Gyn and breast disorders Flashcards
(143 cards)
1
Q
First test to perform when woman presents with amenorrhea
A
Beta hCG
2
Q
Term for heavy bleeding during and between menstrual periods
A
Menometrorrhagia
3
Q
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, history of D and C
A
Asherman’s syndrome- scaring of uterus
4
Q
Therapy for PCOS
A
Weight loss
OCP
Consider metformin
5
Q
Meds used to induce ovulation
A
Clomiphene citrate
6
Q
Dx step required in postmenopausal woman who presents with vaginal bleedings
A
Endometrial biopsy
7
Q
Indications for medical Tx of ectopic
A
Pt stable, unruptured ectopic pregnancy of <6 wks gestation
8
Q
Medical options for endometriosis
A
OCP
Danaxol
GnRH agonists
9
Q
Lap findings endometriosis
A
Powder burns
Chocolate cysts
10
Q
Most common location for ectopic
A
Ampulla of oviduct
11
Q
How to Dx and follow leiomyoma
A
US
12
Q
Natural Hx leiomyoma
A
Regress after menopause
13
Q
PT has inc vaginal discharge and petechial patches in upper vagina and cervix
A
Trichomonal vaginitis
14
Q
Tx for bacterial vaginosis
A
Oral or topical metronidazloe
15
Q
Most common cause bloody nipple discharge
A
Intraductal papilloma
16
Q
Contraceptive methods that protect against PID
A
OCP
Barrier contraception
17
Q
Unopposed estrogen CI in which Ca?
A
Endometrial or estrogen receptor + brest cancer
18
Q
Pt with recent PID and RUQ pain
A
Fitz Hugh Curtis syndrome
19
Q
Breast malignancy presenting as itching, burning, erosion of nipple
A
Paget’s disease
20
Q
Annual screening for women with strong FH og ovarian Ca
A
CA=125 and transvaginal US
21
Q
50 yr woman leaks urine when laughing or coughing. Non surg Tx?
A
STRESS INCONTINENCE
Kegel
Estrogen
Pessaries
22
Q
30 yo woman has unpredictable urine loss. Exam normal. Tx?
A
URGE INCONTINENCE
Antichol (oxybutynin)
Beta adrenergics (metaproterenol)
23
Q
Lab values suggesting menopause
A
Inc FSH
24
Q
Most common cause female infertility
A
Endometriosis
25
2 consecutive findings of ASUC on Pap smear. Follow up eval?
Colposcopy and endocervical curettage
26
Breast cancer type that inc future rusk of invasive CA in both breast
Lobular carcinoma in situ
27
Order of events of normal female puberty
```
Adrenarche
Gonadarche
Thelarche
Pubarche
Growth spurt
Menarche
```
28
Adrenal androgen production
Adrenarche
29
Activation of gonads by FSH and LH
Gonadarche
30
Appearance of breast tissue
Thelarche: 8-11
31
Appearance of pubic hair
Pubarche
32
Onset menses
Menarche: 10-16
33
Precocious puberty in boys
- Age
- Cause
<9
| Adrenal hyperplasia
34
Isosexual precocious puberty cause (major)
CNS lesion
| Trauma
35
Midcycle surge induces ovulation
| Regulates chol conversion to pregnenolone in ovarian theca cells as initial step in estrogen synthesis
LH
36
Stimulates development of ovarian follicles
| Regulates ovarian granulosa cell activity to control estrogen synthesis
FSH
37
```
Stimulates endometrial proliferation
Aids follicle growth
Induce LH surge
High levels inhibit FSH secretion
Principal role in sexual development
```
Estrogens (estradiol)
38
```
Stimulates endometrial gland development
Inhibits uterine contraction
Increases thickness cervical mucus
Inhibits LH and FSH secretion; maintains pregnancy
Decrease in levels leads to menstruation
```
Progesterone
39
Acts like LH after implantation of fertilized egg
| Maintains corpus luteum viability and progesterone secretion
hCG
40
Necessary for pt who is XY but androgen insensitive
Must remove testicle- inc risk cancer
41
Length of time without menses to qualify as secondary amenorrhea
6 months
42
Dysmenorrhea: primary Sx begin when, secondary when?
