Week 4 pt 1 highlights

Question 1

Examination of the cervix using a microscope to identify cervical, vaginal and vulvar pathology is called what?

Answer 1

Colposcopy

Question 2

What is a LEEP Biopsy (Loop Electrosurgical Excisional Biopsy)?

Answer 2

Removes section of cervix for biopsy

Question 3

Colposcopy: the cervix is washed with a 3% to 4% _________________ solution, which dehydrates cells, causing those with large nuclei (i.e., those undergoing metaplasia, potential neoplastic change, or HPV infection) to appear ___________ .

Answer 3

acetic acid; white

Question 4

Colposcopy: Lesions usually appear with relatively discrete borders near the _________ within 10 to 90 seconds of acetic acid application. Tissue samples for biopsy can be collected

Answer 4

SCJ

Question 5

Cone biopsy of cervix:
1) Abnormal changes in the cells on the surface of the cervix is calledwhat?
2) Usually performed under what?

Answer 5

1) cervical dysplasia.
2) general or regional anesthesia.

Question 6

Potential D&C findings:
1) A precancerous condition in which the uterine lining becomes too thick is called what?
2) What are 2 other potential findings?

Answer 6

1) Endometrial intraepithelial hyperplasia
2) Uterine polyps or uterine cancer

Question 7

What is the only absolute contraindication to D&C?

Answer 7

A desired viable pregnancy

Question 8

List the 3 types of hysterectomy and specify which is most common

Answer 8

1) Total (leaves ovaries; most common)
2) Hysterectomy with oophorectomy
3) Radical hysterectomy

Question 9

HSG (hysterosalpingography): Radiographically (xray procedure) evaluates the patency/shape of the uterus and _______________

Answer 9

fallopian tubes

Question 10

What is the most common indication for the use of laparoscope in gyn?

Answer 10

Tubal sterilization

Question 11

Pelvic ultrasounds can be performed 3 ways; list them

Answer 11

1) Transabdominal
2) Transrectal
3) Transvaginal (TVUS)

Question 12

There are two types of hydatidiform mole, what are they?

Answer 12

1) Complete
2) Partial

Question 13

What do trophoblasts develop into?

Answer 13

A large part of the placenta

Question 14

True or false: complete & incomplete hydatidiform moles are always non-cancerous

Answer 14

True

Question 15

Recite the Gestational Trophoblastic Disease flow chart

(important)

Answer 15

Question 16

The most common form of GTD is called what?

Answer 16

Hydatidiform mole (molar pregnancy)

Question 17

A _____________ hydatidiform mole develops when a sperm fertilizes an “empty” egg (contains no nucleus or DNA).

Answer 17

complete

Question 18

Complete hydatidiform mole:
1) All genetic material comes from the ___________ sperm SO _____ fetal tissue.
2) Usually _______ karyotype

Answer 18

1) father’s; no
2) 46,XX

Question 19

Complete hydatidiform mole: 15-20% may transform into what?

Answer 19

Choriocarcinoma, a malignant form of GTD.

Question 20

GDT complete mole
1) What does all material come from? Is there fetal tissue?
2) What is the karyotype?

Answer 20

1) Father’s sperm SO no fetal tissue.
2) Usually 46,XX karyotype

Question 21

A _____________ hydatidiform mole develops when two sperm fertilize a normal egg.

Answer 21

partial

Question 22

GTD: Partial Mole
1) Is there fetal tissue?
2) Is there are viable fetus being formed?
3) Are they malignant?

Answer 22

1) Some fetal tissue.
2) RARE that a viable fetus is being formed.
3) Partial moles rarely develop into malignant GTD.

Question 23

True or false: partial moles rarely develop into malignant GTD.

Answer 23

True

Question 24

True or false: With partial moles, it is RARE that a viable fetus is being formed.

Answer 24

True

Question 25

What type of mole contains some fetal tissue?

Answer 25

A partial hydatidiform mole

Question 26

Molar pregnancy: Symptoms 1) Almost all women (97%) with _____________ hydatidiform moles have irregular vaginal bleeding during pregnancy. 2) Bleeding typically starts during the first trimester, often between the ______ and the ________ week of pregnancy. 3) Occasionally, pass pieces of the moles resembling what?

Answer 26

1) complete 2) 6th and the 16th 3) Bunch of grapes (or a snowstorm)

Question 27

Molar pregnancy: List some symptoms other than bleeding

Answer 27

1) Abdominal swelling 2) Vomiting 3) Painless 1st-2nd trimester bleeding 4) Preeclampsia (HTN, proteinuria, possible hyperreflexia) 5) Potentially signs of metastasis

Question 28

1) What is different about preeclampsia in a molar pregnancy? 2) Severe HTN before 20 weeks is suggestive of what?

