05-21-2007, 08:26 PM
papsmears r used as a screening method for cancerUS or precaNrous lesion....mos ca AND atypia r located in tnsformation zone...bet the endo and exo cervix so its crucial to get a goood sample of this area...
annual pap smears should b started at 18 yrs of age and continued upto 65 yrs ofage if all r normal.after that u can d/c..
if ist 3 annual papsmears r negative then do it every 3 yr..if previous exam is negative then no papsmears after 65...
always remmber that pap is just a screening test and u need a biopsy to daig ca of cx or cin
there r threee grades on papsmears... a)ACUS>>>>B)LGSIL>>>> USUALLY REFLECT CIN 1 BUT SOME TIME CIN 2 AND 3 ....C)HGSIL(DUE TO CIN 11/CIN111 OR INVASIVE CANCER OF CX...
BOTH LGSIL AND HGSIL REQ COLPOSCOPIC EXAM AND PUNCH BIOPSY(MOST COMMON Q ASK ON EXAM)COLPO IS ALSO RECOMONDED IF PAP IS NORMAL AND VISIBLE CERVICAL LESIONS
IF ASCUS.... THEN REPEAT PAP IN 4-6 MONTHS (MY EXA Q)
IF PA P SHOW INFLAMATION OR INFECTION TRET AIT AND THEN REPEAT THE SMEAR IN 3 -6 WKS...
CIN...NORMALLLY RESOLVED WHILE CIN2/3 NEED TRETMENT..ALL U HAVE TO DO WITH CIN 1 IS TO REPEAT THE SMEAR IN 6 MONTH...
CIN 2...NEED CRYO OR LASER IF Q NOT ANSWERED BY THE PUNCH BIOPSY THEN CONIZATION IS DONE... CIN IS REEXAMIN AND CYTOLOGY DONE IN 3MONTHS AND REPEAT EVERY 6 M..AFTER 3 SUCCESSIVE NEGATIVE EXAM ANNUAL F/U IS CONTINUED INDEFINATELY...
LOCAL INVASIVE CA IS TRETED WITH VARIOUS COMBO OF HYSTRECTOMY,PELVIC NODE DISSECTION AND RADIATION...
OVARIAN CA... ITS MOST DEADLY GYNECOLOGICAL CA BCZ IT ALWAYS DISCOVER LATE..ITS EPITHELIAL CELL MOSTLY ...ITS MOST COMMON TYPE IN POST MENOPAUSAL WHITE F BUTIN NON WHITE YOUNG NON WHITE FEMALE GERM CELL TYPE IS COMMON...
BRCA 2 IS ASSOCIATED WITH BREAST A S WELLL AS OVARIAN CA(EXAMQ)
PREVIOUS USE OF OCP DEC THE RISK OF OVARIAN CA
CA 125 AND TRANSVIGINAL U/S IS GOOOD FOR INITIAL WORK BUT NOT FOR SCREENING..THERE IS NOTHING FOR ROUTINE SCREENING ONLY WITH HIGH RISK PT WE DO THESE TWO...(EXAM Q)
AFP AND BHCG R NOT INC IN THE EPITHELIAL OVARIAN TUMOR INC IN NON EPITHELIAL GERM CELL TUMOR JUST LIKE THEY R NOT INC IN SEMINOMA ALWAYS INDICATE NONSEMINONAS TUMORS...
STAG I WHEN TUMOR IS CONFINE TO TH OVARY ONLY...STAGE 2 WHEN EXTENDED TOADJACENT PELVIC STRUCTURE STAGE 3 WHEN EXTENDED TO PERITONEAL STS ANDINCLUDES LIVERAND DAPHRAGM AND 4 STAGE IS IDSTANT METS...TAH/BSO OMENECTOMY AND RESECTION OF ALL GROSS TUMORALSO NEED WWASHING OF BLADDER AND RECTAL SEROSA,PERITONEAL CAVITIES,PELVIC LIGAMENTS AND PERITONIUM AND BIOPSY OF EXPOSED LYMPH NODE... TRETA THE CA WITH SURGERY AND 6CYCLES OF PLATINUM...CISPLATIN AND CYCLOPHOSPHAMIDE IS SEC LINE THERAPY CARBOPLATIN HAS A LESS TOXICITY THAN THE CISPALATIN..LESS EMETOGENIC/LESS NEPHRO AN DLESS NEUROTOXIC...(CARBOPLATIN)
FIBROIDS!!!ALSO KNOWN AS LEIOMYOMAS...IS CH BY IRREGULAR ENLARGEMNTOF THE UTERUS IST ASYMPTOMATIC..LATER HEVAY ORIRREGULAR VIGINAL BLEEDING,DYMENORHEA,ACUTE AND RECURRENT PELVIC PAIN,IF TH E TUMOR BECOE TWISTE DOR INFARCTED ..SS ON TH ENEIGHBOURING ORAGN IS COMMON..ITS MOST C BENIGN TUOR OFTH E GENITAL TRACT...DISCRETE ROUND FIRMMULTIPLE TUMORS COMPOSED OF SMOOOTH MUSCLE AND CONNECTIVE TISSUES..THESER INTRAMURAL ,SUBMUCUS,SUBSEROUS INTRALIGAMENOUS PARACITIC...CERVICAL...
