GYNECOLOGY

GYNECOLOGY
1. Trichomonas Vaginitis Yellow green discharge, Strawberry patches, Motile flagellated, Tx: Metronidazole

2. Gardenerella Vaginitis KOH whiff test = fish; Clue cells, most common symptomatic infection; Metronidazole

3. Condyloma Acuminata Warts, HPV 6, 11, Not assoc w/ cervical cancer

4. PID Cervical motion tenderness, Purulent discharge, assoc w/ ectopic pregnancy & infertility; Leukocytosis, neutrophilia, incr. ESR

5. Candida cottage cheese, red vulva; Pseudohypahe & spores on wet mount, DM, antibiotics, OC, pregnancy

6. UTI E coli, Dysuria, frequency, urgency; Tx: TMP-SMX, Bactrim, Septra

7. Toxic Shock Syndrome Staph aureus exotoxin, rash, high fever, hypotensive shock

8. Chancroid H. Ducreyi, tropical & sub tropical climates, gram neg; Tx Emycin or Ceftriaxne

9. Chlamydia Trachomatis Intracellular, columnar epithelium, mucopurulent, Immunofluoresent discharge, Tx: Doxycycline (Emycine if pregnant)

10. Herpes Genitalis HSV II clear sores , multinucleated giant cells w/ intracell inclusions; Tzanck smear

11. Molluscum Contagiosum umbilicated nodule, remove & cauterize

12. Endometriosis Ectopic endometrium tissue, Dysmenorrhea, Dyspareunia, infertility

13. Paget's Disease of Breast Intraductal Ca in main excretory ducts; crusting erosion of nipples w/ or w/o discharge

14. Polycystic Ovarian Disease incr. LH, decr. or normal FSH; hirsutism, obesity, menstrual irregularities, infertility

15. Menopause Avg age =51; incr. FSH & LH; Hot flashes, Atrophic vaginal epithelium

16. Urinary Incontinence Stress = incr. intra abd pressure, leak small amts of urine; Kegel exercises, estrogen
17. Urge = detrussor instability; lg amts of urine leaked immediately after urge to void

18. 1o Amenorrhea Absence age 16 w/ 2o sex development or absence by age 14 w/o 2o characteristics
19. Anatomic Abnormalities; Ovary Failure ( incr. FSH & LH, decr. estradiol) (XO, turners, no ovary); Pituitary = Prolactinoma presents w/ galactorrhea (Bromocriptine to Tx), Hypothalamic = decr. FSH & LH, (anorexia, incr. exercise, stress); XY karotype

20. 2o Amenorrhea Absence for 6 mos if prev normal; absence for 12 months if prev oligomenorrhea; r/o pregnancy; Galactorrhea = prolactinoma; Hirsutism = polycystic ovarian; Tx: 1st = progestin challenge (bleed w/ in 2 wks) if no bleed measure FSH levels

21. 1o Dysmenorrhea correlates w/ 1st day of menses, cyclic, begins in adolescence, low back & abd pain, N/V/D, fatigue, HA

22. 2o Dysmenorrhea acquired, Sx don't correlate w/ 1st day of cycle, Endometriosis most common cause

23. Asherman's Syndrome intrauterine adhesions after D&C; destruction of endometrium => amenorrhea

24. Fibroademoma Age 19 -29, stromal fibrosis; nontender, estrogen sensitive, regress w/ menopause

25. Fibrocystic Breast Disease Age 29 - 39, may have green nipple discharge; tender w/ ovulation, regress w/ pregnancy,

26. Breast Disease Age 39-49 malignant = intraductal Ca (bloody nipple discharge); Papillary #1 cause of nipple discharge; Sclerosing Adenitis

27. Breast Ca Upper outer quadrant, Mets = bone, liver, lung, brain; Risks: Family Hx, menarche <> 35; late menopause, null parity, obesity, other breast, radiation, reserpine

28. PAP Smear Atypia = inflamm, infection HPV (16 & 1 ; Mild Dysplasia = lowgrade epithelial lesion; Mod/Severe=high grade intraepithelial;

