Untitled Deck Flashcards
What is a nevus?
A mole or cluster of melanocytes from the embryonic neural crest, common in the vulva.
How do benign nevi appear on examination?
Flat, elevated, or pedunculated with sharp borders, even color, and symmetric shape.
What is the most common malignancy transformation of a nevus in the vulva?
Melanoma.
What is the ABCD rule for melanoma?
Asymmetry, Border irregularity, Color variation, Diameter >6mm.
What is the treatment for a dysplastic nevus in the vulva?
Excision with a 0.5–1 cm margin.
What is the most common solid tumor of the vulva?
Fibroma.
How does a vulvar fibroma typically present?
A slow-growing, solid mass, usually 1–10 cm, most commonly in the labia majora.
What is the management of a vulvar hematoma <10 cm?
Conservative treatment with compression and ice packs.
What is the treatment for vulvar hematomas >10 cm or expanding?
Surgical evacuation and identification of the bleeding vessel.
What are common causes of vulvar pruritus?
STI, vulvar dystrophy, lichen sclerosis, contact dermatitis, and diabetes.
What is the most common cause of vaginal trauma?
Coitus.
What is the management of a vaginal laceration due to coital trauma?
Suturing under anesthesia and checking for injury to the urinary or GI tract.
What are common predisposing factors for vaginal trauma?
Virginity, postpartum state, menopause, and intercourse after prolonged absence.
What is the most common site for vaginal lacerations?
The transverse tear of the posterior fornix.
How is vaginismus defined?
Painful coitus due to involuntary vaginal muscle contractions.
What is the management for straddle injuries in children?
Conservative treatment and ruling out abuse.
How is vaginal stenosis typically diagnosed?
Inability to pass a 1–2 mm dilator and ultrasound findings.
What are the symptoms of congenital imperforate hymen?
Primary amenorrhea, cyclic abdominal pain, and hematometra.
What diagnostic tool is preferred for hematometra?
Ultrasound.
What is the treatment for hematometra caused by imperforate hymen?
Surgical incision and drainage.
What is a cervical myoma?
A leiomyoma arising from the cervix, causing symptoms like dysuria and dyspareunia.
What is the main risk factor for cervical stenosis?
Previous surgeries like LEEP or cryotherapy.
How does cervical stenosis present in premenopausal women?
Dysmenorrhea, pelvic pain, and infertility.
What is the treatment for cervical stenosis?
Dilation under ultrasound guidance.
What is the most common cause of cervical lacerations?
Obstetric deliveries or mechanical dilation during procedures.
What is an endometrial polyp?
A localized overgrowth of endometrial glands and stroma.
What is the typical age group for endometrial polyps?
Women aged 40–49 years.
What medication increases the risk of endometrial polyps?
Tamoxifen.
What is the gold standard for diagnosing endometrial polyps?
Hysteroscopy.
What is the most common symptom of endometrial polyps?
Abnormal uterine bleeding.
What is the most common pelvic tumor in women?
Leiomyoma.
What hormone primarily drives the growth of leiomyomas?
Estrogen.
What is the most common type of leiomyoma?
Intramural leiomyoma.
What type of leiomyoma is most symptomatic?
Submucosal leiomyoma.
What is the FIGO classification for a submucosal leiomyoma protruding into the uterine cavity?
Type 0.
What is adenomyosis?
Ectopic endometrial glands and stroma within the myometrium.
What is the definitive treatment for adenomyosis?
Hysterectomy.
How does adenomyosis typically present?
Dysmenorrhea, menorrhagia, and a diffusely enlarged uterus.
What is the most common benign tumor of the fallopian tube?
Adenomatoid tumor.
What is the management of paratubal cysts?
Observation or excision if symptomatic.
What is the most common benign ovarian cyst?
Follicular cyst.
What is Meigs syndrome?
A triad of ovarian fibroma, ascites, and pleural effusion.
What are the features of benign nevi in the vulva?
Sharp borders, even color, symmetric shape, and asymptomatic.
What type of trauma commonly causes vulvar hematomas in children?
Straddle injuries.
What is the first-line management for pruritus of vulvar origin?
Establish diagnosis, treat the underlying cause, and improve hygiene.
