Gynecology
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| If find mass on CBE: | Order a diagnostic mammogram (not screening), unless age <30, then order U/S
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| fibroadenoma Dx | FNA; Cyto study of bloody fluid or solid tumor aspirate; U/S to differentiate solid from cystic mass; excisional bx
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| Age <30 yo, palpable lump, still there after menses, order: | unilateral breast U/S
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| Age > 30yo, palpable lump, order: | unilateral dx mammogram & U/S;
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| Palpable lump, age >40 yo & due for screening mammo: | get mammogram on unaffected side at same time
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| BI-RADS category 0-4: | Needs additional imaging evaluation
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| BI-RADS category 4: | Suspicious abnormality
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| BI-RADS category 6: | biopsy-proven malignancy
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| Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is: | less than 15%
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| Primary diagnosis of syphilis | Darkfield microscopy of chancre
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| Diagnosis of neurosyphilis | CSF examination recommended in symptomatic, late-latent, HIV co-infection (lumbar puncture)
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| VDRL becomes positive __ after inoculation with syphilis | About 2 weeks
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| Gram stain with a “school of fish” appearance is probably what | Chancroid (Haemophilus ducreyi)
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| Best source of HSV for testing | Unroofing the vesicle
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| Gold standard for HSV testing | Culture
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| __% of US have positive herpes Abs on serological testing | 50
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| Most appropriate way to test for herpes | Culture (not serological)
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| Primary test of menopause: | FSH
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| GnRH Low: | hypothalamic hypogonadism, dopamine, opiates
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| GnRH high: | primary hypopituitary hypogonadism, epinephrine
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| GnRH testing: avoid: | steroids, ACTH, gonadotropin or estrogen medications for ≥48hrs
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| FSH low: | secondary gonadal failure, stress, malnutrition/anorexia, severe illness, hyperprolactinemia, PG
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| FSH high: | primary gonadal failure, castration, alcoholism
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| LH low = | pit or hypothalamic failure, severe stress, anorexia, malnutrition, severe illness, PG, hemochromatosis, sickle cell anemia, hyperprolactinemia
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| LH high = | gonadal failure, precocious puberty, pituitary adenoma, menopause, PCOS
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| LH: Best time to obtain single specimen | between 11am and 3pm
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| Progesterone low = | preeclampsia, threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction, PCOS
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| Progesterone High = | ovulation, PG, hyperadrenocorticalism, adrenocortical hyperplasia, luteal cysts, molar pregnancy, choriocarcinoma
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| FSH assays done to dx: | menopause, menstrual irregularities, gonadal failure, predicting ovulation, evaluating infertility, pituitary disorders
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| Estrogen: high = | precocious puberty, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis, liver necrosis, hyperthyroidism
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| Estrogen: Low = | failing PG, Turner syndrome, hypopituitarism, hypogonadism, Stein-Leventhal syndrome, menopause, anorexia, PCOS
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| Max testosterone values when: | around 7am and 8pm
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| testosterone high = | ovarian tumors, adrenal tumor, congenital adrenocortical hyperplasia, trophoblastic tumor, PCOS, idiopathic hirsutism, drugs
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| testosterone low = | primary/ secondary ovarian failure, drugs
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| Progesterone w/drawal test evaluates: | H-P-gonadal axis
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| Progesterone withdrawal test: in normal cycle, progesterone surge: | inhibits FSH/LH and leads to withdrawal bleeding
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| Progesterone withdrawal test: probs causing failure of bleeding: | Estrogen production inadequate; Hypothalamic dysfunction; Uterus abnormal
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| Prolactin high = | pit adenoma, 2d amenorrhea, galactorrhea, hypothyroid, hypoglycemia, PCOS, anorexia, paraneoplastic syndromes, dz of hypothalamus /pituitary stalk, renal fail, drugs lowering dopamine, high estrogen
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| Prolactin low = | Sheehan syndrome, pituitary destruction by tumor
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| Prolactin levels should be collected: | 3-4hrs after waking
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| Ovarian cancer workup | US (if pos: CXR for mets). CA-125. HCG. Ex-lap. CT or MRI prn. Colonoscopy. Mammogram if breast mass.
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| Ovarian failure / amenorrhea: associated hormones | elevated FSH / LH
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Created by:
Abarnard
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