GYN Office and Misc Mgmt

Question 1

Which vulvar cyst pts to give I&D + Abx to?

Answer 1

> 5cm
extends into other compartments
extensive cellullitis
likely MRSA+(hospital, long term care, HIV, IVD, military)
systemic infxn (fever)
immunocompromised (DM, immunosuppressant therapy)
recurrent abscess

Question 2

postmenopausal + Bartholin’s: mgmt?

Answer 2

biopsy!

Question 3

ovarian torsion sono signs

Answer 3

enlarged ovary
echogenic stroma
whirlpoon sign

Question 4

Absolute CI for endometrial ablation

Answer 4

1. endometrial CA or hyperplasia
2. current or future pregnancy
3. IUD
4. active PID

Question 5

Relative CI for endometrial ablation

Answer 5

1. risk factors for endometrial CA (PCOS, obesity, tamoxifen, Lynch Sd)
2. postmenopause
3. myometrial thinning (i.e. hx myomectomy)
4. uterine anomalies

Question 6

Mgmt PMB + EMB = polypoid

why

Answer 6

HSC polypectomy

why: 5.4% of polyps in postmenopausal are malignant, hyperpplastic

Question 7

Mgmt postmenopausal, asx incidental finding ET >4mm + EMB = polypoid

Answer 7

expectant (b/c asx) vs surgical

Question 8

Describe FIGO 0 fibroids

Answer 8

intracavitary, pedunculated

Question 9

Describe FIGO 1 fibroids

Answer 9

submucosal, <50% intramural

Question 10

Describe FIGO 2 fibroids

Answer 10

submucosal, >50% intramural

Question 11

Describe FIGO 3 fibroids

Answer 11

contacts endoometrium but 100% intramural

Question 12

Describe FIGO 4 fibroids

Answer 12

does not contact enodmetrium
100% intramural

Question 13

Describe FIGO 5 fibroids

Answer 13

subserosal >50% intramural

Question 14

Describe FIGO 6 fibroids

Answer 14

subserosal <50% intramural

Question 15

Describe FIGO 7 fibroids

Answer 15

subserosal pedunculated

Question 16

Describe FIGO 8 fibroids

Answer 16

Other (cervical, broad ligament, etc)

Question 17

describe vestibulodynia

Answer 17

vulvar pain

Question 18

vestibulodynia mgmt

Answer 18

pelvic floor rehab
anticonvulsants, antidepressants
vestibulectomy (definitive)

Question 19

Medical tx options genital warts

Answer 19

podofilox
imiquimod
sinecatechins
podophyllin
TCA

Question 20

Procedural Tx options for genital warts

indication / candidate

Answer 20

cryotherapy
surgical rmeoval (laser, electrocautery, sharp)

failed medical mgmt, discomfort due to size, +biopsy for cytology

Question 21

Genital warts caused by:

Answer 21

HPV6, HPV11

Question 22

PEP for HIV: regimen

initiate how long after exposure?

Answer 22

28-day course
3-drug antiretrovirals (tenofovir, emtricitabine, raltegravir)

within 72hrs (~3d)