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51 Cards in this Set

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Q1250. Oligomenorrhea - What is it; MCC
A1250. ↑ length of time between menses; 35–90 days between cycles; MCC - pregnancy
Q1251. Polymenorrhea - What is it; Cause
A1251. Frequent menstruation; < 21-day cycle; cause - anovulation
Q1252. Metrorrhagia - What is it; Causes
A1252. Bleeding between periods Causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
Q1253. Menometrorrhagia - What is it; Causes
A1253. Excessive and irregular bleeding causes:; endometrial polyps; endometrial cancer; cervical cancer; pregnancy complications; exogenous estrogen
Q1254. Postmenopausal Bleeding - What is it; Causes
A1254. Uterine bleeding > 1 year after menopause Causes:; vaginal atrophy; exogenous hormones; cancer
Q1255. Abnormal Uterine Bleeding - Dx
A1255. Distinguish ovulatory from anovulatory disorders; thorough menstrual History - bleeding freq., vol, duration, bimanual exam, pap smear; ovulatory - transvag US, sonohysterogram, D&C with hysteroscopy; anovulatory - B-hCG, CBC, coag profile, FSH, LH, TSH, prolactin, endometrial biopsy; any postmenopausal woman with uterine bleeding - endometrial biopsy to rule out endometrial cancer
Q1256. Abnormal Uterine Bleeding - Tx
A1256. Treat underlying disorder; ovulatory - NSAIDs +/- OCPs; anovulatory – OCPs, cyclic progestin (medroxyprogesterone); high-dose IV estrogen; D&C; endometrial ablation; hysterectomy - last resort
Q1257. Amenorrhea - What is Primary Amenorrhea
A1257. No menses by 16 y/o; no secondary sexual characteristics by 14 y/o
Q1258. Primary Amenorrhea - Causes
A1258. Mullerian anomalies; vaginal agenesis; imperforate hymen; testicular feminization; ovarian failure; Turner's; Kallmann's; anorexia; excess exercise; weight loss; stress; tumor; infection
Q1259. Amenorrhea - What is Secondary Amenorrhea
A1259. No menses for 3 cycles if history of irreg cycles - no menses for 6 mos.
Q1260. Secondary Amenorrhea - Causes
A1260. Asherman's syndrome; cervical stenosis; pregnancy; polycystic ovarian syndrome; anorexia; excess exercise; weight loss; stress
Q1261. Amenorrhea - Tx
A1261. Tx underlying cause; if low estrogen – HRT, Ca2+ supplements
Q1262. Dysmenorrhea - What is it
A1262. Pain during menses that - requires meds; prevents normal activity; primary - no structural gyn disorder, start < 20 y/o, tends to decreased with age, due to uterine contractions, probably mediated by PGE, Tx - NSAIDs and OCPs; secondary - pelvic pathology, MC – endometriosis, adenomyosis, myomas, pelvic congestion, PID, ovarian cysts, cervical stenosis, pelvic adhesions
Q1263. Endometriosis- What is it
A1263. Functional endometrial tissue (glands and stroma) implanted outside uterus; women of reproductive age; common sites – ovaries, cul-de-sac, uterosacral ligament; due to - implant via retrograde menses; vascular and lymph dissem, metaplasia; risk factors - family History, nulliparity, infertility
Q1264. Endometriosis- History/PE
A1264. History - premenstrual pain; dyschezia; chronic pelvic pain; dyspareunia; abnorm bleeding; infertility; PE - tender, nodularity along uterosacral ligament, fixed, retroverted uterus, tender, fixed adnexal masses
Q1265. Endometriosis- Dx
A1265. Definitive Dx - direct visualization via laparoscopy or laparotomy; implants - rust-colored, dark brown "powder burns", raised blue raspberry lesions"; severe - adhesions surround implants; ovary may have - endometrioma (chocolate cysts); pain severity - doesn't always correlate with extent of disease
