Women's Health Exam Flashcards
(368 cards)
1
Q
Mastoplasia
A
ropy thickening of tissues; often UOQ, persist throughout menstrual cycle
2
Q
Allodynia
A
hypersensitivity to touch
3
Q
Galactorrhea
A
abnormal breast discharge
usually benign
4
Q
Gynecomastia
A
breast tissue swelling in boys/men
estrogen/testosterone imbalance
estrogen worsens
in alcoholic men
5
Q
What changes occur in women >40 in breast anatomy?
A
more fat tissue than glandular
6
Q
Milk secretion pathway
A
secretory cell of alveoli –> lactiferous ducts (lobules) –> lactiferous sinus –>excretory duct of each lobe –> nipple
7
Q
Abnormal breast discharge, what Dx test
A
serum prolactin
8
Q
How does cancer in cooper’s ligament present?
A
retraction of breast
9
Q
What’s the lymphatic drainage of breast?***
A
75% axillae***
direct lymphatics to mediastinum
internal mammary vessels
10
Q
What does Plan B do?
A
ton of progesterone
11
Q
How prevalent is breast cancer?
A
1/8
12
Q
What can sudden microcalcifications in the breast indicate?
A
breast cancer
13
Q
Which patients get screening mammograms?
A
asymptomatic
14
Q
What is the protocol for mammograms?
A
Screening Mammo Abnormal > Diagnostic Mammo > Breast U/S > Biopsy
15
Q
What do breast ultrasounds do?
A
determine is mass is cyst or solid mass
precisely locate during procedure
16
Q
Types of Mastodynia
A
Cyclic: menstruation
Non-cyclic: 40-50yo
17
Q
Mastodynia Tx
A
spontaneously resolution 80-90%
1st line: NSAIDs
Refractory - severe cases (ex: tamoxifen)
18
Q
Fibrocystic breast changes
A
50% menstruating women
benign: lump and pain
fibroadenomas, cysts, etc
19
Q
What can caffeine cause?
A
mastodynia or fibrocystic changes
20
Q
difference between cysts and cancer
A
cysts: well circumcised (defined edges), rolls around
cancer: fixed
21
Q
Tietze’s Syndrome
A
costochondritis: inflammation of cartilage connecting rib to breastbone
22
Q
What should you always keep on the Dx for fibrocystic changes?
A
breast cancer
23
Q
What is the shortcoming of mammograms compared to U/S?
A
Cant differentiate cysts from solid mass
24
Q
Galactocele
A
well circumscribed milk cysts no inflammation (red, hot, tender)
25
Most common tumor in the breast?
Carcinoma
26
2nd most common tumor in breast?***
fibroadenoma
27
Fibroadenoma
firm, benign, smooth
freely moving breast mass
most common tumor in women <30
fatty tissue lumps
28
Categories of fibroadenoma
Giant: >5cm
Juvenile: adolescents/young adults
29
Who gets fibroadenomas***
common in women 15-35
| unknown cause
30
How to diagnose fibroadenomas?
biopsy (mammogram can't differentiate)
31
Cystosarcoma phyllodes*
rapid growth*
necrosis - push into vasculature*
benign or malignant
destroys breast - needs to be caught early
32
Who gets cystosarcoma phyllodes more often
60+, genetically linked
| can arise from fibroadenoma
33
intraductal papilloma
spontaneous UNILATERAL nipple discharge
masses RARE
usually benign but similar to carcinoma
34
fat necrosis
bruised/dead tissue in breast
| can be delayed from trauma
35
Stellate lesion***
think cancer or fat necrosis***
36
Prolactinoma Dx***
keep prolactinoma on Dx but dont go to it first
order mammogram and blood tests first***
order MRI of pituitary if evidence (prolactinoma)
37
Most common cause of Mastitis and abscess***
Staph aureus*** --> SYSTEMIC symptoms
38
When is tamoxifen used?
severe cases of fibrocystic lesions
39
Paget's Disease of Nipple
malignant ductal cells invading to epidermis
| looks like psoriatic rash from nipple
40
Skin dimpling
tumor on Cooper's ligament
41
Peau d'orange
edema of breast skin
| causes: lymphatic blockage, mastitis
42
What is hallmark of inflammatory carcinoma of breast?
