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ENRP Exam 1 > Benign Conditions Uterus, Cervix, Ovary, Fallopian Tubes - Dr. Moulton > Flashcards

Benign Conditions Uterus, Cervix, Ovary, Fallopian Tubes - Dr. Moulton Flashcards

1
Q

Didelphysis is what and caused from

A

2 uterus bodies with their own cervix and 1 fallopian tube and 1 vagina
= paramesonephric ducts dont fuse

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2
Q

Septate uterus happens from

A

midline fusion of paramesonephric ducts does not dissolve

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3
Q

no mullarian duct formed causes

A

unicornuate uterus

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4
Q

mother exposure to what can cause anomalies

A

Diethylstilbestrol (DES) = T shaped endometrium cavity, cervical collar deformity

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5
Q

Uterine Leiomyomas are what other name

  1. what are they and who
  2. sx
  3. risks
A

FIBROIDS

  1. benign tumor from SM (myometrium) proliferation (usually high E), 5th decade F
  2. asymptomatic only can cause (uterine bleeding, pelvic P / pain, infertility)
  3. AA, age, no pregs, FH
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6
Q

Fibroids = uterine leiomyomas feel like what, enlarge when, calcify when

A
  1. rubbery solid ball,
  2. pregnancy, can also degenerate during preg and cause pain
  3. postmenopausal calcification
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7
Q 
Types of Fibroids, what thy mean :
Subserosal 
Intramural 
Submucosal
Cervical 
Intraligamentous
A
  1. Subserosal = under uterine serosa, can at times attach to Bowel BF, loosing uterine connection
  2. Intramural = myometrium fibroids
  3. Submucosal = endometrium fibroids, can go through cervix (PROLONGED heavy menstrual bleeding)
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8
Q

paracytic fibroid

A

when a subserosal fibroid attached to bowel and disconnects from uterus

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9
Q
  1. heavy menstrual bleeding happens from what 2 fibroids

2. infertility usually from what fibroid

A
  1. intramueral + submucosal

2. submucosal

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10
Q

size of fibroid is said how + when palpating how to know its a fibroid

A
  1. week size (preg size at that week is how you name the enlargement of fibroid and uterus)
  2. it moves with the cervix
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11
Q

imaging of fibroid

A

US (lateral vs adnexal)

adnexal = next to uterus (on fallopian tube or ovary)

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12
Q

TX fibroids

A
  1. oral contraceptives (E +P) * first line*
  2. Depo-Provera, Mirena Intrauterine System (P only)
  3. Depo-Lupron (GnRH agonist) = decreases 40% in 30 mo fast, usually before surgery**
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13
Q

5 surgeries for TX Leiomyomas

A
  1. Hysteroscopic Myomectomy = submucosal
  2. Laparoscopic / robotic myomectomy = pedunculated, subserosal, intramural
  3. Endometrial ablation
  4. Uterine A Embolism = fibroid necrosis + painful
  5. Hysterectomy = definitive tx
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14
Q

uterine A embolism is done how

A

inject microspheres/polyvinyl alcohol particles through the femoral A –> uterine A

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15
Q

Myomectomy IMPORTANT to know for pts who have had this and are pregnant

A

CAN ONLY DO C-SECTION (if endometrial cavity was entered during surgery = to avoid contractions)

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16
Q

Myomectomy success

A

usually gets rid of them however 25% grow back

= if too much is removed then surgeon does hysterectomy

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17
Q

endometrial polyps are what

  1. sx
  2. what to do with them
  3. imaging
A

benign hyperplasia soft friable protrusions into endometrial cavity

  1. heavy bleeding, postmenopausal bleeding
  2. hysteroscopy removal and sent to pathology = check for cancer invasion or benign
  3. sampling usually miss these, US saline + hysterosonography/ hysteroscopy**
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18
Q

Nabothian Cervical Cyst

  1. looks like
  2. are what
  3. histo and how it forms
A
  1. yellow or blue tint on opaque (white)
  2. Squamous metaplasia (superficical squamous epithelium entraps columnar cells under
  3. columnar cells inside secrete mucous and cause cyst to grow
19
Q

Cervical polyp

  1. most common 2 types
  2. what are they
  3. sx
  4. what to do with them
A
  1. Endocervical**, + Ectocervical
  2. benign growths
  3. heavy bleeding or none
  4. remove and send to path (rare to invade)
20
Q

Endocervical Polyps rate + color

Ectocervical polyp rate + color

A
  1. most common, beefy red

2. not as common, pale color

21
Q

Endometrial Hyperplasia can be cused by what 5 things **

A
  1. unopposed E (no preg, long mestruating period in life)
  2. PCOS, anovulation
  3. granulosa theca cell tumor = makes E
  4. obesity (leptin)
  5. Tamoxifen (increase E in endometrium, lowers in breasts)
22
Q

