Second Half Flashcards
What is the most common malignant cell type for ovarian cancer in adults?
Epithelial cell
What is the most common malignant cell type for ovarian cancer in children/adolescents?
Germ Cell
You are currently in the room with a patient who has been diagnosed with submucosal leiomyoma (fibroids). She is 33 and still desiring pregnancy what are your two options for treatment?
1) Hysteroscopic myomectomy
2) short-term contraceptive management
What is the treatment for endometritis?
Doxycycline 100mg bid x 10-14 days
How do you treat an 18 year old female who has a CIN3 on colposcopy?
Excision Procedure/Ablation
Which tool diagnoses and stages ovarian cancer?
Laparotomy
A 15 yo girl has not yet had her period and is worried about it since all her friends have had theirs. What should you use to help you differentiate between various causes of amenorrhea?
Whether or not she has had any secondary sexual development.
What are some side effects of menopause?
Hot flashes, sleep disturbances, new onset depression, vaginal dryness, memory change, joint aches and pain
What falls under the Rotterdam criteria?
Anovulation or oligo-ovulation
Hyperandrogenism
Polycystic ovaries via TVUS
What is the most common cause of Secondary Amenorrhea?
Pregnancy
What are some risk factors for ovarian cancer?
Long term estrogen (nulliparity, early menarche, late menopause), endometriosis, genetics (BRCA, HNPCC), lower SES, Caucasian, age > 50
True or false: the goal of PCOS management is to prevent endometrial dysplasia & induce ovulation.
True
A 25 y/o female comes in to do her routine pap smear. What is the next step if the cytology report comes back “unsatisfactory cytology” ?
Repeat pap smear
What is the most common cause of secondary amenorrhea?
Pregnancy
What are some possible symptoms of cervical cancer?
Early → often Asx but may see lesions, AUB, postcoital bleeding
Advanced → Pelvic or low back pain, Lymphadenopathy, Bulk sx, Visible lesions on exam
What are some protective factors against ovarian cancer?
Anything that lowers ovulation frequency → Multiparous, Breastfeeding, Contraceptives, Tubal ligation
What is the first line of prevention for Cervical Cancer?
HPV Vaccination
A 40 year old women claims she is not sexually active, should she still get HPV testing?
Yes because the patient’s claims can not always be trusted
Pt age 55 comes in with vague sxs including bloating, loss of appetite, weight loss, stomach ache and pelvic pain. What is most likely diagnosis?
Ovarian CA
What age should you start HPV testing with cytology?
Age 30
What is the diagnosis and treatment for GYN patients who present with endometrial or cervical polyps?
Polypectomy
What is the number 1 cause of primary amenorrhea?
Pregnancy
How often should you perform cervical cytology for patients ages 21-29?
Every 3 years
What is a common presentation for a female with hyperprolactinemia and hypogonadotropic hypogonadism?
Short stature, galactorrhea, diabetes insipidus, H/A
What are the physical findings for advance ovarian cancer?
Ascites and pleural effusion
What is/are the recommended treatment for early stage (1A, 1B1) cervical cancer.
- Modified radical hysterectomy with pelvic lymphadenectomy
- Radiation if non surgical candidate
Which medications do you use to help your patient with PCOS get pregnant?
Clomiphene (Clomid) or Letrazole (Femara)
What should be included in the workup for secondary amenorrhea?
UPT, FSH, LH, estradiol, testosterone, prolactin, TSH, ultrasound
What is the recommended management for CIN 2, 3?
if the patient is over 25, then management is preferred with excisional procedure or abalative.
if the patient is less than 25, observation with cytology and colposcopy (CIN 2) or excisional procedure (CIN 3)
What is the recommended management for CIN 1?
if low grade on colposcopy, observe initially and follow up closely with an annual cotest
In any instance when a cytology report comes back unsatisfactory, what is the next best step?
repeat cytology
If a patient is postmenopausal and starts having abnormal vaginal bleeding, what do we assume it is until proven otherwise?
endometrial cancer
T/F ovarian cysts are only found in women who have their menses.
false, women of all ages can get ovarian cysts.
