question

Vulva supply: Blood Nerve Lymph

answer

Blood- branches of external and internal pudendal a. Nerve- ilioinguinal and genital branch of genitofemoral (ant); post cutaneous of thigh and perineal n. (post) Lymph- medial group of superficial inguinal

question

Vagina supply: Blood Nerve

answer

Blood- branch of uterine a.; middle rectal and inferior vaginal branch of hypogastric Nerve- hypogastric (symp) and pelvic (parasymp) plexus

question

Uterus supply: Blood Nerve

answer

Blood- uterine a and ovarian a Nerve- sup hypogastric, inf hypogastric, common iliac n.

question

Fallopian tubes supply: Blood Nerve Lymph

answer

Blood- uterine and ovarian a Nerve- pelvic and ovarian plexus

question

Ovaries supply: Blood Nerve Lymph

answer

Blood- ovarian a (L1); IVC and L renal vein Nerve- aortic plexus

question

Chronic Pelvic Pain Etiologies

answer

L- leiomyoma E- endometriosis A- adhesions, adenomyosis P- PID (MCC) I- infections N- neoplasia

question

Acute Pelvic Pain Differential

answer

A- appendicitis R- ruptured ovarian cyst (MCC) O- ovarian torsion/abscess P- PID E- ectopic pregnancy all life-threatnening/emergent except PID

question

MC functional ovarian cyst

answer

Follicular cysts

question

Follicular cyst Tx

answer

2 mos- laparotomy/scopy to eval/ r/o neoplasia

question

Theca lutein cyst Tx

answer

Tx underlying condition causing elevated hCG

question

MC indication for hysterectomy

answer

Leiomyomas

question

Sequelae of uterine fibroids

answer

Hyaline degen, calcification, red degen, cystic degen

question

Submucosal and intramural types of fibroids usually present as ___

answer

menorrhagia

question

Subserous type of fibroids usually present as ___

answer

torsion

question

Tx is initiated for fibroids when: 1. 2. 3.

answer

1. tumor is >12 to 14 wks gestation 2. hematocrit falls 3. tumor is compressed

question

Risk factors for cervical dysplasia

answer

O-Oral contraceptives S- Sex H- HPV (80%- 16, 18, 31, 33) A- Alcohol Ends- Education/poverty Dirt- Diethylstilbestrol (DES) Garbage- Genetics and Chemicals- Cigarettes (deficient in folic acid)

question

Most common gyn malignancies

answer

1. Breast 2. Ovarian 3. Cervical

question

Cervical Ca symptoms Early stage: Middle stage: Late stage:

answer

Early stage: none, irreg/prolonged vag bleeding/pink discharge, postcoital bleeding Middle stage: postvoid bleeding, dysuria/hematuria Late stage: weight loss, bloody/malodorous discharge, severe pain due to spread to sacral plexus

question

Direct Met to cervix

answer

Rectum, intra-ab, bladder, endometrial

question

Met from cervix

answer

lung, liver, bone

question

Radical hysterectomy requires removal of:

answer

Uterus Cervix Parametrial tissue Upper vagina Pelvic lymphadenectomy from the bifurcation of the iliac vessels to the level of the inguinal ligament

question

DES exposed fetus ages now

answer

41-72 y/o

question

Protective factors for endometrial cancer

answer

combined oral contraceptives, cigarette smoking, multiparity

question

Simple endometrial hyperplasia

answer

glandular and stromal proliferation; most differentiated and lowest risk of cancer

question

Complex endometrial hyperplasia

answer

glandular proliferation only

question

Tx of atypical endometrial hyperplasias that progress to cancer

answer

simple- hysterectomy complex- treated like cancer

question

Histo subtypes of endometrial cancer

answer

Endometroid (ciliated adenocarcinoma)- 80% Papillary serous- poor prog, no hx of estrogen, presents late, more common in blacks, acts like ovarian cancer Sarcomas

question

Staging of: cervical cancer endometrial cancer ovarian cancer

answer

cervical- clinically endometrial- surgically ovarian- surgically

question

___ is the most important prognostic indicator in endometrial cancer

answer

grade

question

Adjuvant Tx for endometrial cancer

answer

stages 1-2: brachytherapy stages 3-4: external beam, hormone (progestin), chemo (doxorubicin, cisplatin)

question

Dx of uterine sarcoma

answer

>10 mitosis/HPF

question

Tx of uterine sarcoma

answer

surgical + adjuvant: leiomyosarc- doxo and cis; mixed mesodermal- ifosphamide and cis; endometrial stromal sarcoma- progestin

question

5 histo subtypes of ovarian cancer

answer

1. serous 2. endometroid 3. mucinous 4. undiff 5. clear cell

question

A postmenopausal woman with widening girth notices that she can no longer button her pants. Dx?

