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OBGYN EOR > Gynecology > Flashcards

Gynecology Flashcards

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1
Q

Workup for amenorrhea

A

Pregnancy test
FSH, LH
Serum prolactin
TSH

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2
Q

Primary amenorrhea

A

Failure of menarche onset (menstruation) by age 15 y/o in the presence of secondary sex characteristics

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3
Q

Secondary amenorrhea

A

Absence of menses for > 3 months in pt with previously normal menstruation
Or > 6 months in pt with oligomenorrhea

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4
Q

Amenorrhea: hypothalamus dysfunction

A

Anorexia
Exercise
Systemic disease (celiac dz)

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5
Q

Management of amenorrhea - hypothalamus dysfunction

A

Stimulate gonadotropin secretion

Clomiphene, Menotropin

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6
Q

Amenorrhea: pituitary dysfunction

A

Prolactin-secreting pituitary adenoma

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7
Q

Management of amenorrhea - pituitary dysfunction

A

Transsphenoidal surgery

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8
Q

Amenorrhea: ovarian disorder

A

Polycystic ovarian syndrome

Turner’s syndrome

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9
Q

Diagnosis of amenorrhea - ovarian disorder

A

Progesterone Challenge Test
10 mg medroxyprogesterone for 10 days
+ withdrawal bleeding –> ovarian dysfunction

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10
Q

Amenorrhea: Uterine disorder

A

Scarring of the uterine cavity

Asherman’s Syndrome

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11
Q

Diagnosis of amenorrhea - uterine disorder

A

Pelvic US

Hysteroscopy to diagnose and treat

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12
Q

Management of amenorrhea - uterine disorder

A

Estrogen treatment to stimulate endometrial regeneration

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13
Q

Normal menstrual cycle: cycle length and length of menstruation

A

24-38 days in cycle length

4.5-8 days of menstruation

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14
Q

Dysfunctional uterine bleeding - chronic anovulation

A

Due to disruption of the HPO axis
Extremes of age
Unopposed estrogen - irregular, unpredictable bleeding

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15
Q

Dysfunctional uterine bleeding - ovulatory

A

Ovulation with prolonged progesterone secretion

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16
Q

Dysfunctional uterine bleeding is a:

A

Diagnosis of exclusion

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17
Q

Workup for dysfunctional uterine bleeding

A

Pregnancy test
Hormone levels
Transvaginal US
Endometrial biopsy if US endometrial stripe > 4 mm

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18
Q

Management of dysfunctional uterine bleeding - acute severe bleeding

A

High dose IV estrogens or high dose OCPs

If IV estrogen fails, may do D and C

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19
Q

Management of dysfunctional uterine bleeding

A
  1. OCPs
  2. Progesterone
  3. GnRH agonists (leuprolide)
  4. Hysterectomy or endometrial ablation
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20
Q

Primary dysmenorrhea is not due to pelvic pathology, but:

A

Due to increased prostaglandins

Painful uterine muscle wall activity

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21
Q

Causes of secondary dysmenorrhea

A 
Endometriosis
Adenomyosis
Leiomyomas
Adhesions
PID
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22
Q

Diffuse pelvic pain right before or with onset of menses

May be associated with HA, N/V

A

Dysmenorrhea

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23
Q

Management of dysmenorrhea

A
  1. NSAIDs first line
  2. OCPs, progestins
  3. Laparoscopy if medications fails to r/o secondary causes
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24
Q

Premature menopause may occur sooner in pts with:

