Gyn, Reproductive and Sexual Disorders

Question 1

The cyclic occurrence in the luteal phase of a group of physical and distressing physical and psychological symptoms that begin 5-7 days before menses and resolves 4 days after onset of menses is considered what?

Answer 1

Premenstrual syndrome (PMS)

Question 2

PMDD must include at least one of what 4 symptoms?

Answer 2

markedly depressed mood, marked anxiety, marked affective lability, persistent and marked anger

Question 3

What medications are approved by the FDA for treatment of PMDD?

Answer 3

Drospirenone containing combination hormonal contraceptives and fluoxetine, paroxetine and sertraline

Question 4

Which dysmenorrhea is pain shortly before the onset of menses, is stimulated by prostaglandin release and rarely begins after age 20?

Answer 4

Primary dysmenorrhea

Question 5

Which dysmenorrhea can cause pain at anytime during the cycle, is related to underlying pathology and can occur at any age?

Answer 5

Secondary dysmenorrhea

Question 6

What is the treatment of choice for primary dysmenorrhea and how is it best used?

Answer 6

NSAIDs (mefenamic acid, naproxen sodium, ibuprofen and indomethacin) best if begun 2 days before expected menses or at onset continuing for 48-72 hours

Question 7

What is a progestin challenge test and what does it indicate?

Answer 7

Progestin daily for 10-14 days which should induce bleeding within 7-14 days which indicates adequate estrogen production and stimulation

Question 8

If FSH and LH levels are low, what does it indicate the cause of amenorrhea is?

Answer 8

Hypothalamic or pituitary dysfunction

Question 9

If FSH and LH levels are high, what does it indicate the cause of amenorrhea is?

Answer 9

Ovarian failure and menopause

Question 10

What are the structural causes of AUB using the acronym PALM?

Answer 10

Polyp, Adenomyosis, Leiomyoma (fibroids), Malignancy/Hyperplasia

Question 11

What are the non-structural causes of AUB using the acronym COEIN?

Answer 11

Coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified

Question 12

At what age is endometrial evaluation recommended in women with AUB?

Answer 12

40 years

Question 13

What are two non hormonal medications used for AUB?

Answer 13

NSAIDS and TXA both taken at menses onset for 5 days

Question 14

High levels of prolactin inhibit ovulation how?

Answer 14

By inhibiting GnRH from the hypothalamus thereby inhibiting LH/FSH production by the anterior pituitary

Question 15

What are the three components of the Rotterdam criteria for PCOS?

Answer 15

Oligo-ovulation/an-ovulation, clinical/biochemical hyperandrogegism and polycystic ovaries

Question 16

If pregnancy is desired, what is first line option for patients with PCOS?

Answer 16

Letrozole (Femara)

Question 17

The presence of endometrial stroma and glands outside of the uterus is what?

Answer 17

Endometriosis

Question 18

A benign condition in which ectopic endometrium is found within the myometrium is what?

Answer 18

Adenomyosis

Question 19

What is the first choice of analgesics for adenomyosis and endometriosis?

Answer 19

NSAIDs

Question 20

What serum prolactin levels are suggestive of a pituitary adenoma?

Answer 20

100-300ng/mL, refer if over 20ng/mL

Question 21

What pharmacologic agent decreases or stops galactorrhea?

Answer 21

Dopamine Agonist such as bromocriptine

Question 22

What are some pharmacologic agents to treat fibroids that are growing in size and causing bleeding issues?

Answer 22

GnRH agonist, MPA, IUDs

Question 23

What diagnostic test is used to evaluate ovarian cyst?

Answer 23

Transvaginal US

Question 24

How would you manage a functional ovarian cyst?

Answer 24

Refer if greater than 10cm; if less than 10cm and a simple cyst, then repeat serial US every 4-12weeks; if post menopause, consider any cancer risk factors and refer if they are present or cyst is greater than 10cm

Question 25

What is the most common gynecologic malignancy that usually presents with painless vaginal bleeding, watery leukorrhea that progresses to hemorrhage, and lower abdominal pain?

