Editing OBGYN - Review
From Iusmicm
Warning: You are not logged in.
Your IP address will be recorded in this page's edit history.
The edit can be undone.
Please check the comparison below to verify that this is what you want to do, and then save the changes below to finish undoing the edit.
Current revision | Your text | ||
Line 60: | Line 60: | ||
*Trisomies of chr 13, 16, 18, 21, and 22 are the most common ch abnormalities. | *Trisomies of chr 13, 16, 18, 21, and 22 are the most common ch abnormalities. | ||
*Ch abnormalities by frequency: trisomy > polyploidies > Monosomy X (Turner’s). | *Ch abnormalities by frequency: trisomy > polyploidies > Monosomy X (Turner’s). | ||
- | |||
*A history of 2 or 3 consecutive spontaneous early pregnancy losses (recurrent abortions) and no previous live born (RPL) is an indicator for karyotyping the couple. | *A history of 2 or 3 consecutive spontaneous early pregnancy losses (recurrent abortions) and no previous live born (RPL) is an indicator for karyotyping the couple. | ||
**''3-8% of these couples will have some abnormality, most frequently a balanced chromosomal rearrangement or translocation.'' | **''3-8% of these couples will have some abnormality, most frequently a balanced chromosomal rearrangement or translocation.'' | ||
Line 362: | Line 361: | ||
*3 questions; 1 focuses on the type of anomaly, 1 on incidence of congenital anomalies | *3 questions; 1 focuses on the type of anomaly, 1 on incidence of congenital anomalies | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | + | *Definitions: | |
+ | **Malformations are abnormalities that result from ''intrinsically abnormal development processes that have been wrong from the beginning.'' | ||
+ | **Disruptions are abnormalities that interferes with previously normal development. | ||
+ | ***'''Disruptions include teratogens and ''amniotic bands''.''' | ||
+ | **Deformations are abnormaliteis of form or shape because of mechanical disturbance. | ||
+ | ***Deformities include oligohydraminos (low amniotic fluid levels) which results in a smushed face (like wearing a pair of lady's hose over one's head). | ||
+ | **Dysplasias are abnormal cellular formations. | ||
+ | ***Dysplasias include renal issues due to obstruction of flow. | ||
+ | |||
+ | |||
*Single minor anomalies are very common: '''14% of live births have a minor anomaly.''' | *Single minor anomalies are very common: '''14% of live births have a minor anomaly.''' | ||
- | |||
- | |||
- | |||
*Single major anomalies are not uncommon: '''3% of live births have a major anomaly.''' | *Single major anomalies are not uncommon: '''3% of live births have a major anomaly.''' | ||
- | |||
- | * | + | *Teratology: |
- | + | **The first two weeks of gestation is the "all or nothing" stage in which teratogen exposure results in fetal abortion (nothing). | |
+ | ***In this all or nothing period, the '''teratogen is interfering with implantation and cleavage'''. | ||
+ | *75% of all pregnancies are aborted. | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | + | *questions: | |
- | * | + | |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
==Abnormal Uterine Bleeding== | ==Abnormal Uterine Bleeding== | ||
- | *3 questions | + | *3 questions, AUB |
- | |||
- | |||
- | |||
- | |||
- | + | *Know the uterine / ovarian cycle! | |
- | * | + | **Leading up to ovulation is the follicular phase (estrogen dominated) of the ovarian cycle and the proliferative phase of the uterine cycle. |
- | ** | + | **Post-ovulation is the luteal phase (progesterone dominated) of the ovarian cycle and the secretory phase of the uterine phase. |
- | ** | + | **http://upload.wikimedia.org/wikipedia/commons/c/cd/MenstrualCycle2.png |
- | *Anovulation is the most common cause of abnormal uterine bleeding. | + | *Abnormal uterine bleeding: |
- | *When a woman doesn't ovulate, there is no corpus luteum and therefore no progesterone. | + | **Anovulation is the most common cause of abnormal uterine bleeding. |
