1° Dysmenorrhea Mechanism? Treatment? 2

↑ Prostaglandin 1. NSAID 2. OCP (1st if sexually active)

Breast discharge Most common cause? Diagnostic? 3

• papilloma bHCG @ bilateral Mammogram @ unilateral + Age > 30 US @ unilateral + Age < 30

AdenoMyosis Symptoms? Treatment?

Dysmenorrhea Menstrual bleeding (regular & heavy) Pelvic pain Diffuse globular uterus (uniform enlargement) Anemia = Fatigue / HR ↑ • Hysterectomy

Breast Cancer Screening indication? High risk indication (needs counseling)? 5

• F 50-74 @ q2y 1° relative breast cancer > 2 Breast cancer in family > 3 1° relative L+R breast cancer Breast cancer in male relative Ashkenazi Jew + FH breast/ovarian cancer

Breast mass Abnormal US/mamo management Age > 30? Age < 30? 2

• Cone biopsy Simple = Needle aspiration Complex/Solid = Cone biopsy

Ovarian HyperStimulation US findings? 2 Cause / pathology?

L+R enlarged ovaries Multiple follicles hCG injection for induction VEGF ↑ --> permeability ↑

Vulvular Cancer Cause? 2 Treatment? 2

HPV infection Chronic inflammation Excision Radiation

Endometriosis Symptoms? PE? Common site? 2 Treatment?

Dysmenorrhea cPelvic pain unilateral Dyspareunia Dyschezia (pelvic pain @ BM) Tender adnexal mass Pain @ lateral cervical movement Uterus – fixed & immobile 1) Ovary 2) Cul-de-sac 1) NSAID 2) OCP 3) MedroxyProgesterone / GnRH (Leuprolide) / Androgen (Danazol) 4) Resection (TAH-SBO)

OCP failure with anti-siezure meds Which meds? Why? Which meds have no effect?

Phenytoin Carbamazepine Ethosuximide Phenobarbital Topiramate OCP metabolism ↑ Gabapentin / Valproate

UW3 (13 Gyn) Flashcards by M S

MenoPausal bleed

Endometrial biopsy indication?

Age > 45 + Anovulatory bleed

How well did you know this?

Not at all

Perfectly

1° Dysmenorrhea

Mechanism?
Treatment? 2

↑ Prostaglandin

NSAID
OCP (1st if sexually active)

How well did you know this?

Not at all

Perfectly

Breast discharge

Most common cause?
Diagnostic? 3

• papilloma

bHCG @ bilateral
Mammogram @ unilateral + Age > 30
US @ unilateral + Age < 30

How well did you know this?

Not at all

Perfectly

OCP (contraindication) 10

Migraine
Age > 35 + Cig > 15/d
BP > 160/100
Heart disease
DM + Organ damage
History of VTE / CVA
Breast cancer
Liver cancer
Anti-Phospho Lipid
Postpartum < 3w

How well did you know this?

Not at all

Perfectly

AdenoMyosis

Symptoms?
Treatment?

Dysmenorrhea
Menstrual bleeding (regular & heavy)
Pelvic pain
Diffuse globular uterus (uniform enlargement)
Anemia = Fatigue / HR ↑

• Hysterectomy

How well did you know this?

Not at all

Perfectly

DysMenorrhea (differential)

1) Fixed & Immobine uterus / Adenexal mass/nodule
2) Irregular menstruation
3) Irregular uterus
4) Irregular menses

1) Endometriosis
2) HypoThyroidism
3) LeioMyoma
4) Perimenopause

How well did you know this?

Not at all

Perfectly

Breast Cancer

Screening indication?
High risk indication (needs counseling)? 5

• F 50-74 @ q2y

1° relative breast cancer > 2
Breast cancer in family > 3
1° relative L+R breast cancer
Breast cancer in male relative
Ashkenazi Jew + FH breast/ovarian cancer

How well did you know this?

Not at all

Perfectly

Breast mass
Abnormal US/mamo management

Age > 30?
Age < 30? 2

• Cone biopsy

Simple = Needle aspiration
Complex/Solid = Cone biopsy

How well did you know this?

Not at all

Perfectly

Ovarian HyperStimulation

US findings? 2
Cause / pathology?

L+R enlarged ovaries
Multiple follicles
hCG injection for induction
VEGF ↑ –> permeability ↑

How well did you know this?

