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obstetric - gynecol STEP 2 > Uterus > Flashcards

Uterus Flashcards

1
Q

Adenomyosis - presentation

A
  1. dysmenorrhea
  2. menorrhagia
  3. uniformly enlarged, soft, globular uterus
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2
Q

Adenomyosis - treatment

A
  • only hysterectomy is definitive treatment

- GnRH agonists

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3
Q

adenomyosis - definition / age

A
  • invasion of endometrial glands into the myometrium

- women 35-50

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4
Q

adenomyosis - RF

A
  1. endometriosis

2. uterine fibrinoids

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5
Q

adenomyosis - diagnosis / physical findings

A

diagnosis: it is clinical / MRI is the most accurate test. hysteroctomy for definitive diagnosis
examination: large globular and boggy

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6
Q

soft and tender uterus - MC?

A

adenomyosis

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7
Q

endometriosis - epidimiology

A

women in reproductive age and is MORE COMMON if a FIRST DEGREE RELATIVE (mother or sister) has

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8
Q

endometriosis - symptoms presentation

A

cyclic pelvic pain that starts 1 to 2 weeks before menstruation and peaks 1 to days before. The pain end with menstruation.
Abnormal bleeding is common
dysmenorrhea and dyspraeunia are also common

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9
Q

endometriosis - physical exam

A

tenderness of the recto-vaginal area, tenderness withh movement of the uterus, thickening of the uterosacral ligaments caused by endometrial implants on the recto-vaginal septum, pelvic peritoneum, anterior and posterior cul-de-sac, and uterosacral ligaments

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10
Q

endometriosis - diagnosis (and appearance)

A

can be made only by direct visualization via laparoscopy. It looks like rusty or dark brown lesions. On the ovary, a cluster of lesions called an endometrioma looks like a chocolate cyst

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11
Q

endometriosis - treatment

A
  1. analgesia (NSAID)
  2. OCPs to iterrupt the menstrual cycle and stop ovaluation (mild symptoms)
  3. danazole or leuprolide to decrease FSH/LH (moderate to severe pain)
  4. surgical treatment (severe symptoms or infertility)
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12
Q

Danazole - mechanism of action and SE

A

androgen derivative that is associated with acne, oily skin, weigh gain, hirsutism

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13
Q

surgery on endometriosis - purpose

A

attempts to remove all endometrial implants and adhesion, and to restore pelvic anatomy. Patients who have completed their childbearing may undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy

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14
Q

DDX of dysmenorrhea

A
  1. 1ry desmenorrhea
  2. endometriosis
  3. fibroids
  4. adenomyosis
  5. pelvic congestion
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15
Q

tenderness and nodularity in theposterior cul-de-sac

A

endometriosis

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16
Q

Dysmenorrhea?

A

pain with menses

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17
Q

Dysmenorrhea - DDX

A
  1. Primary
  2. endometriosis
  3. Fibroids
  4. Adenomyosis
  5. pelvic congestion
  6. pelvic infection
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18
Q

1ry desmenorrhea - treatment

A

NSAID

Hormonal contraception

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19
Q

pelvic congestion syndrome

A

dull and ill-defined pelvic ache –> worsens prior to menstruation or with long periods of sanding and is relieved by mense
- also it is often associate with history of sexual problems

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20
Q

menorrhagia - description

A
  • heavy and prolonged menstrual bleeding (more than 80 ml or more than 7 days)
  • Gushing of blood
  • clots may be seen
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21
Q

menorrhagia - etiology

A
  1. endometrial hyperplasia
  2. uterine fibroids
  3. Dysfunction uterine bleeding
  4. intrauterine device
22
Q

hypomenorrhea - description

A
  • light menstrual flow

- my only have spotting

23
Q

hypomenorrhea - etiology

A
  • obstruction (hymen, cervical stenosis)

- oral contraceptive pills

24
Q

metrorrhagia - description

A

inter-menstrual bleeding

25
Q

metrorrhagia - etiology

A
  1. endometrial polyps
  2. endometrial/cervical cancer
  3. exogenous estrogen administration
26
Q

menometrorragia - etiology

A
  1. endometrial polyps
  2. endometrial/cervical cancer
  3. exogenous estrogen administration
27
Q

oligomenorrhea - description

A

menstrual cycles smaller than 35 days

28
Q

oligomenorrhea - etiology

A
  1. pregnancy
  2. menopause
  3. signif weight loss (anorexia)
  4. Tumor secreting estrogens
29
Q

abnromal uterine bleeding - diagnostic test

A
  1. CBC (for Hb and Hct)
  2. PT/PTT to evaluate for coagulation disorders
  3. Pelvic US (for anatomic abnormalities)
30
Q

