Gynecology Step Up - Comlex Step 2

Front 1

thelarche

Back 1

breast budding

Front 2

mean age of menarhce in usa

Back 2

13

Front 3

precious puberty can be central which means it involves the

Back 3

hypothalamus-pit axis (Early activation)

Front 4

pseduoprecocious puberty

Back 4

autotnomous secretion of LH/FSH without hypothalamic involvement

Front 5

w/u for pseudoprecpuberty

Back 5

17Dehydroxyprogesterone, testes and abd usa, cortisol and DHEA

Front 6

most common cause of precocious puberty and common ages for boys and girls.

Back 6

common age is <9 boys, <8 girls, and adrenal hyperplasia (CAH)

subtypes: isosexual and heterosexual

Front 7

adrernarche

Back 7

axillary hair growth

Front 8

pubarche

Back 8

pubic hair growth

Front 9

lab tests to dx central prec puberty

Back 9

do ls and fsh levels, will be increased and even increase more when GNRH is added, then get imaging of the head and a TSH. levels of LH/FSH that remain low means its of excess sex steroid production.

Front 10

what does DHEAS tell you?

Back 10

specfic for marking a adrenal cause for precious puberty

Front 11

go to test for pesudoprecious puberty?

Back 11

get imaging of the abdomen and testes , ovaries - possible sertoli and leydig cell tumor?

Front 12

Tx for central prec puberty

Back 12

GNRH analogue = leuprolide

Front 13

estrone

Back 13

fat produces estrogen

Front 14

Name the TANNER stage
thelarche: areola and papila form secondary growth, above level of breast (secondary mound forms)

pubarche: hair becomes coarser and spreads over much of pubic region

Back 14

4

Front 15

Name the TANNER stage


thelarche: areola recedes to level of breast and papila remains extended
pubarche: hair is coarser and spreads over much of pubic region and to thighs

Back 15

5

Front 16

estriol

Back 16

placental estrogen

Front 17

estradiol

Back 17

estrogen produced by ovaries (spec. the follicle is stimulated by granulosa cells by
FSH)

Front 18

Name the TANNER stage

thelarche: areola and papila enlarge further
pubarche: hair becomes coarser and grows

Back 18

3

Front 19

Name the TANNER stage

thelarche: breast budding, areolar enlargement
pubarche: slight fine hair

Back 19

2

Front 20

Name the TANNER stage

thelarche: raised papila only, nothing else

pubarche: no hair

Back 20

1 - prepubertal

Front 21

sudden sharp pain at onset of ovuation is called

Back 21

mittleshmierz

Front 22

temp recording tells a woman what?

Back 22

that her ovulation has ended - end of the fertile phase.

Front 23

hcg pre-placentally is produced by the?

Back 23

endometerium until 8-12 wks (placenta takes over)

Front 24

progesterone is produced by the _________________ pre placentally?

Back 24

before 8-12 wks its the job of the corpus luteum

Front 25

menopause range

Back 25

41-55, classic is 50.

Front 26

breakthrough bleeding is common in perimenopause but if there is abnormal bleeding (heavy) then r/o

Back 26

uterine hyperplasia

Front 27

which phase of menopause is always consistently the same time length?

Back 27

13-14 days = luteal phase

Front 28

stress incontinence with menopausal females is due to

Back 28

atrophic vaginitis, do kegels

Front 29

urge incontinence in menopausal females is due to

Back 29

bladder spasms, w/u

Front 30

labs in complete menopause will show

Back 30

increased LH, FSH and estradiol

Front 31

which hormone is responsible for?

midcycle surge, induces ovulation

Back 31

LH

Front 32

which hormone is responsible for?