A SUBMUCUS MYOMAA MA BECOME PEDUNCUALTED AND HANG FROM VIGINA THROUGH CX..
IF PT IS PREG IT CAUSE ABORTION,MALPRESENTAION AND FAILURE OF ENGAGEMET,PREMATURE LABOUR LOCALIZED PAIN FROM TORSION OBSTRUCTED LABOUR...HGB IS DEC BUT IN SOM ECASES POLYCYTHEMIA IS PRESENT...BCZ FIBROID CAUSE IC PRODUCTION OF ERYTHROPOITIN...
ULTARSOUN D IS GOOOD FOR INITIAL DIAG AND F/U TO MONITOR THE GROWTH
HYSTEROGRAPHY AND HYSTEROSCOPY ALSO CONFIRM TH E SUBMUCUS MYOMA
OF PT IS ANEMI DUE TO IN C BLOOOD LOSSS THEN INITIAL TREATMENT OF MPA INJECTION IS USUFUL...AN DANAZOL IS GOOOD TOOOFESO4 SHOUL DB GIVE N PRIOR TO SURGERY
REMMBER ONLY INDICATION OF MYOMECTOMY IN PREG IS TORSION...
IF PT IS NOT PREG AND HAS MYMA OBSERVE THE PT FOR SIX MONTHS...EMERGENCY SURGERY IS ONLY WHEN ANEMIA IS TOOO MUCH /PRESUURE ON NEIGHBOURING ORGAN BY GROWTH CERVICAL MYOMA MORE THAN 3-4 CM HANG FROM CERVIX THEN THROUGH VIGINA MUST B REMOVED
SUBMUCUS MYOMA CAN B REMOVED BY HYSTEROSCOPE AND LASER OR RESECTION INSTRUMENTS...BCZ IT CAUSE BLEEDING..
INC SIZE CAUSE COMPLICATIO POST OP SO GIVE LEPRON TO DEC THE SIZE OF THE MYOMA SO DEC THE COMPLICATION LATER ON....NAFARELEIN IS ALSO USED FOR THE SAME PURPOSE..
IF MYOMA IS NOT LIKE 6 MONTH OF PREG SIZE IN 4TH MONTH OF PREG U CA ANTICIPATE NO PROB...
ENDOMETRIAL CANCER.............IT IS SEC MOST COMMON CAIT OCCUR IN AGE 50-70...OBESITY ,NULLIPARITY,DM,POLYCYSTIC OVARIES,TOMOXIFEN USE MORETHAN 5 YR
LOWER ABD PAIN AND IRREGULAR BLEEDING IS A SIGN OF FURTHER INVESTIGATION IFWOMEN IS MORE THAN 50ORTOOOK UNAPPOSE D ESTROGEN IN THE PAST...PAPSMEARS HELPS IN DIAG...
ENDOCERVICAL AND ENDOMETRIAL SAMPLING IS MOST USEFUL
TOTA HYSTRECTOMY BSP IS TH EBEST WITH PERITONEAL SAMPLING..
ADVANCED METS ENDOMETRIAL CA IS TREATED BYLARGE DOSES OF MEDROXY PROGESTRONE LIKE 400 MG1/M WKLYOR MEGESTROL ACETATE
STAGING IS SURGICALLL AND PATAHLOGICAL.....(EXAMQ) IN UTERINE CA
VIGINAL ULTRASOUN DIS GOOOD TOOOL FOR DIAG BESIDE PAPSMEARS..
TREATMET OF UTERINE PROLAPSE...(MY EXAM Q)
TRUMA WETHER FROM CHILD BIRTH OR PELVIC SURGERY IS TH E CAUSE...LIG MOST COMMONLY LAX R TARNSVERSE CERVICAL AND UTEROSACRAL LIGAMENT...
INABILITY TO WALK COMFORTABLY IS AN INDICATION OF SURGERY FROM UTERINE PROLAPSE..
TREAT WITH VIGINAL HYSTRECTOMY WITH ANT REAPIR OR IF RECTAL PROLAPSE POST REPAIR ..
