Gyn Uworld

Question 1

what hormone are PCOS deficient in

Answer 1

progesterone

Question 2

at risk for what with PCOS

Answer 2

endometrial carcinoma from increased estrogens causeing hyperplasia

Question 3

unnopposed estrogen is increased risk for what

Answer 3

endometrial cancer

Question 4

common age endometriosis

Answer 4

nulliparous age 25-35

Question 5

medical Tx endometriosis

Answer 5

NSAIDs and OCPs

Question 6

If Sx do not improve with NSAIDs and OCPS in endometriosis

next step

Answer 6

laparscopy

because is Dx and therapeutic when biopsying ablating or excising

Question 7

25 yr old nulligravid
bimaanual shows tenderness in posterior vaginal fornix and decreased uterine mobility
no adenexal masses
thickening of uterosacral ligaments

Answer 7

endometriosis

Question 8

common complication endometriosis

Answer 8

infertility

Question 9

aromatase deficiency

Answer 9

rare genetic disorder
cannot convert androgens to estrogens
virilization XX child
cliteromegaly
delayed puberty
osteoporosis

Question 10

hormone levels in aromatase deficiency

Answer 10

high FSH and LH with low estrogen

Question 11

mccune albright

Answer 11

cafe au lait
polyostotic fibrous dysplasia and auronomous endocrine hyperfunction
GnRH independed precocious puberty

Question 12

kallmans syndrome

Answer 12

hypogonadotropic hypogonadism with anosmia
delayed puberty
low or absent LH and FSH

Question 13

ruptured ovarian cyst signs

Answer 13

sudden onset severe unilateral lower abdomina pain after activity or sex

Question 14

signs ovarian torsion

Answer 14

sudden onset severe lower abdominal pain on one side
nausea and vomiting
unilateral tender adenexal mass

Question 15

enlarged ovary with decreased blood flow

Answer 15

ovarian torsion

Question 16

best reccommendation for patient to avoid breast cancer

Answer 16

decrease alcohol intake

Question 17

in postmenopasual women

next step after detecting adenexal mass

Answer 17

transvaginal US and serum CA-125

Question 18

first steps for abnormal uterine bleeding in premenopausal woman

Answer 18

exclude pregnnancy

CBC coags, tSH

Question 19

risk factors for endometrial cancer

Answer 19

>45
obesity
DM
unopposed Estrogen exposure
PCOS
early menarche/late menopause

Question 20

why not go to transvaginal US in premenopausal women looking for endometrial strip

Answer 20

because differ in thickness depending on cycle
instead do Bx
older post menopasual patients transvaginal US is better test

Question 21

when to do endometrial Bx in premenopausal patient

Answer 21

persistent Sx with negative lab results

risk factors for endometrial cancer

Question 22

physiologic galactorrhea

Answer 22

bilateral and no blood

Question 23

Sx fibroids

Answer 23

heavy menses with clots
constipation
urinary frequency, pelvic pain and heaviness
enlarged uterus on exam

Question 24

Sx adenomyosis

Answer 24

dysmenorrhea, pelvic pain, menorrhagia and bulky globular tender uterus

Question 25

how do tamoxifen and raloxifene work

Answer 25

estrogen agonist and antagonist activity estrogen agonist in uterus-- inc endometrial CA tamoxigen is antagonist in breast

Question 26

common side effect tamoxifen

Answer 26

hot flashes

Question 27

inc risk for what with tamoxifen

Answer 27

endometrial cancer and DVT

Question 28

flaty velvety wart like lesion

Answer 28

condyloma lata- secondary syphilis

Question 29

lichen sclerosis

Answer 29

white thin and wrinkled skin over labia | elderly and have pruritis

Question 30

vulvar lichen planus

Answer 30

middle aged women hyperkeratotic erosive papulosquamous pruritis, soreness and vaginal discharge

