Female Reproductive System & Breast

Question 1

Most common histologic subtype of ovarian cancer

Answer 1

Epithelial ovarian carcinoma

Question 2

Epithelial ovarian carcinoma

1. Clinical presentation
2. Laboratory findings
3. Ultrasound findings
4. Management

Answer 2

Question 3

Polycystic ovarian syndrome

1. Clinical features
2. Pathophysiology
3. Comorbities
4. Treatment options

Answer 3

Question 4

High risk family history for breast cancer

Answer 4

Two 1st degree relatives with breast cancer, including one before age 50

Three or more 1st of 2nd degree relatives with breast cancer

1st or 2nd degree relative with breast & ovarian cancer

1st degree relative with bilateral breast cancer

Breast cancer in a male relative

Ashkenazi Jewish women with any 1st of 2nd degree relatives with breast or ovarian cancer

Question 5

US Preventative Services Tast Force recommendations for breast cancer screening

1. Definitely beneficial - recommended

Answer 5

Question 6

Cervical cancer screening guidelines

1. HIV
2. Immunosuppressed (SLE, organ transplant)
3. Age < 21
4. Age 21-29
5. Age 30-65
6. Age >= 65

Answer 6

Question 7

Bartholin gland abscess

Answer 7

Pain with walking, sitting, and sexual intercourse

Tender, fluctuan mass in the medial aspect of the labium majus at 4 or 8 o’clock

Incision and drainage

Question 8

Chlamydia trachomatis

Answer 8

Dysuria

Sterile pyruria

Non-monogamous sexual contacts

Question 9

Benefits and risk of combined estrogen-progestin contraceptives

1. Benefits
2. Risks

Answer 9

Question 10

Answer 10

Lichen sclerosis

Causes intense pruritus and white atrophic plaques involving the vulvar and sometimes perianal skin but not the vagina

Punch biopsy confirms the diagnosis and rules out vulvar squamous cell carcinoma

Question 11

Scaping for potassium hydroxide test

Answer 11

Performed when dermal candidiasis is suspected

Question 12

Wet mount microscopy

Answer 12

Used to evaluate bacterial vaginosis, trichomoniasis, or vaginal candidiasis

Question 13

Atrophic vaginitis versus lichen sclerosis

1. Clinical features
2. Treatment

Answer 13

Question 14

Pharyngitis, fever, lower abdominal pain in a sexually active patient

Answer 14

Gonococcal pharyngitis with associated pelvic inflammatory disease

Question 15

High grade squamous intraepithelial lesion on pap

Answer 15

Require evaluation with immediate colposcopy

Can be treated with immediate loop excision in non-pregnant women

Question 16

Genitourinary syndrome of menopause

1. Symptoms
2. Physical Exam
3. Treatment

Answer 16

Question 17

Differential diagnosis of vaginitis

1. Diagnosis
2. Examination
3. Laboratory findings
4. Treatment

Answer 17

Question 18

Workup of palpable breast mass

Answer 18

Question 19

Inflammatory breast cancer

Answer 19

Question 20

Causes of urinary incontinence in elderly

1. Genitourinary
2. Neurologic
3. Potentially reversible

Answer 20

Question 21

Medications that cause urinary incontinence

Answer 21

Alpha-adrenergic antagonists (urethral relaxation)

Anticholinergics, opiates, calcium channel blockers (urinary overflow)

Diuretics (excess urine production)

Question 22

Disorders of sexual development

(Diagnosis, cause, breast development, reproductive organs, axillary and pubic hair, karyotype)

1. Complete androgen insensitivity syndrome
2. Mullerian agenesis
3. Transverse vaginal septum
4. Turner syndrome

Answer 22

Question 23

Genital development

Answer 23

Question 24

Anatomy of genital development (male and female)

Answer 24

Question 25

Emergency contraception options 1. Method 2. Mechanism 3. Time after intercourse (hours) 4. Efficacy

Answer 25

Misoprostol: prostaglandin analog used with mifepristone in the medical abortion mechanism. It works by stimulating uterine contractions. It has no effect on pregnancy prevention.

