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1

ligament: allows anteversion of the uterus

round ligament

2

ligament: contains uterine vessels

broad ligament

3

ligament: contains ovarian artery, nerve, and vein

infundibular ligament

4

ligament: holds cervix and vagina

cardinal ligament

5

very good at diagnosing disorders of the female genital tract

ultrasound

6

when can you see pregnancy on ultrasound?

6 weeks

7

beta-HCG: gestational sac

1,500

8

beta-HCG: fetal pole

6,000

9

abortion: 1st trimester bleeding, closed os, positive sac on ultrasound and no heartbeat

missed abortion

10

abortion: 1st trimester bleeding, positive heartbeat

threatened

11

abortion: tissue protrudes through os

incomplete

12

(life threatening) - acute abdominal pain; positive beta-hcg, negative ultrasound for sac; can have missed period, vaginal bleeding, hypotension

ectopic pregnancy

13

risk factors for ectopic pregnancy

previous tubal manipulation
pid
previous ectopic pregnancy

14

why is ectopic pregnancy life threatening?

significant shock and hemorrhage can occur

15

dysmenorrhea, infertility, dyspareunia
- can involve the rectum and cause bleeding during menses

endometriosis

16

what will endoscopy show in endometriosis involving the rectum?

endoscopy shows blue mass

17

most common site of endometriosis

ovaries

18

tx: endometriosis

OCPs

19

- has increased risk of infertility and ectopic pregnancy
- pain, nausea, vomiting, fever, vaginal discharge
- most commonly occurs in the first half of the menstrual cycle

pelvic inflammatory disease

20

risk factors: pid

multiple sexual partners

21

dx: pid

cervical motion tenderness, cervical cultures, positive gram stain

22

tx: pid

ceftriaxone, doxycycline

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complications: pid

persistent pain, infertility, ectopic pregnancy

24

pid: vesicles

HSC

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pid: condylomata

HPV

26

pid: positive dark-field microscopy, chancre

syphilis

27

pid: diplococci

gonococus

28

- rupture of graafian follicle
- causes pain that can be confused with appendicitis
- occurs 14 days after the 1st day of menses

mittelschmerz

29

#1 primary vaginal cancer

squamous cell CA

30

can cause clear cell CA of vagina

DES (diethlstilbestrol)

31

rhabdosarcoma that occurs in young girls

botryoides

32

tx: used for most cancers of vagina

XRT

33

elderly, nulliparous, obese; usually unilateral

vulvar cancer

34

tx:

WLE and ipsilateral inguinal node dissection

35

tx: > 2cm (stage 2 or greater)

radical vulvectomy (Bilateral labia) with bilateral inguinal dissection, posted XRT if close margins (

36

premalignant lesion in vulvar cnacer

paget's VIN 3 or higher

37

define VIN

vulvar intra-epithelial neoplasia

38

leading cause of gynecologic death

ovarian cancer

39

abdominal or pelvic pain; change in stool or urinary habits; vaginal bleeding

ovarian cancer

40

decreases risk of ovarian cancer

OCPs, bilateral tubal ligation

41

increases risk of ovarian cancer

nulliparity, late menopause, early menarche

42

types of ovarian cancer (x8)

.1. teratoma
2. granulosa-theca
3. sertoli-leydig
4. struma ovarii
5. choriocarcinoma
6. mucinous
7. serous
8. papillary

43

ovarian CA: estrogen secreting, precocious puberty

granulosa-theca

44

ovarian CA: androgens, masculinization

Sertoli-Leydig

45

ovarian CA: thyroid tissue

struma ovarii

46

ovarian CA: beta-hcg

choriocarcinoma

47

worst prognosis in ovarian CA

clear cell type

48

Ovarian CA: stage 1

one or both ovaries only

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ovarian CA: stage 2

limited to pelvis

50

ovarian CA: stage 3

spread throughout abdomen

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ovarian CA: stage 4

distant metastases

52

stage ovarian CA: bilateral ovary involvement

stage 1

53

mc initial site of regional spread in ovarian CA

other ovary

54

how does debulking tumor help in ovarian CA?

can be effective; including omentectomy (helps chemo and XRT)

55

tx: ovarian CA

total abdominal hysterectomy and bilateral oophorectomy for all stages, plus:
- pelvic and para-aortic LN dissection
- omentectomy
- 4 quadrant washes
- chemotherapy (Cisplatin and paclitaxel (taxol))

