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Flashcards in Gynecology Deck (82):
1

OCPs up risk of what in RUQ

hepatic adenoma

2

delayed puberty definition

girls: > 12 w/o breast growth

3

tx: prolactinoma

cabergoline or bromocriptine
(try one then the other)
if neither work --> transsphenoidal resection

4

dx: syphilis

primary: dark field microscopy or direct florescence Ab testing (lesion tissue)

secondary/tertiary: RPR, VDRL; confirm with fluorescent treponemal Ab absorbed test (FTA-ABS)

Neurosyph (CSF): VDRL best

5

tx: syphilis

1/2: penicillin G (1 dose)
latent: 3 doses
neurosyphilis: continuous infusion

6

tx: fibroids

GnRH agonists (shrinks them)
definitive: hysterectomy or myomectomy (depend on kid-wanting)

7

tx: body dysmorphic disorder

CBT, SSRI

8

Krukenberg tumor?

gastric CA throws mets to ovaries

9

mgmt: ASCUS

21 - 24: repeat pap in 12 mo

25+: HPV test
(+)--> colp
(-) --> repeat cyto in 3 years

10

RFs endometrial CA

unopposed estrogen use
DM
age
fam hx

11

21-hydroxylase deficiency -- what are the junk like?

males: normal
females: ambiguous

12

tx: 21-hydroxylase def

initially: IV hydrocortisone
then glucocorticoid and mineralocorticoid therapy for life

13

tx: TSS

IV fluids
IV nafcillin + aminoglycoside (clinda)

14

trichomoniasis puts at risk for...

HIV and HIV transfer

15

management: bloody nipple discharge

apparently surgery

16

how does hypothyroidism --> galactorrhea?

low thyroid hormone --> increased TRH and TRH stimulates both TSH and prolactin from pituitary

17

normal vaginal pH

3.8 - 4.2

18

candida vaginal pH

normal

19

trichomoniasis vaginal pH

> 4.5

20

tender utero-sacral nodules

endometriosis

21

dx: endometriosis

laparoscopy (gun-powder lesions)

22

palpable testes in labia majora

androgen insensitivity syndrome

23

who do you screen for syphilis?

high risk: MSM, sex workers, risky business
+ preggos

24

mgmt: LSIL

21-24: no colp
HPV (-): repeat cyto + HPV in 1 year
HPV(+) or not done: colp

25

age of precocious puberty

7 in females
8 in males

26

risks of tamoxifen

hot flashes (MC)
endometrial CA
DVTs

27

AEs: MTX

hepatotoxicity
stomatitis (mouth ulcers)
pancytopenia
lung fibrosis
alopecia

28

MTX rescue

leucovorin

29

ddx hirsutism

PCOS
21-hydroxylase def
androgen secreting tumors (often ovarian)
Cushing syndrome

30

lady stuff + liver things

think Fitz-Hugh-Curtis

31

suspected orgs in osteomyelitis after UTI

klebsiella
pseudomonas

32

tx: syphilis (pt has severe PCN allergy)

primary: doxy x 14
secondary: doxy x 14
latent: doxy x 28
tertiary: ceftriaxone x 14
preggo: desensitize then PCN

33

hormones in PCOS

T up (or norm)
E up
LH (up or norm)/ FSH imbalance

34

OCP AEs

DVT
HTN
hepatic adenoma
rare: stroke/MI

35

tx: symptomatic bartholin cyst

I+D
Word catheter

36

dx: endometriosis

laparoscopy (usually don't need definitive dx)

37

risks of endometriosis

infertility

38

when do you use a pessary

stress incontinence (3rd line)

39

explain the hormones in primary ovarian insufficiency

(a type of hypogonadotropic hypogonadism)
ovaries stop functioning --> estrogen down
amps up feedback @ hypothalamus --> increased GnRH and FSH

40

explain the hormones in hypothalamic hypogonadism

usually they're too skinny --> shuts down hypothalamus
less GnRH --> less FSH --> less estrogen

41

explain the hormones in PCOS

(i think)
the ovaries are crap and not really ovulating --> estrogen down
hypothalamus goes nuts trying to help --> GnRH up (but not pulsatile)
this makes LH go up more than FSH (which is low/normal)
then also you're making a bunch of androgens and they get converted to estrone which is an estrogen but doesn't help so you get high (unhelpful) estrogen
Total: GnRH up, LH up, FSH low/norm, E up

