ClinMed I Flashcards
(135 cards)
1
Q
2 leading causes f death in US women
A
- heart disease
2. cancer
2
Q
cervical cancer screening ages 21-29
A
pap test q3 yr
3
Q
cervical cancer screening ages 30-65
A
pap test and HPV q5 yr
OR pap test q3 yr
4
Q
gonorrhea/chlamydia screening ages
A
=24 yrs
5
Q
HPV immunization ages
A
=26 yo
6
Q
routine screening for uterine and ovarian cancer
A
none
7
Q
what pelvic measurement is used to approximate the obstetric conjugate?
A
diagonal conjugate
8
Q
what measurement describes the smallest diameter a fetal head must pass?
A
obstetric conjugate
9
Q
what is the most common pelvis shape?
A
gynecoid
10
Q
what is considered the keystone of perineum
A
perineal body
11
Q
what is the adnexa?
A
uterine tube + ovaries
12
Q
what drapes over pelvic viscera?
A
parietal peritoneum
13
Q
what nerve is responsible for innervation of vagina?
A
pudendal nerve
14
Q
what is the site called where ectocervical and endocervical cells meet?
A
squamo-columnar junction
15
Q
MC position of uterus
A
on top of bladder, with slight anteflexion and anteversion
16
Q
what is adrenarche
A
maturational increase in adrenal androgen production (begins 6-8yrs)
17
Q
what is gonadarche
A
maturation of neuroendocrine-gonadotropin-gonadal axis; marks onset of puberty
18
Q
proliferative phase of the endometrium corresponds with what phase in the ovary?
A
follicular
19
Q
secretory phase of the endometrium corresponds with what phase in the ovary?
A
luteal
20
Q
what is perimenopause
A
time between normal ovarian function and ovarian failure; decreased number of ovarian follicles and estradiol production
21
Q
how do you define menopause
A
absence of menses for > 1 year
22
Q
what hormone triggers ovulation and where is it produced
A
LH, anterior pituitary
23
Q
what hormone does the corpus luteum make?
A
progesterone primarily
24
Q
what hormonal changes cause menses
A
withdrawal of progesterone
25
what hormone do the ovarian follicles make?
estrogen
26
why is estrogen without progesterone a problem?
the lining with proliferate (at risk for uterine cancer)
27
diagnosis of uterine fibroids via ...
pelvic U/S
28
MC presentation of uterine fibroids
bleeding
but most are ASX
29
MC causes of bartholin's gland abscess
n. gohorrhea or clamydia
but r/o adenocarcinoma in women over 40
30
major risk factor for endometrial cancer
increased estrogen exposure
31
definitive dx for endometriosis
laparoscopy
32
what might you find on PEx in a patient with adenomyosis?
tender, uniformly enlarged, boggy uterus
33
PCOS triad
amenorrhea
obesity
hirsutism
34
2 main menstrual irregularities with PCOS
amenorrhea (50%); oligomenorrhea (70%)
35
what do you do when a patient with PCOS says she doesn't have a menses?
pregnancy test
36
what should you always order in a pt with acute pelvic pain
pregnancy test
37
what tumor marker is followed with ovarian cancer?
CA-125
38
which cancer has the highest mortality of all gyn cancers?
ovarian
39
3 ovarian cancer risk reduction strategies
1. OCPs >5 years
2. preg prior to 25
3. prophylactic salpingo-oophorectomy
40
what is the MC gyn malignancy
endometrial
41
your pt is being given unopposed estrogen. why is this a big no no?
increases risk for endometrial cancer (proliferation without shedding)
42
OCPs are protective against what two cancers?
ovarian
| endometrial
43
what's a big red flag symptom for endometrial cancer?
abnormal uterine bleeding (esp postmenopausal)
44
what the main dx method for endometrial cancer?
endometrial biopsy
45
stage I endometrial cancer treatment
hysterectomy +/- post op radiation
46
HPV is a risk for what type of cancer?
cervical
47
early onset of sexual activity, high number of sexual partners, smoking, OCPs are all risk factors for what
cervical cancer
48
MC symptoms of cervical cancer
post coital bleeding and intermenstrual spotting
49
diagnosis cervical cancer is done via
colposcopy/biopsy
| pap smear with cytology used for screening
50
what are 4 ways to reduce cervical cancer risk?