Peau d'orange (plug dermal lymphatics)
43
When does PMS occur
during LUTEAL phase of menstruation
to to 75% of women
interfering
44
PMDD
premenstruation dysphoric disorder
DEBILITATING
up to 10%
45
What is the ABCD classification (Abraham's)
Diagnostic for PMS
46
Dx of PMS***
symptoms for at least 2 consecutive cycles!***
| diagnosis of exclusions
47
What can anemia and hypothyroidism cause?
depression and lethargy
48
Hormonal changes during PMS and when*
prior to menses
estrogen/progesterone levels
Low endorphins - LUTEAL***
49
What can B6 deficiency cause?
impair estrogen metabolism-->fluid retention
low prostaglandins (moderate hormones)
affects serotonin and melatonin levels
50
What is serotonin produced from
Tryptophan
51
What can serotonin deficiency affect?
sleep
menstruation
carb metabolism
52
Normal metabolism and serotonin
eat carb --> tryptophan in brain --> serotonin release --> high serotonin --> protein craving -->eat protein --> lowers serotonin --> triggers carb craving
53
Abnormal metabolism and serotonin
insufficient serotonin release from tryptophan --> no craving for protein --> continued carb craving
54
What worsens PMS
saturated fat, sugar, caffeine
55
How can sugar and caffeine affect hormones?
deplete B vitamins and minerals (makes prostaglandins)
56
Tx of PMS
```
Diet and exercise
vitamin supplement (E, B6, Zinc, C, Ca)
herbal supplement (primrose oil, Gringko, chasteberry, St. john's wort)
```
57
what drugs do St. John's worts act like?
SSRIs
58
How can diuretics help PMS? (ex: HCTZ)
decrease fluid retention
59
Typical Antidepressants/NSAIDs for PMS***
Prozac
Zoloft
Serafem
Ibuprofen
60
Core symptoms of PMDD
Markedly depressed mood
anxiety, tension, "on edge"
DEBILITATING*** and destroys relationships
61
Standard test for PMS***
NONE
62
Drug Tx for PMS***
Oral contraceptives, antidepressants
| but first counsel: diet, exercise, sleep
63
Dx for PMS***
Pt chart symptoms for 2 cycles
64
When during menstruation does PMS occur?
Luteal phase (1-2wks before menses)
65
DMS-5 diagnostic criteria for PMDD
1 year of symptoms
| need 1: markedly depressed mood/anxiety/affect lability/anger
66
Difference between PMS and PMDD
PMDD: primarily mood
PMS: primarily physical
67
Why is Dx of PMDD difficult?
high comorbidity
| take good Hx and find out relationship to menstruation
68
Acute Pelvic pain
<3 months
69
Most severe causes of acute pelvic pain and their complications if missed Dx***
ectopic pregnancy: death***
| PID: infertility
70
Chronic Pelvic Pain
nonmenstural; >3-6months
common: 1/7 women
up to 70% multi-factorial
most common reproductive age
71
Differential Dx of Acute Pelvic pain***
```
PREGNANCY***
ectopic pregnancy***
cervicitis***
PID***
CANCER***
appendicitis
UTI
```
72
Common causes of chronic pelvic pain
```
endometriosis
pelvic adhesion (from surgery)
irritable bowel syndrome
interstitial cycstitis
```
73
Leiomyoma
uterine fibroids
can be anywhere in uterus
acute pain when disintegrate
74
Hydrosalpinx
obstructed fallopian tube with fluid accumulation
| can cause acute pain
75
PID
Pelvic inflammatory disorder: general term for infection of uterus, fallopian tube, ovaries
76
Salpingitis
inflammation to fallopian tube
77
Ectopic pregancy
fertilization in fallopian tube
| fatal if ruptures
78
vaginismus
involuntary contraction of pelvic muscles
79
Chandelier's sign
cervical motion tenderness of PID during pelvic exam
80
loss of pelvic muscle support causes
cystocele
| rectocele
81
What is a significant effect of chronic pelvic pain?
significant impact of woman's daily functioning and relationship
(pain becomes illness)
(episodic or continuous)
(no obvious pathology)
82
pelvic congestion syndrome
varicose veins in pelvis
| can cause chronic pelvic pain
83
chronic pelvic pain Dx
good history and physical exam!
