GYN Flashcards
(190 cards)
1
Q
estrogen amount in COCs is _______ than the amount of estrogen in menopausal HRT
A
HIGHER
2
Q
If a woman is having infrequent periods, she is not ovulating frequently.
If she’s not ovulating, she’s not making a corpus luteum.
If there’s no corpus luteum, there’s no progesterone.
A
Know This!!
3
Q
PMS occurs during the late _________ phase, cycle days ___-___
A
luteal, cycle days 21-28ish
4
Q
structural causes of AUB
A
fibroids
adenomyosis
polyps
5
Q
only hormonal causes of AUB cause change in:
A
length of the cycle
6
Q
structural causes of AUB cause the period to be:
A
heavier and/or breakthrough bleeding b/t periods
7
Q
basal body temperature increases after ovulation in response to __________ secreted by the __________
A
progesterone secreted by the corpus luteum
8
Q
hormone that stimulates follicular growth in the ovaries and stimulates estrogen secretion (from developing follicles)
A
FSH
9
Q
hormone that surges to cause ovulation resulting in the formation of the corpus luteum
A
LH
10
Q
hormone that thickens the uterine lining, inhibits FSH and LH for most of the cycle, and stimulates FSH and LH release pre-ovulation
A
estrogen
11
Q
hormone that thickens the uterine lining and inhibits FSH and LH
A
progesterone
12
Q
FSH is secreted by the:
A
anterior pituitary
13
Q
LH is secreted by the:
A
anterior pituitary
14
Q
estrogen and progesterone are secreted by the:
A
ovaries
15
Q
Endometrial Cycle includes these menstrual cycle phases:
A
Proliferative
Secretory
Menstrual
16
Q
Ovarian Cycle includes these menstrual cycle phases:
A
Follicular
Ovulatory
Luteal
17
Q
basal body temp increases due to increase in:
A
progesterone
18
Q
first day of bleeding is menstrual cycle day #:
A
1
19
Q
The ___________ phase is always 14 days long
A
luteal
20
Q
high estrogen levels after dominant follicle has been established increase:
A
FSH and LH secretion
21
Q
prolactin is secreted by the:
A
anterior pituitary
22
Q
when estrogen is the dominant hormone, the endometrium:
A
proliferates
23
Q
when progesterone is the dominant hormone, the endometrium:
A
thickens to prepare for implantation
24
Q
leave diaphragms and cervical caps in for at least ___ hours
A
6
25
remove diaphragm by ___ hours
24
26
remove cervical cap by ___ hours
48
27
MOA of ___________:
- Supresses ovulation
- Thickens cervical mucus
- Thins asynchronous endometrial lining: decreases chance of implantation
- Slows tubal motility
COCs, Ring, Patch
28
MOA of ___________:
- Thickens cervical mucus for 2-4 hrs after ingestion, lasting for 22 hrs
- Inhibits ovulation (**40% ovulate normally)
POPs
29
MOA of ___________:
- Inhibits LH and FSH surge: suppresses ovulation, thickens cervical mucus
- Slows tubal and endometrial mobility
- Thins endometrium
Depo
30
```
MOA of ___________:
-Thickens cervical mucus
-Inhibits ovulation x 2 yrs
-Atrophies endometrium
(**may rarely ovulate after 2 yrs)
```
etonogestrel implant (Nexplanon)
31
```
Contraindications for ____________:
-Active gallbladder or liver disease
-Multiple CVD risk factors
HTN >/= 160/100
Current DVT or PE
Hx of thrombogenic mutations (Factor V leiden)
-Current breast cancer
-Migraines w/ aura at any age
-Migraines w/o aura if age > 35
-Hx of stroke
-Diabetes > 20 yrs w/retinopathy, nephropathy, neuropathy or other complications
-Major surgery w/prolonged immobilization
-Prior to 21 days postpartum
```
COCs, ring, patch
32
```
Contraindications for ____________:
-Active liver disease
-Multiple CVD risk factors
HTN >/= 160/100
Current DVT or PE
Hx of thrombogenic mutations (Factor V leiden)
-Current or recent breast cancer
```
POPs, Depo, Nexplanon
33
most effective EC
copper IUD
34
most effective PO method of EC
UPA
35
UPA EC effectiveness: ___ pregnancies in 1000 uses
10 (1.8% chance of pregnancy after 1 act)
36
POPs/LNG IUDs EC effectiveness: ____ pregnancies in 1000 uses
12 (2.6% chance of pregnancy after 1 act)
37
COCs EC effectiveness: ____ pregnancies in 1000 uses
