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Kaplan Flashcards

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1
Q

Adenomyosis Definition

A

ectopic endometrial glands and stroma located within the myometrium

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2
Q

Adenomyosis Diagnosis

A

enlarged symmetric tender uterus in the absence of pregnancy

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3
Q

Symptoms of Adenomyosis

A

Majority asymptomatic
Dysmenorrhea and menorrhagia
Uterus globular
Tenderness before and during menses

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4
Q

Management of Adenomyosis

A

Levonorgestrel

Hysterectomy

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5
Q

Leiomyoma vs Adenomyosis

A

Leimoyoma: asymmetric, firm, nontender
Adenomyosis: symmetric, soft tender

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6
Q

Menopause definition

A

Three continuous months of cessation of bleeding with elevated gonadotropins.

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7
Q

Most common gynecologic malignancy

A

endometrial carcinoma

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8
Q

DD of Postmenopausal bleeding

A

Endometrial carcinoma
Vaginal or endometrial atrophy
Postmenopausal hormone replacement therapy.

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9
Q

Mediating factor of most endometrial carcinomas

A

Unopposed estrogen

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10
Q

Risk Factors for Endometrial carcinoma

A

Obesity, HTN, Diabetes
Increased estrogen exposure
Late menopause
Chronic anovulation conidtions

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11
Q

Diagnosis Endometrial carcinoma

A

Endometrial biopsy
Hysteroscopy
Ultrasound measures the thickness of the endometrium

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12
Q

Staging of Endometrial carcinoma

A

Stage 1: limited to uterus
Stage 2: Extension to the cervix
Stage 3: outside of the uterus
Stage 4 spread further from the uterus

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13
Q

Endometrial atrophy treatment

A

Must give estrogen AND progesterone so no unopposed estrogen

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14
Q

Treatment of adenocarcinoma

A

Surgery: Total abdominal hysterectomy and bilateral salpingooophrectomy. and para-aortic lymphadenectomy with peritoneal washing. Consider radiation or chemo

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15
Q

Treatment of hyperplasia without atypia

A

Progestin. Only do hysterectomy if advancing to atypia or carcinoma

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16
Q

Precocious puberty

A

secondary sexual characteristics

Before age 8 in girls, 9 in boys

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17
Q

Progression of puberty in girls

A

Thelarche 9-10
Adrenarche 10-11
Growth 11-12
Menarche 12-13

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18
Q

Concerns in precocious puberty

A

Short stature from closing of epiphysis

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19
Q

Incomplete precocious

A 
Only one change
Thelarche
Adrenarche
Menarche
Likely from end organ sensitivity
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20
Q

Complete Gonadotropin Dependent Precocious Puberty

A

All changes are seen and the change is from the HPA.
80% idiopathic 6-7yrs
Others are CNS path

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21
Q

Management Complete Gonadotropin Dependent Precocious Puberty

A

CNS imaging to rule out.

Leuprolide (GnRH agonist) to suppress the HPA

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22
Q

CNS pathology causing Complete Gonadotropin Dependent Precocious Puberty

A 
Hydrocephalus
von Recklinghausen disease
Meningitis
Sarcoid
Encephalitis
All cause an increase in GnRH --> increase FSH--> estrogen
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23
Q