Question 31

important factor for invasive ductal carcinoma

Answer 31

HER2neu

Question 32

how to detect her2neu

Answer 32

FISH or immunohistochemical staining

Question 33

what chemo is effective against her2neu+

Answer 33

trastuzumab and anthracycline

Question 34

hormone levels of LH and FSH in PCOS

Answer 34

excess LH | little FSH

Question 35

injury to pelvic floor muscles cna result in what

Answer 35

urethral hypermobility and urethral prolpase get stress incontinence cystocele

Question 36

Dx test for urethral hypermobility

Answer 36

Q tip test checking the angle

Question 37

Tx for stress incontinence

Answer 37

kegel exercises | urethral sling

Question 38

boggy tender uniformly enlarged uterus

Answer 38

adenomyosis

Question 39

initial workup if suspect adenomyosis

Answer 39

Pelvic US and MRI | definitive is with histo exam of uterus

Question 40

bimanual and speculum shows dilated cervix with firm dark red round mass at os

Answer 40

prolapsing leimyoma uteri (fibroid)

Question 41

most common Sx of submucous fibroid

Answer 41

heavy and prolonged menstrual bleeding

Question 42

tx for woman with endometrial Bx showing complex hyperplasia without atypia

Answer 42

potent progestin to stop effects of estrogen

Question 43

premature ovarian failure causes in women

Answer 43

chemo, radiation, autoimmune ovarian failure, turners, fragile X

Question 44

hormone levels in premature ovarian failure

Answer 44

decreased Estrogen levels causing increased FSH and LH usuall FSH:LH >1

Question 45

role of bhCG

Answer 45

maintenance of corpus luteum

Question 46

cervical mucus in ovulatory phase

Answer 46

profuse, clear and thin

Question 47

cervical mucus in post and pre ovulatory phase

Answer 47

scant opaque and thick

Question 48

when is cervical mucus more basic

Answer 48

during ovulation >6.5

Question 49

what stimulates prolactin

Answer 49

TRH and serotonin and GnRH

Question 50

medications that cuase high prolactin

Answer 50

antipsychotics, TCAs and MAOIs

Question 51

unilateral bloody nipple discharge

Answer 51

intraductal papilloma

Question 52

first step for workup of bloody nipple discharge of breast unilaterally

Answer 52

mammo to rule out carcinoma

Question 53

next step to identify fibroids causing stress incontinence

Answer 53

US of pelvis

Question 54

posterior acoustic enhavement of breast mass

Answer 54

fluid

Question 55

aspiration of breast mass revealed clear fluid and mass disappeared. next step

Answer 55

return 2-4 months for follow up clinical breast exam

Question 56

what is the reason for amenorrhea in crazy athlete

Answer 56

estrogen deficiency

Question 57

hormones in female olympic athletes

Answer 57

decreased LH and GnRH | estrogen deficiency

Question 58

most efficient emergency contraceptive

Answer 58

copper IUD

Question 59

risk of amenorrhea from HPO axis suppression from extreme weight loss or exercise

Answer 59

decreased bone mineral density

Question 60

first step for determining infertility

Answer 60

semen analysis

Question 61

which side is more common for ovarian torsion

Answer 61

right

Question 62

risk factors for ovarian torsion

Answer 62

pregnancy, ovulation induction for infertility, ovarian masses

Question 63

Dx ovarian torsion

Answer 63

color doppler

Question 64

antibiotics for lactational mastitis

Answer 64

dicloxacillin or cephalexin

Question 65

first line test to assess fallopian tube patency

Answer 65

hysterosalpingogram

Question 66

risk of PID later for pregnancy

Answer 66

fallopian tube scaring

Question 67

obesity cause of infertiliy

Answer 67

anovulation from not enough progesterone

Question 68

Tx for vaginismus

Answer 68

kegel exercises and gradual dilatation

Question 69

first step for breast mass- non malignant like but patient has +FMH breast cancer

