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GYNECOLOGY Flashcards

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1
Q

Etiology of cervical cancer

A

HPV 16, 18

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2
Q

Hydatidiform mole, which lab?

A

b-Hcg

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3
Q

How do you treat vulvar benign lesions?

A

Surgical excision

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4
Q

In uterine prolapse, what type of surgery?

A

Vaginal hysterectomy

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5
Q

Pediatric gynecology, most common complaints?

A

Infection, amenorrhea, precocious or delayed puberty

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6
Q

Most common causes of infertility?

A

Mention some of the female and male reasons
Male: sperm disorders, erectile dysfunction
Female: anatomical (PID, Asherman syndrome), ovulatory dysfunction, abnormal cervical mucus

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7
Q

Inflammatory disorders of vulva and vagina - most common vaginal infections?

A

Bacterial vaginosis (Gardnerella, mycoplasma), trichomonas

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8
Q

Staging of ovarian cancer?

A

Only high-risk group: US and CA-125

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9
Q

Urinary incontinence types?

A

Irritative, stress, urge, mixed, neurogenic/overflow, fistula/

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10
Q

Gynecology operation techniques - conization?

A

Cone-shaped portion of the cervix removed. Using scalpel, laser or electrosurgical techniques. Can be diagnostic or therapeutic.

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11
Q

Primary Amenorrhea- when do we begin evaluation?

A

I said the ages in the notes but he did say nowadays people wait till 18. Mention both. He accepted my answer as correct

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12
Q

At which stage of cervical cancer can you see with the naked eye

A

IB

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13
Q

Puberty- Tanner stages

A

I didn’t say them exactly, just described how its based on breast development, pubic hair growth, there was no need to be precise

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14
Q

Types of Uterine Fibroids

A

intramural, subserosal, submucosal

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15
Q

Breast cancer- what is a radical mastectomy

A

entire breast removed + axillary lymph node dissection

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16
Q

Syphilis, how to treat:

A

penicillin 2,4 mill units

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17
Q

Benign lesions of vulva - Mention some

A

Lichen sclerosus (post-menopausal), Lichen Simplex Chronicus. He just moved on before I could mention more.

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18
Q

Screening of endometrial cancer - Who would you screen and how?

A

High risk women with long term estrogen exposure (PCOS, hormonal replacement treatment, family history). Do an intravaginal US and examine the endometrial wall thickness

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19
Q

How would you screen for ovarian cancer?

A

Measure of serum CA-125 + US examination of ovaries.

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20
Q

Mention some abnormal positions of vagina:

A

Ant wall vaginal prolapse (Cystocele), Rectocele, Enterocele. After he asked what is enterocele? Part of the small intestine protrudes into vagina, due to wall weakness.

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21
Q

Ectopic pregnancy - He gave a case: If you have a woman with absence of menses for 7 weeks and you examine the uterus and there is no intrauterine pregnancy. How would you diagnose?

A

Measure beta-hCG, if elevated, but not doubling every 2nd day - indicate ectopic pregnancy. Next step will be to do a laparoscopy.

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22
Q

In the end he asked an extra question (he didn’t expect an answer to it, but wanted to ask it to test me): Genital development (not a topic for this year) - What is the equivalent of the prostate in a female?

A

Prostate consists of glands and smooth m. It is equivalent to the upper 1⁄3 of vagina.

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23
Q

Common STDs?

A

Chlamydia, gonorrhea, syphilis

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24
Q

What changes are seen in Puberty?

A

accelerated growth and development of secondary sexual characteristics + I mentioned Tanner stages and briefly described them: pubic hair growth, breast development

