chapter 40: gynecology Flashcards
1
Q
ligament: allows anteversion of the uterus
A
round ligament
2
Q
ligament: contains uterine vessels
A
broad ligament
3
Q
ligament: contains ovarian artery, nerve, and vein
A
infundibular ligament
4
Q
ligament: holds cervix and vagina
A
cardinal ligament
5
Q
very good at diagnosing disorders of the female genital tract
A
ultrasound
6
Q
when can you see pregnancy on ultrasound?
A
6 weeks
7
Q
beta-HCG: gestational sac
A
1,500
8
Q
beta-HCG: fetal pole
A
6,000
9
Q
abortion: 1st trimester bleeding, closed os, positive sac on ultrasound and no heartbeat
A
missed abortion
10
Q
abortion: 1st trimester bleeding, positive heartbeat
A
threatened
11
Q
abortion: tissue protrudes through os
A
incomplete
12
Q
(life threatening) - acute abdominal pain; positive beta-hcg, negative ultrasound for sac; can have missed period, vaginal bleeding, hypotension
A
ectopic pregnancy
13
Q
risk factors for ectopic pregnancy
A
previous tubal manipulation
pid
previous ectopic pregnancy
14
Q
why is ectopic pregnancy life threatening?
A
significant shock and hemorrhage can occur
15
Q
dysmenorrhea, infertility, dyspareunia
- can involve the rectum and cause bleeding during menses
A
endometriosis
16
Q
what will endoscopy show in endometriosis involving the rectum?
A
endoscopy shows blue mass
17
Q
most common site of endometriosis
A
ovaries
18
Q
tx: endometriosis
A
OCPs
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
20
Q
risk factors: pid
A
multiple sexual partners
21
Q
dx: pid
A
cervical motion tenderness, cervical cultures, positive gram stain
22
Q
tx: pid
A
ceftriaxone, doxycycline
23
Q
complications: pid
A
persistent pain, infertility, ectopic pregnancy
24
Q
pid: vesicles
A
HSC
25
pid: condylomata
HPV
26
pid: positive dark-field microscopy, chancre
syphilis
27
pid: diplococci
gonococus
28
- rupture of graafian follicle
- causes pain that can be confused with appendicitis
- occurs 14 days after the 1st day of menses
mittelschmerz
29
#1 primary vaginal cancer
squamous cell CA
30
can cause clear cell CA of vagina
DES (diethlstilbestrol)
31
rhabdosarcoma that occurs in young girls
botryoides
32
tx: used for most cancers of vagina
XRT
33
elderly, nulliparous, obese; usually unilateral
vulvar cancer
34
tx:
WLE and ipsilateral inguinal node dissection
35
tx: > 2cm (stage 2 or greater)
radical vulvectomy (Bilateral labia) with bilateral inguinal dissection, posted XRT if close margins (
36
premalignant lesion in vulvar cnacer
paget's VIN 3 or higher
37
define VIN
vulvar intra-epithelial neoplasia
38
leading cause of gynecologic death
ovarian cancer
39
abdominal or pelvic pain; change in stool or urinary habits; vaginal bleeding
ovarian cancer
40
decreases risk of ovarian cancer
OCPs, bilateral tubal ligation
41
increases risk of ovarian cancer
nulliparity, late menopause, early menarche
42
types of ovarian cancer (x8)
.1. teratoma
2. granulosa-theca
3. sertoli-leydig
4. struma ovarii
5. choriocarcinoma
6. mucinous
7. serous
8. papillary
43
ovarian CA: estrogen secreting, precocious puberty
granulosa-theca
44
ovarian CA: androgens, masculinization
Sertoli-Leydig
45
ovarian CA: thyroid tissue
struma ovarii
46
ovarian CA: beta-hcg
choriocarcinoma
47
worst prognosis in ovarian CA
clear cell type
48
Ovarian CA: stage 1
one or both ovaries only
49
ovarian CA: stage 2
limited to pelvis
50
ovarian CA: stage 3
spread throughout abdomen
51
ovarian CA: stage 4
distant metastases
52
stage ovarian CA: bilateral ovary involvement
stage 1
53
mc initial site of regional spread in ovarian CA
other ovary
54
how does debulking tumor help in ovarian CA?
