Chapter 40 - Gynecology

Question 1

What does the round ligament do?

Answer 1

Allows for anteversion of the uterus

Question 2

What does the broad ligament contain?

Answer 2

Uterine vessels

Question 3

What does the infundibular ligament contain?

Answer 3

Ovarian artery, nerve, vein

Question 4

What does the cardinal ligament do?

Answer 4

Holds cervix and fun box

Question 5

When can you see pregnancy on ultrasound?

Answer 5

Six weeks

Question 6

With what beta hCG is a fetal pole seen?

Answer 6

6000

Question 7

At what hCG is a gestational sac seen?

Answer 7

1500

Question 8

What is a missed abortion?

Answer 8

First trimester bleeding, closed os positive second ultrasound, no heartbeat

Question 9

What is a threatened abortion?

Answer 9

First trimester bleeding, positive heartbeat

Question 10

What is a incomplete abortion

Answer 10

Tissue protrudes through os

Question 11

What is an ectopic pregnancy?

Answer 11

Acute abdominal pain; positive beta hCG, negative ultrasound for sac; missed period, Vaginal bleeding, hypotension

Question 12

What are risk factors for ectopic pregnancy?

Answer 12

Previous tubal manipulation, PID, previous ectopic pregnancy. Shock and hemorrhage can occur from the ectopic pregnancy

Question 13

What are the symptoms of endometriosis and how is it diagnosed?

Answer 13

Dysmenorrhea, infertility, despareuinia Laparoscopy shows blue mass

Question 14

What are the symptoms of pelvic inflammatory disease?

Answer 14

Pain, nausea, vomiting, fever, vaginal discharge. Most commonly occurs in the first half of the menstrual cycle
Risk factors include whoring it up
Cervical motion tenderness, cervical cultures, Gram stain

Question 15

What is mittelschmerz?

Answer 15

Rupture of graafian follicle. Causes pain that can be confused with appendicitis. Occurs 14 days after first day of menses

Question 16

What is the number one type of vaginal cancer?

Answer 16

Squamous cell carcinoma. DES can cause clear cell carcinoma

Question 17

What is botryoides?

Answer 17

Rhabdomyosarcoma of the vagina that occurs in young girls

Xrt

Question 18

What are risk factors for vulvar cancer?

Answer 18

Old, fat, nulliparous
TX: less than 2 cm wide local excision and ipsilateral inguinal node dissection. Greater than 2 cm vulvectomy with bilateral inguinal dissection, postop XRT

Question 19

What is the leading cause of gynecologic death?

Answer 19

Ovarian cancer. Decreased risk with OCP’s and bilateral tubal ligation. Increased risk with nulliparity, late menopause, early monarchy

Question 20

What are the types of ovarian cancer?

Answer 20

Teratoma, granulosa theca, Sertoli leydig storms ovarii, choriocarcinoma, mucinous, serous papillary

Question 21

What type of ovarian cancer has the worse prognosis?

Answer 21

Clear-cell

Question 22

What stage ovarian cancer is bilateral ovaries?

Answer 22

One

Question 23

What is the most common initial site of regional spread of ovarian cancer?

Answer 23

The other ovary

Question 24

What is the treatment for ovarian carcinoma?

Answer 24

Total abdominal hysterectomy and bilateral oophorectomy for all stages. Pelvic and a para aortic lymph node dissection. Omentectomy, four quadrant washes

Question 25

What is the chemotherapy for ovarian cancer?

Answer 25

Cisplatin and paclitaxel

Question 26

What is the stomach cancer that has metastasized to ovary? What is shown on pathology?

Answer 26

Krukenberg tumor. Pathology shows signet rings

Question 27

What is meige's syndrome?

Answer 27

Pelvic ovarian fibroma that causes ascites and hydrothorax

Question 28

What is the most common malignant tumor in female genital tract?

Answer 28

Endometrial cancer

Question 29

What are the risk factors for endometrial cancer?

Answer 29

Nulliparity, late first pregnancy, obesity, tamoxifen, unopposed estrogen

Question 30

What is vaginal bleeding in postmenopausal woman until proven otherwise?

Answer 30

Endometrial cancer

Question 31

What subtypes of endometrial carcinoma have worse prognosis?

Answer 31

Serous and papillary

Question 32

What nodes does cervical cancer go to first?

Answer 32

Obturator nodes

Question 33

What types of HPV are associated with cervical cancer?

Answer 33

16 and 18

Question 34

What is the most common type of cervical cancer?

Answer 34

Squamous cell

Question 35

How do you cervical carcinoma?

Answer 35

Stage 1 and 2A-total abdominal hysterectomy. Stages 2-4 xrt

Question 36

Where the stages of cervical cancer?

Answer 36

One cervix Two upper two thirds of vagina Three pelvis, sidewall, lower one third of vagina, hydronephrosis Four bladder and rectum

Question 37

What do you do with ovarian cysts in a post menopausal patient

Answer 37

If septated, has increased vascular flow on Doppler, has solid components, or has papillary projections-oophorectomy with intraoperative frozen sections; TAH if ovarian CA

Question 38

What do you do with ovarian cyst in a premenopausal patient?

Answer 38

If septated, has increased vascular flow on Doppler, has solid components, or has papillary projections-oophorectomy with intraoperative frozen sections

Question 39

What do you do with an incidental ovarian mass at the time of laparotomy for another procedure?

Answer 39

Postmenopausal-oophorectomy, frozen section, TAH and BSL if ovarian CA Premenopausal patient-complicated

Question 40

What do you do with abnormal uterine bleeding in a patient under 40?

Answer 40

Usually from anovulation. Treat with Medroxyprogesterone. If leiomyomas-GnRH

Question 41

What do you do with abnormal uterine bleeding in a patient older than 40?

Answer 41

Usually from cancer or menopause-need biopsy

Question 42

What are contraindications to estrogen therapy

Answer 42

Endometrial cancer, active thromboembolic disease, Undiagnosed vaginal bleeding, breast cancer

Question 43

What can a uterine endometrial polyp present as?

Answer 43

Progressively heavier menses

Question 44

What is caused by uterine fibroids?

Answer 44

Recurrent abortions, infertility, bleeding | Under hormonal influence.

Question 45

What is the most common vaginal tumor?

Answer 45

Invasion from surrounding or distant structure

Question 46

Appendicitis with pregnancy causes what?

Answer 46

Increased risk of premature labor and fetal mortality

Question 47

What is a hydatidiform mole?

Answer 47

Malignancy risk with partial mole; complete mole is of paternal origin. Treat with methotrexate

Question 48

What do you get with toxic shock syndrome?

Answer 48

Fever, erythema, diffuse desquamation, nausea, vomiting. Associated with highly absorbent tampons (gag).

Question 49

What do you do with ovarian torsion?

Answer 49

Remove torsion and check for viability

Question 50

What do you do with adnexal torsion with vascular necrosis?

Answer 50

Adnexectomy

Question 51

What do you do with ruptured tubo-ovarian abscess?

Answer 51

Drainage

Question 52

How do you diagnose ovarian vein thrombosis?

Answer 52

CT scan. Treat with heparin

Question 53

What do you do with postpartum pelvic thrombophlebitis?

Answer 53

Heparin and antibiotics