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Family Medicine EOR > OBGYN > Flashcards

OBGYN Flashcards

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1
Q

CIN types

A

CIN 1: mild, lower 1/3
CIN 2: moderate, lower 2/3
CIN 3: severe, over 2/3

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2
Q

Gardasil vaccine

A

Recommended at age 11-12 (from Hannah’s quizlet)

Age 9-14: 2-dose - 0 months and 6-12 months OR 3-dose - 0, 2, 6 months
Age 15-45: 3-dose (0, 2, 6 months)
(from Epperly’s slides)

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3
Q

Cervical cancer screening

A

Start at age 21
Pap every 3 years until 30
Pap & HPV every 5 years from 30-65 OR pap only every 3 years

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4
Q

When to stop screening for cervical cancer?

A

65+
No hx of moderate or severe dysplasia
3 negative paps in a row

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5
Q

Pap smear results

A

ASCUS (undetermined significance)
ASCH (cannot exclude high-grade lesion)
LGSIL (low-grade squamous intraepithelial, corresponds to CIN 1)
HGSIL (high-grade squamous intraepithelial, corresponds to CIN 2/3)
AGC (atypical glandular cells)

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6
Q

Treatment of ASCUS

A

Repeat paps every 6 months until normal

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7
Q

Next step for LGSIL and HGSIL

A

Colposcopy and biopsy

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8
Q

Treatment of CIN 1

A

Expectant management
2 paps every 6 months or pap & HPV test every 6 months

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9
Q

Treatment of CIN 2 or 3

A

Surgical procedure

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10
Q

HPV strains most correlated with cervical cancer

A

16, 18, 45

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11
Q

S/S of cervical cancer

A

Abnormal vaginal bleeding
*Postcoital bleeding

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12
Q

Treatment of cervical cancer

A

Radical hysterectomy and lymphadenectomy

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13
Q

Most common gyn malignancy

A

Endometrial cancer

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14
Q

Risk factors for endometrial cancer

A

Unopposed estrogen
Obesity

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15
Q

Risk reduction for endometrial cancer

A

Combo OCP use
Smoking

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16
Q

S/S of endometrial cancer

A

Abnormal uterine bleeding

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17
Q

MCC of endometrial cancer

A

Adenocarcinoma

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18
Q

Diagnosis of endometrial cancer

A

US first
Biopsy

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19
Q

Treatment of endometrial cancer

A

Total hysterectomy with bilateral salpingo-oopherectomy

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20
Q

Lactational amenorrhea

A

Exclusive breastfeeding leading to amenorrhea and contraception

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21
Q

MOA of OCP

A

Ovulation suppression

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22
Q

Benefits of combination OCP use

A

Reduced endometrial and ovarian cancer
Increase bone mass
Acne improvements
Dysmenorrhea improvement

