Download PAEA OBGYN EOR Topics Study Guide with Solutions 2024 and more Exams Nursing in PDF only on Docsity!
PAEA OBGYN EOR Topics Study Guide with Solutions 2024
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
- 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
- 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
