NU623 Final Exam Questions with Correct
Answers
Endometriosis
Condition is common and nonmalignant process: Endometrial glands and stroma that occur
outside the uterine cavity typically located in the pelvis but can occur at multiple sites
including the bowel, diaphragm, and pleural cavity. Ectopic endometrial tissue and resultant
inflammation can cause dysmenorrhea, dyspareunia, chronic pain, and infertility.
endometriosis symptoms
o chronic abdominal/pelvic pain (dull, throbbing, sharp, and/or burning) and/or pressure
§ abdominal wall typically present with a painful abdominal wall mass; the pain may
be cyclic with menses or continuous
o severe dysmenorrhea,
o dyspareunia,
o heavy menstrual bleeding
o infertility
bowel and bladder dysfunction (eg, pain, urgency, frequency) or constipation
Suggestive findings for endometriosis on exam
focal tenderness on vaginal examination, nodules in the posterior fornix, adnexal masses, and
immobility or lateral placement of the cervix or uterus
endometriosis diagnosis
o Clinical = based on symptoms and imaging (US, Cystoscopy)
,o Surgical diagnosis with biopsy via laparoscopic exploratory surgery
§ Stage I – Minimal disease is characterized by isolated implants and no significant
adhesions.
§ Stage II – Mild endometriosis consists of superficial implants that are less than 5 cm in
aggregate and are scattered on the peritoneum and ovaries. No significant adhesions are
present.
§ Stage III – Moderate disease exhibits multiple implants, both superficial and deeply
invasive. Peritubal and periovarian adhesions may be evident.
§ Stage IV – Severe disease is characterized by multiple superficial and deep implants,
including large ovarian endometriomas. Filmy and dense adhesions are usually present.
endometriosis treatment
· Treatment:
o estrogen-progestin contraceptives
o surgically confirm prior to gonadotropin-releasing hormone (GnRH) analog
o aromatase inhibitors (AIs)
o NSAIDs
o acetaminophen/paracetamol
o Pelvic floor physical therapy
Uterine Fibroid (Leiomyomas or Myomas)
· Con cancerous monoclonal tumors arising from smooth muscle cells and fibroblasts of the
myometrium
intramural myoma
,leiomyomas protrude into the uterine cavity
§ Type 0 - completely within endometrial cavity
§ Type 1 - extend less than 50% into myometrium
§ Type 2 - extend 50% or more into myometrium
Subserosal myomas
leiomyomas from the myometrium at serosal surface and can be intra-ligamentary
uterine fibroid symptoms
o Abnormal uterine bleeding (Heavy and prolonged)
o pelvic pain/pressure
§ lower back pain, menstrual pain.
§ Abdominal bloating or protrusion
§ dyspareunia
o Fibroid degeneration or torsion of pedunculated fibroid
§ low-grade fever, uterine tenderness on palpation, elevated white blood cell count, or
peritoneal signs lasting days to weeks
o infertility or adverse pregnancy outcomes
o prolapsed fibroid causes bleeding, ulceration and infection
o endocrine effects (polycythemia, hypercalcemia, hyperprolactinemia)
o Bowel/Bladder issues
§ Constipation
§ Hydronephrosis, frequency, inability to empty bladder
Uterine Fibroid diagnosis
, o Clinical diagnosis: pelvic examination and pelvic ultrasound findings, and symptoms of
abnormal bleeding (prolonged >8 days, heavy changing pads/tampons <3hrs, pain
o Hysteroscopy
o MRI
o Definitive diagnosis: pathology - pursued when mass is suspicious for precancer or cancer
uterine fibroid treatment
o Fibroid resection via hysteroscopic myomectomy
o Estrogen-progestin contraceptives
o Progestin-releasing intrauterine devices (IUDs)
o Tranexamic acid taken during menses or during the heavy days of menses
o GnRH analogs, including antagonists and agonists, can reduce HMB. Agonists also
significantly reduce fibroid volume but have potential adverse effects that limit use.
ovarian cancer acute presentation
Ascites, pleural effusion (SOB), bowel obstruction, venous thromboembolism
- typically indicates advanced disease and indicates urgent evaluation
ovarian cancer subacute presentation
- more common, pelvic or abdominal pain, bloating, gastrointestinal symptoms (poor PO,
nausea, anorexia, early satiety)
fallopian tube cancer
clear or blood-tinged vaginal discharge, pelvic pain, and a pelvic mass.