What is the most likely cause of a female developing hyperandrogenic symptoms (facial hair development, acne, male pattern baldness)?
PCOS
What are key PE findings for a patient with suspected adenomyosis?
A tender uterus that is BOGGY and ENLARGED (uterus size comparable to a woman who is several weeks pregnant)
What are the steps when looking at pap results?
- Look and see if there were sufficient cells for testing.
- Pathology of the cells.
- HPV positive or negative.
What are patient’s with PCOS at risk to develop?
Diabetes mellitus
Most common cause of cervical cancer
HPV 16, 18, 31, 45
Symptoms of ovarian cancer?
Often asymptomatic, but can have swollen abdomen, wt loss, constipation/bowel obstruction, ascites, and pleural effusion
You are urgently evaluating a pregnant patient (first trimester) for bleeding and pain. What must be immediately considered and ruled out?
ectopic pregnancy
when do you do polypectomy for ovarian polyp
symptomatic, increased risk of endometrial cancer, or if unclear on ultrasound
what are common physical exam findings of adenomyosis
tender, boggy, enlarged uterus
What is the most likely cause of a female developing hyperandrogenic symptoms (facial hair development, acne, male pattern baldness)?
PCOS
What is the number one prevention factor in preventing HPV and cervical cancer?
Getting vaccinated when eligible!
What is the number one prevention factor in preventing HPV?
Getting vaccinated when eligible!
What is LSIL (low-grade squamous intraepithelial lesion) typically caused by?
HPV - typically self-resolves
what is the recommended screening for cervical cancer for 30-65
cytology + HPV every 5 years
what is the most common type of ovarian cancer in children?
germ cell
What are key PE findings for a patient with suspected adenomyosis?
A tender uterus that is BOGGY and ENLARGED (uterus size comparable to a women who is several weeks pregnant)
What is the first line treatment for a woman who presents with fibroids (leiomyomas) with bulk symptoms and does not desire pregnancy?
GnRH analogs (leuprolide)
What is the most immediate concern for a thickened endometrial lining and must be ruled out before considering any other diadnosis?
Endometrial Cancer
What does ASC-US stand for?
Atypical Squamous Cells of Undetermined Significance
Postmenopausal bleeding is what until proved otherwise?
endometrial cancer
What is the ovarian morphology index useful for?
predicting benign masses
What are some symptom management options for PCOS?
Weight Loss
Spironolactone
Metformin (If insulin resistance).
What does NILM Stand for?
Negative for Intraepithelial Lesion or Malignancy
Treatment for simple ovarian cyst?
Watchful waiting and surveillance.
How can you prevent new cysts from forming?
Oral Contraceptives
When would you consider surgery for a simple ovarian cyst?
Hemorrhagic or large and associated with bulk symptoms.
What is a general risk factor for the development of ovarian cancer?
Anyone with more menses over their lifetime
What are the general prevention and screening measures for cervical cancers?
Vaccination, Pap smear +/- HPV testing
What are the three types of imaging ordered to help diagnose leiomyomas?
TVUS, SIS, MRI
What does Endometrioma decidualization do?
Prepares the endometrial lining for pregnancy.
For cervical cancer screening in women ages 21-29, what test do you order and how often?
Cytology ONLY q3 years (reflex HPV)
What is the most common type of abnormal pap smear?
ASC-US
what is the gold standard to diagnose breast cancer?
biopsy!
a 32 year old female has an estrogen receptor positive tumor which requires systemic therapy. What will most likely be given to her for treatment?
Tamoxifen QD for 10 years.
a 75 year old female has a progesterone receptor positive tumor which requires systemic therapy. what is the best treatment?
Aromatase inhibitors QD for 5 years.
True or false: Survival is the same regardless of mastectomy or breast conservation
True
What type of biopsy is the best for breast cancer diagnosis
core biopsy
what are the indications for an MRI for breast cancer?
