Icm Winter Ob Gyn

Front 1

what are hte 3 guidlines about colon cancer screening from the USPSTY (gov supported)

Back 1

1. annual high sensitivity fecal occult blood

2. flex sigmoid q 5 years combined with high sensitivity fecal occult blood q3 years

3. Screening colonoscopy at intervals q10 years

**you can choose as you please but need to continue with the same therapy
**pts 50-75

Front 2

according to the USPSTF can you screen for colon cancer by a high sensitivity fecal occult blood every year and NOT have to do colonoscopy/signoidoscopy

Back 2

YEP!

1. annual FOB w/high sensitivity
2. sigmoidoscopy q5 year and FOB q3 year
3. colonoscopy q 10 years

*pts 50-75

Front 3

what are hte american cancer society recommendations for colon cancer screening

Back 3

more stringent

1. annual FOB (same as USPSTF)
2. flexible sigmoidoscopy q 5 years
3. double contrast barium enema q 5 years
4. CT cholography q 5 years
5. screen colonoscopy q 10 years
6. fecal DNA test

Front 4

the USPSTF indicates 3 guidlines to screen for colon cancer, what are they. what are the 3 additional screening guidlines as indicated by american cancer association

Back 4

BOTH
1. annual high sensitivity fecal occult blood
2. colonoscopy q 10 years
3. sigmoidoscopy q 5 years (USPSFT also says FOB q3)

ACA only
1. dbl contrast BE q 5 years
2. CT colonography q 5 years
3. fecal DNA test

**pts 50-75

Front 5

what do the following have to do with breast cancer

1. current age
2. age of menstruation
3. age of menopause
4. age when first kid was delivered
5. preg?
6. breastfeeding
7. EtoH
8. Hormone therapy
9. Ca hx
10. femal health hx
11. family hx
12. jewish
13. BMI

Back 5

ALL ARE INCREASED RISK OF BREAST CANCER....

1. current age: increased risk as we age
2. age of menstruation: increased risk when you start early
3. age of menopause: increased risk w/late menopause
4. age when first kid was delivered: increased risk if you ahve kids young
5. NEVER being preg increases risk
6.not breastfeeding increases risk
7. EtoH: increased risk
8. Hormone therapy: increased risk
9. Ca hx: increased risk if + personal hx for endometrial, ovarian, colon cancer
10. femal health hx: increased risk w/duct hyperplasia
11. family hx: FIRST degree relative
12. jewish:
13. BMI: overweight after menopause is increased risk

BIRTH CONTROL- NOT A SIGNIFICANT risk factor

Front 6

50 year old female presents for a physical.
She has no past medical history, she states she is healthy. She has been pregnant 3 times, 2 living children, one miscarriage. Married 20 years, monogamous. No menses for 6 months. Denies hot flashes or mood changes. She denies vaginal or breast changes. She has never had a mammogram or colonoscopy. Her complete ROS is otherwise negative.
Family history:
Mother: HTN, breast cancer diagnosed age 70, living.
Father: Colon cancer age 60, living.
Medications/ supplements: multivitamin, calcium
Social history: smoker 15 pack years, quit 3 years ago, alcohol 2 drinks per week, no recreational drugs. Works as a teacher in community college.

Back 6

Risk Factors: EtOH

Help Factors: preggo, early menses

**SMOKE Is NOT listed as a breast cancer risk factor

**she is 50 so we can start one of the colon cancer screens

Front 7

TRUE OR FALSE: ALL PATIENTS OVER THE
AGE OF 50 NEED ANNUAL FECAL OCCULT
BLOOD TESTING WITH GUAIAC CARDS?

Back 7

F

Front 8

WHICH OF THE FOLLOWING IS NOT A RISK
FACTOR FOR BREAST CANCER?