Not at all

Perfectly

PCOS

Treatment? 4

1) Weight↓
2) OCP
3) Progestin
4) Clomiphene (↑ ovulation

How well did you know this?

Not at all

Perfectly

PMS

Treatment? 3

1) Fluoxetine
2) Other SSRI
3) OCP (E+P)

How well did you know this?

Not at all

Perfectly

Cyclic intermittent abd pain
“1° amenorrhea”
Uterine enlargement
Tender suprapubic mass
Blue Intralabial mass

1) Diagnosis?
2) Cause?
3) Complication?
4) Treatment?

1) Imperforate hymen
2) Cause: Estrogen ↑ @ newborn
3) Complication: Intra-abdominal adhesion
4) Treatment: Hymenectomy

How well did you know this?

Not at all

Perfectly

Urinary Incontinence

Diagnosis? Mechanism? Management?

1) Leak @ activity & valvalsa
2) Sudden onset / Freq ↑
3) Constant dribble / Incomplete empty / Nocturia

1) Stress
Sphincter tone ↓ / HyperMobile
Pelvic floor exerc / Pessary / Urethral sling

2) Urge
Detrusor ↑
Bladder train / Anti-Muscarinic

3) Overflow
Detrusor ↓ / Outlet obstruction
Intermittent Cath / Correct cause

How well did you know this?

Not at all

Perfectly

Vulvular
HypoPigmentation
Pruritus – erosion / excoriation
Plaque - Thin to Thick / Permeant thickening

Diagnosis?

Lichen Sclerosis

How well did you know this?

Not at all

Perfectly

Vulvular Cancer

Cause? 2
Treatment? 2

HPV infection
Chronic inflammation
Excision
Radiation

How well did you know this?

Not at all

Perfectly

Endometriosis

Symptoms?
PE?
Common site? 2
Treatment?

Dysmenorrhea
cPelvic pain unilateral
Dyspareunia
Dyschezia (pelvic pain @ BM)
Tender adnexal mass
Pain @ lateral cervical movement
Uterus – fixed & immobile

1) Ovary
2) Cul-de-sac

1) NSAID
2) OCP
3) MedroxyProgesterone / GnRH (Leuprolide) / Androgen (Danazol)
4) Resection (TAH-SBO)

How well did you know this?

Not at all

Perfectly

OCP failure with anti-siezure meds

Which meds? Why?
Which meds have no effect?

Phenytoin
Carbamazepine
Ethosuximide
Phenobarbital
Topiramate
OCP metabolism ↑
Gabapentin / Valproate

Infertility

Definition?

No conception @

1) 12m
2) > 6m @ F > 35

Nipple discharge

Benign symptoms? 3
Management? 4

Bilateral
Non-bloody
Only @ manipulation

1) Physical exam
2) Mammo/US  Biopsy
3) Prolactin+TSH  treat
4) Reassure / Obs
If uncertain – duct excision

PID

1) Risk factors? 2
2) OP treatment?
3) IP treatment?

1) Multiple partner > Prior PID
2) OP: Ceftriaxone + Doxy
3) IP: Cefoxitin + Doxy

Raw burning pain @ void > 3m
Dyspareunia
Irritation

Diagnosis?
Treatment? 3

• VulvoDynia

Behavioral
Pelvic floor PT
CBC

Uterine Sarcoma

Symptoms? 4
Risks?
Treatment?

Abnormal bleed
Pelvic pain/pressure
Uterine mass
Ascites
Pelvic radiation
Tamoxifen
PostMenopause

• Hysterectomy

Emergency contraception? 4

1) Copper IUC
2) Ulipristal
3) Levonorgestrel
4) OCP

Copper IUD

Contraindication? 4

Pelvic infection
Wilson’s disease
Organ transplant failure
Abnormal uterine cavity

Breast cyst * Simple indication? * Complex indication? * Management?

* Simple = benign * Thin wall * Fluid filled * No septation * Complex * Thick wall * Solid * Septations 1) Complex = biopsy 2) Simple a. Asymptomatic = observation b. Tender / Symptom = FNA 3) FNA a. Non-bloody = reassure + US 4-6w b. Non-bloody + persist/recur = biopsy 4) Bloody = Biopsy

Sexual Assault PEP 5 diseases? Treatment?

