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Flashcards in Gyn Uworld Deck (108):
1

what hormone are PCOS deficient in

progesterone

2

at risk for what with PCOS

endometrial carcinoma from increased estrogens causeing hyperplasia

3

unnopposed estrogen is increased risk for what

endometrial cancer

4

common age endometriosis

nulliparous age 25-35

5

medical Tx endometriosis

NSAIDs and OCPs

6

If Sx do not improve with NSAIDs and OCPS in endometriosis
next step

laparscopy
because is Dx and therapeutic when biopsying ablating or excising

7

25 yr old nulligravid
bimaanual shows tenderness in posterior vaginal fornix and decreased uterine mobility
no adenexal masses
thickening of uterosacral ligaments

endometriosis

8

common complication endometriosis

infertility

9

aromatase deficiency

rare genetic disorder
cannot convert androgens to estrogens
virilization XX child
cliteromegaly
delayed puberty
osteoporosis

10

hormone levels in aromatase deficiency

high FSH and LH with low estrogen

11

mccune albright

cafe au lait
polyostotic fibrous dysplasia and auronomous endocrine hyperfunction
GnRH independed precocious puberty

12

kallmans syndrome

hypogonadotropic hypogonadism with anosmia
delayed puberty
low or absent LH and FSH

13

ruptured ovarian cyst signs

sudden onset severe unilateral lower abdomina pain after activity or sex

14

signs ovarian torsion

sudden onset severe lower abdominal pain on one side
nausea and vomiting
unilateral tender adenexal mass

15

enlarged ovary with decreased blood flow

ovarian torsion

16

best reccommendation for patient to avoid breast cancer

decrease alcohol intake

17

in postmenopasual women
next step after detecting adenexal mass

transvaginal US and serum CA-125

18

first steps for abnormal uterine bleeding in premenopausal woman

exclude pregnnancy
CBC coags, tSH

19

risk factors for endometrial cancer

>45
obesity
DM
unopposed Estrogen exposure
PCOS
early menarche/late menopause

20

why not go to transvaginal US in premenopausal women looking for endometrial strip

because differ in thickness depending on cycle
instead do Bx
older post menopasual patients transvaginal US is better test

21

when to do endometrial Bx in premenopausal patient

persistent Sx with negative lab results
risk factors for endometrial cancer

22

physiologic galactorrhea

bilateral and no blood

23

Sx fibroids

heavy menses with clots
constipation
urinary frequency, pelvic pain and heaviness
enlarged uterus on exam

24

Sx adenomyosis

dysmenorrhea, pelvic pain, menorrhagia and bulky globular tender uterus

25

how do tamoxifen and raloxifene work

estrogen agonist and antagonist activity
estrogen agonist in uterus-- inc endometrial CA
tamoxigen is antagonist in breast

26

common side effect tamoxifen

hot flashes

27

inc risk for what with tamoxifen

endometrial cancer and DVT

28

flaty velvety wart like lesion

condyloma lata- secondary syphilis

29

lichen sclerosis

white thin and wrinkled skin over labia
elderly and have pruritis

30

vulvar lichen planus

middle aged women
hyperkeratotic erosive papulosquamous
pruritis, soreness and vaginal discharge

31

important factor for invasive ductal carcinoma

HER2neu

32

how to detect her2neu

FISH or immunohistochemical staining

33

what chemo is effective against her2neu+

trastuzumab and anthracycline

34

hormone levels of LH and FSH in PCOS

excess LH
little FSH

35

injury to pelvic floor muscles cna result in what

urethral hypermobility and urethral prolpase
get stress incontinence
cystocele

36

Dx test for urethral hypermobility

Q tip test checking the angle

37

Tx for stress incontinence

kegel exercises
urethral sling

38

boggy tender uniformly enlarged uterus

adenomyosis

39

initial workup if suspect adenomyosis

Pelvic US and MRI
definitive is with histo exam of uterus

40

bimanual and speculum shows dilated cervix with firm dark red round mass at os

prolapsing leimyoma uteri (fibroid)

