Gyn Stepup Flashcards
(235 cards)
1
Q
when have all oocytes formed
A
20 weeks
2
Q
what causes low FSH LH and androgens in 4-8 yr olds
A
GnRH suppression
3
Q
When are initial pubertal changes
A
8-11 yrs
4
Q
what time of day are hormones in kids highest
A
at night
5
Q
normal events female puberty
A
adrenarche: adrenal androgens
gonadarche: FSH and LH activation
Thelarche: breast tissue
Pubarche: pibic hair
growth spurt
Menarche: onset menses
6
Q
what happens in >50 y.o to LH and FSH
A
increase with onset of ovarian failure
7
Q
Tanner I
A
raised nipple and no hair growth yet
8
Q
Tanner 2
A
breast budding, areolar enlargement with slight growth of labial hair
9
Q
Tanner 3
A
Further breast and areolar enlargement
more hair growth
10
Q
Tanner 4
A
areola and nipple form above the breast
hair becomes coarse and spreads over pubic area
11
Q
Tanner 5
A
areola recedes and nipple stays out
coarse hair extends to medial thighs
12
Q
what causes central precocious puberty
A
early activation of hypothalamic pituitary gonadal axis
13
Q
precocious puberty age in girls and boys
A
girls
14
Q
isosexual precocious puberty
A
premature development appropriate for gender
15
Q
heterosexual precocious puberty
A
virilization/,asculinization firls
feminization boys
girls with virilization is due to CAH, exposure to androgens or androgen secreting neoplasm
16
Q
what is GnRH stimulation test
A
give GnRH:
- if LH and FSH increase then central precocious puberty
- if LH and FSH have no response then pseudoprecocious puberty ( peripheral autonomous secretion sex steroids)
17
Q
labs that suggest ectopic hormone production causing precocious puberty
A
low LH and FSH with high estrogen
probably noeoplasm or exogenous consumption estrogen
18
Q
which endocrine path can cause precocious puberty
A
chronic hypothyroid
19
Q
what is used for Lh and FSH suppression
A
GnRH analogues
20
Q
Tx for precocious puberty caused by CAH
A
cortisol replacement
21
Q
complications of precocious puberty
A
short statures
social and emotional adjustment issues
22
Q
what peaks right before ovulation
A
LH
23
Q
when does progesterone peak
A
during the luteal phase or proliferative phase
24
Q
which phase does ovulation occur in
A
right between end of follicular/proliferative and right before luteal/secretory
25
what peaks before LH
17B estradiol
26
when does body temp rise in menstrual cycle
with ovulation
27
which cells are regulate by LH
theca cells
28
which cells are regulated by FSH
granulosa cells
29
what stimulates endometrial proliferation
estrogens
| induce the LH surge and hgih levels of Estrogen inhibit FSH secretion
30
role of progesterone
```
stimulate endometrial glands development
inhibit contraction
increase cervical mucus thickness
increase basal body temp
inhibit LH and FSH secretion
maintain pregnancy
```
31
decreased levels progesterone leads to
menstruation
32
role of hCG
acts like LH after implantation fertilized egg
| maintain corpus luteum viability
33
follicular phase
starts with menstruation.
