GYNE Benign Disorders of the Upper and Lower Genital Tract, Blueprints Flashcards
1
Q
Most common cause of labial fusion
A
Exogenous androgen
2
Q
Most common form of enzymatic deficiency
A
21-hydroxylase deficiency
3
Q
21-hydroxylase deficiency: Associated condition
A
Congenital adrenal hyperplasia (CAH)
4
Q
Congenital adrenal hyperplasia (CAH): Hormone elevated
A
17α-hydroxyprogesterone
5
Q
Congenital adrenal hyperplasia (CAH): Serum cortisol, increased vs decreased
A
Decreased
6
Q
Congenital adrenal hyperplasia (CAH): Treatment
A
Exogenous cortisol
7
Q
Congenital adrenal hyperplasia (CAH): Mechanism of exogenous cortisol
A
Negative feedback on pituitary > decrease ACTH > inhibition of adrenal gland stimulation > decrease in androgens
8
Q
Primary amenorrhea + cyclic pelvic pain: Condition
A
1) Imperforate hymen
2) Transverse vaginal septum
3) Vaginal atresia
9
Q
Accumulation of menstrual flow behind the hymen in the vagina
A
Hematocolpos
10
Q
The caudal portion of the Müllerian ducts develops into
A
Uterus and upper vagina
11
Q
Structure that must be canalised for normal vagina to form
A
Mullerian tubercle
12
Q
Failure of mullein tubercle to canalise results in
A
Transverse vaginal septum
13
Q
Most common site of transverse vaginal septum
A
Between upper 1/3 and lower 2/3
14
Q
Occurs when the lower vagina is replaced by fibrous tissue and on PE reveals a vaginal dimple
A
Vaginal atresia
15
Q
Vaginal atresia, management
A
Vaginal pull-through
16
Q
Congenital absence of vagina and absence or hypoplasia of all or part of the cervix, uterus, and fallopian tubes
A
Vaginal agenesis
17
Q
Vaginal agenesis is aka
A
Meyer-Rokitansky-Kuster-Hauser syndrome
18
Q
T/F Ovary is hypoplastic in vaginal agenesis
A
F, normal
19
Q
Vaginal agenesis: T/F Normal external genitalia
A
T
20
Q
Vaginal agenesis: T/F Normal secondary sexual characteristics (breast development, axillary, and pubic hair)
A
T
21
Q
Vaginal agenesis: T/F Normal ovarian function
A
T
22
Q
Vaginal agenesis: T/F Phenotypically female
A
T
23
Q
Vaginal agenesis: T/F Genotypically female
A
T
24
Q
Vaginal agenesis: Management
A
1) Non-surgical with the use of dilators
2) Surgical
25
Vaginal agenesis: Most common surgical procedure used
McIndoe procedure
26
Vaginal agenesis: T/F Will be unable to carry a pregnancy
T
27
Inflammatory dermatosis that is associated with a risk for vulvar skin Ca in postmenopausal women
Lichen sclerosis
28
Inflammatory dermatosis associated with vaginal adhesions and erosive vaginitis
Lichen planus
29
T/F Lichen planis carries a risk of vulvar skin cancer
T
30
Inflammatory dermatosis that generally occurs in women in their 50s and 60s
Lichen planus
31
Skin disorder of the vulva that leads to a scratch–itch cycle
Lichen simplex chronicus
32
Management of nonneoplastic epithelial disorders of vulva
1) Lifestyle
| 2) Topical steroids
33
High-potency topical steroids that can be used to treat lichen sclerosis or lichen planus, and severe lichen simplex chronicus
Clobetasol
34
T/F There is no role for topical estrogens or testosterone in the treatment of nonneoplastic epithelial disorders of vulva
T
35
Most common tumor found on the ulva
Epidermal inclusion cyst
36
T/F Epidermal inclusion cysts usually result from occlusion of a pilosebaceous duct or a blocked hair follicle
T
37
Symmetric white, thinned skin on labia, perineum, and perianal region; shrinkage and agglutination of labia minora
Lichen sclerosis
38
Multiple shiny, flat, red-purple papules, usually on the inner aspects of the labia minora and vestibule with lacy white changes; often erosive
Lichen planus
39
Red moist lesions on the vulva, sometimes scaly; usually asymptomatic but sometimes pruritic
Vulvar psoriasis
40
Sweat glands found throughout the mons pubis and labia majora
Apocrine sweat glands
41
An infrequently occurring chronic pruritic papular eruption in the vulva that localizes to areas where apocrine glands are found
