OB/GY Flashcards
Clear cell carcinoma of the vagina - large cells with abundant clear cytoplasm RISK FACTOR?
DES - diethylstilbestrol - synthetic estrogen used in the 40s to prevent miscarriage > discontinued in 1970 because of transplacental carcinogen potency for vaginal cancer (daughters of these women) and breast cancer (mothers).
LEEP - loop electrosurgical excision procedure
Remove high-grade intraept lesions of the cervix
Fibroadenoma - solid mass with well-defined borders and low clinical suspicion for malignancy - MANAGEMENT
Reassurance and follow-up examination in 6 months
Risk factors for ENDOMETRIAL CANCER
Nulliparity, obesity, diabetes mellitus, late menopause, tamoxifen use…
Phyllodes tumor - pathology
Leaf-like architecture of papillary projections of epthelium-lined stroma;
Lobular appearance on mammography (can be similar to fibroadenoma)
Phyllodes tumor - clinical presentation
Painless breast lump: Lesion >3cm, rapidly enlarging with NO AXILLARY LYMPHADENOPATHY associated. 25% is malignant - surgery with wide margins is required
Invasive ductal carcinoma - malignant cells in the ducts with micro calcification and stromal invasion - CLINICAL PRESENTATION
Most common form of breast cancer; painless breast mass, often associated with skin changes ( retraction, dimpling, edema), nipple retraction, bloody nipple discharge, and/or lymphadenopathy.
Invasive lobular adenocarcinoma - malignant cells in lobules and monomorphic cells in single rows
10-15% of breast cancers; painless nodule, skin changes, nipple retraction, bloody nipple discharge, lymphadenopathy
Intraductal papilloma - central, branching fibrovascular core with surrounding myoepithelial and epithelial cells.
Multiple/single, sometimes palpable lesions with serous or bloody nipple discharge (60-80%)
Paget disease of breast
Erythematous and scaly rash affecting the nipple and areola, accompanied by pruritus, burning, nipple retraction, blood-tinged nipple discharge (Ductal Carcinoma)
Fibrocystic breast disease - focal lesions of thick parenchyma or cysts
Most common benign condition of the breast - palpable breast mass; mastalgia, cyclic pain with menses and clear/white nipple discharge
Cardiotocogram
Fetal heart rate range: 6-25bpm
Decelerations: diration <60s, abrupt <30s from onset to nadir, vary in shape, temporal relationship with uterine contractions, occur with <50% of uterine contractions over a 20-minute time period =intermittent variable decelartions
Fat necrosis of the breast - oil cysts; foam cells and multinucleated giant cells
Benign; trauma related; exam and radio mimics malignancy - DOES NOT increase the risk of breast cancer > reassurance and follow-up
Solitary malignant tumor treatment
Lumpectomy with axillary staging
Radiation
Anastrozole
Postmenopausal women with HR + breast cancer
Tamoxifen
Premenopausal HR+ breast ca
Trastuzumab
HER2+ breast cancer
Endometriosis definitive diagnosis
LAPAROSCOPY - Presumptive clinical diagnosis but inconclusive imaging findings, no response to medical therapy or to exclude malignancy
Presence of small bluish endometric lesions - POWDER-BURN
Letrozole - aromatase inhibitor
First-line pharmacotherapy for ovulation induction in PCOS
Better than clomiphene
Bromocriptine - dopamine agonist
Anovulatory infertility in hyperprolactinemia
Topical clobetasol
Lichen sclerosus treatment
Lichen sclerosus increases the risk of what type of cancer?
