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GYN > Benign genital tract disorders > Flashcards

Benign genital tract disorders Flashcards

1
Q

Diagnosis of benign epithelial disorders of vulva/vagina?

A

CLINICALLY.

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2
Q

Lichen sclerosis

A

Thinning of the vulvar skin. Sx: asymptomatic or can have pruritis/dyspareunia

An inflammatory dermatosis
Postmenopauseal women
3-4% inc risk of vulvar skin cancer

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3
Q

Lichen planus

A

Papular or erosive lesions of the vulva that may also involve vagina. Pruritis–>severe erosions.

Purple papules with white striae on vulva

Complication of vaginal adhesions with erosive vaginitis

50s or 60s
3-4% inc risk of vulvar skin cancer

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4
Q

Lichen simplex chronicus

A

“itch that rashes”; chronic pruritis

THICKENED skin because of the scratching

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5
Q

When should you biopsy the lesion?

A

If there is ulceration, unifocal lesion, uncertain suspicion of lichen sclerosis, unidentifiable lesions, unresponsive to treatment.

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6
Q

Treatment?

A

Hygeine, loose clothes, unscented soaps.

Topical steroid like clobetasol for LS, LP, or SEVERE LSC

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7
Q

MC tumor found on the vulva?

A

Epidermal inclusion cysts. Formed by occlusion of hair follicle.

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8
Q

Sebaceous cyst

A

When duct of sebaceous gland is blocked. Often multiple and asymptomatic

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9
Q

Hiradenitis suppurativa

A

Skin disease that affects the apocrine sweat glands

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10
Q

Where is skene’s gland?

A

Next to the urethral meatus

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11
Q

Where are Bartholin’s glands?

A

4 and 8 o’clock

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12
Q

How do you treat a Bartholin’s gland cyst? Recurrent ones?

What should you do in one that appears in a woman over 40?

A

Word catheter placement (balloon left in place for 4-6 wks then serially reduced in size while the cyst/tract re-epithelialize)

Marsupialization- incision, removal, cyst wall sutured to vaginal mucosa to prevent reformation.

Over 40- biopsy it to r/o rare possibility of Bartholin’s gland carcinoma.

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13
Q

What is a Gartner duct cyst? Usually found where?
Presenting sx?
Rx?

A

Remnant of the mesonephric ducts of the Wolffian system.

Anterolateral vagina.

Usually ASYMPTOMATIC but could have dyspareunia or difficulty inserting a tampon

Excision (use vasopressin bc they tend to bleed a lot)

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14
Q

Rx of urethral caruncles or urethral prolapse? Who?

A

None req.

Postmenopauseal women due to vulvovaginal atrophy.

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15
Q

DES exposure #1 risk?

A

Cervical insufficiency in pregnancy.

Clear cell adenocarcinoma of cervix and vagina in only 0.1% of exposed!!!!! Women under 20

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16
Q

What is a nabothian cyst?

A

Dilated retention cyst of the cervix. Caused by intermittent blockage of an endocervical gland.

Usually asymptomatic.

Look like dots on cervix.

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17
Q

Rx of cervical polyp that is asymptomatic?

A

Remove it anyway bc it could mask something BAD, like cancer, fibroids, adenomyosis, etc.

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18
Q

Symptoms of cervical polyp

A

Intermenstrual or postcoital spotting

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19
Q

Can cervix have fibroids?

A

Yes, either arising from it OR prolapsing into it from the endometrial cavity

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20
Q

What complications can a cervical fibroid have in pregnancy?

A

Poor dilation, malpresentation, obstruction of the birth canal, hemorrhage (think stretching out during dilation and bam.)

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21
Q

What can lead to cervical stenosis?

A

Infection, atrophy, scarring, idiopathic

Neoplasm, polyp, fibroid.

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22
Q

Sx of cervical stenosis?

A

ASYMPTOMATIC and doesn’t affect menstruation or fertility

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23
Q

Rx of cervical stenosis?

A

IF there are sx, gently dilate cervix. Can leave a catheter in for a few days.

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24
Q

How does labial fusion come about?

A

Excess androgen exposure or enzymatic deficiency. MC from CAH 21-a-hydroxylase deficiency.

25
Q

Rx of benign cystic and solid skin tumors?

A

Don’t treat unless symptomatic or infected. Incision/drainage OR excision.

26
Q

Lower 1/3 of vagina arises from __

A

urogenital diaphragm

27
Q

Ovaries arise from ___

A

Genital ridge

28
Q

Everything else arises from ____

A

Mullerian system

29
Q

MC congenital mullerian abnormality?

How is this usually discovered?

A

Septate uterus

25% of these patients have first trimester pregnancy loss (bc it’s collagenous and can’t support placentation)

30
Q

Which abnormality for 1st trimester pregnancy loss? 2nd?

A

Uterine septa

Bicornuate or unicornuate uterus (also assoc with preterm labor)

31
Q

How do you differentiate between uterine septa vs. bicornuate uterus?

