GYN Flashcards
(95 cards)
1
Q
What is endometrial hyperplasia?
A
abnormal proliferation of glandular and stromal elements of the endometrium
*premalignant!
2
Q
Breast development, blind pouch and shortened vagina, normal ovaries, pelvic mass consistent with uterus
-Diagnosis?
A
Mayer-Rokitansky-Kuster-Hauser syndrome
3
Q
Female genitalia externally and internally; no breast development
-Diagnosis?
A
Swyer’s syndrome
4
Q
What are the 3 types of ovarian cancer?
A
- germ (dysgerminoma, teratoma, choriocarcinoma)
- stromal (granulosa-theca, sertoli-leydig)
- epithelial (serous, mucinous, endometrioid, Brenners)
5
Q
Post-coital bleeding, black, itching suggests what cancer?
A
cervical, vaginal, vulvar
6
Q
Post-menopausal bleed suggests what cancer?
A
endometrial
7
Q
What is the etiology of the following cancers?
- cervical, vaginal, vulvar
- endometrial
- ovarian
- choriocarcinoma
A
- cervical, vaginal, vulvar: HPV
- endometrial: estrogen
- ovarian: ovulation
- choriocarcinoma: gestational trophoblast
8
Q
What is the treatment for endometrial cancer?
A
TAH + BSO
9
Q
How does the treatment for endometrial cancer differ from endometrial cancer w/ mets?
A
- endometrial cancer: TAH + BSO
- endometrial cancer w/ mets: TAH + BSO +/- radiation/ chemo
10
Q
What is the difference in appearance of vulvar cancer and Paget’s?
A
- vulvar SCC or melanoma: black and itchy
- Paget’s: red lesion and itchy
11
Q
Pathology of endometriosis
A
retrograde menses –> fallopian tube
12
Q
What is the treatment for a tubo-ovarian abscess?
A
IV cefoxitin + doxy + MTZ
13
Q
What can cause cervicitis?
A
Gonorrhea, Chlamydia
14
Q
What is the difference in treatment of PID for inpatient vs outpatient?
A
- inpatient: cefoxitin + doxy; clinda/gent
- outpatient: IM ceftriaxone + doxy + MTZ
15
Q
What is the difference between an inevitable, incomplete, complete, and missed abortion?
A
- inevitable: no passage of contents, os open, U/S dead baby
- incomplete: passage of contents, os open, U/S retained parts
- complete: passage of contents, os closed, U/S nothing
- missed: no passage of contents, os closed, U/S dead baby
16
Q
What does PALM COEIN stand for?
A
Causes of vaginal bleeding: Polyp Adenomyosis Leiomyoma Malignancy Coagulopathy Ovarian dysfxn Endometrium Idiopathic Not yet classified
17
Q
How does adenomyosis present?
A
symmetric, smooth, boggy uterus
18
Q
If a GnRH stimulation test results in increased LH, is the problem central or peripheral?
A
central
19
Q
No secondary sex characteristics, female external genitalia, no uterus
-nml T, FSH, LH
A
mullerian agenesis (idiopathic loss of mullerian ducts)
20
Q
Secondary sex characteristics, female external genitalia, no uterus
- increased T, nml FSH, LH
- U/S: testes
A
AIS (resistance to T)
21
Q
No secondary sex characteristics, female external genitalia, +uterus
- increased FSH, LH
- U/S: streak ovaries
A
Turner’s Syndrome
22
Q
What is the next step in working up secondary amenorrhea after checking TSH, UPT, and prolactin?
A
progesterone for withdrawal bleed (if pt bleeds, think PCOS)
23
Q
Hirsutism
- increased T, nml DHEA-S, LH:FSH >3:1
- U/S: bilateral ovaries
A
PCOS
24
Q
What is the treatment for PCOS?
A
- exercise, wt loss
- metformin
- OCPs
- clomiphine
- spironolactone
25
Virilization
- super increased T, nml DHEA-S
- U/S: unilateral ovary
Sertoli-Leydig tumor
26
Virilization
- nml T, super increased DHEA-S
- CT/MRI: unilateral adrenal
Adrenal tumor
27
Hirsutism
| -nml T, increased DHEA-S, 17OHP in urine
CAH
28
How do you treat CAH?
