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Genitourinary & Reproductive System > Gynecology: Female Genitalia & Reproductive Tract > Flashcards

Gynecology: Female Genitalia & Reproductive Tract Flashcards

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1
Q

Cervical cancer is strongly associated with what virus?

A

HPV: High risk strands 16.18; Low risk strands 6,11

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2
Q

What are some of the predisposing factors for cervical cancer?

A

HPV infection
Sext at a young age
Multiple Sex partners
Hx of STIs
Promiscuous male partners
Smoking

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3
Q

What methods are used to evaluate for cervical cancer?

A

Pap Smear
Colposcopy directed Biopsy

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4
Q

Upon a routine GYN exam on a post-menopausal woman you distinctly feel one of the ovaries. It feels hard, irregular and fixed. What do you presume this is?

A

Ovarian Cancer

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5
Q

What cancer marker is often positive in ovarian cancer?

A

CA-125 (elevated in ovarian cancer), Others to consider: AFP, LDH

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6
Q

What are some of the predisposing factors associated with ovarian cancer?

A

Excess Estrogen
-Nulliparity
-Early menarche/late menopause
Genetic Factors
-Mutations of BRCA 1 & 2 suppressor genes
-Turners Syndrome
-Family Hx of Cancer
Race: Caucasian
Postmenopausal estrogen therapy
Obesity (increased estrogen)
Talc or asbestos exposure

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7
Q

A female patient presents to the clinic with lower abdominal/pelvic pain. Upon questioning she describes it as a feeling of heaviness or dragging in the lower abdomen. She has had increased urinary frequency but a low urine output. Upon examination you feel palpable masses on the uterine wall. What is your primary suspicion?

A

Leiomyoma/Uterine Fibroids

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8
Q

What is the technical term for uterine fibroids?

A

Leiomyoma

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9
Q

How are uterine fibroids diagnosed?

A

Physical Exam: Bimanual Examination for uterine fibroids
Transabdominal/Pelvic or Transvaginal Ultrasound (confirm diagnosis- golden standard)

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10
Q

What is a homeopathic remedy to consider for fibroids in a woman who has profuse, bright red hemorrhages?

A

Phosphorous

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11
Q

The use of unopposed estrogen is associated with what type of female reproductive cancer?

A

Endometrial Carcinoma (Prolonged estrogen stimulations, unopposed by progesterone)

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12
Q

What populations is most affected by endometrial cancer?

A

Women 55-65 years old, postmenopausal women

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13
Q

What cells are affected in vulvar cancer?

A

90% Squamous Cell Carcinoma, others are melanomas, BCC, Paget’s disease, Bartholin’s gland carcinoma

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13
Q

What is the standard method of evaluating endometrial cancer

A

Endometrial biopsy

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14
Q

A patient presents with a palpable non-painful mass in the labia majora,; the mass occasionally bleeds and is itchy. There is some mild lymphadenopathy. What do you need to rule out?

A

Vulvar Cancer
Palpation of Bartholin’s gland: R/o an adenocarcinoma from the gland

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15
Q

What vulvar cancer in situ known as?

A

Bowen’s Disease : a very early form of squamous cell carcinoma

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16
Q

What are some of the predisposing factors associated with vulvar cancer?

A

Unclear, possibly related to HPV, HIV, vulvar intraepithelial neoplasia, lichen sclerosis, hx of cervical dysplasia or cigarette smoking

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17
Q

What are common causes of PID (Pelvic Inflammatory Disease)?

A

C. Trachomatis (Chlamydia)
N. Gonorrheae
Group B Strep
Gardnerella Vaginalis

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18
Q

What are the associated risk factors for PID?

A

Below the age of 30
Chlamydia & Gonorrhea Infection
IUD
Invasive procedures
Multiple sex partners
Low socioeconomic status

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19
Q

What are some of the sequelae of PID?

A

Infertility
Ectopic Pregnancy
Abscess
Chronic Pelvic Pain
Peritonitis
Bacteremia
Septic Arthritis
Infective endocarditis

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20
Q

What are the common signs and symptoms of toxic shock syndrome?

A

Sudden Fever
Malaise/Fatigue
Myalgias
Refractory hypotension: Circulatory collapse
Diffuse, red macular rash including palms and soles (Flaking)
Weakness (asthenia)
Neutrophilia

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21
Q

What is a common cause of endometrial hyperplasia?

A

High levels of estrogen: Unopposed Estrogen or estrogen dominance
Low levels of progesterone
PCOS
Estrogen Replacement Therapy
Irregular menstruation
Obesity

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22
Q

What are the common signs and symptoms of endometriosis?

A

Secondary dysmenorrhea
Menorrhagia
Cyclic Symptoms
Premenstrual and post-menstrual spotting
Dsypareunia
Infertility
Chronic pelvic pain

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23
Q

What is the only definitive way to diagnose endometriosis?