Gonadotropin independent

A

Estrogen production independent of gonadotropin secretion

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24
Q

Diseases causing Gonadoptropin independent

A

McCune Albright

Granulosa Cell Tumor

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25
McCune Albright findings
syndrome-autonomous stimulation of aromatase enzyme production of estrogens by the ovaries multiple cycstic bone lesions cafeau lait Rx is aromtase enzyme inhibitos
26
Diagnosis of Premenstural disorder
``` Symptom diary over 3 periods: absent in preovulatory phase 2postovulatory weeks interfere with normal function must resolve with onset menses ```
27
Symtpoms in Premenstrual syndrome
Fluid retention Emotional Musculoskeletal Autonomic
28
Treatment of Premenstrual Symptoms
``` SSRI Yaz (drospirenone) ```
29
virilization
excessive male pattern hair growth in women PLUS other male signs clitorimegaly, baldness, lowering of voice, increasing muscle mass and loss of female body contour
30
Dehydroepiandrosterone sulfate
produced ONLY in the adrenal glands. Markedly elevated DHEAS is consistent with adrenal tumor
31
17OH progesterone
precursor to cortisol.
32
Conditions with elevated 17OH progesterone
congenital adrenal hyperplasia 21-hydroxylase deficiency (converted peripherally into androgens)
33
Where are androgens produced in the female body.
ovaries adrenal glands hair follicle
34
Testosterone production
ovary and adrenal glands.
35
Mild elevated testosterone
PCOS
36
Markedly elevated testosterone
Ovarian tumor
37
Abrupt onset virilization Abdominal/flank mass Increase DHEAS
Adrenal tumor
38
Abrupt onset virilization Adnexal mass Markedly increase testosterone
Ovarian tumor
39
Gradual onset hirsutism Normal exam increase 17-OH progesterone
Congenital Adrenal Hyperplasia
40
Treatment of CAH 21 OH deficiency
corticosteroids (suppresses ACTH)
41
Gradual onset hirsutism Irregular Bleeding Infertility Increase testosterone and LH:FSH ratio 3:1
PCOS
42
Necklace of pearls on ultrasound
PCOS | Also bilateral enlarged ovaries
43
Management of PCOS
OCPs
44
Acanthosis nigricans
PCOS
45
most common cause of androgen excess in women
Idiopathic
46
Gradual onset hirsuitism Normal exam Normal DHEAS, testosterone and 17OH progesterone
Idiopathic
47
PCOS RX OCP mechanism
1) lower testosterone by lowering LH stimulation of ovarian follicle theca cells 2) increase SHBG thus decreasing free testosterone
48
Management of Idiopathic hirsuitism
Spironolactone | Eflornithine
49
Increased 5 alpha reductase
Idiopathic
50
Spironolactone MOA
decreases the activity of 5 alpha hydroxylase
51
Management of PCOS: Irregular bleeding Hirsuitism Infertility
Irregular bleeding-OCP Hirsuitism-OCP, Spironolactone Infertility- Clomiphene or HMG and Metformin
52
Fecundability
Likelihood of conception occurring with one cycle of appropriately timed mud cycle intercourse
53
``` Sperm details: volume pH density motility morphology ```
``` Sperm details: >2ml pH 7.2-7.8 >20 million/ml >50% motility sperm morphology >50% ```
54
intrauterine insemination
When low sperm count inject directly into the uterine cavity.
55
intracytoplasmic sperm injection
Can be used with IVF. For severely abnormal sperm.
56
Objective data in Anovulation
Basal body chart shows no rise in temp Serum progesterone low Endometrial biopsy shows proliferative histology
57
Correctable causes of anovulation
Hypothyroidism and hyperprolactinemia
58
Induction of ovulation
Clomiphene-tricks pituitary 9given for five days on the fifth day of menstrual period) HMG- exogenous gonadatropins
59
Hyper stimulation of ovaries
most common side effect of ovulation induction. Ascities, SOB, hyper coagulation etc.
60
Indication for ovarian reserve testing
Woman over the age of 35 with infertility
61
What is being assessed when doing ovarian reserved testing
1) assesses # of follicles available for recruitment | 2) Assesses health and quality of eggs in ovary
