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obstetric - gynecol STEP 2 > vagina - cervix > Flashcards

vagina - cervix Flashcards

1
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - when

A

begin when women are in their 20-30

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2
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - symptoms

A
  1. headache
  2. breast tenderness
  3. Pelvic pain and bloating
  4. irritability and luck of energy
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3
Q

premestrual syndrome (PMS) vs premestrual dysmophic disorder (PMDD)

A

PMDD is a more severe vesrion that will disrupt the patient’s daily activities

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4
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - diagnostic tests

A
  • no tests
  • PMDD has DSM-V diagnostic criteria
  • tha patient chart her symptoms
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5
Q

premestrual dysmophic disorder (PMDD) - diagnostic criteria

A
  1. symptoms should be present for 2 consecutive cycles
  2. symptoms-free period of 1 week in the first part of the cycle (follicular phase)
  3. symptoms must present in the second half of the cycle
  4. Dysfunction in life.
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6
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - treatment

A

patient should decrease consumption of caffeine, alcohol, cigarettes and chocolate and should exercise.
IF SEVERE SYMPTOMS –> SSRI

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7
Q

Menopause starts with …. (presentation)

A

it starts with irregular menstrual bleeding. Women are symptomatic for an average of 12 months, but some women can experience symptoms for years

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8
Q

Menopause starts with …. (mechanism)

A

the occytes produce less estronege and progesterone, and both LH and FSH start rise

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9
Q

symptoms of menopause - next step

A

check TSH and FSH

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10
Q

OCPs for vasomotor symptoms

A

in women younger tha n60 who have undergone menopause within the past 10 years

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11
Q

Pap test - how often

A

begenning at age 21, repeat evry 3 years. at 30, pap test with HPV co-testing may be done and repeated every 5 years

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12
Q

when to stop Pap testing

A

age 65 or hysterectomy
PLUS no history of cervical intraepithelial neoplsia 2 or higher
AND 3 conscecutive negative Pap tests
OR 2 consecutive negative co-testing terults
(if intraepithelial neoplasia 2 –> 20 more years)

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13
Q

Cerivical cancer - management of advanced Cerivical cancer

A

CLEAR: perform a hysterectomy

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14
Q

prevention of cervical ca

A
  1. HPV vaccine to all women between 11-26
  2. pap smear starting at 21. Repeat the test every 3 years until 65.
    (of women with fatal Cerivical cancer, 85% have never a pap smear)
  3. pap and hpv testing increase the interval to 5 years
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15
Q

detection of cervical ca

A
  1. low grade and high grade dysplasia on Pap tsmear is followed up with a colposcopy for biopsy
  2. atypical squamous cells of undetermined significance (ASCUS) can be a sign of early, preinvasive cancer or an infection, or may simply be a false positive
  3. IF ASCUS –> perform HPV testing –> hpv (+) –> colposcopy. IF (-) –> pap at 6 months
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16
Q

Pap smear vs mammography vs colonoscopy - mortality

A

pap smear does not lower mortality as the others

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17
Q

Cervical dysplasia and carcinoma - Classification

A

CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extend of dysplasia

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18
Q

cervical dysplasia and carcinoma - pathogenesis

A

HPV 16, 18 –> both produce E6 (inh p53) and E7 (inh RB)

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19
Q

cervical dysplasia and carcinoma - presentation

A
  1. typically asymptomatic (detected with Pap smear - koilocytes)
  2. presents as abnormal vaginal bleeding (often postcoital - after sexual intercourse)
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20
Q

cervical invasive carcinoma - type / Diagnosis / complication

A

often SCC
colposcopy and biopsy
lateranl invasion –> block ureters –> renal failure

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21
Q

cervical dysplasia and carcinoma - Risk factors (MC?)

A
  1. HPV
  2. STD history
  3. immunosuppresion
  4. tovacco
  5. OCPs
  6. early onsert of sexual activity
  7. multiple or high risk sexual partners
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22
Q

postcoital bleeding - etiology

A
  1. cervical cancer
  2. cervical polyps
  3. atrophic vaginitis
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23
Q

postcoital bleeding - diangosis

A

cervical cancer until proven otherwise

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24
Q

cervical conization - indications

A

cervical intraepithelial neoplasia grades 2 + 3

observation is preferred for grade 2 in young women

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25
Q

cervical conization - SE

A
  1. cervical stenosis
  2. preterm birth
  3. preterm premature rupture of membranes
  4. 2nd trimester pregnancy loss
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26
Q

cervical insuf ?

