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OB/GYN > Disorders of the Uterus > Flashcards

Disorders of the Uterus Flashcards

1
Q

irregular uterine bleeding that occurs in the absence of a recognizable
pelvic pathology, general medical disease, or pregnancy

Considered a diagnosis of exclusion

Reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining

Bleeding is unpredictable and can be light, heavy, prolonged, frequent, or random

Most commonly occurs when the ovaries do not release an egg, but it can be ovulatory

A

Dysfunctional Uterine Bleeding

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2
Q

About what percentage of women with improperly managed anovulatory bleeding eventually may develop endometrial cancer?

A

1-2%

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3
Q

Prolonged endometrial proliferation is precursor to what?

A

cancer

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4
Q

What is the most common cause of DUB?

A

PCOS

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5
Q

Rule out endometrial carcinoma in patients with the following high
risk factors:

A

Morbid obesity
Diabetes
Chronic hypertension
Age over 35 years
Longstanding chronic eugonadal anovulation

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6
Q

This medical management of DUB is used to re-establish predictable bleeding patterns, decrease menstrual flow, and lower the risk of iron deficiency anemia

A

Oral Contraceptives

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7
Q

Chronic management of DUB requires episodic or continuous exposure to what to treat proliferative endometrium?

A

a progestin

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8
Q

A synthetic analogue of arginine vasopressin, this has been used as a last resort to treat abnormal uterine bleeding in patients with documented coagulation disorders

A

Desmopressin

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9
Q

What are some complications of DUB?

A

Infertility
Severe anemia/volume loss
Increased risk of endometrial cancer

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10
Q

Localized proliferation of smooth muscle – typically large, midline,
irregularly contoured, mobile pelvic mass with hard, solid quality

A

Leiomyoma

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11
Q

What is another name for Leiomyoma?

A

Fibroids

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12
Q

What is the most common presenting symptom of a leiomyoma?

A

bleeding

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13
Q

High levels of what hormone can lead to growth of a leiomyoma?

A

estrogen

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14
Q

This condition is the most common indication for hysterectomy

A

Leiomyoma

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15
Q

Distorted endometrial stripe on pelvic ultrasound should make you think of what diagnosis?

A

Leiomyoma

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16
Q

Presence of endometrial glands and stroma not in uterus

Aberrant growth of endometrium outside the uterus cavity

A

Endometriosis

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17
Q

Only true diagnosis for this condition is through a biopsy

A

Endometriosis

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18
Q

What is the most common cause of secondary dysmenorrhea?

A

Endometriosis

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19
Q

In endometriosis, what is the most common site?

A

Most common in ovaries – often bilateral

20
Q

The following is the clinical presentation of what disorder?

Progressive dysmenorrhea and deep dyspareunia that worsens over time

Dysmenorrhea - Pain precedes and lasts through menses

Dyspareunia

Infertility

Pelvic pain

Abnormal bleeding

A

Endometriosis

21
Q

The following is a typical physical examination for what condition?

Usually a normal pelvic exam

May have “tender nodularity in the cul de sac”

Adnexal mass

A

Endometriosis

22
Q

Pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus

A

Uterine Prolapse

23
Q

What are some risk factors for uterine prolapse?

A

Genetic predisposition
Connective tissue disorders
Prior pelvic surgery
Advanced age
Parity (vaginal births)
Menopause
Elevated intra-abdominal pressure

24
Q

Uterine prolapse staging: Which stage is described below?

no prolapse

A

Stage 0

25
Q

Uterine prolapse staging: Which stage is described below?

> 1cm above hymen

A

Stage 1

26
Q

Uterine prolapse staging: Which stage is described below?

1cm or less above or below the hymen

A

Stage 2

27
Q

Uterine prolapse staging: Which stage is described below?

> 1cm below the hymen

A

Stage 3

28
Q

Uterine prolapse staging: Which stage is described below?

complete eversion

A

Stage 4

29
Q

Most common gynecologic cancer in women in US

A

Endometrial Cancer

30
Q

Arises from endometrial hyperplasia

Have to have hyperplasia before cancer

A

Endometrial Cancer

31
Q

The majority of endometrial cancer types are which type?

A

adenocarcinomas

32
Q

What percentage of endometrial cancers are estrogen dependent?

A

90%

33
Q

What are the risk factors for endometrial cancer?

A

Age
Obesity
Nulliparity
Late menopause
Tamoxifen therapy
PCOS
Diabetes
Hypertension
Genetics (BRCA and Lynch syndrome)

34
Q

Which type of endometrial cancer is described below?

90% of cases

Better prognosis

Estrogen dependent (90% of cases caused by unopposed estrogen)

Low grade atypia

Adenocarcinoma origin

A

Type I

35
Q

Which type of endometrial cancer is described below?

Poor prognosis

Aggressive, more dangerous

Estrogen independent

10% cases

spontaneous

Common in thin, older, post-menopausal women

Arises in atrophic endometrium rather than a hyperplastic one

Less well-differentiated

A

Type II

36
Q

Post menopausal bleeding is considered what until proven
otherwise?

A

cancer

37
Q

What is the first test in suspected endometrial cancer?

A

Pelvic ultrasound – transvaginal

Gives information on size and shape of uterus, thickness, and contour of the endometrium

38
Q

What endometrial thickness is considered abnormal?

A

> 5mm

39
Q

What is the gold standard for diagnosing endometrial cancer?

A

endometrial biopsy

40
Q

Which patients should have annual screening for endometrial cancer because they have a 10-fold increased lifetime risk?

A

Patients with HNPCC Syndrome

41
Q

Hysterectomy is appropriate after completion of childbearing due to
a lifetime risk of endometrial cancer of what percentage?

A

60%

42
Q

What is the number one prognostic factor in endometrial cancer?

A

Histological grade

43
Q

What is the number two prognostic factor in endometrial cancer?

A

Depth of myometrial invasion

44
Q

What are some modifiable risks in endometrial cancer?

A

Obesity
Diabetes
HTN

45
Q

What type of therapy in endometrial cancer is contraindicated and why?

A

HRT post treatment of endometrial carcinoma is considered
contraindicated due to risk of activating occult metastatic disease

OB/GYN (14 decks)

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