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114 Cards in this Set
- Front
- Back
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the first test to perform when a woman presents with amenorrhea
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B-HCG; the most common cause of amenorrhea is pregnancy
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term for heavy bleeding during and between menstrual periods
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menometrorrhagia
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cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C
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Asherman's syndrome
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therapy for PCOS
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weight loss and OCPs
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medication to induce ovulation
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clomiphene citrate
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diagnostic step required in a postmenopausal woman who presents with vaginal bleeding
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endometrial biopsy
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indications for medical treatment of ectopic pregnancy
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stable, unruptured ectopic pregnancy of <3.5cm at <6 weeks gestation
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medical options for endometriosis
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OCPs, danazol, GnRH agonists
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laparoscopic findings in endometriosis
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"chocolate cysts", powder burns
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the most common location for an ectopic pregnancy
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ampulla of the oviduct
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how to diagnose and follow a leiomyoma
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ultrasound
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natural history of a leiomyoma
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regresses after menopause
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a patient has increased vaginal discharge and petechial patches in the upper vagina and cervix
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Trichomonas vaginitis
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treatment for bacterial vaginosis
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oral or topical metronidazole
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the most common cause of bloody nipple discharge
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intraductal papilloma
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contraceptive methods that protect against PID
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OCP and barrier contraception
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unopposed estrogen is contraindicated in which cancers?
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endometrial, estrogen receptor-positive breast cancer
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a patient presents with PID and RUQ pain
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Fitz-Hugh-Curtis syndrome
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breast malignancy presenting as itching, burning, and erosion of the nipple
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Paget's disease
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annual screening for women with a strong family history of ovarian cancer
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CA-125 and transvaginal ultrasound
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A 50 year old woman leaks urine when laughing or coughing. Non-surgical options?
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Kegel exercises, estrogen, pessaries for stress incontinence
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A 30 year old woman has unpredictable urine loss. Examination is normal. Medical options?
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anticholinergics (oxybutynin) or B-adrenergics (metaproterenol) for urge incontinence
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lab values suggestive of menopause
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increased serum FSH
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the most common cause of female infertility
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endometriosis
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Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow up evaluation?
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colposcopy and endocervical curettage
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breast cancer type that increases the future risk of invasive carcinoma in both breasts
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lobular carcinoma in situ
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medical management for ectopic includes what drug?
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methotrexate for unruptured ectopics in asymptomatic woman <3cm in size
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how do you diagnose vaginitis? (trichomonas, BV, yeast)
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via wet prep and whiff test for Trichomonas or BV, KOH prep for yeast
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what causes BF? what do you look for on slides?
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overgrowth of Gardenella; look for clue cells
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what should you suspect if you see many WBCs but no organisms on saline smear
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chlamydia
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what is the most common benign gynecological neoplasm?
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leiomyoma (fibroids)
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what HPV types increase risk for cervical cancer?
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HPV types 16, 18, 31
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what is the most common cause of death caused by ovarian tumors?
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bowel obstruction
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what types of masses are most suspicious for ovarian neoplasms?
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adenexal or ovarian masses in pre-menarchal or post-menopausal women
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what is Lynch II Syndrome?
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HNPCC that is associated with an increased risk of colon/ovarian/endometrial/breast cancer
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what hormone do you expect to be elevated with Turner's syndrome?
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increased FSH due to negative feedback
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Turner syndrome is associated with what cardiac problem
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aortic coarctation
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how do you diagnose endometriosis?
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laparoscopy
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what do you look for on laparoscopy with endometriosis?
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blue/black (raspberry) or dark brown (powder-burned) appearances
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how do you treat endometriosis?
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treat via ovulation inhibition, i.e. GnRH analogs (nafarelin, leuprolide), danazol
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most common cause of secondary amenorrhea
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pregnancy
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what is Asherman's syndrome?
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secondary amenorrhea due to endometriosis, scarring after delivery or DNC
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most common cause of abnormal uterine bleeding
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pregnancy
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post-menopausal bleeding should be treated as what?
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cancer until proven otherwise
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what is the treatment for endometrial hyperplasia with atypical cells or carcinoma?
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hysterectomy
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what is hirsutism?
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excessive sexual hair
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what is virilization?
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excessive androgenic influence
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what is another name for Stein-Leventhal syndrome?
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polycystic ovarian syndrome
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most frequent cause of infertility
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usually male pathology
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what sign do you see on ultrasound with PCOS?
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"pearl necklace"
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most common location for ectopic pregnancy
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ampulla of oviduct
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amenorrhea + light vaginal bleeding + lower abdominal/pelvic pain = ??
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ectopic pregnancy triad
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most common cause of bloody vaginal discharge
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intraductal papilloma
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what types of pathology are at increased risk for breast cancer?
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ductal epithelial hyperplasia or cellular atypia
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most common breast lesion in women under 30
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fibroadenoma
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name the breast cancer stages
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Stage I - tumor size <2cm
Stage II - tumor size 2-5cm Stage III - axillary node positive Stage IV - distant mets |
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what is an adenomyosis?
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endometrial tissue in the myometrium that makes the uterus symmetrically enlarged and globular
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what are the breast cancer markers?
