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Spring Round II Exams > WH- Vulvar/Ovarian > Flashcards

WH- Vulvar/Ovarian Flashcards

1
Q

EPITHELIAL ovarian CA

A

elevated CA-125
Bilateral
Older age

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2
Q

GERM cell ovarian CA

A

elevated hcg, AFP, LDH
Unilateral
Younger women

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3
Q

Pruritis

Usually POST menopausal

A

Lichen Schlerosus

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4
Q

if d/t trauma: Kobners phenomenom

sharp, well demarcated plaques

A

Lichen Schlerosus

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5
Q

Cellophane paper is pathognomic for

A

Lichen Schlerosus

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6
Q

Fragility (purpura, erosions, fissures) are hallmark for

A

Lichen Schlerosus

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7
Q

5% risk of Vulvar CA if left untreated bc Hyperkeratotic lesions can be PreCA

A

Lichen Schlerosus

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8
Q

Tx for Lichen Schlerosus

A

Ultrapotent Steroid ointment: Temovate

and Topical Estrogen

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9
Q

Bartholin Cyst

4 and 8oclock

A

1-3 cm
Unilateral acute pain

d/t ductal obstruction

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10
Q

Tx is I and D and insert Word catheter

Culture definitely if POST menopausal bc concerned about CA

A

Bartholin cyst

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11
Q

Empiric tx for Bartholin cyst

A

Keflex or
Doxy

and Sitz bath

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12
Q

Burning
Stinging

Pt is frustrated, hard to treat

A

Vulvodynia

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13
Q

Vulvodynia (burning) tends to occur in what age

A

Peri or Post menopausal

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14
Q

Associations w Vulvodynia

A

Estrogen
Pelvic floor dysfx
Mood/anxiety disorder
Neuro sensitive

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15
Q

Pain is triggered in the Vestibule for what disorder

Q tip test

A

Vulvodynia

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16
Q

Tx options for Vulvodynia (all over the place)

A

Avoid triggers (scents, tight clothes, vigorous exercise)

Sitz bath
Couples counseling
Topical vaginal estrogen w/Testosterone
Pelvic floor Physical Therapy
Nortriptyline
Gabapentin
Local nerve block
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17
Q

Vulvar Intraepithelial Neoplasia (VIN)

A

vinU: usual. younger

VinD: diff. older women

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18
Q

Vin 1 is likely to

A

resolve on its own

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19
Q

Vin U

mostly asymptomatic

A

ALWAYS associated with HPV

Younger women

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20
Q

Vin U

A

Risk factors: smoking, immunosupp, many sex partners

Dx: Vulvar Colposcopy

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21
Q

Vin U tx

A

Surgery is standard of care

Co2 laser- not if invasion is expected, Wide excision, Vulvectomy

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22
Q

Vin U tx

Med options (off label)

A

5FU
Imiquimod (Aldara)cream **
Interferon

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23
Q

What to consider with Vin U and Vin D

A

Vaccinate with Gardisil!!! up to age 45

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24
Q

Vin D

Not related to HPV

A

Lower 1/3 epithelium

Older women who previously had Lichen (untreate)