62
Ovarian Reserve Testing
Day 3 FSH-increase in FSH if follicle depletion Anti-Mullerian hormone- produced by small astral ovarian follicles *direct measure of the ovarian pool* Antral follicle count total number of follicles not observed during an early follicular phase on transvaginal sonogram
63
Treatment of unexplained infertility
60% will achieve conception in next three years. Controlled ovarian hyper stimulation with clomiphene and IUI IVF
64
Invasive Anovulation tests
Hysterosalpingogram Chlamydia antibody Laparoscopy
65
Premature menopause
idiopathic post radiation surgical oophrectomy
66
Most common cause of mortality in post menopausal women
Cardiac disease
67
Most common method of assessing calcium loss
urine hydroxyproline | Urine NTX N-telopeptide
68
Most common risk factor for osteoporosis
Positive family history
69
Treatment of osteoperosis
Bisphosphonates | SERMS
70
Indications for Menopausal hormone therapy
``` Vasomotor symptoms Vaginal dryness Premature menopause Benefits: Osteoporosis CHD ```
71
Risks of Menopausal hormone therapy
VTE Stroke Breast cancer
72
Drugs that are SERMS
Tamoxifen | Raloxifene
73
PID
spectrum of upper genital tract conditions ranging from acute bacterial infection to to massive adhesions and old inflammatory scaring. Ascending infection
74
Symtpoms of Cervicitis
friable cervix on exam with mucopurulent discharge.
75
Symptoms Acute Salpingo-oophritis
Bilateral abdominal/pelvic pain Mucopurulent cervical discharge Cervical motion tenderness
76
Minimal criteria for acute salpingo-oophoritis
Sexually active young woman Pelvic or lower abdominal tenderness Cervical motion uterine or adnexal tenderness
77
Outpaitent treatment for acute salpingo-oophoritis
Ceftriaxone IM x1 ( gonorhhea) Doxy BID 14 days +/- metronidazole BID 14d for anerobes
78
Inpatient treatment for acute salpingo-ooporitis
Cefotetam IV 12hr Doxy PO or IV q12hr Clinda + Genta IV q8hr for anerobes and gram neg
79
Symptoms Chronic Salpingo-oophoritis
Bilateral abdominal/pelvic pain No cervical discharge Cervical motion tenderness
80
Management of Chronic Salpingo-oophoritis
Mild analgesia Lysis of tubal adhesions Pelvic clean out
81
Definition primary dysmenorrhea
recurrent, crampy lower abdominal pain Associated with N/V/D occurs with menstruation No associated pelvic pathology
82
Pathogensis primary dysmenorrhea
excess production of prostoglandin F2 alpha causes harsh and dysrhythmic pelvic contractions
83
Treatment of primary dysmenorrhea
suppression of prostoglandins with NSAIDs | Can also use OCP,
84
Common Sites of endometriosis
Ovary- chocolate cyst Cul-de sac uterosacral ligament nodularity
85
Symptoms of endometriosis
Dyspareunia Dyschezia Infertility
86
Investigative findings of endometriosis
WBC and ESR normal CA-125 may elevate Sonogram may show endometrioma
87
Diagnostic test for endometriosis
Laparoscopy
88
Therapy for endometriosis
``` Use progesterone to encourage endometrial atrophy Pregnancy Pseudopregnancy (medroxyprogesterone acetate,OCP, depo) Pseudomenopause (Danazol/Danocrine) (Leuprolide) ```
89
Layers of endometrium
Functionalis zone- sloughs off with withdrawl of progesterone causing spiral artery spasm Basalis zone
90
Menstrual phase
First four days of menstrual cycle | Withdrawl of progesterone causing spasm of spiral arteries in functionalis zone causes sloughing off.
91
Proliferative phase
Estrogen driven early division of basalis to make functionalis. lengthening of spiral arteries ***UNSTABLE-prolonged anovulation will cause bleeding
92
Secretory phase
Glandular secretion of glycogen and mucous mediated by progesterone from corpus luteum STABLE-only ceases when the corpus luteum involutes
93
Role of Beta HCG in preg
Tells corpus luteum to continue to make progesterone
94
inhibin
Controls the amount of FSH via feedback. Produced by granulosacells.
95