A

DM
Smokers
Vegetarians
Malnourished pts

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25
Signs/Symptoms of menopause
Estrogen deficiency changes Atrophic vaginitis Decreased bone density
26
Ex of estrogen deficiency changes
``` Menstrual cycle alterations Vasomotor instability (hot flashes) Mood changes Skin/nail/hair changes Increased risk of cardiovascular events HLD Osteoporosis Urinary incontinence ```
27
Atrophic vaginitis
Thin, yellow discharge, vaginal pH >5.5, pruritus
28
Diagnosis of menopause
``` FSH assay (>30 IU/mL) Increased FSH, increased LH, decreased estrogen ```
29
Predominant estrogen after menopause
Estrone
30
Complications of menopause
Osteoporosis Cardiovascular risk Hyperlipidemia
31
Management of menopause - vasomotor insufficiency
Estrogen, progesterone Clonidine SSRIs Gabapentin
32
Management of menopause - vaginal atrophy
Transdermal, intravaginal estrogen
33
Management of menopause - osteoporosis prevention
``` Calcium + vitamin D Weight bearing exercises Bisphosphonates Calcitonin SERM (raloxifene, tamoxifen) ```
34
Risks of estrogen alone tx for menopause
Thromboembolism (CVA, DVT, PE) | Liver disease
35
Risks of estrogen + progestin tx for menopause
``` Breast cancer (slightly increased risk) Thromboembolism ```
36
Endometrium thickens under the influence of:
Estrogen
37
Enhances the lining of the uterus to prepare it for implantation
Progesterone
38
Physical, behavioral and mood changes with cyclical occurrence during the ________ phase of the menstrual cycle
Premenstrual Syndrome | Luteal phase
39
Severe PMS with functional impairment
Premenstrual Dysphoric Disorder (PMDD)
40
Signs/Symptoms of PMS:
1. Physical: bloating, breast swelling/pain 2. Emotional: depression, hostility, irritability, libido changes 3. Behavioral: food cravings, poor concentration
41
Criteria for diagnosis of PMS:
1-2 weeks before menses (luteal phase) | Relieved within 2-3 days of the onset of menses
42
Management of PMS:
1. Stress reduction, exercise, caffeine and salt restriction 2. NSAIDs 3. SSRIs 4. OCPs 5. Drospirenone-containing OCPs for PMDD
43
MC cause of cervicitis
Chlamydia
44
What organism causes LGV
Chlamydia
45
Painless genital ulcer + painful inguinal LAD
LGV
46
Diagnosis of chlamydia / gonorrhea
NAAT Cultures DNA probe
47
Management of chlamydia / gonorrhea
1 g Azithromycin PO 250 mg Ceftriaxone IM (co-tx for gonorrhea) Can use doxycycline instead of azithromycin
48
Pt instructions for chlamydia / gonorrhea tx
Avoid sexual intercourse 7 days after treatment
49
Haemophilus ducreyi
Bacteria that causes chancroid
50
Soft, shallow, painful genital ulcer that may have foul discharge Painful inguinal LAD
Chancroid
51
Diagnosis of chancroid
Clinical, culture
52
Treatment of chancroid
Azithromycin
53
HPV strains that cause genital warts
6, 11
54
Flat, pedunculated or papular flesh-colored growths | Cauliflower-like lesions
HPV Genital warts 6, 11
55
Diagnosis of HPV
Whitening with 4% acetic acid application Clinical diagnosis +/- colposcopy, biopsy
56
Management of HPV (genital warts)
``` Trichloroacetic acid Podophyllin Cryotherapy Surgical removal Outpt: podofilox, imiquimod ```
57
Genital ulcer disease caused by Chlamydia trachomatis
LGV
58
Diagnosis of LGV
NAAT (Chlamydia)
59
Tx of LGV
Doxycycline 100 mg PO BID x 21 days | Azithromycin effective as well
60
Pts with LGV should be also be tested for:
HIV and other sexually transmitted diseases
61
Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, nausea, vomiting, fever
Pelvic Inflammatory Disease
62
Physical exam sign of PID
+ chandelier's sign - cervical motion tenderness to palpation and rotation
63
Diagnosis of PID
Clinical diagnosis BhCG to r/o ectopic pregnancy Cervical motion tenderness plus > 1 of the following: + gram stain, WBC > 10,000, pus on culdocentesis or laparoscopy, increased ESR or CRP Pelvic ultrasound - may show abscess
64
Outpatient management of PID
Doxycycline + Ceftriaxone | +/- Metronidazole
65
Inpatient management of PID
IV doxycycline + 2nd gen ceph (cefoxitin or cefotetan)
66
Complications of PID
Fitz-Hugh Curtis Syndrome
67
Caused by spirochete Treponema pallidum
Syphilis
68
