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OB GYN > Test 3 Deck 3 > Flashcards

Test 3 Deck 3 Flashcards

1
Q

What are the first and second MC vulvar cancers?

A

Squamous cell MC (vestibule) then

Malignant melanoma (poor prognosis)

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2
Q

Vulvar cancer in a person less than <55 is MC linked to what?

A

HPV

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3
Q

Vulvar cancer in a woman 55+ is most like a NONSMOKER, and it linked to ___ ___.

A

Lichen sclerosis

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4
Q

What two things make you much more likely to develop vulvar cancer?

A

Smoker + genital warts

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5
Q

What is the presentation of early vulvar cancer?

A

Pruritis and visible lesion (pain bleeding, ulceration, inguinal mass)

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6
Q

What is the evuaaltion procedure for vulvar cancer?

A

Vulvoscopy (4mm punch, acetowhite)

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7
Q

Treatment for vulvar cancer?

A

Wide local excision (1A) good prognosis,

Radical vulvar resection (w/ inguinal lymphadenectomy + chemo)

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8
Q

What is the follow up for vulvar cancer?

A

Q3 months 2 years, q6 months 5 years, annually

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9
Q

What indicates very poor prognosis for vulvar cancer?

A

Recurrence

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10
Q

Vaginal cancer is most commonly from where?

A

Somewhere else

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11
Q

Very old 80+ year old woman presents w/ vaginal bleeding (MC), and dysuria, hematuria, urgency/ constipation. Dx__

A

Vaginal cancer, anterior wall for the urine stuff and posterior for the constipation

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12
Q

What is the treatment for vaginal cancer?

A

Surgery, radiation, chemo

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13
Q

Endometrial hyperplasia is a result of?

A

Anovulation

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14
Q

What is the gold standard diagnosis for a woman w/ suspected endometrial hyperplasia?

A

Endometrial biopsy, but can use TVUS in a post menopausal woman

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15
Q

POST menopausal woman w/ complaint of bleeding presents. You perform a transvaginal U/S and see thickened endometrium >4mm. What do you do?

A

Endometrial biopsy, looking for endometrial atypia

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16
Q

What is the treatment for atypical endometrial hyperplasia in a post-menopausal woman?

A

Hysterectomy and BSO

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17
Q

What is the treatment for atypical endometrial hyperplasia in a pre menopausal woman that wants to still give birth?

A

Progestins

18
Q

What is the treatment for a pre menopausal woman w/ hyperplasia and no atypia?

A

Progestins, or COC. F/U bx after treatment, if resolves continue treatment until menopause. If fails to resolve then refer for minimally invasive surgery

19
Q

What is the MC GYN in cancer in the US?

A

Endometrial cancer

20
Q

What is the treatment for endometrial cancer if you are not concerned w/ fertility?

A

Hysterectomy w/ BSO and lymph node staging. If advanced then chemo

21
Q

What are the two MC risk factors for endometrial cancer?

A

Obesity and unopposed estrogen

22
Q

What is the MC presenting symptom for endometrial cancer?

A

Irregular vaginal bleeding. In premenopausal woman it heavy or intermenstrual, post menopausal (any bleeding)

23
Q

Women w/ lynch syndrome are at an increase risk for ___. They receive an EMB every 1-2 years starting age __-__. MC endometrial cancer is the __ cancer. What do you offer to these patients in their mid 40’s?

A

Cancer (colon, endometrium, small bowel, renal pelvis, ovary), 30, 35, sentinel, prophylactic hysterectomy

24
Q

What are additional labs/ studies to perform for endometrial cancer?

A

CXR/ CT for metastasis, CA125 (to response)

25
Q

Treatment for endometrial cancer if you are attempting to retain fertility?

A

Evaluate to see if possible w/hysteroscopy and D&C. Then provide hormonal treatment w/ progestin and tamoxifen (unregulated progesterone)

26
Q

Woman that gets cancer following/ with pregnancy?

A

Gestational trophoblastic neoplasia

27
Q

Gestational trophoblastic neoplasia produces what?

A

B-hCG so follow the levels.

28
Q

What is the treatment for gestational choriocarcinoma?

A

Very responsive to chemo/ invasive mole

29
Q

What are some risk factors for ovarian cancer?

A

Fam hx breast/ovarian (BRCA),
Nulliparity (more periods cause of the Fallopian tubes)

Personal hx or breast cancer

Postmenopausal hormone therapy (estrogen)

30
Q

What is the most deadly GYN cancer?

A

Ovarian cancer (epithelial MC)

31
Q

What are some protective factors for ovarian cancer?

A

Breast feeding
Long term oral contraceptives
Tubal ligation/hysterectomy
Diet (high fiber)

32
Q

Large masses on pelvic exam tend to be __

A

Benign

33
Q

What are some common lab and exam findings in ovarian cancer?

A

Ascites, pleural effusion on pulm. Exam

Labs:
CBC- thrombocytosis 
Hyponatremia
CA-125
Human epididymal protein 4 tumor marker
34
Q

What is the most useful initial test for ovarian cancer and what may you see?

A 
TVUS
Multiloculated, solid, echogenic
Large->5cm
Thick septa w/ nodules
Papillar projections/neovasularization
35
Q

Treatment for ovarian cancer?

A

Hysterectomy w/ BSO, lymph node Eval, very rarely would you consider performing fertility sparing because so deadly

36
Q

Size and treatement for premenopausal simple ovarian cysts?

A

<=3 normal
<=5 nada
>5/ <=7 TVS repeat 6-12 wks the yearly TVS if persistent

> 7 MRI/ surgery

37
Q

Pot menopausal treatment of simple cyst w/ benign qualities

A

<=1 normal
<=5 CA125, if normal TVS 6-12 weeks, then years TVS if persistent
>7 MRI surgery

38
Q

Treatment for cysts we/ indeterminate, but probably benign qualities pre/post menopausal?

A

Premenopausal: TVS reprinted in 6-12 weeks, if persistent MRI/surgery

Post menopausal: surgery

39
Q

Treatment for cysts w/ qualities suggesting malignancy?

A

Surgical (thick (>3mm) irregular septations)(nodule w/ blood flow)

40
Q

Hemorrhagic ovarian cyst pre/post menopausal treatment?

A

Premenopausal
<=3 norm
<=5 nada
5-7 TVS repeated 6-12 weeks then MRI/surgery

Early post menopause: CA125 (if normal) then TVS 6-12 weeks, if persistent MRI/ surgery

Late menopause: surgery

OB GYN (9 decks)

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