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Women's Health > Benign & Neoplastic Vulvar & Ovarian Disease > Flashcards

Benign & Neoplastic Vulvar & Ovarian Disease Flashcards

1
Q

Presentation

a. Post-menopause
b. Pruritis +/- dysuria, dyspareunia
c. Doesn’t go away

A

Lichen Sclerosis

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2
Q

Lichen Sclerosis is associated w.

A

SCC > melanoma

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3
Q

i. Sharp, “Cellophane Paper” white plaques
ii. Fragility: purpura, erosions
iii. Begins periclitorally, not seen in hair bearing areas

A

Lichen Sclerosis

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4
Q

Dx of Lichen Sclerosis

A

vulvar punch bx

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5
Q

Tx of Lichen Sclerosis

A

Topical Ultrapotent Steroid Ointment: Temovate 0.05%

+/- topical estrogen

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6
Q

Pt. p/w

b. Acute unilateral labial swelling
c. Pain, dyspareunia

A

Bartholin Cysts

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7
Q

Tender fluctuant labial mass with erythema/edema

+/- abscess w. fever, cellulitis

A

Bartholin Cysts

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8
Q

Tx for Bartholin Cysts

A

I & D + Word Catheter +/- abx

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9
Q

Pt. p/w

a. Burning, stinging, raw or stabbing sensation
b. Introital/vestibular pain
c. No underlying pathology

A

Vulvodynia

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10
Q

Dx of Vulvodynia

A

Q-tip to see if pain limited to vestibule

Digital exam for spasm/tenderness

non-specific vestibular erythema

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11
Q

VINd or VINu?

a. Younger women
b. HPV

A

VINu

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12
Q

2 Sxs of VINu

A

a. Mostly asxs

b. Vulvar burning/pruritis

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13
Q

colposcopy w. 5% acetic acid shows color from gray to white or red to black on lesion only

A

VINd and VINu

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14
Q

3 medical options to tx VINu

A

(off-label uses)

i. 5FU
ii. Interferon
iii. Imiquimod 5%

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15
Q

3 surgical options to tx VINu…

A

i. CO2 laser
ii. Wide excision
iii. Vulvectomy

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16
Q

how often does VINu recur?

A

30-50%

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17
Q

VINu or VINd?

a. SCC
b. Lichen Sclerosis
c. Older women

A

VUNd

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18
Q

Where is VINd confined to?

A

lower 1/3 of epithelium

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19
Q

Tx for VINd…

A

surgical excision

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20
Q

age distro of vulvar CA

A

i. 20-40 (VINu) and 60-70 (VINd)

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21
Q

Main Sx of Vulvar CA…

A

pruritis

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22
Q

What type of vulvar CA?

cauliflower lesions or small ulcerative lesions w. hyperkeratosis

A

SCC

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23
Q

What type of vulvar CA?

raised, rolled borders + ulcerated center

A

BCC

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24
Q

Tx of vulvar CA

A

Surgical Removal + Inguinal Node Dissection

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25
Q

Pt. p/w…

a. Hx of HPV
b. Lesions in upper 1/3 of vagina

A

VAIN

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26
Q

Dx of VAIN (2)

A

Pap Smear

Colposcopy

27
Q

Tx of VAIN 1

A

observation + testing q 6 mo

28
Q

Tx of VAIN 2/3

A

Vaginectomy > laser > 5FU (last line)

29
Q

MC type of vaginal CA

30
Q

Vaginal CA results in mets from…

A

Mets from endometrium, ovary, cervix

31
Q

MC presentation of vaginal CA? (3)

A

a. Asxs

b. Leukorrhea, odor

32
Q

Tx of vaginal CA

A

Vaginectomy + radiation

33
Q

Pt. p/w:

a. Infertility: Oligo/Amenorrhea, Anovulation
b. Acne
c. Hirsutism

34
Q

Rotterdam criteria for PCOS requires 2 of what 3 sxs?

