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STEP 2 SECRETS > Gynecology > Flashcards

Gynecology Flashcards

0
Q

What is the most likely cause of infertility in a menstruating woman Under the age of 30?

A

PID

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1
Q

What is the most common cause of preventable infertility in the US?

A

Pelvic inflammatory disease (PID)

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2
Q

Female between 13-35

1-Abdominal Pain
2-Adnexal Tenderness
3-Cervical Motion Tenderness

Plus one of these:
Elevated VSG
C-reactive protein level
Leukocytosis
Fever
Purulent Cervical Discharge
A

Pelvic inflammatory disease

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3
Q

Treatment for PID

A

For outpatients: Cefoxitin/Ceftriaxone and Doxycycline

For Inpatients: Clindamycin and Gentamicin

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4
Q

Most common organisms off pelvic inflammatory disease

A

Neisseria Gonorrheae

Chlamydia Trichomatis

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5
Q

Pelvic inflammatory disease, With a history of DIU

A

Actinomyces Israelii

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6
Q

Common sequelae of PID

A

Infertility

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7
Q

Rupture of tuboovarian abscess

Treatment

A

Emergent Laparotomy
Unilateral = excision of the affected tube
Bilateral = Histerectomy and bilateral salpingoophorectomy

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8
Q

The first test to perform when a woman percents with Amenorrhea

A

B-hCG; The most Common cause of amenorrhea is Pregnancy

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9
Q

Term for heavy bleeding during and between menstrual periods

A

Menometrorrhagia

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10
Q

Cause of amenorrhea with Normal Prolactin,
No response to estrogen-progesterone challenge
History of D&C

A

Asherman’s Syndrome

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11
Q

Therapy for polycystic ovarian syndrome

A

Weight loss and OPCs

Consider Metformin

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12
Q

Medication use to induce ovulation

A

Clomiphene citrate

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13
Q

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding

A

Endometrial biopsy

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14
Q

Indications for medical treatment of ectopic pregnancy

A

Patient stable; unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation

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15
Q

Medical option for Endometriosis

A

OPCs
Danzol
GnRH agonists

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16
Q

Laparoscopic findings in endometriosis.

A

Powder burns, “chocolate cysts”

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17
Q

The most common location for an ectopic pregnancy.

A

Ampulla of the oviduct.

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18
Q

How to diagnose and follow a Leiomyoma

A

Ultrasound

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19
Q

Natural history of a Leiomyoma

A

Regresses after menopause

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20
Q

A patient has > vaginal discharge and petechal patches in the upper vagina and cervix

A

Trichomonal Vaginitis

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21
Q

Treatment for bacterial vaginosis

A

Oral or topical Metronidazole

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22
Q

The most common cause of bloody nipple discharge

A

Intraductall papilloma

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23
Q

Contraceptive methods that protect against PID

A

OCPs and barrier contraception

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24
Q

Unopposed estrogen is contraindicated in which cancers?

A

Endometrial
or
Estrogen receptor + Breast cancer

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25
Q

A patient presents with recent PID with RUQ pain.

A

Consider Fitz-Hugg-Curtis Syndrome

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26
Q

Breast malignancy presenting as;

Itching, burning and erosion of the nipple

A

Paget’s Disease

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27
Q

Annual screening for women with a strong family history of Ovarian Cancer

A

CA-125 and Transvaginal Ultrasound

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28
Q

50-year-old women leaks urine when laughing or coughing.

Nonsurgical options?

A

Kegel exercises
Estrogen
Pressaries of stress incontinence

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29
Q

A 30-year-old women has unplredictable urine loss.
Examination is normal
Medical options?

A

Anticholinergics (oxibutynin)
B-adrenergics (metaproterenol)
For urge incontinence

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30
Q

Lab values suggestive of menopause

A

> serum FSH !

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31
Q

The most common cause of female infertility

A

Endometriosis

32
Q

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear.
Follow up evaluation?

A

Colposcopy and endocervical curettage

33
Q

Breast cancer type that > the future risk of invasive carcinoma in both breast

A

Lobular carcinoma in situ

34
Q

Endometrial glands outside the uterus (ectopic)
The most common site for ectopic endometrial glands is the
1- Ovaries (Tender adnexae in an afebrile patient)
-Others: uterosacral ligament (nodularities!) sequela: reverted uterus
-Peritoneal surface.

