Gynecology Flashcards Preview

OBCE OB/Gyn Review > Gynecology > Flashcards

Flashcards in Gynecology Deck (187):
1

Day 1 of the menstrual cycle is slated by the onset of _____?

Menses

2

Days 1-14 of the menstrual cycle are described as which phase?

Follicular

3

Day 14 is typically the day of ________?

Ovulation

4

Days 14-30 of the menstrual cycle are described as which phase?

Luteal

5

GnRH from the hypothalamus stimulate which organ?

Anterior pituitary

6

The anterior pituitary, once stimulated by GnRH, secretes ____ and _____?

FSH and LH

7

LH is responsible for which stimulating production of which hormone(s)?

Androgens and progesterone

8

LH stimulates what process?

Ovulation

9

FSH is responsible for stimulating production of which hormone(s)?

Estrogen (E2) "Estradiol"

10

What are signs of Estrogen excess?

- dysmenorrhea
- menorrhagia
- nausea
- edema
- enlarged uterus/fibroids
- fibrocystic breast changes

11

What are signs of Estrogen deficiency?

Scant menses and mid-cycle spotting

12

What are signs of progesterone excess?

- Edema
- Bloating
- Weight gain
- Fatigue
- HTN
- Varicose veins
"Things you would expect in a pregnant woman"

13

What are signs of progesterone deficiency?

- Endometriosis
- Adenomyosis
- Endometrial hyperplasia
- Prolonged/heavy menses
- Severe cramps
- Luteal spotting and BTB (breakthrough bleeding)

14

How many days are in a "normal" menstrual cycle?

21-35 days

15

Define amenorrhea

absence/abnormal cessation of menses for more than 3mo

16

Define oligomenorrhea

scant menses; periods occur >35 days apart

17

Define polymenorrhea

menses of increased frequency; periods occur <21 days apart

18

Define menorrhagia

AKA Hypermenorrhea; prolonged or profuse menses (>7days or 80cc)

19

Define metrorrhagia

any irregular uterine bleeding between cycles; spotting out of cycle

20

Define menometrorrhagia

both profuse bleeding during menstruation and between periods

21

Define dysmenorrhea

painful menses

22

Define mittelschmertz

pain with ovulation; "middle of month pain"
- typically unilateral, front or back

23

Define contact bleeding

cervix bleeding from tip of condom/penis/manual physical exam

24

What would contact bleeding indicate?

Cervical cancer, cervicitis (CT/Gon), period starting

25

What is dyspareunia?

Painful intercourse

26

Why could there be pain with entry at introitus (vaginal opening)?

- vaginismus mm. contractions
- infection, sores, low Estrogen

27

Why could there be pain with sexual friction?

- infection
- low estrogen

28

Why could there be pain with deep penetration?

- Pelvic pathology
- Cervix/uterus/adnexal inflammation

29

Which hormone is responsible for reducing vaginal pH and increasing cervical pH?

Estrogen
- low vag pH to prevent infection
- high cx mucous pH to welcome sperm

30

Which hormone is responsible for vaginal cornification?

Estrogen

31

Which hormone and contraceptives is/are responsible for decreasing cervical pH?

Progesterone
- Progesterone OCP, IUD, Prog injection

32

T/F: Hypothyroid disease often presents with hypermenorrhea (menorrhagia)

True

33

What is primary amenorrhea?

No secondary sex characteristics by age 14; no menses by age 16

34

What are potential causes for primary amenorrhea?

CNS hypothalamic disorder, hymen blockage, eating disorder, hypoglycemia, thyroid condition

35

What is secondary amenorrhea?

no menses for 3 cycles OR 6 months (whichever sooner), in a woman with previous menses

36

What are potential causes of secondary amenorrhea?

PREGNANCY, weight changes, stress/depression, thyroid conditions, PCOS, increased prolactin, early menopause, medications

37

Hypoestrogenic amenorrhea puts women at a higher risk for developing which condition?

osteoporosis d/t bone mineral density loss;

- also at risk for dyslipidemia, DM, breast cancer

38

Which initial labs are important to order for amenorrhea evaluation?

b-HCG, TSH, PRL;

- also r/o estrogen deficiency

39

When does exercise induced amenorrhea occur?

