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Clin Medicine > Endo Repro Koulton > Flashcards

Endo Repro Koulton Flashcards

1
Q

Fhs lh tsh hcg

A

Alpha subunit

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2
Q

Follicular phase

A

Onset menstration to preovulatory LH surge

Estradiol

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3
Q

Lumen

A

Tart with LH surge to start menstration

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4
Q

Theca

A

LH cholesterol to androstenedione and testosterone

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5
Q

Granulosa

A

FSH aromaiation a and t to estradiol

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6
Q

FHS LH

A

High follicular down luteeal from high progesterone

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7
Q

Corpus luteum to albicans

A

FSH up and estradiol positive feedback later LH surge

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8
Q

What day try and conceive

A

14

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9
Q

If cycle 114 days when have intercourse

A

Day 100…first half can be off but once ovulate bleed 14 days later ***

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10
Q

GnRH

A

Decapeptide from arcuate nucleus cause secretion of gonadotrops (LH and FSH)

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11
Q

LH FSH forms

A

Release and storage

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12
Q

As estradiol goes get get wht

A

Positive feedback and surge

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13
Q

Gonadotrops on GnRH

A

Decrease

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14
Q

Why get progesterone follicular

A

Prior to ovulation the unruptured luteinizing Graafian follicle begins to produce increasing amounts of progesterone

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15
Q

When secretion of progesterone by CL reaches max

A

5-7 days after ovulation and returns before menstration

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16
Q

Primordial follicles

A

Undergo sequential development, differentiation and maturation until mature

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17
Q

Rupture follicle

A

Release egg ovum

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18
Q

Luteinization of ruptured follicle

A

Makes cl

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19
Q

When do oocytes become surrounded by precursor granulosa cells

A

8-10 weeks

Called a primordial follicle

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20
Q

In ADULT ovary, graffiti follicle form

A

Inner most 3-4 layers of multiplying granulosa cells become cuboidal and adherent to the ovum thi is called cumulus oophorus

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21
Q

A fluid filled antrum forms among the granulosa cells

A

Antrum enlarges and the centrally located primary oocyte migrates t the wall of the follic;e

The innermost layer of the granulosa cells of the cumulus become elongated and for the corona radiata

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22
Q

Corona radiata

A

Released with the oocyte at ovulation

Innermost layer of granulosa cells of the cumulus becomes elongated and rorm it

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23
Q

LH surge

A

Ovulation

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24
Q

After ovulation

A

Granulosa undergoes luteinization

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25
Q

Corpus luteum

A

Lutenized granulosa cells, theca cells, capillaries and CT from corpus luteum

-make progesterone

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26
Q

Lifespan CL

A

9-10 days

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27
Q

Pregnancy not occur what is fate of CL

A

Gradually replaced by an avascular scar called corpus albicans

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28
Q

How does pituitary respond decreasing p and e

A

Increase LH and FSH

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29
Q

Diagnose menopause

A

FSH high from no neg feedback

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30
Q

2 zones of endometrium

A

Basalis and functionalis

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31
Q

Functionalis

A

Outer potion

Cyclic changes during menstrual cycle and sloughed off

Spiralis

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32
Q

Basalis

A

Remains relatively unchanged

Basal arteries

Provides stem cells

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33
Q

Cyclic changes

A

Menstrual phase

Proliferative

Secretory phase

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34
Q

Cycle day 1

A

1st day menstruation

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35
Q

When reach maximal thickness

A

Secretory phase

Proliferative 4-8 mm
Secretory 8-14. Ml

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36
Q

Conception not by day 23

A

CL regress, decrease p and e, endometrial involution

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37
Q

Menstration cycle

A

Terminal event of process for uterus to get baby

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38
Q

Intact coagulation pathways important

A

Healed with normal hemostasis

Need platelets and clotting factors

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39
Q

Warfarin

A

Heavy enstruation

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40
Q

Girls with HEAVY period at 12 years old. What have

A

Von williebrands disease.

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41
Q

Age menarche

A

12.43

2-3 years of thelarche at tanner IV

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42
Q

Primary amenorrhea

A

No menstration by 13 without secondary characteristics

By 15 with sex characteristics

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43
Q

Excessive flow

A

Greater than 80 cc (30 cc normal) associated with anemia

-changing pat q1-2 hours and considered excessive if >7 days

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44
Q

Puberty and factors

A

10-16

Geographic location, genetic, nutritional status

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45
Q

20 week in uteru

A

Have 6-7 million oocytes

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46
Q

HPO suppressed when

A

4-10 years

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47
Q

Function of low level gonadotropins and sx steroids during prepubertal period

A

Gonadostat sensitivity to the negative feedback of low circulating estradiol

Intrinsic central nervous system inhibiton of the hypothalmic GnRH secretion

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48
Q

8-11

A

Increase serum DHEA and DHEaS

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49
Q

Initial endocrine changes associated with puberty

A

Adrenal androgen production and differentiation by zone reticularis of the adrenal cortex

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50
Q

Rise in adrenal androgens

A

Growth of axillary and pubic hair

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51
Q

11

A

Loss of sensitivity by gonadostat to the negative feedback of sex steroids. In combination with the intrinsic loss of central nervous system inhibiton of GnRH

Sleep associated GnRH secretion occur and gradually shift into adult type secretory patterns

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52
Q

Increase GnRH 11

A

Promotes ovarian follicular maturation and sex steroid production, which leads to the development of secondary sex characteristics

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53
Q

Mid to late puberty

A

Positive feedback mechanism of estradiol on LH release from anterior pituitary is complete and osculatory cycles are established

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54
Q

Thelarche requires ___

A

Estrogen

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55
Q

Pubarche/adrenarche requires ___

A

Androgens

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56
Q

Maximal growth or peak height velocity when

A

2 years earlier in girls and 1 year before menses

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57
Q

Menarche

A

Require pulsatilla GnRH from hypothalamus, FHS< and LH from the pituitary, estrogen and progesterone from the ovaries, normal outflow tract

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58
Q

Thelarche race

A

African American and Hispanic go through before caucasion

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59
Q

Tanne 1

A

Preadolesence, elevate pilla

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60
Q

2

A

Breast bud

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61
Q

3

A

Enlarge breast aerola

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62
Q

4

A

Projection secondary mound

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63
Q

5

A

Projection papilla recession aerola

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64
Q

1

A

No pubes

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65
Q

2

A

Slight pigment and down

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66
Q

3

A

Coarser hair pubes

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67
Q

4

A

Adult hair not medial thighs

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68
Q

5

A

Medial thighs and inverted triangle

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69
Q

Precocious puberty

A

Secondary sexual characteristics prior to 2.5 SD expected

8 year old girl 9 boys

Rare

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70
Q

What do

A

Thorough evaluation to rule out serious disease and stop premature fusion of long bones so as adults short

