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OB/GYN > CaseFiles_4 > Flashcards

CaseFiles_4 Flashcards

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1
Q

If a patient has hypothalamic dysfunction, will a progestin challenge cause her to bleed?

A

No! Without estrogen, there won’t be any endometrium to shed.

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2
Q

The postmenopausal hypoestrogenic state is associated with pH that is (greater/less) than 4.5 and a thin and atrophic vulvar and vaginal epithelium.

A

Greater! (alkaline)

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3
Q

What is the most common way ovarian cancer kills? What is the most common way cervical cancer kills?

A

Ovarian cancer –> cachexia (starvation) as a result of widespread bowel metastasis

Cervical cancer –> bilateral ureteral metastases leading to uremia

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4
Q

Breast cancer that is her2/neu positive tends to be (more/less) aggressive.

A

more

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5
Q

Be less aggressive with cervical dysplasia in younger patients less than age ___.

A

25

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6
Q

When is NST not reliable?

A

When there is an absence of accelerations and decelerations

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7
Q

How do you treat lichen sclerosis?

A

Corticosteroid treatment (Clobetasol)

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8
Q

Between lichen planus and lichen sclerosis, which usually presents in the vagina?

A

licehn planus

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9
Q

How can lichen sclerosis lead to dyschezia?

A

Scratching can lead to constriction of the anus. It can also cause to narrowing/closure of the vaginal introitus

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10
Q

What is “marsupialization” and what is it used for?

A

Surgical fixation of an inflamed Bartholin cyst wall everted against hte mucosa of the vulva (just like incision and placement of a small balloon catheter, it allows drainage of the infection for several weeks).

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11
Q

Why should a Bartholin gland infection be biopsied in a woman over 40?

A

can be associated with cancer

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12
Q

Hyperthyroidism can be caused by a benign cystic teratoma containing thyroid tissue, called

A

struma ovarii

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13
Q

What is the most common type of ovarian malignancy? What is its most common subtype?

A

epithelial ovarian tumor. Arises from outer layer of the ovary; usually occurs in older women. The serous subtype is most common (and more often bilateral!). Mucinous –> pseudomyxoma peritonei. BRCA1 or 2

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14
Q

What is the second most common type of ovarian neoplasm, and which is its most common subtype?

A

germ cell ovarian tumor. The most common subtype is dermoid cyst (contains all three germ cell layers. If mature, benign; if immature, malignant).

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15
Q

Why should you always ultrasound the other ovary if a dermoid cyst is found?

A

they can be bilateral 10-15% of the time

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16
Q

What determines the grade of malignant teratomas?

A

The quantity of immature neural elements

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17
Q

How does struma ovarii present on MRI?

A

complex multilobulated masses with thick septa (like large thyroid follicles)

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18
Q

What common tumor marker is elevated in most epithelial ovarian tumors?

A

CA-125

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19
Q

What is the treatment of epithelial tumors?

A

Surgical staging with maximum removal (debulking) and combination chemotherapy, esp. with a platinum agent (cisplatinum or carboplatinum) and taxane!

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20
Q

How do sex cord stromal tumors appear on ultrasound?

A

solid

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21
Q

In general, any adnexal mass greater than ___ cm in size is likely to be a tumor and should be excised.

A

10

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22
Q

Any adnexal mass less than ___ cm in size in reproductive women suggests a functional cyst.

A

5 cm. Note: this should be excised in menopausal women and not just observed.

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23
Q

What is the mean age of presentation of cervical cancer?

24
Q

Why do women with cervical cancer have malodorous discharge?

