婦產科 - 婦

53 flashcards · Other · by Wanying Koh

1. ovarian germ cell tumor most common of all germ cell tumors most common malignant second most common malignant

   teratoma (aka mature cystic teratoma / dermoid cyst) - benign dysgerminoma yolk-sac tumor

2. ovarian sex-cord stromal tumor most common malignant most common benign

   granulosa cell tumor fibroma

3. RF of ovarian ca nulliparity 1st degree relative w ovarian ca oral contraceptives prior hx of ovarian ca

   all are risk factors except : oral contraceptives --> protective factor

4. most common ovarian tumors

   epithelial tumors

5. ovarian cancer tx

   staging surgery (see how far the ca has spread: 切除構造 ovaries, fallopian tube, uterus, omentum, LN + debulking surgery remove as much of the tumor as possible + adjuvant chemo

6. 43 yo patient w CA-199 increase Dx

   mature teratoma / dermoid cyst (CA 19–9 can be increased in benign ovarian cysts

7. ovarian tumor 特性 call-Exner bodies coffee-bean grooved nuclei associated w endometrial hyperplasia/ca inc of testosterone and virilization bilateral secretes estrogen 排列成 clusters/rosette， like primordial follicles

   granulosa cell tumor '' '' sertoli-leydig cell dysgerminoma (granulosa cell tumor - mostly unilateral granulosa cell tumor ''

8. 65yo female, asymptomatic calcifications under xray Dx

   popcorn calcifications --> Dx: uterine myoma

9. diagnostic tools for endometrial lesions most accurate

   endometrial aspiration biopsy - 會遺漏病灶 hysteroscopy-guided biopsy - most accurate dilation and curettage - most accurate

10. 34yo F irregular mensus abnormal vaginal bleeding for 1/2 a year obesity U/S: uterus size larger than normal, endometrium wall thickened next step of diagnostic tool possible dx

    Risk factors present for endometrial hyperplasia/Ca (chronic anovulation/mensus irregular, obesity) --> need endometrial biopsy need to suspect endometrial ca, endometrial hyperplasia, myoma endometriosis / adenomyosis NOT LIKELY --> causes uterine muscle hyperplasia, not endometrial wall thickening

11. endometrial ca FIGO staging ? no LN meta no cervical stroma invasion invasion into uterine myometrium ------ no LN meta myometrium invasion to 1/2

    stage 1 stage 1a

12. which of the following is not a risk factor of endometrial ca obesity early first mensus late menopause oral contraceptive pills

    oral contraceptive pills 是protective factor 應該是 unopposed estrogen 為 RF

13. which pts suitable for HPV vaccine 25yo w 5 sexual partners 12yo 46yo cervical ca pt 23yo w CIN1 patho

    all suitable except pts w confirmed cervical ca

14. factors that increase risk for recurrence in cervical ca

    positive or close margins microscopic parametrial involvement positive LN (NOT large tumor size 這為次要)

15. cervical ca rx for different staging （開刀那些stages）

    IA - IIA: OP IB2 - IIA2 tumor size too big: CCRT IIB - IVA: CCRT IVA: exenteration 骨盆腔器官刨除術 IVB: chemo / RT / palliative

16. cervical ca + hydronephrosis staging

    IIIB （endometrial ca hydronephrosis - stage IV)

17. vaginal ca most commonly found at ? upper or lower third posterior or anterior

    upper 1/3 posterior

18. vaginal ca common s/s vaginal bleeding vaginal secretions vaginal mass vaginal pain

    all except vaginal pain 不會疼痛！

19. gestational trophoblastic disease w brain meta rx

    chemo EMA-CO + brain irradiation

20. which hydatidiform mole type: karyotype 46,XX or 46,XY villous scalloping, and stromal trophoblastic inclusions

    complete hydatidiform mole partial

21. benign or malignant hydatidiform mole invasive mole placental site trophoblastic tumor

    benign (possible malignant change_會變成 invasive mole/choriocarcinoma) malignant malignant

22. tx for stage I placental site trophoblastic tumor

    total hysterectomy (no need chemo)

23. mullerian agenesis pts 是否會有 endometriosis mechanism？

    yes coelomic metaplasia of 體腔上皮細胞

24. adenomyosis define s/s tx

    endometriosis that invades uterus myometrium 月經量過多，經痛 OCPs, progesterone, GnRH agonist, aromatase inhibitors

25. which implantation rates are higher: IVF or IUI what infertility reason causes lower IVF implantation rates than others endometriosis 應該利用short or long IVF protocol

    IVF > IUI endometriosis long protocol. GnRH agonist can decrease hormones in body, 抑制 endometriosis

