Week 4 pt 1 highlights Flashcards
Examination of the cervix using a microscope to identify cervical, vaginal and vulvar pathology is called what?
Colposcopy
What is a LEEP Biopsy (Loop Electrosurgical Excisional Biopsy)?
Removes section of cervix for biopsy
Colposcopy: the cervix is washed with a 3% to 4% _________________ solution, which dehydrates cells, causing those with large nuclei (i.e., those undergoing metaplasia, potential neoplastic change, or HPV infection) to appear ___________ .
acetic acid; white
Colposcopy: Lesions usually appear with relatively discrete borders near the _________ within 10 to 90 seconds of acetic acid application. Tissue samples for biopsy can be collected
SCJ
Cone biopsy of cervix:
1) Abnormal changes in the cells on the surface of the cervix is calledwhat?
2) Usually performed under what?
1) cervical dysplasia.
2) general or regional anesthesia.
Potential D&C findings:
1) A precancerous condition in which the uterine lining becomes too thick is called what?
2) What are 2 other potential findings?
1) Endometrial intraepithelial hyperplasia
2) Uterine polyps or uterine cancer
What is the only absolute contraindication to D&C?
A desired viable pregnancy
List the 3 types of hysterectomy and specify which is most common
1) Total (leaves ovaries; most common)
2) Hysterectomy with oophorectomy
3) Radical hysterectomy
HSG (hysterosalpingography): Radiographically (xray procedure) evaluates the patency/shape of the uterus and _______________
fallopian tubes
What is the most common indication for the use of laparoscope in gyn?
Tubal sterilization
Pelvic ultrasounds can be performed 3 ways; list them
1) Transabdominal
2) Transrectal
3) Transvaginal (TVUS)
There are two types of hydatidiform mole, what are they?
1) Complete
2) Partial
What do trophoblasts develop into?
A large part of the placenta
True or false: complete & incomplete hydatidiform moles are always non-cancerous
True
Recite the Gestational Trophoblastic Disease flow chart
(important)
The most common form of GTD is called what?
Hydatidiform mole (molar pregnancy)
A _____________ hydatidiform mole develops when a sperm fertilizes an “empty” egg (contains no nucleus or DNA).
complete
Complete hydatidiform mole:
1) All genetic material comes from the ___________ sperm SO _____ fetal tissue.
2) Usually _______ karyotype
1) father’s; no
2) 46,XX
Complete hydatidiform mole: 15-20% may transform into what?
Choriocarcinoma, a malignant form of GTD.
GDT complete mole
1) What does all material come from? Is there fetal tissue?
2) What is the karyotype?
1) Father’s sperm SO no fetal tissue.
2) Usually 46,XX karyotype
A _____________ hydatidiform mole develops when two sperm fertilize a normal egg.
partial
GTD: Partial Mole
1) Is there fetal tissue?
2) Is there are viable fetus being formed?
3) Are they malignant?
1) Some fetal tissue.
2) RARE that a viable fetus is being formed.
3) Partial moles rarely develop into malignant GTD.
True or false: partial moles rarely develop into malignant GTD.
True
True or false: With partial moles, it is RARE that a viable fetus is being formed.
True
What type of mole contains some fetal tissue?
A partial hydatidiform mole
Molar pregnancy: Symptoms
1) Almost all women (97%) with _____________ hydatidiform moles have irregular vaginal bleeding during pregnancy.
2) Bleeding typically starts during the first trimester, often between the ______ and the ________ week of pregnancy.
3) Occasionally, pass pieces of the moles resembling what?
1) complete
2) 6th and the 16th
3) Bunch of grapes (or a snowstorm)
Molar pregnancy: List some symptoms other than bleeding
1) Abdominal swelling
2) Vomiting
3) Painless 1st-2nd trimester bleeding
4) Preeclampsia (HTN, proteinuria, possible hyperreflexia)
5) Potentially signs of metastasis
1) What is different about preeclampsia in a molar pregnancy?
