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GYNO NAGY FAVE Flashcards

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1
Q

➔ Etiology of cervical cancer:

A

◆ HPV 16, 18

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2
Q

➔ Hydatidiform mole, which lab?

A

◆ b-Hcg (highly increased in molar pregnancy)

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3
Q

➔ How do you treat vulvar benign lesions?

A

◆ Surgical excision

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4
Q

➔ In uterine prolapse, what type of surgery?

A

◆ Vaginal hysterectomy

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5
Q

➔ Pediatric gynecology, most common complaints?

A

◆ Infection, amenorrhea, precocious or delayed puberty

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6
Q

➔ Most common causes of infertility?

A

◆ Male: sperm disorders, erectile dysfunction
◆ Female: anatomical (PID, Asherman syndrome, endometriosis), ovulatory
dysfunction, abnormal cervical mucus

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7
Q

➔ Inflammatory disorders of vulva and vagina - most common vaginal infections?

A

◆ Bacterial vaginosis (Gardnerella, mycoplasma), trichomonas, candida

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8
Q

➔ Staging of ovarian cancer?

A

◆ Only high-risk group: US and CA-125
◆ Staging:
● I: confined to ovaries or FTs
● II: ovaries + pelvis or peritoneal involvement
● III: ovaries + spread to peritoneum outside the pelvis and/or mets to
retroperitoneal LNs
● IV: distant mets - liver, lung, pleural fluid

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9
Q

➔ Urinary incontinence types?

A

◆ stress, urge, overflow, neurogenic

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10
Q

➔ Gynecology operation techniques - conization?

A

◆ Cone-shaped portion of the cervix removed. Using scalpel, laser or
electrosurgical techniques. Can be diagnostic (HSIL) or therapeutic (CIN2+3

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11
Q

➔ Primary Amenorrhea- when do we begin evaluation?

A

◆ I said the ages in the notes (age 16 or 2 years after onset of puberty OR age 14 if
no puberty)
◆ but he did say nowadays people wait till 18. Mention both. He accepted my
answer as correct

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12
Q

➔ At which stage of cervical cancer can you see with the naked eye

A

IB

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13
Q

PUBERTY

A

◆ Tanner stages I-V.
◆ I didn’t say them exactly, just described how its based on breast development,
pubic hair growth, there was no need to be precise

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14
Q

➔ Types of Uterine Fibroids

A

◆ intramural, subserosal, submucosal, and don’t forget broad ligamental
fibroids!!

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15
Q

➔ Breast cancer- what is a radical mastectomy

A

◆ entire breast removed + axillary lymph node dissection

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16
Q

➔ Syphilis, how to treat:

A

◆ penicillin G 2,4 mill units

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17
Q

➔ Benign lesions of vulva - Mention some

A

◆ Lichen sclerosus (post-menopausal), Lichen Simplex Chronicus. He just moved
on before I could mention more.

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18
Q

➔ Screening of endometrial cancer - Who would you screen and how?

A

◆ High risk women with long term estrogen exposure (PCOS, HRT, family history).
◆ Do an transvaginal US and examine the endometrial wall thickness (should not
be more than 8 mm in total)

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19
Q

➔ How would you screen for ovarian cancer?

A

◆ High risk women - Measure of serum CA-125 + US examination of ovaries.

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20
Q

➔ What is enterocele?

A

◆ Part of the small intestine protrudes into vagina, due to wall weakness.

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21
Q

➔ Ectopic pregnancy - He gave a case: If you have a woman with absence of menses for 7
weeks and you examine the uterus and there is no intrauterine pregnancy. How would
you diagnose?

A

◆ Measure beta-hCG, if elevated, but not doubling every 2nd day - indicate ectopic
pregnancy. Next step will be to do a laparoscopy

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22
Q

➔ In the end he asked an extra question (he didn’t expect an answer to it, but wanted to
ask it to test me): Genital development (not a topic for this year) - What is the equivalent
of the prostate in a female?

A

◆ Prostate consists of glands and smooth m. It is equivalent to the upper ⅓ of
vagina.

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23
Q

➔ Common STDs?

A

◆ Chlamydia, gonorrhea, syphilis, genital herpes (HSV-2), genital warts (HPV)

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24
Q

➔ How often do you screen for infections?

