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Clinical Medicine 5 > GYN (part 3)-Exam 2 > Flashcards

GYN (part 3)-Exam 2 Flashcards

1
Q

Papanicolaou test – “Pap Smear”
* Routine screening for what?
* May also screen for what?
* When should you should you start screenign?
* What should be biopsied?

A
  • Routine screening for cervical cancer, or cell changes known to lead to cancer
  • May also screen for HPV
  • Should start screening at age 21, even if sexually active earlier.
  • ALL visible abnormal cervical lesions should be biopsied
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2
Q

Under notes

What is the timeline for paps?

A

Anyone with a cervix between the ages of 21 and 30 should get a Pap smear at least once every three years.Between the ages of 30 and 65, you should have one every five years.

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3
Q

How do you do the brush at the cervix?

A

Brush is the best at he squamocolumnar junction.

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4
Q

Where does 90% of squamous cervical intraepithelial neoplasia (CIN) occurs?

A

within the transformation
* This is why it is so important to get cells from the squamous epithelium (exocervix) and the columnar epithelium (endocervix).

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5
Q

She said FYI

A
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6
Q

Cervical Intraepithelial Neoplasia (CIN)
* Hormonal influence of puberty + changes in vaginal pH causes what?

A

causes squamous margin to encroach on the single-layer, mucous secreting epithelium, creating an area of metaplasia - “transformation zone”

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7
Q

Cervical Intraepithelial Neoplasia (CIN): HPV types
* What are the high risk HPV cancer related types
* HPV types associated with genital warts?

A

Human papillomavirus (HPV) types.
* High Risk HPV-cancer related types: 16 and 18 (70%), 31, 33 and 45
* HPV types associated with genital warts: 6 & 11 (90%) (condyloma acuminata)

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8
Q

Cervical Intraepithelial Neoplasia (CIN)
* What are the classification?

A

Describes degree of abnormality
* CIN 1 = LSIL
* CIN 2, 3 = HSIL

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9
Q

U. S. Preventive Services Task Force Recommendation: PAP
* When do you do screenings? (average risk group)

A
  • Women aged 21-29 - screening with cytology (pap smear or liquid based) every 3 years
  • Women aged 30-65 - screening with cytology every 3 years + HPV testing every 5 years or with co-testing (both) q 5 years
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10
Q

U. S. Preventive Services Task Force Recommendation: PAP
* What is the screening timeline for high risk group?

A

ANY previous abnormal cytology screening or HIV or DES exposure in utero -> yearly screening

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11
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A
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12
Q

American Cancer Society Guidelines: pap+HPV
* Screening should begin when?
* What is the timeline?
* Who should stop cervical cancer screening?

A
  • Screening should begin at age 25
  • Women aged 25-65 should have HPV test q 5 years combined with PAP test or a PAP test alone q 3 years
  • Women over 65 who have had regular screenings for past 10 years with no history of CIN2 or more serious diagnosis should stop cervical cancer screening
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13
Q

Cerival cancer
* What is the most primary initating event? What is it?
* What are other risk factors?(4)

A

HPV infection is the primary initiating event
* HPV a double stranded DNA virus infects epithelium near transformation zone.
* HPV 16 & 18 most frequently associated

Other risk factors: Multiple sex partners, first intercourse <18yo, smoking, STD and DES exposure

  • Most women are infected with HPV, but most clear it.
  • Some women keep a chronic infection, and it is thought there is a genetic predisposition associated
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14
Q

Screening for cervical cancer
* What test
* make take how long to progress?
* Primary prevention is what?

A
  • Pap test
  • May take years to progress from dysplasia to cancer
  • Primary prevention is via HPV vaccines
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15
Q

Clinical Presentation: Cervical cancer
* What are the early stages and later stages?

A

Early stages are asymptomatic

Later stages:
* Post-intercourse bleeding
* Intermenstrual cycle bleeding
* Persistent yellow discharge
* Foul smelling discharge
* Heavy menstrual bleeding
* Pelvic/sacral pain
* Most common presentation of later stage cancer is a visible lesion on the cervix

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16
Q
A
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17
Q

cervix cancer
* how do you dx it?

