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USMLE STEP 2, for real tho > MORE GYN! > Flashcards

MORE GYN! Flashcards

1
Q

Overflow incontinence is characterized by?

A

failure to empty the bladder adequately
due to an underactive detrusor muscle (neurologic disorders, diabetes or multiple sclerosis) or obstruction (postoperative or severe prolapse).

n elevated PVR, usually >300 cc, is found in overflow incontinence.

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2
Q

A normal post-void residual (PVR) is ?

A

50-60 cc.

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3
Q

Stress incontinence occurs when the bladder pressure is greater than the intraurethral pressure.

A

Genuine stress incontinence (GSI) is the loss of urine due to increased intra-abdominal pressure in the absence of a detrusor contraction.

The majority of GSI is due to urethral hypermobility (straining Q-tip angle >30 degrees from horizon).

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4
Q

underactive detrusor muscle is

A

neurologic disorders, diabetes or multiple sclerosis

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5
Q

bladder obstruction is

A

postoperative or severe prolapse

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6
Q

Risk factors for the development of pelvic organ prolapse are

A 
increasing parity
 increasing age
obesity
some connective tissue disorders (Ehlers-Danlos syndrome)
 chronic constipation.

Women with a family history of POP have up to a 2.5 fold increase in prolapse

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7
Q

Retropubic urethropexy

A

a

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8
Q

Needle suspension

A

a

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9
Q

Artificial urethral sphincter

A

Artificial sphincters should be used in patients as a last resort to treat treats intrinsic sphincteric deficiency (hose in the sand)

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10
Q

Urethral bulking procedure

A

treats intrinsic sphincteric deficiency

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11
Q

Sling procedure

A

sling that is inserted through a small vaginal incision and attached to another structure in the pelvis for the purpose of supporting the urethra*

Suburethral slings may be either bladder neck or midurethral slings.

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12
Q

Mechanisms of stress incontinence include?

A

urethral hypermobility and intrinsic sphincteric deficiency (ISD).

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13
Q

Urethral hypermobility is ?

A

Stress urinary incontinence
like stepping on a hose in sand

-insufficient support of the pelvic floor musculature and vaginal connective tissue to the urethra and bladder neck
- causes the urethra and bladder neck to lose the ability to completely close against the anterior vaginal wall.
-with increases in intra-abdominal pressure
the muscular tube of the urethra fails to close, leading to incontinence

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14
Q

Intrinsic sphincteric deficiency (ISD) is ?

A
  • stress urinary incontinence (SUI)
  • loss of urethral tone that normally keeps the urethra closed
  • severe urinary leakage even with minimal increases in abdominal pressure.
  • can be +/- urethral hypermobility
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15
Q

Urgency incontinence is?

A

Women with urgency incontinence experience the urge to void immediately with involuntary leakage of urine

detrusor overactivity –> uninhibited (involuntary) detrusor muscle contractions

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16
Q

Overflow incontinence is caused by?

A

detrusor underactivity or bladder outlet obstruction

symptoms of pressure, fullness, and frequency, and is usually a small amount of continuous leaking.

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17
Q

Vaginal atrophy and loss of urine

A

low estrogen levels –> atrophy of the urethral mucosal epithelium.
Atrophy results in urethritis, diminished urethral mucosal seal, loss of compliance, and possible irritation, all of which can contribute to incontinence

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18
Q

– Functional incontinence occurs when?

A

a patient has intact urinary storage and emptying functions but is physically unable to toilet herself in a timely fashion (mobility issues)

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19
Q

detrusor instability is treated via?

A

anticholinergics are the mainstay of pharmacologic treatment. Oxybutynin is one example

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20
Q

Central and lateral cystoceles are repaired by?

A

fixing defects in the pubocervical fascia or reattaching it to the sidewall, if separated from the white line.

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21
Q

Defects in the ______ are repaired in rectoceles.

A

rectovaginal fascia

22
Q

Uterine prolapse is surgically treated by a ?

A

vaginal hysterectomy

23
Q

Vaginal vault prolapse is treated either by?

A

supporting the vaginal cuff to the uterosacral or sacrospinous ligaments, or by sacrocolpopexy.

24
Q

Colpocleisis is a procedure where ?

A

the vagina is surgically obliterated and can be performed quickly without the need for general anesthesia.

