Repro Exam Flashcards
(455 cards)
1
Q
when is Rhogam given?
A
28 weeks
2
Q
when is the QUAD screen given?
A
second trimester
3
Q
when is round ligament pain common?
A
second trimester
4
Q
when is G/C tested for?
A
1st and 3rd trimester
5
Q
when is GBS tested for?
A
35+ weeks
6
Q
what is the first line treatment for N/V in pregnancy?
A
unisom
7
Q
when is the GCT given?
A
24-28 weeks (first trimester if risk factors)
8
Q
HA, vision changes, and RUQ pain are sx of what?
A
preeclampsia
9
Q
how many weeks is considered a term pregnancy?
A
37
10
Q
what is the standard for kick counts?
A
10 kicks/2 hrs
11
Q
when is a fetal non-stress test performed?
A
after 28 weeks
12
Q
what is considered post term (and labor should be induced)?
A
42 weeks and up
13
Q
where is the most common place for the sperm and egg to meet?
A
ampulla
14
Q
what are the risk factors for an ectopic pregnancy
A
1) previous ectopic
2) tubal surgery
3) endometriosis
4) hx pelvic infection
5) hx of infertility
6) IUD (if currently inserted)
7) smoking
15
Q
what are the most common symptoms of an ectopic pregnancy
A
1) abd pain
2) missed LMP
3) vaginal bleeding
16
Q
which should be included in the workup if you suspect an ectopic?
A
1) BHcg
2) CBC
3) type and screen
4) pelvic US
17
Q
what does a bhcg tell you over a upreg?
A
quantity
18
Q
what is the discriminatory zone and what is the lab range?
A
bhcg level at which an intrauterine gestational sac should be seen
19
Q
at what value should a gestational sac be seen on US?
A
> 2000
20
Q
at what point in a pregnancy should a gestational sac be seen?
A
4-5 weeks
21
Q
at what point in a pregnancy should a yolk sac be seen?
A
5 weeks
22
Q
at what point in a pregnancy should a fetal pole be seen?
A
6 weeks
23
Q
at what point in a pregnancy should fetal heart motion (FHM) be seen?
A
6 1/2 weeks
24
Q
how would you expect a bhcg value to change over 2 days?
A
should at least double
25
what is a heterotypic pregnancy?
extrauterine and intrauterine pregnancies occur simultaneously
26
how is a an ectopic dx?
1) adnexal mass c/w ectopic
2) free fluid in pelvis (ruptured ectopic)
3) hemodynamically unstable
4) bhcg > 1500-2000 w/o an intrauterine sac
27
what should you do if you suspect an ectopic but can't prove it yet?
1) repeat bhcg in 48 hrs
2) repeat pelvic US
3) give ectopic precautions and bleeding precautions
28
how is an ectopic pregnancy managed medically?
Methotrexate (MTX)
| check bhcg on day 1, 4, 7
29
how is an ectopic pregnancy managed surgically?
laparoscopic salpingectomy/salpingostomy
30
how do you know if a medically managed ectopic was a "success"?
15% in bhcg between day 4-7
31
how long should bhcg be followed after treating an ectopic?
until < 5 (considered negative)
32
when is surgical management for an ectopic used over medical?
1) evidence of rupture
2) hemodynamically unstable
3) CI to MTX
33
what must you remember to give a patient with an ectopic?
Rhogam!
34
what two supplements counteract MTX?
DHA and folic acid
35
for which surgical procedure to remove an ectopic must bhcg be followed and why?
salpingostomy
| b/c need to make sure you removed all of the pregnancy
36
why must remnants from a surgical excision of an ectopic be sent to pathology?
to confirm chorionic villi
37
what is GTD?
gestational trophoblastic disease
lesions characterized by abnormal proliferation of placenta trophoblast (complete or partial hydatiform mole or placental site nodule)
38
what is GTN?
gestational trophoblastic neoplasia
malignant neoplasms arising from abnormal proliferation of placental trophoblast (choriocarcinoma, placental site trophoblastic tumor, epitheliod trophoblastic tumor, invasive mole)
39
which surgical procedure for an ectopic has more risk of recurrence and threat to fertility?
both the same!
40
what are the sx of GTD?
1) abnormal vaginal bleeding
2) uterine size > dates
3) hyperemesis gravidarum
4) bhcg > 100,000
5) hyperthyroidism
6) preeclampsia
41
what gives you morning sickness in pregnancy?
bhcg
42
how is a molar pregnancy (GTD) dx?
1) bhcg level > 100, 000
2) US
3) pathology = definitive
43
how does a complete mole look on US?
"snowstorm" appearance form hydropic villi w/o fetal parts
44
how does a partial mole look on US?
+/- fetal parts
| enlarged cystic placenta
45
which type of mole confers a higher risk of GTN?
complete mole
46
why must a woman use contraception and be sure not to become pregnant after have a GTD treated?
if get pregnant - can't tell if the bhcg is positive from the mole or a new pregnancy
47
how can you tell if GTD has progressed to GTN?
1) bhcg rise 10% over 2 weeks
2) bhcg plateau 10% over 3 weeks
3) bhcg positive at 6 month
48
what is the tx for low risk GTN?
single agent
| MTX or Actinomycin-D
49
what is the tx for high risk GTN?
multi agent
| EMA-CO (etoposide, MTX, actinomycin-D, cyclophosphamide, vincristine)
50
after a GTD is treated how is bhcg followed?
weekly until < 5
| monthly for 6 mon
51
what is another name for the placenta?
chorion
52
what is another name for the sac?
amnion
53
how many days before split result in conjoined twins?
