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Summer 15 - Women's Health > GU Benign and Malignant > Flashcards

GU Benign and Malignant Flashcards

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1
Q

What is lichen sclerosis?

A
  • chronic inflammatory condition

- likely autoimmune

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2
Q

S/S of Lichen Sclerosis

A
  • chronic vulvar pruritus and pain
  • dysuria
  • dyspareunia
  • rectal bleeding
  • diffuse, thin, white wrinkled skin localized to labia
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3
Q

Dx of Lichen Sclerosis

A

-punch biopsy to confirm and r/o malignancy

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4
Q

Tx of Lichen Sclerosis

A

-topical steroids 2-3 months until resolved then weekly for maintenance

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5
Q

What is lichen simplex chronicus?

A
  • lichenified skin reaction to chronic scratching
  • caused by atopic dermatitis, tinea or candida infection
  • worsens with heat, excessive sweating, clothing irritation
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6
Q

S/S of Lichen Simplex Chronicus

A
  • progressive pruritus and burning

- red papules form lichenified, thickened, scaly localized plaques

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7
Q

Dx of Lichen Simplex Chronicus

A
  • clinical

- biopsy if not resolving

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8
Q

Tx of Lichen Simplex Chronicus

A
  • treat underlying cause
  • antipruritus medications
  • topical steroid cream
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9
Q

What is lichen planus?

A
  • autoimmune inflammatory condition

- age 50-60

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10
Q

S/S of Lichen Planus

A
  • intense chronic pruritus
  • insertional dyspareunia, post-coital bleeding
  • vulvar pain
  • erosive type: red/white patchy, ulcerative lesions
  • vagina often involved (differentiates from lichen sclerosis which is external only)
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11
Q

Dx of Lichen Planus

A
  • clinical

- consider biopsy to r/o malignancy or wet prep to r/o infx

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12
Q

Tx of Lichen Planus

A
  • steroids for vulvar lesions
  • intravaginal steroids for vaginal lesions
  • oral prednisone if refractory to topical tx
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13
Q

Psoriasis

A
  • autosomal dominant
  • mildly pruritic
  • scaly, silvery patch atop an erythematous base
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14
Q

Dx and Tx of Psoriasis

A

Dx: biopsy
Tx: topical steroid

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15
Q

Dermatitis

  1. Etiology
  2. Dx
  3. Tx
A
  • etiology: eczema, seborrheic dermatitis
  • Dx: clinical
  • Tx: remove offending agent, topical steroids
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16
Q

S/S Vestibulitis

A
  • localized vulvar pain w/o dermatitis
  • severe pain provoked by focal touch of vulva
  • insertional dyspareunia over weeks-months
  • small, reddened patchy areas over glands and vestibule
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17
Q

Dx of Vestibulitis

A

-light touch over vestibule recreates pain

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18
Q

Tx of Vestibulitis

A
  • controversial
  • topical lidocaine if localized, oral nortriptyline or gabapentin
  • remove irritants
  • abstinence
  • steroid ointments
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19
Q

Bartholin Gland Cyst

A
  • obstruction of bartholin glands

- mucus accumulates usually due to bacterial cause

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20
Q

S/S of Bartholin Gland Cyst

A
  • often asymptomatic
  • pain and tenderness with sex, sitting, ambulation
  • firm swelling at posterior vaginal introitus
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21
Q

Dx of Bartholin Gland Cyst

A

clinical

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22
Q

Tx of Bartholin Gland Cyst

A
  • asymptomatic: no intervention

- symptomatic: I/D with word cath placement, marsupialization, excision

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23
Q

Vulvar Hygiene

A
  • cotton underwear
  • loose garments
  • tampons instead of pads
  • fragrance free soap
  • omit sprays, powders, douches
  • pat dry
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24
Q

