Female Reproductive System and Breast I

Question 1

Acute mastitis is due to bacterial infection of the breast, most commonly with […].

Answer 1

Acute mastitis is due to bacterial infection of the breast, most commonly with Staphylococcus aureus.

Question 2

Adenomyosis typically causes dysmenorrhea and heavy menstrual bleeding in multiparous women > […] years of age.

Answer 2

Adenomyosis typically causes dysmenorrhea and heavy menstrual bleeding in multiparous women > 40 years of age.

new-onset dysmenorrhea in later reproductive years is classic

Question 3

Adolescents with irregular menstrual bleeding due to anovulatory cycles may benefit from […] therapy.

Answer 3

Adolescents with irregular menstrual bleeding due to anovulatory cycles may benefit from progesterone therapy.

progesterone, which is normally secreted by the corpus luteum during ovulatory cycles, causes differentiation of the proliferative endometrium into secretory endometrium; withdrawal causes menstruation

Question 4

An intrauterine pregnancy is typically seen on TVUS with beta-hCG levels > […] IU/L.

Answer 4

An intrauterine pregnancy is typically seen on TVUS with beta-hCG levels > 1500-2000 IU/L.

Question 5

Androgen insensitivity syndrome is characterized by an absent uterus, cervix, and upper vagina due to normal production of […].

Answer 5

Androgen insensitivity syndrome is characterized by an absent uterus, cervix, and upper vagina due to normal production of anti-Mullerian hormone.

normal lower vagina because the fetal urogenital sinus defaults into external female genitalia due to a mutated androgen receptor

Question 6

Androgen insensitivity syndrome is characterized by […] breast development.

Answer 6

Androgen insensitivity syndrome is characterized by normal breast development.

due to conversion of testosterone to estrogen

Question 7

Antibiotic therapy for hospitalized patients with pelvic inflammatory disease includes IV […] or […] plus oral doxycycline.

Answer 7

Antibiotic therapy for hospitalized patients with pelvic inflammatory disease includes IV cefoxitin or cefotetan plus oral doxycycline.

an alternative broad-spectrum antibiotic regimen is IV clindamycin plus gentamicin; metronidazole is added when PID is complicated by tubo-ovarian abscess

Question 8

Aromatase deficiency is associated with […] ovaries on ultrasound due to high concentrations of gonadotropins.

Answer 8

Aromatase deficiency is associated with polycystic ovaries on ultrasound due to high concentrations of gonadotropins.

Question 9

Biopsy of breast tissue with fat necrosis typically reveals calcifications, foamy macrophages, and […].

Answer 9

Biopsy of breast tissue with fat necrosis typically reveals calcifications, foamy macrophages, and fat globules.

the presence of calcifications on mammography and a fixed mass on physical exam can mimic breast cancer

Question 10

BRCA mutations result in significantly increased risk of […] and […] cancer.

Answer 10

BRCA mutations result in significantly increased risk of breast and ovarian cancer.

Question 11

BRCA-positive individuals are recommended to have a […] to decrease incidence of ovarian cancer.

Answer 11

BRCA-positive individuals are recommended to have a prophylactic bilateral salpingo-oophorectomy to decrease incidence of ovarian cancer.

recommended as soon as childbearing is complete; may cause side effects from surgical menopause

Question 12

Candida vaginitis is more common in patients with recent […] or […] use.

Answer 12

Candida vaginitis is more common in patients with recent corticosteroid or antibiotic use.

other risk factors include pregnancy and diabetes mellitus

Question 13

Choriocarcinoma is a tumor with early, diffuse hematogenous spread, especially to the […].

Answer 13

Choriocarcinoma is a tumor with early, diffuse hematogenous spread, especially to the lungs.

presents as hemoptysis, shortness of breath, and/or chest pain; other common sites of metastasis include the vagina and brain

Question 14

Common side effects of the injectable medroxyprogesterone contraceptive are vaginal bleeding/spotting and weight […].

Answer 14

Common side effects of the injectable medroxyprogesterone contraceptive are vaginal bleeding/spotting and weight gain.

Question 15

Condylomata acuminata (genital warts) is associated with HPV strains […] and […].