20-32
38
failure rate of copper IUD EC
under 1 in 1000 (99.9% effective)
39
```
SE of _____________ (EC):
Increased bleeding during periods
Increased dysmenorrhea
Infection during first 20 days
Uterine perforation
Expulsion
Vasovagal or fainting w/ insertion
```
copper IUD
40
```
SE of _____________ (EC):
N+V (**most common)
HA
Abdominal pain
Breast tenderness
Fatigue
Dizziness
```
UPA, POPs/LNG, COCs
41
nausea + vomiting is less severe with ______ as EC than _______ as EC
POPs/LNG less severe than COCs
42
POPs/LNG methods of EC
Plan B
43
Plan B timeframe for use
72 hours but may work up to 120 hours
44
ella (UPA) EC is available by __________ only
prescription
45
EC that is less effective in women with BMI >30
ella (UPA)
46
EC that delays ovulation even when LH is rising
ella (UPA)
47
ella (UPA) timeframe for use
120 hours
48
copper IUD can be inserted up to ___ days after ovulation (up to 5 days after unprotected sex that occurs mid-cycle or earlier) to prevent pregnancy
5
49
EC methods that delay ovulation
COCs, POPs/LNG, UPA
50
EC methods that have spermicidal activity
copper IUD only
51
EC methods that prevent implantation via uterine line effects
copper IUD
| *possibly* UPA
52
type of IUD that is associated with irregular bleeding after 3 months of use
Mirena
53
co-test for HPV with pap for women over age:
30
54
start pap smears at age:
21
55
paps are q___ year until age 30
3
56
Reasons for more frequent pap smears
HIV positive
immunocompromised
DES exposure
after treatment for CIN2/3 cervical cancer
57
paps are q___ years after age:
30
58
paps are not recommended after age:
65
59
ASC-US
Atypical Squamous Cell of Undetermined Significance
60
lowest clinical concern result of pap
ASC-US
61
LSIL
Low-grade Squamous Intraepithelial Lesion
62
pap result that includes mild hyperplasia, cervical intraepithelial neoplasia (CIN) 1-- probably HPV but with a high likelihood of resolution especially among young women
LSIL
63
pap result that includes moderate to severe dysplasia, carcinoma in situ, CIN 2 and 3-- almost 100% HPV and not as likely to spontaneously resolve
HSIL
64
HSIL
High-grade Squamous Intraepithelial Lesion
65
for women > age 25 with ASC-US or LSIL pap result, order:
reflex testing for High Risk HPV
66
for women younger than age 25 with ASC-US or LSIL pap result:
repeat pap in 1 year
67
if High Risk HPV is present on reflex testing, next step is:
colposcopy
68
for HSIL result at any age, woman will need:
colposcopy + biopsy
69
___-___% of ASC-H is already cancer
5-10%
70
If HPV 16 or 18 is detected, even if pap is normal, woman will need:
colposcopy
71
negative pap with positive HPV management
repeat pap in 1 year, if same result- refer for colposcopy
72
if HPV is high-risk but not types 16 or 18, when should pap be repeated?
1 year
73
for unsatisfactory pap result on 3 month repeat pap, midwife should:
refer for colposcopy
74
woman < age 25 with negative pap but insufficient sampling of transformation zone, midwife should:
advise screening at regular interval
75
LSIL result, repeat pap in:
1 year
76
```
Type of Nipple Discharge:
Lesion in duct
Spontaneous (without stimulation)
UNIDUCTAL
UNILATERAL
Bloody nipple discharge
```
Intraductal papilloma
77
Type of Nipple Discharge:
Milky discharge in someone who is not pregnant/lactating in the last 12 months
BILATERAL
MULTIDUCTAL
May occur spontaneously OR with nipple stimulation
Galactorrhea
78
dilation of ducts w/ surrounding INFLAMMATION and fibrosis that usually occurs in women > 50 yo, bilateral, multiductal with sticky brown/black/green discharge (can present as firm mass under nipple)
Mammary duct ectasia
79
Diagnostics for __________:
*depends on masses presence and discharge characteristics
If discharge black-->guaiac test for blood
If age>40 and hasn’t had a mammogram in last 6 months-->mammogram
Mammary duct ectasia
80
Treatment for __________:
- Advise to avoid nipple stimulation and follow up in 3-4 months
