Gynecology Flashcards
(163 cards)
1
Q
2 definitions of Primary Amenorrhea?
A
No menses by age of 16 yo; No secondary sex characteristics by age of 14 yo
2
Q
Female presents with Primary Amenorrhea and shortening of 4th metacarpal bone – diagnosis?
A
Turner Syndrome
3
Q
2 cardiac manifestations of Turner’s Syndrome?
A
Coarctation of aorta, Bicuspid aorta
4
Q
1 renal manifestation of Turner’s Syndrome?
A
Horseshoe kidney
5
Q
1 MSK manifestation of Turner’s Syndrome?
A
Lymphedema
6
Q
Change to FSH/LH in Turner’s Syndrome?
A
Increased
7
Q
Patient presents with primary amenorrhea; PE shows no palpable cervix, no uterus; Karyotype shows 46XX – diagnosis?
A
Mullerian agenesis
8
Q
Patient presents with primary amenorrhea; PE shows no palpable cervix, no uterus; Karyotype shows 46XY – diagnosis?
A
Androgen Insensitivity Syndrome
9
Q
2 PE manifestations of Androgen Insensitivity Syndrome?
A
Lack of pubic hair, Bilateral inguinal swelling
10
Q
1st step of treatment in Androgen Insensitivity Syndrome?
A
Removal of testes … Increased risk for testicular CA
11
Q
Timeframe needed for diagnosis of Secondary Amenorrhea?
A
6 months
12
Q
1st step in workup up Secondary Amenorrhea?
A
β-HCG
13
Q
3 cardinal features of PCOS?
A
Secondary amenorrhea, Hirsutism, Cystic ovaries
14
Q
Lab value that suggests diagnosis of PCOS?
A
LH:FSH > 3
15
Q
DOC for infertility in PCOS?
A
Clomiphene citrate
16
Q
MOA of Clomiphene Citrate?
A
Estrogen-R antagonist in hypothalamus; Increases FSH/LH release … stimulates ovulation
17
Q
DOC for metabolic syndrome in PCOS?
A
Metformin
18
Q
How does prolactin cause amenorrhea?
A
Inhibits release of GnRH from hypothalamus; Decreases release of LH/FSH
19
Q
In addition to amenorrhea, what is another clinical feature seen in setting of hyperprolactinemia?
A
Galactorrhea
20
Q
Change to FSH. LH levels in setting of Premature Ovarian Failure?
A
Increased
21
Q
Source of estrogen production in post-menopausal women?
A
Peripheral conversion of testosterone to estrogen
22
Q
Enzyme responsible for peripheral conversion of androgen to estrogen?
A
Aromatase
23
Q
Treatment of choice for atrophic vaginitis?
A
Estrogen
24
Q
Which drug should be added to estrogen during treatment of atrophic vaginitis?
A
Progesterone
25
Value of adding progesterone to estrogen in setting of atrophic vaginitis?
Decreases risk of endometrial CA … (caused by unopposed estrogen exposure)
26
1st step in workup for older female who presents with hirsutism, amenorrhea, virilization?
CT scan to rule out adrenal/ovarian tumor
27
Dysmenorrhea is mediated by …
Prostaglandin F2α
28
Treatment of choice for dysmenorrhea?
NSAIDs, OCPs
29
Difference between Primary dysmenorrhea and Secondary dysmenorrhea?
Primary = occurs in absence of pathology; Secondary = occurs in presence of pathology
30
___ refers to mid-cycle pain due to ovulation
Mittelschmerz
31
When does Premenstrual Syndrome typically occur?
7-10 days before beginning of menstrual cycle
32
Treatment of choice for Premenstrual Syndrome?
Aerobic exercise, OCPs
33
Treatment of choice for severe Premenstrual Syndrome?
SSRI
34
1st test for diagnosis of endometriosis?
US, MRI
35
Definitive test for diagnosis of endometriosis?
