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97 Cards in this Set
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- Back
- 3rd side (hint)
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How are benign vulvar lesions diagnosed? |
With biopsy unless there is very low suspiciousness of cancer |
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When should a bartholin gland cyst make you suspicious for cancer? |
If it is a first time occurrence after the age of 40 |
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Difference between simple and complex endometrial hyperplasia? |
Simple involves the glands and stroma, 1% chance of carcinoma Complex involves glands only, 3% chance of carcinoma |
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Management of pt with complex endometrial hyperplasia with atypia? |
D&c or hysterectomy because 29% progress to carcinoma |
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Medical !management of endometrial hyperplasia? |
Progestin therapy for 3 months |
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What categories are ovarian masses divided into? |
Functional cysts And neoplastic growths |
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Presentation and prognosis of follicular cyst? |
Typically asymptomatic, though Large size cam lead to torsion Most resolve spontaneously in 60 days |
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3 types of functional cysts? |
Follicular Corpus luteum (can rupture and prevent menses) Theca lutean (due to bhcg exposure) |
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In reproductive age women, what percent of women of ovarian masses are neoplasms, what percent are functional cysts? |
Only 25% are neoplasms, the rest are cysts |
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Which ovarian masses need further evaluation/possible laparotomy? |
Masses in premenarchal or postmenopausal Mass >8cm or persisting longer than 60 daysin reproductive age |
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What kind of medical !management can accompany the waiting period on a possibly benign ovarian mass? |
OCP's |
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What is required to diagnose endometriosis? |
Surgical confirmation |
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Is there a familial component to endometriosis? |
7x more likely if you have a first degree relative with it |
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Presentation of chanchroid? |
Painful ulcer+painful lymphadenopathy |
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Cause and presentation of lymphogranuloma venerum? |
Chlamydia trachomatis: painless ulcer that can lead to systemic lymphadenopathy and eventually rectal mucous discharge |
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Treatment of chanchroid? Of lymphogranuloma venerum? |
Abx like erythromycin or ceftriaxone Doxycycline |
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Etiology of molluscum contagiosum? |
Pox virus |
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Treatment of endometritis? |
IV gentamicin and clindamycin |
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What is Ditzhugh-curtis syndrome? |
Promiscuous girl got PID then developed hepatitis |
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Treatment of PID and TOA? |
Cephalosporin + doxycycline |
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Clinical picture of TOA? |
chronic PID + adnexal mass |
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Presentation of toxic shock syndrome? |
Fever + rash + desquamation of palms and soles |
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Difference between total urinary incontinence and urge incontinence? |
Total urinary incontinence is a fistula that constantly leaks urine Urge incontinence is due to detrusor muscle instability |
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4 types of urinary incontinence? |
Stress Urge Total Overflow |
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What role does estrogen play in urinary incontinence? |
Filling of the submucosal vasculature of the urethra causes increased pressure in the urethra leading to continence. This is an estrogen sensitive process |
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Which spinal levels control the parasympathetic control of the bladder? |
S2 S3 S4 |
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What nerves and spinal levels control sympathetic influence of the bladder? |
Hypogastric nerve, T10-L2 |
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What nerves control somatic control of the bladder? |
Pudendal nerve controls external sphincters |
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Theory behind cotton swab test? |
Urethrovesicular junction moves posteriorly when straining to urinate. This movement is normally <30°change. Changes greater than 30°are considered to be a hyperactive bladder |
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Test that can tell the difference between stress and urge incontinence? |
Cystometrogram |
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Pathogenesis of stress incontinence? |
Pelvic relaxation leads to a hypermobile bladder neck, thus increases in intraabdominal pressure get unequally transmitted to the bladder leading to increased pressure in relation to the urethra, leading to incontinence Basically caused by increased bladder pressure and decreased urethra pressure |