- Expectant management due to benign process
- Surgically treated with removal of the subareolar duct system if imaging shows focal thickening of the duct wall or if symptoms are severe
Mammary duct ectasia
81
small WART-LIKE (solitary or multiple) benign growth in the duct usually occurs in women 40-50 years of age with unilateral, uniductal bloody/serosanguinous discharge...may or may not have palpable mass
Intraductal papilloma
82
Treatment for __________:
Without atypia, single papilloma and < 1 cm: Do not remove
Multiple papillomas or single papilloma > 1 cm: duct excision
Intraductal papilloma
83
Treatment for __________:
-Decrease breast/nipple stimulation to decrease discharge
-Outside of pregnancy/lactation:
Pituitary tumors → expectant management, medication, and/or surgery
Meds: bromocriptine and cabergoline
Discontinuation of meds → recurrence of galactorrhea, therefore lifelong therapy required
Discontinuing medication causing galactorrhea
Galactorrhea
84
dense epithelial and fibroblastic tissue, usually nontender, encapsulated, round or oval, smooth, mobile, firm, rubbery, can be large
Fibroadenoma
85
incidence of this breast mass decreases with increased age- commonly benign usually singular mass in younger women
Fibroadenoma
86
treatment for Fibroadenoma
expectant management
87
fluid-filled mass most common in 35-50 yo women
| *Discrete, tender, mobile, size may fluctuate with menstrual cycle
cyst
88
area of fatty tissue may occur in the breast or other areas - usually in later reproductive years
**Discrete, soft, nontender, may or may not be mobile
Lipoma
89
Poorly defined, firm, nontender, nonmobile mass that is usually result of trauma or surgical manipulation of the tissue that resolves spontaneously
Fat necrosis
90
Glandular tissue, fat and fibrous connective tissue mass
* Discrete, nontender, nonmobile, may be nonpalpable with incidental dx on imaging studies
* Average age of diagnosis: 45 yo
Hamartoma
91
Milk-filled cysts that usually occur during or after lactation
* Discrete, firm, sometimes tender
* Duct dilation often have an inflammatory component
Galactocele
92
Treatment for Galactocele
aspiration for diagnosis and appropriate treatment
93
```
Suspicious for _________:
skin changes
lesion is hard
painless/ non-tender
irregular borders
immobile mass fixed to the skin or surrounding tissue
gritty
enlarged axillary cervical and supraclavicular lymph nodes
```
Breast CA
94
```
Risk Factors for __________:
BRCA 1 or 2 mutation
smoking
age
female sex
personal hx
family hx
genetic mutations
breast lesions with atypia
dense breast tissue
high-dose radiation to chest (esp during puberty)
menarch before age 12
menopause after age 55
nulliparity
first full-term pregnancy after age 30
current use of COC
use of COC after menopause
weight gain after age 18
physical inactivity
alcohol consumption
Jewish ancestry
Born in North America, North Europe, Asia, or Africa
```
Breast CA
95
ACS recommends yearly mammograms starting at age:
45
96
ACOG recommends yearly mammograms starting at age:
40
97
USPSTF recommends biennial mammograms starting at age:
50
98
Normal physiological process that occurs at the squamocolumnar junction or transformation zone
initiated by the eversion of the columnar epithelium onto the ectocervix - occurs under the influence of estrogen and its ensuing exposure to acidic vaginal pH
squamous metaplasia
99
Squamous metaplasia may arise through reproductive years but is most active during:
adolescence and first pregnancy
100
Breast mass that occurs in ages 30-50 that may cause skin stretching due to rapid growth
Phyllodes tumor
101
woman whose depression being treated with fluoxetine (Prozac) who reports a decrease in libido should be prescribed:
buproprion (Wellbutrin)
102
HRT regimen for women WITHOUT a uterus; sometimes called unopposed estrogen which would increase the risk of endometrial cancer if a postmenopausal woman with a uterus used them.