can be effective; including omentectomy (helps chemo and XRT)
55
tx: ovarian CA
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
chemotherapy: ovarian CA
cisplatin and paclitaxel (Taxol)
57
stomach CA that has metastasized to ovary
| - pathology classically shows signet ring cells
krukenberg tumor
58
pelvic ovarian fibroma that causes ascites and hydrothorax
| - excision of tumor cures syndrome
meige's syndrome
59
most common malignant tumor in female genital tract
endometrial cancer
60
risk factors: endometrial cancer
nulliparity, late 1st pregnancy, obesity, tamoxifen, unopposed estrogen
61
vaginal bleeding in postmenopausal patient
endometrial CA until proven otherwise
62
chance of malignancy in uterine polyps
very low chance of malignancy (0.1%)
63
polyps: worst prognosis in endometrial cancer
serous and papillary subtypes
64
stage 1 endometrial cancer: tx
- endometrium
| - tx: TAH and BSO or XRT
65
stage 2 endometrial cancer: tx
- cervix
| - TAH and BSO or XRT
66
stage 3 endometrial cancer: tx
- vagina, peritoneum, and ovary
| - TAH and BSO and XRT
67
stage 4 endometrial cancer: tx
- bladder and rectum
| - TAH and BSO and XRT
68
where does cervical cancer go first?
obturator nodes
69
what is cervical cancer associated with?
HPV 16 and 18
70
most common cervical cancer
squamous cell CA
71
location: stage 1 cervical cancer
cervix
72
location: stage 2 cervical cancer
upper 2/3 of vagina
73
location: stage 3 cervical cancer
pelvis, side wall, and lower 1/3 of vagina; hydronephrosis
74
location: stage 4 cervical cancer
bladder and rectum
75
tx: cervical cancer - microscopic disease with basement membrane invasion
cone biopsy (conization sufficienct to remove disease)
76
tx: stages 1 and 2a cervical cancer
total abdominal hysterectomy (TAH)
77
tx: stages 2b and 4
XRT
78
tx postmenopausal ovarian cyst:
| septated, has increased vascular flow on Doppler, has solid components, or has papillary projections
oophorectomy with intraoperative frozen sections; TAH if ovarian cancer
79
tx postmenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections
follow with ultrasound for 1 year -> if persists or gets larger -> oophorectomy with intraoperative frozen sections; TAH if ovarian CA
80
tx premenopausal ovarian cyst:
| septated, has increased vascular flow on Doppler, has solid components, or has papillary projections
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
tx premenopausal patient ovarian cyst: if no septation, no vascular flow on doppler, no solid components, no papillary projections
can follow with ultrasound; surgery if suspicious findings appear
82
management: incidental ovarian mass at the time of laparotomy for another procedure
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
tx: abnormal uterine bleeding:
clomiphene citrate
84
tx: abnormal uterine bleeding:
GnRH agonists (leuprolide)
85
tx: abnormal uterine bleeding
| > 40 years old - cancer or menopause
need biopsy
86
contraindications to estrogen therapy
endometrial CA, thromboembolic disease, undiagnosed vaginal bleeding, breast CA
87
can present as progressively heavier menses
uterine endometrial polyp
88
under hormonal influence; recurrent abortions, infertility, bleeding
uterine fibroids (leiomyomas)
89
most common vaginal tumor
invasion from surrounding or distant structure
90
malignancy risk with partial mole; complete mole is of paternal origin
- treatment?
hydatidiform mole
| - tx: chemo (methotrexate)
91
fever, erythema, diffuse desquamation, nausea, vomiting; associated with highly absorbent tampons
toxic shock syndrome
92
tx: ovarian torsion
remove torsion and check for viability
93
tx: adnexal torsion with vascular necrosis
adnexectomy
94
tx: ruptures tuboovarian abscess
percutaneous drainage
95
dx / tx: ovarian vein thrombosis
dx: CT scan
tx: heparin
96
can lead to ovarian vein, IVC, and hepatic vein thrombosis, get liver failure with ascites after pregnancy
- tx: heparin and antibiotics
postpartum pelvic thrombophlebitis