Question 26

PMS/PMDD 1. Clinical features (occurring during luteal phase) 2. Evaluation 3. Treatment

Answer 26

Question 27

Evaluation of primary amenorrhea

Answer 27

Question 28

Role of hCG in pregnancy

Answer 28

Preservation of the corpus luteum in early pregnancy Begins to be secreted 8 days after fertilization Peaks at 6-8 weeks

Question 29

Differential diagnosis of Dysmenorrhea 1. Diagnosis 2. Clinical features

Answer 29

Question 30

Endometriosis (classic triad)

Answer 30

Dysmenorrhea Dysparunia Infertility

Question 31

Causes of abdnormal menstrual bleeding 1. Diagnosis 2. Clinical features

Answer 31

Question 32

Answer 32

Pelvic endometriosis

Question 33

Answer 33

Adenomyosis

Question 34

Benign breast disease (Diagnosis, clinical features) 1. Breast cyst 2. Fibrocystic changes 3. Fibroadenoma 4. Fat necrosis

Answer 34

Fat necrosis can mimic breast cancer bc it commonly presents as a fixed mass with skin or nipple retraction and gives the appearance of calcifications on mammagrophy. Ultrasound can demonstrate a hyperechoic mass, which often correlates with a benign etiology. Biopsy of fat necrosis is diagnostic and shows fat globules and foamy histiocytes

Question 35

Vaginal Cancer 1. Type 2. Epidemiology 3. Risk factors 4. Location of cancer 5. Clinical features 6. Diagnosis

Answer 35

Question 36

Answer 36

**Dimpling** of the skin strongly suggests inflammatory breast cancer

Question 37

Endometriosis 1. Pathogenesis 2. Physical examination 3. Diagnosis 4. Treatment

Answer 37

Noncyclic pain can be exacerbated by exercise Endometrioma may be the only exam finding with a homogeneous cystic appearance on ultrasound

Question 38

Ovarian torsion 1. Risk factors 2. Clinical presentation 3. Ultrasound 4. Treatment

Answer 38

Question 39

Ovarian torsion versus appendicitis (or tubo-ovarian abscess)

Answer 39

An infectious etiology would be accompanied by **fever** and **leukocytosis**

Question 40

Acute abdominal/pelvic pain in women 1. Diagnosis 2. Clinical presentation 3. Ultrasound findings

Answer 40

Question 41

Characteristics of ulcerative sexually transmitted diseases (Disease, Causative agent, Features of primary lesion, Initial Lesion Painful?) 1. Chancroid 2. Genital herpes 3. Granuloma inguinale 4. Syphilis 5. Lymphogranuloma venereum

Answer 41

Question 42

Syphilis - diagnostic serology 1. Nontreponemal 2. Treponemal

Answer 42

Question 43

Management of CIN3

Answer 43

Question 44

Pelvic inflammatory disease 1. Symptoms 2. Physical examination **3. Treatment** 4. Complications

Answer 44

Cervicitis can cause intermenstrual spotting. Can be complicated by perihepatitis (Fitz-Hugh-Curtis disease), producing right upper quadrant pain

Question 45

Sjogren's syndrome

Answer 45

Autoimmune disorder caused by inflammatio of exocrine glands Can cause generalized dryness of mucous membranes, including vaginal dryness SS is associated with a significant risk for non-Hodgkin lymphoma

Question 46

Vaginismus

Answer 46

Dyspareunia due to muscle spasm that prevents vaginal penetration

Question 47

Indication for hormone replacement therapy

Answer 47

Treatment of vasomotor symptoms (e.g., hot flashes) in women \< 60 who have undergone menopause within the past 10 years. Contraindications to HRT: History of CAD, thromboembolism, TIA/stroke, breast cancer, endometrial cancer

Question 48

First line treatment for women with symptomatic hot flashes

Answer 48

Weight loss

Question 49

Indications for hospitalization for pelvic inflammatory disease

Answer 49

Regimens for hospitalized patients include **IV cefoxitin** or **cefotetan** plus **oral doxycycline**, or **parenteral (IV) clindamycin** plus **gentamycin**. **Outpatient regimen for PID**: IM ceftriaxone + oral doxycycline.

Question 50

Selective estrogen receptor modulators 1. Drugs 2. Mechanism of action 3. Indications 4. Adverse effects

Answer 50