* Chlamydia = Azithromycin * Gonorrhea = Ceftriaxone * Trichomoniasis = Metronidazole * HIV = Tenofovir / Emtricitabine / Raltegravir * Hep B= Vaccine / IVIG

Urge incontinence * Cause? * Treatment? 4

• Detrusor muscle ↑ * Timed void / bladder training * Life style (Weight ↓/ Smoke ∅ / Alcohol ∅ / Caffeine ∅) * Anti-Muscarinic (Tolterodine / Solifenacin / Oxybutynin) * Alternative (Botulinum toxin / Precut tibial nerve stim)

Gonorrhea / Chlamydia * Screening? * Treatment? * Follow up?

* Sexually active / Age < 25 * Q1y NAAT * Empiric = Ceftriaxone + Azithromycin * G = Ceftriaxone + Azithromycin * C = Azihthyromycin / Doxycycline * Test & treat partner * No sex x7d after tx completion

Progetin subdermal implant * Effects? * Side effects? * Contraindication?

• FSH ↓ / LH ↓ * Random bleeding * Weight ↑ * Headaches • Progestrin ⊕ breast cancer

Condylomata Accuminata 1) Cause? 2) External treatment? 3) Internal treatment? 4) Treatment @ pregnancy? 5) Pregnancy management/ follow up?

1) HPV infection 2) Podophyllin 3) TrichloroAcetate 4) Podophyllin 5) No vertical transmission / No tx @ delivery / Vaginal delivery

Contraception (side effects) 1) Estrogen+Progestrin ? 3 2) DMPA ? 4 3) Progestrin SD implant ? 1 4) IUD progastrin? 2 5) IUC copper? 2

1) Breakthrough bleed / Breast tenderness / Nausea 2) Irregular bleed / Amenorrhea / Bone loss (reversible) / Weight ↑ 3) Irregular bleeding 4) Irregular bleeding / Amenorrhea 5) Dysmenorrhea / Heavy menses

Functional HypoThalamic Amenorrhea 1) Symptoms? 2) Risks? 3) Complications? 4) Effects / Labs? 5) Treatment?

1) Amenorrhea / Breast atrophy / Anovulatory infertility / Vaginal atrophy 2) Athlete / Stress / Anorexia 3) Fracture risk / Cholesterol ↑ / Triglyceride ↑ 4) Calory ↓ / GnRH ↓ / LH ↓ / FSH ↓ / Estrogen ↓ 5) ↑ caloric intake / Calcium & Vitamin D / Estrogen

Female normal puberty * Thelarche (breast) * Menarche * Constitutional delay

* Age 8-12 * Age < 15 + 2° sex * Delayed bone age * Age > 12 * Short * No breast development

Pre-Puberty Spotting Vaginal discharge & odor Intermittent bleeding * Diagnosis? * Common cause?

* Vaginal Foreign Body | * Toilet paper

Vaginal spotting (differential) 1) Development of: Breast / Axillary & Pubic hair 2) Bloody & mucoid discharge / Grape structure protrusion 3) Dysuria / Red & purple mass 4) Anti biotic use / Immunocompromised / Vulvular pruritus / Thick & white discharge

1) Precocious puberty 2) Sarcoma Botyroides 3) Urethral prolapse 4) Candidiasis

Breast Mass = Single, Rubbery, Mobile, Well circumscribed, Upper outer quadrant * Diagnosis? * Symptoms associated with menstruation?

• FibroAdenoma * Tender before menstruation * Improve after menstruation

Most common breast mass @ adolescent

FibroAdenoma

Tamoxifen (complication) * Post menopause? 2 * Pre menopause? 2

* Endometrial hyperplasia & cancer * Uterine sarcoma * Endometrial polyp * Abnormal uterine bleeding

Cervical cancer / HSIL Management? 2

* Colposcopy | * LEEP @ ( Age > 25 / Not pregnant & Don’t want kids anymore)

PAP / Cervical cancer Screening?

* Age 21 – 65 q3y | * If age 30-65, cytology + HPV q5y

Gestational TrophoBlastic Neoplasia * Common metastasis location? * Labs to check? * Imaging study? 2 * Treatment? * Follow up?

• Lung > Vagina * bHCG ⊕ * US pelvis / XR chest * Methotrexate * Hysterectomy • bHCG monitor