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Gyn PANCE
| Question | Answer |
|---|---|
| Physiologically most important estrogen | Estradiol (E2); produced in ovary; peaks in ovulatory phase; FB to inc LH & decrease FSH |
| Primary estrogen in PG | Estriol (E3); produced in placenta |
| Before menopause, primary circulating estrogen = | Estradiol (E2); serum estradiol levels 30-200 pg/mL |
| After menopause, primary circulating estrogen = | Estrone (E1); secreted by ovary; mean serum estradiol levels < 15 ng/mL |
| Induces glandular secretion in endometrium: | Progesterone |
| Main role of testosterone in women | estrogen precursor |
| Decreased testosterone levels in females cause: | decline in libido, mood changes |
| Progesterone produced where? | in corpus luteum after ovulation; by placenta in PG |
| Progesterone levels rise rapidly after: | ovulation |
| FSH fn: | binds to granulosa cells and stimulates estradiol secretion |
| In a state of estrogen deficiency, more ____ is secreted | FSH |
| During luteal (secretory) phase, ______ are suppressed to low levels | FSH and LH |
| Plasma LH surge precedes ovulation by | 24-36 hrs |
| Estrogen pattern during menstrual cycle | Secretion peaks just before midcycle, drops sharply with ovulation, rises again to plateau, then decreases again before menstruation |
| During luteal (secretory) phase, predominant hormone changes from: | estradiol to progesterone |
| Adequate progesterone prodn is necessary to facilitate: | implantation and sustain early pregnancy |
| Progesterone MOA | Acts primarily on endometrium, initiates secretory phase |
| Results of hyperprolactinemia | Loss of libido; Galactorrhea; Oligomenorrhea/ amenorrhea; Infertility; Decreased muscle mass; Osteoporosis |
| Decreased _____ levels in females cause decline in libido, mood changes | testosterone |
| Vaginitis sxs | vaginal discharge; Dyspaurenia; Dysuria; Urinary Frequency |
| Ectopic PG sx | Missed menses/unusual menses; Lower abdominal/pelvic pain; Vaginal bleeding; Positive PG test |
| Ovarian cyst sx | Unilateral/diffuse; Sharp; Spontaneous resolution common; Uncommon on OCPs |
| Ovarian torsion sx | severe pain, down legs/back |
| PID sx | Dyspaurenia; Fever; Chills; Diarrhea; Vaginal discharge |
| Chronic pelvic pain sx | Intermittent, cyclical; Constant pain is possible; Dull, nonspecific, diffuse; Generally afebrile |
| Endometriosis sx | Dysmenorrhea; Dyspaurenia; Adhesive dz devt possible; improved with suppression of ovulation |
| Uterine fibroid sx | Dysmenorrhea; Dyspareunia; Urinary frequency; Lower back pain |
| Osteitis pubis | Symphysis pain; Pelvic joint instability following childbirth |
| Vulvodynia | Vulvar pain; Painful urination; Dyspaurenia; Vaginal and Pelvic floor symptoms |
| Primary dysmenorrhea: onset within: | 1-2 years of menarche |
| Musculoskeletal pelvic pain includes: | Myofascial pain; Muscle spasm; Round ligament; Spinal nerve innervation |
| Painful bladder syndrome = | Dysuria; Negative UA; Urinary Frequency; Dyspareunia ; Dx of exclusion/ autoimmune component |
| Chancroid: cofactor in contracting: | HIV |
| Chancroid: often co-infection with: | HSV or syphilis |
| Most common symptom of endometrial neoplasia: | AUB (90% of pts) |
| endometrial ca RF | Post or late menopause; FH/PMH ca (ov, BrCa, colon, endomet); Tamoxifen; PCOS; Obesity; nulliparity; Estrogen Tx w/o progestin; Prior Endometrial Hyperplasia; DM, HTN |
| average uterine length = | 6-8 cm |
| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Premenopause etio: | Obesity; PCOS; eating disorders; Thyroid; Herbals; other anovulation |
| Simple/Complex Endometrial Hyperplasia: causes unopposed estrogen: Postmenopause etio: | Obesity; HRT; herbals w/estrogen (soy); Ovar/ adrenal estrogen producing tumor |
| Postmenopausal, dyspareunia, thin vaginal discharge, atrophic vulvar changes, vaginal petechiae | Atrophic vaginitis; Tx = topical estrogen |
| 20 yo female w/ rubbery, firm, well-circumscribed, non-tender breast lesion, doesn't change w/ cycle | Fibroadenoma |
