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Spring Round II Exams > WH- Vulvar/Ovarian > Flashcards

WH- Vulvar/Ovarian Flashcards

1
Q

EPITHELIAL ovarian CA

A

elevated CA-125
Bilateral
Older age

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2
Q

GERM cell ovarian CA

A

elevated hcg, AFP, LDH
Unilateral
Younger women

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3
Q

Pruritis

Usually POST menopausal

A

Lichen Schlerosus

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4
Q

if d/t trauma: Kobners phenomenom

sharp, well demarcated plaques

A

Lichen Schlerosus

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5
Q

Cellophane paper is pathognomic for

A

Lichen Schlerosus

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6
Q

Fragility (purpura, erosions, fissures) are hallmark for

A

Lichen Schlerosus

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7
Q

5% risk of Vulvar CA if left untreated bc Hyperkeratotic lesions can be PreCA

A

Lichen Schlerosus

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8
Q

Tx for Lichen Schlerosus

A

Ultrapotent Steroid ointment: Temovate

and Topical Estrogen

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9
Q

Bartholin Cyst

4 and 8oclock

A

1-3 cm
Unilateral acute pain

d/t ductal obstruction

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10
Q

Tx is I and D and insert Word catheter

Culture definitely if POST menopausal bc concerned about CA

A

Bartholin cyst

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11
Q

Empiric tx for Bartholin cyst

A

Keflex or
Doxy

and Sitz bath

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12
Q

Burning
Stinging

Pt is frustrated, hard to treat

A

Vulvodynia

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13
Q

Vulvodynia (burning) tends to occur in what age

A

Peri or Post menopausal

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14
Q

Associations w Vulvodynia

A

Estrogen
Pelvic floor dysfx
Mood/anxiety disorder
Neuro sensitive

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15
Q

Pain is triggered in the Vestibule for what disorder

Q tip test

A

Vulvodynia

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16
Q

Tx options for Vulvodynia (all over the place)

A

Avoid triggers (scents, tight clothes, vigorous exercise)

Sitz bath
Couples counseling
Topical vaginal estrogen w/Testosterone
Pelvic floor Physical Therapy
Nortriptyline
Gabapentin
Local nerve block
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17
Q

Vulvar Intraepithelial Neoplasia (VIN)

A

vinU: usual. younger

VinD: diff. older women

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18
Q

Vin 1 is likely to

A

resolve on its own

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19
Q

Vin U

mostly asymptomatic

A

ALWAYS associated with HPV

Younger women

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20
Q

Vin U

A

Risk factors: smoking, immunosupp, many sex partners

Dx: Vulvar Colposcopy

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21
Q

Vin U tx

A

Surgery is standard of care

Co2 laser- not if invasion is expected, Wide excision, Vulvectomy

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22
Q

Vin U tx

Med options (off label)

A

5FU
Imiquimod (Aldara)cream **
Interferon

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23
Q

What to consider with Vin U and Vin D

A

Vaccinate with Gardisil!!! up to age 45

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24
Q

Vin D

Not related to HPV

A

Lower 1/3 epithelium

Older women who previously had Lichen (untreate)

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25
Q

Vin D etiology

A

Undiff Carcinogenic agents combined w environment (ie chronically irritated)

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26
Q

Tx for Vin D

A

Handle underlying condition

Surgical excision-mainstay tx

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27
Q

4th most common GYN CA

A

Vulvar CA

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28
Q

Vulvar CA sx

A

usually none

if any: Prutitis

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29
Q

Vulvar CA is uncommon

A

10% have underlying DM

50% are obese/HTN

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30
Q

Bimodal peak of Vulvar CA

A

younger 20-40 (vinU related)

older 60-70 (vinD related)

31
Q

Vulvar CA can present many diff ways

squamous, basal, malignant melanome

A

cauliflower
ulcers
rolled border
raised, dark lesion

32
Q

Tx for Vulvar CA

A

Complete surgical removal with Inguinal node dissection

radiation if lymph spread

33
Q

VIN

A

vulvar neoplasia

34
Q

VAIN

A

vaginal neoplasia

35
Q

VAIN

HPV must be present

A

upper 1/3 of vagina

extremely rare

35-55 YO

36
Q

Dx of VAIN

A

Pap smear

Colposcopy

37
Q

Tx of VAIN

A

type 1: observe

type 2/3: Surgical vs Chemo (vaginectomy, laser, topical 5FU/chemo)