2) Severe HTN before 20 weeks is suggestive of what?
1) Can occur during the first or second trimester
2) Molar pregnancy
Molar Pregnancy/ GTD: Work-Up should include what? Describe each part
1) Urine hCG +
2) Quantitative hCG: excessively elevated for gestational age
3) Transvaginal Ultrasound (TVUS): “bunch of grapes” or “snowstorm” appearance
4) Baseline CXR to check for mets
5) CBC, T&S, clotting function studies
What is the main Tx for molar pregnancy?
Prompt evacuation of the uterine contents via D&C or hysterectomy
Molar pregnancy/ GTD Tx: After Tx, you should monitor weekly ______ hCG levels to make sure levels fall to _______(may take 6 months) then monthly for at least a _______.
serum; zero; year
Molar pregnancy/ GTD Tx:
1) What should you provide to pts who are Rh negative?
2) What should you provide to all pts?
3) What should you do if levels plateau or rise after falling?
1) Rh immunoglobulin.
2) Reliable contraceptive method
3) Chemotherapy (high cure rates)
GTD/ molar pregnancy Tx: When is Hysterectomy +/- chemo an option?
If not interested in preserving fertility
___________ GTD is a locally invasive tumor of the myometrium.
Invasive
True or false: Invasive GTD category includes GTD not cured by D&C.
True
~150-200/1000 cases of ______________ molar pregnancy develop trophoblastic disease that keeps growing after the mole is removed (20%)
complete
~50/1000 cases of ___________ molar pregnancy develop trophoblastic disease (5%)
partial
*Persistent (or invasive) mole diagnosed if what?
Quant hCG decreases but then levels off or starts to rise again (never gets to zero)
What cancerous form of GTD is NOT sensitive to chemo and must be completely removed by surgery?
Trophoblastic Tumor (aka Placental Site Tumor)
If you have a concern about persistent GTD, your first step should be what?
to order a quant hCG
Risks for Persistent GTD: List 3 risks
1) Long time (more than 4 months) between the time menses stopped and treatment started
2) Woman > 40yo and < 21yo
3) Fam Hx of GTD (possible genetic component?)
What form of GTD secretes very small amounts of hCG so better followed by human placental lactogen levels?
Trophoblastic Tumor(aka Placental Site Tumor)
Persistent GTD: What are the 2 steps of Dx & Treatment?
1) Reexamination
2) Chemotherapy
Nonmetastatic persistent GTD treated by _______________ chemotherapy (i.e., methotrexate)
single-agent
A malignant form of GTD is called what?
Choriocarcinoma
Choriocarcinoma:
1) Is it common?
2) What does it most often develop from?
3) When can it also occur?
4) What is more common in this condition?
1) Rare
2) Complete hydatidiform mole
3) Normal pregnancy or one where the fetus is lost early in pregnancy.
4) Metastasis
True or false: Choriocarcinoma is usually not diagnosed promptly
True
Choriocarcinoma:
1) Where can it occur? Is it aggressive?
2) What is the issue with this cancer?
3) What will indicate the Dx?
4) What pt should be evaluated with hCG testing to exclude a new pregnancy or GTN?
1) Anywhere in the body and is a very aggressive cancer.
2) Very invasive and destroys the tissue; bleeds profusely.
3) A simple pregnancy test that is positive after d&c or without visible pregnancy
4) Abnormal bleeding for more than 6 weeks after any pregnancy
What should you evaluate for with choriocarcinomas?
Metastasis
True or false: Choriocarcinoma is highly sensitive to chemotherapy
True
1) What is the rare form of GTD that develops where the placenta attaches to the uterus called?
2) When does it usually develop?
3) Do most of these spread?
1) Trophoblastic Tumor(aka Placental Site Tumor)
2) A normal pregnancy or spontaneous abortion (miscarriage).
3) No
