Term
| When are mullerian defects usually detected? |
|
Definition
| discovered in patients presenting with infertility |
|
|
Term
| What does complete verticle fusion result in? |
|
Definition
|
|
Term
| What does incomplete vertical fusion result in |
|
Definition
|
|
Term
| What does incomplete vertical fusion result in |
|
Definition
|
|
Term
| What is intermenstrual bleeding called when on OCPs |
|
Definition
|
|
Term
| What is intermenstrual bleeding called when on OCPs? |
|
Definition
|
|
Term
| What is the most common cause of infertility in the U.S.? |
|
Definition
|
|
Term
| What are physical characteristics of PCOS? |
|
Definition
Increased facial hair, acne, chest hair, losing hair on head, deep voice (make too much free testosterone), infertility (common), Acanthosis nigricans, BP >130/85 mmHg
> may be pre-diabetic state, more prone to developing type II diabetes
> a form of insulin resistance |
|
|
Term
| What is the classic triad of PCOS? |
|
Definition
1. abnormal anovulatory cycle
2. hyperadrogenism (hirsutism, acne, alopecia)
3. polycystic ovaries bilaterally |
|
|
Term
| What do women with PCOS have in relationship to insulin? |
|
Definition
|
|
Term
| What is the most commonly occurring nonepithelium neoplasm of the breast? |
|
Definition
| Phyllodes tumor (note: 10-15% are malignant) |
|
|
Term
| What is a smooth, firm, rubbery, non-tender,mobile mass that is benign? What influences it? |
|
Definition
Fibroadenoma
- hormonally influenced |
|
|
Term
| What area of the breast is most commonly described as “fibrocystic”? |
|
Definition
| Most common in the UPPER OUTER quadrant |
|
|
Term
| When do you biopsy with nipple discharge |
|
Definition
|
|
Term
| What are the causes of Nipple discharge?what is the most common? |
|
Definition
1. Duct ectasia = most common. D/C is usually green, serous, greenish or bloody - premenopausal
2. Carcinoma = usally with mass
3. Intraductal Papilloma = postmenopausal women |
|
|
Term
| What are most cancers that induce nipple discharge |
|
Definition
| Most cancers that produce nipple discharge are IN SITU and seen on MRI, usually unilateral |
|
|
Term
| What tissue do a breast abscess take place in? |
|
Definition
| Parenchymal (fatty) tissue |
|
|
Term
| What kind of women do breast abscesses occur in? How? |
|
Definition
Breast-feeding women
- through crack or break in skin, commonly the nipple |
|
|
Term
| What do you do if the patient has a breast abscess that is NOT caused from breast-feeding? |
|
Definition
must R/O cancer (inflammatory carcinoma)
Requires more surgical exploration of the area involved |
|
|
Term
| How do you treat a breast abscess? |
|
Definition
- Abx
-bromocriptine (prolactine inhibitor – if lactating)
- I&D |
|
|
Term
| What is Paget’s Disease? What is the lesion most likely (no mass)? If a mass, what is it most likely? |
|
Definition
- rare type of breast cancer (1%)
- appearance: eczematoid lesion of the nipple cause by large malignant Paget Cells that arise from duts and invade the surrounding nipple endothelium – DO NOT MISTAKE FOR ECZEMA
- most likely Intraductal Carcinoma (NO MASS)
- IF MASS, it is most likely invasive ductal carcinoma |
|
|
Term
| What is the tx for Paget’s disease? |
|
Definition
|
|
Term
| Where is the most common location of breast cancer? |
|
Definition
| - the UPPER OUTER quadrant |
|
|
Term
| What is an MRI particulary useful for detecting in breast cancer? |
|
Definition
|
|
Term
| What are the U/S features of Typical breast CA? |
|
Definition
- irregular borders/shape
- Hypoechogenic relative to adjacent tissue
- Heterogenic texture
-post acoustic shadowing
-echogenic of variable thickness |
|
|
Term
| When will insurance cover MRI with breast cancer? |
|
Definition
|
|
Term
| What is the Sentinel Lymph node biopsy procedure? |
|
Definition
| tracer is injected into tumor bed and drainage is followed to the primary (sentinel) node whic is the first node to receive lymphatic drainage from tumor |
|
|
Term
| What is the assumption made if Sentinel (primary) node is negative? |
|
Definition
| the rest of the nodes are negative |
|
|
Term
| what is the assumption if the sentinel (primary) node is positive after SLNB? |