Answer 25

Endometrial carcinoma

Question 26

What are the Amsel criteria for diagnosing BV? (3 of 4 must be present)

Answer 26

vaginal pH greater than or equal to 4.5, clue cells on saline wet mount, homogeneous discharge that is white and coats vaginal walls, and a positive whiff test

Question 27

Increasingly severe dysmenorrhea and heavy bleeding during menses is a common symptom of what?

Answer 27

Adenomyosis

Question 28

What are the Amsel criteria for diagnosing BV? (3 of 4 must be present)

Answer 28

vaginal pH greater than or equal to 4.5, clue cells on saline we mount,

Question 29

What is the treatment for BV?

Answer 29

Metronidazole 500mg BID for 7 days

Question 30

What is used to treat Chlamydia?

Answer 30

Azithromycin 1g PO, single dose; Doxycycline 100mg PO BID for 7 days; avoid intercourse for 7 days

Question 31

A wet mount with pseudohyphae and pH less than 4.5 is consistent with which vaginal infection and how would you treat it?

Answer 31

Vaginal candidiasis; OTC suppositories or prescription oral fluconazole 150mg in a single dose

Question 32

What is used to treat Chlamydia?

Answer 32

Azithromycin 1g PO, single dose; Doxycycline 100mg PO BID for 7 days

Question 33

Postcoital bleeding, inter-menstrual bleeding, vaginal d/c, abdominal pain and symptoms of UTI could be c/w which STI?

Answer 33

Chlamydia

Question 34

What causes condyloma acuminata (anogenital warts)?

Answer 34

HPV

Question 35

Which HSV type is commonly found in the mouth and accounts for 15% of genital infections?

Answer 35

HSV 1, type 1

Question 36

What are symptoms of local prodrome of HSV and how long does it appear before lesions?

Answer 36

pruritus, erythema | 1-2 days before lesions

Question 37

Which HSV type causes 85% of genital infections?

Answer 37

HSV Type 2

Question 38

What is the suppressive therapy regimen for first clinical episode of HSV?

Answer 38

Acyclovir 400mg PO TID for 7-10 days

Question 39

What is the suppressive therapy regimen for episodic outbreak of HSV?

Answer 39

Acyclovir 400mg PO TID for 5 days

Question 40

What is the suppressive therapy regimen for recurrent outbreaks of HSV?

Answer 40

Acyclovir 400mg PO TID daily

Question 41

What are symptoms of local prodrome of HSV and how long does it appear before lesions?

Answer 41

pruritus, erythema | 1-2 days before lesions

Question 42

What are some systemic symptoms that may occur about 1 week after HSV exposure?

Answer 42

fever, malaise, headache

Question 43

Flesh-colored, white or pink waxy, smooth, firm spherical papules ranging from 2-5mm in diameter is likely what?

Answer 43

Molloscum Contagiosum

Question 44

What occurs during the primary stage of syphilis and how soon does it occur after exposure?