56

chemotherapy: ovarian CA

cisplatin and paclitaxel (Taxol)

57

stomach CA that has metastasized to ovary
- pathology classically shows signet ring cells

krukenberg tumor

58

pelvic ovarian fibroma that causes ascites and hydrothorax
- excision of tumor cures syndrome

meige's syndrome

59

most common malignant tumor in female genital tract

endometrial cancer

60

risk factors: endometrial cancer

nulliparity, late 1st pregnancy, obesity, tamoxifen, unopposed estrogen

61

vaginal bleeding in postmenopausal patient

endometrial CA until proven otherwise

62

chance of malignancy in uterine polyps

very low chance of malignancy (0.1%)

63

polyps: worst prognosis in endometrial cancer

serous and papillary subtypes

64

stage 1 endometrial cancer: tx

- endometrium
- tx: TAH and BSO or XRT

65

stage 2 endometrial cancer: tx

- cervix
- TAH and BSO or XRT

66

stage 3 endometrial cancer: tx

- vagina, peritoneum, and ovary
- TAH and BSO and XRT

67

stage 4 endometrial cancer: tx

- bladder and rectum
- TAH and BSO and XRT

68

where does cervical cancer go first?

obturator nodes

69

what is cervical cancer associated with?

HPV 16 and 18

70

most common cervical cancer

squamous cell CA

71

location: stage 1 cervical cancer

cervix

72

location: stage 2 cervical cancer

upper 2/3 of vagina

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location: stage 3 cervical cancer

pelvis, side wall, and lower 1/3 of vagina; hydronephrosis

74

location: stage 4 cervical cancer

bladder and rectum

75

tx: cervical cancer - microscopic disease with basement membrane invasion

cone biopsy (conization sufficienct to remove disease)

76

tx: stages 1 and 2a cervical cancer

total abdominal hysterectomy (TAH)

77

tx: stages 2b and 4

XRT

78

tx postmenopausal ovarian cyst:
septated, has increased vascular flow on Doppler, has solid components, or has papillary projections

oophorectomy with intraoperative frozen sections; TAH if ovarian cancer

79

tx postmenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections

follow with ultrasound for 1 year -> if persists or gets larger -> oophorectomy with intraoperative frozen sections; TAH if ovarian CA

80

tx premenopausal ovarian cyst:
septated, has increased vascular flow on Doppler, has solid components, or has papillary projections

oophorectomy with intraoperative frozen sections usual: algorithm becomes very complicated, weighing aggression of cancer (based on histology and stage at time of operation) compared with whether the pt desires future pregnancy

81

tx premenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections

can follow with ultrasound; surgery if suspicious findings appear

82

management: incidental ovarian mass at the time of laparotomy for another procedure

biopsy mass, 4 quadrant wash, biopsy omentum, look for metastases and biopsy.
- if original procedure elective (Eg gastric bypass), may need to abort procedure depending on findings
- do not perform oophorectomy

83

tx: abnormal uterine bleeding:

clomiphene citrate

84

tx: abnormal uterine bleeding:

GnRH agonists (leuprolide)

85

tx: abnormal uterine bleeding
> 40 years old - cancer or menopause

need biopsy

86

contraindications to estrogen therapy

endometrial CA, thromboembolic disease, undiagnosed vaginal bleeding, breast CA

87

can present as progressively heavier menses

uterine endometrial polyp

88

under hormonal influence; recurrent abortions, infertility, bleeding

uterine fibroids (leiomyomas)

89

most common vaginal tumor

invasion from surrounding or distant structure

90

malignancy risk with partial mole; complete mole is of paternal origin
- treatment?

hydatidiform mole
- tx: chemo (methotrexate)

91

fever, erythema, diffuse desquamation, nausea, vomiting; associated with highly absorbent tampons

toxic shock syndrome

92

tx: ovarian torsion

remove torsion and check for viability

93

tx: adnexal torsion with vascular necrosis

adnexectomy

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tx: ruptures tuboovarian abscess

percutaneous drainage

95

dx / tx: ovarian vein thrombosis

dx: CT scan
tx: heparin

96

can lead to ovarian vein, IVC, and hepatic vein thrombosis, get liver failure with ascites after pregnancy
- tx: heparin and antibiotics

postpartum pelvic thrombophlebitis