Primary: beginning of menstruation Sx
Secondary: midcycle and increase until menstruation over
43
Most common cause female infertility
Endometriosis
44
Abnormal uterine bleeding defined as
35 d, last >7 d, >80 ml blood loss
45
Needed to Dx PCOS
3 of following:
- Anovulation
- Androgen excess
- Polycystic ovaries on US
46
PCOS increased risk
Endometrial cancer 2/2 increased estrogen
47
Gardnerella, Trichomonas, Candida- which need to Tx partner
Trichomonas
48
Clue cells
Gardnerella
49
Motile
Trichomonas
50
Normal vag pH
Candida
51
Cause TSS
S, aureus
52
Causes cervicitis
GC or chlam
53
Thayer Martin agar
GC
54
Tx Cervicitis
Ceftriaxone for GC
| Azithro or doxy-Chlam
55
Causes PID
GC/Chlam
| Infrequent: bacteroides, E coli, streptococci
56
Chandelier sign
PID: palpate cervix during pelvic exam cause pt to jump off table
57
Pt with PID also has signs of sepsis or peritonitis - should suspect?
Tx?
Tubo-ovarian abscess
| Inpt Tx with IV abx and IVF
58
1 vs 2 vs 3 syphilis
1: 3 wks after exposure - solitary chancre to painless ulcer
2: chancre heals, maculopapular rash palm and soles, condylama lata; relapses up to 30 yrs
3: gummas, tabes dorsalis, Argyll Robertson pupil
59
Dx and Tx syphilis
| After Tx, which test will remain +
Dx: VDRL, RPR; FTA-ABS, MHA-ABS (microhemagglutination), spirochetes on dark field (Cannot culture)
+ = FTA-ABS positive for life
Tx: Pen G, doxy, tetracycline; IV Pen G for tertiary
60
Tx HPV
```
Podophyllin
Trichloroacetic acid
5FU
alpha IFN
Cryo or laser
```
61
Cause syphilis
Treponema pallidum
62
Characterization of genital ulcers
Some Girls Love Licorice but Fellows Hate Candy
Syphilis, Granuloma inguinale, Lymphogranuloma venereum = painLess
PainFul= Herpes simplex, Chancroid
63
Tx Chancroid
Dx
Cause
Ceftriaxone, erythromycin, azithromycin
Dx: gram stain (-) rods
Cause: Haemophilus ducreyi
64
Tx lymphogranuloma venereum
Dx
Cause
Tetracycline, erythromycin, doxycycline
Immunoassay
Chlamydia trachomatis L1, L2, L3
65
Tx granuloma inguinale
Dx
Cause
Doxy or TMP SMX
Giemsa stain Donovan bodies
Cause: Klebsiella granulomatis
66
Tx uterine fibroid/leiomyoma
GnRH agaonist - temporary
Myomectomy
Hysterectomy
67
CA 125
Endometrial Ca
Cervical Ca
Ovarian but only if pest menopausal
68
Most common cause vaginal bleeding
Atrophic vaginitis
69
ACUS Tx
HPV
Pap in 6 and 12 months
Repeat HPV in 12 months
70
ASCH (ASUC, cannot exclude HSIL) Tx
HPV
Endocervical biopsy
Pap 6 and 12 months
REpeat HPV 12 months
71
LSIL - CIN 1 Tx
Pap 6 and 12
HPV 12 months
LEEP or conization or laser ablation
72
HSIL Tx - CIN 2 and 3 (include in situ) Tx
LEEP or conization or laser ablation
| Repeat cytology q 6 months
73
Benign ovarian mass: granulosa cells, occur first 2 weeks of cycle, may regress over menstrual cycle
Follicular cyst
Tx: observe
74
Benign ovarian mass: theca cells - cystic or hemorrhagic
Corpus luteum cyst
Tx: observation, cystectomy if not regress
75
Benign ovarian mass: from epi tissue, may resemble endometrial or tubal histology, cystic with serous or mucinous contents, may calcify= PSAMMOMA BODIES