| FSH stimulates growth ovarian follicle (granulosa cells) which secete estradiol
34
role of estradiol in follicular phase
induce endometrial proliferation and increase FSH and LH
35
Luteal phase
the LH surge causes ovulation and the residual follicle (corpus luteum) secretes estradiol and progesterone to maintain endometrium
high levels estradiol inhibit FSH and LH
36
what happens when egg is notfertilized
corpus luteum degrades, progesterone and estradiol levels decrease and the endometrial lining degrades (menses)
37
fertilization
egg implants in endometrium and the endometrial tissue begins to secrete hCG to maintain corpus luteum
CL secretes progesterone until placenta can make it around 8-12 weeks
38
when does ovulation occur
14 days since 1st day of last menses
39
premature menopause
ovarian failure before age 40
40
what happens to FSH and LH in perimenopasual period
increase
| but ovarian response decreases
41
signs of menopause
```
hot flashes
breast pain
sweting
menstrual irregularity
amenorrhea
fatigue
anxiety
dyspareunia
urinary frequency
change in bowel habits
```
42
topical estrogen is contraindicated in what patients
any with a Hx of breast CA
43
what hormone is decreased in menopause
estradiol
44
what reduce osteoporosis and CV risks of menopause
raloxifene and tamoxifen
| Selective E R modulators
45
what causes increased risk osteoporosis in menopause
decreased estrogen by ovaries
46
complications menoapuse
osteoporosis, CAD and dementia
47
most effective birth control
progestin implant
48
least effective Rx birth control
progestin OCP and regualr OCP
49
what birth control should be avoided in obese women
transderman contraceptive patch because diffusion into adipose tissue
50
how effective is lactation as birth control
95%
51
how effective are IUDs
99%
52
what is primary amenorrhea
no menses ever with normal secondary sexual characteristics age 16
13 if no sexual characteristics
53
secondary amenorrhea
absense of menses for 6 mo+ with prior Hx of menses
54
causes of secondary amenorrhea
```
pregnancy
ovarian failure
hypothalamic or pituitary disease
uterine abnormalitiles
PCOS
anorexia
malnutrtion
thyroid disease
```
55
Ashermann syndrome
intrauterine adhesions from surgical procedure or possible infection
56
labs to order in amenorrhea
```
b-hCG
TSH T4 T3
prolactin
FSH and LH
androgens
```
57
what is the progestin challenge
five progesterone and observe for bleeding for 5 days
58
Tx prolactinoma
dopamine agonists
59
XY patient with androgen insensitivity syndrome and has testicles, next step
remove testicles because of increased risk testicular cancer
60
primary amenorrhea with secondary sexual charcteristics
| causes
look for anatomical abrnomatliies or XY genotype
61
steps for labs for secondary amenorrhea
check b-hCG
then check TSH, T4T3
then if normal check prolactin
then do progestin challenge
62
if progestin challenge is negative and have amenorrhea, now what
estrogen-progesterone challenge
if does cause bleeding check FSH and LH
if FSH and LH are hgiht- ovarian failure
if LH and FSH are low- hypothalamic pituitary dysfunction
63
labs for dysmenorrhea
bhCG and vaginal cultures
US for lesions
hysteroscopy if uterine pathology
64
Tx for dysmenorrhea
NSAIDs or OCPs
65
risk factor for severe pain with menses
family histroy
66
Tx for PMS or PMDD
exercise, Vit B6, NSAIDs, OCPs, progestines, SSRIs, alprazolam
67
when do mood Sx from PMS occur
second half of cycle
68
most common cause female infertility
endometriosis
69
what is endometriosis
endometrial tissue outside the uterus
70
causes of endometriosis
retrograde menstruation, vascular or lymphatic spread of endometrial tissue, iatrogenic from surgery or C section
71
risk factors fo endometriosis
FMH
infertility
nulliparity
low BMI
72
Signs Sx endometriosis
dysmenorrhea, dyspareunia, painful bowel movements
