General Gyne

Question 1

What is the DSM IV Dx: Persistent or recurrent deficiency or absence or sexual fantasies and desire for sexual activity

Answer 1

Hypoactive Sexual desire disorder

Question 2

What is the DSM IV Dx: Persistent or recurrent extreme aversion to or avoidance of all or almost all genital sexual contact with a sexual partner

Answer 2

Sexual aversion disorder

Question 3

What is the DSM IV Dx: Persistent or recurrent delay in or absence of orgasm following sexual excitement phase

Answer 3

Orgasmic disorder

Question 4

What is the DSM IV Dx: Persistent or recurrent genital pain associated with sexual intercourse

Answer 4

Dyspareunia

Question 5

What is the DSM IV Dx:
Persistent or recurrent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal pentration with penis, finger, tampon or speculum is attempted

Answer 5

Vaginismus

Question 6

First line treatment for PMDD

Answer 6

SSRI

Question 7

What is the diagnosis? Vaginal burning and pain, vaginal pH <4.5, pseudohyphae on wet mount

Answer 7

Vulvovaginal Candidiasis

Question 8

How do you diagnose and treat recurrent vulvovaginal candidiasis?

Answer 8

4 or more episodes in 12 months
Tx: Induction and maintenance treatment.
Eg. Fluconazole 150mg PO 3 doses 72 hours apart THEN 150mg PO weekly x 6 months

Question 9

What is the diagnosis and treatment? malodorous frothy voluminous discharge with wet mount showing motile parasite

Answer 9

Dx: Trichomonas (flagellated parasitic protozoan)

Tx: Metronidazole 500mg PO BID x 7 days or 2g PO x1, treat partner (not reportable disease in Canada)

Question 10

What is the diagnosis and treatment? Vaginal pH > 4.5, Clue cells on wet mount, positive whiff test (amine odour with additional of KOH

Answer 10

Dx: Bacterial Vaginosis (overgrowth of vaginal flora, less lactobacilli)

Tx: Metronidazole 500mg PO BID x 1 week (or vaginal 0.75% x 5days), alternate Metronidazoel 2g PO x1 or clindamycin cream or PO x 7 days

Question 11

When does hysterosalpingogram require antibiotics?

Answer 11

When tubes are dilated, give doxycycline

Question 12

Most common strain of HSV causing genital herpes

Answer 12

HSV2

Question 13

What is the rate of transmission of genital HSV to a partner while on suppressive therapy?

Answer 13

1%

Question 14

Genital Warts in prepubertal child requires consideration of what?

Answer 14

Sexual abuse, no need to biopsy

Question 15

Cervical cytology screening is considered what type of prevention?

Answer 15

Secondary prevention (looking for pre cancerous lesions)

Question 16

What kind of prevention is the HPV Vaccine?

Answer 16

Primary Prevention - the best form of prevention for HPV

Question 17

HPV is implicated in what types of cancers?

Answer 17

cervical, vaginal, vulvar, anal, head and neck

Question 18

HPV is associated with what percentage of vulvar cancer and vaginal cancer ? Anal cancer? Head and neck cancer?

Answer 18

Vu/Va: 20-50%, Ano: 80-90%, H&N: 10-20%

Question 19

HPV is most common among young sexually active women, what percentage will clear the virus?

Answer 19

80%

Question 20

What proteins doe HPV use to be oncogenic?

Answer 20

E6 and E7 proteins interfere with normal cell regulatory functions

Question 21

When should an IUD be removed in PID?

Answer 21

after 72 hours if no clinical improvement

Question 22

Risk of PID post IUD placement in the first 90 days?

Answer 22

0.5%

Question 23

What are the Benefits of OCP?

Answer 23

• Contraception
• Regulation of menses
• Treatment of the following:
  o dysmenorrhea
  o PMS
  o Menstrual headaches
  o Acne
  o Hirsutism
• Long term benefits:
  o Reduced rates of endometrial, ovarian and colorectal cancer

Question 24

What is the risk of VTE with OCP?

Answer 24

Background risk 4-5/10 000 women years
(doubles)
OCP risk 8-10/10 000 women years

Pregnancy risk 29/10 000

Peripartum risk 300/10 000

Question 25

Treatment for Primary Dsymenorrhea

Answer 25

C - Heat pads, exercise M - NSAIDS (Tylenol), COC (IUD, DMPA, Visanne) S - for secondary causes (endo ablation, hysterectomy EM ablation + COC) Other: TENS, accupuncture

Question 26

Adolescent Pregnancies are at higher risk for:

Answer 26

Maternal: antepartum - depression, ?HTN, IPV, anaemia, substance use, etoh, STI, PPROM intrapartum: SVD Postpartum: unintended pregnancy, depression, low rate of breast feeding Fetal: antepartum - congenital anomaly, congenital infection (chlamydia), IUGR, PTL, PTN Intrapartum - SB Post partum - NND, children with lower education

Question 27

Most common US findings for Ovarian torsion and what are other US findings?

Answer 27

1. Ovarian enlargement 2. absence of doppler flow Others:

Question 28

When would you consider oopheropexy in the management of ovarian torsion?

Answer 28

1. repeat torsion 2. congenitally long ligament 3. no obvious cause of torsion

Question 29

Classic findings in Turners 46 X

Answer 29

- Short stature - Micrognathia - Epicanthal folds - High arched palate - Hearing loss - Webbed neck - Shield chest - Absent breast development - Wide spaced areolae - Cubitus valgus - Short 4th metacarpal - AI disorder - AI thyroiditis - Renal anomalies - Aortic coarctation

Question 30

Obstructive hemi vagina is associated with ?

Answer 30

ipsilateral renal agenesis (didelphys, obstructed hemivagina and ipsilateral renal anomaly = OHVIRA

Question 31

What are the most common additional anomalies seen with mullerian anomalies?

Answer 31

Renal, Spinal

Question 32

What mullerian anomaly has the best fertility outcomes?

Answer 32

Didelphis uterus

Question 33

What are the obstetrical complications associated with mullerian anomalies?

Answer 33

SA, RPL, PTL, PTB, IUGR, SGA, PPROM, Malposition, Fetal malformation (septum)

Question 34

Describe the phenotype for 46XY complete AIS

Answer 34

No uterus, testis present (intra-abdominal), no pubic or axillary hair, breasts present , short blind end vagina

Question 35

Describe the phenotype for 46 XX with Complete mullerian genesis (MRKH)

Answer 35

No uterus, short pouch vagina, no testis, ovaries present, normal breasts, axillary and pubic hair present

Question 36

What are the indications for EUA with a straddle injury?

Answer 36

1. inability to void 2. ongoing bleeding 3. expanding hematoma 4. suspicion of penetrating injury (need to inspect upper vagina) 5. suspected anal sphincter injury