Vulvar squamous cell carcinoma
Dyspareunia and pruritus in a postmenopausal woman with a white vulvar plaque on pelvic examination
Lichen sclerosus
Topical estrogen
Atrophic vaginitis treatment
UVA1 phototherapy
Topical tacrolimus
Improves lichen sclerosus symptoms, less effective than other therapies
Pregnant women with syphilis allergic to penicillin
Desentization
Syphilis treatment (non pregnant)
Doxy, ceftriaxone, azithromycin
Adenocarcinoma (breast) - intraepithelial
Paget disease of breast - ductal carcinoma (niple-areola complex)
Erythematous, scaly, vesicular rash w/ pruritus, burning, and nipple retraction > ulcerates > blood-tinged nipple discharge
Unilateral solid benign tumor + pregnancy + virilization
Sertoli-Leydig cell tumor
Benign tumor uni/bilateral >4cm + pregnancy (bHCG) + with or without virilization + with or without mass-related features (risk of ovarian torsion)
Luteoma (androgen-prod lutein cells)
Fitz-Hugh-Curtis syndrome
A syndrome characterized by inflammation of the liver capsule that occurs in women as a complication of pelvic inflammatory disease. Clinical features include fever, nausea, vomiting, right upper quadrant pain, and/or pleuritic chest pain.
USPSTF HPV recommendations
21-29yrs: solitary Pap smear every 3 years
30–65 years: HPV/Pap smear cotesting every 5 years
USPSTF mammography recommendations
50–74 years: mammography every 2 years between
>40 years: several risk factors
Pelvic pressure and/or pain, which worsens on standing or walking, in the presence of posterior vaginal wall protrusion and lax sphincter tone on pelvic examination, increased vaginal discharge
Enterocele (upper 1/3rd of the posterior vaginal wall) or Rectocele (middle 1/3rd of the posterior vaginal wall)
Enterocele risk factors
multiparity, postmenopausal status, and prior pelvic surgery.
Patients with endometrial cancer who do not wish to preserve fertility or have reached menopause - MANAGEMENT
Total hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)
High-dose progestins
Young patients with early-stage endometrial cancer confined to the uterus who desire future pregnancies.
Solitary intraductal papillomas
Unilateral bloody nipple discharge, absence of associated breast skin changes or axillary lymphadenopathy and the ultrasound finding of a dilated duct enclosing a well-defined solitary mass
Breast US - well-defined solitary mass within a dilated mammary duct
Main differential diagnoses are intraductal papilloma, ductal carcinoma (especially papillary carcinoma), and inspissated secretions (do not vasc.
Papillary carcinoma of the breast - bloody discharge from the nipple and an intraductal mass on ultrasound.
Usually occurs in postmenopausal women, with a peak incidence in the seventh decade.
Chancroid -Haemophilus ducreyi (painful inguinal lymphadenopathy) LESIONS
women - multiple purulent lesions that are 1–2 cm in size, clearly demarcated with a greyish necrotic base, and typically very painful.
men - single lesion is common.
Granuloma inguinale - donovan bodies - Klebsiella granulomatis- painless - LESIONS
Nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily; regional lymph nodes are typically spared
Chancre
Solitary (or multiple) painless ulcer with indurated borders; bilateral nontender regional lymphadenopathy
Lymphogranuloma venereum (LGV)
Transient papule that is painless and heals rapidly without scarring. Painful suppurative lymphadenopathy is seen 2–6 weeks after the papule heals, with systemic symptoms like fever, malaise, and chills.
Genito-pelvic pain/penetration disorder
Difficulty with vaginal penetration, vulvovaginal or pelvic pain during intercourse, anticipatory anxiety, and pronounced tightening of the pelvic floor muscles
Vulvodynia
Soreness and burning of the vulva that may be present continuously or triggered by touch or pressure (e.g., sexual intercourse, tampon use).
Endometrial biopsy indications
Postmenopausal patients with any uterine bleeding; those ≥ 45 years of age with frequent, heavy, or prolonged bleeding; and those < 45 years of age with persistent bleeding (≥ 6 months) and risk factors for endometrial cancer
Hysteroscopy with uterine dilation and curettage
Used to manage acute heavy AUB in patients who do not respond to medical treatment within 12–24 hours.
Hysteroscopic polypectomy
symptomatic endometrial polyps, asymptomatic polyps > 1.5 cm in diameter in premenopausal women; infertility, multiple polyps, polyps that have prolapsed through the cervix, polyps in postmenopausal women, and polyps in women with risk factors for endometrial hyperplasia or carcinoma
Premenopausal women with asymptomatic endometrial polyps and without risk factors for endometrial hyperplasia
Follow-up with transvaginal ultrasonography in 6 months
(SSRIs)
first-line therapy for PMDD
