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Flashcards in Gynecology Deck (38):

A 52-year-old woman with a past medical history of hypertension presents to the office for her routine physical exam. She states that she is feeling well, although tired at times. Her colonoscopy, mammogram, and Pap smear done at age 50 were normal. She has blood pressure of 135/80 mmHg, RR 12, temperature 98.5F, and BMI 29. Physical exam is within normal limits. Which of the following screening tests is indicated at this time?

a. Colonoscopy
b. DEXA scan
c. Mammogram
d. Pap smear
e. Hepatitis B

C. Screening mammogram is recommended every other year for women age 50 to 74. Colonoscopy is done every 10 years in the general population; repeat colonoscopy is done every 3 to 5 years if there is a polyp present. Osteoporosis screening with a DEXA scan starts at age 65. Pap smear is done every 3 years if cytology alone is done or every 5 years if done in conjunction with HPV testing. Hepatitis B screening is not conducted routinely unless the patient is high risk.


When do you start breast cancer screening?

50 to 74

40 for those with family history


A 55-year-old woman presents to the office for a breast mass that she felt. The mass is painless and mobile, and it has been present for the past week. Her mammogram done last year was negative. Vital signs are stable. Physical exam is significant for a 3 cm by 3 cm, round, firm mass that is mobile and nontender, located on the right breast at the 4 o'clock position. No nipple discharge or skin changes are noted, and no axillary lymph nodes are palpated. What is the next step in the management of this patient?

a. Biopsy
b. Mammogram
c. Breast ultrasound
d. Breast MRI
e. No further treatment

B. Diagnostic mammogram is done as the first-line test in women with a palpable breast mass, regardless of when the last mammogram was done. Even in a woman under the age of 30, a mammogram should be performed first. Breast ultrasound is done first only if the woman is breastfeeding or pregnant. Breast MRI is not a screening test. Biopsy is never the first step in the workup.


Give the 4 most common breast masses

Fibrocystic changes
Fat necrosis


This is a type of breast mass that can increase in size during pregnancy, common in 15-35-year-old women that presents with benign, well-defined, and mobile solid mass.



This is a type of breast mass that is common in premenopausal women, cyclical breast pain that increases with approach of menses, returns to baseline once menstruation starts. It presents with nodular tissue on physical exam with diffuse tenderness and mass that is not discrete or well defined.

Fibrocystic changes


This is a type of breast mass that occurs in pregnancy, breastfeeding, or weaning. There will be milk retetntion cyst caused by blocked milk duct. It is usually painless but painful when infected.



This is a type of breast mass that occurs after blunt trauma to the breast. It may also occur after radiation, breast reconstruction, injection of substances into the breast, or breast reduction.

Fat necrosis


Define Primary Amenorrhea

It is defined as the absence of menstruation by the age of 15 years in a female who has normal secondary sexual characteristics.


Enumerate possible causes of primary amenorrhea.

Gonadal dysgenesis (Turner syndrome)
Mullerian agenesis
Delay of puberty


What are the initial tests for primary amenorrhea?

Pelvic ultrasound (to assess for presence of a uterus)


Define Secondary Amenorrhea

It is the absence of menses for more than 3 months in a female who menstruates regularly or absence of menses for 6 months in a female who menstruates irregularly.


What are the possible causes of secondary ammenorhea?

Pregnancy (most common)
Hypothalamic amenorrhea
Primary ovarian insufficiency
Thyroid abnormalities


What are the initial tests for Secondary Amenorrhea

Prolactin levels


What is diagnostic for Menopause?`

increased FSH level


True/False: Postcoital bleeding is cervical cancer until proven otherwise



Any patient older than 35 with abnormal bleeding should undergo ____________ to rule out endometrial carcinoma.

endometrial biopsy


What is the most common cause of labial fusion?

21-B hydroxylase deficiency


Patient presents with white, thin skin extending from labia to perineal area. Any age can be affected; however, if postmenopausal, there is an increased risk of cancer.

Lichen sclerosis


Patients presents with chronic irritation in the vulva and develops hyperkeratosis (raised white lesion). It presents at any age to those who have had chronic vulvar pruritus.

Squamous cell hyperplasia


Patient presents with violet, flat papules in the vulva typically in 30-60s.

Lichen planus


Treatment for Lichen Sclerosus

Topical Steroids


Treatment for Squamous Cell Hyperplasia

Sitz baths or lubricants (relieve the pruritus)


Treatment for Lichen Planus

Topical steroids


A 19-year-old woman presents for vaginal pruritus and discharge for one week. She complains that the discharge is green and profuse. She has had multiple sexual partners in the past 2 months. Her last menstrual period was 2 weeks. On wet mount, the vaginal discharge has motile flagellates present.

Which of the following is the most likely diagnosis?

a. Chlamydia
b. Bacterial vaginosis
c. Neisseria gonorrhoeae
d. Candidiasis
e. Trichomonas vaginalis

E. Trichomonas presents with a profuse, green, frothy discharge. Neisseria is a bacterial infection that is identified by culture. Chlamydia is diagnosed by serology DNA probe. Candidiasis is associated with white, cheesy vaginal discharge and a fishy odor without pruritus


What are the risks factors for vaginitis?

Antibiotic use
Overgrowth of normal flora


This a type of vaginitis with vaginal discharge described as fishy odor; gray white in color. Clue cells present in saline wet mount.

Bacterial Vaginosis


Treatment for Bacterial Vaginosis

Metronidazole or Clindamycin


Treatment for Candidiasis

Miconazole or Clotrimazole, Econazole, or Nystatin


Treatment for Trichomonas

Metronidazole for both patient and partner


This is an intraepithelial neoplasia that most commonly occurs in postmenopausal Caucasian women. Ot presents with vulvar soreness and pruritus appearing as a red lesion with a superficial white coating.

Paget disease


This is the most common type of vulvar cancer

Squamous cell carcinoma


This is the invasion of endometrial glands into the myometrium



This is the implantation of endometrial tissue outside of the endometrial cavity. It presents with cyclical pelvic pain that starts 1 to 2 weeks before menstruation and peaks 1 to 3 days before menstruation. The pain ends with menstruation. Abnormal bleeding is common. The physical exam reveals a nodular uterus and adnexal mass.



How would you diagnose endometriosis?

Direct visualization via laparoscopy

On the ovary, a cluster of lesions called an endometrioma looks like a "chocolate cyst"


What is the most accurate test for Adenomyosis?



What will you expect in the PE of a patient you suspect with Adenomyosis?

large, globular, and boggy uterus


What are the risk factors of Endometrial Carcinoma?

Obese, postmenopausal woman
Tamoxifen therapy
Early menarche
Late menopause
Lynch syndrome