Mucinous or serous cystadenoma
Tx: unilat salpingo-oophorectomy
TAH BSO if postmenopausal
76
Benign ovarian mass: Spread of endometriosis to involve ovary
Endometrioma
Tx: OCP, GnRH agonist, progrestin, danazol - Sx
Cystectomy or oopherectomy because recur
77
Benign ovarian mass: originates as germ cell, composed of multiple dermal tissues - hair, teeth, sebaceous glands
Benign cystic teratoma (desmoid cyst)
Tx: cystectomy with attempted preservation of ovary
1-2% transform to malignant
78
Benign ovarian mass: origin-granulosa, theca, Sertoli, Leydig cells' secrete hormones of cell of origin
CAUSES: PRECOCIOUS PUBERTY or VIRILIZATION
Stromal cell tumor
- granulosa or theca: precocious puberty
- Sertoli-Leydig: virilization
Tx: unilat salpingo oopherectomy, TAH BSO if postmenopausal
79
BRCA 1 and 2
Breast Ca
| Ovarian Ca
80
US: smooth lesion edges, few septa, cystic mass
Benign
81
US: irregular, nodular, multiple septa, pelvic extension
Malignant
82
Types ovarian Ca
Epi or germ cell
83
Types cervical ca
SCC
Adeno
Mixed
84
Nonbloody nipple discharge with noncancerous pathology- excise or no
Not needed
85
Most common site breast cancer
Upper outer
86
Problem with FNA
High false negative rate
87
Malignant cells in ducts without stromal invasion, maybe calcification
DCIS
Higher risk of subsequent invasive cancer than DCIS
NO Sx
88
Malignant cells in lobules without stromal invasion, no calcifications, can be multifocal, increased risk contralat malignancy
LCIS
No Sx
89
Malignant cells in ducts with stromal invasion and calcification, fibrotic response in surrounding tissue
Infiltrating ductal
MOST COMMON INVASIVE
Firm mass, skin dimples, nipple retraction, peau d orange, nipple discharge
90
Malignant cells in breast lobules with infiltration and less fibrous response; usu multifocal or bilat; slower mets; assoc HRT
Infiltrating lobular
Same Sx as infiltrating ductal
91
Well circumscribed, rapid growth; soft
Medullary Ca
Better prognosis than ductal Ca
92
Well circumscribed, slow growth, older women; gelatinous
Mucinous Ca
Better prognosis than ductal Ca
93
Slow growing malignancy of well formed tubular structure invading stroma, pt in late 40s, excellent prognosis
Tubular Ca
94
Subtype of ductal, rapid progression and angioinvasive, poor prognosis
Inflammatory
95
Primary amenorrhea - caues if no secondary sexual characteristics
Constitutional growth delay= commonest
Primary ovarian insufficiency= Turner, rad/chemo
Central hypogonadism= undernourishment, stress, hyperprolactinemia, exercise, CNS tumor, Kallman's (anosmia)
96
Primary amenorrhea- causes if secondary sexual characteristics
Mullerian agenesis- absence of 2/3 vagina
Imperforate hymen
Complete androgen insensitivity
97
Increased amount of time bewteen menses (35-90 d)
Oligomenorrhea
98
Frequent menstruation <21 d
Polymenorrhea
99
Increased flow or prolonged bleeding
Menorrhagia
100
Bleeding between periods
Metrorrhagia
101
Excessive and irregular bleeding
Menometrorrhagia
102
Midcycle estrogen surge- secretions are?
Clear, elastic mucoid
103
Luteal phase pregnancy - secretions are?
