GYN Flashcards
(200 cards)
1
Q
MCC vulvovaginitis
A
Bacterial vaginosis
candida, trichomoniasis, atrophy
2
Q
normal vaginal bacteria, pH (reproductive, puberty & menopause)
A
lactobacilli, anaerobic
reproductive pH: 3.5-4.7 (acidic)
puberty, menopause pH: 6-8 (neutral)
3
Q
MCC bacterial vaginosis
A
Gardnerella vaginalis
4
Q
Bact vaginosis Sx
A
- grey/yellow discharge (milky, filmy)
- fishy odor
5
Q
Dx Bact vaginosis
A
grey discharge pH > 4.5 clue cells (ground glass) pos whiff test, fishy odor
6
Q
Tx bact vaginosis, how long
A
flagyl (metronidazole) 500mg x 7 days
7
Q
Tx bact vaginosis in pregnancy, refractory, recurrent
A
preg: flagyl after 37 wks
refractory: metronidazole x 14 days
recurrent: normal Tx
8
Q
complications bact vaginosis
A
PROM, preterm delivery, PID, postop infections, HIV, HSV
9
Q
2 MCC vulvovaginitis candidiasis
A
- C. albicans
2. C. galbrata
10
Q
RF for candida vulvovaginitis
A
DM!!! pregnancy, obesity, immunosuppression, tight clothing/nylon, panty liners, corticosteroids, abx
11
Q
Sx candida vulvovaginitis
A
cottage cheese discharge, pruritis, redness, pH normal 4-5
12
Q
Dx candida vulvovaginitis
A
KOH pseudohyphae!
13
Q
Tx candida vulvovaginitis
A
topical: terconazole, miconazole, clotrimazole, butoconazole, nystatin
oral: fluconazole (diflucan) x 1
q 72 hrs x 3
takes 24 hrs to improve Sx
14
Q
can you prophylactically treat for recurrent candida with abx?
A
yes. fluconazole (diflucan)
15
Q
Tx refractory/recurrent candidiasis (3)
A
- fluconazole (diflucan)- 3 doses q 72 hrs
- gentian violet stain
- boric acid vaginal tablet x 14 days
16
Q
Tx candidiasis in pregnancy
A
topical only
terconazole, miconazole, clotrimazole, butoconazole, nystatin
17
Q
trichomonas Sx
A
- yellow/grey discharge (bact vaginosis)
- fishy odor (bact vaginosis)
- pos whiff test (bact vaginosis)
- frothy
- pruritis
- strawberry cervix!!!
- pH >5 (bact vaginosis >4.5)
18
Q
trichomonas culture media
A
modified diamond media
19
Q
Tx trichomonas
A
metronidazole (flagyl) 500mg x 7 days
same as bact vaginosis
or 2g x 1
or tinidazole 2g x 1 (category D not in pregnancy!)
20
Q
category of tinidazole
A
D
21
Q
trichomonas (and bact vaginosis) in pregnancy
A
no Tx in 1st trimester
Tx after 37 wks
22
Q
trichomonas in lactation
A
metronidazole 2g x 1
no breastfeeding x 24 hrs
23
Q
complications trichomonas (and bact vaginosis)
A
PROM, preterm, PID, ectopic, HIV
24
Q
atrophic vaginitis cause
A
decr estrogen
25
Tx atrophic vaginitis
estrogen
26
Sx atrophic vaginitis
pH > 4.7
| dry, itch, burn, dyspareunia, thin, friable
27
painful lesions
herpes, chancroid
28
painless chancre
syphilis
29
syphilis Dx
VDRL, RPR,
| confirm: FTA-ABS, darkfield
30
Tx syphilis
PCN G
31
Tx chancroid
azithromycin, ceftriaxone
32
chancroid organism
Haemophilus ducreyi
33
MC STD
chlamydia
34
Dx GC/chlamydia
NAAT, cervical swab
35
Tx chlamydia
azithromycin, doxycycline
36
Tx Gonorrhea
azithromycin AND ceftriaxone
37
Tx chlamydia in pregnancy
azithromycin
38
uretrhitis/cervicitis screening
- sexually active < 25 y/o
- mucopurulent cervicitis
- pregnant
39
PID organisms, location
GC, chlamydia
| cervix--> salpinx--> pelvic cavity
40
PID age
15-29 y/o
41
PID RF
untreated GC/chlamydia, IUD
42
PID Sx
-mucopurulent discharge
-HIGH FEVERS (>101 F, 38 C)
-GC/chlamydia labs
-incr WBC, ESR, CRP
pelvic pain/cramping, dyspareunia, post-coital bleeding, vaginal bleeding
1. CERVICAL MOTION TENDERNESS
2. ADNEXAL FULLNESS/MASS/TENDERNESS
3. UTERINE TENDERNESS
43
DDx PID
appendicitis, ovarian torsion, ectopic, pyelonephritis, ruptured ovarian cyst
44
Tx PID outpatient
ceftriaxone AND doxycycline x 14 days
45
don't use what to Tx PID?
