Penalver USMLE 2 Gynecology Flashcards

Squamous cell carcinoma
Terms Definitions
32 y/o w/R complex adnexal mass
What is the next best step?
1. Exploratory laparotomy
2. R salpingo-oophorectomy
3. Send for frozen section
(if borderline ovarian CA, then resection is curative)
42 y/o w/hx menometrorrhagia
1. Next step?
2. Possible diagnoses and management
1. Endometrial sampling
2. If hyperplasia (cystic, adenomatous, adenocarcinoma), treat with oral progesterone (Provera). If atypical hyperplasia, do hysterectomy.
62 y/o w/vulvar pruritus, white lesion in L labia minora.
1. Next step and likely result?
2. Treatment?
1. Bx, vulvar carcinoma in situ
2. Treat with wide excision, laser therapy, cryotherapy.
62 y/o w/2cm white lesion in L vaginal wall.
1. Next step?
2. Treatment based on likely cause?
1. Biopsy. Result is severe dysplasia of vaginal.
2. This is a precancerous lesion, perform laser removal or cryotherapy.
What do you do for the following PAP smear results:
1. ASCUS
2. HPV
3. Precancerous lesion
1. Repeat PAP in 3-6 months
2. Repeat PAP in 3-6 months
3. Colposcopy w/bx.
What is Meigs syndrome?
1. Benign ovarian tumor (adnexal mass/benign fibroma)
2. Ascites
3. R pleural effusion
What is the most common cancer in women?
Breast cancer
What is the cancer in women with the highest mortality?
Lung Ca
What is the gynecologic cancer with the highest mortality? Why?
Ovarian cancer. It is silent.
What is the most common gynecologic cancer in women?
Endometrial carcinoma.
What is the most common cause of mortality in patients with ovarian carcinoma?
Bowel obstruction.
What is the most common cause of mortality in women?
Heart disease
What are the three most common cancers in females, and what cancers have the highest mortality in women?
Most common cancers: 1. Breast 2. Lung 3. Colon. Highest mortality: 1. Lung 2. Breast 3. Colon.
Cervical cancer:
1. Etiology
2. MC symptom
3. Histology
4. Mortality
1. HPV
2. Post-coital bleeding
3. Squamous cell carcinoma (ectocervix), 15% adenocarcinoma (endocervix)
4. Renal failure
Endometrial cancer:
1. Etiology
2. MC symptom
3. Histology
1. Estrogen
2. Post-menstrual bleeding
3. Adenocarcinoma
Ovarian cancer:
1. Etiology
2. MC symptom
3. Histology
4. Treatment
5. Mortality
1. Ovulation
2. Ascites (be suspicious in a postmenopausal patient w/ascites)
3. #1 Epithelial #2 Germ cell #3 Stromal
4. Debulking surgery (TAH-BSO, Omentectomy), cytoreductive surgery, Carboplatin and Taxol.
5. Bowel obstruction, secondary to seeding.
What are the types of epithelial ovarian cancer, the symptoms, and the tumor marker?
#1: Serous
Then: Mucinous, Endometrioid, Brenner.
Symptom: No pain, picked up in stage 3 due to slow growth.
Tumor marker: CA-125.
Ovarian germ cell cancer:
1. Types
2. Symptoms
3. Tumor markers
1. Dysgerminoma, endodermal sinus tumor, teratoma, choriocarcinoma
2. Pain due to rapid growth. Picked up in stage 1. Teenagers.
3. Dysgerminoma: LDH, Endodermal sinus tumor: alpha fetoprotein, Teratoma, Choriocarcinoma: hCG.
Ovarian stromal cancer
1. Types
2. Tumor markers
1. Sertoli-Leydig cell tumors, or granulosa thecal cell tumor
2. Hormones. Sertoli-Leydig: Testosterone. Granulosa-theca: Estrogen.
Vulvar cancer:
1. Etiology
2. MC symptom
3. Histology
1. HPV
2. Pruritus
3. #1: Squamous cell carcinoma #2: Melanoma (black lesion) #3: Paget's disease (Red lesion)
Vaginal cancer:
1. Etiology
2. MC symptom
3. Causes
1. HPV
2. Bloody vaginal discharge
3. #1: Squamous cell carcinoma #2: Adenocarcinoma (DES exposure causing clear cell carcinoma, or metastasis from cervical carcinoma.
Fallopian tube cancer:
1. Etiology
2. MC symptom
1. Unknown
2. Clear, serous vaginal discharge.
When does PAP screening begin?
18 years of age or onset of sexual intercourse.
At which point can PAP smears be done every 2 years?
If PAP smears are negative for 3 years in a row.
What are the effects of DES?
1. Clear cell carcinoma
2. Structural abnormalities (hypoplastic cervix, t-shaped uterus (increased incidence of miscarriage/ectopics)
3. Adenosis of vagina (columnar cells)
What do the L and R ovarian veins drain into?
L ovarian vein: L renal vein
R ovarian vein: IVC
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