Exam 2 Uterine Dz

Question 1

Uterine Fibroids (Myomas)? (4)

Answer 1

Most C pelvic tumor
Most C need for hyster
Collagen/smooth mm/elastin in pseudocapsule
C in blacks in 40s

Question 2

Uterine Fibroids caused by?

Answer 2

U/K

E2 makes them grow but doesn’t cause them

Question 3

Uterine Fibroids classification:

Submucosal (0,I,II)?

Subserosal?

Intramural?

Answer 3

Just below endometrium

Serosal surface of uterus

w/i uterine wall

Question 4

Uterine Fibroids presentation? (6)

Answer 4

Sxs in ~1/2, depends on location/size

Abn uterine bleed = submucosal (↑ SA of endometrium)

Pain

Pelvic pressure = mass/compression of organs

Infertile = impinged uterine cavity

Miscarriage

Question 5

Uterine Fibroids exam findings?

Answer 5

Bimanual exam =
Hard mass
Irregular shape
Enlargement

Question 6

Uterine Fibroids labs?

Answer 6

Hct/Hgb = anemia

Question 7

Uterine Fibroids imaging?

Answer 7

Transvag US
Saline sonohystogram (US w/ saline injection)
Hysteroscopy (camera)
MRI for planning

Question 8

Uterine Fibroids meds mgmt? (3)

Answer 8

GnRH analog
Steroids (if heavy/long bleeds): E2/P2
Transexamic acid (if heavy/long bleeds): Lysteda during menstruation

Question 9

Uterine Fibroids Expectant Mgmt?

Answer 9

May shrink postpartum or postmeno
Annual pelvic
Watch CBC for anemia
If ↑ sxs or size -> treat

Question 10

leimyosarcoma is?

Answer 10

Uterine CA U in postmeno

Rapid enlarg mass w/ pain and d/c

Question 11

Depo Lupron for Uterine Fibroids? (4)

Answer 11

Depo Lupron (GnRH analog): 
Temp induce meno -> ↓E2 -> ↓ size
Fix anemia
↓ blood loss in surgery
Don't use > 6 mo

Question 12

Uterine Fibroids; Myomectomy? (3)

Hysteroscopic Myo?

Answer 12

Preserves fertility/uterus
High recurrence
C-section req’d to avoid uterine rupture

Only for submucosal fibroids
P fluid overload during procedure

Question 13

Uterine Fibroids; Ablation?

Answer 13

For heavy bleeds
Must remove fibroids first
Still need contraceptive

Question 14

Uterine Fibroids: Uterine Artery Embolization? (4)

Answer 14

Preserves uterus NOT fertility
Kills blood supply to fibroid
Not for numerous/large fibroids
Postembolization Synd

Question 15

Postembolization Synd? (6)

Answer 15

Must hospitalize
Endometritis/Uterine infection
Non-puss d/c
Embolization agent on non-target tissues
Uterine necrosis, sepsis, bacterima, death

Question 16

Endometriosis is?

Causes what? (6)

Answer 16

Benign, chronic E2-dependent disorder
Endomet glands/stroma at extra uterine sites
Lesion expansion premenstrual

Retrograde flow through tubes/peritoneum
Vascular/Lymph spread
Coelomic metaplasia
Infertility
↑ risk of autoimm dz
↑ risk of ovarian CA-125

Question 17

Endometriosis exam findings? (3)

Answer 17

Posterior cul-de-sac tender
Fixed or retrovert uterus from adhesions
Adnexal masses/tender

Question 18

Endometriosis imaging/studies? (3)

Answer 18

Pelvic US

Laparoscopy =
Erythema/Petechia
Ovary “Chocolate Cysts” (most C site of dz)

Bx = confirms dx

Question 19

Endometriosis tx:

Mild?

Mod/Severe? (5)

Answer 19

Watch/NSAIDs

Interrupt endo stim:
OCP (cause endo atrophy)
Progestins
Depot Lupron (↓ E2/P2)
Lap w/ fulguration (electrical destruction)
Hyster w/ salping-oophorectomy

Question 20

Endometrial CA?

Risk factors? (4)

Answer 20

Most C gyn CA
U by 60yo

Continuous E2 therapy
Lynch Synd
Cowden Syn
Polycyst

Question 21

Endometrial CA Type 1?

Answer 21

From unopposed E2
Well-differentiated tumors
Good prognosis

Question 22

Endometrial CA Type 2?

Answer 22

Independent of E2
U w/ endo atrophy
Poor diff, poor prog

Question 23

Endometrial CA presentation?

Answer 23

Abn vag bleed (heavy, inter spotting, post meno bleed)
Abd cramps
Back pain
Wgt loss
Painful sex

Question 24

Endometrial CA studies? (7)

Answer 24

CBC
CA-125
Pap
D&C
Transvag US
MRI-CT
Endo Bx

Question 25

Endometrial CA tx?

Answer 25

Hyster w/ salpoogectomy + pelvic and peraortic lymphadenoectomy
Radio/Chemo