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Flashcards in UWorld GYN Deck (20)
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Consider these if FSH and LH levels are:
1. Both under 5
2. FSH >40 and LH >25

1. pituitary dysfunction
2. Premature ovarian failure


Squamous cell carcinoma removal guidelines?

Removed surgically if: stage 1/2 and less than 2 cm in size

Irradiate if stage 1/2 and more than 2 cm in size


Vaginismus? Tx?

Involuntary psychological contraction of the perennial musculature

Kegel exercisers, dilators


Medical therapy for endometriosis?

OCP, GnRH analogues, danazol


Cervical mucus in different phases of menstruation?

follicular – thick, scant, acidic (no penetration of sperm)

Ovulatory phase – stretches to 6 cm, pH >6.5 (most basic), ferning when smeared on microscope

Lute phase – mucus becomes thicker and less stretchy, inhospitable to sperm


Postmenopausal patient with ovarian mass – treatment?

Ultrasound for size of mass and Measure CA-125

If size less than 10 cm and CA-125 low, followed conservatively

Otherwise chemo or surgery


Skin colored lesions on vulva – Diagnosis? Treatment of small lesions? Large lesions?

Genital warts (condyloma acuminata)

small lesions – acetic acid, podophyllin

Larger lesions – excision or fulguration (electric current)


Adenomyosis? Age? Presents with? Physically exam findings? Management?

Invasion of endometrial glands into uterine muscle

Woman about 40; presents with dysmenorrhea and menorrhagia
PE – enlarged but symmetric uterus

Endometrial curettage to rule out endometrial carcinoma


Discharge consistent with ovulation?

"Egg white like" thickening


Interstitial cystitis?

Chronic condition of the bladder characterized by

Pelvic pain worsened my bladder filling, sexual intercourse, and relieved by avoiding


Patient secondary amenorrhea – work up?

Beta HCG, if negative

1. Elevated Prolactin – normal TSH, creatinine, get MRI
2. Elevated FSH – ovarian failure
3. Elevated testosterone – PCOS
4. Elevated TSH – hypothyroidism
5. History of uterine procedures – estrogen/progestin stimulation test – if no withdrawal bleeding, rule out Ashermann 's


Ovarian hyperstimulation syndrome – Cause? Symptoms? Associated symptoms?

Population-inducing drugs; abdominal pain due to ovarian enlargement

Ascites, respiratory difficulty, other systemic findings


Secondary amenorrhea – diagnosis?

1. Beta hCG
2. TSH and prolactin
A. If prolactin and TSH are elevated, treat for hypothyroidism
B. If prolactin elevated TSH normal, r/o pituitary lesion
3. progesterone challenge test to assess estrogen production


Management of primary dysmenorrhea?

1. Antiprostaglandin agents and NSAIDs
2. OCP
3. Cervical dilation


Differential for abnormal uterine bleeding?

1. Vaginal
2. Cervical
3. Uterine – Fibroids, adenomyosis, cancer


Treatment for dysfunctional uterine bleeding?

1. OCP or conjugated estrogens
2. If blood loss and abnormal vitals signs, IV conjugated estrogens


Postmenopausal bleeding – differential?

Non-gynecologic – hemorrhoids, anal issues, rectal prolapse, G.I. tumors

Gynecologic – vaginal (atrophy, lesions), cervical (cancer), endometrial (hyperplasia, polyps, cancer)


Postmenopausal bleeding – diagnosis?

One. Pap smear,
2. Digital rectal and a cold blood screening
3. Endometrial biopsy
4. Pelvic ultrasound for polyps and endometrial stripe
5. Hysteroscopy
6. D & C


Hirsutism – differential?

1. Andrenal – Cushing's, congenital adrenal hyperplasia
2. Non-neoplastic Ovarian – PCOS, theca lutein cyst, stroma hyperthecosis
3. Neoplastic – adrenal tumor, Stertoli-Leidig cell tumor, granulosa-cell tumor, luteoma pregnancy


Treatment of hirsutism?

1. If adrenal - finisteride (inhibit 5am-reductase), Spironolactone
2. If ovarian – OCP, progesterone (decreases LH), GnRH agonist