Gynecology Flashcards
How is lichen sclerosis treated?
High-potency topical steroids
What is vestibulodynia?
A constellation of symptoms related to the vulvar vestibule - severe pain on vestivular touch or attempted vaginal entry, tenderness to pressure and erythema of various degrees. Often, a primary or inciting event cannot be determined.
What are treatments for vestibulodynia?
Tricyclic antidepressants, pelvic floor rehab, biofeedback, and topical anesthetics. Surgery is reserved for severe cases
What is lichen simplex chronicus?
Easy irritation and itching of the vulva due to chronic scratching and rubbing (damage to the skin leads to loss of the protective barrier). Leads to a perpetual itch-scratch-itch cycle. Treatment is with short-course of high-potency topical corticosteroids.
What is the treatment for vulvadynia?
Estrogen cream and clobetasol (high potency steroid)
What are risk factors for pelvic organ prolapse?
Increasing parity, increasing age, obesity, connective tissue disorder (e.g. Ehlers-Danlos), chronic constipation, and a family history (2.5 fold increase). There is unclear evidence about whether hysterectomy increases the risk for bladder prolapse.
What straining Q-tip angle is associated with urethral hypermobility?
> 30 degrees
What procedure has the best 5-year success rates for treating genuine stress incontinence (loss of urine due to increased intra-abdominal pressure in the absence of detrusor contraction)?
Retropubic urethropexy (e.g. tension-free vaginal tape and other sling procedures)
How are cystoceles fixed?
Fixing defects in the pubocervical fascia or reattaching it to the sidewall
What is colpoclesis?
A procedure to fix vaginal prolapse - the vagina is surgically obliterated and can be performed quickly without need for general anesthesia. good for patients with high surgical morbidities (e.g. uncontrolled diabetes).
What is a good, relatively non-invasive first step for correcting pelvic floor prolapse?
Insertion of a pessary
What Is nodularity along the back of the uterus along the uterosacral ligaments suggestive of?
Endometriosis
How is endometriosis managed?
Initially medically with OPCs or progestin-only methods (but note the estrogen-containing methods are more effective) plus NSAIDs, then laser ablation may be considered if that fails and a woman does not want a hysterectomy. Hysterectomy is definitive treatment. GnRH agonists mays also be tried but they are only good for short term use.
How is endometriosis diagnosed definitively?
Exploratory laparoscopy and biopsy
What are symptoms of interstitial cystitis?
Due to chronic inflammation of the bladder - recurrent irritative voiding symptoms of urgency and frequency (in the absence of objective evidence of another disease process), pelvic pain, dyspareunia. May be due to autoimmune causes
What are treatments for uterine polyps?
Observation, medical management with progestin, curettage, surgical removal (polypectomy) via hysteroscopy or hysterectomy. Note that observation is not recommended for polyps > 1.5 cm. In women with infertility, polpectomy is recommended.
How is abnormal uterine bleeding evaluated?
Polyp Adenomyosis Leiomyoma Malignancy and hyperplasia Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not otherwise classified
What should be done in all women over 40 with irregular bleeding?
An endometrial biopsy to r/o endometrial carcinoma
Do subserosal fibroids cause pain with menstruation?
No
At pH do uric acid vs. calcium oxalate stones form?
Low pH of uric acid
High pH for calcium oxalate
What is the most common symptom of uterine fibroids?
Heavy menstrual bleeding
What are the 3 main symptoms of endometriosis?
The “3 Ds”: dysmenorrhea, deep dyspareunia, and dyschezia (pain with defecation)
In a postmenopausal woman with abnormal uterine bleeding, at what endometrial stripe size on ultrasound should a endometrial biopsy be performed?
> 4mm
What is a Gartner duct cyst?
Results from incomplete regression of the Wolffian duct during fetal development. These cysts may be single or multiple and are submucosal along the lateral aspects of the upper anterior vagina.
