OB/GYN 6 Flashcards
Between OCP, condoms and injections…list them in order of effectiveness.
Injections (94%) > OCP (91%) > Condom (82%)
How does a copper vs Evonogestrel IUD work?
How long do they last?
COPPER IUD:
- induced endometrial inflammation
- Directly toxic to sperm
- 10 years
EVONOGESTREL:
- Progesteron induces cervical mucus thickening
- decrease fallopian tube movement due to thickening
- Progesterone suppressed FSH/LH, therefore suppressing ovulation.
- 5 years.
The first step in Breast lump/mass work-up is based on what?
AGE…
if > 30 yo –> Mammogram
if <30 yo –> US (younger breast tissue is denser so US better)
In a woman > 30 yo who you find a breast lump and do mammography. What do you do next if results are concerning for malignancy (speculated, calcifications)? Unconcerning/indeterminate?
What are the features of “simple” vs “complex” breast cyst?
Concerning - Core BX
Indeterminante or not concerning –> US to determine if BX needed.
Simple Cyst:
- Thin walled
- NO septations
Complex Cysts:
- Thick walls
- Septations
- Irregular/lobulated walls
A woman < 30 yo who presents with breast lump. You do the first step in work up, an US….
How does management differ based on wether you see a SOLID MASS VS CYST.
SOLID MASS –> Mammogram + bx
CYST –>
- IF SIMPLE –>
- Asymptomatic –> No further work up
- Tender –> FNA (further work up depends on bloody vs non-body) - IF COMPLEX –> BX
You have a < 30 yo woman who presented with a breast lump. You do an US and find that she has a complex cyst. You do a FNA…
How does management differ between BLOODY vs Non-Bloody aspirate?
BLOODY
- Mammogram + Bx
NON-BLOODY -
- If Cyst resolves after FNA –> follow up with US in 2-6 weeks
- If Cyst persists after FNA –> Mammogram + Bx
How do you treat HOT FLASHES in menopause?
How do you treat Vaginal dryness in Menopause?
HOT FLASHES –> Venlafaxine
Vaginal dryness–> low dose vaginal estrogen
What is the pathophysiology of exercise induced hypothalamic amenorrhea?
What are the long-term consequences?
TRX?
Low body weight causes LOSS of GnRH pulse –> decreased LH/FSH –> suppressed ovulation and hypo estrogen state.
Long term consequences:
- Decreased bone density
- Increased total cholesterol
- Increased TG
TRX:
- Increase caloric intake
- Supplement Calcium and Vit D.
Primary dysmenorrhea (painful menses) is caused by excessive prostaglandin production.
What is First Line trx?
What is second line trx?
First line trx = NSAID.
Second line = OCP (can be first line if sexually active)
What are the 7 absolute C/I to combined E and P contraception (OCP, ring, transdermal patch)?
- Migraine + aura
- > 35 yo + smoking
- HTN >160/100
- DM with end organ disease
- Hx of blood clots
- Hx of stroke
- Heart disease.
What are the three progesterone only contraception options?
In what situation would you preferentially choose Progesterone only options ….?
Implant
IUD
Injection
Combined C/I
OR
Heavy painful bleeds.
What is the diagnosis?
- KOH causes fishy odor (+ve whiff test)
- Mobile bugs seen on vaginal wet mount.
- Clue cells
- vaginal PH normal
- Vaginal PH >4.5 (normal 3.8 -4.5)
- Bacterial BV
- Trichomonas
- BV
- Candida Vaginitis
- BV and trichomonas
- Can you breast feed with breast implant?
- Is there an increased risk of autoimmune disease, breast cancer, connective tissue disease or neurologic disease with breast implant?
- Do breast implants pose risk to fetus during pregnancy?
- YES
- NO
- NO
How does having breast implants change mammogram screening?
NO CHANGE
Like all women, start @ 50 yo, then q 2 years.
(start 40-50 if RFs)
What is the Treatment of recurrent spontaneous abortions due to uterine septum?
Hysteroscopy and resection of septum