Vulvar Neoplasia

  • S/S
  • Dx
  • Tx
A
  • may be associated w/ HPV
  • vulvar irritation, pruritus, raised lesions
  • Dx: biopsy
  • Tx: excision
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25
Vaginal Intraepithelial Neoplasia (VAIN)
-more commonly neoplasia is result of spread from another site (eg cervical)
26
S/S of Vaginal Cancer
- asymptomatic | - vaginal bleeding
27
Dx of Vaginal Cancer
- PAP | - biopsy
28
Tx of Vaginal Cancer
- radiation | - radical hysterectomy, upper vaginectomy, pelvic lymphadenectomy
29
Nabothian Cysts
- benign cervical tumor | - squamous cells cover columnar cells, which continue to secrete mucoid material
30
Polpys
- benign cervical tumors | - polypectomy if symptomatic or large
31
Role of HPV in Cervical Cancer
- infx with HPV is central factor | - HPV easily transmitted via sex
32
Why are PAP smears now every 3-5 years instead of yearly?
-precursor lesions precede invasive disease by 10 years so easy to catch in time to treat it and b/c most healthy women will clear HPV infx in 2 years
33
PAP Test
- collection of cervical cells using speculum - detect cervical abnormalities - want the report to say satisfactory for exam, transformation zone present
34
Transformation Zone
- junction of squamous and columnar cells on the cervix - these are the least mature cells of cervix and more prone to metaplasia - carcinoma usually arises in squamocolumnar junction or transformation zone
35
Screening Guidelines for PAP Test
- none under 21 - 21-29: cytology q3 years - 30-65: cytology and HPV every 5 years or cytology alone every 3 years - over 65: no screening if negative history
36
HPV
- precursor to cervical carcinoma | - most common types: 16, 18, 31, 45
37
Risk Factors for HPV
- multiple sex partners - early age at first intercourse - smoking - immunocompromised
38
HPV Vaccination
- routine for boys and girls 11-12 years old | - catch up until age 26
39
Colposcopy
- microscopic guided evaluation with biopsy and endocervical curettage - identify areas of dysplasia - test for confirmation of PAP results
40
Cervical Carcinoma S/S
- asymptomatic - watery vaginal discharge - intermittent spotting - postcoital bleeding
41
Dx of Cervical Carcinoma
- pap test - colposcopy - conization
42
Tx of Cervical Carcinoma
- conization of cervix (LEEP excision) - hysterectomy - lymph node dissection - radiation therapy - chemotherapy
43
Uterine Leiomyoma (Fibroids)
- localized proliferation of smooth muscle cells - benign - pt presents with abnormal bleeding - common in 50s
44
S/S of Uterine Leiomyoma (Fibroids)
- menorrhagia - pelvic pressure - secondary dysmenorrhea - pelvic mass
45
Dx of Uterine Leiomyoma (Fibroids)
- clinical - pelvic US - endometrial biopsy to r/o carcinoma
46
Tx of Uterine Leiomyoma (Fibroids)
- reassurance, observation - intermittent progestin - myomectomy - hysterectomy - GnRH agonists
47
Uterine Leiomyoma (Fibroids) and Pregnancy
- usually associated w/ infertility - 3cm: preterm labor, placental abruption, pelvic pain, C-section - Tx with analgesics and bedrest
48
What is adenomyosis?
-disorder in which endometrial glands and stroma are present within uterine musculature
49
S/S of Adenomyosis
- menorrhagia - dysmenorrhea - enlarged uterus
50
Dx of Adenomyosis
- MRI | - histology from hysterectomy confirms
51
Tx of Adenomyosis
hysterectomy if significant symptoms
52
What are endometrial polyps and who gets them?
- focal, benign processes - may be found in association with endometrial hyperplasia or carcinoma - perimenopausal women
53
S/S of Endometrial Polyps
- abnormal bleeding | - pelvic pain
54
Dx of Endometrial Polyps
- ultrasound - excision - histology
55
Tx of Endometrial Polyps
-polypectomy if symptomatic
56
What is endometrial hyperplasia and what causes it?
- proliferation of endometrial glands - due to excess estrogen: obesity, estrogen therapy w/o progestin, anovulation, ovarian tumors, nulliparity, older age, late menopause
57
S/S of Endometrial Hyperplasia
-abnormal uterine bleeding
58
Dx of Endometrial Hyperplasia
- endometrial biopsy | - transvaginal US
59
Tx of Endometrial Hyperplasia
- D&C - cyclic progestins - medroxyprogesterone - progesterone intrauterine contraceptive - hysterectomy after childbearing is complete
60
S/S of Endometrial Cancer
- postmenopausal bleeding - vaginal dischare - endometrial cells on cervical cytology
61
Tx of Endometrial CA
- hysterectomy - high dose progestin - advanced dz needs radiation and chemo
62
Symptoms of Benign Ovarian Cysts and Tumors
- asymptomatic - mass - pelvic pain - dyspareunia - dysmenorrhea
63
Dx of Benign Ovarian Masses
- pelvic exam - US - pathology - CBC, UPT
64
When do theca lutein cysts occur and why?
- pregnancy - overstimulation with high hCG levels - usually bilateral and large
65
Mature Cystic Teratoma
-may contain teeth, hair, sebum, bone, skin
66
S/S of Ovarian Neoplasms
- abdominal fullness/bloating - pelvic, abd, back pain - early satiety, difficulty eating - decreased energy - urinary frequency - irregular, fixed, solid pelvic mass - asymptomatic or vague sxs = usually diagnosed late
67
Dx of Malignant Ovarian Neoplasms
-US and histopathology
68
Tx of Malignant Ovarian Neoplasms
TAH-BSO
69
Risks for Ovarian CA
- Caucasian - nulliparous - primary infertility - endometriosis
70
Protective Factors for Ovarian CA
- OCP use - breastfeeding - multiparity - tubal ligation
71
What might cause elevated CA-125 levels?
- CA: ovarian, endometrial, breast, colon - endometriosis - fibroids - pregnancy - PID - liver dz, heart failure, renal dz - diabetes, sarcoid, TB, ascites
72
What is the most deadly GYN cancer? What is the most common malignant carcinoma?
- ovarian is most deadly | - malignant epithelial cell carcinoma is most common
73
Ovarian Torsion 1. What is it? 2. What can happen?
1. twisting of ovary on ligamentous support impedes blood supply 2. ovarian ischemia: necrosis, infarction, local hemorrhage, systemic infx
74
What increases the risk of ovarian torsion?
- ovarian cyst - ovarian neoplasm - pg
75
S/S of Ovarian Torsion
- acute pelvic pain - N/V - adnexal mass
76
1. Dx of Ovarian Torsion | 2. Tx of Ovarian Torsion
1. CBC, electrolytes, US, surgical | 2. surgery to preserve ovarian function

Summer 15 - Women's Health (7 decks)

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