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women's health exam 2 > vulvar and ovarian > Flashcards

vulvar and ovarian Flashcards

1
Q

lichen sclerosus is most commonly seen in what patient population

A
  • postmenopausal women
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2
Q

clinical presentation

  • pruritus
  • dysuria (when urine hits vulvar tissue); dyspareunia
  • well-demarcated white plaques
    • “cellophane paper”
  • fragility
A

lichen sclerosus

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3
Q

lichen sclerosus usually starts where

A
  • begins periclitorally with spread to perineal skin
  • not usually seen at keratinzied, hair-bearing labia majoria or mucus membranes
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4
Q

patients with hyperkeratotic lesions associated with lichen sclerosus have a risk for

A

squamous cell carcinoma

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5
Q

how is lichen sclerosus diagnosed

A

vulvar punch biopsy

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6
Q

treatment of lichen sclerosus

A
  • topical ultrapotent steroid ointment
    • ​Temovate ointment

​*does not go away -> long term f/u

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7
Q

where are bartholin glands located? function?

A
  • 4 and 8-oclock positions within labia minora. ducts open into vestibule adjacent to vaginal introitus
  • secrete mucus to maintain moisture of vaginal mucosa
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8
Q

clinical presentation

  • acute, painful unilateral labial swelling
  • dyspareunia
  • pain with sitting or walking
  • tender, fluctuant labial mass
A

bartholin cyst

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9
Q

treatment of bartholin cyst

A
  • I&D with insertion of word catheter
  • culture; +/- empirical abx therapy
  • sitz bath 2-3 days after I&D
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10
Q

when does vulvodynia typically present

A
  • onset around menopause
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11
Q

clinical presentation

  • vulvar discomfort “burning” sensation
  • absent clinical findings, pain limited to vestibule
  • introital pain with intercourse
  • mood or anxiety disorders (4x more likely)
A

Vulvodynia

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12
Q

treatment of Vulvodynia

A
  • avoid scented products, tight clothing, pads
  • sitz bath followed by thin film petroleum jelly
  • gabapentin
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13
Q

define vulvar intraepithelial neoplasia

A
  • neoplastic cells confined to squamous epithelium
  • VIN2/3 are precursors to vulvar cancer
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14
Q

vulvar intraepithelial neoplasia 2/3 are further differentiated into

A
  • VINu: usual type
  • VINd: differentiated type
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15
Q

VINu: usual type is associated with what condition? what patient population is it normally seen in

A
  • HPV type 16, 18
  • younger women
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16
Q

how is VINu: usual type diagnosed

A
  • vulvar colposcopy
    • acetic acid over lesion will bring out characteristics
  • biopsy all pigmented lesions
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17
Q

why is VINu: usual type concerning

A

associated with high grade CIN: Cervical intraepithelial neoplasia

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18
Q

How is VINd: differentiated type different from VINu

A
  • unrelated to HPV
  • seen in older women
  • involves lower 1/3 of epithelium
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19
Q

VINd: differentiated type is associated with

A

squamous cell hyperplasia

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20
Q

clinical presentation of vulvar cancer

A
  • asymptomatic
    • ​inspect vulva
  • pruritus is the most common symptom
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21
Q

vulvar cancer can be what 3 types

A
  1. squamous cell carcinoma
  2. basal cell carcinoma
  3. malignant melanoma
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22
Q

what has to be present in order to develop vaginal intraepithelial neoplasia (VaIN)

A
  • HPV
23
Q

risk factors for vaginal intraepithelial neoplasia (VaIN) AND CIN

A
  • smoking
  • multiple sex partners
  • early onset of sexual activity
24
Q

most lesions of vaginal intraepithelial neoplasia (VaIN) are located where

A

upper 1/3 of vagina

25
Q

list the classifications for vaginal intraepithelial neoplasia (VaIN)

