Tx: Uterine, Vulvar, Vaginal, and Cervical Conditions

Question 1

Leiomyoma (fibroids) - Pharm

Answer 1

Asx:

1. Reassurance
2. Observation

Sx:

1. OCPs
2. GnRH agonists (Leuprolide)
3. Antiprogesterins
4. Progesterone receptor modulators

Question 2

Leiomyoma (fibroids) - surgical

Answer 2

1. Myomectomy
2. Hysterectomy
3. Uterine artery embolectomy

Question 3

Endometrial polyps

Answer 3

1. Polypectomy
   
   • all postmenopausal women and premenopausal women if >1.5 cm, multiple, prolapsed, infertility, or risk of endometrial hyperplasia/CA

Recurrence:

1. Removal (hysterectomy)
2. IUD
3. Endometrial ablation

Question 4

Endometriosis

Answer 4

No permanent cure. Recurrence common.

1. NSAIDs
2. Progestins (OCPs, IUD, medroxyprogesterone acetate)
3. Surgery/ablation
4. TAH-BSO (total abdominal hysterectomy and bilateral salpingo-oophorectomy

Question 5

Pelvic Organ Prolapse

Answer 5

1. Psychosocial Treatment
2. PT referral
3. Urogynecology referral
4. Psychologist/therapist

Question 6

Uterine prolapse

Answer 6

Asx: watchful waiting

Sx:

1. Pessaries
2. Pelvic floor muscle exercises (PT, Kegels)
3. Surgical repair

Question 7

Vaginal Vault Prolapse

Answer 7

Asx: watchful waiting

Sx:

1. Pessaries
2. Pelvic floor muscle exercises (PT, Kegels)
3. Surgical repair

Question 8

Cystocele

Answer 8

Asx: watchful waiting

Sx:

1. Pessaries
2. Pelvic floor muscle exercises (PT, Kegels)
3. Surgical repair

Question 9

Rectocele

Answer 9

Asx: watchful waiting

Sx:

1. Pessaries
2. Pelvic floor muscle exercises (PT, Kegels)
3. Surgical repair

Question 10

Endometrial carcinoma

Answer 10

1. Onc referral. Pap q6m x 2 years & monitor CA 125
2. TAH-BSO +/- LN sampling
3. Radiation, chemo progesterone therapy when surgery is not an option, or as adjuvant

Question 11

Endometrial carcinoma emergency management

Answer 11

1. Volume repletion
2. blood transfusion
3. tamponade of uterus/vaginal packing
4. D&C
5. High dose radiation

Question 12

Endometrial hyperplasia

• without atypia, with atypia

Answer 12

• Without Atypia: Progestin
• Atypia: Hysterectomy
  
  • can use progestin if need to preserve fertility or cannot do surgery

Question 13

Vulvar dystrophy

Answer 13

1. Hypertrophic dystrophy/squamous hyperplasia:
   
   • Fluorinated corticosteroid cream
2. Atrophic dystrophy/Lichen sclerosis:
   
   • Clobetasol cream

Question 14

Vulvar malignancy

Answer 14

1. Radical vulvectomy
2. Modified radical vulvectomy
3. Lymphadenectomy
4. Squamous dysplasia: surgical excision
5. CIS: laser vaporization

Question 15

Ovarian Cancer - big 4 symptoms!

Answer 15

1. Bloating
2. Pelvic or abdominal pain
3. Difficulty eating or feeling full quickly
4. Urinary symptoms (urgency, frequency)

Question 16

Ovarian cancer

Answer 16

• Early-stage: surgery + adjuvant chemo
• Late-stage: Surgery + adjuvant chemo +/- IP chemo
• Surgery: laparotomy
  
  • cytoreduction (debulking)
  • +/- appendectomy
  • Resect visible disease
  • Omentectomy
  • peritoneal cytology
  • retroperitoneal lymphadenectomy
  • total extra fascial hysterectomy

Question 17

Cervical cancer

Answer 17

• Early-stage: surgical removal +/- chemo
• Prevention: Gardasil 9 (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58)