Fox-Fordyce disease
42
Skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands
Hidradenitis suppurativa
43
Paraurethral glands are aka
Skene glands
44
Location of Bartholin glands
4 o'clock and 8 o'clock positions of vaginal orifice
45
Bartholin cyst affects which part of the gland
Duct, gland itself remains unchanged
46
Bartholin duct cyst, management: 2cm
Can be left untreated or managed with sitz baths
47
Bartholin duct cyst, management: >40 years old
Biopsy to rule out Bartholin gland Ca
48
Catheter that can be used to manage complicated or troublesome Bartholin duct cyst
Word catheter
49
Done for recurrent Bartholin’s duct cysts or abscesses
Marsupialization
50
Bartholin duct cyst: Adjunct antibiotic therapy is only recommended when
1) Drainage culture is positive for N. gonorrheae
| 2) Refractory to simple surgical treatment
51
Remnants of the mesonephric ducts of the Wolffian system found in the vagina
Gartner's duct cysts
52
Gartner's duct cysts: Found most commonly in
Anterior lateral aspects of upper vagina
53
Gartner's duct cysts: T/F Most are asymptomatic
T
54
Gartner's duct cysts: Management
Excision
55
Elevated soft red papules on the vulva tha contain an abnormal proliferation of blood vessels
Cherry hemangiomas aka Campbell de Morgan spots
56
T/F Isolated congenital anomalies of the cervix are rare
T
57
25% of women who were exposed in utero to ___have an associated cervical hypoplasia, cervical collars, cervical hoods, cock’s comb cervix, and pseudo polyps
DES
58
T/F DES exposure in utero are at increased risk of cervical insufficiency in pregnancy
T
59
T/F Clear cell adenocarcinoma of the cervix and vagina is common in women exposed to DES in utero
F, occurs in only 0.1%
60
Caused by intermittent blockage of an endocervical gland
Nabothian cyst
61
T/F Nabothian cyst expand to no more than 1 cm in diameter
T
62
T/F Nabothian cysts are more commonly found in postmenopausal women
F, menstruating
63
T/F Nabothian cysts are usually symptomatic
F, asymptomatic
64
T/F Nabothian cysts require no treatment
T
65
Remnants of the mesonephric ducts of the Wolffian system found in the cervix
Mesonephric cysts
66
Nabothian vs mesonephric cysts: Lie deeper in the cervical stroma and on the external surface of the cervix
Mesonephric cysts
67
Red or purple lesion on the cervix associated with cyclic pelvic pain and dyspareunia
Endometriosis
68
T/F Cervical polyps are often asymptomatic
T
69
Cervical polyps: Most common symptom
Intermenstrual or postcoital spotting
70
T/F Cervical polyps are not usually considered a premalignant condition
T
71
Cervical polyps: Management
Removed to decrease the likelihood of masking irregular bleeding from another source
72
Leiomyomas are aka
Myomas or fibroids
73
T/F Leiomyomas may arise in the cervix
T
74
Leiomyoma of cervix: T/F Can cause intermenstrual bleeding
T
75
T/F When evaluating an asymptomatic cervical fibroid, the possibility of cervical cancer should be ruled out
T
76
Management for symptomatic fibroid
Hysterectomy > myomectomy
77
T/F Cervical stenosis is typically asymptomatic
T
78
Cervical stenosis: Management
Cervical dilatation and catheter insertion to maintain patency
79
Lower vagina is derived from
Urogenital sinus
80
All reproductive structures arise from the müllerian system except
1) Ovaries (genital ridge)
| 2) Lower 1/3 of vagina (urogenital diaphragm)
81
Mullerian ducts are aka
Paramesonephric ducts
82
Most common congenital mullerian/uterine anomaly not related to drugs
Septate uterus
83
Septate uterus is brought about by
Malfusion of paramesonephric ducts
84
All reproductive structures arise from the müllerian system except
1) Ovaries (genital ridge)
| 2) Lower 1/3 of vagina (urogenital diaphragm)
85
Why septate uterus is related to recurrent ___trimester pregnancy loss
First