A
  • VaIN 1: benign viral proliferation
  • VaIN 2: intermediate risk
  • VaIN 3: true precursor to vaginal cancer
26
Q

how is vaginal intraepithelial neoplasia (VaIN) diagnosed

A
  • pap smear
  • colposcopy
27
Q

what is the most common cause of invasive vaginal cancer

A
  • metastasis from
    • endometrium
    • ovary
    • cervix
  • only when primary site of growth is from vagina can it be called vaginal cancer
28
Q

what is the most common type of vaginal cancer

A
  • squamous cell
29
Q

pathophysiology of polycystic ovarian syndrome

A
  • abnormal androgen and estrogen metabolism
  • hyperinsulinemia
  • elevated LH (greater LH:FSH ratio)
30
Q

clinical presentation

  • infertility
  • oligomenorrhea/amenorrhea
  • acne
  • hirsuitism
  • acanthosis nigricans
A

polycystic ovarian syndrome

31
Q

US findings of “string of pearls” on ovaries is consistent with

A

polycystic ovarian syndrome

32
Q

what is the initial workup with assessing for polycystic ovarian syndrome

A
  • total testosterone
    • ​if elevated > 60 ng/dl, then further lab evaluation
33
Q

hyperandrogenism requires the following workup

A
  • 17-OH progesterone
    • r/o congential adrenal hyperplasia
  • DHEA-S
    • r/o adrenal source
  • cortisol
    • r/o cushing’s syndrome
  • TSH
  • prolactin
34
Q

treatment for polycystic ovarian syndrome

A
  • weight loss
    • ​will inc SHBG and lower free testosterone
  • metformin only in pts with hyperinsulinemia
  • combination oral contraceptives
35
Q

thick septations > 2mm on ultrasound of an adnexal mass is consistent with a

A

malignant mass

36
Q

solid component that appears nodular or papillary on ultrasound of an adnexal mass is consistent with a

A

malignant mass

37
Q

(+) blood flow to solid component on ultrasound of an adnexal mass is consistent with a

A

malignant mass

38
Q

thin walled mass on ultrasound of an adnexal mass is consistent with a

A

benign mass

39
Q

List the types of ovarian cysts

A
  • follicular cysts
  • corpus luteum cyst
  • theca lutein cyst
  • mature teratoma
  • serous and mucinous cystadenoma
40
Q

what is the most common ovarian cyst? will it go away

A
  • follicular cyst
    • non-malignant
    • regress after 1-2 menstrual cycles
41
Q

follicular cysts result from

A
  1. failure of mature follicle to rupture (release the ovum)
  2. failure of non-dominant follicles to undergo atresia in the presence of the mature follicle
42
Q

how do corpus luteum ovarian cysts develop

A
  • following ovulation, blood accumulates within the cavity of the corpus lutuem.
  • if resorption doesn’t occur and corpus luteum > 3 cm -> cyst
  • usually resolves after 1-2 menstrual cycles
43
Q

how do theca lutein cysts form

A
  • seen with elevated chorionic gonadotropin levels (infertility tx)
  • usually bilaterally
44
Q

mature teratoma are composed of

A
  • well differentiated tissue derived from any of the three germ layers
    • ectodermal germ cell is most common (hair, teeth)
45
Q

ovarian cancer is divided into what 4 major histological types

A
  1. epithelial
  2. germ cell
  3. sex cord and stromal
  4. neoplasms metastatic to ovary
46
Q

What is the incessant ovulation theory of epithelial ovarian cancer

A
  • repeated ovarian epithelial trauma by follicular rupture and subsequent epithelial repair results in malignant transformation
47
Q

explain how and where epithelial ovarian cancer arises in the fallopian tube

A
  • mutant p53
  • distal fallopian tube
48
Q

what is the most common type of ovarian cancer epithelial neoplasm? where does it arises from

A
  • high grade serous carcinoma
  • the fallopian tube
49
Q

germ cell ovarian cancer are most common in what age range?

A

20-30s

50
Q

describe characteristic of germ cell ovarian cancer

A
  • germ cell tumors grow rapidly
  • favor lymphatic spread
  • unilateral
51
Q

Dysgerminoma is the most common germ cell ovarian cancer. Does it usually present unilaterally or bilaterally

A
  • unilateral
52
Q

what are the two acute symptoms of ovarian cancer

A
  • pleural effusion
  • bowel obstruction
53
Q

what lab tests for epithelial ovarian cancer

A
  • CA-125 elevated
54
Q

what labs test for germ cell ovarian cancer

A
  • elevated
    • hCG
    • AFP
    • LDH

women's health exam 2 (3 decks)

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