A
  • Most found during Pap test screening of asymptomatic women
  • Colposcopy with biopsy
  • MRI or PET-CT used for staging
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18
Q

cervix cancer
* What are all the different treatments? (5)

A
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19
Q

How do you do cryotherapy?

A
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20
Q

Cervix cancer
* How do you conization/cone biopsy?

A
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21
Q

Cervix cancer
* How do you do a loop Excisional Biopsy?

A
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22
Q
A
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23
Q

LSIL Management

A
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24
Q

HSIL Management

A
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25
Q

AGC Management
* What do you for Atypical endocervical cells, favor neoplastic ; or Atypical glandular cells, favor neoplastic ?

A
  • Colposcopy
  • Endocervical Bx
  • Diagnositic excisional cervical procedure
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26
Q

AGC Management
* What do you do for adenocarcinoma in-situ?

A
  • Colposcopy
  • Endocervical Bx
  • Diagnositic excisional cervical procedure
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27
Q

Atypical Glandular Cells Management

A
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28
Q

Cervical Dysplasia Summary:
* What do you do if pap result show ASCUS or LSIL/CIN I

⭐️TEST

A

Test for HPV

Repeat pap in 2-12 months

If the pap shows ASCUS/LSIL CIN I is present again then perform a colposcopy: use of a colposcope to visualize vulva, vagina and cervix with magnification to evaluate benign, premalignant and potentially malignant disease

The lesions will turn white when acetic acid is applied
* Higher grade will cause greater/more rapid absorption (Higher grade= more white and faster)

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29
Q

Cervical Dysplasia Summary:
* What do you do if pap result shows HSIL/CIN II or III

A

LEEP or colposcopy and biopsy

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30
Q

Cervical Dysplasia Summary:
* What do you do if pap result shows AGC?

A

AGC can indicate adenocarcinoma in situ
* Repeat pap with endocervical brush, and if confirmed:
* Endometrial bx and cone bx of cervix

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31
Q

Cervical cancer: Prognosis
* Dependent on what?
* What is the treatment?
* How is it preventable?
* Gardasil vaccination targets what HPV Strands?

⭐️TEST

A
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32
Q
A
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33
Q

What is this?

A

Vestibulitis

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34
Q

Vulvar Intraepithelial Neoplasia: VIN, usualy type
* Occurs in who? What are the risk factors?(3)

A
  • Occurs in younger, premenopausal women
  • Risk factors: HPV infection, cigarette smoking, immunodeficiency or immunosuppression
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35
Q

Vulvar Intraepithelial Neoplasia: VIN, usualy type
* What does basaloid subtype have?
* What is warty subtype?

A
  • Basaloid subtype has a thickened epithelium with a relatively flat, smooth surface
  • Warty (condylomatous) subtype is characterized by a surface that is undulating or spiking, giving it a condylomatous appearance
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36
Q

Vulvar Intraepithelial Neoplasia: VIN, differentiated type
* Comprises of how much?
* Typically occurs in who?
* Not often assoicated with what?

A
  • Comprises less than 5 percent of VIN
  • Typically occurs in postmenopausal women
  • Not often associated with HPV infection
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37
Q

Vulvar Intraepithelial Neoplasia
* What are the clinical manifestations?

A
  • Pruritis
  • Visible lesions
  • Palpable abnormality
  • Perineal pain or burning
  • Dysuria
  • 50% asymptomatic
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38
Q

Vulvar Intraepithelial Neoplasia
* What is for definitive dx?

A
  • Tissue biopsy for definitive diagnosis; biopsy sites are identified by physical examination and colposcopy
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39
Q
A
40
Q

What is this?

A

VIN usual

41
Q

Vulvar Intraepithelial Neoplasia
* What are the goals of treatment?

A

Goals of treatment are to prevent development of invasive vulvar cancer and relieve symptoms, while preserving normal vulvar anatomy and function.

42
Q

Vulvar Intraepithelial Neoplasia
* What are the management options?