86
Why septate uterus is related to recurrent first-trimester pregnancy loss
Septa lack adequate blood supply
87
Pregnancy complications associated with bicornuate and unicornuate uteri
1) 2nd trimester pregnancy loss
2) Malpresentation
3) Preterm labor and delivery
88
Why bicornuate and unicornuate uteri are related to pregnancy complications
Limited size of uterine horn
89
Congenital anomaly associated with increased incidence of renal anomalies
Mullerian anomaly
90
Most infrequent Mullerian anomaly
Uterus didelphys with septate vagina
91
T/F Most uterine myomas cause no major symptoms and require no treatment
T
92
T/F Most uterine myomas cause no major symptoms and require no treatment
T
93
T/F Fibroids are also hormonally responsive to both estrogen and progesterone
T
94
Leiomyomas of uterus: Most common type
Intramural
95
Leiomyomas of uterus: Most commonly associated with heavy or prolonged bleeding
Submucosal
96
A pedunculated fibroid that becomes attached to the pelvic viscera or omentum and develops its own blood supply
Parasitic leiomyoma
97
T/F Pseudocapsule of leiomyoma has abundant blood vessels and lymphatics
F
98
T/F Pseudocapsule of leiomyoma has abundant blood vessels and lymphatics
F
99
T/F Leiomyomas enlarge, they can outgrow their blood supply, infarct, and degenerate, causing pain
T
100
T/F Leiomyosarcomas arise from leiomyomas
F
101
Risk factors for uterine leiomyoma
1) Non-smoker
2) Early menarche
3) Nulliparity
4) Perimenopause
5) Increased alcohol use
6) Htn
102
T/F The use of hormone replacement in postmenopausal women with fibroids is as- sociated with fibroid growth but typically does not result in clinical symptoms
T
103
T/F The risk of fibroids decreases with oral contraception use
T
104
Uterine leiomyoma: Most common symptom
AUB, heavy or prolonged bleeding
105
Uterine leiomyoma: Most common symptom
AUB
106
Increasingly heavy periods of longer duration
Menorrhagia
107
Bleeding between periods
Metrorrhagia
108
Heavy irregular bleeding
Menometrorrhagia
109
Uterine leiomyoma: Type that most commonly presents with pelvic pain
Subserosal pedunculated fibroid (due to vascular compromise)
110
T/F Leiomyomas enlarge, they can outgrow their blood supply, infarct, and degenerate, causing pain
T
111
T/F Leiomyosarcomas arise from leiomyomas
F
112
Fibroid characteristics that may contribute to increased rates of pregnancy complications
1) Multiple
2) Large, 5-10 cm
3) Located behind the placenta
113
T/F The use of hormone replacement in postmenopausal women with fibroids is as- sociated with fibroid growth but typically does not result in clinical symptoms
T
114
T/F The risk of fibroids decreases with oral contraception use
T
115
T/F The risk of fibroids decreases with injectable depot medroxyproges- terone acetate use
T
116
Uterine leiomyoma: Most common symptom
AUB
117
Increasingly heavy periods of longer duration
Menorrhagia
118
Bleeding between periods
Metrorrhagia
119
Uterine leiomyoma: Treatment that may be given prior to surgical treatment of uterine fibroids to shrink fibroid size, stop bleeding, and increase the hematocrit
GnRH agonists
120
Less invasive surgical approach for treating symptomatic fibroids that are large and pedunculated
Uterine artery embolization
121
Blood vessel catheterised to reach the uterine artery in uterine artery embolization
Femoral artery
122
Uterine leiomyoma: Type unlikely to affect conception or pregnancy loss
1) Subserous
| 2) Intramural
123
T/F Majority of women with fibroids are able to conceive without any difficulties
T
124
Fibroid characteristics that may contribute to increased rates of pregnancy complications
1) Multiple
2) Large, 5-10 cm
3) Located behind the placenta
125
Indications for Surgical Intervention for Uterine Leiomyomas
1) Abnormal uterine bleeding, causing anemia
2) Severe pelvic pain or secondary amenorrhea