A

PAINLESS dilation of cervix in the 2nd trimester and loss of pregnancy

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27
Q

Genitourinary syndrome of menopause - symptoms

A
  1. vuvlovaginal dryness, irritation, pruritus
  2. dyspareunia
  3. vaginal bleeding
  4. urinary incontinence
  5. recurrent UTI
  6. pelvic pressure
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28
Q

Genitourinary syndrome of menopause - physical examination

A

narrowed introitis
pale mucosa, decreased elasticity
petecheia, fissures
loss of labial volume

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29
Q

High grade squamous intraepithelial lesion in pap –> next step

A

colposcopy

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30
Q

vaginal tumors - types and characteristics

A
  1. SCC: usually 2ry to cervical SCC (rare 1ry)
  2. clear cell adenocarcinoma: Women who had exposure to DES in utero
  3. Sarcoma botryoides: girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina
31
Q

menopause - diagonosis

A
  • amenorrhea for 12 months

- is it is unclear –> High FSH levels are diagnostic

32
Q

labial fusion - definition / mechanism

A
  • labia minora become fused together
  • due to excess androgen (exogen, increased production)
  • MCC: 21-β-hydroxylase deficiency
33
Q

labial fusion - treatment

A

reconstructive surgery

34
Q

vulva and vagina - epithelial abnormalities types

A
  1. lichen sclerosus
  2. squamous cell hyperplasia
  3. lichen planus
35
Q

vulva and vagina - lichen sclerosus - age

A

any age –> however if Postmenopausal there is an increased risk of cancer

36
Q

vulva and vagina - lichen sclerosus - appearance and treatment

A
  • thin white, wrinkled skin over the labia majora/minora, atrophic changes that may extend over the perineum + around the anus / can cause painful defacation
  • excoriations, erosions, fissures from severe pruritus
  • diruria, dyspareunia painful defection
37
Q

squamous cell hyperplasia - age

A

any –> patietns who have had chronic vulvar pruritus

38
Q

squamous cell hyperplasia - treatment

A

Sitza baths or lubricants (relieve pruritus)

39
Q

Liches planus - age

A

prepubertal girls + perimenopausal or postmenopausal women

40
Q

Liches planus - appearance and treatment

A
  • violet flat papules

- topical steroids

41
Q

vulvar lichen sclerosus - treatment

A

superpotent costicosteroid ointment

42
Q

vulvar lichen sclerosus - workup

A

punch biopsy of adult onset lesions to exclude malignancy

43
Q

atrophic vaginitis vs lichen sclerosus regarding treatment

A

atrophic –> low dose topical estrogen

lichen –> high potency topical steroids

44
Q

atrophic vaginitis vs lichen sclerosus regarding clinical features

A

atrophic –> vluvlovaginal dryness, loss of vaginal elasticity/rugae, thinning vulvar skin/loss of minora, decreased vaginal diameter
lichen –> white vulvar plaques/loss of minora/ dryness, pruritus, perianal involvement, spares vagina

45
Q

vaginal SCC - RF / diagnosis

A

RF: HPV 16 + 18, smoking, history of cervical dysplasia or cancer
diagnosis by biopsy

46
Q

vaginal cancer - SCC vs clear cell adeno regarding location

A

SCC: upper 1/3 of posterior wall
clear: upper 1/3 of anterior

47
Q

RF for vaginal SCC

A

HPV

48
Q

Bartholin gland cyst - location

A

lateral sides of the vulva

49
Q

Bartholin gland cyst - presentation

A

secrete mucus and can become obstructed leading to a cyst or abscess that causes:
1. PAIN 2. TENDERNESS 3. DYSPAREUNIA

50
Q

Bartholin gland cyst - physical exam

A

edema and inflammation of the area with a deep fluctuant mass

51
Q

Bartholin gland cyst - treatment

A

if asymptomatic –> nothing
IF SYMPTOMATIC –> incision and drainage –> if continue to recur –> marsupialization
culture the fluid (for STDs)

52
Q

marsupialization?

