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obstetric - gynecol STEP 2 > vagina - cervix > Flashcards

vagina - cervix Flashcards

1
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - when

A

begin when women are in their 20-30

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2
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - symptoms

A
  1. headache
  2. breast tenderness
  3. Pelvic pain and bloating
  4. irritability and luck of energy
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3
Q

premestrual syndrome (PMS) vs premestrual dysmophic disorder (PMDD)

A

PMDD is a more severe vesrion that will disrupt the patient’s daily activities

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4
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - diagnostic tests

A
  • no tests
  • PMDD has DSM-V diagnostic criteria
  • tha patient chart her symptoms
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5
Q

premestrual dysmophic disorder (PMDD) - diagnostic criteria

A
  1. symptoms should be present for 2 consecutive cycles
  2. symptoms-free period of 1 week in the first part of the cycle (follicular phase)
  3. symptoms must present in the second half of the cycle
  4. Dysfunction in life.
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6
Q

premestrual syndrome (PMS) and premestrual dysmophic disorder (PMDD) - treatment

A

patient should decrease consumption of caffeine, alcohol, cigarettes and chocolate and should exercise.
IF SEVERE SYMPTOMS –> SSRI

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7
Q

Menopause starts with …. (presentation)

A

it starts with irregular menstrual bleeding. Women are symptomatic for an average of 12 months, but some women can experience symptoms for years

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8
Q

Menopause starts with …. (mechanism)

A

the occytes produce less estronege and progesterone, and both LH and FSH start rise

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9
Q

symptoms of menopause - next step

A

check TSH and FSH

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10
Q

OCPs for vasomotor symptoms

A

in women younger tha n60 who have undergone menopause within the past 10 years

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11
Q

Pap test - how often

A

begenning at age 21, repeat evry 3 years. at 30, pap test with HPV co-testing may be done and repeated every 5 years

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12
Q

when to stop Pap testing

A

age 65 or hysterectomy
PLUS no history of cervical intraepithelial neoplsia 2 or higher
AND 3 conscecutive negative Pap tests
OR 2 consecutive negative co-testing terults
(if intraepithelial neoplasia 2 –> 20 more years)

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13
Q

Cerivical cancer - management of advanced Cerivical cancer

A

CLEAR: perform a hysterectomy

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14
Q

prevention of cervical ca

A
  1. HPV vaccine to all women between 11-26
  2. pap smear starting at 21. Repeat the test every 3 years until 65.
    (of women with fatal Cerivical cancer, 85% have never a pap smear)
  3. pap and hpv testing increase the interval to 5 years
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15
Q

detection of cervical ca

A
  1. low grade and high grade dysplasia on Pap tsmear is followed up with a colposcopy for biopsy
  2. atypical squamous cells of undetermined significance (ASCUS) can be a sign of early, preinvasive cancer or an infection, or may simply be a false positive
  3. IF ASCUS –> perform HPV testing –> hpv (+) –> colposcopy. IF (-) –> pap at 6 months
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16
Q

Pap smear vs mammography vs colonoscopy - mortality

A

pap smear does not lower mortality as the others

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17
Q

Cervical dysplasia and carcinoma - Classification

A

CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extend of dysplasia

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18
Q

cervical dysplasia and carcinoma - pathogenesis

A

HPV 16, 18 –> both produce E6 (inh p53) and E7 (inh RB)

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19
Q

cervical dysplasia and carcinoma - presentation

A
  1. typically asymptomatic (detected with Pap smear - koilocytes)
  2. presents as abnormal vaginal bleeding (often postcoital - after sexual intercourse)
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20
Q

cervical invasive carcinoma - type / Diagnosis / complication

A

often SCC
colposcopy and biopsy
lateranl invasion –> block ureters –> renal failure

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21
Q

cervical dysplasia and carcinoma - Risk factors (MC?)

