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PD3 > GYN > Flashcards

GYN Flashcards

1
Q

Vaginal discharge
Red and swollen vulva
Hx of use of tampon, condom or diaphragm

A

Foreign body

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2
Q

Bleeding at irregular intervals particularly between expected menstrual periods

examples?

A

Metrorrhagia or intermenstrual bleeding

Endometrial polyps,
DUB,
uterine or cervical cancer,
OCP

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3
Q

When does the screening start for cervical cancer?

A

Screening starts at 21 independent of sexual Hx

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4
Q

Extension of areas of endometrial glands and stroma into the myometrium

Mean age 40-50 yr;Common in parous women

Clinical Features
Pain:
New onset dysmenorrhea 
Pelvic pain
Dyspareunia
Heavy menstrual bleeding

Bimanual Exam: Bulky/ boggy, symmetrically enlarged, smooth*, globular, mobile, tender uterus

A

Adenomyosis

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5
Q

What is the clinical feature of endometrial cancer?

A

Postmenopausal vaginal bleeding

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6
Q

Pathophysiology: ↓estrogen at perimenopause and menopause
History

HX: Varying discharge; Dyspareunia; vaginal dryness
Peri/postmenopausal

PE: Pale, thin vaginal mucosa

Wet mount: folded, clumped epithelial cells

A

Atrophic vaginitis

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7
Q

Hx of sexual contact
Whitish pink to reddish brown, fleshy/soft, painless wart-like growths on external genitalia, perineum or anus
May enlarge to form cauliflower-like lesions

Pap smear: koilocytes

A

Condyloma acuminatum

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8
Q

Protective factor for endometrial cancer

A

Protective factor: OCPs ↓ risk

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9
Q

Cycles occurring at intervals < 21 d

A

Polymenorrhea

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10
Q

First infection
Fever, malaise
multiple, very painful, vesicular, ulcers
Inguinal lymphadenopathy

Viral culture
Gold standard; preferred in patients with ulcer
Direct fluorescent antigen (immunofluorescence)
Using cells scraped from ulcer bases

A

Genital herpes (HSV2)

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11
Q

loss of the normal ligamentous support for the uterus

causes the uterus to descend into the vaginal canal

A

Uterine prolapse

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12
Q

Watery discharge with foul odor
Dyuria and dyspareunia if severe

Profuse, frothy, yellowish, or greenish malodorous discharge; pH > 4.5; “strawberry cervix

Wet mount: round or pear-shaped protozoa

A

Trichomoniasis (Trichomonas vaginalis)

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13
Q

Lack of organic pelvic disease

Prostaglandins

A

Primary dysmenorrhea

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14
Q

Primary: presents 2 to 4 weeks after exposure
Painless (papule/ulcer with raised borders)
heals without Tx after 3-6 weeks
Painless bilateral inguinal lymphadenopathy
Serology usually negative

A

Syphilitic chancre

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15
Q

Secondary: 2 to 6 months after exposure
Generalized maculopapular rash- palms, soles, trunk, limbs
Flat, round or oval papules in the perineal area covered by a gray exudate
Serology usually positive

A

Condyloma lata (Treponema pallidum)

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16
Q

decrease in FSH/LH

increase prolactin

A

Prolactinoma

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17
Q

Common sites of endometrial implants:

A

uterosacral ligaments
rectouterine pouch (pouch of Douglas)
peritoneum

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18
Q

protective factors for ovarian cancer

A 
Protective Factors (for epithelial ovarian cancers)
↓ number of ovulatory cycles
OCP use
Pregnancy and breastfeeding
Hysterectomy and salpingo-oophorectomy
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19
Q

risk factors for ovarian cancer

A

Risk Factors
↑number of ovulatory cycles
Nulliparity, early menarche, late menopause
Age > 50
Genetic factors:
BRCA1 and BRCA-2; FHx of breast, colon, endometrial, ovarian cancer

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20
Q

History:
D/C: initially watery, becoming dark brown or red
Vaginal bleeding: post-coital, postmenopausal or intermenstrual

Physical Exam
Cervical D/C
Friable, raised, reddened or ulcerated cervical mass

Colposcopy
dysplasia may show white areas with mosaic pattern
with acetic acid application

A

Squamous type Cervical cancer

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21
Q

Uterine prolapse

3rd degree:

A

the cervix and vagina drop outside the introitus

22
Q

highest in 25-29 yr
Clinical Findings
Infertility
Pain: dysmenorrhea, deep dyspareunia, chronic pelvic pain,

Examination:
Adnexal masses* or tenderness
Nodules/ tenderness- in the posterior vaginal fornix, uterosacral ligament, *rectovaginal septum
Fixed, retroverted uterus

A

Endometriosis

23
Q

What age should the HPV vaccine?

A

(Gardasil 9): CDC recommendation
All boys and girls age from age 11
May be given up to age 21 (men), 26 (women)

24
Q

Absent upper vagina and uterus; cryptorchid testes

46, XY

breast dvlpment

A

Complete androgen insensitivity

synrome

25
Q

Abnormal bleeding: most common presenting symptom
Rapid uterine enlargement
Pelvic or abdominal pain

A

Uterine Leiomyosarcoma

26
Q

2 stages:
Vaginal or cervical infection
Ascending infection to the upper genital tract

History
Nausea, vomiting, fever
Lower quadrant pain and cramping
May be accentuated by motion or coitus
Vaginal discharge or bleeding

Mucopurulent cervical discharge
Cervical motion tenderness + adnexal tenderness

A

Salpingitis

27
Q

HX: Partner with NGU
Often no Sx + Postcoital spotting

PE: +/- Purulent discharge
Cervix may or may not be red or friable

A

Chlamydia (Chlamydia trachomatis)

28
Q

Age > 40, risk factors for endometrial disease, no response to Tx

what investigations and why ?

