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Senior - OB 3 > 12 - Benign Gyn Disorders > Flashcards

12 - Benign Gyn Disorders Flashcards

1
Q

Describe the normal cycle for breast epithelial cells

A

Proliferate during luteal phase

Breast fullness and tenderness in the week preceding menses

Undergo programmed cell death at the ends of the luteal phase

Estrogen and progesterone levels decline

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2
Q

What happens to breast lobules at menopause?

A

They involute and are replaced with fat

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3
Q

Fibroadenomas are composed of:

A

Glandular and cystic epithelial structures surrounded by a cellular stroma

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4
Q

What is the MC breast mass ID’d in adolescence?

A

Fibroadenomas

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5
Q

When are fibroadenomas most frequently found?

A

Premenopausal women

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6
Q

Galactorrhea

A

Expressible nipple discharge - common, probably not a big deal

Spontaneous nipple discharge (galactorrhea) - must evaluate!

Commonly 2/2 prolactinoma or hypothyroidism (long list slide 15)

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7
Q

MC organism for mastitis?

- what’s a girl to do?

A

Staphylococcus

Keep breastfeeding or pumping

If sxs don’t improve rapidly with ABX, get US to r/o abscess

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8
Q

Nonpuerperal mastitis?

A

Uncommon

Image and bx to r/o inflammatory breast CA

Peripheral abscess? I and D and ABX

Subareolar abscess? Duct excision / removal of sinus tracts

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9
Q

Two main categories for breast pain

A

Cyclic or noncyclic

If it’s noncyclic -> more concerning…frequently a simple cyst, but COULD BE CA

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10
Q

How does vulvar dz most commonly present?

A

Itching

  • but the working diagnosis is CANCER so get a biopsy if you see something
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11
Q

Lichen sclerosis

  • definition
  • presentation/sx
  • dx
  • tx
A

Post-menopausal women

Hormones/genetics/AI/we dont know

INFLAMMATION of the dermis

Pruritus, irritation, vulvar thickening

Burning, dyspareunia

CELLOPHANE paper appearance of gentle stretching of skin

May need to bx if suspicious lesions

Txt - minimize irritation, topical ‘roids - if severe, retinoids or phototherapy

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12
Q

Lichen simplex chronicus

  • cause
  • txt
A

2/2 chronic irritation - intense itch-scratch cycle

Excoriations - skin responds by thickening

Txt - eliminate the trigger, sitz baths, benadryl, wear cotton gloves at night, topical steroids

If no resolution in 3 weeks, bx

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13
Q

Red lesions (dermatoses) include:

A

Atopic dermatitis

Contact dermatitis

Psoriasis

Vestibulitis

Lichen planus

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14
Q

Atopic derm

A

Pt will have hx of allergies, eczema

Chronic relapsing course

Topical steroids, immunomodulators, treat the dry skin

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15
Q

Contact derm

A

Usually 2/2 irritant

20% of the time 2/2 allergy

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16
Q

Common vulvar irritants:

A

Slide 34 (review deck)

She mentioned dyes and laundry detergents

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17
Q

Psoriasis

A

Adherent silver scale

T-cell mediated

Stress or menses can exacerbate

Txt - emollients, steroids

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18
Q

Lichen planus

  • definition
  • presentation
A

Uncommon - affects men and women equally, ages 30-60

Autoimmune T-cell disorder

May be drug-induced

Cutaneous and mucosal surfaces

Pt c/o vaginal discharge, pruritus, burning pain, dyspareunia, postcoital bleeding

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19
Q

3 variants of licen planus

A
  1. Erosive (MC and most difficult to treat)
  2. Papulosquamous
  3. Hypertrophic
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20
Q

The 5 p’s of lichen planus?

A

Purple pruritic polygonal papules and plaques

21
Q

Txt for lichen planus

A

Topical steroids

Vaginal hydrocortisone

22
Q

Sxs of intergtrigo

A

Friction / moisture between skin folds

Burning and itching

Longstanding -> hyperpigmentation and verrucous changes

23
Q

Txt of intertrigo

A

Drying agents

Mild topical steroid if inflamed

If infected, txt

Lose some weight

Wear loose-fitting clothing

24
Q

What is the MCC of vaginal irritation after menopause?

  • sxs?
  • txt?
A

Atrophic vaginitis

Sxs - vulvar irritation, clear/yellow or blood-tinged discharge, urinary sxs, dyspareunia

Friable vaginal epithelium, loss of rugae, pale mucosa

Txt - topical estrogen (be careful with unopposed estrogen if uterus still present - if patient has a uterus, CANNOT have unopposed estrogen)

25
Q

Bartholin’s Cyst

  • overview
  • txt
  • risk
A

Reproductive-age women

Painless

No txt necessary if asxs, but women don’t like it, so - I and D plus packing, or Word cath placement, or marsupialization (taking out the whole cyst wall - done only if failed Word catheter)

If over 40yrs, concern for CA (get bx)