A

it is a form of incision and drainage in which the open space is kept open with sutures –> this allows the space to remain open, and decreases the risk of a recurrent Bartholin gland cyst

53
Q

cervical mucus secreation

A

close to ovulation –> increases in quantity and can be perceived by patients as vaginal discharge –> mucus is clear, elastic thin and described similar in appearance to an uncooked egg white –> facilitate sperm transport into the uterus

54
Q

Vaginitis - RF

A

any factor that will increase the ph of the vagina

  1. antibiotic use (Lactobacillus normally keeps ph below 4.5
  2. diabetes
  3. overgrowth of normal flora
55
Q

vaginitis - symptoms

A
  1. itching
  2. pain
  3. abnormal odor
  4. discharge
56
Q

types of vaginitis and the pathogen

A

bacterial –> gardenella
candidiasis –> candida albicans
trichomonas –> trichomonas vaginalis

57
Q

types of vaginitis and presentation

A

bacterial –> vaginal discharde with fishy ofor, gray white
candidiasis –> white cheesy vaginal discharge
trichomonas –> profuse, green frothy vagina discharge

58
Q

types of vaginitis and diagnostic test

A

bacterial –> saline wet mount shows CLUE CELLS, ph more than 4.5
candidiasis –> KOH shows PSEUDOHYPHAE, ph 4-4.5
trichomonas –>saline wet mount shos MOTILE FLAGELLATES, ph more than 4.5

59
Q

types of vaginitis and treatment

A

bacterial –> metronidazole or clindamycin
candidiasis –> miconazole or clotrimazole, econazole, nystatin
trichomonas –> treat patient and partner with metronidazole

60
Q

vulva - paget disease - definition / epidimiology

A

intraepithelial neoplasia that MC occurs in POSTMENOPAUSAL CAUCASIAN WOMEN

61
Q

vulva - paget disease - presentation and appearance

A

vulvar soreness and prurritus appearing as RED lesion with a superficial white coating

62
Q

vulva - paget disease - diagnosis

A

biopsy to confirm

63
Q

vulva - paget disease - treatment

A
  • radical vulvectomy for bilateral lesion

- modified vulvectomy for unilateral lesion

64
Q

Squamous cell carcinoma of vulva - presentation

A
  1. pruritus
  2. bloody vaginal discharge
  3. postmenopausal
65
Q

Squamous cell carcinoma of vulva - appearance

A

from small ulcerated lesion to a large cauliflowerlike lesion

66
Q

Squamous cell carcinoma of vulva - diagnosis / how to stage

A

diagnosis: biopsy is essential

staging is done whlie the patient is in surgery

67
Q

Squamous cell carcinoma of vulva - stage

A

0: in situ
I: limited to vaginal wall less than 2 cm
II: limited to vulva or perineum less than 2 cm
III: tumor spreading to lower urethral or anus, unilateral lymph nodes present
IV: tumor invasion into bladder. rectum, or bilateral lymph nodes
IVa: distant metastasis

68
Q

Squamous cell carcinoma of vulva - treatment

A

unilateral lesion without lymph node: modified radical vulvectomy
bilateral lymph node: radical vulvectomy
lymph nodes that are involved must undergo lymphadenectomy

69
Q

vulvar hematoma

A

results from a local trauma and presents as a tender ecchymotic indurated firm mass

70
Q

in contrast to Bartholin cysts, Gartner duct cysts …

A

do not involve the valvula

71
Q

Bartholin cysts present as ….. / treatment

A

soft, mobile, well-circumscribed masses at the base of labia majora and are usually asymptomatic
treatment: observation if asymptomatic, if symptomatic –> incision and drainage

72
Q

Management of CIN3

A

if older than 25 and not currently pregnant –> loop electrosurgical excision procedure or cold Knife conization or cryoablation –> Pap test with HPV 1 and 2 years postprocedure
if pregnant –> colposcopy first

73
Q

Genitourinary syndrome of menopause - treatment

A

vaginal moisturizer + lubricant

vaginal estrogen

obstetric - gynecol STEP 2 (22 decks)

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