Female Reproductive Health Review — Contraception, Gynecologic Disorders, and Obstetrics (Flashcards)

A comprehensive set of practice flashcards covering contraception, gynecologic disorders, gynecologic cancers, STI management, and obstetric/gynecologic emergencies drawn from the lecture notes.

What is the primary mechanism by which adding exogenous progesterone (and possibly estrogen) in hormonal contraception prevents ovulation?

It suppresses the mid-cycle LH and FSH surge, preventing ovulation and creating a pseudopregnancy.

Which contraception method is described as having the lowest reported efficacy?

Natural family planning (fertility awareness-based methods).

What data points might be tracked in fertility awareness-based methods to identify a fertile window?

Cervical mucus, basal body temperature, and cycle length data.

Name a key contraindication to estrogen-containing contraceptives.

Smokers >15 cigarettes/day who are >35 years old (plus other risk factors like migraines with aura and uncontrolled hypertension).

When is progesterone-only contraception preferred?

In lactating women in the early postpartum months, in those with hypercoagulable states, or when estrogen-containing methods are contraindicated (e.g., migraines with aura, heavy smoking with age).

What are the three components of the PCOS Rotterdam criteria?

Oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound.

What ultrasound finding is typical for PCOS?

Peripheral follicles giving a 'string of pearls' appearance around the ovary.

What is a common initial approach to inducing ovulation in PCOS if pregnancy is desired, particularly with insulin resistance?

Metformin to improve insulin resistance and help regulate ovulatory cycles (often with additional ovulation induction agents if needed).

Differentiate endometriosis from adenomyosis in terms of tissue location.

Endometriosis: ectopic endometrial tissue outside the uterus; adenomyosis: endometrial tissue within the myometrium.

What is the definitive diagnostic procedure for endometriosis?

Exploratory laparoscopy with visualization and biopsy of ectopic tissue.

What symptom is highly characteristic of endometriosis and often begins 2-3 days before menses?

Dysmenorrhea with pain that can extend through the cycle (and dyspareunia).

What ovarian condition is also called a teratoma and may contain teeth, bone, or hair?

Dermoid cyst (mature cystic teratoma).

How is a dermoid cyst typically treated if fertility preservation is desired?

Cystectomy to remove the mass while preserving the ovary.

Which ovarian condition is the leading cause of death from reproductive tract cancers?

Ovarian cancer (epithelial type is most common); early disease is often not detected by routine exams.

What is the first-line diagnostic test for suspected endometrial pathology after ultrasound suggests thickening?

Endometrial biopsy for definitive diagnosis.

What screening strategy is used for cervical dysplasia and how does age affect HPV testing?

Pap smear with possible HPV co-testing; HPV testing is prioritized or added for older individuals (often over 25–30) and in abnormal cytology.

Which HPV types are most commonly associated with cervical cancer?

HPV types 16 and 18.

DES exposure in utero increases risk for which cervical cancer histology?

Adenocarcinoma (more than squamous cell carcinoma risk).

What is the most common gynecologic cancer?

Endometrial cancer; risk rises with prolonged estrogen exposure.

Which imaging modality is preferred to evaluate endometrial thickness in suspected endometrial pathology?

Transvaginal ultrasound to measure endometrial stripe (thickness).

What is the role of ultrasound versus biopsy in endometrial cancer evaluation?

Ultrasound screens for thickened endometrium; endometrial biopsy provides the diagnostic confirmation.

What is PALM-COEIN used to classify?

Abnormal uterine bleeding causes: PALM = structural (polyp, adenomyosis, leiomyoma, malignancy); COEIN = nonstructural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified).

What is the typical presentation of a cervical dysplasia screen in younger vs older patients regarding HPV testing?

Younger patients may be managed with repeat cytology; older patients often have HPV testing with Pap (co-testing) to guide further workup.

What is the utility of CA-125 in ovarian cancer?

Not specific for ovarian cancer but can be used as a marker for risk of malignancy and progression in epithelial ovarian cancers.

What is the management implication of an ovarian mass >5 cm in relation to torsion risk?

Increased risk of ovarian torsion; prompt evaluation with ultrasound and consideration of detorsion or surgical management.

What is a key imaging finding for an ovarian torsion on Doppler ultrasound?

Enlarged ovary with edema; may have reduced or absent blood flow, but flow can be variable due to dual ovarian blood supply.

What is the most common presenting sign of pelvic inflammatory disease (PID) and how is it diagnosed clinically?

Lower abdominal or pelvic pain with adnexal tenderness and cervical motion tenderness; diagnosed clinically without waiting for pathogen identification.

What is the initial management principle for PID?

Broad-spectrum antibiotics covering gonorrhea and chlamydia; hospitalization for severe illness or failure of outpatient therapy.

What are the classic causes of primary amenorrhea based on the presence or absence of secondary sexual characteristics?