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25
Types of Endometrial Hyperplasia?
simple, complex, atypical and typical.
26
40 yo woman with dysmenorrhea. Tx?
Dysmenorrhea is the medical term for menstrual cramps, which are caused by uterine contractions. Primary dysmenorrhea refers to common menstrual cramps, while secondary dysmenorrhea results from a disorder in the reproductive organs. Tx: NSAIDs such as ibuprofen, hormonal birth control, IUD with progestogen
27
Dysfunctional uterine bleeding in a 42 year old woman, what to do
D&C
28
Normal causes of secondary amenorrhea
pregnancy, menopause, lactation
29
How to differentiate malignant from benign ovarian cysts
MRI
30
Functional ovarian cyst: what does it look like
unilateral, uniloculated, simple cell inside, no papillary protrusion into cyst
31
Ectopic preg: treatment
Salpingostomy: refers to the surgical removal of a Fallopian tube. This may be done to treat an ectopic pregnancy or cancer, to prevent cancer, or as a form of contraception. Salpingectomy Salpingectomy is the surgical removal of a fallopian tube. Salpingectomy is different from salpingostomy (also called neosalpingostomy). Salpingostomy is the creation of an opening into the fallopian tube, but the tube itself is not removed in this procedure.
32
Screening of endometrial cancer
measure the endometrial thickness (should be 8mm for both walls)
33
Causes of secondary amenorrhea
Pregnancy, hyperthyroidism, drugs, pituitary tumors
34
Secondary amenorrhea - what is the progestin test?
Give progestin and then withdraw it. If there is withdrawal bleeding then the diagnosis is PCOS/anovulation. If there is no bleeding, further diagnostic tests should be done
35
Malignant vs benign ovarian tumors
I just said US and tumor markers / biopsy - but idk if it was correct or not he never said Ovarian cancer is the leading cause of reproductive-aged cancer death. This is because there’s no good screening tool for ovarian cancer; it often presents as Stage III or worse when trying to screen. Because it’s in the pelvis there are no structures to bump against and plenty of room to grow before becoming symptomatic. A workup begins with pelvic ultrasound and an MRI or CT scan confirms diagnosis and stages the cancer. Ca-125 levels should NOT be used for diagnosis, but can be used to track recurrence. Types: Germ cell tumor (Choriocarcinoma (bHCG), Teratoma) Stromal tumor (Sertoli - Leydig (Testosterone), Granulosa Theca (Estrogen)) Epithelial (Serous, mucous, Brenner)
36
Malignant vs benign ovarian tumors
I just said US and tumor markers / biopsy - but idk if it was correct or not he never said
37
Choriocarcinoma follow up
b-hCG
38
Barrier contraception
Male and female condoms, diaphragm
39
Symptoms of genital herpes
Vesicles on genitals, with pain, pruritus, discharge, dysuria. Sometimes systemic symptoms - fever, malaise, lymphadenopathy
40
What infections cause painless lymphadenopathy with genital lesions and what causes painful lymphadenopathy
Painless: syphilis (painless ulcer and painless lymphadenopathy) Painful: lymphogranuloma venerum
41
Symptoms of perimenopause
Hot flashes, night sweats, mood swings, vaginal dryness, loss of libido
42
Treatment of cervical cancer
Depends on stage - Transabdominal or Radical hysterectomy, chemoirradiation, palliative chemo, RT, surgery
43
Which lab do you measure in postmenopausal for dx.
FSH (increased)
44
Stage III of cervical cancer
Lower third of vagina involved (IIIA) or whole parametrium infiltrated (IIIB) Tx: chemoirradiation
45
What lab marker would you use to dx PCOS?
I mentioned hyperandrogenism, so high androgens. He said yes, but he wanted to hear that LH/FSH ratio is 3:1
46
Total uterus prolapse: what is the treatment?
Hysterectomy --> What kind? Vaginal
47
Types of breast cancer surgery:
Lumpectomy, quadrantectomy, mastectomy, radical mastectomy + I described shortly what each are
48
Basics of cancer therapy
