEAS, normal testosterone

A

adrenal tumor

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41
Q

patient with suspected PCOS, what need to r/o?

A

late-onset 21-hydroxylase deficiency

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42
Q

PCOS - hat lab is abnormal?

A

testosterone

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43
Q

what use to treat hirsutism? why?

A

OCPs - establish regular menses and lower ovarian androgen production

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44
Q

test to evaluate Cushing’s disease?

A

dexamethasone suppression test or a 24-hour urinary measurement for cortisol can be performed

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45
Q

Sertoli-Leydig tumors - age at dx?

A

20-40

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46
Q

Sertoli-Leydig - side?

A

unilateral

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47
Q

Rapid onset of hirsutism and virilizing signs are hallmarks of this disease, and include many of the findings in this patient including acne, hirsutism, amenorrhea, clitoral hypertrophy, and deepening of the voice.

A

Sertoli-Leydig tumor

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48
Q

Abnormal laboratory findings include suppression of FSH and LH, marked elevation of testosterone, and presence of an ovarian mass.

A

Sertoli-Leydig tumor

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49
Q

causes of virilization (5)

A

PCOS, hypothyroidism, androgen producing tumors (ovarian, adrenal, or pituitary), and anabolic steroid use. A rare cause may be late onset CAH

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50
Q

hyperthecosis - definition

A

more severe form of polycystic ovarian syndrome (PCOS

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51
Q

hyperthecosis - symptoms

A

virilization due to the high androstenedione production and testosterone levels. In addition to temporal balding, other signs of virilization include clitoral enlargement and deepening of the voice

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52
Q

hyperthecosis - tx

A

more difficult to treat with OCPs

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53
Q

hirsutism - tx (in addition to OCP) - how does it help?

A

Spironolactone, an aldosterone antagonist diuretic

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54
Q

endometriosis - medical tx

A

Danazol

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55
Q

2nd line tx for hirsutism

A

lupron, depo-provera

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56
Q

progestin withdrawal

A

sloughing of endometrium

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57
Q

involution of corpus luteum

A

progestin withdrawal

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58
Q

inhibin in luteal phase?

A

increases

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59
Q

method to evaluate abnormal bleeding?

A

pelvic u/s

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60
Q

observation of endometrial polyp NOT recommended when?

A

> 1.5cm

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61
Q

management of endometrial polyp

A

observation, medical management with progestin, curettage, surgical removal (polypectomy) via hysteroscopy, and hysterectomy

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62
Q

irregular, heavy vaginal bleeding - study/test? why?

A

endometrial biopsy - to r/o endometrial hyperplasia or carcinoma

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63
Q

LH and FSH in PCOS?

A

elevated (high ovarian androgen production = high estrogen)

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64
Q

why is T high in PCOS?

A

sex hormone binding globulin is low b/c high circulating androgens = high free/active T

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65
Q

workup for irregular/heavy vaginal bleeding

A

TSH, Prolactin, pelvic ultrasound and endometrial biopsy

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66
Q

cause of midcycle bleeding?

A

drop in estrogen at time of ovulation

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67
Q

dysmennorrhea - tx

A

NSAIDs, OCPs

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68
Q

how do OCPs help dysmenorrhea?

A

progestin = endometrial atrophy (endometrium = where PGEs are made = fewer = less pain)

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69
Q

secondary dysmenorrhea - cause?

A

PID

70
Q

screening for sexually active patients <25yo?

A

gonorrhea, chlamydia,

71
Q

Blue-black powder burn lesions

A

endometriosis

72
Q

endometrial glands/stroma and hemosiderin-laden macrophages

A

endometriosis

73
Q

treatment of adenomysosis (surgical vs medical)

A

hysterectomy vs GnRH agonist

74
Q

to improve irregular bleeding but keep option fo future pregnancy

A

progesterone IUD

75
Q

perform ___ on all women >40yo with irregular/heavy menstrual bleeding (regardless of presence of other things ie fibroids)?

A

ENDOMETRIAL BIOPSY

76
Q

well-circumscribed, non-encapsulated myometrium

A

fibroids (>10 mitotic figures/hpf)

77
Q

patient >50 with menopausal sx and intermittent vaginal bleeding - contraindication for hormonal treatment?

A

vag bleeding (sign of cancer)

78
Q

premature ovarian failure - definition

A

< 35yo

79
Q

postmenopausal women require ___ ca per day?

A

1200mg

80
Q

how often repeat bone mineral density test when pt on bishosphonates?

A

Q2yr

81
Q

SE of starting hormone therapy for menopausal sx?

A

vaginal bleeding in 1st 6mo

82
Q

effect of estrogen on lipids?

