| Term | Definition |
| Müllerian agenesis
rare, congenital defect in which the Müllerian ducts fail to fuse, | - atretic uterus, cervix, and upper-third of the vagina.
- primary amenorrhea
- normal secondary sexual characteristics.
- normal ovaries |
| pt had ambiguous genitalia as an infant & now with primary amenorrhea, severe acne, tall stature, & several fractures following minor trauma. her mother had virilization during pregnancy. | - features are suggestive of low estrogen and high androgen levels.
Aromatase deficiency;
--normal internal genitalia
-- tall
-- cystic ovaries |
| Aromatase deficiency | tall stature due to a delayed fusion of the epiphyseal growth plates and signs of osteoporosis (e.g., bone fractures after minor trauma), caused by estrogen deficiency. |
| pt with obesity exhibits signs of isolated adrenarche and pubarche in the absence of thelarche and menarche, indicating peripheral precocious puberty (PPP). | obesity related hyperandrogenemia
GnRH pulsatility is not increased in PPP, |
| Early secondary sexual development with an advance bone age in a 6-year-old girl is indicative of precocious puberty. Elevation of serum LH levels after stimulation with a GnRH agonist indicates central precocious puberty | next step in management
- MRI of brain |
| development of secondary sexual characteristics in a 7-year-old girl indicates precocious puberty. The lack of elevation of LH levels following GnRH agonist stimulation indicates | peripheral precocious puberty.
-Granulosa cell tumor is a common cause of PPP
finding of a palpable mass in the lower abdomen and pelvic imaging shows enlarged ovaries |
| an adolescents with primary amenorrhea despite normal uterine development, negative pregnancy test. | gonadotropin levels should be tested.
- check serum FSH, LH levels |
| Vaginismus
Genito-pelvic pain/penetration disorder | female psychosexual disorder
- involuntary tightening of the pelvic floor muscles during vagina penetration
- seen in ppl with relationship issues (sexual problem in the partner), poor body image, psychiatric disorders |
| Psychogenic dyspareunia | - pain during sexual intercourse
- not due to an underlying organic cause (e.g., endometriosis, vaginal infections) |
| Genito-pelvic pain/penetration disorder management | Pelvic floor physical therapy |
| onset of lower abdominal pain, dysuria, dyspareunia, and vaginal discharge, along with physical findings such as uterine tenderness in a sexually active woman, are highly suggestive of | pelvic inflammatory disease (PID)
- intramuscular ceftriaxone and oral doxycycline is the first-line treatment for PID
- Oral administration of levofloxacin and azithromycin is suitable for pts with penicillin allergies. |
| Trichomonas vaginalis | - flagellated protozoa that can cause sexually transmitted infections such as vaginitis or urethritis |
| Patients with recent use of antibiotics, foul-smelling, frothy, yellow-green, purulent vaginal discharge with a pH > 4.5. | Trichomonas vaginalis |
| HPV-16 and HPV-18 | the oncogenic high-risk HPV strains |
| HPV strains 6 and 11 | 90% of genital warts, or condylomata acuminata.
- lesions are cauliflower-like , a flat, papular, or pedunculated shape
- commonly found on the mucosa or along the epithelium of the anogenital tract. |
| pt presents with septic shock (leukocytosis, fever, tachycardia, low blood pressure), diffuse erythematous rash, skin peeling, acute kidney injury, & thrombocytopenia. This presentation indicates ? | toxic shock syndrome (TSS), likely due to Staphylococcus aureus |
| test of choice in the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae | Nucleic acid amplification test of vaginal fluid, urine |
| Rx of choice for Disseminated gonococcal infection? | Intravenous ceftriaxone |
| Pt has thin whitish vaginal discharge, PH 5.1 and the wet mount showing vaginal epithelial cells covered with bacteria , this patient most likely has ? | bacterial vaginosis caused by Gardnerella vaginalis.