Tall when prsent then close then short

Emotionally hard for girls and icnreased risk sexual abuse

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71
Q

Heterosexual precocious puberty

A

Dev of secondary sex characteristics opposite expect

Virilizing neoplasma
CAH
Exogenous androgen exposure

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72
Q

Isosexual precocious puberty

A

Premature sexual maturation that is appropriate for the phenotype of the affected individual

Constitutional and organic brain disease
-tumors, trauma, infectious process

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73
Q

Heterosexual precocity androgen secreting neoplasms

A

Rare
Usually in ovaries
Diagnosed PE and radiological exam and treated with surgical

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74
Q

CAH heterosexual

A

Most commonly 21 hydroxylase

Classical-birth of females with ambiguous genetalia-if untreated virilization and short

Nonclassical-resemble POCS premature pubarche

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75
Q

Isosexual precocity true

A

Arises from premature activation of the normal process of pubertal development involving the HPA

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76
Q

Isosexual precocity pseudosexual precocity

A

Exposure of estrogens independent of HPO axis

Estrogen producing tumors

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77
Q

Diagnose true

A

Idiopathic most common

Give GnRH see rise in LH

CNS disorder
-willl have neurological symptoms before sexual dev
MRI head

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78
Q

Treat true

A 
Gnrh agonsit (leuprolide acetate)
-decrease gonadotropins to prepubertal
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79
Q

Not treater true

A

Will not attain 5 foot adult height

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80
Q

Pseudo

A

Without activation of HPO

Ovarian tumor, exogenous estrogenic, mccune Albright and peutz=jeghers

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81
Q

Mccune Albright

A

Somatic mutation during embryogenesis which causes them to function independent of their normal stimulating hormones
5%

Multiple cystic bone defects, cafe au last spots
Adrenal hypercortisolism

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82
Q

Peutz jeghers

A

Associated with a sex cord tumor that secretes estrogen

GI polyposis and mucocutaneous pigmentation

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83
Q

Delayed puberty

A

Secondary sex not by 13 or thelarche not by 14

No menses 15 or 16

Menses not 5 years after thelarche

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84
Q

Cause

A

Hypergonadotropic hypogonasism
-turner/gonadal dysgenesis
FSH>30

Hypogonadotropic hypogonasism (FSH LH <10)
Kallman, anorexia, pituitary tumors, hyperprolactinemia, drug use

Anatomic causes
-mullerian agenesis, imperforate hymen, transverse vaginal septum

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85
Q

Amenorrhea primary

A

No spontaneous uterine bleeding by 13 without secondary sex characteristics

No menstruation by 15 years with secondary sexual development

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86
Q

Amenorrhea secondary

A

Patient with prior menses has absent at least 6 months

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87
Q

If primary amenorrhea

A

Does she have secondary sex

Low-look FSH LH

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88
Q

Primary with absence of secondary sex

A

FSH LH<5
Hypogonadotropic hypogonadism
MRI

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89
Q

Causes hypogonadotropic hypogonadism

A 
Lesions/tumors HPA
Anorexia/exercise
Hyperprolactinemia
Kallman
Constitutional delay
-most common, hereditary factors may play role 20%
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90
Q

Most common delayed puberty

A

Constitutional

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91
Q

Hypogonadotropic hypogonadism kallman

A

Mutation KAL gene on X chromosome that prevents the migration of GnRH neurons into hypothalamus
Have anosmia or hyposmia

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92
Q

Hypergonadotropic hypogonadism (chromosomal or injury to ovaries by surgery, chemo, radiaiton

A

Ok

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93
Q

Treat to evaluate delayed puberty

A

MRI, FSH, karyotype, progesterone, prolactin

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94
Q

What is karyotype comes back with Y chromosome

A

Gonadectomy is recommended to prevent malignant neoplastic transformation

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95
Q

Primary amenorrhea with absence of secondary sexual characteristics

A

FSH>20 L LH >40
Hypergonadotropic hypogonadism
Karyotype to rule out Y chromosome

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96
Q

Cause hypergonadotropic hypogonadism

A

Gonadal agenesis/dysgenesis of the presence of an abnormally developed gonad due to chromosomal defects (TURNER 45 XO)

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97
Q

Turner

A

MOst common female gonadal dysgenesis

No signs of secondary sexual characteristics

Mosaicism in 25% may have normal phnenotype with spontaneous onset of puberty and menarche

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98
Q

Signs turner

A

Broad flat chest wide neck
Streak ovaries
No puberty

Coarctation aorta

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99
Q

Primary amenorrhea with secondary sexual characteristics US show no uterus

A

Do karyotype

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100
Q

Androgen insensitivity syndrome

A

46XY
Male levels of testosterone
Defect in androgen receptor
Testes in abdominal wall
-secrete antimullerian hormone so no uterus
-external female genetalia with no pubic hair

Breast development with small aerola/nipples
-caused by estrogen secretion in testes and conversion of androgens to estrogen int he liver

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101
Q

Mullerian dysgenesis/agenesis

A

Primary amenorrhea, normal breast dev, levels of testosterone with females
-mullerian defects that cause obstruction of vaginal canal
—imperforate hymen or a transverse septum
-absence of normal uterus is known as mullerian agenesis
-failure of Müllerian ducts to defuse distally and to form the upper GI tract will have a vaginal dimple
-absent uterus but may have a unilateral or bilateral rudimentary uterine tissue, tubes and ovaries
-associated with renal abnormalities
-IV pyelogram should be ordered to assess urinary system

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102
Q

Abnormal shaped uterus…

A

Order IV pyelogram to assess urinary system or CT to see ureters

Get IVP

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103
Q

Androgen insensitivity

A

Normal breasts no sexual hair

Normal looking female external genetalia

Absent uterus and upper vagina

Karyotype 46 XY
Male range T level

Test with gonadectomy

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104
Q

Mayer rokitansky kuster hauler

A 
Normal secondary dev and external female genetalia
Normal female range testosterone
Absent uterus and upper vagina 
Normal ovaries
46 XX
Renal abnormalities get IVP

Most common cause or primary amenorrhea in women with normal breast dev.