84
Dx method for severe abdominal w/o cause
abdominal laparoscopy
85
Tx for chronic pelvic pain
goal is NOT pain free but pain management --> be up front w/pt - hollistic
be careful w/NSAIDs dosage: can cause GI bleed and renal failure
86
Tx for neuropathic pain of chronic pelvic pain
antidepressants (SSRIs, TCAs)
gabapentin
pregabalin
87
Tx for CYCLIC pain of chronic pelvic pain
```
oral contraceptives
intrauterine devices (IUD)
```
88
last resort of chronic pelvic pain
hysterectomy
89
Dyspareunia
painful intercourse
90
Most common cause of dyspareunia
vulvovaginitis
91
dysplasia
abnormal cell growth/development
92
hyperplasia
increase in number of cells
| usually adaptive response to demand for increase tissue function
93
neoplasia
new cell growth
| accelerate/uninhibited division/growth of abnormal cells
94
Benign vs Malignant neoplasia***
Benign: well-differentiated, slow, localized, clear demarcations
Malignant: poorly-differentiated, fast growth, invasive, unclear margins
95
Most cancers are?
Monoclonal! arise from single cell
96
carcinoma vs sarcoma
carcinoma: epithelial cell origin
sarcoma: connective tissue origin
97
direct spread vs metastasis
direct spread: invasion of surrounding tissue
| metastasis: invasion of vessels/lymph
98
TNM classification of cancer***
Tumor: size of primary (T0-T4)
Nodes: number of Lymph nodes (N0-N4)
Metastasis: M0 none, M1 present
*lower the stage, better the prognosis
99
Strongest cause of Vaginal/Vulva cancer
HPV
100
Types of malignant vulva disorders
Vulvar intraepithelial Neoplasia (VIN): epithelial cells
Paget's Disease: basal cell layer
Vulvar carcinoma: squamous cells
101
VIN III
involved all epithelial layers
| aka "carcinoma in situ"
102
Classification of VIN
classify by depth and epithelial cell maturation, can become invasive:
VIN I: most mature, partial thickness, mild dysplasia
VIN II: moderate dysplasia
VIN III: least mature, full thickness, severe dysplasia
103
VIN and Vulvar cancer S/S
asymptomatic
chronic pruritus (itching), palpable lumps
progression more likely w/elder/immunocompromised
104
What is present in 1/3 of patients w/VIN and vulvar cancer?***
second malignancy (cervical or vaginal)***
105
Dx of VIN/vulvar cancer
Physical exam
vulvoscopy
biopsy
106
Tx of VIN
Surgical excision w/wide margins
look for additional cancers
has frequent recurrence (follow up)
107
Risk factors of vulvar cancer
multiple sex partners, HPV (worts), smoking
108
Difference between VIN occupying non-hairy cells and hairy cells
non-hairy: epithelial disease
| hairy: greater depth of destruction
109
presentation of Paget's disease of vulva
pruritus, vulvar soreness
eczematoid appearing lesion
looks like psoriasis
110
Extensive disease presentation of Paget''s disease of vulva
Raised, velvety, weepy lesion
111
Tx of Paget's disease of vulva
surgical wide excision (high recurrence) or complete vulvectomy
112
Nodal involvement of Paget's disease of vulva
could be FATAL
113
What is present with 1/3 of patients w/Paget's disease of vulva?***
second neoplasm (cervical or vaginal)
114
Paget's disease of breast
rare breast cancer: starts on nipple, extend to areola
115
Late lesion of Vulvar cancer presentation
cauliflower-like, hard ulcerated area
| usually delay reporting symptoms
116
What cells do vulvar cancer affect?
90% squamous cells
117
Tx of Vulvar cancer
excision
radical node dissection
irradiation
chemotherapy
118
Tx of stage IV vulvar cancer
radical vulvectomy, pelvic exenteration (remove all organs)
post surgical radiation
left w/colostomy, urinary diversion
LIFE CHANGING Dx
119
Most common vagina cancer
extension of cervical cancer
120
What cell type is affected in vaginal cancer?
