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Step studying 5 Flashcards

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1
Q

What are the epithelial cell ovarian tumors

A

Serous, mucinous, endoemetriod, and brenner

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2
Q

Risk factors for epithelial cell ovarian tumors

A

♣ Pathology of epithelial tumors = endothelial trauma aka ovulation
• So risk increases with age and nulli/low parity

♣ Associated with BRCA1, BRCA2, and HNPCC

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3
Q

Presentation and prognosis of epithelial cell ovarian tumors

A

Are malignant
♣ Usually present as stage IIIb or worse due to asymptomatic
♣ Advanced disease often present with renal failure, small bowel obstruction, or ascites

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4
Q

Tx of epithelial cell ovarian tumors

A

TAH + BSO + Chemo (Paclitaxel)

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5
Q

What are the ovarian germ cell tumors

A

Teratoma, Dysgerminoma, Endodermal sinus tumor, Choriocarcinoma

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6
Q

Presentation of germ cell ovarian tumors

A
  • Are non-malignant

- Usually present in teenage girls as an adnexal mass and weight gain

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7
Q

Tx of ovarian germ cell tumors

A

Unilateral salpingoophorectomy

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8
Q

Tx of choriocarcinoma

A
  • Surgical = TAH, debulking

* Medical = MAC (Methotrexate, Actinomycin D, Cyclophosphamide)

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9
Q

What are the 3 types of vulvar cancer and their presentation

A
  • SCC = black and itchy lesion
  • Melanoma = black and itchy lesion
  • Paget’s = RED and itchy
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10
Q

Tx of 3 types of vulvar cancer

A
  • SCC = vulvectomy and lymph node dissection
  • Melanoma = vuvlectomy and lymph node dissection
  • Paget’s = (less aggressive cancer) wide local excision
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11
Q

Tx of simple ovarian cyst

A

• <3 cm = nothing
• <10 cm = repeat imaging
o If it grows or does not resolve, then remove

• Wrong treatments:
o Aspiration
o OCPs

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12
Q

Tx of complex ovarian cysts

A

• >10 cm = remove

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13
Q

Tx of endometriosis

A

NSAIDs, OCPs

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14
Q

Diagnosis of endometrioma

A

Diagnostic laparascopy with visualization of chocolate cyst

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15
Q

Tx of ectopic pregnancy

A

Methotrexate only okay very early on in pregnancy (b-hCG <5,000, gestational sac <3cm, no cardiac activity)

Otherwise tx is surgery

  • Salpingostomy if no rupture
  • Salpingectomy if rupture
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16
Q

Diagnosis of ovarian torsion

A

US with doppler to see decreased flow

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17
Q

Diagnosis of tuboovarian abscess

A

It is a subtype of pelvic inflammatory disease

  • Will have tenderness at CMT, adnexal, or uterine
  • US for diagnosis
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18
Q

Tx of tuboovarian abscess

A

• Cefoxitin + Doxycycline + Metronidazole
• Clindamycin + Gentamycin
♣ Surgery in worst case scenario

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19
Q

How do you calculate corrected sodium in a patient who is hyponatremic in the setting of hyperglycemia

A

Observed sodium + 2 for every 100 that glucose is over 100

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20
Q

Tx of endometriosis

A

NSAID + OCP

- Laparatoscopy if above tx is unsuccessful

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21
Q

Medication tx of agitation in the elderly

Study These Flashcards
A

Low dose Haloperidol

22
Q

Adverse effects of oxytocin

Study These Flashcards
A
  • Hyponatremia (oxytocin is produced by posterior pituitary and has similar structure to ADH and can lead to water retention and thus hyponatremia
  • Tachysystole
  • Hypotension
23
Q

What do you do when b-hCG is below discriminatory zone and you can’t visualize anything on US

Study These Flashcards
A

• Can check quant again in 48 hours if it is not yet at discriminatory zone
o Normal IUP should double b-hCG in 48 hours
o Ectopic pregnancy will have a slower rise in b-hCG (will not double)

