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EOR Exam - Women's Health > Gynecology Part 3 > Flashcards

Gynecology Part 3 Flashcards

1
Q

What is the most common gynecological cancer in the US?

A

Endometrial Cancer

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2
Q

T/F: Endometrial cancer generally has a poor prognosis.

A

False: Endometrial cancer is the most survivable of all GYN cancers

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3
Q

What screening test is done for endometrial cancer?

A

There is none - patients are typically symptomatic at an early stage

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4
Q

What is the hallmark sign or symptom of endometrial cancer?

A

Heavy vaginal bleeding

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5
Q

What is Lynch Syndrome and how is it related to endometrial cancer?

A

Lynch Syndrome is autosomal dominant condition associated with high risk of colorectal and endometrial cancer. Patients get routine biopsies to screen for endometrial cancer.

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6
Q

List risk factors for developing endometrial cancer.

A

Inc age, Lynch syndrome, inc estrogen (PCOS, overweight, estrogen tumor, etc.), nulliparity, early menarche, late menopause, family Hx of endometrial CA

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7
Q

What medication used to treat breast cancer increases risk of endometrial cancer?

A

Tamoxifen - SERM that stimulates estrogen receptors in the endometrium

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8
Q

List some protective factors that reduce the risk of endometrial cancer.

A

OCPs, parity, breast feeding, early menopause, lean habitus, smoking

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9
Q

What S/S should trigger a biopsy to assess for endometrial cancer?

A

Prolonged, frequent, or heavy menses, any post-menopausal vaginal bleeding

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10
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

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11
Q

What imaging is used to assess for endometrial cancer in a patient that presents with abnormal vaginal bleeding and what is a normal result?

A

Transvaginal US is test of choice. Endometrial thickness < 5mm is normal in post-menopausal women. Endometrial thickness varies through the menstrual cycle in pre-menopausal women.

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12
Q

When should an endometrial biopsy be obtained and how is it obtained?

A

Endometrial thickness > 4mm in post-menopausal women. Obtained via suction curette –> simple office procedure.

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13
Q

List the four categories of endometrial hyperplasia in order from lowest risk of progressing to cancer to highest risk.

A

Simple - lowest risk
Complex
Simple Atypical
Complex Atypical - highest risk (treat as CA)

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14
Q

Define the 4 stages of endometrial cancer.

A

1: confined to uterus
2: invades cervix
3: serosa/adnexa, vagina/perimetrium, lymph nodes
4: invades bladder/bowel or distant metastases

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15
Q

What is the treatment for endometrial cancer?

A

Dependent on staging. Stage 1 = 1 hysterectomy. Stage 2+ = radical hysterectomy plus chemo/radiation

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16
Q

Differentiate a hysterectomy from a radical hysterectomy.

A

Hys: removal of uterus (may/may not include cervix)
Rad: removal of uterus, fallopian tubes, and ovaries

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17
Q

What are the three anatomical parts of the ovaries?

A

Epithelium, stroma, and germ cells

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18
Q

In what part of the ovary does ovarian cancer originate?

A

Can originate in any portion –> epithelial ovarian cancer is most common

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19
Q

What is the least survivable gynecological malignancy?

A

Ovarian cancer –> typically asymptomatic until late stages

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20
Q

List the risk factors for ovarian cancer.

A

Nulliparity, early menarche, late menopause, positive BRCA, Lynch syndrome, high fat diet

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21
Q

What are some protective factors that lower the risk of ovarian cancer?

A

Tubal ligation, pregnancy, OCPs –> less ovulation lowers risk

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22
Q

Why does tubal ligation lower the risk of ovarian cancer?

A

Some data suggests ovarian cancer actually begins in the fallopian tubes

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23
Q

What are the common S/S of ovarian cancer?

A

Usually asymptomatic –> may have pain, bloating, early satiety, weight loss

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24
Q

What symptoms might be present in ovarian cancer that originates as a sex cell cord tumor?

A

Tumor may be hormone producing –> hirsutism, inc muscle mass, deepening of voice (if T producing)

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25
Q

What physical exam findings are consistent with ovarian cancer?

A

Abdominal fluid wave, sub-Q nodules, pelvic mass or cul-de-sac nodularity, DVT (Pt’s are hypercoagulable)

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26
Q

What screening tests for ovarian cancer are routinely performed?

A

Bimanual exam is only screening tool - no evidence of benefit for any specific screening tests

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27
Q

What are the general recommendations for cancer testing when an ovarian cyst is found?

A

Mass < 10cm in premenopausal woman = no need for testing
Complex, bilateral, or > 5cm in Pt > 40 yoa = ongoing monitoring
Persistent concerning cysts or with accompanying S/S = surgical evaluation

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28
Q

What is the most common type of ovarian cyst?

A

Follicular cyst

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29
Q

What is the most common site of initial metastases from ovarian cancer?

A

Liver or diaphragm - cancer can travel through peritoneal fluid

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30
Q

Define the four stages of ovarian cancer.