> 12
54
how many days before split results in monochorionic diamniotic twins?
4-8
55
how many days before split results in monochorionic monoamniotic twins?
8-12
56
how many days before split results in dichorionic diamniotic twins?
0-4
57
how can you tell if twins are fraternal or identical?
genetic testing at birth
58
what does the T sign on US tell you about twins?
monochorionic
59
what does the lambda sign on US tell you about twins?
dichorionic
60
what is the risk with monochorionic twins?
congenital anomalies (heart defects)
61
what is the risk with monochorionic diamniotic twins?
twin twin transfusion syndrome (TTTS)
twin anemia polycythemia sequence (TAPS)
twin reversed arterial perfusion (TRAP)
62
what is the risk with monochorionic monoamniotic twins?
cord entanglement/accident
63
when are DCDA twins delivered?
38 wks
64
when are MCDA twins delivered?
34-37 wks
65
when are MCMA delivered?
32-34 wks
66
at what point is mom of MCMA twins managed inpatient?
@ 24wks
67
how do you determine mode of delivery for twins?
depends on presentation of twin A
68
if twins are vertex-vertex, how are they delivered?
vaginally
69
if twins are vertex/breech or transverse, how are they delivered
vaginally or C section
70
if twin A is non-vertex how are they delivered?
C section
71
if twins are MCMA, how are they delivered?
C section
72
why would you screen for pregestational DM (GCT at 1st prenatal visit)?
1) BMI > 30
2) 1st degree relative with DM
3) hx of GDM in prior pregnancy
4) hx macrosomic infant
5) physical inactivity
6) A1C > 5.7
73
what guidelines are used in the US for GDM dx?
carpenter/coustan
74
how many times daily for glucose be checked in GDM?
4-5x
75
what are the benchmarks to follow for glucose in GDM?
fasting < 95
1 hr postprandial < 140
2hr postprandial < 120
76
how does the dose of insulin needed trend throughout pregnancy
increases b/c resistance increases as you go along
77
what risks do glyburide pose if used for GDM?
risk of macrosomia and hypoglycemia
78
how often are growth scans required in GDM?
q4wks
79
in addition to a growth scan, what does A2 GDM require for surveillance?
non-stress test (NST) wkly 28-32 weeks
80
what testing does a GDM mother get post partum?
75g OCTT at 6-12 wks postpartum
81
what is the definition of chronic HTN in pregnancy?
BP > 140/90
| GA < 20wks
82
what characteristics do GHTN, pre-eclampsia, and eclampsia have in common?
BP > 140/90
x2 > 4hrs apart
GA > 20 wks
83
what is eclampsia?
condition where high blood pressure results in seizures during pregnancy
84
how is pre-eclampsia with severe features defined?
BP> 160/110
| severe ft. = ptl < 100,000, pulm edema, headache, vision changes, oliguria
85
what is pre-eclampsia?
multisystem d/o caused by placental and maternal vascular dysfunction
86
what is treatment for pre-eclampsia?
delivery
87
how is GHTN differentiated from pre-eclampsia?
proteinuria
88
what BP meds are recommended in pregnancy?
labetolol, hydralazine, nifedipine, methyldopa
89
what are the fetal consequences of Rh incompatibility?
anemia, hydrops fetalis, death
90
when is Rhogam given?
28 wks
within 72 hrs of delivery if Rh positive
setting of any sensitizing event
91
what is considered preterm labor?
< 37wks
92
what is the definition of labor?
regular contractions and cervical changes
93
what are tocolytics?
prevent uterine contraction
94
what is betamethasone used for?
given to mothers in preterm labor for fetal lung maturity
95
what is magnesium sulfate used for?
cerebral palsy prevention
96
what are the stronger tocolytics?
nifedipine, indomethacin
97
what are CI to tocxolysis (where baby really just needs to come out)?
1) fetal distress
2) placental abruption
3) pre-eclampsia
4) intrauterine fetal demise
5) intrauterine infection
6) lethal fetal anomaly
98
how is a premature rupture of membranes dx?
sterile speculum exam
99
what is PROM?
premature rupture of membranes
| ROM before onset of labor (contractions)
100
what is PPROM?
preterm premature rupture of membranes
| ROM < 37 wks and before onset for labor
101
what is prolonged rupture of membranes?
ROM > 18 hrs
102
what is the "latency period"?
time between ROM and delivery
103
if a pregnancy is at term and the water breaks, how long is the latency period?
1-2 days
104
what labs must be checked after ROM?
gonorrhea, chlamydia, UA, urine culture, GBS
105
at what point in pregnancy must D&E be considered if there is a PROM?
< 24 wks
106
how is a PROM patient managed inpatient?
1) daily non-stress test
2) serial growth US
3) limit vaginal exams (d/t infection risk)
107
what type of cells make up the endocervix?
columnar epithelium
108
what type of cells make up the ectocervix?
nonkeratinizing squamous epithelium
109
how does the cervix change after menarche?
acidification --> ectocervis undergoes squamous transformation --> metaplastic changes radiate inward from the original squamocolumnar junction to new SCJ ---> creates a transformation zone
110
when is ectropion seen?