Forms chancre at the inoculation site and from there, goes to the regional lymph nodes before disseminating
Syphilis
69
Painless ulcer with raised indurated edges (usually begins as a papule that ulcerates) Nontender regional lymphadenopathy
Primary Syphilis
70
Maculopapular rash involving palms/soles Condyloma lata (wart-like, moist lesions involving mucus membranes and other moist areas) Fever, lymphadenopathy
Secondary Syphilis
71
Gumma: non cancerous granulomas on skin and body tissues Neurosyphilis: headache, meningitis, dementia Tabes dorsalis: ataxia, areflexia burning pain, weakness Argyll-Robertson Pupil: does not constrict/react to light Cardio: aortitis, aortic regurgitation, aortic aneurysms
Tertiary syphilis
72
Clinical syndrome that occurs within the first year of infection: includes primary, secondary and early latent
Early syphilis
73
Asymptomatic infection + normal physical exam but positive serologic testing
Latent syphilis Early latent if < 1 year (highly contagious) Late latent if > 1 year
74
Congenital syphilis
Hutchinson teeth (notches on teeth) Sensorineural hearing loss Saddle-nose deformity ToRCH syndrome
75
Diagnosis of syphilis
1. Darkfield microscopy | 2. RPR, FTA-Abs
76
Jarisch-Herxheimer reaction
S/E of penicillin rxn | Acute febrile response, myalgias, HA
77
A ________ reduction in the titer for syphilis within 6 months denotes adequate management
4-fold
78
All pts with syphilis should be tested for:
HIV
79
Signs/Symptoms of atrophic vaginitis
Thin, yellow discharge Vaginal pH > 5.5 Pruritus Recurrent UTIs
80
Tx of atrophic vaginitis
Transdermal, intravaginal estrogen Ospemifene Vaginal moisturizers
81
Copious vaginal discharge, watery grey-white "fish rotten" smell
Bacterial vaginosis
82
Malodorous vaginal discharge, frothy yellow-green discharge, strawberry cervix
Trichomoniasis
83
Thick curd-like/cottage cheese vaginal discharge
Candida vaginitis
84
Diagnosis of bacterial vaginosis
``` Whiff test (fishy odor) Microscopic: clue cells - epithelial cells covered with bacteria ```
85
Diagnosis of trichomoniasis
Mobile protozoa on wet mount, WBCs
86
Diagnosis of candida vaginitis
Hyphae, yeast and spores on KOH prep
87
Copious lactobacilli, large number of epithelial cells on microscope
Cytolytic
88
Management of BV
Metronidazole or Clindamycin
89
Management of trichomoniasis
Metronidazole or Tinidazole
90
Management of candida
Fluconazole, intravaginal antifungals
91
Management of cytolytic vaginitis
Discontinue tampon usage, sodium bicarbonate (sitz bath)
92
Most common non-skin malignancy in women
Breast cancer
93
Second most common cause of cancer death in women
Breast cancer
94
Risk factors for breast cancer
``` BRCA 1 / 2 1st degree relative with breast CA Age > 65 y/o Increased number of menstrual cycles 75% have no risk factors ```
95
Most common types of breast cancer
1. Ductal carcinoma (MC) | 2. Lobular Carcinoma
96
Most common location of BC METS
Lung Liver Bone Brain
97
Chronic eczematous itchy, scaling rash on the nipples and areola. Lump often present.
Paget's disease of the nipple
98
Red, swollen, warm, itchy breast. Often with nipple retraction, peau d' orange, usually not associated with lump
Inflammatory breast cancer
99
Dx of breast cancer
1. mammogram 2. ultrasound 3. biopsy, FNA
100
Hormone therapy for breast cancer pts
1. Tamoxifen (ER positive) - premenopausal 2. Letrozole, anastrozole (ER positive) - postmenopausal 3. Herceptin (HER2 positive)
101
Timing for breast self-examinations
Immediately after menstruation or on days 5-7 of menstrual cycle
102
Breast cancer prevention in high-risk patients
SERM: tamoxifen or raloxifene | Tamoxifen preferred
103
Third most common gynecologic cancer
Cervical carcinoma
104
Most common METS w/ cervical carcinoma
Local --> vagina, parametrium, pelvic lymph nodes
105
Risk factors for cervical carcinoma
HPV, early sexual activity, increased number of partners, smoking, STIs, immunosuppression
106
MC type of cervical carcinoma
Squamous (90%)
107
Most common symptoms of cervical carcinoma
Post coital bleeding/spotting | Pelvic pain, watery vaginal discharge
108
Diagnosis of cervicial carcinoma
