Uterine Disease

Question 1

Most common site of endometriosis

Answer 1

ovaries, typically bilateral

Question 2

Clinical definition of endometriosis

Answer 2

presence of endometrial glands and stroma in ANY extrauterine structure

Question 3

Dx of endometriosis confirmed by ________.

Answer 3

tissue biopsy

Question 4

Why is endometriosis seen mostly in pre-menopausal women?

Answer 4

endometrial implants and cysts respond to hormonal fluctuations of menstrual cycle

Question 5

What are “chocolate cysts”

Answer 5

endometrial cysts filled with dark red or brown hemosiderinladen fluid

Question 6

Classic sx’s of endometriosis

Answer 6

progressive dysmenorrhea and deep dyspareunia

unknown cause of infertility

Question 7

Classic sign of endometriosis on pelvic exam

Answer 7

uterosacral nodularity
BUT OFTEN NORMAL

ovarian endometriomas may be tender to palpate and freely mobile in pelvis or adhered

Question 8

How does Danazol treat endometriosis?

Answer 8

suppresses LH and FSH surge, which induces amenorrhea and endometrial atrophy

puts in menopausal state

Question 9

Treatment of Endometriosis

Answer 9

Oral contraceptives
Danazol
GnHR agonists (less ADR than Danazol)

May surgically remove

Question 10

Side effects of Danazol

Answer 10

acne, spotting, hot flush, oily skin, facial hair, decreased libido, atrophic vaginitis and deepening voice

Question 11

Extrauterine causes of secondary dysmenorrhea

Answer 11

Endometriosis
Tumors (benign and malignant)
PID or inflammation
Adhesions
Psychogenic
Nongynecologic

Question 12

Intrauterine causes of secondary dysmenorrhea

Answer 12

Leiomyomata (fibroid)
Polyps
IUDs
Infection
Cervical stenosis
Cervical lesions

Question 13

Intramural causes of secondary dysmenorrhea

Answer 13

adenomyosis

leiomyomata

Question 14

Treatment of primary and secondary dysmenorrhea

Answer 14

Primary-NSAIDs (PG inhibitors), heat, exercise, psychotherapy and reassurance; OCs if NSAIDs not helpful

Secondary-treat underlying condition or sx therapy

Question 15

What is criteria for chronic pelvic pain?

Answer 15

NONCYCLE pain for > 6 mon that localizes to pelvis, anterior abd wall at or below umbilicus, lumbosacral back or buttocks

causes decreased quality of life

Question 16

Pathophysiology behind primary dysmenorrhea

Answer 16

prostaglandin production

Question 17

What is Carnett sign and what pain does it differentiate?

Answer 17

tensing of abd wall while raising legs or chin to chest in supine position

increased pain if myofascial pain, and decreased or unchanged pain if visceral

Question 18

Positive Carnett sign in what uterine disease?

Answer 18

Chronic pelvic pain

Question 19

Localized proliferation of smooth muscle cells surrounded by pseudocapsule of compressed muscle fibers.

Answer 19

Leiomyomata (Fibroids/Myomas)

Question 20

What causes rapid growth of leiomyomatas?

Answer 20

estrogen

Question 21

Presentation of leiomyomata

Answer 21

BLEEDING, typically progressively heavier menstrual flow (menorrhagia)

progressive increase in pelvic pressure

Question 22

Subgroups of leiomyomata based on anatomic position?

Answer 22

Intramural-centered in the muscular wall of the uterus (most)
Subserosal-just beneath the uterine serosa
Submucosal-just beneath the endometrium
Pedunculated leiomyoma-connected to uterus by a stalk

Question 23

Prevalence of Leiomyomata (Fibroids/Myomas) most common in what women?

Answer 23

age 40s; but any pre-menopausal or pregnant women when estrogen higher

Question 24

What is most common indication for hysterectomy?

Answer 24

Leiomyomata (Fibroids/Myomas)

Question 25

Treatment leiomyomata

Answer 25

usually just treat symptoms and may not require medical or surgical intervention

GnRH analogs to reduce size
Myomectomy vs hysterectomy

Question 26

Abnormal uterine bleeding with focal, benign hyperplastic processes on uterus; seen mostly in perimenopausal.

Answer 26

polyps

Question 27

__________ most common precursor to endometrial adenocarcinoma.

Answer 27

endometrial hyperplasia

Question 28

Most common cause of uterine corpus cancer?

Answer 28

excess unopposed estrogen

Question 29

What characteristic makes endometrial hyperplasia more likely to progress to cancer?

Answer 29

if complex hyperplasia with atypia

Question 30

What is the hallmark finding of endometrial hyperplasia and cancer?

Answer 30

abnormal uterine bleeding (AUB) in post-menopausal women

Question 31

When must cancer be ruled out with abnormal uterine bleeding?

Answer 31

> 35 yo

< 35 yo with risk factors (FHX cancer, obesity, prior hyperplasia, chronic involution, tamoxifen or estrogen therapy)

Question 32

How is tamoxifen a risk factor for endometrial cancer?

Answer 32

breast cancer drug that blocks estrogen receptors on tumor

causes overgrowth of endometrial lining and promoting hyperplasia

Question 33

What test do we do prior to endometrial sampling in premenopausal woman with AUB?

Answer 33

pregnancy test

Question 34

How is endometrial hyperplasia and cancer dx’d?

Answer 34

Endometrial biopsy and tissue sampling
D&C
Transvaginal ultrasound

Pap smear NOT reliable

Question 35

What findings on transvaginal U/S need follow up biopsy?

Answer 35

endometrial thickness of > 4mm in postmenopausal pt

polypoid mass or fluid collection

Question 36

What lab may be elevated in advanced stage endometrial cancer and may assist in predicting tx response?

Answer 36

CA-125

Question 37

Treatment of endometrial cancer if estrogen dependent?

Answer 37

progesterone
hysterectomy
chemo/radiation

Question 38

Post-op surveillance to detect recurrent endometrial cancer for women without radiation therapy?

Answer 38

speculum and rectovaginal exam q3-4mo for 2-3yr then 2/yr