A

1: ovaries only (rarely diagnosed)
2: pelvic extension
3: extrapelvic extension
4: intraparenchymal mets, pleural effusion

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31
Q

Describe the preferred chemotherapy used following surgery in treatment of ovarian cancer.

A

IV carboplatin and paclitaxel on a dose dense schedule. Do not delay more than 4 weeks after surgery.

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32
Q

The majority of germ cell ovarian tumors can be categorized as what?

A

Benign teratomas (dermoids)

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33
Q

Define teratoma (aka dermoid).

A

Large, heavy tumor that contains a lot of sebaceous material. May grow skin, hair, etc.

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34
Q

What is the most common complication of a benign ovarian teratoma?

A

Ovarian torsion

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35
Q

What is the treatment for a benign ovarian teratoma?

A

Surgical removal because of their size

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36
Q

What is the next step in management when an ovarian tumor is found on US?

A

Order serum tumor markers –> aid in Dx and monitoring treatment

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37
Q

What is the greatest risk of a sex cord stromal ovarian tumor?

A

Endometrial cancer s/p production of excess estrogen. Tumors themselves rarely malignant.

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38
Q

What patients are most likely to be diagnosed with vulvar cancer?

A

Post menopausal women

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39
Q

What is the hallmark sign or symptom of vulvar cancer?

A

Single pruritic lesion to the labia majora

40
Q

What are the risk factors for developing vulvar cancer?

A

Prior HPV infection, smoking, Northern European descent, vulvar dystrophy, immunocompromised, prior cervical cancer.

41
Q

What is the most common biopsy finding in vulvar cancer?

A

Squamous cell carcinoma

42
Q

What is the most common treatment of vulvar cancer?

A

Surgical resection followed by radiation. Chemotherapy only used if metastases are present.

43
Q

What are the most common pathogenic causes of a breast abscess?

A

Staph Aureus. If recurrent, more likely to be mixed flora/anaerobic pathogens.

44
Q

What are the S/S of a breast abscess?

A

Localized pain and inflammation. May have fever and malaise. Tender, fluctuant mass on PE

45
Q

What is the primary method of managing a breast abscess?

A

Drainage - needle aspiration or surgical

46
Q

What abx are best in treating a breast abscess?

A

Dicloxacillin or cephalexin. Clindamycin if PCN allergy
Bactrim or clindamycin if MRSA risk
Vancomycin if severe infection

47
Q

How should a woman that is lactating be counseled if she develops a breast abscess?

A

Continue breast feeding if possible –> will help resolve infection.

48
Q

Define a breast fibroadenoma.

A

Firm, rubbery, mobile solid mass that is usually solitary.

49
Q

T/F: Breast fibroadenomas are rare.

A

False: 2nd most common breast diagnosis

50
Q

What are the common S/S of a breast fibroadenoma?

A

Painless, slow growing mass typically found on self breast exam. Avg size is 2.5 cm. Firm, rubbery, mobile, and painless on PE.

51
Q

What imaging is used to aid in the diagnosis of a breast fibroadenoma?

A

US will help differentiate from a cyst. Mammogram if patient is older than 30.

52
Q

How is a breast fibroadenoma managed?

A

Fine needle aspiration. Surgical excision if histopathology not identified by aspiration.

53
Q

What patients are most likely to develop a breast fibroadenoma?

A

Peak incidence ages 25 - 40. May enlarge during pregnancy - they are partially hormone dependent.

54
Q

Define fibrocystic breast disease.

A

Exaggeration of normal changes in breast tissue in response to cyclic levels of ovarian hormones.

55
Q

What hormone is the primary cause of fibrocystic breast disease?

A

estrogen

56
Q

What is the most common benign breast condition?

A

Fibrocystic breast disease

57
Q

What are the S/S of fibrocystic breast disease?

A

Cyclic, bilateral breast pain. Inc engorgement and density of breasts. Excess nodularity. Rapid changes in size of cystic areas. Tenderness. Well delineated, slightly mobile nodules. Occasional spontaneous clear nipple discharge. Symptoms peak before menstruation and decrease after menopause.

58
Q

How is a definitive diagnosis of fibrocystic breast disease made?

A

Biopsy - will see a variety of histopathology

59
Q

What imaging and other studies are helpful in diagnosing fibrocystic breast disease?

A

US, mammography, needle aspiration

60
Q

What is the most common finding on US in fibrocystic breast disease?

A

Dense, prominent fibroglandular tissue with solitary or grouped cysts but no discernable mass.

61
Q

What is the treatment for fibrocystic breast disease?

A

Supportive: well fitting bra, loose clothing, dec caffeine, smoke cessation. May consider PO progestin.

62
Q

T/F: Patients with fibrocystic breast disease have an increased risk of developing breast cancer.

A

False: no increased risk of breast cancer

63
Q

What new treatments may be available for fibrocystic breast disease?

