GYN- Upper GU

Question 1

What are uterine anatomic anomalies assc with

Answer 1

urinary tract anomalies and inguinal hernias

Question 2

etiology of uterine anatomic anomalies

Answer 2

problems in fusion of paramesonephric (mullerian) ducts

Question 3

MC uterine anatomic anomaly

Answer 3

septate > bicornate > didelphys (double uterus, cervix, vagnia)

Question 4

what uterine anatomic anomlaies get surgery

Answer 4

septate, bicornate, didelphys

Question 5

term for uterine fibroids

Answer 5

leiomyoma

Question 6

what are uterine fibroids

Answer 6

estrogen sensitive smooth muscle proliferation of myometrium

Question 7

what is a uterine fibroid pseudocapsule?

Answer 7

compressed smooth musles cells surrounding fibroids

Question 8

what causes the pelvic pain assc with fibroids

Answer 8

fibroid outgrows blood supply –> infarction and degeneration –> pelvic pain

Question 9

who gets uterine fibroids/leiomyomas

Answer 9

black women of reproductive age (20-30% repro age and 50% are black)

Question 10

subtypes of uterine fibroids/leiomyomas

Answer 10

intramural (MC)
submucosal (most likely to bleed)
subserosal
pedunculated

Question 11

presentation of uterine fibroids/leiomyomas

Answer 11

ususally asx

menorrrhagia (MC), pelvic pain and pressure, infertility (rare)

Question 12

How are fibroids managed?

Answer 12

asmx = leave alone

temporarily shrink with progesterone, danazol, leuprolide (these decrease E)

myomectomy (if fertility desired)
hystorectomy is definitive
uterine artery embolism if bad surgical candidate

Question 13

do leiomyomas have potential to transform into leiosarcoma

Answer 13

NO

Question 14

what are endometrial polyps? How do they present?

Answer 14

benign overgrowth of endometrial glands/stroma

vaginal bleeding btwn prds (menorrhagia)

Question 15

how are endometrial polyps managed?

Answer 15

Dx with pelvic US, Tx is D&C + Bx to r/o cancer

Question 16

how does endometrial hyperplasia present?

Answer 16

vaginal bleeding

Question 17

what % of each stage progresses to cancer:

• simple hyperplasia w/o atypia
• complex hyperplasia w/o atypia
• simple hyperplasia w/ atypia
• complex hyperplasia w/ atypia

Answer 17

"penny, nickle, dime, quarter" rule
1%
3-5%
8-10%
25-30%

Question 18

risk factors for developing endometrial hyperplasia

Answer 18

anything that increases E levels:

unopposed E therapy 
tamoxifen
obesity/HTN/DM (inc aromatase in fat cells)
PCOS
chronic anovulaiton 
nulliparity
early menarche/late menopause
granulosa cell tumor

Question 19

protective factors for developing endometrial hyperplasia

Answer 19

anything that decreases E levels

COP/POP/combined HRT
multiparity
diet and exercise

Question 20

management of endometrial hyperplasia

Answer 20

Bx –> D&C –> progestins for 3 mos + repeat endometrial Bx

HYSTORECTOMY if complex/atypia

Question 21

MC ovarian cyst + management

Answer 21

Folliculalr (2/2 unruptured follicle); usually asymptomatic

observe 8-12 wks then repeat pelvic U/S; if unresolved get cystectomy or oophorectomy

Question 22

ovarian cyst 2/2 to hemorrhage into persistent corpus luteum + smx? + Tx?

Answer 22

corpus luteum cyst

presents with dull abd pain if unruptured or acute abdomen if ruptured

usually resolves spontanously but can suppress with OCPs

Question 23

multiple/bilaterial ovarian cysts due to FSH/LH stimulation

Answer 23

theca-lutein cysts

Question 24

ovarian endometreosis = ___ cyst

Answer 24

chocolate

Question 25

enlarged ovaries with multiple subcortical cysts

Answer 25

PCOS

Question 26

cysts assc with moles and choriocarcinoma

Answer 26

Theca-lutein cysts

Question 27

what are high risk factors for malignant ovarian cyst–what if fist step of diagnosis/management in these patients

Answer 27

premenarchal
postmenopausal
> 8cm size
persists > 60 days

get EX LAP for cancer r/o

Question 28

what is first step for diagnosis in low risk pts with ovarian mass

Answer 28

pelvic US