fluoroquinolones
46
Tx PID inpatient
IV abx x 48 hrs
| cefoxitin + doxycycline
47
complications PID
- perihepatitis (Fitz-Hugh-Curtis syndr)- scar liver
- infertility!! (fallopian tubes scar)
- ectopic
48
bartholin gland normal size, location
< 1 cm, 5 and 7 o'clock
49
Sx bartholin gland infection
pain with walking & intercourse
50
organisms of Bartholin gland infection (and PID)
GC, chlamydia
51
Tx bartholin gland infection
I&D, catheter afterward
52
stages of uterine prolapse
```
0= none
IV= complete
```
53
procidentia
uterine prolapse, cervix passes beyond vulva
54
Tx uterine prolapse
1st line: pessary
pelvic floor exercise
surgery: hysterectomy, ligament fixation, sacral hysteropexy, colpocleisis (no vagina lumen)
55
MC type incontinence
stress MC
| urge MC in elderly
56
stress incontinence
incr abdom pressure, decr fascia integrity
- worse with cough/laugh
- loss in sm spurts
57
urge incontinence
detrusor overactivity
- leak without incr abdom pressure
- urgency, frequency
58
incontinence that can result after bladder surgery
urge
59
urge incontinence Tx
lifestyle changes
habit training
```
medication
-antimuscarinics:
oxybutinin (avoid in elderly)
Vesicare, Enablex (good in elderly)
-Anticholinergics: imipramine
-myrbetriq (avoid in uncontrolled HTN)
```
60
stress incontinence Tx
- 1st line: pelvic floor exercise
- lifestyle modification: stop smoking, wt loss, no caffeine
-surgery: slings (TENSION-FREE VAGINAL TAPE), retropubic colposuspension (Burch procedure), bulking agents (around bladder neck)
61
overflow incontinence
detrusor inactivity, neurogenic problems (MS)
urethra obstuction
-constant dribbling
62
watery vaginal discharge, fishy odor, grey discharge, pH 5.0, clue cells, one partner
treatment?
metronidazole 500mg x 7days
| (bact vaginosis)- DDx: trichomonas
63
crampy abdominal pain, chills, nausea, 101 F temp, mucopurulent discharge, cervical motion tenderness, adnexal discomfort
treatment?
ceftriaxone 250mg x 1
AND doxycycline 100mg x 14 days
(PID)
64
dyspareunia, vaginal pain worse with activity, afebrile, no abdom pain, 4cm mass 5o'clock
organism?
C. trachomatis
| bartholin gland infection
65
elderly with urine leakage, urgency, frequency
| Tx?