|
Definition
| the rest of the nodes are positive |
|
|
Term
| what are the indications for a sentinel lymph node biopsy? |
|
Definition
- early invasive, clinically node negative breast cancer
-adenopathy on mammogram
-full understanding for patient: further axillary dissection if the biopsy is positive |
|
|
Term
| what is a common surgical treatment for breast cancer? |
|
Definition
Modified Radical Mastectomy
+/- tamoxifen or chemo |
|
|
Term
|
Definition
A selective estrogen-receptor modulator (anti-estrogen therapy)
used 5 years after breast CA treatment |
|
|
Term
| What type of breast CA is confined to the inside of the ductal system? |
|
Definition
| Ductal Carcinoma In-situ (DCIS) |
|
|
Term
| What is the most common TYPE of breast CA? |
|
Definition
| Infiltrating Ductal carcinoma (IDC) |
|
|
Term
| What type of breast CA presents with cells that resemble the medulla (Gray matter) of the brain? |
|
Definition
|
|
Term
| What type of breast CA apprease as a subtle thickening in the upper-quadrant of the breast? |
|
Definition
| Infiltrating LObular Carcinoma |
|
|
Term
| What type of breast CA has distinctive tubular structure and is typically found in women >50 |
|
Definition
|
|
Term
| What type of breast CA appears as stellate (star-lke) or well circumscribed (rounded) on a mammogram? |
|
Definition
| Infiltrating ductal carcinoma |
|
|
Term
| What type of breast CA features mucous production and poorly defined cells? |
|
Definition
| Mucinous Carcinoma (colloid) |
|
|
Term
| what type of breast cancer cause the breast to look swollen & red and is rare but very aggressive? |
|
Definition
| Inflammatory Breast CA (IBC) |
|
|
Term
| How does breast CA present on mammogram? |
|
Definition
| asymmetry, microcalcification, mass, or architectural distortion |
|
|
Term
|
Definition
| urethral descent along the anterior vaginal wall |
|
|
Term
| What is prolapse of the bladder towards or past the vaginal introitus with the cervix as the presenting part? |
|
Definition
|
|
Term
|
Definition
| rectal herniation through the POSTERIOR wall of the vagina |
|
|
Term
|
Definition
| small intestinal herniation (behind the cervix or near the tope of the vag) |
|
|
Term
| What is stage II of pelvic organ prolapse grading system |
|
Definition
| leading edge within 1 cm proximal or distal to the hymen |
|
|
Term
| What is stage III of the pelvic organ prolapse grading system? |
|
Definition
| leading edge 1-2 cm DISTAL to the hymen |
|
|
Term
| What is stage 4 of the pelvic organ prolapse grading? |
|
Definition
| leading edge at least 2 cm distal to hymen |
|
|
Term
| what device is used to treat pelvic organ prolapse? |
|
Definition
|
|
Term
| how do you treat Uterine prolapse? |
|
Definition
1. vaginal hysterectomy
2. vaginal vault suspension |
|
|
Term
| what type of stress incontinence is most common? |
|
Definition
genuine stress incontinence ( urethral fxn and pressure is normal)
- attributed to urethral hypermobility
- bladder is dropped |
|
|
Term
| what UI is loss of urine with sudden increase in abdominal pressure? |
|
Definition
|
|
Term
| What UI is uncontrolled contractions of bladder musculature that can lead to involuntary expulsion of urine? |
|
Definition
|
|
Term
| What UI is characterized by constant urine loss with concomitant inability to void sig. amounts? |
|
Definition
|
|
Term
| What does continuous incontinence suggest? |
|
Definition
| can suggest a Urinary tract fistula or neurologic condition (Alzheimer's, MS) |
|
|
Term
| what UI has symptoms of uncontrollable dribbling of urine and inability to generate strong urine stream? what is it a result of? |
|
Definition
Overflow incontinence
result of chronically overfilled bladder |
|
|
Term
| How do you treat a first break out of herpes? |
|
Definition
| Acyclovir 400 mg X 7-10day |
|
|
Term
| how do you treat recurring herpes? |
|
Definition
| acyclovir 400 mg oral X 5 days |
|
|
Term
| how do you treat clamydia? |
|
Definition
| Azithromycin 1 g or Doxycycline 100 mg X 7day |
|
|
Term
| how do you treat clamydia in a pregnant woman? |
|
Definition
Doxy, ofloxacin, levoflexin are CONTRAINDICATED!
