GYNE Benign Disorders of the Upper and Lower Genital Tract, Blueprints Flashcards
Most common cause of labial fusion
Exogenous androgen
Most common form of enzymatic deficiency
21-hydroxylase deficiency
21-hydroxylase deficiency: Associated condition
Congenital adrenal hyperplasia (CAH)
Congenital adrenal hyperplasia (CAH): Hormone elevated
17α-hydroxyprogesterone
Congenital adrenal hyperplasia (CAH): Serum cortisol, increased vs decreased
Decreased
Congenital adrenal hyperplasia (CAH): Treatment
Exogenous cortisol
Congenital adrenal hyperplasia (CAH): Mechanism of exogenous cortisol
Negative feedback on pituitary > decrease ACTH > inhibition of adrenal gland stimulation > decrease in androgens
Primary amenorrhea + cyclic pelvic pain: Condition
1) Imperforate hymen
2) Transverse vaginal septum
3) Vaginal atresia
Accumulation of menstrual flow behind the hymen in the vagina
Hematocolpos
The caudal portion of the Müllerian ducts develops into
Uterus and upper vagina
Structure that must be canalised for normal vagina to form
Mullerian tubercle
Failure of mullein tubercle to canalise results in
Transverse vaginal septum
Most common site of transverse vaginal septum
Between upper 1/3 and lower 2/3
Occurs when the lower vagina is replaced by fibrous tissue and on PE reveals a vaginal dimple
Vaginal atresia
Vaginal atresia, management
Vaginal pull-through
Congenital absence of vagina and absence or hypoplasia of all or part of the cervix, uterus, and fallopian tubes
Vaginal agenesis
Vaginal agenesis is aka
Meyer-Rokitansky-Kuster-Hauser syndrome
T/F Ovary is hypoplastic in vaginal agenesis
F, normal
Vaginal agenesis: T/F Normal external genitalia
T
Vaginal agenesis: T/F Normal secondary sexual characteristics (breast development, axillary, and pubic hair)
T
Vaginal agenesis: T/F Normal ovarian function
T
Vaginal agenesis: T/F Phenotypically female
T
Vaginal agenesis: T/F Genotypically female
T
Vaginal agenesis: Management
1) Non-surgical with the use of dilators
2) Surgical
Vaginal agenesis: Most common surgical procedure used
McIndoe procedure
Vaginal agenesis: T/F Will be unable to carry a pregnancy
T
Inflammatory dermatosis that is associated with a risk for vulvar skin Ca in postmenopausal women
Lichen sclerosis
Inflammatory dermatosis associated with vaginal adhesions and erosive vaginitis
Lichen planus
T/F Lichen planis carries a risk of vulvar skin cancer
T
Inflammatory dermatosis that generally occurs in women in their 50s and 60s
Lichen planus
Skin disorder of the vulva that leads to a scratch–itch cycle
Lichen simplex chronicus
Management of nonneoplastic epithelial disorders of vulva
1) Lifestyle
2) Topical steroids
High-potency topical steroids that can be used to treat lichen sclerosis or lichen planus, and severe lichen simplex chronicus
Clobetasol
T/F There is no role for topical estrogens or testosterone in the treatment of nonneoplastic epithelial disorders of vulva
T
Most common tumor found on the ulva
Epidermal inclusion cyst
T/F Epidermal inclusion cysts usually result from occlusion of a pilosebaceous duct or a blocked hair follicle
T
Symmetric white, thinned skin on labia, perineum, and perianal region; shrinkage and agglutination of labia minora
Lichen sclerosis
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
Red moist lesions on the vulva, sometimes scaly; usually asymptomatic but sometimes pruritic
Vulvar psoriasis
Sweat glands found throughout the mons pubis and labia majora
Apocrine sweat glands
An infrequently occurring chronic pruritic papular eruption in the vulva that localizes to areas where apocrine glands are found
Fox-Fordyce disease
Skin disease that most commonly affects areas bearing apocrine sweat glands or sebaceous glands
Hidradenitis suppurativa
Paraurethral glands are aka
Skene glands
Location of Bartholin glands
4 o’clock and 8 o’clock positions of vaginal orifice
Bartholin cyst affects which part of the gland