Known BRCA1 or BRCA2 mutation carrier
Untested first-degree relative of known mutation carrier
Radiation to chest, especially ages 10-30
Other genetic abnormality (Li-Fraumeni, Cowden’s, etc.)
Lifetime risk >20% by models based on family history
What is the surveillance recommendation for patients w/ a previous mastectomy?
Chest Breast Exam only
What carbohydrate antigen (Cancer Antigen) is best for detecting ovarian cancer?
Ca 125
What are some treatment options for Early stage (1A, 1B1) Cervical cancer?
modified radical hysterectomy with pelvic lymphadenectomy OR radiation if not a surgical candidate.
What is the Classification System used for abnormal uterine bleeding in non-pregnant, reproductive age women?
PALM-COEIN
What is each classification within PALM-COEIN mnemonic for abnormal uterine bleeding in non-pregnant, reproductive-age women?
Polyp
Adenomyosis
Leiomyoma
Malignancy (& hyperplasia)
Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not yet Classified
What is the recommendation for breast cancer screening?
Annually starting at 40 years old beginning with a mammogram
Tamoxifen is a hormonal therapy that can be used for breast cancer treatment. What are some side effects of Tamoxifen?
Vasomotor symptoms (hot flashes) Thrombotic events Endometrial stimulation
A 25 y/o patient presents with a mass in her right breast. What is the first line imaging to order for this patient?
U/S (pt is under 30)
What is the most common type of breast cancer?
infiltrating ductal carcinoma
What are some protective factors against endometrial cancer?
OCPs, parity, breastfeeding, smoking, weight loss
What are some protective factors against ovarian cancer?
Things that lower ovulation: multiparous, breastfeeding, contraceptives ( at least 5 years), tubal ligation
What are the indications for a screening MRI for a patient with a potential breast cancer?
1) Known BRCA2 mutation
2) First degree relative w/ known BRCA2 mutation
3) Radiation to chest during ages 10-30
4) Known genetic abnormality (Li-Fraumeni, Cowden’s)
5) Lifetime risk >20% by models based on FHx
What is the first diagnostic technique that should be obtained for a pregnant patient with a breast mass?
Order an US, but radiologists may change the order to a diagnostic mammogram based on what they see that day
What is the MC type of benign breast tumor?
Fibroadenoma
How does Intraductal Papilloma present?
With bloody, serous, or turbid discharge from the nipple
What updated patient education is considered regarding the self breast exam?
A monthly self breast exam is no longer recommended by the USPSTF. Instead breast awareness is encouraged to recognize any changes and get them checked out early.
What is the treatment for symptomatic fibrocystic breast?
NSAIDS, heating pad, Supportive bra, OCPs
A 36 yo female was previously treated for Mastitis for 7 days, but continues to have a tender, enlarged, and erythematous right breast. What should you be concerned about?
Inflammatory breast cancer
What is the 1st line treatment for Leiomyoma in a patient NOT desiring pregnancy, but with bulk symptoms?
Uterine artery embolization
GnRH analogs
A patient presents with irregular menses, hirsutism and weight gain. A TVUS is completed. What finding might you expect?
“string of pearls”
what kind of benign ovarian cyst may form as a result of IVF therapy?
Theca lutein cysts
A patient presents to the ER with acute onset of pelvic pain localized to the R side. She endorses abdominal bloating and pain with her LNMP 3 days ago. TVUS is performed and a cyst with a lattice-like internal structure is seen. What benign ovarian cyst is consistent with this presentation?
Hemorrhagic cyst
What is the treatment of choice for mastitis?
Dicloxacillin and continued breastfeeding or pumping
A white milky discharge of the breast is indicative of what?
galactorrhea
True or False: A patient who has received the HPV vaccine, does NOT need to get a pap smear.
False
What is the preferred treatment for a 23 year old female with CIN 2?
Observe with cytology and colposcopy
Which of the following is NOT considered a risk factor for ovarian cancer? A. long term estrogen B. endometriosis C. genetics D. age <50
D. age <50
What is the first step for the workup of ovarian cancer?
UPT, followed by pelvic US or contrasted CT of abdomen and pelvis