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23
Q

SE of combo OCP use

A

VTE
Cervical dysplasia
Breast cancer

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24
Q

CI of combo OCP use

A

Migraines with aura
Smokers over 35
Hx of VTE
Hx of breast cancer

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25
CI for progestin only OCP use
breast cancer
26
Paragard characteristics (Copper IUD)
Every 10 years Non-hormonal
27
Nexplanon characteristics (implant)
Every 3 years Progesterone only
28
Depo characteristics (injection)
Every 3 months Progesterone only
29
IUD characteristics
Progesterone only
30
Cystocele
Protrusion of the bladder into anterior vagina
31
S/S of pelvic organ prolapse
Fullness and pressure (“falling out” sensation) Pelvic pain Urinary incontinence Straining worse with prolonged standing better with lying down.
32
Uterine prolapse
Descent of uterus into the vagina
33
grading for uterine prolapse
grade 0: no descent grade 1: descent into upper 2/3 of vagina grade 2: cervix approaches introitus grade 3: cervix outside introitus grade 4: uterus outside vagina
34
Rectocele
Protrusion of rectum into posterior vagina
35
Enterocele
pouch of douglas small bowel herniating into upper vagina.
36
Treatment of pelvic organ prolapse
Pessary Kegels Surgical treatment (hysterectomy) Estrogen for vaginal atrophy
37
Dysmenorrhea
Painful menstruation
38
Etiology of dysmenorrhea
* primary = increased prostaglandins * secondary = pelvis/uterus pathology (endometriosis, PID, ect. )
39
Treatment of dysmenorrhea
NSAIDs Hormonal contraceptives if unresponsive to 3 cycles of initial therapy, consider laparoscopy.
40
When does PMS/PMDD tend to occur
1-2 weeks prior to menses lasting until 2nd/3rd day of menses
41
S/S of PMS and PMDD
HA Fatigue Breast tenderness Bloating Abdominal pain Mood swings Irritability
42
PMS vs PMDD
PMS: cluster of physical, behavioral and mood changes with cyclical occurrence during the luteal phase of menses PMDD: Severe PMS presenting with clear functional impairment and predominant psych symptoms
43
Treatment of PMS/PMDD
Mild: behavioral modifications and symptomatic tx Severe: SSRIs and OCPs
44
Menorrhagia
Heavy bleeding
45
Hypomenorrhea
Light bleeding
46
Metrorrhagia
Bleeding between normal menses
47
Polymenorrhea
Menses occurring too frequently
48
Menometrorrhagia
Bleeding with irregular intervals and amount
49
Oligomenorrhea
Menses occurring too infrequently
50
What is a common underlying cause of dysfunctional uterine bleedig
* anovulation: ovaries producing estrogen but not ovulation (corpus luteum) * unopposed estrogen leads to endometrial growth and shedding.
51
what physical exam findings may be present in dysfunctional uterine bleeding
* abnormal bleeding with normal exam * mass or enlarged irregular uterus (leiomyoma) * symmetrically enlarged uterus (adenomysosis or endometrial cancer)
52
Evaluation of dysfunctional uterine bleeding (DUB)
Pelvic US Endometrial biopsy Hysteroscopy
53
when is endometrial biopsy warranted in dysfunctional uterine bleeding
to rule out cancer in all women >35 with obesity, HTN, or DM with postmenopausal bleeding.
54
Treatment of DUB 2/2 acute hemorrage
* IV estrogen (premarin) * observation and COC’s * refractory = IUD * definitive = hysterectomy
55
Treatment of postmenopausal DUB
Hormones US Hysteroscopy
56
Menopause
No period for 12 months
57
What are the stages of menopause
1. climacteric (phase transitioning from reproductive -> non-reproductive) 1. menopausal transition (phase when menstrual cycle is irregular, lasts 1-3 years.) 1. menopause (final menstrual cycle occurs) 1. postmenopause (after menopause)
58
What is considered premature menopause
prior to age 40
58
Hormone levels in menopause, consider effects on: LH, FSH, Inhibin, estrogen, progesterone, androstenedione, sex hormone binding globulin, and testosterone.
Low inhibin Increased FSH and LH Decreased estrogen (greatest decreased in estradiol!) Decreased progesterone decreased androstenedione decreased testosterone decreased sex hormone binding globulin basically everything decreases except LH and FSH. (these rise because there is no negative feedback from estrogen and progesterone)
59
S/S of menopause
Hot flashes Mood swings Vaginal dryness Hair loss
60
When does a female have the most oocytes
As a fetus at 20 weeks gestation. (7 million) just fun fact: 7 million at 20 weeks 1-2 million @ birth 300,000-500,000 at puberty
61
Treatment of menopause
Vaginal moisturizer Estrogens
62
Known risks of hormone replacement
Endometrial cancer Breast cancer Clots
63
1st line tx for vasomotor menopause sx (hot flashes)
Transdermal estrogen
64
what if the tx of hot flashes if trasndermal estrogen is CI
progestin alone SSRI or SNRI black cohosh gabapentin clonidine
65
Pros and cons of combination hormone therapy | for menopause
Pro: adding progesterone to estrogen decreases risk of endometrial cancer rather than just unopposed estrogen Con: addition of progesterone to estrogen increases risk of breast cancer
66
If patient has intact uterus ___ | (menopause treatment)
Must do combo estrogen and progesterone
67
what occurs as a result of atrophic vaginitis
loss of lactobacillus which converts glucose to lactic acid leading to an increase in vaginal pH of 5-7
68
what is the first line INITIAL treatment for atrophic vaginitis
vaginal moisturizer
69
what is the treatment of moderate/severe atrophic vaginitis if vaginal moisturizer fails.
topical vaginal estrogen
70
aside from vaginal moisturizer and vaginal estrogen, what are the other options for tx of atrophic vaginitis
* prasterone suppository (converts androtest and test -> estrone and estradiol. ) * ospemifene oral (mimics estrogen but causes hot flashes) * testosterone 1-2% cream (if estrogen CI)
71
Actions of estrogen
Endometrial proliferation Development of secondary sex characteristics Increased vaginal lubrication
72
Actions of progesterone
Decrease uterine contractility Promotes breast development Falling levels trigger menses and lactation
73
Major hormone of pregnancy
Progesterone
74
Etiology of pelvic inflammatory disease
Polymicrobial | gonorrhea, chlamydia, mycoplasma genintalum
75
S/S of PID
Lower abdominal pain Cervical motion tenderness (chandelier sign) Fever
76
Treatment of PID
Rocephin + Doxy + Flagyl

Family Medicine EOR (17 decks)

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