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OBGYN > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Depo-provera SE

A

Bleeding x3 months

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2
Q

Contraindications to OCPs (estrogen)

A

DVT, lactation, >35yo and smoke, severe nausea with OCP

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3
Q

OCP benefits/risks

A
  • Decrease ovarian and endometrial cancer, PID, endometriosis, benign breast disease, ectopic pregnancy risk.
  • Risk in CIN, HTN, DVT
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4
Q

Tubal ligation benefits/risks

A
  • Decreased risk of ovarian cancer

* Risk of regret if young <25 (40%), not married, within a year of delivery, partner conflict

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5
Q

Copper IUD contraindication

A

Wilson disease

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6
Q

IUD benefits

A

Decreased risk of endometrial cancer; decreased rate of repeat adolescent pregnancy and repeat abortion

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7
Q

Contraindication to birth control patch

A

Less effective if >198 pounds

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8
Q

Birth control patch

A

Releases ethinyl estradiol and norelgestromin

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9
Q

Pregnant woman with fever, bleeding, dilated cervix

A

Septic abortion

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10
Q

Threatened abortion

A

Bleeding and closed cervix

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11
Q

Missed abortion

A

Retained dead fetus/blighted ovum

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12
Q

Treatment of septic abortion

A

Uterine evacuation, board spectrum abx

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13
Q

Workup of recurrent pregnancy loss (>2 consecutive or >3 spontaneous before 20 weeks)

A

Antiphospholipid antibodies (and anti-cardiolipin, beta-2 glycoprotein, PTT, russell vipor venom time)

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14
Q

Preterm birth history treatment

A

17-hydroxyprogesterone

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15
Q

Treatment of antiphospholipid syndrome

A

Aspirin and heparin

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16
Q

Surgical abortions

A

1) Manual vacuum aspiration < 8 weeks
2) D&C < 16 weeks
3) D&E > 16 weeks (max 24 weeks unless not viable d/t malformation)

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17
Q

Most common cause of vaginitis

A

BV d/t non-hydrogen peroxide-producing lactobacilli, allowing anaerobic proliferation.

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18
Q

Treatment of BV

A

Metronidazole 500 BID x 7 days, or vaginal Metronidazole 0.75% gel QHS for five days.

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19
Q

Diagnosis of BV

A

Modified Amsel criteria requires 3/4:

1) Thin, gray, homogenous DC
2) Whiff test (amine on KOH)
3) Clue cells
4) Basic pH > 4.5

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20
Q

Lichen sclerosis early skin changes

A

Polygonal ivory papules involving the vulva and perianal areas, waxy sheen on the labia minora and clitoris, hypopigmentation. No vaginal involvement.

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21
Q

Lichen sclerosis advanced skin changes

A

Fissures and erosions due to a chronic itch-scratch-itch cycle, mucosal edema and surface vascular changes. Scarring with loss of normal architecture (introital stenosis, and resorption of the clitoris (phimosis) and labia minora)

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22
Q

Treatment of lichen sclerosis

A

High-potency topical steroids

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23
Q

Lichen sclerosis risks

A

SCC (<5% within field)

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24
Q

Trichomoniasis

A

T. vaginalis: Diffuse, malodorous, frothy yellow-green DC, vulvar irritation, cervix petechiae
*Dx on microscopy

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25
Q

Trichomoniasis treatment

A

Metronidazole 2 gm PO x1, or 500mg BID x7 days

*Treat partner

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26
Q

Vulvovaginal candidiasis

A

Pruritis, vulvovaginal soreness/burning, +/- DC

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27
Q

Treatment of candidiasis

A

Topical azoles

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28
Q

Lichen planus

A

Derm disorder: hair-bearing skin, nails, mucosa, vulva; inflammatory eruptions with remissions/flares
*Vulva: burning, itching, bleeding, pain, adhesions; Lacy, reticulated pattern of labia and perineum +/- scarring and erosions

