Uterine Disorders

Question 1

What is another name for leiomyoma

Answer 1

Uterine fibroids

Question 2

What is a benign tumor of localized proliferation of smooth muscle cells surrounded by a pseudo capsule of compressed muscle fibers

Answer 2

Leiomyoma

Question 3

Are Leiomyoma hormoally resonsive

Answer 3

Yes they come with a rapid growth if high estrogen and will often go away with menapause

Question 4

Name the dx.
32 y/o Patient comes to you with bleeding from the vagina. Recently she has noticed her menses are getting heavier and longer and she has been trying to get pregnant over the past 2 years with no success.
On exam there is an irregular mobile hard mass. That has a cobblestone feel to it.

Answer 4

Leiomyoma

Question 5

What is used to confirm the dx of Leiomyoma

Answer 5

Ultrasound

Question 6

What is the treatment of Leiomyoma

Answer 6

NSAIDS and iron supplements if anemic

Question 7

What can be used to minimize the bleeding of a Leiomyoma

Answer 7

Progesterone, GnRH agonist, and Danazol

Question 8

What are the surgical options for Leiomyoma

Answer 8

Myomectomy: preserves pregnancy
Hysterectomy: No longer desire pregnancy

Question 9

What is the definitive treatment of a Leiomyoma

Answer 9

Hysterectomy

Question 10

What is the most common indication for a hysterectomy

Answer 10

Leiomyoma

Question 11

What is known as an abnormal proliferation of endometrial tissue

Answer 11

Endometrial hyperplasia

Question 12

Can endometrial hyperplasia go to cancer? And if so what kind?

Answer 12

Yes, Endometrial cancer

Question 13

What hormone can cause endometrial hyperplasia

Answer 13

It is due to unopposed estrogen, there is no progesterone to balance out the estrogen

Question 14

What is simple endometrial hyperplasia

Answer 14

Abnormal proliferation of both stromal and glandular tissue, basic structure not changed

Question 15

What is complex endometrial hyperplasia

Answer 15

Abnormal proliferation of glandular tissue, abnormal structure with crowding of glands

Question 16

What is atypical simple endometrial hyperplasia

Answer 16

Abnormal proliferation of both stromal and glandular tissue, basic structure not changed + atypia-large nuclei hyperchromatic

Question 17

What is atypical complex endometrial hyperplasia

Answer 17

Abnormal proliferation of glandular tissue, abnormal structure with crowding of glands + atypia-large nuclei hyperchromatic

Question 18

60 y/o women presents to you with abnormal bleeding. On exam the uterus feels enlarged and on US you find 6mm of thickness of endometrium. What is the next best step

Answer 18

Possibly cancer or endometrial hyperplasia need an endometrial biopsy to diagnose

Question 19

What is the treatment of endometrial hyperplasia

Answer 19

Progestin for simple

Hysterectomy if atypia present due to high rate of possible cancer

Question 20

When do you want to repeat an EMB after starting Progestin for endometrial hyperplasia

Answer 20

3 months

Question 21

What is the most common type of endometrial cancer

Answer 21

Adenocarcinoma

Question 22

What is the most common GYN cancer

Answer 22

Endometrial cancer

Question 23

What can reduce the risk of developing endometrial cancer

Answer 23

OCP

Question 24

What is the most common symptom of endometrial cancer

Answer 24

Abnormal bleeding typically post-menopausal

Question 25

How do you diagnose endometrial cancer

Answer 25

EMB

Question 26

Where is endometrial cancer most likely to spread to

Answer 26

Direct extension downward to cervix and outward through myometrium

Question 27

What is the treatment of endometrial cancer

Answer 27

Total hysterectomy and bilateral salpingo-oophorectomy with peritoneal cytology and LN sampling

Question 28

What is the presence of endometrial tissue in any extrauterine site

Answer 28

Endometriosis

Question 29

Where is endometriosis most commonly found

Answer 29

Ovaries

Question 30

What can endometriosis lead to

Answer 30

Scarring and adhesions

Question 31

When is endometriosis seen most likely age wise

Answer 31

Reproductive years

Question 32

Name the dx. 38 y/o G0P0 female comes to you with pelvic pain. Patient stated that she has a lot of pain with intercourse and her pelvic pain is getting worse. On exam you find uterosacral nodularity and otherwise the pelvic exam is normal.

Answer 32

Endometriosis

Question 33

How do you confirm the diagnosis of endometriosis

Answer 33

Endometrial tissue biopsy

Question 34

What is the treatment for endometriosis

Answer 34

NSAIDS and OCP's for pain

Question 35

What is the most definitive treatment of endometriosis

Answer 35

TAH-BSO

Question 36

What is irregular bleeding unrelated to anatomic lesions of the uterus

Answer 36

Anovulatory uterine bleeding

Question 37

What is due to the high levels of estrogen without progesterone, so the endometrium will continually grow leading to irregular bleeding

Answer 37

Anovilatory uterine bleeding

Question 38

What will you find if you check a patient with anovilatory uterine bleeding, progesterone during the literal phase

Answer 38

Will be low because she is not ovulating

Question 39

What is the treatment for anovulatory uterine bleeding

Answer 39

Progesterone for 10-14 days | OCP

Question 40

What is it called if you have pain with menstruation

Answer 40

Dysmenorrhea

Question 41

What kind of dysmenorrhea has no underlying pathology

Answer 41

Primary Dysmenorrhea

Question 42

What kind of dysmenorrhea is associated with an underlying pathology

Answer 42

Secondary dysmenorrhea

Question 43

What disorder is due to increased prostaglandins during menses and causing uterine contractions

Answer 43

Dysmenorrhea

Question 44

During what time of the menses does dysmenorrhea normally occur

Answer 44

1st and 2nd day of menses

Question 45

Do you want to suspect primary or secondary dysmenorrhea if onset is well after menarche

Answer 45

Secondary, primary will normally be within 1-2 years of menarche

Question 46

What is the treatment for dysmenorrhea

Answer 46

NSAIDS-start them 1-2 days before period OR | OCP's

Question 47

What is the constellation of sx that recur 4 days prior to onset of menses and stop within 4 days after the start of menses

Answer 47

Premenstrual syndrome

Question 48

Name the dx. A 28 y/o female presents to you because she is tired of feeling bloated, breast pain, irritatbilty, fatigue and food cravings around the time of her period. THis is beginning to severely affect her life and she wants something to be done.

Answer 48

Premenstrual Syndrome

Question 49

How do you treat a patient with premenstral syndrome

Answer 49

No single treatment Patient education: good diet and exercise OCP's or NSAIDS for pain SSRI if mood symptoms

Question 50

What is a severe form of PMS

Answer 50

Premenstrual dysphoric disorder

Question 51

Name the dx. A patient comes to you with mood swings, and sudden sadness around the time of her period. She has food cravings, difficulty concentrating, feeling overwhelmed, tired, and has breast tenderness. This normally all goes away a few days after her period starts. What is the diagnosis and treatment of this patient

Answer 51

Premenstral dysphoric disorder Treat with SSRI (Fluoxetine, Paroxetine, Sertiline) OR OCP's which inhibit ovulation and reduce sx.

Question 52

Your patient comes to you who has premenstral dysphoric disorder. SHe is currently taking an SSRI daily for this disorder. She wants to know if there is anyway she can just take the SSRI a couple times a month rather than everyday because the side effects are starting to bother her some. Is this possible to do and if so when can she take it?

Answer 52

The patient can just take in during the luteal phase of her cycle (so day 14-start of next cycle)