A

IDFK=i dont fuckinknow

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25
➔ What changes are seen in Puberty?
◆ accelerated growth (growth spurt) ◆ development of secondary sexual characteristics, axillary hair growth ◆ + I mentioned Tanner stages and briefly described them: pubic hair growth, breast development
26
➔ Types of Endometrial Hyperplasia?
◆ Simple typical - increase in glands but normal glandular architecture ◆ Complex typical - crowded irregular glands ◆ Simple atypical - simple hyperplasia with presence of atypical cells ◆ Complex atypical - complex hyperplasia with presence of atypical cells. Highest malignant potential (30%)
27
➔ What are the stages + At what stage is Cervical cancer observable?
◆ I: confined to cervix ● IA: microscopically visible (Tx: TAH) ● IB: macroscopically visible (Tx: TAH + pelvic LND) ◆ II: invades beyond uterus, to upper vagina (Tx: TAH + pelvic LND) and perimetrium, but not beyond pelvic wall ◆ III: invades pelvic wall or lower ⅓ of vagina ◆ IV: invades bladder/rectum or distant mets (Tx: palliative chemo, RT, surgery)
28
➔ 40 yo woman with dysmenorrhea. Test?
◆ D&C
29
➔ Dysfunctional uterine bleeding in a 42 year old woman, what to do
◆ D&C
30
➔ Normal causes of secondary amenorrhea
◆ pregnancy, menopause, lactation
31
➔ How to differentiate malignant from benign ovarian cysts
◆ MRI, US, CA-125, biopsy
32
➔ Functional ovarian cyst: what does it look like
◆ unilateral, uniloculated, simple cell inside, no papillary protrusion into cyst ◆ Types: follicular, corpus luteum cyst, theca-lutein cyst
33
➔ Ectopic preg: treatment
◆ Laparoscopy - Salpingostomy, salpingectomy
34
➔ Causes of secondary amenorrhea
◆ Pregnancy, menopause, lactation, hyperthyroidism, drugs | antidopaminergic), pituitary tumors (prolactinoma
35
➔ Secondary amenorrhea - what is the progestin test?
◆ Give progestin and then withdraw it. If there is withdrawal bleeding then the diagnosis is PCOS/anovulation. If there is no bleeding, further diagnostic tests should be done
36
➔ Choriocarcinoma follow up
◆ b-hCG
37
➔ Symptoms of genital herpes
◆ Vesicles on genitals, with pain, pruritus, discharge, dysuria. Sometimes systemic symptoms - fever, malaise, lymphadenopathy
38
➔ What infections cause painless lymphadenopathy with genital lesions and what causes painful lymphadenopathy
◆ Painless: syphilis (painless ulcer and painless lymphadenopathy) ◆ Painful: lymphogranuloma venerum
39
➔ Symptoms of perimenopause
◆ Hot flashes, night sweats, mood swings, vaginal dryness, loss of libido
40
➔ Treatment of cervical cancer
◆ Depends on stage ● Transabdominal hysterectomy ● Radical hysterectomy (uterus, cervix + parametrium and LNs) ● chemoirradiation, palliative chemo, RT, surgery
41
➔ Which lab do you measure in postmenopausal for dx.
◆ FSH (consistently elevated)
42
➔ Stage III of cervical cancer
◆ Lower third of vagina involved (IIIA) or whole parametrium infiltrated (IIIB) ◆ Tx: chemoirradiation
43
➔ What lab marker would you use to dx PCOS?
◆ I mentioned hyperandrogenism, so high androgens. He said yes, but he wanted to hear that LH/FSH ratio is 3:1
44
➔ Treatment of Infertility: What would you do? What is IVF and how is it performed? At what time is best?
◆ Ovarian follicular stimulation - retrieve egg via US guidance - mix sperm and egg - incubation - transfer 2-5 embryos into uterus in cleavage or blastocyte stage ◆ Best to do on day 20-24 of menstrual cycle (according to google)
45
➔ Types of breast cancer surgery:
◆ Lumpectomy, quadrantectomy, mastectomy, radical mastectomy + I described shortly what each are
46
➔ Basics of cancer therapy
◆ I just said surgery, RT and chemo and that in most cases today you do a combination of the above mentioned and he moved on
47
➔ This is the question I couldn't answer and he didn't say what was correct: he said the topic was about D&C and conization- there is a pregnant women who they need to do a conization procedure on, what would be different in this procedure compared to doing it on a nonpregnant women, what should they focus on? (PS: I took a long time to think about it so I couldn't even say my answer before he said that was too much time so he wouldn't accept my answer, just so people know to not take too long to think- he wants an answer pretty quickly :))
