FARR Gynecology

Question 1

The first test to perform when a woman presents with amenorrhea.

Answer 1

β-hCG; the most common cause of amenorrhea is pregnancy.

Question 2

Term for heavy bleeding during and between menstrual periods.

Answer 2

Menometrorrhagia.

Question 3

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

Answer 3

Asherman’s syndrome.

Question 4

Therapy for polycystic ovarian syndrome.

Answer 4

Weight loss and OCPs.

Question 5

Medication used to induce ovulation.

Answer 5

Clomiphene citrate.

Question 6

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

Answer 6

Endometrial biopsy.

Question 7

Indications for medical treatment of ectopic pregnancy.

Answer 7

Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation.

Question 8

Medical options for endometriosis.

Answer 8

OCPs, danazol, GnRH agonists.

Question 9

Laparoscopic findings in endometriosis.

Answer 9

“Chocolate cysts,” powder burns.

Question 10

The most common location for an ectopic pregnancy

Answer 10

Ampulla of the oviduct.

Question 11

How to diagnose and follow a leiomyoma.

Answer 11

Ultrasound.

Question 12

Natural history of a leiomyoma.

Answer 12

Regresses after menopause.

Question 13

A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.

Answer 13

Trichomonas vaginitis.

Question 14

Treatment for bacterial vaginosis.

Answer 14

Oral or topical metronidazole.

Question 15

The most common cause of bloody nipple discharge.

Answer 15

Intraductal papilloma.

Question 16

Contraceptive methods that protect against PID.

Answer 16

OCPs and barrier contraception.

Question 17

Unopposed estrogen is contraindicated in which cancers?

Answer 17

Endometrial or estrogen receptor–

Question 18

A patient presents with recent PID with RUQ pain

Answer 18

Consider Fitz-Hugh–Curtis syndrome.

Question 19

Breast malignancy presenting as itching, burning, and erosion of the nipple.

Answer 19

Paget’s disease.

Question 20

Annual screening for women with a strong family history of ovarian cancer.

Answer 20

CA-125 and transvaginal ultrasound.

Question 21

A 50-year-old woman leaks urine when laughing or coughing. Nonsurgical options?

Answer 21

Kegel exercises, estrogen, pessaries for stress incontinence.

Question 22

A 30-year-old woman has unpredictable urine loss. Examination is normal. Medical options?

Answer 22

Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.

Question 23

Lab values suggestive of menopause.

Answer 23

↑ serum FSH.

Question 24

The most common cause of female infertility.

Answer 24

Endometriosis.

Question 25

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear. Follow-up evaluation?

Answer 25

Colposcopy and endocervical curettage.

Question 26

Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.

Answer 26

Lobular carcinoma in situ

Question 27

HRT has been shown to

Answer 27

↑ cardiovascular morbidity and mortality and may ↑ the incidence of breast and endometrial cancers. For this reason, clinicians should thoroughly review the risks and benefits of HRT before initiating treatment.

Question 28

Contraindications to HRT include

Answer 28

vaginal bleeding, suspected or known breast cancer, endometrial cancer, and a history of throm- boembolism, chronic liver disease, or hypertriglyceridemia.

Question 29

Non-HRT:

Answer 29

Venlafaxine and, less commonly, clonidine can be given to ↓ the frequency of hot flashes.

Question 30

Secondary Dysmenorrhea DIAGNOSIS

Answer 30

I First step: Obtain a β-hCG to exclude ectopic pregnancy. I Second step: Order the following:
I A CBC with differential to rule out infection or neoplasm. I UA to rule out UTI.
I Gonococcal/chlamydial swabs to rule out STDs/PID.
I Stool guaiac to rule out GI pathology.
I Third step: Look for pelvic pathology causing pain (see Table 2.12-4).

