MTB (3) 2

Question 1

MCC of nipple discharge

Answer 1

Intraductal Papilloma

- Bloody

Question 2

Workup discharge that is what?

Answer 2

Unilateral
Spontaneous
Bloody
Ass’d with a mass

Question 3

Workup for Intraductal Papilloma

Answer 3

Mammogram

Surgical duct excision

Question 4

When do we do cytology for nipple discharge

Answer 4

Never

Question 5

Workup for BL, milky nipple discharge?

Answer 5

Prolactinoma

Question 6

How does fibrocystic dz of breast present

Answer 6

BL
Painful Breast lumps
Pain varies w menstrual cycle
Simple cyst with sharp margins, collapses on FNA

Question 7

Tx for fibrocystic dz

Answer 7

OCPs

Question 8

Presentation of fibroadenoma

Answer 8

Discrete, firm, nontender, highly mobile breast nodule

Question 9

FNA of fibroadenoma

Answer 9

Epithelial stromal elements

Question 10

Workup for pt with breast mass

Answer 10

Breast exam
US or Mammography
FNA Bx

Question 11

First step in workup of a palpable mass that feels cystic

Answer 11

US

Question 12

Invasive Ductal carcinoma

Answer 12

> 2cm

HER2 = prognostic factor

Question 13

How to check for HER2 expression

Answer 13

FISH

IHC

Question 14

Tamoxifen increases risk of what

Answer 14

Endometrial cancer

Question 15

Tamoxifen benefits

Answer 15

Decrease serum cholesterol, CV risk
increased bone density = decreased Fx
d

Question 16

Causes of enlarged uterus

Answer 16

Pregnancy
Leiomyoma
Adenomyosis

Question 17

Leiomyoma Presentation

Answer 17

Smooth muscle growth of myometrium
AA female
Childbearing age
Secondary dysmenorrhea and menorrhagia
\+/- sx's of rectal, ureter or bladder compression

Question 18

Workup for Ovarian mass

Answer 18

B-HCG
US
Laparoscopy/Laparotomy if complex of > 7 cm

Question 19

Leiomyoma on pelvic exam

Answer 19

Enlarged
firm
asymmetric
NONtender uterus

Question 20

What is the difference b/t leiomyoma and adenomyosis

Answer 20

Leio - Asymmetrically enlarged and NON tender

Adeno - Symmetric and tender

Question 21

How do simple ovarian cysts present

Answer 21

Asymptomatic unless torsion

Question 22

Dx test for simple cyst

Answer 22

US shows fluid-filled simple cyst

Question 23

Management of simple cyst

Answer 23

F/U in 6-8 weeks + steroid contraception for PPX

Laparoscopic removal if > 7 cm or steroid did not prevent

Question 24

What seizure medication is ass’d w PCOS

Answer 24

Valproic acid

Question 25

Postmenopausal woman with severe hirsutism and virilization

Answer 25

Ovarian hyperthecosis - nests of luteinized theca cells in ovarian troma High levels of androgens

Question 26

Management of ovarian hyperthecosis

Answer 26

OCPs (both E and P) = suppress androgens by lowering LH of theca cells Decrease free androgens = stimulate SHBG

Question 27

How does a luteoma of pregnancy present

Answer 27

Incidental finding on c-section or postpartum tubal ligation | Fetal and maternal hirsutism and virilization

Question 28

Theca Lutein cysts - what are they? Labs? In whom?

Answer 28

Benign neoplasms High FSH and B-hCG Twins/molar pregnancies

Question 29

Theca Lutein cysts Management

Answer 29

Spontaneously regress

Question 30

Postmenopausal woman w abdominal distension, ovarian mass - first step?

Answer 30

CT to assess mass and confirm ascites (peritoneal seeding)

Question 31

If ascites present w ovarian mass postmenopausal woman, next step?

Answer 31

Laparotomy, oophorectomy, surgical staging

Question 32

9 yo girl with R adnexal pain and complex cystic mass on US?

Answer 32

Germ cell tumor | MC malignant - dysgerminoma

Question 33

Germ cell tumor markers

Answer 33

LDH B-hCG a-FP

Question 34

67 yo woman w progressive wt loss, distended abdomen, and L adnexal mass

Answer 34

EPithelial tumor = MC ovarian cancer in postmenopausal women | MC malignant = serous

Question 35

Tumor markers for Epithelial tumor of ovarian cancer

Answer 35

CA-125 | CEA

Question 36

58 yo w postmenopausal bleeding. EMB - endometrial hyperplasia. Pelvic US shows R ovarian mass

Answer 36

Granulosa-theca stromal tumor | Secretes estrogen causing causing endometrial hyperplasia

Question 37

48 yo c/o increased facial hair and deepening of voice. Adnexal mass on exam

Answer 37

Sertoli-Leydig cell stromal tumor | Secretes testosterone

Question 38

64 yo presents w hx of gastric ulcer, recent worsening dyspepsia, wt loss, abd pain. Adnexal mass is found

Answer 38

Mets gastric cancer | Krukenberg tumor

Question 39

Tumor marker for krukenberg

Answer 39

Mucin producing tumor from stomach

Question 40

TX for ovarian masses

Answer 40

``` Sonogram/CT = postmenopausal Bx via laparoscopy for simple cysts Tumor markers Cystectomy - benign Premenstrual - Salpinoophorectomy (SO) Postmenopausal - TAH, BSO, post op chemo ```

Question 41

What is workup for pt with ASCUS

Answer 41

Do HPV testing: Negative -> Repeat pap 6 mos Positive -> Colposcopy

Question 42

What imaging study is done for cervical cancer

Answer 42

None. Only gyn cancer that is not staged clinically

Question 43

What is management for invasive cervical cancer

Answer 43

Simple hysterectomy | Modified radical hysterectomy

Question 44

WU for pregnant patient and abnormal pap?

Answer 44

Same as non-pregnant | Except endocervical curettage

Question 45

WHo gets HPV vaccine

Answer 45

All females 8-26 | Men 11-22

Question 46

DDx for Pelvic pain

Answer 46

Cervicitis Acute salpingoophoritis Chronic PID Tuboovarian abscess

Question 47

WU for Pelvic pain

Answer 47

1. Pelvic Exam 2. Cervical Culture 3. Labs: ESR, WBC 4. Sonogram

Question 48

Pt c/o cervical motion tenderness + lower pelvic pain after menstruation

Answer 48

Acute Salpingoophoritis

Question 49

Labs for Acute Salpingoophoritis

Answer 49

Positive cultures | High ESR and WBC

Question 50

Tx for Acute Salpingoophoritis

Answer 50

ABX