USTEP3 gyn

  1. unilatearl nonbloddy discharge
    intraductal papilloma
  2. bilateral breast lumps varying with menstrual cycle
    fibrocystic dz
  3. rx for fibrocystic disease
  4. manageent of breast suspected fibroadenoma
    • ultrasound
    • fna
  5. findings of DCIS
    • DCIS-resect, radiation and tamoxifen x5 years
    • LCIS- just tamoxifen
  6. most common form of breast cancer
    invasive ductal-unilateral
  7. when do you test for BRCA
    • ashkenazi jew
    • male breast cancer
    • cancer in <50 you
    • breast and cervical in the same patient
  8. rx for invasive breast cancer <5cm
    • surgery
    • sentinel ln biopdy
    • radiation
    • chemotherapy
    • adjuvant¬†
    • esr/prog, her
  9. when is mastectomy done
    • tumor size >5cm
    • more than 1 site involved
    • prior radiation
    • postivie tumor margins
    • pregnancy
  10. when is neoadjuvant chemo done
    anytime it is hormone receptor+
  11. premenopausal ER+, rx
    postmenopausal ER+ Rx
    • tamoxifen
    • tamoxifen or anastrozole
  12. when is chemo given for brast ca
    • tumor >1cm
    • +ln
  13. when is trastuzamab given
    HER2 + and metastasis
  14. leiomyoma or adenomyosis changes with high or low esterogen states
    lyiomyoma changes
  15. asymmetric and non tender uterus

    symmetric and tender uterus

  16. rx for adenomyosis
    levonorgestrel Intrauterine system
  17. endometrial cancer + metastasis
    surgery + chemo and radiation
  18. indication for removal of ovarian cysts
    >7cm in size
  19. mcc of cyst in reproductive years
    • luteal or follicular cyst
    • leave alone if <7cm
  20. management of complex cyst
  21. initial w/u of cyst
    • beta hcg
    • u/s
    • lapatoaomy if >7cm
  22. when do you do FNA of complex cyst
  23. 9 yo f with complex cyst
    • germ cell tumor
    • ldh
    • afp
    • beta hcg
  24. 67 yo F with adnexal mass
    • epithelial tumor
    • cea
    • ca125
  25. 58 yo f presents with endometrial hyperplasia and adnexal mass
    • granulosa theca tumor
    • estrogen
  26. 48 yo f presents with masculinization and adnexal mass
    • sertoli leydig tumor
    • testosterone
  27. krukenberg tumor
    gastric cancer metastezied to ovaries bilatearlly
  28. hpv is a
    nonenveloped dna virus
  29. 2 ascus means
    1 ascus? colposcopy or epeat
    • colposcopy and biopsy
    • repeat if patient is reliable to follow up
  30. when do you observe and follow up
    after CIN1 or CIN2 or 3 after ablation
  31. when do you answer ablative therapy
    CIN2 or CIN3
  32. when do you ansser hysterectomy
    • biopsy confimed
    • recurrent cin2 or 3
  33. when is chemo and radiation given for cervical cancer
    • +margins
    • +ln
    • tumor sixze >4cm
    • local recurrence
    • poorly differentiated
  34. how are pap smears abnormal managed in pregnancy
    same as non-pregnant, except ECC is not done
  35. management of CIN/dysplasia in pregnancy
    microinvasive cervical cancer
    invasaive cancer
    pap and colopscopy

    cone biopsy to ensure to invasion

    • <24 hysterectomy
    • >24 c-section and definitive therapy
  36. who does not get gardasil
    • pregnant
    • lactating
    • immunocompromised
  37. w/u for pelvic pain
    • pelvic exam
    • beta hcg
    • esr, cbc
    • sono
  38. rx for acute salpingo oophoritis
    ceftirazone and doxycycline
  39. rx for chronc pelvic inflammatory dz
    lysis of tubal adhesions
  40. when do you admit for pelvic pain
    • failure of OP rx
    • IUD in place
    • tuboovarian abscess
  41. rx for inpatient tubo ovarian abscess
    cefoxitin + doxy
  42. rx for primary dysmenorrerhea
    • nsaids
    • then OCP's
  43. secondary dysmenorrhea cause
  44. chocolate cyst
    endometrioss implant on ovary
  45. rx for endometriosis
    • progestins
    • ocp
    • danazol
  46. sarcoma botryoides
    grapelike tumor of vagina causing pre-menarchal bleeding
  47. work up of premenarchal vaginalbleeding
    ct or mri of pituatiray abdomnen or pelvis to look for esterogen secreting tumors
  48. if work up of premenarchal bleeding is negative, diagnosis is
    idiopathic precocious puberty
  49. primary amenorrhea
    • 14 with no secondary sex features
    • 16 with secondary sex features
  50. 2 causes of amenorrhea with breasts present but no uterus
    • mullerian agenesis
    • androgen insensitivity
  51. breasts absent and uterus present but there is amenorhhea
    • turners
    • hypothalamic pituitary failure
  52. rx for mullerian agenesis
  53. rx for adnrogen insensitivity
    removal of testes before 20 yo
  54. work up of 2ndary amenorrhea
    • beta hcg
    • tsh
    • prolactin
    • progesterone challenge if -ve progesterone test, then do estrogen-progesterone challenge test
  55. if negative progesterone challenge test then dx is? inadequate esterogen or outflow tract obstruction
    inadequate esterogen or outflow tract obstruction
  56. in case it is negative progesterone withdrawal test next step
    • estrogen and progesterone¬†
    • if + esterogen and progesterone test then check fsh, if high then ovarian failure
    • if low then pituaitray tumor
    • if - estrogen progesterone test then check for asherman
  57. rx for PMDD
  58. work up of virilization/hirsutism
    • 17 oh progesterone
    • dheas
    • lf/fh
    • testosterone
  59. what is the ratio of LH/FSH in PCOS
  60. rx for infertility in pcos
  61. how to assess calcium loss in menopause
    24 hour hydroxyproline
  62. what is denosumab
    RANKL inhibitor
  63. when do you use teriparatide
    when bisphosphonates fail
  64. how long should you use HRT
    no longer than 4 years
  65. when should you give hrt
    • vasomotor symptoms
    • dyspareunia
    • genitourinary atrophy
  66. gestational trophoblastic dz is most common in
    taiwan or phillipines populations
  67. uterus is larger then dates, dx
    molar pregnancy
  68. hydatifiform mole, complete
    • complete
    • empty egg
    • 46xx
    • fetus absent
    • 20% malignacy potential
  69. rx for molar pregnancy
    • beta hcg
    • cxr
    • ocp
    • d and c
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USTEP3 gyn
USTEP3 gyn