Question 31

Abnormal Uterine Bleeding AUD DIAGNOSIS

Answer 31

I First step: Obtain a β-hCG to rule out ectopic pregnancy. I Second step: Order a CBC to rule out anemia.
I Third step:
I Pap smear to rule out cervical cancer (which can present with bleed-
ing).
I TFTs to rule out hyper-/hypothyroidism and hyperprolactinemia.
I Obtain platelet count, bleeding time, and PT/PTT to rule out von
Willebrand’s disease and factor XI deficiency.
I Order an ultrasound to evaluate the ovaries, uterus, and endometrium.
Look for uterine masses, polycystic ovaries, and thickness of the endo-
metrium.
I If the endometrium is ≥ 4 mm in a postmenopausal woman, obtain
an endometrial biopsy. An endometrial biopsy should also be obtained if the patient is > 35 years of age, obese (BMI > 35), and diabetic.

Question 32

PCOS

HISTORY/PE

Answer 32

I High BP.
I BMI > 30 (obesity).
I Stigmata of hyperandrogenism or insulin resistance (menstrual cycle dis-
turbances, hirsutism, obesity, acne, androgenic alopecia, acanthosis nigri-
cans).

Question 33

Women with PCOS are also at ↑ risk for the following:

Answer 33

I Type 2 DM
I Insulin resistance
I Infertility
I Metabolic syndrome—insulin resistance, obesity, atherogenic dyslipidemia, and hypertension

Question 34

PCOS Women who are not attempting to conceive:

Answer 34

Treat with a combination of OCPs, progestin, and metformin (or other insulin-sensitizing agents).

Question 35

PCOS Women who are attempting to conceive:

Answer 35

Clomiphene +/− metformin is first-line treatment for ovulatory stimulation.

Question 36

PCOS Symptom-specific treatment:

Answer 36

I Hirsutism: Combination OCPs are first line; antiandrogens
(spironolactone, finasteride) and metformin may also be used.
I Cardiovascular risk factors and lipid levels: Diet, weight loss, and ex-
ercise plus potentially lipid-controlling medication (e.g., statins).

Question 37

Acute causes of pelvic pain—

Answer 37

A ROPE
Appendicitis
Ruptured ovarian cyst Ovarian torsion/abscess PID
Ectopic pregnancy

Question 38

Toxic Shock Syndrome (TSS)

Answer 38

Caused by preformed S. aureus toxin (TSST-1); often occurs within five days of the onset of a menstrual period in women who have used tampons. The in- cidence in menstruating women is now 6–7:100,000 annually. Nonmenstrual cases are nearly as common as menstrual cases.

Question 39

TSS HISTORY/PE

Answer 39

I Presents with abrupt onset of fever, vomiting, and watery diarrhea, with fever 38.9°C (102°F) or higher.
I A diffuse macular erythematous rash is also seen.
I Nonpurulent conjunctivitis is common.
I Desquamation, especially of the palms and soles, generally occurs dur-
ing recovery within 1–2 weeks of illness.

Question 40

Fibroid Pharmacologic treatment:

Answer 40

I NSAIDs.
I Combined hormonal contraception.
I Medroxyprogesterone acetate or danazol to slow or stop bleeding.
I GnRH analogs (leuprolide or nafarelin) to ↓ the size of myomas, sup-
press further growth, and ↓ surrounding vascularity. Also used prior
to surgery.

Question 41

HPV DNA is found in 99.7% of all cervical carcinomas.

Answer 41

HPV 16 is the most prevalent type in squamous cell carcinoma; HPV 18 is most preva- lent in adenocarcinoma.

Question 42

Premenopausal women: ↑ CA-125 may point to

Answer 42

benign disease such

as endometriosis.

Question 43

Postmenopausal women: ↑ CA-125 (> 35 units)

Answer 43

indicates an ↑ likeli-

hood that the ovarian tumor is malignant.

Question 44

Causes of urinary incontinence without specific urogenital pathology—

Answer 44

DIAPPERS
Delirium/confusional state
Infection
Atrophic urethritis/
vaginitis Pharmaceutical Psychiatric causes
(especially
depression) Excessive urinary output
(hyperglycemia,
hypercalcemia, CHF) Restricted mobility Stool impaction

Question 45

Fibroadenoma

Answer 45

A benign, slow-growing breast tumor with epithelial and stromal components. The most common breast lesion in women < 30 years of age. Cystosarcoma phyllodes is a large fibroadenoma.