pelvic pain, possible infertility
uterine or adnexal tenderness
palpable adhesions
73
Labs in endometriosis
Bx of endometrial tissue
bhCG and UA
Ca-125 sometimes increased, but not sensitive
74
powder burn lesions
seen on laparascopy of uterus with endometriosis
75
Tx endometriosis
OCPs. progestins, danazol, GnRH agonists
ablation
hysterectomy
76
adenomyosis
endometrial tissue that invades myometrium causing uterine enlargement and cyclical pain
77
complications endometriosis
infertility
78
what are the parameters of defining abnormal mesnes
35 day intervals
lasting >7 days
blood loss 80 mL
79
labs in abnormal uterine bleeding
```
bhCG
CBC with coag
TSH LH FSH
PAP smear
endometrial Bx
```
80
Tx abnormal bleeding
tx underlying disorder
OCPs can help
endometrial ablation
81
most common cause andogen excess in women
PCOS
82
what is produced in PCOS
excess LH induces overproduction androgens by ovaries
| some have hyperinsulinemia
83
labs in PCOS
```
increased LH
LH:FSH ration >2
increased DHEA
increased total testosterone
+ progestin
```
84
what causes amenorrhea and infertility in PCOS
abnomral high LH levels and FSH inhibition by high estrogen
85
what causes cysts in PCOS
the androgen excess
86
what is helpful for pregnancy in PCOS
clomiphene (antiestrogen induces follicule stimulation and maturation)
metformin
87
complications PCOS
infertility, increased risk DM, HTN, ischemic heart disease, ovarian torsion, endometrial CA
88
what is greatest contributing factor to increased risk endometrial CA in PCOS
increased estrogens
89
Tx gardnerella vaginalis or BV
metro or clinda
90
what normal flora overgrowth do you Tx partners for
trichomonas, Tx with metro
91
on pap exam see cervical petechiae
trichomonas
92
thin white fishy odor vaginal discharge
gardnerella
93
malodorous frothy green discharge
trichomonas
94
clu cells
gardnerella
95
motile things on slide
trichomonas
96
+ whiff test
gardnerella (with KOH)
97
pseudohyphae with KOH
candida
98
vaginal pH is 3.5-4.5 (normal) and has discharge
candida
99
vaginal pH is more alkalotic >4.5 and has discharge
gardnerella or trichomonas
100
Tx for gardnerella
metro
101
Tx for trich
metro and Tx partner
102
Tx for candida
topical clotrimazole, miconazole or nystatin
| oral fluconazole
103
signs Sx TSS
vomiting, diarrhea, sore throat, HA, high fever
macular rash
hypotension, shock, resp distress
desquamation palms and soles
104
labs in TSS
vaginal culture shows staph aureus
dec platelets
inc AST and ALT
inc BUN and Cr
105
Tx TSS
clinda or penicillinase R beta lactams like oxacillin and nafcillin
vanco if MRSA
106
what causes cervicitis
N gon or C trach
107
Signs Sx cervicitis
dyapreunia, bleeding after intercourse, purulent vaginal discharge
urethritis
108
Dx cervicitis
gram stain for N gonn
| enzyme immunoassays or PCR for both
109
Tx cervicitis
ceftriaxone for N gonn
| doxy or azithro for chlamydia
110
do you T partners for cervicitis
yes
111
complication cervicitis
PID or septic arthritis
112
what reduces risk PID
barrier contraception
113
labs for PID
bhCG
inc WBC and ESR
gram stain
culdocentesis
114
Tx PID
empiric antibiotics doxy ceftriaone cefoxitin
| Tx inpatient if high fever or young age
115
complications PID
infertility from adhesions
chronic pelvic pain
tuboovarian abscess
increased risk ectopic pregnancy
116
tubo ovarian abscess presentation
PID with signs of sepsis or peritonitis
117
Tx tuboovarian abscess
IV hydration, IV antibiotics and surgical drainage
118
primary syphilis
1-13 weeks post exposure
| solitarty chancre that heals sponateously
119
secondary syphilis
```
as chancre heals
HA, malaise, fever, maculopapular rash on palsm and soles
lymphadenopathy
papules in moist areas condylma lata
resolve spontaneously
```
120
tertiary syphilis
1-30 years later
