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OB/GYN > CaseFiles_4 > Flashcards

CaseFiles_4 Flashcards

1
Q

If a patient has hypothalamic dysfunction, will a progestin challenge cause her to bleed?

A

No! Without estrogen, there won’t be any endometrium to shed.

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2
Q

The postmenopausal hypoestrogenic state is associated with pH that is (greater/less) than 4.5 and a thin and atrophic vulvar and vaginal epithelium.

A

Greater! (alkaline)

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3
Q

What is the most common way ovarian cancer kills? What is the most common way cervical cancer kills?

A

Ovarian cancer –> cachexia (starvation) as a result of widespread bowel metastasis

Cervical cancer –> bilateral ureteral metastases leading to uremia

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4
Q

Breast cancer that is her2/neu positive tends to be (more/less) aggressive.

A

more

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5
Q

Be less aggressive with cervical dysplasia in younger patients less than age ___.

A

25

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6
Q

When is NST not reliable?

A

When there is an absence of accelerations and decelerations

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7
Q

How do you treat lichen sclerosis?

A

Corticosteroid treatment (Clobetasol)

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8
Q

Between lichen planus and lichen sclerosis, which usually presents in the vagina?

A

licehn planus

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9
Q

How can lichen sclerosis lead to dyschezia?

A

Scratching can lead to constriction of the anus. It can also cause to narrowing/closure of the vaginal introitus

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10
Q

What is “marsupialization” and what is it used for?

A

Surgical fixation of an inflamed Bartholin cyst wall everted against hte mucosa of the vulva (just like incision and placement of a small balloon catheter, it allows drainage of the infection for several weeks).

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11
Q

Why should a Bartholin gland infection be biopsied in a woman over 40?

A

can be associated with cancer

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12
Q

Hyperthyroidism can be caused by a benign cystic teratoma containing thyroid tissue, called

A

struma ovarii

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13
Q

What is the most common type of ovarian malignancy? What is its most common subtype?

A

epithelial ovarian tumor. Arises from outer layer of the ovary; usually occurs in older women. The serous subtype is most common (and more often bilateral!). Mucinous –> pseudomyxoma peritonei. BRCA1 or 2

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14
Q

What is the second most common type of ovarian neoplasm, and which is its most common subtype?

A

germ cell ovarian tumor. The most common subtype is dermoid cyst (contains all three germ cell layers. If mature, benign; if immature, malignant).

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15
Q

Why should you always ultrasound the other ovary if a dermoid cyst is found?

A

they can be bilateral 10-15% of the time

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16
Q

What determines the grade of malignant teratomas?

A

The quantity of immature neural elements

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17
Q

How does struma ovarii present on MRI?

A

complex multilobulated masses with thick septa (like large thyroid follicles)

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18
Q

What common tumor marker is elevated in most epithelial ovarian tumors?

A

CA-125

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19
Q

What is the treatment of epithelial tumors?

A

Surgical staging with maximum removal (debulking) and combination chemotherapy, esp. with a platinum agent (cisplatinum or carboplatinum) and taxane!

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20
Q

How do sex cord stromal tumors appear on ultrasound?

A

solid

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21
Q

In general, any adnexal mass greater than ___ cm in size is likely to be a tumor and should be excised.

A

10

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22
Q

Any adnexal mass less than ___ cm in size in reproductive women suggests a functional cyst.

A

5 cm. Note: this should be excised in menopausal women and not just observed.

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23
Q

What is the mean age of presentation of cervical cancer?

A

51 years

24
Q

Why do women with cervical cancer have malodorous discharge?

A

result of a large necrotic tumor

25
Q

Why might women with cervical cancer have flank tenderness?

A

metastasis obstructing the uterues

26
Q

What are risk factors for cervical cancer?

A

multiparity, cigarette smoking, history of STD, early age of coitus, multiple sexual partners, HIV infection

27
Q

What is a radical hysterectomy?

A

removal of the uterus, cervix, proximal vagina, and supportive ligaments including the uteroscaral ligament and cardinal ligament (contains uterine arterine and vein, connects cervix to lateral wall)

28
Q

What is radiation brachytherapy?

A

Radioactive implants placed near the tumor bed

29
Q

What is radiation teletherapy?

A

External beam radiation where the target is distanced from the radiation source

30
Q

What usually characterizes the severity of cervical cancer?