26. OCPs contraindication

    cirrhosis liver tumor SLE breast ca CV disease RF (old age, HTN, DM, smoking, obesity) CV dz (ischemic heart dz, valvular heart dz) >35y/o + smoking stroke hx or vein thrombosis

27. febrile morbidity definition

    post-op 24h, 2 times of 38 degree fever, at least 4 hours apart

28. epidermal inclusion cyst most common locations in perineal

    labia majora clitoris 陰蒂

29. germinal vesicle breakdown occurs during?

    during LH surge --> oocytes halted at meiosis I undergoes germinal vesicle breakdown --> resumes and complete meiosis I

30. implantation period during when of the menstrual cycle

    after ovulation (day 14) ----> implantation at day 20-24

31. hormones made by a + B subunit

    TSH LH FSH B-hCG 都是 same a subunit, different B subunit (GnRH 不是 --- 10 aa 組成)

32. congenital adrenal hyperplasia 如何遺傳

    autosomal recessive

33. can clomiphene be used to treat anorexia pt w amenorrhea

    no pt has hypogonadotrophic hypogonadism from anorexia --> causes hypothalamus 機能異常 --> low FSH and LH. (clomiphene [i] negative feedback loop to hypothalamus --> GnRH secretion continues --> inc FSH, LH --> ovulation)

34. prolactin highest during? amenorrhea occurs at what levels 2-30mg/ml 是否會排卵 as levels increase, what happens

    10pm- 2am (diurnal cycle secretion) >100mg/mL can still ovulation (low levels of prolactin) inc prolactin --> anovulation, amenorrhea, dec progesterone

35. turner syndrome s/s 那個不是 acne amenorrhea short stature infertile

    acne 不是 turner syndrome s/s

36. amenorrhea, galactorrhea suspect what check for what hormones

    prolactinemia check TSH, prolactin, drug hx --> 都可能造成 high prolactin NOT FSH

37. menopause hormonal therapy if pt complains of vaginal dryness, dyspareunia (性交疼痛), tx?

    vaginal estrogen for local use NO need 一般 estogen-progesterone hormonal therapy if no vasomotor s/s (e.g. hot flushes, palpitation)

38. menopause hormonal therapy hx of hysterectomy 可以用什麼藥物

    estrogen 即可 NO need E-P as no uterus

39. bone mineral density peak age 70yo F or M faster bone loss?

    30y/o peak bone density, after 35 y/o start decreasing both loss at the same rate above 70yo

40. most common reason for 習慣性流產

    septate uterus other reasons - submucosal myoma (septate uterus 少有 urinary tract anomalies)

41. best day(s) of menstrual cycle for hysterosalphingogaphy test

    days 7-14 (特別是 7-11 ）

42. IVF: how many hours after injecting B-hCG 才可以取卵

    34-36hours later

43. sperms maturation ---> fertilization process acrosomal reaction cortical reaction capacitation ejaculation

    ejaculation --> capacitation --> acrosomal rxn --> cortical rxn capacitation - contact of sperm w uterus secretions --> energy for flagella mvmt acrosomal rxn - contact of sperm w zona pellucida of ovum --> energy to 穿入 cortical rxn - ovum stt changes, prevents polyspermy

44. ovarian hyperstimulation syndrome RF

    pregnancy young pt PCOS - high antral follicle count long protocol of IVF use of hCG 破卵針

45. 尿路的神經支配 SNS PNS somatic

    SNS: T10-TL2 - hypogastric n. - mid urethra PNS: S2-4 - pelvic n. - proximal urethra , bladder somatic NS: pudendal n. - distal urethra, sphincter

46. kegel exercises fnt

    增強pelvic floor muscles - including bladder and proximal m. 改善urinary incontinence , pelvic organ prolapse , sexual fnt

47. stress urinary incontinence OP failure 原因

    urethra sphincter deficiency open bladder neck low Valsalva leak-point pressure low max urethral closure pressure urethral hypermobility - 可以用OP固定住

48. UTI during pregnancy tx needs to be more agressive than normal pts?

    yes, 不能只有單給one dose of ABx

49. clear cell epithelial type ovarian cancer staging most common epithelial type ovarian cancer comorbid w endometriosis psammomma body present: good or bad prognosis?

    都是 grade 3 endometrioid type > clear cell type good prognosis - psammocarcinoma. psammomma present in papillary RCC, papillary thyroid ca, ovarian serous papillary ca

50. estrogen effects on FSH and LH during follicular phase

    negative feedback FSH high estrogen stimulates LH surge

51. ovulation releases what oocyte

    secondary oocyte

52. meiosis II completed during?

    fertilization baby: arrested in prophase I after puberty: finish metaphase II during ovulation: release secondary ooctye at fertilization: complete meiosis II

53. ovarian tumors in children