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105
Q

Primary amenorrhea with secondary with urterus : outflow obstruction

A

Normal uterus

Imperforate hymen or transverse vaginal septum

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106
Q

Imperforate hymen

A

Present complaining monthly dysmenorrhea without vaginal bleeding

Vaginal bulge and midline cystic mass
US confirm normal uterus

Do hymenectomy

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107
Q

Transverse vaginal septum

A

Simila symptoms but no vaginal bulge

Diagnosed with MRI

Correct with surgery

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108
Q

Secondary ameonrrhea

A

Absence for 6 months after having it

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109
Q

Causes secondary amenorrhea

A

Pregnancy! Get pregnancy test

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110
Q

What do if present with secondary amenorrhea

A

Look for weight change, preg test, exercise, diet, ill, abnormal facial hair, galactorrhea, dyspareunia, hot flashes or night sweats

Uring HcG, TSH prolactin, FSH

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111
Q

Secondary amenorrhea: hypothyroidism porlactinoma

A

Normal TSH

Galactorrhea is most common symptom of hyperprolactinemia

Really high >100
-MRI for empty sella, pituitary adenoma

High prolactin<100
-if MRI negative consider other causes

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112
Q

Secondary amenorrhea hypothyroidism

A

Normal prolactin
Abnormal TSH

Mild hypothyroidism-hypermenorrhea or oligomenorrhea,

Treat-restore menes

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113
Q

Abnormal micro vs macroadenomas

A

<10 mm on MRI-slow growing, manage , bromocriptine

> 1 cm-bromocriptine, resection or craniotomy

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114
Q

What causes prolactin <100

A

Ectopic production

Breast feeding and stimulation

Exercise

Head trauma

Hypothyroidism

Liver renal failure

Meds

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115
Q

Cause proacting >100

A

Pituitary adenoma

Empty sella

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116
Q

Secondary amenorrhea did tsh prolactin and negative

A

Progesterone challenge test
-give provers for several days then stop it. Positive bleed usually POCS

Negative-no bleeding-inadequate estrogen or abnormal outflow tract

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117
Q

Negative progesterone channelge

A

Estrogen/progesterone challenge
Negative-outflow tract of
Positive-abnormalities with HPA or ovaries
—-

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118
Q

Positive e/p test elevated fsh and lh

A

Hypergonadotropic hypogonasism

Ovarian abnormalities

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119
Q

Positive e/p test and normal or low FSH LH

A

Pituitary or hypothalmic abnormality
Get MRI
-no tumor then a hypothalmic cause of amenorrhea diagnosis

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120
Q

Anatomic causes

A

Asherman

Cervical stenosis

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121
Q

Asherman

A

Incomplete abortion but had normal periods

DNC was done…can be scarring so menstruation come out

As age sometimes opening of cervical os narrow

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122
Q

Secondary amenorrhea normogonadotropin hypogonadism

A

Adrenal disorders, ovarian, other

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123
Q

Adrenal nonclassical

A

CAH increase 17 hydroxyprogesterone
-no genital abnormalities
But have hirsutism, acne and menstrual irregular near puberty

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124
Q

Cushing

A

Central obesity, moon like faces, buffalo hump, HTN, striae, hirsutism, acne and irregular menses

High cortisol

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125
Q

Adrenal androgen secreting tumor

A

DHEAS>700

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126
Q

Ovarian disorders

A

POCS

Ovarian androgen secreting tumor
-sertoli leydig tumros (T>200)

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127
Q

Other

A

Exogenous androgens

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128
Q

POCS

A

10%
Leading cause of female anovulatory infertility

Insulin sensitivity
-decrease insulin hypersecrtion

Elevated insulin and androgen levels reduce the hepatic production of sex hormone binding globulins
-increased T

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129
Q

Diagnose POCS

A

Oligomenorrhea and amenorrhea
Biochemical or clincial signs or hyperandrogenism
-LH to FSH 2:1
US revealing multiple small cysts beneath the cortex of the ovary

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130
Q

Lab POCS

A

Increase LH decrease FHS

Extraglandular armoatization, chronic anovulation, decreased follicular maturation, stim of stroma and theca

Androgen excess

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131
Q

POCS stuck in ___ phase

A

Follicular

Increase stroma stimulation increase LH
Chronic anovulation

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132
Q

Features POCS

A 
Anovulation
T
LH up
Acyclic estrogen production
Fat
Acanthosis nigricans
Lipid abnormalities DM CVD
Anovulation
-increase chance endometrial hyperplasia and cancer
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133
Q

Treat POSC

A

Weight loss

OC
-suppress FSH and LH
-allow regression of T and androstenedione of ovary
Estrogen stimulates the sex hormone binding globulin

Clomiphene citrate
-can induce ovulation

Ovarian diathermy/laser

Spironolactone and or electrolysis
-competes for testosterone binding sites thereby exerting. Direct antiandrogenic effect at target organ and also interferes with steroid enzymes and decreases testosterone production

Insulin sensitizing agents-biguanides (metformin)

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134
Q

Secondary amenorrhea hypergonadotropic hypogonadism

A

Pct neg, e p positive, check fsh lh

FSH>20 LH>04
-hypergonadotropic hypogonadism
Postmenopausal ovarian failure-average age of menopause is 51
Premature ovarian failure before 40

Cause-ovarian injury from surgery, pelvic radiation, chemo, carrier status of fragile syndrome, autoimmune, mumps

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135
Q

FSH LH<5

A

MIR for pituitary tumor

Normal=hypogonadotropic hypogonadism
-anorexia, bulimia
-chronic renal dinsuffiency< DM, IBD
Radiation, exercise, malnutrition, HPA destruction

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136
Q

History hyperandrogenism

A

PCOS and late onset CAH
Neoplastic disorders

PE-hirsutism, acne, alopecia document, cushing, acanthosis nigricans, bimanual exam for ovarian enlargement

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137
Q

Acanthosis nigricans

A

Dark velvety skin

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138
Q

Hirsutism

A

Excess terminal hair in male pattern baldness

Represents exposure of hair t androgen excess

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139
Q

Virilization

A

Masculinization of a females associated with marked increase in circulating T
Enlargement of clit, temporal balding, deep voice, decreased breast, loss sof female body fat distribution, and hirsutism

Fast rapid onset

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140
Q

Ferrima galloway scale

A

For hirsutism

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141
Q

Labs hyperandrogenism

A

17 hydroxyprog

24 hr urinary cortisol and overnight dexameth suppression test

Prolactin and tsh

Glucose and lipid

Testosterone and DHEA-S
(If DHEEAS over 7000 suspect adrenal androgen producing tumor and if T over 200 suspect ovarian androgen producing tumor)