1. HPV vaccine
2. pap smear/HPV testing
3. smoking cessation
4. counsel safe sex practices
51
pruritus is the most common complaint with what type of cancer
vulvar cancer
52
MC cell type of vulvar cancer
squamous
53
two main groups of female incontinence
stress UI
urgency UI
also mixed UI
54
your pt complains of involuntary loss of urine when they sneeze and also when they jump. what type of incontinence is this?
stress UI
55
pathophys of majority of urge urinary incontinence
idiopathic
56
risk factors for stress incontinence
```
obesity
childbirth
family history
age
previous pelvic surgery
```
57
what are the two main categories of AUB?
anovulatory vs ovulatory
58
MC secondary cause of amenorrhea
pregnancy
59
primary amenorrhea is failure to menstruate by age ___ in presence of 2ndary sex characteristics OR by age ____ in absence of secondary sexual characteristics
15-16 in presence of 2ndary characteristics
OR
14 in absence of 2ndary characteristics
60
4 main causes of primary amenorrhea
1. chromosomal disorder
2. mullerian genesis
3. physiological delay
4. PCOS
61
secondary amenorrhea is defined as
cessation of regular menses for 3 cycles OR cessation of menses for 6 months
62
if pt is post menopausal and has bleeding what TWO things must be done?
endometrial biopsy
| pelvic US
63
medical management for anovulatory AUB (3)
1. OCPs
2. medroxyprogesterone monthly
3. levonorgesterel-releasing intrauterine system
64
medical management ovulatory AUB (4)
1. NSAIDs
2. OCPs OR progesterone (oral or IUD)
3. GnRH agonists
4. tranexamic acid
65
3 options for AUB for women who do NOT desire fertility
1. endometrial ablation
2. uterine artery embolization
3. hysterectomy (definitive)
66
three breast palpation techniques
circular
vertical strip
wedge
67
limitations of mammograms
detects 85% of cancers, false positives
68
what is the breast imaging reporting and database system called?
BI-RADS
| 0-5
69
what can US differentiate between and who is it helpful in?
differentiate between solid mass and fluid filled cyst
| helpful in younger women with denser breast tissue
70
two categories of mastalgia
cyclic (typically bilateral) vs non-cyclic (unilateral, sharp)
71
5 treatments for mastalgia
1. supportive bra
2. reduce or eliminate caffeine
3. avoid sodium premenstrually
4. NSAIDs
5. evening primrose oil
72
two categories of nipple discharge
pathologic: spontaneous, unilateral, bloody, associated with mass, often confined to one duct, age >40
physiologic: discharge only with compression, multiple duct involvement, often bilateral
73
if you suspect physiologic nipple discharge, what is your work-up? (2)
1. exclude coexisting abnormalities w exam and mammogram if women is > 35 yrs
2. check prolactin level
74
if pathologic discharge is suspected, what is your workup (2)
1. diagnostic mammogram +/- US
2. surgical referral for excision of duct
*cytology is generally unhelpful*
75
intraductal papilloma -- benign or malignant? discharge type? treatment?
- benign
- often bloody discharge
- surgical excision
76
ductal ectasia-- benign or malignant? discharge type? treatment?
- benign
| - thick, stick discharge (often clear, brown, green), - warm compresses and abx can help
77
breast abscess with often associated with what?
lactation
78
bug MC responsible for non-lactating breast abscess
s. aureus
cellulitis can lead to abscess (needs I&D)
79
what is the MC benign condition of the breast?
fibrocystic changes
80
you get an FNA to eval fibrocystic changes. what would indicate you need to get a follow up biopsy?
need to exclude cancer if:
1. no fluid or bloody fluid on aspiration
2. mass persists after aspiration
81
what med can be used for severe, persistent breast pain?
danazol
82
if women >30 yrs with fibroadenoma, what do you need to consider as a ddx?
fibrocystic condition or malignancy
83
age group that fibroadenoma is MC seen
teens to 30s
84
your pt is less than 30, and she has a mass that you suspect is a cyst (based on characteristics). what can you do (2)?
1.monitor x 1-2 menstrual cycles
OR
2. aspirate
85
your pt is less than 30, and she has a mass that persists or is suspicious. what should you start with?
