Uterine Disorders- Dobbs

Question 1

Discrete, round, firm, often multiple uterine tumor with well-defined border composed of smooth muscle and connective tissue found within the uterus on bi-manual exam

Answer 1

Leiomyoma (uterine fibroid)

Question 2

_______ is the mc presenting symptom of a uterine fibroid

Answer 2

bleeding

Question 3

A patient comes in complaining of pressure or fullness in her pelvis with increased bleeding when she is not on her period. What is the most likely dx?

Answer 3

Uterine fibroid

Question 4

What is the best way to dx a uterine fibroid?

Answer 4

Pelvic u/s

Question 5

What is the treatment for a uterine fibroid?

Answer 5

Depends on how severe it is. Observation, myomectomy, D&C or Depo-provera can be used to stop the bleeding

Question 6

Condition where endomitreal tissue is found outside of the endometrial cavity

Answer 6

Endometriosis

Question 7

On ovaries, you may see “chocolate cysts”

Answer 7

Endometriosis

Question 8

3 D’s:

Answer 8

Dysmenorrhea, dyspareunia, Dyschezia (painful bleeding, painful intercourse, painful stools)

Question 9

How to dx endometriosis?

Answer 9

Tissue bx with labrascopy

Question 10

Treatment for endometriosis?

Answer 10

Depends on the severity of symptoms, location and desire for childbearing

• Expectant (watch and wait)
• NSAIDs for pain
• Can try oral contraceptives to control menses to know when the pain will occur

Question 11

T/F: Pregnancy cures endometriosis?

Answer 11

False preg does not cure endometriosis. It may temporarily improve or worsen symptoms

Question 12

A middle aged woman comes into the clinic with severe dysmenorrhea, hx of childbearing, symmetric enlarged uterus and menorrhagia. What is the most likely dx?

Answer 12

Adenomyosis (this is where the endometrial cells end up in the uterine musculature)

Question 13

How to diagnose Adenomyosis?

Answer 13

Pelvic U/S or MRI

Question 14

Treatment for Adenomyosis?

Answer 14

• NSAID

- Hormones (trying to control hormonal fluctuation to suppress/irregulate menstrual cycle

Question 15

This is a bladder prolapse of the anterior (front) vaginal wall where the bladder dalls towards the vagina and creates a bulge

Answer 15

Cystocele

Question 16

This is a prolapse of the rectum or large bowel

Answer 16

Rectocele (feels full during intercourse- difficulty passing stool)

Question 17

A patient states that she feels vaginal fullness and lower abdominal pain that is worse with prolonged standing and she feels a “falling out sensation.” What could the possible cause be?

Answer 17

Uterine prolapse

Question 18

What grade uterine prolapse is this?

normal- no prolapse

Answer 18

Grade 0 uterine prolapse

Question 19

What grade uterine prolapse is this?

Descent is >1cm above the hymen

Answer 19

Grade 1

Question 20

What grade uterine prolapse is this?

Descent to hymen

Answer 20

Grade 2

Question 21

What grade uterine prolapse is this?

Protrudes, but no less than 2cm total vaginal length

Answer 21

Grade 3

Question 22

What grade uterine prolapse is this?

Total eversion of lower genital tract

Answer 22

Grade 4

Question 23

Uterine prolapse management?

Answer 23

Refer to gyn!

Question 24

Bleeding between periods, bleeding after intercourse, spotting anytime in the menstrual cycle, bleeding heavier for more days than normal and bleeding after menopause. NOrmal?

Answer 24

NO! Abnormal uterine bleeding (AUB)

Question 25

What are structural causes of AUB?

Answer 25

``` PALM Polyp Adenomyosis (when the muscle of the uterus breaks through the uterus) Leiomyoma Malignancy & hyperplasia ```

Question 26

Nonstructural Causes of AUB?

Answer 26

``` COEIN Coagulopathy Ovarian dysfunction Endometrial process Iatrogenic Not yet classified ```

Question 27

What is the gold standard way of figuiring out AUB cause?

Answer 27

hysterocopy (where they look into the uterus)

Question 28

Treatment of AUB?

Answer 28

Primary goal is to determine the underlying cause and resume regular shedding of the endometrium -Could give progesterone or oral contraceptives

Question 29

What FSH and estradiol level is suggestive of menopause?

Answer 29

FSH >30 and estradiol below 20

Question 30

Is postmenopausal bleeding in a woman normal?

Answer 30

No- endometrial cancer until proven otherwise

Question 31

What is the most common cause of postmenopausal bleeding?

Answer 31

The use of exogenous hormones

Question 32

What is the most common type of endometrial cancer?

Answer 32

adenocarcinoma

Question 33

Abnormal uterine bleeding is the cardinal symptom of what disease?

Answer 33

endometrial cancer

Question 34

How to dx endometrial cancer?

Answer 34

U/S and bx **Refer to GYN

Question 35

Treatment for endometrial cancer?

Answer 35

Total hysterectomy with salpingo-oophrectomy because we dont want any chance that we missed anything)