1. Age > 50
2. No history of term
pregnancies
3. Personal history of
atypical ductal
hyperplasia on past
breast biopsies
4. Late cessation of menses
> 55
5. Early cessation of menses
< 40

Back 8

5. if you stop menses early its LESS estrogen so less risk

Front 9

58 y.o. post menopausal female presents with concerns regarding breast cancer family history. Started menses at age 12.
Family history:
Sister 50 y.o. breast cancer, living.
Mother 68 y.o. dx breast cancer, deceased at age 78.
Personal history of one breast biopsy at age 52, US showing lump, benign disease found on pathology.
Smoker for 10 years, quit 3 yrs ago.
No history of pregnancy.
No history of hormone replacement therapy

what are the risks for breast CA
what do you order

Back 9

RISK:
1 sister (first degree) had CA at young age
1. Mother was old, not a huge risk on its own
2. smoke
3. NO preggo

GOOD: no hormone tx

She is high risk: order,
Mammogram
MRI
US

Front 10

what are hte American CA society breast cancer screen recommendations

Back 10

1. CBE q 3 years 20-39 yo
2. annual mammography and CBE at 40+

**say NOT to do self breast exam
**NO MRI if you are average risk, MRI only for high risk

Front 11

whos reccomendations are listed

1. CBE q 3 years 20-39
2. CBE q1 years 40+

Back 11

American Cacner Society

**does NOT recommend self breast exam
**does NOT recommend MRI for average risk ppl

Front 12

what are the recommendations of the USPSTF for breast cancer screens

Back 12

1. NO routine screen for women 40-49
2. mammorgraphy q2 years for 50-74

Front 13

WHAT are the recommendations for breast cancer screen from USPSTF and ACS

Back 13

USPSTF
1. no screen .49
2. mammography q2 years for 50-74

ACS
1. CBE q 3 years 20-39
2. annumal mammography 40+

Front 14

23 year old female presents for WWE (Well Woman Exam).
LMP- 12/31/11
Menses are regular
No complaints
On OCP (oral contraceptive pills)
Monogamous at present; 6 lifetime partners
No history of STDs
Asks about HPV, as she has seen TV commercials about cervical cancer and is worried.
“Do you think I have been exposed to or have HPV?”
“Can I get tested today?”

Back 14

lifetime risk of HPV 75-90%
15-25% risk with each partner

increased risk:
1. >1 sexual partner
2. parter who had a partner who got cervical cancer
3. SMOKE

Front 15

what is the most common STI overall

Back 15

HPV

lifetime liklihood of getting it... 75-90%

15-25% risk with each partner

Front 16

does smoking increase the risk of breast cancer or HPV

Back 16

HPV

Front 17

when do pap smears begin

Back 17

21 or 3 years after onset of sexual activity

agreed on by all 3 ppl: ACOG, USPSTF, ACS

Front 18

what HPV causes...

1. cacner
2. warts

Back 18

Cancer: 16 18

Warts: 6 11

Front 19

ok so everyone agrees to start PAP at 21 or 3 years after sexual onset. when do they say to STOP paps

1. ACOG
2. USPSTF
3. ACS

Back 19

1. ACOG: ---

2. USPSTF- 65 unless high risk

3. ACS- 70 yo w/3 - results, or no + w/i past 10 years

Front 20

how long btwn papsmears

1. ACOG
2. USPSTF
3. ACS

Back 20

1. ACOG- annual <30, >30 q 2-3 years after 3 consucetive negs

2. USPSTF- q3 years

3. ACS- same as ACOG (annual, then >30 yo get 2-3 years after 3 consecutive negs)

Front 21

6 11 16 18

Back 21

6, 11-warts
1618 cancer

Front 22

do you give women w/total hysterrectomy pap smears

Back 22

not indicated

Front 23

ok so pap smear = HPV testing

when do you test for HPV

1. ACOG
2. USPSTF
3. ACS

Back 23

ACOG and ACS are the same

*test all women >30 get it done ~ q3 years

**the HPV DNA test is MUCH more sensitive than the normal PAP cytology

Front 24

shoudl a 25 yo female w/1 monomogous lifetime sex partner get HPV teste

Back 24

dont test until >30 according to ACOG and ACS

Front 25

whats dysmenorrhea

Back 25

painful periods that PREVENT ADL, can be associated with diarrhea, nausea, vomit, HA, dizzy

can be primary: excess PG (younger women)
can be secondary: endometriosis, PID, adhesions, leioyomas, (older women)

Front 26

what causes 1 dysmenorrhea
what causes 2 dysmenorreha

**what is the clinical od dysmenorrhea

Back 26

Primary: excess PG, more common in younger. Tx w/NSAIDS

Secondary: endometriosis, adenomyosis, PID, adhesions, leiomyomas, more common in older women. Tx the cause

**PAINFUL periods that prevent ADL, associated with diarrhea, NV, HA, dizzy

Front 27

what is the tx for 1 nad 2 dysmenorrhea

Back 27

Primary- tx w/NSAIDS, PG inhibitors, topical. heat pack, OCP to prevent ovulation