- cortisol
| - fludrocortisone
29
What drug can be given for hot flashes and mood swings of menopause?
venlafaxine (SSRI)
30
What is the first line treatment of lichen sclerosis?
high-potency topical steroid (clobestasol)
31
______________ is an inflammation of the cervix, the lower, narrow end of the uterus that opens into the vagina
Cervicitis
32
What are possible symptoms of cervicitis?
bleeding between menstrual periods, pain with intercourse or during a cervical exam, abnormal vaginal discharge
33
What are common causes of cervicitis?
STI (Chlamydia, gonorrhea)
34
Mixed gonadal dysgenesis has an increased risk of what type of cancer?
vulva
35
No menses. Breast and pubic hair normal. Vagina of normal length. Cervix and uterus are hypoplastic. What is the diagnosis?
gonadal dysgenesis
36
Which of the following is a confirmatory test for syphilis?
- RPR
- Serum antinuclear antibody assay
- Quantitative VDRL
- Serologic test for Treponema pallidum antibodies
- Dark-field examination of vaginal fluid
serologic test for treponema pallidum
37
Painful vulvar swelling, multiple episodes of neisseria gonorrhea infection suggest...?
Bartholin's duct abscess
38
How does molar pregnancy present?
like pre-E but in the first half of pregnancy (severe HTN, hyperreflexia, proteinuria, etc.)
39
Chronic anovulation is associated with an increased risk of...
endometrial cancer
40
______________ tumors are associated with elevated AFP
Intradermal sinus (smooth palpable ovarian mass)
41
What is the next step for a patient with endometriosis who has failed medical management?
laparoscopy
42
What is the next step in management for a 21-24 year old with ASCUS and HPV+?
repeat cytology in 1 year
43
What is the greatest risk factor for developing osteoporosis?
family history
44
What is the diagnosis?
| heavy menses, constipation, urinary frequency, pelvic pain/heaviness, enlarged uterus
fibroids
45
What is the diagnosis?
| dysmenorrhea, pelvic pain, heavy menses, bulky/globular and tender uterus
adenomyosis
46
What is the diagnosis?
| Hx obesity, nulliparity, or chronic anovulation; irregular, intermenstrual, or postmenopausal bleeding; nontender uterus
endometrial cancer/hyperplasia
47
What is the diagnosis?
| dyspareunia, dysmenorrhea, chronic pelvic pain, intertility
endometriosis
48
Mature cystic teratomas arise from what cells?
ectoderm
49
A large ovarian mass with thick septations, solid components, and peritoneal free fluid (ascites) suggests...
epithelial ovarian carcinoma
50
Why is there abnormal uterine bleeding following menarche?
immaturity of the developing hypothalamic-pituitary-gonadal axis
51
Vulvovaginal atrophy (menopausal GU syndrome) is due to...
estrogen deficiency
52
Genitourinary syndrome of menopause presents with sxs including...
vulvovaginal dryness, irritation, pruritis, irritation, bleeding, incontinence
53
What type of tumor is this?
| complex ovarian mass, precocious puberty, AUB, post-menopausal bleeding
granulosa cell tumor
54
What is the histopathology of granulosa cell tumors?
call-exner bodies
55
Embryonal carcinomas secrete _____ and ______
AFP, hCG
56
What type of birth control will decrease risk of ovarian and endometrial cancer?
OCPs
57
What is the correct order of sexual maturation?
| thelarche, adrenarche, menarche
thelarche --> adrenarche --> menarche
58
What is the diagnosis?
| renal anomalies, absent uterus and cervix, normal ovaries and secondary sex characteristics
Mullerian agenesis
59
What is the karyotype and testosterone level in patients with mullerian agenesis?
Karyotype: 46 XX
| Testosterone level: normal female range
60
What is the next step after identifying atypical glandular cells on a pap?
endometrial bx
61
A granulosa cell tumor presents as...
precocious puberty
62
What are some complications of suction D&C?
- bowel and bladder injury
- cervical laceration
- uterine perforation
63
What is the most sensitive test to confirm HSV?
