02a: Gyn Malignancies

Question 1

Most common gyn cancer:

Answer 1

Endometrial cancer

Question 2

1 “killer” of the gyn cancers

Answer 2

Ovarian

Question 3

Type (X) endometrial cancer is more common (80%), with risk factors reflecting (excess/deficiency) of (Y).

Answer 3

X = I (endometrioid)
Excess
Y = estrogen (endometrial hyperplasia)

Question 4

Post-menopausal woman presenting with bleeding is (X) diagnosis until proven otherwise.

Answer 4

X = endometrial cancer

Question 5

Which two key risk factors/diseases put women at about 3x relative risk of endometrial cancer?

Answer 5

1. PCOS/chronic anovulation

2. Obesity (2-4x)

Question 6

List 3 risk factors in patient’s Hx that put women at 2x relative risk for endometrial cancer

Answer 6

1. Nullparity
2. Late menopause
3. DM (II esp; linked to obesity)

Question 7

Which drug can be given to decrease risk for endometrial cancer?

Answer 7

Progesterone

Question 8

Type (X) endometrial cancer is less common (20%), with which risk factors?

Answer 8

X = II

1. Multiparity
2. Advanced age
3. Black race

Question 9

T/F: Endometrial cancer is characterized by hyperplasia of endometrium.

Answer 9

False - Type I is, but Type II arises from atrophic endometrium

Question 10

Diagnosis of Type II endometrial cancer by:

Answer 10

Tissue pathology (histo)

Question 11

Endometrial echo for abnormal bleeding: endometrial thickness (greater/less) than (X) mm is reassuring, because it suggests (Y) changes.

Answer 11

Less
X = 5
Y = atrophic (lining not thickened)

Question 12

(X)% of endometrial cancers diagnosed at Stage I

Answer 12

X = 70

Question 13

Women over age (X) with abnormal vaginal bleeding should be evaluated for endometrial hyperplasia/cancer.

Answer 13

X = 40

Question 14

35 year old woman with abnormal uterine bleeding. Which finding(s) in her Hx would prompt you to test for endometrial hyperplasia/cancer?

Answer 14

1. Morbid obesity
2. Unopposed hormonal estrogen Rx
3. HNPCC

Question 15

T/F: Mean age of epithelial ovarian cancer is 70 y.o.

Answer 15

False - mid-50s

Question 16

Most epithelial ovarian cancers present with (X) symptoms in early stages.

Answer 16

X = no

Question 17

RFs for epithelial ovarian cancers:

Answer 17

1. FHx (BRCA1/2)
2. Nullgravity
3. Infertility
4. Early menarche/late menopause

Question 18

Epithelial Ovarian Cancer has been shown to maybe start in which structure?

Answer 18

Fallopian tubes

Question 19

List the 3 key factors that decrease risk for Epithelial Ovarian Cancer

Answer 19

1. Bilateral Salpingectomy
2. OCP use
3. Tubal ligation

Question 20

Rx for Epithelial Ovarian Cancer

Answer 20

Surgery and followup chemo

Question 21

T/F: High parity is a RF for cervical cancer

Answer 21

True

Question 22

Smoking is RF for (X) type of cervical cancer

Answer 22

X = squamous cell

Question 23

Which part of HPV genome is oncogenic?

Answer 23

E6-E7

Question 24

Non-sexual routes for HPV transmission

Answer 24

1. Mother to newborn (rare)

2. Fomites (exam gloves, undergarments…? Maybe..)

Question 25

T/F: 80% of HPV infections are transient in young women.

Answer 25

True - median duration is 8 months

Question 26

Abnormal pap smear is followed up with:

Answer 26

Colposcopy (inspect cervix/vagina)

Question 27

Coposcopy: (X) is applied and abnormal areas turn (Y) color.