42

tx: disseminated GC

IV ceftriaxone, switch to oral cefixime when clinically improved

43

mgmt: pap --> atypical glandular cells

could be cervical or endometrial adenocarcinoma
who: > 35 or < 35 w/ RFs (obese, anovulation)
mgmt: colp, endocervical curettage and EMB

44

breast: peau d'orange

inflammatory breast carcinoma

45

breast: firm, mobile spherical, palpable mass (young woman)

fibroadenoma (benign)

46

breast: unilateral nipple discharge w/o skin changes or other sx

intraductal papilloma (benign)
even if discharge is bloody

47

breast: fever, diffuse warmth, erythema

mastitis

48

breast: dimpling/contour changes

infiltrating ductal carcinoma or lobular breast carcinoma
or inflammatory breast carcinoma

49

breast: diffuse erythema, edema and dimpling

inflammatory breast carcinoma

50

mammography: microcalcifications

ductal carcinoma in situ

51

breast: diffuse nodularity with b/l mastalgia

fibrocystic changes

52

breast: fixed, palpable mass with irregular borders

lobular breast carcinoma

53

ages for HPV vaccine

female: 11 - 26
males: 9 - 21 (9 - 26 for MSM or HIV)

54

psych med --> infertility

dopa blockers

55

workup: primary amenorrhea

uterus?

yes --> FSH (increased --> karyotyping; decreased --> MRI)

no --> karyotype, serum T (XX, normal --> abnormal mullerian; XY, normal --> androgen insensitivity syndrome)

56

definition abnormal uterine bleeding

heavy
> 7 days
more often than every 21 days
less often than every 35
any post meno bleeding

57

when do you do an EMB: > 45 yo

any abnormal uterine bleeding

58

when do you do an EMB: < 45 yo

abnormal uterine bleeding + (any of following)
- unopposed estrogen exposure
- failed medical mgmt
- lynch syndrome (HNPCC)

59

needs to stop paps

65 or hysterectomy w/o CIN 2+
AND
3 neg paps/2 co-tests

60

PCOS a/w

metabolic syndrome (DM, HTN)
OSA
NASH
endometrial hyperplasia/CA

61

painful genital ulcers

HSV
haemophilus ducreyi (has big LNs too)

62

painless genital ulcers

treponema pallidum
chlamydia trachomatis
granuloma inguinale (klebsiella granulomatis)

63

when to get CA-125 for ovarian cancer dx

post meno and see a mass on U/S (it's more specific in post meno)
high --> get MRI or CT

64

workup: secondary amenorrhea

1. beta hCG
2. prior uterine procedure? --> hysteroscopy
3. check prolactin, TSH, FSH
- up prolactin --> brain MRI
- up TSH --> hypothyroid
- up FSH --> premature ovarian failure

65

OCPs down risk of what CA

ovarian
endometrial

66

talk through hormones in irregular teen periods

not enough GnRH --> less GSH/LH --> not really ovulating

67

PCOS @ risk for what cancer

endometrial

68

tx: septic pelvic thrombophlebitis

anticoagulation
broad spectrum antibiotics

69

urinary problems post menopause

GU syndrome of menopause
E deficiency --> atrophy of vagina and urethral epithelium --> UTIs, incontinence (stress and urge)

70

pelvic U/S: ovarian mass w/ thickened endometrium

granulosa cell tumor

71

female: high T and androstenedione, no estradiol or estrone

aromatase deficiency

72

morbid obesity effect on girl hormones

--> anovulation
ovaries still make E --> normal FSH/LH
they just don't make progesterone

73

ovarian tumor making E

granulosa cell tumors

74

ovarian tumor making beta hCG

dysgerminoma

75

ovarian tumor making androgens

sertoli-leydig

76

ovarian tumor making LDH

dysgerminoma

77

pain from endometriosis vs pain from dysmenorrhea

endometriosis usually hurts a couple days before menses, not first couple days of menses

78

b/l cordlike thickening of breasts

fibrocystic changes

79

tx: fibrocystic changes

NSAIDs or OCPs

80

chemo effects on lady hormones

transient amenorrhea
ovarian failure happens earlier

81

pain worse with bladder filling or sex and relieved by voiding

interstitial cystitis

82

effects of E on thyroid things

up TBG
need more levo if hypothyroid