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Summer 15 - Women's Health > GU Benign and Malignant > Flashcards

GU Benign and Malignant Flashcards

1
Q

What is lichen sclerosis?

A
  • chronic inflammatory condition

- likely autoimmune

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2
Q

S/S of Lichen Sclerosis

A
  • chronic vulvar pruritus and pain
  • dysuria
  • dyspareunia
  • rectal bleeding
  • diffuse, thin, white wrinkled skin localized to labia
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3
Q

Dx of Lichen Sclerosis

A

-punch biopsy to confirm and r/o malignancy

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4
Q

Tx of Lichen Sclerosis

A

-topical steroids 2-3 months until resolved then weekly for maintenance

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5
Q

What is lichen simplex chronicus?

A
  • lichenified skin reaction to chronic scratching
  • caused by atopic dermatitis, tinea or candida infection
  • worsens with heat, excessive sweating, clothing irritation
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6
Q

S/S of Lichen Simplex Chronicus

A
  • progressive pruritus and burning

- red papules form lichenified, thickened, scaly localized plaques

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7
Q

Dx of Lichen Simplex Chronicus

A
  • clinical

- biopsy if not resolving

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8
Q

Tx of Lichen Simplex Chronicus

A
  • treat underlying cause
  • antipruritus medications
  • topical steroid cream
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9
Q

What is lichen planus?

A
  • autoimmune inflammatory condition

- age 50-60

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10
Q

S/S of Lichen Planus

A
  • intense chronic pruritus
  • insertional dyspareunia, post-coital bleeding
  • vulvar pain
  • erosive type: red/white patchy, ulcerative lesions
  • vagina often involved (differentiates from lichen sclerosis which is external only)
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11
Q

Dx of Lichen Planus

A
  • clinical

- consider biopsy to r/o malignancy or wet prep to r/o infx

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12
Q

Tx of Lichen Planus

A
  • steroids for vulvar lesions
  • intravaginal steroids for vaginal lesions
  • oral prednisone if refractory to topical tx
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13
Q

Psoriasis

A
  • autosomal dominant
  • mildly pruritic
  • scaly, silvery patch atop an erythematous base
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14
Q

Dx and Tx of Psoriasis

A

Dx: biopsy
Tx: topical steroid

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15
Q

Dermatitis

  1. Etiology
  2. Dx
  3. Tx
A
  • etiology: eczema, seborrheic dermatitis
  • Dx: clinical
  • Tx: remove offending agent, topical steroids
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16
Q

S/S Vestibulitis

A
  • localized vulvar pain w/o dermatitis
  • severe pain provoked by focal touch of vulva
  • insertional dyspareunia over weeks-months
  • small, reddened patchy areas over glands and vestibule
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17
Q

Dx of Vestibulitis

A

-light touch over vestibule recreates pain

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18
Q

Tx of Vestibulitis

A
  • controversial
  • topical lidocaine if localized, oral nortriptyline or gabapentin
  • remove irritants
  • abstinence
  • steroid ointments
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19
Q

Bartholin Gland Cyst

A
  • obstruction of bartholin glands

- mucus accumulates usually due to bacterial cause

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20
Q

S/S of Bartholin Gland Cyst

A
  • often asymptomatic
  • pain and tenderness with sex, sitting, ambulation
  • firm swelling at posterior vaginal introitus
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21
Q

Dx of Bartholin Gland Cyst

A

clinical

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22
Q

Tx of Bartholin Gland Cyst

A
  • asymptomatic: no intervention

- symptomatic: I/D with word cath placement, marsupialization, excision

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23
Q

Vulvar Hygiene

A
  • cotton underwear
  • loose garments
  • tampons instead of pads
  • fragrance free soap
  • omit sprays, powders, douches
  • pat dry
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24
Q

Vulvar Neoplasia

  • S/S
  • Dx
  • Tx
A
  • may be associated w/ HPV
  • vulvar irritation, pruritus, raised lesions
  • Dx: biopsy
  • Tx: excision
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25
Q

