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Flashcards in gyn procedures Deck (170):
1

LSIL - LEEP procedure indicated?

no f/u with repeat pap in 6 months

2

indications for cold knife conization

+ endocervical curettage, HSIL lesion too big for LEEP, lesion extends into endocervical canal beyond vision, r/o invasive cancer

3

cervical cancer tx

radical hysterectomy

4

IUD for endometriosis

Levonorgestrel IUD

5

thelarche

breast budding

6

adrenarche

hair growth

7

menarche

onset of menses

8

order of puberty

thelarche, adrenarche, growth spurt, menarche

9

weight required for menses

85-105 lbs

10

Noonan's syndrome - physical chracteristics

short stature, webbed neck, heart defects, abnormal faces and delayed puberty

11

Noonan's syndorme - karyotype

normal

12

Turner syndrome - karyotype

XO

13

Turner syndrome - physical characteristics

pterygium colli, shield chest and cubitus valgus

14

Rokitansky-Kuster-Hauser Syndrome

vaginal/uterine agenesis

15

Kallmann syndrome

olfactory tract hypoplasia and the arcuate nucleus does not secrete GnRH

16

Kallmann syndrome - tx for no puberty

pulsatile GnRH therapy

17

true precocious puberty

diagnosis of exclusion, sex steroids increased by hypothalamic, pituitary, gonadal axis with increased pulsatile GnRH secretion

18

precocious puberty - CNS causes

tumors (astrocytoma, glioma, germ cell tumors secreting hCG), hypothalamic hamatomas, injury (surgery, trauma, radiation, inflammation, abscess), congenital (hydrocephalus, arachnoid cysts, suprasellar cysts)

19

McCune Albright

premature menses BEFORE breast/pubic hair development

20

true precocious puberty - tx

if not within several months o expected puberty, GnRH agonist to suppress axis (non-pulsatile = suppression)

21

congenital adrenal hypoplasia - mechanism

21-hydroxylase type results in the adrenal being unable to produce adequate cortisol as a result of a partial block in the conversion of 17-hydroxyprogesterone to desoxycorticosterone, with the accumulation of adrenal androgens

22

congenital adrenal hypoplasia - outcome

precocious adrearche

23

congenital adrenal hypoplasia - tx

steroid replacement

24

congenital adrenal hypoplasia, premature adrenarche, some then develop ___ in adlescence

PCOS

25

normal ages for menarche

9 - 17

26

pt with uterine agenesis, look for __

Renal anomalies occur in 25-35% of females with Mullerian agenesis

27

most common lower genital tract malformation

imperforate hymen

28

short vagina and pelvic mass on exam

iperforate hymen/vaginal or cervical agenesis

29

weight loss - hypothalamic dysfunction - lack of pulsatile GnRH - pituitary doesnt secrete LH/FSH

hypothalamic pituitary dysfunction

30

causes of hypothalamic-pituitary amenorrhea

functional (weight loss, obesity, excessive exercise), drugs (marijuana and tranquilizers), neoplasia (pituitary adenomas), psychogenic (chronic anxiety and anorexia nervosa), and certain other chronic medical conditions

31

PCOS tx

OCPs

32

PCOS desiring pregnancy - tx

clomiphene

33

most common cause of amenorrhea

pregnancy

34

Mayer-Rokitansky-Kϋster-Hauser syndrome - aka...

Mullerian agenesis - congenital absence of vagina (absence of allopian tubes/uterus), ovaries are present and functioning (secondary characteristics of puberty occur at appropriate time)

35

Asherman's syndrome - causes

endometritis or curettage

36

Sheehan's syndroe - cause

postpartum hemorrhage, pituitary apoplexy

37

initial laboratory assessment for a patient with amenorrhea and no other symptoms or findings on physical exam

prolactin

38

if elevated prolactin - order

brain MRI

39

if first round of labs are normal - order...

17-hydroxyprogesterone, LH, FSH

40

short duration hirsutism, high DHEAS, normal testosterone

adrenal tumor

41

patient with suspected PCOS, what need to r/o?

late-onset 21-hydroxylase deficiency

42

PCOS - hat lab is abnormal?

testosterone

43

what use to treat hirsutism? why?