Answer 69

US

Question 70

if breast US shows complex cyst or solid mass, next step

Answer 70

image guided core biopsy

Question 71

OCP increase risk for what cancer

Answer 71

cervical

Question 72

what liver disorder do OCP increase risk for

Answer 72

hepatic adenoma

Question 73

heavy menses in young patient with first year of menses

Answer 73

anovulation

Question 74

patient with new onset night sweats, insomnia and irregular menses. in middle aged

Answer 74

check TSH and FSH

Question 75

pagets is associated with what breast cancer

Answer 75

adenocarcinoma

Question 76

chocolate appearing material in ovarian cyst

Answer 76

old blood | endometrioma

Question 77

gold standard Dx endometriosis

Answer 77

laparoscopy

Question 78

patient with high grade squamous epithelial lesion on cervix and is pregnant

Answer 78

repeat pap and colpo after delivery

Question 79

when do you do a LEEP procedure

Answer 79

when >25 and have HGSIL of cervix | unless post menopausal or pregnant

Question 80

common cause heavy menstrual bleeding

Answer 80

fibroids | proliferation smooth muscle in myometrium

Question 81

what significantly decreases risk of ovarian CA in BRCA + patients

Answer 81

prophylactic BSO

Question 82

ulcer in syphlis

Answer 82

painless that forms punched out base with raised indurated margins

Question 83

non modifiable breast cancer risk factors

Answer 83

genetic mutation in first degree relative swhite >50 years old early menarche or later menopause

Question 84

Dx fibroids

Answer 84

pelvic US

Question 85

normal increase bhCG in pregnancy

Answer 85

increase every 2 days

Question 86

infertility definition in women >35 years old

Answer 86

trying for 6+ months

Question 87

how to assess infertility due to aging

Answer 87

early follicular phase GSH level, clomiphene challenge test | inhibin B level

Question 88

what increases risk for clear cell adenocarcinoma of vagina and cervix

Answer 88

in utero exposure to DES

Question 89

males exposed inutero to DES

Answer 89

microphallus cyrptorchidism hypospadias testicular hypoplasia

Question 90

side effect tamoxifen

Answer 90

hyperplasia endometrium

Question 91

21-24 year old with atypical squamous cells of undetermined significance on pap next step

Answer 91

repeat cytology in 1 year

Question 92

birth control for woman undergoing chemo for breast cancer

Answer 92

copper IUD

Question 93

common side effet of OCPs

Answer 93

worsening HTN

Question 94

5 alpha reductase deficiency

Answer 94

cannot convert testosterone to DHES abiguous genitalia at birth male internal urogenital tract from AMH

Question 95

mullerian agenesis

Answer 95

no upper vagina, cervix or uterus otherwise notmal female developmen normal pubic and axillary hair female testosterone levels

Question 96

what is HELPP

Answer 96

systemic inflammation and platelet consumption

Question 97

next step in HELPP

Answer 97

delivery Mg anti HTN

Question 98

suspect lichen sclerosis, next step

Answer 98

vulvar punch biopsy

Question 99

risk with lichen sclerosis

Answer 99

vulvar squamous cell carcinoma

Question 100

Tx lichen sclerosis

Answer 100

topical corticosteroids

Question 101

need to do what before starting herceptin Tx

Answer 101

echo because risk of cardiotoxicity especially in those with low EF

Question 102

best chance for pregnancy with premature ovarian failure

Answer 102

in vitro fertilizaiton using donor oocytes

Question 103

CI to raloxifene and tamoxifen

Answer 103

VTE disorders like PE, DVT and retinal vein thrombosis

Question 104

msot common Sx vaginal CA

Answer 104

vaginal bleeding and malodorous vaginal discharge

Question 105

fat necrosis of the breast

Answer 105

fixed mass with skin or niple retraction and gives calcifications in spiculated pattern on mammo fat globules and foamy macrophages on Bx

Question 106

how does clomiphene work

Answer 106

estrogen analog that imporves GnRH release and RSH release improving chance of ovulation

Question 107

when is HPV screening started

Answer 107

>30

Question 108

when to stop paps

Answer 108

>65 if previous negative screens