OCPs, menarche (before squamous metaplasia)
111
why is ectropion prone to bleeding?
columnar cells are not meant for friction
112
what is a nabothian cyst?
forms on the cervix during squamous metaplasia
mucus trapping --> bleb formation
trapping what normally would get secreted
113
what is the MC benign cervical neoplasm?
cervical polyp
114
what is a cervical polyp?
hyperplastic endocervical fold of columnar epithelium
115
which is more likely to bleed - cervical polyp or nabothian cyst?
cervical polyp
116
why would a cervical polyp be removed?
bothersome to patient (bleeding)
117
how does cervical insufficiency differ from preterm labor?
preterm labor = painful
| cervical insufficiency = painless
118
what can cervical stenosis lead to?
hematometra (retention of blood in uterus) and infertility
119
what is the MC STI?
HPV
120
what is the strongest factor that predisposes someone to HPV?
sexual partners
121
what percent of HPV cases regress in 2 years?
70-90%
122
when do paps start?
21
123
when are paps done from 21-29?
q3yrs
124
when is pap with HPV cotesting done?
30-65 y/o
125
when would you need a pap earlier than 21?
if you have HIV
| start pap at time dx or once sexually active if congenitally acquired
126
what is colposcopy?
used to evaluate abnormal pap or persistent HPV infection
127
what is used during a colposcopy?
acetic acid (makes it white) & Lugol's sol'n (makes it brown)
128
what is another name for cervical dysplasia?
cervical intraepithelial neoplasia
129
what is cervical dysplasia?
HPV-mediated abnormal growth of squamous epithelium
130
since cervical dysplasia can be potentially malignant, how is it classified?
by risk
- CIN 1 = low risk
- CIN2-3 = high risk
131
how is CIN characterized into high risk vs low risk?
1) cellular immaturity
2) cellular disorganization
3) nucelar abnormalities
4) increased mitotic activity
132
in terms of placement on the cervix, how is CIN grade determined?
CIN 1 = lower 1/3 of epithelium
CIN 2 = middle 1/3
CIN 3 = upper 1/3
133
what is the treatment for CIN2-3?
excision method - LEEP/cold knife cone
| ablative method - cryotherapy
134
what is the downside of ablation?
harder to see if you got everything (nothing goes to path like with LEEP)
135
what is the most common gyn cancer in women in the world?
cervical
136
what are the histological types of cancer?
1) squamous cell carcinoma
2) adenocarcinoma
3) mixed cervical carcinoma and neuroendocrine tumors
137
what is the most common type of cervical cancer?
squamous cell carcinoma
138
what are the sx of cervical cancer?
1) abnormal bleeding
2) watery d/c
3) postcoital bleeding
4) venous/lymphatic/ureteral compression
139
why is adenocarcinoma of the cervix sneaky?
just b/c you removed the cancer from place on the cervix doesn't mean that you don't have it elsewhere (skip lesion)
140
what is the tx for stage IA cervical cancer?
radical hysterectomy
141
what is the tx for stage IB - IIA cervical cancer?
surgery and/or pelvic radiation
142
what is the tx for stage IIB - IVA cervical cancer?
radiation and chemo
143
what is the tx for stage IVB cervical cancer?
palliative care
144
what supplementation might a breast feeding baby need?
vitamin D
145
what in terms of immunity does a breastfeeding baby get from mom?
IgA
146
what are maternal benefits of breastfeeding?
1) decr postpartum depression
2) boosts maternal weight loss
3) uterine involution (oxytocin release, uterine contractions, minimizes hemorrhage)
147
what is colostrum? and when does it occur?
yellow milk containing fat, minerals, IgA
| starts at 2nd day postpartum
148
what is mature milk composed of?
protein, lactose, water, fat
149
what maintains lactation?
decrease in estrogen and progesterone causes loss of PRL inhibition
150
how does the role of oxytocin differ from PRL in terms of breastfeeding?
oxytocin is responsible for the myoepithelial contraction within the alveoli
151
how does PRL affect the ovaries?
suppresses ovulation by inhibiting GnRH, LH, FSH
152
what are 4 problems with breastfeeding?
1) mastitis
2) suppression
3) mastitis
4) nipple problems
5) infant drug exposure
153
when is mastitis MC?
2-4 hours postpartum
154
what is the MC cause of mastitis?
staph aureus from infants pharynx
155
what medications can suppress lactation?
1) bromocriptine
2) pseudoephedrine
3) estrogen-containing contraceptives
156
what medication can boost lactation?
domperidone
157
when are NSAIDs contraindicated?
pregnancy but ok during breastfeeding!
158
why are NSAIDs CI in pregnancy?
can cause closure of the patent ductus arteriosus
159
what medications can impact a baby via breastmilk and how?
1) narcotics --> sedation
| 2) nitrofurantoin --> hemolytic anemia in G6PD deficient babies
160
what is the MC cause of maternal death?
hemorrhage (ante, intra, or postpartum)
161
what are the MC causes of 3rd trimester bleeding?
1) placenta previa
2) abruption
3) preterm labor
162
what is placenta previa?
placenta covering the cervix
| doesn't move up the uterus to where there is more muscle likes it's supposed to
163
what is placenta accreta?
abnormal placental attachment to the myometrium
| absent Nitabuch's layer causing defective decidual formation
164
what is the decidua?
the endometrium during pregnancy
165
what is an accessory or "succenturiate" lobe?
small lobe of the placenta that often infarcts
166
what is the risk with a "succenturiate" lobe?
retained portion of the placenta after birth
| can result in postpartum bleeding
167
what is required after a "succenturiate" lobe?
hysterectomy upon delivery of baby
168
what is abruptio placentae and how does it start?
premature separation of the placenta
initiated by hemorrhage into the decidua basalts which causes a decidua hematoma and decidua separation from the basal plate
169
what can abruptio placentae lead to and why?