- | *Recall that progesterone causes the endometrium to become secretory. | + | **When a woman doesn't ovulate, there is no corpus luteum and therefore no progesterone. |
- | *Without ovulation / progesterone, the endometrium just keeps proliferating. | + | **Recall that progesterone causes the endometrium to become secretory. |
- | *Initially, there will be a lack of bleeding as the endometrium doesn't get the progesterone signal drop that causes menses. | + | **Without ovulation / progesterone, the endometrium just keeps proliferating. |
- | *Once the excessively-proliferating endometrium outgrows its blood supply, it will bleed--heavily. | + | **Initially, there will be a lack of bleeding as the endometrium doesn't get the progesterone signal drop that causes menses. |
+ | **Once the excessively-proliferating endometrium outgrows its blood supply, it will bleed--heavily. | ||
- | + | ||
- | *Menorrhagia means ''heavy, prolonged bleeding''. | + | *Terminology: |
- | *Metorrhagia means '''light, irregular bleeding'''. | + | **Menorrhagia means ''heavy, prolonged bleeding''. |
- | *Menotorrhagia means '''heavy, irregular bleeding'''. | + | **Metorrhagia means '''light, irregular bleeding'''. |
- | *Amenorrhea is defined as absent bleeding '''for 3 or more cycles'''. | + | **Menotorrhagia means '''heavy, irregular bleeding'''. |
- | *Eumeorrhea has a cycle of 21-35 days. | + | **Amenorrhea is defined as absent bleeding '''for 3 or more cycles'''. |
- | *Oligomenorrhea is an interval over 35 days. | + | **Eumeorrhea has a cycle of 21-35 days. |
- | *Polymenorrhea is an interval less than 24 days. | + | **Oligomenorrhea is an interval over 35 days. |
- | *Intermenstrual bleeding is bleeding between regular menses. | + | **Polymenorrhea is an interval less than 24 days. |
- | *Prementstrual spotting refers to light bleeding just before menses begins. | + | **Intermenstrual bleeding is bleeding between regular menses. |
- | *Post-coital spotting refers to bleeding ''within 24 hours of vaginal intercourse''. | + | **Prementstrual spotting refers to light bleeding just before menses begins. |
+ | **Post-coital spotting refers to bleeding ''within 24 hours of vaginal intercourse''. | ||
Line 455: | Line 437: | ||
**Anatomical: coagulopathies | **Anatomical: coagulopathies | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | + | *questions: | |
- | * | + | **atrophic vaginitis |
- | * | + | |
- | * | + | |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
==Menopause and Hormone Replacement Therapy== | ==Menopause and Hormone Replacement Therapy== | ||
- | *3 questions; 1 | + | *3 questions; 1 clinical scenario, sx w/ menopause, menopause workup |
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | + | *'''FSH is increased when menopausal''' | |
- | * | + | **No end organ means no estrogen to feed back on hypothal to inhibit fsh release. |
- | *'''Declining fertility | + | *Checking estrogen doesn't help |
+ | |||
+ | |||
+ | *'''Declining fertility in menopause is not absolute.''' | ||
**One can still get pregnant after the onset of menopause. | **One can still get pregnant after the onset of menopause. | ||
**Be sure to talk to menopause pts about birth control. | **Be sure to talk to menopause pts about birth control. | ||
- | |||
- | |||
- | + | ||
- | *Contraindications | + | *Contraindications to estrogen replacement therapy include: |
**Undiagnosised abnormal genital bleeding | **Undiagnosised abnormal genital bleeding | ||
- | ** | + | **Cctive thrombosis |
**Pregnancy | **Pregnancy | ||
**'''Endometrial cancer and breast cancer''' | **'''Endometrial cancer and breast cancer''' | ||
- | |||
- | * | + | *Evaluation of the post-menopausal pt: |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
**Determine the menopausal stage. | **Determine the menopausal stage. | ||
+ | **Determine the diagnsis | ||
**Do a mammogram | **Do a mammogram | ||
- | ** | + | **'''Be sure to rule out pregnancy!''' |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | *S&S of Menopause | + | *S&S of Menopause |