Body fat goes below 15-19%, BMI<18;
- usually not just d/t exercise alone- nutrition is often a factor

40

What initial labs should you order if you suspect premature ovarian failure?

FSH, LH and E2 *(rule out Estrogen deficiency)*

41

What age category would you consider for premature ovarian failure?

<40 y.o.

42

What are the criteria for Dx of PCOS?

1- oligomenorrhea
2- hyperandrogenism
3- exclusion of other known disorders
**polycystic ovaries not required

43

What are S/Sx of PCOS?

hirsutism, anovulation, + FGT, +2hr PPGT, +insulin, increased free Testosterone,

44

What is the proper management of PCOS?

Meds - Progesterone, Spironolactone, Metformin
Supplements - soy/flax, saw palmetto, green tea
Other - High PRO/Low CHO diet

45

What are common causes of menorrhagia?

pregnancy (r/o placenta prev.), infection, IUD, fibroids/polyps, Hypothyroid, blood disorder, neoplasms

46

What does a workup of menorrhagia consist of?

urine pregnancy -> STI screen -> endocrine workup -> PAP -> U/S -> biopsy

47

What are the S/Sx of cervicitis?

*Chronic:* thick yellow d/c w. no bacterial etiology
*Acute:* (STI- NG, CT, trick), acute trauma, polyps and cancer

48

How do you diagnose cervicitis?

Pap smear and/or biopsy

49

What is adenomyosis? What are some sx?

Endometrial glands + stroma grow into the uterine wall, creating a spongelike effect;
*Sx:* associated w/ heavy, painful periods & uterine enlargement.

50

What is Dysfunctional uterine bleeding (DUB)?

Anovulatory cycles and endometrium overgrowth

51

How do you diagnose DUB?

Dx of exclusion w/ irregular menstrual intervals

52

What are treatment options for DUB?

- Stabilize estrogen via: diet, exercise, GnRH agonist- Lupron
- Anti-inflammatory via NSAIDs
- Limit endometrial overgrowth via Progesterone in any form (cream, pill, IUD)
- Dilatation and Curretage
- Endometrial ablation
- Historectomy

53

What is the most common solid tumor in women?

Uterine fibroids AKA Leiomyomata, Leiomyoma, Fibromyoma, Myoma

54

What makes uterine fibroid removal/surgery controversial?

They are 1% malignant (leosarcoma) and the process may lead to a spread

55

T/F: Nulliparous women have increased risk of uterine fibroid.

True

56

What are Sx of uterine fibroids?

50-80% are asymptomatic
- UF are the MC cause of abnormal uterine bleeding
- Pain is NOT typical
- Urinary abnormalities
- "Pressure", bloating, heaviness

57

How do you dx uterine fibroids?

Pelvic ultrasound, however it is not definitive

58

When would surgery be an option for uterine fibroids?

- Bleeding causes severe anemia
- Unmanageable bleeding
- Severe dysmenorrhea
- Pelvic pain
- Urinary tract compression- pt tolerant level and kidney function compromised
- Infertility
- Rapid growth
- Affects adnexal evaluation

59

What is endometrial hyperplasia?

Overgrowth of endometrial cells in the endometrium.

60

What are sx of endometrial hyperplasia?

- abnormal bleeding
- postmenopausal bleeding

61

How do you dx endometrial hyperplasia?

- Pelvic US *Endometrial stripe*
- Endometrial biopsy
- D&C
- Hysterectoscopy

62

What are treatment options for endometrial hyperplasia?

Progesterone, dietary changes, exercise, possible D&C, ablation, hysterectomy

63

What is a dangerous warning sign for endometrial cancer?

Postmenopausal bleeding, postmenopausal pap with abnormal cells, premenopausal inter menstrual bleeding

64

What is the difference between primary and secondary dysmenorrhea?