| 30 - 50yo female, painful, multiple, bilateral breast masses that increase in pain and size before menses | Fibrocystic breast disease |
| Spontaneous bloody, serous, or cloudy nipple discharge | Intraductal papilloma |
| Breast mass, nipple retraction, bloody nipple discharge | Breast cancer (mass is most common presenting clinical manifestation) |
| Overweight, irregular menstrual cycles (poss. Amenorrhea), elevated blood sugar, hirsutism | PCOS (stein-leventhal syndrome) |
| Adolescent female with midcycle pain alternating from left to right side. Relieved w/ NSAIDs | Mittelschmerz |
| Dysmenorrhea, dyspareunia, dyschezia. Uterus is fixed, retroflexed. Cyclic pelvic pain. May have palpable pelvic mass | Endometriosis |
| Palpable pelvic mass - "chocolate cyst" = | Endometriosis |
| Firm irregular shaped, NONTENDER enlarged uterus | Leiomyoma |
| Softened, tender, diffusely globular uterine enlargement | Adenomyosis |
| 6cm unilateral, mobile, tender adnexal mass | Tubo-ovarian abscess |
| Postmenopausal vaginal bleeding | Endometrial Ca - do endometrial biopsy |
| Postmenopausal adnexal mass | Ovarian Ca |
| yellow creamy discharge | chlamydia |
| primary amenorhhea = | absence of menses by 16 yo |
| secondary amenorhhea = | absence of menses x 6 mos (if h/o oligomenorrhea, 12 mos) |
| secondary amenorhhea: pt w/o 2nd sex characteristics = | 2/2 gonad agenesis, pubertal delay, ovarian resistance syndrome, galactosemia, GnRH def, CNS mass lesion |
| secondary amenorhhea: pt w/ breast devt but no pubic hair = | androgen insensitivity |
| secondary amenorhhea: normal 2nd sex characteristics = | imperf hymen, transverse vaginal septum, mullerian dysgenesis |
| secondary amenorhhea: incomplete 2nd sex characteristics = | HPA tumor, hypothyroid, hyperprolactinemia, premature ovar failure |
| secondary amenorrhea, not PG: | Asherman syndrome (uterine synechiae) or PCOS |
| primary dysmenorrhea = | painful menses 2/2 xs prostaglandin E2 secretion; onset near menarche, peaks in late teens |
| secondary dysmenorrhea = | 2/2 other condition (endometriosis, adenomyosis, fibroids); usu >25 yo |
| Adenomyosis = | implantation of endometrial tissue in myometrium; tender, symmetrically enlarged boggy uterus |
| PMS course | 1-2 weeks before menses (during luteal phase) to 1-2 days post onset; sx-free during follicular phase |
| DUB causes | usu increased anovulatory cycles; also PCOS, obesity, adrenal hyperplasia |
| endometriosis physio | endomet glands & stroma outside endometrium, usu pelvis or on ovary (90%) or distant |
| uterine prolapse grading | 0 (no descent) to 4 (thru hymen) |
| ovarian cysts in postmenopausal women are presumed to be: | malignant until proven otherwise |
| OCPs are protective vs cancer of: | endometrial, ovarian; not vs ovarian cysts |
| 2 forms hereditary ovarian ca | BOC (BR & ov); HNPCC |
| anterior vaginal prolapse includes: | cystocele or cystourethrocele |
| apical vaginal prolapse includes: | uretovaginal or vaginal vault prolapse |
| posterior vaginal prolapse includes: | enterocele or rectocele |
| vulvar malig: | rarest of Gyn ca; usu SCC |
| in utero exp to DES = | risk of clear cell adenocarcinoma of vagina |
| vulvar malig comorbids: | obesity, DM, HTN, arteriosclerosis; in younger F, also SMK & HPV |
| most VIN occur where: | upper 1/3 of vagina; are Asx |
| fibroadenoma s/s | round firm smooth discrete mobile nontender |
| Br Ca: estrogen receptors | All invasive lobular and 2/3 of ductal ca are est rec pos |
| Br Ca typical presentations | single nontender firm immobile mass; 45% in UOQ, 25% nipple |
| Br Ca increases risk of: | endometrial ca, and vice versa |
| PID includes: | acute salpingitis (gono or non), IUD pelvic cellulitis, TOA, pelvic abscess |
| Tabes dorsalis = | in tertiary syphilis: loss of proprioception & vibratory sense, Argyll Robertson pupil (reacts to light but does not accommodate) |
| Breast exam: lymph nodes | Axillary, supraclavicular, and infraclavicular lymph nodes |
| Polythelia = | supernumerary nipples |