DEVELOPS THE OVARIAN FOLLICLE

Back 32

fsh

Front 33

which hormone is responsible for?

induces the LH surge and stimulates endometrial prolifeation, contraindicated in women with hx of breast cancer as a oral or topical rx

Back 33

estrogen

Front 34

which hormone is responsible for?

increases the basal body temperature, decrease in levels leads to menstruation and the hormone is res responsible for the consistency of the cervical mucus (makes it more thick)

Back 34

progesterone

Front 35

which hormone is responsible for?

stimulates endometrial gland proliferation in luteal phase

Back 35

progesterone

Front 36

which hormone is responsible for?
acts like LH after feertilized egg is implanted and maintains the corpluterum and it's progesterone secretion

Back 36

hcg

Front 37

define primary amenorhhea

Back 37

absense of menses in someone who has never had it

Front 38

define secondary amenorrhea

Back 38

absence of menses in someone who has had it but hasn't recently had it in the past 6 mo

Front 39

most common cause for secondary amenorrhea

Back 39

prego or menopause

then: ashermans, pcos, anorexia, hypothyroid, hyperthyroid, malnutrition

Front 40

most common cause for primary amenorrhea

Back 40

hypothalamis or pit dysfunction.

then: chromosome abnm, gonadal dysgenesis, prolactinoma, gnrh def, hypo-pit dys, premature ovarian failure,

Front 41

causes of amenorrhea

Back 41

nutrition

ovarian disease

cushing's syndrome

anatomic issues

thyroid

chromosomal - turners

hypothalamic

pit dysfunction

uterine disease

pregnancy

over exercise!!

Front 42

FIRST THING YOU DO FOR AMENORRHEA W/U?

Back 42

BHCG PREGNANCY TEST - FOR BOTH TYPES

Front 43

4 types of emergency contraception?

Back 43

1. estradiol -progestin taken 4-5 pills atm

2. levenorgestrel (planB) taken w/in 72 hrs intercourse

3. copper IUD

4. anti progestin - mifiprestone (RU4B)

Front 44

ocp's side effects

Back 44

dvt, nv, wt gain

Front 45

ocp contraindications

Back 45

heavy smokers

hx of dvt, estrogen related cancers, liver disease or hyperTRIG

Front 46

ocp (progestin only formulation) either depo shot or implant advefx?

Back 46

breakthrough bleeding

Front 47

depo provera is the most _____________________ ocp and is given at ____ mo intervals as a shot

Back 47

medroxy progesterone acetate shot

3 mo intervals

cost effective

Front 48

worst ocp choice in fatties?

Back 48

progestin implant (3yr) or transdermal contraceptive patch (weekly) - combo

Front 49

ethinyl estradiol ring changed every?

Back 49

3 wks

Front 50

why is nuvaring bad?

Back 50

only estrogen, risk for dvt,

Front 51

best ocp for down's pts?

Back 51

depo provera

Front 52

best way to prevent stds?

Back 52

barrier methods ( not spermi alone)

Front 53

which intrauterine devices increase the risk for std's?

Back 53

copper iud
progestin releasing iud

Front 54

dysmenorrhea - primary , etiology?

Back 54

symptoms begin in the beginning of mensuration resolve over a few days and primary means without pelvic pathology.

Front 55

dysmenorrhea - secondary - etiology?

Back 55

symptoms begin midcycle before onset of menstruation and get worse (pain) until the end of menstruation. so the pain lasts longer in this type of dysmenorrhea and this type also has some undelrying pelvic problem (hence secondary) = fibroids, pms, cysts, adenomyosis, endometriosis, pid

Front 56

treatment for primary dysmenorrhea

Back 56

ocp and nsaids

Front 57

treatment for pms/pmdd

Back 57

ocp, nsaids, b6 exercise, ssri +/- alprazolam (pmdd)

Front 58

modd disorder throughout bthe entire cycle w/u for?

Back 58

mood disorder bc pmdd/pms should be just later half of cycle.

