Gynecology

Question 1

OCPs decrease risk of what type of cancer?

Answer 1

ovarian, endometrial

Question 2

what causes labial fusion?

Answer 2

excess androgens

Question 3

most common enzymatic cause of labial fusion?

Answer 3

21-B hydroxylase deficiency

Question 4

marsupialization of bartholin gland cyst?

Answer 4

suture gland to keep open and prevent from forming another cyst in patients where this has become a recurrent problem

Question 5

treatment for bacterial vaginosis?

Answer 5

metronidazole or clinda

Question 6

if trichomonas is diagnosed….who needs treatment?

Answer 6

both partners

Question 7

red unilateral vulvar lesion with superficial white coating in a postmenopausal caucasian female

Answer 7

paget disease

Question 8

squamous cell carcinoma of the vulva presents as?

Answer 8

Itching, bloody vaginal discharge, postmenopausal bleeding. small ulcerated lesion to large cauliflower like lesion.

Question 9

invasion of endometrial glands into the myometrium? risk factors? presents as?

Answer 9

adenomyosis: endometriosis and uterine fibroids are risk factor. presents with dysmenorrhea and menorrhagia with a large, globular, boggy uterus.

Question 10

what is the most accurate test for adenomyosis? only definitive way to diagnose?

Answer 10

MRI; laporoscopic

Question 11

what is the definitive treatment for adenomyosis?

Answer 11

hysterectomy

Question 12

dysadvantage of implanon (progestin only implant)

Answer 12

irregular periods

Question 13

First step in work up of primary or secondary amenorrhea is always a?

Answer 13

pregnancy test

Question 14

Asherman syndrome

Answer 14

adhesions or fibrosis of endometrium. particularly associated with D+C.

Question 15

medical therapy for prolactinoma

Answer 15

bromocriptine

cabergoline

Question 16

Causes of abnormal uterine bleeding:

PALM-COEIN-

Answer 16

P: polyp
A: adenomyosis
L: leiomyoma
M: malignancy/hyperplasia

C: coagulopathy
O: ovulatory
E: Endometrial
I: iatrogenic
N: not classified

Question 17

When should you do an endometrial biopsy on premenopausal women?

Answer 17

> 35, risk factors for endometrial carcinoma like obesity, diabetes and AUB

Question 18

Treatment of acute-heavy bleeding of uterus? What if that treatment is contraindicated?

Answer 18

high dose estrogen IV and then transition to OCP or progestin when stable

Give progestin alone

Question 19

If acute uterine blood loss has not stopped in 12-24 hours - what is management?

Answer 19

D+C

Question 20

Firstline treatment of abnormal uterine bleeding during ovulation?

Answer 20

NSAIDS- reduce blood loss

Question 21

Treatment for anovulatory bleeding?

Answer 21

progestin X 10 days to stimulate withdrawal bleeds
OCPS
Projestin IUD

Question 22

which CAH presents with hypotension?

Answer 22

21-hydroxylase

Question 23

which CAH presents with hypertension?

Answer 23

11Bhydroxylase and 17-hydroxylase due to accumulation of deoxycorticosterone

Question 24

Treatment for CAH

Answer 24

glucocorticoids

Add mineralocorticoid if salt wasting

Question 25

Rotterdam criteria

Answer 25

2/3 needed to diagnose PCOS - PC ovaries on US - oligo/anovulation - clinical or biochem evidence of hyperandrogens

Question 26

woman says that 2 weeks after her period she has intense sharp lower quad abd pain that lasts a few hours and alternates sides with each cycle. what is this?

Answer 26

mittelschmirz- pain at ovulation due to progesterone production.

Question 27

+ chandelier sign =

Answer 27

cervical motion tenderness

Question 28

patient has cervical motion tenderness and fever. you start abx. what is next step in management?

Answer 28

pelvic ultrasound to rule out out tubo-ovarian abscess

Question 29

definition of infertility

Answer 29

inability to conceive after 12 months of nml reg sex

Question 30

Is bacterial vaginosis an infection?