A

the vascular pattern (mild = punctuated (end-on), while atypical = corkscrew and hairpin)

31
Q

What type of chemotherapy is used for cervical cancer?

A

Platinum based (like cisplatin) to sensitize the tissue to radiotherapy (used as “radiosensitizer,” esp in patients with flank tenderness or lew swelling which indicates advanced cancer)

32
Q

When does screening for cervical cancer start? When can it stop?

A

Starts q2y at age 21; can be extended to every 3 years if 3 negative tests by 30; stops at age 65 to 70 after 3 negative tests and no abnormal tests in the last 10 years.

33
Q

What about cervical cancer screening in patients with hysterectomy?

A

Not recommended in patients who had hysterectomy for benign reasons; Pap smear of vaginal cuff still needed for hysterectomy performed for cervical dysplasia (CIN III)

34
Q

What is done for cervical cancer if a woman desires children??

A

Radical trachelectomy (removal of cervix and upepr vagina while leaving the uterus)

35
Q

For patients with advanced cervical cancer, which is better: radiotherapy or surgical therapy?

A

Radiotherapy! However, radical hysterectomy an preserve sexual function while radiotherapy may cause closure of vagina due to vaginal agglutination

36
Q

Finding of ASCUS on HPV testing is followed up by an HPV test in which women?

A

Over age 25! (before age 25 = likely to resolve and may be observed)

37
Q

If a patient has a history of cervical dysplasia, how often should they have pap smears?

A

yearly

38
Q

What are risk factors for endometrial cancer?

A

obesity, diabetes (!! you always forget!), hypertension, prior anovulation (irregular menses), late menopause, nulliparity

39
Q

If endometrial sampling is negative for cancer, what is another cause for postmenopausal bleeding?

A

atrophic endometrium or endometrial polyp

40
Q

An endometrial thickness greater than ___ mm is abnormal in a postmenopausal woman.

A

4

41
Q

How is Type II endometrial cancer different from Type I?

A

Type II = atypical; papillary or clear cell, estrogen-independent, late menopausal women, thin patients, regular menses, MORE AGGRESSIVE

42
Q

What is the most common etiology of postmenopausal bleeding? But what must be ruled out?

A

atrophic endometritis. BUT endometrial carcinoma must be ruled out in any patient with postmenopausal bleeding.(because endometrial malignancy can coexist with atrophic changes)

43
Q

What is the most common female genital tract malignancy?

A

endometrial carcinoma

44
Q

What type of cancer(s) does atypical glandular cells on a Pap smear indicate?

A

cervical, endometrial, or ovarian!

45
Q

For stage I endometrial cancer, what is the appropriate therapy?

A

Surgical. Radiation therapy when strong suspicion of spread; chemotherapy when metastasis is revealed

46
Q

What are the 3 Ds of endometriosis?

A

dysmennorhea, dyspareunia, dyschezia

47
Q

What is the difference between primary and secondary infertility?

A

Primary: never been able to get pregnant. Secondary: pregnant in the past, but 1 year unable to conceive

48
Q

How is “fecundability” defined?

A

probability of achieving pregnancy within one menstrual cycle (20-25% for a normal couple)

49
Q

What percentage of couples should conceive after 12 months?

A

90%

50
Q

How do you test for ovulatory dysfunction?

A

Basal body temperature (biphasic; rise of temperature after ovulation, compared to lower temp before) or LH surge or testing of ovarian reserve (day 3 FSH or AMH testing)

51
Q

What is the test for a uterine disorder interfering with fertility?

A

Hysterosalpingoram (performed between days 6 and 10 in cycle)

52
Q

If you suspect tubal factors for infertility, what should you do to confirm? WHat is the therapy?

A

HSG, then laparoscopy to confirm. In vitro fertilization.

53
Q

T/F: THe majority of women with tubal factor infertility have no history of STIs.

A

True. Due to the asymptomatic nature of the infections

54
Q

How do you confirm endometriosis? How ts it treated?

A

Laparoscopy and then use it for ablasion/excision

55
Q

What are the five basic etiologies of infertility?

A

1) ovulatory; 2) uterine, 3) tubal, 4) male factor, 5) peritoneal factor (endometriosis)

OB/GYN (6 decks)

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