Obgyn Exam 4

Front 1

The MC benign lesion of the uterus is?

Back 1

myomata uteri (fibroids)

Front 2

describe a myoma and where they originate

Back 2

localized proliferation of smooth mm cells, originate in myometrium

Front 3

localized proliferation of smooth mm cells, originate in myometrium

Back 3

myoma / fibroid

Front 4

generally, what are the sx for myomata uteri?

Back 4

sx vary greatly and depend on size, number and location. May be asymptomatic!

Front 5

what is the MC characteristic of fibroids?

Back 5

abnormal menstrual bleeding

Front 6

what are the sx of myomata uteri?

Back 6

1. abnormal bleeding (MC)
2. Pain (from torsion)
3. Pressure (urinary and bowel problems)
4. GI sx (constipation, tinismus)
5. Bladder sx (frequency, urgency, incontinence
6. Reproductive disorders (infertility, abortion, premature labor)
7. Misc. (fatigue)

Front 7

describe what a myoma feel like upon abdominal exam?

Back 7

smooth, irregular, nodular protruding against anterior abdominal wall. Its firm upon papation

Front 8

what will you find on pelvic examination with a myoma?

Back 8

uterine enlargment MC finding
assymetrical and irregular outline

Front 9

what test would we use to dx myoma?

Back 9

If abnormal bleeding would consider endometrium bx but for the most part just use pelvic, vaginal US (transvaginal)

Front 10

what is the treatment for myoma?

Back 10

depends on the patient and the size of the tumor and whether or not there are sx.

1. expectant
2. medical
3. surgical

Front 11

WHen deciding how to manage myoma we should consider what factors?

Back 11

depends on myoma size, location, number of tumors present, rate of growth, patient age, associated sx, desire for fertility

Front 12

how to GnRH agonist work?

Back 12

by creating a state of estrogen deficiency. suppress gonadtropin secretion and create pseudo menopause

Front 13

what is the main medical treatment do we use for myomas?

Back 13

Use GnRH agonist first. they will suppress the amount of gonadotropins in the body (after a few days, they cause down regulation of receptors) and therefore decrease estrogen. thus decreasing the size of the tumors. however, need to continue medication or else tumors will grow again. don't want young people on this because loss of bone. use fosomax to protect bone density

Front 14

what are medical treatment options for myomas?

Back 14

1. GnRH agonist
2. Danazol - inhibits pituitary from releasing LH/FSH. (bad SE, dont use
3. NSAIDs for menorrhagia not fibroids
4. progesterone derivatives - to control abnormalbleeding no change in fibroids
5. anti-estrogens
6. iron supplements (bleeding may cause anemia)

Front 15

if surgery is indicated and the patietn's childbearing years are complete what is the surgery of choice for myoma?

Back 15

hysterectomy - keep ovaries intact if 40-45 yo. eliminates all risk of recurrence

Front 16

what must you do prior to hysterectomy?

Back 16

curettage of endometrial cavity to r/o pathology, especially endometrial neoplasia

Front 17

surgery for myoma is indicated when uterus is what size?

Back 17

12-week gestation size.

Front 18

this surgical procedure for myoma is usually reserved for women who want to get pregnant

Back 18

myomectomy

Front 19

removal of single or multiple myomas while preserving uterus is known as?

Back 19

myomectomy

Front 20

what is the MC type of myomectomy?

Back 20

laparotomy -- delay pregnancy 6 mo after

Front 21

with this myoma surgery the uterus is preserved for submucosal fibroids <5cm. and you can attempt to conceive one month after surgery! and can deliver vaginally.

Back 21

Hysteroscopic myomectomy

Front 22

what myoma surgery is limited to subserosal myomata and preserves the uterus

Back 22

laparoscopic myomectomy

Front 23

what is the newest type of surgery used for treatment of fibroids?

Back 23

uterine artery embolization

Front 24

what artery is catheterized in uterine artery embolization

Back 24

femoral artery, dye is injected. this halts blood flow to fibroids and they shrink. repeated in contralateral side. minimally invasive. no general anesthesia needed.