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Treatment of stress incontinence? |
Kegels Alpha adrenergics Urethropexy |
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Possible medications for urge incontinence? |
Anticholinergics (oxybutynin) Beta agonists TAC's |
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Most common causes of total incontinence? |
Pelvic surgery Pelvic radiation |
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Which chemicals can you use to aid in the diagnosis of total incontinence? |
Methylene blue for vesiculovaginal Indigo Carmine IV for ureterovsginal |
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Symptoms of overflow incontinence? |
Straining to pee, poor stream, incomplete emptying |
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Treatment of overflow incontinence? |
Cholinergics, alpha adrenergics to decrease urethral pressure Straight catheterization |
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Which hormone causes development of the follicle? |
FSH |
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When does the LH surge happen? What is the end result? |
Day 14 Result is ovulation |
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What allows FSH levels to rise in normal menstrual period? |
The withdrawal of estrogen and progesterone at the end of the previous cycle |
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How is estrogen p produced in the follicle? |
LH stimulates the theca cells to make androstenedione, which is then transported to the granulosa cells which convert it to estrogen under the influence of FSH |
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Most concerning side effects of menopause? |
Osteoporosis Coronary artery disease |
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Medications for hot flashes? |
Clonidine SSRI |
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Definitions of primary and secondary amenorrhea? |
Primary is absence of menarche by age 16 Secondary is lack of 3+cycles or no cycles for 6 months following previously normal cycles |
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What are the 3 categories of causes for primary amenorhhrea |
Outflow tract obstruction End organ damage Central regulatory disfunction |
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Lack of GnRH production + anosmia. Dx? |
Kallman's syndrome |
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Primary amenorrhea with no breasts and no uteruses? |
Typically XY males with gonadal dysgenesis or steroid synthesis problems. Still had the power to produce MIF |
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Primary amenorrhea with breasts but no uteruses? |
We know they have estrogen somehow from the breast development. This mullerian agenesis or testicular feminization (still have peripheral conversion of testosterone to estrogen) |
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Table of primary amenorrhea |
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Differences between hypergonadotrophic and hypogonadotrophic hypogonadism? |
Both lack gonads, but in hypo there is no FSH or LH due to a central problem. In hyper the lack of gonads is the starting point and there is increased FSH and LH because of lack of feedback |
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LH and FSH in menopause and in PCOS? |
In menopause FSH is up In PCOS, LH:FSH ratio is increased |
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MOA of bromocriptine? Use in obgyn? |
Dopamine agonist. User to inhibit hyperprolactinemia |
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Definition of menorrhagia and how clinicians decipher it? |
>80 ml/ menstrual cycle More than 1 pad per hour. Using greater than 24 pads per day |
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Difference between oligomenorrhea and polymenorrhea? |
Oligo is greater than 35 days Poly is less than 21 days |
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Difference between polymenorrhea and metrorrhagia? |
Polymenorrhea bleeding comes at similar intervals and had consistent amount of bleeding each time |
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Most common causes of abnormal uterine bleeding? |
Structural issues of the uterus (fibroids, polyps, adenomyosis, cancer) |
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Diagnosis of no cause for menorrhagia or metrorrhagia? |
Dysfunctional uterine bleeding |
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#1 cause of postmenopausal bleeding? |
Exogenous hormones |
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What do you always need to do for a woman with postmenopausal bleeding? |
Endometrial biopsy to rule out cancer! |
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Which hormone causes increased terminal hair growth? What EZ is needed to create it? |
DHT. 5 @reductase |
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Why does a high LH:FSH ratio lead to hirsutism? |
LH stimulates the theca cells to produce androgens |
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Which type of adrenal tumors typically produce androgens, which don't? |
Carcinomas typically produce androgens, adenomas typically do not. |
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How to diagnose Cushing's? |
Overnight dexamethasone suppression tests If cortisol is >10, then Cushing's. If <5, no cushings |