Answer 44

``` Primary lesion (chancre) arises at point of entry. Often painless, ulcerated with raised borders. Occurs 10-90 days after exposure ```

Question 45

What occurs during the secondary stage of syphilis and how soon after primary lesions does it occur?

Answer 45

Localized or diffuse lesions on palms and soles, condyloma lata with generalized lymphadenopathy and flu like symptoms 4-6 weeks

Question 46

When does latent phase of syphilis occur and how is it detected?

Answer 46

After spontaneous resolution of secondary stage. | Detected by serologic testing

Question 47

What are the characteristics of the tertiary stage of syphilis?

Answer 47

Nodular lesions on skin, mucous membranes and viscera. Cardiac and neruo symptoms are also present

Question 48

What are the initial non-treponemal tests for syphilis?

Answer 48

Venereal disease research laboratory (VDRL) or rapid plasma reagin (RPR)

Question 49

After a positive non-treponemal test, what do you do next?

Answer 49

Confirm with a treponemal test like FTA-ABS or TP-PA

Question 50

What medication is prescribed in different doses for the different stages of syphilis?

Answer 50

Benzathine penicillin G

Question 51

What should titers for syphilis do within 12-24. months?

Answer 51

decline at least four fold

Question 52

What indicates inadequate treatment or a new infection in terms of titer levels in the case of syphilis?

Answer 52

A fourfold increase in titers

Question 53

Haemophilus ducreyi is the bacteria that causes what STI and what is the recommended treatment?

Answer 53

Chancroid; Azithromycin 1g PO or Ceftriaxone 250mg IM

Question 54

What is a STI that presents with painless ulcerations, painful bowel movements, possible flu like symptoms, and blood/pus from the rectum?

Answer 54

Lymphogranuloma Venereum (LGV)

Question 55

What is the treatment for Lymphogranuloma Venereum (LGV) in non-pregnant and pregnant women?

Answer 55

Doxycycline 100mg PO BID for 21 days for non-pregnant woman; Erythromycin 500mg PO QID for 21 days in pregnant woman

Question 56

GC and CZ can lead to what if left untreated?

Answer 56

PID

Question 57

The presence of one or more of what symptoms on a pelvic exam lead to a diagnosis of PID?

Answer 57

cervical motion tenderness, uterine tenderness, adnexal tenderness

Question 58

An abundance of _____ on a microscopic wet mount correlates with a diagnosis of PID?

Answer 58

WBCs

Question 59

What are recommended IM/oral regimens for treatment of PID?

Answer 59

Ceftriaxone 250mg IM + Doxy 100mg PO BID for 14 days with or without metronidazole 500mg PO BID for 14 days

Question 60

When should a follow up examination be performed after treatment of PID is initiated?

Answer 60

72hours

Question 61

Which vulvar dermatoses presents as thickening of skin in response to chronic rubbing or scratching; may be atopic reaction; sometimes reaction to chronic inflammation from underlying skin condition?

Answer 61

Lichen simplex chronicus

Question 62

Which vulvar dermatoses presents as an inflammatory skin condition manifested in the vulva, vagina, and other mucous membranes; typically seen in perimenopausal and post menopausal women; flares and remits spontaneously; lasts from several weeks to years; thought to be autoimmune?

Answer 62

Lichen planus

Question 63

Shiny, erythematous papules/patches, gray-white lace strands of hyperkeratosis overlay patches, vaginal erythema, and loss of vulvovagina architecture is associated with which vulvar dermatoses?

Answer 63

Lichen planus

Question 64

Physical findings of thickened, leathery plaques on labia majora and possible involvement of other body areas (nape of neck, ankle, forearm) is c/w which vulvar dermatoses?

Answer 64

Lichen simplex chronicus

Question 65

What are common treatments for vulvar dermatoses?

Answer 65

Skin emollients/protectants, removing irritants and corticosteroids (short or long term)

Question 66

A chronic vulvar discomfort often described as burning pain occurring in the absence of relevant physical findings that can be generalized or localized is c/w with a diagnosis of what?

Answer 66

Vulvodynia

Question 67

What test is performed to assess for vulvodynia?

Answer 67

Cotton swab test

Question 68

What are some common topical or oral neuropathic pain medications for treatment of vulvodynia?

Answer 68

Lidocaine, gabapentin (PO or topical), nitroglycerine, amitriptyline (PO or topical)

Question 69

A chronic, progressive inflammatory skin condition primarily affecting the perineal/perianal are and is most common in menopause is c/w which vulvar dermatose?

Answer 69

Lichen sclerosus

Question 70

Physical findings of maculopapular lesions, plaques, loss of pigmentation, thin and white epidermis, loss of vulvar architecture and obliteration of clitoris is consistent with which vulvar dermatoses?

Answer 70

Lichen Sclerosus

Question 71