How does lichen simplex chronicus develop?
Chronic untreated dermatitis leads to a leathery appearance of the skin.
What is the primary risk factor for melanoma of the vulva?
Family history of cancer.
What is the most common site of vaginal tears during trauma?
The posterior fornix.
What are the symptoms of a postcoital vaginal tear?
Profuse bleeding and sharp pelvic pain.
How is sexual assault-related vaginal trauma managed?
Suturing under anesthesia, ruling out injuries to urinary and GI tracts.
Why is vaginal trauma common in postmenopausal women?
Vaginal atrophy due to estrogen deficiency.
What diagnostic tests should be performed for suspected vaginal abuse in children?
A thorough examination and documentation, with imaging if necessary.
What is a vascular leiomyoma of the cervix?
A leiomyoma with thick-walled blood vessels causing potential bleeding.
How does cervical stenosis lead to hematometra?
Obstruction of the cervical canal prevents normal menstrual blood flow.
What is a congenital cause of cervical stenosis?
Müllerian duct anomalies.
What imaging modality is preferred for diagnosing cervical stenosis?
Ultrasound.
What is the primary symptom of postmenopausal cervical stenosis?
Hematometra or hydrometra.
What are the histological components of an endometrial polyp?
Endometrial glands, endometrial stroma, and central vascular channels.
What is the treatment of choice for symptomatic endometrial polyps?
Hysteroscopy with dilation and curettage.
What are the differential diagnoses for endometrial polyps?
Submucosal leiomyomas, retained products of conception, and carcinoma.
How does tamoxifen contribute to endometrial polyps?
It stimulates endometrial hyperplasia due to its estrogenic effects on the uterus.
What is the incidence of malignancy in endometrial polyps?
3–5%.
What is the pseudocapsule in a leiomyoma?
Compressed myometrium surrounding the leiomyoma, useful in surgery.
What is the relationship between leiomyomas and pregnancy?
They may enlarge due to increased estrogen and progesterone.
What is the most common complication of submucosal leiomyomas?
Abnormal uterine bleeding and infertility.
What is the risk of malignant transformation in leiomyomas?
0.3–0.7%.
What is the FIGO classification system used for in leiomyomas?
Categorizing leiomyomas based on their location and relationship with the endometrium.
What layer of the uterus is disrupted in adenomyosis?
The barrier between the endometrium and myometrium.
How does adenomyosis differ from leiomyoma in imaging?
Adenomyosis appears as a diffusely enlarged uterus with no clear demarcation.
What age group is most symptomatic for adenomyosis?
35–50 years old.
What is the standard criterion for diagnosing adenomyosis histologically?
Endometrial glands >2.5 mm from the basalis layer.
Why is hysterectomy the definitive treatment for adenomyosis?
It completely removes the affected uterus.
What are hydatid cysts of Morgagni?
Pedunculated paratubal cysts near the fimbrial end of the fallopian tube.
How does fallopian tube torsion present clinically?
Acute abdominal pain, often during pregnancy or with an ovarian mass.
What is the relationship between salpingectomy and ovarian cancer prevention?
Removal of the fallopian tubes reduces the risk of high-grade serous carcinoma.
Why is it important to preserve ovaries during salpingectomy?
Ovaries produce estrogen, which is vital for overall health up to age 64.
What is Halban’s triad in corpus luteum cysts?
Delay in menses, unilateral pelvic pain, and a small adnexal mass.
How is a ruptured corpus luteum cyst managed?
Observation unless there is significant intraperitoneal bleeding.
What is the most common complication of ovarian dermoid cysts?
Torsion.
What is Meigs syndrome?
Ovarian fibroma associated with ascites and pleural effusion.
How is an endometrioma diagnosed?
Ultrasound showing a thick-walled cyst with homogenous echolucency.
What is the first-line imaging modality for benign gynecologic lesions?
Ultrasound.
What is the hallmark finding of lichenification in chronic vulvar pruritus?
Thickened skin with exaggerated markings.
Why are minimally invasive surgeries preferred for leiomyomas?
They reduce recovery time and preserve fertility.
What is the hallmark symptom of adenomyosis?
Secondary dysmenorrhea.
What is the treatment for paratubal cysts causing torsion?