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CEA, CA-15-3, CA27-29
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treatment for estrogen-receptor-positive tumors
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tamoxifen
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treatment for estrogen receptor-negative tumors
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chemotherapy
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most common cause of irregular menstrual cycles shortly after menarche
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immaturity of the hypothalamic-pituitary-gonadal axis
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amenorrhea in elite athletes is caused by what hormone deficiency?
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estrogen deficiency
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pain that radiates to the thighs and back just before menstruation is called what and what causes it?
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primary dysmenorrhea; cause by spikes in prostaglandin levls
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treatment for vaginismus
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treat with Kegel exercises, relaxation techniques and insertion of objects of increasing size to dilate
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what is the treatment of choice for non-surgical candidates with squamous cell carcinoma of the vagina?
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radiation
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treatment for vulvular lichen sclerosis
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topical corticosteroids
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can chlamydia be identified by gram stain?
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no
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development of secondary sex characteristics before what age constitutes precocious puberty?
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before 8 in girls and before 9 in boys
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PID + increased LFTs = ?
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Fitz-Hughes-Curits syndrome
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most common cause of fitz-hughes-curtis syndrome
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chlamydia
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treatment guidelines for PID:
cultured chlamydia cultured gonorrhea unknown |
cultured chlamydia - doxycycline only
cultured gonorrhea - ceftriaxone + doxy unknown - ceftriaxone + doxy |
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most common cause of dysfunctional uterine bleeding
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overproduction of estradiol
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treatment for dysfunctional uterine bleeding in patient >35
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DNC to rule out endometrial cancer
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Chapmans point for dysmenorrhea
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thoracolumbar junction
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viscersomatic location for dysmenorrhea
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T9-L1
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pain with intercourse + pelvic cramping just before menses + sleeping difficulities = ??
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endometriosis
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name the breast cancer screening guidelines
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20-40 = breast exams q3 years
40+ = exam and mammogram yearly |
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thin, grayish-white vaginal discharge with fishy odor
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BV
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cause of BV
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gardenella vaginalis
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how do you diagnose Ashermans syndrome?
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hysteroscopy
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how does Ashermans affect LH/FSH?
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it doesn't, normal ovarian tissue; therefore FSH/LH
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gram-positive filamentous rods
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Actinomyces
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cause of isolated PID with an IUD in place
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Actinomyces
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treatment for Actinomyces
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penicillin G
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infection with sinus tracts containing sulfur granules
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Actinomyces
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next step in management of suspect vulvular cancer in post-menopausal women
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biopsy via wide local excision
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next step in management for patient <30 with non-suspicious breast mass; what is the most likely cause?
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observe for at least one menstrual cycle; most likely fibroadenomatous
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what do you do next with an abnormal pap smear?
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colposcopy
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what is the next step in management for a patient with an IUD that is pregnant?
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pull string to remove IUD
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prior to surgery, when should OCPs be stopped?
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one month prior
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next step in management with a pap that shows ASU-US
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repeat q6 months for one year
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what do you see with BV and how do you treat it?
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+Whiff test, pH>4.5, Clue cells; treat with metronidazole; no partner treatment
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what do you see with Trichomonas? treatment? partner?
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strawberry cervix, malodorous frothy discharge, flagellated organisms on wet mount; treat patient and partner with metronidazole
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young female with grape-like mass at vaginal introitus
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sarcoma boyryoides
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how do you confirm diagnosis of sarcoma boyryoides?
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pelvic ultrasound
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branching hyphae and spores on wet mount
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candidiasis
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what agar is most sensitive for identifying candida?
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Sabourards agar
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multinucleated epithelial cells diffusely covered in bacteria
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BV
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most effective method of post-coital contraception
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insertion of copper IUD
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chronic eczematous rash on nipple and adjacent aerolar skin
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Pagets disease of breast
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most common side effects of depo-provera use
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in order: bleeding, HA, breast tenderness
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next step in management of GBS+ pregnant patient
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ampicillin during labor and 4 hours before delivery
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what is the difference between a radical and modified-radical mastectomy?
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both remove all of the breast tissue, pectoralis minor, ipsilateral axillary lymph nodes however a radical removes the pec major as well
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work up for secondary amenorrhea protocol
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beta-HCG --> TSH --> prolactin --> progesterone challenge --> estrogen-progesterone challenge --> if EP challenge is positive then order FSH and LH
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motile, flagellated organisms on wet mount
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trichomonas
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treatment for trichomonas
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treat patient and partner with metronidazole
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long-term treatment for uterine prolapse
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strengthening of pelvic floor muscles
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what must you inquire about with anorexic patients?
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suicidal ideations
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most common cause of post-menopausal bleeidng
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atrophic vaginitis
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why do uterine fibroids regress after menopause?
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they are estrogen dependent
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what are the two biggest risk factors for breast cancer?
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early menarche, nulliparity
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what is the main risk associated with medical induction of ovulation?
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risk of multiple ovulations
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when should women begin self-breast exams and how often?
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every month starting at age 20
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what is the next step in management for a palpable breast mass in patients >35?
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biopsy
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