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1

Define spontaneous abortion

Loss of fetus in less than 20 weeks

2

Most common organisms responsible for PID

Gonorrhea, chlamydia

Then think of ascending infxns: so anerobes, GN/GB, GBS

3

Danazol

Indications

Danazol = synthetic steroid/androgen previously used in the tx of endometriosis

-largely replaced by GnRH agonists b/c of their masculinizing/virulizing effects

4

What time of the month are pts most likely to present w/ PID

Beginning of the cycle (like day 1 aka on first day of menstrual period)
-for some reason when the pain is the worst

5

How does obesity increase risk of endometrial hyperplasia

-obesity: adipose tissue contains aromatase => increased peripheral conversion of androgens to estrogens

6

Differentiate appearance of pt w/ PID 2/2 gonorrhea vs. chlamydia

Gonorrhea- more ill appearing, usually more tender, higher fever, thicker discharge

Chlamydia- less severe, discharge thinner/more watery

7

Prevalence of ectopic pregnancy

(a) How does it change if have previous ectopics?

1% overall

(a) 10% if had one previously
25% if had 2+

8

Differentiate which part of puberty estrogen and testosterone are responsible for in females

Estrogen = thelarche (breast development)
Progesterone = pubarche (pubic hair)

9

Top 2 things on Ddx for postmenopausal bleeding

60-80% endometrial atrophy
10-15% endometrial cancer => hence all F over 45 w/ AUB get endometrial biopsy

10

Risk factors for vulvar neoplasms

-smoking
-age
-HPV, h/o abnormal pap
-lichen sclerosis** (thin white patches of skin)
-immunocompromised or immunsuppressed
-Paget's disease (adenocarcinoma)

11

Gold standard tx for endometriosis

OCPs, specifically continual OCPs (no progesterone withdrawal bleed part)

12

Gold standard diagnostic test for endometriosis

Technically gold standard diagnostic tool is laparoscopic exploration w/ tissue biopsy
-but that's pretty invasive so really just diagnosed clinically

13

Differentiate the two classifications of delayed puberty

1. Hypergonadotropic hypogonadism = elevated FSH
ex: Turners, Mullerian agenesis, imperforate hyman

2. Hypogonadotropic hypogonadism = arcute nucleus not producing GnRH
-constitutional delay

14

Location of cervical cancer

Squamocolumnar junction- squamous outside and columnar inside
-squamocolumnar junction receds up the endocervical canal w/ age, as it recedes that's where you get the transitional zone where metaplasia occurs

15

Difference in UA interpretation in pregnant women

Pregnant women can have + leukestrase w/o UTI, but nitrates is ALWAYS abnormal
-ketonuria in pregnancy can be 2/2 dehydration

Low threshold for treating UTI in pregnancy b/c pregnant women have higher incidence of asymptomatic UTI

16

32 yo F1 p/w positive urine pregnancy test at 9 4/7 and painless vaginal bleeding w/ chills
-T 101.5, HR 95, BP 95/60
-cervix closed on exam
-beta-hCG of 6500
-no fetus in gestation sac on US

Dx?
Tx

Septic abortion
= infectioned POCs

Tx- surgery, need to evacuate the uterus

17

Most common sit of endometriosis

Bilateral Ovaries
-ovarian endometrioma = chocolate cyst

2nd most common = posterior col de sac

18

Teen w/ ovarian mass

Buzzword for germ cell tumor

19

List in order the normal process of puberty in girls

Breast development (thelarche) --> Adrenarche --> Growth spurt --> Menarche

-20% of the time adrenarche comes before thelarche

20

Difference in risk profile from estrogen/progesterone therapy from only estrogen therapy

E/P has increased risk of 4: VTE, stroke, coronary heart disease, breast cancer

While just estrogen: increased risk of VTE and stroke (not of coronary heart disease or breast cancer)

21

Tx for gonorrohea

Ceftriaxone IM x1
+ Azithromycin to tx common chlamydia coinfection

-also tx partners

22

Describe the process of a D&C for termination of pregnancy

Paracervical block w/ or w/o mild IV sedation
-serial dilation of cervix
-then curretage out intrauterine material

23

Lupron- what is it?

Lupron = GnRH agonist

For hormone-responsive cancers and estrogen-dependent conditions (ex: endometriosis or uterine fibroids)

-can be given pre-op before myomectomy to decrease burden

24

Inpatient tx for PID

Cefotetan (cephamycin = type of cephalosporin) IV q12
+ Doxy IV q12

Treat until afebrile or clinically improved for 24 hrs, then switch to PO and monitor

25

Ddx of first trimester vaginal bleeding

spontaneous abortion
ectopic pregnancy
vaginal/cervical lesions or lacerations
extrusion of molar pregnancy

26

Risk factors for ectopic pregnancy

Fallopian tube scarring/damage
-h/o ectopic
-chlamydial infection

Smoking
ART (assistive reproductive therapy): IVF

27

Most common subtype of vulvar neoplasm

90% of vulvar neoplasms are squamous cell carcinomas (can be progression from VIN)

-5% melanoma
-5% other: Bartholin's, Pagets (red and scaly)

28

Explain the mechanism of hypogonadotropic hypogonadism

Delayed puberty b/c arcuate nucleus doesn't produce GnRH

29

Describe what it means for a pap smear to show a high-grade squamous intraepithelial lesions

cells on the pap smear suggest an abnormality that will be present from 2/3 to full thickness of the transitional zone

30

Ddx for acute abdominal pain in 25 yo sexually active female

1. 1. 1. R/o ectopic pregnancy
-PID
-Appendicitis
-Torsion
-Ovarian Cyst
-Kidney stone