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Flashcards in Women's Health-Gyn Deck (72):
1

Follicular Phase =

aka Proliferative
Days 1-14 of cycle
**Estrogen predominant

2

Luteal Phase =

aka Secretory
Occurs after ovulation (aka after day 14)
**Progesterone predominant
-made by corpus luteum

3

When is the only time you do PAP before the age of 21?

When you are trying to rule out cervical causes of abnormal bleeding. IE: when there is post-coital bleeding

4

What is menorrhagia and what are ddx

-Heavy menstrual bleeding
DDx:
-Leiomyomas (not painful)
-Adenomyosis (Painful)
-Bleeding disorder
-hyperplasia/carcinoma

5

Ddx of intermenstrual bleeding

-endometrial polyps
-unscheduled bleeding w/ contraceptive use
-endometrial hyperplasia or carcinoma
-infection (pain, discharge)

6

Irregular bleeding ddx

**typically these women are not ovulating**
-ovulatory dysfunction
-common at extremes of repro age
-endocrine disorders (thyroid, PCOS)

7

Indications for endometrial biopsy

-post-menopausal (ie: any bleeding after menopause)
-age >45
-obesity (endogenous unopposed estrogen)
-diabetes (increased risk of endometrial cancer)
-break through bleeding on HT
-infertility
-family history of endometrial or colon cancer

8

Treatment of Abnormal uterine bleeding

-NSAIDs (naproxyn, ibuprofen) start 1 day before menses
-Hormonal manipulation (OCPS, progestin IUD)
-Endometrial ablation
-Hysterectomy
-Acute bleeding

9

What increases risk of endometrial cancer?

Unopposed estrogen
-RF: age, obesity, nulliparity, late menopause, tamoxifen, PCOS, DM, HTN, genetics (lynch and BRCA genes)

10

Most common type of endometrial cancer

-atypical glandular cells on cytology = Adenocarcinoma

11

What is primary amenorrhea?

-lack of menarche by age 16
-no evidence of pubertal onset by 13
-lack of menstruation w/in 2 years of onset of breast development

12

What is Sheehan Syndrome

-Pituitary infarct from post-pregnancy hemorrhage
Ex: Post partum woman breast feeding can't make milk anymore

13

What labs to order to work-up secondary amenorrhea?

-HCG
-TSH
-Prolactin
-FSH
-Progesterone challenge

14

Secondary Amenorrhea w/ Prolactin >200

-Pituitary adenoma (check MRI/CT of sella)

15

Secondary Amenorrhea w/ Prolactin <200

-Medications (antipsychotics, lithium, anticonvulsants)

16

Secondary Amenorrhea w/ high FSH

Ovarian failure

17

Secondary Amenorrhea w/ low or normal FSH

Hypothlamic pituitary ovarian abnormality

18

What does progesterone challenge do?

Checks to see if pt is ovulating
-if she does bleed = everything is functioning just not ovulating

19

Primary Dysmenorrhea

begins soon after menarche
-non-pathologic
Tx: NSAIDs, OCPs

20

Secondary Dysmenorrhea

new onset in an older woman
-organic cause

21

Most common cause of secondary dysmenorrhea =

#1 = Endometriosis
other = cervical stenosis

22

Presentation of endometriosis

-Pain PRECEDES and lasts through menses
-dysparenia
-infertility
-pelvic pain
-abnormal bleeding
Dx via laparoscopy

23

Tx of Endometriosis

ABlation, excision especially if they want to conceive
-Meds = ocps, nsaids, progesterone only, gnrh agonists (lupron, danocrine)

24

Tx of PMS

SSRIs
(reg exercise, avoid sugar and Etoh, NSAIDS)
other = spironolactone

25

Risk factors for cervical cancer

-early age of first coitus
-multiple sexual partners
-HPV 16, 18, 31, 33, 35
-personal hx of cervical dysplasia
-immunocomprised
-smoking (more difficult for immune sys to clear infection)

26

PAP Screen criteria

-age 21 regardless of age of onset of sexual intercourse
-21-29: screen w/ cytology alone every 3yrs **HPV test not recommended**
-30-65: screen w/ cytology and HPV testing every 5yrs (or cytology alone q 3yrs)
->65: discontinue screen if 2neg paps in past 10yrs and no hx of CIN2+ w/in the last 20yrs

27

About Follicular Cysts

Failure of the fluid in an incompletely developed follicle to be reabsorbed
**NORMAL** usually found incidentally on US
-20-25mm in size, clear fluid filled cyst
-usually asymptomatic
Tx: self-limited

28

About Corpus Luteum Cysts

Normal after ovulation
-may or may not be painful
-Typical in 1st trimester of pregnancy
Tx: self-limited

29

About Endometriomas

Associated w/ endometriosis
aka chocolate cyst
-benign
-palpable mass on ovary
-may or may not be painful
Dx & Tx: US and aspiration

30

About Dermoids

Benign germ cell tumor
-usually in young women
-asymp finding on bimanual exam
-CALCIFICATION on US/X-ray
Tx: remove to avoid torsion or bleeding

31

Ovarian Torsion presentation and Tx

Most commonly caused by DERMOIDs
-sudden severe pelvic pain
US w/ doppler to look for blood flow
-surgery is necessary ASAP to preserve ovarian function

32

What is Stein-Leventhal Syndrome

aka PCOS
-Hyperandrogenism
-Insulin Resistance
-Anovulation

33

Clinical Presentation of PCOS

-Infertility
-Chronic Menstrual Irreg (oligomen, endometrial cancer)
-Hyperangdrogenism (acne, hirsuit, male pattern baldness)
-Insulin Resistance (central adip, acanthosis, DM2, CVD)