38
Q

If someone has VAIN, likely

A

pre-existing or coexisting squamous CA of vulva or cervix

39
Q

VAIN takes longer to develop (HPV must be present) because

A

the vaginal tissue is different and HPV prefers the cervix

40
Q

Vaginal CA usually arises from

A

METs

from: endometrium, breast, or cervix

can only be called Vaginal CA if this is the primary site

41
Q

Vaginal CA

A

abnormal d/c (leukorrhea)
vaginal odor
post coital bleed

Acetowhite changes
Punctation

42
Q

Tx of Vaginal CA

A

no standard since its so rare

Combined Vaginectomy and Radiation

43
Q

Most common type of Vaginal CA

A

Squamous cell

44
Q

PCOS

A 
Infertility
Oligo/Amenorrhea
Acne
Hirsutism
Acanthosis nigricans
45
Q

PCOS

A

Hyperinsulinemia

46
Q

The following must be present to dx PCOS

A

Oligomenorrhea
High androgen
(+ polycystic ovaries as well for Rotterdam criteria)

47
Q

Following must be excluded when dx PCOS

A

Hyperprolactin
CAH (congenital)
Cushings

48
Q

What to start w when testing for PCOS

A

Testosterone

if normal: dx confirmed
if elevated: need to r/o other causes

49
Q

US shows String of pearls

A

PCOS

50
Q

Tx for PCOS

A

Weight loss!!!
Metformin
Birth control-COC
Provera (if dont want birth control, this is Prog to protect uterus)

51
Q

NIH and

Rotterdam

A

criteria for PCOS

52
Q

Concerning signs of CA in Adnexal Masses

A

Solid part looks Nodular or Papillary

Thick septation

Blood flow to solid part

53
Q

Signs that Adnexal mass is prob BENIGN

A 
thin walled
<3 cm if pre meno
<1 cm if post meno
hyperechoic w distal shadowing (teratoma)
curvilinear pattern (hemorrhagic cyst)
homogenous echo
54
Q

Most common type of ovarian cyst

A

Follicular

failure to release ovum or failure of leftover part to break down

regresses after 1-2 cycles

55
Q

Corpus luteum cyst

A

Just blood if the extra blood doesnt resorb after ovulation and corpus luteum is >3cm, considered cyst

regresses after 1-2 cycles

56
Q

Theca Lutein cyst

A

Bilateral

Usually seen during infertility tx when ovary is being Hyperstimulated

57
Q

Fluid is clear and straw colored in what type of ovarian cyst

A

Theca Lutein

58
Q

Originate from primordial germ cells

Unilateral

arise from Ectoderm usually

Unilateral, hypoechoic

A

Mature teratoma

59
Q

Gel like mucous

Mucinous>serous

women 30-50 YO

can look bad on US, need to remove to be sure its Benign AND to avoid torsion

A

Serous/Mucinous Cystadenoma in the ovary

60
Q

Tx of Serous/Mucinous cystadenoma

A

Surgical excision

61
Q

2nd most common GYN CA

A

Ovarian CA

62
Q

Highest incidence of Ovarian CA is age

A

65-75

63
Q

Risk factors of Ovarian CA

A

Basically having menses for longer

Nulliparity
Early menses
Late menopause

64
Q

Ovarian CA sx

A

Acute sx:
Pleural effusion
Bowel obstruction

Subacute:
Adenxal mass
Bloating
Abd distension
Early satiety
Abn vaginal bleed
Altered bowel habit
65
Q

Dx of Ovarian CA

A

Transabdominal/Vaginal US

66
Q

Epithelial ovarian CA

A

CA-125 marker

67
Q

Germ Cell ovarian CA

A

hCG
AFP
LDH

68
Q

Tx of Ovarian CA

A

Bilateral tubal ligation
Low fat diet
Bilateral salpingectomy

69
Q

Most common type of Ovarian CA

A

Epithelial: High grade serous

70
Q

Epithelial CA

A

Older age

Bilateral

71
Q

High grade serous CA

A

p53 gene
Fallopian tube
CA starting here

72
Q

Germ cell CA

A

Younger age

Unilateral

73
Q

Germ Cell Ca

A

grow RAPIDLY
lymph spread
YOUNG women- 20-30 YO

hCG, AFP, LDH

74
Q

Sex cord and Stromal ovarian CA

A

Granulosa cell (most common) causes Hyperestrogen –> precocious puberty or Post meno bleeding

Spring Round II Exams (10 decks)

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