Vesicare
66
benign vulvar disease: cigarette paper skin, onion skin, atrophic, figure 8 around perineum, itching
Lichen sclerosus
67
benign vulvar disease: whickham straie, pruritis, demarcated edges
lichen planus
68
benign vulvar disease: hyperplastic, erythematous, lichenification, itch that rashes
lichen simplex chronicus
69
VIN risk factors
HPV, smoking
70
VIN Tx
excision, laser ablation
| imiquimod, 5-fluorouracil topical
71
MC type vulvar cancer
SCC
72
PRURITIS, ulcerative red/white lesion on post 2/3 labia majora
what am i?
vulvar cancer
73
vulvar cancer MC site
labia majora
| posterior 2/3
74
Tx vulvar cancer
excision, vulvectomy, L issection
75
location of inclusion cysts
posterior
76
causes of inclusion cysts
TRAUMA, GYN procedures, childbirth
77
Gartner duct cyst location
anterior
| lateral walls of vagina
78
causes of Gartner duct cyst
residual from fetal development
79
VAIN risk factors
HPV
80
VAIN associated with what?
cervix, vulva neoplasia
81
VAIN Sx
asymptomatic!
82
VAIN Tx
vaginectomy, laser ablation, excision
| 5-fluorouracil
83
MC type of invasive vaginal cancer
SCC
84
pediatric invasive vaginal cancer
sarcoma botryoides
85
cervical polyps risk factor
multiparous
86
Tx cervical polyps
remove, send for Bx, ablation/liquid nitrogen at base
87
causes of cervical stenosis
TRAUMA, procedures (colposcopy), infections, cervical cancer
88
cervical ectopy
columnar epithelium rolled out of os
89
transformation zone
- b/t squamo-columnar junction
| - fastest growing cells = oncogenic susceptible
90
cervical ectopy- spatula or brush?
spatula
91
risk factors for CIN
HPV!!, smoking
| mult sex partners, early age intercourse (<17), HIV, organ transplant (kidney), STD, DES, Hx CIN
92
HPV types linked to CIN
6, 11, 16, 18, 31, 45
93
progression of cervical disease
normal--> HPV--> CIN 1--> 2--> 3--> invasive CA
94
pathognomonic for HPV
koilocytosis
| -infected cells have halo appearance
95
PAP screening when to start?
21 y/o
| within 3 yrs of sex
96
PAP screening when to stop?
65-70 y/o
- no Hx abnorm
- normal last 3 PAPs
- no abnormals x 10 yrs
97
PAP screening frequency?
-high risk twice annually then q year
-21-29 y/o: 3 annual neg smears--> q 2-3 yrs
>30 y/o: q 3-5 yrs if neg HPV
98
abnormal PAP. now what?
HPV reflex test
99
HPV test everyone at what age?
30 y/o
100
dysplastic tissue on colposcopy test looks like?
green filter, acetic acid wash
| -dysplastic tissue: whitish
101
must visualize entire squamo-columnar junction (ectopy) for adequate colposcopy. if can't visualize, do what?
endocervical currettage
102
PAP smear result is ASCUS, what now?
HPV test
103
PAP- ASCUS, HPV pos, next step?
colposcopy
104
PAP- ASCUS, HPV neg, next steps?
repeat PAP in 6 mo, if abnorm then colposcopy, if normal do normal screening
105
colposcopy, no CIN, now what?
repeat PAP in 6 mo, 12 mo
| HPV in 12 mo
106
colposcopy, CIN pos, now what?
treatment
CIN 1: cryo/liquid nitrogen
CIN 2, 3: conization, LEEP
107
when to treat PAP results?
CIN pos, HSIL
108
PAP- LSIL now what?
colposcopy
109
PAP- ASCH now what?
colposcopy
110
contraindications to HPV vaccine
yeast allergy, pregnancy
111
CIN 2/3 conization- if margins not clear, now what?
repeat conization
112
CIN 2/3 conization- if margins include HSIL, now what?
hysterectomy
113
PAP screening schedule after conization procedure
q 6 mo x 2 yrs
114
cervical cancer RF
HPV
115
types of cervical cancer
SCC, adenocarcinoma
116
staging cervical cancer I-IV
I- cervix only
II- + vagina
III- + pelvic wall
IV- +beyond pelvis
cervix- vagina- pelvis- beyond
117
HPV vaccine covers which types?