answer

Ovarian cancer

question

Hereditary ovarian cancer syndromes 1. 2. 3.

answer

1. Breast- ovarian ca syn: linked to BRCA-1, AD, younger women 2. Lynch II syn: HNPCC; breast, ovaries, uterus, colon 3. Site-specific ovarian ca- strong genetic link; 2 or more 1st degree relative have the dz

question

Ovarian Ca met to the umbilicus is called?

answer

Sister Mary Joseph's nodule

question

Tx of Ovarian Ca

answer

Surgery + Stage 1-2: only chemo (paclitaxel and cisplatin (or carboplatin) stage 3-4: chemo + radiation if residual tumor 2cm

question

Types of ovarian germ cell tumors

answer

dysgerminoma- MC endodermal sinus tumor immature teratoma embryonal and choriocarcinoma mixed- MC is endodermal sinus + dysgerminoma

question

Tumor marker for: dysgerminoma endodermal sinus tumor embryonal and choriocarcinoma

answer

dysgerminoma- LDH endodermal sinus tumor- AFP embryonal and choriocarcinoma- B-hCG

question

Tx of Ovarian germ cell tumors

answer

surgery + adjuvant chemo (bleomycin, etoposide, cisplatin) - BEP therapy chemo for all stages except grade 1, stage 1 immature teratoma

question

Types of Sex cord- stromal tumors

answer

granulosa- theca cell sertoli-leydig cell

question

Tumor marker for: granulosa-thecal cell sertolic-leydig cell

answer

granulosa- theca cell- inhibin sertoli-leydig cell- testosterone

question

Classic presenting triad of fallopian cell carcinomas

answer

pain, vaginal bleeding, leukorrhea

question

Hydrops tubae perfluens

answer

pathognomonic finding for fallopian cell carcinomas; cramping pain relieved with watery discharge

question

Risk factors for vulvar cancer

answer

HPV, HSVII, lymphogranuloma venerum, pigmented moles, poor hygiene

question

Gestational trophoblastic tumor types

answer

hyadtidiform mole invasive mole choriocarcinoma placental site trophoblastic tumor

question

DNA of complete mole DNA of partial mole

answer

complete mole- paternal only (46XX) partial mole- paternal and maternal (69XXY)

question

All early preclampsia (?weeks) is molar pregnancy until proven otherwise

answer

<20 weeks

question

Gestational trophoblastic neoplasias secrete_____

answer

hCG, lactogen, thyrotropin

question

Average age of menopause onset

answer

51

question

Premature ovarian failure age

answer

35

question

Risk factor for decreasing age of menopause

answer

smoking (by 3 yrs), genetics, chemo/radiation

question

Sheets of trophoblasts

answer

choriocarcinoma

question

Placental site trophoblastic tumor

answer

infiltration of the myometrium by intermediate trophoblasts; stain + for HPL; unlike other GTNs, hCG is only slightly elevated

question

After Tx of partial or complete moles, hCG should return to normal w/in

answer

2 mos; if hCG rises, doesn't fall, or falls and then rises again, molar preg is considered malignant

question

Polymenorrhea—

answer

menses with regular intervals that are too short (under 21 days)

question

Menorrhagia—

answer

menses that are too long in duration (over 7 days) and/or menses associated with excessive blood loss (> 80 mL) occurring at normal intervals

question

Hypermenorrhea—

answer

menses that are too long in duration (over 7 days) and/or menses associated with excessive blood loss (> 80 mL) occurring at regular but not necessarily normal intervals

question

Oligomenorrhea—

answer

menses with intervals that are too long (cycle lasts more than 35 days)