us Azithromycin 1 g oral OR Amoxicillian 500 mg x 7 days |
|
|
Term
| how do you treat Gonorrhea? |
|
Definition
| Ceftriaxone 250 mg IM AND Azithromycin 1 G (to cover clamydia) |
|
|
Term
| how do you treat HPV genital warts? |
|
Definition
Acids TCA
- Aldera
- interferon |
|
|
Term
| how do you treat syphilis? |
|
Definition
Benzathine PCN G 2.4 million units IM
Pregnant: PCN only |
|
|
Term
|
Definition
|
|
Term
| what does failure of fusion of the mullerian ducts result in? |
|
Definition
| results in bicornate (partial nonfusion/class 4), or didelphysis (complete nonfusion/ class 3) |
|
|
Term
| What is the difference between a didelphys uterus (class 3) and bicornate uterus (class 4) |
|
Definition
didelphys uterus results from COMPLETE nonfusion
-bicornate uterus results from PARTIAL nonfusion, requires metroplasty |
|
|
Term
| what is the treatment for septate uterus? |
|
Definition
| Transvaginal hysteroscopic resection of septum |
|
|
Term
| When is referral recommended for children exibiting precocious puberty? |
|
Definition
| when there are 2 or more signs of maturity before age 8 |
|
|
Term
| what initiate the follicular phase of the ovarian cycle |
|
Definition
|
|
Term
| what is the dominant pituitary hormone in the follicular phase of the ovarian cycle? what is it's function? |
|
Definition
FSH
- stimulate the follicles in the ovary to grow and produce estrogen |
|
|
Term
| what is the function of LH in the in the follicular phase? |
|
Definition
LH surges mid-cycle in response to high amounts of estrogen being released from the mature cycle
- it stimulate the ovary to produced PROGESTERONE after ovulation |
|
|
Term
| What occurs in the ovulatory phase of the ovarian cycle? |
|
Definition
Estrogen peak at 200-300 ml inhibiting GnRH (FSH drops off)
- an egg is released 36-42 hours after the onset of surge
- corpus luteum not fertilized become corpus albicans afer 10-14 days --> menstration occurs |
|
|
Term
| What is dominant in the luteal phase of the ovarian cycle? |
|
Definition
Progesterone dominant (secreted by corpus luteum)
-increases and peaks day 20 of the cycle
-estrogen levels loff |
|
|
Term
| what happens to progesterone levels if implantation occurs? |
|
Definition
levels stay UP due to hCG
progesterone would further inhibit FSH and new follicle |
|
|
Term
| What is the uterine cycle composed of? |
|
Definition
1. proliferative phase
2. secretory
3. menses |
|
|
Term
| what is the proliferative phase of the uterine cycle influenced by? |
|
Definition
| estrogen! corresponds to follicular phase of ovarian) |
|
|
Term
| What is the secretory phase of the uterine cycle influenced by? |
|
Definition
progesterone influence from corpus luteum
- lining becomes highly vascularized and begin to secrete clear fluid |
|
|
Term
| What happens to progesterone and estrogen during menstration? |
|
Definition
| they rapidly FAll causing the endometrium to become unstable |
|
|
Term
| what is primary amenorrhea? |
|
Definition
|
|
Term
| what is secondary amenorrhea? most common cause? |
|
Definition
menstruated but failed to menstruate for more than 3 cycles or within 6 month
MC cause is PREGNANCY! |
|
|
Term
|
Definition
| must treat to avoid prolonged uterine exposure to unopposed estrogen for anovulation |
|
|
Term
| what is the most common sx of endometriosis? |
|
Definition
|
|
Term
| What is the primary therapy for endometriosis? |
|
Definition
|
|
Term
| What is the best tx option for menorrhagia? |
|
Definition
|
|
Term
| What tx is used to prevent endometrial hyperplasia? |
|
Definition
|
|
Term
| Progestin does not protect against what type of cancer? |
|
Definition
| no protection against ovarian cancer |
|
|
Term
| What is the mechanism of action of OCPs? |
|
Definition
1. ovulation suppression (steady state of hormones, suppress FSH/LH)
2. Endometrial regression (steady state, less proliferation) |
|
|
Term
| high dose estrogen for acute menorrhagia management? |
|
Definition
| Premarin (4 pills x5days) |
|
|
Term
| What is postcoital bleeding considered until proven otherwise? |
|
Definition
|
|
Term
| what is postmenopausal bleeding until proven otherwise? |
|
Definition
|
|
Term