**Loss of concentration | **Loss of concentration | ||
**Loss of libido | **Loss of libido | ||
Line 533: | Line 475: | ||
**Depression | **Depression | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
+ | **blue slide: don't worry about it | ||
- | * | + | |
- | ** | + | *questions |
+ | **endometrial cancer suspicion | ||
+ | **all the rest are not contraindications | ||
+ | **loss of concentration is a s/e of menopause | ||
+ | ***others are: decrease libido, decreased vag lubrication, depression | ||
==Infertility== | ==Infertility== | ||
- | *3 questions | + | *3 questions that center on evaluation and diagnositics for infertility |
- | |||
*The definition of infertility is '''1 year of regular coitus without conception'''. | *The definition of infertility is '''1 year of regular coitus without conception'''. | ||
*Infertility can be the result of a single factor or several factors. | *Infertility can be the result of a single factor or several factors. | ||
- | |||
- | |||
**Therefore, we work up from easiest / most-likely / cheapest / least invasive. | **Therefore, we work up from easiest / most-likely / cheapest / least invasive. | ||
- | *A careful history and physical exam is important for narrowing the tests to be ordered | + | *A careful history and physical exam is important for narrowing the tests to be ordered |
+ | |||
- | + | *Normal fertility requirements | |
- | * | + | |
**Regular ovulation | **Regular ovulation | ||
**Patent fillopian tubes | **Patent fillopian tubes | ||
Line 566: | Line 502: | ||
**Erectile and ejaculatory competence | **Erectile and ejaculatory competence | ||
- | |||
- | |||
+ | *Anovulation associated with ovarian failure: | ||
+ | **Most of the details of ovarian failure are in excess. | ||
+ | **Turner syndrome is one cause of ovarian failure. | ||
+ | ***'''Turner syndrome is characterized by primary amenorrhea, ovarian streaks, no secondary sexual characteristics (because of primary gonadal failure).''' | ||
+ | **Primary gonadotropic deficiency is another cause of ovarian failure. | ||
+ | ***No GnRH / LH / FSH; | ||
+ | ***Hypogonadic | ||
+ | ***'''Anosmia''' | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
+ | *Functional chronic anovulation: | ||
+ | **Commonly seen in athletes, anorexics, high stress situations, and physical-appearance-success coupling. | ||
+ | **Stress suppresses gonadotropic release at hypothalamus. | ||
+ | ***This response to stress is good for a state of famine (don't make more eaters when there's little eating to be done). | ||
+ | **Part of the problem in functional chronic anovulation is that '''a certain amount of body fat needed to maintain LH / FSH levels''' and these women lack that fat threshold. | ||
- | |||
- | |||
- | + | *Polycystic ovarian disease: | |
- | * | + | **'''POCD is the most common cause of anovulation.''' |
- | ** | + | **POCD '''presents as hirsuitism, high BMI, oligo- / a-menorrhea, and insulin resistance.''' |
- | + | ||
- | *'' | + | |
- | + | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
*Workup for the anavulating patient: | *Workup for the anavulating patient: | ||
- | **Chemistries: FSH, LH, prolactin | + | **Chemistries: FSH, LH, prolactin |
- | ***Recall that prolactinemia / prolactinomas can cause anovulation | + | ***Recall that prolactinemia / prolactinomas can cause anovulation |
- | + | ||
**Imaging: | **Imaging: | ||
- | ***CT of the sela tercica to identify a | + | ***CT of the sela tercica to identify a prolacitnoma |
- | ***U/S of ovaries to be sure they exist and do not have cysts | + | ***U/S of ovaries to be sure they exist and do not have cysts |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
==Gynecological Cancers== | ==Gynecological Cancers== | ||
- | *3 questions; 1 on | + | *3 questions; 1 on risk factors of endometrial cancer, 1 on diagnosis, 1 on appropriate tx for pelvic mass |
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | + | *Endometrial cancer | |