PAP smear with cytology used for screening | Colposcopy with biopsy
109
Management of pt > 25 y/o, with normal PAP screen but + HPV test
Cytology and HPV testing in 1 year OR | Genotype for HPV 16/18
110
70% of _________ lesions regresses at 24 months but HPV + lesions have higher risk of progression into carcinoma
ASC-US
111
Management of pt > 25 y/o with ASC-US PAP screen
HPV testing: HPV (+) - colposcopy with biopsy HPV (-) - repeat PAP and HPV in 1 year
112
Management of pt 21-24 y/o with ASC-US or LSIL PAP screen results:
Repeat PAP in 1 year or HPV testing
113
Management of pt < 32 with ASC-US PAP screen results:
Repeat PAP in 1 year
114
Management of pt with ASC-H PAP screen results
Colposcopy and biopsy | Higher chance of cancer than ASC-US
115
Most commonly associated with cellular changes seen with transient HPV infection
LSIL
116
Management of 25+ y/o pt with LSIL PAP screen results
Colposcopy with biopsy
117
Includes CIN II, CIN III, and carcinoma in situ
HSIL
118
Management of HSIL
Colposcopy with biopsy in all ages Excision of ablation mainstay of tx Excision: LEEP, cold knife cervical conization Ablation: Cryocautery, laser cautery, electrocautery
119
CIN
Cervical Intraepithelial Neoplasia | Precursor for cervical carcinoma
120
Highest risk for malignancy on the cervix
Transformation zone (squamocolumnar junction)
121
Moderate dysplasia including 2/3 thickness of basal epithelium
CIN II
122
Severe dysplasia including > 2/3 - up to full thickness of basal epithelium
CIN II
123
Most common gynecologic malignancy in the US
Endometrial cancer
124
4th most common non-skin cancer in women overall
Endometrial cancer | Breast --> lung --> colorectal --> endometrial
125
Endometrial cancer is most commonly seen in what population?
Postmenopausal
126
Endometrial cancer is ________ dependent
Estrogen
127
Risk factors for endometrial cancer
Increased estrogen exposure (nulliparity, PCOS) Tamoxifen HTN, DM
128
Combination OCPs are protective against:
Ovarian and endometrial cancer
129
Signs/Symptoms of endometrial cancer
Abnormal uterine bleeding | Postmenopausal bleeding
130
Diagnosis of endometrial cancer
Endometrial biopsy: adenocarcinoma (80%) | Ultrasound: endometrial stripe > 4 mm
131
Second most common gynecologic cancer
Ovarian cancer
132
Highest mortality of all gynecologic cancer
Ovarian cancer
133
Risk factors for ovarian cancer
+ family history Increased number of ovulatory cycles BRCA 1/2 Turner's syndrome
134
Abdominal fullness/distention, back or abdominal pain, early satiety, urinary frequency, irregular menses, menorrhagia, postmenopausal bleeding, constipation
Ovarian cancer
135
Physical exam signs on ovarian cancer
Palpable abdominal mass +/- ascites Sister Mary Joseph's node - METS to umbilical lymph node
136
Diagnosis of ovarian cancer
Biopsy - 90% epithelial Transvaginal US Mammography to look for METS to breast
137
Management of ovarian cancer
TAH-BSO + selective lymphadenopathy Serum CA-125 levels used to monitor treatment progress Chemotherapy
138
Dermoid cystic teratomas
Most common benign ovarian neoplasm
139
Management of dermoid cystic teratomas
Removal due to potential risk of torsion or malignant transformation
140
Most common type of vaginal cancer
Squamous cell (95%)
141
S/S of vaginal cancer
Asymptomatic Changes in menstrual period Abnormal vaginal bleeding Vaginal discharge
142
Management of vaginal cancer
Radiation therapy
143
Most common type of vulvar cancer
Squamous cell (90%)
144
Most common presentation of vulvar cancer
Pruritus (MC) Vaginal itching, irritation Post-coiting bleeding, vaginal discharge
145
Red/white ulcerative, crusted lesions
Vulvar cancer
146
Dx of vulvar cancer
Biopsy
147
Management of vulvar cancer
Surgical excision, radiation therapy, chemotherapy
148
Seen mostly in lactating women secondary to nipple trauma
Infectious mastitis
149
Most common organisms in infectious mastitis
Staph aureus | Strep +/- candida
150
Bilateral breast enlargement 2-3 days postpartum
Congestive mastitis
151
Unilateral breast pain (especially in one quadrant) with tenderness, warmth, swelling, and nipple discharge
Infectious mastitis
152