Rx; Metronidazole |
| pregnant pt's with vulvar pruritus, dysuria, & whitish, chunky discharge, combined with pseudohyphae & hyphae with budding yeast on wet mount with potassium hydroxide, indicates | - a vaginal yeast infection.
appropriate treatment for pregnant women;
Intravaginal clotrimazole |
| The USPSTF recommends screening for N. gonorrhoeae and C. trachomatis infections in ? | - sexually active women ≤ 24 years of age
- older women with specific risk factors (e.g., women with new or multiple sex partners). |
| Fluorescent treponemal antibody absorption test (FTA-ABS) | - detects specific antibodies to treponemal antigens.
- confirmatory test
- performed after positive nontreponemal test such as venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR) test |
| effective treatment of syphilis in pregnant women. | Penicillin
- desensitization to penicillin should be performed in all patients with penicillin allergies who are diagnosed with syphilis |
| sexually active patient presents with mucopurulent, foul-smelling vaginal discharge and cervical erythema, indicating cervicitis. | - NAAT is the test of choice to diagnose chlamydial genitourinary infection
- detects chlamydial RNA or DNA from vaginal swabs.
- 1 dose of oral azithromycin is first-line Rx both in pregnant & nonpregnant pts |
| Pt is a sexually active adolescent, has multiple hyperkeratotic exophytic papules over the valvula and turns white on application of 3% acetic acid indicates? | HPV infection.
- Condylomata acuminata
vaccine given starting at the age of 11–12 years
rx; cryotherapy |
| toddler presents with treatment-resistant, blood-tinged, foul-smelling vaginal discharge, and vaginal erythema, which suggest | - vulvovaginitis that appears to be caused by a vaginal foreign body (tissue paper)
Rx; vaginal irrigation with warm saline water.
***In children presenting with a vaginal foreign body, the possibility of sexual abuse should always be considered. |
| pt with a left-sided, erythematous, edematous tender mass in the left inner labia that is causing pain with movement and dyspareunia. These features are consistent with? | a Bartholin gland abscess.
Rx; Incision and drainage followed by irrigation and packing
** change packing regularly and remove within 2 days.
OR
- fistulization with a Word catheter |
| Bartholin gland abscess | - acute infection of a Bartholin gland or Bartholin gland cyst,
- commonly due to E. coli. Strep, Staph
- unilateral pain & swelling of the vulva
- dyspareunia |
| patient presents with a mass that is characteristically found only at the four and eight o'clock positions of the vestibule of the vagina. mass shows no sign of inflammation | Bartholin gland cyst
Obstruction of the orifice of Bartholin gland duct by inflammation or trauma --> formation of palpable mass in posterior vaginal introitus |
| Bartholin gland cyst management | Sitz baths to facilitate rupture of the cyst. |
| Granuloma inguinale
Donovanosis | STI by Klebsiella granulomatis
- painless nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily.
- regional lymph nodes are typically spared |
| painful purulent and necrotic ulcers and lymphadenopathy suggest a sexually transmitted infection with a gram-negative organism. | Chancroid/ Soft chancre
STD
- by Haemophilus ducreyi.
- Pt's present with one or more painful genital ulcers
- with painful, suppurative inguinal lymphadenopathy
rx; single dose oral azithromycin or intramuscular ceftriaxone. |
| What is the appropriate treatment for pyelonephritis during pregnancy? | pregnant women with pyelonephritis should be admitted and receive IV cefotaxime therapy. |
| pt present with dysuria & tenderness to palpation over pelvic region, elevated WBCs in the urine, positive nitrites, and bacteriuria, are consistent with | cystitis
- caused by an ascending bacterial infection from urethra
- E. coli is the most common causative organism |
| Cystitis | Escherichia coli ( urinary nitrites)
Staphylococcus saprophyticus ( no urinary nitrites ) |
| first-line treatment for acute uncomplicated cystitis in nonpregnant women is | TMP-SMX for 5 days
Alternative first-line Rx; nitrofurantoin for 3 days
or fosfomycin 1 dose. |
| Pts with a urinary tract infection (UTI) (suprapubic tenderness, urine nitrites, >WBC, urine bacteria, alkaline urine (pH > 7)) with delirium and an indwelling urinary catheter | most likely infected with Proteus mirabilis.
- converts urea in urine into ammonia --> an alkalizing effect.