Answer 15

Condylomata acuminata (genital warts) is associated with HPV strains 6 and 11.

Question 16

Congenital aromatase deficiency in newborn females is characterized by […] internal genitalia and […] external genitalia.

Answer 16

Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

due to high levels of gestational androgens

Question 17

Congenital […] deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

Answer 17

Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

due to high levels of gestational androgens

Question 18

Congenital aromatase deficiency in newborn females is characterized by […] internal genitalia and […] external genitalia.

Answer 18

Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

due to high levels of gestational androgens

Question 19

Congenital […] deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

Answer 19

Congenital aromatase deficiency in newborn females is characterized by normal internal genitalia and ambiguous external genitalia.

due to high levels of gestational androgens

Question 20

Daughters of women exposed to […] during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.

Answer 20

Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.

additionally, daughters and sons with in-utero exposure are at risk for genital tract anomalies

Question 21

Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing […] of the vagina and cervix.

Answer 21

Daughters of women exposed to diethylstilbestrol (DES) during pregnancy are at increased risk of developing clear cell adenocarcinoma of the vagina and cervix.

additionally, daughters and sons with in-utero exposure are at risk for genital tract anomalies

Question 22

Does lichen sclerosus cause an increased risk for squamous cell carcinoma?

Answer 22

Yes, slightly increased risk.

Question 23

During the luteal phase of menstruation, cervical mucus becomes more […] and less penetrable by sperm.

Answer 23

During the luteal phase of menstruation, cervical mucus becomes more thick (less watery) and less penetrable by sperm.

Question 24

Empiric treatment for endometriosis consists of […] and/or […].

Answer 24

Empiric treatment for endometriosis consists of NSAIDs and/or OCPs.

laparoscopy is reserved for treatment failure, adnexal mass, or infertility

Question 25

Evaluation of atypical glandular cells on Pap test in women \> 35 years old includes colposcopy, [...], and endometrial biopsy.

Answer 25

Evaluation of atypical glandular cells on Pap test in women \> 35 years old includes colposcopy, **endocervical curettage**, and endometrial biopsy.

Question 26

Evaluation of atypical glandular cells on Pap test in women \> 35 years old includes colposcopy, endocervical curettage, and [...].

Answer 26

Evaluation of atypical glandular cells on Pap test in women \> 35 years old includes colposcopy, endocervical curettage, and **endometrial biopsy**.

Question 27

Hormone replacement therapy is only indicated for the treatment of [...] in women age \< 60 who have undergone menopause within the past 10 years.

Answer 27

Hormone replacement therapy is only indicated for the treatment of **vasomotor symptoms** in women age \< 60 who have undergone menopause within the past 10 years. e.g. hot flashes, sleep disturbances; not indicated for chronic disease prevention (e.g. osteoporosis, coronary heart disease)

Question 28

How can hypothyroidism lead to hyperprolactinemia?

Answer 28

Stimulation of prolactin secretion by TRH (thyrotropin-releasing hormone). TRH is released in response to hypothyroidism.

Question 29

How does bone density change in patients with hypothalamic amenorrhea?

Answer 29

Decreased (e.g. osteopenia) due to estrogen deficiency secondary to loss of pulsatile GnRH secretion

Question 30

If a patient has a history of CIN 2 or higher, Pap testing should continue for another [...] years after detection.

Answer 30

If a patient has a history of CIN 2 or higher, Pap testing should continue for another **20** years after detection.

Question 31

Indications for endometrial biopsy include abnormal uterine bleeding in women age

Answer 31

Indications for endometrial biopsy include abnormal uterine bleeding in women age obesity and/or **anovulation**. due to increased risk for endometrial hyperplasia/cancer from unopposed estrogen; other indications in women \< 45 include Lynch syndrome and failed medical management

Question 32

Indications for endometrial biopsy include abnormal uterine or postmenopausal bleeding in women age \> [...].

Answer 32

Indications for endometrial biopsy include abnormal uterine or postmenopausal bleeding in women age \> 45.

Question 33

Infertility in patients age \< 35 is defined as the failure to achieve pregnancy after [...] of regular, unprotected sexual intercourse.