3) Uterine size > 12 wk obscuring evaluation of adnexa
4) Urinary frequency, retention, or hydronephrosis
5) Growth after menopause
6) Recurrent miscarriage or infertility
7) Rapid increase in size
126
Uterine leiomyoma: Most common means of diagnosis
Pelvic ultrasound
127
Hysterectomy for leiomyoma: Age for which ovaries should be preserved
Younger than 45 years with normal- appearing ovaries
128
Diagnostic modality especially helpful in distinguishing fibroids from adenomyosis as well as for surgical planning
MRI
129
Actively growing fibroids should be monitored every
6 months
130
Uterine leiomyoma: Treatment associated with shrinkage of fibroids, decrease in bleeding, and increase in hct by decreasing circulating estrogen levels
GnRH agonists
131
Uterine leiomyoma: Treatment that may be given prior to surgical treatment of uterine fibroids to shrink fibroid size, stop bleeding, and increase the hematocrit
GnRH agonists
132
Less invasive surgical approach for treating symptomatic fibroids
Uterine artery embolization
133
Blood vessel catheterised to reach the uterine artery in uterine artery embolization
Femoral artery
134
T/F UAE should not be used in women who are planning to become pregnant after the procedure
T
135
New option for management of uterine fibroids typically reserved for premenopausal women who have completed childbearing and wish to retain their uterus
MRI-guided high-intensity ultrasound
136
Uterine leiomyoma: Primary disadvantage of myomectomy
1) Recurrence in more than 60% of patients in 5 years
| 2) Adhesions
137
Endometrial hyperplasia: Brought about by
Unopposed endogenous or exogenous estrogen
138
Definitive treatment for leiomyoma
Hysterectomy
139
Hysterectomy for leiomyoma: Age for which ovaries should be preserved
Younger than 45 years with normal- appearing ovaries
140
T/F Endometrial hyperplasia is the abnormal proliferation of only the glandular elements of the endometrium
F, glandular and stromal
141
Localized benign overgrowths of endo- metrial glands and stroma over a vascular core
Endometrial polyps
142
Endometrial polyps: Most common age group
40-50
143
Endometrial polyps: Risk factor/s
Tamoxifen
144
Endometrial polyps: Most common presentation
Abnormal vaginal bleeding
145
Endometrial polyps: Accounts for ___% of all causes of postmenopausal bleeding
25
146
Classification of endometrial hyperplasia: Carries a higher risk of progression to endometrial cancer and may have coexistent endometrial cancer
Atypical hyperplasia
147
Women 45 or older with abnormal bleeding from en- dometrial polyps should be evaluated with ___ prior to removal
Endometrial biopsy
148
Endometrial polyps: Can be malignant or premalignant
T
149
Endometrial hyperplasia: Brought about by
Unopposed estrogen
150
Most common exogenous source of estrogen
HRT w/o progesterone
151
Source of increased oestrogen in obese women
Peripheral conversion of androgens (androstenedione and testosterone) to estrogens (estrone and estradiol) by AROMATASE
152
Property of tamoxifen that increases the risk of endometrial hyperplasia
Weak estrogenic agonist activity
153
Endometrial hyperplasia: Only architectural changes are present
Simple or complex
154
Endometrial hyperplasia: When cytologic atypic is present
Atypical simple or atypical complex
155
Architectural changes vs cytologic atypia: Changes in complexity and crowding of the glandular components of the endometrium
Architectural changes
156
Architectural changes vs cytologic atypia: Changes in the cellular structure of the endometrial cells
Cytologic atypia
157
T/F Tissue diagnosis is required for the diagnosis of endometrial hyperplasia
T
158
Classification of endometrial hyperplasia: Carries a higher risk of progression to endometrial cancer and may have coexistent endometrial cancer
Atypical hyperplasia
159
Classification of endometrial hyperplasia: Abnormal proliferation of both the stromal and glandular endometrial elements