Laparoscopy
36
Treatment for Endometriosis?
NSAIDs, Progesterone, GnRH agonists (continuous), Danazol
37
MOA of Danazol?
Testosterone agonist
38
AE of Danazol?
Hirsutism
39
Epidemiology of Acute endometritis?
Post-partum female
40
3 aspects of clinical presentation of Acute endometritis?
Fever, Lower abdominal pain, Purulent cervical drainage
41
Etiology of Acute endometritis?
Retained products of conception
42
2 most common pathogens responsible for Acute endometritis?
Peptostreptococcus, Group B Strep … POLYMICROBIAL
43
Which type of WBC is most commonly found in Acute endometritis infiltrate?
PMNs
44
Which type of WBC is most commonly found in Chronic endometritis infiltrate?
Plasma cells + Lymphocytes
45
Presence of which WBC type is REQUIRED for diagnosis of Chronic endometritis?
Plasma cells
46
Pathogen responsible for Chronic Endometritis in setting of IUD use?
Actinomyces Israeli
47
Clinical presentation of Leiomyoma?
Uterine bleeding; Fe-deficiency anemia
48
Characteristic of Leiomyoma?
Estrogen-sensitive … increase in size during pregnancy
49
Leiomyoma represents growth of …
Smooth muscle
50
Epidemiology of Endometrial Carcinoma?
55 – 65 yo females
51
When does Endometrioid Carcinoma typically occur?
Peri-Menopausal
52
Etiology of Endometrioid Carcinoma?
Excessive estrogen exposure
53
Histologic appearance of Endometrioid Carcinoma?
Adenocarcinoma (glandular)
54
When does Serous Endometrial Carcinoma typically occur?
Post-Menopausal
55
Etiology of Serous Endometrial Carcinoma?
Endometrial atrophy
56
Clinical presentation of Serous Endometrial Carcinoma?
Post-menopausal vaginal bleeding
57
Most common type of Vaginal Neoplasm?
Squamous Cell
58
Risk factor for Squamous Cell Vaginal neoplasm?
HPV infection
59
In addition to Squamous Cell vaginal carcinoma, what is another type of vaginal carcinoma?
Clear Cell Adenocarcinoma
60
Risk factor for Clear Cell Vaginal Adenocarcinoma?
DES exposure in utero
61
Alternate name for Sarcoma Botryoids?
Embryonal rhabdomyosarcoma
62
Clinical presentation of Embryonal rhabdomyosarcoma?
Bunch of grapes protruding from vagina
63
Epidemiology of Embryonal rhabdomyosarcoma?
Females < 5 yo
64
Prognosis for Vulvar leukoplakia?
Precursor for squamous cell carcinoma
65
1st step of diagnosis for Vulvar leukoplakia?
Biopsy lesion
66
Prognosis for vulvar Lichen Sclerosis?
NO increased risk for squamous cell carcinoma
67
Etiology of vulvar Squamous Cell carcinoma?
HPV infection
68
Clinical appearance of Paget’s Disease of vulva?
Vulvar pruritis, Velvet red lesion
69
Paget’s Disease of vulva represents which type of vulvar CA?
Adenocarcinoma
70
Characteristic of vaginal discharge in setting of vulvovaginal candidiasis?
White, “cottage cheese” consistency
71
Appearance of vulvovaginal candidiasis on wet prep?
Hyphae
72
Epidemiology of vulvovaginal candidiasis? (3)
DM, ABX use, Immunosuppression
73
Treatment of choice for vulvovaginal candidiasis?
-Azole … NO need to treat partner
74
Treatment for Bacterial Vaginosis?
Metronidazole
75
Appearance of vaginal discharge in setting of Trichomoniasis?
Yellow-Green
76
Appearance of cervix in Trichomoniasis?
Strawberry cervix
77
Treatment of choice for Trichomoniasis?
Metronidazole … TREAT the partner!
78
AE of Metronidazole?