Thick, white, adhere to vaginal wall
104
Criteria for Dx bacterial vaginitis
Need 3 of 4
1. whitish gray discharge
2. ph >4.5
3. + amine/whiff test
4. clue cells >20% on wet mount
105
Causes acute pelvic pain
A ROPE
```
Appendicitis
Ruptured ovarian cyst
Ovarian torsion/abscess
PID
Ectopic
```
106
2 types endometrial cancer
Endometroid (type I) and serous (type II)
107
Endometrial cancer: most common, 2/2 unopposed estrogen, dx around 55 yrs, good prognosis
Endometroid - type I
108
Endometrial cancer: not as common, unrelated to estrogen, p53 mutation, dx around 67 yrs, poor prognosis
Serous- type II
109
Rx protective against endometrial and ovarian cancer
OCP
110
Pelvis mass: mobile, cystic, unilateral, smooth = benign or malignant
Benign
111
Pelvis mass: fixed, solid or firm, bilateral, nodular = benign or malignant
Malignant
112
Adnexal mass: < 8 cm, cystic, unilocular, unilateral, calcifications = benign or malignant
Benign
113
Adnexal mass: > 8 cm, solid/ cystic and solid, multilocular, bilat, ascites = benign or malignant
Malignant
114
CA-125 tumor marker ovarian cancer
Epithelial
115
AFP tumor marker ovarian cancer
Endodermal sinus
116
AFP, hCG tumor marker ovarian cancer
Embryonal Ca
117
hCG tumor marker ovarian cancer
Choriocarcinoma
118
LDH tumor marker ovarian cancer
dysgerminoma
119
Inhibin tumor marker ovarian cancer
Granulosa cell
120
Causes of urinary incontinence without specific urogenital pathology
DIAPPERS
```
Delirium
Infection
Atrophic urethritis/vaginitis
Pharmaceuticals
Psych (esp depression)
Excessive urinary output (hyperglc, hyperCa, CHF)
Restricted mobility
Stool impaction
```
121
Uncontrolled loss of urine at all times and in all positions - loss of sphincter efficiency, fistula
Total
122
Urinary incontinence after increased intra-abdominal pressure (coughing, sneezing. lifting) - urethral sphincter insufficiency due to lax of pelvic floor mm
Tx
Stress
Kegel, pessary, vaginal vault suspension surgery
123
Urinary incontinence that is strong, unexpected urge to void that is unrelated to position or activity. Due to detrusor hyperreflexia or sphincter dysfunction due to inflammation or neurogenic
Tx
Urge
Tx: antichol or TCA, biofeedback
124
Urinary incontinence due to chronic urinary retention. Chronically distended bladder with inc intravesical pressure that just exceeds the outlet resistance, allowing a small amt of urine to dribble out
Tx
Overflow
Tx: placement of urethral catheter in acute settings; Tx underlying disease; timed voided
125
Peds, bunch of grapes in vagina
Sarcoma botryoides - rhabdomysarcoma
126
Uncommon fibroepithelial breast tumors -capable of a diverse range of behavior.
- Similar to benign fibroadenomas, although with a propensity to recur locally following excision without wide margins.
- Tumors that metastasize distantly, sometimes degenerating histologically into sarcomatous lesions that lack an epithelial component
phyllodes tumor
127
Tumor markers recurrent breast cancer
CEA
CA 15-3
CA 27-29
128
Breast cancer stages
I; <2 cm
II: 2-5 cm
III: axillary LN
IV: distant mets
129
Testing to do if sexual assault
```
HIV
Syphilis
HSV
HBV
CMV
Pregnancy
GC and chlam
BAC, urine tox
```
130
Endometrial glands within uterine musculature
Adenomyosis
131
Phenotypically normal female with absence of axillary and pubic hair, primary amenorrhea
Androgen insensitivity syndrome
| NO UTERUS
132
Normal breast development and a uterus, primary amenorrhea
Prolactin level to R/O pituitary adenoma
-Prolactin high: MRI
Normal: give progesterone and evaluate same as for secondary amenorrhea
133
Side effects OCP
```
Glc intolerance
Edema
Weight gain
Cholithiasis
Benign liver adenoma
Melasma
N/V, HHA
HTN
```
134
Mammogram vs US when Dx breast mass
Mammo > 30 yrs
| US <30 because breast too dense for mammo
135
Women post menopause and new breast mass
MUST CONSIDER CANCER
136
3 D endometriosis
Dysmenorrhea
Dyspareunia
Dyschezia
137
Location endometriosis
Ovaries
Broad or uterosacral ligament
Peritoneal surface
138
Location endometriosis
Ovaries
Broad or uterosacral ligament
Peritoneal surface
139
Gold standard Dx endometriosis
Lap with visualization
140
Benefits HRT
Decreased osteoporosis
Reduces hot flashes and GU Sx
Decreased risk colorectal Ca
141
Benefits HRT
Decreased osteoporosis
Reduces hot flashes and GU Sx
Decreased risk colorectal Ca
142
Absolute CI to HRT
```
Unexplainred vag bleeding
Acute liver disease
CAD
Thromboembolism HX
CAD
Hx endometrial or breast cancer
Pregnancy
```
143
If do not have a uterus, which hormone do you not need
Progesterone
