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Step 2 OB/GYN
Gynecology Notes Rx
| Question | Answer |
|---|---|
| What is the best treatment option for asymptomatic uterine fibroids? | Observation |
| Non-tender enlarged uterus + negative pregnancy test and lack of adnexal masses. Dx? | Uterine fibrinoid |
| How is the contour of a uterine fibroid described? | Irregular |
| What is the screening test for cervical cancer in patients 21-24 years old? | Colposcopy |
| What age group is screened for Cervical cancer with Loop Electrosurgical Excision Procedure (LEEP)? | Women over 25 y.o. |
| Which stages/level of CIN warrant LEEP? | Only CIN-2 and CIN-3 |
| What procedure to confirm CIN may cause deleterious damage to women still planning to get pregnant? | Cold Knife Conization |
| What is the normal (time) menstrual cycle? | 21-35 days |
| How do you get the exact day of ovulation? | Subtract 14 from the total length of the patient's menstrual cycle |
| What is Endometrial cancer main mechanism of etiology? | Unopposed estrogen exposure over a prolonged period leading to hyperplasia and eventually to cancer. |
| What is the most common type of malignancy in a post-MP woman with vaginal bleeding? | Estrogen-secreting Granulosa cell tumor |
| What is pathognomy of Premature Ovarian Failure (POF)? | High levels of FSH and LH |
| What are the risk factors for Endometrial carcinoma? | Obesity, chronic anovulation/PCOS, nulliparity, early menarche, and late menopause, as well Tamoxifen |
| What are protective factors against Endometrial cancer? | Combined OCPs, late menarche, early MP, and multiparity |
| What is the best treatment for localized Endometrial carcinoma? | Total hysterectomy with bilateral salpingo-oophorectomy |
| What is the most significant or best clue for benign intraductal carcinoma of the breast? | Unilateral bloody nipple discharge |
| What is the NBSM of bloody nipple discharge suspecting of intraductal papilloma? | Surgical duct excision and complete removal of any identified tumor |
| How is the discharge produced by Candida vulvovaginitis? | Thick, curdy, and white discharge that adheres to the vaginal walls |
| What is the TOC for Candidal vaginitis? | Single dose of oral fluconazole |
| How is a definite DX of endometriosis made? | Direct visualization or BX of ectopic endometrial tissue via laparoscopy |
| Important contraindication for Copper IUD insertion | Active infection of Hx of pelvic infection in the last 3 weeks |
| MOA of Levonorgestrel: | Prevents and delays ovulation, Prevents egg fertilization by affecting cervical mucus and/or ability of sperm to bind to egg |
| MOA of Copper IUD: | Prevents fertilization by causing chemical changes to egg and sperm prior to them meeting. |
| What causes primary dysmenorrhea? | Excess production of prostaglandins in the endometrium, lead to crampy abdominal pain associated with menses |
| What is the 1st LOT for Primary dysmenorrhea? | NSAIDs |
| What is the 2nd LOT for Primary dysmenorrhea? | OCPs, which exert effect by suppressing ovulation as well as reducing thickness of endometrium |
| What action can mask the S/S of menopause? | MP-woman on cOCPs due to the estrogen in them |
| In case that S/S of MP are masked due to exogenous estrogen, what is the best indicator of MP? | Age over 51 |
| 1st LOT for hyperandrogenism | cOCPs |
| 2nd LOT for hyperandrogenism | Spironolactone |
| What are clinical findings of Androgen Insensitivity syndrome? | Amenorrhea and absent uterus and cervix in young woman with normal secondary sexual characteristics and a normal FSH level |
| How is the FSH level in Androgen Insensitivity syndrome? | Normal |
| What procedure is used to obtain a biopsy tissue for Endometrial cancer? | Dilation and curettage, which serves as biopsy tissue and treatment |
| What is intended to treat D & C in Endometrial cancer? | Heavy vaginal bleeding |
| What is a key clue for a Sertoli-Leydig tumor? | New, rapid onset of virilization |
| What is Thelarche? | Premature development of breasts in absence of other signs of premature puberty |
| What is the management of Premature Thelarche? | Reassurance only |
| What are treatment options for stress incontinence? | Strengthening pelvic muscles (Kegels), vaginal pessaries, and if severe, pelvic floor surgery |
| What is the best test to Dx or confirm a Hypothalamic dysfunction? | Progestin Challange test |
| What levels of FSH after "Progestin Challange test" indicate Hypothalamic dysfunction? | Normal to Low FSH levels |
| What is a common complication of untreated cervical cancer? | Hydronephrosis due to ureteral obstruction |
| What are structural causes of AUB in an adolescent? | Polyps, Adenomyosis, Leiomyoma, and Malignancy (PALM) |
| What are non-structural causes of AUB in an adolescent? | Coagulopathy, Ovarian dysfunction, Endometrial, Iatrogenic, and Not yet classified (COEIN) |
| What are the best initial Diagnostic tests for coagulopathy? | Coagulation factors such as vWF and PT/PTT |
| Common aromatase inhibitor | Anastrozole |
| What is inhibited by an aromatase inhibitor? | Androgen --> Estrogen |
| How does hypoestrogenic states cause post-coital bleeding? | ↓Estrogen --> vaginal atrophy --> ↑risk of trauma --> vaginal bleeding |
| How is vaginal candidiasis clinically presented? | Vaginal inflammation, intense itching, and thick, curdy, white d/c adherent to vaginal walls |
| What is oral treatment for Vaginal Candidiasis? | Oral Fluconazole for 1 day |
| What is the topical treatment option for Vaginal Candidiasis? | Topical Miconazole for 3, 5, or 7 days |
| Why are topical azoles preferred over oral fluconazole in treating candidiasis infection in a pt on phenytoin? | Phenytoin --> ↓↓Fluconazole metabolism and ↑risk of toxicity |
| What condition predisposes or ↑risk of vaginal candidiasis? | Diabetes mellitus |
| What is a common sequelae or complication of Cervical cone biopsy? | Uterine Cervical stenosis |
| What is a common cause of Asherman syndrome? | Instrumentation of the uterine cavity |
| What is the gold-standard treatment for instrumentation of uterine cavity? | Surgical hysteroscopy with removal of adherences |
| What is the most likely prognosis of low-grade CIN? | Regression w/out additional treatment |
| What is the NBSM for a low-grade CIN patient? | Surveillance Pap test with HPV co-test in 12 months |
| Is vaccination against HPV 100% secure of not getting infected by the strain? | No, it only reduces the chances |
| What is a pharmacotherapy option for MP-symptoms in women that cannot take HRT? | SNRIs |
| How many months after d/c of cOCPs is considered clinically relevant for the HPO axis to restart? | 3-6 months of amenorrhea after cessation of cOCPs |
| What anti-cancer drug is well known to potentially increase risk of endometrial carcinoma? | Tamoxifen |
| What is the MOA of Tamoxifen? | Estrogenic modulator used to Tx breast cancer, but with estrogen agonist effect on endometrial tissue |
| DOC for H. ducreyi | IM ceftriaxone |
| What is caused by H. ducreyi infection? | Painful chancroid --> ulcer accompanied by exudates and inguinal lymphadenopathy |
Created by:
rakomi
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