Secondary: tx the initial cause- can be endometriosis, adenoleiyloma, PID, adhesions, leilymoma

Front 28

what is the def of primary and secodnary amenorrhea

Back 28

PRIMARY: NO period by 13 w/o sexual development OR 15 w/o period but does have sex characteristics

SECONDARY: NO menses for 3-6 months. most commonly caused by PREGNANCY

Front 29

secondary amenorrhea is no period for 3-6 months. what are some common causes of this

Back 29

1. PREGNANCY
2. hypothalamic,
3 pituitary,
4. ovarian,
5anovulation,
6 outflow tract issue

Front 30

Oligomenorrhea
Hypomenorrhea
Polymenorrhea
Menorrhagia
Metrorrhagia
Menometrorragia

Back 30

Oligomenorrhea: infrequent period

Hypomenorrhea: regular cycle, <7 day bleed

Polymenorrhea: FREQUENT blooding

Menorrhagia: regular cycle, HEAVY flow

Metrorrhagia: bleeding btwn, irregular cycle

Menometrorragia: inpredicitble and heavy

Front 31

why might an increase in PG be the cause of a young woman with dysmenorrhea

Back 31

PG stim SM mm to contract. dilator, plagelet inhibitor (heavy_

Front 32

what are the MOST common causes of primary amenorrhea

Back 32

1. Ovarian failure. Turners XO
2. Congenitcal absence of uterus/vagina
3. GnRH deficit- Kallman anosmia
4. Constitutinal delay

Front 33

most common cause of secondary amenorrhea

Back 33

pregnancy!



can also be PCOS
Hypothalamic dysfx
hyperprolactinemia
ovarian failure

Front 34

how does a lesion in the hypothalamus that decreases GnRH affect menses?
What are some things that fall into this category

Back 34

2 amenorrhea

**no GnRh --> no LH, FSH --> no stim on uterine lining for menses

1. Strenous exercise
2 weight loss/anorexia
3 hypothalamic lesion/trauma
4. GnRH secreting tumor like acromegaly (this does - feedback)
-no ovulation

Front 35

how will exercise/weight loss affect menses

Back 35

these both will act at hypothalamus to decrease GnRH --> decrease FSH, LH --> no menses no ovulation

Front 36

what is the main category of 2 amenorrhea bc of PITUITARY reasons

Back 36

HYPERprolactin!

1. preggo
2. galactorrhea- milk coming out/BREASTfeeding
3. drugs

Front 37

if you are breastfeeding why dont youlactate

Back 37

hyperprolactinemia shuts down the pituitary so no LH, FSH get out

Front 38

if you have 2 amenorrhea bc of ovarian failure what is increased? what is the classification based on pts age

Back 38

FSH!!! its working from pit but not being recognized by ovary

>40 menopause
<40 premature ovarian failure

Front 39

ok so your 35 yo woman comes in with no period and is NOT preggo. Her FSH is elevated. whats the deal

Back 39

Premature ovarian failure

Front 40

can too many androgens be the cause of a secondary amenorrhea

Back 40

YES!!

1. PCOS
2. Adult onset congenital adrenal hyperplasia
3. cushing syndrome
4. thyroid disease
5. acromegaly- GnRH releasing tumor
6. Androgen secreting tumor

Front 41

whats WU for pt w/ 2 amenorrhea

Back 41

1. PREGGO TEST, PREGGO TEST, PREGGO TEST

2. Hx
3. PE- do they HAVE a uterus/vagina
4. prolactin
5. TSH, FSH, LH

Front 42

your 37 yo female is not having a period and her preg test is NEG, what lab do you order next

Back 42

TSH, Prolactin

TSH abnormal- thyroid problem
Prolactin abnormal- pit problem
BOTH normal- do progesterone challenge

Front 43

your pt is not menstruating, she is NOT preggo. TSH notmal and prolactin is

1. <100
2. >100

Back 43

<100: breast feed, hypothyroid, meds

>100: no pit, pit adenoma

Front 44

no period and elevated TSH indicates...

