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06 - absite > chapter 40: gynecology > Flashcards

chapter 40: gynecology Flashcards

1
Q

ligament: allows anteversion of the uterus

A

round ligament

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2
Q

ligament: contains uterine vessels

A

broad ligament

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3
Q

ligament: contains ovarian artery, nerve, and vein

A

infundibular ligament

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4
Q

ligament: holds cervix and vagina

A

cardinal ligament

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5
Q

very good at diagnosing disorders of the female genital tract

A

ultrasound

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6
Q

when can you see pregnancy on ultrasound?

A

6 weeks

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7
Q

beta-HCG: gestational sac

A

1,500

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8
Q

beta-HCG: fetal pole

A

6,000

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9
Q

abortion: 1st trimester bleeding, closed os, positive sac on ultrasound and no heartbeat

A

missed abortion

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10
Q

abortion: 1st trimester bleeding, positive heartbeat

A

threatened

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11
Q

abortion: tissue protrudes through os

A

incomplete

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12
Q

(life threatening) - acute abdominal pain; positive beta-hcg, negative ultrasound for sac; can have missed period, vaginal bleeding, hypotension

A

ectopic pregnancy

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13
Q

risk factors for ectopic pregnancy

A

previous tubal manipulation
pid
previous ectopic pregnancy

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14
Q

why is ectopic pregnancy life threatening?

A

significant shock and hemorrhage can occur

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15
Q

dysmenorrhea, infertility, dyspareunia

- can involve the rectum and cause bleeding during menses

A

endometriosis

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16
Q

what will endoscopy show in endometriosis involving the rectum?

A

endoscopy shows blue mass

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17
Q

most common site of endometriosis

A

ovaries

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18
Q

tx: endometriosis

A

OCPs

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19
Q
  • has increased risk of infertility and ectopic pregnancy
  • pain, nausea, vomiting, fever, vaginal discharge
  • most commonly occurs in the first half of the menstrual cycle
A

pelvic inflammatory disease

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20
Q

risk factors: pid

A

multiple sexual partners

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21
Q

dx: pid

A

cervical motion tenderness, cervical cultures, positive gram stain

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22
Q

tx: pid

A

ceftriaxone, doxycycline

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23
Q

complications: pid

A

persistent pain, infertility, ectopic pregnancy

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24
Q

pid: vesicles

A

HSC

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25
Q

pid: condylomata

A

HPV

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26
Q

pid: positive dark-field microscopy, chancre

A

syphilis

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27
Q

pid: diplococci

A

gonococus

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28
Q
  • rupture of graafian follicle
  • causes pain that can be confused with appendicitis
  • occurs 14 days after the 1st day of menses
A

mittelschmerz

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29
Q

1 primary vaginal cancer

A

squamous cell CA

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30
Q

can cause clear cell CA of vagina

A

DES (diethlstilbestrol)

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31
Q

rhabdosarcoma that occurs in young girls

A

botryoides

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32
Q

tx: used for most cancers of vagina

A

XRT

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33
Q

elderly, nulliparous, obese; usually unilateral

A

vulvar cancer

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34
Q

tx:

A

WLE and ipsilateral inguinal node dissection

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35
Q

tx: > 2cm (stage 2 or greater)

A

radical vulvectomy (Bilateral labia) with bilateral inguinal dissection, posted XRT if close margins (

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36
Q

premalignant lesion in vulvar cnacer

A

paget’s VIN 3 or higher

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37
Q

define VIN

A

vulvar intra-epithelial neoplasia

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38
Q

leading cause of gynecologic death

A

ovarian cancer

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39
Q

abdominal or pelvic pain; change in stool or urinary habits; vaginal bleeding

A

ovarian cancer

40
Q

decreases risk of ovarian cancer

A

OCPs, bilateral tubal ligation

41
Q

increases risk of ovarian cancer

A

nulliparity, late menopause, early menarche

42
Q

types of ovarian cancer (x8)

A

.1. teratoma

  1. granulosa-theca
  2. sertoli-leydig
  3. struma ovarii
  4. choriocarcinoma
  5. mucinous
  6. serous
  7. papillary
43
Q

ovarian CA: estrogen secreting, precocious puberty

A

granulosa-theca

44
Q

ovarian CA: androgens, masculinization

A

Sertoli-Leydig

45
Q

ovarian CA: thyroid tissue

A

struma ovarii

46
Q

ovarian CA: beta-hcg

A

choriocarcinoma

47
Q

worst prognosis in ovarian CA

A

clear cell type

48
Q

Ovarian CA: stage 1

A

one or both ovaries only

49
Q

ovarian CA: stage 2

A

limited to pelvis

50
Q

ovarian CA: stage 3

A

spread throughout abdomen

51
Q

ovarian CA: stage 4

A

distant metastases

52
Q

stage ovarian CA: bilateral ovary involvement

A

stage 1

53
Q

mc initial site of regional spread in ovarian CA

A

other ovary

54
Q

how does debulking tumor help in ovarian CA?