Front 25

malaise, postop pain, fever, leukocytosis, groin hematoma, N, infection lasts 4-5 days is known as?

Back 25

postembolization syndrome

Front 26

what is ExAblate 2000?

Back 26

relatively new FDA approved device that uses MRI guided US bems to destroy fibroids

Front 27

what is the MC benign lesion of the lining of the uterus?

Back 27

endometrial polyps

Front 28

if undiagnosed or untreated endometrial polyps can lead to?

Back 28

adenomatous hyperplasia and ultimately endometrial cancer

Front 29

what is another name for prolapse of the uterus?

Back 29

Procidentia

Front 30

this condtion is childbirth related and involved the endopelvic fascia being damaged during childbirth

Back 30

prolapse of the uterus

Front 31

What fascia is damaged during childbirth and creates a hernia through the vagina?

Back 31

endopelvic -- prolapse of the uterus

Front 32

what are the 3 types of uterine prolapse?

Back 32

first degree is when the uterus protrudes to mid vagina
2nd degree the uterus protrudes to introitus
3rd degree the uterus is outside the vagina

Front 33

uterine prolapse usually pulls on other organs such as the bladder and the rectum leading to what?

Back 33

Rectocele, Eneterocele, Cystoceles (may or may not be associated with urinary incontinence)

Front 34

what are tx options for uterine prolapse?

Back 34

non surgical - exercises, pessaries
surgical - hysterectomy, supportive slings, occlusion of vagina (sew it up), plastic surgery repairs

Front 35

what is the MC benign growth of the cervix?

Back 35

cervical polpys

Front 36

what is the MC symptom of cervical polyps?

Back 36

postcoital bleeding

also intermenstrual bleeding, leukorrhea, asymptomatic

Front 37

what is the MC ovarian tumor found during pregnancy?

Back 37

teratoma "ovarian dermoid cyst"

Front 38

what are the 3 layers in a teratoma?

Back 38

ectoderm, endoderm and mesoderm

Front 39

what is another name for ovarian dermoid cyst?

Back 39

teratoma
unborn twin

Front 40

screening mamommagraphy for women involved which views?

Back 40

craniocaudal view and mediolateral oblique view

Front 41

at what age do we begin screening women with mammograms?

Back 41

40 yo

Front 42

do women with breast implants need regular mamographic screening?

Back 42

yes

Front 43

what is a common finding on mammogram (usually benign, 20% indicator of cancer)

Back 43

calcifications

Front 44

what is the MC imaging study used after mammogram?

Back 44

Ultrasound

Front 45

what is the main advantage of ultrasound in assessing breast mass?

Back 45

tells us if its solid or cystic

Front 46

MRI is a becoming more popular for mammography. is it more sensitive or specific or both than mammography?

Back 46

its more sensitive but less specific

Front 47

_______ are the MC anomaly found on clinical and self-exam

Back 47

breast lumps

most are benign but all need evaluation

Front 48

describe a breast lump that is suspicious for cancer?

Back 48

unilateral, non-tender, fixed

Front 49

what are skin changes requiring imaging?

Back 49

1. peau d' orange
2. erythematous
3. scaly red patches
4. bloody unilateral, persistant or spontanious nipple discharge

Front 50

what is the breast imaging report and data systems called that interprets breast imagine?

Back 50

BI-RADS

Front 51

describe the 5 ratings of the BI-RAD system

Back 51

1. normal
2. finding -benign
3. finding -probably benign but follow-up recommended
4. Intermediate abnormality -- surgeon for bx
5. probably cancer

Front 52

what are the essentials of dx of fibrocystic breast disease?

Back 52

1. Painful, often multi, usually bilateral masses
2. rapid fluctutation in size common
3. frequently larger and more painful pre menses
4. most common in 30-50 yo not seen in post-menopausal women

Front 53

what are other names for fibrocystic disease?

Back 53

mammary dysplasia, fibrocystic dz, chronic cystic mastitis

Front 54

What is the MC benign condition of the breast?