OCPs - establish regular menses and lower ovarian androgen production

44

test to evaluate Cushing's disease?

dexamethasone suppression test or a 24-hour urinary measurement for cortisol can be performed

45

Sertoli-Leydig tumors - age at dx?

20-40

46

Sertoli-Leydig - side?

unilateral

47

Rapid onset of hirsutism and virilizing signs are hallmarks of this disease, and include many of the findings in this patient including acne, hirsutism, amenorrhea, clitoral hypertrophy, and deepening of the voice.

Sertoli-Leydig tumor

48

Abnormal laboratory findings include suppression of FSH and LH, marked elevation of testosterone, and presence of an ovarian mass.

Sertoli-Leydig tumor

49

causes of virilization (5)

PCOS, hypothyroidism, androgen producing tumors (ovarian, adrenal, or pituitary), and anabolic steroid use. A rare cause may be late onset CAH

50

hyperthecosis - definition

more severe form of polycystic ovarian syndrome (PCOS

51

hyperthecosis - symptoms

virilization due to the high androstenedione production and testosterone levels. In addition to temporal balding, other signs of virilization include clitoral enlargement and deepening of the voice

52

hyperthecosis - tx

more difficult to treat with OCPs

53

hirsutism - tx (in addition to OCP) - how does it help?

Spironolactone, an aldosterone antagonist diuretic

54

endometriosis - medical tx

Danazol

55

2nd line tx for hirsutism

lupron, depo-provera

56

progestin withdrawal

sloughing of endometrium

57

involution of corpus luteum

progestin withdrawal

58

inhibin in luteal phase?

increases

59

method to evaluate abnormal bleeding?

pelvic u/s

60

observation of endometrial polyp NOT recommended when?

>1.5cm

61

management of endometrial polyp

observation, medical management with progestin, curettage, surgical removal (polypectomy) via hysteroscopy, and hysterectomy

62

irregular, heavy vaginal bleeding - study/test? why?

endometrial biopsy - to r/o endometrial hyperplasia or carcinoma

63

LH and FSH in PCOS?

elevated (high ovarian androgen production = high estrogen)

64

why is T high in PCOS?

sex hormone binding globulin is low b/c high circulating androgens = high free/active T

65

workup for irregular/heavy vaginal bleeding

TSH, Prolactin, pelvic ultrasound and endometrial biopsy

66

cause of midcycle bleeding?

drop in estrogen at time of ovulation

67

dysmennorrhea - tx

NSAIDs, OCPs

68

how do OCPs help dysmenorrhea?

progestin = endometrial atrophy (endometrium = where PGEs are made = fewer = less pain)

69

secondary dysmenorrhea - cause?

PID

70

screening for sexually active patients <25yo?

gonorrhea, chlamydia,

71

Blue-black powder burn lesions

endometriosis

72

endometrial glands/stroma and hemosiderin-laden macrophages

endometriosis

73

treatment of adenomysosis (surgical vs medical)

hysterectomy vs GnRH agonist

74

to improve irregular bleeding but keep option fo future pregnancy

progesterone IUD

75

perform ___ on all women >40yo with irregular/heavy menstrual bleeding (regardless of presence of other things ie fibroids)?

ENDOMETRIAL BIOPSY

76

well-circumscribed, non-encapsulated myometrium

fibroids (>10 mitotic figures/hpf)

77

patient >50 with menopausal sx and intermittent vaginal bleeding - contraindication for hormonal treatment?

vag bleeding (sign of cancer)

78

premature ovarian failure - definition

< 35yo

79

postmenopausal women require ___ ca per day?

1200mg

80

how often repeat bone mineral density test when pt on bishosphonates?

Q2yr

81

SE of starting hormone therapy for menopausal sx?

vaginal bleeding in 1st 6mo

82

effect of estrogen on lipids?