Estrogen-only therapies (ET)
103
HRT regimen for women WITH a uterus; the progestogen is really only for the purpose of endometrial protection
Estrogen plus Progestogen therapies (EPT)
104
```
Contraindications for __________:
Hx breast cancer
CHD
Hx venous thromboembolic (VTE) event
Hx stroke
active liver disease
unexplained vaginal bleeding
high-risk endometrial cancer
transient ischemic attack
```
Menopausal HRT
105
SYSTEMIC vaginal therapy of HRT
Femring
106
vaginal therapy that is local only
Estring
107
SE of ________:
reflux exacerbation
GERD
esophageal ulceration
biophosphonates (Alendronate)
108
If a HT option is low estrogen for local vaginal symptoms only, you do not need to:
add progesterone
109
DEXA scans are recommended for all women over age:
65
110
tool used to estimate risks to make decision on whether to screen a woman early for osteoporosis
FRAX
111
compares a woman's bone mass to peak bone mass of the average woman aged 30
T-score
112
normal bone density T-score
> -1
113
osteopenia T-score
-1.1 -- -2.49
114
osteoporosis T-score
-2.5 or less
115
recommended daily calcium intake for women over 50
1200 mg
116
recommended daily calcium intake for premenopausal women under age 50
1000 mg
117
recommended daily calcium intake for postmenopausal women on estrogen under age 65
1000 mg
118
recommended daily calcium intake for postmenopausal women not taking estrogen
1500 mg
119
recommended daily calcium intake for premenopausal women over age 50
1200 mg
120
Treatment of chlamydia for non-pregnant women
Azithromycin 1 g orally in a single dose OR
| Doxycycline 100 mg orally twice/day x 7 days
121
retest for chlamydia (test of cure) in ___ months
3
122
```
Treatment for ___________:
Acyclovir 400 mg TID x 7-10 days OR
Acyclovir 200 mg 5 times/day x 7-10 days
Valacyclovir 1 g BID x 7-10 days OR
Famciclovir 250 mg TID x 7-10 days
```
1st clinical episode of HSV
123
Treatment for __________:
Acyclovir 400 mg BID OR
Valacyclovir 500 mg QD OR 1 g QD OR
Famciclovir 250 mg BID
suppressive therapy for HSV
124
"strawberry cervix" is a sign of:
trich
125
Treatment for _____________:
Metronidazole 2 g orally in a single dose OR
Tinidazole 2 g orally in a single dose
Trich
126
Treatment for _____________:
PO metronidazole* (Flagyl) 500 mg bid x 7 d OR Topical metronidazole (Metrogel), qhs x 5 d OR
Topical clindamycin vaginal cream (Cleocin Vaginal) 5 gm qhs x 7d
BV
127
- Homogenous, thin white discharge that smoothly coats vaginal walls
- Clue cells
- pH of vaginal fluid > 4.5
- Fishy odor of discharge before or after adding KOH ***Must have 3 out of 4 to diagnose:
BV
128
Gonorrhea is diagnosed with:
NAAT or culture on Thayer Martin media
129
Chlamydia is diagnosed with:
NAAT
130
trich is diagnosed with:
wet mount
131
Treatment of gonorrhea in nonpregnant women:
ceftriaxone 250 mg IM once with azithromycin
132
Syphyllis is treated with:
benzathine Pen G 2.4 million units
133
```
Risk Factors for _____________:
Pregnancy
Diabetes
Previous history of cystitis
Use of spermicides
Use of diaphragm for contraception
Sexual activity
History of UTI
```
UTI (cystitis)
134
least expensive effective treatment available for the treatment of cystitis and should be recommended unless the patient is allergic or the community has high levels of resistance to this regimen.
Trimethoprim/sulfasmethoxazole
135
choose SSRI w/ long half-life for PMS/PMDD such as:
fluoxetine (Prozac)
| sertraline (Zoloft)
136
gonadotropin hormones
FHS and LH
137
gonadism
ovarian estrogen production
138
type of amenorrhea with normal levels of FSH and LH (ex: outflow obstruction, cervical stenosis, chronic anovulation, hyperandrogenism, PCOS)
normogonadotropic amenorrhea
139
type of amenorrhea with decreased levels of FSH and LH where ovaries don't produce enough estrogen (ex: anorexia, chornic illness, excessive exercise, weight loss)
hypogonadotropic/ hypogonadism amenorrhea
140
type of amenorrhea with increased levels of FSH and LH where ovaries don't produce enough estrogen (ex: premature ovarian failure due to autoimmune, chemotherapy, etc.)