- empiric Rx; parenteral ceftriaxone/ciprofloxacin,
- urine culture & sensitivity testing,
- replacement of the urinary catheter |
| pt with bladder discomfort for 5 months, > urinary frequency, suprapubic tenderness, dyspareunia. urine dipstick is negative for leukocyte esterase, pyuria, or nitrites. | Interstitial cystitis
Bladder pain syndrome
- diagnosis of exclusion & other causes of cystitis such as UTI, STI, /bladder masses must be ruled out first. |
| Pyelonephritis | infection of the renal pelvis and parenchyma
- presents with flank pain,
- costovertebral angle tenderness,
- fever,
- features of cystitis (e.g., dysuria, frequency). |
| pt has no urinary frequency or dysuria. Her urinalysis is positive for leukocyte esterase and nitrite. urine culture grows E. coli. This indicates? | asymptomatic bacteriuria.
- Screening for asymptomatic bacteriuria is recommended for all pregnant women in the first trimester. |
| first-line antibiotic agent for asymptomatic bacteriuria during pregnancy? | Amoxicillin/clavulanate |
| Other antibiotic agents used to treat cystitis that are safe during pregnancy include | - oral cephalosporins (e.g., cefpodoxime, cephalexin),
- fosfomycin,
- nitrofurantoin (during the 2nd and 3rd trimesters)
** fluoroquinolones (cipro) are contraindicated during pregnancy. |
| Complicated urinary tract infection | factors that > risk of infection/failed therapy
- male sex
- pregnancy
- childhood, functional/anatomical abnormalities (BPH, kidney stones)
- immunocompromise, multi-drug resistant bacteria, catheterization or instrumentation, recent antibiotic use. |
| pregnant Pt with increased urinary frequency, dysuria, flank pain & positive leukocyte esterase, urine nitrites. costovertebral tenderness on palpation. | likely has an acute urinary tract infection (UTI)
- Hormonal changes during pregnancy affect the urinary tract --> risk of asymptomatic bacteriuria --> acute cystitis, acute pyelonephritis
Rx: intravenous empiric antibiotics (e.g., ceftriaxone) |
| UTI in pregnancy | > progesterone in pregnancy -> ureteral smooth muscle relaxation and ureteral dilation.
expanding uterus pressure on bladder -> ureteral dilation.
Ureteral dilation --> urinary stasis & ureterovesical reflux -> ascending bacterial infections. |
| Pts with recurrent UTI should be treated with prophylactic antibiotics for at least 3 months after eradication of their current UTI. | Continuous or postcoital trimethoprim-sulfamethoxazole
alternatives; nitrofurantoin/ cephalexin /ciprofloxacin. |
| Recurrent UTI management | Supportive; consistent postcoital voiding & > fluid intake to increase frequency of micturition.
- self-medication at first onset of symptoms; short course of TMP-SMX / quinolone
- Continuous /postcoital TMP-SMX, nitrofurantoin, cephalexin, quinolone, |
| Amoxicillin-clavulanate | - second-line agent for acute uncomplicated cystitis in nonpregnant women
- first-line agent for uncomplicated cystitis in pregnant women. |
| Urge incontinence | increased detrusor muscle activity--> involuntary detrusor muscle contraction & urinary tenesmus --> sudden release of urine.
RX; Anticholinergic agents ( oxybutynin |
| Stress incontinence | - involuntary leakage of urine,
- activity associated with increased intra-abdominal pressure (e.g., coughing, sneezing).
-caused by sphincteric resistance overcome by bladder pressure (pelvic floor weakness, intrinsic sphincter deficiency,). |
| Urethral hypermobility | one of the most common causes of stress incontinence.
- urethral hypermobility can result from postmenopausal estrogen loss and as part of the normal aging process. |
| elderly pt presents after the acute onset (2 weeks) of urinary incontinence, urgency, and frequency, which suggests a possibly reversible cause of incontinence. | UTI is a common cause of acute urinary incontinence in elderly patients;
urinalysis should be performed to screen for signs of infection. |
| If urinalysis is positive in elderly Pts | empiric treatment; TMP-SMX or fosfomycin
If symptoms still persist after 48-72 hrs complicated UTI (e.g., due to resistant bacteria) is likely; administer fluoroquinolones |
| first-line surgical procedure for stress incontinence | A urethral sling
done if conservative therapy; pelvic floor muscle exercises (Kegel exercises),
lifestyle changes (e.g., weight loss, alcohol cessation),
& use of continence pessaries have failed. |
| Pelvic pain and/or pressure, which worsens on standing or walking, in presence of posterior vaginal wall protrusion & lax sphincter tone on pelvic examination, is diagnostic of ? | enterocele.