GOOD for both = increase HDL, decrease LDL

83

osteopenia definition

-1 to -2.5

84

fracture risk factors

prior fracture, family history of osteoporosis, race, dementia, history of falls, poor nutrition, smoking, low body mass index, estrogen deficiency, alcoholism, and insufficient physical activity

85

circulating androgens are converted to ___ in fat?

entrone, estradiol

86

PCOS - LH and FSH - what is the relationship?

LH/FSH ratio is increased

87

menstrual irregularities d/t hypothyroid correct with OCPs?

no

88

ovulatory dysfunction in PCOS - tx

metformin + ovulatory agents (clomid)

89

imipramine can cause

hyperprolactinemia

90

hypothyroidism - hormone changes?

increased TSH, decreased T4, HIGH prolactin, decreased LH/FSH

91

exercise-induced hypothalamic-pituitary dysfunction - characteristic hormones?

low estrogen, normal FSH

92

treat exercise hypothalamic-pituitary dysfunction?

if less exercise+weight gain dont work = exogenous LH/FSH

93

clomiphene challenge test

giving clomiphene citrate days 5-9 of the menstrual cycle and checking FSH levels on day 3 and day 10, will help determine ovarian reserve

94

when are women most fertile?

mid-cycle when ovulating (approx day 14)

95

egg viability after ovulation

24 hours

96

vitamins that help with PMS

A, E, B6

97

when experience PMS and PMDD symptoms?

luteal phase of menstrual cycle

98

tx for PMS/PMDD

OCPs (suppress hypothalamic-pituitary axis), SSRIs (every day or for 10 days in luteal phase)

99

strongest associations with PMS

+ family history, B6, calcium, magnesium deficit

100

increased risk for molar pregnancy

Asian race (1/800), 2+ miscarraiges

101

risk for recurrent molar if had 1 already

1-2%

102

vaginal bleeding, enlarged uterus size>dates, or size

molar pregnancy

103

manage molar pregnancy?

suction curettage

104

complete mole karyotype?

complete moles are diploid resulting from fertilization of “empty egg” by single sperm (46XX, 90%) or by two sperm (X & Y = 46XY 6-10%)

105

partial molar preg - look like?

villi swelling

106

complete molar preg - look like?

trophoblastic proliferation with hydropic degeneration

107

partial mole karyotype?

2 sperm fertilize egg with genetic material = XXY XXX XYY

108

how long wait to conceive after molar preg?

6mo after resolution of BhCG

109

association between infertility and molar pregnancy? t/f?

NO, FALSE

110

choriocarcinoma - dx?

quantitative B-hCG w/hx of recent pregnancy

111

choriocarcinoma - biopsy?

never!!! (super vascular)

112

choriocarcinoma - biopsy?

never!!! (super vascular)

113

moderately differentiated vulvar carcinoma - tx?

radical vulvectomy + node dissection

114

microinvasive squamous cell carcinoma of vulva

wide local excision

115

most common vulva malignancy

squamous cell carcinoma (90%)

116

risk for SCC of vulva

lichen sclerosus

117

"crinkled tissue paper" on vulva

lichen sclerosus

118

white plaque-like lesions and poorly demarcated erythema, not a discrete mass

Paget's disease of vulva

119

vulvar intraepithelial neoplasia (VIN)

related to HPV, multifocal hyperpigmented areas on vulva

120

hidradenitis

chronic, unrelenting skin infection causing deep, painful scars and foul discharge

121

vulvar intraepithelial neoplasia (VIN3) - tx?

wide local excision, close subsequent surveillance

122

vulvar intraepithelial neoplasia (VIN3) - tx?

wide local excision

123

condyloma tx?

trichlolroacetic acid, imiquimod

124

cervical dysplasia - tx?

cryotherapy

125

VIN2 tx?

laser ablation

126

Paget's disease of vulva - what is it?

in situ carcinoma of the vulva (scattered whitish lesions, VERY itchy, assoiated with breast ca,

127

cervical ectropion

central, columnar epithelium of endocervical canal protrudes out into outer cervix = reddish ring of tissue surrounding cervical os

128

Punctations and mosaicism represent ___?

new blood vessels on end/side

129

cervical dysplasia - graded based on?

degree of involvement of epithelial layer - NOT invasion beyond basement membrane (becomes more than dysplasia, more than CIN)

130

cervical dysplasia - graded based on?

degree of involvement of epithelial layer - NOT invasion beyond epithelial layer (becomes more than dysplasia, more than CIN)

131

+ endocervical curettage - tx?

cervical conization

132

when use cryotherapy?

cervical dysplasia when malignancy RULED OUT (have full visualization of lesion)

133

Cervical cancer screening should start at ?

age 21 years.

