IC and benign uterine and ovarian conditions

Question 1

urinary frequency >8 daytime, > 2 nighttime, and subprapubic pain is most likely what condition?

Answer 1

Interstitial cystitis

Question 2

Most common type of person to get interstitial cystitis

Answer 2

White women and men aged 40-50’s

Question 3

Suprapubic pain that is increased with bladder filling and urinating but that goes away after emptying is most likely what condition?

Answer 3

Interstitial cystitis

Question 4

foods that can exacerbate IC

Answer 4

beer, spices, bananas, tomatoes, chocolate, strawberries, artificial sweeteners, oranges, cranberries, and caffeine

Question 5

Tests for IC

Answer 5

there is no definite diagnostic test, it is a diagnosis of exclusion. Can use questionnaires like the PUF, can use a voiding diary (low volume, high frequency), anesthetic bladder challenge, cystoscopy and hydrodistension, Parson’s potassium sensitivity test, UA and culture, and CT or abdominal/pelvic US. Bladder biopsy should not be done for diagnosis of IC

Question 6

Anesthetic bladder challenge

Answer 6

if you add an anesthetic cocktail to the bladder, IC symptoms are relieved.

Question 7

Parsons potassium sensitivity test

Answer 7

tests bladder epithelial permeability, and is a hallmark test in 80% of IC cases. If there is increased pain and urgency with K induction, that is a positive test and is a potential indicator for IC

Question 8

Indications for urine cytology in an IC workup

Answer 8

if hematuria, smoking, > 40 yo

Question 9

most effective medication for IC

Answer 9

most pts have a course of empiric abx, but long term abx is not good. Pentosan polysulfate sodium (Elmiron) is the best oral therapy for IC

Question 10

adjunct medications for IC treatment

Answer 10

TCA (amitriptyline), cimetidine, antihistamines, neuroleptics (gabapentin), analgesics (Nsaids, maybe opioids), occasionally antimuscarinics.

Question 11

If hunners ulcers are present in an IC patient what medication will you add to therapy

Answer 11

Oral prednisone

Question 12

Intravesicle treatment for IC

Answer 12

used when oral meds fan, for acute flare up s and before po meds take full effect. DMSO is the only FDA approved (garlic taste).

Question 13

f/u for IC

Answer 13

every month x 3 months, then every 3 months. Epithelial damage can lead to cancer.

Question 14

abnormal uterine bleeding in a very young woman right after menarche, or in perimenoupausal women may indicate

Answer 14

DUB

Question 15

test for anovulatory cycles

Answer 15

if give a woman progestin trial and their bleeding stops, then it confirms that they are having anovulatory cycles

Question 16

C/I for OCPs in DUB pts

Answer 16

smokers, HTN, DM, vascular disease, breast ca, liver disease and focal HA

Question 17

Treatment options for DUB

Answer 17

OCP, cyclic progestins alone is good for younger women, IUD, D&C. If refractory, consider ablation or hysterectomy

Question 18

Adenomyosis

Answer 18

the extension of endometrial GLANDS into the uterine musculature.

Question 19

middle aged, porous woman with severe secondary dysmenorrhea, menorrhagia and a symmetrically enlarged uterus may have what condition?

Answer 19

adenomyosis

Question 20

Diagnosis of adenomyosis

Answer 20

must r/o preg.

May do US

must r/o endometrial cancer, can do endometrial biopsy or fractional D&C or hysteroscopy

Question 21

management of adenomyosis

Answer 21

if you do a diagnosis D&C that is also a treatment. Can also try giving a GnRH agonist or mifepristone (abortant, helps with shedding). Hormone therapy less likely to be effective in severe cases. Overall, Hysterectomy is definitive therapy.

Question 22

most common benign uterine tumur

Answer 22

Leiomyoma, aka fibroids

Question 23

an AA woman of childbearing age with abnormal uterine bleeding and ascites may have what condition?

