Sketchy Path: Reproductive & GU - "Abnormal Uterine Bleeding (AUB) & Endometriosis"

Question 1

Review PALM-COEIN.

Answer 1

PALM: structural disorders

• Polyps
• Adenomyosis
• Leiomyoma
• Malignancy

COEIN: functional disorders

• Coagulopathy
• Ovulatory disorders
• Endometrial causes
• Iatrogenic
• Not otherwise specified

Question 2

Pathologically, polyps are composed of ______________.

Answer 2

glands and stroma (like the polyp beets with root and leaves)

Question 3

True or false: polyps are benign.

Answer 3

True, but they have a very small risk of cancer (like the little crab legs sticking out of the beet)

Question 4

Adenomyosis is ______________.

Answer 4

glands and stroma in the deeper layers of the muscle (like the gopher ADDing endometrial dirt to the muscle border)

Question 5

Adenomyosis is most common in _______________.

Answer 5

pre-menopausal, middle-aged women

Question 6

Endometrial biopsy will come back ____________ in adenomyosis.

Answer 6

normal (because it is the MYOMETRIAL layer that is abnormal)

Question 7

Fibroids are proliferations of _________________.

Answer 7

myometrial smooth muscle cells

Think of the spindle cells.

Question 8

Fibroids are ___________-sensitive.

Answer 8

estrogen

Question 9

List the three types of fibroids based on location.

Answer 9

• Outer: subserosal
• Middle: intramural
• Inner: submucosal

Question 10

Other than AUB, large fibroids can cause ______________.

Answer 10

obstructive symptoms, both urinary and colonic (like the obstructed irrigation tubes)

Question 11

The main risk factor for endometrial hyperplasia is ______________.

Answer 11

estrogen (like the Estro-Grow fertilizer)

Question 12

Which SERM is an endometrial agonist?

Answer 12

Tamoxifen (like the TM trademark on the Estro-Grow fertilizer)

Question 13

List five common ways women have unopposed estrogen.

Answer 13

• Obesity (obese gardener)
• PCOS 2/2 anovulation and lack of progesterone (cystic flowerbeds)
• Hormone replacement
• Early menarche and late menopause (like the “early bloomers” and “late deciduous” seeds)
• Nulliparity

Question 14

__________ syndrome increases risk of endometrial cancer.

Answer 14

Lynch (like the L-iNCH worms)

Question 15

Endometrial hyperplasia is broken into two categories: _________________.

Answer 15

simple (increased number but retained structure) and complex (increased number with crowding)

Question 16

There are three hypotheses for the origins of endometriosis. Review them!

Answer 16

• Reverse menses: endometrial tissue spreads through fallopian tubes to the peritoneum (girl throwing dirt)
• Coelomic transformation: pluripotent stem cells differentiate outside the uterus (coelomic trash pile)
• Hematogenous spread (red hoses)

Question 17

The most common site of endometriosis is __________.

Answer 17

the ovary

Question 18

What is the pouch of Douglas?

Answer 18

The rectouterine space (“Dirty pouch, Douglas! Dirty pouch, Douglas!”)

Question 19

List the four classic signs/symptoms of endometriosis.

Answer 19

• Dysmenorrhea before, during, and after menses (girl getting hit in stomach)
• Dyschezia (next to guy with pouch)
• Dyspareunia
• Infertility (gnarled infertility tree)

Question 20

The first treatment for endometriosis is ___________.

Answer 20

OCPs (like the woman with the OCP leaf blower)