A
  1. HPV
  2. STD history
  3. immunosuppresion
  4. tovacco
  5. OCPs
  6. early onsert of sexual activity
  7. multiple or high risk sexual partners
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22
Q

postcoital bleeding - etiology

A
  1. cervical cancer
  2. cervical polyps
  3. atrophic vaginitis
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23
Q

postcoital bleeding - diangosis

A

cervical cancer until proven otherwise

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24
Q

cervical conization - indications

A

cervical intraepithelial neoplasia grades 2 + 3

observation is preferred for grade 2 in young women

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25
cervical conization - SE
1. cervical stenosis 2. preterm birth 3. preterm premature rupture of membranes 4. 2nd trimester pregnancy loss
26
cervical insuf ?
PAINLESS dilation of cervix in the 2nd trimester and loss of pregnancy
27
Genitourinary syndrome of menopause - symptoms
1. vuvlovaginal dryness, irritation, pruritus 2. dyspareunia 3. vaginal bleeding 4. urinary incontinence 5. recurrent UTI 6. pelvic pressure
28
Genitourinary syndrome of menopause - physical examination
narrowed introitis pale mucosa, decreased elasticity petecheia, fissures loss of labial volume
29
High grade squamous intraepithelial lesion in pap --> next step
colposcopy
30
vaginal tumors - types and characteristics
1. SCC: usually 2ry to cervical SCC (rare 1ry) 2. clear cell adenocarcinoma: Women who had exposure to DES in utero 3. Sarcoma botryoides: girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina
31
menopause - diagonosis
- amenorrhea for 12 months | - is it is unclear --> High FSH levels are diagnostic
32
labial fusion - definition / mechanism
- labia minora become fused together - due to excess androgen (exogen, increased production) - MCC: 21-β-hydroxylase deficiency
33
labial fusion - treatment
reconstructive surgery
34
vulva and vagina - epithelial abnormalities types
1. lichen sclerosus 2. squamous cell hyperplasia 3. lichen planus
35
vulva and vagina - lichen sclerosus - age
any age --> however if Postmenopausal there is an increased risk of cancer
36
vulva and vagina - lichen sclerosus - appearance and treatment
- thin white, wrinkled skin over the labia majora/minora, atrophic changes that may extend over the perineum + around the anus / can cause painful defacation - excoriations, erosions, fissures from severe pruritus - diruria, dyspareunia painful defection
37
squamous cell hyperplasia - age
any --> patietns who have had chronic vulvar pruritus
38
squamous cell hyperplasia - treatment
Sitza baths or lubricants (relieve pruritus)
39
Liches planus - age
prepubertal girls + perimenopausal or postmenopausal women
40
Liches planus - appearance and treatment
- violet flat papules | - topical steroids
41
vulvar lichen sclerosus - treatment
superpotent costicosteroid ointment
42
vulvar lichen sclerosus - workup
punch biopsy of adult onset lesions to exclude malignancy
43
atrophic vaginitis vs lichen sclerosus regarding treatment
atrophic --> low dose topical estrogen | lichen --> high potency topical steroids
44
atrophic vaginitis vs lichen sclerosus regarding clinical features
atrophic --> vluvlovaginal dryness, loss of vaginal elasticity/rugae, thinning vulvar skin/loss of minora, decreased vaginal diameter lichen --> white vulvar plaques/loss of minora/ dryness, pruritus, perianal involvement, spares vagina
45
vaginal SCC - RF / diagnosis
RF: HPV 16 + 18, smoking, history of cervical dysplasia or cancer diagnosis by biopsy
46
vaginal cancer - SCC vs clear cell adeno regarding location
SCC: upper 1/3 of posterior wall clear: upper 1/3 of anterior
47
RF for vaginal SCC
HPV
48
Bartholin gland cyst - location
lateral sides of the vulva
49
Bartholin gland cyst - presentation
secrete mucus and can become obstructed leading to a cyst or abscess that causes: 1. PAIN 2. TENDERNESS 3. DYSPAREUNIA
50
