Uterus

Question 1

Adenomyosis - presentation

Answer 1

1. dysmenorrhea
2. menorrhagia
3. uniformly enlarged, soft, globular uterus

Question 2

Adenomyosis - treatment

Answer 2

• only hysterectomy is definitive treatment

- GnRH agonists

Question 3

adenomyosis - definition / age

Answer 3

• invasion of endometrial glands into the myometrium

- women 35-50

Question 4

adenomyosis - RF

Answer 4

1. endometriosis

2. uterine fibrinoids

Question 5

adenomyosis - diagnosis / physical findings

Answer 5

diagnosis: it is clinical / MRI is the most accurate test. hysteroctomy for definitive diagnosis
examination: large globular and boggy

Question 6

soft and tender uterus - MC?

Answer 6

adenomyosis

Question 7

endometriosis - epidimiology

Answer 7

women in reproductive age and is MORE COMMON if a FIRST DEGREE RELATIVE (mother or sister) has

Question 8

endometriosis - symptoms presentation

Answer 8

cyclic pelvic pain that starts 1 to 2 weeks before menstruation and peaks 1 to days before. The pain end with menstruation.
Abnormal bleeding is common
dysmenorrhea and dyspraeunia are also common

Question 9

endometriosis - physical exam

Answer 9

tenderness of the recto-vaginal area, tenderness withh movement of the uterus, thickening of the uterosacral ligaments caused by endometrial implants on the recto-vaginal septum, pelvic peritoneum, anterior and posterior cul-de-sac, and uterosacral ligaments

Question 10

endometriosis - diagnosis (and appearance)

Answer 10

can be made only by direct visualization via laparoscopy. It looks like rusty or dark brown lesions. On the ovary, a cluster of lesions called an endometrioma looks like a chocolate cyst

Question 11

endometriosis - treatment

Answer 11

1. analgesia (NSAID)
2. OCPs to iterrupt the menstrual cycle and stop ovaluation (mild symptoms)
3. danazole or leuprolide to decrease FSH/LH (moderate to severe pain)
4. surgical treatment (severe symptoms or infertility)

Question 12

Danazole - mechanism of action and SE

Answer 12

androgen derivative that is associated with acne, oily skin, weigh gain, hirsutism

Question 13

surgery on endometriosis - purpose

Answer 13

attempts to remove all endometrial implants and adhesion, and to restore pelvic anatomy. Patients who have completed their childbearing may undergo total abdominal hysterectomy and bilateral salpingo-oophorectomy

Question 14

DDX of dysmenorrhea

Answer 14

1. 1ry desmenorrhea
2. endometriosis
3. fibroids
4. adenomyosis
5. pelvic congestion

Question 15

tenderness and nodularity in theposterior cul-de-sac

Answer 15

endometriosis

Question 16

Dysmenorrhea?

Answer 16

pain with menses

Question 17

Dysmenorrhea - DDX

Answer 17

1. Primary
2. endometriosis
3. Fibroids
4. Adenomyosis
5. pelvic congestion
6. pelvic infection

Question 18

1ry desmenorrhea - treatment

Answer 18

NSAID

Hormonal contraception

Question 19

pelvic congestion syndrome

Answer 19

dull and ill-defined pelvic ache –> worsens prior to menstruation or with long periods of sanding and is relieved by mense
- also it is often associate with history of sexual problems

Question 20

menorrhagia - description

Answer 20

• heavy and prolonged menstrual bleeding (more than 80 ml or more than 7 days)
• Gushing of blood
• clots may be seen

Question 21

menorrhagia - etiology

Answer 21

1. endometrial hyperplasia
2. uterine fibroids
3. Dysfunction uterine bleeding
4. intrauterine device

Question 22

hypomenorrhea - description

Answer 22

• light menstrual flow

- my only have spotting

Question 23

hypomenorrhea - etiology

Answer 23

• obstruction (hymen, cervical stenosis)

- oral contraceptive pills

Question 24

metrorrhagia - description

Answer 24

inter-menstrual bleeding

Question 25

metrorrhagia - etiology

Answer 25

1. endometrial polyps 2. endometrial/cervical cancer 3. exogenous estrogen administration

Question 26

menometrorragia - etiology

Answer 26

1. endometrial polyps 2. endometrial/cervical cancer 3. exogenous estrogen administration