6, 11 (genital warts)
| 16, 18 (cervical cancer)
118
Gardasil
HPV vaccine
119
when to give HPV vaccine
12-26 y/o females
| 12-21 y/o male
120
breastfeeding and HPV vaccine
yes
121
vulvar pruritis DDx
lichen(s)
psoriasis
vulvar carcinoma
dermatitis
(not bartholin gland cyst)
122
leiomyomata aka
uterine fibroids
| prolif muscle cells, estrogen sensitive
123
Sx leiomyomata
menorrhagia (incr bleeding), Fe def anemia
| dysmenorrhea
124
leiomyomata what population
AA
125
Dx leiomyomata
pelvic US
| -uterus "bulky" large
126
Tx leiomyomata
- progesterone supplement (decr bleeding)
- GnRH, danazol (decr estrogen)- b/c estrogen sensitive
- myomectomy
- endometrial ablation
- uterine artery/fibroid embolization
- hysterectomy (definitive Tx)
127
MC site endometriosis
ovary
128
causes of endometriosis
- retrograde menstruation
- vascular/lymph dissemination
- coelomic metaplasia (multipotential cells in peritoneal cavity--> endometrial tissue)
unopposed estrogen
129
endometrioma aka
chocolate cysts, hemosiderin deposits
130
Sx endometriosis
dysmenorrhea, dyspareunia, chronic pelvic pain, infertility
131
Dx endometriosis
laparoscopy direct visualization, tissue Bx
132
Tx endometriosis
- OCP (progesterone), NSAIDs, danazol, GnRH
- cauterization, hysterectomy, oophorectomy
(decr estrogen, incr progesterone)
133
can endometriosis recur?
yes.
134
MC genital tract cancer
endometrial cancer (uterine cancer)
135
MC Sx endometrial cancer
abnormal bleeding, postmenopausal bleeding
136
simple hyperplasia- what tissue
glandular & stromal tissue
137
complex hyperplasia- what tissue
glandular only
138
Braxton Hicks contractions
"false labor", sporadic uterine contractions
| 2nd-3rd trimester
139
goodell's sign
indication of pregnancy
| -softening of the vaginal portion of the cervix from increased vascularization
140
hegar's sign
softening and compressibility of the lower segment of the uterus
141
Chadwick's, Goodell's, Hegar's sign
Chadwick: vagina, "C"olor change, a dark blue to purplish-red congested appearance of the vaginal mucosa, an indication of pregnancy.
goodell: cervix, "G"ooey/softening, softening of the cervix; a sign of pregnancy.
hegar: lower uterus, "H"ey it hurts to touch, softening of the lower uterine segment; indicative of pregnancy.
(alphabetical out to in)
142
postmenopausal bleeding - always think what?
endometrial cancer
| hormone therapy; endometrial atrophy, polyps, hyperplasia
143
Dx endometrial cancer
transvaginal US, endometrial Bx is definitive
144
endometrial cancer findings on transvaginal US
>5mm endometrial stripe in POSTMENOPAUSAL women
145
RF for endometrial CA
long term estrogen use!! nulliparity, PCOS, older age, infertility, tamoxifen, late age menopause, early menarche
146
endometrial cancer types
adenocarcinoma, endometrioid
147
type I endometrial CA
MC endometrial CA, estrogen dependent, favorable prognosis
148
type II endometrial CA
estrogen independent, poor prognosis
149
endometrial CA Tx
hysterectomy, pelvic washings (look for spread)
150
is endometrial CA high risk of recurrence?
yes!
151
f/u of endometrial CA pts
pelvic speculum exam
q 3-4 mo x 3-4 yrs
then q 6 mo
152
uterine fibroid degeneration leads to this, Sx: post menopausal bleeding, distant mets
uterine sarcoma
| Tx: hysterectomy
153
ovaries not palpable in premenopausal women...
more concerning vs. postmenopausal
154
ovaries palpable in postmenopausal women...
maybe malignant
155
simple ovarian cyst benign if what size?
