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Q4 Women's Health > Exam 2 Vaginal, Ovary Dz > Flashcards

Exam 2 Vaginal, Ovary Dz Flashcards

1
Q

Vaginal Intraepithelial Neoplasm (VaIN) epidemiology? (4)

A

U 40s - 60s
U HPV related
U pt also had cervical or vulvar IN
U in upper 1/3 of vagina

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2
Q

VaIN risk factors? (3)

A

Smoking
Immunocomp
Sluts

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3
Q

VaIN classifications:

1?

2?

3?

A

1: = basal epith layers
2: ≤ 2/3 of vag epith
3: ≥ 2/3 of vag epith

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4
Q

VaIN presentation? (4)

A

U asympt
P post-sex spotting
P vag d/c (unlike STDs d/c)
Abn pap

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5
Q

VaIN studies?

A

Colposcopy

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6
Q

VaIN tx:

1?

2, 3?

Prognosis?

A

1 = observation

2/3 = Surgery, imiquimod, 5-FU

30% recurrence

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7
Q

Vaginal CA is? (3)

A

U > 55
U 2° to cancer elsewhere
U SCC

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8
Q

Vaginal CA presentation? (4)

A

Asymp
U painless vag bleeding
Vag d/c
Pelvic pain

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9
Q

Vaginal CA tx? (3)

A

No standard
Vaginectomy, radiation, chemo
< 50% survival

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10
Q

Ovarian Cysts: Follicular? (5)

A 
Most C fxn'l cyst
Failure of mature cyst to rupture
~ 3-8 cm
Not malignant
U resolve w/i 6 wks
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11
Q

Ovarian Cysts: Corpus Luteum? (4)

A

Failure of resorption post ovulation
Filled w/ blood, hemorrhage concerns
~3-11 cm
U resolves in 1-2 cycles

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12
Q

Ovarian Cysts: Theca Lutein? (3)

A

Fxn’l cyst resulting from ↑ gonadotrophins
U bilateral
U resolves w/ tx of ↑ gonad

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13
Q

Mature Teratoma is?

A

Benign Ovarian Neoplasm:

U reproductive age
Well differentiated tissue from ecto-, meso- or endoderm

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14
Q

Mature Teratoma presentation? (4)

A

Asympt
Pelvic pain 2° to torsion/rupture
Polyuria/urgency
Back pain

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15
Q

Mature Teratoma exam findings?

Labs?

Imaging?

A

Pelvic mass

CEA, CA-125, AFP, βHCG (CA markers) = N

US = unilateral complex cyst

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16
Q

Mature Teratoma tx? (3)

A

Size dependent
Removal w/ or w/o ovary
10% recurr

17
Q

Ovarian CA? (3)

A

1/2 found in post meno
Pathophys unclear
High mortality

18
Q

Ovarian CA risk factors? (4)

Decreased risk w/? (4)

A

BRCA1/2
Lynch Syndrome (hereditary non-poly colon CA)
Early menarche
Late menopause

Past oral contraceptive
Past breast feed
Tubal ligation
Pregnancies

19
Q

Ovarian CA: Epithelial Neoplasm?

Serous?

Mucinous?

Endometrial?

Clear Cell?

Brenner?

A

90% of ovarian tumors

Serous = most C, 1/2 are bilateral, S to fallopian tubes

Mucinous = Large, U unilateral, S to endocervix

Endometrial = P bilateral

Clear Cell = rare, small, a/w hyperCa2+/pyrexia

Brenner = rare

20
Q

Ovarian CA: Germ Cell Neoplasm? (2)

A

U 30-40s

Produce markers

21
Q

Ovarian CA: Sex-Cord Stromal Tumor

Granulosa? (3)

Sertoli-Stromal?

A

Granulosa:
70%
Causes hyperestrogenism (early puberty, post meno bleed)
U 60s

S-S:
Rare
Causes hyperandrogenism
40-50s

22
Q

Ovarian CA presentation? (3)

A

Bloating
Pelvic/Abd pain
Difficulty eating/Early filling
Lasting > few wks

23
Q

Ovarian CA exam findings? (3)

A

Pelvic mass
Inguinal LAD
Ascites

24
Q

Ovarian CA labs? (2)

A

↑ CA-125 suspect epith tumor

↑ hCG, AFP, LDH suspect germ cell tumor

25
Q

Ovarian CA imaging? (4)

A

US
CT = retroperitoneal involvement, met to pelvic organs
MRI = neoplasm characteristics
CXR

26
Q

Ovarian CA: Epithelial tx?

A

GYN oncologist
FIGO staging
Chemo

27
Q

Ovarian CA: Germ tx?

A

GYN oncologist
Remove involved adnexa only if early
FIGO staging

28
Q

BRCA testing guidelines: Non-Ash Jews? (5)

A

two 1° w/ breast CA, one ≤ 50yo

three+ 1° or 2° BCA, any age

BCA and OCA 1° and 2°, any age

bilat BCA 1°

male w/ BCA

29
Q

BRCA testing guidelines: Ash Jews?

A

1° or two 2° BCA

30
Q

Genetic risk of Lynch Synd?

A

Endometrial or colorectal CA < 50yo

31
Q

Polycystic Ovarian Synd causes what? (3)

A

1) Abn E2 and androgen metabolism -> high test/DHEA/androst
2) Insulin resistance/Hyperinsulinemia -> ∆ FSH/LH -> ∆ ovarian fxn
3) ↓ adiponectin (lipid metab/glucose) -> DMII

32
Q

Polycystic Ovarian Synd signs? (9)

A 
Infertile
Anovulation (amenorrhea)
Obesity
Acne
HIRSUTISM
MP baldness
Acanthosis nigricans
Sleep apnea
Metabolic synd
33
Q

Polycystic Ovarian Synd diagnostic criteria? (4)

A 
Exclude other causes
2 of 3:
Oligo- or anovulation
Signs of hyperandrogenism (acne, high testo)
Polycystic ovaries
34
Q

Polycystic Ovarian Synd imaging?

A

Transvag US =
> 12 follicles in each ovary 2-9mm
String of pearls appearance
Ovarian vol >10mL

35
Q

Polycystic Ovarian Synd Labs? (7)

A 
Fasting lipids = ↑ LDL/trigly, ↓ HDL
Fasting glu = >100 (DMII)
Free testost > 50 !!
LH =  ↑
LH/FSH = > 2:1 !!
LFT =  ↑AST,ALT
DHEAs (Always order this!)
36
Q

Polycystic Ovarian Synd tests for DDX:

Cushings?

Androgen-secreting tumor?

Congenital hyperplasia?

Hyperprolactinemia?

Thyroid dysf?

A

Cushings = 24hr urine cortisol

Androgen-secreting tumor = Free testost

Congenital hyperplasia = a.m. 17-hydroxyprogesterone

Hyperprolactinemia = serum prolactin

Thyroid dysf = TSH/FT4/FT3

37
Q

Polycystic Ovarian Synd tx? (5)

A

Lifestyle
Combo oral contra (opposes E2) or Cyclic Provera (progest)
Metformin (for hyperinsulin)
Fertility consult

38
Q

Polycystic Ovarian Synd may lead to? (4)

A

Endometrial hyperplasia/CA
DMII
Metab syn (HTN, Dyslipidemia)
Non-alcoholic steatohep

Q4 Women's Health (20 decks)

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