25
Q

Who is at increased risk for molar prego

A 
Asian women in the United States 
under 20 yo 
over 40 yo 
women with two or more miscarriages.
Hx of molar (2%)
26
Q

________ s/s is universal in molar pregnancies.

A

Vaginal bleeding

27
Q

Findings of findings of an enlarged uterus and vaginal bleeding, a Beta-hCG value >1,000,000 mIU/mL are ddx for?

A

molar prego

28
Q

In the face of discrepancy between dates and uterine size, a pelvic ultrasound is indicated for?

A

to confirm dates, exclude multiple gestation, uterine abnormalities, and molar pregnancy.

29
Q

With a Beta-hCG above the __________ an IUP should be easily identified on transvaginal ultrasound.

A

discriminatory zone (>1500 mIU)

30
Q

If an IUP is not seen, the ultrasound findings (in conjunction with the Beta-hCG level) should identify a?

A

mole (multiple internal echoes) or an ectopic (absence of intra-uterine gestation).

31
Q

__________ is the standard management for molar pregnancies.

A

Suction curettage

methotrexate is post- GTD may help

32
Q

Tissue diagnosis is the standard in establishing a diagnosis of almost all malignancies, with the exception of _______________

A

choriocarcinoma.

33
Q

DDX of choriocarcinoma

A

+ Beta-hCG in a reproductive-aged woman

Hx of recent pregnancy .

34
Q

_____________ is the most common vulvar malignancy and may arise in the setting of chronic irritation from lichen sclerosus.

A

Squamous cell carcinoma

accounts for approximately 90% of vulvar cancers

35
Q

The mean age of squamous cell carcinoma is 65 years and _____ is known to increase the risk of development of vulvar cancer

A

smoking- especially in the setting of HPV infection.

36
Q

_________ represents 5% of vulvar cancer

A

Melanoma

37
Q

Vulvar intraepithelial neoplasia s/s

A
  • itchy
  • multicentric brown-pigmented papules on the perineum, perianal region and labia minora.
  • No induration or groin adenopathy is noted.
38
Q

___________ most likely arise from the Bartholin gland

A

Primary vulvar adenocarcinomas

*other histologies such as squamous cell, transitional, adenosquamous, and adenoid cystic carcinomas can also arise from this location

39
Q

VIN III should be treated with ___________

A

local superficial excision

radical surgery if it carcinoma (which is not VIN3, just almost)

40
Q

Trichloroacetic acid (TCA) treats?

A

genital warts

41
Q

Paget’s is an in situ carcinoma of the vulva is acs w/ ?

A

is a adenocarcinoma

association with breast cancer is significant, but not as high as Paget’s disease of the nipple.

42
Q

Paget’s looks like?

A

vulva is fiery red mottled background with whitish hyperkeratotic areas

43
Q

Recommends that management options for ASCUS

A

include performing HPV DNA testing or repeat cytology at 12 months following the abnormal Pap test result.

44
Q

ASCUS w/ + HPV

A

If HPV is positive, or if repeat cytology at 12 months reveals ASCUS or higher, then colposcopy should be performed

45
Q

ASCUS w/ - HPV

A

If the HPV testing is negative then routine screening can be resumed at three years.

46
Q

________ is an area of columnar epithelium that has not yet undergone squamous metaplasia.

A

Ectropion

It appears as a reddish ring of tissue surrounding the external os.

47
Q

________ can represent dysplasia but, in most cases, is less concerning than the above vascular changes like ____________

A

Acetowhite epithelium is dysplasia

atypical vessels and Punctations and mosaicism represent new blood vessels are more dangerous

48
Q

Cervical conization refers to?

A

an excision of a cone-shaped sample of tissue from the mucous membrane of the cervix.

49
Q

Carcinoma in situ vs Microinvasive cervical cancer

A

In microinvasive cancer, they invade less than 3 mm

Carcinoma in situ (CIS) represents abnormal cells involving the entire epithelium to the basement membrane.

50
Q

Cervical conization is indicated in this patient who has a positive

A

endocervical curettage

Cryotherapy will not provide a pathologic specimen to rule out invasive cancer, but can be used to treat cervical dysplasia once cancer has been completely ruled out and the entire lesion can be visualized.

51
Q

Cryotherapy will not provide a pathologic specimen to rule out invasive cancer, but can be used to treat cervical dysplasia once _______________

A

cancer has been completely ruled out and the entire lesion can be visualized.

USMLE STEP 2, for real tho (16 decks)

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