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Women's Health-Gyn Flashcards

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1
Q

Follicular Phase =

A

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

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2
Q

Luteal Phase =

A

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

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3
Q

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

A

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

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4
Q

What is menorrhagia and what are ddx

A 
-Heavy menstrual bleeding
DDx: 
-Leiomyomas (not painful)
-Adenomyosis (Painful)
-Bleeding disorder
-hyperplasia/carcinoma
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5
Q

Ddx of intermenstrual bleeding

A
  • endometrial polyps
  • unscheduled bleeding w/ contraceptive use
  • endometrial hyperplasia or carcinoma
  • infection (pain, discharge)
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6
Q

Irregular bleeding ddx

A
  • *typically these women are not ovulating**
  • ovulatory dysfunction
  • common at extremes of repro age
  • endocrine disorders (thyroid, PCOS)
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7
Q

Indications for endometrial biopsy

A
  • 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
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8
Q

Treatment of Abnormal uterine bleeding

A
  • NSAIDs (naproxyn, ibuprofen) start 1 day before menses
  • Hormonal manipulation (OCPS, progestin IUD)
  • Endometrial ablation
  • Hysterectomy
  • Acute bleeding
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9
Q

What increases risk of endometrial cancer?

A

Unopposed estrogen

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

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10
Q

Most common type of endometrial cancer

A

-atypical glandular cells on cytology = Adenocarcinoma

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11
Q

What is primary amenorrhea?

A
  • 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
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12
Q

What is Sheehan Syndrome

A

-Pituitary infarct from post-pregnancy hemorrhage

Ex: Post partum woman breast feeding can’t make milk anymore

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13
Q

What labs to order to work-up secondary amenorrhea?

A
  • HCG
  • TSH
  • Prolactin
  • FSH
  • Progesterone challenge
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14
Q

Secondary Amenorrhea w/ Prolactin >200

A

-Pituitary adenoma (check MRI/CT of sella)

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15
Q

Secondary Amenorrhea w/ Prolactin <200

A

-Medications (antipsychotics, lithium, anticonvulsants)

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16
Q

Secondary Amenorrhea w/ high FSH

A

Ovarian failure

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17
Q

Secondary Amenorrhea w/ low or normal FSH

A

Hypothlamic pituitary ovarian abnormality

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18
Q

What does progesterone challenge do?

A

Checks to see if pt is ovulating

-if she does bleed = everything is functioning just not ovulating

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19
Q

Primary Dysmenorrhea

A

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

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20
Q

Secondary Dysmenorrhea

A

new onset in an older woman

-organic cause

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21
Q

Most common cause of secondary dysmenorrhea =

A 
#1 = Endometriosis
other = cervical stenosis
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22
Q

Presentation of endometriosis

A

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

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23
Q

Tx of Endometriosis

A

ABlation, excision especially if they want to conceive

-Meds = ocps, nsaids, progesterone only, gnrh agonists (lupron, danocrine)

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24
Q

Tx of PMS

A

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

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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

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