A WELL FITTED VIGIAL APSSERY IF SURGERY IS CI..
.
annual pap smears should b started at 18 yrs of age and continued upto 65 yrs ofage if all r normal.after that u can d/c..
if ist 3 annual papsmears r negative then do it every 3 yr..if previous exam is negative then no papsmears after 65...
always remmber that pap is just a screening test and u need a biopsy to daig ca of cx or cin
there r threee grades on papsmears... a)ACUS>>>>B)LGSIL>>>> USUALLY REFLECT CIN 1 BUT SOME TIME CIN 2 AND 3 ....C)HGSIL(DUE TO CIN 11/CIN111 OR INVASIVE CANCER OF CX...
BOTH LGSIL AND HGSIL REQ COLPOSCOPIC EXAM AND PUNCH BIOPSY(MOST COMMON Q ASK ON EXAM)COLPO IS ALSO RECOMONDED IF PAP IS NORMAL AND VISIBLE CERVICAL LESIONS
IF ASCUS.... THEN REPEAT PAP IN 4-6 MONTHS (MY EXA Q)
IF PA P SHOW INFLAMATION OR INFECTION TRET AIT AND THEN REPEAT THE SMEAR IN 3 -6 WKS...
CIN...NORMALLLY RESOLVED WHILE CIN2/3 NEED TRETMENT..ALL U HAVE TO DO WITH CIN 1 IS TO REPEAT THE SMEAR IN 6 MONTH...
CIN 2...NEED CRYO OR LASER IF Q NOT ANSWERED BY THE PUNCH BIOPSY THEN CONIZATION IS DONE... CIN IS REEXAMIN AND CYTOLOGY DONE IN 3MONTHS AND REPEAT EVERY 6 M..AFTER 3 SUCCESSIVE NEGATIVE EXAM ANNUAL F/U IS CONTINUED INDEFINATELY...
LOCAL INVASIVE CA IS TRETED WITH VARIOUS COMBO OF HYSTRECTOMY,PELVIC NODE DISSECTION AND RADIATION...
OVARIAN CA... ITS MOST DEADLY GYNECOLOGICAL CA BCZ IT ALWAYS DISCOVER LATE..ITS EPITHELIAL CELL MOSTLY ...ITS MOST COMMON TYPE IN POST MENOPAUSAL WHITE F BUTIN NON WHITE YOUNG NON WHITE FEMALE GERM CELL TYPE IS COMMON...
BRCA 2 IS ASSOCIATED WITH BREAST A S WELLL AS OVARIAN CA(EXAMQ)
PREVIOUS USE OF OCP DEC THE RISK OF OVARIAN CA
CA 125 AND TRANSVIGINAL U/S IS GOOOD FOR INITIAL WORK BUT NOT FOR SCREENING..THERE IS NOTHING FOR ROUTINE SCREENING ONLY WITH HIGH RISK PT WE DO THESE TWO...(EXAM Q)
AFP AND BHCG R NOT INC IN THE EPITHELIAL OVARIAN TUMOR INC IN NON EPITHELIAL GERM CELL TUMOR JUST LIKE THEY R NOT INC IN SEMINOMA ALWAYS INDICATE NONSEMINONAS TUMORS...
STAG I WHEN TUMOR IS CONFINE TO TH OVARY ONLY...STAGE 2 WHEN EXTENDED TOADJACENT PELVIC STRUCTURE STAGE 3 WHEN EXTENDED TO PERITONEAL STS ANDINCLUDES LIVERAND DAPHRAGM AND 4 STAGE IS IDSTANT METS...TAH/BSO OMENECTOMY AND RESECTION OF ALL GROSS TUMORALSO NEED WWASHING OF BLADDER AND RECTAL SEROSA,PERITONEAL CAVITIES,PELVIC LIGAMENTS AND PERITONIUM AND BIOPSY OF EXPOSED LYMPH NODE... TRETA THE CA WITH SURGERY AND 6CYCLES OF PLATINUM...CISPLATIN AND CYCLOPHOSPHAMIDE IS SEC LINE THERAPY CARBOPLATIN HAS A LESS TOXICITY THAN THE CISPALATIN..LESS EMETOGENIC/LESS NEPHRO AN DLESS NEUROTOXIC...(CARBOPLATIN)
FIBROIDS!!!ALSO KNOWN AS LEIOMYOMAS...IS CH BY IRREGULAR ENLARGEMNTOF THE UTERUS IST ASYMPTOMATIC..LATER HEVAY ORIRREGULAR VIGINAL BLEEDING,DYMENORHEA,ACUTE AND RECURRENT PELVIC PAIN,IF TH E TUMOR BECOE TWISTE DOR INFARCTED ..SS ON TH ENEIGHBOURING ORAGN IS COMMON..ITS MOST C BENIGN TUOR OFTH E GENITAL TRACT...DISCRETE ROUND FIRMMULTIPLE TUMORS COMPOSED OF SMOOOTH MUSCLE AND CONNECTIVE TISSUES..THESER INTRAMURAL ,SUBMUCUS,SUBSEROUS INTRALIGAMENOUS PARACITIC...CERVICAL...