- | * | + | **Risk factors: age, null-gravis, unopposed hormone replacement, obesity, hypertension, and diabetes. |
- | + | **Presentation of endometrial cancer includes '''abnormal bledding, post-menopausal bleeding, pre-menopausal bleeding'''. | |
- | + | ||
- | *Risk factors: age, null-gravis | + | |
- | * | + | |
- | + | ||
- | *Presentation of endometrial cancer includes '''abnormal | + | |
- | + | ||
- | |||
- | |||
- | |||
- | |||
- | |||
- | |||
- | *For diagnosing uterine cancer, '''histeroscopy is the gold standard.''' | + | *Uterine cancer: |
- | **Hysteroscopy can reveal cancer lesion for direct biopsy. | + | **For all gynecological problems, consider a pregnancy test as the first diagnostic. |
- | **Hysteroscopy should not be used for known uterine cancer cases as the fluid used can push malignant cells to new locations | + | **Upon suspecting uterine cancer, '''take a biopsy'''. |
+ | ***Biopsy is via pipelle. | ||
+ | ***Biopsies have a 98% sensitivity for uterine cancer. | ||
+ | **For diagnosing uterine cancer, '''histeroscopy is the gold standard.''' | ||
+ | ***Hysteroscopy can reveal cancer lesion for direct biopsy. | ||
+ | ***Hysteroscopy should not be used for known uterine cancer cases as the fluid used can push malignant cells to new locations | ||
+ | **Suspicion of a uterine cancer can also indicate an U/S. | ||
+ | ***The endometrium in non-malignant cases should be less than 6mm thick. | ||
+ | ***Endometrium over 6mm is an indication for biopsy. | ||
- | |||
- | |||
- | |||
- | + | *Cervical Cancer Epidemiology: | |
- | *Cervical cancer screening | + | **Cervical cancer screening: |
- | **Screening is now recommended to begin at 21 yo--not based on time of first coitus. | + | ***Screening is now recommended to begin at 21 yo--not based on time of first coitus. |
- | **Pap smears should be | + | ***Pap smears should be done every 1-2 years until 70yo or until a ''total'' hysterectomy is performed. |
- | + | ***'''Pap smears catch most cervical cancer cases: 60% are caught in stage 1.''' | |
- | + | **Cervical cancer risk factors: minorities / underserved, multiparity, early parity, early coitus | |
- | + | **HPV strains 16, 18, 31, 33 are associated with cervical cancer. | |
- | **'''Pap smears catch most cervical cancer cases: 60% are caught in stage 1.''' | + | **Some cases of HPV infection (especially in the young, with their highly proliferative cervical epithelium) resolve spontaneously. |
- | * | + | *no stats |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | * | + | *Adnexal masses: |
- | * | + | **Good prognostic indicators of adnexal masses: being asymptomatic, cystic nature (fluid filled, means it is benign), being young (15-45 yo) |
- | + | **Bad prognostic indicators of adnexal masses: having associated pain, solid / complex nature, ascites, omental caking quality, lymphadenopathy | |
- | + | **The differential diagnosis for an adnexal mass should include: | |
- | + | **Adnexal mass workup: | |
- | *Good prognostic indicators of adnexal masses: being asymptomatic, cystic nature (fluid filled, means it is benign), being young (15-45 yo) | + | ***Pelvic exam |
- | *Bad prognostic indicators of adnexal masses: having associated pain, solid / complex nature, ascites, omental caking quality, lymphadenopathy | + | ***CA 125 as triage, be ready to call in gyncological oncology as backup |
- | + | ***Imaging | |
- | + | ****U/S is superior to CT | |
- | *The differential diagnosis for an adnexal mass should include: | + | **Adnexal mass Treatment: |
- | * | + | ***Operate on large masses. |
- | + | ***Operate on masses with many bad indicators (old age, ascites, etc.) | |
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | + | ||
- | *Adnexal mass workup: | + | |
- | **Pelvic exam | + | |
- | **CA 125 as triage, be ready to call in gyncological oncology as backup | + | |
- | **Imaging | + | |
- | ***U/S is superior to CT | + | |
- | + | ||
- | |||
- | |||
- | |||
- | + | *questions: | |
- | * | + | |
- | + | ||
- | + | ||
- | + | ||
- | + |