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Flashcards in Gyn Stepup Deck (235):
1

when have all oocytes formed

20 weeks

2

what causes low FSH LH and androgens in 4-8 yr olds

GnRH suppression

3

When are initial pubertal changes

8-11 yrs

4

what time of day are hormones in kids highest

at night

5

normal events female puberty

adrenarche: adrenal androgens
gonadarche: FSH and LH activation
Thelarche: breast tissue
Pubarche: pibic hair
growth spurt
Menarche: onset menses

6

what happens in >50 y.o to LH and FSH

increase with onset of ovarian failure

7

Tanner I

raised nipple and no hair growth yet

8

Tanner 2

breast budding, areolar enlargement with slight growth of labial hair

9

Tanner 3

Further breast and areolar enlargement
more hair growth

10

Tanner 4

areola and nipple form above the breast
hair becomes coarse and spreads over pubic area

11

Tanner 5

areola recedes and nipple stays out
coarse hair extends to medial thighs

12

what causes central precocious puberty

early activation of hypothalamic pituitary gonadal axis

13

precocious puberty age in girls and boys

girls

14

isosexual precocious puberty

premature development appropriate for gender

15

heterosexual precocious puberty

virilization/,asculinization firls
feminization boys
girls with virilization is due to CAH, exposure to androgens or androgen secreting neoplasm

16

what is GnRH stimulation test

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

labs that suggest ectopic hormone production causing precocious puberty

low LH and FSH with high estrogen
probably noeoplasm or exogenous consumption estrogen

18

which endocrine path can cause precocious puberty

chronic hypothyroid

19

what is used for Lh and FSH suppression

GnRH analogues

20

Tx for precocious puberty caused by CAH

cortisol replacement

21

complications of precocious puberty

short statures
social and emotional adjustment issues

22

what peaks right before ovulation

LH

23

when does progesterone peak

during the luteal phase or proliferative phase

24

which phase does ovulation occur in

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