Gyn flash cards partial
What are the other names for the Mullerian ducts? Wolffian ducts?
Mullerian: paramesonephric
Wollfian: mesonephric
(Metanephric ducts give rise to kidneys)
What abnormalities are associated with DES exposure?
Small, T-shaped endometrial cavity (infertility and miscarriage)
Fallopian tube abnormality (risk of ectopic)
Cervical hood
Vaginal adenosis (columnar epitheliam in vagina)
What malignancy DES exposure put the female child at risk for?
Clear cell carcinoma of the vagina
What can cause labial fusion?
Congenital adrenal hyperplasia and other excess androgen exposures
What presents with normal female external genitalia, normal secondary sexual characteristics, but absence of upper vagina, uterus, and fallopians?
Mullerian agenesis (a.k.a. MRKH syndrome, for Mayer-Rokitansky-Kuster-Hauser)
(Karyotype is XX, will have normal ovaries)
What presents with normal female external genitalia, normal breast development but scant pubic hair, and absence of upper vagina, uterus, and fallopians?
Androgen insensitivity syndrome (AIS)
(Karyotype is XY, will have undescended testes that need to be removed)
What condition is associated with squamous cell carcinoma of the vulva?
Lichen sclerosis
(These patients need careful surveillance, every 6 months. SCC follows vulvar intraepithelial neoplasia)
What condition can lead to destruction of external genetalia architectures ((loss of labial folds, obliteration of clitoris, vaginal stenosis)?
Lichen sclerosis
What is associated with thin, pale, crackled vulvar skin?
Lichen sclerosis (skin described as cigarette paper, onion skin, or parchment paper)
What is associated with loss of rete pegs on histology?
What else is seen on histology in this condition?
Lichen sclerosis
Also thin epithelium, with or without overlying hyperkeratosis
What is the treatment for lichen sclerosis?
High potency topical steroids (0.05% clobetasol or halobetasol)
What is associated with elongated rete pegs on histology?
What else is seen on histology in this condition?
Lichen simplex chronicus
Hyperkeratosis also seen.
What is the treatment for lichen simplex chronicus?
Medium potency steroids (1% hydrocortisone or 0.1% triamcinolone), antihistamines, remove irritants
Which lichen is associated with vaginal discharge (in addition to burning and insertional dyspareunia)
Lichen planus
What is associated with multiple flat, purple papules on the inner labia minora, vagina, and vestibule?
What two other things may be seen on exam in this condition?
Lichen planus
May also see Wickham striaie (whitish, lacy lines around ulcerated lesions) and vaginal adhesions leading to vaginal stenosis
What condition may lead to vaginal adhesions?
Lichen planus
Which of the lichens may also have oral involvement?
Lichen planus
What presents with red, fleshy exophytic tissue at the urethral meatus?
What is the treatment?
Urethral caruncle (prolpased urethral epithelium)
Treat with topical estrogen (due to urogenital atrophy)
How is a Bartholin abscess treated?
Need more than I&D, need to keep open.
Word catheter to drain for 4-6 weeks to create epitheliazed tract is one option.
Marsupialization is another (open cyst and sew walls to skin to externalize cyst)
What is the normal length of the clitoris?
What 3 things can cause clitoromegaly?
- CAH (21-hydroxylase or 11-hydroxylase deficiency)
- Androgen-producing ovarian or adrenal tumor
- Cushing disease
What is vaginismus?
Involuntary contractions of muscles surrounding vaginal orifice during sex.
What can result from obstructed Skene glands?
Urethral diverticula (obstructed periurethral Skene glands can drain into urethra), leading to repeat UTIs.
What presents with red glandular patches in the upper 1/3 of the vagina?
What is the cause?
Vaginal adenosis (sqaumous epithelium replaced with columnar)
DES exposure is the cause
What presents with soft 1-5 cm cysts anterior to the upper vagina or lateral to the mid-vagina?
What is the treatment?
Gartner duct cysts (Wolffian duct remnants)
Uually no treatment required, may be excised if symptomatic
What is cervical ectropion?
Mucinous columnar epithelium on the outside of the external os.
(Susceptible to trauma (postcoital spotting) and infection (HPV)
What presents with a mucus-filled cysts on the surface of the cervix?
What is the treatment?
Nabothian cyst (blocked mucinous endocervical glands)
No treatment required (normal variant)
How do estrogen and progesterone influence fibroids?
Estrogen stimulates smooth muscle proliferation.