26
Q

Bartholin’s abscess

  • cause
  • sxs
  • txt
A

Usually a sequelae of the cyst

Polymicrobial - screen for STD’s

Sxs - severe pain, difficulty walking, sitting, or having sex

Txt - if fluctuant, I and D (immediate relief) and Word cath (if packing unavailable)

ABX if: recurrent OR high risk (i.e. preggo, cellulitis, systemic infx, immunosuppressed)

27
Q

Cervical stenosis

  • definition
  • sxs
  • cause
  • tx
A

Scar tissue contraction or adhesions block the os

Sxs - dysmenorrhea, amenorrhea, infertility

Caused by certain procedures (i.e. LEEP), congenital, or spontaneously

Txt - cervical dilators - vaginal estrogen

If severe - increased risk for infection, uterine distention, dystocia
- 2/2 impeded menstrual flow

28
Q

What cervical diameter is needed to be considered “sufficient” in the setting of cervical stenosis?

A

5mm is sufficient for flow

Less than 2mm associated with retrograde flow

29
Q

Nabothian cysts

  • definition
  • sxs
  • txt
A

Trapped columnar cells that secrete mucus resulting in discrete cyst on cervix

Usually asxs, no txt necessary

If you have to txt, refer for electrocautery or excision

30
Q

Cervical polyp

  • what is it
  • txt
  • dont forget?
A

One of the most common benign cervical neoplasms

Less than 3cm

Txt - if small - grasp with forceps and twist off. If sessile, remove with biopsy forceps, cauterize the base.

Send ALL to pathology

31
Q

What is the MC pelvic tumor in women?

  • describe it
  • sxs
  • dx
  • txt
A

Leiomyomas “fibroids”

Slow-growing, estrogen-dependent benign tumor

Common indication for hysterectomy

Round, rubbery

Sxs - most are asxs - bleeding, sensation of pressure, urinary frequency, pelvic pain, infertility possible

Dx - bimanual exam, US, path

Txt - observe, COCPs, mirena, surg, hysterectomy

32
Q

Adenomyosis

  • what is it
  • who gets it
  • dx
  • txt
A

Nests of endometrial glands and stroma embedded within the muscular uterine wall

Uterus often globally enlarged

Age 40-50 heavy abnormal uterine bleeding

1/3 are asxs

Dx - MRI best, then TVUS, then bx

Txt - hysterectomy

33
Q

Endometrial polyps

  • what
  • who
  • sxs
  • dx
  • txt
A

Overgrowth of endometrium on a stalk

All ages, peaks in 50’s

MC sxs - metrorrhagia (intermenstrual bleeding)

Dx - TVUS

Txt - removal if large or symptomatic

34
Q

Functional cyst syndrome

  • size
  • sxs
  • dx
A

> 3cm

Pelvic pain, dull sensation, heaviness, hemorrhage

Dx - bimanual exam, US

35
Q

MC benign ovarian neoplasm type?

A

Epithelial

36
Q

Benign cystic teratoma

A

Dermoid cyst

Single most common ovarian neoplasm

Risk of torsion

37
Q

Txt for premenopausal ovarian cysts 5-7cm (simple, benign qualities)

A

TVS repeated in 6-12 weeks

If over 7cm, MRI or surgical evaluation

38
Q

Txt for postmenopausal ovarian cysts 1-5cm (simple, benign qualities)

A

CA125 level - if normal, TVS in 6-12 weeks

If over 7cm, MRI or surgical eval

39
Q

25% of ovarian torsion cases occur during:

50-80% of cases have?

A

Pregnancy

Ovarian mass

40
Q

Risk factor for ovarian torsion:

A

Large (>6cm) ovaries - rise up out of the confines of the pelvic bones where they’re more likely to twist

41
Q

Presentation of ovarian torsion

A

Sudden onset progressive sharp lower abdominal pain

Low-grade fever suggests necrosis

N/V

Can mimic ectopic

42
Q

Txt for ovarian torsion

A

Salvage if possible

Resect tumor or cyst

Possible oophoropexy

If necrosis or rupture with hemorrhage - remove adnexal structures

43
Q

Fibrocystic changes

A

Palpably nodular breast tissue or to the
histologic pattern of dilated ducts and acini
invested with dense collagenous stroma

Not a breast CA risk by itself

Benign, characterized by hyperplasia

Pain and tenderness, usually premenstrual

Txt with less caffeine, chocolate, supportive bra

44
Q

Slide 14

A

Lots of causes galactorrhea

45
Q

Slide 77-78

A

Ovarian cyst txt guidelines - chart

46
Q

Indications for surgical interventions in leiomyomas?

A

Rapid enlargement

Severe pelvic pain or secondary dysmenorrhea

Abnormal uterine bleeding with anemia

Urinary tract symptoms

Inability to evaluate the adnexa (usually corresponds with fibroid >12 week gestational size uterus)

Growth of fibroid after menopause

Infertility

47
Q

Benign uterine d/o types?

A

Estrogen dependent

  • Leiomyomata - “fibroids”
  • Adenomyosis
  • Endometrial hyperplasia

Non estrogen dependent
- polyp

48
Q

Public cervix announcement

A

Get your pap today

Senior - OB 3 (6 decks)

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