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obstetric - gynecol STEP 2 > Uterus > Flashcards

Uterus Flashcards

(50 cards)

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1
Q

Adenomyosis - presentation

A
  1. dysmenorrhea
  2. menorrhagia
  3. uniformly enlarged, soft, globular uterus
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2
Q

Adenomyosis - treatment

A
  • only hysterectomy is definitive treatment

- GnRH agonists

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3
Q

adenomyosis - definition / age

A
  • invasion of endometrial glands into the myometrium

- women 35-50

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4
Q

adenomyosis - RF

A
  1. endometriosis

2. uterine fibrinoids

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5
Q

adenomyosis - diagnosis / physical findings

A

diagnosis: it is clinical / MRI is the most accurate test. hysteroctomy for definitive diagnosis
examination: large globular and boggy

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6
Q

soft and tender uterus - MC?

A

adenomyosis

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7
Q

endometriosis - epidimiology

A

women in reproductive age and is MORE COMMON if a FIRST DEGREE RELATIVE (mother or sister) has

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8
Q

endometriosis - symptoms presentation

A

cyclic pelvic pain that starts 1 to 2 weeks before menstruation and peaks 1 to days before. The pain end with menstruation.
Abnormal bleeding is common
dysmenorrhea and dyspraeunia are also common

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9
Q

endometriosis - physical exam

A

tenderness of the recto-vaginal area, tenderness withh movement of the uterus, thickening of the uterosacral ligaments caused by endometrial implants on the recto-vaginal septum, pelvic peritoneum, anterior and posterior cul-de-sac, and uterosacral ligaments

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10
Q

endometriosis - diagnosis (and appearance)

A

can be made only by direct visualization via laparoscopy. It looks like rusty or dark brown lesions. On the ovary, a cluster of lesions called an endometrioma looks like a chocolate cyst

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11
Q

endometriosis - treatment

A
  1. analgesia (NSAID)
  2. OCPs to iterrupt the menstrual cycle and stop ovaluation (mild symptoms)
  3. danazole or leuprolide to decrease FSH/LH (moderate to severe pain)
  4. surgical treatment (severe symptoms or infertility)
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12
Q

Danazole - mechanism of action and SE

A

androgen derivative that is associated with acne, oily skin, weigh gain, hirsutism

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13
Q

surgery on endometriosis - purpose

A

attempts to remove all endometrial implants and adhesion, and to restore pelvic anatomy. Patients who have completed their childbearing may undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy

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14
Q

DDX of dysmenorrhea

A
  1. 1ry desmenorrhea
  2. endometriosis
  3. fibroids
  4. adenomyosis
  5. pelvic congestion
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15
Q

tenderness and nodularity in theposterior cul-de-sac

A

endometriosis

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16
Q

Dysmenorrhea?

A

pain with menses

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17
Q

Dysmenorrhea - DDX

A
  1. Primary
  2. endometriosis
  3. Fibroids
  4. Adenomyosis
  5. pelvic congestion
  6. pelvic infection
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18
Q

1ry desmenorrhea - treatment

A

NSAID

Hormonal contraception

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19
Q

pelvic congestion syndrome

A

dull and ill-defined pelvic ache –> worsens prior to menstruation or with long periods of sanding and is relieved by mense
- also it is often associate with history of sexual problems

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20
Q

menorrhagia - description

A
  • heavy and prolonged menstrual bleeding (more than 80 ml or more than 7 days)
  • Gushing of blood
  • clots may be seen
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21
Q

menorrhagia - etiology

Study These Flashcards
A
  1. endometrial hyperplasia
  2. uterine fibroids
  3. Dysfunction uterine bleeding
  4. intrauterine device
22
Q

hypomenorrhea - description

Study These Flashcards
A
  • light menstrual flow

- my only have spotting

23
Q

hypomenorrhea - etiology

Study These Flashcards
A
  • obstruction (hymen, cervical stenosis)

