Benign Disorders of the Upper Genital Tract Flashcards

1
Q

Lower one third of the vagina derives from what embryonic structure?

A

Urogenital diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Ovaries derive from what embryonic structure?

A

Genital ridge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Upper vagina, cervix, uterus, and fallopian tubes derive from what embryonic structure?

A

Fusion of the paremesonephric (Mullerian) ducts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common anatomic anomaly of the uterus?

A

Septate uterus - from malfusion of the paremesonephric (Mullerian) ducts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause for increase in mullerian anomalies in the female population? Classic presentation of this anomaly?

A

DES exposure in utero. T-shaped uterus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most common complication of having a uterine septum?

A

First trimester pregnancy loss (25%) - Decreased ability to perfuse the placenta.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common complications of having a uni/bicornuate uterus (3)?

A

Second trimester pregnancy loss, malpresentation, and preterm labor and delivery - Decreased size of the uterine horn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What tests can distinguish between unicornuate and bicornuate uteri?

A

MRI or laparoscopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common indication for surgery for women in the US? Symptoms?

A

Uterine leiomyomas (fibroids). Can cause pelvic pain, urinary frequency, constipation, abnormal uterine bleeding, and secondary dysmenorrhea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Are fibroids polyclonal or monoclonal?

A

Monoclonal - from from propagation of a single muscle cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What increases the growth rate of fibroids? What decreases the growth rate of fibroids?

A

ESTROGEN and progesterone (endogenous and exogenous). Menopause - decreased estrogen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Three classes of uterine fibroids?
Most common type?
Type that causes the heaviest bleeding?
Type that causes the most pain?

A

Submucosal, intramural, and suberosal.
Intramural.
Submucosal.
Pedunculated subserosal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to distinguish between fibroids and adenomyosis? Most helpful test?

A

Fibroids are encapsulated in pseudocapsule.

MRI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which race of women are more likely to develop fibroids (as well as at a younger age with more severe fibroids, bleeding, and anemia)

A

Black women! 50% will get them by 40, only 30% of the general population will get them by 40.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common symptom of fibroid? Second most common symptom?

A

Asymptomatic.

Abnormal uterine bleeding - Menorrhagia, metorrhagia, postcoital spotting, and menometorrhagia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common means of diagnosing fibroids?

Best diagnostic test for submucosal fibroid?

A

Pelvic ultrasound.

Sonohysterography.

17
Q

How frequently should a woman with actively growing fibroids be assessed?

A

Every 6 months.

18
Q

Role of GNRH agonists (Lupron) in treatment of fibroids?

A

Decrease size, stops bleeding, and increases hermatocrit.

19
Q

What is the definitive treatment for uterine fibroids?

Issue with myomectomy?

A

Hysterectomy.

50% recurrence.

20
Q

Indications for surgery for fibroids (7)?

A
Bleeding causing anemia.
Pelvic pain.
Urinary symptoms.
Growth after menopause.
Recurrent miscarriage/infertility.
Rapid increase in size. 
Large uterine size (>12 weeks)
21
Q

Cause of endometrial polyps?
Which age groups are most effected?
Most common symptoms?
Best diagnostic tests?

A

Overgrowths of endometrial glands and stroma.
40-50 year old women (especially on tamoxifen).
Metrorrhagia, menorrhagia, and menometrorrhagia.
Ultrasound and sonohysteogram.

22
Q

Why is it important to remove symptomatic endometrial polyps?

A

They mask bleeding from another source (endometrial hyperplasia or cancer).

23
Q

DDX of Abnormal bleeding (7)?

A

Adenomyosis, endometrial polyps, endometrial hyperplasia, endometrial cancer, dysfunctional uterine bleeding, ectopic pregnancy, and Uterine Fibroids.

24
Q

What causes endometrial hyperplasia?

A

Unopposed estrogen!
Exogenous - Hormone replacement therapy
Endogenous - Conversion of androgens to estrogens by aromatase in adipocyte cells.

25
Q

Classifications and progression from Simple Endometrial Hyperplasia to Endometrial Cancer (4).

A

Simple Hyperplasia - 1% risk of progressing to cancer.
Complex Hyperplasia - 3% risk of progressing to cancer.
Atypical Simple Hyperplasia - 8% risk of progressing to cancer.
Atypical Complex Hyperplasia - 29% risk of progressing to cancer.

26
Q

Treatment of Endometrial Atypical Complex Hyperplasia? Treatment in younger patients?

A

Hysterectomy - high risk of concurrent or incipient cancer.

Endometrial cuettage, progestin managment, and weight loss to maintain opportunity for pregnancy.

27
Q

Physical exam findings for Endometrial hyperplasia?

Diagnostic test?

A

Typically none - might see symtpoms of chronic annovulation like obesity, acanthosis, acne, or hirsutism.
Endometrial biopsies.

28
Q

Treatment of Endometrial Simple/Complex Hyperplasia?

A

Progestin therapy! Depo, Mirena, Provera…just give them progesterone.

29
Q

75% of ovarian cysts in reproductive age women are functional ovarian cysts, what are the three types of functional cysts?
Common risk factor?

A

Follicular - Most common, can cause torsion if large but mostly spontaneously resolve.
Corpus Luteum - Cause delay in menstration, pain, and signs of hemoperitoneum.
Theca Lutein - Large bilateral cysts from abnormally high bHCG.
SMOKING doubles the risk of developing functional cyst.

30
Q

Classic presentation of torsed adnexa from an ovarian cyst?

A

Waking and waning pain and nausea.

31
Q

Diagnostic test for functional ovarian cysts?

A

Pelvic ultrasound - most will spontaneously resolve in 60-90 days.

32
Q

Treatment of an 8 year old girl with a cystic adnexal mass >2cm?

A

It’s most likely a neoplasm - Exploratory Laparotomy.

33
Q

Treatment of a 30 year old woman with a cystic adnexal mass <8 cm?
What about a non resolving mass greater than 8cm?

A

Observation and ultrasound - put on OCP to suprress ovulation and formation of future cysts.
Ex lap or laparoscopy.

34
Q

Treatment of a 60 year old woman with a palpable cystic adnexal mass?

A

It’s most likely a neoplasm - Exploratory Laparotomy or laparoscopy.