A

Surgical

Topical treatment
* Imiquimod cream (Aldara®)
* 5-fluorouracil cream

43
Q

Vulvar Intraepithelial Neoplasia
* Despite treatment, what happens?
* When is f/u?

A
  • Despite treatment, VIN recurs in one-third of women
  • Follow-up every six months for five years after the last treatment and then annually
44
Q

Vulvar Intraepithelial Neoplasia
* 4-8% of patients develop what?
* What could prevent 2/3 of neoplasia?

A
  • 4 - 8% of patients develop locally invasive cancer
  • Prophylactic HPV vaccination could prevent 2/3 of vulvar, vaginal, and perianal intraepithelial neoplasia in younger women
45
Q

Ovarian cyst:
* most ovarian masses are what?
* Divided into what?
* Difficult to do what?
* Majority is what?

A
46
Q

Ovarian cyst: Signs & Symptoms
* Most are what?
* What is the MC sxs?
* When should you think torsion?

A
  • Most are asymptomatic
  • Pain is most common symptom
  • Acute, severe pain with vomiting–think torsion
47
Q

Ovarian cyst-Sxs
* How is the pain?
* May be accompanied by what?
* What is on pelvic exam?

A
48
Q

What are the functional ovarian cysts?(3)

A
  • Follicular cyst
  • Corpus luteum cyst
  • Theca luteum cyst
49
Q

What are the benign ovarian neoplasms?(3)

A
  • Epithelial cell tumors
  • Germ cell tumors
  • Stromal cell tumors
50
Q

Functional Ovarian Cyst
* What is a follicle?
* Development and release of what?
* What is corpus luteum?

A
  • Follicle: Contains a single oocyte (egg); once a month, hormonal influences stimulate growth
  • development and release of a single, competent oocyte (ovulation)
  • Corpus Luteum: develops from an ovarian follicle following the release of an oocyte from the follicle during ovulation.
51
Q

⭐️⭐️⭐️⭐️

A
52
Q

Follicular Cyst
* Forms when?
* Presents as what?
* Clinically significant when?
* Rupture may cause what?
* How do you evaluate?

A
  • Forms when an ovarian follicle fails to rupture
  • Presents as a unilateral (ovulate from one side only), +/- palpable, mobile adnexal mass
  • Clinically significant if large enough to cause pain
  • Rupture may cause acute pain
  • U/S to evaluate
53
Q

Follicular Cyst
* Most do what?
* What may prevent the development of new cyst?
* What is no longer used?
* When is cystectomy considered?

A
  • Most resolve spontaneously within 60 days
  • OCPs may prevent development of new cyst
  • “Therapeutic” aspiration is no longer used due to high rate of recurrence
  • Consider cystectomy if symptomatic or large (≥ 5cm)->High risk of torsion
54
Q

Corpus Luteum Cyst
* Develops after what?
* Size?

A
  • Develops after the oocyte is released from the follicle (end of the menstrual cycle)
  • May reach 5-12cm in size
55
Q

Corpus Luteum Cyst
* May do what?
* Increase risk for what?
* What is first line?
* What is for persistent cysts?

A
  • May expand, fill with blood and rupture (if rupture - corpus hemorrhagicum)
  • Increase risk for ovarian torsion
  • Observation (up to three months) is first-line therapy even with hemorrhage or severe pain
  • Cystectomy for persistent cysts
56
Q

Theca Lutein Cyst
* Common or rare?
* Associated with what?

A
  • Least common functional cyst
  • Associated with pregnancy (Particularly molar pregnancy)-form as a result of overstimulation or hypersensitivity to hCG
57
Q

Theca Lutein Cyst
* Usually what?
* Regresses how?

A
  • Usually bilateral
  • Regress spontaneously in weeks to months after source of hCG is eliminated (normal pregnancy is delivered or molar pregnancy is eliminated).
58
Q

⭐️⭐️⭐️

What is a must in the eval of ovatian cysts with acute pain?