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142
Q

Polymenorrhea

A

<21 days

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143
Q

Menorrhagia

A

Prolonged bleeding at normal intervals

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144
Q

Menorrhagia

A

Irregular episodes bleed

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145
Q

Menometorrhagia

A

Heavy and irregular

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146
Q

Intermenstrual bleeding

A

Scant bleeding at ovulation for 1 to 2 days

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147
Q

Oligomenorrhea

A

Menstrual cyclets occurring>35 days but less then 6 months

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148
Q

Dysfunctional uterine bleeding

A

Abnormal from HPA and bimodal first start and menopause

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149
Q

PALM-COEIN

A

Palp structural

Polyp, adenomyosis, leimyoma, malignancy

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150
Q

Coein

A

Coagulopathies, ovulation dysfunction, endometrial causes, iatrogenic, not yet classified

151
Q

Coaguloapatheis

A

Heavy flow

Vw

152
Q

Ovulation year dysfunction

A

POC

153
Q

Endometrial causes

A

Infection

154
Q

Iatrogenic

A

IUD, hormones

155
Q

Lab test abnormal uterine bleeding

A

Pregnancy test no matter what

Cbc, Von Willie Randolph, pT PTT, TSH, chlamydia

Endometrial biopsy to look for endometrial hyperplasia and cancer

156
Q

Treat massive bleeding

A

Hospital 2 large IV bores give IV conjugated estrogen then hormonal treatment

MIRENA! Within 2 years stop bleeding

157
Q

Treat moderate bleeding

A

Combination OCP, mirena

158
Q

Unresponsive to conservative therapy bleeding

A

D and C, polypectomy, myomectomy, endometrial ablation, hysterectomy

159
Q

Ambiguous genitalia

A

Clitoromegaly

Clitoral agenesis
Bifid clit

Midline fusion of labiascrotal folds

Cloaca-no separation between vagin and bladder

160
Q

What do if present with ambiguous genetalia

A

PE, US, hormonal studies, karyotype General

In general with suboptimal development of penile or scrotal structure the infant is usually assigned a female gender

161
Q

Females pseudohermaphroditism

A 
Masculinization in utero of femal fetus
-CAH
-ingestion of exogenous hormones
-androgen secreting tumors of mother adrenal or ovaries
(sertoli leydig)
See clitoromegaly

Internal genital organs develop normally

162
Q

Male pseudohermaphroditism

A

Commonly results from mosaicism and can occur with varying degrees of virilization and mullerian development
-androgen insensitivity syndrome

163
Q

Androgen insensitivity

A

46XY testes undescended

Remove gonads risk of cancer
Occur mullerian inhibiting substance made lack of Müllerian duct development

X linked

Ambiguous genetalia

164
Q

True hermaphroditism

A

Both male and female externally and internally

165
Q

Labia agglutination

A

Treated by estrogen cream and massage to separate the labia majora

166
Q

Fox ford he disease

A

Severe pruritis raised yellow retention cyst in axilla and labia majora and minora resulting form keratin plugged inflammation of apocrine glands

167
Q

Inclusion cysts-most common genital cyst

A

Located beneath the epidermis and are mobile, nontender, spherical and slow growing. Usually no treatment

Develop when hair follicles become obstructed the deeper portion of the follicle swells to accommodate the desquamated cells

168
Q

Vulvar varicosities

A

Can enlarge and become painful in pregnancy, have characteristic blue color

169
Q

Lentils (freckles) and nevi (moles)

A

Need to distinguish from melanomas

170
Q

Urethral caruncles

A

Small fleshy red outgrowth at distal edge of urethra
Kids caused by spontaneous prolapse of the urethral epithelium

Post menopausal women is secondary to contraction of the hypoestrogenic vaginal epithelium resulting in everting of the urethral epithelium

171
Q

Vulvar vestibulitis*

A

Rare condition in whihc one or more of the minor vestibular glands becomes infected

Bright red super tender

1-4 mm erythematous dots that are extremely tender
Characterized by severe introital dyspareunia and occasionally vulvar panin

Can try topical estrogens/hydrocortisone or surgical therapy may be required

172
Q

Sebaceous cyst

A

Caused by inflammatory blockage of sebaceous gland ducts

Small smooth nodular masses usually on inner surface of labia minora and majora

Contain a cheesy sebaceous material

173
Q

Fibroams

A

Most common benign solid tumors of the vulva
Slow growing, most range from 1-10 cm
Can become gigantic (250 lbs)

174
Q

Lipoma

A

Slow growing tumros composed of adipose cells

175
Q

Hide adenoma

A

Rare lesion arising from sweat gland of the vulva

176
Q

Syringomyelia

A

Eccrine gland tumor

177
Q

Neurofibroma

A

From Von recklinghausen disease

178
Q

Angiomatosis

A

Appear as multiple 2-3 mm red lesions usually in 4th and 5th decade

179
Q

Most common benign solid tumros of vulva

A

Fibroma

180
Q

Vulvar vestibulitis

A

Painful insertion , punctuated lesions at entrance when tough with q tip super painful

181
Q

Bartholin gland

A

5 and 7 o clock position

182
Q

Vulvar hematoma

A

Collections of blood that collect following trauma

Bike risde

Close observation and occasional surgery

183
Q

Female genital circumcision

A

More common in africa and Eastern Asia

Degree of anatomic change has an effect on infection risk, sexual function and vaginal delivery

184
Q

Obstetric related trauma

A

Usually from lacerations or episiotomies can result in scarring

185
Q

Atrophic vaginitis

A

Loss of estrogen (menopause, surgery)

Atrophy of external genetalia

Minora regresses and majora shrinks

Loss of vaginal rugae

Vaginal introitus constriction

186
Q

Treat atrophic vaginitis

A

Topical estrogen

Oral estrogen to prevent reoccurrence

187
Q

Lichen simplex chronicus

A

Local thickening of epithelium that result from prolonged itch scratch cycle

Pruritis

188
Q

Exam liche simplex chronicus

A

White reddish thickened leathery, raised surface

Looks similar to psoriasis

Biopsy-elongated retention ridges
Hyperkeratosis of the keratin layer

189
Q

Treat lichen simplex chronicus

A

Moderate strength steroid ointments with antipruritic agents

190
Q

Lichen sclerosis-most common menopausal

A

Can cause genital structural
Can get squamous cell carcinoma

Itching, pruritis, dyspareunia

Parchment papare onion scaling,

Thin epithelium loss or rete ridges and inflammatory cells lining b***how tell apart