Back 54

fibrocystic dz, chronic cystic mastitis, mammary dysplasia, fibrocystic dz

Front 55

what features are most helpful in differentiating fibrocystic disease from carcinoma?

Back 55

1. pain
2. multiplicity
3. fluctuation in size

Front 56

do we biopsy any fibrocystic breast disease masses?

Back 56

yes, the dominant one

Front 57

what is the MC benign neoplasm of the breast?

Back 57

Fibroadenoma of the breast

Front 58

who usually gets fibroadenomas?
fibrocystic breast dz?

Back 58

12-25
30-50

Front 59

In doing a fine needle aspiration of the most dominant cyst of fibrocystic breast disease discuss what happens if no fluid, bloody fluid or if the mass persists

Back 59

biopsy should then be performed

Front 60

when might we see mouse tumors?

Back 60

fibroadenoma of the breast

Front 61

diffuse, usually non-tender, ill-defined

Back 61

lipoma

Front 62

solitary, tender, ill-defined mass +/- skin retractions

Back 62

fat necrosis

Front 63

round, firm, non-tender, relatively moveable

Back 63

fibroadenoma

Front 64

non-tender ill defined

Back 64

lipoma

Front 65

non-tender, discrete

Back 65

fibroadenoma

Front 66

what is the MC cancer in women?
what is the MC death causing cancer in women?

Back 66

breast cancer
lung cancer

we treat and cure breast!

Front 67

breast cancer is the #_____ cause of cancer death in women

Back 67

2 after lung cancer

Front 68

USPSTF recommends screening mammography for whom?

Back 68

women over 40 years old every 1-2 years

Front 69

who have the greatest risk for BRCA-1 gene? what is their lifetime risk of breast cancer?

Back 69

Ashkenazi, caucasian, or eastern European jewish decent
87%!!!!

Front 70

are abortions and abx related to increased breast cancer?

Back 70

NO

Front 71

what four factors were listed under epidemiology of breasat cancer?

Back 71

1. fatty foods
2. alcohol
3. smoking
4. estrogen

Front 72

what are non-modifiable risk factors for breast cancer?

Back 72

FAR H2 MM GABPI
Female
Age
Race/ethnicity
Hx -family
Hx - personal
Menopause >55
Menarche <12
Genetic factors
Abnormal breast bx
Benign proliferative breast dz
Previous chest wall irradiation

Front 73

what are modifiable risk factors for breast cancer?

Back 73

NBO, N-BO, PATS
Nulliparity
No birth of child >30
Not breast feeding
Obesity
OCP's
Prolonged post-menopausal HRT
ETOH
Tobacco
Sedentary lifestyle

Front 74

most common breast cancer is?

Back 74

infiltrating ductal carcinoma IDC

Front 75

most aggressive type of breast cancer?

Back 75

Inflammatory breast cancer IBC

Front 76

Early, later, or LATE finding
a. retraction
b. edema of arm
c. non-tender, firm to hard mass
d. fixaton of mass to skin or chest wall

Back 76

a. later
b. LATE
c. early
d. later

Front 77

Early, later or LATE finding

axillary lymphadenopathy

Back 77

later

Front 78

Early, later or LATE finding
breast enlargement, edema redness, pain

Back 78

later

Front 79

Early, later or LATE finding?
ulceration

Back 79

LATE

Front 80

Early, later or LATE finding

supraclavicular lymphadenopathy

Back 80

LATE

Front 81

Early, later or LATE finding

fixation of mass to skin or chest wall

Back 81

later

Front 82

how common is Paget's disease?

Back 82

NOT common 1% of all breast cancer

Front 83

what kind of cancer is paget's disease?

Back 83

ductal cancer in excretory ducts out to skin through nipple

Front 84

what is the first sx of paget's disease?

Back 84

often itching or bruning of nipple with superficial erosion or ulceration. red scaly lesion of nipple/areola

Front 85

How do we dx paget's disease?

Back 85

biopsy of the erosion

Front 86

what is paget's dz frequently misdx as?

Back 86

dermatits or bacterial infection. leads to dleay in detection.