test 3 deck 1 Flashcards
pt. presents w/ no pain and enlarged tumor in vuvla-vaginal region. She is >40. treatment ___
bx.
what is the evaluation for ovarian cysts w/ indeterminate, but probaly benign qualities (hemorrhagic cyst, mature cystic teratoma, endometrioma) pre/post menopausal?
premenopausal: TVS repeated 6-12 weeks if persistent then consider surgical evaluation
post menopausal surgical evalation
when is a cyst considered functional?
>3cm w/ symptoms of pelvic pain, dullness and heaviness
what is the difference between the benign stromal neoplasms granulosa-theca, sertoli-leydig, and ovarian fibroma?
granulosa theca: estrogen
steroli-ledic: testosterone
ovarian: no hormones
most benignand malignant breast disease arise in the?
terminal duct-aciner structures (lobules)
mastitis/ abscess that’s nonpuerperal requires what?
biopsy to exclude inflammatory breast cancer
peripheral abscess I&D (dont get better) and abx
subareolar abscess: duct excision/ sinus tract removal
estrogen dependent, benign smooth muscle tumor, distinct autonomy from their surrounding. typcially ayspmptomatic, may have mass effect or cause infertility. on bimanual you note an increased size of the uterus. dx__ next step__
leioymoma, U/S
what is the evaluation for a simple benign cyst postmenopausal that >7 cm?
mri/surgery evaluation
what are the indications for surgery of leiomyomas?
- rapid enlargement
- severe pelvic pain
- abnomral uterine bleeding w/ anemia
- UTI
- inability to evaluate adnexa
- growth of fibroid after menopause
- infertility
smooth, clear, white/yellow rounded elevations on the cervix. dx__ trx__
nabothian cysts
no treatment for asymptomatic
what is the MC breast mass ID’s in adolescent female
fibroadenoma
pt. presents w/ contraction of scar tissue or adhesions w/ in the endocervical canal. They have a hx of treatments for CIN (LEEP/CKC), and are hypoestrogenic. They hav complaints of dysmenorrhea, amenorrhea, and infertility. DX__ trx__
cervical stenosis
cervical dialator, vaginal estrogen if hypostrogenic
what to do w/ spontaneous discharge?
evaluate
what is the preferred imagin for leiomyoma?
u/s
pt presents post menopause/post oophorectomy. they are complaining of pain during sex, urinary symptoms, clear, yellow, blood tinged discharge. You perform a PAP and the their are changes (parabasal epithelial cells). On speculum you see a fiable vaginal epithelium, loss of rugae, and pale mucose. dx__ trx__
atrophic vaginitis,
topical estrogen (give progesterone if pt. has uterus)
what stage does normal breat proliferation occur?
luteal phase of menstrual cycle (estrogen and progesterone increase)
post menopausal woman presents w/ inflammation in the dermis of vulva. she has pruruitis, vulvar thickening, that has progressed to burning and dyspareunia. her vaginal skin looks like cellphane paper/tissue paper/ crinkled cigarette paper on gentle streching of skin. wk up__ trx__ concern__
biopsy, examine q12 mos,
treatment: symptomatic, topical corticosteroid, phototherapy if initiated w/ 1st 2 years reduces scarring
squamous cell carcinoma
ovarian torsion is a __
emergency associated w/ ovarian mass typically >6cm, more commonly Right adenexa
nests of endometrial glands and stoma embedded w/in the muscular uterine wall (actually in wall opposed to leiomyomas). Pt. presens w/ heavy abnormal uterine bleeding or dysmenorrhea in parous women between ages of 40-50. dx__ trx__
adenomyosis
hysterectomy (classicly), maybe GnRH agonists (danazol) or progestins
pt. has bilateral breast pain, with multiple bilateral cysts that feels nodular. Increased tenderness especially premenstrual. you know this is aused by dialted ducts and acini invested w/ dense collagenous stroma. DX__ TRX__ PROG__
fibrocystic breast disease, premenstrual, decrease chocolate intake +/- caffeine, support bra
ovarian cysts that suggest malignancy (irregular septations, nodule blood flow)?