◆ Risk of bleeding and premature birth in the pregnant woman?
48
➔ Treatment of choriocarcinoma? Prognosis? 5 year survival rate?
◆ Methotrexate, good prognosis, 95%
49
➔ How do you diagnose cervical cancer
◆ Pap smear
50
➔ If you see a single unicellular cyst on one ovary US what is it and how would you treat it?
◆ probably a Follicular Cyst and watchful waiting is usually enough, but can be removed surgically if there’s risk for torsion or rupture. (he didn’t seem super stoked about my answer but accepted it lol not sure what else he wanted me to say)
51
➔ They give you the symptoms of PCOS and you have to name the disease
◆ Hirsutism, acne, obesity, amenorrhea, insulin resistance
52
➔ Pearl index definition and the index for condom
◆ Def: Number of unintended pregnancies in 100 women over 1 year of contraception use. Tells us the efficacy of various contraceptive methods. ◆ For condoms: 3-26 (much lower for hormonal contraception)
53
➔ 18 year old pt with primary amenorrhea, 46XY, breast developed, but no pubic hair - what is the diagnosis?
◆ Genetically male - so Androgen insensitivity syndrome?
54
➔ Cause of dysmenorrhea
◆ Endometriosis, idiopathi
55
➔ Symptom of corporal cancer
◆ Vaginal bleeding
56
➔ Vulvar cancer treatment:
◆ local excision (in VIN), radical vulvectomy (+ inguinofemoral lymphadenectomy)
57
➔ Name endometrial benign lesions that are not fibroids
◆ adenomyosis (and he moved on haha) | ◆ Endometrial polyps?
58
➔ Histology of types of breast cancer:
◆ I shortly explained about ductal and lobular carcinoma
59
➔ Diagnosis of hydatidiform mole:
◆ b-HCG (very high), snowstorm or honeycomb pattern on US. confirm with biopsy
60
➔ Possible locations of ectopic pregnancy
◆ Fallopian tubes (ampulla), uterine horns, cervix, scar from prior C-section, abdomen
61
➔ Cause of Pelvic pain?
◆ Dysmenorrhea, endometriosis, PID, ruptured ectopic pregnancy, adnexal torsion
62
➔ Ovarian cancer, how to screen. Etiology
◆ US, CA125, also HE4 Human epididimys protein 4 (best for premenopausal women). Compare to CA125. ◆ RMA: Risk of malignancy index. If over 200 → suspicious for malignancy ● US features ● menopausal status ● levels of CA125
63
Radical vulvectomy, what is it
◆ Surgical removal of vulva + inguinofemoral LNs
64
➔ Virulism and hisutism difference
``` ◆ Hirsutism is a clinical presentation of virilization = the appearance of male secondary sex characteristics in a female. ◆ Other symptoms of virilization can be: ● Clitoromegaly ● Deep voice ● Male pattern hair loss ● Acne ● Increased muscle mass ```
65
➔ How to check for fallopian stricture:
◆ Hysterosalpingography
66
➔ Endometrial cancer screening:
: Not feasible to test everyone, only ones with high | risk. Measure endometrial thickness (tot 8 mm)
67
➔ Hydatiform mole:
◆ see snowstorm pattern on US, no fetus
68
➔ Mayer Rokitansky Kuster Hauser syndrome - what is it?
◆ Mullerian agenesis
69
➔ Stein Leventhal Syndrome, what is it & Diagnostic criteria.
◆ PCOS. Dx criteria (Anovulation, hyperandrogenism, >10 follicles) ◆ Which lab values? Incr LH:FSH ratio (3:1)
70
➔ Classification of human sexuality
◆ Heterosexual, homosexual, bisexual, transsexual, etc. ?? I THINK ACTUALLY ITS: phenotype, karyotpye, genitals, how the patient feels
71
➔ Perimenopause diagnosis.
◆ Exclude pregnancy, FSH consistently increased. No follicles in ovaries on US. Vulvovaginal atrophy on physical exam.
72
➔ Benign lesions of vagina and vulva: What is vulvodynia (he had this lecture)
◆ “Vulvar discomfort, most often described as burning pain, occurring in the absence of relevant visible findings or a specific, identifiable neurologic disorder”
73
➔ Stage 1 of corporal cancer, how to diagnose?
◆ Myometrium 50%, diagnose with US and D&C
74
➔ Obstetric & gynecological evaluation - What kind of examination do you perform on a female without any complaint?
◆ Vaginal inspection, speculum examination and Bimanual pelvic examination, breast exam. Pap smear
75
➔ Types of benign ovarian tumors
◆ Epithelial - serous cystadenoma, mucinous cystadenoma, endometrioid ◆ Gonadal stromal tumors - Granulosa theca cell tumors, Sertoli-Leydig cell tumors ◆ Germ cell tumors - dysgermimoma, teratoma
76
➔ Treatment of PID, how long and why