Disulfiram reaction, Metallic taste
79
Which patient should be treated, even if asymptomatic … Gardnerella, Candida, Trichomonas?
Trichomonas
80
Definition of infertility?
Inability to conceive after 12 months of unprotected sex
81
Three most common causes of female infertility?
Pelvic inflammatory disease, endometriosis, anovulatory cycles
82
First step of management for infertility?
Male evaluation
83
Etiology of anti-sperm antibodies?
Contact between sperm and serum via testicular trauma or vasectomy
84
When should you screen lesbians for HPV?
If there is a history of male sexual contact
85
Lesbians have a lower risk for which type of cancer?
Cervical
86
Lesbians have an increased risk of which two types of cancer?
Breast, ovarian – Nulliparity
87
When should females begin Pap smear screening?
21 years old
88
How often should Pap smear screenings occur after the age of 21?
After three consecutive negative annual exams, repeat Pap smear every three years
89
Which condition does not require repeated Pap smear screenings?
Hysterectomy
90
After which age are Pap smears no longer required if history is negative?
70 years old
91
Next step of work up for Pap smear that shows either high or low grade dysplasia?
Biopsy
92
Next step of work up for Pap smear that shows atypia?
Check for history of HPV
93
Next step of work up for Pap smear that shows atypia with negative HPV history?
Repeat cytology in one year
94
Next step of work out for Pat spears that shows atypia with positive HPV history?
Colposcopy
95
Two additional indications for colposcopy?
Any visible lesions on the cervix, cervical intraepithelial neoplasia (CIN)
96
Definition of cervical dysplasia?
Cervical cells that show increased chromatin condensation, but have not yet penetrated the basal membrane of the epithelium
97
What is the major complication of cervical conization as treatment for cervical dysplasia?
Bleeding
98
Four lifestyle modifications that can lead to regression of cervical dysplasia?
Diet heavy in fruits and vegetables, condom use, smoking cessation
99
Most common type of cervical cancer?
Squamous cell carcinoma
100
Second most common type of cervical cancer?
Adenocarcinoma
101
Which anatomic structure is frequently involved in cervical cancer?
Ureter
102
Clinical manifestation of ureter involvement in the setting of cervical cancer?
Hydronephrosis, renal failure
103
Is BRCA1 or BRCA2 more commonly responsible for ovarian cancer?
BRCA1
104
Two types of cancer associated with Lynch syndrome?
Ovarian, colorectal
105
Which pattern of ovulation is more associated with increased risk for ovarian cancer?
Nulliparity, early menarche
106
Tumor marker associated with ovarian cancer?
CA – 125
107
First step of workup for suspected ovarian mass?
Transvaginal ultrasound
108
Which tumor markers are often elevated in the setting of germ cell ovarian tumors?
AFP, BHCG
109
Which procedure is required for staging, diagnosis, treatment of ovarian cancer?
Laparotomy
110
Definition of stage one ovarian cancer?
Ovarian cancer that is limited to the ovary
111
Treatment of choice for stage one ovarian cancer?
Surgical excision
112
Treatment of choice for stage 2–5 ovarian cancer?
Surgical excision, chemotherapy
113
Which two chemotherapy drugs are indicated for treatment of ovarian cancer?
Cisplatin, paclitaxel
114
___ refers to infection of breast parenchyma
Mastitis
115
Which pathogen is most commonly responsible for mastitis?
Staph aureus
116
Best advice for a breast-feeding mother who develops mastitis?
Continue breast-feeding
117
Best treatment for mastitis?
Dicloxacillin, I&D
118
What is the most common breast disorder in women 25–50 years old?
Fibrocystic change
119
Characteristic of breast masses in fibrocystic change?
Estrogen sensitive, fluctuate with menstrual cycle
120
Epidemiology of Fibroadenoma?
Females less than 35 years old
121
Most common benign breast mass?
Fibroadenoma
122
Prognosis of Fibroadenoma?