| What hormone is PCOS insulin resistance associated with? |
|
Definition
|
|
Term
| What causes too much facial hair and masculinity in PCO? |
|
Definition
| increased free testosterone levels |
|
|
Term
| how are polycystic ovaries defined? |
|
Definition
defined as 12 or more follicles in at least 1 ovary measuring 2-9 mm OR
total volume >10 cm 3 |
|
|
Term
| what are the surgical treatments for PCO? |
|
Definition
1. ovarian wedge resection
2. laparoscopic surgery |
|
|
Term
| what medications are used to treat PCO? |
|
Definition
1. metformin (reduces insulin resistance)
2. spironolactone ( treats hirsutism)
3. OCs ( increase SHBG and reduce free testosterone)
4. Provera (progestins stop proliferation of endometrial cells, allows for sloughing off) |
|
|
Term
|
Definition
| PMS is relieved with chronic ovarian suppression |
|
|
Term
| what phase of the menstral cycle does PMS occur? |
|
Definition
| PMS appears in the luteal phase (after ovulation) and resolves with menses |
|
|
Term
| what is the hallmark of PMS? |
|
Definition
| symptom free during follicular phase (right after period) |
|
|
Term
| how is the diagnosis of PMS made? |
|
Definition
|
|
Term
| what is diagnostic of PMDD |
|
Definition
occurs in luteal phase only!
it affects daily life - erodes a woman's ability to cope
disabling and requires treatment |
|
|
Term
| what are the hormone levels in menopause? |
|
Definition
increased FSH
Decreased Estrogen |
|
|
Term
| what is a strong predictor of perimenopause? |
|
Definition
|
|
Term
| why do menopausal women have palpitations? |
|
Definition
| lack of estrogen lowers ventricular repolarization causing arrhythmias |
|
|
Term
| what is the number one cause of death for women? |
|
Definition
|
|
Term
| What HRT do you give a postmenopausal woman WITHOUT a uterus? |
|
Definition
| Estrogen therapy (you don't have to worry about hyperplasia) |
|
|
Term
| What HRT do you give to a postmenopausal woman WITH a uterus? |
|
Definition
| combination (estrogen + progesterone) |
|
|
Term
| what is the most common way to treat a women with a uterus? name? |
|
Definition
Continuous estrogen/progesterone
Goal is NO bleeding
RX: Prempro |
|
|
Term
| What patients are recommended to use transdermal estradiol? |
|
Definition
| women with high triglycerides (less passage through the liver) |
|
|
Term
|
Definition
| provides the lowest dose of progetin that protect the endometrium |
|
|
Term
| What is an alternative for women who cannot use HRT? |
|
Definition
Isoflavones (soybeans, soy proucts)
- have anti-oxident properties that protect against breast CA) |
|
|
Term
| What is sexual dysfunction? |
|
Definition
| difficulty during any stage sex (desire, arousal, orgasm) that prevents the individual from enjoying sex |
|
|
Term
|
Definition
| involuntary vaginal spasms |
|
|
Term
| what is primary sexual dysfunction? |
|
Definition
expectations are never met! (possible never orgasm)
- usually psychogenic |
|
|
Term
| what is secondary sexual dysfunction? |
|
Definition
all phases functioned in the past, 1 or more no longer do
-organic or pharmacologic |
|
|
Term
| what is the most popular contraceptive method? |
|
Definition
female sterilization (#1)
OCs (#2) |
|
|
Term
| when should a diaphragm be inserted? |
|
Definition
| insert 6 hours before sex and 6 hours after |
|
|
Term
| is the cervical cap better for parous women or nulliparous women? |
|
Definition
| better for nulliparous women |
|
|
Term
| what are the two type of IUDs |
|
Definition
1. copper (paragard) = non-hormonal
2. Mirena = progestin only |
|
|
Term
| What is the best contraceptive method for parous women? |
|
Definition
|
|
Term
|
Definition
| prevents fertilazation by interfering with implantation |
|
|
Term
| what are the early warning signs for when you should stop taking Oral contraceptives? |
|
Definition
ACHES
A= Abdominal pain
C = chest pain
H = headache, dizzy, weak
E = eye problems
S= severe leg pain |
|
|
Term
| how does the Mini Pill work? |
|
Definition
Progestin only (at low dose)
- inhibits ovulation, thickens mucous, thins endometrium |
|
|
Term
| What OC's can be used with breastfeeding? |
|
Definition
Progestin only!