Endometrial Hyperplasia is precursor to

A

endometrial carcinoma

23
Q

Endometrial Hyperplasia classified by what and 4 types they classify into risks of carcinoma progression

A

WORLD HEALTH ORG. CLASSIFICATION

  1. Simple + no atypia = 1%
  2. Simple + no atypia = 3%
  3. Simple + Atypia = 9%
  4. Complex + Atypia = 27%
24
Q

Endometrial Hyperplasia

  1. sx
  2. DX how
  3. TX
A
  1. heavy or prolonged bleeding, esp if during menopause (any spotting)
  2. Embx sample endo., + US (if 4mm or thicker in postmenopausal endometrium** KNOW THIS**)
  3. no atypia —> PROGESTIN and resample in 3mo
    Atypia —> hysterectomy
25
Q

abnormal ovarian development is usually associated with

A

not having an XX baby 1. (45XO Turner syndrome) 2. (46XY complete androgen insensitivity syndrome, testicular feminization) = male looks like female

26
Q

Turner Syndrome SX

A

ovarian streaks, secondary sexual characteristics entering menopause after

27
Q

Complete androgen insensitivity syndrome

  1. important thing to do
  2. sx
A
  1. remove gonads after puberty = can turn malignant

2. X androgen receptors = male looking like female

28
Q

fallopian tube developmental problem usually happens from

A

DES (short clubbed)

29
Q

Follicular Cysts

A

when ovarian follicle dies not rupture , lined by granulosa cells

30
Q

Corpus Luteum Cysts

A

corpus luteum becomes cystic (larger 3cm) and does not regress after 14days

31
Q

Hemorrhagic cysts

A

PAIN

hemorrhage in corpus luteum cyst (2-3 days after ovulation)

32
Q

Polycyctic Ovaries

A

enlarged ovaries with many simple follicles

33
Q

Theca-Lutein Cyst happen how and from what + TX

A
  1. high hCG levels
  2. preg, choriocarcinoma, hydatiform molar preg
  3. TX : regress when gonadotropin levels fall
34
Q

Luteoma of Pregnancy

  1. caused by
  2. looks like
  3. what to do with this
A
  1. hyperplastic reaction of theca cells in ovary (from high hCG)
  2. red/brown
  3. DONT surgically remove, regresses postpartum*
35
Q

Polycystic Ovarian Cyst

  1. associated with what 3 conditions
  2. looks like on what imaging
A
  1. chronic anovulation
  2. hypreandrogenism
  3. insulin resistance

= large ovaries with many follicles arrested in min-antral stage on US

36
Q

Polycystic Ovarian Cyst happens how

A
  1. high LH = androgen secretion from thecal cells = androstenedione + testosterone ovarian derived INCREASE
  2. high androgens —-> Estrogen elevation —-I FSH (chronic E exposure**)
37
Q

antral follicle

A

graffian follicle, teritary follicle (6-12 normal amount)

38
Q

Functional Ovarian Cysts (follicular, corpus luteual, hemorrhagic, PCOS, theca-lutein, luteoma of preg)

  1. sx
  2. DX
  3. manage
  4. risk
A
  1. asymptomatic, regress usually in next cycle
  2. US after 6 weeks (At next cycle), bimanual exam to see it also
  3. *asympto +premenopausal = Oral contraceptives (lower hCG) + repeat US
  • sx and premenopausal = RULE out ectopic, torsion, tubo ovarian abscess
    4. can grow and cause torsion
39
Q

Benign neoplastic ovarian tumores 3 types

A
  1. epithelial = serous, mucinous, brenner, clear cell
  2. sex cord stroma tumors = fibroma, s-l cell, granulosa-theca cell
  3. germ cell tumors = benign cystic teratoma
40
Q

mucinous ovarian tumors resemble what lining

A

endocervical epithelium

41
Q

endometrioid ovarian tumors resemble what lining

A

endometrium

42
Q

serous ovarian tumors resemble what lining

A

fallopian tubes

43
Q

most common epithelial ovarian tumor

  1. what type is it usually
  2. tx
  3. histo
A

Serous cystadenoma

  1. benign (25% malignant)
  2. cystectomy, oophorectomy, hyst with bilateral oophorectomy (depening on fertility desire)
  3. psammoma bodies (usually in malignant)
44
Q

Mucinous cystadenoma

  1. type usually
  2. associated with what
  3. can lead to what rarely
  4. looks like
A
  1. benign
  2. mucocele of appendix
  3. pseudomyxoma peritonei (in bowel benign implants making a bunch of mucus)
  4. jelly in the belly, fillinf pelvis and abdomen

ENRP Exam 1 (13 decks)

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