A

ENDOMETRIOSIS

35
Q

Nulliparous and >30 with the following symptoms;

  • Dysmenorrhea (painful menstruation)
  • Dyspareunia (painful intercourse)
  • Dyschezia (painful defecation)

&/or= perimenstrual spotting

A

ENDOMETRIOSIS

36
Q

Gold Standart for diagnosis of Endometriosis

A

Laparoscopy with visualization of the endometriosis

37
Q

Treatment of Endometriosis

First and second line agents
Surgery
Older patients

A

*First-line= birth control pills( if acceptable)
Second-line= Danzol; GnRH agonists

  • Surgery and cautery will destroy the endometriomas !
  • Older patient, Hysterectomy and bilateral salpingoophorectomy for SEVERE symptoms!
38
Q

What is the most likely cause of infertility in a menstruating woman over the age of 30 without a history of PID ?

A

ENDOMETRIOSIS

39
Q

“Cottage cheese” pseudohyphae on KOH preparation
History of -DBT
-ATB treatment
-Pregnancy

A

Candida sp.

Tx: topical or oral antifungal

40
Q

Bugs can be seen swimming under microscope; pale green, frothy, watery discharge; “Strawberry” cervix.

A

T. Vaginalis

Tx: metronidazole

41
Q

Malodorous discharge; FISH SMELL on KOH preparation

CLUE CELLS

A

G. Vaginalis

Tx: metronidazole

42
Q

Veneral wats, koilocytosis on Pap smear

A

Human Papillomavirus

Tx: - acid

  - cryo therapy
  - laser
  - podophyllin
43
Q

Multiple shallow, painful ulcers; recurrence and resolution

A

Herpes virus

Tx: Acyclovir

44
Q

Painless chancre, spirochete on dark-field microscopy

A

Syphilis ( stage I)

Tx: Penicillin

45
Q

Condyloma lata, maculopapular rash on palms, serology

A

Syphilis (stage II)

Tx: Penicillin

46
Q

Most common SDT; dysuria, + culture and antibody tests

A

C. Trachomatis

Tx: Doxycycline
Azithromycin*( for compliance issue; one single dose 1mg orally)
Chlamydia in pregnancy: eritromycin!

-gonorrhea should be treated as presumed chlamydial coninfection. ( but the opposite is not true)

47
Q

Mucopurulent cervicitis; gram - bug on Gram stain

A

Neisseria Gonorrheae

Tx: Ceftriaxone
Fluoroquinolone

Treat for chlamydial coninfection !

48
Q

Characteristic apearence of lesions, intracellular inclusions

A

Molluscum

Tx: curette
cryotherapy
electrocauterization
coagulation

49
Q

“Crabs”’ look for Itching; lice can bee seen on pubic hairs

A

Pediculosis

Tx: permethrin cream

50
Q

Seek and treat the patients’s sexual partners

A 
T. Vaginalis
Human Papillomavirus 
Herpes virus
Syphilis
Chlamydia Trachomatis
Neisseria Gonorrheae 
Molluscum
Pediculosis

( gardenella and candida they are not typically sexual transmitted disease)

51
Q

Patients with Gonorrhea usually are treated for presumed chlamydial infection

A

CEFTRIAXONE (Gonorrhea)

DOXYCYCLINE ( Chlamydia)

But, do NOT give Gonorrhea treatment to chlamydia infection!

52
Q

> 40-y-o.
Dysmenorrhea Menorrhagia
Large Boggy uterus on physical exam
Endometrial glands within the uterine musculature

A

Adenomyosis

53
Q

Management of Adenomyosis

A

1-Dilatation and curettage first rule out endometrial cancer.

  • Hysterectomy: To relieve Severe symptoms
  • GnRH.
54
Q

The most common tumors in woman

The most common indication of hysterectomy

A

Fibroids -Leiomyomas-
BENIGN!
40% of women have Fibroids by the age of 40!

55
Q

Leiomyomas of the uretus are estrogen-dependent
They grow during pregnancy and oral contraceptive pills.
They me
Ay cause;

A

Infertility, pain, And Menorrhagia or metrorrhagia.
Anemia—–> indication of hysterectomy
Dilate tigon and curettage are needed to rule out endometrial cancer if >35y

56
Q

First test to order in any woman of reproductive age with abnormal uterine bleeding?

A

A pregnancy test!

