glines trophoblast and abortion

Question 1

The commonality of all gestational trophoblastic diseases is that they secrete ________

Answer 1

BETA – HCG

Question 2

Which 2 gestational trophoblastic diseases can metastasize?

Answer 2

choriocarcinoma and invasive moles (though not a cancer)

Question 3

What is the gold standard for diagnosing ectopic pregnancy? How will the results of a mole be different?

Answer 3

Ultrasound and B-HCG (1200), in a mole the B-HCG will be much higher

Question 4

How do you get a complete mole and what is the karyotype?

Answer 4

fertilization of empty ovum by haploid sperm; 46 XX RARELY is it 46 xy

Question 5

What is the usual way by which you get a partial mole? Karyotype?

Answer 5

2 sperm fertilize a NON empty ovum; 69 XXY, XXX, or XYY

Question 6

Because you know you’ve wondered this since embyro day #1, where does the term hydatidiform mole come from?

Answer 6

mole from latin mola, refers to false conception/millstone and hydatisia is greek for a drop of water (chorionic villi are fluid filled) and it looks very similar to hydatid cysts in echinococcus infections. Now you know.

Question 7

Which type of mole is often present with a co-existing fetus?

Answer 7

partial or incomplete mole

Question 8

Name 2 cancers that can cross placenta

Answer 8

melanoma and choriocarcinoma

Question 9

What disease represents the majority of patients who have elevated B-HCG AFTER molar evacuation

Answer 9

invasive mole, not choriocarcinoma

Question 10

What is the main route of metastasis for choriocarcinoma?

Answer 10

hematogenous

Question 11

There will be no test question on this tumor

Answer 11

placental site trophoblastic tumor, not gonna worry about it then! But the major problem is that it is insensitive to chemo

Question 12

The frequency of gestational trophoblastic disease is highest in this country

Answer 12

TAIWAN

Question 13

Gestational trophoblastic disease tends to occur in areas with less of these 2 nutrients are consumed

Answer 13

beta carotene and folic acid

Question 14

What should you do to the dose of folate in a pregant woman who has Hx of mole

Answer 14

increase the dose

Question 15

What kind of age distribution occurs with moles?

Answer 15

bimodal (under 20, over 40)

Question 16

Are moles benign or malignant?

Answer 16

benign (both are, complete and partial)

Question 17

Complete moles have hyperplasia of this tissue

Answer 17

trophoblastic tissue

Question 18

T/F: complete moles usually cause tremendous amounts of pain and mimic ectopic pregnancies

Answer 18

false, actually. They are surprisingly not associated with much pain

Question 19

T/F: complete moles can mimic pre-ecclampsia

Answer 19

TRUE

Question 20

Why would you hear wheezing/rhonchi in a patient with a mole?

Answer 20

they can spread to the lungs

Question 21

What is the Tx for a complete mole?

Answer 21

suction evacuation followed by sharp curretage; IV pitocin with follow up B HCGS

Question 22

If the B HCG levels don?t decline after molar evacuation which 2 drugs can you use?

Answer 22

methotrexate (also DOC for ectopic pregnancy) and actinomycin D

Question 23

At what age is hysterectomy for Tx of molar pregnancy appropriate?

Answer 23

over 40

Question 24

What is the most common gynecologic cancer?

Answer 24

endometrial

Question 25

How awesome is Dr. Glines?

Answer 25

Pretty awesome

Question 26

Which molar pregnancy is associated with a developing fetus?

Answer 26

partial mole

Question 27

T/F: partial moles are defined as a snow-storm pattern on ultrasound

Answer 27

false, complete moles are snow-storm patterns because the fluid filled cysts are very large and look like a snow storm

Question 28

Path tie-in, the snowstorm pattern on ultrasound translates to a ____________ pattern on histology

Answer 28

coast of norway, again both are caused by the fact that there are large cystic spaces

Question 29

What is a common way for partial moles to present?

Answer 29

they may present as a spontaneous or missed abortion

Question 30

T/F most patients with partial moles have very large uterus for gestational age

Answer 30

false, this is true of complete moles but partial mole pts are small for dates

Question 31

When will a partial mole patient become pre-ecclamptic in comparison to a complete mole patient?

Answer 31

usually one month later

Question 32

Which patient is more likely to have wheezes and rhonchi, one with a complete or partial mole?

Answer 32

complete mole as it is more likely than a partial mole to metastasize

Question 33

What is the work up of choriocarcinoma and why would you suspect this?

Answer 33

You suspect this after molar evacuation when there is elevated B HCG that is persistent, then you also do a CT of pretty much the whole body, also a lumbar puncture

Question 34

How do you Tx choriocarcinoma with a good prognosis

Answer 34

actinomycin D and methotrexate

Question 35

If choriocarcinoma is metastatic what is used in conjunction with medications?