granulmoatous skin bone and liver lesions (gummas)
loss of 2 point discrimination (tabes dorsalis) and argyll robertson pupils
121
what lab will be + for life with sphyliiss
FTA-ABS
122
Tx syphilis
Penicilin G, doxy or tetra
| IV penicillin G for severe tertiary cases
123
can you culture for syphilis
no
124
complications syphilis
destruction from gummas
CV- aortic regurg and aortitis
neuro- cerbral atrophy, tabes dorsalis and meningitis
125
which HPV assoc with cervical CA
16 18
126
acetic acid on cervix and some cells turn white
HPV
127
Tx HPV
podophyllin, trichloroacetic acid, topical 5-fluorouracil, alpha INF
cryotherapy
laser therapy
128
what strains is HPV vaccine out for
6 11 16 18
129
complicaitons HPV
vaginal scarring
| possible increased risk cervical cancer
130
chancroid
H ducreyi
painful ulcer with grayish base and foul odor
possible inguinal adenopathy and bubos
131
gram stain of H ducreyi
gram neg rods
132
Tx chancroid
ceftriaxone, erythromycin, azithromycin
133
Lymphogranuloma venerium
L1 L2 L3 serotypes of C trachomatis
| different from the one causes cervicitis
134
signs Sx lymphogranuloma venerium
malaise, HA, fever, formation papule at site that is painless ulcer
after 1 month have significant inguinal buboes
can progress to bubo ulceration and elephatiasis
fistula and abscess formation
135
labs in lymphogranuloma venereum
immunoassays for chlamydia
136
Tx lymphogranuloma venereum
tetracycline
erythromycin
doxycyline
137
what causes granuloma inguinale
Klebsiella granulmoatis
138
signs Sx granuloma inguinale
papule on external genitatial and becomes painless ulver with beefy red base and irregular borders
mild lymphadenopathy
139
Bx in granuloma inguinale
giemsa stain shows donovan bodies
| red encapsulated intracellular bacteria
140
Tx granuloma inguinale
doxy or TMP SMX for 3 weeks
141
risk factors for fibroids (leiomyomas)
```
nulliparity
african american
diet high in meats
alcohol
FMH
```
142
signs Sx fibroids
menorrhagia, pelvic pressure or pain, urinary frequency or infertility
143
what imaging is used for fibroids
transvaginal US or hysteroscopy
144
Tx for fibroids
follow with US
FnRH agonists reduce bleeding and size but use only temporary
myomectomy for sypmotmatic
hysterectomy for those Sx and already had kids
Uterine artery embolization
145
endometrial CA with no relation to excess estrogen
worse prognosis
146
what is endometrial CA
adenocarcinoma of uterine tissue usually related to high exposure estrogen
147
which syndrome inc risk endometrial CA
lynch syndrome II
148
signs Sx endometrial CA
heavy menses, midcycle bleeding, postmenopasual bleeding, possible abdominal pain, ovaries and uterus feel fixed
149
labs for endometrial CA
Bx to examen cells that show hyperplastic abnormal glands with vascular invasion
increased CA-125
150
Imaging in endometrial CA
CXR and cT to detect mets
| transvaginal US to detect mass and measure wall thickness
151
most common cause vaginal bleeding in menopausal women
atrophic vaginitis
| but still need endometrial Bx to rule out cA
152
Tx endometrial CA
TAH BSO and lymph node sampling
| if no kids yet and limited CA to lining, can shrink with progestins and do TAH BSO after childbirth
153
adjuvant for endometrial CA
radiation for high grade
| chemo for spread beyond uterus and cant have radiation
154
which hormones are good for unresectable endometrial CA
progesterone and tamoxifen
155
complications endometrial CA
local extension
| mets to peritoneum aortic and pelvic lymph nodes, lungs and vagina
156
most common cervical cancer
squamous cell
157
risk factors cervical ca
```
early first intercourse
tobacco
HPV 16 18 31 33
multiple sexual partners and high risk
history STIs
```
158
when is first pap smear
21 years old
159
screening with pap smears
21-29 years old every 3 years
| women >30 every 5 years HPV
160