A

Transvaginal ultrasound
Assess endometrial thickness and other pathologies
Endometrial biopsy
To r/o endometrial hyperplasia and cancer

29
Q

breast dvlpment variable (depending on ovarian function)

Vagina: normal
Uterus: normal
Ovaries: streak

45, XO

A

Turners Syndrome

30
Q

Cyclic bleeding with diminished flow or shortening of menses

A

Hypomenorrhea

31
Q

Risk factors for Endometrial cancer ?

A 
Risk factors: ↑ estrogen exposure**
Obesity
Chronic anovulation; PCOS
Nulliparity
Early menarche/ late menopause
unopposed postmenopausal estrogen replacement
32
Q

a hernia of the bladder wall into the vagina

causes a soft, anterior fullness

A

Cystocele

33
Q

Cycles occurring at intervals > 35 d

A

Oligomenorrhea

34
Q

What can you find expect to find during a Bimanual exam for Ovarian CA?

A

Premenopause: enlarged ovary
Postmenopause: palpable ovary
Solid, irregular, or fixed pelvic mas

35
Q

Absent or rudimentary upper vagina and uterus

A

Mullerian agenesis

36
Q

Uterine prolapse

2nd degree:

A

the cervix is at the introitus

37
Q

Rotterdam Criteria- must meet 2 of 3:
Oligo/anovulation
menstrual cycles > 35 days apart or
Signs of hyperandrogenism

Clinical: hirsutism (less common- alopecia); acne

Biochemical: ↑DHEA-S, *free testosterone, SHBG

Polycystic ovaries by ultrasound
>10 small antral follicles are seen in each ovary

A

PCOS

38
Q

PE: Purulent cervical discharge; Skene/ Bartholin gland inflammation
+/- Inflammation of cervix and vulva

A

Gonorrhea (Neisseria gonorrhea)

39
Q

complication of sexually transmitted infections

Pain: dyspareunia, dysuria, RUQ abdominal pain
Vaginal discharge + foul odor

Risk Factors: age < 25, risky sexual behavior, early age at first intercourse

PE
Acute: fever; cervical motion tenderness; very tender uterus and adnexae

Chronic: bilateral tender, irregular, fairly fixed adnexae
Abnormal cervical discharge or bleeding

can cause Fitz-Hugh-Curtis (perihepatitis) syndrome

A

PID

40
Q

Secondary dysmenorrhea

A 
Endometriosis*
Adenomyosis*
Leiomyomas*
PMS)
IUD
41
Q

HX: Intense pruritus, swollen, inflamed genitals, vulvar burning, dysuria, dyspareunia
Hx of immunosup-pression, recent ATB use, ↑estrogen levels

PE: White, curdy discharge; pH < 4.5 Cervix may be red
+ Erythema of perineum or thighs

Tests: KOH: spores; mycelia, budding, branching yeast; pseudohyphae

A

Moniliasis / Candida vulvovaginitis (Candida albicans)

42
Q

Hx of sexual contact
Painless, dimpled or umbilicated flesh-colored or pearly papules several millimeters in diameter in genital area
resolve spontaneously within months of appearance

cytoplasmic inclusion bodies

A

Molluscum contagiosum

43
Q

Most common benign tumor of the pelvis
40-50% of pre-menopausal woman > 35 yr

Heavy menses + clots
Dysmenorrhea

Bimanual exam
Firm, regular/irregular, nontender nodules
+ enlarged uterus

asymmetric/nodular

A

Leiomyomata (Fibroids)

44
Q

Any bleeding that presents > 1 yr after menopause

A

Post-menopausal bleeding

45
Q

Uterine prolapse

1st degree:

A

the cervix remains within the vagina

46
Q

Risk Factors for Cervical Cancer

A

HPV infection: Types 16, 18 highest risk
> 99% of cervical cancers contain one of the high risk HPV types
High risk behaviors:
Multiple sexual partners, other STI, early age at first intercourse, high risk male partner
History of STI
Smoking
Immunosuppression

47
Q

Use of new hygiene products

A

Allergic vaginitis

48
Q

leading cause of gynecological cancer deaths

A

Ovarian cancer

49
Q

Cyclic bleeding that is heavy (> 80 ml blood loss) and prolonged (>7d)

examples ?

A

Menorrhagia or heavy menstrual bleeding (HMB)

Endometrial polyps, 
DUB, 
adenomyosis, 
leiomyomas, 
IUD
50
Q

Clinical: Absence of menses x 1 yr
↑ levels of FSH on day 3 of cycle

Average age of onset: 52 years

Hot flushes/flashes, night sweats, sleep disturbances, palpitations

A

Menopause

51
Q

Swelling on the introitus
Dyspareunia
Discomfort when walking on adducted thighs
Fluctuant mass on either labium

Acute: Hot and tender swelling
Chronic: Non-tender

A

Bartholin cyst and abscess

Acute- abscess: Hot and tender swelling
Chronic- cyst: Non-tender

PD3 (11 decks)

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