Primary - no underlying pelvic pathology (dx of exclusion)
Secondary - there IS underlying pathology

65

What are sx of primary dysmenorrhea?

Abdominal/pelvic/Low back pain that begins with onset of menses and lasts 8-72hrs, headache, diarrhea, N/V

66

What are common/possible etiologies for secondary dysmenorrhea?

Ovarian disorders (Endometrioma, cysts/neoplasm)
Uterine disorders (Fibroids, adenomyosis, endometriosis, PID, IUD)

67

What are sx of secondary dysmenorrhea?

- Onset after painless menstrual cycles in past
- Pain during times other than menses
- Infertility
- Heavy flow

68

What are the labs to R/O secondary amenorrhea?

- Cervical culture, hCG, CBC/UA/ESR

69

What is the prostaglandin theory?

LH & Progesterone increases the release of local Pgs, the endometrium increases prostaglandin production as a response to progesterone withdrawal

70

What is the required timeframe to dx chronic pelvic pain (CPP)?

6 months

71

What is endometriosis?

Presence of endometrial glands and stroma outside the uterus

72

What is the clinical presentation fora woman with endometriosis?

- Pelvic pain @ ovulation, before/during menses
- dyspareunia
- infertility
- LB/leg pain
- severe dysmenorrhea
- irregular or heavy menses

73

How do you dx endometriosis?

laparoscopy is gold standard
- appearance of blue-grey powder burned lesions

74

How do you treat endometriosis?

- Analgesics
- Endocrine therapy
- Surgery

75

What is PMS? (premenstrual syndrome)

Monthly recurrence of mood, cognitive or physical symptoms during the luteal phase, remits with menses
*Confirmed w/ > 2 cycles*

76

What is PMDD? (premenstrual dysphoric disorder)

Psychosocial impairment, Sx worsen in luteal phase (after ovulation) and BEGIN to remit in menses.
*7 symptom free days in follicular phase*

77

What is PMM? (premenstrual magnification)

Distressing physical or affective symptoms THROUGHOUT the cycle, symptoms may NEVER remit
*only one that may be an exacerbation of underlying condition*

78

What are the different types of functional cysts?

- Follicular cyst (MC ovarian mass)
- Corpus luteum cyst
- Theca lutein cyst (rare)

79

T/F: Endometrioma, PCOS and tubo-ovarian abscesses are all examples of ovarian masses

True

80

When would a corpus luteum cyst develop?

if the sac doesn’t dissolve, but seals off after the egg is released --> Fluid builds up inside

81

Are corpus luteum cysts clinically important?

Yes, with the possibility of bleeding/torsion; whereas the other two functional cysts are not clinically important.

82

What are Sx of functional ovarian cysts?

- often asymptomatic & discovered during routine pelvic exam
- unilateral pressure, fullness, or pain in lower abd

83

Which cyst contains all 3 germ layers?

Dermoid cyst (Teratoma)
- could be benign or malignant
*"adnexal calcifications"*

84

What is an endometrioma?

Part of endometriosis picture, with blood-filled cysts forming on ovaries requiring laparoscopy

85

What is the typical cause of tubo-ovarian abscess?

Infection at the junction; d/t NG or CT

86

What are sx of tubo-ovarian abscess?

- Pelvic pain
- Fever
- Vaginal d/c
- Tubal/ovarian swelling
long term: CPP, infertility

87

At what stage in life are ovarian masses most likely malignant?

In postmenopausal women (45% malignancy risk)

88

What are some risk factors of ovarian cancer?

Fam Hx, Prior BRCA, Nullparity, early menarche or late menopause, fertility promoting drugs, ashkenazi jews

89

What are some s/Sx of ovarian cancer?

- Non specific GI Sx
- Maybe asymptomatic
- pelvic pressure
- No spotting or other red flags for early detection

90

T/F: Hormonal contraceptives and breast feeding help prevent ovarian cancer

true

91

Where is the MC site for fibrocystic breast changes or malignant disease?

Upper outer quadrant

92

Why is the inframammary line important?