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29
Q

Vulvar vestibulitis

A

Severe pain limited to vulvar vestibule

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30
Q

Treatment of vulvar vestibulitis

A

TCAs, pelvic rehab, biofeedback, topical anesthetics; surgery with vestibulectomy if unresponsive or cannot handle intercourse

31
Q

Lichen simplex chronicus

A

Common vulvar non-neoplastic disorder d/t chronic scratching causing loss of protective barrier. Itch-scratch-cycle -> infection, irritation. Lichenified, enlarged and rugose labia +/- edema. Localized or generalized. Dx clinical and vulvar biopsy**

32
Q

Pruritis hx, fissures and erosions with mucosal edema and surface vascular changes. Scarring with introital stenosis, phimosis and loss of labia minora.

A

Lichen sclerosis

33
Q

Inflammatory eruptions of hair-bearing skin, nails, mucosa, vulva; with remissions/flares; vulva burning, itching, bleeding, pain, adhesions; Lacy, reticulated pattern of labia and perineum +/- scarring and erosions

A

Lichen planus

34
Q

Lichenified, enlarged and rugose labia +/- edema. Localized or generalized. Chronic scratching causing loss of protective barrier.

A

Lichen simplex chronicus

35
Q

Treatment of lichen simplex chronicus

A

Short-course of high-potency corticosteroids and antihistamines

36
Q

Mucopurulent cervicitis

A

Thick yellow endocervical discharge. Gonorrhea or chlamydia (but in most cases no organism isolated). Test for both, but if high likelihood or poor followup, then treat.

37
Q

Gonorrhea treatment

A

Cephalosporin or quinolone + chlamydia tx (azithromycin or doxycyclne)

38
Q

Diagnosis and treatment of genital herpes

A

Confirm with viral culture;

Treat with acyclovir, famciclovir, or valacyclovir

39
Q

Pelvic prolapse treatment

A

1) Pessary fitting

2) Sacrospinous ligament suspension

40
Q

Woman with new onset vulvar burning and irritation, new sex partner, and cold 10 days ago

A

HSV: viral symptoms -> prodrome burning or irritation -> vesicular lesions

  • Primary: dysuria causing retention
  • Tx: sitz bath, perineal care, topical Xylocaine; acyclovir
41
Q

Woman without HBV vaccine and recent exposure to person who is HBsAG positive: treatment

A

Dose of HBIG and start HBV series

  • Source unknown: HBV series only
  • Woman vaccinated: no tx
  • Woman vaccinated but non-responder: HBIG + HBV or HBIGx2
42
Q

Treatment of gonorrhea/chlamydia with fever (or N/V)

A

inpatient treatment with IV abx (to prevent tube scarring and infertility)
*Tx partner, too

43
Q

TOA and salpingitis

A
  • Ascending infection from GIT or GUT, or gonorrhea/chlamydia
  • Polymicrobial
  • May be bilateral
  • *Lower abdominal tenderness, uterine/adnexal tenderness, mucopurulent cervicitis
44
Q

IV treatment of GCCT

A

1) Cefotetan/cefoxitin + doxycycline/clindamycin + gentamicin
2) Outpatient: ceftriaxone/cefoxitin/ceftizoxime/cefotaxime + doxycycline +/- metronidazole

45
Q

Woman with infertility. Hx PID and LEEP. Most likely cause?

A

Tubal disease

46
Q

UTI screening

A
  • Woman with pelvic pain, frequency/urgency, etc.