41

most common Sx of submucous fibroid

heavy and prolonged menstrual bleeding

42

tx for woman with endometrial Bx showing complex hyperplasia without atypia

potent progestin to stop effects of estrogen

43

premature ovarian failure causes in women

chemo, radiation, autoimmune ovarian failure, turners, fragile X

44

hormone levels in premature ovarian failure

decreased Estrogen levels causing increased FSH and LH usuall FSH:LH >1

45

role of bhCG

maintenance of corpus luteum

46

cervical mucus in ovulatory phase

profuse, clear and thin

47

cervical mucus in post and pre ovulatory phase

scant opaque and thick

48

when is cervical mucus more basic

during ovulation >6.5

49

what stimulates prolactin

TRH and serotonin and GnRH

50

medications that cuase high prolactin

antipsychotics, TCAs and MAOIs

51

unilateral bloody nipple discharge

intraductal papilloma

52

first step for workup of bloody nipple discharge of breast unilaterally

mammo to rule out carcinoma

53

next step to identify fibroids causing stress incontinence

US of pelvis

54

posterior acoustic enhavement of breast mass

fluid

55

aspiration of breast mass revealed clear fluid and mass disappeared. next step

return 2-4 months for follow up clinical breast exam

56

what is the reason for amenorrhea in crazy athlete

estrogen deficiency

57

hormones in female olympic athletes

decreased LH and GnRH
estrogen deficiency

58

most efficient emergency contraceptive

copper IUD

59

risk of amenorrhea from HPO axis suppression from extreme weight loss or exercise

decreased bone mineral density

60

first step for determining infertility

semen analysis

61

which side is more common for ovarian torsion

right

62

risk factors for ovarian torsion

pregnancy, ovulation induction for infertility, ovarian masses

63

Dx ovarian torsion

color doppler

64

antibiotics for lactational mastitis

dicloxacillin or cephalexin

65

first line test to assess fallopian tube patency

hysterosalpingogram

66

risk of PID later for pregnancy

fallopian tube scaring

67

obesity cause of infertiliy

anovulation from not enough progesterone

68

Tx for vaginismus

kegel exercises and gradual dilatation

69

first step for breast mass- non malignant like but patient has +FMH breast cancer

US

70

if breast US shows complex cyst or solid mass, next step

image guided core biopsy

71

OCP increase risk for what cancer

cervical

72

what liver disorder do OCP increase risk for

hepatic adenoma

73

heavy menses in young patient with first year of menses

anovulation

74

patient with new onset night sweats, insomnia and irregular menses.
in middle aged

check TSH and FSH

75

pagets is associated with what breast cancer

adenocarcinoma

76

chocolate appearing material in ovarian cyst

old blood
endometrioma

77

gold standard Dx endometriosis

laparoscopy

78

patient with high grade squamous epithelial lesion on cervix and is pregnant

repeat pap and colpo after delivery

79

when do you do a LEEP procedure

when >25 and have HGSIL of cervix
unless post menopausal or pregnant

80

common cause heavy menstrual bleeding

fibroids
proliferation smooth muscle in myometrium

81

what significantly decreases risk of ovarian CA in BRCA + patients

prophylactic BSO

82

ulcer in syphlis

painless that forms punched out base with raised indurated margins

83

non modifiable breast cancer risk factors

genetic mutation in first degree relative
swhite
>50 years old
early menarche or later menopause

84

Dx fibroids

pelvic US

85

normal increase bhCG in pregnancy

increase every 2 days

86

infertility definition in women >35 years old

trying for 6+ months

87

how to assess infertility due to aging

early follicular phase GSH level, clomiphene challenge test
inhibin B level

88

what increases risk for clear cell adenocarcinoma of vagina and cervix

in utero exposure to DES

89

males exposed inutero to DES

microphallus
cyrptorchidism
hypospadias
testicular hypoplasia

90

side effect tamoxifen

hyperplasia endometrium

91

21-24 year old with atypical squamous cells of undetermined significance on pap
next step

repeat cytology in 1 year

92

birth control for woman undergoing chemo for breast cancer

copper IUD

93

common side effet of OCPs

worsening HTN

94

5 alpha reductase deficiency

cannot convert testosterone to DHES
abiguous genitalia at birth
male internal urogenital tract from AMH

95

mullerian agenesis

no upper vagina, cervix or uterus otherwise notmal female developmen
normal pubic and axillary hair
female testosterone levels

96

what is HELPP

systemic inflammation and platelet consumption

97

next step in HELPP

delivery
Mg
anti HTN

98

suspect lichen sclerosis, next step

vulvar punch biopsy

99

risk with lichen sclerosis

vulvar squamous cell carcinoma

100

Tx lichen sclerosis

topical corticosteroids

101

need to do what before starting herceptin Tx

echo because risk of cardiotoxicity especially in those with low EF

102

best chance for pregnancy with premature ovarian failure

in vitro fertilizaiton using donor oocytes

103

CI to raloxifene and tamoxifen

VTE disorders like PE, DVT and retinal vein thrombosis

104

msot common Sx vaginal CA

vaginal bleeding and malodorous vaginal discharge

105

fat necrosis of the breast

fixed mass with skin or niple retraction and gives calcifications in spiculated pattern on mammo
fat globules and foamy macrophages on Bx

106

how does clomiphene work

estrogen analog that imporves GnRH release and RSH release improving chance of ovulation

107

when is HPV screening started

>30

108

when to stop paps

>65 if previous negative screens