Simple hyperplasia
160
Classification of endometrial hyperplasia: Abnormal proliferation of the glandular endometrial elements without prolifera- tion of the stromal elements
Complex hyperplasia
161
Classification of endometrial hyperplasia: Cellular atypia and mitotic figures in addition to glandular crowding and complexity
Atypical hyperplasia
162
Classification of endometrial hyperplasia: Glands are crowded in a back-to-back fashion and are of varying shapes and sizes, but no cytologic atypia is present
Complex hyperplasia
163
Duration of progestin treatment for endometrial hyperplasia
3-6 months, then repeat EMB
164
Endometrial hyperplasia: Management after treatment to prevent recurrence
Regular cyclic or continuous progestin
165
Independent risk factors for endometrial hyperplasia
1) Htn
| 2) DM
166
Syndrome related to a 10-fold increased lifetime risk for endometrial hyperplasia and cancer
Lynch II syndrome (HNPCC)
167
Typical presentation of endometrial hyperplasia
Long periods of oligomenorrhea or amenorrhea followed by irregular or excessive uterine bleeding
168
Stigmata associated with chronic anovulation
1) Obesity
2) Acanthosis
3) Acne
4) Hirsutism
169
Duration of progestin treatment for endometrial hyperplasia that is predictive of failure
9 months
170
Method of choice for evaluation of abnormal uterine bleeding including that from endometrial hyperplasia
Endometrial biopsy
171
Indications for D&C in ruling out endometrial hyperplasia and cancer
1) Insufficient tissue
2) Patient discomfort
3) Cervical stenosis
4) Atypical complex hyperplasia on biopsy (coexistent endometrial Ca
172
Endometrial hyperplasia: Goal of treatment
1) Prevent progression of disease
| 2) Control abnormal bleeding
173
Treatment for simple and complex hyperplasia without atypia
Progestin
174
Progestin MOA for endometrial hyperplasia
Activation of progestin receptors, resulting in stromal decidualization and thinning of endometrium
175
Follicular cysts: Size that can lead to pelvic pain, ovarian torsion, and dyspareunia
> 4cm
176
Treatment of choice for women with endometrial hyperplasia with atypia who do not desire future fertility
Hysterectomy
177
Population of women most commonly with atypical complex hyperplasia
1) Perimenopausal
| 2) Postmenopausal
178
Management recommended for younger patients with atypical complex hyperplasia and chronic anovulation who wish to preserve fertility or if the patient is a poor surgical candidate
1) Longer-term progestin
| 2) Weight loss
179
When to repeat EMB after longer-term progestin and weight loss
3 months
180
Duration of progestin treatment for endometrial hyperplasia that is predictive of failure
9 months
181
T/F Functional cysts of the ovaries result from normal physiologic functioning of the ovaries
T
182
Cysts that can cause a amenorrhea or delay in menstruation and dull lower quadrant pain
Corpus luteum cysts
183
Condition: Acute pain and signs of hemoperitoneum late in the luteal phase
1) Ruptured corpus luteum cyst
2) Ovarian torsion
3) Hemorrhagic corpus luteum cyst
184
Follicular cysts: T/F Classically asymptomatic
T
185
Follicular cysts: T/F Usually bilateral
F, unilateral
186
Theca lutein cysts: Result from
Stimulation by abnormally high ß-human chorionic gonadotropin
187
Follicular cysts: T/F Most resolve spontaneously
T
188
Follicular cysts: Expected duration of resolution
60-90 days
189
Normal size of an ovarian follicle (physiologic cyst)
Less than 2.5 cm
190
2 types of functional ovarian cysts
1) Follicular cysts
| 2) Corpus luteum cysts
191
Increases the risk for functional cysts twofold
Smoking
192
Corpus luteum cysts: Arise from
Failure of corpus luteum to regress after 14 days and becomes enlarged to > 3cm or hemorrhagic
193
Cysts that can cause a delay in menstruation and dull lower quadrant pain