Answer 33

Infertility in patients age \< 35 is defined as the failure to achieve pregnancy after **12 months** of regular, unprotected sexual intercourse. for women age \> 35, infertility evaluation can begin after 6 months

Question 34

Infertility in patients age \> 35 is defined as the failure to achieve pregnancy after [...] of regular, unprotected sexual intercourse.

Answer 34

Infertility in patients age \> 35 is defined as the failure to achieve pregnancy after **6** months of regular, unprotected sexual intercourse. for women age

Question 35

Is weight gain an adverse effect associated with oral contraceptive pills?

Answer 35

No adverse effects include breakthrough bleeding (most common), worsening of hypertension, increased risk of cervical cancer, and increased risk of venous thromboembolism

Question 36

Just prior to ovulation, cervical mucus increases in quantity and becomes more [...] and penetrable by sperm.

Answer 36

Just prior to ovulation, cervical mucus increases in quantity and becomes more **watery** and penetrable by sperm. this change corresponds with the LH surge

Question 37

Just prior to [...], cervical mucus increases in quantity and becomes more watery and penetrable by sperm.

Answer 37

Just prior to ovulation, cervical mucus increases in quantity and becomes more watery and penetrable by sperm. this change corresponds with the LH surge

Question 38

Lack of menses is considered normal at age

Answer 38

Lack of menses is considered normal at age 15 if development of secondary sex characteristics has been appropriate. typically occurs around Tanner stage 4

Question 39

Lactational amenorrhea occurs due to high levels of [...], which has an inhibitory effect on the production of GnRH.

Answer 39

Lactational amenorrhea occurs due to high levels of **prolactin**, which has an inhibitory effect on the production of GnRH. thus LH and FSH production is also suppressed and ovulation does not occur

Question 40

Lactational amenorrhea occurs due to high levels of prolactin, which has an inhibitory effect on the production of [...].

Answer 40

Lactational amenorrhea occurs due to high levels of prolactin, which has an inhibitory effect on the production of **GnRH**. thus LH and FSH production is also suppressed and ovulation does not occur

Question 41

Lichen simplex chronicus presents as leukoplakia with [...] vulvar skin.

Answer 41

Lichen simplex chronicus presents as leukoplakia with thick, **leathery** vulvar skin. versus the "paper thin" skin of lichen sclerosus

Question 42

Mammary Paget's disease is typically associated with an underlying [...].

Answer 42

Mammary Paget's disease is typically associated with an underlying **adenocarcinoma (e.g. DCIS)**.

Question 43

Menopausal women with vasomotor symptoms and contraindications to HRT are typically managed with non-hormonal therapy, such as [...].

Answer 43

Menopausal women with vasomotor symptoms and contraindications to HRT are typically managed with non-hormonal therapy, such as **SSRIs**. contraindications include history of coronary heart disease, thromboembolism, TIA/stroke, breast cancer, or endometrial cancer

Question 44

Menopause before age 40 suggests [...] insufficiency.

Answer 44

Menopause before age 40 suggests **primary** ovarian insufficiency. also known as premature ovarian failure or hypergonadotropic hypogonadism; more common in women who smoke or those receiving chemotherapy/radiation

Question 45

Methods for lactation suppression include a supportive bra, avoidance of nipple stimulation, application of ice packs to the breast, and administration of [...].

Answer 45

Methods for lactation suppression include a supportive bra, avoidance of nipple stimulation, application of ice packs to the breast, and administration of **NSAIDs.** NSAIDs are used to reduce pain and inflammation; medications are not recommended to suppress lactation (e.g. dopamine agonists)

Question 46

Most current guidelines suggest routine screening mammography every two years beginning at age \> [...].

Answer 46

Most current guidelines suggest routine screening mammography every two years beginning at age \> **50.** increased risk of cancer with increased age

Question 47

Most current guidelines suggest routine screening mammography every [...] years beginning at age \> 50.

Answer 47

Most current guidelines suggest routine screening mammography every two years beginning at age \> 50. increased risk of cancer with increased age

Question 48

Normal postvoid residual volume in women is

Answer 48

Normal postvoid residual volume in women is 150 mL. \< 50 mL in men; high PVR may be seen with overflow incontinence

Question 49

One risk factor for endometrial cancer is [...] due to increased peripheral conversion of androgens into estrone.