* Routine in pregnant women to prevent preterm labor

47
Q

70yo woman with incontinence, rectocele, cystocele, PVR 400cc

A

Overflow incontinence: failure to empty adequately d/t

  • underactive detrusor muscle, or
  • obstruction (prolapse)
48
Q

Incontinence

A
  • Overflow: underactive detrusor or obstruction (failure to empty adequately)
  • Stress: bladder P > intraurethral P without detrusor contraction (sphincter deficiency/uretheral hypermobility)
  • Urge: overactive detrusor - uninhibited contraction of bladder with filling
  • Mixed: stress + urge
49
Q

Overflow incontinence

A

underactive detrusor or obstruction (failure to empty adequately)

  • constant leakage
  • no associated events
50
Q

Stress incontinence

A

bladder P > intraurethral P without detrusor contraction (uretheral hypermobility&raquo_space; sphincter deficiency)
*Straining Q-tip angle >30 degrees from horizon

51
Q

Urge incontinence

A

overactive detrusor - uninhibited contraction of bladder with filling

52
Q

Mixed incontinence

A

Stress + urge

53
Q

Stress incontinent -surgical treatment

A
  • Best: Retropubic urethropexy (tension-free vaginal tape, sling procedures)
  • Intrinsic sphincter deficiency w/immobile urethra: urethral bulking
54
Q

Uterine/vaginal prolapse surgical treatment

A

Colpocleisis: vaginal obliterated quickly, without general anesthesia

55
Q

Treatment of urge incontinence (detrusor instability)

A

Oxybutynin and other anticholinergics

56
Q

Stress incontinence medical treatment

A

Pseudoephedrine (alpha-adrenergic improves urethral tone); kegel exercises

57
Q

Surgical repair of cystocele

A

Pubocervical fascia plicated in midline and laterally to arcus tendineus fascia (white line)

58
Q

Surgical repair of uterine prolapse

A

Hysterectomy

59
Q

Surgical repair of vaginal vault prolapse

A

Support vaginal cuff to uterosacral ligaments, sacrospinous ligament, or sacrocolpopexy: all require anesthesia
(colpocleisis does not require anesthesia)

60
Q

Pelvic prolapse treatment

A

Pessary fitting -> sacrospinous ligament suspension

61
Q

Woman with dysmenorrhea, dyspareunia. Periods regular. On exam, nodularity on the back of the uterus.

A

Endometriosis

62
Q

History of infertility, painful but regular periods, dyspareunia, normal weight. Complex adnexal masses.

A

Endometriomas

63
Q

Complex adnexal mass in a postmenopausal woman

A

Exploratory surgery

64
Q

OCPs for endometriosis

A

Negative feedback to the pituitary-hypothalamic axis -> stops stimulation of the ovary to produce sex hormones, such as estrogen, which stimulates endometrial tissue

65
Q

Treatment for endometriosis

A

NSAIDs and OCPs, GnRH agonists, danazol; laparoscopy if failed med/wants pregnancy

66
Q

Danazol SE

A

Androgenic: wt gain, hirsutism, lipids

67
Q

48yo with regular periods, LMP 3 weeks ago. On exam, L adnexal mass. On US, 4 cm complex left ovarian cyst and a 2 cm simple cyst on the right ovary.

A

Hemorrhagic cysts

Repeat US in 2 months

68
Q

Patient with known endometriosis, and inability to conceive, now wanting fertility treatment. Otherwise normal workup and semen analysis.

A

Clomid

69
Q

Pelvic pain, dyspareunia, recurrent irritative voiding symptoms of urgency and frequency, in the absence of objective evidence of another disease

A

Interstitial cystitis

70
Q

Mech of GnRH agonist for endometriosis

A

Suppression of hypothal-pituitary gland production, and FSH and LH levels -> less estradiol

71
Q

Mech of danazol for endometriosis

A

17-alpha-ethinyl testosterone derivative, suppresses midcycle FSH and LH surge

72
Q

Mech of OCP for endometriosis

A

Pseudopregnancy

73
Q

Pelvic congestion syndrome

A

Chronic pelvic pain occurring in the setting of pelvic varicosities. Pain worse premenstrually, during pregnancy, standing, fatigue and coitus. Pelvic “fullness” or “heaviness,” may extend to the vulvar area and legs. Associated symptoms of discharge, backache urinary frequency.

OBGYN (4 decks)

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