85% squamous
121
Most common distant metastasis of vaginal cancer?
liver and lungs
122
15% of vaginal cancer in 17-21 yo's get what?
adenocarcinoma (increase in metastasis)
123
Dx of vaginal cancer
Look and feel vaginal walls during pelvic exam
biopsy vaginal lesion
mandatory cervical biopsy
rule out vulvar cancinoma
124
Effects of chemotherapy on vaginal cancer***
HAS NOT BEEN SHOWN TO CURE***
| use radiation therapy
125
What is cervical cancer strongly associated with?***
HPV***
126
Most common HPV serotypes associated with cervical cancer*
HPV Serotype 16, 18*
127
Most common gynecologic malignancy***
endometrial cancer***
128
Endometrial cancer TRIAD***
Obesity
HTN
DM
129
What increases risk of endometrial cancer
increased estrogen
| nulliparity
130
Endometrial cancer Sx***
>60% abnormal uterine bleeding***
| uterus can be enlarged, hard, fixed
131
Menopausal or postmenopausal women w/abnormal bleeding***
MUST evaluate for endometrial cancer***
132
Uterine sarcoma derived from which tissue types?
leiomyosarcoma: from myometrial muscle
| mesodermal and stromal sarcoma: from endometrial epithelium (can have teeth, bones, cartilage, etc)
133
Uterine sarcoma presentation
usually after 40yo
| rapid enlargement of uterus or mass
134
Highest mortality rate of all gynecologic cancers
ovarian cancer (but only 5% of cancers in women)
135
Main risk factor of ovarian cancer
exposure to estrogen
136
Syndromes w/40% lifetime risk of developing ovarian cancer
Lynch II syndrome: cancer of colon, breast, endometrium, ovary w/HNPCC
Breast-ovarian cancer syndrome: BRCA1, 2 mutation
137
Types of ovarian cancer
epithelial
germ cell
sex chord and stromal
metastic
138
Primary mode of dissemination of epithelial ovarian cancer***
implantation on peritoneal surfaces***
139
Ovarian cancer presentation***
ASYMPTOMATIC UNTIL WELL ADVANCED***
| symptoms don't become apparent until tumor compress/invade adjacent structures, ascites develop, or evident metastasis
140
Sister Mary Joseph Nodule
metastatic implant in umbilicus
141
screening for ovarian cancer
bimanual exam best even though low sensitivity and specificity
palpable only with advanced disease...
142
Benign ovarian tumors***
tend to be cystic, smooth, unilateral, mobile
143
Malignant ovarian tumors***
tend to be solide, nodular, bilateral, immobile/fixed
144
What lab result is elevated in ovarian cancer?***
Ca-125 (postmenopausal women, advanced stage)
| ^serum tumor marker
145
Ovarian cancer prophylaxis in high risk women
recommend bilateral salpingo-oophorectomy by 40 yo
| BRCA: surgery by 35 yo
146
Neuropeptide Y
stimulate pulsatile release of GnRH --> gonadotropin
| but in absence of estrogen: inhibit gonadotropin release (undernutrition)
147
Angiotensin II
receptors in pituitary
| influence EPI/NE in hypothalamus --> changes gonadotropin and prolactin release
148
Somatostatin
hypothalamic peptide
| influence growth hormone, prolactin, TSH from pituitary
149
Galanin
released in portal circulation of pituitary
increases LH
inhibited by: dopamine, somatostatin
stimulated by: TRH, estrogen
150
Activin and Inhibin
produced by gonads
growth factor beta family
Inhibin: decreases FSH, +conversion: progesterone
Activin: increases FSH, + conversion: estradiol
151
Follistatin
inhibit FSH synth and release
inhibit FSH response to GnRH
binds to activin to inhibit
152
Melatonin
pineal gland
converted from tryptophan
inhibits GnRH
increase at night
153
Leptin
```
produced by adipose cells
INCREASE GnRH release in hypothalamus
negatively correlated w/DHEA
increased in obesity
role in implantation
```
154
Kisspeptin (KISS1)
stimulate GnRH
KISS1 neurons innervate GnRH neurons in hypothalamus
mediates sex hormone feedback
role in initiating puberty
155
Arcuate nucleus
secretes most of GnRH in hypothalamus
156
Reproductive cycle vs Sexual cycle
Reproductive: after fertilization to birth
Sexual: occurs every month in absence of pregnancy (ovarian and menstrual cycles)
157
Ovarian cycle vs Menstrual cycle
Ovarian: events in ovaries
Menstrual: concurrent events in uterus
158
What inhibits and stimulates GnRH?***
Inhibits: DA/S, GABA, opioid Beta endorphin, CRH
Stimulates: EPI/NE, leptin, NPY, Galanin
159
What happens when GnRH release rate and amplitude is decreased or increased?
