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  1. work up for a b/l white milky breast discharge
    • prolactin
    • tsh and t4 levels
  2. working up a breast mass in a woman?
    • pe
    • ultrasound/mammography
    • fna
  3. an aspirate that is grossly blood, next step
    sent for cytology
  4. 50 yo woman with cluster of calcifications, next step
    core biopsy
  5. mnx of dcisvs lcis
    dcis---resect, radiotherapy, + tamoxifen

    lcis-- tamoxifen only for 5 years
  6. contraindication to tamoxifen
    • active smoking
    • thromboembolism in the past
  7. what is the most common cancer
  8. 4 types of  invasive breast cancer
    • ductal
    • lobular
    • inflammatory
    • paeu the organge
  9. when are brca1 and 2 gene testing indicated
    early breast disease or ovarian

    breast and ovarian in same patient
  10. symmetric and tender uterus
    asymmetric and non tender uterus
    • adenomysosi
    • leyimyoma
  11. management of leyomyoma
    management of adenomyosis
    • gnrh
    • myomectomy
    • ultrasound to observe

    adenomyosis--iud prevents pain
  12. when do you remove an ovarian cyst
    if larger than 7 cm
  13. mnx of complex cyst
    remove it
  14. pcos is associated with what med
  15. mnx of ovarian hyperthecosis that produces virilization and hirsutism
  16. mnx of luteoma of pregnancy
  17. theca lutein cysts and luteoma of pregnancy mnx
    both the same--obseve
  18. luteoma or theca lutein cysts are associated with twins and molar pregnancies
    theca lutein cysts
  19. when is hpv testing done vs repeat pap
    hpv testing if liquid based cytology done

    repeat pap is done if normal pap was done
  20. when is colposocpy done
    after 2 abnormal pap smears and hpv testing showed 16 and 18

    first abnormal pap smear
  21. who doesnt get endocervical curetagge
    pregnant women
  22. mnx of cin1, cin2 and 3
    follow up pap smears and colposcopy/hpv testing
  23. how do you manage cin2 and 3
    • ablative modalities
    • excisional modalities
  24. mnx of invasive cervical cancer
    when is radio or chemo given
    hysterectomy or modified radical hysterectomy

    for metastatic, large tumore, recurrent
  25. mnx of cin, dysplasia
    microinvasive cancer
    invasive cancer in pregnancy
    • pap smear
    • cone biopsy to ensure no invasion

    • <24 weeks--hysterectomy
    • >24 weeks conservative
  26. who is not a candidate for hpv
    • older females
    • pregnant, lactating, immunocompromised women
  27. 4 dd of pelvic pain
    • cervicitis
    • salpingo-oophoritis
    • tubo-ovarian abscess, chronic pid
  28. initial work up for pelvic pain
    • pelvic exam
    • cervical cultures
    • wbc
    • sonogram
  29. rx for acute salpingo-oophoritis
    • outpatient---fq and metro
    • inpatient--gentamycin, 3rd gen cephalo, doxycycline
  30. dx of chronic pid
    sono will show bilateral cystic masses
  31. rx for chronic pid
    lysis of tubal adhesions
  32. dx of tubovarian abcsess
    culdocentesis will show pus
  33. mnx of tuboovarian abcess
    • iv clinda and gentamycin
    • if no improvement after 72 hours do drianage, ex lap
  34. when do you treat pelvic pain as outpatient vs inpatient
    • all cases of cervicitis
    • acute salpino oophoritis
    • both are treated as inpatient

    cases of an abscess or systemic signs like fever, voimiting, nausea are treated as inpatient
  35. rx for primary dysmenorrhea
    • nsaids
    • ocp
  36. primary vs secondary dysmenorrhea
    • primary--high prostaglandins
    • secondary- due to endometriosis, adenomyosis, lyomyoma
  37. best initial rx for endometriosis
    • ocp
    • danazol or gnrh agonists
    • lysis of adhesions
    • tah:sbo
  38. work up of premenarchal menstrual bleeding
    • pelvic exam
    • mri of pituitary, abdomen, pelvis to look for estrogen secreting tumors
    • if all are negative^ its idiopathic precocious puberty
  39. abnormal bleeding in reproductive years, next step
    get beta hcg
  40. definition of primary amenorrhea and secondary amenorrhea
    • primary--14 with no secondary sexual characterisitcs
    • secondary-16 with secondary sexual characteristics
  41. cause for uterus present and breast present
    breast absent uterus present
    • low gonadotropics i.e exercise, anorexia
    • imperforate hymen

    turners or low gonadotropics from pituitary

    uterus absent and breast present--mullerian agenesis, complete androgen insensitivity
  42. rx for androgen insensitivity
    removal of testes
  43. rx for turners
    hormones for normal development
  44. 5 steps in management of secondary amenorrhea
    • beta hcg
    • tsh
    • prolactin
    • progesterone stimulation test
    • estrogen/progesterone stimulation test
  45. rx of choice for premenstrual dysphoric disorder
    • ssri
    • vit b6
  46. initial steps in working up virilization
    • lh/fsh
    • testo
    • dheas
    • 17 oh progesterone
  47. dx of pcos
    • lh/fsh ratio
    • testo
    • ultrasound
  48. rx for pcos
    • ocp
    • metformin
    • clomiphene
  49. hirsutism and dheas high, next step
    and high test
    ct of abdomen

    ultrasound of pelvis
  50. rx for idiopathic hirsutism
    • spironolactone
    • eflornithine
  51. how does congenital adrenal hyperplasia present
    gradual onset hirsutism in the 20's with anovulation and irregular menses
  52. next step when u suspect cah as causing hirsutism
    acth stimulation test
  53. how is osteoporosis assessed?
    dexa bone scan

    urinary hydroxyproline levels
  54. what is a teripiratide?
    pth agonist used for osteo
  55. how long should hrt last
    no more than 4 years
  56. work up for infertility
    • semen analysis
    • if normal, work up for anovulation, if normal work up for tube abnormality
  57. complete or incomplete mole has 46 xx and absent fetus parts
  58. mnx of gestational trophoblastic disease
    • baseline beta hcg
    • chest xray
    • d/c
    • ocp
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