surgical evlation
are palpable nodular breast tissue a breast cancer risk by itself?
not a breast cancer risk by itself
green galactorrhea is related to ___ ___
cholesterol dieposides
pt. presents w/ non-neoplastic morphologic alteration of the vulvar skin related to chronic irriation. results from intense itch/scratch cycle that even wakes her from sleep. the patient started w/ excoriations and erythema that progressed to a greyish/leathery appearnace that extends past the labia major(MC). dx__ treat__
lichen simplex chronicus
eliminate triggers (clothing, heat, chemicals in laundry/hygiene products, food sensitivty), lubricate (petroleum jelly, vegetable oil), antihistamines, gloves at night
pt. presents w/ severe pain, difficulty walking, sitting or having intercourse. she has a tumor in vulva region. she is under 40. dx__ trx__
bartholin’s abscess,
I&D w/ packing or word catheter
abx: if recurrent or high risk for complicated infection (pregnant, cellulitis, systemic infection, immunosuppressed)
culture for MRSA
Augmentin/Clindamycin, screen for chlamydia/gonorhea
what is the MC symptom for endometrial polyps and what are the imaging studies?
metrorrhagia
TVUS intially then sonohysterography
what cervix size is needed for sufficient flow?
5mm if <2mm there may be retrograde flow and you have to worried about retrograde flow
pt. presents w/ progressive sharp lower abdominal pain, low grade fever, N/V. you suspect ovarian torsion. what is the treatment?
salvage, resect tumor, possible oophorectomy
for vulvar disease your patients will commonly present w/ ___. your working diagnosis is __, alway ___ suspicious lesion, and teach your patients to ___.
itching, cancer, biopsy, look
treatment for fibroadenoma?
benign
what is the evaluation for a simple ovarian cyst with bengin qualites pre menopausal that >5 cm, but <=7 cm?
TVS repeated in 6-12 to document resolution then yearly TVS
autoimmune disorder of t-cells. pt presents after drug use w/ NSAIDS, B-blockers, methyldopa, penicillamine, quinine. They have intense vaginal itching, burning pain, dyspaerunia and postcoital bleeding. They have purple, pruruitic, polygonal, papules and plaques. They are erosive, papulosquamous and hypertrophic. They are located on both the vagina and gingiva. DX__ trx__
lichen planus
topical steroids-> clobetasol, vaginal hydrocortisone
imaging study for adenomyosis?
TVUS, then MRI for differentiation
what is the treatment for leimyomas?
observe, COCPs to reduce bleeding, GnRH agonist for pre-op surgery
what is the MC pelvic tumor in women?
leiomyomas “fiborids”
what is the evaluation for simple cyst w/ benign qualities <=5 cm but >1cm postmenopausal?
CA125, if normal then TVS repeated in 6-12 weeks. Then yearly TVS
what is the evlation for a simple ovarian cyst w/ bengin qualities >7 cm premenopausal?
mri/surgical evaluation
treatment for intertrigo? Most often found in genitocurual folds, also in inguinal and intergluteal regions
treatment: drying agents, inflammation (topical steroid), infection (nystatin), weight loss, light weight clothing
hyperlastic overgrowth of endometrial lining on a stalk?
endometrial polyps
pt. presents w/ rash following vaginal trauma. its adherent silver scale, but in skin folds are more red w/ fine scale. DX__ TRX___
inverse psoriasis
emollients, steroids, dovenex after control
what is the treatment for cervical polyp?
benign, but still need to go to pathology
small, pedunculated, remove w/ forceps
sessile, remove w/ forceps and cauterize
what is the surgical treatment for ovarian cysts?
cystectomy, unilateral salpingo-oophorectomy, TAH/BSO for malignancy
what is the MC ovarian neoplasma?
benign cystic teratoma (dermoid cyst), presents risk of torsion
breast pain that follows cycle is what?
mastalgia, normal, if noncyclic investigate for cancer
