OB/GYN 8

Question 1

Antiphospholipid syndrome is a contraindication to pregnancy…

What is the preferred birth control method?

What type of birth control should you avoid?

Answer 1

USE, progesterone only birth control.

IUD preferred because best at decreasing menstrual bleed, which is good bc APS are anti coagulated.

AVOID Estrogen containing (transdermal, RING, OCP) bc increased risk of thrombosis.

Question 2

What is the most common palpable breast mass in women < 30 yo?

What is the classic presentation?

Management?

Answer 2

Fibroadenoma

Presentation = single, rubbery, well-circumscribed mass, that changes with menses.

Management = Observation for 1-2 months cycles and assure that it will resolve on it’s own.

Question 3

Ovarian torsion occurs when the ovary twists around the suspensory ligament and utero-ovarian ligament…it presents with sudden onset SEVER unilateral pelvic pain, N/V, palpable adnexal mass and fever/leukocytosis (if necrosis started) …

What side is more common?

What labs do you want to get initially and how do you dx?

TRX?

Answer 3

Commonly on R side (longer ligament and L side has sigmoid occupying the space)

Management = B-HCG to rule out ectopic + Pelvic US with color doppler.

TRX = Emergent Surgery

Question 4

Ovulatory dysfunction is common during first few years of Menarche… and can present with irregular and HEAVY menses following periods of anovulation…

How do you trx a woman coming in with acute heavy bleeding episode and HD stable?

What if HD unstable?

Answer 4

HD stable:

• OCP
• High dose Estrogen (hemostasis + stabilize endometrium)

HD Unstable:

• D and C
• IV Estrogen

Question 5

What illnesses are over represented in WSW? (women who have sex with women)

Answer 5

1. CVD
2. Obesity
3. Type 2 DM
4. Cervical, Breast, Ovarian CA
5. Depression + Anxiety
6. Bacterial Vaginosis
7. Intimate partner violence.

Question 6

BRCA gene testing is recommended for what 6 HIGH RISK groups?

Answer 6

1. 2 first degree relatives with breast ca, one < 50 yo
2. 3 first/second degree relative with breast ca
3. 1 relatie with both breast and ovarian cancer
4. 1 relative with bilateral breast ca
5. Male relative with breast cancer
6. Askenazi jew with one relative with breast or ovarian ca.

Question 7

How do OCPs effect AEDs in general?

What two AEDs are NOT effected by OCPs?

Answer 7

OCP induce CYT P450 and DECREASED efficacy of AEDs

VPA and Gabapentin NOT effected by OCP.

Question 8

A couple is having infertility (defined by 1 year of not conceiving, despite appropriately time intercourse)..

What is the first step in work up?

Answer 8

SEMEN ANALYSIS

Question 9

What is the most common cause of male infertility?

Answer 9

Klinefelter

Question 10

What is the management of BILATERAL NIPPLE DISCHARGE?

Answer 10

1. Urine pregnancy test
2. If not pregnant –> Gallactorrhea eval
   
   • Prolactin level
   • Medication review
   • THS (rule out hypothyroidism)

Question 11

What is the management of UNILATERAL NIPPLE Discharge?

Answer 11

Age < 30 yo –> US

Age > 30 yo –> Mammogram + US.

- Mammogram (better for breast tissue pathology) 
- US (better for intraductal lesions)

Question 12

What is the most common cause of unilateral nipple discharge?

Answer 12

Papillary tumor (more of breast duct lining, typically benign, but may have atypical cells)