question

Metrorrhagia—

answer

bleeding occurring at irregular intervals; intermenstrual bleeding

question

Kleine regnung—

answer

bleeding for 1 to 2 days during ovulation (scant)

question

Menometrorrhagia-

answer

combination of both menorrhagia and metrorrhagia; menses too long in duration or excessive blood loss + irregular bleeding intervals

question

Differential for Menorrhagia

answer

L- leiomyoma A- adenomyosis C- cervical cancer C- coagulopathy E- endometrial cancer, polyps, cancer

question

Differential for premenopausal Metomenorrhagia

answer

P- polys I- inc estrogens N- neoplasia C- contraceptive complications

question

Only contraceptive effective in protecting against STDs

answer

Male Condom

question

To ensure sterility after vasectomy:

answer

have 2 consecutive - sperm counts or use contraception for 6 wks or 15 ejaculations

question

___ is the most popular tubal method and most difficult to reverse

answer

electrocautery

question

___ is the most easily reversed tubal method but also the most likely to fail

answer

clipping

question

Pomeroy method

answer

A segment of isthmus is lifted and a suture is tied around the approximated base. The resulting loop is excised, leaving a gap between the proximal and distal ends. This is the most popular laparoscopic method.

question

Parkland method

answer

Similar to the Pomeroy but without the lifting, a segment of isthmus is tied proximally and distally and then excised.

question

Madlener method

answer

Similar to the Pomeroy but without the excision, a segment of isthmus is lifted and crushed and tied at the base.

question

Irving method

answer

The isthmus is cut, with the proximal end buried in the myometrium and the distal end buried in the mesosalpinx.

question

Kroener method

answer

Resection of the distal ampulla and fimbrae following ligation around the proximal ampulla

question

Uchida method

answer

Epinephrine is injected beneath the serosa of the isthmus. The mesosalpinx is pulled back off the tube, and the proximal end of the tube is ligated and ex- cised. The distal end is not excised. The mesosalpinx is reattached to the ex- cised proximal stump, while the long distal end is left to "dangle" outside of the mesosalpinx.

question

Luteal phase pregnancy

answer

preg dx after tubal sterilization but conceived before

question

Spermicide

answer

Nonoxynol-9 and octoxynol-3; effective for only about 1 hour

question

Major differences btwn combination OCP pills and progestin only:

answer

a mature follicle is formed (but not released); no sugar pill is used

question

Progestin-only polls are used for:

answer

lactating women (doesn't suppress milk), women >40 y/o, women who can't take estrogen

question

Risk of oral contraceptives

answer

inc VTEs/stroke, MI, depression

question

Contraindications of oral contraceptives

answer

Thromboembolism CVA or CAD Breast/endometrial cancer Cholestatic jaundice Undiagnosed vaginal bleeding Hepatic disease Known/suspected pregnancy Concomitant anticonvulsant therapy Some antibiotics Relative contraindications: Migraines, hypertension (HTN), lactation

question

Contraindications for injectable hormones

answer

pregnancy, undiagnosed vaginal bleeding, breast cancer, liver dz

question

Indications for implant hormonal agents

answer

OCP contraindicated/intolerated, smokers >35 y/o, women w/ DM, HTN, CAD

question

Contraindications for implant hormonal agents

answer

thrombophelibitis/embolism pregnancy liver dz/cancer breast ca concomitant anticonvulsant therapy

question

IUDs:

answer

Paragard--made with copper and lasts 10 year Progestasert- releases progesterone and lasts 1 year

question

Indications for IUDs

answer

OCP contraindicated/intolerated smokers >35 y/o

question

Infertility- ? mons of unprotected sex

answer

12

question

Primary infertility Secondary infertility

answer

Primary- in absence of previous pregnancy Secondary- after previous pregnancy

question

Drugs that can impair sperm function and quantity

answer

CCB Furantoin

question

Average thelarche— Average pubarche— Average menarche—

answer

Average thelarche—10 years old due to ↑ estradiol Average pubarche—11 years old due to ↑ adrenal hormones Average menarche—12 years old due to ↑ estradiol

question

Precocious puberty age

answer

<8

question

Primary amenorrhea: Secondary amenorrhea:

answer

Absence of menses by age 16 Absence of menses for ≥ 6 months in a woman who previously had normal menses

question

Savage's syndrome

answer

ovarian resistance to FSH/LH

question

Asherman's syndrome:

answer

Uterine scarring and adhesions following dilation and curettage (D&C)

question

Progestin challenge test:

answer

Give progestin for 5 days and then stop. This stimulates progesterone withdrawal. If ovaries are secreting estrogen, sloughing will occur and menses results. No menses indicates no ovaries, no estrogen, or blood flow obstruction.