Progesterone interferes with apoptosis.
What contraceptive method is associated with decreased bone mineral density?
Depot medroxyprogesterone acetate (DMPA)
(However, may regain BMD after stopping and no clear association with increased fractures)
What are the contraindications for progesterone-only contraceptives?
Breast cancer and liver disease
(Unlike combined OCPs, can use in smokers, those with HTN, CAD, or CVD, and those with migraines.
What reliable birth control is a good choice for someone with breast cancer or liver disease?
Copper IUD
What percentage of patients undergoing myomectomy will need repeat surgery for fibroids?
25%
How is the definitive diagnosis for adenomyosis made?
Post-hysterectomy pathology
What presents with heavy, painful menses and an enlarged, “boggy” uterus?
Adenomyosis
What is the treatment for endometrial polyps?
Removal with hysteroscopy or D&C (risk of cancer)
What should the length of the endometrial stripe be in a postmenopausal woman?
What test needs to be done on women with atypical glandular cells on pap smear?
Endometrial biopsy (as well as endocervical curettage I think)
What is the most important factor for cancer risk on endometrial biopsy?
Cellular atypia (complex hyperplasia also a factor, but less important)
(Simple hyperplasia without atypia has 1% chance of progressing to cancer. Complex hyperplasia increases this to 3%, cellular atypia alone increases this to 8%, both together increases wirk to 29%).
In general, how is endometrial hyperplasia without atypia treated? With atypia?
Without atypia: symptom management: continuous progestins, cyclic progestins, or combination OCPs
With atypia: hysterectomy preferred due to high cancer risk, if want to preserve fertility can use high dose progestins and close following
How does Asherman syndrome present?
Irregular bleeding (metrorrhagia), amenorrhea, and/or dysmenorrhea.
(Intrauterine scarring and sometimes adhesions)
What syndrome is associated with uterine adhesions after procedures like D&C or endometrial ablation?
Asherman syndrome (intrauterine scarring in denuded epithelium)
What are the three types of functional ovarian cysts?
Follicular cyst (follicle that fails to rupture)
Corpus luteum cyst (corpus luteum fails to regress)
Theca lutein cyst (results from excessive HCG)
What presents with large (e.g. 30 cm) bilateral fluid-filled ovarian cysts?
Theca lutein cysts
(These are the rarest functional ovarian cysts, result from excessive HCG such as with molar pregnancy or multiple gestations)
What functional ovarian cysts are at risk for hemorrhage?
Corpus luteum cysts
How are cystic adnexal masses managed in reproductive-age women? Postmenopausal women?
Reproductive age: observe if less than 8-10 cm, exploratory laparoscopy/laporatomy for ovarian cystectomy if larger. If smaller cyst persists >90 days, do same procedure.
Postmenopausal: any palpable cyst indicates exploratory laparoscopy/laparotomy for ovarian oopherectomy
What ist he most common ovarian tumor?
Benign cystic teratoma (dermoid cyst)
How are benign cystic teratomas treated?
Surgical excision due to risk of torsion and rupture
What are the two most common types of ovarian epithelial neoplasms? Which is more common?
Serous tumors more common than mucinous tumors
What percenate of serous ovarian tumors are malignant? Mucinous?
Serous: 20-25% malignant, 5-10% borderline
Mucinous: 15% malignant
What type of ovarian epithelial neoplasm is associated with calcific concentric concretions? What are these concretions called?
Serous tumors associated with these psammoma bodies
What type of ovarian epithelial neoplasm is associated with being extremely large?
Mucinous tumors
What is a Brenner cell tumor?
Ovarian tumor that represents bladder transitional epithelium
(Brenner = Bladder)
What are the three types of stromal cell tumor?
Granulosa-thecal cell: produces estrogen
Sertoli-Leydig cell: produces androgens
Ovarian fibroma: ovarian spindle cells, lots of collagen, does not produce hormone
(Fibrothecoma: mixed fibroma and thecal cell tumor)
What presents with a benign ovarian tumor, ascites, and pleural effusion?
What is the treatment?
Meigs’ syndrome, usually associated with fibroma or fibrothcoma tumor, also may be Brenner tumor
Treatment: remove mass, effusion will resolve
What presents with acute severe pelvic pain alternating with dull pain?
How is it diagnosed? What is the treatment?
Adnexal torsion
Diagnosis: ultrasound with doppler showing decreased flow
Treatment: surgical emergency, untwist mass, remove cyst/mass, remove ovary if necrotic.