Breasts and uterus present: imperforate hymen; breasts absent but uterus present: gonadal dysgenesis (Turner); breasts present but uterus absent: androgen insensitivity; no secondary sexual characteristics: Müllerian agenesis or 46,XY with severe gonadal dysfunction.

What is the withdrawal progesterone test used to assess in amenorrhea?

Withdrawal bleeding after stopping progesterone indicates adequate estrogen and ovulatory potential; no bleeding suggests low estrogen or anovulation.

What characterizes premenstrual syndrome and how can it be managed?

Affective or somatic symptoms preceding menses; management includes lifestyle changes, NSAIDs, hormonal contraception to stabilize cycles, and addressing mood symptoms.

What is the distinction between primary and secondary dysmenorrhea and their typical treatments?

Primary dysmenorrhea is prostaglandin-mediated pain at menses and is treated with NSAIDs and sometimes hormonal suppression; secondary dysmenorrhea is due to underlying pathology (e.g., endometriosis, fibroids) and requires treating the underlying condition.

What does PALM refer to in the PALM-COEIN framework for abnormal uterine bleeding?

Structural causes: polyp, adenomyosis, leiomyoma, malignancy.

What is the diagnostic workup for postmenopausal bleeding?

Ultrasound to assess endometrial thickness; if thickened or inconclusive, endometrial biopsy to evaluate for hyperplasia or cancer.

How is menopause diagnosed clinically and which tests support it?

Clinical diagnosis (cessation of menses for 12 months); labs (elevated FSH/LH, low estrogen) can support but are not required.

What is the recommended local therapy for vaginal atrophy due to menopause?

Vaginal estrogen (local) therapy to treat dryness without systemic risks; systemic HRT is reserved for more severe vasomotor symptoms.

Which medications are preferred for vasomotor symptoms in menopause and what are the systemic therapy risks?

SSRIs/SNRIs and gabapentin; systemic HRT is effective but increases risks of breast cancer, thromboembolism, stroke, and cardiovascular events.

What is a fibroadenoma and how is it diagnosed across age groups?

A common benign breast lump; ultrasound for younger patients and mammography for patients over 40.

What is the typical management of a breast abscess in a lactating woman?

Clinical diagnosis with drainage and antibiotics as needed; often requires drainage and sometimes persistent antibiotics depending on severity.

What is galactorrhea and its common causes?

Watery or milky nipple discharge due to hyperprolactinemia; causes include prolactinomas, medications, hypothyroidism, renal disease, and hypothalamic issues.

What are the main postpartum mood disorders and their first-line treatments?

Baby blues (self-limited); postpartum depression (SSRIs); postpartum anxiety (SSRIs); postpartum psychosis (urgent psychiatric evaluation; antipsychotics/therapy).

What is postpartum hemorrhage most commonly due to and its primary initial management?

Uterine atony; immediate uterine massage, uterotonic medications (e.g., oxytocin), assessment for retained products, and blood product support as needed.

How is Rh incompatibility prevented and managed?

Rho(D) negative mothers receive anti-D immunoglobulin (RhoGAM) at 28 weeks and after bleeding events; postpartum neonatal blood typing guides additional dosing.

What is the two-step approach to diagnosing gestational diabetes?

1-hour 50 g glucose screening; if >125, proceed to 3-hour 100 g diagnostic oral glucose tolerance test; diagnosis if two or more values are abnormal.

What are the hallmark risks and management for placenta previa?

Low-lying placenta covering the cervix; avoid intercourse, monitor with serial ultrasounds, and deliver via cesarean section around 36–37 weeks.

What are the hallmark risks and management for placental abruption?

Premature separation of the placenta causing painful bleeding; stabilize mother, monitor fetus, and deliver if fetal distress or instability occurs.

What is shoulder dystocia and how is it managed in delivery?

Shoulders stuck beneath the maternal pubic symphysis; immediate 'shoulder code' maneuvers to enlarge the birth canal and deliver the infant; risk of brachial plexus injury and hemorrhage.

What is umbilical cord prolapse and why is it dangerous?

Umbilical cord presents before the baby, risking cord compression and fetal hypoxia; abort delivery or perform emergent cesarean if needed.

What is a Bartholin gland cyst/abscess and its management?

Occlusion of Bartholin gland with potential abscess formation; sitz baths, antibiotics, and drainage; rare need for prolonged catheter drainage to keep the gland patent.

What is the common cause of mastitis in the postpartum period and its management?

Staphylococcus aureus infection; treat with antibiotics and encourage continuing breastfeeding; warm compresses are helpful.

What is the typical treatment approach for asthma exacerbations during pregnancy?

Continue inhaled therapies; add inhaled corticosteroids if needed (Advair example); avoid non-preferred systemic agents if possible.

What is the clinical significance of an endometrioma and how is it named?

An ovarian endometrioma (‘chocolate cyst’) from ectopic endometrial tissue; associated with endometriosis and treated accordingly.