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A

result of a large necrotic tumor

25
Why might women with cervical cancer have flank tenderness?
metastasis obstructing the uterues
26
What are risk factors for cervical cancer?
multiparity, cigarette smoking, history of STD, early age of coitus, multiple sexual partners, HIV infection
27
What is a radical hysterectomy?
removal of the uterus, cervix, proximal vagina, and supportive ligaments including the uteroscaral ligament and cardinal ligament (contains uterine arterine and vein, connects cervix to lateral wall)
28
What is radiation brachytherapy?
Radioactive implants placed near the tumor bed
29
What is radiation teletherapy?
External beam radiation where the target is distanced from the radiation source
30
What usually characterizes the severity of cervical cancer?
the vascular pattern (mild = punctuated (end-on), while atypical = corkscrew and hairpin)
31
What type of chemotherapy is used for cervical cancer?
Platinum based (like cisplatin) to sensitize the tissue to radiotherapy (used as "radiosensitizer," esp in patients with flank tenderness or lew swelling which indicates advanced cancer)
32
When does screening for cervical cancer start? When can it stop?
Starts q2y at age 21; can be extended to every 3 years if 3 negative tests by 30; stops at age 65 to 70 after 3 negative tests and no abnormal tests in the last 10 years.
33
What about cervical cancer screening in patients with hysterectomy?
Not recommended in patients who had hysterectomy for benign reasons; Pap smear of vaginal cuff still needed for hysterectomy performed for cervical dysplasia (CIN III)
34
What is done for cervical cancer if a woman desires children??
Radical trachelectomy (removal of cervix and upepr vagina while leaving the uterus)
35
For patients with advanced cervical cancer, which is better: radiotherapy or surgical therapy?
Radiotherapy! However, radical hysterectomy an preserve sexual function while radiotherapy may cause closure of vagina due to vaginal agglutination
36
Finding of ASCUS on HPV testing is followed up by an HPV test in which women?
Over age 25! (before age 25 = likely to resolve and may be observed)
37
If a patient has a history of cervical dysplasia, how often should they have pap smears?
yearly
38
What are risk factors for endometrial cancer?
obesity, diabetes (!! you always forget!), hypertension, prior anovulation (irregular menses), late menopause, nulliparity
39
If endometrial sampling is negative for cancer, what is another cause for postmenopausal bleeding?
atrophic endometrium or endometrial polyp
40
An endometrial thickness greater than ___ mm is abnormal in a postmenopausal woman.
4
41
How is Type II endometrial cancer different from Type I?
Type II = atypical; papillary or clear cell, estrogen-independent, late menopausal women, thin patients, regular menses, MORE AGGRESSIVE
42
What is the most common etiology of postmenopausal bleeding? But what must be ruled out?
atrophic endometritis. BUT endometrial carcinoma must be ruled out in any patient with postmenopausal bleeding.(because endometrial malignancy can coexist with atrophic changes)
43
What is the most common female genital tract malignancy?
endometrial carcinoma
44
What type of cancer(s) does atypical glandular cells on a Pap smear indicate?
cervical, endometrial, or ovarian!
45
For stage I endometrial cancer, what is the appropriate therapy?
Surgical. Radiation therapy when strong suspicion of spread; chemotherapy when metastasis is revealed
46
What are the 3 Ds of endometriosis?
dysmennorhea, dyspareunia, dyschezia
47
What is the difference between primary and secondary infertility?
Primary: never been able to get pregnant. Secondary: pregnant in the past, but 1 year unable to conceive
48
How is "fecundability" defined?
probability of achieving pregnancy within one menstrual cycle (20-25% for a normal couple)
49
What percentage of couples should conceive after 12 months?
90%
50
How do you test for ovulatory dysfunction?
Basal body temperature (biphasic; rise of temperature after ovulation, compared to lower temp before) or LH surge or testing of ovarian reserve (day 3 FSH or AMH testing)
51
What is the test for a uterine disorder interfering with fertility?
Hysterosalpingoram (performed between days 6 and 10 in cycle)
52
If you suspect tubal factors for infertility, what should you do to confirm? WHat is the therapy?
HSG, then laparoscopy to confirm. In vitro fertilization.
53
T/F: THe majority of women with tubal factor infertility have no history of STIs.
True. Due to the asymptomatic nature of the infections
54
How do you confirm endometriosis? How ts it treated?
Laparoscopy and then use it for ablasion/excision
55
What are the five basic etiologies of infertility?
1) ovulatory; 2) uterine, 3) tubal, 4) male factor, 5) peritoneal factor (endometriosis)

OB/GYN (6 decks)

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