Answer 35

radiation

Question 36

Can a woman who has had choriocarcinoma get pregnant again?

Answer 36

she can but she SHOULD NOT AS SHE CAN DIE!

Question 37

Can a woman who has had a molar evacuation get pregnant again?

Answer 37

yes 1 year later

Question 38

Miscarraige is a is a lay term for \_\_\_\_\_\_

Answer 38

abortion

Question 39

A spontaneous abortion that occurs AFTER 20 weeks but before 37 is deemed \_\_\_\_\_\_\_\_\_\_\_

Answer 39

Intrauterine fetal demise

Question 40

A spontaneous abortion that occurs BEFORE 20 weeks is called

Answer 40

a missed abortion

Question 41

What is the frequency of abortions?

Answer 41

50% of pregnancies, they think that many women do not know they are pregnant

Question 42

At what maternal age is the risk of spontaenous abortion higher?

Answer 42

30 but even higher at 35 and 40

Question 43

Name the 7 types of abortions

Answer 43

threatened, inevitable, incomplete, complete, missed, therapeutic/elective, septic (any of the others PLUS infection)

Question 44

Define threatened abortion

Answer 44

vaginal bleeding before the 20th week with a CLOSED CERVICAL OS

Question 45

Define inevitable abortion

Answer 45

bleeding that occurs with the cervical os OPEN

Question 46

Define incomplete abortion

Answer 46

vaginal bleeding with the os open and passage of some fetal tissue

Question 47

Define complete abortion

Answer 47

bleeding with the os closed (??) and passage of all products of conception

Question 48

Define missed abortion

Answer 48

fetus dies before 20 weeks and is retained in uterus

Question 49

Define septic abortion

Answer 49

any abortion that occurs with infection

Question 50

This is the term to describe 3 or more successive abortions

Answer 50

recurrent abortion

Question 51

What kind of abortion occurs when there is vaginal bleeding without the passage of fetal tissue with an open cervical os?

Answer 51

inevitable abortion

Question 52

What kind of abortion occurs before 20 weeks and the fetus is retained in the uterus?

Answer 52

missed abortion

Question 53

What term describes when the fetus dies after 20 weeks of gestation and is retained in the uterus?

Answer 53

Intrauterine fetal demise

Question 54

What term describes when there is vaginal bleeding prior to the 20th week with a closed cervical os?

Answer 54

threatened abortion

Question 55

What term describes when there is vaginal bleeding with an open cervical os and some passage of fetal tissue?

Answer 55

incomplete abortion

Question 56

What term describes when a woman is 18 weeks pregnant, has a closed os and is bleeding and it is found that there is chorionitis due to ascending E. coli infection?

Answer 56

septic abortion (any abortion with an infection)

Question 57

What is the most common cause of spontaneous abortion?

Answer 57

genetic anomaly

Question 58

This bug can be harbored in the male prostate and causes spontaneous abortions

Answer 58

Listeria monocytogenes

Question 59

What is Asherman's syndrome?

Answer 59

When the lining of the cervix adheres to itself i.e. left side adheres to right side so there is obliteration of the uterine cavity

Question 60

What is a BIG cause of uterine abnormalities?

Answer 60

D/C and scrapings

Question 61

Name 3 important immunologic causes of abortion i.e. Rh and 2 others

Answer 61

Kell and Duffy antigens (Kell kills, Duffy dies)

Question 62

How do you manage a threatened abortion?

Answer 62

ultrasound and rest and reassurance (just because bleeding doesn?t mean baby died but still called threatened "abortion")

Question 63

How do you manage an inevitable abortion?

Answer 63

Admit the patient, analgesia, D/C etc.

Question 64

How do you manage an incomplete abortion?

Answer 64

Admit the patient, analgesia, D/C etc. --same as inevitable

Question 65

How do you manage a missed abortion?

Answer 65

D/C , cytotec, prostaglandins, laminaria

Question 66

How do you manage a complete abortion?

Answer 66

supportive measures if necessary

Question 67

How do you manage a septic abortion?

Answer 67

IV antibiotics and evacuation

Question 68

How do you manage recurrent abortions?

Answer 68

start doing cultures and labs for antibodies such as Rh, duffy, kell, etc.

Question 69

If a patient has any abortion and is Rh negative what do you give them?

Answer 69

rhogam

Question 70

What is Spalding's sign?

Answer 70

overlapping of fetal skull bones on X-ray due to liquefaction of the fetal brain

Question 71

How do you ultimately Dx an abortion?

Answer 71

no fetal movement, no cardiac motion

Question 72

How can you induce labor for someone with an abortion at 13-28 weeks? After 28 weeks? Why the difference?

Answer 72

13-28 weeks = prostaglandins; after 28 weeks = pitocin? The use of prostaglandins after 28 weeks is associated with a risk of uterine rupture