Front 59

RISK FACTORS for dysmenorrhea

Back 59

PID, early menarche <12, menorrhagia, pms, smoker, sex assault, skinny

Front 60

risk factors for endometriosis

Back 60

family, infertility, nulliparity (no estogen holidays), low bmi

Front 61

3D's of endometriosis

Back 61

dysmenorrhea
dyspareunia
dyschezia (painful bowel movements)

Front 62

most common cause of female infertility

Back 62

endometriosis

Front 63

treatment for endometriosis:

Back 63

if wanting to maintain fertility: laproscopic ablation of adhesions and cysts
if not : ocp, pulsatile danazol/leuprolide (gnrh agonist), hyster, progestin

Front 64

common causes of abnormal uterine bleeding

Back 64

PANAMA CUTIE

P- PREGNANCY #1
A- ANOVULATION
N -NEOPLASM
A- ANATOMIC ABNORMALITY
M-MEDS
A- ATROPHY (UTERINE)

C-COAG DISORDER (HYPER/FACTvLEIDEN OR HYPO/VwF)
U- urinary tract pathology
T-trauma
I- infection
E-endocrine (pcos, thyroid)

Front 65

avg normal monthly menstrual cycle length

Back 65

28 days

Front 66

polymenorrhea defined as

Back 66

<24 days cycle

Front 67

oligomenorrhea defined as

Back 67

>35 dayys cycle

Front 68

abnormal uterine bleeding defined as

Back 68

>7 days and >80ml blood loss with poly or oligomenorrhea

Front 69

pcos triad of sx

Back 69

virilization
infertility
amenorrhea

Front 70

excess ___ produces excessive androgen production by the ovaries

Back 70

LH - in PCOS

Front 71

In PCOS we have amenorrhea and infertility due to

Back 71

abnormally high LH levels >3 LH:FSH ratio

Front 72

most common cause of hirsuitsm in females

Back 72

pcos

Front 73

labs in pcos

Back 73

LH:FSH >3 and hi dhea, hi androstedione, + progestin challenge

Front 74

DHEA vs DHEA-s, levels in pcos?

Back 74

DHEAs a/w adrenal androgen secreting tumors, normal in pcos

DHEA elevated

Front 75

US findings in pcos

Back 75

enalrged ovaries with multiple cysts

Front 76

what 3 risk factors put female highest at risk for DVTs?

Back 76

smoker
on ocp (esp orthoevra, trasdermal combo patch)
>35

Front 77

gram - diplococci

culture on?

Back 77

neiserria ghonorrheae

thayer-martin agar

Front 78

top three causes of vagnitis

Back 78

trichmonas (STD)
garderella vaginalis
candida

Front 79

labs done for vagintis

Back 79

wet mount, koh prep for fungus
vaginal pH,

Front 80

clue cells are

Back 80

epithelial cells wth attached bacteria - seen with vaginosis

Front 81

vaginosis sx

Back 81

smelly, fishy, thin white secretions, clue cells, basic ph, + whiff test

Front 82

cervical pethichiae, green secretions and frothy malodorous, basic ph,

Back 82

trichooniasis

Front 83

ph in candida whats seen on koh?

Back 83

normal 3.5-4.5, psuedohyphae

Front 84

elevated labs with TSS? tx?

Back 84

CR, bun, ast, alt
oxacillin, clindamycin, vanc

Front 85

cervicitis h/p

Back 85

female has purulent vaginal drainage, dyspareunia, urtheririts, rectal and pharyngeal infections from other sex types.

Front 86

intracellular bacteria, most common std and may not see on g stain

Back 86

c. trachomatais

Front 87

clinical cervicits w/ - gram stain

Back 87

think chalmydia

Front 88

are flq safe in pregnant and gonorrhea pts?

Back 88

no

Front 89

most sensitive means to detect cervical pathogens?

Back 89

dna probes and dna amp

Front 90

chandleier's sign

Back 90

cervical motion tenderness with jumping off the table pain on exam, seen with pid

Front 91

complications of pid

Back 91

tubo-ovarian abscess - will have sepsis, periotnitis

increased risk of ectopic and infertlity, pelvic pain

Front 92

syphillis progession?

