Lecture 34 - Common Gynecological Conditions

Question 1

_______ Leiomyomas (a subtype of Subserosal) are so termed because they grow from the uterus into surrounding tissue and begin to feed from a blood supply from that tissue (e.g. colon, or peritoneum, or omentum).

Answer 1

Parasitic

Question 2

Leiomyomas can cause ______ (increased or decreased?) menstrual bleeding, which can lead to _____ deficiency _______. Because these can grow to be very large, patients may present with different manifestations of _____ effect –> look for a patient who feels pressure and movement in her pelvis on urination.

Answer 2

Increased

Iron deficiency anemia

Mass effect

Question 3

Physical exam of a patient with a Leiomyoma will reveal a uterus that is _____ (soft or firm?) and multi______.

Answer 3

Firm

Multinodular

Question 4

______ is typically used as a treatment for Leiomyoma in patients nearing menopause. Why is that?

It can also be used to allow less invasive hysterectomy but NOT Myomectomy –> bc it shrinks the tumor, the procedure can be done through the _____ instead of the ______.

Answer 4

GnRH

It is because it essentially mimics menopause –> decreasing Estrogen –> shrinks Leiomyoma and causes amenorrhea, so it’s used as a bridge to get to menopause.

Vagina instead of the abdomen.

Question 5

Endometriosis, ectopic endometrial tissue, most often involves the _____ (which organ?). It appears to be more common in _____, but this is thought to be due to sampling bias.

It’s the MOST common cause for hospitalizations of women aged ___-___.

Answer 5

Ovary

Whites

15-44

Question 6

Endometriosis is associated with a triad of pain: 1. _______ (pain during/around time of menses) 2. _______ (pain during penetrative intercourse) 3. _______ (pain during bowel movements)

Answer 6

1. Dysmenorrhea
2. Dyspareunia
3. Dyschezia

Question 7

The physical exam findings vary widely in women with Endometriosis, but the classic presentation is Uterosacral _______, posterior to the uterus and usually felt best when trying to palpate the ovaries.

Answer 7

Uterosacral Nodules

Question 8

Treatment of endometriosis can include NSAIDs (to decrease bleeding), OCPs (to regulate menstrual cycle), ______ (a testosterone analogue), _____ agonists, and ______ (a progesterone antagonist).

Answer 8

Danazol

GnRH agonists

Mifepristone

Question 9

80% of all abortions occur in the ______ trimester. ______ abnormalities account for about 50% of abortions/miscarriages.

Answer 9

First trimester

Chromosomal abnormalities

Question 10

Types of spontaneous abortions:

Threatened –> products of conception are still present and viable. Patients present with spotting and cramping.

Complete –> __________

Inevitable –> Products of conception are going to pass. Cervix is open. Patients present with some bleeding.

Incomplete –> some of the products of conception have passed. Bleeding tends to increase.

Missed –> products of conception are not viable but are not being expelled.

Answer 10

Complete –> all the products of conception have been expelled. Patient’s bleeding has likely stopped by the time you see them.

Question 11

Keep in mind that chromosomal abnormalities are the most common reason for spontaneous abortion (about 50%). As a group, autosomal ______ are the most common, but considered individually, aneuploidy _____ (aka Turner syndrome) is the most common.

Answer 11

Trisomies

Aneuploidy X

Question 12

Measurement of ___-_____ is used as a qualitative measure of pregnancy. If it is < ______IU/mL, you don’t expect to see anything on transvaginal ultrasound (no fetal development). If it’s > _______IU/mL, you should expect to see a gestational sac. If it’s _____-_____ IU/mL, you should expect to see a fetus with a heartbeat.

Answer 12

Beta-hCG

< 1000IU/mL

> 2000IU/mL

3000-5000IU/mL