57
Q

Abnormal uterine bleeding not associated with tumor, inflammation or pregnancy

A

Dysfunctional Uterine Bleeding (DUB)

Is the most common cause of abnormal uterine bleeding.
>70 associates with anovulatory cycles.
Consider physiologic.
The most common non physiologic cause is Polycystic ovary syndrome (PCOS).

58
Q

DUB > 35 y-o:

DUB in all women age:

A

DUB > 35 y-o: dial attain and curettage —> to rule out Endometrial Cancer!

DUB in all women age: look for Anemia!

59
Q

Causes of DUB:

A

Infections
Endocrine disorders
Coagulation defects
Estrogen-producing neoplasms

60
Q

Treatment of DUB

A

NSAIDs = First line

Oral contraceptive pills = First line for DUB and Dysmenorrhea
(And if the patient does not desire pregnancy

Progesterone monotherapy = severe bleeding!

61
Q

Overweight
Hirsutism
Amenorrhea
Infertility

A

PCOS
>LH
< or normal FSH

Ultrasound= multiple peripheral-oriented cysts

62
Q

What is the most likely cause for infertility in a woman under 30 with abnormal menstruation ?

A

PCOS

63
Q

Tx of PCOS

Risk.

A

Oral contraceptive pills
If desire pregnancy= clomiphene to induce ovulation

> risk of Endometrial Cancer!

64
Q

Is infertility usually a male or a female problem?

A

2/3 cases are due to Female problem.

1/3 male.

65
Q

First step evaluating a couple for infertility.

Physical exam no clues.

A

Semen analysis

Cheap, easy, non invasive!

66
Q

Characteristics of normal semen

A

Ej volume= >1 ml
Sperm concentration= > 20 million/ml
Inicial foward motility = > 50% of sperm
Normal morphology = > 60% of sperm

67
Q

Next step after semen evaluation;

A

Documentation of ovulation

Basal body temperature
Progesterone levels
Endometrial Bx

68
Q

Radiologic test to examine the Fallopian tubes.

A

Histerosalpingogram

69
Q

Previous dilatation and curettage that cause intrauterine synechiae
History of Fibroids
Simptoms of Endometriosis

Lead you to suspect uterine problem

A

PID
Previous ectopic pregnancy

Lead to suspect tube problem

70
Q

Last resort in the work up of infertility?

A

Laparoscopy= in a patient of history suggestive of Endometriosis

Lysis of adhesions and destruction of endometriosis often restore fertility

71
Q

Medications to try restore female fertility

A

-Woman with adequate production of estrogen:
CLOMIPHENE

-Woman hipoestrogenic:
hMG Menopausal Gonadotropin! ( LH & FSH)

-In vitro fertilization

72
Q

What is the risk associated with medical induction of ovulation?

A

Multiple-Gestation pregnancies.

73
Q

Distinguish between primary and secondary amenorrhea

A

Primary amenorrhea : patient has NEVER menstruated

Secondary amenorrhea: patient used to menstruate but has STOP

74
Q

What is the cause of secondary amenorrhea Ina previously menstruating women of reproductive age?

A

Pregnancy ! Until proved otherwise!

Order hCG in order to rule out pregnancy as first step!

75
Q

Excessive exercise may cause amenorrhea

A

True

Athlets

76
Q

Common causes of secondary amenorrhea:

A

PCOS
Anorexia (amenorrhea is required for diagnosis of anorexia)
Endocrine disorders:
-headaches, /
-galactorrhea, /-> PITUITARY TUMOR
-visual field defects./
Antipsychotics: due to > Prolactin.
Previous Chemotherapy ( 1* ovarian failure)
( keep in mind = menopause, although is not 2* amenorrhea )

77
Q

Secondary Amenorrhea
1) Rule out pregnancy

Next step?

A

2) Progesterone challenge

2.A)Vaginal bleeding (Enough estrogen)
-look LH:
> LH = PCOS
< LH = Ideopathic. ( PRL & TSH)
Hypothyroidism : > TSH >PRL
Pituitary Prolactinoma : MResonance
PRL normal= ask for GnRH (stress;exercise;drugs)

        CLOMIPHENE

2.B) No Vaginal Bleeding( inadequate estrogens)
-FSH
FSH > = OVARIAN FAILURE
-Autoinmune disorders
-Karyotype abnormalities
-Chemotherapy
FSH < = BRAIN TUMOR ( craneopharyngioma)
-Order MRI

          CLOMIPHENE INEFECTIVE !
78
Q

Pregnancy can present as primary amenorrhea

A

True! Always check hCG in any amenorrhea !

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