MTB (3) 1

Question 1

What are cervical cultures in PID

Answer 1

Negative

Question 2

WHat does sonogram show for PID

Answer 2

BL cystic pelvic masses

Question 3

Management of Chronic PID

Answer 3

Lysis of tubal adhesions

Question 4

Presentation of Tuboovarian Abscess (TOA)

Answer 4

Ill-appearing woman
Severe, lower abdominal pelvic pain
Back pain, Rectal pain
Systemic Si’s - N/V, fever, tachy

Question 5

Labs for Tuboovarian Abscess

Answer 5

WBC and ESR = high

Question 6

Tuboovarian Abscess sonogram

Answer 6

Unilateral pelvic mass

Pus on culdocentesis

Question 7

What is a culdocentesis

Answer 7

Fluid extraction from rectouterine pouch posterior to vagina via needle

Question 8

Management for Tuboovarian Abscess

Answer 8

1. Admit to hospital
2. IV Clindamycin and IV genta micin
3. If no response or rupture -> Exploratory lapartomy

Question 9

Primary Dysmenorrhea Presentation

Answer 9

Recurrent, crampy, lower abdominal pain
N/V/D during menstruation
Sx’s begin 2.5 yrs after menstruation

Question 10

Pathophysiology of Primary Dysmenorrhea

Answer 10

Excessive endometrial PGF2 - causes uterine CTX adn acts on GI smooth muscle

Question 11

Management for Primary Dysmenorrhea

Answer 11

NSAIDS

OCPs (combination)

Question 12

MCC of Secondary Dysmenorrhea

Answer 12

Endometriosis
Adenomyosis
Leiomyoma

Question 13

What is primary amenorrhea

Answer 13

Absence of menses age 14 w/out secondary sexual development

Or age 16 WITH secondary sexual development

Question 14

WU for primary amenorrhea

Answer 14

1. PE and US
   - Breasts present or absent? Estrogen production
   - Uterus present or absent?
2. Karyotype, testosterone, FSH

Question 15

What is mullerian agenesis

Answer 15

Normal female secondary sexual traits
Normal estrogen/testosterone
Absence of Mullerian duct derivatives -fallopian tubes, uterus, cervix, upper vagina

Question 16

Management of mullerian agenesis

Answer 16

Reconstructive surgery to elongate vagina for sexual intercourse

Question 17

WU for primary amenorrhea w breasts absent

Answer 17

FSH and Karyotype

Question 18

Androgen Insensitivity Presentation

US

Answer 18

No pubic or axillary hair
Male genotype
US - testes produce normal estrogen (F) and testosterone (M) levels

Question 19

Management for Androgen Insensitivity

Answer 19

Remove testes before 20
Risk of testicular cancer
Estrogen replacement

Question 20

Turner syndrome Karyotype
Presentation
Labs

Answer 20

45, XO
Absent secondary sexual traits
Streak gonads
High FSH

Question 21

Management of Turner’s

Answer 21

Estrogen and progesterone replacement for development of secondary sexual characteristics

Question 22

Hypothalamic-Pituitary Failure
Presentation
Labs

Answer 22

No sexual characteristics
Normal uterus on US
FSH LOW

Question 23

Kallman syndrome

Answer 23

Hypothalamic - pituitary failure + Anosmia

Hypothalamus not producing GnRH

Question 24

Tx for Hypothalamic-Pituitary Failure

Answer 24

Estrogen and progesterone replacement for development of secondary sexual characteristics

Question 25

What is secondary amenorrhea

Answer 25

Regular menses replaced with absence of menses - 3 months OR Irregular menses replaced by absence of menses - 6 months

Question 26

WU of secondary amenorrhea

Answer 26

1. B-hCG 2. TSH to R/O hypothyroid (Hi TRH = Hi PRL) 3. PRL - meds, AP's = anti-Da = Hi PRL - CT/MRI r/o tumor 4. Progesterone Challenge 5. Estrogen Challenge

Question 27

Pituitary tumor

Answer 27

CT/MRI - tumor < 1cm = Bromocriptine - Tumor > 1cm = Surgery

Question 28

What does withdrawl bleeding in progesterone challenge test mean?

Answer 28

Anovulation

Question 29

What cancer are PCOS pts at risk for and why?

Answer 29

Endometrial cancer | Unopposed estrogen b/c no corpus luteum to make progesterone

Question 30

Testosterone level in PCOS

Answer 30

Increased total and free = mildly elevated - Increased LH - increased theca cell production of androgens - hepatic production of SHBG suppressed =increased testosterone

Question 31

Tx for PCOS

Answer 31

1. OCPs - irregular bleeding, hirsutism 2. Spironolactone - suppresses hair follicles 3. Clomiphene citrate - infertility 4. Metformin- ovulation/insulin resistance

Question 32

Rapid onset hirsutism + virilization + NO FHX

Answer 32

Adrenal/ovarian tumor

Question 33

How to differentiate adrenal and ovarian tumor

Answer 33

``` Adrenal = High DHEAS Ovarian = High testoserone ```

Question 34

Next step in management adrenal/ovarian tumor after labs

Answer 34

US - adnexal mass | CT - adrenal mass

Question 35

CAH - 21-OH deficiency Presentation

Answer 35

``` Gradual onset hirsutism + NO Virilization 2nd or 3rd decade Menstrual irregularities Anovulation Precocious puberty + short stature ```

Question 36

Labs in CAH - 21-OH deficiency | TX

Answer 36

Elevated serum 17-hydroxyprogesterone | Corticosteroid replacement

Question 37

What is the T score in osteoporosis

Answer 37

> -2.5

Question 38

MOA of bisphosphonates

Answer 38

Inhibit osteoclastic activity

Question 39

Benefits of HRT

Answer 39

Decrease osteoporotic Fx | Decrease rate of colorectal cancer

Question 40

Risks of HRT

Answer 40

Increased risk of DVT MI Breast cancer if tx > 4yrs

Question 41

Next step if pt unable to conceive, semen analysis is low

Answer 41

Repeat in 4-6 wks

Question 42

Infertility WU

Answer 42

1. Semen analysis 2. Anovulation WU 3. Fallopian tube abnormalities