A

COULD appear identical on hysteroscopy

MRI or laparoscopy to evaluate the uterine fundus

Also can look for renal anomalies in any Mullerian disorder

32
Q

What can a woman with bicornuate uterus expect wrt pregnancy?

A

Possible to carry fetus to term. Risk of preterm labor.

If having trouble, surgical unification procedure can help with fertility.

33
Q

Are fibroids responsive to anything?

A

Yes, grow in response to both estrogen and progesterone, so they get bigger in pregnancy and shrink in menopause.

34
Q

How are fibroids distinguished from adenomyosis?

A

Fibroids have a pseudocapsule, uterus gets bigger non-uniformly from them.

MRI is the best for differentiating.

35
Q

Leiomyoma epidemiology?

A

More than 80% of AA women will develop them by age 50. Younger, bigger fibroid, heavier bleeding, more #, more severe anemia.

Lifetime risk in whites is 70.

50% of reproductive age women

36
Q

Risk factors of leiomyoma

A

AA heritage, nonsmoking, early menarche, nulliparity, perimenopause, alcohol use, htn.

Low dose OCPs can INHIBIT NEW fibroids but may STIMULATE existing ones.

37
Q

How often are leimyomas asymptomatic?

What is most common symptom?

A

50-65%

Abnormal uterine bleeding (due to SUBMUCOSAL fibroids impinging on the endometrium).

38
Q

Medical treatment for fibroids that is non hormonal?

A

NSAIDs (decreases prostaglandin levels which are ouch), anti-fibrinolytics eg. tranexamic acid

39
Q

What medical rx can decrease fibroid size?

A

GnRH agonists (nafarelin acetate, leuprolide acetate, goserelin acetate)

40
Q

Surgical option for fibroids?

A

Uterine artery embolization (not for women who desire future pregnancy; not for large or pedunculated fibroids).

Myomectomy

Hysterectomy is the definitive rx.

41
Q

Main disadvantage of myomectomy?

A

Fibroids recur in >60% of patients in 5 years.

42
Q

Indications for surgery for leiomyomas?

A

Anemia, severe pain or secondary amenorrhea, uterine size >12 wks, urinary sx like hydronephrosis/freq/retention, growth after menopause, recurrent miscarriage or infertility, rapid inc in size

43
Q

Endometrial polyps risk of malignancy?

A

Malignant or premalignant in 1-2% of premenopausal, 5% of postmenopausal

44
Q

Progression of endometrial hyperplasia to endometrial cancer?

Risk factors?

Independent risk factors?

10x lifetime inc risk?

A

Penny-nickel-dime-quarter

Simple w/out atypia
Complex w/out atypic
Simple w/ atypia
Complex w/ atypia

UNOPPOSED ESTROGEN (oligmenorrhea, obesity form peripheral conversion of androgens to estrogens)

Independent are DIABETES AND HTN.

Lynch syndrome

45
Q

Diagnosis of endometrial hyperplasia

A

EMB

46
Q

Rx of simple and complex hyperplasia w/out atypic?

A

Progestin (Depo, medroxyprogesterone oral, Mirena ring)

47
Q

Rx of endometrium with atypia?

A

D&C or hysterectomy

If younger and desiring pregnancy, LOSE WEIGHT and repeat EMB in 3 months.

48
Q

What are the functional ovarian cysts?

A

Follicular cysts and corpus luteum cysts

49
Q

How do follicular cysts arise?

A

After the follicle fails to rupture during the follicular phase. Most resolve by 60-90 days.
Asymptomatic/unilateral

50
Q

Corpus luteum cyst?

A

Corpus luteum fails to regress after 14 days then becomes enlarged or hemorrhagic.

MAY CAUSE A MISSED PERIOD OR DULL LOWER QUADRANT PAIN.

51
Q

What are theca lutein cysts?

A

Ovarian large bilateral cysts filled with clear straw-colored fluid.

52
Q

How do theca lutein cysts arise?

A

By abnormally high beta-HCG (eg. ovulation induction therapy, molar pregnancy)

53
Q

What kind of cyst with an endometrioma?

A

Chocolate cyst

54
Q

Complication of a large ovarian cyst?

A

Rupture

Torsed adnexa with waxing/waning pain/nausea/vomiting

55
Q

Diagnosis of ovarian cyst?

A

Pelvic u/s and f/u with serial u/s to see if it resolves like they normally do.

56
Q

General rule of palpable ovaries in premenarchal or postmenopausal female?

What do you do?

A

OVARIAN NEOPLASM MORE LIKELY

Ex-lap or laparotomy

57
Q

Patient of reproductive age with cyst. Cutoff size for getting observation and f/u u/s?

A

7 cm

58
Q

What is the size when cyst is at risk of torsion?

A

4cm

59
Q

Best treatment to prevent formation of FUTURE cysts?

A

OCPs b/c they suppress ovulation

Mirena is progesterone-containing IUD and only PARTIALLY INHIBITS cyst formation…`

GYN (14 decks)

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