PCR
64
What is definitive treatment for endometriosis?
simple hysterectomy with bilateral salpingo-oophorectomy
65
What does lubrication during intercourse depend on?
transudate of fluid across the vaginal mucosa
66
Can vaginismus resolve on its own?
rarely does (requires dilators)
67
The 3 D's (dysmenorrhea, deep dyspareunia, and dyschezia (pain w/ defecation)) are suggestive of...
endometriosis
68
Endometriosis should be treated with
NSAIDs and OCPs (may relieve pain by ovulation suppression, which may result in atrophy of endometrial tissue)
69
A soft, mobile, contender, well-circumscribed mass behind the labium majus suggests...
a bartholin gland cyst
70
What is the appropriate follow-up for for these low grade paps?
- ASCUS/HPV-
- ASCUS/HPV+
- LSIL/HPV-
- LSIL/HPV+
- ASCUS/HPV-: 3 year co-test
- ASCUS/HPV+: colpo
- LSIL/HPV-: 1 year co-test
- LSIL/HPV+: colpo
71
What is the appropriate follow-up for the following?
- CIN I/LSIL
- CIN II/LSIL
- CIN II/HSIL
- CIN III/HSIL
- Cancer
- CIN I/LSIL: co-test 1 year --> co-test 3 year --> routine
- CIN II/LSIL: co-test 1 year --> co-test 3 year --> routine
- CIN II/HSIL: LEEP, cryo, expectant management
- CIN III/HSIL: LEEP, cryo, expectant management
- Cancer: cold knife cone
72
What is Mittelschmerz and how does it present?
ovulation pain, presents with unilateral lower abdominal pain
73
What is the only indication for use of hormone replacement therapy?
reduction of vasomotor sxs
74
A teenage girl with really heavy menses may have...
a clotting disorder (fibroids are more common for women in their 30-40s)
75
How is lichen sclerosis treated?
topical steroids
76
When is an endometrial biopsy indicated in a woman <45 years old?
AUB + unopposed estrogen (obesity, anovulation), failed medical management, or Lynch syndrome
77
How should suspicion for epithelial ovarian cancer be worked up in a woman...
- with sxs?
- without sxs?
- with sxs: ex lap
| - w/o sxs: CA-125
78
RUQ pain, fevers, chills, vomiting, irregular menstrual periods
PID
79
Inflammatory mucocutaneous eruptions of the skin, scalp, nails, vulva, etc.
lichen Planus
80
What is colpocleisis?
vagina is surgically obliterated
| -used with patients who have vaginal prolapse but are poor surgical candidates because it can be done quickly
81
How can you definitively diagnose endometriosis?
exploratory surgery and biopsies
82
How do you recommend a woman with endometriosis get pregnant via fertility treatment?
ovarian stimulation (w/ or w/o artificial insemination)
83
What is the definitive treatment for a patient with pelvic pain due to endometriosis?
hysterectomy with bilateral salpingo-oophorectomy
84
Secondary sex characteristics present, Ovaries present; No uterus or cervix; Possible RENAL anomalies
mullerian agensis
85
What are some causes of secondary dysmenorrhea?
endometriosis, adenomyosis, uterine fibroids, infection
86
Severe menstrual cramping, heavy bleeding, inter menstrual spotting w/ normal gyn exam is most likely...
endometrial polyp
87
Hormone replacement therapy increases the risk of what cancer?
breast
88
What vitamin supplement improves sxs of PMS?
calcium
89
What is the recommended surgical approach to an early endometrial cancer?
total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic LAD
90
What imaging is helpful to assess the extent of ovarian cancer?
CT
91
What are the hallmarks of endometriosis? ("3 D's")
dysmenorrhea, dyspareunia, dyschezia (pain w/ defecation)
92
What is first line therapy for vulvar lichen sclerosis?
steroids
93
What are some risk factors for endometrial cancer?
obesity, PCOS/chronic anovulation, nulliparity, early menarche or late menopause
94
What is Meig's syndrome?
- ovarian fibroma
- ascites
- right pleural effusion
95
What is secreted with each tumor?
- endodermal sinus tumor
- embryonal carcinoma
- granulosa cell tumor
- Sertoli-Leydig tumor
- endodermal sinus tumor: AFP
- embryonal carcinoma: AFP, bHCG
- granulosa cell tumor: estrogen, inhibin
- Sertoli-Leydig tumor: testosterone
