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PANCE- OB/GYN > Uterus > Flashcards

Uterus Flashcards

1
Q

Dysfunctional Uterine Bleeding (DUB) Definition

A

ABN bleeding w/o evidence of underlying cause

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2
Q

Post-menopausal bleeding is cancer until proven otherwise

A

:)

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3
Q

Oligomenorrhea

A

Increased length of time between menses (35-90 days)

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4
Q

Polymenorrhea

A

Frequent menstruation (<21 d cycle), anovulatory

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5
Q

Menorrhagia

A

Increased amount of flow (>80mL) or prolonged bleeding (>8 days) –> may lead to anemia

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6
Q

Metorrhagia

A

Bleeding between periods

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7
Q

Menometorrhagia

A

Excessive bleeding at irregular intervals

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8
Q

DUB Exam: look for…

A

palpable uterus, cervical mass, polyps to assess for cervical cancer, myoma or pregnancy

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9
Q

DUB Diagnostic labs

A

BhCG to R/O pregnancy
CBC: r/o anemia
Thyroid function tests
Platelets/PT/PTT: r/o Von Willebrands disease, Factor XI deficiency

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10
Q

DUB Diagnostic procedures

A

Pap: r/o cervical CA
US: polycystic ovaries, uterine mass, endometrial thickness

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11
Q

DUB Endometrial Biopsy is indicated WHEN

A

Endometrium is >4mm in a POSTMENOPAUSAL women
OR
Pt is >35 yo w/ RF of endometrial hyperplasia (obesity, diabetes)

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12
Q

Pregnancy is the most common cause of ABN uterine bleeding

A

:)

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13
Q

TX of heavy bleeding

A

High-dose estrogen IV - stabilizes uterine lining, controls bleeding w/in one hour.
D/C indicated if bleeding not controlled w/in 24 hours

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14
Q

TX of ovulatory bleeding

A

NSAIDs to decrease blood loss

If hemodynamically unstable, OCPs or Mirena IUD

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15
Q

Anemia and endometrial hyperplasia are the main complications of DUB

A

:)

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16
Q

TX of anovulatory bleeding

A

goal is to convert proliferative endometrium into secretory endometrium (decr. risk of hyperplasia and CA)
Progestin x10d –> stimulates withdrawal bleeding
Desmopressin –> increases Von WIllebrand and FactorVIII
OCP or Mirena

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17
Q

Surgical TX of DUB

A

D&C

Hysteroscopy: direct visualization of endometrium for biopsy

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18
Q

DUB Hysterectomy IF

A

Fail or do not want hormone treatment,

Symptomatic anemia or decreased QOL

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19
Q

Type 1 endometrial CA is derived from

A

atypical endometrial hyperplasia

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20
Q

Type 2 endometrial CA is derived from

A

serous or clear cell histology

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21
Q

Type 1 endometrial CA is the most common F reproductive CA

A

(%75)

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22
Q

Estrogen’s role in type 1 endometrial CA

A

High - from unopposed estrogen stimulation

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23
Q

Estrogen’s role in type 2 endometrial CA

A

Unrelated - mostly from p53 gene mutation

24
Q

Precursor lesions - Type 1 endometrial CA

A

endometrial hyperplasia and atypical hyperplasia

25
Q

Precursor lesions - Type 2 endometrial CA

A

None

26
Q

Prognosis - Type 1 endometrial CA

A

favorable

27
Q

Prognosis - Type 2 endometrial CA

A

poor - very agressive

28
Q

Mean age Type 1 endometrial CA

A

55 yo

29
Q

Mean age Type 2 endometrial CA

A

67 yo

30
Q

Post-menopausal vaginal bleeding is an early PE finding of endometrial CA

A

:(

31
Q

Abdominal pain is a late PE finding in endometrial CA

A

:(

32
Q

DX of endometrial CA

A

endometrial/endocervical biopsy

U/S will show thickened endometrium

33
Q

Child bearing age TX of endometrial CA

A

High dose progestin

34
Q

TX of endometrial CA

A

total hysterectomy, bilateral salpingo-oophrectomy +/- radiation or chemotx

35
Q

Definition of endometriosis

A

functional endometrial glands and stroma outside the uterus

36
Q

HX/PE - endometriosis

A

cyclical pelvic pain and/or rectal pain, dyspareunia

37
Q

classic lesions of endometriosis

A

dark brown or blue-black in color, “chocolate cysts” on ovaries (endometriomas)

38
Q

DX of endometriosis

A

direct visualization with laparoscopy or laparotomy

39
Q

TX (pharm) endometriosis

A 
inhibit ovulation!
Combo OCP - 1st line
GnRH analogue
NSAIDs
Progestins
40
Q

TX (surgery) of endometriosis

A

Excision, cauterization, cauterization, ablation of lesions and adhesions

41
Q

TX (definitive) of endometriosis

A

Total hysterectomy - bilateral salpingo-oophrectomy +/- lysis of adhesions

42
Q

Uterine fibroids are the most common benign OBGYN tumor

A

:)

43
Q

Fibroids are…

A

discrete, round, firm and often multiple tumors made up of smooth muscle and connective tissue

44
Q

Uterine fibroids are sensitive to these hormones

A

Estrogen and Progesterone - will grow in pregnancy and decrease in size at menopause

45
Q

Malignant transformation of fibroids into leiomyosarcoma is RARE

A

:)

46
Q

SSx of fibroids may include

A 
Uterine bleeding
Pelvic pressure
bloating/constipation
urinary frequency/retention
firm, non-tender, "bumpy" uterus on pelvic exam
47
Q

DX of fibroids

A

CBC (r/o anemia)
U/S (exclude ovarian mass)
MRI (delineate cell source of growth)

48
Q

Pharm TX of fibroids

A

NSAIDs. Combo OCPs. Medroxyprogesterone acetate (DEPO) or danazol to slow/stop bleeding. GnRH analog to decrease size, growth and vasculature.

49
Q

Surgical TX of fibroids

A

Emergency if torsion occurs
Child bearing age: myomectomy
Otherwise: hysterectomy

50
Q

If a uterine mass continues to grow after menopause - suspect malignancy

A

:)

51
Q

Uterine fibroid prevalence

A

25% Caucasian

50% African American

52
Q

Uterine prolapse risk factors

A

vaginal birth, genetics, adv. age, Hx of pelvic surgery, CT disorders, increased intra-abdominal pressure secondary to obesity or straining

53
Q

Prolapse HX/PE

A

sensation of bulge or protrusion in vagina
urinary or fecal incontinence
sense of incomplete bladder emptying
Dyspareunia

54
Q

DX of uterine prolapse

A

Bare down in stirrups and visualize

55
Q

Supportive TX - uterine prolapse

A

increased fiber diet, weight reduction, limit straining/lifting
Pessary if unable to or not interested in surgery

56
Q

Surgical TX - Uterine prolapse

A

hysterectomy w/ vaginal vault suspension

PANCE- OB/GYN (9 decks)

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