Clobetasol

191
Q

Lichen sclerosis

A

Loss of labia minora

192
Q

Lich simplex vs sclerosis

A

Sclerosis-hyaline zone in the superficial dermis from edema

Both hyperkeratosis, but epidermis thinner in sclerosis

Acanthosis with elongated rete ridges simplex

193
Q

Lichen plants

A

Purplish polygonal papules that may appear in an erosive form

Vulvar vaginal gingival syndrome
-when lichen planus involves the vulva, vagina, and mouth

Symptoms-vulvar burning, severe insertional dyspareunia

Treat-topical and systemic steroids

194
Q

Psoriasis

A

AD

Velvety but may lack the silver scaly patches

195
Q

Eczema

A

More erythematous presentation

196
Q

Pemphigus

A

Autoimmune blistering disease involving the vulvovaginal and conjunctival areas

197
Q

Bechet syndrome

A

Classically involves ulcerations int he genital oral areas with uveitis

198
Q

Crohn

A

GI but vulvar ulcerations can occur due to fistulization

199
Q

Aphthous ulcers

A

Superficial and painful and are more common in mouth

200
Q

Decubitus ulcer

A

When chronic pressure is applied or secondary to tissue being moist secondary to urinary incontinence

201
Q

Acanthosis nigricans

A

Most commonly found in the intertriginous area, vulva, axilla or nape of the neck

Appear as a demarcated brown pigmented thickened are int he superficial layers of the skin

Is mot commonly related to insulin resistance and obesity but can be linked to other benign conditions and malignancy

202
Q

Contact dermatitis

A

A careful history may identify the specific irritant

PE may reveal erythema, edema, excoriation or ulceration

May need biopsy

203
Q

Imperforate hymen

A

After birth a bulging membrane like structuremay be noticed into e vaginal opening can block mucus

If not detected until menarche see thin dark blue with old menstrual fluid

204
Q

Vaginal transverse septum

A

In upper and middle thirds of vagina often a small sinus tract or perforation will be present whihc allows the egress of menstrual flow

May only become apparent when intercourse is impeded

205
Q

Midline longitudinal

A

Created a double vagina, a longitudinal septum can attach to the lateral wall thus creating a blind vaginal pouch

These septa are usually associated with various duplication anomalies of the uterine fundus

206
Q

Vaginal agenesis

A

Absence except most distal portion from urogenital sinus

Rokintansky kuster hauler if uterus is absent but Fallopian tubes are spread

207
Q

Adenosis

A

Islands of columnar cells in normal squamous epithelium

DES

208
Q

Gardner’s duct cyst

A

Arise from the remnant of the wolffian duct

Vary in size from 1-5 cm and are found int he lateral walls of the vagina

Asymptomatic mostly and no intervention

209
Q

Urethral diverticula

A

.3-3 cm sac like projection in anterior vagina alons posterior urethral

UTI, dysuria, urinalysis leak,

Give urethral dilation or excision

210
Q

Inclusion cyst

A

From infolding of vaginalis epithelium

In posterior or lateral wall in lower third of the vagina

Frequently associate with gynecological surgery or lacerations from childbirth

211
Q

Endometriosis

A

Implants can be seen inv agina and change in appearance with menstrual cycle

212
Q

Bartholin cyst-most common vulva vaginal tumor

A

3 cm asymptomatic
Unilateral
Need to biopsy in women 40+ to rule out bartholin carcinoma

213
Q

Bartholin gland abscess

A

From blockage and accumulation of purulent material and is painful

Treat-word catheterization
Leave in 4-6 weeks which promotes an epitheliazed tract for drainage of glandular secretions
OR
Marsupilization
-creates a new ductal opening by everting the cyst wall onto the epithelial surface where it is sutured with interrupted absorbable sutures

214
Q

Most common cause of a final trauma

A

Sexual assault

215
Q

Dermatological atrophy

A

After menopause the vaginal rugations flattern out and the vaginal epithelium becomes thin, pale and inelastic

Vaginal pH rises

216
Q

Vulvar neoplasms mostcommon

A

Squamous cell carcinoma

217
Q

Who tests squamous cell carcinoma of vulva

A

Post menopausal

Long history of scratching

Melanomas, adenocarcinomas, basal cell carcinoma, sarcoma

218
Q

VIN III

A

In situ linked to vulvar cancer and VIN I II III based on depth of epithelial involvment

219
Q

VIN III

A

High grade

220
Q

VIN usual

A

HOV 16 smoking and immunocompromised

Gardasil

221
Q

Differented VIN

A

Not HPV

Vulvar dermatological like lichen sclerosis

222
Q

Clincial VIN III

A

Pruritus is most common

No absolute diagnostic appearance
-most elevated, but color can be white, red, pink, grey or brown
20% of lesions have a warty appearance

223
Q

VIN III diagnosis

A

Inspection of vulva and biopsy

224
Q

Manage VIN III

A

Excision

Skinning vulvectomy removes skin is rarely required

Laser therapy is useful if lot around clit or bottom

225
Q

Paget

A

Rare
Postmenopausal white females

Itching, tenderness are common
Well demarcated and eczematois appearance and white plaque like lesion

Biopsy paget cells

Superficial excision to clear

226
Q

Squamous cell carcinoma clincial

A

Post menopausal
Vulvar limo
Present with a lesion that is pruiritis, raised, ulcerated, pigmented or warty on labia majora

Requires biopsy

227
Q

Method of squamous cell carcinoma spreas

A

Direct extension to adjacent structures
Lymphatic embolization to regional lymph nodes

Hematogenous to distant sites (lung, liver, bone)

228
Q

Manage SCC

A

Radical vulvetomy and regional lymphadenectomy

Wide local excision with inguinal lymph node , if positive nodes also get chemo

229
Q

Malignant melanoma

A

Second most common vulvar

Postmenopausal white women lesions noted on labia

Wide local excision

30% comparable

230
Q

Verrucous carcinoma

A

Warty cauliflower confused with condyloma

Variant SCCC
Don’t radiate may induce anaplastic transformation

231
Q

Bartholin gland carcinoma

A

Bartholin gland prob after 40

Painless

No history

Recurrence common

232
Q

Basal cell carcinoam

A

Appear as a rolled edge ulceration

Do not metastasize

Wide local excision is adequate

233
Q

Preinvasive disease of vagina etiology

A

HPV

50-90% with VAIN have prior neoplasia or cancer of cervic of vulva

234
Q

Diagnose VAIN

A

Asymptomatic

Considered with an abnormal pap in a woman who is status post hysterectomy or has no demonstratable cervical lesion