Duct, gland itself remains unchanged
Bartholin duct cyst, management: 2cm
Can be left untreated or managed with sitz baths
Bartholin duct cyst, management: >40 years old
Biopsy to rule out Bartholin gland Ca
Catheter that can be used to manage complicated or troublesome Bartholin duct cyst
Word catheter
Done for recurrent Bartholin’s duct cysts or abscesses
Marsupialization
Bartholin duct cyst: Adjunct antibiotic therapy is only recommended when
1) Drainage culture is positive for N. gonorrheae
2) Refractory to simple surgical treatment
Remnants of the mesonephric ducts of the Wolffian system found in the vagina
Gartner’s duct cysts
Gartner’s duct cysts: Found most commonly in
Anterior lateral aspects of upper vagina
Gartner’s duct cysts: T/F Most are asymptomatic
T
Gartner’s duct cysts: Management
Excision
Elevated soft red papules on the vulva tha contain an abnormal proliferation of blood vessels
Cherry hemangiomas aka Campbell de Morgan spots
T/F Isolated congenital anomalies of the cervix are rare
T
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
T/F DES exposure in utero are at increased risk of cervical insufficiency in pregnancy
T
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%
Caused by intermittent blockage of an endocervical gland
Nabothian cyst
T/F Nabothian cyst expand to no more than 1 cm in diameter
T
T/F Nabothian cysts are more commonly found in postmenopausal women
F, menstruating
T/F Nabothian cysts are usually symptomatic
F, asymptomatic
T/F Nabothian cysts require no treatment
T
Remnants of the mesonephric ducts of the Wolffian system found in the cervix
Mesonephric cysts
Nabothian vs mesonephric cysts: Lie deeper in the cervical stroma and on the external surface of the cervix
Mesonephric cysts
Red or purple lesion on the cervix associated with cyclic pelvic pain and dyspareunia
Endometriosis
T/F Cervical polyps are often asymptomatic
T
Cervical polyps: Most common symptom
Intermenstrual or postcoital spotting
T/F Cervical polyps are not usually considered a premalignant condition
T
Cervical polyps: Management
Removed to decrease the likelihood of masking irregular bleeding from another source
Leiomyomas are aka
Myomas or fibroids
T/F Leiomyomas may arise in the cervix
T
Leiomyoma of cervix: T/F Can cause intermenstrual bleeding
T
T/F When evaluating an asymptomatic cervical fibroid, the possibility of cervical cancer should be ruled out
T
Management for symptomatic fibroid
Hysterectomy > myomectomy
T/F Cervical stenosis is typically asymptomatic
T
Cervical stenosis: Management
Cervical dilatation and catheter insertion to maintain patency
Lower vagina is derived from
Urogenital sinus
All reproductive structures arise from the müllerian system except
1) Ovaries (genital ridge)
2) Lower 1/3 of vagina (urogenital diaphragm)
Mullerian ducts are aka
Paramesonephric ducts
Most common congenital mullerian/uterine anomaly not related to drugs
Septate uterus
Septate uterus is brought about by
Malfusion of paramesonephric ducts
All reproductive structures arise from the müllerian system except
1) Ovaries (genital ridge)
2) Lower 1/3 of vagina (urogenital diaphragm)
Why septate uterus is related to recurrent ___trimester pregnancy loss
First
Why septate uterus is related to recurrent first-trimester pregnancy loss
Septa lack adequate blood supply
Pregnancy complications associated with bicornuate and unicornuate uteri
1) 2nd trimester pregnancy loss
2) Malpresentation
3) Preterm labor and delivery
Why bicornuate and unicornuate uteri are related to pregnancy complications
Limited size of uterine horn
Congenital anomaly associated with increased incidence of renal anomalies
Mullerian anomaly
Most infrequent Mullerian anomaly
Uterus didelphys with septate vagina
T/F Most uterine myomas cause no major symptoms and require no treatment
T
T/F Most uterine myomas cause no major symptoms and require no treatment
T