DIC
| b/c decidua separation from the basal plate causes further separation and bleeding which leads to DIC
170
what is uterine rupture and what is a major risk factor for it?
complete separation of all layers of the uterus
| prior uterine scar
171
how is the source (baby or mom) of intrapartum hemorrhage determined?
Apt test
| test specimen of the blood that comes out and turns a different color if its mom vs baby
172
what is the definition of postpartum hemorrhage
intrapartum and postpartum 24 hrs > 1000mL blood loss with delivery and s/sx of hypovolemia
173
what are causes of postpartum hemorrhage?
1) uterine atony
2) obstetric trauma
3) uterine inversion
4) abnormal placentation
5) coagulation d/o
6) DIC
174
what is sequelae of postpartum hemorrhage?
Sheehan, mortality, DIC, hypovolemic shock, end-organ failure
175
what is anaphylactoid syndrome?
amniotic fluid embolism
fetal antigens enter the mother and there is an inflammatory response that causes DIC and decrease of myocardial function
176
when should pitocin be given during labor?
before the end of stage 3 (before the end of placental delivery)
177
how is puerperal endometriosis start?
intraamniotic infection ascending from lower GI or GU tract
178
what are the risk factors for puerperal endometriosis?
prolonged labor and membranous rupture
179
what is usually the cause of puerperal endometriosis?
polymicrobial
180
what do you do if a woman goes into preterm labor and you haven't swabbed her for GBS yet?
give abx (assume positive)
181
what is the SART?
sexual assault response team
182
what is a SANE?
sexual assault nurse examiner
183
what is PERK and when is it good for?
physical evidence recovery kit
| good for up to 96hrs after assault
184
which injuries are only seen within 24hrs of assault and why?
anogenital injuries b/c they heal very quickly
185
what are the 2 MC places of injury in sexual assault?
fossa navicularis and posterior fourchette
186
how do you handle a Nuvaring in an assault patient?
take out, swab and put back
187
why is an HIV test not done in SANE exam?
don't want to tell them same day they got assaulted that they also have HIV
also it wouldn't be from assault it have been contracted earlier
188
what is the MC dx in patients seeking evaluation of breast lumps?
fibrocystic changes
189
what is the pathological agent in mastitis?
staph aureus
190
what are the sx of mastitis?
induration, redness, swelling, pain, heat and edema
191
what is fat necrosis?
firm nodule that can mimic CA
| often hx of trauma causing damage to breast fat
192
what is MC breast disorder?
fibrocystic changes
193
what is the age range fibrocystic changes are dx?
20-40
194
what is fibrocystic breast disease associated with?
hyperestrenism
195
what are the non proliferative patterns of FCC?
1) cyst formation
2) fibrosis
3) adenosis
196
what are the proliferative patterns of FCC?
1) sclerosing adenosis
2) epithelial hyperplasia
3) atypical hyperplasia
4) small duct papilloma
197
what are the features of sclerosing adenosis?
1) small lesions
2) mammography calcifications
3) rarely palpable
4) proliferation of acini
198
what FCC confers a moderately increased risk?
atypical ductal hyperplasia
| atypical lobular hyperplasia
199
what diseases can be associated with gynecomastia?
cirrhosis and functioning testicular tumor
200
what are the stromal breast tumors?
fibroadenoma
| phyllodes tumor
201
what are the epithelial breast tumors?
large ductal papilloma
| carcinoma
202
what tumor causes bloody nipple d/c?
large duct papilloma
203
Paget's disease is a subtype of what?
DCIS
204
what are the clinical features of invasive carcinoma?
1) fixed firm nodule
2) dimpling of skin
3) retraction of nipple
205
what are the "special" histological breast carcinomas?
1) mutinous carcinoma
2) medullary carcinoma
3) papillary carcinoma
206
what are the most common causes of infectious vaginitis?
1) bacterial vaginosis
2) vulvovaginal candidiasis
3) trichomoniasis
207
what is the vulva?
external female sex organs
208
what is the normal pH of a menstruating woman?
3.5 - 4.5
209
generally, what type of bacteria reside in the vagina?
aerobic
210
what do the lactobacilli do in the vagina?
1) produce lactic acid
2) inhibits growth of bacteria
3) maintains acidic environment
211
specifically, what 3 types of bacteria are typically present in the vagina?
yeast and pathogenic bacteria in small amounts
| lactobacilli
212
what is the purpose of the lactic acid production in the vagina?
detrimental to the growth of pathogens
213
what is physiologic discharge?
clear/cloudy odorless, non-adherent to walls
| contains lactobacilli
214
when does physiologic discharge MC occur?
1) ovulation
2) postcoitus
3) postmenses
4) pregnancy
215
what can be examined on a wet mount?
1) BV (saline)
2) trichomonas (saline)
3) candida (KOH)
216
where do you take the specimen from for a wet mount?
lateral wall of the vagina
217
what is the BD Affirm VP III lab study?
used for bacterial vaginosis
| DNA probe
218
what does BD Affirm VP III test for?
Gardnarella vaginalis, Trichomonas vaginalis, Candida
219
what is the MC vaginal infection in WOCBP?
BV
220
what is the MC cause of vaginal d/c and odor?