Answer 49

One risk factor for endometrial cancer is **obesity** due to increased peripheral conversion of androgens into estrone.

Question 50

Oral contraceptives are associated with a [...]-coagulable state.

Answer 50

Oral contraceptives are associated with a **hyper**-coagulable state. thus should not be used in women age \> 35 that use tobacco due to risk of myocardial infarction and stroke

Question 51

Oral contraceptives are associated with decreased risk for [...] and [...] cancer.

Answer 51

Oral contraceptives are associated with decreased risk for **ovarian** and **endometrial** cancer. due to chronic suppression of ovulation and suppressed endometrial proliferation, respectively

Question 52

Oral contraceptives are associated with [...] (blood pressure).

Answer 52

Oral contraceptives are associated with **hypertension** (blood pressure). due to increased angiotensinogen synthesis by estrogen during first-pass metabolism; discontinuing use can correct the hypertension in most patients

Question 53

Outpatient antibiotic therapy for patients with pelvic inflammatory disease includes IM [...] plus oral [...].

Answer 53

Outpatient antibiotic therapy for patients with pelvic inflammatory disease includes IM **ceftriaxone** plus oral **doxycycline**.

Question 54

Ovarian cyst rupture is commonly precipitated by strenuous activity or [...].

Answer 54

Ovarian cyst rupture is commonly precipitated by strenuous activity or **sexual intercourse**.

Question 55

Pap smears with HPV co-testing are repeated every [...] years beginning at age [...].

Answer 55

Pap smears with HPV co-testing are repeated every **5** years beginning at age **30**.

Question 56

Pap smears without HPV co-testing are repeated every [...] years beginning at age [...].

Answer 56

Pap smears without HPV co-testing are repeated every **3** years beginning at age **21**. begin at age 21 regardless of age of onset of sexual activity in immunocompetent patients; at age 30, Pap tests with HPV co-testing may be done at repeated every 5 years if negative

Question 57

Pap testing may be discontinued in patients age \> 65 with no history of CIN 2 or higher and [...] consective negative Pap tests or [...] consecutive negative co-testing results.

Answer 57

Pap testing may be discontinued in patients age \> 65 with no history of CIN 2 or higher and **3** consective negative Pap tests or **2** consecutive negative co-testing results. patients with cervical cancer risk factors (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing

Question 58

Pap testing may be discontinued in patients age \> [...] with no history of CIN 2 or higher and 3 consective negative Pap tests or 2 consecutive negative co-testing results.

Answer 58

Pap testing may be discontinued in patients age \> **65** with no history of CIN 2 or higher and 3 consective negative Pap tests or 2 consecutive negative co-testing results. patients with cervical cancer risk factors (e.g. immunosuppression, tobacco use, DES exposure, high-risk sexual activity) may need continued Pap testing

Question 59

Patients with PCOS may have [...] due to anovulation from failed follicular maturation.

Answer 59

Patients with PCOS may have **infertility** due to anovulation from failed follicular maturation. due to imbalance of LH and FSH hormone levels

Question 60

Patients with polycystic ovarian syndrome have increased risk of [...] carcinoma.

Answer 60

Patients with polycystic ovarian syndrome have increased risk of **endometrial** carcinoma. due to unregulated endometrial proliferation from unopposed estrogen stimulation

Question 61

Patients with suspected premenstrual syndrome (PMS) should record a [...] to aid in diagnosis.

Answer 61

Patients with suspected premenstrual syndrome (PMS) should record a **symptom/menstrual diary** to aid in diagnosis. symptoms typically occur 1-2 weeks before menses (luteal phase) and resolve after menses (follicular phase)

Question 62

Placental [...] deficiency can present with maternal virilization during pregnancy.

Answer 62

Placental **aromatase** deficiency can present with maternal virilization during pregnancy. fetal androgens can cross the placenta

Question 63

Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo [...] prior to surgical exploration.