Excision of the cyst.
A 55-year-old woman presents with a pigmented lesion on her vulva that has grown irregular in shape over the past year. What is the likely diagnosis, and what is the next step?
Melanoma. The next step is excision with a 0.5–1 cm margin and biopsy.
A 35-year-old woman reports a slow-growing, painless mass on her labia majora that started as a small pimple two years ago. What is the most appropriate management?
Excision of the fibroma.
A 25-year-old cyclist presents with severe pain and swelling in her vulva after a fall. What is the best course of action?
Conservative management with ice packs and compression.
A postmenopausal woman complains of intense vulvar itching that has persisted for months. What is the most likely diagnosis, and how should it be treated?
Lichen simplex chronicus. Treat with topical steroids and address any underlying causes.
A 28-year-old woman presents with vaginal bleeding and pain after intercourse. What is the next step in management?
Suturing under anesthesia and evaluation for urinary or GI injury.
A newlywed reports painful intercourse due to involuntary vaginal muscle contractions. What is the diagnosis, and what initial steps should be taken?
Vaginismus. Initial steps include pelvic floor therapy and counseling.
A 30-year-old woman presents with profuse vaginal bleeding following a mechanical dilation procedure for D&C. How should this be managed?
Inspect and repair the laceration under visualization.
A 45-year-old woman with a history of loop electrosurgical excision presents with secondary amenorrhea and cyclic pelvic pain. What is the likely diagnosis and management?
Cervical stenosis. Management involves cervical dilation under ultrasound guidance.
A 42-year-old woman reports intermenstrual spotting and postcoital bleeding. What is the most appropriate diagnostic and therapeutic procedure?
Hysteroscopy with dilation and curettage.
A 14-year-old girl presents with cyclic pelvic pain but no menses. What is the likely diagnosis and treatment?
Hematometra due to an imperforate hymen. Treatment involves surgical incision and drainage.
A 35-year-old woman presents with heavy menstrual bleeding and pelvic pain. What is the best management approach?
Myomectomy if the patient desires future fertility; otherwise, consider medical management or hysterectomy.
A 32-year-old woman with a history of infertility is diagnosed with a submucosal leiomyoma distorting the endometrial cavity. What is the best management option?
Hysteroscopic resection of the submucosal leiomyoma.
A 38-year-old woman complains of progressively worsening dysmenorrhea and heavy menstrual bleeding. What is the likely diagnosis and definitive treatment?
Adenomyosis. The definitive treatment is hysterectomy.
A 45-year-old woman undergoing evaluation for infertility is incidentally found to have a 5 cm paratubal cyst near the fimbrial end. What is the most appropriate management?
Surgical excision if symptomatic or large; otherwise, observation.
A 30-year-old pregnant woman presents with acute pelvic pain.
Further evaluation is needed to determine the cause.
What is the likely diagnosis for a diffusely enlarged, tender uterus with thickened myometrium?
Adenomyosis. The definitive treatment is hysterectomy.
What is the most appropriate management for a 5 cm paratubal cyst found incidentally in a 45-year-old woman?
Surgical excision if symptomatic or large; otherwise, observation.
What is the best treatment for an 8 cm ovarian mass and a twisted fallopian tube in a pregnant woman?
Laparoscopic untwisting and cystectomy.
What is the most appropriate next step for a 4 cm simple ovarian cyst found in a 25-year-old asymptomatic woman?
Observation with repeat ultrasound in 6 weeks.
What is the likely diagnosis for sudden-onset unilateral pelvic pain with free fluid and a complex adnexal mass?
Ruptured corpus luteum cyst. Manage conservatively unless hemodynamically unstable.
What is the likely diagnosis for a 7 cm unilocular cyst with calcifications found incidentally in a 35-year-old woman?
Dermoid cyst (mature teratoma). Treatment is cystectomy.
What is the likely diagnosis and management for a 6 cm homogenous cyst with ‘ground-glass’ echogenicity in a woman with infertility?
Endometrioma. Management includes medical therapy or surgical excision if symptomatic.
What is the diagnosis and management for a woman with acute pelvic pain and reduced blood flow to the right ovary?
Ovarian torsion. Immediate laparoscopic detorsion is needed.
