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Follicular Phase vs. Luteal phase - correct answers ✅1. Estrogen dominant (Day 1-14)
- Progesterone dominant (Day 14-28) FSH vs. LH - correct answers ✅1. Causes follicle & egg maturation
- Stimulate maturing follicle to produce estrogen Estrogen vs. Progesterone - correct answers ✅1. Thickens endometrium
- Enhances lining of uterus to prepare for implantation In the follicular phase (days 1-14) of the menstrual cycle, FSH is increasing which causes a _______ to develop which produces ________ to help proliferate the lining of the endometrium; at the end of this phase _______ surges causing ovulation - correct answers ✅1. Primary ovarian follicle
- Estrogen
- LH
In the luteal phase (days 14-28), after ovulation, the leftover follicle becomes the _________ which produces _________ which maintains the endometrial lining for fertilization - correct answers ✅1. Corpus luteum
- Progesterone In the luteal phase, the endometrial lining is prepared for fertilization from progesterone from the corpus luteum; the ________ degrades causing a drop in progesterone/estrogen and _________ begins - correct answers ✅1. Corpus luteum
- Menstruation In the luteal phase, the endometrium is prepared for fertilization by progesterone from the corpus luteum; if fertilization does occur __________ gets released by the developing trophoblast/placenta which maintains the __________ to continue making progesterone/estrogen - correct answers ✅1. hCG
- Corpus luteum Cryptomenorrhea - correct answers ✅Light flow or spotting
- Increased blood loss (due to endometrial vessel dilation and prostaglandins) = menorrhagia REMEMBER this is a Dx of exclusion Primary Amenorrhea Definition (2) - correct answers ✅1. No menstruation by age 15 in the presence of 2° sex characteristics
- No menstruation by age 13 in the absence of 2° sex characteristics In a pt with primary amenorrhea, who's uterus & breasts are present, what may be the cause? - correct answers ✅Outflow obstruction (transverse vaginal septum, imperforated hymen) In a pt with primary amenorrhea, who's uterus is present but breasts are not, what may be the cause? (2) - correct answers ✅1. If elevated FSH and LH = Ovarian causes (Premature ovarian failure, gonadal dysgenesis)
- If normal/low FSH and LH = Hypothalamus-Pituitary failure
In a pt with primary amenorrhea who's uterus is absent but breasts are present, what may be the cause? (2) - correct answers ✅1. Mullerian agenesis (46XX)
- Androgen Insensitivity (46XY) In a pt with primary amenorrhea who's uterus and breasts are absent, what may be the cause? - correct answers ✅RARE Defect in testosterone synthesis; presents like a phenotypic immature girl but will often have intraabdominal testes Secondary Amenorrhea Definition (2) - correct answers ✅1. No menstruation for > 3 months in a pt with previously normal menstruation
- No menstruation for > 6 months in a oligomenorrheic pt Amenorrhea caused by Ovarian Disorders Sx + Dx - correct answers ✅Elevated FSH/LH, Decreased estradiol Dx: Progesterone challange test (10 mg for 10 days; if has withdrawal bleeding = ovarian; if no withdrawal bleeding = hypoestrogenic or uterine disorder
Primary vs. Secondary Dysmenorrhea - correct answers ✅1. NOT due to pelvic pathology → due to ↑ prostaglandin
- Due to pelvic pathology (ex: endometriosis) Premenstrual Syndrome (PMS) Tx (5) - correct answers ✅1. Supportive
- SSRI (for emotional symptoms)
- OCP including Drosperinone
- GnRH *(if no response to SSRI or OCP)
- Spironolactone (for bloating) Premenstrual Dysphoric Disorder (PMDD) - correct answers ✅Severe PMS with functional impairment Menopause Sx (2) - correct answers ✅1. ↑ FSH, LH (FSH > LH) → FSH > 30
- ↓ Estrogen Premature menopause = <40 years old
Hormonal Replacement Therapy for Menopause (2) - correct answers ✅1. Estrogen only (most effective symptomatic tx; Transdermal/vaginal preferred) → No risk of breast CA but risk of endometria CA
- Estrogen + Progesterone → protect against endometrial CA but risk of breast CA and DVT Endometrial Hyperplasia is caused by - correct answers ✅Unopposed estrogen causing thickening/build up of endometrial lining A 55 yo women with post-menopausal bleeding, menometrorrhagia receives a TVUS showing a >4mm endometrial stripe... what is the most likely Dx? - correct answers ✅Endometrial hyperplasia/gland proliferation Do an endometrial Bx to confirm How is endometrial hyperplasia WITHOUT atypia treated? WITH atypia? - correct answers ✅1. WITHOUT atypia: progestin (po or IUD Mirena) stops estrogen from being unopposed and limits endometrial growth; repeat EMBx in 3-6 mos
- Infertility
- Ectopic pregnancy Fitz-Hugh Curtis Syndrome Sx (2) - correct answers ✅Hepatic fibrosis and peritoneal involvement