I just said surgery, RT and chemo and that in most cases today you do a combination of the above mentioned and he moved on
49
This is the question I couldn't answer and he didn't say what was correct: he said the topic was about D&C and conization- there is a pregnant women who they need to do a conization procedure on, what would be different in this procedure compared to doing it on a nonpregnant women, what should they focus on? (PS: I took a long time to think about it so I couldn't even say my answer before he said that was too much time so he wouldn't accept my answer, just so people know to not take too long to think- he wants an answer pretty quickly :))
Risk of bleeding and premature birth in the pregnant woman?
50
Treatment of choriocarcinoma? Prognosis? 5 year survival rate?
Methotrexate, good prognosis, 95%
51
How do you diagnose cervical cancer
he cut me off after saying Pap smear, that was apparently enough
52
If you see a single unicellular cyst on one ovary US what is it and how would you treat it?
probably a Follicular Cyst and watchful waiting is usually enough, but can be removed surgically if there’s risk for torsion or rupture. (he didn’t seem super stoked about my answer but accepted it lol not sure what else he wanted me to say) Your doctor will likely recommend that you get follow-up pelvic ultrasounds at intervals to see if your cyst changes in size.
53
Common factor and difference between SGA and IUGR
Both are in the lower 10th percentile of fetus size, but SGA is usually physiological while IUGR is always pathological.
54
Vaginal inflammations
Bacterial vaginosis (Gardnerella, Mycoplasma), trichomoniasis, candida infection
55
Pearl index definition and the index for condom
Def: Number of unintended pregnancies in 100 women over 1 year of contraception use For condoms: 3-26
56
18 year old pt with primary amenorrhea, 46XY, breast developed, but no pubic hair - what is the diagnosis?
Androgen insensitivity syndrome?
57
Cause of dysmenorrhea
Endometriosis
58
Symptom of corporal cancer
Vaginal bleeding
59
Vulvar cancer treatment:
local excision, radical vulvectomy (+ inguinofemoral lymphadenectomy )
60
Name endometrial benign lesions that are not fibroids:
adenomyosis (and he moved on haha)
61
Histology of types of breast cancer:
I shortly explained about ductal and lobular carcinoma
62
Diagnosis of hydatidiform mole:
b-HCG (very high), snowstorm or honeycomb pattern on US. confirm with biopsy
63
How to check puberty:
Tanner stage (+a short explanation)
64
Vulvar cancer
local excision, radical vulvectomy (+lymph node)
65
Endometriosis
Endometrial-like tissue outside the uterine cavity. Dx: Gold standard = Laparoscopic visualization Tx: Surgery Drugs - Pseudopregnancy - Pseudomenopause = GnRH analogue
66
Long-term OCP use
``` Good: ↓ Ovarian/endometrial cancer ↓ Bone loss ↓ Dysmenorrhea ↓ Acne ↓ Risk of trisomies in ↑ maternal age Regulates cycle Bad: ↑ DVT/stroke ↑ BP ↑ Weight Depression ```
67
Urinary incontinence
Irritative: Urinalysis = Cystitis/tumor/foreign body Stress: Loss of bladder support = Cough Urge: Hypertonic = ↑ Detrusor Tx: Anticholinergics Overflow/neurogenic: Hypotonic w/ dribbles Tx: Cholinergics Bypass/Fistula
68
Main vaginal infections
Bacterial vaginosis Trichomonas Mycosis (Candida) Condyloma
69
Stopping uterine bleeding
Young: Progesterone = Preserve fertility Old: D&C Dilation and curettage refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping. It is a therapeutic gynecological procedure as well as the most often used method of first trimester miscarriage or abortion
70
Mayer-Rokitansky-Küster-Hauser Syndrome
Fancy name for Müllerian agenesis. - Congenital malformation - Failure of Müllerian duct to develop Missing uterus, cervix, vagina Variable degree of upper vaginal hypoplasia (shortened) - Causes 15% of primary amenorrhea - Ovaries intact, ovulation usually occurs - Enter puberty with secondary sexual characteristics
71
Papanicolau classification