A

Laparoscopy

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24
What is the most common causes of endometritis?
Post-partum and pelvic inflammatory disease -Prolonged labor -Caesarian Section -Multiple Vaginal Examinations
25
What are the common signs and symptoms of endometritis?
Abdominal pain Abnormal vaginal discharge that is foul-smelling (lochia) Abnormal vaginal bleeding Fevers Chills Uterine Tenderness
26
What is the typical presentation of a Bartholin cysts?
Unilateral (usually) or bilateral distention of labia majora Non-tender on palpation (unless infected) Pain when walking or sitting Dyspareunia
27
What is the term for pain during intercourse?
Dyspareunia
28
A women comes to the clinic with pain on urination, mild pelvic pain, incontinence and pain on intercourse. She is multiparous. On GYN exam you ask her to strain as if passing stool and you notice a bulging through the vaginal wall anteriorly. What is going on?
Cystocele: Prolapsed bladders, drops in vaginal canal
29
What is a bulging from the posterior vaginal wall called?
Rectocele
30
What is colpocele?
Prolapse of uterus in vagina
31
What are the 4 main classifications of vaginitis?
Bacterial Vaginosis Candidal Vaginitis Atropic Vaginitis Trichomoniasis Vaginitis Inflammatory Foreign Body
32
A fishy vaginal odor is associated with what types of vaginitis?
Bacterial Vaginosis (Gardnerella Vaginalis) Trichomoniasis
33
Pruritus, burning, redness, excoriations and friable tissue are associated with what vaginitis?
Candidal vaginitis: vaginal burning, itching, redness, edema
34
What would you see on a wet mount/KOH prep with vulvovaginal candidiasis?
Hyphae, spores Pseudohyphae, Yeast Buds, WBCs, Lactobacilli
35
What herbs are indicated for vulvovaginal candidiasis?
Allium Sativa Boric Acid ( not an herb but effective)
36
What drugs are used to treat vaginal candidiasis?
Antifungal Creams: Miconazole, Clotrimazole, Fluconazole
37
A microscopic report comes back for the lab with these findings: Low lactobacilli, low WBCs, low RBCs, no pathogens seen. These findings are associated with what type of vaginitis?
Atropic Vaginits
38
Creamy, thin, or watery discharge with white plaques adhering to the vaginal wall is associated with what type of vaginitis?
Candidiasis
39
Erythema, friable cervix, abdominal pain, and swollen lymph nodes are associated with what type of vaginitis?
Trichomoniasis
40
1. Low 2. Low 3. Low 4. Elevated bacteria, clue cells 5. <4.5 (very acidic) 6. Elevated 7. 5-7 8. Elevated 9. Motile Trichomonads
41
What is the term for pain during ovulation?
Mittelschmerz Lower abdominal or pelvic pain that occurs at midway point a women's menstrual cycle
42
What are the common signs and symptoms of ovarian cysts?
Pelvic pain -Radiates to lower back and thighs -Before menstruation or afterwards Dyspareunia Irregular menstruation "Fullness" in abdomen Ruptured cyst results in sudden, unilateral sharp pelvic pain
43
How are ovarian cysts diagnosed?
Ultrasound
44
What are some common risk factors for PCOS?
Obesity Insulin Resistance Family Hx of diabetes Genetic
45
What are the common signs and symptoms of polycystic ovarian syndrome?
Menstrual Irregularities: Oligomenorrhea Abnormal uterine bleeding Obesity (50%) Androgenization: Hirsutism, acne, male pattern baldness Polycystic Ovaries Insulin Resistance Endometrial Hyperplasia
46
What are the three diagnostic criteria for PCOS?
Need 2 of 3 to make diagnosis Oligomenorrhea/irregular menses for 6 months Clinical or lab evidence of hyperandrogenism -Blood Test: LH:FSH Ratio >2; LH chronically high Polycystic ovaries on Ultrasound
47
What is one of the best treatments for PCOS?
Diet Modification: Increase fiber, unsaturated fatty acids, proteins, and decrease refined sugar and saturated fats Exercise: Weight Loss Avoid Cigarette Smoking Low dose OCPs medroxyprogesterone to suppress ovarian steroidogenesis LH-release Hormone Analogues Spironolactone: Diuretic helps lower androgens Metformin: help improve insulin sensitivity
48
In the conventional model, what is a common treatment for PCOS?
Oral contraceptives
49
The results of a patient's PAP Smear come back as HSIL. Describe what this means.
This means that it is likely there is a high grade lesion which has an increased chance of progressing to cervical cancer
50
What is the next step of a patient has an abnormal pap (+) high risk HPV?
Colposcopy of the cervix w/ biopsy
51
What is the description for a normal PAP smear?
Negative intraepithelial lesion or malignancy
52
What is CIN I?
Cervical Intraepithelial Neoplasm I (CIN I): Mild cervical dysplasia involving the lower third of the epithelium
53
What is CIN II?
Moderate dysplasia involving the lower two thirds of the epithelium
54
What is CIN III?
Severe dysplasia/carcinoma in situ (CIS) involving full thickness of the epithelium
55
What diagnostic technique is used when a patient has an abnormal pap?
Colposcopy (microscope) & Biopsy of the cervix
56