134

women aged 21-29 should have pap every ___ years?

3

135

· Women aged 30 – 65 years should have a Pap test and an HPV test (co-testing) every ____years (preferred). It is acceptable to have a Pap test alone every __ years.

5, 3

136

· Women should stop having cervical cancer screening after age __years if they do NOT have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row, or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past five years.

65

137

exceptions to cervical ca screening guidelines

· Women who have a history of cervical cancer, are infected with HIV, have a weakened immune system, or who were exposed to DES before birth should not follow these routine guidelines.

138

most common symptom with leiomyoma?

menorrhagia

139

which type of leiomyomas cause infertility

submucosal

140

fibroid growth stimulated by?

estrogen

141

if fibroid pain, nsaids fail, dont want surgery = tx options?

GnRH agonist = suppresses estrogen)

142

postmenopausal woman with bleeding, pelvic pain coupled with uterine enlargement, and vaginal discharge

consider uterine leiomyosarcoma

143

endometrial hyperplasia more common in who?

perimenopausal who dont ovulate regularly, potmenopausal

144

complex atypical hyperplasia - risk of progressing to endometrial ca?

28% (30% of women with that dix will end up having ca on final path)

145

complex atypical hyperplasia - risk of progressing to endometrial ca?

28%

146

most women with endometrial ca present with?

bleeding (80-90%)

147

endometrial ca - hereditary?

no

148

endometrial ca - associated with what syndrome?

Hereditary Non-polyposis Colorectal Cancer Syndrome (HNPCC, or Lynch II)

149

most common gyn malignancy?

endometrial carcinoma

150

after pathalogic diagnosis from biopsy, what test next?

extent of disease

151

most common site of distant spread of endometrial ca?

lungs

152

surgery for early endometrial ca? (well-differentiated endometrioid adenocarcinomas)

extrafascial total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy

153

surgery for early endometrial ca?

extrafascial total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy

154

aggressive types of endometrial ca?

clear cell or papillary serous carcinomas

155

adnexal mass in perimenopausal woman ,irregular bleeding, endometrial hyperplasia,

granulosa cell tumor (ovarian mass + Secretes estrogen = hyperplasia)

156

presenting symptom of endometrial ca in postmenopausal woman?

bleeding or discharge

157

most common cause postmenopausal bleeding

most common causes of postmenopausal bleeding are atrophy of the endometrium (60-80%), hormone replacement therapy (15-25%), endometrial cancer (10-15%), polyps (2-12%), and hyperplasia (5-10%).

158

risk factors for ovarian ca?

nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe (NOT SMOKING)

159

risk factors for ovarian ca?

nulliparity, family history, early menarche and late menopause, white race, increasing age and residence in North America and Northern Europe

160

lager than functional cyst, presents with increasing abdmoinal girth

serous cystadenoma

161

multilocular and quite large cyst on ovary

mucinous cystadenoma

162

solid components or appear echogenic on ultrasound, on ovary

dermoid cyst

163

to assess extent of ovarian ca spread, use __?

abdomen/pelvis CT

164

widespread ovarian ca with large tumor burden - initial tx?

tumor debulking

165

widespread ovarian ca but unresectable or pt is bad surgical candidate - tx?

neoadjuvant chmotherapy

166

what determines 5 year survival of women with epithelian carcinoma of ovary

tumor STAGE

167

tx for women with advanced ovarian ca?

surgical cytoreduction then chemo (taxane, platinum)

168

5 year survival with stage III / IV ovarian ca?

30%

169

most common karyotype in spontaneous abotuses

autosomal trisomy

170

what is danazol?

GnRH agonist