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150 Cards in this Set
- Front
- Back
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Contraindications for HRT
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Vaginal bleeding
Breast, endometrial ca. Thromboemboli |
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OCP benefits
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Ovarian, endometrial ca prevention
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OCP serious side effects
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Venous thromboemboli
Stroke Cholestasis, cholestitis DM HTN Hyperlipidemia |
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Primary amenorrhea
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Absence of menses by age 16 w secondary sex characteristics
Absence of menses by age 14 w/o secondary sex characteristics |
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Causes of 1o amenorrhea without breast development
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Constitutional growth delay
1o ovarian insufficiency (Turner's) Central hypogonadism |
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Causes of 1o amenorrhea with breast development
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Mullerian agenesis
imperforate hymen Complete androgen insensitivity |
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Initial tests for 1o amenorrhea
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Pregnancy test
Bone age radiograph |
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Contraceptive methods with side effect of weight gain
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Implanon (progestin-only implant)
Depo-Provera (medroxyprogest injection) |
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Contraceptive safe with breast-feeding
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Progestin-only "minipills"
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Treatment for hypogonadism causing 1o amenorrhea
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HRT followed by cyclic estrogen/progesterone therapy
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2o amenorrhea
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3+ months of amenorrhea after menarche
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Best initial tests for 2o amenorrhea
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Pregnancy test!
TSH and prolactin levels Progestin challenge |
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"Morning-after" pill
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Combined estrogen/progesterone
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"Plan B" pill
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Progestin-only
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Positive progestin challenge
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Withdrawal bleeds
Noncyclic gonadotropin release Eg. PCOS, idiopathic anovulation |
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Negative progestin challenge
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No withdrawal bleeds
Hypogonadotropic hypogonadism Ovarian failure Anatomical problem |
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Causes of premature ovarian failure
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Radiation, chemo, autoimmune, Turner's, Fragile X
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Premature ovarian failure FSH/LH ratio
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> 1.0
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1o dysmenorrhea
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Cyclic menstrual pain without obvious pathology
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Treatment for 1o dysmenorrhea
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NSAIDS, heat, OCP, Mirena coil
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Common causes of 2o dysmenorrhea
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Adenomyosis, endometriosis, fibroids, adhesions, PID, polyps
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Best initial tests for 2o dysmenorrhea
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B-hCG (ectopic)
CBC (infection, neoplasm) UA (UTI) Gono/Chlam swabs |
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Endometriosis
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Endometrial glands/tissue outside of uterus
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Presentation of endometriosis
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Cyclical pain +/- rectal pain, dyspareunia
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Diagnosis of endometriosis and results seen
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Laparotomy/laparoscopy
Blue-black, dark brown lesions Ovarian chocolate cysts |
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Treatment of endometriosis (Rx, surg)
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Rx: DOC-OCPs; leuprolide, danazol, NSAIDS, progestin
Surg: excision/hysterectomy |
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Complications of endometriosis
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Infertility
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Adenomyosis
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Endometrial tissue in myometrium of uterus
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Adenomyosis presentation
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NONCYCLIC pain, menorrhagia, enlarged uterus
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Treatment of adenomyosis
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Rx: NSAIDS + OCPs, progestin
Surg: endometrial ablation, resection; hysterectomy (definitive) |
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Workups for abnormal uterine bleeding
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B-hCG
CBC (anemia) TFT, prolactin Platelet, PT/PTT US (endometrial thickness) |
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When is endometrial biopsy indicated for AUB?
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Endometrium >4cm in postmenopausal women
Age >35 with risk of endometrial hyperplasia |
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Most common cause of AUB, amenorrhea
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Pregnancy!
