Gynecology uWise 2 Flashcards
Enlarged uterus in 70 yo PMP female
Also see adnexal mass.
What kind of mass and why?
Granulosa cell tumor (Sex-cord stromal tumor)
- must be producing estrogen - explain enlarged uterus in PMP female
- functional sex-cord stromal tumor induces hyperplasia in uterus and even endometrial cancer
Dysgerminoma (Germ cell tumor)
Affects younger women 10-30
- 70% of ovarian tumors in this age group
Papillary serous carcinoma (Epithelial ovarian tumor)
Very common
Affect women of all ages
Malignancy usually in women in 6th decade of life
A 61-year-old G3P3 woman is diagnosed with stage IIIA papillary serous adenocarcinoma of the ovary. She is concerned about her long-term prognosis. Which of the following factors would be most helpful in determining this patient’s prognosis?
The five-year survival of patients with epithelial ovarian cancer is directly correlated with the tumor stage.
Women with poorly differentiated tumors or clear-cell carcinomas typically have a worse survival than those with well to moderately differentiated tumors.
A 44-year-old G0 woman returns to the office for a post operative check following tumor debulking for stage IIIB endometrioid adenocarcinoma of the ovary. Her medical history is significant for diabetes, hypertension, obesity, hypercholesterolemia and major depression. Which of the following is the most appropriate next step in the management of this patient?
In all patients with advanced ovarian cancer, post-operative chemotherapy with a combination of a taxane and platinum adjunct is considered standard of care in the United States. Women who undergo surgical cytoreduction, followed by chemotherapy, have a better overall survival rate than those who undergo surgery alone.
A 30-year-old G1P1 woman presents to the emergency department with left-sided abdominal pain. Physical examination is notable for a 5 x 6 cm mobile left adnexal mass. An ultrasound is performed, which shows a left ovarian mass with cystic and solid components. Which of the following is the most likely diagnosis in this patient?
The most common tumor found in women of all ages is the dermoid. The median age of occurrence is 30 years, and 80% occur during the reproductive years. Dermoids may contain differentiated tissue from all three embryonic germ layers. Dermoid tumors can contain teeth, hair, sweat and sebaceous glands, cartilage, bone, and fat.
Clue Cells + ?? discharge + other?? + ph??
Treat?
Bacterial Vaginosis: shift in the vaginal flora from hydrogen peroxide-producing lactobacilli to non-hydrogen peroxide-producing lactobacilli
- thin, gray discharge with a characteristic fishy odor
- elevated vaginal pH >4.5.
Treat: metronidazole
Severe vulvar pruritus + introital dyspareunia + resorption of clitoris & labia minora
Treat?
Lichen sclerosus is a chronic inflammatory skin condition
- premenstrual girls & PMP women (Caucasian)
- early skin changes include polygonal ivory papules involving the vulva and perianal areas, waxy sheen on the labia minora and clitoris, and hypopigmentation.
Treatment involves use of high-potency topical steroids.
Frothy yellow vaginal discharge
- pH?
- dx?
Treatment?
Trichomoniasis, which is caused by the protozoan, T. vaginalis
- malodorous, yellow-green discharge with vulvar irritation
- Vaginal pH of 7
Pt + partner treat w/ Metronidazole
Thick white vaginal discharge
Vulvovaginal candidiasis usually is caused by C. albicans - pH = 4.0 - recent antibiotic use - erythema w/ satellite lesions Treat: Azole
Inflammatory mucocutaneous eruptions characterized by remissions and flares
Vulvar symptoms include irritation, burning, pruritus, contact bleeding, pain and dyspareunia
Lacy, reticulated pattern of the labia and perineum, +/- scarring and erosions as well.
Vagina can become obliterated.
Oral lesions, alopecia and extragenital rashes.
Lichen planus
- treat supportive + high potency corticosteroids
Severe pain on vestibular touch or attempted vaginal entry, tenderness to pressure and erythema of various degrees.
Symptoms often have an abrupt onset and are described as a sharp, burning and rawness sensation.
Women may experience pain with tampon insertion, biking or wearing tight pants, and avoid intercourse because of marked introital dyspareunia.
Vestibular findings include exquisite tenderness to light touch of variable intensity with or without focal or diffuse erythematous macules.
Vestibulodynia (formally vulvar vestibulitis) syndrome:
Treat: Tricyclic antidepressants
- block sympathetic afferent pain loops
Pelvic floor rehabilitation
Topical anesthetics
Surgery?
- unresponsive to other therapies
- unable to tolerate intercourse
Severe vulvar pruritus (can be worse at night)
Thick, lichenified, enlarged and rugose labia, +/- edema
Dx?
Tx?
Lichen simplex chronicus, a common vulvar non-neoplastic disorder, results from chronic scratching and rubbing, which damages the skin and leads to loss of its protective barrier. Over time, a perpetual itch-scratch-itch cycle develops, and the result is susceptibility to infection, ease of irritation and more itching.
Treat high potency corticosteroids + antihistamine
A 20-year-old G0 college student presents with a one-month history of profuse vaginal discharge and mid-cycle vaginal spotting. She uses oral contraceptives and she thinks her irregular bleeding is due to the pill. She is sexually active and has had a new partner within the past three months. She reports no fevers or lower abdominal pain. She has otherwise been healthy. On pelvic examination, a thick yellow endocervical discharge is noted. Saline microscopy reveals multiple white blood cells, but no clue cells or trichomonads. Potassium hydroxide testing is negative. Vaginal pH is 4.0. No cervical motion tenderness or uterine/adnexal tenderness is present. Testing for gonorrhea and chlamydia is performed, but those results will not be available for several days and the student will be leaving for Europe tomorrow. Which of the following is the most appropriate treatment for this patient?
A. Metronidazole and erythromycin B. Ceftriaxone and azithromycin C. Ampicillin and doxycycline D. Azithromycin and doxycycline E. No treatment is necessary until tests results are known
Mucopurulent cervicitis (MPC) is characterized by a mucopurulent exudate visible in the endocervical canal or in an endocervical swab specimen. MPC is typically asymptomatic, but some women have an abnormal discharge or abnormal vaginal bleeding. MPC can be caused by Chlamydia trachomatis or Neisseria gonorrhoeae; however, in most cases neither organism can be isolated.
B. Ceftriaxone and azithromycin
Chlamydia: azithromycin or doxycycline
Gonorrhea: cephalosporin or quinolone
(Ceftriaxone)
Mom w/ uncontrolled DM, child most at risk for?
Cardiac abnormalities, CNS, and limb deformities