see abnormal lesion on pap smear, next step
punch biopsy or cone biopsy
161
imaging for cervical CA
CT MRI or US to determine extent
162
Atypical squamous cells of undetermined significance
do HPV screening and pap smears in 6 and 12 months
| HPV testing in 12 months again
163
atypical squamous cells, cannot exclude HSIL
| next step
do HPV screening, endocervical biopsy
repeat Pap in 6 and 12 months
repeat HPV in 12 months
164
low grade squamous intraepithelal lesion on pap
| next step
this is CIN 1
repear pap in 6 and 12 months
repeat HPV in 12 months
excision loop or leepprocedure or conization/laser therapy
165
high grade squamous intraepithelial lesion on pap
| next step
HSIL or CIN 2 or 3
excision by LEEP or conization or laster
repeat cytology every 6 months
166
pap shows highly atypical cells with stromal invasion
squamous cell carcinoma
167
cervical CA visible invasive lesions that involve uterus but to not extend into pelvic wall or lower third of vagina
Tx
radical hysterectomy with lympadenectomy or radiation and cisplatin chemo
168
cervical cA lesions that extend to parametrial tissue, pelvic wall, lower 3rd vagina or adjacent organs
Tx
radiation and chemo
169
what is a follicular cysts
from ovarian follicle and granulosa cells
may regress with cycles
have abdominal pain and gullness
170
Tx for follicular cyst
obsercation
171
corpus luteum cyst
from theca cells
or hemorrhagic corpus luteum
usually larger than follicular cysts and later in cycle
have abdominal pain and fullness but at greater risk of rupture
greater risk of torsion
172
Tx corpus luteal cyst
obsercation, cystectomy if does not regress or significant hemorrhage
173
mucinous or serous cystadenoma
from epithelial tissue resembles endometrial or tubal histo
| can have psammoma bodies
174
Tx mucinous or serous cystadenoma
unilateral SO or TAHBSO if postmenopausal
175
what is an endometrioma
spread of endometriosis to ovary
| abdominal pain, dyspareunia, infertility
176
Tx endometrioma
OCPs, GnRH agonists, progestins, danazol
| cystectomy or oophorectomy frequently required because reoccur
177
Teratoma or dermoid cyst
from germ cells with multiple dermal tissues
| rupture can cause peritonitis
178
Tx for dermoid cyst
cystectomy with attempted presercation of ovary
179
stromal cell tumor
granulosa, theca or sertoli leydig cells
secrete hormones
can cause precocious puberty or virilizaiton if sertoli leydig
180
Tx stromal cell tumor of ovary
unilateral SO or TAH BSO if post menopasual
181
most common CA of ovaries
epithelial
182
risk factors ovarian CA
FMH
infertility
nulliparity
BRCA1 or 2
183
Sx ovarian CA
abdominal pain, fatigue, weight loss, change in bowel habits, menstrual irregularity, ascites
184
labs in ovarian CA epithelial origin
increased CA-125 in epithelial tumors
185
labs in germ cell ovarian CA
increased AFP bhCG, LDH
186
Tx epithelial ovarian CA
TAH BSO with pelvic wall sampling, appendectomy and adjuvant chemo
187
Tx germ cell ovaraian CA
unilateral SP if limited
surgical debuking
chemo
188
complications ovarian CA
prognosis is usually poor because at time of Dx pretty advanced
189
US shows cystic ovarian mass with smooth lesion edges and few septa
benign
190
US cystic mass show irregularity nodularity, multiple septa and pelvic extension
malignancy
191
how to properly stage ovarian malignancy
surgical resection and histo staging
192
what causes breast abscess
S aureus or strep or anaerobic subareolar infections
193
breast abscesses are more common in which women
smokers
194
painful mass in breast, fever with plapable red warm breast mass
breast abscess
195
labs in breast abscess
increased WBCs, fine needle aspiration confirms
196
Tx breast abscess
oral or IV antibiotic
incision and drainage of fluctuant masses
continue breast feeding
197
what would a Bx of fibrocystic changes of breast show you
