Routine Gyn/ Female Patient Health Maintenance

Question 1

A pt comes in with no concerning PMH,complaints, or abnormal bleeding. Ultrasound shows an anechoic mass with no septae with thin walls as shown in the photo. What is recommended for this patient?

Answer 1

F/u exam.
Her findings are suggestive of a benign ovarian cyst. Management consists of follow-up examinations to monitor possible growth of the cyst, of which the majority resolve spontaneously. Treatment is only required if complications occur (e.g., ovarian torsion, ovarian cyst rupture).

Question 2

What signs and findings would you observe with a patient in TSS-1?

Answer 2

-leukocytosis
-fever
-tachycardia
-low blood pressure
-along with a diffuse, erythematous rash
-skin peeling
-acute kidney injury (look at Cr and urea nitrogen)
-thrombocytopenia (low platelets!)

Question 3

What organism causes TSS-1?

Answer 3

Staph a

Question 4

For a self-palpated breast lumps in women, when do we recommend US over mammography as our next steps?

Answer 4

US is for women younger than 30 yo, for women over 40 yo we recommend mammography

Question 5

A small, concentric, hypoechoic myometrial mass in a nulliparous woman of reproductive age is suggestive of

Answer 5

uterine leiomyoma

Question 6

For a female of reproductive age presenting with signs of PCOS with no desire for children at this time, what is the first line therapy for her?

Answer 6

Combo OCPs

A combination oral contraceptive pill (COCP) containing ethinylestradiol and progestin is the first-line pharmacotherapy for patients with PCOS who currently do not wish to conceive. COCPs help regulate the menstrual cycle and, because of antiandrogenic effects, relieve symptoms of hyperandrogenism. In addition, progestin decreases the risk of endometrial hyperplasia and cancer, which are possible complications of PCOS (due to the increased levels of estrogen from aromatization of androgens). Besides pharmacotherapy, weight loss is the mainstay of treatment because obesity and the associated insulin resistance play an important role in the pathophysiology of PCOS.

Question 7

_______________ a selective estrogen receptor modulator (SERM), is the drug of choice for osteoporosis in postmenopausal women who are at an increased risk of developing breast cancer (in this case, the history of breast cancer at a young age in a first-degree relative and nulliparity increase this patient’s risk). An adverse effect that is due to its estrogenic activity should be considered.

Answer 7

Raloxifene

Question 8

This mediation prevents bone resorption by acting as an agonist on estrogen receptors in the bone. At the same time, it acts as an estrogen antagonist in the breast and endometrium.

Answer 8

raloxifene

Question 9

What is the most severe adverse effects of raloxifene?

Answer 9

Thromboembolic events

Question 10

Combo CHC’s decrease risk of what cancers?

Answer 10

COCPs can decrease the risk of ovarian cancer, possibly through reduced cell proliferation within the ovaries and fallopian tubes. They also reduce the risk of endometrial cancer; the progestin contained therein opposes estrogen-driven endometrial hyperplasia, which reduces the risk for the development of type 1 endometrial cancer.

Question 11

What cancer risk is contraindicative for COCPs?

Answer 11

Combined oral contraceptives do not reduce the risk for breast cancer. However, there is controversy as to whether current OCPs actually increase the risk for breast cancer, and therefore should be used with caution in a patient with a high risk for breast cancer development (e.g., BRCA mutations).
COCP’s may also increase the incidence of hepatic adenomas.

Question 12

_________________________is a common benign phenomenon in women of reproductive age that is caused by physiologic enlargement and rupture of the follicular cyst during ovulation, which leads to the release of small amount of intraperitoneal fluid and subsequent peritoneal irritation. The pain is self-limited and usually subsides within a few hours to two days.

Answer 12

Mittelschmerz

Question 13

What is our firstline tx for mittelschmerz?

Answer 13

Reassurance and NSAIDs

Question 14

What are the cardiovascular side effects of COCPs?

Answer 14

Hypertension and thromboembolism. Estrogen-containing oral contraceptives may also cause hyperlipidemia and a mild increase in the incidence of hepatic adenomas.

Question 15

For women ages 30 to 65, what is the screening recommendations for cytology and high risk HPC testing (“co-testing)?

Answer 15

Co-testing every 5 years assuming that their last pap/cotest was clear, high risk HPV testing along every 5 years or cytology alone every 3 years is also acceptable

Question 16

A 28 yo women comes in with HSIL cytology result on her pap/co test. What is recommended for her?

Answer 16

Colposcopy

Question 17

Lower abdominal pain, adnexal tenderness, faver, cervical motion tenderness, and vaginal discharge are all indicative of…

Answer 17

PID

Question 18

On a wet mount, a drop of KOH releases amines from the cells and a fishy odor can be noted if _________________ is present

Answer 18

bacterial vaginosis

Question 19

Multinucleate giant cells and inflammation are microscopic findings consistent in a patient with

Answer 19

herpes

Question 20

THe primary screening modality for breast cancer in women with average risk of developing BC is…

Answer 20

US

Question 21

A patient with a high BMI and acanthosis nigrans should increase your suspicion for what physiologic concern?

Answer 21

Insulin resistance, acanthosis nigrans and high bmi are both consistent and associated with insulin resistance. A patient with that presentation should be tested for diabetes.

Question 22

Women should be offered colorectal cancer screening starting at age ____

Answer 22

45

Question 23

What are the options for colorectal screening?

Answer 23

Hemoccult testing, flexible sigmoidoscopy q5yrs, or colonoscopy q10yrs

Question 24

What kind of incontinence: unprecipitated urine leakage, inability to empty the bladder

Answer 24

Overflow incontinence

Question 25

The most common type of urethral carcinoma in women is

Answer 25

squamous cell carcinoma

Question 26

Outpouching of the urethra that presents with recurrent UTIs, urethritis, urinary incontinence, and incomplete bladder emptying

Answer 26

Urethral diverticulum

Question 27

What is first line therapy for bacterial vaginosis?

Answer 27

Metronidazole

Question 28

This occurs secondary to pelvic floor dysfunction and weakness, most commonly in multiparous patients. This weakness causes herniation of the vaginal vault through the vagina and introitus. It presents with a heavy sensation in the pelvic area, incontinence, and constipation or difficulty initiating a bowel movement.

Answer 28

Vaginal vault prolapse

Question 29

Common in multiparous patients due to weakness of the pelvic floor causing the bladder to infringe on the anterior vaginal wall. Pts present with stress incontinence.

Answer 29

Cystocele

Question 30

Can be a consequence of gyn surgery or radiation therapy. It presents with asymptomatic urinary leakage from the vagina that is often worse with standing.

Answer 30

Vesicovaginal fistula

Question 31

What are the major causes of dysmenorrhea?

Answer 31

Primary: Dx of exclusion, its pain with menses not attributed to underlying pathology. Pat presents with pain with menses that radiates to the lower abdomen and pelvis/lower back and thighs. It is accompanied by nausea, diarrhea, heafaches, and flushing. Its thought to be attributed to prostaglandin production by the endometrium (hence the use of nsaids).

Secondary: endometriosis, leiomyomas, adhesions, PID, adenomyosis.

Question 32

What are the recommendation for pap and HPV testing?

Answer 32

Pap q3 years for 21-29 yo
Pap and HPV q5 years 30-65 (or q3 if no HPV testing done with it)