Colposcopic directed vaginal biopsy

235
Q

Manage VAIN

A

If lesion involves the vault
-surgical excision to treat and exclude vaginal cancer

Multifocal-treat with laser therapy or topical 5-FU if unsuccessful ay require vaginectomy

236
Q

Carcinoma vagina

A

Rare, 60 (most common SCC)

Abnormal discharge, bleeding, urine blood

Exophytic or ulcerative

-direct to bladder urethra rectum, or lateral
Lymphatic spreas
Hematogenous spread

Diagnose with punch biopsy

237
Q

Diagnose carcinoma vagina

A

Punch biopsy

238
Q

Treat carcinoma vagina

A

Radiation chemo

If lower 1/3 groin nodes removed

Upper vagina-surgery radical hysterectomy, upper vaginectomy bl lymphadenectomy

239
Q

Prognosis carcinoma of vagina

A

5- year survival rate for squamous cell vaginal cancer is 50%

240
Q

Adenocarcinoma

A

Metastatic from cervix, endometrium or ovary

Clear cell carcinoma from DES

RADICAL HYSTERECTOMY and vaginectomy or radiation

241
Q

Malignant melanoma

A

55 distal anterior wall

Poor prognosis

242
Q

Sarcoma Botryoides

A

Presents as a mass of grape like polyps protruding from the introitus

Histological the tumor is embryonal rhabodomyosarcoma

Mean age is 2-3 years old

Treat-surgical resection, chemo, radiation

243
Q

Normal vagina

A

Nonkeratinized stratified squamous epithelium

244
Q

Acidic vagina

A

Lactic acid and hydrogen peroxide producing lactobacilli

-protect sti

245
Q

Increase alter microflora

A

Antibiotics

Douching

Intercourse

Foreign body

246
Q

Nitrosine paper

A

Acidic yellow

Basic green or blue

247
Q

Vaginal discharge do nitrazine paper

A

Posterior fornix beneath cervix and put under microscope

248
Q

Bacterial vaginosis

A

Most common vaginitis

-gardnerella vaginalis most common

249
Q

Risk BV

A

New or multiple sex partners, smoking IUD, douching

250
Q

Symptoms BV

A

Asymptomatic milky discharge fishy amine odor after intercourse

251
Q

Diagnose BV

A

Saline wet mount clue cells

KOH whiff test

PH>4.5

252
Q

Treat BV

A

Metronidazole

DONT TREAT partner not std

253
Q

Vulvovaginal candida

A

Second most common

Candia

254
Q

Risk candida

A

Increase estrogen

DM, antibiotic, steroid

255
Q

Symptoms candida

A

Pruiritis, irritation/dyspareunia

Clumpy cottage cheese

256
Q

Diagnose candida

A

10% KOH wet prep positive for budding yeast
Pseudohyphae

<4.5 pH

257
Q

Treat candida

A

Diflucan

Miconazole

258
Q

Trich

A

T vaginalis flagellated protozoan

Strawberry cervix

259
Q

Symptoms trich

A

Asymptomatic
Dyspareunia , vulvovaginal irritation, occasional dysuria

Green yellow frothy discharge

260
Q

Diagnose trich

A

Saline wet mount motil trichomonads pH>4.5, strawberry cervic

261
Q

Treat trich

A

Metronidazole

Test partner

262
Q

Benign conditions of the uterus, cervic, ovary and Fallopian tubes

A

Ok

263
Q

Absence Y chromosome absence mullerian inhibiting substance

A

Development of paramesonephric system with the regression of mesonephric

264
Q

Describe paramesonephric duct

A

Arise 6 weeks gestation and by 9 weeks they fuse in the midline to form the uterovaginal primordium
Later the septum resolves between he fused paramesonephric ducts leading to the development of a single cervix and uterus

265
Q

Uterus didelphysis

A

Failure of the paramesonephric duct to fuse can lead to

-uterus didelphysis-2 separate uterine bodies with its own cervic, attached Fallopian tube and vagina

266
Q

Bicornuate uterus

A

Rudimentary horn

267
Q

Birnuate uterus

A

With or without double cervices

268
Q

Incomplete dissolution of midline fusion fo paramesonephric ducts

A

Septate uterus

269
Q

Failure of formation of Müllerian ducts

A

Unicornate uterus

270
Q

Mullerian agenesis (Meyer rokitansky kuster hauler syndrome)

A

The complete lack of development of the paramesonephric system
-absence of the uterus and msot of the vagina

271
Q

Most common congenital anomalies of cervic

A

Malfusion of paramesonephric ducts

Didelphys cervix and septate cervix

272
Q

Unicornate uterus

A

Check for renal abnormalities

273
Q

Majority of uterine and cervical anomalies

A

Spontaneous

DES
-small t shaped endometrial cavity
Cervical collar deformity

274
Q

Fibroid leiomyoma

A

Smooth msucle (polyp is glandular tissue)

Most common

Higher age more incidence

Rarely malignant

Familial

275
Q

Symptomatic fibroids

A

Excessive uterine bleeding , pelvic pressure, pelvic pain and infertility

276
Q

Most common indication for hysterectomy

A

Fibroids

277
Q

Risk factors fibroids

A

Increasing age

African america
Nulliparity
Family history

278
Q

Fibroids pathogenesis

A

Hormone, e and p stimulate it

279
Q

Treat fibroids

A

Block or change hormones

280
Q

Preg and fibroids

A

They enlarge

281
Q

Characteristics fibroids

A

Spherical whirled appearance can degenerate and cause pain

282
Q

After menopause fibroid

A

Shrink and go away

283
Q

Subserosal fibroid

A

Beneath uterin serosal surface

Can attach to blood supply of the omentum or bowel mesentery an lose uterine connection thus becoming parasitic fibroid

284
Q

Intramural fibroid

A

Fibroid arises within myometrium

Most common *

285
Q

Submucosal fibroid

A

Beneath endometrium

Can be pedunculated and come through the cervical os

Prolonged or heavy menstrual bleeding is common

286
Q

Cervical and intraligamentous fibroids

A

Arise between broad ligaments

287
Q

Symptoms fibroid

A

80% uterine asymptomatic

Pelvic lower back pain
Pelvic pressure fullness

INFERTILICY if submucosa

Frequency urination

288
Q

Signs bimanual exam fibroid

A

Enlarged, irregularly shaped uterus

If palpated mass moves with the cervic it is suggestive of a fibroid uterus

The degree of enlargement is described in week size used to estimate equilvent gestation size