Wont ovulate, FSH/LH not released! very specific
160
estradiol effect on GnRH
Decreases amplitude of GnRH (neg feedback)
161
Progesterone effect on GnRH
Decreases frequency of GnRH (neg feedback)
162
Day 1 of menstrual cycle
first day of bleeding
163
What hormones are in birth control pills?
estrogen and progesterone (balance each other; progesterone stops ovulation)
164
Normal pH of vagina and what makes vagina more receptive to sperm?
vagina acidic
| LH makes vagina more basic --> better for sperm
165
What does LH do?
thickens mucus and makes vagina more basic
166
Most fertile age of women
23-25
167
Age most likely to have twins
mid to late 30s
168
What does estrogen do in the beginning of follicular phase? (Day 1-7)
inhibit FSH/LH release, negative feedback
169
What does estrogen do later in the follicular phase
triggers LH --> ovulation
| becomes POSITIVE feedback
170
What does LH before ovulation do?
stimulate follicle to secrete progesterone
171
what does the low level of progesterone immediately before ovulation do?
FSH SURGE
| positive feedback of estradiol in increasing LH
172
What does FSH surge do?
- matures oocyte to meiosis I
- produce proteolytic enzymes for follicle release
- increases LH receptors in ovaries to increase progesterone during luteal phase
173
What does LH surge do?
- follicular rupture: increase intrafollicular proteolytic enzymes
- luteinization of granulosa and theca cells --> inc progesterone
- influx blood vessel to follicle to prepare transition to corpus luteum
174
What does the corpus luteum do after ovulation?
high secretion of estrogen and progesterone inhibits GnRH and gonadotrophs
175
What happens as corpus luteum dies off?
hormones levels subside
176
What happens to eggs by age 37?
90% depletion!
177
What hormone stimulates completion of Meiosis I and produce secondary oocyte and 1st polar body? (stops right before fertilization)
FSH during ovulation
178
What happens to the egg right after fertilization?
Meiosis II and release of second polar body
179
What causes the corpus luteum to become corpus albicans?
if no secretion of hCG
180
What state is the egg before menarche?
primary oocyte
181
What hormone binds to granulosa cells?
FSH
182
What hormone binds to thecal cells?
LH
183
Antrum
develops around oocyte as follicle matures
184
What hormone is at the highest concentration right before ovulation?
Estradiol
185
What is the pregnancy hormone that inhibits LH, FASH?
progesterone - measured in ovulation kits
186
When does oocyte degenerate?
12-24 hrs after ovulation of not fertilized
187
Graafian follicle
only one egg becomes graafian follicle, prepares to ovulate
188
What stage of meiosis is the ovulated egg stopped at?
Metaphase II
189
Tunica albuginea
covers surface of ovaries
190
What phase does corpus luteum become corpus albican in the absence of pregnancy?
premenstrual phase
191
Two cell theory
Theca produce androgens and granulosa cells convert androgens to estrogen
192
What hormone thickens endometrium and what triggers shedding?
estradiol thickens
| progesterone sheds
193
What level of progesterone indicates occurence of ovulation?
> 3ng/mL, secretory phase
194
Estriol
pregnancy hormone
195
Estrone
postmenopausal estrogen
196
catechol estrogens
increase w/low body weight and hyperthyroidism
197
What cell produces activin and inhibin?
granulosa cells
198
What are true androgens?***
testosterone and dihydrotestosterone
only ones bind to androgen receptors
converted from DHEA and ANDROSTENEDIONE
199
What hormone is implicated in CAH?