Do nabothian cysts progress to cancer?
No, they are benign cervical lesions.
57
What are the common signs and symptoms of lichen sclerosus?
Pruritis White, parchment-like paper appearance to skin Tearing and bleeding of skin Genital soreness Dysuria; Dyspareunia Atrophy of clitoral blood
58
Lichen sclerosus is a risk factor for what gynecological malignancy?
Vulvar cancer
59
A patient presents with a beefy red rash on the vulva with satellite lesions. What do you suspect, what type of evaluation would you do and what would you expect to see?
Suspect vulvar candidiasis Perform KOH prep of skin scrapings Expect to see hyphae or yeast buds
60
What should you consider in a patient present with amenorrhea?
Pregnancy Menopause Early stage of lactation Endocrine Dysfunction (Cushing Syndrome) Strenuous exercise, weight loss OCP usage Hypothalamic Dysfunction Pituitary Dysfunction
61
What herbs may be indicated for amenorrhea?
Alteris Farinosa Angelicia Sinensis Caulophylum Thalictroides Chamalirium luteum Vitex agnus-castus
62
What are the serum FSH levels typically associated with menopausal symptoms?
Increased levels of FSH (>30/35 IU/L) on day 3 of cycle and LH; (FSH > LH)
63
What are the serum estrogen and progesterone levels typically associated with menopausal symptoms?
Low estrogen (deficiency) and progesterone
64
What herbs are indicated for menopause?
Cimicifuga racemosa Angelicia sinensis Trifolium Prantense
65
What other class of herbs may be useful in treating menopause symptoms?
Adaptogens
66
What nutrients are used to treat menopause?
Soy Isoflavones, flax seeds
67
What homeopathic remedy would you consider for menopausal hot flashes when the woman has flushes of heat that prevent from falling asleep?
Sulphur
68
What is excessive menstrual flow called?
Menorrhagia
69
What herbs are indicated for menorrhagia?
Caulophylum thalictroides Capsella bursa-pastoris Chamaelirium luteum Cinnamon zeylancium Geranium maculatum Glycyrrhiza glabra Mitchella repens
70
What nutrients could be used to treat menorrhagia?
Iron, Vitamin A, Vitamin C
71
What are some of the risk factors associated with menorrhagia?
Obesity Estrogen dominance PCOS Prolonges progestin Coagulation Disorders Iron Deficiency
72
What type of contraception can be associated with menorrhagia?
*IUD, will typically resolve in 3 days OCPs, Progestin therapy
73
Menstrual bleeding that occurs at an inappropriate time in the menstrual cycle is known as what?
Metrorrhagia, abnormal uterine bleeding that happens between periods
74
What is the term for greater than 35 days between menstrual cycles?
Oligomenorrhea, light or infrequent menstruation (cycle is >35 days) in women of childbearing age
75
What herbs are indicated for PMS?
Angelica sinensis Borago officinalis Cimicifuga racemosa Dioscorea villosa Leonorus Cardiaca Oenotheria biennis Ricinis communis (Caster oil topically) Viburnum opulus Viburnum prunifolium Vitex agnus-castus
76
What nutrients are used to treat PMS?
Essential Fatty Acids Vitamin E B6 Magnesium Calcium Avoid sodium, simple sugars, caffeine, and alcohol
77
What might be the history in a person who is having diffculty conceiving?
Age STI Cervical/Uterine Abnormalities Medications/Drugs Hormonal Imbalance Immunologic Incompatibility Metabolic Disorders Nutrition and Lifestyle Ovulation Failure Tubal Obstruction
78
What is the definition of infertility?
Inability to conceive after one year of trying (in women less than 35 years old)
79
What are some of the ovulatory disorders that could cause infertility?
PCOS *Primary ovarian insufficiency Premature menopause *Hypothalamic amenorrhea Ovarian Cancer Luteal insufficiency *Corpus luteum Defect
80
What are some of the tubal disorders that could cause infertility?
PID Ectopic Pregnancy Endometriosis Tubal occlusion/dysfunction Abdominal/Pelvic Surgery
81
What are some of the cervical disorders that could cause infertility?
Cervical stenosis Excessive Cervical Mucus Uterine Fibroids
82
What are some of the other disorders that could contribute to infertility?
Obesity or being underweight Abnormal vaginal flora Alcohol or increased caffeine intake Heavy metal toxicity Uterine Malformations Intrauterine Adhesions Endometriosis
83
What are some of the causes of male infertility?
84
What are some of the findings of male infertility?
85
How is male infertility diagnosed?
86
What are some of the structural abnormalities that could lead to male infertility?
87
A deficiency of what mineral might be contributing to male infertility?
Zinc
88
What herbs may be indicated for infertility in general?
Vitex agnus-castus Angelica sinensis Caulophylum thalictroides Chamaelirium luteum Cimicifuga racemosa Leonurus cardiaca Medicago sativa Mitchella repens Smilax officinalis Verbena officinalis Lepidium meyenii
89
What amino acids are indicated for infertility?
Arginine L-carnitine

Genitourinary & Reproductive System (3 decks)

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