Answer 28

1) Can occur during the first or second trimester 2) Molar pregnancy

Question 29

Molar Pregnancy/ GTD: Work-Up should include what? Describe each part

Answer 29

1) Urine hCG + 2) Quantitative hCG: excessively elevated for gestational age 3) Transvaginal Ultrasound (TVUS): “bunch of grapes” or “snowstorm” appearance 4) Baseline CXR to check for mets 5) CBC, T&S, clotting function studies

Question 30

What is the main Tx for molar pregnancy?

Answer 30

Prompt evacuation of the uterine contents via D&C or hysterectomy

Question 31

Molar pregnancy/ GTD Tx: After Tx, you should monitor weekly ______ hCG levels to make sure levels fall to _______(may take 6 months) then monthly for at least a _______.

Answer 31

serum; zero; year

Question 32

Molar pregnancy/ GTD Tx: 1) What should you provide to pts who are Rh negative? 2) What should you provide to all pts? 3) What should you do if levels plateau or rise after falling?

Answer 32

1) Rh immunoglobulin. 2) Reliable contraceptive method 3) Chemotherapy (high cure rates)

Question 33

GTD/ molar pregnancy Tx: When is Hysterectomy +/- chemo an option?

Answer 33

If not interested in preserving fertility

Question 34

___________ GTD is a locally invasive tumor of the myometrium.

Answer 34

Invasive

Question 35

True or false: Invasive GTD category includes GTD not cured by D&C.

Answer 35

True

Question 36

~150-200/1000 cases of ______________ molar pregnancy develop trophoblastic disease that keeps growing after the mole is removed (20%)

Answer 36

complete

Question 37

~50/1000 cases of ___________ molar pregnancy develop trophoblastic disease (5%)

Answer 37

partial

Question 38

*Persistent (or invasive) mole diagnosed if what?

Answer 38

Quant hCG decreases but then levels off or starts to rise again (never gets to zero)

Question 39

What cancerous form of GTD is NOT sensitive to chemo and must be completely removed by surgery?

Answer 39

Trophoblastic Tumor (aka Placental Site Tumor)

Question 40

If you have a concern about persistent GTD, your first step should be what?

Answer 40

to order a quant hCG

Question 41

Risks for Persistent GTD: List 3 risks

Answer 41

1) Long time (more than 4 months) between the time menses stopped and treatment started 2) Woman > 40yo and < 21yo 3) Fam Hx of GTD (possible genetic component?)

Question 42

What form of GTD secretes very small amounts of hCG so better followed by **human placental lactogen levels**?

Answer 42

Trophoblastic Tumor(aka Placental Site Tumor)

Question 43

Persistent GTD: What are the 2 steps of Dx & Treatment?

Answer 43

1) Reexamination 2) Chemotherapy

Question 44

Nonmetastatic persistent GTD treated by _______________ chemotherapy (i.e., methotrexate)

Answer 44

single-agent

Question 45

A malignant form of GTD is called what?

Answer 45

Choriocarcinoma

Question 46

Choriocarcinoma: 1) Is it common? 2) What does it most often develop from? 3) When can it also occur? 4) What is more common in this condition?

Answer 46

1) Rare 2) Complete hydatidiform mole 3) Normal pregnancy or one where the fetus is lost early in pregnancy.  4) Metastasis

Question 47

True or false: Choriocarcinoma is usually not diagnosed promptly

Answer 47

True

Question 48

Choriocarcinoma: 1) Where can it occur? Is it aggressive? 2) What is the issue with this cancer? 3) What will indicate the Dx? 4) What pt should be evaluated with hCG testing to exclude a new pregnancy or GTN?

Answer 48

1) Anywhere in the body and is a very aggressive cancer. 2) Very invasive and destroys the tissue; bleeds profusely. 3) A simple pregnancy test that is positive after d&c or without visible pregnancy 4) Abnormal bleeding for more than 6 weeks after any pregnancy

Question 49

What should you evaluate for with choriocarcinomas?

Answer 49

Metastasis

Question 50

True or false: Choriocarcinoma is highly sensitive to chemotherapy

Answer 50

True

Question 51

1) What is the rare form of GTD that develops where the placenta attaches to the uterus called? 2) When does it usually develop? 3) Do most of these spread?

Answer 51

1) Trophoblastic Tumor(aka Placental Site Tumor) 2) A normal pregnancy or spontaneous abortion (miscarriage). 3) No