Question 27

oligomenorrhea - description

Answer 27

menstrual cycles smaller than 35 days

Question 28

oligomenorrhea - etiology

Answer 28

1. pregnancy 2. menopause 3. signif weight loss (anorexia) 4. Tumor secreting estrogens

Question 29

abnromal uterine bleeding - diagnostic test

Answer 29

1. CBC (for Hb and Hct) 2. PT/PTT to evaluate for coagulation disorders 3. Pelvic US (for anatomic abnormalities)

Question 30

Dysfunctional uterine bleeding - ovaluation (mechanism)

Answer 30

the ovary produces estrogen but no corpus lateum --> no progesteron --> this prevents the usual withdrawal bleeding --> the continuously high estr continues to stimulate growth of the endometrium --> bleeding occurs only once the endometrium outgrows the blood supply

Question 31

Dysfunctional uterine bleeding - diagnostic tests

Answer 31

1. rule out systemic reasons for anovulation, such as hypothyroid and hyperprolactinemia 2. endometrial biopsy for women over 35 (for CA)

Question 32

Dysfunctional uterine bleeding - treatment

Answer 32

1. OCP: 1. adolescents and young women who are anovulatory 2. Women over 35 who have normal biopsy 2. in acute hemorrhage: Dilation and Curettage is done to stop the bleeding 3. IF SEVERE --> endometrial ablation or hysterectomy

Question 33

Dysfunctional uterine bleeding is severe if

Answer 33

1. patients are anemic 2. hemorrhage are not controled by OCPs 3. patients report that their lifestyle is compromised

Question 34

evaluation of 2ry amenorrhea

Answer 34

amenorrhea for menses for 3 or more cycles or 6 or more months: HCG? positive --> pregnancy negative --> if prior uterine procedure or infection do hysteroscopy, if no, check prolactin, TSH, FSH

Question 35

Leiomyoma (fibrinoid) - pathophysiological characteristic

Answer 35

Estrogen sensitive --> increased tumor size in pregnancy and decreased with menopause

Question 36

Leiomyoma (fibrinoid) - presentation

Answer 36

1. asymptomatic 2. abnormal uterine bleeding 3. miscarriage 4. iron deficiency anemia (if severe bleeding)

Question 37

fibroid - the best imaging modality to diagnose

Answer 37

U/S of pelvis

Question 38

urinary stress incontinence can be a presenting symptom of

Answer 38

fibroids (due to direct pressure on the bladder from an irregularly enlarged uterus)

Question 39

myomectomy - contraindication for labor

Answer 39

if there is uterine cavity entry

Question 40

leiomyoma work-up

Answer 40

leiomyoma work-up

Question 41

anatomic cause of 1ry amneorrhea

Answer 41

imperforate hymen

Question 42

prolapsing leiomyoma

Answer 42

firm smooth round mass at the cervical os consistent with an aborting submucous myoma --> labor like pain due to mechanical cervical dilation

Question 43

fibroids - treatment

Answer 43

asymptomatic: observation symptomatic: OCP, surgery

Question 44

fibroids - clinical features

Answer 44

1. heavy prolonged menses 2. pressure symptoms 3. obstetric complications (impaired fertility, pregnancy loss, preterm labor) 4. enlarged, irregular uterus

Question 45

Endometrial hyperplasia - definition/mechanism/complications

Answer 45

- abnormal endometrial gland proliferation usually caused by excess estrogen stimulation - high risk for endometrial carcinoma - nuclear atypia is greater risk factor than complex (vs simple)

Question 46

Endometrial hyperplasia - presentation

Answer 46

postmenopausal vaginal bleeging

Question 47

Endometrial hyperplasia - risk factors

Answer 47

1. anovulatory cycles 2. hormone replacement therapy 3. polycystic ovarian sydrome 4. granulosa cell tumor

Question 48

endometrial carcinoma - risk factors

Answer 48

1. prolonged use of estrogen without progestins 2. obesity 3. diabetes 4. hypertension 5. nulliparity 6. late menopause 7. Lynch syndrome

Question 49

endometrial biopsy - indications

Answer 49

- 45 or older: abnormal uterine bleeding, postmenopausal bleeding - younger than 45: abnormal uterine bleeding PLUS: unopposed estrogen (obesity, anovulatio) or failed medical management or Lynch syndrome - 35 or older: atypical glandular cells on Pap

Question 50

endometrial hyperplasia / cancer - treatment

Answer 50

hyperplasia: progenstin therapy or hysterectomy cancer: hysterectomy