Bartholin gland cyst - physical exam
edema and inflammation of the area with a deep fluctuant mass
51
Bartholin gland cyst - treatment
if asymptomatic --> nothing IF SYMPTOMATIC --> incision and drainage --> if continue to recur --> marsupialization culture the fluid (for STDs)
52
marsupialization?
it is a form of incision and drainage in which the open space is kept open with sutures --> this allows the space to remain open, and decreases the risk of a recurrent Bartholin gland cyst
53
cervical mucus secreation
close to ovulation --> increases in quantity and can be perceived by patients as vaginal discharge --> mucus is clear, elastic thin and described similar in appearance to an uncooked egg white --> facilitate sperm transport into the uterus
54
Vaginitis - RF
any factor that will increase the ph of the vagina 1. antibiotic use (Lactobacillus normally keeps ph below 4.5 2. diabetes 3. overgrowth of normal flora
55
vaginitis - symptoms
1. itching 2. pain 3. abnormal odor 3. discharge
56
types of vaginitis and the pathogen
bacterial --> gardenella candidiasis --> candida albicans trichomonas --> trichomonas vaginalis
57
types of vaginitis and presentation
bacterial --> vaginal discharde with fishy ofor, gray white candidiasis --> white cheesy vaginal discharge trichomonas --> profuse, green frothy vagina discharge
58
types of vaginitis and diagnostic test
bacterial --> saline wet mount shows CLUE CELLS, ph more than 4.5 candidiasis --> KOH shows PSEUDOHYPHAE, ph 4-4.5 trichomonas -->saline wet mount shos MOTILE FLAGELLATES, ph more than 4.5
59
types of vaginitis and treatment
bacterial --> metronidazole or clindamycin candidiasis --> miconazole or clotrimazole, econazole, nystatin trichomonas --> treat patient and partner with metronidazole
60
vulva - paget disease - definition / epidimiology
intraepithelial neoplasia that MC occurs in POSTMENOPAUSAL CAUCASIAN WOMEN
61
vulva - paget disease - presentation and appearance
vulvar soreness and prurritus appearing as RED lesion with a superficial white coating
62
vulva - paget disease - diagnosis
biopsy to confirm
63
vulva - paget disease - treatment
- radical vulvectomy for bilateral lesion | - modified vulvectomy for unilateral lesion
64
Squamous cell carcinoma of vulva - presentation
1. pruritus 2. bloody vaginal discharge 3. postmenopausal
65
Squamous cell carcinoma of vulva - appearance
from small ulcerated lesion to a large cauliflowerlike lesion
66
Squamous cell carcinoma of vulva - diagnosis / how to stage
diagnosis: biopsy is essential | staging is done whlie the patient is in surgery
67
Squamous cell carcinoma of vulva - stage
0: in situ I: limited to vaginal wall less than 2 cm II: limited to vulva or perineum less than 2 cm III: tumor spreading to lower urethral or anus, unilateral lymph nodes present IV: tumor invasion into bladder. rectum, or bilateral lymph nodes IVa: distant metastasis
68
Squamous cell carcinoma of vulva - treatment
unilateral lesion without lymph node: modified radical vulvectomy bilateral lymph node: radical vulvectomy lymph nodes that are involved must undergo lymphadenectomy
69
vulvar hematoma
results from a local trauma and presents as a tender ecchymotic indurated firm mass
70
in contrast to Bartholin cysts, Gartner duct cysts ...
do not involve the valvula
71
Bartholin cysts present as ..... / treatment
soft, mobile, well-circumscribed masses at the base of labia majora and are usually asymptomatic treatment: observation if asymptomatic, if symptomatic --> incision and drainage
72
Management of CIN3
if older than 25 and not currently pregnant --> loop electrosurgical excision procedure or cold Knife conization or cryoablation --> Pap test with HPV 1 and 2 years postprocedure if pregnant --> colposcopy first
73
Genitourinary syndrome of menopause - treatment
vaginal moisturizer + lubricant | vaginal estrogen

obstetric - gynecol STEP 2 (22 decks)

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