17-hydroxyprogesterone
200
What test to order to check Menopause?***
FSH!!! will be HIGH
201
embryonic age
first day of fertilization, ovulation age
202
gestation age
2 wks longer than embryonic
203
Paramesonephric duct
Mullerian, Female
204
Mesonephric duct
Wolffian, Male
205
Differentiation
Male development, active, requires androgen + MIF
206
Development
Female development, passive
207
What are three developmental defects?*** (identify them)
agenesis
lateral fusion defects
vertical fusion defects
208
Agenesis
MRKH Syndrome
| ex: mullerian duct doesnt develop --> no cervix, uterus, vagina, tubes
209
Lateral fusion defects***
Mullerian ducts dont fuse --> various effects
210
Didelphys
double uterus, can get pregnant
| fusion failure
211
complete uterus didelphys
2 cervix, uterus, vagina
212
Bicornuate uterus
heart shaped uterus, normal pregnancy
| partial fusion
213
unicornuate uterus***
destruction of one mullerian duct
almost always MISSING KIDNEY AND URETER ON SAME SIDE***
pregnancy loss
214
Most common type of developmental defect***
septate uterus***
indented fundus
failure of reabsorption of septum
215
Vertical fusion defects
vagina and cervix abnormalities
216
What should you check w/mullerian abnormalities?***
50% renal anomalies
| 12% skeletal
217
CAH
ambiguous genitalia
too little cortisol so ACTH increased --> too much androgens
also little aldosterone
218
hydrocolpos
distention of vagina w/fluid
219
hematocolpos
accumulation of menstrual blood in vagina
220
effects of imperforate hymen
hydrocolpos
| hematocolpos
221
Time of presentation w/reproductive defects
birth
puberty
pregnancy
222
Acquired structural abnormalities***
fibroids
uterine adhesion
cervical insufficial, short cervix
223
Uterine fibroids
leiomyomas
benign smooth muscle growths
most asymptomatic, can go away on their own
224
incidence of uterine fibroids
3/4 of women in 30s!
225
pedunculated fibroids
outpouching of wall, hangs
226
Uterine adhesions
Asherman syndrome
scar tissue
can be asymptomatic
227
cervical insufficiency
premature cervical opening during pregnancy
more likley bc of short cervix
tx: can suture during pregnancy
228
Hirsutism
abnormal hair growth w/excessive androgens (female)
229
Polycystic Ovarian Syndrome features
excessive androgens
ovulatory dysfunction
polycystic ovaries
230
What is POS strongly associated with?
obesity
231
POS onset***
progressive onset at puberty
| NOT sudden
232
Hormonal changes w/POS
Suppressed FSH, elevated LH
Inc insulin (insulin resistant)
theca over produce androgens
233
What is PCOS at increased risk for?***
Endometrial cancer (3x)
234
What is NOT typical of PCOs?***
true virilization!
235
What is ovulatory bleeding suggested by?
premenstrual symptoms (mood, fluid retention, tender breasts)
236
acanthosis nigricans
discoloration of skin folds from hyperinsulinemia
237
What is NOT associated w/PCOS
true virilization
cliterohypertrophy
galactorrhea
238
Rotterdam criteria for PCOS
```
Need 2/3:
irregular menses
excessive androgen
polycystic ovaries
exclude all other
```
239
Tx PCOS
```
Weight loss
Oral contraceptives (infertile) --> suppress LH
```
240
most common cause of pelvic relaxation?
childbirth
241
episiotomy
surgical cut through levator ani during childbirth
242
atrophic vaginitis
lose labial fold
| skin looks white
243
Genuine stress incontinence
leak urine
| trauma, pelvic prolapse, drugs relax sphincter
244
Detrusor instability/urge incontinence
losing all urine
| overstimulation of detrusor
245
Overflow incontinence
reduced sensation of full bladder, leaking
| cant stimulate detrusor
246
interstitial cystitis
chronic pain and pressure in bladder
247
What does interstitial cystitis NOT have?
incontinence!
248
How to definitive Dx leiomyoma?***
transvaginal ultrasound
249
Triad of ectopic pregnancy***
amenorrhea
irregular vaginal bleeding
pelvic pain
250
Dysfunctional uterine bleeding caused by?***
90% by anovulation
251
How to Dx Dysfunctional Uterine Bleeding?
Hysteroscopy and endometrial biopsy
252
Dysfunctional Uterine Bleeding Tx
NSAIDs, High dose estrogen, OCP
| depends on underlying cause
253
Dysfunctional Uterine Bleeding Tx adolescent
just watch if no anemia
254
Biggest thing to rule out in secondary amenorrhea
pregnancy
255
Number 1 cause of hypothalamic disorders*
systemic stresses: excessive weight loss, exercise, emotional distress
256
What does hypothalamic disorders cause?
low GnRH
257
Endometriosis
endometrial tissue outside of uterus
estrogen dependent, benign
in reproductive popu.