289
Q

US fibroid

A

Performed and can help distinguish between adnexal masses and lateral leiomyoma

290
Q

Differential for fibroid

A

Ovarian neoplasm

Inflammatory mass
Pelvic kidney
Bowel mass
Colon cancer

IMAGINGG

291
Q

Treat fibroid

A

E and p ocp
-1st idea

Progesterone only
-depo, minera

GnRH agonist
-depo-Lipton
-can decrease size in 3 months
Usually used to alter route of surgery

292
Q

Surgery fibroma

A

Myomectomy

Endometrial ablation

Uterine artery embolization

Hysterectomy
-definitive harpy

293
Q

Myomectomy

A

Future deliveries must b c section

Often grow back

294
Q

Endometrial polyps

A

From endometrium create soft friable protrusion into endometrial cavity

Glandular

295
Q

Symptoms endometrial polyps

A

Menorrhagia, spontaneous or post menopausal bleeding

296
Q

Diagnose polyp

A

US endometrial stroke

-saline hysterosonography and hysteroscopy allow better detection

297
Q

Benign or malignant polyp

A

Benign hyperplastic mass

298
Q

Why remove endometrial polyp

A

Endometrial hyperplasia and carcinoma may also present as polyps

299
Q

Nabothian cervical cyst

A

Normal variant

Opaque with a yellow or blue hue

3cm 3 mm

From squamous metaplasia in which a layer os superficial squamous epithelial cells entrap a layer of columnar cells beneath its surface
-columnar cells continue to secrete mucus and a mucus retention cyst is formed

300
Q

Cervical polyp

A

Ectocervical and endocervical polyps are most common benign growths on the cervix

301
Q

Symptom cervical polyp

A

Non coital bleeding or menorrhagia

302
Q

Treat cervical polyp

A

Remove in office benign

303
Q

Endocervical polyp

A

More common

Beefy red in color

Arise from endocervical canal

304
Q

Ectocervical polyps

A

Less common

Pale in appearance

305
Q

Endometrial hyperplasia

A

Thickened endometrium from estrogen

306
Q

Who get endometrial hyperplasia

A

PCOS and anovulation
Granulosa heca cell tumors-estrogen producing tumors
Obese-secondary to peripheral conversion of androgens to estrogens in adipose cells
Exogenous estrogens-without progesterone
Tamoxifen

307
Q

Endometrial hyperplasia is a precursor to endometrial cancer

A

2-3% of women will develop endometrial cancer

308
Q

Simple hyperplasia without atypia

A

1% progress to cancer

309
Q

Complex hyperplasia without atypia

A

3% progress to cancer

310
Q

Simple hyperplasia with atypia

A

9% progress

311
Q

Complex hyperplasia with atypia

A

27% progress

312
Q

Symptoms endometrial hyperplasia

A

Intermenstrual , heavy or prolonged bleeding that is unexplained

313
Q

Diagnosis endometrial hyperplasia

A

Sample the endometrium
US reveals endometrial lining >4 mm in postmenopausal female
NEED TO SAMPLE ENDOMETIUM

314
Q

Treat endometrial hyperplasia

A

Simple and ocomplex without atypia give progestin and reasmple in 3 months

Simple and complex with atypia give hysterectomy

315
Q

Turner

A

45XO abnormal gonad development
Small rudimentary streaked ovaries
Develop secondary sexual haracteristics but enter menopause shortly after

316
Q

Complete androgen insensitivity syndrome /testicular feminization

A

46 Xa

Lack androgen receptors
Phenotypically female

Gonads need to remove after puberty bc of malignant potential

317
Q

Fallopian tube anomalies

A

Rare

DES short distorted or clubbed tubes

318
Q

Functional cyst ovary

A

Follicular, lutein, hemorrhagic, polycystic

319
Q

Benign neoplastic cyst ovary

A

Epithelial-serous or mucinous cystadenoma

Sex cord-fibromas, granulosa theca cell, sertoli

Germ cell-mature cystic teratoma/dermis

320
Q

Follicular cyst

A

Happen every month
Lined by one or more layers of granulosa cells
Develops when an ovarian follicle fails to rupture
Is CLINCIALLY significant if it gets large enough to cause pain

321
Q

Corpus luteum cyst

A

May develop if the CL becomes cystic, larger than 3 cm and fails to regress normally after 14 days

322
Q

Hemorrhagic cysts

A

More likely to cause symptoms

Caused by hemorrhage in CL cyst 2-3 days after ovulation

323
Q

Polycystic ovaries

A

Enlarged ovaries with multiple simple follicles

324
Q

Functional ovarian cyst

Theca lutein cyst!!

A

B/l large

325
Q

Who gets theca lutein cyst

A

High serum levels of human hCG

Pregnancy, choriocarcinoma, hydatiform molar preg, ovulation induction (gonadotropins or clomic)

326
Q

Theca lutein cysts regress when what

A

Gonadotropins levels fall

327
Q

Functional ovarian cyst LUTEOMA OF PREGNANCY

A

Hyperplastic reaction of the ovarian theca cells
-secondary to prolonged hCG stimulation during pregnancy

Appear as reddish brown nodules
Surgical resection is not indicated
-usually regress spontaneously postpartum

328
Q

When do luteoma of pregnancy regress

A

Post partum

When gonadotropin fall dont do surgery

329
Q

PCOS functional ovarian cyst

A

Anovulation, hyperandrogenism, insulin resistance

Enlarged ovaries with multiple small follicles that are inactive and arrested int he mid antral stage

Increased LH levels promote androgen secretion from the ovarian theca cells, leading to elevated levels of ovarian derived androstenedione and testosterone

330
Q

US POCS

A

String of pearls

331
Q

Clincial features functional cyst

A

With every cycle
Asymptomatic
Regress during subsequent cycle
Large and can cause torsion

332
Q

Diagnose functional cyst

A

Bimanual exam reveals and enlarged, mobile, unilateral cyst

US

333
Q

Manage functional ovarian cyst

A

Asymptomatic and premenopausal-ocp

Symptomatic and pre menopausal-have to rule out ectopic, torsion, tubo ovarian abscess