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Treatment of heavy AUB
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High dose estrogen IV
D&C if bleeding not controlled |
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Treatment of ovulatory AUB
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NSAIDS, OCP, Mirena coil
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Treatment of anovulatory AUB
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Progestins
Desmopressin OCP, Mirena coil |
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Treatment of medicine-resistant AUB
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D&C, hysteroscopy, hysterectomy/ablation
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Congenital adrenal hyperplasia (CAH) presentation in infant female
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Ambiguous genitalia and salt-wasting, hyperglycemia
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CAH presentation in infant males
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Normal
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CAH enzyme deficiency
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21B- or 11B- hydroxylase
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CAH presentation in adult female
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Amenorrhea, hirsutism, cliteromegaly, acne, infertility +/- palpable uterine mass
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Dx for CAH
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Serum testosterone (>2ng), DHEAS (>7ug/mL)
Increased 17OH-progesterone |
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Differentiation between PCOS and mild CAH
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17OH-progesterone elevated in CAH, not in PCOS
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Elevated testosterone in context of CAH
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Suspect ovarian tumour
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Elevated DHEAS in context of CAH
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Suspect adrenal tumour
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PCOS
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Polycystic ovaries
Anovulation Hyperandrogenism |
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Presentation of PCOS
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Obese woman with acne, hirsutism, amenorrhea, male-pattern alopecia, acanthosis nigricans
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Risks of PCOS
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Insulin resistance/DM
Metabolic syndrome Infertility |
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Blood dx for PCOS
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Testosterone, DHEA, DHEAS
TFT/prolactin 17OH-progesterone 2-hr glucose tolerance Lipid panel |
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PCOS sign seen on US
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"Necklace sign" - >8 subcapular follicles
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FSH:LH ratio in PCOS
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>2:1
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Tx for PCOS in women who want to conceive
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Clomiphene +/- metformin (ovary stimulation)
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Tx for PCOS in women who don't want to conceive
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OCPs, progestins, metformin
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Complications of PCOS
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Type 2 DM
Miscarriage Breast and endometrial ca. |
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Tx for asymptomatic Bartholin's cysts
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No treatment, warm soaks
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Tx for Bartholin's abscess
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Aspirate, drain with Word catheter
Culture for STIs (Chlamydia) |
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Secretions during 1) midcycle and 2) luteal phase
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1) Clear, elastic, mucoid
2) Thick and white |
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Bacterial vaginosis diagnosis
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White-grey discharge
Vaginal pH >4.5 Pos whiff test (fishy) Clue cells on wet mount |
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Dx of sexual assault
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STI screen (syph, G/C, HIV, HBV, HCV, CMV)
Pregnancy test BAL and tox screen |
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Presentation of cervicitis
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Yellow-green mucopurulent discharge
Pos chandelier sign (severe cervical motion tenderness) |
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PID causes
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Gonorrhea (1/3)
Chlamydia (1/3) Anaerobes/aerobes (1/3) |
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PID presentation
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Lower abdo pain
Fever, chills Purulent cervical discharge Pos chandelier sign, adnexal tenderness |
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US showing of PID
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Fallopian tube thickening, dilation
Fluid in cul-de-sac Tubo-ovarian abscess Polycystic ovary |
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Outpatient antibiotic regime for PID
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Ofloxacin/levofloxacin +/- metronidazle x 14d
Ceftriaxone IM x 1 dose/cefoxitin + probenecid + doxycyclin +/- metronidazle x 14d |
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Inpatient antibiotic regime for PID
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Cefoxitin/cefotetan + doxycyclin x 14d
Clindamycin + gentamicin x 14d |
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Complications of PID
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Chronic pelvic pain
Infertility Ectopic pregnancy Fitz-Hugh-Curtis syndrome |
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Fitz-Hugh-Curtis syndrome
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Perihepatic adhesions due to PID
RUQ pain Raised LFTs Referred shoulder pain |
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Vaginosis key findings
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Gardnerella vaginalis
White-grey discharge Clue cells on wet mount KOH prep whiff test - fishy |
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Antibiotic regime for bact. vaginosis
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Metronidazole PO/vag
Clindamycin vag |
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Complications of vaginitis
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Chorioamnionitis/endometritis, miscarriage, PID
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Trichomonas key findings
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Thin, green, frothy, smelly discharge
Pruritis, dysuria, "strawberry petechiae" Motile trichomonads on wet mount |
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Antibiotic regime for trichomonas
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Metronidazole PO
Tinidazole PO Treat partners |
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Candida vaginitis key findings