Q1266. Endometriosis- Tx
A1266. OCPs or progestin; danazol or GnRH agonists; lap ablation; TAH-BSO; lysis of adhesions
Q1267. Vulvar Cancer - What is it; Risk Factors
A1267. 4th MC gyn malignancy; usu occurs after menopause - (peaks in 60s); squamous cell ca (90%); risk factors – diabetes, obesity, HTN, vulvar dystrophy, HPV- 16, HPV-18
Q1268. Vulvar Cancer - History/PE
A1268. Asymp in early stages; vulvar pruritis (MC); erythematous or ulcerated vulvar lesion; palpable vulvar mass
Q1269. Vulvar Cancer - Dx
A1269. Definitive Dx - Biopsy
Q1270. Vulvar Cancer - Tx
A1270. Wide local excision; regional lymph node dissection; radiation - decreased tumor metas, recurrence
Q1271. Cervical Cancer - What is it; Risk Factors
A1271. 3rd MC gyn malignancy; squamous cell ca (most); adenoca (most of remaining); results from cervical intraepithlial neoplasia (CIN), if untreated => invasive ca; spreads – directly, blood, lymphatics to - pelvic lymph nodes, para-aortic lymph nodes; Risk factors - HPV 16, 18 and 31, early onset of sex, multiple sex partners, immune compromised, tobacco, STDs
Q1272. Cervical Cancer - History/PE
A1272. History - usu asymp; if asymp, usu Dx by - Pap smear, colposcopy and biopsy; if symp - postcoital bleeding is usu 1st Sx, menorrhagia, metrorrhagia, pelvic pain, vag discharge; PE - cervical discharge, cervical ulceration, pelvic mass, fistulas
Q1273. Cervical Cancer - Dx
A1273. Bx all lesions; colposcopy and endocervical curettage if - dysplasia (on Pap smear),; squamous intraepithelial neoplasia (on Pap smear); or 2 consec findings of atyp squamous cells of undet signif (ASCUS); pelvic exam under anesthesia; CXR; IVP; staging – clinical based on invasion into adjacent structures and metastases; CT/MRI can't be used to stage
Q1274. Cervical Cancer - Tx
A1274. Carcinoma in situ - finished childbearing – TAH; wish to keep uterus - cervical conization; ablation of lesion: cryotherapy / laser; invasive: all stages - radiation & chemo; less radical surgeries: early stages - radical hysterectomy, lymph node dissection; advanced disease or bulky tumors - radiation +/- chemo
Q1275. Cervical Cancer- Staging of CIN
A1275. CIN I - mild dysplasia, low-grade squamous intraepithelial lesion (LSIL); CIN II - moderate dysplasia, high-grade squamous intraepithelial lesion (HSIL); CIN III - severe dysplasia or carcinoma in situ, high-grade squamous intraepithelial lesion (HSIL)
Q1276. Endometrial Cancer - What is it; Risk Factors
A1276. MC gyn malignancy; strong association with high levels of unopposed estrogen; ages 50-70; usu adenoca; mets to: direct – cervix; intraperitoneal seeding; blood - lungs, vagina; lymphatics - aortic node, pelvic node; risk factors - unopposed estrogen, diabetes, HTN, nulliparity, family History
Q1277. Endometrial Cancer - Examples of Unopposed Estrogen
A1277. Estrogen replacement therapy; chronic anovulation; early menarche; late menopause; ovarian granulosa cell tumors; polycystic ovarian syndrome; obesity; tamoxifen
Q1278. Endometrial Cancer - History/PE
A1278. postmenopausal bleeding; menorrhagia; metrorrhagia; lower abdom pain; cramping; uterus - fixed, immobile if spread to adnexa & peritoneum; signs of mets – hepatosplenomegaly, lymphadenopathy, abdom masses
Q1279. Endometrial Cancer - Dx