- Violin string adhesion on anterior liver surface
- RUQ pain, may radiate to right shoulder Bacterial Vaginosis Sx (3) + Tx (2) - correct answers ✅1. MCC of vaginitis
- (+) Whiff test → fishy odor
- Clue cells → epithelial cells covered with bacteria Tx: Metronidazole, Clindamycin Trichomoniasis Sx (5) + Tx (2) - correct answers ✅1. Sexually transmitted
- Pruritus
- Dysuria
- Frothy yellow-green discharge
- Strawberry cervix Tx: Metronidazole, Tinidazole (MUST TREAT PARTNER) Candidiasis Sx (4) + Tx - correct answers ✅1. Swelling
- Burning
- Pruritus
- Thick cottage cheese discharge Tx: Fluconazole (1st line) Atrophic Vaginitis - correct answers ✅Thinning, drying and inflammation of the vaginal walls due to less estrogen (MC after menopause) Chlamydia Sx (3) + Tx (2) - correct answers ✅1. MCC of cervicitis
- Asymptomatic
- Lymphogranuloma venerum in developing countries (PAINLESS genital ulcer → PAINFUL inguinal LAD)
Chancroid Sx (4) + Tx - correct answers ✅1. Haemophilus ducreyi
- PAINFUL genital ulcer
- PAINFUL inguinal LAD
- Small vesicles or papules Tx: Azithromycin What bug causes syphilis? - correct answers ✅Spirochete Treponema pallidum Primary Syphilis Sx (2) - correct answers ✅(3 - 4 wks)
- Chancre (Painless ulcer)
- Nontender LAD Secondary Syphilis Sx (3) - correct answers ✅(3 wks - 6 mos after)
- Maculopapular rash (palms/soles common)
- Condyloma lata (wart-like lesions on mucous membranes)
- Systemic symptoms (fever, LAD, arthritis, meningitis, HA, hepatitis, increased alk phos) Tertiary Syphilis Sx (4) - correct answers ✅1-20 yrs after infection
- Gumma (noncancerous granulomas)
- Neurosyphilis (HA, meningitis, dementia, vision/hearing loss, incontinence, tabes dorsalis)
- Argyll-Robertson pupil (accommodation only)
- Cardiovascular (aortitis, AR, aortic aneurysms) Syphilis Tx (4) - correct answers ✅1. PCN G
- Doxycycline, Macrolide, Ceftriaxone if PCN allergy BRCA 1 & 2 genetic mutations are associated with what cancers? - correct answers ✅Breast and Ovarian cancers Breast Cancer (2) - correct answers ✅1. MC non-skin malignancy in women
- 2nd MCC of cancer death
What neoadjuvant hormone therapy could you give to a pt with HER (human epidermal growth factor receptor) (+) breast cancer? - correct answers ✅monocloncal Ab treatment (trastuzumab/Herceptin) but s/e are cardiotoxicity How often should clinical breast exams, self breast exams, and screening MMGs take place? & in what age group? - correct answers ✅1. Clinical breast exam: q3y age 20-39, annually @ age ≥
- Self breast exam: monthly ≥20yo right after menstruation
- Mammo: annually ≥40yo or 10y before 1st deg relative Dx Endometrial Cancer (5) - correct answers ✅1. MC GYN cancer in the US
- 4th MC cancer in women overall (Breast → lung → colorectal)
- MC PMP
- Estrogen dependent cancer (Risk factor = ↑ estrogen exposure)
- MC adenocarcinoma Combination OCP are protective of endometrial and ovarian cancer
Endometrial Cancer Sx (2) + Dx (2) - correct answers ✅1. PMP bleeding
- Menorrhagia or metrorrhagia in pre or perimenopausal Dx: Biopsy, US (endometrial stripe >4mm) Endometrial Cancer Tx (3) - correct answers ✅1. Stage I = Hysterectomy +/- post op radiation
- Stage II-III = Hysterectomy + lymph node excision +/- post-op radiation
- Stage IV = Systemic chemotherapy What is the MC benign ovarian neoplasm? + Tx - correct answers ✅Dermoid cystic teratomas Tx: Removal (due to risk of torsion or malignancy development) 90% of ovarian neoplasms are benign in reproductive age women
27 yo pt with ASCUS (atypical squamous cells of undetermined significance) on pap; next step? If she was 23? - correct answers ✅21-24 w/ ASCUS → repeat pap in 1 yr or can do HPV testing but not recommended ≥25 w/ ASCUS → HPV testing If (-) repeat co-testing in 3 yrs If (+) colposcopy + Bx 22 yo w/ ASC-H (atypical squamous cells can't exclude HSIL) on pap; next step? - correct answers ✅Any age w/ ASC-H = colposcopy + Bx 27 yo pt with LSIL (low grade squamous intraepithelial lesion) on pap; next step? If she was 23? If she was 33? - correct answers ✅21-24 w/ LSIL → repeat pap in 1 yr 25-29 w/ LSIL → colposcopy + Bx
≥30 w/ LSIL → HPV testing If (-) repeat pap in 1 yr If (+) colposcopy + Bx LSIL includes CIN1 27 yo pt with HSIL (high grade squamous intraepithelial lesion) on pap; next step? - correct answers ✅Any age w/ HSIL = colposcopy + Bx HSIL includes CIN2, CIN3, and carcinoma in situ What region of the cervix has the highest risk for malignancy? - correct answers ✅Transformation zone (squamocolumnar junction) - junction of squamous cell of ectocervix and glandular columnar cells near end of endocervical canal CIN1 Sx + Tx (3) - correct answers ✅Mild dysplasia contained to the basal 1/3 of the epithelium
