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enrp exam 1 > Conditions of the Uterus, Cervix, Ovary and Fallopian tubes > Flashcards

Conditions of the Uterus, Cervix, Ovary and Fallopian tubes Flashcards

1
Q

What forms the upper vagina, cervix, uterus and fallopian tubes?

A

The paramesonephric (Mullerian) ducts

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2
Q

The absence of the Y chromosome and absence of Mullerian inhibiting substance leads to the development of what?

A

The paramesonephric system with the regression of the mesonephric system

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3
Q

At what point in time do the paramesonephric ducts arise?

A

At 6 weeks gestational and by 9 weeks they fuse in the midline to form the uterovaginal primordium

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4
Q

When the septum resolves between the fused paramesonephric ducts its leads to the development of what structures?

A

A single cervix and uterus

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5
Q

Failure of the paramesonephric duct to fuse can lead to which anomalies?

A

Uterus didelphysis (2 separate uterine bodies with its own cervix, attached Fallopian tubes and vagina); bicronuate uterus with a rudimentary horn; bicorunuate uterus w/ or w/o double cervices

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6
Q

Incomplete dissolution of the midline fusion of the paramesonephric duct leads to which anomaly?

A

Septate uterus

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7
Q

Failure of formation of Müllerian ducts can lead to which anomaly?

A

Unicornate uterus

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8
Q

What is Mullerian agenesis?

A

The complete lack of development of the paramesonephric system; absence of the uterus and mot of the vagina

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9
Q

The MC congenital cervical anomalies are the result of what?

A

Malfusion of the paramesonephric ducts with varying degrees of separation; examples include didelphys cervix and septate cervix

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10
Q

What are the characteristics of fibroids?

A

Spherical, well circumscribed, white firm lesions with a whorled appearance on cut sections; may degenerate and cause pain; may calcify especially if postmenopausal pts

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11
Q

What are the signs of a leiomyoma upon a bimanual exam?

A

Can reveal an enlarged irregularly shaped uterus; if palpated mass moves with the cervix it is suggestive of a fibroid uterus; the degree of enlargement is described in week size used to estimate equivalent gestational size

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12
Q

What are the signs of a leiomyoma on an US?

A

Can help distinguish between adnexal masses and lateral leiomyomas

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13
Q

If endometrial cavity is entered for myomectomy future deliveries must be what?

A

C section

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14
Q

If uterine tissue remains after a myomectomy, what may be warranted?

A

Hysterectomy

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15
Q

What percentage of simple hyperplasia without atypia progresses to cancer?

A

1%

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16
Q

What percentage of complex hyperplasia without atypia progresses to cancer?

A

3%

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17
Q

What percentage of simple hyperplasia with atypia progresses to cancer?

A

9%

18
Q

What percentage of complex hyperplasia with atypia progresses to cancer?

A

27%

19
Q

What is Turner syndrome?

A

45 XO, associated with abnormal gonad development; small rudimentary streaked ovaries; develop secondary sexual characteristics but enter menopause shortly after

20
Q

What is complete androgen insensitivity syndrome/testicular feminization?

A

Lack androgen receptors, phenotypically female, gonads (functioning testes) need to be removed after puberty because of malignant potential

21
Q

What are some congenital anomalies of the ovaries?

A

Turner syndrome and androgen insensitivity

22
Q

How can DES affect the Fallopian tubes?

A

May lead to shortened, distorted or clubbed tubes

23
Q

What are the types of benign neoplastic ovarian tumors?

A

Epithelial, sex cord stromal and germ cell tumors

24
Q

What are the characteristics of epithelial ovarian tumors?

A

Derived from the mesothelial cells lining the peritoneal cavity and also the lining from the surface of the ovary

25
Q

Mucinous ovarian tumors cytologically resemble what?

A

The endocervical epithelium

26
Q

Serous ovarian tumors resemble what?

A

The lining of the Fallopian tubes

27
Q

Sex cord stromal ovarian tumors are derived from what?

A

From the sex cords stroma of the developing gonad

28
Q

What are the clinical features of benign ovarian tumors?

A

Often nonspecific and asx; enlarge very slowly, generally pain is mild to intermittent; can be painful if tumor twists on its pedicure (torsion) or rupture of cyst resulting in pain and peritoneal irritation

29
Q

What are some of the methods used to diagnose an ovarian tumor?

A

Abd and bimanual pelvic exam, US, tumor markers, laparoscopy

30
Q

How can US be used to diagnose benign ovarian tumors?

A

Looking for simple vs complex nature; can be helpful identifying dermoid cyst (can sometimes see a tooth like calcification)

31
Q

Which tumor marker can be used to dx benign ovarian tumors?

A

CA 125 serum marker esp in post menopausal women

32
Q

How can laparoscopy be used to diagnose benign ovarian tumors?

A

Can be helpful in distinguishing between uterine fibroids, ovarian tumors and hydrosalpinx; in general laparotomy is preferable to laparoscopy unless the mass can be removed without rupture

33
Q

How are ovarian neoplasms managed?

A

No persistent ovarian neoplasm should be assumed to be benign until proved by surgical exploration and path examination; if surgery is warranted collect pelvic washing for cytologic examination and obtain a frozen section for histologic dx; definitive tx depends on pt age and desire for future pregnancy

34
Q

What are the most benign conditions of the Fallopian tubes?

A

Most are infectious or inflammatory; hydrosalpinx and pyosalpinx

35
Q

What is hydrosalpinx?

A

Fluid filled tubes from previous infection

36
Q

What is pyrosalpinx?

A

Purulent filled tube from active infection

37
Q

What is an ovarian torsion?

A

The complete or partial rotation of the ovary on its ligamentous supports which often results in impedance of its blood supply; one of the MC gynecological emergencies

38
Q

What is an adnexal torsion?

A

When the ovary and Fallopian tube both twist

39
Q

What is the primary RF for an ovarian torsion?

A

An ovarian mass >5cm

40
Q

What is the classic presentation of an ovarian torsion?

A

Acute onset of unilateral pain, nausea and possibly vomiting

41
Q

How is a dx of ovarian torsion made?

A

US is first line imaging study to ID mass; definitive dx is made by direct visualization

42
Q

What is the tx for an ovarian torsion?

A

Detorsion and ovarian conservation with an ovarian cystectomy; salpingo-oophorectomy is performed if ovary is necrotic or you suspect malignancy

enrp exam 1 (10 decks)

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