Exam 2 Vaginal, Ovary Dz Flashcards Preview

Q4 Women's Health > Exam 2 Vaginal, Ovary Dz > Flashcards

Flashcards in Exam 2 Vaginal, Ovary Dz Deck (38):
1

Vaginal Intraepithelial Neoplasm (VaIN) epidemiology? (4)

U 40s - 60s
U HPV related
U pt also had cervical or vulvar IN
U in upper 1/3 of vagina

2

VaIN risk factors? (3)

Smoking
Immunocomp
Sluts

3

VaIN classifications:

1?

2?

3?

1: = basal epith layers

2: ≤ 2/3 of vag epith

3: ≥ 2/3 of vag epith

4

VaIN presentation? (4)

U asympt
P post-sex spotting
P vag d/c (unlike STDs d/c)
Abn pap

5

VaIN studies?

Colposcopy

6

VaIN tx:

1?

2, 3?

Prognosis?

1 = observation

2/3 = Surgery, imiquimod, 5-FU

30% recurrence

7

Vaginal CA is? (3)

U > 55
U 2° to cancer elsewhere
U SCC

8

Vaginal CA presentation? (4)

Asymp
U painless vag bleeding
Vag d/c
Pelvic pain

9

Vaginal CA tx? (3)

No standard
Vaginectomy, radiation, chemo
< 50% survival

10

Ovarian Cysts: Follicular? (5)

Most C fxn'l cyst
Failure of mature cyst to rupture
~ 3-8 cm
Not malignant
U resolve w/i 6 wks

11

Ovarian Cysts: Corpus Luteum? (4)

Failure of resorption post ovulation
Filled w/ blood, hemorrhage concerns
~3-11 cm
U resolves in 1-2 cycles

12

Ovarian Cysts: Theca Lutein? (3)

Fxn'l cyst resulting from ↑ gonadotrophins
U bilateral
U resolves w/ tx of ↑ gonad

13

Mature Teratoma is?

Benign Ovarian Neoplasm:

U reproductive age
Well differentiated tissue from ecto-, meso- or endoderm

14

Mature Teratoma presentation? (4)

Asympt
Pelvic pain 2° to torsion/rupture
Polyuria/urgency
Back pain

15

Mature Teratoma exam findings?

Labs?

Imaging?

Pelvic mass

CEA, CA-125, AFP, βHCG (CA markers) = N

US = unilateral complex cyst

16

Mature Teratoma tx? (3)

Size dependent
Removal w/ or w/o ovary
10% recurr

17

Ovarian CA? (3)

1/2 found in post meno
Pathophys unclear
High mortality

18

Ovarian CA risk factors? (4)

Decreased risk w/? (4)

BRCA1/2
Lynch Syndrome (hereditary non-poly colon CA)
Early menarche
Late menopause

Past oral contraceptive
Past breast feed
Tubal ligation
Pregnancies

19

Ovarian CA: Epithelial Neoplasm?

Serous?

Mucinous?

Endometrial?

Clear Cell?

Brenner?

90% of ovarian tumors

Serous = most C, 1/2 are bilateral, S to fallopian tubes

Mucinous = Large, U unilateral, S to endocervix

Endometrial = P bilateral

Clear Cell = rare, small, a/w hyperCa2+/pyrexia

Brenner = rare

20

Ovarian CA: Germ Cell Neoplasm? (2)

U 30-40s
Produce markers

21

Ovarian CA: Sex-Cord Stromal Tumor

Granulosa? (3)

Sertoli-Stromal?

Granulosa:
70%
Causes hyperestrogenism (early puberty, post meno bleed)
U 60s

S-S:
Rare
Causes hyperandrogenism
40-50s

22

Ovarian CA presentation? (3)

Bloating
Pelvic/Abd pain
Difficulty eating/Early filling
Lasting > few wks

23

Ovarian CA exam findings? (3)

Pelvic mass
Inguinal LAD
Ascites

24

Ovarian CA labs? (2)

↑ CA-125 suspect epith tumor
↑ hCG, AFP, LDH suspect germ cell tumor

25

Ovarian CA imaging? (4)

US
CT = retroperitoneal involvement, met to pelvic organs
MRI = neoplasm characteristics
CXR

26

Ovarian CA: Epithelial tx?

GYN oncologist
FIGO staging
Chemo

27

Ovarian CA: Germ tx?

GYN oncologist
Remove involved adnexa only if early
FIGO staging

28

BRCA testing guidelines: Non-Ash Jews? (5)

two 1° w/ breast CA, one ≤ 50yo

three+ 1° or 2° BCA, any age

BCA and OCA 1° and 2°, any age

bilat BCA 1°

male w/ BCA

29

BRCA testing guidelines: Ash Jews?

1° or two 2° BCA

30

Genetic risk of Lynch Synd?

Endometrial or colorectal CA < 50yo

31

Polycystic Ovarian Synd causes what? (3)

1) Abn E2 and androgen metabolism -> high test/DHEA/androst

2) Insulin resistance/Hyperinsulinemia -> ∆ FSH/LH -> ∆ ovarian fxn

3) ↓ adiponectin (lipid metab/glucose) -> DMII

32

Polycystic Ovarian Synd signs? (9)

Infertile
Anovulation (amenorrhea)
Obesity
Acne
HIRSUTISM
MP baldness
Acanthosis nigricans
Sleep apnea
Metabolic synd

33

Polycystic Ovarian Synd diagnostic criteria? (4)

Exclude other causes
2 of 3:
Oligo- or anovulation
Signs of hyperandrogenism (acne, high testo)
Polycystic ovaries

34

Polycystic Ovarian Synd imaging?

Transvag US =
> 12 follicles in each ovary 2-9mm
String of pearls appearance
Ovarian vol >10mL

35

Polycystic Ovarian Synd Labs? (7)

Fasting lipids = ↑ LDL/trigly, ↓ HDL
Fasting glu = >100 (DMII)
Free testost > 50 !!
LH = ↑
LH/FSH = > 2:1 !!
LFT = ↑AST,ALT
DHEAs (Always order this!)

36

Polycystic Ovarian Synd tests for DDX:

Cushings?

Androgen-secreting tumor?

Congenital hyperplasia?

Hyperprolactinemia?

Thyroid dysf?

Cushings = 24hr urine cortisol

Androgen-secreting tumor = Free testost

Congenital hyperplasia = a.m. 17-hydroxyprogesterone

Hyperprolactinemia = serum prolactin

Thyroid dysf = TSH/FT4/FT3

37

Polycystic Ovarian Synd tx? (5)

Lifestyle
Combo oral contra (opposes E2) or Cyclic Provera (progest)
Metformin (for hyperinsulin)
Fertility consult

38

Polycystic Ovarian Synd may lead to? (4)

Endometrial hyperplasia/CA
DMII
Metab syn (HTN, Dyslipidemia)
Non-alcoholic steatohep