Answer 23

Uterine fibroids. up to 50% of fibroids in women

Question 24

A young woman with oligomenorrhea/amenorrhea, DUB, acne, male pattern obesity, and HTN may have what condition?

Answer 24

PCOS. May also have alopecia, acanthosis nigans, T2DM

Question 25

the most common cause of chronic an ovulation when estrogen is present

Answer 25

PCOS

Question 26

what is PCOS

Answer 26

the accumulation of incompletely developed follicles in the ovaries due to anovlation, it is associated with ovarian androgen production.

Question 27

Diagnosis of PCOS

Answer 27

must have at least 2:

1. Oligo or anovulation
2. clinical or biochemical signs of hyperangrogenism
3. Polycystic ovaries

Question 28

how to test for presence of estrogen

Answer 28

Do a progesterone withdrawal test. Give Provera 10 mg qd x 5 d. If bleeding occurs, estrogen is present

Question 29

Pelvic US or CT in PCOS

Answer 29

wil show two-fivefold enlargement of the ovaries with 20+ sub capsular follicles that are up to 15cm in diameter.

Question 30

A nulliparous woman in her 20’s with dysmenorrhea and dyspareunia, with uterosacral modularity and a fixed and retroverted uterus may have what condition?

Answer 30

endometriosis. Other s/sx include abnormal bleeding, chronic pelvic pain, infertility and dyschezia. The degree of endometriosis does not correlate with symptoms

Question 31

most common sites for endometriosis

Answer 31

ovary, pelvic peritoneum, round ligament, fallopian tubes and sigmoid colon.

Question 32

diagnosis of endometriosis

Answer 32

laparoscopy- direct visualization is required to make the diagnosis.

Question 33

Nabothian cyst

Answer 33

benign cervical cyst filled with mucus, present at the surface of the cervix. Will be translucent or yellow.

Question 34

Mesonephric cyst

Answer 34

benign cervical cyst that is actually wolffian duct remnant that become cystic.

Question 35

management of cervical polyp

Answer 35

even though most are benign and do not bother pt, all need to be removed via polypectomy and sent to pathology. also test for any infection

Question 36

papillomas of the cervix

Answer 36

d/t HPV. They are asymptomatic. Definitive is cytologic finding of koilocytes.

Question 37

Follicular ovarian cyst

Answer 37

the most common type of ovarian cyst, d/t failure in ovation. most do not require any treatment and will reabsorb within 60 days

Question 38

corpus luteum cyst

Answer 38

type of ovarian cyst where the corpus luteum does not fully reabsorb and becomes cystic, > 3cm. Most regress in 1-2 months in a menstruating woman, however they have been associated with rupture and ovarian torsion

Question 39

Theca lutein ovarian cyst

Answer 39

presents sometimes in women undergoing fertility treatments, or its with choriocarcinoma. cyst will go away with termination of fertility treatments or termination of the molar pregnancy. May require surgery if torsion or rupture

Question 40

Endometriomas

Answer 40

essentially it is a piece of endometrium that is on top of the ovary that fills with blood. Called chocolate cyst. will have chronic pelvic pain, dyspareunia, dysmenorrhea and infertility

Question 41

serous epithelial ovarian tumor

Answer 41

50% of all epithelial ovarian tumors, occur more in 20-30s. They contain clear yellow fluid and are benign but can grow to be huge.

Question 42

Mutinous epithelial ovarian tumor

Answer 42

the largest tumors found in the human body. Mimics the appearance of pregnancy. 75-85% of them are benign

Question 43

causes of hirsuitism

Answer 43

PCOS, congenital adrenal hyperplasia, androgen secreting tumors, Cushings, acromegaly, idiopathic

Question 44

drug that can cause hirsuitism

Answer 44

phenytoin, anti seizure medication

Question 45

Ferryman-Gallwey score that is + for hirsuitism

Answer 45

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