What kind of catheter can be placed after I&D of bartholin's gland/cyst, what is its purpose and how long should you leave it for?

Answer 71

Word. 4-6 weeks. | Formation of epithelialized tract and continued drainage of the gland

Question 72

Prenatal DES exposure is an increased risk for what?

Answer 72

Reproductive abnormalities, infertility and adenocarcinoma of cervix and vagina

Question 73

What condition occurs with tampon use(less likely with sponges and diaphragms), is caused by S. aureus, presents with a high fever, a rash, and can affect multiple organ systems?

Answer 73

Toxic Shock Syndrome

Question 74

Addyi, Vyleesi, Viagra, and Intrarosa are all FDA approved drugs for what condition?

Answer 74

Sexual Dysfunction

Question 75

Anomalies involving an incomplete or complete lack of development of the uterus Fallopian tubes, or upper vagina resulting from the absence of anti-mullerian hormone is termed as ______ abnormalities.

Answer 75

Mullerian abnormalities

Question 76

A female who only has one X chromosome or an abnormality of an X chromosome along with physical characteristics such as short stature, webbed neck, low neck hairline, short legs, lack of breast development, or scant pubic hair, and absent or streak ovaries most likely has what syndrome?

Answer 76

Turner's syndrome

Question 77

Which type of fibrocystic breast change includes a layering of cells; has malignant potential if atypical?

Answer 77

Hyperplasia

Question 78

Which type of fibrocystic breast change refers to dilation of ducts; may regress with menses, may persist, or may disappear and reappear?

Answer 78

Cystic changes

Question 79

Which type of fibrocystic breast change refers to a mass that develops following an inflammatory response to ductal irritation?

Answer 79

Fibrous change

Question 80

A patient that presents with well defined/mobile/tender masses in the breast along with clear or white nipple discharge that is bilaterally most likely has what breast condition?

Answer 80

Fibrocystic Breast Changes

Question 81

A patient that presents with a breast mass that is firm, freely movable, rubbery, non-tender, and has no nipple discharge or breast skin changes may likely have what breast condition?

Answer 81

Fibroadenoma; these are benign

Question 82

A patient that presents with blood, serous, or turbid nipple discharge with no palpable mass or skin changes and pain beneath the areola most likely has which breast condition?

Answer 82

Intraductal Papilloma

Question 83

A periareolar inflammation with mass or abscess in a woman who is not lactating and is most common in reproductive age group is what breast disorder?

Answer 83

Nonpuerperal/periductal mastitis

Question 84

What organism is commonly related to a dx of Nonpuerperal/periductal mastitis and how is it treated?

Answer 84

Staphylococcus aureus | Oral antibiotics for 10days with abx that covers gram positive organisms (Augmentin, Dicloxacillin, cephalexin)

Question 85

Dilation of ducts with surrounding inflammation and fibrosis that is most common in women >50 with an increased incidence in smokers is c/w which breast disorder?

Answer 85

Mammary duct ectasia

Question 86

What kind of discharge would be expected from the breast with mammary duct ectasia?

Answer 86

Green, brown, black. Often bilateral

Question 87

Menarche before age ____ and menopause after age ____ increases the risk for breast carcinoma.

Answer 87

<12 | >55

Question 88

In breast carcinoma, where is the breast mass most often located?

Answer 88

upper-outer quadrant

Question 89

A fixed mass, poorly defined, irregular and non tender can be consistent with what breast disorder?

Answer 89

breast carcinoma

Question 90

What lymph nodes may be enlarged with a breast carcinoma?

Answer 90

axillary, supra-clavicular and infra-clavicular

Question 91

What do you use to distinguish a sold from cystic breast mass?

Answer 91

ultrasound

Question 92

What is the most common symptom of vulvar cancer?

Answer 92

Pruritus `

Question 93

What is the most lethal gynecologic malignancy?

Answer 93

Ovarian cancer

Question 94

Normal breast development, scant pubic hair, blind vaginal pouch with no palpable uterus or ovaries in a 16 year old would be c/w with which diagnosis?

Answer 94

androgen insensitivity/resistance syndrome

Question 95

Vaginal cancer is most commonly found in which part of the vagina?

Answer 95

the upper one-third of the vagina

Question 96

Herniation of the bladder into the vaginal lumen is which pelvic relaxation disorder?

Answer 96

Cystocele

Question 97

Herniation of the urethra into the vagina is which pelvic relaxation disorder?

Answer 97

Urthrocele

Question 98

Bulging or herniation of the anterior rectal wall and posterior vaginal wall into the opening of vagina is which pelvic relaxation disorder?

Answer 98

Rectocele

Question 99

Herniation of a portion of the small intestine into the upper vagina is which pelvic relaxation disorder?

Answer 99

Enterocele