epithelial hyperplasia
198
when should you start mammos
age 40 or 50 depending
199
suspicious lesions on mammos are what
hyperdense regions or calcifications
200
Tx for fibrocystic changes
caffeine and diet reduction
OCPs
progesterone
tamoxifen
201
what is most common benign breast tumor
fibroadenoma from proliferation of single duct
| usually
202
fibroadenoma findings
solitary solid and mobile
well defined edges
Bx FNA will confirm
203
Tx for fibroadenoma
surgical excision or US guided crytotherapy
204
nonbloody nipple disharge
noncancerous pathology
205
bloody or nonbloody discharge from nipple on stimulation
| breast pain and palpable mass behind areola
intraductal papilloma
206
Tx intraductal paiplloma
surgical excision
207
most common malignant neoplasm of breast
fuctal CA
208
risk Fx for breast CA
```
FMH
BRCA 1 or 2
ovarian CA
endometrial CA
prior breast CA
increased estrogen exposure
early menarche, late menopause, nulliparity, late first pregnancy
increased age, obesity, alcohol, DES, industrial chemicals or pesticides
```
209
palpable solid immobile breast lumo
breast CA
210
peau dorange
lymhatic obstruction causing lympedema and skin thickening that makes breast look like orange peel
211
most common site breast cancer
upper outer quadrant
212
next step when find breast mass
biopsy FNA with US
| core Bx is more definitive and determines if invasive
213
most breast CA are detected how
screening mammos
214
DCIS of breast
ductal carcinoma in situ
| malignant cells in ducts without stromal invasion
215
LCIS of breast
lobular
malignant cells in lobules without stromal invasion
can be multifocal
increased risk CONTRAlateral malignancy
216
invasice ductal carcinoma
malignant cells in ducts with stromal invasions and microcalcifications
fibrotic response in breast tissue
most common invasive breast CA!!!!!!!
217
findings in invasive ductal carcinoma
firm palpable mass with skin dimpling, nipple retraction
| peau d'orange or nipple discharge
218
invasive lobular carcinoma
malignant cells in breast lobules with infiltration and less fibrotic response in breat
bilateral and multifocal
slower mets
assoc with hormone replacement!!!!!!!
219
paget disease of breast
malignant adenocarcinoma infiltrate epithelium of nipple and areola
usually ductal carcinoma
220
signs of pagets of breast
scaly eczematous or ulcerated lesion on nipple and areola
| preceded by pain, burning or itching
221
inflammatory carcinoma of breast
subtype ductal characterized by rapid progression and angioinvasive behavior, poor prognosis
222
signs inflammatory carcinoma of breast
breast pain, tenderness, erythema, warmth, pearu d'orange, lymphadenopathy
223
medullary carcinoma of breast
well cicrumscribed rapid growth
| better prognosis
224
mucinous carcinoma of breast
well circumscribed slow growth
more common in older women
gelatinous in palpation
225
tubular carcinoma of breast
tubular structures invading the stroma
usually in 40s
good prognosis
226
what is used to determine extend of breast lesion
MRI
227
what is used to determine possible mets of breast lesion
bone scan and cT
228
Tx DCIS of breast
lumpectomy
maybe radiation
mastectomy in hight risk
229
Tx LCIS of breast
close observation and tamoxifen or raloxifene
230
Tx invascve carcinoma of breast
lumpectomy if early and focal
mastectomy for multifocal and radiation if > 5cm
sentinel lymph node Bx always
hormone or chemo for all node + cancers > 1cm and aggressive tumors
231
negative FNA on solid breast mass
need more definitive Bx because 20% false negative
232
Mab used in breast CA
trastuzumab anti Her 2 neu
233
Tx inflammatory breast CA
mastectomy, radiation and chemo
234
mets of breast CA
bone, thoracic cavity, brain and liver
235
tumors with + Estrogen or progesterone R or her2neu
better prognosis