24
Q

What are the causes of abnormal uterine bleeding

Study These Flashcards
A

PALM COEIN

Polyps
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovarian dysfunction
Endometrium
Iatrogenic (IUD)
Not yet classified
25
Tx of fibroids
• OCP/IUD +/- NSAIDs for pain
26
Surgery options for fibroids
* Leuprolide to shrink prior to surgery * Myomectomy if want to maintain fertility * TAH if she doesn’t want kids
27
Describe pathogenesis of PCOS
o Increases LH = stimulation of theca cells = increased androgen production by theca cells = increased peripheral conversion of androgens into estrone in adipose tissue = decreased FSH (negative feedback) = decreased stimulation of granulosa cells = degeneration of follicles cystic follicles
28
Diagnosis of PCOS
``` Diagnostic criteria (1 + 2 or 3): (1) Oligo- or anovulation (2) Hyperandrogenism ♣ Elevated DHEAS ♣ Elevated Testosterone ♣ LH:FSH > 3:1 (3) Polycystic ovaries on US ```
29
Describe how Kallman syndrome causes amenorrhea
♣ Defective migration of GnRH-releasing neuron (problem at level of the hypothalamus) • No GnRH to stimulate FSH or LH
30
What will you seen in Kallman syndrome in terms of: - Internal sex organs - External sex organs - Secondary sex characteristics
♣ Will have uterus and fallopian tubes but no secondary sex characteristics
31
Tx of Kallmans
♣ Tx: give estrogen and progesterone
32
Describe how craniopharyngeoma causes amenorrhea
♣ Problem is at the level of the anterior pituitary | • No FSH or LH being produced
33
What will you seen in Craniopharyngioma in terms of: - Internal sex organs - External sex organs - Secondary sex characteristics
♣ Will have uterus and fallopian tubes but no secondary sex characteristics
34
Tx of craniopharyngeoma
♣ Tx: give estrogen and progesterone + resection
35
Describe how Mullerian agenesis causes amenorrhea
♣ Recall that Mullerian ducts create the upper 3rd of vagina, uterus, and tubes
36
What will you seen in Mullerian agenesis in terms of: - Internal sex organs - External sex organs - Secondary sex characteristics
♣ Normal female (XX) • No uterus • Normal female external genitalia • Female secondary sex characteristics • Patient will still have ovaries which can produce estrogen and progesterone, and will develop secondary sex characteristics
37
Tx of mullerian agenesis
• Elevate the vagina and she can live a normal life but infertile
38
How does Androgen insensitivity syndrome cause amenorrhea
♣ Patient has all male sex characteristics including testes, but testosterone produced by testes is not recognized by the body
39
What will you seen in Androgen insensitivity syndrome in terms of: - Internal sex organs - External sex organs - Secondary sex characteristics
♣ Karyotypically male (XY) • Internal sex organs are male (+testes) • External sex organs are female (+vulva, vagina, clitoris) • Female secondary sex characteristics Conversion of testosterone to estrogen allows for secondary female characteristics to still develop
40
Management of androgen insensitivity syndrome
• Elevate vagina • Need to perform orchiectomy because undescended testes are at increased risk of testicular cancer o Wait til after puberty so that testosterone can be produced and turn into estrogen for secondary sex characteristics
41
What will you seen in Turner syndrome in terms of: - Internal sex organs - External sex organs - Secondary sex characteristics
♣ Will have elevated LH and FSH in attempt to stimulate nonexistent ovaries ♣ Since there are no ovaries to create estrogen and progesterone, there will be no secondary female sex characteristics
42
Describe how hypothyroidism causes amenorrhea
♣ Low T3/T4 increases TRH (produced by hypothalamus) = increased TRH stimulates the anterior pituitary to produce prolactin = high prolactin inhibits GnRH = low GnRH causes low FSH and LH
43
First tests that should be ordered for secondary amenorrhea
UPT, TSH, Prolactin
44
If initial tests for secondary amenorrhea are normal, what is next step
Start from endometrium and work your way up | --> Progesterone challenge
45
Describe results of progesterone challenge
♣ If she bleeds in response progesterone, problem is anovulation • Most likely due to PCOS ♣ If she does not bleed, try estrogen + progesterone
46
Describe results of estrogen + progesterone
♣ If she still does not bleed, problem is endometrial • Asherman’s, ablation ♣ If she bleeds, then the problem is due to signaling
47
Next test after P + E if she bled, and interpret results
FSH/LH ♣ High FSH/LH means problem is with ovary ♣ Low/normal FSH/LH means problem is with pituitary or hypothalamus
48
Next step if she had high FSH/LH
``` Problem of ovary • US to see if follicles are present o +Follicles ♣ Dx = Resistant ovarian syndrome (aka Savage syndrome) ♣ Tx = hormone replacement o –Follicle ♣ <40 y/o = premature ovarian failure ♣ >40 y/o = menopause ```
49
Next step if she had low FSH/LH
o MRI to evaluate anterior pituitary ♣ +MRI = anterior pituitary problem ♣ -MRI = hypothalamic problem
50
What lab value might you see in menopaus
Increased FSH - Body pump out more FSH in response to decreased estrogen
51
Tx of hot flashes
SSRI - Venlafaxine

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