-
unilatearl nonbloddy discharge
intraductal papilloma
-
bilateral breast lumps varying with menstrual cycle
fibrocystic dz
-
rx for fibrocystic disease
ocp
-
manageent of breast suspected fibroadenoma
-
findings of DCIS
LCIS
- DCIS-resect, radiation and tamoxifen x5 years
- LCIS- just tamoxifen
-
most common form of breast cancer
invasive ductal-unilateral
-
when do you test for BRCA
- ashkenazi jew
- male breast cancer
- cancer in <50 you
- breast and cervical in the same patient
-
rx for invasive breast cancer <5cm
- surgery
- sentinel ln biopdy
- radiation
- chemotherapy
- adjuvant
- esr/prog, her
-
when is mastectomy done
- tumor size >5cm
- more than 1 site involved
- prior radiation
- postivie tumor margins
- pregnancy
-
when is neoadjuvant chemo done
anytime it is hormone receptor+
-
premenopausal ER+, rx
postmenopausal ER+ Rx
- tamoxifen
- tamoxifen or anastrozole
-
when is chemo given for brast ca
-
when is trastuzamab given
HER2 + and metastasis
-
leiomyoma or adenomyosis changes with high or low esterogen states
lyiomyoma changes
-
asymmetric and non tender uterus
symmetric and tender uterus
leiomyoma
adenomyosis
-
rx for adenomyosis
levonorgestrel Intrauterine system
-
endometrial cancer + metastasis
surgery + chemo and radiation
-
indication for removal of ovarian cysts
>7cm in size
-
mcc of cyst in reproductive years
- luteal or follicular cyst
- leave alone if <7cm
-
management of complex cyst
removal
-
initial w/u of cyst
- beta hcg
- u/s
- lapatoaomy if >7cm
-
when do you do FNA of complex cyst
never
-
9 yo f with complex cyst
- germ cell tumor
- ldh
- afp
- beta hcg
-
67 yo F with adnexal mass
-
58 yo f presents with endometrial hyperplasia and adnexal mass
marker
- granulosa theca tumor
- estrogen
-
48 yo f presents with masculinization and adnexal mass
- sertoli leydig tumor
- testosterone
-
krukenberg tumor
gastric cancer metastezied to ovaries bilatearlly
-
hpv is a
nonenveloped dna virus
-
2 ascus means
1 ascus? colposcopy or epeat
- colposcopy and biopsy
- repeat if patient is reliable to follow up
-
when do you observe and follow up
after CIN1 or CIN2 or 3 after ablation
-
when do you answer ablative therapy
CIN2 or CIN3
-
when do you ansser hysterectomy
- biopsy confimed
- recurrent cin2 or 3
-
when is chemo and radiation given for cervical cancer
- +margins
- +ln
- tumor sixze >4cm
- local recurrence
- poorly differentiated
-
how are pap smears abnormal managed in pregnancy
same as non-pregnant, except ECC is not done
-
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
-
who does not get gardasil
- pregnant
- lactating
- immunocompromised
-
w/u for pelvic pain
- pelvic exam
- beta hcg
- esr, cbc
- sono
-
rx for acute salpingo oophoritis
ceftirazone and doxycycline
-
rx for chronc pelvic inflammatory dz
lysis of tubal adhesions
-
when do you admit for pelvic pain
- failure of OP rx
- IUD in place
- tuboovarian abscess
-
rx for inpatient tubo ovarian abscess
cefoxitin + doxy
-
rx for primary dysmenorrerhea
-
secondary dysmenorrhea cause
endometriosis
-
chocolate cyst
endometrioss implant on ovary
-
-
sarcoma botryoides
grapelike tumor of vagina causing pre-menarchal bleeding
-
work up of premenarchal vaginalbleeding
ct or mri of pituatiray abdomnen or pelvis to look for esterogen secreting tumors
-
if work up of premenarchal bleeding is negative, diagnosis is
idiopathic precocious puberty
-
primary amenorrhea
- 14 with no secondary sex features
- 16 with secondary sex features
-
2 causes of amenorrhea with breasts present but no uterus
- mullerian agenesis
- androgen insensitivity
-
breasts absent and uterus present but there is amenorhhea
- turners
- hypothalamic pituitary failure
-
rx for mullerian agenesis
reconstruction
-
rx for adnrogen insensitivity
removal of testes before 20 yo
-
work up of 2ndary amenorrhea
- beta hcg
- tsh
- prolactin
- progesterone challenge if -ve progesterone test, then do estrogen-progesterone challenge test
-
if negative progesterone challenge test then dx is? inadequate esterogen or outflow tract obstruction
inadequate esterogen or outflow tract obstruction
-
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
-
-
work up of virilization/hirsutism
- 17 oh progesterone
- dheas
- lf/fh
- testosterone
-
what is the ratio of LH/FSH in PCOS
elevated
-
rx for infertility in pcos
clomiphene
-
how to assess calcium loss in menopause
24 hour hydroxyproline
-
what is denosumab
RANKL inhibitor
-
when do you use teriparatide
when bisphosphonates fail
-
how long should you use HRT
no longer than 4 years
-
when should you give hrt
- vasomotor symptoms
- dyspareunia
- genitourinary atrophy
-
gestational trophoblastic dz is most common in
taiwan or phillipines populations
-
uterus is larger then dates, dx
molar pregnancy
-
hydatifiform mole, complete
incomplete
- complete
- empty egg
- 46xx
- fetus absent
- 20% malignacy potential
-
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