A

can be effective; including omentectomy (helps chemo and XRT)

55
Q

tx: ovarian CA

A

total abdominal hysterectomy and bilateral oophorectomy for all stages, plus:

  • pelvic and para-aortic LN dissection
  • omentectomy
  • 4 quadrant washes
  • chemotherapy (Cisplatin and paclitaxel (taxol))
56
Q

chemotherapy: ovarian CA

A

cisplatin and paclitaxel (Taxol)

57
Q

stomach CA that has metastasized to ovary

- pathology classically shows signet ring cells

A

krukenberg tumor

58
Q

pelvic ovarian fibroma that causes ascites and hydrothorax

- excision of tumor cures syndrome

A

meige’s syndrome

59
Q

most common malignant tumor in female genital tract

A

endometrial cancer

60
Q

risk factors: endometrial cancer

A

nulliparity, late 1st pregnancy, obesity, tamoxifen, unopposed estrogen

61
Q

vaginal bleeding in postmenopausal patient

A

endometrial CA until proven otherwise

62
Q

chance of malignancy in uterine polyps

A

very low chance of malignancy (0.1%)

63
Q

polyps: worst prognosis in endometrial cancer

A

serous and papillary subtypes

64
Q

stage 1 endometrial cancer: tx

A
  • endometrium

- tx: TAH and BSO or XRT

65
Q

stage 2 endometrial cancer: tx

A
  • cervix

- TAH and BSO or XRT

66
Q

stage 3 endometrial cancer: tx

A
  • vagina, peritoneum, and ovary

- TAH and BSO and XRT

67
Q

stage 4 endometrial cancer: tx

A
  • bladder and rectum

- TAH and BSO and XRT

68
Q

where does cervical cancer go first?

A

obturator nodes

69
Q

what is cervical cancer associated with?

A

HPV 16 and 18

70
Q

most common cervical cancer

A

squamous cell CA

71
Q

location: stage 1 cervical cancer

A

cervix

72
Q

location: stage 2 cervical cancer

A

upper 2/3 of vagina

73
Q

location: stage 3 cervical cancer

A

pelvis, side wall, and lower 1/3 of vagina; hydronephrosis

74
Q

location: stage 4 cervical cancer

A

bladder and rectum

75
Q

tx: cervical cancer - microscopic disease with basement membrane invasion

A

cone biopsy (conization sufficienct to remove disease)

76
Q

tx: stages 1 and 2a cervical cancer

A

total abdominal hysterectomy (TAH)

77
Q

tx: stages 2b and 4

A

XRT

78
Q

tx postmenopausal ovarian cyst:

septated, has increased vascular flow on Doppler, has solid components, or has papillary projections

A

oophorectomy with intraoperative frozen sections; TAH if ovarian cancer

79
Q

tx postmenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections

A

follow with ultrasound for 1 year -> if persists or gets larger -> oophorectomy with intraoperative frozen sections; TAH if ovarian CA

80
Q

tx premenopausal ovarian cyst:

septated, has increased vascular flow on Doppler, has solid components, or has papillary projections

A

oophorectomy with intraoperative frozen sections usual: algorithm becomes very complicated, weighing aggression of cancer (based on histology and stage at time of operation) compared with whether the pt desires future pregnancy

81
Q

tx premenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections

A

can follow with ultrasound; surgery if suspicious findings appear

82
Q

management: incidental ovarian mass at the time of laparotomy for another procedure

A

biopsy mass, 4 quadrant wash, biopsy omentum, look for metastases and biopsy.

  • if original procedure elective (Eg gastric bypass), may need to abort procedure depending on findings
  • do not perform oophorectomy
83
Q

tx: abnormal uterine bleeding:

A

clomiphene citrate

84
Q

tx: abnormal uterine bleeding:

A

GnRH agonists (leuprolide)

85
Q

tx: abnormal uterine bleeding

> 40 years old - cancer or menopause

A

need biopsy

86
Q

contraindications to estrogen therapy

A

endometrial CA, thromboembolic disease, undiagnosed vaginal bleeding, breast CA

87
Q

can present as progressively heavier menses

A

uterine endometrial polyp

88
Q

under hormonal influence; recurrent abortions, infertility, bleeding

A

uterine fibroids (leiomyomas)

89
Q

most common vaginal tumor

A

invasion from surrounding or distant structure

90
Q

malignancy risk with partial mole; complete mole is of paternal origin
- treatment?

A

hydatidiform mole

- tx: chemo (methotrexate)

91
Q

fever, erythema, diffuse desquamation, nausea, vomiting; associated with highly absorbent tampons

A

toxic shock syndrome

92
Q

tx: ovarian torsion

A

remove torsion and check for viability

93
Q

tx: adnexal torsion with vascular necrosis

A

adnexectomy

94
Q

tx: ruptures tuboovarian abscess

A

percutaneous drainage

95
Q

dx / tx: ovarian vein thrombosis

A

dx: CT scan
tx: heparin

96
Q

can lead to ovarian vein, IVC, and hepatic vein thrombosis, get liver failure with ascites after pregnancy
- tx: heparin and antibiotics

A

postpartum pelvic thrombophlebitis

06 - absite (44 decks)

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