Disorders of the cervix, uterus, ovaries - aa Flashcards
Current Ob/Gyn
What are the most common causes of infectious cervicitis?
N. gonorrhoeae Chlamydia trachomatis HSV, HPV, CMV Trichomoniasis BV
Cervicitis may be asymptomatic and remain undiagnosed for a long time.
T/F
True
What is the primary sign and symptom of acute cervicitis?
Purulent vaginal discharge; some women have bleeding after intercourse
When squamous epithelium of outer cervix grows over the mucus-producing columnar epithelium of the inner cervix, causing mucus-filled cysts to form.
Nabothian cysts
What is the treatment for nabothian cysts?
Usually no treatment required, unless they get really big and prevent pap smear or cause problems.
What is the most common type of ovarian cyst?
Follicular cyst, a type of functional/physiologic cyst (the other type is corpus luteum cyst)
What are the s/s of follicular cyst?
Often asymptomatic. May cause bleeding, dyspareunia, aching pelvic pain
What is the treatment of follicular cyst?
Usually resolve spontaneously within 60 days.
A disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining
Endometriosis
Although endometriosis can occur very rarely in postmenopausal women, it is found almost exclusively in women of reproductive age.
T/F
True
Name 5 risk factors for endometriosis.
~Family history ~Early menarche ~Long duration of menstrual flow ~Heavy bleeding during menses ~Shorter cycles (equals more cycles per year)
What are the main presenting complaints of endometriosis?
~Infertility, dysmenorrhea, and dyspareunia
~Most patients complain of constant pelvic pain or a low sacral backache that occurs premenstrually and subsides after menses begins
Physical exam findings for endometriosis?
Classically, pelvic examination reveals tender nodules in the posterior vaginal fornix and pain upon uterine motion.
Endometriosis should be suspected in any patient of reproductive age complaining of pain or infertility.
T/F
True
What is the only way endometriosis can be definitively diagnosed?
The final diagnosis of endometriosis can only be made at laparoscopy or laparotomy, by direct observation of the implants.
Xray/CT/US NOT helpful.
What is the treatment for endometriosis?
~In asymptomatic patients or those with mild symptoms or minimal endometriosis: watch and wait
~NSAIDs for mild premenstrual pain
~Hormones, to interrupt the cycle of stimulation/bleeding of endometrial tissue: OCPs, GnRH agonists, progestin, aromatase inhibitors
~Surgical excision of endometrial tissue
What is the most common benign ovarian neoplasm in reproductive-age women?
teratoma, aka dermoid cyst
Teratomas are usually asymptomatic.
T/F
True, unless a complication like torsion or rupture occurs.
Teratomas can contain hair and/or teeth.
T/F
True. Teratomas are germ cell tumors.
How is teratoma diagnosed?
Transvaginal ultrasound
What is the treatment for teratoma?
Laparoscopic removal
Benign smooth muscle neoplasms that typically originate from the myometrium. Because their considerable collagen content creates a fibrous consistency, they are incorrectly called fibroids.
Leiomyoma of the uterus
What are two risk factors for development of leiomyomas?
~early menarche
~obesity
(both cause increased longterm exposure of myometrium to estrogen, which increases risk of leiomyoma)
~smoking DECREASES risk
African-American women have a higher incidence of leiomyoma than white, Asian, or Hispanic women.
T/F
True.
What is the most common symptom of leiomyoma?
Menorrhagia
How is leiomyoma treated?
~asymptomatic: watch and wait ~NSAIDs for mild pain ~Hormonal therapy ~Uterine artery embolization ~Surgical excision of leiomyoma ~Hysterectomy
When there is ectopic endometrial tissue within the myometrium of the uterus:
adenomyosis
Symptoms of adenomyosis?
Often asymptomatic, but dysmenorrhea and menorrhagia
Who gets adenomyosis?
Parous women in their 40s and 50s
How is adenomyosis diagnosed?
~transvaginal ultrasound
~pathological examination of uterus after hysterectomy
Treatment for adenomyosis?
~NSAIDs, OCPs
~Endometrial ablation might work, might make it worse
~Hysterectomy is the definitive treatment
What is the difference between endocervical and ectocervical polyps?
endocervical polyps: red, flame-shaped, fragile, narrow stalk
ectocervical polyps: pale, flesh-colored, smooth, round, broad stalk
Who gets cervical polyps?
multigravidas > 20 years old
What is the most common symptom of cervical polyps?
Postcoital bleeding
Your patient is 29, obese, infertile/amenorrheic, and hirsute. What is your suspicion? What is your workup? What is your treatment?
~PCOS
~check serum FSH, LH, prolactin, and TSH, and also A1C
~if want to get pregnant: clomiphene
~if don’t want to get pregnant: Medroxyprogesterone acetate for the first 10 days of each month
What are the USPSTF/ACOG recommendations regarding HPV co-test?
~HPV co-test should not be performed in women under 30
~HPV co-test every 5 years for women 30-65
What are the USPSTF & ACOG recommendations regarding chlamydia/gonorrhea screening?
~USPSTF: screen sexually active women with risk factors for gonorrhea; screen all sexually active nonpregnant women under 25 for chlamydia, and older women with risk factors
~ACOG: if 25 or younger and sexually active, screen for gonorrhea and chlamydia
