GYN Flashcards
Treatment of postmenopausal symptoms in a 38 y/o after TAH-BSO for endometriosis?
Estrogen
Hyst BSO = definitive tx Endometriosis
Ovarian preservation a/w up to 60% change of recurrence of sx.
30% change requiring additional surgery.
-Hypoestrogenic women younger that 40 y/o 1.5-3x higher risk of bone loss, 50% higher risk of death from ischemic cardiovascular events
-These younger women are also more likely to experience vasomotor sx, sleep disturbances, psychosexual dysfxn, and vaginal dryness
-Risk of endometriosis recurrence after definitive surgery w/ estrogen use might be slightly higher compared to those without estrogen but overall rate is very low <1%
Prolog- GYN Q1
What is a single-dose treatment of Bacterial Vaginosis and intolerant to flagyl?
Secnidazole 2g PO once
-Second generation 5-nitroimidazole
-17 hour half life (metronidazole 8 hour half life)
-Similar clinical cure rate to metronidazole (77.0 v 79.3%)
-Recommend to use in patient who forget pills, dislike vaginal preparations, or experience nausea with metronidazole
Prolog- GYN Q2
Best options for fertility-sparing treatment of complex atypical hyperplasia?
Levonorgestrel IUD
~40% of patients with CAH had concurrent carcinoma after hysterectomy
-Surgery not appropriate if patient desires fertility
-90% regression of hyperplasia with LNG IUD (70% regression with oral progestins)
-Would still need q3-6 month sampling for surveillance
Prolog- GYN Q3
Necessary procedure in the workup of hematuria in a postmenopausal woman with increased urinary frequency, who smokes and has a history of cervical cancer w/ radiation therapy
Cystoscopy
-Bladder cancer has very non-specific symptoms including increased frequency and dysuria
-Tobacco use is greatest risk factor for bladder cancer (radiation as well)
-Hematuria without evidence of UTI or stone requires further eval
Prolog- GYN Q4
Treatment of intraoperative anaphylaxis includes:
Epinephrine
-Periop patient with anaphylaxis has 1.4-9% mortality risk
-~50% of periop anaphylactic rxns are due to abx
-Treatment steps: early recognition, fluids, epinephrine
Prolog- GYN Q5
Postoperative cause of spontaneous oxygen desaturation in a patient with obstructive sleep apnea
Morphine PCA
-Post op pain management plans should be carefully monitored in patients with OSA
-When possible, use regional analgesic techniques to reduce or eliminate the need for systemic opioids
-The addition of systemic NSAIDs like Ketorolac can help manage pain and do not contribute to oxygen desaturation
-If PCA is to be used, continuous rate should be avoided
Prolog- GYN Q6
When & What testing is needed an LEEP for CIN3 shows negative margins and negative ECC?
Repeat cervical cytology and HPV testing in 12 months
-Meta analysis showed that HPV testing detected residual disease earlier and with a higher sensitivity, and similar specificity compared to cytology and histology
-With negative margins the risk of sudden recurrence is so small that 6 months would be inappropriate and 12 months is reasonable
Prolog- GYN Q7
Management of premenopausal patient with first episode of ovarian torsion and a necrotic looking ovary with cyst > 6cm
Ovarian cystectomy
-Torsion more likely with cyst >5cm
-Ovary can appear large and edematous “whirlpool” sign
-The generally recommended procedure is detorsion with cystectomy
-Even in cases of necrosis and ischemia the ovary will usually reperfuse so avoid oophorectomy unless cancerous appearing
-Consider ovarian fixation only in cases of recurrent torsion
Prolog- GYN Q8
First imaging study to get in a patient with chronic pelvic pain and right sided adnexal fullness/tenderness on examination
Transvaginal ultrasound
-Chronic pelvic pain–6 months or longer of non-cyclic pelvic pain–affects 15-20% of women 18-50 y/o
-Diagnostic imaging should be guided by H&P
-TVUS is first-line in evaluation of a pelvic mass (accurate, inexpensive, readily available)
Prolog- GYN Q9
Treatment of a postmenopausal patient with VB, bloating, negative EMB, thin lining, and a growing leiomyoma with central necrosis and increased vascularity
TAH-BSO
-Leiomyomas develop in 75% of women at some point in their lives
-These are estrogen responsive and will stabilize or shrink after menopause
-Any leiomyoma that grows after menopause should raise suspicion for LMS
-Incidence of undiagnosed LMS is patient undergoing surgery for leiomyoma is 0.02-0.2%
-EMB correct in only 33-68% of LMS patients (negative result does not rule out LMS)
-MRI has benefit over TVUS in characterizing LMS
Prolog- GYN Q10
Best ERAS method to promote return of bowel function in a patient after laparoscopic hysterectomy
Regular diet within 24 hours
-Benefits of early feeding include: Faster return to normal bowel activity, reduced hospital stay, increased patient satisfaction
-Most post-op patient should be offered liquid diet within first 4 hours and a regular diet within 24 hours
-Early feeding does NOT increase the risk of complications such as anastomotic leaks or poor wound healing
Prolog- GYN Q11
Best treatment of a premenopausal patient with cyclic breast pain after counseling on supportive measures
NSAIDS
–Mastalgia affects more than 50% of reproductive aged women
-Can be cyclic or non-cyclic and is usually benign
-Diagnosis in clinical
-Breast pain is rarely a presenting symptom for people who ultimately get a breast cancer diagnosis but concerning characteristics would be: unilateral, noncyclic, severe, progressive pain, and is of particular concern if a discrete mass or lesion is found on exam or imaging
-Cyclic mastalgia is almost always benign and does not require diagnostic imaging
-Management of cyclic mastalgia is reassurance, recommending well-fitted supportive bras, and as needed NSAIDs
-Danazol is FDA approved for cyclic mastalgia but is reserved for severe cases refractory to more conservative tx
Prolog- GYN Q12
Most likely diagnosis in a patient s/p uterine artery ablation who presents with vaginal bleeding, abdominal pain, fever, purulent vaginal discharge (2 weeks after UAE)?
Endometritis
-Uterine infection after UAE is rare (1% of cases)
-Presents as fever, pain, purulent discharge, CMT, uterine tenderness and can occur day to weeks after procedure
-More common after UAE for submucosal leiomyoma
-Tx is IV abx
Prolog- GYN Q13
Best treatment for an 83 y/o patient with multiple co-morbidities who has anterior and apical prolapse refractory to pessary, not desiring ability to have vaginal intercourse?
Colpocleisis
-More important than the degree of prolapse can be the effect on QOL; repeat hospitalizations due to recurrent UTIs can indicate the need for a more aggressive approach
-Initial steps should be conservative (PT, pessary)
-Surgery should be considered in patients who have failed multiple attempts with pessary fitting or who have persistent ulcers, infections, or allergies from pessaries
-With multiple co-morbidities it is best to select shortest procedure, least risk of morbidity, requiring least amount of anesthesia
-Colpocleisis is not for anyone who desires future vaginal intercourse
Prolog- GYN Q14
Best initial treatment of dysmenorrhea in a patient who has had a tubal ligation?
NSAIDS
-Dysmenorrhea-prevalence ranges from 20-80%
-First-line therapy should be NSAIDs
-No specific NSAID is more effective than another
-Symptoms should be reassessed after 3 months of treatment
-OCPs should be used in someone who needs contraception or in whom pain is refractory to NSAIDs
Prolog- GYN Q15