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Is pelvic infection a common complication of IUD? |
Only during the first 20 days of placement, then no increased risk |
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How do combined OCP'S result in anovulation? |
The progesterone and estrogen supplementation inhibit pulsations in FSH and LH levels, decreasing the spokes necessary for ovulation |
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Disadvantages of OCP'S? |
Increased gallbladder disease Cardiovascular diseases increase Hepatic adenomas |
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Primary side effects of depoprovera? |
Weight gain Depression Irregular menstrual bleeding |
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How soon must emergency contraception pills be used? |
Within 72 hours of sex |
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How soon must IUD emergency contraceptives be used? |
Within 7 days |
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Prior to 16 weeks, which treatment is favorable and safer in second trimester elective abortions? |
D&E is safer than induction of labor |
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At how many months do 90%of couples conceive after trying? |
18 months |
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Top tubal and peritoneal factors for female infertility? |
Endometriosis and adhesions from prior surgeries inhibit proper tubal movement |
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Major complications of reproductive assistive technology? |
Complications with multiple gestations and ovarian hyperstimulation which can lead to rupture, enlargement, and torsion |
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Risk of cancer with Paget's disease of the vulva? Treatment? Prognosis? |
20% have associated adenocarcinoma Wide local excision Recurrs a lot. Fatal if adenocarcinoma and in lymph nodes |
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What is VIN and VAIN most associated with? |
80-90% of VIN have HPV dna fragments
60% of VAIN have concomitant cervical neoplasia |
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Therapy for VIN? HOW MUCH SHOULD BE TAKEN? |
wide local excision? 5mm clear margins |
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Follow up of VIN patients? |
Colposcopy every the months till 2 years disease free, then every 6 months |
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Most common etiology of vaginal cancer? |
Most are metastasis or extension from cervical cancer. Primary vaginal cancer is rare |
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Treatment for vaginal cancer in upper ⅓/lower ⅔of vagina? |
Upper ⅓: surgical resection Lower ⅔: radiation therapy alone |
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Next step of ASC-US, ASC-H, LSIL, HSIL? |
ASC-US should get HPV testing. If positive go for Colposcopy All others should get Colposcopy |
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Which pap results require Colposcopy? |
2+ ASC-US ASC-H LSIL (CIN I) HSIL (CIN II & CIN III) |
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Treatment for CIN II and CIN III? |
Conization of cervix |
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Treatment for CIN I? |
Can be followed with repeat pap and colposcopies |
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Classic presentation of cervical cancer? |
Postcoital bleeding |
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Define 3 stages of cervical cancer |
Stage 1 is just cervix Stage 2 if some extension but not into pelvic side wall or lower vagina Stage 3 extends to pelvic side wall and lower vagina Stage 4 is extension beyond this |
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Demographics that have estrogen independent endometrial carcinoma? |
Post menopausal without significant estrogen exposure AAA (Afr Amer & Asian) |
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Most important prognostic factor in endometrial carcinoma? |
Histologic grade |
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Top 3 in differential diagnosis of postmenopausal bleeding? |
1. Endometrial atrophy (60%) 2. Exogenous estrogen use (15%) 3. Endometrial cancer (10%) |
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Overall 5 year survival rate for ovarian cancer? |
20% |
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Yolk sac tumor produces which marker? |
AFP |
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Dysgerminoma produces which marker? |
LDH |
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Choriocarcinomas produce which marker? |
B hcg |
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Which germ cell tumor is very sensitive to radiation? |
Dysgerminoma |
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Components of Meig's syndrome? |
Ovarian tumor Right hydrothorax Ascites |
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Pathognomonic signs for fallopian tube tumors? |
Hydrops tubae profens ( pain, menorrhagia, diffuse watery discharge) |
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Treatment of DCIS vs LCIS? |
DCIS gets lumpectomy with radiation because it is premalignant LCIS gets local resection |
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Standard adjuvant treatment for premenopausal woman with positive node breast cancer? |
Cyclophosphamide methotrexate 5FU |
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