BV
221
why is BV bad in pregnancy?
increased risk of preterm labor
222
what causes BV?
incr in pH causes overgrowth of bacteria
223
what is the pathogen MC identified in BV?
Gardnerella vaginalis
224
are most women sx with BV?
only 50%
225
which patients are at increased risk of getting BV?
STI patients and WSW
226
is BV an STI?
no it is sexually associated
227
how does douching affect the vagina?
makes it more alkalinic
228
what are the risk factors for getting BV?
1) recent abx use
2) douching
3) unprotected sex
229
what are the sx of BV?
1) increased d/c white, grey in appearance
2) fishy odor
3) odor worse with sex
230
what are the signs of BV?
1) thin, white vaginal d/c
2) KOH whiff test
3) clue cells on wet mount
4) few lactobacilli on wet mount
5) ph> 4.5
231
what is seen on a saline wet pre in BV?
Clue Cells - fuzziness with stippled borders
| predominance of anaerobic organisms
232
why is there not a lot of WBCs on a saline wet prep in BV?
not inflammatory
233
what is the Amsel criteria?
```
dx for BV
need 3/4
1) homogenous, thin, grayish-white d/c
2) pH > 4.5
3) positive whiff test
4) clue cells on wet mount
```
234
what is the recommended tx for BV in pregnancy?
oral metronidazole
235
what is considered recurrent BV and what does it require that normal BV does not necessarily?
>3 episodes/yr
1) consistent condom use
2) longer treatment period
236
when is vulvovaginal candidiasis MC?
in WOCBP
237
what is vulvovaginal candidiasis?
yeast infection
238
if you see hyphae on slides but patient is asx do you need to treat? why?
no
| b/c candidiasis is part of the normal vaginal flora
239
what bacteria is the MC cause of vulvovaginal candidiasis?
Candida albicans
240
what is the less common cause of vulvovaginal candidiasis that usually doesn't cause sx?
Candida glabrata
241
what are the sx of vulvovaginal candidiasis?
1) vulvar pruritis
2) vulvovaginal burning and irritation
3) cottage cheese d/c
4) dysuria
5) dyspareunia
242
what are the signs of vulvovaginal candidiasis?
1) erythema of vulva and vaginal mucosa
2) vulvar edema
3) thick white d/c adherent to vaginal walls
4) pseudohyphae (tree-branch looking) on wet mount
243
how is the pH affected in vulvovaginal candidiasis?
it isn't
244
what is the dx test for vulvovaginal candidiasis?
KOH prep
245
what type of treatment is best for more severe very itchy vulvovaginal candidiasis? why?
vaginal imidazole (topical) b/c will take care of sx quicker than oral
246
what is the oral medication for vulvovaginal candidiasis?
fluconazole
247
what are the types of topical vulvovaginal candidiasis tx?
vaginal imidazole, miconazole, clotrimazone, terconazole
248
what is recurrent vulvovaginal candidiasis?
> 4 episode/yr
249
when and how do you tx vulvovaginal candidiasis in pregnancy?
only tx if sx
topical (clotimazole or miconazole)
no PO meds!
250
what is the tx for candida glabrata? why?
boric acid intravaginally
| b/c azoles won't work for this type
251
what is the MC non-viral STI?
trichomoniasis
252
what are the sx of trichomoniasis?
1) yellow green vaginal d/c
2) vulvovaginal irritation
3) dyspareunia
4) dysuria
5) male partner asx
253
what are the signs of trichomoniasis?
1) motile flagellated organisms on wet mount
2) copious frothy cervical-vaginal d/c
3) strawberry cervix
4) presence of other STIs
254
what does a strawberry cervix look like?
punctate macular hemorrhages
255
how is trichomoniasis dx?
saline wet mount - motile trichomonads
| pear shaped
256
what typically is present with trichomoniasis?
BV
257
why can trichomoniasis not be dx on pap?
can easily get a false positive
258
what is different about trichomoniasis compared to other STIs?
doesn't progress to PID like other STIs
259
what must patients not do during tx for trichomoniasis?
EtOH and abstinence
260
what does trichomoniasis require that BV does not in terms of tx?
need to tx partner
261
why is trichomoniasis bad with pregnancy?
preterm labor and low birth weight
262
what are the bartholin glands for?
moisture and lubrication during sex
263
how should the bartholin glands feel on exam?
non-palpable
264
what is a bartholin gland cyst?
cyst that develops when main duct draining the gland is occluded
265
what is the MC vulvovaginal tumor?
bartholin gland cyst
266
what are the s/sx of a bartholin gland cyst?
painless vulvar mass detected on pelvic exam
| may be uncomfortable if very large
267
what does the drainage of a bartholin gland cyst look like?
clear, white fluid
268
what are the s/sx of a bartholin gland abscess?
1) tender, erythematous, severe pain with mucopurulent drainage
2) warm, tender, fluctuant mass
269
what should also be tested for with a bartholin gland abscess?
G/C
270
what is a Word catheter?
balloon tipped device inserted after I&D
| inflatable tip left in place for 4-6 wks
271
how does the Word catheter tx a bartholin gland cyst?
promotes formation of epitheialized duct
272
what is marsupialization?
surgical procedure that forms a new ductal orifice
273
in which age group is vulvar cancer MC?
postmenopausal women
274
what are the risk factors for vulvar cancer?