Mini pill, Mirena, implanon |
|
|
Term
| what are emergency contraceptives? |
|
Definition
HIGH dose progestin-only pills
(plan B, Yuzpe method, four OCs, Copper-T IUD) |
|
|
Term
| what is the normal pH of the vagina? |
|
Definition
|
|
Term
| What is the role of Acidophilus lactobacilli in the vagina? |
|
Definition
regulates pH at 3.8-4.2
- inhibits G. vaginalis and anaerobes
-prevents overgrowth of Candida sp.
-protects against infection by interfering w/bacterial adherence to epithelial cells |
|
|
Term
| what is the most common vaginosis? |
|
Definition
|
|
Term
| is bacterial vaginosis an STD? |
|
Definition
|
|
Term
| What is the cause of bacterial vaginosis> |
|
Definition
| anaerobes and G.vaginalis |
|
|
Term
| Pt. present with milky grayish vaginal discharge, the pH is >4.5 and the odor is "fishy" and a positive whiff test, what are you thinking? |
|
Definition
|
|
Term
| what cells are diagnostic of bacterial vaginosis? |
|
Definition
clue cells
decreased WBCs |
|
|
Term
| how do you treat bacterial vaginosis? |
|
Definition
|
|
Term
| What is candida vulvovaginitis cause by? |
|
Definition
|
|
Term
| Pt. presents with "cottage cheese" discharge, ph = normal,erythema, vulvar pruitis - what are you thinking? |
|
Definition
|
|
Term
| A KOH wet prep reveals yeast buds, hyphae, or pseudohyphae |
|
Definition
| C. albicans (candida vulvovaginitis) |
|
|
Term
| how do you treat candida vulvovag? |
|
Definition
| with -azole, most commonly Fluconazole (can be used with pregnancy) |
|
|
Term
|
Definition
|
|
Term
| PT. presents with bubbly, pale green, frothy discharge, and pH 5-6.5, wiht petechiae or strawberry patches on the cervix. What are you thinking? |
|
Definition
|
|
Term
| you find protozoa and many WBCs on a wet mount...what are you thinking? |
|
Definition
|
|
Term
| what test can you do to test for Trich?? |
|
Definition
| trichomonas rapid antigen test |
|
|
Term
| how do you treat Trichomoniasis? |
|
Definition
| Metronidazole (ok for pregnancy) |
|
|
Term
| Pt. presents with atrophy, pale mucosa, loss of rage, and a ph 6.0-7.0...what are you thinking? |
|
Definition
|
|
Term
| on a wet mount you see PARABASAL CELLS and increase WBC...what are you thinking? |
|
Definition
|
|
Term
| Pt presents with bilateral pain, vaginal Discharge, cervical tenderness, T>38 degree C, and leukocytosis...what are you thinking? |
|
Definition
| Pelvic inflammatory disease |
|
|
Term
| what do you have to R/O with PID? |
|
Definition
| gonococcal infection (can cause infertility) |
|
|
Term
| Pt presents with burning, erythema, blisters, scant discharge after exposure to latex...what are you thinking? |
|
Definition
|
|
Term
| what do you do if you PAP for cervical cancer comes back abnormal? |
|
Definition
| coloscopy and colposcopic biopsy |
|
|
Term
| where do most cervical cancers occur? |
|
Definition
| in the transformation zone called the squamocolumnar junction |
|
|
Term
| what dose a PAP smear evaluate? Colposcopy with biopsy? |
|
Definition
Papsmear is CYTOLOGY
Colposcopy with biopsy is HISTOLOGY |
|
|
Term
| what do you do next if after colposcopy you find the abnormal area extends inside the cervix? |
|
Definition
| a cone biopsy or LEEP is done next |
|
|
Term
| what are caused by localized proliferation of smooth muscle cells surrounded by pseudocapsule of compressed muscle fibers? |
|
Definition
|
|
Term
| what is the most common presenting sx of Uterine fibroids? |
|
Definition
|
|
Term
| what is the treatment for uterine fibroids? |
|
Definition
Progestin
-inhibit estrogen |
|
|
Term
| the most common type of ovarian malignancy? |
|
Definition
| serous cystadenocarcinoma |
|
|
Term
| what women are cervical polps most commonly found in? |
|
Definition
|
|
Term
| what is the most common type of cervical cancer? |
|
Definition
|
|
Term
| what is the most common symptom of vulvar carcinoma? |
|
Definition
|
|