Ovarian cancer workup
Answers
Endometriosis
Condition is common and nonmalignant process: Endometrial glands and stroma that occur
outside the uterine cavity typically located in the pelvis but can occur at multiple sites
including the bowel, diaphragm, and pleural cavity. Ectopic endometrial tissue and resultant
inflammation can cause dysmenorrhea, dyspareunia, chronic pain, and infertility.
endometriosis symptoms
o chronic abdominal/pelvic pain (dull, throbbing, sharp, and/or burning) and/or pressure
§ abdominal wall typically present with a painful abdominal wall mass; the pain may
be cyclic with menses or continuous
o severe dysmenorrhea,
o dyspareunia,
o heavy menstrual bleeding
o infertility
bowel and bladder dysfunction (eg, pain, urgency, frequency) or constipation
Suggestive findings for endometriosis on exam
focal tenderness on vaginal examination, nodules in the posterior fornix, adnexal masses, and
immobility or lateral placement of the cervix or uterus
endometriosis diagnosis
o Clinical = based on symptoms and imaging (US, Cystoscopy)
,o Surgical diagnosis with biopsy via laparoscopic exploratory surgery
§ Stage I – Minimal disease is characterized by isolated implants and no significant
adhesions.
§ Stage II – Mild endometriosis consists of superficial implants that are less than 5 cm in
aggregate and are scattered on the peritoneum and ovaries. No significant adhesions are
present.
§ Stage III – Moderate disease exhibits multiple implants, both superficial and deeply
invasive. Peritubal and periovarian adhesions may be evident.
§ Stage IV – Severe disease is characterized by multiple superficial and deep implants,
including large ovarian endometriomas. Filmy and dense adhesions are usually present.
endometriosis treatment
· Treatment:
o estrogen-progestin contraceptives
o surgically confirm prior to gonadotropin-releasing hormone (GnRH) analog
o aromatase inhibitors (AIs)
o NSAIDs
o acetaminophen/paracetamol
o Pelvic floor physical therapy
Uterine Fibroid (Leiomyomas or Myomas)
· Con cancerous monoclonal tumors arising from smooth muscle cells and fibroblasts of the
myometrium
intramural myoma
,leiomyomas protrude into the uterine cavity
§ Type 0 - completely within endometrial cavity
§ Type 1 - extend less than 50% into myometrium
§ Type 2 - extend 50% or more into myometrium
Subserosal myomas
leiomyomas from the myometrium at serosal surface and can be intra-ligamentary
uterine fibroid symptoms
o Abnormal uterine bleeding (Heavy and prolonged)
o pelvic pain/pressure
§ lower back pain, menstrual pain.
§ Abdominal bloating or protrusion
§ dyspareunia
o Fibroid degeneration or torsion of pedunculated fibroid
§ low-grade fever, uterine tenderness on palpation, elevated white blood cell count, or
peritoneal signs lasting days to weeks
o infertility or adverse pregnancy outcomes
o prolapsed fibroid causes bleeding, ulceration and infection
o endocrine effects (polycythemia, hypercalcemia, hyperprolactinemia)
o Bowel/Bladder issues
§ Constipation
§ Hydronephrosis, frequency, inability to empty bladder
Uterine Fibroid diagnosis
, o Clinical diagnosis: pelvic examination and pelvic ultrasound findings, and symptoms of
abnormal bleeding (prolonged >8 days, heavy changing pads/tampons <3hrs, pain
o Hysteroscopy
o MRI
o Definitive diagnosis: pathology - pursued when mass is suspicious for precancer or cancer
uterine fibroid treatment
o Fibroid resection via hysteroscopic myomectomy
o Estrogen-progestin contraceptives
o Progestin-releasing intrauterine devices (IUDs)
o Tranexamic acid taken during menses or during the heavy days of menses
o GnRH analogs, including antagonists and agonists, can reduce HMB. Agonists also
significantly reduce fibroid volume but have potential adverse effects that limit use.
ovarian cancer acute presentation
Ascites, pleural effusion (SOB), bowel obstruction, venous thromboembolism
- typically indicates advanced disease and indicates urgent evaluation
ovarian cancer subacute presentation
- more common, pelvic or abdominal pain, bloating, gastrointestinal symptoms (poor PO,
nausea, anorexia, early satiety)
fallopian tube cancer
clear or blood-tinged vaginal discharge, pelvic pain, and a pelvic mass.
Ovarian cancer workup