A
  • Rule out Ectopic Pregnancy!
  • Any adnexal finding evaluation must include a serum beta hCG test to rule out pregnancy.
59
Q

⭐️⭐️⭐️⭐️

Benign vs. Malignant in Premenopausal Women
* What are the different sizes+ what you need to do?

A
60
Q

⭐️⭐️⭐️⭐️

In Postmenopausal Women……
* What are the different sizes+what you need to do?

A
61
Q

What is a tumor marker?

A

CA 125

62
Q

Ovarian Cyst Pearls
* Vast majority are what
* What are the red flags?
* What is typically required?

A
63
Q

Polycystic Ovarian Syndrome
* What are some sxs?
* Often presents as what?
* Ranging from what?
* What are on ovaries?

A
  • Chronic anovulation, polycystic ovaries and hyperandrogenism.
  • Often presents as a menstrual disorder.
  • Ranging from amenorrhea to menorrhagia and infertility
  • Numerous cystic lesions on ovaries.
64
Q

Clinical sxs of PCOS
* What is the classic clinical presentation?
* Oftern presents as what type of disorder?
* What happens to the face?
* Higher risk of what?

A
65
Q

⭐️

Dx of PCOS
* What are the labs?

A
66
Q

⭐️⭐️

Dx of PCOS
* What is the imaging?

A

Pelvic US may reveal polycystic ovaries “sting of pearls”

67
Q

Treatment of PCOS
* What do you give to a patient that desires to become pregnant
* What do you give to a paitent that does not desire pregnant?

A
  • For patients who desire to become pregnant-Clomiphene
  • For patient who do not desire to become pregnant medrozyprogesterone actate for the first 10 days of every 1 to 3 months-may combine with contraceptive
68
Q

Treatment of PCOS
* What do you do for hirsutism?
* What is teratogenic?
* What other supportive measures?

A
69
Q

Metformin in PCOS
* Can produce what?
* Alters what?
* Positive effect on what?

A
  • Can produce ovulatory cycles
  • Alters insulin’s effect on ovarian androgen synthesis to allow reutn of ovulation
  • Positive effect on blood glucose and hyperinsulinemia
70
Q

Metformin in PCOS
* What happens to the weight?
* Inhibits what?
* Less waht?

A
  • Weight loss (10lbs)
  • Inhibits ovarian gluconeogenesis and androgen synthesis
  • Less androgens to conver into estrone that persistently promotes LH release
71
Q

Benign Ovarian Neoplasms
* What is an adnexal tumor?

A

Adnexal Tumor – growths that form on the organs and connective tissues around the pelvic organs

72
Q

Benign Ovarian Neoplasms
* Categorized by the cell type of origin: (3)

A
  • Germ cell tumors (Ovarian teratoma) – most common
  • Epithelial cell tumors
  • Stromal cell tumors
73
Q

Ovarian Teratoma
* What is it?
* Also called what?
* Arise from what?

A
74
Q

Ovarian Teratoma
* How does it grow?
* May contain what?
* What is struma ovarri?

A
75
Q

Solid Ovarian Mass
* Typically what?
* What do you need to do?
* Most common solid benign tumors are what?

A
  • Typically, benign
  • Are surgically removed to confirm
  • Most common solid benign tumors are fibromas
76
Q

Ovarian Cancer
* What are most of the tumor?
* Risks? (3)

A
77
Q

Ovarian Cancer
* Most patients with OC are what?
* May have minor what?
* Advanced signs include what?

A
78
Q

⭐️⭐️

Ovarian Cancer
* What serum marker is high?
* What imaging needs to be done?

A
  • Serum CA125 elevated in 80% of women with epithelial ovarian cancer
  • Imaging- US or MRI revels an ovarian mass
79
Q

What is this?

A

Sister mary joseph node

80
Q

Ovarian Mass Evaluation
* What size is usually benign?
* What requires surgical evaluation?
* What does oophorectomy allows for what?

A
  • Simple cysts up to 5 cm in diameter are universally benign
  • Larger masses, or masses that grow larger or unchanged on transvaginal ultrasound require surgical evaluation
  • Oophorectomy (removal of ovary) allows for confirmation and staging
81
Q

Ovarian cancer
* What is the treatment?