258
three forms of endometriosis
pelvis endometriosis
ovarian endometrioma
deeply infiltrating endometriosis
259
most common symptoms of endometriosis
dysmenorrhea
dyspareunia
chronic pelvic pain
260
Gold standard endometriosis Tx
hysterectomy, but permanent
261
Endometriosis Dx
1st line: U/S
| Gold standard: laparoscopy
262
Tx goal for endometriosis
relief pain and reserve fertility bc most found in reproductive women
263
Adenomyosis
ectopic endometrial tissue grow down into myometrium
| perimenopausal women
264
Gold standard Tx for adenomyosis
hysterectomy (also 1st line)
265
What is a common change in squamous cells of vulva, vagina, cervix?
HPV
266
What cell type does vulva neoplasia target?
squamous
267
What age group is affected by vulvar cancer?
postmenopausal
268
What vulvar disease looks like psoriasis?
Paget's disease
269
Psoriasis of vulva Tx
Steroids
270
Verrucous Carcinoma
cauliflower lesions
| chewing tobacco
271
Invasive Squamous Cell Carcinoma
induration, thickened skin, ulceration
| hurts
272
Sarcoma S/Sx
rapidly expanding and painful
273
possible dx for inflammed vulvar lesions
Fungi
Folliculitis: staph.
Cancer
reactive vulvitis: physical/chem irritation
274
Leukoplakia
white lesions
hyperkeratosis
avascularity
275
What is mandatory for white/dark lesions
BIOPSY
276
Vitiligo v Lentigo
Vitiligo: white
Lentigo: dark, freckle
benign
277
Nevi
moles
278
Wet mount
KOH
fungus
yeast
279
Vaginal pH of bacterial vaginosis or Trich?
>5.0
280
Vaginal pH of fungal infection or physiological discharge?
<4.5
281
Do postmenopausal women get yeast infections?
No but can get atrophic vaginitis
282
Atrophic vaginitis
vaginal inflammation from thinning of tissue, decreased lubrication
from low estrogen
283
Lichen planus (psoriasis)
inflammatory, autoimmune
| mucous mem.
284
erosive lichen planus and Tx
glassy, bright red erosions on vulva, vagina
can bleed, yellow discharge
Tx: testosterone/corticosteroid cream, tacrolimus
285
lichen sclerosis
vulva, no vagina
286
Candida vaginitis
thick, curd-like vaginal discharge
| itching
287
intertrigonal candida
skinfolds
288
Tx for Candidas albicans, tropicalis, glabrata
a: PO diflucan (hyphae and buds)
t: Terazol (hyphae)
g: nystatin, azole resistant (buds)
289
Organism that common causes BV
Gardnerella vaginalis
290
recurrent candida Tx
nystatin
291
What is BV similar to?*
Trich but same Tx
292
Dx criteria for BV
Clue cells
ph >4.5
"whiff" test
thin homogenous discharge
293
Flora change in BV
shift from lactobacilli to anaerobic
294
BV Tx
metronidazole
| clindamycin
295
"strawberry cervix"
trichomonas (women more symptomatic)
| 5%
296
Trichomonas SSx
copious discharge, can be frothy
| 50% irritation, dysuria
297
Trich Tx
Metronidazole
298
Fitz Hugh Curtis Syndrome
GC or chlamydia move from fallopian tube to diaphragm; RUQ pain
299
Leiomyoma v. adnexal masses
Leiomyoma: central/uterine
Adnexal: more lateral
300
Uterine sarcoma
Uterine malignancy - not common (endometrial ca more common)
301
Leiomyoma are dependent on what hormone?
estrogen
302
Classifications of leiomyoma (in to out)
submucous
intramural
subserous
303
What is significant about ovaries 5 years after menopause?
should not be palpable!
304
functional v. complex cysts in the ovaries
function: fluid filled, benign
complex: multi-chamber, solid/semi-solid; more likely malignant
305
What test to order in all post-menopausal ovarian cysts?
ca-125
306
Types of functional ovarian cysts
follicular
| luteal
307
Infertility***
failure of a couple to conceive
<35yo: after 12 months trying
>35yo: after 6 months
308
fecundability
probability of achieving pregnancy in 1 month
309
3 most common causes of infertility
ovulatory disorders
fallopian tube problems
sperm/semen problems
310
oligoovulation
infrequent
311
What can scarring of ducts from STI PID cause?
tubal occlusion - infertility
312
1/5 women w/PID (infections) gets what?
infertility
313
Why shouldn't patients "douche"?
can force bacterial vagination infections into upper resp tract
314
asthenozoospermia
reduce sperm motility
315
Teratozoospermia
abnormal sperm morphology
316
azoospermia
no sperm
317
aspermia
no semen
318
Is heat induced infertility reversible?
potentially
319
OTC urinary ovulatory kits test for?