Common fibrous area due to bras

93

What is mastalgia and what are the s/sx?

Breast pain/tenderness common in premenopausal women. Can be cyclical or non-cyclical

94

What is fibrocystic breast changes?

Benign condition w/ bilat diffuse changes with hormone fluctuation.
- Masses that don't reduce with menses should be evaluated further

95

What is fibroadenoma?

Fibrous stroma in breast that responds to E/P, size fluctuates with cycle.
- rubbery, firm, smooth, round, mobile, painless

96

Which age do women get fibroadenoma and simple cysts?

15-50 yrs, NOT common in menopause unless on HRT

97

What are characteristics of simple cysts?

- Fluid filled breast lesions
- Soft, firm, mobile, well-circumscribed, uni/bilat, TENDER
- cyclical fluctuations

98

What is mastitis?

-infection with lactation or skin disruption
- MC in 2-4wks post partum

99

What are s/sx of mastitis?

fever, erythema, pain, induration, N/V, malaise, chills

100

What is the etiology of mastitis?

S. aureus, S. epidermis, strep

101

What is a galactocele and how do you treat?

Obstruction of breast duct, becomes tender and enlarged.
Tx- excise and drain

102

What is the MC cause of nipple discharge?

benign breast disease

103

What is the MC pathologic cause of nipple discharge?

intraductal papilloma (still benign but pathologic)

104

What characteristics of nipple discharge seem pathologic?

- unilateral
- spontaneous
- frank blood, serous, green/grey
- any other color (d/t carcinoma)

105

What is galactorrhea and what is commonly the cause?

Inappropriate lactation in non puerperal woman
- uni OR bilateral
- evaluate for elevated PROLACTIN levels (r/o pituitary tumor)

106

What is intraductal papilloma?

papillary growth inside lactiferous duct, d/c may be bloody or serous
Tx- surgical excision

107

What causes subareolar abscess?

s. aureus or anaerobic organisms
- common in women w/ inverted nipples or nipple piercings
Tx- antibiotics, drainage, excision

108

What is MC cancer in women?

Breast cancer

109

What is leading cause of cancer deaths in women?

Lung cancer (Breast is second, cause there are two boobs)

110

When would you order MRI instead of US if you suspected breast cancer?

- current or past dx of BrCa
- dense breasts
- high risk with fam hx

111

What are s/sx of early stage BrCa?

- firm/hard mass
- irregular contour
- immobile
- unilateral

112

What are s/sx of late stage BrCa?

- skin/nipple retraction
- tenderness
- axillary
lymphadenopathy
- erythema/edema/ulcer
- pain
- fatigue
- PEAU D'ORANGE

113

Risk factors for BrCa?

- Age (older)
- Sex (Female)
- Race (white)
- Genetic mutations
- Hormone use
- Breast feeding (decr. risk)
- Years of exposure to ovarian estradiol

114

How do you diagnose BrCa?

Biopsy
Screen w/ self and clinical breast exams and mammography

115

What is Paget's disease of the breast?

- Adenocarcinoma of the nipple
"Itching or burning of the nipple"
- May also be erythema, rash and ulcer

116

How is cervical dysplasia graded?

- Mild (CIN 1)
- Mod (CIN 2)
- Severe (CIN 3)
CIN = cervical intraepithelial neoplasia
SIL = (low or high) squamous intraepithelial lesion

117

T/F: Family history is not a risk factor for cervical cancer.

True

118

What are RF for cervical cancer?

- Early age of first intercourse
- Multiple sex partners
- HPV infection
- Smoking
- Hormonal contraception > 5yrs
- exposure to DES

119

When is a colposcopy performed?

To identify abnormal areas that require biopsy after the Pap smear screening test showed abnormal cells

120

What is the recommended pap smear frequency?

Screening starts within 3 years after having vaginal intercourse or by age 21; every 1-2 years

121

What is LEEP?

Fine wire loop with electrical energy to remove tissue

122

What is conization?