hypergonadotropic/ hypogonadism amenorrhea
141
type of amenorrhea where there is presence of secondary sex characteristics without menses by age 16 or absence of secondary sex characteristics by age 14
primary amenorrhea
142
prolactin may be increased by:
medications
benign pituitary tumor
breastfeeding
breast stimulation
143
women with PCOS or excess adipose tissue have ________ estrogen
normal to high estrogen
144
conditions that cause _____ estrogen:
anorexia
chronic disease
prolactemia
low
145
conditions that cause ______ estrogen and ______ FSH+LH:
menopause
premature ovarian failure
low estrogen, high FSH+LH
146
without sufficient levels of estrogen, progesterone challenge test will:
NOT result in a withdrawal bleed
147
with sufficient levels of estrogen, progesterone challenge test will:
result in a withdrawal bleed
148
condition in which the endometrial tissue invades the uterine muscle tissue most common in women aged 35-50 and sometimes asymptomatic but can cause dysmenorrhea, non-cyclic uterine cramping, deep dyspaurenia, menorrhagia (often contributed to perimenopause)
adenomyosis
149
Symptoms of __________:
large, boggy, tender uterus
irregular contour of uterus
myometrial lesions that look like fibroids
adenomyosis
150
```
Treatment of ___________:
NSAIDs
narcotics
hormonal contraceptives
hysterectomy
```
adenomyosis
151
benign uterine smooth muscle tumors
fibroids (aka leimyomas, myomas)
152
```
symptoms of __________:
**asymptomatic often
menorrhagia
dysmenorrhea
pelvic pressure
increased abdominal size
irregular contour of uterus
usually non-tender
```
fibroids
153
```
Treatment of ____________:
expectant management/symptom relief
COCs
anti-estrogen therapies (leuprolide)
LNG_IUS
surgery (myomectomy, hysterectomy)
uterine artery embolization
```
fibroids
154
causes painless bleeding
cervical polyp
155
painless, white, firm nodules visible on the cervix
Nabothian cysts
156
full development of breast tissue occurs during:
pregnancy and lactation
157
approximate number of oocytes that are left when a female reaches puberty
200,000
158
acts as a sling for the vagina and the vaginal sphincter
pubovaginalis band of the pubococcygeus perineum muscle
159
pelvic type that poses difficulty for SVB and increases the likelihood of OP position and forceps-assisted delivery
heart-shaped
160
stretching of the _______ may occur during the 2nd stage, & can result in rectal prolapse
levator ani muscle
161
sling and accessory sphincter for the rectum.
puborectalis band of the pubococcygeus perineum muscle
162
muscle that controls defecation
pubococcygeus proper band of the pubococcygeus perineum muscle
163
female sexual response that may cause vasocongestion to occur in 50% to 75% of women
desire
164
average range for the menstrual cycle
21-34 days
165
____% of women report a 28-day menstrual cycle
15
166
amount of blood loss during menstruation, if reported by a woman, the NP documents as abnormal
>80 mL
167
discomfort during ovulation
mittleschmerz
168
endocrine disorder that causes amenorrhea
ovarian tumor
169
pituitary disorder that causes amenorrhea
Cushing's disease
170
HSV-1 and HSV-2 can cause genital infection but typically______ causes more genital pain, & outbreaks are more frequent
HSV-2
171
most common symptom of endometriosis
dysmenorrhea
172
migration of endometrial tissue into the peritoneal cavity via the fallopian tubes during menses
retrograde menstruation
173
breast assessment method recommended for subsequent examinations for an individual with dense breasts
ultrasound
174
tamoxifen increases risk of __________ cancer
endometrial
175
```
SE of _________:
**Dangerous:
abnormal vaginal bleeding or discharge
pain or pressure in the pelvis
leg swelling or tenderness
chest pain
shortness of breath
weakness, tingling, or numbness in face, arm, or leg
difficulty speaking or understanding
vision problems
dizziness
sudden severe headache
***Most common:
increased tumor or bone pain
hot flashes
nausea
fatigue
mood swings
depression
headache
hair thinning
constipation
dry skin
loss of libido
```
tamoxifen
176
```
SE of ____________:
hot flushes
night sweats
nausea
vomiting
loss of appetite
constipation
diarrhea
heartburn
stomach pain
changes in weight
muscle, joint, or bone pain **most common
excessive tiredness
headache
dizziness
weakness
swelling of the hands, feet, ankles, or lower legs
difficulty falling asleep or staying asleep
vaginal bleeding or irritation
breast pain
hair loss
blurry vision
```
letrozole
177
administration route for trastuzumab (Herceptin) for breast CA
IV
178
Pelvic inflammatory disease consists of pelvic or lower abdominal pain and at least one of these 3 signs:
uterine tenderness
cervical motion tenderness
adnexal tenderness
179
category of medical eligibility for contraceptive use where there is an advantage of using this method that outweighs any risk
Category 2
180
category of medical eligibility for contraceptive use where There is no restriction for the use of the contraceptive method.
Category 1
181
category of medical eligibility for contraceptive use where there is a risk that outweighs the advantages of the contraceptive method
Category 3
182
category of medical eligibility for contraceptive use where there is an unacceptable health risk if the contraceptive method is used
Category 4
183
For a couple that uses no contraception, ___ of every 100 couples will experience an unintended pregnancy within 1 yr
85
184
spermicide that can be used immediately before sex
foam
185
typical users of spermicides, during the 1st year of use, approximately ____% will have an unintended pregnancy.
28%
186
sponges work for ___ hours
3
187
to remove the female condom, __________ the ring
squeeze and twist
188
absolute contraindication for COCs
acute viral hepatitis
189
absolute contraindication for Depo
Long-term corticosteroid use with history of nontraumatic fracture
190
factor that has been associated with spontaneous menopause that occurs earlier than the avg age of 51 yrs
smoking