- Herniation of a peritoneum-lined sac, containing a portion of the small bowel, into the rectovaginal space. |
| pt's 6 hrs after giving birth has involuntary loss of urine, Blood-red vaginal discharge abdominal distention, & tenderness after administration of epidural analgesia suggest ? | overflow incontinence
- Postpartum urinary retention
***Blood-red vaginal discharge (lochia rubra) is a normal finding during the first 4 days after birth |
| Postpartum urinary retention risk factors | - spinal anesthesia (< bladder & internal sphincter contractility as well as the micturition reflex)
- vaginal delivery (perineal trauma can injure the pudendal nerve -> dysfunction external urethral sphincter.)
- episiotomy,
- primiparity. |
| Combined oral contraceptive pills (those containing both estrogen and progestin) are contraindicated in | - women over 35 years who smoke due to an increased risk of venous thromboembolism.
- cardiovascular diseases , metabolic disorders ,
- estrogen-dependent tumors,
- SLE, and/or vasculitis. |
| viable option for postpartum contraception | - breastfeeding women, progestin-only contraceptive pills (minipill) or progestin-only implants.
- estrogen-containing combined contraceptives may reduce breast milk production (inhibition of prolactin activity) & enter milk |
| estrogen-containing oral contraceptives increases the risk of | - cardiovascular events; hypertension & thromboembolism.
- headaches
- hyperlipidemia
- a mild increase in the incidence of hepatic adenomas. |
| Estrogen found within OCPs decreases | protein S levels.
- protein S is an essential cofactor for protein C, which inactivates procoagulant factors Va and VIIIa, |
| the recommendation for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome? | A regimen of low-dose aspirin and low molecular weight heparin (e.g., such as enoxaparin), |
| pt's has galactorrhea, irregular menses, vaginal atrophy, headaches & confirmatory hormone assays, positive findings on MRI (probably an intrasellar mass) are suggestive of | hyperprolactinemia.
prolactin-secreting pituitary adenoma (i.e., prolactinoma) |
| first-line treatments of prolactinomas | Dopamine receptor agonists (cabergoline or bromocriptine )
- induce regression of tumor size,
-decrease prolactin secretion |
| Primary hypothyroidism | In addition to increasing TSH production,
excessive TRH also stimulates the lactotroph cells of the anterior pituitary to release prolactin, |
| Anorexia nervosa complication | Severe bone loss and subsequent fractures
prolonged QT interval.
functional cardiac abnormalities, including hypotension, bradycardia |
| Osteopenia | A reduction of bone mineral density with a T-score of -1 to -2.5.
- lack of estrogen or testosterone,
- lack of exercise,
- alcohol and cigarette consumption, and use of glucocorticoids |
| Osteoporosis | affects postmenopausal women and the elderly population,
- loss of bone mineral density leads to decreased bone strength --> increased susceptibility to fractures. |
| combination of a painful, itchy breast lump and erythematous, edematous overlying skin with axillary lymphadenopathy in a postmenopausal woman is suggestive | inflammatory breast cancer
- results from the infiltration of the dermal lymphatics, |
| pt with LCIS that is ER positive. She is being treated with the selective estrogen receptor modulator (SERM) tamoxifen, which has both agonist and antagonist effects on ER in the body. | - antagonist effects on the breast tissue
- agonist effects in the bone and uterine tissue. |
| pt has multiple risk factors for breast cancer, including nulliparity, late menopause & HRT. What is the most appropriate next step in a patient with a high risk of breast cancer and suspicious findings on mammography? | ultrasound-guided core needle biopsy |
| pt presents with fatigue, ascites, weight loss, and a right adnexal mass, all of which are suggestive of | diagnosis of ovarian cancer.
