Flashcards in Lectures 2 Deck (81)
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31
Clear cell adenocarcinoma
Buzzword for DES exposure
DES exposure in utero increased risk for ovarian clear cell carcinoma
32
Name 4 medication options to tx endometriosis
Want to cause deciduation of the endometrial lining
1. OCPs = gold standard
2. Progesterone- minipills, depot, IUP
3. GnRH agonists (basically induce menopause so use transiently)
4. Danazol- synthetic androgen to suppress FSH/LH release
33
Describe how endometriosis causes
(a) Pain
(b) Infertility
(a) Ectopic endometrial stroma/glands cause inflammation that build into adhesions and scarring
(b) Adhesions and occlusions => infertility
34
Checking progesterone on what day of the menstrual cycle would help confirm ovluation
Day 21
35
Name 2 etiologies of GnRH independent precocious puberty
GnRH independent precocious puberty = puberty not due to early activation of HPA axis, instead due to some form of peripheral estrogen production
1. McCune Albright syndrome = ovaries producing estrogen w/o stimulation
2. Granulosa cell tumor
36
Buzzword: uterosacral nodularity
Endometriosis
37
Physical exam findings of ectopic pregnancy
-Abdominal or adnexal tenderness
if ruptured- acute abdomen w/ rebound/guarding
-uterus small for gestational size (aka normal sized)
38
Etiology of GnRH dependent precocious puberty
GnRH dependent precocious puberty = early activation of the HPA axis
-most often idiopathic
39
Clinical presentation of ectopic pregnancy
Main features = vaginal bleeding + abdominal pain
40
Outpatient tx for PID
Ceftriaxone IM x1
+ Doxy PO BID x14 days
then RTC in 3 days for f/u
-need broad spectrum b/c of polymicrobial nature of PID infections 2/2 ascending vaginal infxn
41
What blood test is essential in every pt w/ any type of abortion
Type and screen!
Prevent autoimmunization if Rh- mother
42
First steps of management for woman of reproductive age who p/w vaginal bleeding
-beta-hCG
-if pregnant => vaginal ultrasound to determine location of pregnancy (ectopic of IUP)
-pelvic exam etc
43
56 yo nulligravid post-menopausal F p/w intermittent vaginal bleeding
Next step in workup
Transvaginal ultrasound to look at endometrial stripe- if under 4-5mm that's thin and believe bleeding is 2/2 atrophy
If endometrial stripe isn't thin => do endometrial biopsy
44
Contraindications to medical MTX tx for first semester abortion
-fetal cardiac activity (usually fetal heart beat seen around 6 weeks)
-beta-hCG over 5,000
-impaired renal fxn (MTX is renally cleared)
-elevated LFTs (MTX is directly hepatotoxic)
-HD unstable (b/c they're ruptured => need surgery)
45
Surgical tx options for ectopic pregnancy
Salpingectomy vs. salpingostomy
Salpingectomy = removal of fallopian tube
Salpingostomy = surgical unblocking of fallopian tube (remove pregnancy w/o removing the tube)- preserves fertility
46
What is Ashermna syndrome?
Intrauterine adhesions + symptoms (infertility, amenorrhea)
-syndrome 2/2 scar tissue development in the uterine cavity
Infertility if scarring prevents normal implantation
Amenorrhea/AUB when scarring prevents normal endometrial growth/shed
47
3 theories of the mechanism of endometriosis
1. Retrograde menstrual flow (most likely)
2. Vascular/lymphatic dissemination
3. Coelomic metaplasia (from pleuripotent/undifferentiated cells in the peritoneum)
48
Name some RF for endometrial hyperplasia/carcinoma
-unopposed estrogen exposure: nulliparity, early menarche, late menopause
-age
-obesity: adipose tissue contains aromatase => increased peripheral conversion of androgens to estrogens
-Tamoxifen
-granulosa cell tumor of the ovary (secretes estrogen)
49
Overview of tx for ovarian cancer
Surgery, then chemotherapy: surgical b/c almost always diagnosed so late (stage III) so already have peritoneal disease
-often intraperitoneal chemo
50
Which method of ovarian stimulation is more likely to result in multiple gestations
Clomiphene citrate (SERM); 10% risk
GnRH: 25% risk of multiple gestations
51
16 yo G1P1 p/w severe lower abdominal pain, F/C/N/V, rebound tenderness
-purulent vaginal d/c
-b/l adnexal fullness
-+ GC, -RPR, WBC 17.6 w/ left shift
Dx
PID
Major criteria = abdominal/adnexal pain
+
Minor criteria = white count, fever
52
Explain how giving GnRH can suppress ovulation
FSH/LH respond to pulsatile GnRH, not continuous => if you give continuous GnRH it'll suppress FSH/LH release
53
Mechanism of tx in endometriosis
Want to cause deciduation of the endometrial lining => use OCPs, progesterone, GnRH agonist (but only transiently b/c induces menopause)
54
Describe the staging of cervical cancer
Need to have a way to stage it worldwide (aka also in undeveloped countries) => cervical cancer is staged clinically
-staged w/ palpation: feel for parametrial involvement, CXR for pulm involvement
-in developed countries use CT/MRI to further characterize, but overall its clinical (physical exam) staging
55
Name 3 etiologies of hypergonadotropic hypogonadism
Hypergonadotropic hypogonadism = elevated FSH but no response => delayed pubrety
1. Turners (XO)
2. Mullerian agenesis
3. Imperforate hyman
56
Hormone replacement therapy
(a) 4 disadvantages (increased risk of...)
(b) Decreases risk of 2 things
HRT (referring to both estrogen and progesterone)
(a) Increased risk of
1. breast cancer (only w/ both E/P)
2. stroke
3. VTE
4. coronary artery disease (only w/ both E/P, not E alone)
(b) Decreased risk of
1. colon cancer
2. fractures
57
Rate of progression of the dif types of endometrial hyperplasias to cancer
quarter, dime, nickel, penny
25% complex w/ atypia => cancer
10% simple w/ atypia => cancer
5% complex w/o atypia => cancer
1% simple w/o atypia => cancer
58
Differentiate the two classifications of precocious puberty
GnRH dependent (high LH)
vs.
GnRH independent (LH doesn't increase w/ GnRH administration)
59
Mechanism of visualization in colposcopy
Acetic acid- use dilute acetic acid to make atypical cells turn white
60
