Uterine disorders

Question 1

Where is the MC place for endometriosis?

Answer 1

Pelvis: Ovaries

Question 2

What is endometriosis highly associated with?

Answer 2

Infertile women

Question 3

What is endometriosis at an increased risk for?

Answer 3

Ovarian CA

Question 4

endometriosis etiology

Answer 4

Retrograde menstruation

Question 5

endometriosis clinical presentation

Answer 5

1. Premenstrual pelvic pain
2. Pain subsides after menses
3. Infertility
4. Dysmenorrhea
5. Dyspareunia

Question 6

What is the definitive dx in endometriosis?

Answer 6

Laparoscopy

Question 7

Laparoscopy findings in endometriosis

Answer 7

1. Petechial lesions
2. Surrounding peritoneum thickened/scarred
3. “Chocolate cysts”: Endometriomas
4. Adhesions

Question 8

endometriosis treatment in mild disease

Answer 8

NSAIDS +/- OCPS

Question 9

endometriosis treatment in moderate/severe disease

Answer 9

1. OCP’s: Causes atrophy of endometrial tissue, decreases risk of ovarian CA
2. Progestins
3. GnRH Agonists: Suppression of estrogen and progesterone d/t down-regulation of pituitary gland

Question 10

What do you want to make sure to supplement your patient with if they are on GnRH Agonist? Why?

Answer 10

Norethindrone acetate to prevent bone loss

Question 11

What ethnicity is uterine fibroids MC in?

Answer 11

Black Women

Question 12

Uterine Fibroids Clinical Presentation

Answer 12

1. Abnormal uterine bleeding*
2. Pelvic Pressure*
3. Pain
4. Infertility

Question 13

Bimanual exam findings in uterine fibroids

Answer 13

1. Enlargement
2. Irregular shape
3. Masses

Question 14

What is the imaging of choice in uterine fibroids?

Answer 14

Transvaginal US

Question 15

Pharmacologic treatment options in uterine fibroids

Answer 15

1. COCs/progestin
2. GnRH analogs
3. Steroid therapies: androgens
4. Tranexamic acid

Question 16

What is the main use of GnRH in uterine fibroids? What age does this serve primary tx in?

Answer 16

Decrease Fibroid Size
Used prior to surgery-improve anemia
Primary role in tx near menopause

Question 17

Who is steroidal therapies indicated in?

Answer 17

Prolonged, heavy menses

NO submucosal fibroids

Question 18

steroidal therapies options

Answer 18

1. OCP’s
2. Mirena
3. Nuvaring

Question 19

Tranexamic acid indications

Answer 19

Prolonged, heavy menses

NO submucosal fibroids

Question 20

When would you use Tranexamic acid?

Answer 20

During menstrual cycle ONLY

Question 21

What does uterine fibroid surgery preserve both fertility and the uterus?

Answer 21

1. Myomectomy

2. Hysteroscopy

Question 22

What type of uterine fibroids do you perform myomectomy in?

Answer 22

1. Intramural
2. Subserosal
3. Pedunculated fibroids

Question 23

Myomectomy laparotomy indications (over laparoscopic)

Answer 23

1. CI to laparoscopic
2. Large fibroid size
3. Prior pelvic/abd radiation
4. Severe hip dz, precluding dorsolithotomy position

Question 24

What type of uterine fibroid do you perform hysteroscopy?

Answer 24

Submucosal fibroids

Question 25

Hysteroscopy risk

Answer 25

1. Fluid overload | 2. Hyponatremia

Question 26

What are the advantages/pro's of endometrial ablation

Answer 26

1. Preserves uterus 2. Outpatient/In-office procedure 3. General/paracervical block 4. No fluid overload 5. Fast: <2 min

Question 27

What are the disadvantages/pro's of endometrial ablation

Answer 27

1. Must remover submucosal fibroids & polyps first 2. Amenorrhea rate=50% 3. Placenta accrete= No kids following procedure

Question 28

Who is a candidate for uterine artery embolization?

Answer 28

Doesn't want kids: Procedure preserves uterus, but NOT fertility

Question 29

CI to uterine artery embolization

Answer 29

Numerous and large fibroids

Question 30

SE's in uterine artery embolization

Answer 30

1. Postembolization syndrome: Hospitalize for pain 2. Uterine necrosis, sepsis, death 3. Embolization in non-target tissue: Ovaries

Question 31

Define Adenomyosis

Answer 31

Growth of endometrial tissue into uterine myometrium

Question 32

Adenomyosis clinical presentation

Answer 32

1. Menorrhagia* 2. Dysmenorrhea 3. Hx uterine surgery: C-section, myomectomy

Question 33

Adenomyosis bimanual exam findings

Answer 33

Diffuse uterine enlargement (globular)

Question 34

Adenomyosis medication treatment

Answer 34

OCP's Mirena Nuvaring

Question 35

What is the definitive tx for Adenomyosis

Answer 35

Hysterectomy

Question 36

What is the #1 RF for Endometrial Hyperplasia?

Answer 36

OBESITY!!!

Question 37

Endometrial Hyperplasia si/sx's

Answer 37

Bleeding: 1. Menorrhagia 2. Prolonged menses 3. Decreased menstrual intervals

Question 38

What pelvic US findings indicated unlikely malginancy with endometrial hyperplasia?

Answer 38

Endometrial thickness <4 mm

Question 39

Hyperplasia without atypia treatment

Answer 39

1. Mirena IUD 2. Provera x3-6 months 3. Reasses with endometrial biopsy

Question 40

What is the TOC in atypical hyperplasia

Answer 40

Hysterectomy

Question 41

What is the MC pelvic genital CA?

Answer 41

Endometrial CA

Question 42

What is the mean age in endometrial CA?

Answer 42

50-69

Question 43

What is the #1 RF for endometrial CA?

Answer 43

OBESITY

Question 44

Which type of endometrial CA has a poor prognosis?

Answer 44

Type 2

Question 45

Which type of endometrial CA is due to unopposed estrogen?

Answer 45

Type 1

Question 46

What is the MC type of endometrial CA?

Answer 46

Adenocarcinoma

Question 47

What types of endometrial CA are NOT associated with a hyperestrogenic state?

Answer 47

Serous Carcinoma Clear Cell Carcinoma *Poor prognosis, aggressive

Question 48

Endometrial CA clinical presentation

Answer 48

1. ABNORMAL BLEEDING 2. Abd cramping 3. Weight loss

Question 49

Endometrial CA diagnosis

Answer 49

1. Transvaginal US | 2. Endometrial Bx

Question 50

What will be elevated if there is extrauterine spread in endometrial CA?

Answer 50

CA-125

Question 51

endometrial CA treatment?

Answer 51

TAH-BSO + Lymphadenectomy (pelvic & periaortic)