elevated CA-125
- CA-125 levels should be used with transvaginal u/s to assess the size & characteristic of her adnexal mass,
followed by surgery to conclusively determine pathology |
| Despite a pt's relatively young age (< 35 years), a nontender, firm, nonmobile breast mass is concerning for breast cancer. | Mammography is the recommended imaging modality for the evaluation of a breast lump in women older than 30 years of age. |
| diagnostic and therapeutic procedures used as a first-line intervention in pts with newly diagnosed invasive ductal carcinoma. | - lumpectomy (breast-conserving surgery) followed by whole-breast radiation therapy
- sentinel node biopsy |
| Early-stage infiltrating lobular carcinoma is usually treated with breast-conserving therapy and adjuvant systemic therapy. however treatment for pregnant women is? | regimen with low risk of fetal damage
- Surgical resection with adjuvant radiation therapy after delivery
- surgical resection with chemotherapy after 1st trimester.
- or complete mastectomy |
| pt has early stage, invasive breast cancer with a large breast/tumor ratio and no clinically apparent skin, nipple, or axillary lymph node involvement. | RX of early stage invasive breast cancer involves;
- breast-conserving therapy with lumpectomy followed by radiation therapy,
- sentinel lymph node biopsy to evaluate for spread
- adjuvant hormone therapy (e.g., tamoxifen) if ER +ve |
| pt's with menorrhagia has multiple intramural masses, visualized on ultrasound. what is next step in preoperative therapy in this pt with a leiomyoma? | The goal of preoperative therapy is;
- decrease size of the leiomyomatous uterus
- to correct anemia by decreasing blood loss
- prescribe GnRH agonist (e.g., leuprolide) |
| Paget disease of the breast | - ductal carcinoma that infiltrates the nipple-areola complex
- a scaly erythematous rash of the nipple and areola.
- pruritus, burning, and/or nipple retraction. |
| a postmenopausal women with endometrial thickness > 5 mm and no evidence of atypia or invasion on endometrial biopsy, is diagnostic of? | endometrial hyperplasia.
Rx of choice is progestin therapy.
Follow-up with ultrasound after 3–6 months |
| HER2/neu positive tumors management | trastuzumab & chemotherapeutic agents such as anthracyclines and taxanes.
AVR; cardiotoxic (e.g., dilated cardiomyopathy with systolic CHF).
Before RX, an echocardiogram should be performed to evaluate cardiac function, |
| if a Pap smear shows a HSIL, or if atypical squamous cells are seen but HSIL cannot be ruled out (ASC-H). | Colposcopy should be performed |
| if the patient showed premalignant cervical changes | A directed cervical biopsy would be performed |
| if the initial Pap smear had shown atypical squamous cells of undetermined significance (ASC-US). | repeat Pap smear (exfoliative cytology) in 6–12 months |
| A Pap smear should be conducted to screen for cervical cell dysplasia | every 3 years starting at 21 years or every 5 years at 30 years, if combined with HPV testing |
| According to the USPSTF, women should start breast cancer screening at the age of | 50 with a mammogram every 2 years until the age of 74.
- women who have several risk factors for breast cancer (early menarche, nulliparity) or a first-degree relative who had breast cancer, mammography should be recommended at 40 |
| Pregnancy luteoma
Luteoma | A rare, benign tumor of the ovary thought to be caused by the hormonal effects of pregnancy.
- manifest with symptoms of virilization..
- Larger ones --> increased mass effect, torsion and lead to secondary hemorrhage
- expectant management |
| pt presents with virilization (hirsutism and deepening of the voice), a palpable adnexal mass, which suggests | a testosterone-producing ovarian tumor.
-Sertoli-Leydig cell tumors
- increased levels of testosterone, DHEA, androstenedione, and dihydrotestosterone.
- DHEA-S is normal |
| Lymphangiosarcoma/Angiosarcoma of the breast | - condition occurs as a result of chronic lymphedema
- is now rare, since breast-sparing surgery techniques are favored & radical mastectomy has become less common.
- multiple purple-colored, macules, and/or papules, |
| HPV immunization | - 2 doses of HPV vaccine should be administered 6 months apart to all individuals 9–14 years of age.