question

MCC of hirsutism

answer

PCOD

question

Hypo or hyper- thyroidism causes an increase in prolactin

answer

Hypo

question

Management of PMS

answer

diet ( low alcohol, caffeine, fats, tobacco, refined sugar, NaCl), OCPs, NSAIDs, SSRIs, GnRH agonists

question

1. MC method of family planning: 2. MC reason for neonatal sepsis: 3. MC reason for hospitalization in women of repro age: 4. MC postoperative complication: 5. MCC of primary amenorrhea: 6. MCC of fetal morbidity and mortality:

answer

1. tubal sterilization 2. chorioamnionitis (GBS, E. coli) 3. endometriosis 4. pulm atelectasis 5. gonadal dysgenesis 6. preterm labor

question

Androgen that the adrenal gland makes

answer

DHEA and DHEA-S

question

High LH:FSH ratio in the context of androgen excess indicates that ____ is the source.

answer

ovary

question

A baby with ambiguous genitalia, dangerously hypotensive, and with elevated 17- hydroxyprogesterone.

answer

21-hydroxylase deficiency

question

Hyperthecosis

answer

when an area of luteinization occurs in the ovary, along with stromal hyperplasia. The luteinized cells produce androgens and hirsutism and virilization may result.

question

Luteoma of pregnancy

answer

benign tumor that grows in response to HCG; virilization can occur in both the mother and the female fetus; tumor disappears postpartum

question

Androgen secreting ovarian neoplasms: differences btwn sertoli-leydig cell tumors and hilar (leydig) cell tumors

answer

sertoli-leydig- present in young women w/ palpable masses hilar cell tumor- present in post-menopausal women w/ nonpalpable masses

question

A baby with ambiguous genitalia is born to a mother who complains of increased facial hair growth over last few months.

answer

Luteoma of pregnancy

question

Theories of endometriosis

answer

retrograde, vascular/lymphatic, mesothelial (peritoneal) metaplasia

question

Diagnosis of Endometriosis

answer

1. Laparoscopy or laparotomy: Ectopic tissue must be seen for diagnosis: Blueimplants—new Brownimplants—older Whiteimplants—oldest 2. Biopsy: Positive findings contain glands, stroma, hemosiderin.

question

Medical Tx of endometriosis

answer

GnRH agonists, progesterone (w/ or w/o estrogen), Danazol (androgen/ FSH/LH suppressant)

question

Medical Tx of adenomyosis

answer

GnRH agonist, Mifepristone (Progesterone antagonist)

question

Adenomysosis versus endometriosis

answer

Adenomyosis- older women, doesn't respond to hormonal stimulation, non-cyclical Endometriosis- young women, responsive to estrogen, cyclical

question

Blood levels of hCG become detectable when?

answer

8-10 days after fertilization (3 - 3.5 weeks after the LMP)

question

UPT- False- False +

answer

-: too early, urine is dilute +: proteinuria, UTI

question

Pregnancy-induced HTN superimposed on chronic HTN

answer

systolic BP rises by 30 and diastolic rises by 15

question

abortus

answer

<20 wk or <500g

question

recurrent abortion

answer

3 or more abortions

question

____ is the leading cause of pregnancy-related death during T1

answer

Ectopic pregnancy

question

Classic triad of ectopic pregnancy:

answer

Amenorrhea Vaginal bleeding Abdominal pain These usually indicate rupture.

question

Medical treatment of abortion: 1st trimester 2nd trimester

answer

1st- antiprogesterone (mifepristone or epostane) or MTX + misoprostol 2nd- intravaginal prostaglandin E2 or F2a w/ urea

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