Back 92

primary - w/in 3 wks of infeciton, get painless hard chancre and then once it resolves w/in 12 wks get a maculopapular rash on palms and soles, lympax, and condyloma lata all over ( secondary infx) thn last stage after latency we see neuro issues, tabes , AR murmur, gummas of skin, bone, liver

Front 93

neurosyphillis will have a +

Back 93

romberg's sign

Front 94

tx for hpv

Back 94

ifn-a, tichloroacetic acid, podophylin, topical 5-fu, cryotherapy

Front 95

painless genital ulcers

Back 95

lymphoG venereum

granuloma inguinale

syphillis

Front 96

painful genital ulcers

Back 96

herpes simplex

chancroid

Front 97

elphatiasis - non pitting edema , inguinal buboes, abscess and fisutula, c. trachomatis

tx?

Back 97

lymphoma venereum infxn


tetracycline, eryhtromycin, doxy

Front 98

painless ulcer, beedfy red base, irregular base, mild lymphax,

Back 98

donovani granulmoatis

granuloma inguinale

Front 99

what are the 5 grades of the Bethesda Cervical Squamous cell dysplasia classification?

Back 99

ASCUS PAP -atypical squamous cells of undetermined signifcance

ASCH PAP - atypical squamous cells cannot r/o hsil

LSIL PAP - low grade suqmous intraepithelial lesion - aka. CIN 1

HSIL PAP - high grade/ CIN2,3

SQUAMOUS CELL CA

Front 100

ASCUS paps are usually incidental finding first time in

Back 100

teenagers

Front 101

management of ascus pap

Back 101

hpv screening, repeat in 3-6 mo, after 3 negatives return to normal screening, repeat hpv screen in 12 mo

Front 102

ASCUS pt got another + pap in their 3 mo f/u visit what to do?

Back 102

colposcopy

Front 103

management of ASCH

Back 103

screen for hpv, repeat in 12 mo, pap in 6-12 mo, endocervical bx (colposcopy now)

Front 104

smear show ______________ in LSIL

Back 104

low grade dysplasia of cervical cells

Front 105

management for LSIL

Back 105

repeat pap in 6-12 mo, repeat hpv testing in 12 mo, excision by LEEP or conization if <5mm. LSIL requires surveillance.

colposcopy if seen.

Front 106

HSIL we see _______________ on smear

Back 106

mod-severe cellular dysplasia, including carcinoma in situ - this is CIN 2-3

Front 107

management for HSIL

Back 107

LEEP and or conization (cold knife) or laser ablation, repeat cervical cytology every 6mo b/c this is preCA

colposcopy is seen on bx.

Front 108

squamous cell ca of the cervix, full blown ca on smear shows __________________

Back 108

atypical cells with stromal invasion

Front 109

management for squamous cell ca of the cervix

Back 109

TAH

Front 110

agus pap (glandular cells of undetermined sig)

Back 110

colposcopy w/ endocervical curettage (bx) if age >35 get endometrial biopsy

Front 111

benign lesion of theca cells (tumor)

Back 111

corpus letueal cyst - see later in cycle

Front 112

benign lesion of the granulosa cells (tumor)

Back 112

follicular cyst - see early

Front 113

most specific test for detection of uterine fibroids

Back 113

transvag us

Front 114

h/p for fibroids

Back 114

abd pain, menorrhagia, infertility,palpable mass on exam, sometimes asympt

Front 115

risk factors for endometrial ca

Back 115

high estrogen exposure - nulliparity, ocp's, pcos, obesity,dm, htn,age >50 , high fat diet, hnpcc (lynch syndrome d/t risk of brca)

Front 116

>35 yo female w/ menometrorhaggia get?

Back 116

eMBx

Front 117

most common causes of vag bleeding in post menopasal pts

Back 117

fibroids and atrophic vagintis

Front 118

(2) stromal cell tumor subtypes, which one causes virilization and which one causes prec puberty?

Back 118

granulosa theca = prec puberty

sertoli leydig = virilization

Front 119

teratoma or desmoid cyst consists of?

Back 119

mutliple dermal tissues = skin, teeth, hair and glands.