LH surge
Dependent on a rise in estrogen
96
Differential Diagnosis of premenarchial vaginal bleeding
``` Most common-foreign body ingestion of estrogen Cancer of vagina or cervix tumor of pituitary or adrenal ovarian tumor sexual abuse precocious puberty ```
97
Causes of abnormal Vaginal bleeding
Pregnancy Anatmoic Inherited Coagulopathy Dysfunction uterine bleeding
98
Anatomic lesions causing abnormal vaginal bleeding
Vaginal lesions-lacerations, varicosity, tumor Cervical lesions- polyps, cervicits, tumors Endometrial lesions- subcutaneous leiomyoma, polyps, hyperplasia, cancer Myometrial lesions- adenomyosis
99
Inherited coagulopathy leading to abnormal vaginal bleeding
von willibrand most common | can measure with a risotcetin assay
100
Symptoms of Endometrial polyp/ leimyoma
predictable vaginal bleeding with intermenstrual bleeding 33YO Nomral weight an height.
101
Management of coagulopathy
PT PTT CBC PC vWF antigen
102
Findings in Dysfunctional Uterine Bleeding
``` irregular, unpredictable bleeding without cramping No prostoglandin release Cervical mucous clear watery and thin No increase in BBT proliferative endometrium on biopsy ```
103
Correctable causes of abnormal uterine bleeding
Hypothyroidism | Hyperprolactinemia
104
Management of abnormal uterine bleeding
Administer progestin/progesterone Cyclic MPA OCP Progestin Intrauterine system
105
Other therapies for abdnormal uterine bleeding
NSAIDS Tranexamic acid Endometrial ablation Hysterectomy
106
Primary amenorrhea
menstrual bleeding has never occured Age 14 with no menarche and no secondary sexual characteristics Age 16 with no menarche and sexual characteristics
107
Primary amenorrhea with breast and uterus
imperforate hymen anorexia nervosa excessive exercise pregnancy
108
Primary amenorrhea breasts but no uterus pubic and axilary hair present
Mullerian agenesis
109
Primary amenorrhea Breasts but no uterus No pubic hair or axillary hair
Androgen insensitivity
110
Primary amenorrhea no breasts but uterine present Increase FSH
Gondal dysgenesis
111
Androgen insensitivity
46XY individuals who do not respond to androgens in system. Thus external genitalia develops as female. Testes produce testosterone tht is not recognized
112
Management of androgen insensitivity
teste removal at age 20 with estrogen replacement therapy
113
streak gonads elevated FSH No secondary sexual characteristics
Turner Syndrome (Gonadal dysgenesis)
114
Primary amenorrhea no breasts but uterus decreased FSH
HPA dysfunction
115
Kallman syndrome
Failure to produce GnRH | Anosmia
116
Diagnosis of Secondary Amenorrhea
No menstruation for 3months of previous regular menses | No menstruation for 6 months if previous irregular menses
117
Most common cause of secondary amennorhea
Pregnancy
118
Management of secondary amenorrhea
``` beta HCG TSH Prolactin Progesterone challenge test (positive if withdrawl bleeding diagnosis anovulation) Estrogen-Progesterone challenge test ```
119
Savage Syndrome
follicles are seen but do not respond to gonadotropins
120
Asherman Syndrome
extensive uterine curretage and infection induced adhesions create out flow tract obstruction leading to secondary amenorrhea.
121
Active ingredient in spermacide
nonoxynol-9: disrupts cell membranes
122
Absolute CI to OCP use
``` Pregnancy Liver Disease Smoker over age 35 Uncontrolled HTN, headache. History of vascular disease (estrogen) ```
123
Types of Combination Contraception
Oral-Yaz estrogen and progesterone Vaginal ring-estrogen and progesterone Transdermal patch- estrogen and progestin
124
Progestin only
injectable is depo provera medroxyprogesterone acetate Subcutaneous Intrauterine Mirena
125
IUS options
Mirena levonorgestrel-impregnanted Skyla- Copper T380A IUS
126
Abortion Options
First tri- D&C and mifepristone Second Tri- D&E or IOL with PGE1 Third Tri- hysterectomy
127
Mifepristone MOA
Progesterone antagonist.
128
