Slides 2 Flashcards
63 år gammel kvinne med 2 cm lesjon på venstre labium major. Har vært der i 3 mnd. neste steg?
Eksisjonsbiopsi
18 år gammel dame med smertefull hevelse i venstre labium som har blitt gradvis verre siste 3 dager. Hun har prøvd OTC smertelindring og Sitz-bad.
Hva er neste steg?
Insisjon og drenasje
21 år gammel dame på college. Har brukt OCP siste 3 årene. Har en 2 mm pigmentert flat lesjon med uregelmessig kant på venstre labium. Hva er neste steg
Eksisjonsbiopsi
36 year old woman with complaints of chronic vaginal infection. She reports little vaginal discharge, but rather a 1 year history of progressively worsening vulvar discomfort that has escalated to pain sufficient to preclude intercourse and tampon use.
Inspection of the vulva demonstrates focal inflammation, punctation and ulceration of the perineal and vaginal epithelium. An attempt to perform a bimanual exam of pelvic organs reveals intense pain and tenderness at the posterior introitus and vestibule
What is the best next step?
Topical anesthetics and antidepressants treatment
What is the immediate precursor lesion for vulvar cancer
Unknown
56 year old woman has Bx-proven VIN III. She undergoes wide excision and returns 3 months later with vulvar pruritus
What should you advise the patient
She may need a repeat biopsy
A 65 year old woman presents with complaints of vulvar redness, pruritus and occational weeping from the skin
Examination reveals erythematous, eczematous lesions on labia minora and the periclitoral area
This is consistent with Pagets disease of the vulva. What characterizes Pagets disease of vulva?
Frequently associated with invasive carcinomas
Most common type of vulvar cancer
Squamous cell carcinoma
What is the most common Sx of vulvar carcinoma in elderly women?
Pruritus
A 1 cm vulvar carcinoma with tumor-positive unilateral lymph nodes would be stage….
Stage 3
A 58 year old woman with 1 cm vulvar ulcer. A biopsy shows invasive SCC with more than 1 mm of stromal invasion
What is the preferred treatment
Radical local excision and ipsilateral inguinofemoral lymph node dissection
A 58 year old woman with 1 cm vulvar ulcer. A biopsy shows invasive SCC with more than 1 mm of stromal invasion
If the lymph nodes are negative, what is the 5 year survival?
90%
A 58 year old woman with 1 cm vulvar ulcer. A biopsy shows invasive SCC with more than 1 mm of stromal invasion
The patient undergoes radical vulvectomy. Which of the following is the most common complication of radical vulvectomy?
Breakdown of the surgical wound
A 72-year old woman has had a radical vulvectomy for stage II vaginal SCC. She wants to know the most likely site of recurrence if the tumor comes back. Where would the tumor likely appear?
At the site of tumor resection
Which of the following tumors of the vulva has the best prognosis
Stage 1 verrucous carcinoma
Melanoma
Stage 1 SCC
Basal cell carcinoma
Rhabdomyosarcoma
Basal cell carcinoma
A 56 year old woman presents with painless mild vaginal spotting. She had a hysterectomy at age 40 for persistent cervical dyspalsia. She is otherwise healthy and takes no medications
On further review of symptoms she has occasional urgency and dysuria. On pelvic examination, a 0.5 cm lesion is felt and visualized in the anterior vagina. What is the best next stsep=
Perform directed punch biopsy of the lesion
A 30 year old woman presents for antenatal examination. On examination, she reports that her mother used DES during her pregnancy.
What is she most at risk for?
Clear cell adenocarcinoma of vagina
What is a malignant tumor of the vagina of young children that appears clinically as a mass of grape-like edematous polyps?
Sarcoma botryoides
A 72 year old woman complains of vaginal bleeding. On exam, a 2 cm vaginal lesion is found in the upper 1/3 of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall.
On biopsy, vaginal carcinoma is confirmed
What stage cancer does this patient most likely have?
Stage 3
A 72 year old woman complains of vaginal bleeding. On exam, a 2 cm vaginal lesion is found in the upper 1/3 of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall.
On biopsy, vaginal carcinoma is confirmed
Which of the following is the most likely histology of the vaginal carcinoma?
Squamous cell carcinoma
A 72 year old woman complains of vaginal bleeding. On exam, a 2 cm vaginal lesion is found in the upper 1/3 of the anterior vagina. On bimanual and rectovaginal examination, the mass extends to the lateral pelvic wall.
On biopsy, vaginal carcinoma is confirmed
What is the best treatment
Combined chemo and radiotherapy
11 year old giril with sudden onset abdominal pain and inability to void
Vague cyclic abdominal pain. After catheter placement, urin is drained, but abdomen is still distended
1) Diagnosis
2) Treatment
3) After treatment?
Diagnosis: hymen imperforata
Treatment: excision of central part of hymen
After treatment: regular gynecology check up due to higher risk of endometriosis
18 year old white hispanic woman with a FHx of cervical cancer seeks medical advice conserning primary profylaxis against cervical cancer. What is your advice?
Vaccination against HPV
A 35 year old white non-Hispanic nullipara with HSIL. Physical exam reveals normal vulva and vagina. Cervi slightly enlarged. Body of uterus normal size and shape, easily moveable and painless. Both adnexa without any pathology
What is the next step in diagnosis?
Colposcopy with cervical biopsy
A nulliparous 32-year old black patient with a histroy of infertiliy was diagnosed with CIS. What treatment is most appropriate?
Conisation
A 49 year old white non-hispanic multipara was referred to OBGYN due to abnormal vaginal bleeding that occured 6 months after her last period
Physical exam: normal vulva and vagina. The cervix of normal size and shape. Body of uterus enlarged with irregular shape but easily moveable and painless. Both adnexa without any pathology.
Per rectum examination showed no abnormality. Which is the appropriate next stage?
Dilatation and curettage
Hvor mye RhoGAM for 30 mL føtalt blod?
300 mikrogram for 30 mL føtalt blod
Gi 10 mikrogram RhoGAM for hver mL føtalt blod over 30 mL
Leiomyoma - risk factors
African american
FHx
Early menarche
TSH-verdi som signifikerer hypotyreose
TSH > 2.5
Behandling av GBS
Ampicillin
Makrosomi - definisjon
- DM
- Ikke-DM
DM: 4250
Ikke-DM: 4500
Metimazol: bivirkninger i fosteret
Aplasia cutis
Agranulocytose
Hvor produseres AFP
i leveren
Iodine supplement
- Preconception
- In pregnancy
Preconception: 150 microgram
In pregnancy: 250 mikrogram
GBS-screen: hvrodan gjør du det
Prøve fra vagina og rektum
28 year old woman with 6 cm left ovarian tumor. Normal menses. Infectious discharge in vagina. What tests?
TV-USG, Ca-125, B-hCG and CRP
(Ultrasound picture shows simple cyst)
Tx = cystectomy (cysts > 6 cm gives risk of torsion)
35 year old woman with ASC-H on routine Pap. Next step?
Colposkopy and biopsy
If Bx shows CIN 2 or 3: do LEEP
OCP and Pap smear (in poland)
Do Pap before starting OCP
Do Pap every year (because she is on OCP)