The terminology developed by Papanicolaou separated cervical cytological findings into five categories or classes P0: Improper sample P1: Negative result P2: No dysplasia, some benign aberration P3: Pathologic cells, but impossible to tell due to inflammation or dysplasia P4: Atypical cells -> Suspect malignancy P5: True malignancy
72
The Bethesda system
A system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results. Reporting cervical or vaginal cytological Pap smear results. Important steps: 1. Quality of the slide 2. Whether the result is positive or negative 3. Details of the slide (LSIL/HSIL) 4. Physician recommendation of how to proceed
73
Location of Bartholin’s Cyst
Lower 1/3 of labia major.
74
Marsupialization of Bartholin’s Cyst
Cyst opened at the edges + sutured, forming an open pocket.
75
Asherman’s syndrome
Adhesions/fibrosis of the uterine cavity, usually from D&C. Reversible infertility.
76
Endometrial cancer
``` 0: CIS (Carcinoma in situ) I: Limited to the uterus Ia: < 50% myometrial invasion Ib: > 50% myometrial invasion II: Cervical involvement III: Local spread IIIa: Adnexa/uterine serosa IIIb: Vagina/parametrium IIIc1: Pelvic nodes IIIc2: Paraaortic nodes IV: Metastasis IVa: Bladder/rectal mucosa IVb: Distant metastasis, ascites, peritoneum ```
77
Vulvar cancer
``` 0: VIN I: Limited to vulva/perineum < 2cm Ia: < 1mm stromal invasion Ib: > 1mm stromal invasion II: Extension to adjacent perineum III: Any size + extension to perineal structures with positive inguinofemoral LN IIIa1: 1 LN > 5mm IIIa2: 1-2 LN < 5mm IIIb1: > 2 LN > 5mm IIIb2: > 3 LN < 5mm IV: Metastasis IVa: Bladder, urethra, rectum, bone IVb: Distant metastasis (Pelvic LN) ```
78
Vaginal cancer
``` 0: VAIN I: Limited to vagina II: Paravaginal invasion w/ ∅ extension beyond pelvic side walls III: Invasion of pelvic side wall IV: Metastasis beyond pelvis IVa: Bladder, rectum IVb: Distant metastasis ```
79
Cervical cancer
``` 0: CIN I: Limited to cervix Ia: Invasion dx by microscopy Ia1: Stromal invasion < 3mm depth, < 7mm extension (microinvasive) Ia2: Stromal invasion 3-5mm depth, > 7mm extension Ib: Clinically visible lesion Ib1: < 4cm Ib2: > 4cm II: Beyond cervix, ∅ pelvic side walls, ∅ lower 1/3 of vagina IIa: Involved upper 2/3 of vagina, ∅ parametrial involvement IIa1: < 4cm IIa2: > 4cm IIb: Parametrial invasion III: IIIa: Lower 1/3 of vagina, ∅ pelvic wall extension IIIb: Pelvic side wall extension, obstructive uropathy IV: Metastasis IVa: Bladder, rectum IVb: Distant organs ``` LSIL: Condyloma CIN I HSIL: CIN II CIN III -> In situ -> invasive cc
80
Ovarian cancer
I: Ovary/fallopian tube Ia: 1 ovary/fallopian tube Ib: 2 ovaries/fallopian tubes Ic: a/b + Ic1: Surgical spill Ic2: Capsule rupture before surgery, tumor on ovary/fallopian tube surface Ic3: Malignant cells in ascites/peritoneum II: Pelvic extension/primary peritoneal cancer IIa: Uterus/fallopian tubes IIb: Other pelvic tissues III: Cytologically/histologically confirmed spread to peritoneum and retroperitoneal LN IIIa: Retroperitoneal LN, microscopic metastasis beyond pelvis IIIa1(i): Retroperitoneal LN < 10mm IIIa1(ii): Retroperitoneal LN > 10mm IIIa2: Microscopic extrapelvic peritoneal metastasis IIIb: Macroscopic peritoneal metastasis < 2cm IIIc: Macroscopic peritoneal metastasis > 2cm IV: Metastasis IVa: Pleural effusion with positive cytology IVb: Distant metastasis
81
Breast cancer (TNM)
``` Tis: DCIS (Ductal Carcinoma in situ), LCIS (Lobular Carcinoma in situ) T1: 2cm T1mi: 0.1cm T1a: 0.1cm – 0.5cm T1b: 0.5cm – 1cm T1c: 1cm – 2cm T2: 2-5cm T3: > 5cm T4: Metastasis T4a: Chest wall T4b: Skin T4c: Chest wall + Skin T4d: Inflammatory cc N: Lymph nodes Nx: LN cannot be assessed N0: ∅ Cancer cells N1: Cancer cells in armpit LN but not stuck to surrounding tissues N2: Stuck to surrounding tissues N3: Cancer cells in LN below collarbone, behind breast bone, above collarbone M: Metastasis M0: No metastasis M1: Metastasis ```

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