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Thick, white, curdy discharge
Red, itchy vulva/vagina KOH prep: hyphae |
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Risk factors for Candida vaginitis
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Corticosteroids, DM, pregnancy, broad-spectrum antibiotics
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Tx for Candida vaginitis
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Azole topical
Fluconazole PO |
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Toxic shock syndrome presentation
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Fever (>38.9), vomiting, watery diarrhea
Diffuse maculopapular rash Desquamation of palms and soles |
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TSS treatment
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Rapid rehydration
Nafcillin, oxacillin/vancomycin Corticosteroids |
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Causes of death due to TSS
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Hypotension
Hemorrhage 2o to DIC ARDS |
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Uterine leiomyoma/fibroids
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Benign, smooth muscle tumour of uterus
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Uterine leiomyoma presentation
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Discrete, round, firm tumours
Irregularly enlarged uterus E/P sensitive Bleeding, pelvic pressure, pain |
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Workups for uterine leiomyoma
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CBC (anemia)
US MRI (submucosal vs. intramural) |
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Tx for uterine leiomyoma
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OCP, medroxyprog, danazol, leuprolide/nafarelin
Surgery (hysteroscopic myomectomy vs. hysterectomy) |
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Complications of uterine leiomyoma
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Acts at IUD: infertility
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Aetiology of Type I endometrial ca.
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Unopposed estrogen stimulation (eg. tamoxifen, HRT)
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Aetiology of Type II endometrial ca
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p53 mutation
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Type I vs II endometrial ca.
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Type I - adenoca.
Type II - serous, clear cell |
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Dx of endometrial ca.
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Pelvic US
Biopsy |
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Tx of endometrial ca.
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High dose progestins for childbearing women
TAH, BSO with radiation/chemo |
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Fibrocystic disease presentation
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Cyclic, bilateral breast swelling, pain
Rapid change in mass size Irregular, bumpy consistency of breast |
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Dx of fibrocystic change
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US, FNA (also therapeutic)
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When is excisional biopsy of cystic mass is indicated?
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Solid cyst
No fluid or bloody fluid in cyst |
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Tx of fibrocystic disease
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F/U q1m for 3 mths
No caffeine OCPS |
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Common causes of bloody nipple discharge
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Mammary duct ectasia
Intraductal papilloma |
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Most common breast lesion in women <30 yo
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Fibroadenoma
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Fibroadenoma presentation
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Solitary, rubbery, discrete, mobile, non-tender mass 1-3cm in diameter
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Dx for fibroadenoma
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US, FNA
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Tx fibroadenoma
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Excision, but high recurrence rate
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Risk factors for brca
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Female, age
Estrogen exposure 1st deg. FHx of br.ca. BRCA-1/2 gene |
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Early brca findings
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Hard, non-tender mass with irregular margins
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Later brca findings
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Skin and nipple retraction
Aaxillary lymphadenopathy Redness, pain, fixation to skin |
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Late findings of brca
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Ulceration
Supraclavicular lymphadenopathy Paget's disease of nipple Lung, bone, liver mets Arm edema |
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Indication for core needle biopsy
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Receptor status
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Advantage of open excisional biopsy
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More accurate diagnosis + tumour resection
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Tumour markers for brca
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CEA
CA 15-3 CA 27-29 |
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Rx of ER+ brca in postmenopausal women
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Tamoxifen
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HER2/neu receptor antagonist used in brca
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Trastuzumab
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Side effect of trastuzumab and necessary workup
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Cardiotoxicty - need EKG
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Surgical tx of nonmetastatic brca
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Lumpectomy with axillary clearance + radiation
Radical mastectomy + radiation |
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Complications of brca
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Pleural effusion
Arm edema |
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Early presentation of vulvar cancer
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Pruritis, ulceration, pain
White, pigmented, raise, thickened lesion |
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Late presentation of vulvar cancer
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Cauliflower-like lesion or hard ulcerated lesion on vulva
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Dx of vulvar cancer
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Bunch biopsy for suspicious lesions or recurrent pruritis
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Tx of vulvar cancer
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Local disease: Excision, ablation, vulvectomy
Invasive: radical vulvectomy with lymphadenectomy + radiation/chemo |
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Presentation of vaginal ca.
