Disorders of the cervix, uterus, ovaries - aa

Question 1

What are the most common causes of infectious cervicitis?

Answer 1

N. gonorrhoeae
Chlamydia trachomatis
HSV, HPV, CMV
Trichomoniasis
BV

Question 2

Cervicitis may be asymptomatic and remain undiagnosed for a long time.
T/F

Answer 2

True

Question 3

What is the primary sign and symptom of acute cervicitis?

Answer 3

Purulent vaginal discharge; some women have bleeding after intercourse

Question 4

When squamous epithelium of outer cervix grows over the mucus-producing columnar epithelium of the inner cervix, causing mucus-filled cysts to form.

Answer 4

Nabothian cysts

Question 5

What is the treatment for nabothian cysts?

Answer 5

Usually no treatment required, unless they get really big and prevent pap smear or cause problems.

Question 6

What is the most common type of ovarian cyst?

Answer 6

Follicular cyst, a type of functional/physiologic cyst (the other type is corpus luteum cyst)

Question 7

What are the s/s of follicular cyst?

Answer 7

Often asymptomatic. May cause bleeding, dyspareunia, aching pelvic pain

Question 8

What is the treatment of follicular cyst?

Answer 8

Usually resolve spontaneously within 60 days.

Question 9

A disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining

Answer 9

Endometriosis

Question 10

Although endometriosis can occur very rarely in postmenopausal women, it is found almost exclusively in women of reproductive age.
T/F

Answer 10

True

Question 11

Name 5 risk factors for endometriosis.

Answer 11

~Family history
~Early menarche
~Long duration of menstrual flow
~Heavy bleeding during menses
~Shorter cycles (equals more cycles per year)

Question 12

What are the main presenting complaints of endometriosis?

Answer 12

~Infertility, dysmenorrhea, and dyspareunia
~Most patients complain of constant pelvic pain or a low sacral backache that occurs premenstrually and subsides after menses begins

Question 13

Physical exam findings for endometriosis?

Answer 13

Classically, pelvic examination reveals tender nodules in the posterior vaginal fornix and pain upon uterine motion.

Question 14

Endometriosis should be suspected in any patient of reproductive age complaining of pain or infertility.
T/F

Answer 14

True

Question 15

What is the only way endometriosis can be definitively diagnosed?

Answer 15

The final diagnosis of endometriosis can only be made at laparoscopy or laparotomy, by direct observation of the implants.
Xray/CT/US NOT helpful.

Question 16

What is the treatment for endometriosis?

Answer 16

~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

Question 17

What is the most common benign ovarian neoplasm in reproductive-age women?

Answer 17

teratoma, aka dermoid cyst

Question 18

Teratomas are usually asymptomatic.

T/F

Answer 18

True, unless a complication like torsion or rupture occurs.

Question 19

Teratomas can contain hair and/or teeth.

T/F

Answer 19

True. Teratomas are germ cell tumors.

Question 20

How is teratoma diagnosed?

Answer 20

Transvaginal ultrasound

Question 21

What is the treatment for teratoma?

Answer 21

Laparoscopic removal

Question 22

Benign smooth muscle neoplasms that typically originate from the myometrium. Because their considerable collagen content creates a fibrous consistency, they are incorrectly called fibroids.

Answer 22

Leiomyoma of the uterus

Question 23

What are two risk factors for development of leiomyomas?

Answer 23

~early menarche
~obesity
(both cause increased longterm exposure of myometrium to estrogen, which increases risk of leiomyoma)
~smoking DECREASES risk

Question 24

African-American women have a higher incidence of leiomyoma than white, Asian, or Hispanic women.
T/F

Answer 24

True.

Question 25

What is the most common symptom of leiomyoma?

Answer 25

Menorrhagia

Question 26

How is leiomyoma treated?

Answer 26

~asymptomatic: watch and wait
~NSAIDs for mild pain
~Hormonal therapy
~Uterine artery embolization
~Surgical excision of leiomyoma
~Hysterectomy

Question 27

When there is ectopic endometrial tissue within the myometrium of the uterus:

Answer 27

adenomyosis

Question 28

Symptoms of adenomyosis?

Answer 28

Often asymptomatic, but dysmenorrhea and menorrhagia

Question 29

Who gets adenomyosis?

Answer 29

Parous women in their 40s and 50s

Question 30

How is adenomyosis diagnosed?

Answer 30

~transvaginal ultrasound

~pathological examination of uterus after hysterectomy

Question 31

Treatment for adenomyosis?

Answer 31

~NSAIDs, OCPs
~Endometrial ablation might work, might make it worse
~Hysterectomy is the definitive treatment

Question 32

What is the difference between endocervical and ectocervical polyps?

Answer 32

endocervical polyps: red, flame-shaped, fragile, narrow stalk
ectocervical polyps: pale, flesh-colored, smooth, round, broad stalk

Question 33

Who gets cervical polyps?

Answer 33

multigravidas > 20 years old

Question 34

What is the most common symptom of cervical polyps?

Answer 34

Postcoital bleeding

Question 35

Your patient is 29, obese, infertile/amenorrheic, and hirsute. What is your suspicion? What is your workup? What is your treatment?

Answer 35

~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

Question 36

What are the USPSTF/ACOG recommendations regarding HPV co-test?

Answer 36

~HPV co-test should not be performed in women under 30

~HPV co-test every 5 years for women 30-65

Question 37

What are the USPSTF & ACOG recommendations regarding chlamydia/gonorrhea screening?

Answer 37

~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