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| Müllerian agenesis rare, congenital defect in which the Müllerian ducts fail to fuse, | show 🗑
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| show | - features are suggestive of low estrogen and high androgen levels.
Aromatase deficiency;
--normal internal genitalia
-- tall
-- cystic ovaries
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| Aromatase deficiency | show 🗑
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| show | obesity related hyperandrogenemia
GnRH pulsatility is not increased in PPP,
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| show | next step in management
- MRI of brain
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| 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 | show 🗑
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| show | gonadotropin levels should be tested.
- check serum FSH, LH levels
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| show | 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
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| Psychogenic dyspareunia | show 🗑
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| Genito-pelvic pain/penetration disorder management | show 🗑
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| show | 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.
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| Trichomonas vaginalis | show 🗑
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| Patients with recent use of antibiotics, foul-smelling, frothy, yellow-green, purulent vaginal discharge with a pH > 4.5. | show 🗑
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| show | the oncogenic high-risk HPV strains
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| HPV strains 6 and 11 | show 🗑
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| show | toxic shock syndrome (TSS), likely due to Staphylococcus aureus
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| test of choice in the diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae | show 🗑
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| Rx of choice for Disseminated gonococcal infection? | show 🗑
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| 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 ? | show 🗑
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| show | - a vaginal yeast infection.
appropriate treatment for pregnant women;
Intravaginal clotrimazole
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| The USPSTF recommends screening for N. gonorrhoeae and C. trachomatis infections in ? | show 🗑
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| show | - 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
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| effective treatment of syphilis in pregnant women. | show 🗑
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| show | - 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
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| Pt is a sexually active adolescent, has multiple hyperkeratotic exophytic papules over the valvula and turns white on application of 3% acetic acid indicates? | show 🗑
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| toddler presents with treatment-resistant, blood-tinged, foul-smelling vaginal discharge, and vaginal erythema, which suggest | show 🗑
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| 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? | show 🗑
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| Bartholin gland abscess | show 🗑
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| 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 | show 🗑
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| show | Sitz baths to facilitate rupture of the cyst.
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| show | STI by Klebsiella granulomatis
- painless nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily.
- regional lymph nodes are typically spared
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| painful purulent and necrotic ulcers and lymphadenopathy suggest a sexually transmitted infection with a gram-negative organism. | show 🗑
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| show | pregnant women with pyelonephritis should be admitted and receive IV cefotaxime therapy.
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| pt present with dysuria & tenderness to palpation over pelvic region, elevated WBCs in the urine, positive nitrites, and bacteriuria, are consistent with | show 🗑
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| show | Escherichia coli ( urinary nitrites)
Staphylococcus saprophyticus ( no urinary nitrites )
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| show | TMP-SMX for 5 days
Alternative first-line Rx; nitrofurantoin for 3 days
or fosfomycin 1 dose.
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| 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 | show 🗑
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| pt with bladder discomfort for 5 months, > urinary frequency, suprapubic tenderness, dyspareunia. urine dipstick is negative for leukocyte esterase, pyuria, or nitrites. | show 🗑
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| show | infection of the renal pelvis and parenchyma
- presents with flank pain,
- costovertebral angle tenderness,
- fever,
- features of cystitis (e.g., dysuria, frequency).
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| show | asymptomatic bacteriuria.
- Screening for asymptomatic bacteriuria is recommended for all pregnant women in the first trimester.
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| show | Amoxicillin/clavulanate
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| show | - oral cephalosporins (e.g., cefpodoxime, cephalexin),
- fosfomycin,
- nitrofurantoin (during the 2nd and 3rd trimesters)
** fluoroquinolones (cipro) are contraindicated during pregnancy.
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| Complicated urinary tract infection | show 🗑
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| pregnant Pt with increased urinary frequency, dysuria, flank pain & positive leukocyte esterase, urine nitrites. costovertebral tenderness on palpation. | show 🗑
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| UTI in pregnancy | show 🗑
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| Pts with recurrent UTI should be treated with prophylactic antibiotics for at least 3 months after eradication of their current UTI. | show 🗑
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| show | 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,
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| show | - second-line agent for acute uncomplicated cystitis in nonpregnant women
- first-line agent for uncomplicated cystitis in pregnant women.