1. US
if negative --> observe 3-6 months
if suspicious -->consider diag mammo
86
your pt is older than 30, and she has a mass. what do you do?
unilateral diag mammo & US (no reason to wait for imaging!)
if older than 40, and due for screening, can get bilateral
87
what is the recommended for mammography screening?
ages 50-74, every 2 years (average risk)
| Grade B
88
for patients ages 40-49, what is the breast cancer screening recommendation?
case by case (grade C)
89
describe early findings of breast cancer
single, NONTENDER, FIRM mass (often ill defined margins) or mammographic abnormality with no palpable masses
90
MC anatomic quadrant for breast cancer
upper lateral
91
do ER/PR receptor positive or negative tumors have a more favorable course?
receptor-positive!
92
describe two features of HER-2+ tumors
1. more aggressive
| 2. susceptible to certain targeted therapies
93
breast cancer arises from what 2 tissues
ducts or lobules
94
inflammatory breast cancer is often mistaken for what?
infection
95
how is paget's dz diagnosed?
skin biopsy of erosive area
96
what percentage of breast cancers are d/t genetic mutations?
5-10%
97
what is the goal of adjuvant chemo for breast cancer?
cure; eliminate micrometastases
98
what is a BIG no no for contraception containing estrogen?
NEVER EVER give to a smoker aged 35 or older
99
risk of death increases by how much for each additional week of pregnancy beyond 8 weeks
38%
100
when would RhIG (rhogam) be given in terms of IAB care?
after, if patient is Rh negative
101
what is the strongest risk factor for abortion-related mortality?
gestational age
102
untreated chlamydia or gonorrhea may lead to what?
pelvic inflammatory disease (PID)
103
what is the leading infectious cause of infertility in the US?
STIs
104
#1, 2, 3 NEW STIs in the US
HPV
chlamydia
trichomoniasis
105
#1, 2, 3 NEW and EXISTING STIs in the US
HPV
HSV-2
Trich
106
5 Ps of sexual history
partners, practices, prevention of pregnancy, protection, past hx
107
most common genital ulcer in US?
HSV
108
what's the big difference between herpes and primary syphillis
herpes is painful, syphilis is not
109
describes HSV lesions
painful ulcers (usually multiple); small grouped ulcers/vesicles on erythematous base
110
what are two benefits of treating herpes with antivirals?
reduce transmission and heal quicker
111
3 main diagnostic features of chancroid
1. painful soft ulcerations (typically one)
2. painful lymph nodes (50%)
3. foul smelling discharge from ulcer
112
what causes chancroid? is it bacterial, fungal, or viral?
haemophilus ducreyi
| bacteria
113
what's an important follow up for chancroid?
treat sexual partner
114
what causes syphilis? is it bacterial, fungal, or viral?
treponema pallidum
| bacterial
115
describe primary syphilis lesion
chancre: painless ulcer; raised oval ulcer w indurated edges; usually lasts 3-6 weeks
116
when is syphilis contagious?
when it's primary or secondary
117
specific feature of secondary syphilis
bilateral symmetrical papulosquamous rash; involvement of palms and soles is common
118
what STI is known as the great imitator?
syphilis
119
is serology usually reactive with latent syphilis?
yes, despite mostly ASX
120
3 major features of tertiary syphillis
gumma (granulomas on skin)
neurosyphilis (HA, meningitis, etc)
CV (aortitis)
121
tx for syphilis
penicillin G IM
122
what does HPV cause (3)
warts
cervical dysplasia
cancer
123
most patients with HPV are ASX but some have what type of lesion?
condylomata: papillomatous, white, cauliflower-like growth
124
tx for high risk HPV types
colposcopy/bx; surgical excision
125
MC reported STI in US
2nd MC reported?
1st: chlamydia trachomatis
2nd: neisseria gonorrhea
126
who should be tested for chlamydia?
1. women 24 and younger
2. new sex partner in last 60 days
3. >2 sex partners in past year
4. based on PEx
127
5 chlamydia complications
1. PID (40% in untreated females)
2. infertility (20% of PID)
3. ectopic pregnancy
4. perihepatitis
5. perinatal transmission
128
test of choice for gonorrhea and chlamydia dx?
NAAT
129
is granuloma inguinale painful or painless ulcer
painless
130
what two STIs are often found together?
chlamydia and gonorrhea
131
pathogens of PID
N. gonorrhea, c. trachomatis
others
132
cervical motion tenderness suggests what?
PID
aka chandelier sign
133
what is fitz hugh curtis syndrome?
RUQ pain d/t perihepatitis (liver capsule involvement)
134
what is strawberry cervix associated with?
trichomonas vaginitis
135
do you have to treat bacterial vaginosis?
nope, 1/3 NON preggers will resolve on their own
