OBGYN 3 Flashcards
Migraine HA’s, accompanied by neurologic symptoms such as loss of vision, parasthesias, and numbness are generally considered to be contraindications to what type of contraceptive therapy?
Combination oral contraceptive therapy.
These are the most common germ cell tumors and they account for about 20-25% of all ovarian neoplasms. They occur primarily during the reproductive years, but may also occur in postmenopausal women and children. They are usually unilateral, but 10-15% are bilateral. Usually these tumors are asymptomatic, but they can cause severe pain if there is torsion or if the contain material perforates and spills and creates a reactive peritonitis. Diagnosis?
Benign cystic teratoma (Dermoid cyst).
What is the appropriate treatment for a woman older than 40 years of age, who presents with a symptomatic cystic or solid mass in the area of the Bartholin gland?
Surgical excision; although rare, adenocarcinoma of the Bartholin gland must be excluded in a woman over 40 years of age. The appropriate treatment in these cases is surgical excision of the Bartholin gland to allow for a careful pathologic examination. In the case of the asymptomatic Bartholin cyst, no treatment is necessary.
What is the treatment of microinvasive carcinoma of the cervix?
Simple hysterectomy.
What is the most radiosensitive tissue in the pelvis?
Ovarian tissue.
Approximately 20% of ovarian neoplasms are considered malignant on pathologic examination. Still, all must be considered as placing the patient at risk. Given that most ovarian tumors are not found until significant spread has occurred, it is not unreasonable to attempt to operate on such patients as soon as there is a suspicion of tumor. Papillary vegetation, size greater than 10 cm, ascites, possible torsion, or solid lesions are automatic indications for what intervention?
Exploratory laparotomy.
In a younger women an ovarian mass can be followed for what length of time, in order to determine if it is a follicular (physiologic) cyst?
The length of 1-2 menstrual cycles; since a follicular cyst should regress after onset of the next menstrual period. If regression does not occur, then surgery is appropriate.
This procedure involves excision of the uterus, the upper third of the vagina, the uterosacral and uterovesical ligaments, and all of the parametrium, and pelvic node dissection including the ureteral, obturator, hypogastric, and iliac nodes. It is most often used as the primary treatment for early cervical cancer (stages Ib-IIa). What procedure is this?
Radical Hysterectomy; this procedure thus attempts to preserve the bladder, rectum, and ureters while excising as much as possible of the remaining tissue around the cervix that might be involved in microscopic spread of the disease. Preservation of the ovaries is generally acceptable, particularly in younger women unless there is some reason to consider oophorectomy.
The most common ovarian neoplasms in young women in their teens and early twenties are of germ cell origin, and about half of these tumors are malignant. Functioning ovarian tumors have been reported to produce precocious puberty in about 2% of affected patients. Epithelial tumors of the ovary, which are quite rare in pubertal girls, are benign in approximately 90% of all cases. What is an example of a malignant epithelial tumor that might be found in a younger patient?
Papillary serous cystadenocarcinoma.
Sarcoma botryoides is a malignancy associated with Mullerian structures such as the vagina and uterus, including the uterine cervix. What age group is this seen in?
Children.
This is the most common epithelial tumor of the ovary. On histological examination, psammoma bodies can be seen in approximately 30% of these tumors. Bilateral involvement (buzz word) characterizes about 1/3 of these tumors. Diagnosis?
Serous carcinoma.
Mesonephroid carcinomas are associated with what chronic pelvic pain condition/neoplastic condition?
Endometriosis.
Patients with this condition of the vulva tend to be older; they typically present with pruritis, and the lesions are usually white with crinkled skin and well-defined borders. The histological appearance includes loss of the rete pegs within the dermis, chronic infiltrate below the dermis, the development of a homogenous subepithelial layer in the dermis, a decrease in the number of cellular layers, and a decrease in the number of melanocytes. Mechanical trauma produces bullous areas of lymphedema and lacunae, which are then filled with erythrocytes. Ulcerations and ecchymoses may be seen in the traumatized regions as well. Mitotic figures are rar in this condition, and hyperkeratosis is not a feature. While a significant cause of symptoms, this condition is not a premalignant condition. Its importance lies in the fact that it must be distinguished from vulvar squamous cancer. Diagnosis?!?
Lichen sclerosis (formerly lichen sclerosis et. atrophicus; but recent studies indicate that atrophy does not exist.)
What are the four HPV strains associate with cervical malignancy?
16, 18, 31, 45.
What are the two HPV strains are most associated with benign condyloma?
HPV 6 and 11.
These tumors represent less than 1% of ovarian tumors and may produce symptoms of virilization. Histologically they resemble fetal testes; clinically these tumors must be distinguished from other functioning ovarian neoplasms as well as from tumors of the adrenal glands, since they produce androgens. The androgen production can result in seborrhea, acne, menstrual irregularity, hirsutism, breast atrophy, alopecia, deepening of the voice, and clitoromegaly. DIagnosis?