Bilateral breast pain and swelling, may have low grade fever and axillary lymphadenopathy
Congestive mastitis
153
Management of infectious mastitis
``` Supportive measures (warm compress, breast pump) ABX: dicloxacillin, nafcillin, cephalosporin Mother may continue to breast feed ```
154
Management of congestive mastitis
If woman desires to breast feed: manually empty breast completely after breastfeeding Local heat, analgesics, continue nursing If woman does not desire to breast feed: ice packs, tight fitting bras, analgesics, avoid breast stimulation
155
Management of breast abscess
I and D | Discontinue breastfeeding from affected breast
156
Most common breast disorder
Fibrocystic breast disorder
157
Usually multiple, mobile, well demarcated lumps in breast tissue. Often tender and bilateral
Fibrocystic breast disorder
158
May increase or decrease in size with menstrual hormonal changes
Fibrocystic breast disorder
159
Second most common benign breast disorder
Fibroadenoma
160
Most common breast disorder in pts specifically late teens to early 20s
Fibroadenoma
161
Smooth, well-circumscribed, nontender, freely mobile, rubbery lump in breast. Gradually grows over time and does not usually wax and wane with menstruation
Fibroadenoma
162
Management of fibroadenoma
Observation, most small tumors resorb with time | Excision (not usually done)
163
Intermittent pain with spontaneous resolution indicates ________ torsion
Partial ovarian torsion
164
Acute, severe, unilateral abdominopelvic pain. | N/V, possible elevated WBC and low-grade fever
Ovarian torsion
165
Diagnosis of ovarian torsion
Clinical suspicion, may have adnexal mass | TUS with doppler flow studies
166
Management of ovarian torsion
Surgical emergency, laparoscopy, laparotomy
167
Uterine herniation into the vagina
Uterine Prolapse
168
Risk factors for pelvic organ prolapse
Childbirth (especially traumatic) Multiple vaginal births Obesity Repeated heavy lifting
169
Posterior bladder herniating into the anterior vagina
Cystocele
170
Pouch of Douglas (small bowel) into the upper vagina
Enterocele
171
Distal sigmoid colon (rectum) herniates into posterior distal vagina
Rectocele
172
Pelvic or vaginal fullness, heaviness, "falling out" sensation, lower back pain, vaginal bleeding, urinary frequency, urgency, stress incontinence
Pelvic organ prolapse
173
Management of pelvic organ prolapse
1. Kegel exercises, weight control 2. Pessaries, estrogen treatment 3. Hysterectomy, uterosacral or sacrospinous ligament fixation
174
S/E of implanon
Osteoporosis
175
Adverse effect of spermicide
Slightly increased risk of HIV (causes microabrasions)
176
Type of endometrial tissue that is present outside the uterine cavity in endometriosis
Stroma and gland
177
Risk factors for endometriosis
Nulliparity Family history Early menarche
178
Classic triad of endometriosis
Cyclic premenstrual pelvic pain Dysmenorrhea Dyspareunia
179
25% of all causes of female infertility
Endometriosis
180
Diagnosis of endometriosis
Tender adnexal masses Laparoscopy with biopsy (definitive) Raised, patches of thickened, discolored, scarred or "powder burn" appearing plants of tissue
181
Endometriosis involving ovaries large enough to be considered a tumor, usually filled with old blood appearing chocolate-colored
Endometrioma
182
Management of endometriosis
1. OCPs + NSAIDs 2. Progesterone 3. Leuprolide 4. Danazol (induces pseudomenopause) 1. Conservative laparoscopy with ablation if fertility desired 2. TAH-BSO if no desire to conceive
183
Failure to conceive after 1 year of regular unprotected sexual intercourse
Infertility
184
Diagnosis of infertility
Hysterosalpingography - evaluates tubal patency or abnormalities
185
Management of infertility
1. Clomiphene - induces ovulation 2. Intrauterine insemination 3. In vitro fertilization (especially if fallopian tube defect is present)
186
Benign uterus smooth muscle tumor
Leiomyoma (Fibroids)
187
Most common benign gynecologic lesion
Leiomyoma (Fibroids)
188
Growth of fibroids is related to _________ production
Estrogen | Therefore, fibroids regress after menopause - if it grows after menopause, think of other causes
189
Fibroids are 5x more common in:
African-Americans