A

i. Oligomenorrhea
ii. Hyperandrogenism
iii. Polycystic ovaries

35
Q

On US, you see…

i. > 12 follicles
ii. String of Pearls
iii. 2-9 cm diameter

36
Q

to evaluate PCOS, you must get a total testosterone. If it is elevated, what 6 labs should you also get?

A

a. 17-OH Progesterone (r/o adrenal hyperplasia)
b. DHEA
c. Cortisol (r/o cushings)
d. Prolactin (should be normal)
e. TSH (r/o hyperthyroid)
f. B-HCG

37
Q

3 tx options for PCOS

A

a. Weight Loss
b. COCs
c. Metformin only if hyperinsulinemia + clomid

38
Q

Benign or Malignant Adnexal mass?

a. Thick septations
b. Solid appears nodular or papillary
c. + blood flow

39
Q

Which type of ovarian cyst?

MC types

2-8 cm diameter

Regress after 1-2 cycles

A

follicular

40
Q

Which type of ovarian cyst?

3-11 cm

Blurred borders on US due to blood accumulation

Resolves after 1-2 cycles

A

Corpus luteum

41
Q

Which type of ovarian cyst?

Elevated chrionic gonadotropin

Bilateral

Clear, straw colored fluid

A

Theca Lutein

42
Q

Tx for theca lutein cyst?

A

tx underlying d/o

43
Q

Pt. p/w:

Pelvic Pain, urinary frequency, back pain

Pelvic mass on bimanual

A

Mature Teratoma

44
Q

Are mature teratomas benign or malignant?

45
Q

US reveals unilateral, complicated ovarian cyst

A

mature teratoma

46
Q

Labs for tumor markers?

A

CEA, CA-125, AFP, BHCG

47
Q

Tx for mature teratoma

A

a. Laparotomy vs laparoscopy

48
Q

Pt. p/w below ovarian cyst…

a. 30-50 yo
b. Lined w. columnar epithelium, secretes mucin
c. Thin walled, uni or multilocular
d. 5 to over 20 cm

A

serous/mucinous cystadenoma

49
Q

Tx for serous/mucinous cystadenoma

A

surgical excision and path

50
Q

2nd MC gynecologic CA

MC gyn CA death

A

Ovarian CA

51
Q

Major RF for ovarian CA…

A

Increased menses

nulliparity, early menarche, late menopause

52
Q

2 options to reduce risk of ovarian CA…

A

COCs

Bilateral salpingectomy

53
Q

Pt. p/w…

Pleural Effusion
Bowel Obstruction
Ascites
inguinal LAD
adnexal mass
A

ovarian CA

54
Q

Are the below sxs indicative of acute or subacute ovarian CA?

bloating
early satiety
pain
bleeding
altered bowel habits
55
Q

Which type of ovarian CA is likely?

elevated CA 125

A

epithelial ovarian CA

56
Q

Which type of ovarian CA is likely?

elevated HCG, AFT, LDH

A

Germ Cell Ovarian CA

57
Q

Imaging for ovarian CA (6

A

US +/- CT, Mammogram, Colonoscopy, MRI, CXR

58
Q

Which type of ovarian CA?

a. Older pts.
b. Bilateral
c. Assoc. w. High Grade Serous papillary CA

A

epithelial

59
Q

Which type of ovarian CA?

a. 20-30 yo
b. Unilateral
c. Elevated HCG, AFP, LDH

60
Q

MC type of Germ Cell Ovarian CA…

A

Dysgerminoma

61
Q

an immature teratoma is a ____ type of ____ CA

A

malignant

germ cell ovarian CA

62
Q

Which type of Sex Cord Stromal Ovarian CA?

i. Hyperestrogenism
ii. 5th decade of life

A

Granulosa Cell

63
Q

Which type of Sex Cord Stromal Ovarian CA?

i. Hyperandrogenism
ii. 3-4th decade of life

A

Sertoli-Stromal

Women's Health (10 decks)

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