A

Vitamin E supplementation, low salt diet, premenstrual HCTZ. Danazol to suppress FSH and LH if symptoms are severe.

64
Q

Define mastitis.

A

Lactational or non-lactational infection of the breast.

65
Q

When does lactational mastitis most commonly occur?

A

Within the first 6 weeks of delivery.

66
Q

Name and define the two types of non-lactational mastitis.

A

Periductal: inflammation of the subareolar ducts

Idiopathic Granulomatous Mastitis: benign inflammatory breast disease of unknown etiology

67
Q

What pathogen is the most common cause of mastitis?

A

Staph Aureus

68
Q

What are the S/S of mastitis?

A

Firm, red, tender, swollen area of the breast. Fever, myalgia, chills, malaise.

69
Q

How is mastitis treated?

A

NSAIDs, cold compresses, emptying of breasts. If S/S persist > 24 hours –> give abx.

70
Q

What antibiotics are used in the treatment of mastitis?

A

Dicloxacillin or Cephalexin if no MRSA –> Clindamycin if PCN allergy.
Bactrim or Clindamycin if MRSA –> avoid Bactrim in moms breast feeding baby < 1 month old.
Vancomycin if severe infection

71
Q

Define cystocele.

A

Damage to the anterior vaginal wall results in herniation of the bladder into the vaginal lumen.

72
Q

Define urethrocele.

A

Damage to the anterior vaginal wall results in herniation of the urethra into the vaginal lumen.

73
Q

Define rectocele.

A

Damage to the posterior vaginal wall results in herniation of the rectum into the vaginal lumen.

74
Q

What are the S/S of a cystocele?

A

Often asymptomatic. May have urinary incontinence, urgency, and inc frequency.

75
Q

What is the treatment for cystocele?

A

1st line: pessary and pelvic floor muscle training

Many women eventually choose surgical correction.

76
Q

What are common S/S of a rectocele?

A

Inc pelvic pressure, sensation that something is falling out of the vagina, utilization of splinting to achieve a bowel movement, constipation, fecal incontinence, sexual dysfunction.

77
Q

Describe what is meant by splinting to achieve a bowel movement.

A

Firm pressure on the vagina, perineum, or rectum. Common sign of a rectocele.

78
Q

How is diagnosis of a rectocele commonly made?

A

During PE, observance of a bulge in the posterior vaginal wall while bearing down.

79
Q

How might a rectocele be treated?

A

Medications for constipation, pessary, posterior colporrhaphy (surgical correction)

80
Q

What is a common complication of posterior colporrhaphy?

A

Dyspareunia

81
Q

Explain the 2 biggest risk factors for uterine prolapse.

A
  1. Childbirth: s/p excess weight on pelvic floor and birth trauma
  2. Adv. Age: s/p dec estrogen weakens ligaments
82
Q

In addition to advanced aged, what other condition lowers estrogen placing women at increased risk of uterine prolapse?

A

Lactation

83
Q

Aside from the 2 primary risk factors for uterine prolapse, what other risk factors exist?

A

Obesity, hysterectomy, family Hx, connective tissue disorders, constipation (chronic straining)

84
Q

T/F: Surgical correction of uterine prolapse is a permanent fix.

A

False: 30% of cases require a second surgery s/p recurrence.

85
Q

What scoring systems are most commonly used to quantify the degree of organ prolapse.

A

Pelvic Organ Prolapse Quantification (POPQ) and Baden-Walker Halfway Scoring System

86
Q

What are treatment options for uterine prolapse?

A

Kegel exercises, PT with biofeedback, pessary, surgery

87
Q

What is the gold standard surgical option for treatment of uterine prolapse?

A

Sacrocolpopexy - attach mesh to ant and post vagina and tether it to a ligament on sacrum

88
Q

Other than the gold standard, what other surgeries may be performed to correct uterine prolapse?

A

Anterior or posterior colporrhaphy, sacrospinous ligament suspension, LeFort colpocleisis

89
Q

What is a significant consequence of a LeFort colpocleisis?

A

Patient can never have vaginal penetration after procedure.

90
Q

List all methods of birth control that also protect against STIs.

A

Only one –> condoms

91
Q

How should a patient be counseled on use of condoms?

A

Reservoir at tip, withdraw penis while still erect, hold condom at base of penis during withdrawal

92
Q

What are the pros and cons of diaphragm use as birth control?

A

Pros: cheap and very few AEs
Cons: low reliability

93
Q

How should a patient be counseled on the use of a diaphragm?

A

Use with spermicide and insert < 6 hours before sex. Remove more than 6 hours after sex but within 24 hours.

94
Q

What is the only diaphragm product available to be prescribed by providers?

A

Caya cup - one size fits all diaphragm

95
Q

What are the pros and cons of periodic abstinence for birth control?

A

Pros: very effective if patients are adherent
Cons: Requires about 17 days of abstinence per cycle

EOR Exam - Women's Health (7 decks)

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