uterine/cervical clinical

Question 1

increased risk for fibroids?

Answer 1

early menarche

increasedBMI

Nulliparous

Heredity

Question 2

decreased risk

Answer 2

postmenopausal

cigarette smoking

pregnancy

Question 3

types of firboids

Answer 3

subserous

submucous

interstitial of the inter

Question 4

which type of fibroid would present with heavy periods/dysmenorrhea?

Answer 4

submucosal pedunculated

Question 5

which type of fibroid would have little symptoms?

Answer 5

pedunculated subserous (pressure)

Question 6

what would happen is the pedunculated subserous gains blood supply and separates?

Answer 6

parasitic fibroid

Question 7

most common clinical symptom?

Answer 7

bleeding and consequent anemia

Question 8

heavier bleeding due to

Answer 8

venous lakes

Question 9

other symptoms?

Answer 9

pelvic discomfort
hydronephrosis
dyspareunia
INFERTILITY: submucosal

Question 10

pregnancy complications re: placenta?

Answer 10

placenta previa

also preterm

fetal malposition

higher C-section rate

neonatal morbidity

Question 11

on exam?

Answer 11

enlarged, non-tender uterus

Question 12

Diagnosis?

Answer 12

pelvic exam

Transvaginal US

Question 13

management

Answer 13

routine pelvic if asymptomatic

Asymptomatic:

• progestins oral contraceptives
• GnRH agonists rapidly shrink them (bone loss though, end stage)
• aromatase inhibitors

Question 14

treatment by interventional radiologst?

Answer 14

uterine artery embolization

magnetic resonance guided focus ultrasound removal

Question 15

surgical mgmt

Answer 15

hysterectomy most common (subtotal just the uterus, complete=uterus and cervix)

myomectomy (removal of the fibroids)

Question 16

what’s it called when fibroid blocks menstrual blood?

Answer 16

Hematometra

cylcic, midline pain, sometimes amenorrhea

Question 17

menarche, mild menstrual cramps, more painful periods or heavier regular periods

Answer 17

Adenomyosis

Question 18

gold standard for adenomyosis?

Answer 18

MRI

but you can use US

Question 19

tx for adenomyosis

Answer 19

NSAIDS, combined contraceptives

Question 20

3rd most common reason for hysterectomy?

Answer 20

Uterine Prolapse

Question 21

Pelvic floor trauma can cause?

Answer 21

Uterine Prolapse

Question 22

Procidentia?

Answer 22

most severe stage of uterine prolapse

Question 23

tx Uterine prolapse for mild symptoms?

Answer 23

Kegel exercises to strengthen the pubococcygeus and levator ani

Question 24

elderly tx for uterine prolapse

Answer 24

Pessary

Question 25

surgical tx for pelvic organ prolapse?

Answer 25

Obliterative Vaginal Hysterectomy

Question 26

abnormal bleeding is outside what range?

Answer 26

3-7 days

Question 27

menorrhagia

Answer 27

greater than 7 days

Question 28

metrorrhagia

Answer 28

intermenstrual (breakthrough) bleeding

Question 29

Menometrorrhagia

Answer 29

prolonged uterine bleeding occurring at irregular intervals

Question 30

Hypomenorrhea

Answer 30

less than 3 days

Question 31

Oligomenorrhea

Answer 31

longer than 35 days cycle length

Question 32

polymenorrhea

Answer 32

shorter than 24cycle length

Question 33

Causes of abnormal uterine bleeding

Answer 33

``` Polyp/Pregnancy Adenomysosis Leiomyoma Malignancy and Hyperplasia PCOS Fibroid ``` PALM(H)

Question 34

causes of AUB: nonstructural

Answer 34

``` Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not yet classified ``` COEIN

Question 35

AUB dx

Answer 35

rule out cancer

Question 36

what drugs can cause AUB?

Answer 36

contraceptives and HRT

Question 37

NSAIDs block ________ which helps with menorrhagia

Answer 37

prostaglandins

Question 38

what will decrease flow by 40-70%

Answer 38

Hormonal contraceptive pills Levonorgestrel-containing device other progestins (depo shot)

Question 39

surgery for AUB

Answer 39

endometrial destruction (outpatient) only for those with predictable bleeding (otherwise rule out cancer) hysterectomy most effective

Question 40

squamocolumnar junction separates

Answer 40

stratified squamous epithelium of the cervix and mucin secreting columnar epithelium of endocervix

Question 41

squamous metaplasia is a conversion of exposed columnar epithelium into squamous epithelium/metaplasia because of what process?

Answer 41

lowering of the pH of the vagina via glyocgenation of the epithelium of the lower Gen tract

Question 42

CIN chance of invasion?

Answer 42

12%

Question 43

Risk factors for CIN

Answer 43

Early coitarche multiple partners smoking Immunosuppression

Question 44

warning for CIN

Answer 44

postcoital bleeding | discharge

Question 45

bivalent vaccine

Answer 45

16,18

Question 46

quadrivalent

Answer 46

16,18,6,11

Question 47

9 valent

Answer 47

+31,33,45,52,58

Question 48

pap smear more sensitive or specific?

Answer 48

more specific

Question 49

what happens if you add HPV to your pap cytology?

Answer 49

sensitivity increases

Question 50

what are you scraping with a pap

Answer 50

transformation zone

Question 51

21-29 screened?

Answer 51

every 3 years

Question 52

30-65 cotesting

Answer 52

every 5 years

Question 53

TOTAL hysterectomy screening?

Answer 53

no screening

Question 54

do you continue to screen those with dx?

Answer 54

yes, for vaginal spread

Question 55

how are epithelial cell abnormalities managed in HPV positive?

Answer 55

tx'd as low grade lesion

Question 56

imcompetent cervix

Answer 56

silent cervical dilation without uterine contractions risk factors including LEEP or cone biopsy

Question 57

dx for incompetent cervix dx

Answer 57

transvag US

Question 58

what happens if someone has an incompetent cervix and they get pregnant?

Answer 58

screen for that at 16 weeks and then you can suture it and remove before labor .÷