34

Lab Values in PCOS

-Estradiol = normal
***LH/FSH 3:1***
Free Testosterone >50
Insulin Resistance
Large cystic ovaries on US and physical exam

35

Tx of PCOS

Metformin = tx of choice for insulin resistance
-obesity = lifestyle changes
-Endometrial protection = OCPs
-Ovulation induction = weight loss, pharmacotherpay
-Ovulation induction = weight loss, clomiphene
-Dyslipidemia = weight loss, exercise, statins

36

RF for ovarian cancer

-Age (median = 60)
-First degree relative
-genetic synd
-nulliparity
-high fat diet/obesity

OCP use = protective

37

Screening tests for Ovarian Cancer

Screen those w/ 1st degree relative hx
-Pelvic exam
-CA125 (>35 is abnormal)**alot of things w/ this**
-Transvaginal US

38

Where is the first place ovarian cancer spreads

Omentum

39

What causes vagina and vulva cancer?

30-50% = HPV
Diagnosed on biopsy

40

Normal Vaginal pH

<4.5

41

About BV

**Ph >4.5**
-positive whiff test
-clue cells
Tx: Metronidazole 500mg BIDx 7 days

42

About Candida Vagintiits

RF: abx, pregnancy, OCP use **consider DM screen in recurrent**
-KOH = hyphae
Tx: Conazole creams or fluconazole 150mg PO x 1

43

About Trich

Caused by t. vaginalis
-pH > 6.0
-copious, frothy discharge
-punctate erythem vagin and cervix "strawberry"
Tx: Metronidzole 2g X 1 or 250-500 mg TID/BID x 7 days
**treat partner and also test for other STDs**

44

How to screen for chlamydia

-all sexually active women 25 and younger and other asymp women at increased risk
NAAT-Genprobe intracervical swab
LCT/PCR in urine
Tx: Azithromycin 1gram once or Doxycycline 100mg BID

45

Prsentation of PID

pelvic pain
cervical motion tenderness
dysparenia
symp present around the time of menses
FEVER

46

Labs in PID

elevated ESR, SBC
GC/chlamyd
hCG

47

Tx of PID

Hospitalize for high risk
Outpatient = ceftriaxone + doxy + metronidazole

48

PID Sequelae

-chronic pelvic pain
-dysparenia
-infertility
-ectopic pregnancy

49

Most reliable birth control method?

Mirena/Skyla IUD > Paraguard > Nexplanon

50

Depo Negatives

-6% failure rate
-weight gain, menstrual irreg, depression, **BB: lowers bone density**, fertility delay

51

Progesterone only mini pill indications

tx of choice for breastfeeding women

52

Progesterone only mini pill contraindications

DVT
Liver Dz
Breast cancer

53

Advantages of combo hormonal therapies

-reduce risk of endometrial and ovarian cancer
-decrease dysmenorrhea
-improves acne

54

Disadvantages of combo hormonal therapies

-pills must be taken daily
-no protection from STIs
-CVD: thromboembolism, stroke, MI

55

Contraindications to combo hormonal therapies

-DVT/PE, CVA, CAD, Afib
-severe HTN or vascular/heart disease
-Migraine w/ Aura
-35 years or older and smoker (>15 cig/day)
-Breast cancer
-complicated DM
**Competes w/ seziure meds
-liver dz
-gall bladder dz
-lower efficacy in obese ts

56

What counts as infertility?

35 yrs who fail to conceive after 6 mo

57

Menopause is defined as

12mo of amenorrhea

58

How do you dx menopause

Check FSH and LH
FSH >30-40 (FSHincreases a lot; LH is low)

59

Presenting complaints of menopause

-vasomotor symp
-vaginal atrophy
-depressive symp, insomnia, irritability, lack of concentration

60

Hormonal replacement for menopause

Estrogen only = no uterus
Estrogen and Progesterone = if uterine intact
(lowest dose for shortest amount of time)

61

Benefits of HRT

-osteoporosis prevention
-lipid improvement
-may decrease onset of DM
-reduces colon cancer risk

62

Osteoporosis occurs where?

In trabelucar bone

63

T scores

1.0 to -1.0 = normal
-1.0 to -2.5 = osteopenia
< -2.5 = osteoporosis

64

Most common pathogen in mastitis

s. aureus
-most common reason for fever after immediate peurperium in nursing mothers
*if occurs in non-lactating women, consider cancer*

65

Causes of galactorrhea

-psychotropics
-cimetidine
-TCA
-OCP
-Depo
-CNS lesion (measure prolactin)
-Medical conditions (hypothyroidism)

66

Fibrocystic breast dz

-more painful just before menses and w/ consume of caffeine
Tx: avoid trauma, wear sports bra, NSAIDs, acetaminophen, OCPs, danocrine/lupron

67

Fibroadenoma

**most common etiology of breast lump**
-young women
-benign solid mass
-typically painless or minimally painful

68

What do ALL palpable masses get?

-Mammogram
-US
-consider biopsy

69

RF for breast cancer

>70% have no RF
-age
-family hx in 1st degree relative
-Modest increased risk = nulliparity, 1st preg after 30, menarche at 50, alcohol, obesity, and or high fat diet, tobacco use

70

Mammogram Schedule

-every 1-2 years starting at age 40
-every 1 year after age 50
-Women w/ BRCA1 or 2 may have annual or semiannual clinical breast exams along w/ annual mammography beginning at age 25-35.

71

Most common type of breast cancer

Infiltrating ductal carcinoma
(most lethal = inflamm)

72

Paget Dz of breast

-infiltrating intraductal carcinoma in the nipple and ducts of the nipple
-1st symp = itching or burning of the nipple, therefore usually treated as eczema