Always benign
123
Clinical manifestation of Paget’s disease of the breast?
Breast pruritis
124
Paget’s disease of the breast is associated with which type of breast cancer?
Intraductal carcinoma
125
Which medical treatment is associated with an increased risk of breast cancer?
Radiation treatment for Hodgkin lymphoma
126
Prognosis for fibrocystic change in price?
Benign
127
What is the most significant risk factor for development of breast cancer?
Age
128
Laterality of BRCA-related breast CA?
Bilateral
129
BRCA1 is associated with increased risk of ___ CA
Ovarian
130
2 other types of CA that are increased in patients with BRCA1 mutation?
Colon, Prostate
131
BRCA2 is associated with increased risk of ___ CA
Ovarian, Breast
132
Location of BRCA2 gene?
13q
133
What type of breast CA is associated with BRCA1/BRCA2 mutation?
Inherited breast CA
134
Do NOT discontinue mammography screening for …
Old age
135
Patient presents with small breast lump, normal mammography 1 month ago – next step of workup?
Excisional biopsy … NOT needle biopsy
136
Next step of workup for patient with nipple discharge?
Cytology exam
137
42 yo female has HX of breast CA; Presents with small metastatic lesion in R femur only; Is mastectomy recommended?
No … mastectomy is NOT recommended for metastatic breast CA
138
2 conditions in which axillary LN biopsy is NOT recommended?
Metastatic disease; Carcinoma in situ
139
3 prognostic factors in breast CA?
Tumor, Lymph node involvement, Hormone receptors
140
Management of non-invasive DCIS?
Local incision + Radiation … OR … Simple mastectomy
141
Which medication will decrease local recurrence of DCIS after lumpectomy?
Tamoxifen
142
Management of non-invasive LCIS?
Bilateral mastectomy
143
Do DCIS or LCIS require lymph node evaluation?
NO
144
Best treatment for invasive breast CA < 1 cm?
Lumpectomy + Radiation
145
Best treatment for invasive breast CA > 1 cm?
Modified radical mastectomy + Adjuvant chemotherapy
146
Added treatment for invasive breast CA that is Hormone Receptor (+)?
Tamoxifen for 5 years
147
Best treatment for ALL invasive breast CA that is LN (+)?
Modified radical mastectomy + Adjuvant chemotherapy
148
Best treatment for invasive breast CA that is LN (+) and HR (+)?
Add tamoxifen for 5 years
149
Best treatment for invasive breast CA that is LN (+) and HR (-)?
No hormonal therapy
150
2 potential treatments for estrogen/progesterone (+) tumors?
Tamoxifen, Aromatase inhibitors
151
Which females should receive aromatase inhibitors in HR (+) breast CA?
Post-menopausal females
152
Best treatment for HR (+) breast CA with visceral or bone metastasis?
Hormone therapy ONLY
153
Best treatment for breast CA patients with painless lytic bone metastasis?
Bisphosphonates
154
Best treatment for breast CA patients with painful lytic bone metastasis?
Radiation
155
Suffix of Bisphosphonates used in treatment of breast CA with lytic bone lesions?
“-dronate“
156
2 AEs associated with Tamoxifen?
Increased risk of endometrial CA; Uterine sarcoma
157
1 added benefit of Tamoxifen?
Prevents bone loss
158
Best workup for patient with breast CA treated with tamoxifen who experiences abnormal bleeding?
Endometrial biopsy
159
Premenopausal female is treated with chemotherapy for HR (+) metastatic breast CA; Develops DVT – which chemotherapy drug was probably used?
Tamoxifen
160
Shared AE of Tamoxifen and Raloxifene?
Increased risk of DVT
161
Indication for Raloxifene?
Patients who have increased risk of breast CA … but not active breast CA
162
Indication for Trastuzumab in breast CA?
HER2 (+) breast CA
163
AE of Trastuzumab?
Cardiac toxicity