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Abnormal vaginal bleeding, abnormal discharge, post-coital bleedings
Lesion found on upper 1/3 of vagina |
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Dx of vaginal ca.
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Cytology, colposcopy, biopsy
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Tx of vaginal ca.
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Local excision, vaginectomy
Invasive disease needs radiation |
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Risk factors for ovarian ca.
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Estrogen exposure
FHx BRCA-1/2 gene Lynch syndrome |
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Late presentation of ovarian ca.
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Abdo pain, palpable adnexal mass, ascites, bloating
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Tumour marker for ovarian ca. and usefulness
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CA-125; more specific in postmenopausal women
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Best initial test for ovarian ca.
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Transvaginal US
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Tx of ovarian mass in premenopausal women
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Benign masses <8-10cm: obs
Masses >8-10cm: surgery |
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Tx of ovarian mass in postmenopausal women
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Benign mass <5cm: F/U with US, CA-125
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Tx of ovarian cancer
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TAH/BSO with omentectomy and lymphadenectomy
Postop chemo and radiation |
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Tx for dysgerminoma
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Radiation
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Tumour marker for yolk sac tumour
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AFP
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Marker for embryonal carcinoma
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AFP, hCG
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Marker for choriocarinoma
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hCG
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Marker for dysgerminoma
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LDH
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Marker for granulosa cell tumour
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Inhibin A
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Tx for uterine prolapse
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Pessaries; vaginal/abdo hysterectomy with vaginal vault suspension
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Stress incontinence
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Due to increased intraabdominal pressure
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Mechanism of stress incontinence
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Laxity of pelvic floor causing urethral sphincter insufficiency
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Urge incontinence
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Strong, unexpected urge to void unrelated to activity or position
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Mechanism of urge incontinence
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Detrusor hyperreflexia, sphincter dysfunction, neurogenic disorders
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Mechanism of overflow incontinence
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Chronically filled bladder with increased intravesical pressure - small amts of urine dribble out
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Dx of incontinence
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UA for UTI
Urodynamic testing Serum creatinine/GFR Cystogram |
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Causes of infectious vulvovaginitis in paeds
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GAS, Candida, STIs
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Presentation of vulvovaginitis
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Smelly, yellow-green purulent vaginal discharge
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Sarcoma botryoides
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Rhabdomyosarcoma of vagina, "bunches of grapes" lesions
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Precocious puberty
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Onset of 2o sex characteristics <8yrs
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Precocious puberty with breast development, vaginal bleeding
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Suspect ovarian cyst/tumours
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Precocious puberty with cliteromegaly, pubic/axillary hair, acne
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Suspect adrenal tumours, CAH
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Dx of precocious puberty
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Bone age scan
Leuprolide stimulation test |
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Positive leuprolide test in precocious puberty + treatment
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Central cause, treat with leuprolide
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Neg leuprolide test in precocious puberty
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Peripheral cause (ovarian cysts, CAH, adrenal/ovarian tumours)
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McCune Albright syndrome + treatment
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1) Precocious puberty
2) Polyostotic fibrous dsyplasia 3) Cafe-au-lait spots Tx: tamoxifen, ketoconazle (estrogen synthesis blocker) |
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Lichen sclerosis
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Inflammatory pruritis, dysparenunia,
Porcelain-white polygonal macules/papules Atrophic, thin skin |
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Risk associated with lichen sclerosis
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Vulvar SCC
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Presentation of androgen insensitivity syndrome
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1o amenorrhea
Breast development with no axillary/pubic hair Blind vaginal pouch, testes present |
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Increased risk associated with androgen insensitivity syndrome
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Testicular cancer
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