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10 OB > GTD > Flashcards

GTD Flashcards

1
Q

abnormal conceptions with excessive placental and little/no fetal development

A

hydatidiform moles

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2
Q

most common karyotype for h mole

A

46xx (androgenic diploidy, one sperm or 2 sperms)

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3
Q

most common pathogenesis for h mole

A

endoreduplication: empty ovum is fertilized by haploid sperm that endoreduplicates to make a homozygous complete mole

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4
Q

alternate pathogenesis for complete h mole

A

dispermy: empty ovum is fertilized by two haploid sperms giving to a heterozygous complete mole

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5
Q

h mole pattern on uts

A

snowstorm pattern

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6
Q

histopathologic appearance of h mole

A

severe trophoblastic proliferation cauing elevated bhcg

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7
Q

physiologic effects of elevated bhcg titer

A
  • corpus size is larger than aog
  • vaginal bleeding
  • presence of theca lutein cysts
  • presence of medical problems (preeclampsia, anemia, hyperthyroid, pulmo embolism causing rds)
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8
Q

most common pathogenesis in partial hm

A

dispermy on non-empty ovum = triploid partial mole (69xxy, 69xxx, 69xyy)

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9
Q

tvuts appearance

A

baby with many abnormalities or no baby (misdiagnosed as missed abortion)

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10
Q

histopath of phm

A

markedly cystic villi and normal sized villi
fetal components and rbc are present
less elevated bhcg

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11
Q

effects of elevated bhcg in phm

A

vaginal bleeding
corpus similar/smaller than aog
theca lutein cysts and associated medical problems

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12
Q

t/f management is different for the two h moles

A

false, management is similar

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13
Q

principles of h mole management

A

recognize and manage associated medical conditions
evacuate promptly and appropriately
identify patients at high risk for gtn
regular post-evan bhcg surveillance

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14
Q

medical complications that must be treated first

A 
anemia
hyperemesis gravidarum
respiratory insufficiency
dic
preeclampsia
hyperthyroidism
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15
Q

t/f in patients with molar pregnancy, even if they present with elevated bp and proteinuria in the first trimester, then diagnose with pre-eclampsia

A

true

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16
Q

common presenting symptoms of hyperthyroidism in h mole

A

thyroid enlargement and tachycardia

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17
Q

possible evacuation methods for molar products

A

hysterectomy if family is completed

suction curettage

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18
Q

t/f medical induction can be done to evacuate molar products

A

FALSE, causes more bleeding and higher risk for gtns

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19
Q

management procedures for closed cervix, pre-evacuation

A

mechanical dilators and hegar dilators prior to curretage

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20
Q

t/f using prostaglanding and pre-evacuation oxytocin is NOT RECOMMENDED prior to evacuation

A

true

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21
Q

t/f theca lutein cysts indicate oophorectomy

A

false, don’t do anything they will regress in 8 weeks

only indication: with torsion, rupture, or necrosis

22
Q

confirmatory tests for h mole classification

A 
immunostain p57kip2
cytogenetic studies (flow cytometry or karyotyping)
23
Q

risk of malignant degeneration of h mole

A

complete: 15-25%

partial 0.5-4%

24
Q

how to decrease risk for gtn

A

chemoprophylaxis with methotrexate

hcg surveillance

25
Q

indications for chemoprophylaxis

A
  • > 40 yo
  • uterine size 6+ weeks larger than aog
  • theca lutein cyst of 6+ cm
  • medical complications
  • bhcg 100,000+ mlu/ml
  • recurrent h mole
  • h mole with normal twin fetus
  • poor follow up
26
Q

contraindications for chemoprophylaxis

A 
hgb <100 mg/dl or hct <0.3
wbc <3,000 or >10,000
platelet <100,000
neutrophils (ANC) <1.5
active infection
abnormal renal/liver function
27
Q

process of bhcg monitoring

A

1 week after evacuation
every 2 weeks until 3 normal titers
every month for 6 months
no pregnancy

28
Q

preferred contraceptive after h mole

A

barrier: not really
progestins: very, irregular bleeding
combined ocp!!

29
Q

t/f iuds can cause heavy menstrual bleeding which can confuse the monitoring after h mole

A

true

30
Q

t/f ocps suppress endogenous FSH

A

false, LH which has similar structure to bchg

31
Q

when to allow pregnancy after h mole

A

after 6 mos of normal serum bhcg level

32
Q

work-ups during pregnancy after h mole

A

perform early uts
submit placenta for histopath
monitor bhcg 6 weeks postpartum

33
Q

when to refer for post molar gtn

A

rise in bhcg of 10%+
plateauing for bhcg values after evacuation
presence of metastasis at any site

34
Q

risk factors for gtn

A

major risk factor is antecedent pregnancy (h mole is associated with 50% of gtns)
asians

35
Q

history of gtn patient

A

previous h mole
vaginal bleeding and anemia
s/sx of metastasis

36
Q

t/f you can do biopsy if you find a vaginal mass in px suspected with gtn

A

FALSE, DO NOT PERFORM BIOPSY IT WILL CAUSE BLEEDING

37
Q

supporting evidence of gtn with clinical diagnosis

A

sonographic picture and elevated bhcg titer

38
Q

t/f chest ct scan can detect occult metastases in the presence of normal cxr

A

true

39
Q

t/f chest ct is used for monitoring and staging, not for risk score assessment

A

true

40
Q

indications for brain ct

A

neuro s/sx

all px with pulmonary metastases having aggregate diameter of 3+ cm

41
Q

FIGO anatomic staging

A 
I = uterus
II = outside uterus but in pelvis
III = pulmonary metastasis
IV = metastases to the other sites
42
Q

t/f histopath is needed to start gtn treatment

A

false

43
Q

t/f it’s possible to treat gtn with chemo alone

A

true

44
Q

treatments for gtn

A

nonmetastatic or metastatic low-risk: single agent methotrexate or actinomycin
metastatic high risk: emaco regimen

45
Q

when is consolidation therapy done

A

when patient reaches normal hcg titers <5

46
Q

patient is cured of gtn when

A

3 consecutive normal serum bhcg levels

47
Q

hcg monthly monitoring

A 
monthly for first 6 mos
every 2 mos for next 6 mos
every 3 mos for 1 year
evey 6 mos after
lifetime monitoring

no pregnancy for first 2 years

48
Q

complications for gtn

A

early menopause
secondary malignancies (etoposide)
av malformation in uterus

49
Q

clinical presentation of pstt/ett

A

irregular uterine bleeding distant from preceding non-molar gestation

50
Q

diagnosis for pstt/ett

A

histopath

pstt: implantation type intermediate trophoblasts
ett: chorionic type intermediate trophoblasts

51
Q

management of pstt/ett

A

hysterectomy, resistant to chemo

10 OB (6 decks)

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