Back 44

thyroid disease

HYPOthyroid can normal TSH and prolactin <100

Front 45

ok so our pt is NOT having a period but has normal TSH, prolactin, adn a neg preggo test

she is given progesterone and there is withdrawal bleeding, what can be the cause

Back 45

1. hyperandronergic
2. acromegaly
androgen secreting tumor
cushings
exogenous androgens
PCOS

Front 46

out pt is not having periods she is NOT preggo. TSH, prolactin are normal, progesterone does NOT cause withdrawal bleed but estrogen/progesterne DOES cause withdrawal bleed

Back 46

1. Anorexia, bulemia
2. CNS tumor
3. chronic liver disease
4. chronic renal insufficiency
5. inflamm bowel
6. thyroid disease
7. exercise, weight loss
etc
etc

Front 47

Physical Exam
Vitals: BP 126/96, 5’5, weight 248#, RR 18, HR 85, BMI 41.3
General: obese female, no acute distress
Skin: dark hair on chin and chest, moderate facial acne, no acanthosis nigricans
HEENT: normal
Neck: supple, no thyroid enlargement
Lungs/ CV: normal
Abdomen: bs present, soft, non tender, obese, no striae
Pelvic: normal external genetalia, no clitoromegally; cervix normal no lesions, non tender; uterus and adnexa non tender, no masses; vaginal mucosa no lesions.

tests

Back 47

tsh
prlactin
lh
fsh
dhea
testosterone
cortisol
US pelvis

PCOS- androgen excess and hirsuitism (hair growth)

Front 48

whats PCOS

Back 48

most common cause of excess androgen, makes girls grow hair. anne. also get hyperinsulinemia indepedent of DM

EXCESS LH

Front 49

excess LH is associated with what ?

what might be presenting sx

Back 49

PCOS

1. no period,
2. hair growth
3. acne
4. HYperinsulinism independent of DM

Front 50

what is the rotterdam criteria for PCOS

Back 50

1. little ovulation or no periods

2. biochemical or clinical evidence of increased androgen (hair, acne, increased testosterone)

3. polycystic ovaries on US

Front 51

is polycystic ovary on US REQUIRED for dx of PCOS

Back 51

not tech, use the rotterdam criteria and only need 2/3

1. no period
2. clinical/biochemical evidence of increased androgen
3. US of ovary w/lots of cysts

Front 52

if LH:FSH ratio is >3 waht is this dx of

Back 52

PCOS

**NOT part of the rotterdam criteria

**also have hyperinsulinemia INDEPENDENT of DM,

Front 53

excess testosterone can be seen slinically as what in a female

Back 53

large clitorus
deep voice
mm development
breast get little
hair growth
male pattern baldness

**if you see this along with either no period or the US w/cysts is dx of PCOS based on rotterdam criteroa (2/3 needed) LH:FSH ration will also be high (>3)

Front 54

cushings is what

Back 54

increase ACTH

trucan obesity
moon facie
glucose intolerance
skin gets thn
striae
osteoperosis
proximal mm weakness
hyperandrogenism
irregular menses

test w/24 hr free cortisol and dexamethasone supression test

Front 55

what labs are drawn with PCOS

Back 55

1. LH
2. FSH
3. Free testosterone
4. DHEAS
5. 17 OH progesterone
6. 24 hr cortisol
7. dexamethasone suppression test
8. ptolactin
9. TSH

Front 56

what are 5 main categories of contraception

Back 56

1. OCP
2. Ring
3. implantable device
4. injection
5. emergency contraception

Front 57

what are ABSOLUTE CI for OCP

Back 57

1. thrombophelbitis, thromboembolitic disease
2. undx vag bleed
3. stroke risk (cerebral vascular disease)
4. preggo
5. SMOKER >35
6. impaired liver fx
7. liver cancer

Front 58

if your pt has liver cancer can they have OCP

Back 58

NO

absolute CI for OCP
thrombophlebitis/embolitic disease
undx vag cacner
cerebral vascular disease
preggo
coronary disease
SMOKER >35
hepatic cancer/liver cacner

Front 59

what are some benefits of OCP

Back 59

1. predicable periods, shorter, less painful
2. decrease risk of endometrial/ovarian cancer
3. decrease risk of extopic preggo
4. amenorrhea in small amt of ppl

Front 60

does OCP increase or decrease risk of endometrial/ovarian cancer

Back 60

DECREASE

Front 61

what are some risks associated with the use of OCP

Back 61

1. DVT
2. Gallstones
3. MI
4. bloating
5. weight gain
6. breast tenderness
7 nausea
8 fatigue