GYN

Question 1

PMS

Answer 1

• cyclic occurrence in the luteal phase
• begin 5 to 7 days before menses and resolve within 4 days of onset of menses
• disrupt normal activities and interpersonal relationships

Question 2

Non pharm Tx of PMS

Answer 2

• chaste tree berry
• Aerobic exercise 20 - 30 min 4X/week
• Cognitive therapy
• Avoidance of physical/emotional triggers

Question 3

RX Tx of PMS

Answer 3

• Spironolactone during luteal phase (reduce swelling/bloating)
• NSAIDs
• COCs
• SSRIs (may choose to only take during luteal phase)

Question 4

PMDD

Answer 4

• At least 5 PMS-like symptoms severe enough to disrupt normal functioning
• Most if not all menstrual cycles
• Occurs in luteal phase and resolves within 1 week after menses
• Markedly depressed mood, anxiety, anger
• SSRIs (fluoxetine, sertraline, paroxetine)

Question 5

Which phase of the ovarian cycle is most variable?

Answer 5

Follicular phase

Question 6

Which phase of the ovarian cycle is most constant?

Answer 6

Luteal phase (14 days)

Question 7

Is Galactorrhea bilateral?

Answer 7

YES, ALWAYS!

Question 8

Fibrocystic Breast Changes

Answer 8

• occurs 1-2 weeks before menses
• well, defined, mobile, TENDER
• NO SKIN changes
• upper outer quadrant and axillary tail

Question 9

Treatment for Fibrocystic Breast Changes

Answer 9

• Tx not necessary
• Aspiration of palpable cysts may be curative
• Supportive bra
• NSAIDs
• Reduce methylxanthines (caffeine, tea, cola, chocolate)
• Hormonal contraception may improve or worsen

Question 10

Who is most at risk for Fibrocystic Breast Changes?

Answer 10

• Women aged 20 - 50, most common 35 - 50

Question 11

When do Fibroadenomas develop?

Answer 11

Soon after menarche

Question 12

What age group is likely to be affected by Fibroadenoma?

Answer 12

Aged 15 to 25

Question 13

Signs and Symptoms of Fibroadenoma

Answer 13

• painless, single, round rubbery mass
• No nipple D/C
• Does NOT change with menstrual cycle
• NO SKIN changes

Question 14

Diagnostic Tests for Fibroadenoma

Answer 14

• Fine needle aspiration
• Excisional biopsy
• U/S or mammography (U/S best choice for young women)

Question 15

Management for Fibroadenoma

Answer 15

• Observe if less than 25
• May be removed to alleviate anxiety
• Annual clinical breast exam

Question 16

What is the most common cause of pathologic nipple d/c?

Answer 16

Intraductal papilloma

Question 17

Signs and Symptoms of Intraductal Papilloma

Answer 17

• Bloody, serous, or turbid discharge (not milk)
• D/C may occur spontaneously
• Mass not palpable
• Feeling of fullness or pain beneath areola

Question 18

How to definitively evaluate Intraductal Papilloma?

Answer 18

• Excisional biopsy

Question 19

Midwifery Management of Intraductal Papilloma

Answer 19

• REFER

- Excisional biopsy is curative

Question 20

What age group is most at risk for Intraductal Papilloma?

Answer 20

• perimenopausal age group 35-50 yo

Question 21

Breast Carcinoma Signs and Symtpoms

Answer 21

• Breast mass, likely upper outer quadrant
• Mass fixed, poorly defined, nontender
• Spontaneous nipple D/C
• Retraction
• Skin Changes

Question 22

What is the proper follow-up of a patient with galactorrhea who is having regular menses and has normal prolactin and TSH levels?

Answer 22

Yearly prolactin levels

Question 23

Adenomyosis Signs and Symptoms

Answer 23

• dysmenorrhea, heavy uterine bleeding
• boggy tender uterus
• globular enlargement (may be 8 - 10 weeks gestation size)

Question 24

Galactorrhea

Answer 24

• bilateral nipple d/c that occurs in women that have not been pregnant or lactating within the last 12 months
• Not caused by breast disease
• often idiopathic
• May be associated with prolactin-secreting pituitary adenomas

Question 25

Patients with PCOS are at increased risk for:

Answer 25

- endometrial cancer - diabetes mellitus - heart disease

Question 26

What is the treatment for Bacterial Vaginosis?

Answer 26

- Metronidazole 500 mg PO BID X 7d - Metronidazole gel 0.75% QD X5d - Clindamycin cream 2% QD X7d

Question 27

Amsel's Diagnostic Criteria for diagnosing BV

Answer 27

3 of the following: - white d/c that coats vaginal walls - clue cells on microscopic exam - pH of vaginal fluid >4.5 - +Whiff test

Question 28

What is found on BV Gram Stain?

Answer 28

Lactobacilli

Question 29

What is the treatment for vulvovaginal candidiasis?

Answer 29

- OTC or prescription topical "azole"cream | - Fluconazole 150 mg PO 1 time

Question 30

What is seen on wet prep or gram stain of candidiasis?

Answer 30

- budding yeasts - hyphae - pseudohyphae

Question 31

What is the treatment for Chlamydia?

Answer 31

- Azithromycin 1 g PO single dose | - Doxycycline 100 mg PO BID X7d (not approved for tx in pregnancy)

Question 32

What are is most sensitive test in diagnosing Chlamydia?

Answer 32

NAAT

Question 33

What is the treatment for Gonorrhea?

Answer 33

- Ceftriaxone 250 mg IM PLUS Azithromycin 1 g PO single dose

Question 34

What is the treatment for primary, secondary, and early latent syphilis?

Answer 34

- Benzathine PCN G 2.4 million units IM single dose

Question 35

What is the treatment for first episode of HSV (herpes)?

Answer 35

Acyclovir 400 mg PO TID X 7-10d

Question 36

What is the suppressive therapy for recurrent HSV (herpes)?

Answer 36

Acyclovir 400 mg BID

Question 37

When should suppressive therapy for HSV+ women begin in pregnancy?

Answer 37

36 weeks

Question 38

What is the suppressive therapy for HSV in pregnant women?

Answer 38

Acyclovir 400 mg PO TID QD

Question 39

Tx of PCOS in women who do not want to conceive?

Answer 39

- low dose COCs | - progestin contraceptives (irregular bleeding)

Question 40

Tx of PCOS in women who do not desire pregnancy and who do not want hormonal contraception?

Answer 40

- MPA for 10 days a month induces withdrawal bleeding - Weight loss - Insulin sensitizing agents (i.e. metformin)

Question 41

What are potential causes of galactorrhea?

Answer 41

- hypo/hyperthyroidism - some medications (opiates, cannabis) - excessive breast stimulation - pituitary adenoma