| Duct ectasia = | widening of breast ducts; in pts near/past menopause; thick sticky discharge and/or itching around nipple |
| Fat necrosis | Firm round lump; often d/t MVA or trauma |
| Most common breast complaint = | mastalgia (benign breast pain); assoc w/hormonal changes; teens & 40s, usu ends w/menopause |
| Most frequent benign breast condition: | Fibrocystic changes; grainy, palpable, small lumps; 30-50 y.o.; mobile, well defined; bilateral, UOQ; tender last half of cycle; dx w/bx |
| second most common benign breast condition: | fibroadenoma; Hormone influenced abnormal growth of fibrous and ductal tissue; AA women; teens/20s; rapid growth during PG |
| fibroadenoma assessment | discrete lump; firm, rubbery, round, mobile, non-tender, smooth, solitary; Usually UOQ, 1-5 cm |
| Peau d'orange is associated with: | Inflammatory breast ca |
| Paget dz of breast: progression | Begins in duct, spreads to nipple & areola; usu occurs w/ infiltrating ductal br ca; eczematous nipple lesion |
| Ductal BrCa types | In Situ; Invasive; Inflammatory |
| Lobular BrCa types | In situ; Invasive, predominantly in situ; Invasive |
| Nipple BrCa types | Paget dz w/ intraductal ca; Paget dz w/ invasive ductal ca |
| BrCa RF | BRCA 1&2; FH; prior abnormal br bx; age (60 yo ave onset); nulliparous, early menarche, late menopause, LT estrogen, delayed childbearing |
| Cause of characteristic odor in bacterial vaginosis | Anaerobes |
| Bacterial vaginosis requires 3 of 4 criteria: | Typical discharge, alkaline pH(5.0-5.5), positive "whiff" test, clue cells on wet prep |
| Bacterial vaginosis is not considered an __ | STD |
| trichomonas vaginitis Sx/Sx | Severe pruritus, malodorous (musky) discharge, dysuria, dyspareunia, may be asymptomatic, greenish-yellow/frothy discharge, petechiae or "strawberry markings on cervix |
| Atrophic vaginitis often masquerades as: | Infection |
| atrophic vaginitis S/S | Pruritis/burning, vaginal dryness, dyspareunia, possibly spotting, pale/thin vaginal mucosa, loss of vaginal rugation; women w/o menses (decreased estrogen) |
| Bilateral Bartholin abscess said to be associated with: | Gonorrhea; unilateral also strep, e. coli, chlamydia, anaerobes |
| Organism associated with toxic shock syndrome | S. aureus/endotoxins |
| Woman with flu like symptoms, during menses: possibly: | Toxic shock syndrome |
| Fever >38.9 C, hypotension, diffuse erythroderma, desquamation, involvement of at least 3 organ systems = CDC case defn of: | Toxic shock syndrome |
| Condyloma lata = | secondary syphilis; Smooth, moist, flat |
| Pruritus, burning; cottage cheese discharge; dyspareunia | Yeast vaginitis |
| Chronic Bartholin cyst may be mistaken for: | acute abscess, esp perirectal abscess (more posterior) |
| TSS: Skin | Erythroderma of skin / mucous mem; diffuse, red, sunburn-like rash; involves palms and soles; Conjunctival-scleral hemorrhage; later, pruritic maculopapular rash, desquamation |
| History of sexual intercourse with trauma increases the risk for what STD | Hep B , and Hep C |
| 3 causes of genital ulcers in US | Herpes simplex virus, primary syphilis, chancroid |
| Herpes ulcers description: | Painful, small, shallow, may have a clear exudate; secondary ulcers are smaller / less dramatic than primary lesions |
| Primary syphilis description: | Solitary, painless, indurated, large/deep ulcer; local painless rubbery LAD |
| Agent responsible for chancroid | H. ducreyi |
| Clinical presentation of lymphogranuloma venereum (LGV) | Rectal ulceration or stricture, inguinal LAD |
| Etiology of LGV | Chlamydia trachomatis |
| Clinical presentation of granuloma inguinale | Chronic or recurrent ulcerative vulvitis. Donovan bodies on stained direct smear or biopsy of ulcer. |
| etiologic agent of granuloma inguinale | Klebsiella granulomatis (formerly Calymmatobacterium granulomatis) |
| Etiologic agent of condyloma acuminata | HPV 6 & 11 |
| Clinical appearance of condyloma acuminata | Papillomatous, white, cauliflower like |
| Chancroid causative organism | Haemophilus ducreyi |