Removes a cone-shaped piece of the cervix, may interfere with future childbearing

123

What is DES and side effects?

Diethylstilbestrol; synthetic estrogen
- high risk of BrCa, infertility, cx dysplasia, autoimmune disorders, reproductive anomalies

124

What is endometrial adenocarcinoma?

Uterine cancer

125

What is the typical presenting complaint with endometrial adenocarcinoma?

abnormal bleeding

126

What are the RF for endometrial adenocarcinoma?

Age 50-70, Fam hx and unopposed estrogen
- nulliparity, PCOS, tamoxifen, diabetes, HTN

127

How many pregnancies are unintended in USA?

50%, MC 20-24yrs

128

By what mechanism do E/P hormonal contraceptives work?

- Suppress FSH/LH surge, inhibiting follicular maturation- no ovulation, Prog thickens Cx mucous, alters endometrial lining

129

T/F: Nonoral methods of contraception have lower user failure rates and thus greater reliability

True; less human error

130

What hormone does "the patch" use?

Progestin, changed weekly for 3 weeks

131

What hormone does NuvaRing use?

Progestin, take out for menses.
*may cause bacterial vaginosis*

132

What was the major issue with injectable hormones (lunelle, depo-provera)?

difficulties getting pregnant quickly after stopping, osteopenia

133

The Mirena IUD secretes which hormone?

levonorgestrel, a synthetic similar to progesterone

- spotting is MC side effect

134

What are contraindications to taking P/E HCPs?

Liver disease, pregnancy, HTN, neurological migraines, breast cancer, smokers

135

What are drug interactions with HCPs?

Tylenol, Alcohol, Antibiotics, St Johns wort, antidepressants, CS, bronchodilators, rifampin

136

When would you take progestin only pills?

women who can't take estrogen (breast feeding and risk for blood clots)

137

What is Norplant?

Silicone rods w/ progesterone placed subcutaneously for 5yrs

138

What is the minipill?

Prog only OC

139

What element does a non-hormonal IUD use?

Copper

140

What is the mechanism of a copper IUD?

reduces sperm motility (copper is its kryptonite), prevents fertilization

141

When would IUD be contraindicated?

abnormal uterine anatomy, nulliparous, pregnancy, DUB of unknown cause, malignancy, allergy to copper

142

Which receptacles are suitable for spermicide?

condoms, diaphragm, cervical cap

143

What are possible side effects of vasectomy?

pain, infection, granulomas, epididymitis, abscesses, ED,

144

What is Preven?

emergency contraception similar to plan B

145

What methods are used for natural family planning?

cervical mucous, BBT, calendar, symptothermal

146

T/F: IUD can be used as an emergency contraceptive

True

147

What is non surgical abortion RU486?

Mimics SAB via Mifepristone (Antiprogesterone)
- Must be < 49d since LMP

148

What are the contraindications and side effects of RU486?

SE- cramps, nausea, bleeding, retained tissue, need to undergo surgical abortion
Contra- ectopic pg or adnexal mass, IUD, CS therapy, hemorrhagic disorders

149

What hormonal changes occur during perimenopause?

*Rising FSH = marker of perimenopause*
- Ovaries become sporadically responsive to pituitary FSH/LH, with decreased gonadal hormone output

150

What signifies the onset of menopause?

Absent menses for 12 months and elevated FHS/LH with low Estrogen

151

What is the average age of menopause?

50-51yo

152

What are the symptoms of vulvar cancer?

- itching, burning, soreness
- lump/mole/growth
- color change (white/erythematous)

153

What are symptoms of vulvodynia/vulvar vestibulitis?

Chronic perineal discomfort (burning, stinging, irritation), altered cutaneous perception

154

Describe what occurs with cystocele

Herniation of the bladder wall causing an outpouching of anterior vaginal wall
- may be asymptomatic or cause *incontinence*

155

Describe what occurs with rectocele

Herniation of rectal wall causing an outpouching of posterior vaginal wall
- constipation or the need to apply digital pressure in the vagina in order to defecate

156

Describe what occurs with an enterocele

Weakening of the rectovaginal septum allowing the small intestine to herniate down between layers of the septal wall (pouch of douglas)
- usually asymptomatic

157

Describe what occurs with a urethrocele

Round doughnut-shaped mucosa is observed protruding from the urethral opening.
- Vaginal bleeding is MC symptom

158

What is procidentia?