Vaginal Intraepithelial Neoplasia (VAIN)

A

-more commonly neoplasia is result of spread from another site (eg cervical)

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26
Q

S/S of Vaginal Cancer

A
  • asymptomatic

- vaginal bleeding

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27
Q

Dx of Vaginal Cancer

A
  • PAP

- biopsy

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28
Q

Tx of Vaginal Cancer

A
  • radiation

- radical hysterectomy, upper vaginectomy, pelvic lymphadenectomy

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29
Q

Nabothian Cysts

A
  • benign cervical tumor

- squamous cells cover columnar cells, which continue to secrete mucoid material

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30
Q

Polpys

A
  • benign cervical tumors

- polypectomy if symptomatic or large

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31
Q

Role of HPV in Cervical Cancer

A
  • infx with HPV is central factor

- HPV easily transmitted via sex

32
Q

Why are PAP smears now every 3-5 years instead of yearly?

A

-precursor lesions precede invasive disease by 10 years so easy to catch in time to treat it and b/c most healthy women will clear HPV infx in 2 years

33
Q

PAP Test

A
  • collection of cervical cells using speculum
  • detect cervical abnormalities
  • want the report to say satisfactory for exam, transformation zone present
34
Q

Transformation Zone

A
  • junction of squamous and columnar cells on the cervix
  • these are the least mature cells of cervix and more prone to metaplasia
  • carcinoma usually arises in squamocolumnar junction or transformation zone
35
Q

Screening Guidelines for PAP Test

A
  • none under 21
  • 21-29: cytology q3 years
  • 30-65: cytology and HPV every 5 years or cytology alone every 3 years
  • over 65: no screening if negative history
36
Q

HPV

A
  • precursor to cervical carcinoma

- most common types: 16, 18, 31, 45

37
Q

Risk Factors for HPV

A
  • multiple sex partners
  • early age at first intercourse
  • smoking
  • immunocompromised
38
Q

HPV Vaccination

A
  • routine for boys and girls 11-12 years old

- catch up until age 26

39
Q

Colposcopy

A
  • microscopic guided evaluation with biopsy and endocervical curettage
  • identify areas of dysplasia
  • test for confirmation of PAP results
40
Q

Cervical Carcinoma S/S

A
  • asymptomatic
  • watery vaginal discharge
  • intermittent spotting
  • postcoital bleeding
41
Q

Dx of Cervical Carcinoma

A
  • pap test
  • colposcopy
  • conization
42
Q

Tx of Cervical Carcinoma

A
  • conization of cervix (LEEP excision)
  • hysterectomy
  • lymph node dissection
  • radiation therapy
  • chemotherapy
43
Q

Uterine Leiomyoma (Fibroids)

A
  • localized proliferation of smooth muscle cells
  • benign
  • pt presents with abnormal bleeding
  • common in 50s
44
Q

S/S of Uterine Leiomyoma (Fibroids)

A
  • menorrhagia
  • pelvic pressure
  • secondary dysmenorrhea
  • pelvic mass
45
Q

Dx of Uterine Leiomyoma (Fibroids)

A
  • clinical
  • pelvic US
  • endometrial biopsy to r/o carcinoma
46
Q

Tx of Uterine Leiomyoma (Fibroids)

A
  • reassurance, observation
  • intermittent progestin
  • myomectomy
  • hysterectomy
  • GnRH agonists
47
Q

Uterine Leiomyoma (Fibroids) and Pregnancy

A
  • usually associated w/ infertility
  • 3cm: preterm labor, placental abruption, pelvic pain, C-section
  • Tx with analgesics and bedrest
48
Q

What is adenomyosis?

A

-disorder in which endometrial glands and stroma are present within uterine musculature

49
Q

S/S of Adenomyosis

A
  • menorrhagia
  • dysmenorrhea
  • enlarged uterus
50
Q

Dx of Adenomyosis

A
  • MRI

- histology from hysterectomy confirms

51
Q

Tx of Adenomyosis

A

hysterectomy if significant symptoms

52
Q

What are endometrial polyps and who gets them?