Corpus luteum cysts
194
Condition: Acute pain and signs of hemoperitoneum late in the luteal phase
Ruptured corpus luteum cyst
195
Large cysts filled with clear, straw-colored fluid
Theca lutein cysts
196
Theca lutein cysts: T/F Usually bilateral
T
197
Theca lutein cysts: Result from
Stimulation by abnormally high ß-human chorionic gonadotropin
198
Sources of high ß-human chorionic gonadotropin
1) Molar pregnancy
2) Choriocarcinoma
3) Ovulation induction therapy
199
Growth of ectopic endo- metrial tissue within the ovary
Endometerioma
200
Nonfunctional neoplasm vs functional cysts: Most common ovarian masses in women of reproductive age
Functional cysts
201
Functional ovarian cysts can be found most commonly in what age group
Between puberty and menopause
202
Increases the risk for functional cysts twofold
Smoking
203
Management of a cystic adnexal mass: Reproductive age, simple cyst more than 7 cm
Further imaging or surgical evaluation
204
Functional ovarian cysts: Generally larger (greater than 8 cm)
Lutein cysts
205
Functional ovarian cysts: T/F A ruptured cyst can cause pain on palpation, acute abdominal pain, and rebound tenderness
T
206
Classic presentation of ovarian torsion
1) Waxing and waning pain
| 2) Nausea and vomiting
207
Functional ovarian cysts: Tend to be simple or unilocular
Follicular
208
Primary diagnostic tool for the workup of ovarian cyst
Pelvic ultrasound
209
Diagnostic tool used to check for cyst resolution
Serial ultrasounds
210
CA-125: Screening/diagnosis vs response to treatment
Response to treatment
211
Management of a cystic adnexal mass: Premenarchal, more than 2 cm
Surgical evaluation
212
Management of a cystic adnexal mass: Reproductive age, simple cyst less than or equal to 5 cm
No follow-up necessary
213
Management of a cystic adnexal mass: Reproductive age, simple cyst more than 5 cm but less than 7 cm
Repeat ultrasound after 1 year
214
Management of a cystic adnexal mass: Reproductive age, simple cyst more than 7 cm
Further imaging or surgical evaluation
215
Management of a cystic adnexal mass: Reproductive age, hemorrhagic less than or equal to 5 cm
No follow up necessary
216
Management of a cystic adnexal mass: Reproductive age, hemorrhagic more than 5 cm
Repeat ultrasound in 6-12 weeks
217
Management of a cystic adnexal mass: Reproductive age, endometrioma
Repeat ultrasound in 6-12 weeks; surgically remove or follow yearly
218
Management for cysts that do not resolve within 60-90 days
Cystectomy or oophorectomy
219
Medical treatment options to shrink leiomyoma
1) Provera
2) Danazol
3) GnRH analogs
220
Management of a cystic adnexal mass: Postmenopausal, simple more than 1 but less than or equal to 7 cm
Repeat ultrasound in 1 year
221
Management of a cystic adnexal mass: Postmenopausal, more than 7 cm
Further imaging or surgical evaluation
222
Management of a cystic adnexal mass: Early postmenopausal, hemorrhagic
Repeat ultrasound in 6-12 weeks
223
Management of a cystic adnexal mass: Late menopause, hemorrhagic
Surgical evaluation
224
Management of a cystic adnexal mass: Postmenopausal, nodule without flow or multiple thin septations
Surgical evaluation or MRI
225
A palpable ovary or adnexal mass in a premenarchal or post- menopausal patient is suggestive of
Ovarian neoplasm > functional cyst
226
Reproductive-age women with cysts larger than 7 cm or that persist or that are solid or complex on ultrasound are suggestive of
Ovarian neoplasm > functional cyst
227
May be given to patients with follicular cysts during the 60-90-day observation period
OCPs
228
MOA of OCPs during the 60-90-day observation period for follicular cysts
Suppress ovulation to prevent formation of future cysts
229
Management for cysts that do not resolve within 60-90 days
Cystectomy or oophorectomy
230
Medical treatment options to shrink leiomyoma
1) Provera
2) Danazol
3) GnRH analogs