Answer 30

NO- its a shift in flora

Question 31

"strawberry petechia" on upper vagina/cervix?

Answer 31

trichomonas

Question 32

If there are many WBCs and no organisms on smear of vaginal fluid- suspect?

Answer 32

chlamydia

Question 33

Criteria for diagnosis of bacterial vaginosis?

Answer 33

3/4 needed: - abnml white/grey discharge - vaginal pH >4.5 - + whiff test - clue cells > 20% of slide

Question 34

multiple shallow painful ulcers on genitals?

Answer 34

HSV

Question 35

deep painful ulcers with irregular borders?

Answer 35

chancroid. hemophylus ducrey

Question 36

important side effect of metronidazole?

Answer 36

disulfuram reaction when you drink alcohol with it. (flushing, n/v)

Question 37

why are blood cultures negative in TSS?

Answer 37

caused by preformed toxin

Question 38

empiric abx for TSS?

Answer 38

clinda and vanc

Question 39

If a uterine mass continue to grow after menopause...suspect?

Answer 39

malignancy (fibroids shrink after menopause)

Question 40

guardisil vaccine protects against which types of HPV?

Answer 40

6+11 (90% of warts) and 16+18 ( 70% of cerv cancer)

Question 41

``` Give the recommendations for cervical cancer screening for the following ages: 21-29 30-65 65 > DES exposure/immunocompromised ```

Answer 41

21-29: pap every 3 years 30-65: pap every 3 years or pap/HPV cotest every 5 65: stop if prior tests were negative. DES/ImmunoC- continue to screen

Question 42

What do you do for women 21-24 with ASC-US or LSIL? ASC-H, HSIL, atypical glandular cells?

Answer 42

repeat cytology at 12 months (preferred). If (-), repeat again at 12 months. If (-)X2- resume normal screening. If ASC-US >, colposcopy. OR reflux HPV test. If (-) -> normal screening. If (+) resume algorithm above. If ever ASC-H, HSIL, atypical glandular cells -> colposcopy right away

Question 43

If >24 with ASC-US what do you do?

Answer 43

Reflex HPV test. If (-) cotest in 3 years. If (+)-> colpo (preferred) OR retest in 12 months and if (-) routine screen

Question 44

HSIL and > 24 years old?

Answer 44

immediate LEEP excision (not if pregnant)

Question 45

HPV types for vulvar cancer?

Answer 45

16,18,31

Question 46

frequency of female genital tract cancers in order?

Answer 46

endometrial > ovarian > cervical

Question 47

deaths of female genital tract cancer?

Answer 47

ovarian > endometrial > cervical

Question 48

marker for dysgerminoma

Answer 48

LDH

Question 49

marker for granulosa cell tumor

Answer 49

inhibin

Question 50

marker for embryonal carcinoma

Answer 50

AFP, B-hcg

Question 51

marker for endodermal sinus

Answer 51

AFP

Question 52

most common infectious cause of vulvovaginitis in kids?

Answer 52

GAS

Question 53

differential diagnosis of breast mass?

Answer 53

fibrocystic disease, fibroadenoma, mastitis/abscess, fat necrosis, breast cancer

Question 54

most common breast lesion in women < 30?

Answer 54

fibroadenoma

Question 55

Phylodes tumor

Answer 55

difficult to distinguish from fibroadenoma. however usually larger and on histology will see classic "leaflike appearance) - papillary projections

Question 56

Common cancers that met to bone? BLT with Pickle on top

Answer 56

breast, lung, thyroid, prostate

Question 57

first step of mass in women > 30? women < 30?

Answer 57

>30- mammogram <30, US

Question 58

All ER/PR + patients should receive ____ for therapy if premenopausal OR _____ if postmenopausal?

Answer 58

tamoxifen; aromatase inhibitor

Question 59

All Her2/neu cancers should receive?

Answer 59

Trastuzumab

Question 60

ER + and PR + is assocaited with _____ prognosis?

Answer 60

favorable

Question 61

mimicker of breast cancer that occurs after trauma? what will biopsy show?

Answer 61

fat necrosis. coarse (not micro) calcifications and foamy macrophages