190
Types of fibroids
1. Intramural 2. Submucosal 3. Subserosal 4. Pedunculated 5. Parasitic
191
Most common presentation of uterine fibroids
Bleeding, dysmenorrhea Abdominal pressure/pain Bladder frequency, urgency
192
Large, irregular, hard palpable mass in the abdomen or pelvis
Uterine fibroids
193
Diagnosis of uterine fibroids
Ultrasound - heterogenic masses with shadowing
194
Management of uterine fibroids
Observation - most do not need tx Leuprolide (shrinks uterus) Progestins - decreases bleeding Hysterectomy - MC cause for hysterectomy Myomectomy Endometrial ablation
195
Types of ovarian cysts
Follicular - when follicles fail to rupture and continue to grow Corpus luteal cysts - fail to degenerate after ovulation Theca lutein - excess hCG causes hyperplasia
196
S/S of ovarian cysts
``` Most asymptomatic until they rupture, undergo torsion or become hemorrhagic - LLQ/RLQ pain Menstrual changes (AUB), dyspareunia ```
197
Diagnosis of ovarian cysts
Pelvic US Follicular: smooth, thin-walled unilocular Luteal: complex Order hCG to r/o pregnancy
198
Management of ovarian cysts
< 8 cm: rest, NSAIDs, repeat US after 6 weeks OCPs +/- prevent recurrence but do not treat existing ones > 8 cm or cyst in postmenopausal pt: laparoscopy or laparotomy possible
199
Functional incontinence
Problem that keeps the pt from quickly getting to the bathroom
200
Urine leakage due to increased intraabdominal pressure
Stress incontinence
201
Risk factors for stress incontinence
Childbirth Surgery Postmenopausal estrogen loss
202
Increased intraabdominal pressure from sneezing, coughing, laughing --> urine leakage
Stress incontinence
203
Management of stress incontinence
1. Kegel exercises 2. Alpha agonists - midodrine, pseudoephedrine 3. Surgery 4. Anti-continence devices 5. Estrogen cream or vaginal ring
204
Urine leakage accompanied or preceded by urge
Urge incontinence
205
Detrusor muscle overactivity, involuntary detrusor musucle contraction
Urge incontinece
206
S/S of urge incontinence
Urgency, frequency, small volume voids, nocturia
207
Management of urge incontinence
1. Bladder training (timed voiding, decreased fluid intake) 2. Anticholinergics: oxybutynin 3. TCAs 4. Mirabegron (beta agonst) - relaxes bladder 5. Surgical - botox injection 6. Diet - avoid spicy foods, citrus, chocolate, caffeine
208
Urinary retention (incomplete bladder emptying)
Overflow incontinence
209
Underactive bladder due to DM, multiple sclerosis, autonomic dysfunction, spinal injury
Overflow incontinence
210
S/S of overflow incontinence
Small volume voids, frequency, dribbling | Increased void residual > 200 mL
211
Management of overflow incontinece
Bladder atony - intermittent or indwelling catheter first line BPH - alpha blockers - tamsulosin
212
Triad of polycystic ovarian syndrome
1. Amenorrhea 2. Obesity 3. Hirsutism (androgen excess)
213
PCOS is due to:
Insulin resistance
214
S/S of increased androgen effect in PCOS
Hirsutism - coarse hair growth on midline structures (face, neck, abdomen) Acne +/- male pattern baldness
215
Complications/comorbidities of PCOS due to insulin resistance
``` Type II DM Obesity HTN Atherosclerosis Endometrial carcinoma due to infertility ```
216
Bilateral, enlarged, smooth, mobile ovaries on bimanual examination Acanthosis nigricans
Polycystic ovarian syndrome
217
Cysts are immature follicles with arrested development due to abnormal ovarian function
Polycystic ovarian syndrome
218
Diagnosis of PCOS
R/o other disorders: TSH, prolactin levels, ovarian tumors, Cushing's syndrome (dexamethasone suppression test) GnRH agonist stimulation test: rise in serum hydroxyprogesterone Lipid panel: checking insulin resistance Glucose tolerance test Pelvic US: string of pearls (bilateral enlarged ovaries with peripheral cysts)
219
Management of PCOS
OCPs - mainstay Spironolactone - teratogenic (must be used w/ OCPs) Leuprolide Clomiphene (if desiring children) Metformin in pts with abnormal LH:FSH ratios may improve menstrual frequency by reducing insulin Lifestyle changes; diet, exercise, weight loss Surgical: wedge resection

OBGYN EOR (1 decks)

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