Answer 63

Postmenopausal women with ultrasound findings suspicious for ovarian cancer and/or elevated CA-125 should undergo **further imaging (e.g. CT, MRI)** prior to surgical exploration. helps assess for the presence of metastatic disease which can guide surgical exploration

Question 64

Potential complications of cervical conization include cervical [...], cervical incontinence, and preterm delivery.

Answer 64

Potential complications of cervical conization include cervical **stenosis**, cervical incontinence, and preterm delivery.

Question 65

Potential complications of cervical conization include cervical stenosis, cervical incontinence, and [...] delivery.

Answer 65

Potential complications of cervical conization include cervical stenosis, cervical incontinence, and **preterm** delivery.

Question 66

Premature ovarian failure is characterized by [...] FSH and LH levels.

Answer 66

Premature ovarian failure is characterized by **increased** FSH and LH levels. due to lack of feedback inhibition from estrogen

Question 67

Primary genital herpes is associated with high risk for recurrence, with [...] frequent recurrences over time in immunocompetent individuals.

Answer 67

Primary genital herpes is associated with high risk for recurrence, with **less** frequent recurrences over time in immunocompetent individuals. treatment with antiviral medications (e.g. acyclovir) can speed resolution of outbreaks and decrease recurrences

Question 68

Progestin-containing IUDs work by [...] cervical mucus and impairing implantation.

Answer 68

Progestin-containing IUDs work by **thickening** cervical mucus and impairing implantation.

Question 69

Raloxifene is a SERM that acts as an estrogen receptor [...] in breast and [...] in endometrium.

Answer 69

Raloxifene is a SERM that acts as an estrogen receptor **antagonist** in breast and **antagonist** in endometrium. also has agonist activity in bone, which helps prevent osteoporosis without increasing risk of endometrial cancer (versus tamoxifen)

Question 70

Recurrent vulvovaginal candidiasis in a patient warrants evaluation for underlying [...].

Answer 70

Recurrent vulvovaginal candidiasis in a patient warrants evaluation for underlying diabetes mellitus.

Question 71

Risk factors for cervical cancer include early onset of sexual activity, high-risk HPV infection, immunosuppression, and [...] use.

Answer 71

Risk factors for cervical cancer include early onset of sexual activity, high-risk HPV infection, immunosuppression, and tobacco use.

Question 72

Selective estrogen receptor modulators increase the risk for venous thromboembolism by increasing [...] resistance.

Answer 72

Selective estrogen receptor modulators increase the risk for venous thromboembolism by increasing **protein C** resistance. due to estrogen agonist activity

Question 73

Stress urinary incontinence is often associated with urethral [...]-mobility.

Answer 73

Stress urinary incontinence is often associated with urethral **hyper-**mobility. characterized by urethral angle of \> 30 degrees from horizontal with an increase in abdominal pressure (Q-tip test); SUI may also be caused by decreased urethral sphincter tone

Question 74

Tamoxifen is a selective estrogen receptor modulator associated with increased risk of [...] hyperplasia/cancer.

Answer 74

Tamoxifen is a selective estrogen receptor modulator associated with increased risk of **endometrial** hyperplasia/cancer. due to estrogen agonist activity in endometrial tissue

Question 75

Tamoxifen is a SERM that acts as an estrogen receptor [...] in breast and [...] in endometrium.

Answer 75

Tamoxifen is a SERM that acts as an estrogen receptor **antagonist** in breast and **agonist** in endometrium. also has agonist activity in bone which helps prevent osteoporosis, though not used for osteoporosis due to risk of endometrial cancer (versus raloxifene)

Question 76

The "three D's" of endometriosis are [...], deep dyspareunia, and dyschezia.

Answer 76

The "three D's" of endometriosis are **dysmenorrhea**, deep dyspareunia, and dyschezia. other possible symptoms include chronic pelvic pain and infertility (resection of endometriosis improves conception rates)

Question 77

The "three D's" of endometriosis are dysmenorrhea, [...], and dyschezia.

Answer 77

The "three D's" of endometriosis are dysmenorrhea, **deep dyspareunia**, and dyschezia. other possible symptoms include chronic pelvic pain and infertility (resection of endometriosis improves conception rates)