-unvaccinated female patients 15–26 years of age, 3 doses of nine-valent HPV vaccine. |
| If a Pap smear shows LSIL, in a pt 25 years of age or older. | immediate colposcopy is performed |
| If a Pap smear shows LSIL, in a pt 21 - 24 years of age | Pap smear should be repeated twice at 12-month intervals
lesion usually spontaneously resolves over time |
| pt presents with a high-grade squamous intraepithelial lesion (HSIL) and signs of CIN 2, 3 on colposcopy. Since the patient is pregnant, management is | Reevaluation with cytology and colposcopy 6 weeks after birth
OR
reevaluation with cytology and colposcopy not more often than every 12 weeks during pregnancy
options such as neoadjuvant chemotherapy or termination of pregnancy IN ADVANCED |
| Vaginal carcinoma | - postmenopausal bleeding,
- pelvic exam will usually show a mass (or plaque) on the vaginal wall,
- symptoms related to local extension; such as urinary frequency.
-diagnosis requires a biopsy of the suspicious lesion and histological confirmation. |
| Pts with high-risk findings on Pap smear such as atypical glandular cells, HSIL, and ASC-H | - endocervical sampling and colposcopy
- also endometrial sampling in pts who are above 35 years / have > risk factors for endometrial adenocarcinoma (unexplained vaginal bleeding, chronic anovulation) |
| hx of C-section followed by fever, uterine tenderness, and foul smelling lochia indicates postpartum endometritis | polymicrobial infection;
both gram-positive (Staphylococcus epidermidis and group B Streptococcus) and gram-negative (Gardnerella vaginalis) bacteria.
Rx; combination of IV clindamycin and gentamicin. |
| Cesarean delivery (especially when performed after onset of labor) is the most important risk factor for this condition. Prolonged labor is a further risk factor for this condition | Postpartum endometritis
several days after a cesarean delivery for prolonged labor;
- lower abdominal pain,
- uterine tenderness,
- foul-smelling lochia,
- fever, tachycardia,
- leukocytosis |
| During pregnancy, a certain gland becomes significantly enlarged, making it prone to damage. | Pituitary ischemia is the underlying pathophysiology of Sheehan syndrome.
hypopituitarism ; ischemia of the anterior pituitary
posterior pituitary gland hormones, ADH and oxytocin, are not typically affected in sheehan |
| postpartum deep venous thrombosis (DVT) | - peak in the first 6 weeks postpartum
- Smoking
- immobilization after delivery
- surgical delivery
- maternal age > 35 years, and preterm delivery |
| the initial treatment of choice for postpartum deep venous thrombosis (DVT) | LMWH, administered subcutaneously,
- its immediate antithrombotic effect and safety during breastfeeding
- before introducing an oral anticoagulation |
| Uterine atony | Failure of the uterus to effectively contract after delivery
- most common cause of postpartum hemorrhage.
-soft and enlarged uterus
-abnormal vaginal bleeding
- non contracted uterus after delivery |
| Uterine atony management | -Bimanual uterine massage
- uterotonic agents (oxytocin, misoprostol, carboprost)
- Tranexamic acid should be given as soon as possible after bleeding onset to stop fibrinolysis
-B-Lynch uterine compression suture
** carboprost is a NO in asthma pt |
| Placenta accreta | - placenta is directly adherent to the myometrium (without penetrating)
- delayed placental detachment,
- massive life-threatening postpartum hemorrhage at the time of attempted manual separation of the placenta, |
| pt presents with brisk postpartum hemorrhage, a round mass protruding from the vagina, and no fundus (top of the uterus) in place after vaginal delivery. Which condition could cause these clinical findings? | Uterine inversion
- uterine fundus collapses into the endometrial cavity --> turns the uterus partially or completely inside out.
-severe postpartum hemorrhage
- a round, protruding mass from the cervix or vagina. |
| Uterine inversion management | - discontinue Oxytocin
- crystalloids and blood products administered as needed.
** surgical repair If the uterus cannot be repositioned manually after administration of a uterine relaxant (e.g., nitroglycerine) |
| Uterine atony first line management | Bimanual uterine massage |