Answer 27

``` X = acetic acid Y = white ```

Question 28

Surgical Rx of High Squamous Intraepithelial Lesion (HSIL) of cervix typically involves:

Answer 28

Removing entire transition zone

Question 29

9-valent HPV vaccine protects against which strains?

Answer 29

6, 11 (warts), 16, 18 (cancer), 31, 33, 45, 52, 58

Question 30

Bivalent HPV vaccine protects against which strains?

Answer 30

16, 18

Question 31

Most commonly reported STD in US

Answer 31

Chlamydia

Question 32

Condyloma lata are indicative of:

Answer 32

Secondary syphilis

Question 33

List the two types of Condyloma

Answer 33

1. Condyloma lata | 2. Condyloma accuminata

Question 34

Condyloma accuminata indicative of:

Answer 34

HPV infection

Question 35

Condyloma (lata/accuminata) are wart-like and (X) colored.

Answer 35

Accuminata | X = skin

Question 36

Condyloma (lata/accuminata) are flat-topped (macules/papules/patches). They're "velvety" and (X) colored

Answer 36

Lata Papules X = white-ish

Question 37

(X) imaging modality is good for intramural uterine and ovarian lesions

Answer 37

X = US

Question 38

Sonohysterogram is imaging modality similar to (X) but using (Y) injection

Answer 38

``` X = US Y = saline (to distend uterus) ```

Question 39

(X) imaging modality is best for tubal patency

Answer 39

X = hysterosalpingogram (X-ray with intrauterine contrast injection)

Question 40

(MRI/CT) is more commonly used/preferred for gyn purposes.

Answer 40

MRI

Question 41

Perihepatic adhesions after pelvic inflammatory disease:

Answer 41

Fitz-Hugh-Curtis Syndrome

Question 42

Endometriosis refers to:

Answer 42

Presence of endometrial glands/stroma outside endometrial cavity

Question 43

List some postulated theories of endometriosis pathogenesis

Answer 43

1. Retrograde menstruation 2. Coelomic metaplasia 3. Dissemination (via vessels/lymph) 4. Altered immunity 5. Over-expression of ER-beta (suppressing progesterone R levels)

Question 44

Endometriosis is associated with (continuous/an-) ovulation

Answer 44

Continuous (incessant; like ovarian, not endometrial, cancer)

Question 45

Endometriosis: (increased/decreased) risk with multiparity.

Answer 45

Decreased

Question 46

Endometriosis: RF for (X) cancer

Answer 46

X = ovarian

Question 47

T/F: Fibroids, like endometriosis, are estrogen-dependent

Answer 47

True - shrink at menopause

Question 48

T/F: Fibroids have no familial predisposition.

Answer 48

False

Question 49

Clinical findings of uterine fibroids

Answer 49

Menorrhagia, pelvic pressure/pain, reproductive dysfunction

Question 50

Submucosal fibroids are best diagnosed by which exam/modality?

Answer 50

Hysterosalpingogram or sonoysterogram (dye/saline injected into uterus, so helps see submucosal fibroid projecting into cavity)

Question 51

Uterine fibroid Rx:

Answer 51

1. Surg (myomectomy or hysterectomy) | 2. Uterine a embolization (causing fibroid infarction/size reduction)

Question 52

Pt with uterine fibroids is getting prepped for surgery, but is experiencing heavy bleeding. How can you control the bleeding temporarily prior to procedure?

Answer 52

GnRH analogs (limited long-term efficacy though; rebound fibroids)

Question 53

List some scenarios in which uterine fibroid embolization should be avoided

Answer 53

1. Pedunculated/submucosal or very large fibroids 2. Extensive adenomyosis 3. Patients that want future pregnancy

Question 54

Adenomyosis is:

Answer 54

Endometrial glands/stroma present within uterine muscle

Question 55

Best imaging modality to inspect adenomyosis:

Answer 55

MRI

Question 56

Adenomyosis is more common in (multi/nulli)-parous women.

Answer 56

Multiparous (and those with prior uterine surgery)

Question 57

Adenomyosis Rx of choice:

Answer 57

Hysterectomy

Question 58

Surg for adenomyosis can be delayed with which meds?

Answer 58

1. Progestins (Mirena, IUD) 2. GnRH analogs 3. Aromatase inhibitors

Question 59

Uterine Synechiae, aka (X) syndrome, arise as a result of:

Answer 59

X = Asherman Uterine surg or curettage removes deep endometrial layers and destroys basal crypts/glands required for endometrial regeneration

Question 60

Asherman syndrome clinical findings:

Answer 60

1. Amenorrhea or hypomenorrhea 2. Infertility/recurrent fetal loss 3. Cyclic pelvic pain

Question 61

Asherman syndrome best diagnosed by:

Answer 61

Hysterosalpingography, sonohysterography, hysteroscopy

Question 62

Rx for Asherman syndrome:

Answer 62

Hysteroscopic resection