- oral contraceptive pills

24
Q

metrorrhagia - description

Study These Flashcards
A

inter-menstrual bleeding

25
metrorrhagia - etiology
1. endometrial polyps 2. endometrial/cervical cancer 3. exogenous estrogen administration
26
menometrorragia - etiology
1. endometrial polyps 2. endometrial/cervical cancer 3. exogenous estrogen administration
27
oligomenorrhea - description
menstrual cycles smaller than 35 days
28
oligomenorrhea - etiology
1. pregnancy 2. menopause 3. signif weight loss (anorexia) 4. Tumor secreting estrogens
29
abnromal uterine bleeding - diagnostic test
1. CBC (for Hb and Hct) 2. PT/PTT to evaluate for coagulation disorders 3. Pelvic US (for anatomic abnormalities)
30
Dysfunctional uterine bleeding - ovaluation (mechanism)
the ovary produces estrogen but no corpus lateum --> no progesteron --> this prevents the usual withdrawal bleeding --> the continuously high estr continues to stimulate growth of the endometrium --> bleeding occurs only once the endometrium outgrows the blood supply
31
Dysfunctional uterine bleeding - diagnostic tests
1. rule out systemic reasons for anovulation, such as hypothyroid and hyperprolactinemia 2. endometrial biopsy for women over 35 (for CA)
32
Dysfunctional uterine bleeding - treatment
1. OCP: 1. adolescents and young women who are anovulatory 2. Women over 35 who have normal biopsy 2. in acute hemorrhage: Dilation and Curettage is done to stop the bleeding 3. IF SEVERE --> endometrial ablation or hysterectomy
33
Dysfunctional uterine bleeding is severe if
1. patients are anemic 2. hemorrhage are not controled by OCPs 3. patients report that their lifestyle is compromised
34
evaluation of 2ry amenorrhea
amenorrhea for menses for 3 or more cycles or 6 or more months: HCG? positive --> pregnancy negative --> if prior uterine procedure or infection do hysteroscopy, if no, check prolactin, TSH, FSH
35
Leiomyoma (fibrinoid) - pathophysiological characteristic
Estrogen sensitive --> increased tumor size in pregnancy and decreased with menopause
36
Leiomyoma (fibrinoid) - presentation
1. asymptomatic 2. abnormal uterine bleeding 3. miscarriage 4. iron deficiency anemia (if severe bleeding)
37
fibroid - the best imaging modality to diagnose
U/S of pelvis
38
urinary stress incontinence can be a presenting symptom of
fibroids (due to direct pressure on the bladder from an irregularly enlarged uterus)
39
myomectomy - contraindication for labor
if there is uterine cavity entry
40
leiomyoma work-up
leiomyoma work-up
41
anatomic cause of 1ry amneorrhea
imperforate hymen
42
prolapsing leiomyoma
firm smooth round mass at the cervical os consistent with an aborting submucous myoma --> labor like pain due to mechanical cervical dilation
43
fibroids - treatment
asymptomatic: observation symptomatic: OCP, surgery
44
fibroids - clinical features
1. heavy prolonged menses 2. pressure symptoms 3. obstetric complications (impaired fertility, pregnancy loss, preterm labor) 4. enlarged, irregular uterus
45
Endometrial hyperplasia - definition/mechanism/complications
- abnormal endometrial gland proliferation usually caused by excess estrogen stimulation - high risk for endometrial carcinoma - nuclear atypia is greater risk factor than complex (vs simple)
46
Endometrial hyperplasia - presentation
postmenopausal vaginal bleeging
47
Endometrial hyperplasia - risk factors
1. anovulatory cycles 2. hormone replacement therapy 3. polycystic ovarian sydrome 4. granulosa cell tumor
48
endometrial carcinoma - risk factors
1. prolonged use of estrogen without progestins 2. obesity 3. diabetes 4. hypertension 5. nulliparity 6. late menopause 7. Lynch syndrome
49
endometrial biopsy - indications
- 45 or older: abnormal uterine bleeding, postmenopausal bleeding - younger than 45: abnormal uterine bleeding PLUS: unopposed estrogen (obesity, anovulatio) or failed medical management or Lynch syndrome - 35 or older: atypical glandular cells on Pap
50
endometrial hyperplasia / cancer - treatment
hyperplasia: progenstin therapy or hysterectomy cancer: hysterectomy

obstetric - gynecol STEP 2 (22 decks)

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