29. Carcinoma in situ incr. nuclear/cytoplasm, dense chromatin, crowding, incr. mitosis; Koilocytes = HPV, pyknotic nucleus, perinuclear halo; Risks: early sex, multi partners, smoking, decr. social class, HPV; Culposcopy = white epithelium, mosiacism, punctation, atypical vessels

30. Cervical CA 90% squamous cell; s/sx: Early = postcoital bleeding, intermenstral bleed, Late= backache, leg pain, edema, hematuria Tx: Ia=TAH, iB & IIA = rad hysto & pelvic lymph nodes, IIB -IVA = Radiation - Brachytherapy => Radium, Cesium

31. Endometrium CA most common gyn malignancy; Risks: obesity, DM, HTN, anovulation, early menses, later menopause, nullparous, unopposed estrogen; Dx : abnormal menses, post menopausal bleeding; EMB, D&C; Histologic= grade 1-3 based on differentiation;
32. AdenoCA=70%; Adenocanthoma=benign squamous, best prog; adenosquamous= malig squam, poor prog; Papillary Serous = acts like ovarian CA, Clear Cell = poorest prog, older, DES, least common Tx; TAH/BSO, perioneal wash, pelvic & aortic nodes, Adjuvant Rad if + nodes, cervical +, > ½ myometrium, higrade

33. Ovarian CA Abd./pelvic mass, ascites, early satiety, CA125, CEA, CA19-9, 75% w/ stage 3; Path types = Serous (psammoma bodies), Mucinous, Endometroid, Clear Cell (hobnail bodies) Brenner; Staging: 1A= 1 ovary, 1B = both ovaries; 1C= + wash, tumor rupture; IIA = fall tubes/uterus, IIB other pelvic structures, IIB + wash rupture w/ spread; IIIA gros in pelvis, micro to diaphragm or omentum, IIIB Intra abd <> 2cm, pelvic/aortic nodes, inguinal nodes; IV = distant spread, pleural effusion w/ malig cells, liver/spleen mets; Tx: debulk tumor surgery, Chemo = cisplatin/cytotoxin, taxol; Radiation (bowel obstruction);

34. Teratomas immature (neuro epithelial); mature (dermoid)=95% of all teratomas, hemolytic anemia; LDH elev, CA125

35. Dysgerminomas most common malignant, 15% bilateral, radiosensitive

36. Endodermal Sinus Tumor Schiller Duvall Body, AFP

37. Embryonal CA HCG, AFP, CA125

38. Choriocarcinoma HCG

39. Sexcord-Stromal Tuors Granulosa: 50% post menopause, incr. estrogen, Call-Exner bodies
40. Sertoli-Leydig: most often virilizing; Gonado Blastoma: gonadal dysgenesis

41. Krukenburg Tumor: Ovarian mets from GI & breast; Signet ring cells

42. Vulvar CA TNM staging, squamous cell, Vulvar pruritus; Pagets= adenoca of vulva, 20% assoc w/ breast, GI, cervical CA

43. Gestational Trophoblastic - Benign: Complete Mole = 46 XX, paternal, no embryonic tissue; Incomplete = 69 XXY triploid, paternal, no fetal/ embryonic tissue
44. Malignant: Invasive= molar villi; Choriocarcinoma = no villi, any pregnancy; Placental Site = non molar gestations
45. S/Sx: size > dates, hyperemesis, hyperthyroid, large theca lutein cyst
46. F/U = CBC. Liver function, BUN, CR, TSH, HCG, US, CXR; TX = D&C
47. Weekly HCG' until 3 values that are non detectable then 1/mo x 1yr, BCP x 1 yr

48. Ca in Pregnancy Melanoma = worsened by preg, can met to placenta or fetus
49. Breast CA = most common CA in pregnancy