Types of Abortion
``` Missed Threatened Incomplete Complete Inevitable ```
129
Consequences of Fetal Demise
DIC from release of tissue thromboplastin is rare | Grief resolution
130
Mode of delivery for fetal demise
D and E if
131
DIC panel
Platelet count D-dimer Fibrinogen PT/PTT
132
Risk Factors for ectopic
Infections (PID,IUD) Post surgical (ligation) Congenital (DES)
133
Definition of Adnexa
Space between uterine wall and pelvic wall: ovary, oviduct, ureter, cardinal ligaments
134
Specific Criteria for Diagnosis of Ectopic Pregnancy
Serum beta HCG is greater than 1500 with no signs of transvaginal intrauterine gestational sac.
135
Management of Unruptured ectopic
HCG6000: laparoscopy with Rhogam | Possible Salpingectomy if childbearing over
136
What period is most susceptable to tetratogens
Weeks 3-8
137
thin greyish-white discharge pH above 4.5 Whiff test
Bacterial Vaginosis
138
Clue Cells
Bacterial vaginosis
139
Treatment of BV
metronidazole | Clindamycin
140
Vaginal discharge >4.5 Itching and burning strawberry cervix
Trichomonas Vaginitis
141
frothy green discharge
Trichomonas Vaginitis
142
What can you not use when taking metronidazole
alcohol
143
RF for candida infection
``` DM systemic antibiotics pregnancy obesity decreased immunity ```
144
treatment of candida
systemic fluconazole | vaginal azole creams
145
normal vaginal pH infection
Candida
146
excessive, thin watery vaginal discharge
Physiologic discharge | Estrogen dominance
147
whitish focal/diffuse area on vulva | firm and cartilaginous
Squamous Hyperplasia
148
treatment squamous hyperplasia
fluoridated corticosteroid cream
149
bluish-white papule like parchment paper
lichen sclerosus
150
Treatment of lichen sclerosus
Clobetasol cream
151
white, red or pigmented multi focal lesions
Vulvar intraepithelial neoplasia
152
fullthickness vuvlvar dysplasia
vuvlar carcinoma in situ
153
Mittleschmertz
Pain during OVULATION from rupture and blood in pertineum
154
Ovarian Hyperthecosis
increase in LH production of androgens | Leads to peripheral production of estrogen
155
Presentation of Ovarian Hyperthecosis
More severe hirsutism than PCOS | Can also occur in postmenopausal women
156
Differential of Prepubertal Complex Pelvic Mass
Germ Cell tumors Dysgerminoma -LDH levels Choriocarcinoma- beta HCG Endodermal sinus- AFP
157
Management of mass in prepuberty
Simple- laparoscopy and cystectomy | Complex mass- Laparotomy with Unilateral S&O
158
DD of complex mass in premenopausal
``` Dermoid Cyst Benign cystic teratoma Endometrioma tubo-ovarian abcess ovarian cancer ```
159
Solid pelvic mass negative beta HCG increase LDH
dysgerminoma
160
Pelvic mass in reproductive years negative beta HCG Calcifications on ultrasounds
Benign Cystic teratoma (aka dermoid cyst) All germ layers GI histology-carcinoid syndrome Thyroid tissue-strumma ovari
161
Sudden onset severe lower ab pain | adnexal mass
ovarian torsion
162
Management of ovarian torsion
Laparoscopy/otomy tountwist Cystectomy for revitalization Unilateral S&O if necrotic
163
Differential of Postmenopausal Pelvic Mass
``` GI lesion Urinary tract lesion Ovarian tumor -Epithelial -Germ Cell -Sex Cord Stromal ```
164
Postmenopausal woman Pelvic mass Increased CEA/ CA-125
Serous carcinoma
165
Epithelia ovarion tumors
``` Serous Mucinous Brenner Endometriod Clear Cell ```
166
Germ Cell tumors
Dysgerminoa Endodermal sinus teratomas choriocarcinoma
167
Sex Cord Stromal Tumor
``` Granulosa/Theca Sertoli Leydig Fibroma Thecoma Stromal luteoma Pregnancy luteoma ```
168
Postmenopausla pelvic mass Masculinization Increase testosterone
Sertoli Leydig Cell
169
Metastatic Ovarian tumors
Endometrium GI breast Krukenberg
170
Krukenberg
mucin secreting tumors origniationg from the stomach or breast Usually bilateral
171
ascites pleural effusion benign ovarian fibroma
Meigs syndrome

Gynecology (1 decks)

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