334
Q

Benign neoplastic tumros

A

Epithelial, sex cord, germ cell

335
Q

Epithelial benign neoplastic ovarian tumros

A

Most common

Serous, mucinous, Brennan

336
Q

Sex cord tumors

A

Fibroma, granulosa theca, sertoli leydig

337
Q

Germ cell

A

Dermoid

-single most common benign ovarian neoplasm in a premenopausal female

338
Q

Epithelial ovarian neoplasm

A

Derive from mesothelial cells lining peritoneal cavity and lining from surface of ovary

Mucinous, serous, endometrioid

339
Q

Serous cystadenoma MOST COMMON EPITHELIAL OARIAN TUMOR

A

Surgical

340
Q

Histology serous cystadenoma: the most common epithelial ovarian tumor

A

Psammoma bodies

-are more common in malignant serous cystadenocarcinomas

341
Q

Mucinous cystadenoma

A

Large

Second ost common

Associated with a mucocele of the appendix

Rarely can lead to pseudomyxoma peritonei
-numerous benign implants are seeded onto the surface of the bowel and other peritoneal surface producing mucus

342
Q

Remove appendix with mucinous

A

Ok

343
Q

Serous vs mucinous

A

Smooth serous mucinous lumpy

344
Q

Brenner tumor

A

Small smooth solid ovarian neoplasm

Benign

Large fibrotic component that encases epithelioid cells that resemble transitional cells of the bladder

33% of cases are associate with mucinous epithelial elements

345
Q

Sex cord

A

Granulomas a theca, sertoli leydig, fibroma

346
Q

If ultimate differentiation of cell types in tumors is feminine

A

Tumor is feminine

-a granulosa or theca cell tumor or often a mixed granulosa theca cell tumor (inhibin marker)

347
Q

If cell takes on masculine differentiation

A

Sertoli leydig tumor

348
Q

Granulosa

A

Any age
Estrogenic component
Low malignant

-precocious menarche and thelarche
Premenarchal uterine bleeding during infancy and childhood

Menorrhagia, endometrial hyperplasia and endometrial cancer

Breast tenderness, fluid retention, postmenopausal bleeding

349
Q

Sertoli leydig

A

Less frequent

Makes androgenic

Hirsutism, temporal baldness, deep voice, clitoromegaly, defeminizing of the female body habitus to a muscular build

350
Q

Virilizing vs hirsutism

A

Hirsutism-hair growth acne

Virilization-deep voice clitoral change, balding , androgenic body habitus

351
Q

Fibroma

A

Most common benign solid ovarian tumor!!!!
Not secrete steroids

Meigs syndrome

352
Q

Meigs syndrome from fibroma

A

Ascites and right pleural effusion in associationwith an ovarian fibroma

Flow of ascitic fluid through the transdiaphragmatic lymphatics into the right pleural cavity leads to meigs syndrome

353
Q

Germ cell tumors

A

Younger

354
Q

Cystic teratomamost common ovarian neoplasm in women of all ages!!!!!!
Benign cystic teratoma (dermoid)

A

30 yo
Kids-1/2 benign ovarian tumors

Bl

Slow growing <10 cm

355
Q

Describe a dermoid

A

May contain differentiated tissue from all three embryonic germ layers (ectoderm, mesoderm, endoderm)

Mainly ectodermal-skin, sweat, sebaceous gland, hair follicles

356
Q

Most teratomas benign or malignant

A

Benign

357
Q

Cystic teratoma

A

Multicystic mass
Hair, teeth, mixed into sebaceous thick material

Rokintanskys protuberance

358
Q

Rokintanjsy protuberance

A

Solid prominence located at the junction between the teratoma and normal ovarian tissue

359
Q

Rupture cystic teratoma

A

Chemical peritonitis

360
Q

Clincial features benign ovarian tumors

A

Nonspecific and asymptomatic

Enlarge slowly

Pain mild

Can be painful

361
Q

Why would a benign ovarian tumor be painful

A

Twist on its pedicure (torsion)

Rupture of cyst resulting in pain and peritoneal irritation
-rupture can occur spontaneously with trauma, during a bimanual exam or with intercourse

Rupture with serous fluid may evoke little pain

Dermoid or mucinous rupture can be more irritating to peritoneum

362
Q

Diagnosis benign ovarian tumors

A

Abdominal and bimanual pelvic exam

US

  • simple vs complex
  • dermoid cyst (tooth like calcification)

Tumor markers
CA 125 in post menopausal

Laparoscopy

  • uterine fibroids, ovarian tumor and hydrosalpinx differentiation
  • laparotomy is preferable to laparoscopy unless the mass can be removed without rupture
363
Q

Manage ovarian neoplasm

A

Need to prove by surgical exploration and pathological exam!!!

If surgery need to collect pelvic washings for cytologic exam
-obtain frozen section for histological diagnosis

Definitive tratment depends on patients age and desire for future pregnancies

364
Q

Manage epithelial ovarian tumros

A

Unilateral salpingo-oophorectomy
If mucinous cystadenoma tumor is diagnosed
—perform an appendectomy secondary to possible coexistence of an appendices mucocele

In young may do cystectomy for ovarian preservation

In older a total abdominal hysterectomy with bl salpingo oophorectomy is appropriate

365
Q

Stromal cell tumor treat

A

Unilateral salpingo-oophorectomy when future pregnancies are a consideration

366
Q

Fibroma treat

A

Even with meigs syndrome almost always benign

Remove ovary or treat by resection of the ovary in a young woman who desires a future family

367
Q

Treat germ cell dermoid

A

Ovarian cystectomy

Carefully evaluate other ovary since they are bl in approximately 15-20%

Rare recurrence after surgical resection

Copiously irrigate pelvis to avoid chemical peritonitis

368
Q

Fallopian tubes

A

Most benign and infectious or inflammatory

Malignant rare

369
Q

Hydrosalpinx

A

Fluid filled tubes from previous infection

370
Q

Pyosalpinx

A

Purulent filled tube from active infection

371
Q

Malignancy fallopian

A

Some serous ovarian cancers may arise from Fallopian tube

372
Q

Ovarian tosrion presntation

A

Acute onset of unilateral pain

Nausea and vomiting

373
Q

Diagnose ovarian tosrion

A

US first line

Definitive by direct visualization

374
Q

Treat ovarian torsion

A

Detorsion and ovarian conservation with an ovarian cystectomy

Salpingo-oophorectomy is performed if ovary is necrotic or you suspect malignancy

Clin Medicine (28 decks)

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