A1279. Pap smear - not very sensitive; ECC; EMB; D&C - if sample inadeq; US to rule out - fibroids; polyps; endometrial hyperplasia; grade - key prognostic factor; staging - surgical; peritoneal fluid cytology; abdom exploration; TAH-BSO; pelvic & para-aortic nodes
Q1280. Endometrial Cancer - Tx
A1280. High dose progestins - stage I; chemo – doxorubicin, cisplatin; advanced & recurrent dis. adjuvant radiation - cervical & extrauterine spread
Q1281. Ovarian Cancer - What is it; Risk Factors
A1281. 2nd MC gyn malignancy; leading cause of U.S. gyn ca deaths; MC - postmenopausal; OCPs - protective effect; risk factors - fam history of breast or ovarian ca, chronic uninterrupted ovulate- nulliparity, delayed childbearing, infertility, late menopause; categorize by site of origin - epithelial cell – MC; serous cystadenoca; germ cell – dysgerminoma; sex cord-stromal tumors
Q1282. Ovarian Cancer - History/PE
A1282. History - Usu asymp until advanced - abdom pain; bloating; pelvic pressure; urinary freq. early satiety; constipation; vag bleeding; systemic Sxs; PE - solid, fixed nodular pelvic mass, ascites, pleural effusion
Q1283. Ovarian Cancer - Dx
A1283. Pelvic US; CT or MRI; surgical staging - TAH-BSO; omentectomy; tumor debulking; monitor - CA-125, aFP, LDH, hCG
Q1284. Ovarian Cancer - Tx
A1284. Radiation - dysgerminomas; postsurgical chemo – carboplatin, paclitaxel; epithelial cell tumors
Q1285. Ovarian Cancer - Prevention
A1285. 2 first degree relatives - annual screening CA-125; transvag US after childbearng - prophylactic oophorectomy; OCPs may help decreased risk
Q1286. Polycystic Ovarian Syndrome - What is it
A1286. Oligomenorrhea; cause unknown; Sxs of - androgen overproduction; increased circulating androgens, excess LH; b/l polycystic ovaries; chronic anovulation; infertility; obese; hirsute; ages 15-30; association - insulin resistance, DM; increased risk of endometrial ca
Q1287. Polycystic Ovarian Syndrome - History/PE
A1287. History - hirsutism; obesity; amenorrhea; infertility; May have – virilization, acne, DM, HTN, acanthosis nigricans; PE - enlarged cystic ovaries
Q1288. Polycystic Ovarian Syndrome - Dx
A1288. Serum LH/FSH ratio > 3; increased serum androstenedione; increased DHEA; US
Q1289. Polycystic Ovarian Syndrome - Tx
A1289. weight reduction; clomiphene citrate; metformin; OCPs
Q1290. Spontaneous Abortion (SAB) - What is it; Risk Factors
A1290. Nonelective termination at < 20 weeks GA; most 1st tri - fetal factors; most 2nd tri - mat. factors; risk factors - advanced mat. Age, advanced pat. Age, increased gravidity, prior SAB, minority status
Q1291. Spontaneous Abortion (SAB) - History/PE
A1291. History - ask history of: abortions, infections, familial genetic abnorm; PE - vaginal bleeding, passage of tissue, open or closed cervical os
Q1292. Spontaneous Abortion (SAB) - Dx
A1292. B-hCG; establish GA; transvag US - assess viability; CBC; blood type
Q1293. Spontaneous Abortion (SAB) - Tx
A1293. Ensure hemodynamically stable; give Rhogam (if appropriate); uterine evacuation
Q1294. Threatened Abortion - Sxs
A1294. Minimal bleeding; possible abdom pain; no POC expelled; (POC= products of contraception)
Q1295. Threatened Abortion - PE/US
A1295. Closed internal cervical os; normal US
Q1296. Threatened Abortion - Tx
A1296. Avoid heavy activity; pelvic and bed rest
Q1297. Inevitable Abortion - Sxs
A1297. Profuse bleeding; severe cramping
Q1298. Inevitable Abortion - PE/US
A1298. Open internal cervical os
Q1299. Inevitable Abortion - Tx
A1299. Emergent D&C
Q1300. Incomplete Abortion - Sxs
A1300. Some POC expelled