1) HPV 16, 18, 31
2) vulvar intraepithelial neoplasia (VIN)
3) lichen sclerosus - derm condition characterized by thin white patches of vulva with itching
4) hx cervical cancer
5) HIV infection
275
what is the MC vulvar cancer?
squamous cell carcinoma
276
what are the sx of vulvar cancer?
1) vulvar lesion
2) pruritus
3) +/- vulvar bleeding
4) +/- vulvar pain
277
what does a vulvar cancer lesion look like?
1) unifocal plaque
2) ulcer
3) mass on labia, clitoris, perineum
278
what is the MC etiology of vaginal cancer?
secondary to another primary metastatic tumor (cervix MC)
279
what is the etiology of clear cell adenocarcinoma of the vagina?
DES exposure in utero
280
what is the MC site of vaginal cancer?
upper 1/3
281
what is the MC form of vaginal cancer?
squamous cell carcinoma
282
what are the sx of vaginal cancer?
painless vaginal and/or postcoital bleeding
283
how can trichomonas be transmitted non-venereally (super rare)?
toilet seat
swimming pools
hot tubs
284
where is milk produced?
lobules
285
what is the difference between what makes up young breasts vs old breasts?
young - mainly glandular tissue
| older - mainly fat tissue
286
where is the majority of breast cancers?
upper outer quadrant (axillary tail)
287
when should the breast exam be performed in the cycle?
one week post menses
288
what is mastalgia?
breast pain
289
when does cyclic mastalgia occur during the cycle?
during the luteal phase
290
what is extramammary breast pain?
pain referred from an outside source to the breast
291
what are causes of cyclic mastalgia?
1) hormonal changes w/menses
2) OCPs
3) fibrocystic breast disease
292
what are causes of noncyclic mastalgia?
1) pendulous breasts
2) mastitis
3) inflammatory breast cancer
4) poorly fitting bra
5) pregnancy
6) ductal ectasia
7) chest wall causes
293
what is ductal ectasia?
blocked lactiferous duct
294
how is mastalgia dx?
1) clinical breast exam
2) examine lymph nodes
3) US
4) mammogram
295
what are the sx of mastitis?
breast pain, swelling, warmth, redness
296
what is the MC pathogen that causes mastitis?
staph aureus
297
when do you tx mastitis?
sx > 12-24 hrs
298
what are the characteristics of benign nipple d/c?
1) bilateral
2) multi ductal
3) milky
299
what are the characteristics of pathological nipple d/c?
1) spontaneous
2) unilateral
3) uniductal
4) bloody, yellow or clear
5) stains clothes
6) persistent
300
where should you press to try to express d/c?
apply pressure around the areola
301
what labs should be tested to investigate nipple d/c?
1) TSH
2) PRL
3) B-hcg
302
what is an FNA used for?
lymph node or breast cyst
303
in what instances is an FNA used (in terms of cancer likelihood)?
low suspicion for cancer
304
what is the downside of an FNA?
high false negatives and non-diagnostic samples
305
what is a core needle bx used for?
larger tissue specimen
306
what is a punch bx used for?
to distinguish between benign and malignant skin changes (Paget's)
307
what is the image of choice in women < 30 y/o with focal breast sx?
US
308
what is a breast MRI used for?
1) screening for high risk women
2) evaluate suspicious findings
3) assess silicone implant integrity
309
what is the BIRADS score?
suspicion of malignancy
310
which BIRADS scores should be f/u with bx?
4 & 5
311
in a < 30 y/o patient, how should an indeterminate exam be followed up?
breast ultrasound
312
in a > 30 y/o patient, how should an indeterminate exam be followed up?
diagnostic mammogram +/- direct US
313
how should a patient presenting with a breast mass which isn't detectable on PE be followed up?
repeat the exam in 2-3 months
314
what is the "triple assessment"?
1) CBE
2) imaging
3) pathology
315
what is the difference between a simple cyst and a complex cyst?
simple - fluid filled and benign
| complex - fluid + solid components w/small risk for malignancy
316
are cysts painful or painless?
can be either
317
how is a breast cyst managed?
US or mammogram
318
when is a mammogram used for a breast cyst?
> 30 y/o or complex cyst
319
what is the most common benign breast disease?
fibrocystic breast disease
320
what are the sx of fibrocystic breast disease?
1) bilateral cyclic pain
2) breast swelling
3) palpable masses
4) lumpy heavy breasts
321
which patients is fibrocystic breast disease MC in?
20-40 y/o
322
how is fibrocystic breast disease dx?
US
FNA
mammogram > 30 y/o
323
what is a fibroadenoma?
benign solid tumors containing glandular & fibrous tissues
324
when is a fibroadenoma MC?
WOCBP
325
when do fibroadenomas change?
during pregnancy or estrogen therapy
326
what is the most common breast cancer?
ductal carcinoma
327
what are the non-invasive malignant tumors of the breast?
DCIS
| LCIS
328
what are the invasive malignant tumors of the breast?
ductal carcinoma
| lobular carcinoma
329
what are the BRCA genes?
tumor suppressor genes
330
which population is very likely to have the BRCA mutation?
Ashkenazi Jews
331
aside from the mass itself, what are the other sx of breast cancer?
unilateral nipple discharge, dimpling, skin thickening, breast pain, eczematous changes
332
what is the underlying problem with paget's disease?
ductal carcinoma
333
which disease presents with the peas d'orange appearance?
inflammatory breast disease
334
what are the sx of inflammatory breast disease?
erythema
edema
peau d' orange
335
how does chemo help post surgery?
prevents recurrence
336
when is hormonal therapy given in breast cancer?
after surgery, chemo, radiation
337
when the ACS guidelines suggest offering mammogram to women?
