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Women's Health EOR exam 2023/ 199 Questions and Answers / Latest Update /Graded A+
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Women's Health EOR exam 2023/ 199 Questionsand Answers / Latest Update /Graded A+
In reproductive age _____% of neoplasms are benign - -90% ---risk increases with age
-Most common benign ovarian neoplasm - -dermoid cystic teratomas
-Reasons to remove a benign cysts - -risk of torsion or malignant transformation
-Most common gynecological cancer - -endometrial
-Second most common gynecological cancer - -ovarian
-Highest mortality of all gynecological cancers - -ovarian
-Risk factors - -*fam hx = 7% lifetime risk*
- increased # of ovulatory cycles (infertility, nulliparity, >50y, late menopause)
- BRCA1/BRCA-2
- Peutz-Jehgers
- Turner's syndrome
-Peutz-Jehgers - -Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited
disorder characterized by intestinal hamartomatous polyps in association with a distinct
pattern of skin and mucosal macular melanin deposition. Patients with Peutz-Jeghers
syndrome have a 15-fold increased risk of developing intestinal cancer compared with
the general population.
-Protective factors against ovarian CA - -- OCP's
- high parity
- total abdominal hysterectomy
-Clinical Manifestations - -- *rarely symptomatic until late in the stage--mets*
- 40-60yo
- abdominal fullness/distention
- back or abdominal pain
- early satiety
- urinary frequency
- irregular menses
- menorhagia
- postmenopausal bleeding
- constipation (from intestinal compression)
-PE on Ovarian CA - -- palpable abdominal or ovarian mass (solid, fixed, irregular *+/-
ascites*
- sister mary joseph's node: mets the umbilical lymph nodes
,-sister mary joseph's node - -
-Diagnosis: biopsy findings - -- 90% epithelial
- germ cell in <30yo
- transvaginal u/s useful screening in high-risk patients
- mammography to look for primary in breast
-Management of ovarian CA - -- total hysterectomy + BSO + selective
lymphadenectomy
- surger: tumor debulking. *Serum CA-125 levels used to monitor treatment*
- chemo: *paclitaxel (Taxol) + Cisplatin or Carboplatin.
-3 elements of PCOS - -- ammenhoria (anovulation)
- obesity
- hirstuisism (androgen excess)
-PCOS is due to - -insulin resistance
- exact mechanism unknown but abnormal function of hypothalamus-pituitary-ovarian
axis leads to inc insulin, increase LH-driven, increase in ovarian androgen production
-Clinical manifestations of PCOS - -- menstrual irregularity (secondary amenorrhea or
oligomenorrhea)
- increase androgens: hirsutis,
- insulin resistance: Type II DM, obesity, HTN
-Physical Exam of PCOS - -- bilateral enlarged, smooth, mobile ovaries on bimanual
- acanthosis nigricans
-PCOS LH to FSH ratio - -> 3 to 1 (normally 1.5 to 1)
-What to exclude when suspecting PCOS - -- thyroid
- pituitary adenoma (prolactin levels)
- ovarian tumors
- cushing's syndrome (dexamethasone suppression test)
-Lab findings in PCOS - -- incr testosterone
- incr DHEA-S (intermediate of testosterone)
-Diagnosis of PCOS tests - -- GnRH agonist stimulation test: rise in serum
hydroxyprogesterone
- lipid panel (to check for insulin resistance)
- glucose tolerance test (DM)
-PCOS pelvis US classic findings - -bilateral ovararies with peripheral cysts "string of
pearls"
-Mainstay of treatment for PCOS - -combination OCP's
, - normalize bleeding
- stimulates hepatic production of sex horomone binding globulin, reducing androgen
levels
- progesterone decreases action of testosterone at target organisms by antagonism
- *avoid norgestrel or levongestrel* (androgenic progesterone)
-Anti-androgenic agent for hirsutism - -spironolactone (which is teratrogenic)
- added if symptoms persist after OCP's
*other options: leuprolide, finasteride*
-This drug may improve menstrual frequency by reducing insulin with abnormal
LH:FSG ratios. - -Metformin
-Selective estrogen receptor modulator used for infertility - -clomiphene (reestablishes
ovulation)
- abnormal LH:FSH ratios may improve menstrual frequency by reducing insulin
-Surgical options for PCOS - -wedge resection can restore ovulation in patients where
clomiphene is not working
-complications of PCOS - -- incr risk for infertility
- incr endometrial hyperplasia & endometrial carcinoma (due to unopposed estrogen)
- insulin resistance = incr risk of atherosclerosis & HTN
-3rd most common gynecological CA - -- cervical (HPV 16,18 & 31&33, 45, 52, 58)
-Avg age of cervical CA dx - -45
-Most common mets of cervical CA - -locally:
- vagina
- parametrium
- pelvic lymphnodes
-Risk factors for cervical CA - -- early onset of sex activity
- # of partners
- smoking
- CIN
- DES exposure (synthetic estrogen used in OCP's)
- immunosuppression
- STD's
-Most common types of cercical CA - -- squamous: 90%
- adenocarcinoma: 10%
-Lymphogranuloma venerium - -Lymphogranuloma venereum is a sexually
transmitted disease caused by Chlamydia trachomatis subtypes L1, L2, and L3. It is rare
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