50. Chemotherapy Cyclophosphamide (Cytoxan) = ovarian, hem, cystits, alopecia, decr. bone marrow, N/V
51. Cisplatinum = ovaian, renal toxic, ototoxic, bone marrow ß, N/V
52. Adrimycin (Doxyrubicin)= endomet, ovarian; cardiotoxic (heart failure)
53. Bleomycin= cervical, germ cell, Pulmonary fibrosis
54. Vincristine= cervical germ cell; neurotoxic
55. Methotrexate = GTN, germ cell, hepatic & renal toxic, decr. bone marrow

OBSTETRICS
56. Hydantiform Mole Preeclampsia 1st TM, Very high Beta HCG, Snowstorm on US

57. Ectopic Pregnancy Beta HCG rises slowly, Amenorrhea, spotting, pain, Empty gestational sac on ultrasound, Ampulla of fallopian tube is most common site

58. Gestational Age Nagel's = Add 7 days to FDLMP subtract 3 months; fundal ht in cm after 13 weeks

59. Amniocentesis Adv maternal age, abn AFP - incr. Spina bifida, decr. Down's, detect lung maturity, early 2nd trimester

60. CVS Adv. Maternal age, late 1st trimester

61. Non stress Test > 2 fetal movements accompanied by incr. FHR of 15 bpm for at least 15 sec w/ in 20 min period

62. Contraction Stress Test Negative = 3 contractions in 10 min, lasting 40 sec w/o late decelerations
63. Positive = consistent & late decelerations

64. Biophysical Profile Nonstress test, fetal breathing, movement, adeq, amniotic fluid, limb extension

65. Fetal HR normal 120-160, Brady = mild 100-120, < tachy =" mild"> 180

66. Decelerations Early = shape is mirror of contraction, head compression
67. Variable = shape varies, cord compression
68. Late = starts as contraction peaks, recovery after contraction is terminated, uteroplacental insufficiency

69. Placental Previa Partial - partially over os; Complete= covers OS, Marginal = at edge of OS, Complete Previa is indication for C section

70. Placental Abruption Premature separation of a normally implanted placenta, vag bleed, uterine tenderness, back pain, hypertonic uterus, fetal distress

71. Preeclampsia HTN w/ proteinuria & edema after 20 wks gestation

72. Eclampsia Preeclampsia + seizures

73. Gestational Diabetes 1 hr > 140 then do 3 hr; 3hr test = fast > 120, 1 hr > 190; 2 hr > 165, 3 hr > 145; Macrosomia, RSD, Cong abnormalities

74. Types of Pelvises Gynecoid = round inlet, nonprominent spines, wide subpubic angle
75. Anthropoid = heart shaped inlet, decr. transverse and incr. AP diameters, decr. subpubic angle
76. Android= triangular inlet, decr. subpubic angle, prominent spines
77. Platypoid= incr. transverse and decr. AP diameters

78. Leopold's Maneuvers fundal palpation, sides of uterus from feet of mother, lower part of uterus, sides of uterus from head of mother

79. Stages of Labor 1. Onset contract => full dilation 2. Full dilation to delivery of head 3. Delivery of fetus to delivery of placenta 4. Delivery of placenta to 1 hr later

80. Cardinal Movements Engagement, descent, flexion, int rotation, extension, ext rotation, expulsion

81. Post Partum Hemorrhage Uterine Atony (most common); Placental Accreta: Accreta = superficial invasion into myometrium, Increta = deeper, Percreta = invasion to serosa of uterus; Undiagnosed lacerations, Coag defect; Retained placental fragments

82. Apgar Scoring Heart Rate, Resp. Effort, Muscle Tone, Reflex Irritability, Color

83. Shoulder Dystocia Maternal obesity, diabetes mellitus, postterm pregnancy

84. Cesarean Section Indications Health of mom or baby endangered by labor, Dystocia precludes vag delivery, Emergent situation, Herpes, Prev C section if contributing factor still exists, Malpresentation of fetus

85. Premature Rupture of Membranes Pooling of fluid in vagina, + nitrazine test, + ferning test, risk of endometritis

86. Polyhydraminos Duodenal Atresia, Tracheoesophageal fistula, Anencephaly

87. Oligohydraminos Renal Agenesis, Pulmonary hypoplasia