A SUBMUCUS MYOMAA MA BECOME PEDUNCUALTED AND HANG FROM VIGINA THROUGH CX..
IF PT IS PREG IT CAUSE ABORTION,MALPRESENTAION AND FAILURE OF ENGAGEMET,PREMATURE LABOUR LOCALIZED PAIN FROM TORSION OBSTRUCTED LABOUR...HGB IS DEC BUT IN SOM ECASES POLYCYTHEMIA IS PRESENT...BCZ FIBROID CAUSE IC PRODUCTION OF ERYTHROPOITIN...
ULTARSOUN D IS GOOOD FOR INITIAL DIAG AND F/U TO MONITOR THE GROWTH
HYSTEROGRAPHY AND HYSTEROSCOPY ALSO CONFIRM TH E SUBMUCUS MYOMA
OF PT IS ANEMI DUE TO IN C BLOOOD LOSSS THEN INITIAL TREATMENT OF MPA INJECTION IS USUFUL...AN DANAZOL IS GOOOD TOOOFESO4 SHOUL DB GIVE N PRIOR TO SURGERY
REMMBER ONLY INDICATION OF MYOMECTOMY IN PREG IS TORSION...
IF PT IS NOT PREG AND HAS MYMA OBSERVE THE PT FOR SIX MONTHS...EMERGENCY SURGERY IS ONLY WHEN ANEMIA IS TOOO MUCH /PRESUURE ON NEIGHBOURING ORGAN BY GROWTH CERVICAL MYOMA MORE THAN 3-4 CM HANG FROM CERVIX THEN THROUGH VIGINA MUST B REMOVED
SUBMUCUS MYOMA CAN B REMOVED BY HYSTEROSCOPE AND LASER OR RESECTION INSTRUMENTS...BCZ IT CAUSE BLEEDING..
INC SIZE CAUSE COMPLICATIO POST OP SO GIVE LEPRON TO DEC THE SIZE OF THE MYOMA SO DEC THE COMPLICATION LATER ON....NAFARELEIN IS ALSO USED FOR THE SAME PURPOSE..
IF MYOMA IS NOT LIKE 6 MONTH OF PREG SIZE IN 4TH MONTH OF PREG U CA ANTICIPATE NO PROB...
ENDOMETRIAL CANCER.............IT IS SEC MOST COMMON CAIT OCCUR IN AGE 50-70...OBESITY ,NULLIPARITY,DM,POLYCYSTIC OVARIES,TOMOXIFEN USE MORETHAN 5 YR
LOWER ABD PAIN AND IRREGULAR BLEEDING IS A SIGN OF FURTHER INVESTIGATION IFWOMEN IS MORE THAN 50ORTOOOK UNAPPOSE D ESTROGEN IN THE PAST...PAPSMEARS HELPS IN DIAG...
ENDOCERVICAL AND ENDOMETRIAL SAMPLING IS MOST USEFUL
TOTA HYSTRECTOMY BSP IS TH EBEST WITH PERITONEAL SAMPLING..
ADVANCED METS ENDOMETRIAL CA IS TREATED BYLARGE DOSES OF MEDROXY PROGESTRONE LIKE 400 MG1/M WKLYOR MEGESTROL ACETATE
STAGING IS SURGICALLL AND PATAHLOGICAL.....(EXAMQ) IN UTERINE CA
VIGINAL ULTRASOUN DIS GOOOD TOOOL FOR DIAG BESIDE PAPSMEARS..
TREATMET OF UTERINE PROLAPSE...(MY EXAM Q)
TRUMA WETHER FROM CHILD BIRTH OR PELVIC SURGERY IS TH E CAUSE...LIG MOST COMMONLY LAX R TARNSVERSE CERVICAL AND UTEROSACRAL LIGAMENT...
INABILITY TO WALK COMFORTABLY IS AN INDICATION OF SURGERY FROM UTERINE PROLAPSE..
TREAT WITH VIGINAL HYSTRECTOMY WITH ANT REAPIR OR IF RECTAL PROLAPSE POST REPAIR ..
A WELL FITTED VIGIAL APSSERY IF SURGERY IS CI..
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