| Chancroid is most often a co-infection with what | Herpes and or syphilis |
| Test for trichomonas | Wet prep |
| Risk factors for cervical cancer | Smoker, hormones, multiple sexual partners, sex before 18, HIV, poor SES, age, multiple pregnancies, chlamydia infection, diet low in fruit and vegetables |
| Effective methods to prevent cervical cancer | Routine pap tests, avoid smoking, condom use, limit partners, HPV vaccine |
| Low risk HPV strains | HPV-6, and HPV-11 (cause genital warts) |
| High risk strains of HPV | HPV-16 & 18; 31, 33, 45 |
| Offer __ testing for all patients evaluated for STIs | HIV |
| Acute HIV symptoms | Fever, mono-like illness, diarrhea |
| Which hepatitides are commonly sexually transmitted | A, B, and C (especially B) |
| Males voiding within __ before urethral culture washes secretions away | 1-2 hours |
| What is herpetic whitlow | Herpes on the fingers (especially around the nail bed) |
| Characteristic of primary HSV outbreak | 2-7 day course, systemic symptoms possible, local symptoms (painful), first outbreak is the worst |
| Precipitants of HSV recurrent outbreaks | Sun, wind, trauma, fever, menses, stress |
| Multiple, vesicular, pruritic, painful, recurrent rash | Herpes simplex |
| Gonorrhea s/s | Vaginal discharge, abdominal pain, 50% asymptomatic |
| Female complications of gonorrhea | PID, infertility, ectopic pregnancy, tubo-ovarian abscess, perihepatitis (Fitz-Hugh-Curtis syndrome), septic arthritis, vertical transmission, ophthalmia neonatorum |
| Common co-infxn with Gonorrhea: | Chlamydia |
| Violin string adhesions between liver and parietal peritoneum, RUQ pain may be prominent symptom especially in young women, PID complication | Fitz-Hugh-Curtis syndrome |
| Secondary syphilis usual duration: | A few weeks |
| Clinical appearance of secondary syphilis | Bilaterally symmetrical papulosquamous rash, condyloma, alopecia, denuded tongue, lymphadenopathy (firm, rubbery, non-tender) |
| Secondary syphilis is contagious by: | Skin on skin contact (any portion of the body) |
| Latent syphilis = | period after secondary stage, no clinical manifestation |
| Tertiary syphilis is __ infectious | rarely |
| Etiology of syphilis (bug) | Treponema pallidum spirochete |
| How many stages of syphilis are there | 4 |
| Acute syphilis: chancre develops on skin near infection site about __ after inoculation | 3-6 weeks |
| Characteristic of secondary syphilis | Maculopapular rash often on palms and soles, generalized LAD, typically lasts about 3 months |
| How long does the acute syphilitic chancre last | 5-6 weeks |
| How long may syphilis remain inactive | Up to 5 years |
| tertiary syphilis = | End organ manifestation (CNS, cardiovascular, ocular); gummatous lesions of skin, bones, viscera |
| Single, heaped up or rolled edge, textbook case never painful | Syphilitic chancre |
| Bilateral papulosquamous rash on palms and soles | Secondary syphilis |
| What type of bacterium is chlamydia trachomatis | Intracellular obligate bacteria |
| If you are treating a patient for chlamydia do you need to also treat for gonorrhea | Not necessarily |
| Clinical course of chlamydia | Asymptomatic or minor symptoms in majority, vaginal discharge, dysuria, mucopurulent cervicitis, acute urethral syndrome, pelvic pain, lower abdominal pain |
| Perinatal transmission of chlamydia can cause __ | Ophthalmia neonatorum, pneumonia |
| Female chlamydia complications | PID, infertility, ectopic pregnancy, perihepatitis, perinatal transmission |
| Common condition in which microorganisms spreads from lower genital tract, infect & inflame upper genital tract structures including endometrium, tubes, ovaries & peritoneum | PID |
| Symptoms of PID | Abd pain, dyspareunia, possibly fever/chills, possibly RUQ pain |
| Besides 3 CDC minimum criteria, additional criteria for PID dx | Elevated oral temp (>101), abnormal cervical or vaginal discharge, elevated ESR, Elevated C-reactive protein, positive GC or chlamydia, increased WBC |
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