A

GOOD for both = increase HDL, decrease LDL

83
Q

osteopenia definition

A

-1 to -2.5

84
Q

fracture risk factors

A

prior fracture, family history of osteoporosis, race, dementia, history of falls, poor nutrition, smoking, low body mass index, estrogen deficiency, alcoholism, and insufficient physical activity

85
Q

circulating androgens are converted to ___ in fat?

A

entrone, estradiol

86
Q

PCOS - LH and FSH - what is the relationship?

A

LH/FSH ratio is increased

87
Q

menstrual irregularities d/t hypothyroid correct with OCPs?

A

no

88
Q

ovulatory dysfunction in PCOS - tx

A

metformin + ovulatory agents (clomid)

89
Q

imipramine can cause

A

hyperprolactinemia

90
Q

hypothyroidism - hormone changes?

A

increased TSH, decreased T4, HIGH prolactin, decreased LH/FSH

91
Q

exercise-induced hypothalamic-pituitary dysfunction - characteristic hormones?

A

low estrogen, normal FSH

92
Q

treat exercise hypothalamic-pituitary dysfunction?

A

if less exercise+weight gain dont work = exogenous LH/FSH

93
Q

clomiphene challenge test

A

giving clomiphene citrate days 5-9 of the menstrual cycle and checking FSH levels on day 3 and day 10, will help determine ovarian reserve

94
Q

when are women most fertile?

A

mid-cycle when ovulating (approx day 14)

95
Q

egg viability after ovulation

A

24 hours

96
Q

vitamins that help with PMS

A

A, E, B6

97
Q

when experience PMS and PMDD symptoms?

A

luteal phase of menstrual cycle

98
Q

tx for PMS/PMDD

A

OCPs (suppress hypothalamic-pituitary axis), SSRIs (every day or for 10 days in luteal phase)

99
Q

strongest associations with PMS

A

+ family history, B6, calcium, magnesium deficit

100
Q

increased risk for molar pregnancy

A

Asian race (1/800), 2+ miscarraiges

101
Q

risk for recurrent molar if had 1 already

A

1-2%

102
Q

vaginal bleeding, enlarged uterus size>dates, or size<dates, hyperthyroidism (tachycardia), preeclempsia (hypertension)

A

molar pregnancy

103
Q

manage molar pregnancy?

A

suction curettage

104
Q

complete mole karyotype?

A

complete moles are diploid resulting from fertilization of “empty egg” by single sperm (46XX, 90%) or by two sperm (X & Y = 46XY 6-10%)

105
Q

partial molar preg - look like?

A

villi swelling

106
Q

complete molar preg - look like?

A

trophoblastic proliferation with hydropic degeneration

107
Q

partial mole karyotype?

A

2 sperm fertilize egg with genetic material = XXY XXX XYY

108
Q

how long wait to conceive after molar preg?

A

6mo after resolution of BhCG

109
Q

association between infertility and molar pregnancy? t/f?

A

NO, FALSE

110
Q

choriocarcinoma - dx?

A

quantitative B-hCG w/hx of recent pregnancy

111
Q

choriocarcinoma - biopsy?

A

never!!! (super vascular)

112
Q

choriocarcinoma - biopsy?

A

never!!! (super vascular)

113
Q

moderately differentiated vulvar carcinoma - tx?

A

radical vulvectomy + node dissection

114
Q

microinvasive squamous cell carcinoma of vulva

A

wide local excision

115
Q

most common vulva malignancy

A

squamous cell carcinoma (90%)

116
Q

risk for SCC of vulva

A

lichen sclerosus

117
Q

“crinkled tissue paper” on vulva

A

lichen sclerosus

118
Q

white plaque-like lesions and poorly demarcated erythema, not a discrete mass

A

Paget’s disease of vulva

119
Q

vulvar intraepithelial neoplasia (VIN)

A

related to HPV, multifocal hyperpigmented areas on vulva

120
Q

hidradenitis

A

chronic, unrelenting skin infection causing deep, painful scars and foul discharge

121
Q

vulvar intraepithelial neoplasia (VIN3) - tx?

A

wide local excision, close subsequent surveillance

122
Q

vulvar intraepithelial neoplasia (VIN3) - tx?

A

wide local excision

123
Q

condyloma tx?

A

trichlolroacetic acid, imiquimod

124
Q

cervical dysplasia - tx?

A

cryotherapy

125
Q

VIN2 tx?

A

laser ablation

126
Q

Paget’s disease of vulva - what is it?

A

in situ carcinoma of the vulva (scattered whitish lesions, VERY itchy, assoiated with breast ca,

127
Q

cervical ectropion

A

central, columnar epithelium of endocervical canal protrudes out into outer cervix = reddish ring of tissue surrounding cervical os

128
Q

Punctations and mosaicism represent ___?

