Exam 2 Vaginal, Ovary Dz

Question 1

Vaginal Intraepithelial Neoplasm (VaIN) epidemiology? (4)

Answer 1

U 40s - 60s
U HPV related
U pt also had cervical or vulvar IN
U in upper 1/3 of vagina

Question 2

VaIN risk factors? (3)

Answer 2

Smoking
Immunocomp
Sluts

Question 3

VaIN classifications:

1?

2?

3?

Answer 3

1: = basal epith layers
2: ≤ 2/3 of vag epith
3: ≥ 2/3 of vag epith

Question 4

VaIN presentation? (4)

Answer 4

U asympt
P post-sex spotting
P vag d/c (unlike STDs d/c)
Abn pap

Question 5

VaIN studies?

Answer 5

Colposcopy

Question 6

VaIN tx:

1?

2, 3?

Prognosis?

Answer 6

1 = observation

2/3 = Surgery, imiquimod, 5-FU

30% recurrence

Question 7

Vaginal CA is? (3)

Answer 7

U > 55
U 2° to cancer elsewhere
U SCC

Question 8

Vaginal CA presentation? (4)

Answer 8

Asymp
U painless vag bleeding
Vag d/c
Pelvic pain

Question 9

Vaginal CA tx? (3)

Answer 9

No standard
Vaginectomy, radiation, chemo
< 50% survival

Question 10

Ovarian Cysts: Follicular? (5)

Answer 10

Most C fxn'l cyst
Failure of mature cyst to rupture
~ 3-8 cm
Not malignant
U resolve w/i 6 wks

Question 11

Ovarian Cysts: Corpus Luteum? (4)

Answer 11

Failure of resorption post ovulation
Filled w/ blood, hemorrhage concerns
~3-11 cm
U resolves in 1-2 cycles

Question 12

Ovarian Cysts: Theca Lutein? (3)

Answer 12

Fxn’l cyst resulting from ↑ gonadotrophins
U bilateral
U resolves w/ tx of ↑ gonad

Question 13

Mature Teratoma is?

Answer 13

Benign Ovarian Neoplasm:

U reproductive age
Well differentiated tissue from ecto-, meso- or endoderm

Question 14

Mature Teratoma presentation? (4)

Answer 14

Asympt
Pelvic pain 2° to torsion/rupture
Polyuria/urgency
Back pain

Question 15

Mature Teratoma exam findings?

Labs?

Imaging?

Answer 15

Pelvic mass

CEA, CA-125, AFP, βHCG (CA markers) = N

US = unilateral complex cyst

Question 16

Mature Teratoma tx? (3)

Answer 16

Size dependent
Removal w/ or w/o ovary
10% recurr

Question 17

Ovarian CA? (3)

Answer 17

1/2 found in post meno
Pathophys unclear
High mortality

Question 18

Ovarian CA risk factors? (4)

Decreased risk w/? (4)

Answer 18

BRCA1/2
Lynch Syndrome (hereditary non-poly colon CA)
Early menarche
Late menopause

Past oral contraceptive
Past breast feed
Tubal ligation
Pregnancies

Question 19

Ovarian CA: Epithelial Neoplasm?

Serous?

Mucinous?

Endometrial?

Clear Cell?

Brenner?

Answer 19

90% of ovarian tumors

Serous = most C, 1/2 are bilateral, S to fallopian tubes

Mucinous = Large, U unilateral, S to endocervix

Endometrial = P bilateral

Clear Cell = rare, small, a/w hyperCa2+/pyrexia

Brenner = rare

Question 20

Ovarian CA: Germ Cell Neoplasm? (2)

Answer 20

U 30-40s

Produce markers

Question 21

Ovarian CA: Sex-Cord Stromal Tumor

Granulosa? (3)

Sertoli-Stromal?

Answer 21

Granulosa:
70%
Causes hyperestrogenism (early puberty, post meno bleed)
U 60s

S-S:
Rare
Causes hyperandrogenism
40-50s

Question 22

Ovarian CA presentation? (3)

Answer 22

Bloating
Pelvic/Abd pain
Difficulty eating/Early filling
Lasting > few wks

Question 23

Ovarian CA exam findings? (3)

Answer 23

Pelvic mass
Inguinal LAD
Ascites

Question 24

Ovarian CA labs? (2)

Answer 24

↑ CA-125 suspect epith tumor

↑ hCG, AFP, LDH suspect germ cell tumor

Question 25

Ovarian CA imaging? (4)

Answer 25

US
CT = retroperitoneal involvement, met to pelvic organs
MRI = neoplasm characteristics
CXR

Question 26

Ovarian CA: Epithelial tx?

Answer 26

GYN oncologist
FIGO staging
Chemo

Question 27

Ovarian CA: Germ tx?

Answer 27

GYN oncologist
Remove involved adnexa only if early
FIGO staging

Question 28

BRCA testing guidelines: Non-Ash Jews? (5)

Answer 28

two 1° w/ breast CA, one ≤ 50yo

three+ 1° or 2° BCA, any age

BCA and OCA 1° and 2°, any age

bilat BCA 1°

male w/ BCA

Question 29

BRCA testing guidelines: Ash Jews?

Answer 29

1° or two 2° BCA

Question 30

Genetic risk of Lynch Synd?

Answer 30

Endometrial or colorectal CA < 50yo

Question 31

Polycystic Ovarian Synd causes what? (3)

Answer 31

1) Abn E2 and androgen metabolism -> high test/DHEA/androst
2) Insulin resistance/Hyperinsulinemia -> ∆ FSH/LH -> ∆ ovarian fxn
3) ↓ adiponectin (lipid metab/glucose) -> DMII

Question 32

Polycystic Ovarian Synd signs? (9)

Answer 32

Infertile
Anovulation (amenorrhea)
Obesity
Acne
HIRSUTISM
MP baldness
Acanthosis nigricans
Sleep apnea
Metabolic synd

Question 33

Polycystic Ovarian Synd diagnostic criteria? (4)

Answer 33

Exclude other causes
2 of 3:
Oligo- or anovulation
Signs of hyperandrogenism (acne, high testo)
Polycystic ovaries

Question 34

Polycystic Ovarian Synd imaging?

Answer 34

Transvag US =
> 12 follicles in each ovary 2-9mm
String of pearls appearance
Ovarian vol >10mL

Question 35

Polycystic Ovarian Synd Labs? (7)

Answer 35

Fasting lipids = ↑ LDL/trigly, ↓ HDL
Fasting glu = >100 (DMII)
Free testost > 50 !!
LH =  ↑
LH/FSH = > 2:1 !!
LFT =  ↑AST,ALT
DHEAs (Always order this!)

Question 36

Polycystic Ovarian Synd tests for DDX:

Cushings?

Androgen-secreting tumor?

Congenital hyperplasia?

Hyperprolactinemia?

Thyroid dysf?

Answer 36

Cushings = 24hr urine cortisol

Androgen-secreting tumor = Free testost

Congenital hyperplasia = a.m. 17-hydroxyprogesterone

Hyperprolactinemia = serum prolactin

Thyroid dysf = TSH/FT4/FT3

Question 37

Polycystic Ovarian Synd tx? (5)

Answer 37

Lifestyle
Combo oral contra (opposes E2) or Cyclic Provera (progest)
Metformin (for hyperinsulin)
Fertility consult

Question 38

Polycystic Ovarian Synd may lead to? (4)

Answer 38

Endometrial hyperplasia/CA
DMII
Metab syn (HTN, Dyslipidemia)
Non-alcoholic steatohep