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Flashcards in GYN- Upper GU Deck (28)
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1
Q

What are uterine anatomic anomalies assc with

A

urinary tract anomalies and inguinal hernias

2
Q

etiology of uterine anatomic anomalies

A

problems in fusion of paramesonephric (mullerian) ducts

3
Q

MC uterine anatomic anomaly

A

septate > bicornate > didelphys (double uterus, cervix, vagnia)

4
Q

what uterine anatomic anomlaies get surgery

A

septate, bicornate, didelphys

5
Q

term for uterine fibroids

A

leiomyoma

6
Q

what are uterine fibroids

A

estrogen sensitive smooth muscle proliferation of myometrium

7
Q

what is a uterine fibroid pseudocapsule?

A

compressed smooth musles cells surrounding fibroids

8
Q

what causes the pelvic pain assc with fibroids

A

fibroid outgrows blood supply –> infarction and degeneration –> pelvic pain

9
Q

who gets uterine fibroids/leiomyomas

A

black women of reproductive age (20-30% repro age and 50% are black)

10
Q

subtypes of uterine fibroids/leiomyomas

A

intramural (MC)
submucosal (most likely to bleed)
subserosal
pedunculated

11
Q

presentation of uterine fibroids/leiomyomas

A

ususally asx

menorrrhagia (MC), pelvic pain and pressure, infertility (rare)

12
Q

How are fibroids managed?

A

asmx = leave alone

temporarily shrink with progesterone, danazol, leuprolide (these decrease E)

myomectomy (if fertility desired)
hystorectomy is definitive
uterine artery embolism if bad surgical candidate

13
Q

do leiomyomas have potential to transform into leiosarcoma

A

NO

14
Q

what are endometrial polyps? How do they present?

A

benign overgrowth of endometrial glands/stroma

vaginal bleeding btwn prds (menorrhagia)

15
Q

how are endometrial polyps managed?

A

Dx with pelvic US, Tx is D&C + Bx to r/o cancer

16
Q

how does endometrial hyperplasia present?

A

vaginal bleeding

17
Q

what % of each stage progresses to cancer:

  • simple hyperplasia w/o atypia
  • complex hyperplasia w/o atypia
  • simple hyperplasia w/ atypia
  • complex hyperplasia w/ atypia
A
"penny, nickle, dime, quarter" rule
1%
3-5%
8-10%
25-30%
18
Q

risk factors for developing endometrial hyperplasia

A

anything that increases E levels:

unopposed E therapy 
tamoxifen
obesity/HTN/DM (inc aromatase in fat cells)
PCOS
chronic anovulaiton 
nulliparity
early menarche/late menopause
granulosa cell tumor
19
Q

protective factors for developing endometrial hyperplasia

A

anything that decreases E levels

COP/POP/combined HRT
multiparity
diet and exercise

20
Q

management of endometrial hyperplasia

A

Bx –> D&C –> progestins for 3 mos + repeat endometrial Bx

HYSTORECTOMY if complex/atypia

21
Q

MC ovarian cyst + management

A

Folliculalr (2/2 unruptured follicle); usually asymptomatic

observe 8-12 wks then repeat pelvic U/S; if unresolved get cystectomy or oophorectomy

22
Q

ovarian cyst 2/2 to hemorrhage into persistent corpus luteum + smx? + Tx?

A

corpus luteum cyst

presents with dull abd pain if unruptured or acute abdomen if ruptured

usually resolves spontanously but can suppress with OCPs

23
Q

multiple/bilaterial ovarian cysts due to FSH/LH stimulation

A

theca-lutein cysts

24
Q

ovarian endometreosis = ___ cyst

A

chocolate

25
Q

enlarged ovaries with multiple subcortical cysts

A

PCOS

26
Q

cysts assc with moles and choriocarcinoma

A

Theca-lutein cysts

27
Q

what are high risk factors for malignant ovarian cyst–what if fist step of diagnosis/management in these patients

A

premenarchal
postmenopausal
> 8cm size
persists > 60 days

get EX LAP for cancer r/o

28
Q

what is first step for diagnosis in low risk pts with ovarian mass

A

pelvic US