<10 cm
156
CA-125 elevation suspicious when?
always, especially postmenopausal
157
most ovarian enlargements?
functional ovarian cysts-
follicular, corpus luteal, late luteal, theca lutein
158
ovarian cyst Sx
asymptomatic usually, assoc with menstrual abnormalities, pain sometimes
159
DDx ovarian cyst pain
UTI, ovarian torsion, renal calculi, appendicitis, IBD, diverticulitis (LLQ)
160
follicular ovarian cyst Sx
unilateral pelvic pain, palpable mobile adnexal mass
incr estradiol levels (prevents ovulation= follicle fails to rupture)
161
ovarian cyst rupture Sx
acute pelvic pain, peritoneal irritation
162
Tx follicular cyst
NSAIDs
163
follicular ovarian cyst definition
follicle fails to rupture, becomes fluid filled
164
corpus luteal cyst size, definition
follicle turns into corpus luteum, becomes enlarged, progesterone incr
corpus luteum > 3cm
165
Sx corpus luteal cyst
ameorrhea!! lower quadrant pain, missed menses, neg pregnancy test
mimics ectopic!
166
luteal phase cyst definition
spontaneous hemorrhage into cyst
167
luteal phase cyst RF
anticoagulants, bleeding disorders
168
luteal phase cyst rupture
acute pain, luteal phase
blood in peritoneum
Tx: surgical resection
169
theca lutein cysts seen when, Tx?
pregnancy
| regress without Tx
170
Tx benign ovarian neoplasms
surgery b/c potential for malignancy, ovarian torsion
171
3 classes of benign ovarian neoplasms
epithelial, germ, stromal cell tumors
172
3 types of epithelial cell tumors
serous cystadenoma, mucinous cystadenoma (huge), Brenner cell tumor
173
serous cystadenoma
malignant potential
174
mucinous cystadenoma
low malignant potential, huge!
175
Brenner cell tumor
older ppl
176
MC of all benign tumors!!
germ cell tumor (ovarian)
177
germ cell tumor type
benign cystic teratoma (dermoid cyst)
178
dermoid tissue
sweat gland, fat, bone teeth
179
stromal cell tumor types
granulosa thecal cell tumor (F), Sertoli-Leydig cell tumor (M)
180
MC GYN cancer, high mortality!
ovarian cancer
| mortality- slough directly into peritoneum- widespread
181
RF ovarian cancer
- age 50-60 y/o, white
- BRCA 1 & 2
- HNPCC (hereditary nonpolyposis colorectal CA), Lynch syndr
- Hx cancer of uterus/breast/colon
182
decr risk ovarian CA by lots
OCP x 5 yrs
183
Sx ovarian CA
early satiety (unable to eat normally), urinary incontinence, very vague Sx (fatigue, indigestion)!
184
ovarian cancer and CA-125
not a screening tool
young: pos = uterine leiomyomata, PID, endometriosis, preg
old: pos = likely malignant
185
Dx ovarian CA
US
186
Dx adnexal mass
US
187
histology of ovarian cancer
epithelial
188
germ cell tumors age group
< 20 y/o
189
staging ovarian CA
I- ovaries
II- pelvis
III- outside pelvis (nodes, liver, bowel)
IV- distant mets
190
Tx ovarian cancer
SURGERY!
| chemo: Taxol, carboplatin, cisplatin
191
primary dysmenorrhea cause, age
- incr prostaglandins during menstruation
- prostaglandin F2alpha, prostaglandin E2
teens/20s- decr with age
192
secondary dysmenorrhea causes, age
clinically identifiable cause: endometriosis, adhesions, leiomyomata, adenomyosis, polyps, IUD, infection, cervical stenosis
incr age
193
prostaglandin F2alpha purpose
smooth muscle contraction
uterine: cramping
extrauterine: emesis, diarrhea
194
prostaglandin E2 purpose
menorrhagia
195
Tx primary dysmenorrhea
NSAIDs (block prostaglandin synthesis
ibuprofen 800 mg TID
naproxen 500 mg BID
topical heat, OCP (consistent levels)
196
chronic pelvic pain definition
noncyclic pain > 6mo
197
main causes of chronic pelvic pain
PID, IBS, interstitial cystitis, endometriosis, adhesions, psychogenic
198
leiomyomata Tx main overall goal
block estrogen
199
right sided pelvic pain, several days, menstrual irregularities, movable 5cm right adnexal mass palpated
functional ovarian cyst
200
what causes pain assoc with primary dysmenorrhea?
prostaglandin F2alpha