LH --> predict LH surge --> ovulation
320
ovulation serum test detects?
serum progesterone level (ovulation: >3ng/ml)
321
Bodily signs of ovulation
increased temp by 1 F
| cervical mucus thinner
322
What infections are not considered STIs but increase rate of transmission of other STIs/HIV?
BV and candidiasis
323
Ulcers: What STIs should you test for?
herpes and syphilis
324
What infection is not protected by condoms?
HSV, HPV
325
Rash of palms/feet: what do you think of?
Mono, rocky mountain spotted fever, Lyme, syphilis
326
Tabes dorsalis
from neurosyphilis, demyelination of spinal nerves
327
Jarisch-Herxheimer Reaction
fever, headache, myalgia 24hr after starting PCN tx of syphilis
328
Most reported bacterial infection in US
Chlamydia
329
Gonorrhea Tx
2 Abiotics: treat both gonorrhea and chlamydia
| ceftriaxone, azithromycin
330
What can you not ingest before/after BV Tx (metronidazole)
alcohol 24-72hrs
331
Trichomonas and BV Tx
metronidazole
332
Most common STI that doesnt have to be reported?
HPV
333
What are the 5 P's to ask in GYN visit?
```
Partners
Pregnancy
Protection
Practices
Past History
```
334
Chadwick's sign
cyanosis of cervix; early pregnancy
335
How is the endometrium thickened after menses?
mitosis of stratum basalis in proliferative phase
336
How does the endometrium thicken after ovulation?
gland secretion and fluid accumulation in secretory phase
337
Climacteric
transition when ovarian function wanes
338
post menopausal bleeding
6 months after cessation of menses
339
polymenorrhea
cycle shorter than 24 days
340
oligomenorrhea
cycle longer than 25 days
341
hypomenorrhea
bleeding less than 3 days
342
hypermenorrhea
bleeding >7 days
343
gravidity
pregnancy
344
primigravida
experienced first pregnancy
345
Multipara
delivered 2+ times
346
parturient
in labor
347
puerpera
just gave birth
348
What to rule out w/Chancroid by Haemophilus ducreyi
must rule out Syphilis and HSV
| NOT chancre
349
HSV SSx
painful blisters on genitals (butts, thighs)
more likely recurrent than zoster
Raw burning "cut"
350
Tzanck Smear
look for multinucleated cells in HSV, VZV
351
LGV = lymphogranuloma venereum
elephantiasis, enlarged inguinal lymph nodes
352
Congenital syphilis presents with?
```
hutchinson teeth
saddle nose
frontal bossing
(eat away bones)
chancre
```
353
What to check for w/new onset dementia?
Syphilis
354
chancroid
purulent base, bleeds easily
355
disseminated gonococcal infection has pain where?
joints and tendon
356
What to check w/PID
pregnancy
chlamydia
gonorrhea
357
condyloma lata v condyloma accuminata
lata: flat, syphilis
accuminata: HPV
358
Reiter's disease
reactive arthritis
359
colposcopy v LEEP
colposcopy: small biopsy
leep: take whole cervix out
360
monophasic v multiphasic combo OCP
mono: constant doses
multi: varying doses
fertility returns quickly after discontinuation
361
How do combined OCPs work?*
mimicking early pregnancy (estrogen, progesterone)
362
OCP side effects last for how long?
1st 3 months
363
Depo-Provera
3 months effective
injectable
very good and no estrogen
cant be on >2yrs
364
Pros of Depo-Provera
3 months effective
injectable
very good and no estrogen
cant be on >2yrs
365
Cons of Depo-Provera***
return to fertility in 12-18 months
366
emergency contraception mechanism
inhibits/delays ovulation:
Combo OCP
copper IUD (Paragard): within 5 days
plan b very effective: best w/in 12hrs
367
Types of IUD
```
Paragard = copper, 10yrs, spermacidal
LNG = mirena, 5yrs, cervical mucus and endome. atrophy, suppress ovulation
```
368
Pro of IUD
immediate return to fertility after removal
