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72 Cards in this Set
- Front
- Back
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Loss of sensation in which distributions for iliohypogastric vs. ilioinguinal nerve entrapment
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Iliohypogastric nerve: groin, skin overlying the pubis
Ilioinguinal nerve: groin, symphysis, labium and upper inner thigh |
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Breast nodule with normal mammogram
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Still need cytology, e.g. FNA
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This substance can increase the pain from fibrocystic breast changes
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Caffeine
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Management of bloody vs. clear fluid on breast lump FNA
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Clear: f/u in 2mo if mass decreases in size after aspiration (if not, need excisional biopsy)
Bloody: excisional biopsy |
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Rx for mastitis
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Abx and ibuprofen/tylenol
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Bug and abx choice for mastitis
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Dicloxacillin (erythro if pen-allergic)
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Management of vulvar lesion unresponsive to trichloroacetic acid and imiquimod cream
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Vulvar biopsy (if negative, then laser excision)
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How does medroxyprogesterone acetate work to promote regular menses and how is it given
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Switches endometrium from proliferative --> secretory
10mg for 10 days each month |
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LH:FSH ratio in PCOS
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Increased
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Androgen levels are ___ and estrogen levels are ___ in PCOS
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Both increased
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What is hyperthecosis?
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Extreme PCOS; women experience virilization, usually refractory to OCPs
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Elevated DHEAS, but normal testosterone
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Adrenal tumor
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2 tests for Cushing's
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24hr urinary cortisol
Dexamethasone suppression test |
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Hyperinsulinemia may present as
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Acanthosis nigricans; can actually do a fasting insulin level if think pre-diabetic
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Cause of postpartum hair loss
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High estrogen in pregnancy --> synchrony of hair growth
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Signs of hyperthecosis
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Temporal balding, deepening of the voice, clitoral enlargement
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Rx for hirsutism (first and second line)
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OCPs, then add spironolactone
(can also use Lupron or danazol in lieu of OCPs) |
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How do the bisphosphonates work
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Inhibit osteoclast bone resorption
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Oligospermia with low LH and normal testosterone
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Exogenous steroid use
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Recommended calcium supplementation for postmenopausal women
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1200-1500mg
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When to start treatment with bisphosphonates
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Low BMD on DEXA scan, or with history of osteoporotic fracture
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Most common reason women stop hormone replacement therapy
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Vaginal bleeding from cycles after previous amenorrhea
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Most effective treatment for hot flashes
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Estrogen
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Side effect of TCAs
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Hyperprolactinemia, which can lead to infertility
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Rx for infertility from functional hypothalamic amenorrhea
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Weight gain; otherwise, LH and FSH (clomiphene citrate doesn't work as well for ovulation induction)
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How to determine ovarian reserve in pt who may be perimenopausal and wants to conceive
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Clomiphene challenge test
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Basis for PMS/PMDD
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Serotoninergic dysregulation (decreased serotonin in progesterone-dominant luteal phase)
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What is entrainment?
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Luteal phase worsening of underlying medical/psychiatric disorder (e.g. IBS, MDD)
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How do OCPs help with dysmenorrhea?
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Induce endometrial atrophy; with less endometrium, less prostaglandins released
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When is chlamydia and gonorrhea testing indicated?
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In ALL sexually active women under 25
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Menorrhagia with severe dysmenorrhea
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Adenomyosis
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Definitive Rx for adenomyosis
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Hysterectomy (can also use Mirena)
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When do you need an EMB with diagnosis of fibroids?
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Woman >40 with AUB
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Which vitamins can reduce PMS symptoms?
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Vitamin A, E, and B6
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When do pts need a symptom diary for PMS/PMDD diagnosis?
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ALWAYS!
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Strongest risk factor for PMS
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Family history (other than vitamin deficiencies)
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Karyotype of complete vs. partial moles
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Complete: 46XX (entirely paternal)
Partial: 69XXY (one materanl and two paternal) |
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Which has a higher likelihood of malignant transformation, and which is more common
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Complete mole for both
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Second trimester bleeding, no fetal heart tones, exaggerated pregnancy symptoms
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Molar pregnancy (exaggerated symptoms due to high beta-hcg)
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Ovarian appearance with hyaditiform moles and why
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Multicystic from theca lutein cysts due to follicular stimulation from high levels of circulating hCG
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Choriocarcinomas can follow which types of pregnancies?
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Molar, normal, abortion, ectopic
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Form of metastases in choriocarcinoma
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Hematogenous embolization
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Why should metastatic sites in GTD not be biopsied?
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Bleeding complications
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Risk factors for molar pregnancy
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Asian, extremes of age, Hx of 2+ miscarriages, low beta carotene or folic acid
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Uterine size greater than dates can indicate
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Molar pregnancy, esp complete mole
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Rx for molar pregnancy
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Suction curettage
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Contraception length recommendation after molar pregnancy
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For 6mo after negative hCG values
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Risk factor of prolonged lichen sclerosis
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Extensive irritation can --> vulvar SCC
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Significant lifestyle risk factor for vulvar cancer
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Smoking
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Multiple white plaquelike lesions
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Paget disease of the vulva
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Thin, inelastic, white vulvar skin with "tissue paper" appearance
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Lichen sclerosis
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Multicentric brown-pigmented papules on the perineum, perianal area, and labia minora
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HPV-associated VIN (vulvar intraepithelial neoplasia)
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Rx for VIN III
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Wide local excision
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Rx for diffuse lesions from VIN II
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Laser therapy
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Vulva w/ fiery red background mottled with whitish hyperkeratotic areas without a distinct lesion
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Paget disease of the vulva
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Areas involved in lichen planus
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Hair-bearing skin and scalp, nails, oral mucous membranes and vulva
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Severe pain on attempted vaginal entry
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Vulvar vestibulitis
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Rx for vulvar vestibulitis
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TCAs, topical anesthetics, pelvic floor exercises; radical vestibulectomy if refractory
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Persistent itching and scratching --> thick, lichenified, enlarged labia
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Lichen simplex chronicus
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Cause of mucopurulent cervicitis
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Chlamydia or gonorrhea
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Name and management of white lesion on cervix
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Leukoplakia; always must biopsy
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Management of insufficient colpo
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CKC biopsy
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Management of HSIL but negative colpo/biopsy
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Cervical conization, given discrepancy in results
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Definition of microinvasive cancer
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Cells that extend <3mm beyond the basement membrane
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Why should myomectomy at the time of C-section be avoided?
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Increased blood loss
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Which fibroid pts are good candidates for GnRH agonist Rx?
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Pts close to menopause, or pts receiving hysterectomy in 6mo (to reduce size prior to surgery)
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Pregnant pts with myomas >3cm are at increase risk for?
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Preterm labor, placental abruption, pelvic pain, C-section
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Management of EMB with scant tissue and rare atypical cells
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D&C
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Best scan to look for mets in pt with stage 1 endometrial cancer
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CXR (more invasive scans not needed)
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How often do pts on tamoxifen need EMB?
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Never, unless symptomatic; still just regular annual exams
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Yellow-brown discharge and foul odor on a young girl
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Foreign body
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Management of vaginal foreign body in a young girl
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Removal under anesthesia
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