Sertoli-Leydig cell tumors.
These ovarian tumors are often associated with excessive strogen production, which may cause pseudoprecocious puberty, postmenopausal bleeding, or menorrhagia. This neoplasm is associated with endometrial carcinoma in 15% of patients. Because these tumors are quite friable, affected women frequently present with symptoms caused by tumor rupture and intraperitoneal bleeding. Diagnosis?
Granulosa-Theca cell tumors.
This ovarian tumor frequently contains calcifications that can be detected by plain radiograph of the pelvis. Women who have these neoplasms often have ambiguous genitalia. The tumors are usually small and are bilateral in 1/3 of affected women (like serous carcinoma). Diagnosis?
Gonadoblastoma.
The malignant potential of a teratoma correlates with what histological feature?
The degree of immature embryonic tissue present.
In a Teratoma, the presence of choriocarcinoma can be determined histologically as well as by hCG assay. How would this finding affect the patient’s prognosis?
The presence of choriocarcinoma in an immature teratoma worsens the prognosis.
These tumors are typically bilateral, solid masses of the ovary that nearly always represent metastases from another organ, usually the stomach or large intestine. They contain large numbers of signet ring adenocarcinoma cells within a cellular hyperplastic but nonneoplastic ovarian stroma. Diagnosis?
Krukenberg tumor.
Production of allergic reactions and bone marrow suppression are side effects seen with what chemotherapeutic agent?
Paclitaxel
In young, menstruating women, these are the most common reason for an enlargement of one ovary. This type of ovarian cyst is usually asymptomatic, unilateral, thin-walled, and filled with a watery, straw-colored fluid. Diagnosis?
Functional cyst, which is physiologic and forms during the normal functioning of the ovaries.
These types of ovarian cysts are less common, are usually unilateral, but often appear complex, as they may be hemorrhagic. Patients with this type of ovarian cyst may complain of a dull pain on the side of the affected ovary. Diagnosis?
Corpus luteum cyst.
This ovarian cyst is the least common of all three types of functional ovarian cysts. They are almost always bilateral and are associated with pregnancy. Diagnosis?
Theca-lutein cyst.
Lymphogranuloma venerum is a chronic infection most commonly found in the tropics. The primary infection begins as a painless ulcer on the labia or in the vaginal vestibule; the patient usually consults the physician several weeks after the development of painful adenopathy in the inguinal and perirectal areas. Diagnosis can be established by culture or by demonstrating the presence of serum antibodies to what bacterium?
Chlamydia trachomatis.
Donovan bodies are present in patients with Granuloma inguinale. Therapy for this disease as well as LGV is administration of tetracycline. What is the bacteria responsible for causing Granuloma inguinale?
Chlamydia granulomatis.
The antibody titer for HIV becomes positive approx. how many weeks after exposure?
4 to 10 weeks after exposure; because of the occasional delayed appearance of the antibody after initial exposure, it is important to follow up patients for 1 year after exposure.
1) Unsatisfactory colposcopic examination (i.e. the entire transformation zone cannot be seen), 2) a colposcopically directed cervical biopsy that indicates the possibility of invasive disease, 3) neoplasm in the endocervix, 4) cells seen on cervical biopsy that do not adequately explain the cells seen on cytologic examination (ie the Pap), are all indications for what next step?
Cone biopsy.
This is a syndrome of unknown etiology. To make the diagnosis of this disorder, the following three findings must be present: 1) severe pain on vestibular touch or attempted vaginal entry, 2) tenderness to pressure localized with in the vulvar vestibule, 3) visible findings confined to vulvar erythema of of various degrees. To treat this condition the first step is to avoid tight clothing, tampons, hot tubs, and soaps which can all act as vulvar irritants. If this fails topical treatments include lidocaine, estrogen, and steroids. TCAs and intralesional interferon injections have also been used. For women refractory to medical therapy, surgical excision of the vestibular mucosa may be helpful. Diagnosis?
Vulvar vestibulitis.
This is a precancerous lesion of the vulva that has a tendency to progress to frank cancer. Women with this condition complain of vulvar pruritus, chronic irritation, and raised lesions. These lesions are most commonly located along the posterior vulva and in the perineal body and have a whitish cast and rough texture. What is this condition?
Vulvar intraepithelial neoplasia (VIN).
How are pregnant women with bacterial vaginosis treated?
The same way that non-pregnant women are treated; Metronidazole 500 mg BID x 7 days.
Diflucan is used in the treatment of what gynecological condition?
Candidiasis.
The classical lesion of strawberry cervix is associated with vaginal Trichomonas infection. What is the appropriate treatment for a diagnosed Trichomonas infection?
One-time dose of Metronidazole 2g PO.