A
  • Hysterectomy and bilateral oophorectomy and lymphadenectomy.
  • In advanced disease, all visible tumor is removed.
  • Postoperative chemotherapy
82
Q

Ovarian cancer
* What is the prognosis?

A
83
Q

Ovarian Torsion
* most often involves what?
* What is IDed in majority of cases?
* Accounts for what?

A
84
Q

Ovarian Torsion
* Moste common in who?
* when do some of them occur?
* More commonly involves what?

A
85
Q

Dx of ovarian torsion
* patients typically present with what?
* Typically locatized where?

A
  • Patients typically present with sharp lower abdominal pain with a sudden onset that worsens over several hours.
  • Typically localized to one side with radiation to the flank, groin or thigh
86
Q

Dx of ovarian torsion
* What is a red flag?
* What is critical?
* May mimic what?

A
87
Q

⭐️⭐️⭐️⭐️

Specific US Findings Indicative of Torsion
* What does the US show?

A
  • Multiple follicles rimming an enlarged ovary
  • “Bulls-eye” target, “whirlpool” or “snail shell” – rounded hyperechoic structure with multiple hypoechoic rings
  • Disruption of vascular flow on doppler US
88
Q

Management of ovarian torsion
* Rapid what?
* What is the goal?
* Must monitor for what?
* what is the retorsion rate?

A
89
Q

Premenstrual Syndrome
* What is it?

A

“Cluster of physical, mood related and behavioral changes that occur in a regular cyclic relationship to the luteal phase of the menstrual cycle and that interfere with some aspect of the patient’s life.”

90
Q

⭐️⭐️

Premenstrual Syndrome: Clinical work up
* R/O what?
* Dx based on what?
* Daily charting of what?
* Actual sxs less important than what?

A
  • Rule out other possible causes for symptoms
  • Diagnosis based on relationship of symptoms to the luteal phase of the cycle (one week before menstruation starts)
  • Daily charting of symptoms
  • Actual sxs less important than their cyclical pattern of occurrence
91
Q

What is the PMS diagnostic criteria?

A

Patient reports at least one of the following symptoms during the 5 days before menses in each of three cycles:

92
Q

Premenstrual Syndrome: Diagnostic Criteria
* Sxs are relieved when?
* What must exist for dx?
* Patient experiences dysfunction in what?

A
  • Symptoms are relieved within 4 days of the onset of menses
  • A monthly symptom free period during the follicular phase must exist for diagnosis
  • Patient experiences dysfunction in social or economic performance (depends on intensity)
93
Q

What is the Premenstrual Dysphoric Disorder (PMDD) Diagnostic Criteria?

A

Patient reports ≥ 5 of the following sxs during most of the last week before menses in most cycles during the past year; at least one sxs must be a “core symptom” (*):

94
Q

Premenstrual Syndrome
* What is the etiology?

A

Current theory is that of serotoninergic dysregulation
* Progesterone potentiates monoamine oxidase (MAO)
* MAO reduces serotonin
* Therefore, less serotonin is available during the progesterone dominant luteal phase

95
Q

Premenstrual Syndrome Treatment
* What are the lifestyle modifications?

A
96
Q

Premenstrual Syndrome Treatment
* What do you do for pain?
* What do you take during luteal phase?

A
  • NSAIDS: dysmenorrhea, breast pain and leg edema
  • Spironolactone: 100 mg daily during luteal phase
97
Q

⭐️⭐️⭐️

Premenstrual Syndrome Treatment
* What do you give for mod- severe PMS or PMDD?
* What do you give for suppressing ovulation?

A

SSRIs (Therapy of choice in moderate to severe PMS or PMDD)
* Fluoxetine, Sertraline, Paroxetine, Citalopram

Suppressing ovulation (not helpful in PMDD)
* OCPs
* Danazole-modified testosterone
* Gonadotropin-releasing hormone (GnRH)

Clinical Medicine 5 (10 decks)

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