A

new blood vessels on end/side

129
Q

cervical dysplasia - graded based on?

A

degree of involvement of epithelial layer - NOT invasion beyond basement membrane (becomes more than dysplasia, more than CIN)

130
Q

cervical dysplasia - graded based on?

A

degree of involvement of epithelial layer - NOT invasion beyond epithelial layer (becomes more than dysplasia, more than CIN)

131
Q

+ endocervical curettage - tx?

A

cervical conization

132
Q

when use cryotherapy?

A

cervical dysplasia when malignancy RULED OUT (have full visualization of lesion)

133
Q

Cervical cancer screening should start at ?

A

age 21 years.

134
Q

women aged 21-29 should have pap every ___ years?

A

3

135
Q

· Women aged 30 – 65 years should have a Pap test and an HPV test (co-testing) every ____years (preferred). It is acceptable to have a Pap test alone every __ years.

A

5, 3

136
Q

· Women should stop having cervical cancer screening after age __years if they do NOT have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row, or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past five years.

A

65

137
Q

exceptions to cervical ca screening guidelines

A

· Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system, or who were exposed to DES before birth should not follow these routine guidelines.

138
Q

most common symptom with leiomyoma?

A

menorrhagia

139
Q

which type of leiomyomas cause infertility

A

submucosal

140
Q

fibroid growth stimulated by?

A

estrogen

141
Q

if fibroid pain, nsaids fail, dont want surgery = tx options?

A

GnRH agonist = suppresses estrogen)

142
Q

postmenopausal woman with bleeding, pelvic pain coupled with uterine enlargement, and vaginal discharge

A

consider uterine leiomyosarcoma

143
Q

endometrial hyperplasia more common in who?

A

perimenopausal who dont ovulate regularly, potmenopausal

144
Q

complex atypical hyperplasia - risk of progressing to endometrial ca?

A

28% (30% of women with that dix will end up having ca on final path)

145
Q

complex atypical hyperplasia - risk of progressing to endometrial ca?

A

28%

146
Q

most women with endometrial ca present with?

A

bleeding (80-90%)

147
Q

endometrial ca - hereditary?

A

no

148
Q

endometrial ca - associated with what syndrome?

A

Hereditary Non-polyposis Colorectal Cancer Syndrome (HNPCC, or Lynch II)

149
Q

most common gyn malignancy?

A

endometrial carcinoma

150
Q

after pathalogic diagnosis from biopsy, what test next?

A

extent of disease

151
Q

most common site of distant spread of endometrial ca?

A

lungs

152
Q

surgery for early endometrial ca? (well-differentiated endometrioid adenocarcinomas)

A

extrafascial total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy

153
Q

surgery for early endometrial ca?

A

extrafascial total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy

154
Q

aggressive types of endometrial ca?

A

clear cell or papillary serous carcinomas

155
Q

adnexal mass in perimenopausal woman ,irregular bleeding, endometrial hyperplasia,

A

granulosa cell tumor (ovarian mass + Secretes estrogen = hyperplasia)

156
Q

presenting symptom of endometrial ca in postmenopausal woman?

A

bleeding or discharge

157
Q

most common cause postmenopausal bleeding

A

most common causes of postmenopausal bleeding are atrophy of the endometrium (60-80%), hormone replacement therapy (15-25%), endometrial cancer (10-15%), polyps (2-12%), and hyperplasia (5-10%).

158
Q

risk factors for ovarian ca?

A

nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe (NOT SMOKING)

159
Q

risk factors for ovarian ca?

A

nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe

160
Q

lager than functional cyst, presents with increasing abdmoinal girth

A

serous cystadenoma

161
Q

multilocular and quite large cyst on ovary

A

mucinous cystadenoma

162
Q

solid components or appear echogenic on ultrasound, on ovary

A

dermoid cyst

163
Q

to assess extent of ovarian ca spread, use __?

A

abdomen/pelvis CT

164
Q

widespread ovarian ca with large tumor burden - initial tx?

A

tumor debulking

165
Q

widespread ovarian ca but unresectable or pt is bad surgical candidate - tx?

A

neoadjuvant chmotherapy

166
Q

what determines 5 year survival of women with epithelian carcinoma of ovary

A

tumor STAGE

167
Q

tx for women with advanced ovarian ca?

A

surgical cytoreduction then chemo (taxane, platinum)

168
Q

5 year survival with stage III / IV ovarian ca?

A

30%

169
Q

most common karyotype in spontaneous abotuses

A

autosomal trisomy

170
Q

what is danazol?

A

GnRH agonist

OB/Gyn (3 decks)

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