Dysfunctional uterine bleeding - ovaluation (mechanism)

A

the ovary produces estrogen but no corpus lateum –> no progesteron –> this prevents the usual withdrawal bleeding –> the continuously high estr continues to stimulate growth of the endometrium –> bleeding occurs only once the endometrium outgrows the blood supply

31
Q

Dysfunctional uterine bleeding - diagnostic tests

A
  1. rule out systemic reasons for anovulation, such as hypothyroid and hyperprolactinemia
  2. endometrial biopsy for women over 35 (for CA)
32
Q

Dysfunctional uterine bleeding - treatment

A
  1. OCP: 1. adolescents and young women who are anovulatory 2. Women over 35 who have normal biopsy
  2. in acute hemorrhage: Dilation and Curettage is done to stop the bleeding
  3. IF SEVERE –> endometrial ablation or hysterectomy
33
Q

Dysfunctional uterine bleeding is severe if

A
  1. patients are anemic
  2. hemorrhage are not controled by OCPs
  3. patients report that their lifestyle is compromised
34
Q

evaluation of 2ry amenorrhea

A

amenorrhea for menses for 3 or more cycles or 6 or more months: HCG?
positive –> pregnancy
negative –> if prior uterine procedure or infection do hysteroscopy, if no, check prolactin, TSH, FSH

35
Q

Leiomyoma (fibrinoid) - pathophysiological characteristic

A

Estrogen sensitive –> increased tumor size in pregnancy and decreased with menopause

36
Q

Leiomyoma (fibrinoid) - presentation

A
  1. asymptomatic
  2. abnormal uterine bleeding
  3. miscarriage
  4. iron deficiency anemia (if severe bleeding)
37
Q

fibroid - the best imaging modality to diagnose

A

U/S of pelvis

38
Q

urinary stress incontinence can be a presenting symptom of

A

fibroids (due to direct pressure on the bladder from an irregularly enlarged uterus)

39
Q

myomectomy - contraindication for labor

A

if there is uterine cavity entry

40
Q

leiomyoma work-up

A

leiomyoma work-up

41
Q

anatomic cause of 1ry amneorrhea

A

imperforate hymen

42
Q

prolapsing leiomyoma

A

firm smooth round mass at the cervical os consistent with an aborting submucous myoma –> labor like pain due to mechanical cervical dilation

43
Q

fibroids - treatment

A

asymptomatic: observation symptomatic: OCP, surgery

44
Q

fibroids - clinical features

A
  1. heavy prolonged menses
  2. pressure symptoms
  3. obstetric complications (impaired fertility, pregnancy loss, preterm labor)
  4. enlarged, irregular uterus
45
Q

Endometrial hyperplasia - definition/mechanism/complications

A
  • abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
  • high risk for endometrial carcinoma - nuclear atypia is greater risk factor than complex (vs simple)
46
Q

Endometrial hyperplasia - presentation

A

postmenopausal vaginal bleeging

47
Q

Endometrial hyperplasia - risk factors

A
  1. anovulatory cycles
  2. hormone replacement therapy
  3. polycystic ovarian sydrome
  4. granulosa cell tumor
48
Q

endometrial carcinoma - risk factors

A
  1. prolonged use of estrogen without progestins
  2. obesity
  3. diabetes
  4. hypertension
  5. nulliparity
  6. late menopause
  7. Lynch syndrome
49
Q

endometrial biopsy - indications

A
  • 45 or older: abnormal uterine bleeding, postmenopausal bleeding
  • younger than 45: abnormal uterine bleeding PLUS: unopposed estrogen (obesity, anovulatio) or failed medical management or Lynch syndrome
  • 35 or older: atypical glandular cells on Pap
50
Q

endometrial hyperplasia / cancer - treatment

A

hyperplasia: progenstin therapy or hysterectomy
cancer: hysterectomy

obstetric - gynecol STEP 2 (22 decks)

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