40-44 y/o
338
when is annual mammogram screening recommended?
45-55
339
when is biennial mammogram screening recommended?
> 50
340
how can Turner's syndrome patients have a child?
use an egg donor
| can bear a child b/c they have a uterus but not capable of conceiving on own
341
why would you get shoulder pain with ectopic pregnancy?
irritation of the diaphragm
| referred pain via the phrenic nerve
342
where do ovarian cysts develop?
ovary or fallopian tube
343
what can be the sx of an ovarian cyst?
1) pelvic pain
2) pelvic fullness
3) dyspareunia
4) bloating
5) torsion
344
what are the signs of an ovarian cyst?
adnexal fullness and CMT
345
what is contained in the cortex of the ovary?
follicles/eggs
346
where do the most common ovarian cysts arise?
follicle
347
what are the most common types of ovarian cysts?
simple cysts
corpus luteal cysts
endometrioma
348
what is a simple cyst?
```
serous water fluid filled
composed of granulosa cells
thin walled
always benign
can become 5-7 cm
```
349
what is a complex cyst?
```
can be filled w/blood or mucous
solid component
internal debris
thick walled
septations
papilla
have a lower threshold of suspicion
```
350
which cysts are related to ovulation?
simple cysts and corpus luteal cysts
351
which cysts can produce estrogen?
simple cyst
352
which cysts can produce progesterone?
corpus luteal cyst
353
what does a corpus luteal cyst tell you about a woman's cycle?
either she is ovulating or she is pregnant but you can't see it yet
354
what is a "chocolate cyst"?
ectopic growth of endometrial tissue
355
what must you do for a chocolate cyst? why?
wait and watch
remove laparoscopically
OCP
these usually do not resolve on their own
356
what is CA-125?
blood test used to indicate malignancy
| used to monitor response to therapy
357
what is theca lutein cyst?
luteinized follicular cyst
358
how do theca luteal cysts form?
hyperstimulation from hcg
359
how are theca lutein cysts resolved?
source of hcg removed
360
which cysts do not resolve on their own and should be followed?
medullary and germ cell tumors
361
what is a mature cystic teratoma (dermoid cyst)?
germ cell tumor containing ectoderm, mesoderm, and endoderm
362
what is a cyst adenoma?
serous and mucinous
363
when are ovarian cysts suspicious for malignancy?
1) hyperechoic
2) nodular
3) papillary projection
4) presence of ascites
5) blood flow in solid component
6) peritoneal mass
364
what does a CA-125 value not tell you?
how severe the disease is
365
what is the MC gyn malignancy?
endometrial
366
what is the most common cause of gyn CA deaths?
ovarian cancer
367
what are the s/sx of ovarian cancer?
1) pelvic mas
2) pelvic pain
3) abdominal fullness
4) back pain
5) constipation
6) diarrhea
7) early satiety
368
what is the MC ovarian cancer?
epithelial cell
369
when are germ cell tumors MC?
in pediatrics
370
what are sx of a granulosa theca tumor?
precocious puberty
irregular heavy bleeding
postmenopausal bleeding
371
what are the sx of sertoli-leydig tumors?
can be masculinizing in adolescence
372
what is the problem with large cysts?
can cause ovarian torsion
373
what are the sx of ovarian torsion?
1) severe pain
2) N/V
3) low grade fever
374
what are the risk factors for ovarian torsion?
1) pregnancy
2) ovarian cysts
3) neoplasms
375
what is the MC cause of infertility?
PCOS
376
what is the other name for PCOS?
Stein-Leventhal syndrome
377
what are the s/sx of PCOS?
1) oligomenorrhea
2) amenorrhea
3) obesity
4) infertility
5) hyperandrogenism
6) insulin resistance
378
why is PCOS a misnomer?
they don't have any cysts
| they have an incr number of antral follicles
379
what is used to dx PCOS?
Rotterdam criteria
380
what is the Rotterdam criteria and how many are needed for PCOS dx?
1) oligo or anovulation
2) clinical signs of hyperandogenism
3) polycystic ovaries (string of pearls)
381
when does the ovarian reserve decrease the most?
after 35 y/o
382
how is infertility defined?
inability to conceive after 1 yr
383
if a woman is <35 and has regular periods, at what point should she be referred to a fertility clinic?
no pregnancy after 1 yr
384
if a woman is 35-39 and has regular periods, at what point should she be referred to a fertility clinic?
no pregnancy after 6 months
385
if a woman is 40+ and has regular periods, at what point should she be referred to a fertility clinic?
no pregnancy after 3 months
386
what is an SIS?
saline infusion sonohysterography
387
what is SIS used for?
infusion of saline into the uterus allows better visualization of the uterus
388
on day 3 of menses what would elevated estrogen and FSH point toward?
decreased ovarian reserve
389
what is a hysterosalpingogram?
insertion of contrast dye into the uterus and fallopian tubes and an X-ray to check contour and tube patency
390
what are causes of male infertility?
1) varicocele
2) infection
3) ejaculation issues
4) cryptorchidism
5) hormone imbalances
6) chromosomal abnormalities
391
what is the best timing for sex when trying to conceive?
1-2 days prior to ovulation and 1 day after
392
what do ovulation predictor kits (OPK) do?
detect LH surge (which precedes ovulation)
393
when does body temperature increase in the cycle?
after ovulation
394
how long can sperm survive in repro tract?
