Disorders of the Pelvis and Ovaries

Question 1

Pain of at least 6 months’ duration that occurs below the umbilicus

Answer 1

chronic pelvic pain

Question 2

Most common gynecological cause of chronic pelvic pain

Answer 2

endometriosis

Question 3

Signs of depression associated with chronic pelvic pain

Answer 3

early morning awakening, weight loss, anorexia

Question 4

Finding from a bimanual/rectal exam that suggest an acute process such as PID, ectopic pregnancy, or ruptured ovarian cyst

Answer 4

tenderness

Question 5

During a bimanual exam what does non-mobility of the uterus suggest?

Answer 5

pelvic adhesions

Question 6

During a bimanual exam what does cul-de-sac nodularities suggest?

Answer 6

endometriosis

Question 7

Medications for chronic pelvic pain

Answer 7

NSAIDs, antidepressants, oral contraceptives

Question 8

Surgical intervention for chronic pelvic pain

Answer 8

diagnostic and therapeutic laparoscopy or hysterectomy

Question 9

ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.

Answer 9

Pelvic Inflammatory Disease (PID)

Question 10

Primary reason outpatient visits for PID have declined

Answer 10

aggressive population-based chlamydia screening and treatment

Question 11

Most common pathogens implicated in PID and can cause infertility if left untreated

Answer 11

N. gonorrheae and C. trachomatis

Question 12

Pathway of ascendence for PID infection

Answer 12

cervicitis–>endometritis–> salpingitis/oophoritis–> peritonitis

Question 13

How many episodes of PID are necessary for a woman to potentially experience tubal infertility?

Answer 13

three episodes

Question 14

What is the minimum criteria for the diagnosis of PID?

Answer 14

Uterine/adnexal tenderness or Cervical motion tenderness

Question 15

What increases antibiotic levels in the blood and is sometime used as adjunct therapy for treating gonorrhea and chlamydia?

Answer 15

probenecid

Question 16

What are the screening recommendations for chlamydia?

Answer 16

annually for sexually active women 25 and under sexually active women >25 at high risk

Question 17

What are the recommendations for partners of women with PID?

Answer 17

should be examine and treated if they had sexual contact during the preceding 60 days

Question 18

STDs reportable in all states

Answer 18

gonorrhea and chlamydia

Question 19

STD that is more of a risk factor for subsequently contracting HIV

Answer 19

gonorrhea

Question 20

Absence of menses by age 13 with no secondary sexual characteristics OR by age 15 with secondary sexual characteristics present

Answer 20

primary amenorrhea

Question 21

absence of menses for 3 – 6 cycles in women who have had a history of menstruation

Answer 21

secondary amenorrhea

Question 22

Suggestive of ovarian or pituitary failure or a chromosomal abnormality

Answer 22

lack of pubertal development

Question 23

Suggestive of Turner syndrome or hypothalamic-pituitary disease related to primary amenorrhea

Answer 23

short stature

Question 24

Medications that can cause amenorrhea by increasing serum prolacin concentrations

Answer 24

metoclopramide and antipsychotics

Question 25

Drugs that can alter hypothalamic gonadotropin secretion leading to primary amenorrhea

Answer 25

heroin or methadone

Question 26

Features include: low hair line, web neck, shield chest, and widely spaced nipples

Answer 26

Turner syndrome

Question 27

What should be measured in both arms if Turner syndrome is suspected due to increased incidenced of coarctation of the aorta?

Answer 27

blood pressure

Question 28

How is primary amenorrhea best evaluated?

Answer 28

breast development, presence of uterus, and the FSH level

Question 29

Probable diagnosis if there is no breast development and the FSH level is elevated?

Answer 29

gonadal dysgenesis

Question 30

Probable diagnosis if ultrasound indicates absence of uterus, but FSH levels are normal

Answer 30

Mullerian agenesis or androgen insensitivy syndrome

Question 31

First step in evaluating any women with secondary amenorrhea

Answer 31

rule out pregnancy

Question 32

Suggested by h/o of obstetrical catastrophe, severe bleeding, D&C, or endometritis or other infection that might have caused scarring of the endometrial lining

Answer 32

Asherman’s syndrome

Question 33

Most common cause of primary amenorrhea

Answer 33

chromosomal anomalies resulting in gonadal dysgenesis

Question 34

Most common cause of secondary amenorrhea

Answer 34

pregnancy

Question 35

Most common pituitary cause of secondary amenorrhea

Answer 35

hyperprolactinemia

Question 36

Most common uterine disease that causes secondary amenorrhea

Answer 36

Asherman’s syndrome

Question 37

Most common cause of androgen excess and hirsuitism in women and is also the most common hormonal disorder among women of reproductive age

Answer 37

polycystic ovarian syndrome (PCOS)

Question 38

What is polycystic ovarian syndrome (PCOS) frequently associated with?

Answer 38

insulin resistance

Question 39

Ultrasound findings of polycystic ovarian syndrome (PCOS)

Answer 39

multiple follicles around the periphery of the ovary

Question 40

Why do we treat polycystic ovarian syndrome (PCOS)?

Answer 40

decrease risk of endometrial hyperplasia/cancer, breast CA, and sequellae of DM

Question 41

diuretic that antagonizes the DCT aldosterone receptor. acts as an antiandrogen (will help with hirsutism in conjunction with OCPs) by binding with androgen receptors

Answer 41

spironolactone

Question 42

Treatment option for PCOS that acts as an antiandrogen for those trying to become pregnant and are still anovulatory after diet, exercise, and Metformin have been tried

Answer 42

clomiphene (Clomid)

Question 43

binds to estrogen receptors in the hypothalamus to create a state of hypoestrogenicity, causing an enhanced GnRH release followed by an increased secretion of gonadotropins which induces ovulation.

Answer 43

clomiphene (Clomid)