Complete uterine prolapse (3rd degree)

159

T/F: Many RTIs are asymptomatic, even serious ones requiring treatment

True

160

What is the most common gynecologic complaint?

Vaginitis

161

What are the common infectious agents for vaginitis?

- Bacterial vaginosis
- Trichomonas vaginitis
- Candida vaginitis
- Atrophic vaginitis (STI)

162

Which organism is responsible for maintaining a healthy vagina?

Lactobacillus

163

Describe bacterial vaginitis.

Overgrowth of normal bacteria
- not sexually transmitted!!
- gardnerella, haemophilus, GBS

164

What are the clinical criteria for bacterial vaginitis?

- amine "fishy" odor; whiff test
- elevated pH
- clue cells
- discharge

165

What are s/sx of trichomonas vaginalis?

*Frothy yellow-green discharge*
- Strawberry cervix
- may be malodorous
- erythema

166

Which organs does trichomonas vag. infect?

Vagina, scene's ducts, lower urinary tract

167

What are s/sx of candida albicans aka yeast infection?

Pruritis, erythema, WHITE CURD-LIKE DISCHARGE :s

168

What RTI is caused by low estrogen?

Atrophic vaginitis

169

Which organisms infect the upper reproductive tracts?

Gonorrhea, Chlamydia trachomatis

170

What are s/sx of CT?

May be asymptomatic
- cervicitis, urethritis, PID
- Reiter's syndrome

171

What are s/sx of NG?

May be asymptomatic
- cervicitis, urethritis, PID
- pharyngitis and arthritis

172

Which conditions would cause mucopurulent cervicitis?

NG and CT; and PID

173

What are s/sx of PID?

- mucopurulent cervicitis
- adnexal tenderness
- disturbed menses
- chills and fever
- elevated ESR and WBC

174

Which infection is caused by treponema pallidum?

syphilis by the spirochete itself!

175

Describe primary syphilis

- Within 3 weeks
- Highly contagious
- CHANCRE (Painless ulcer w/ firm borders)
- regional lymphadenopathy

176

Describe secondary syphilis AKA the great mimicker

- 2-8wks after chancre, they develop a RASH on palms and soles
- CONDYLOMA LATA
- fever, sore throat, weakness, wt loss, hair loss (patchy)

177

Describe tertiary syphilis

- May begin as early as 1 year after infection
- Gummata (sores) develop
- Cardiovascular and neuro effects occur

178

How do you dx syphilis?

Antibody testing (VDRL) and MHA-TP

179

What STI is caused by haemophilus ducreyi?

Chancroid

180

Describe chancroid

MUCHO painful lesion with ulceration of lymph node in the groin

181

What should be your DDX for genital ulcers?

HSV, Syphilis, Chancroid, Lymphogranuloma venereum (LGV)-CT

182

Number off the herpes viruses

HSV 1 = herpes simplex
HSV 2
VZV (type 3)
EBV (type 4)
CMV (type 5)
HHV roseola (type 6)
HHV (type 7)
HHV Kaposi's sarcoma (type 8)

183

Describe primary herpes progression

- erythematous papule
- vesicle
- pustule
- ulceration
- encrustation

184

What are the s/sx of primary herpes?

golden crusty ulceration, may be asymptomatic, Blisters/vesicles, pain/itching, local/systemic symptoms; sexual hx with partner known to have herpes; new partner

185

T/F: HSV may cause unilateral keratitis (cornea), blepharitis and keratoconjunctavitis

True

186

HPV is also known as _________________

Condyloma accuminata

187

How do you treat HPV?

- Podophyllin resin
- Freezing via cryoprobe/nitrogen
- CO2 laser- anesthesia