Front 120

mucionous or serous adenoma consists of

Back 120

a cyst of epithelial origin that has mucinous or serious contents, may have calcifications and may appear like psammoma bodies

Front 121

brca 1,2 put a women at 10x the risk for

Back 121

ovarian and breast canccer

Front 122

ovarian ca risk factors

Back 122

fmhx, infertility, nulliparity, gene mutaions (brca)

Front 123

which things can one woman do to be protected from ovarian ca, risk reduction?

Back 123

ocp stop early on

pregnancy earlier the better

breast feeeding

Front 124

ca-125 marker for

Back 124

ovarian ca in post menopausal women, of epithelial origin

Front 125

LDH increased in which type of ovarian ca?

Back 125

germ cell tumors - ovarian ca

Front 126

when is it wise to trans vag and ca-125 screen for ovarian ca?

Back 126

if brca +

Front 127

when is the best time to do self breast exams

Back 127

after menses

Front 128

treatment options for breast abscess

Back 128

give - ceflexcin, or agumentin, or dicloxiciln
tmp-smx if mrsa and if anaerobe suspected then metronidazole

Front 129

most common benign breast tumor of <30 yr old h/p?

Back 129

mobile, well defined edges and solid, smooth

fibroadenoma

Front 130

first thing you want to do with a bloody or nonbloody breast discharge and pain behind areola?

Back 130

r/o malignancy extensional bx

think - intraductal papiloma

Front 131

breast cancer most common type?

Back 131

ductal -80% and then lobular - 20%

Front 132

ductal breast cancer subtypes

Back 132

DCIS
INFILTRATING DCa
INFLAMMATORY DCa

Front 133

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

malignant cells in duct w/o stromal invasion, one sided and h/p shows palpable lump, some discharge from nipple

Back 133

DCIS - most common invasive ca

Front 134

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

malignant cells in duct w/ stromal invasion and micro Calcification, mutlifocal but usually one sided and h/p shows palpable lump, discharge from nipple, peaud'orange, and skin dimpling, nipple retracted

Back 134

Infiltrating Ductal ca

Front 135

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

rapid progression, angoinvasive, ductal involvement, poor px, and breat is painful, tender, red, lymphax and peau'dorange noted and looks like mastitis

Back 135

DCa variant - inflammatory carcinoma of the breast

Front 136

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

malignant cells in lobule w/o stromal invasion, may be bilateral and mutifocal and h/p shows nothing, incidental finding usually.

Back 136

LCIS

Front 137

whats so good about LCIS?

Back 137

not as high invasive risk as DCIS and they are ER/PR + so treatment with tamoxifen is easy

Front 138

whats not so good with LCIS?

Back 138

bilateral common and recurrence is common

Front 139

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

malignant cells in lobule w/ stromal invasion, multifocal and bilateral and fibrotic response to surrounding tissues is common. dimpling and retraction of nipple, peau'dorange, firm palpable mass

Back 139

Infiltrating lobular ca

Front 140

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

well circumscribed mass, rapid growing and better px than dc, hp - soft well circumscribed mass

Back 140

medullary breast ca

Front 141

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

well circumscribed mass, slow growing, more common in older women, better px than dc, gealtinous well circumscribed mass

Back 141

mucionous breast ca

Front 142

MATCH THE BREAST CANCER WITH ITS SUBTYPE:

late 40s, excellent prognosis, slow growing

Back 142

tubular ca

Front 143

treatment for dcis

Back 143

lumpectomy if local

Front 144

tx for lcis

Back 144

obs and tamoxifen/raloxifen, proph bilateral mastectomy for those not wanting close observation lifleong

Front 145

tx for invasive breast ca

Back 145

lumpectomy - focal
mastectomy - mutlifocal
radiation - >5cm tumor
sentinnel lymph node - if + then need for ax node dissection

hormone or chemo for node + cancers >1cm

Front 146

urge incontinence in females a/w

Back 146

bladder spasms

Front 147

stress incontinence in female a/w

Back 147

atrophic vaginits - weak pelvic wall musclaulture