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Flashcards in Gynecology Deck (23)
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1

Age of thelarche and menarche

thelarche: btwn 8-11
menarche: btwn 10-16

2

Tx of menopause

HRT (combined estrogen and progest)
Contraindicated: vaginal bleeding, breast cancer, hx thromboembolism, liver disease, hypertriglceridemia
Non-HRT: SSRI/SNRI, clonidine, gabapentin

3

workup, tx of primary amenorrhea

w/u: pregnancy test, bone age radiograph (constitutional delay?), FSH/LH, ultrasound for ovaries, karyotype if no uterus; prolactin, MRI if uterus
tx: (hypogonadism only) low dose estrogen 12-18mo, cyclic estrogen/ progesterone

4

Defn, workup of secondary amenorrhea

6 consecutive months, no menses (menarche passed)
w/u: pregnancy test, TSH, prolactin
progestin challenge: + challenge (bleeding on withdrawal): anovulation (eg PCOS)
-challenge (no bleeding): uterine or estrogen abn
signs hyperglycemia or hyptoension: dexa suppr to rule out CAH, cushing, addison
virilzation: testosterone, DHEAS, 17-hydroxyprog (PCOS, CAH, cushing, tumor)

5

noncyclical pain, menorrhagia, enlarged uterus: dx and tx

adenomyosis
tx: NSAID/OCP/ progestins
endometrial ablation, hysterectomy

6

Guidelines for endometrial bx in women with abnormal uterin bleeding

endometrium >4mm
>35yo with risk factors (obesity, DM)

7

Tx AUB: acute, ovulator, anovulator

Acute: high dose IV estrog, D&C w/in 12-24h
Ovulatory: NSAID, OCP, mirena
Anovulatory: Progestin x10d, desmopressin (vWF/ VIII), OCP, mirena

8

Newborn female infant with ambiguous genitalia and salt wasting

21-hydroxylase deficiency

9

Dx criteria and tx of PCOS

(req 2/3)
1. polycystic ovaries
2.oligo/anovulation
3/ clinical or biochemical evidence of hyperandrogenism (testosterone, DHEAS, DHEA)
Tx: OCP, progestin, metformin (if not trying to conceive)
clomiphene +/- metformin (trying to conceive)
Hirsutism: OCP, antiandrogen (spironolactone, finasteride), metformin

10

Fluctuant mass 1-4 cm at inferior portion labium nimus: dx and tx

bartholin cyst
If symptomatic: aspiration and I&D if symptomatic; word catheter insertion
Abx only if celluitis

11

Abx regimens for PID

Outpatient:
Regimen A: Ceftriaxone IM or Cefoxitin plus probenecid
+doxycycline x14d +/-metronidazole 14d
Regimen B: oxafloxicin or levofloxacin x14d +/- metronidazole 14d
Inpatient: cefoxitin or cefotetan plus doxy x14d
clindamycin + gentamicin x14d

12

Perhepitits, RUQ pian, abn liver fxn, shoulder pain with hx of PID

fitz hugh curtis

13

Abrupt onset of fever (>102), vomiting watery diarrhea, macular erythematous rash in female: dx and tx

TSS
Rapid rehydration
Antistaph (nafcillin, oxacillin, vanc)
corticosteroids to reduce severity/ fever

14

Tx leiomyoma

NSAID, OCP
medroxyprogestrone acetate or danazol to stop or slow bleeding
GnRH analogs (leuprolide or nafarelin) to decr size
myomectomy or hysterectomy or uterine artery embolization

15

Types of endometrial cancer and etiology

Type I (endometrioid): unopposed estrogen
Type II (serous): unrelated to estrogen, p53 mut, older age; poor prognosis

16

Types of HPV assoc with diff types cancer

HPV 16: SCC
HPV 18: adenoca

17

vulva: pruritic or painful white, pigmented, raised, thickned, or ulcerated lesion: workup and tx

possible vulvar cancer: punch bx
Tx: topical chemo, laser abl, WLE, or vulvectomy

18

Inhibin producing ovarian mass

granulosa cell

19

LDH producing ovarian mass

dysgerminoma

20

AFP producing ovarian mass

endodermal sinus or embryonal carcinoma

21

criteria for tx of ovarian mass (by age)

premenarchal : >2cm-> close monitoring
Premenopausal: 8-10cm and complex/ unchanged: surgical exc
Postmenopausal: asymptomatic,

22

Presents as "a bunch of grapes" in the vagina of pediatric patient

sarcoma botyroides (rhabdomyosarcoma)

23

Etiologies + treatments precocious puberty

Central: leuprolide
Peripheral:
-ovarian cyst: none, will regress
-CAH: glucocorticoids
-Adrena/ovarian tumor: excision
-Mccune albright: toamoxifen or ketoconazle/testolactone