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25
Vin D etiology
Undiff Carcinogenic agents combined w environment (ie chronically irritated)
26
Tx for Vin D
Handle underlying condition Surgical excision-mainstay tx
27
4th most common GYN CA
Vulvar CA
28
Vulvar CA sx
usually none if any: Prutitis
29
Vulvar CA is uncommon
10% have underlying DM | 50% are obese/HTN
30
Bimodal peak of Vulvar CA
younger 20-40 (vinU related) older 60-70 (vinD related)
31
Vulvar CA can present many diff ways squamous, basal, malignant melanome
cauliflower ulcers rolled border raised, dark lesion
32
Tx for Vulvar CA
Complete surgical removal with Inguinal node dissection | radiation if lymph spread
33
VIN
vulvar neoplasia
34
VAIN
vaginal neoplasia
35
VAIN HPV must be present
upper 1/3 of vagina extremely rare 35-55 YO
36
Dx of VAIN
Pap smear | Colposcopy
37
Tx of VAIN
type 1: observe | type 2/3: Surgical vs Chemo (vaginectomy, laser, topical 5FU/chemo)
38
If someone has VAIN, likely
pre-existing or coexisting squamous CA of vulva or cervix
39
VAIN takes longer to develop (HPV must be present) because
the vaginal tissue is different and HPV prefers the cervix
40
Vaginal CA usually arises from
METs from: endometrium, breast, or cervix can only be called Vaginal CA if this is the primary site
41
Vaginal CA
abnormal d/c (leukorrhea) vaginal odor post coital bleed Acetowhite changes Punctation
42
Tx of Vaginal CA
no standard since its so rare Combined Vaginectomy and Radiation
43
Most common type of Vaginal CA
Squamous cell
44
PCOS
``` Infertility Oligo/Amenorrhea Acne Hirsutism Acanthosis nigricans ```
45
PCOS
Hyperinsulinemia
46
The following must be present to dx PCOS
Oligomenorrhea High androgen (+ polycystic ovaries as well for Rotterdam criteria)
47
Following must be excluded when dx PCOS
Hyperprolactin CAH (congenital) Cushings
48
What to start w when testing for PCOS
Testosterone if normal: dx confirmed if elevated: need to r/o other causes
49
US shows String of pearls
PCOS
50
Tx for PCOS
Weight loss!!! Metformin Birth control-COC Provera (if dont want birth control, this is Prog to protect uterus)
51
NIH and | Rotterdam
criteria for PCOS
52
Concerning signs of CA in Adnexal Masses
Solid part looks Nodular or Papillary Thick septation Blood flow to solid part
53
Signs that Adnexal mass is prob BENIGN
``` thin walled <3 cm if pre meno <1 cm if post meno hyperechoic w distal shadowing (teratoma) curvilinear pattern (hemorrhagic cyst) homogenous echo ```
54
Most common type of ovarian cyst
Follicular failure to release ovum or failure of leftover part to break down regresses after 1-2 cycles
55
Corpus luteum cyst
Just blood if the extra blood doesnt resorb after ovulation and corpus luteum is >3cm, considered cyst regresses after 1-2 cycles
56
Theca Lutein cyst
Bilateral | Usually seen during infertility tx when ovary is being Hyperstimulated
57
Fluid is clear and straw colored in what type of ovarian cyst
Theca Lutein
58
Originate from primordial germ cells Unilateral arise from Ectoderm usually Unilateral, hypoechoic
Mature teratoma
59
Gel like mucous Mucinous>serous women 30-50 YO can look bad on US, need to remove to be sure its Benign AND to avoid torsion
Serous/Mucinous Cystadenoma in the ovary
60
Tx of Serous/Mucinous cystadenoma
Surgical excision
61
2nd most common GYN CA
Ovarian CA
62
Highest incidence of Ovarian CA is age
65-75
63
Risk factors of Ovarian CA
Basically having menses for longer Nulliparity Early menses Late menopause
64
Ovarian CA sx
Acute sx: Pleural effusion Bowel obstruction ``` Subacute: Adenxal mass Bloating Abd distension Early satiety Abn vaginal bleed Altered bowel habit ```
65
Dx of Ovarian CA
Transabdominal/Vaginal US
66
Epithelial ovarian CA
CA-125 marker
67
Germ Cell ovarian CA
hCG AFP LDH
68
Tx of Ovarian CA
Bilateral tubal ligation Low fat diet Bilateral salpingectomy
69
Most common type of Ovarian CA
Epithelial: High grade serous
70
Epithelial CA
Older age | Bilateral
71
High grade serous CA
p53 gene Fallopian tube CA starting here
72
Germ cell CA
Younger age | Unilateral
73
Germ Cell Ca
grow RAPIDLY lymph spread YOUNG women- 20-30 YO hCG, AFP, LDH
74
Sex cord and Stromal ovarian CA
Granulosa cell (most common) causes Hyperestrogen --> precocious puberty or Post meno bleeding

Spring Round II Exams (10 decks)

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