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| show | increased detrusor muscle activity--> involuntary detrusor muscle contraction & urinary tenesmus --> sudden release of urine.
RX; Anticholinergic agents ( oxybutynin
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| Stress incontinence | show 🗑
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| Urethral hypermobility | show 🗑
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| show | UTI is a common cause of acute urinary incontinence in elderly patients;
urinalysis should be performed to screen for signs of infection.
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| show | 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
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| show | 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.
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| 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 ? | show 🗑
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| show | overflow incontinence
- Postpartum urinary retention
***Blood-red vaginal discharge (lochia rubra) is a normal finding during the first 4 days after birth
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| show | - 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.
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| show | - 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.
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| show | - 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
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| estrogen-containing oral contraceptives increases the risk of | show 🗑
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| Estrogen found within OCPs decreases | show 🗑
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| the recommendation for preventing thrombosis and pregnancy-related complications in pregnant women with antiphospholipid syndrome? | show 🗑
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| pt's has galactorrhea, irregular menses, vaginal atrophy, headaches & confirmatory hormone assays, positive findings on MRI (probably an intrasellar mass) are suggestive of | show 🗑
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| first-line treatments of prolactinomas | show 🗑
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| show | In addition to increasing TSH production,
excessive TRH also stimulates the lactotroph cells of the anterior pituitary to release prolactin,
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| Anorexia nervosa complication | show 🗑
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| Osteopenia | show 🗑
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| show | affects postmenopausal women and the elderly population,
- loss of bone mineral density leads to decreased bone strength --> increased susceptibility to fractures.
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| show | inflammatory breast cancer
- results from the infiltration of the dermal lymphatics,
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| 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. | show 🗑
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| 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? | show 🗑
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| show | 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
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| show | Mammography is the recommended imaging modality for the evaluation of a breast lump in women older than 30 years of age.
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| show | - lumpectomy (breast-conserving surgery) followed by whole-breast radiation therapy
- sentinel node biopsy
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| Early-stage infiltrating lobular carcinoma is usually treated with breast-conserving therapy and adjuvant systemic therapy. however treatment for pregnant women is? | show 🗑
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| show | 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
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| show | 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)
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| show | - ductal carcinoma that infiltrates the nipple-areola complex
- a scaly erythematous rash of the nipple and areola.
- pruritus, burning, and/or nipple retraction.
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| show | endometrial hyperplasia.
Rx of choice is progestin therapy.
Follow-up with ultrasound after 3–6 months
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| show | 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,
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| if a Pap smear shows a HSIL, or if atypical squamous cells are seen but HSIL cannot be ruled out (ASC-H). | show 🗑
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| show | A directed cervical biopsy would be performed
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| show | repeat Pap smear (exfoliative cytology) in 6–12 months
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| A Pap smear should be conducted to screen for cervical cell dysplasia | show 🗑
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| According to the USPSTF, women should start breast cancer screening at the age of | show 🗑
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| show | 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
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| show | a testosterone-producing ovarian tumor.
-Sertoli-Leydig cell tumors
- increased levels of testosterone, DHEA, androstenedione, and dihydrotestosterone.
- DHEA-S is normal
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| Lymphangiosarcoma/Angiosarcoma of the breast | show 🗑
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| show | - 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.
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| If a Pap smear shows LSIL, in a pt 25 years of age or older. | show 🗑
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| show | Pap smear should be repeated twice at 12-month intervals
lesion usually spontaneously resolves over time
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| 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 | show 🗑
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| Vaginal carcinoma | show 🗑
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| show | - 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)
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| hx of C-section followed by fever, uterine tenderness, and foul smelling lochia indicates postpartum endometritis | show 🗑
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| 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 | show 🗑
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| show | 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
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| show | - peak in the first 6 weeks postpartum
- Smoking
- immobilization after delivery
- surgical delivery
- maternal age > 35 years, and preterm delivery
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| show | LMWH, administered subcutaneously,
- its immediate antithrombotic effect and safety during breastfeeding
- before introducing an oral anticoagulation
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| Uterine atony | show 🗑
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| show | -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
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| Placenta accreta | show 🗑
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| 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? | show 🗑
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| show | - 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)
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| show | Bimanual uterine massage
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