◆ Empirical antibiotic therapy ● Outpatient: one single IM dose ceftriaxone + po doxycycline. Add po metronidazole if signs of vaginitis ● Inpatient: IV cephalosporin (cefoxitin, cefotaxime) + doxycycline. If tuboovarian abscess, add metronidazole. ◆ Need to treat due to risk of complications: Fitz-Hugh-Curtis sy, tuboovarian abscess, infertility, ectopic pregnancy, chronic pelvic pain
77
➔ How to confirm intersexuality (disorder of sex development) - 4 steps ??? Guessing the answers here:
◆ Karyotyping - check chromosomes ◆ Secondary sex characteristics ◆ Check internal gonads ◆ Mental/psychological is the last stage
78
➔ Female sex development
◆ External genitalia develop from genital and urogenital folds (from urogenital membrane) ◆ Muellerian (paramesonephric) duct gives rise to upper vagina, cervix, uterus and FTs. Absence of Y chromosome leads to total regression of Wolffian (mesonephric) duct ◆ Ovaries develop from germinal epithelium
79
➔ Endocrinology of female reprod system during, before and after reproductive stage of life: - What is the changes that occur during puberty?
◆ Pulsatile (!) GnRH release, increased in freq and amplitude from the hypothalamus, stimulting the ant pituitary to release LH and FSH.
80
➔ Barrier and chemical contraceptive - what different barriers do we have?
◆ female and male condoms, pessaries, cervical cups and sponges. diaphragm
81
➔ Symptoms, signs and screening of corporal cancer: - What is the screening method for corporal cancer
◆ I said that there is really no screening method for corporal/uterine/endometrial cancer, but TV-US is an alternative and measure the endothelial lining. I said that if it’s > 4 mm its suspective. He then corrected me, because thats the measurment for one, meaning that the cut off is 8 mm!
82
➔ Normal and abnormal position of the vagina - What is the treatment for complete uterine prolaps?
◆ Vaginal hysterectomy
83
➔ Benefits and risk of hormone contraceptives ( he wanted the list from the Nagy favorites file)
``` ◆ Benefits: ● decreased incidence of ovarian and endometrial cancer ● Decreased bone loss ● Treats dysmenorrhea ● Treats acne ● Decreases risk of trisomies with increasing maternal age ◆ Risks ● Thrombosis, DVT/stroke ● Increased BP ● Weight gain ● Depression ```
84
➔ How can you differentiate btw Bartolins cyst vs abscess?
◆ Abscess will be painful
85
➔ What are some genital malformations
◆ I said Mullerian agenesis - then he also wanted the Mayer-Rokitansky-Kuster-Hauser name. ◆ Other: bicornuate uterus, septate uterus and he was happy. Transverse vaginal septum, vaginal atresia, imperforate hymen
86
➔ What is Stein-Leventhal syndrome? What is the metabolic disorder associated with it?
◆ PCOS. Insulin resistance/DM
87
➔ A postmenopausal woman have thickened endometrium on US - What do you do next?
◆ D&C --> histo
88
➔ Causes of primary amenorrhea
◆ Anorexia, weight loss, pregnancy, imperforate hymen ◆ Mullerian agenesis, androgen insensitivity syndrome ◆ Primary hypogonadism (hypergonadotropic hypogonadism): Turner sy. ◆ Secondary hypogonadism (hypogonadotropic hypogonadism): Kallman sy (impaired GnRH release + anosmia); pituitary tumor (craniopharyngioma)
89
➔ External female genitalia parts
◆ Vulva: labia minora and majora, clitoris, vulvovaginal (Bartholin) glands, perineum, fourchette
90
➔ Bacterial vaginosis
◆ Symptoms: vaginal discharge, foul smell, dyspareunia ◆ What causes it? Gardnerella or other anaerobic bacteria ◆ Is it an STD: No ◆ Diagnosis: KOH prep, see clue cells ◆ Treatment: Metronidazole
91
➔ Uterine fibroids
◆ What are the types ◆ How can you remove them? Laparoscopy, hysteroscopy in case of submucosal fibroids ◆ Complications: problems with conception, infertility, can grow to a large size
92
➔ Symptoms of endometriosis
◆ Dysmenorrhea, abdominal pain, problems with defecation, dyspareunia ◆ Dx: US, laparoscopic visualization
93
➔ Ecoptic pregnancy
◆ Symptoms: signs of pregnancy (e.g. breast enlargement), irregular bleeding, abdominal pain and peritoneal signs if ruptured. ◆ Diagnosis: take bhCG, do US. ◆ How does bHCG change during normal pregnancy: doubles every other day. Is it elevated bu does not double in ectopic pregnancy.

OBGYN (2 decks)

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