2-3 days
395
how long is the window for eggs to be fertilized?
24 hrs
396
what is clomid used for? and what type of drug is it?
first line for ovulatory d/o
| SERM
397
what is femara used for? and what type of drug is it?
suppresses estrogen production
| AI
398
what is ART?
assisted reproductive technology
399
what is OHSS?
ovarian hyperstimulation syndrome
400
what can be a complication of OHSS?
3rd spacing - bloating, abdominal fullness, n/v/d, weight gain, decreased urine output, excessive thirst, pleural effusion, SOB, chest pain, electrolyte imbalance
401
what is polymenorrhea?
incr in frequency of bleeding
402
what is menorrhagia?
incr in the amount of bleeding
403
what is oligomenorrhea?
decrease in the frequency of bleeding
404
what is metromenorrhagia?
irregular intervals of bleeding
405
what is menometrorrhagia?
irregular intervals of bleeding with excessive amounts of bleeding
406
what are the structural causes of AUB?
```
PALM
polyp
adenomyosis
leiomyoma
malignancy & hyperplasia
```
407
what are the non-structural causes of AUB?
```
COEIN
coagulopathy
ovulatory dysfunction
endometrial
iatrogenic
not yet classified
```
408
what is a concerning menses account?
soaking two or more pads/hour for >2 hours
409
which imaging studies can also be used as a treatment?
1) hysterosalpingogram
2) laparoscopy
3) hysteroscopy
410
in postmenopausal women, what should be the thickness of the uterus?
thin (or else concerning)
411
which procedure is done in the office setting - endometrial bx or hysteroscopy?
endometrial bx
412
what is the age you MC see endometrial polyps?
> 50
413
what are the sx of endometrial polyps?
1) intermenstrual bleeding
2) post-coital bleeding
3) post-menopausal bleeding
414
how are endometrial polyps dx?
US or hysteroscopy
415
when should an endometrial polyp be removed?
menopausal or causing sx
416
what is adenomyosis?
barrier between endometrium and myometrium breaks allowing endometrial cells to invade the myometrium
417
what is the age you MC see adenomyosis?
30-50
418
how does adenomyosis differ from endometriosis?
the ectopic endometrial tissue does not respond to hormones
419
what are the sx of adenomyosis?
1) heavy menstrual bleeding
2) noncyclic pelvic pain
3) progressive dysmenorrhea
420
how does the uterus feel on PE in adenomyosis?
boggy and globular with symmetrical uterine enlargement
421
what is leiomyosis?
benign proliferation of smooth muscle cells of the myometrium
422
what is the MC benign uterine tumor?
leiomyoma
423
what is esp bad about pedunculated and subserosal fibroids?
can sit on other organs and cause sx
424
which leiomyoma is assoc with infertility?
submucosal fibroid
425
what are the s/sx of a leiomyoma?
```
HMB
pelvic pain or pressure
infertility
compressive sx
enlarged, firm, nontender uterus
```
426
how is hyperplasia of the endometrium dx?
endometrial bx
427
what is the cardinal sx of malignancy?
AUB
428
what does the pap show which is concerning for malignancy?
atypical glandular cells
429
what are the type I endometrial malignancies called?
endometroid
430
what are the type II tumors called?
serous and clear cell
431
what is leiomyosarcoma?
fibroid that has progressed to cancer
| rapidly growing mass with vaginal bleeding and pain
432
what is the prognosis for leiomyosarcoma?
poor
433
what is anovulatory AUB?
excess estrogen in absence of progesterone
| incomplete sloughing of the endometrium
434
what is ovulatory AUB?
prolonged progesterone secretion
| causes irregular shedding of the endometrium
435
what is the triad that can be found in a later stage chlamydia infection?
urethritis, uveitis, arthritis
436
what is the MC form of chronic prostatitis - bacterial or abacterial?
abacterial
437
what is the major hormone contributing to BPH?
DHT
438
what is the gold standard for treating BPH
TURP
439
what is the MC malignancy in men in the US?
prostate carcinoma
440
where does prostate cancer normally arise?
peripheral zone of the posterior prostate
441
on histology, what does prostate cancer look like?
one layer of basal cells and cherry nucleolus
442
what is the Gleason grading used for and what is it based on?
staging of prostate cancer
| based on architectural parameters
443
what on a bone scan would be pathognomonic for prostate cancer?
osteoclastic bony mets
444
which cells support spermatogenesis?
sertoli cells
445
when does cryptorchidism need to be treated by in order to prevent atrophy?
2 y/o
446
what is not performed before a surgery on a testicular mass?
bx
447
what is the age range MC for testicular cancer?
25-45
448
what are the type of testicular germ cell tumors?
seminoma and non-seminoma
449
what is the most common germ cell tumor of the testicles
classic seminoma
450
what does a seminoma look like on gross exam?
solid tan bulky mass
451
what is a highly malignant testicular tumor and why?
choriocarcinoma
| b/c it mets very early
452
what is ITGCN?
Intratubular germ cell neoplasia - precursor lesion for invasive testicular germ cell tumors (TGCTs) of adolescents and young adults
453
what is the hormone producing tumor in the testicles?
stromal tumor and leydig cell tumor
454
are stromal tumors and leydig cell tumors usually malignant or benign?
benign
455
what is the MC testicular neoplasm in men > 60?
aggressive non-Hodgkin