A
  • focal, benign processes
  • may be found in association with endometrial hyperplasia or carcinoma
  • perimenopausal women
53
Q

S/S of Endometrial Polyps

A
  • abnormal bleeding

- pelvic pain

54
Q

Dx of Endometrial Polyps

A
  • ultrasound
  • excision
  • histology
55
Q

Tx of Endometrial Polyps

A

-polypectomy if symptomatic

56
Q

What is endometrial hyperplasia and what causes it?

A
  • proliferation of endometrial glands
  • due to excess estrogen: obesity, estrogen therapy w/o progestin, anovulation, ovarian tumors, nulliparity, older age, late menopause
57
Q

S/S of Endometrial Hyperplasia

A

-abnormal uterine bleeding

58
Q

Dx of Endometrial Hyperplasia

A
  • endometrial biopsy

- transvaginal US

59
Q

Tx of Endometrial Hyperplasia

A
  • D&C
  • cyclic progestins
  • medroxyprogesterone
  • progesterone intrauterine contraceptive
  • hysterectomy after childbearing is complete
60
Q

S/S of Endometrial Cancer

A
  • postmenopausal bleeding
  • vaginal dischare
  • endometrial cells on cervical cytology
61
Q

Tx of Endometrial CA

A
  • hysterectomy
  • high dose progestin
  • advanced dz needs radiation and chemo
62
Q

Symptoms of Benign Ovarian Cysts and Tumors

A
  • asymptomatic
  • mass
  • pelvic pain
  • dyspareunia
  • dysmenorrhea
63
Q

Dx of Benign Ovarian Masses

A
  • pelvic exam
  • US
  • pathology
  • CBC, UPT
64
Q

When do theca lutein cysts occur and why?

A
  • pregnancy
  • overstimulation with high hCG levels
  • usually bilateral and large
65
Q

Mature Cystic Teratoma

A

-may contain teeth, hair, sebum, bone, skin

66
Q

S/S of Ovarian Neoplasms

A
  • abdominal fullness/bloating
  • pelvic, abd, back pain
  • early satiety, difficulty eating
  • decreased energy
  • urinary frequency
  • irregular, fixed, solid pelvic mass
  • asymptomatic or vague sxs = usually diagnosed late
67
Q

Dx of Malignant Ovarian Neoplasms

A

-US and histopathology

68
Q

Tx of Malignant Ovarian Neoplasms

A

TAH-BSO

69
Q

Risks for Ovarian CA

A
  • Caucasian
  • nulliparous
  • primary infertility
  • endometriosis
70
Q

Protective Factors for Ovarian CA

A
  • OCP use
  • breastfeeding
  • multiparity
  • tubal ligation
71
Q

What might cause elevated CA-125 levels?

A
  • CA: ovarian, endometrial, breast, colon
  • endometriosis
  • fibroids
  • pregnancy
  • PID
  • liver dz, heart failure, renal dz
  • diabetes, sarcoid, TB, ascites
72
Q

What is the most deadly GYN cancer?

What is the most common malignant carcinoma?

A
  • ovarian is most deadly

- malignant epithelial cell carcinoma is most common

73
Q

Ovarian Torsion

  1. What is it?
  2. What can happen?
A
  1. twisting of ovary on ligamentous support impedes blood supply
  2. ovarian ischemia: necrosis, infarction, local hemorrhage, systemic infx
74
Q

What increases the risk of ovarian torsion?

A
  • ovarian cyst
  • ovarian neoplasm
  • pg
75
Q

S/S of Ovarian Torsion

A
  • acute pelvic pain
  • N/V
  • adnexal mass
76
Q
  1. Dx of Ovarian Torsion

2. Tx of Ovarian Torsion

A
  1. CBC, electrolytes, US, surgical

2. surgery to preserve ovarian function

Summer 15 - Women's Health (7 decks)

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