Second Half

Question 1

What is the most common malignant cell type for ovarian cancer in adults?

Answer 1

Epithelial cell

Question 2

What is the most common malignant cell type for ovarian cancer in children/adolescents?

Answer 2

Germ Cell

Question 3

You are currently in the room with a patient who has been diagnosed with submucosal leiomyoma (fibroids). She is 33 and still desiring pregnancy what are your two options for treatment?

Answer 3

1) Hysteroscopic myomectomy

2) short-term contraceptive management

Question 4

What is the treatment for endometritis?

Answer 4

Doxycycline 100mg bid x 10-14 days

Question 5

How do you treat an 18 year old female who has a CIN3 on colposcopy?

Answer 5

Excision Procedure/Ablation

Question 6

Which tool diagnoses and stages ovarian cancer?

Answer 6

Laparotomy

Question 7

A 15 yo girl has not yet had her period and is worried about it since all her friends have had theirs. What should you use to help you differentiate between various causes of amenorrhea?

Answer 7

Whether or not she has had any secondary sexual development.

Question 8

What are some side effects of menopause?

Answer 8

Hot flashes, sleep disturbances, new onset depression, vaginal dryness, memory change, joint aches and pain

Question 9

What falls under the Rotterdam criteria?

Answer 9

Anovulation or oligo-ovulation
Hyperandrogenism
Polycystic ovaries via TVUS

Question 10

What is the most common cause of Secondary Amenorrhea?

Answer 10

Pregnancy

Question 11

What are some risk factors for ovarian cancer?

Answer 11

Long term estrogen (nulliparity, early menarche, late menopause), endometriosis, genetics (BRCA, HNPCC), lower SES, Caucasian, age > 50

Question 12

True or false: the goal of PCOS management is to prevent endometrial dysplasia & induce ovulation.

Answer 12

True

Question 13

A 25 y/o female comes in to do her routine pap smear. What is the next step if the cytology report comes back “unsatisfactory cytology” ?

Answer 13

Repeat pap smear

Question 14

What is the most common cause of secondary amenorrhea?

Answer 14

Pregnancy

Question 15

What are some possible symptoms of cervical cancer?

Answer 15

Early → often Asx but may see lesions, AUB, postcoital bleeding

Advanced → Pelvic or low back pain, Lymphadenopathy, Bulk sx, Visible lesions on exam

Question 16

What are some protective factors against ovarian cancer?

Answer 16

Anything that lowers ovulation frequency → Multiparous, Breastfeeding, Contraceptives, Tubal ligation

Question 17

What is the first line of prevention for Cervical Cancer?

Answer 17

HPV Vaccination

Question 18

A 40 year old women claims she is not sexually active, should she still get HPV testing?

Answer 18

Yes because the patient’s claims can not always be trusted

Question 19

Pt age 55 comes in with vague sxs including bloating, loss of appetite, weight loss, stomach ache and pelvic pain. What is most likely diagnosis?

Answer 19

Ovarian CA

Question 20

What age should you start HPV testing with cytology?

Answer 20

Age 30

Question 21

What is the diagnosis and treatment for GYN patients who present with endometrial or cervical polyps?

Answer 21

Polypectomy

Question 22

What is the number 1 cause of primary amenorrhea?

Answer 22

Pregnancy

Question 23

How often should you perform cervical cytology for patients ages 21-29?

Answer 23

Every 3 years

Question 24

What is a common presentation for a female with hyperprolactinemia and hypogonadotropic hypogonadism?

Answer 24

Short stature, galactorrhea, diabetes insipidus, H/A

Question 25

What are the physical findings for advance ovarian cancer?

Answer 25

Ascites and pleural effusion

Question 26

What is/are the recommended treatment for early stage (1A, 1B1) cervical cancer.

Answer 26

1. Modified radical hysterectomy with pelvic lymphadenectomy 2. Radiation if non surgical candidate

Question 27

Which medications do you use to help your patient with PCOS get pregnant?

Answer 27

Clomiphene (Clomid) or Letrazole (Femara)

Question 28

What should be included in the workup for secondary amenorrhea?

Answer 28

UPT, FSH, LH, estradiol, testosterone, prolactin, TSH, ultrasound

Question 29

What is the recommended management for CIN 2, 3?

Answer 29

if the patient is over 25, then management is preferred with excisional procedure or abalative. if the patient is less than 25, observation with cytology and colposcopy (CIN 2) or excisional procedure (CIN 3)

Question 30

What is the recommended management for CIN 1?

Answer 30

if low grade on colposcopy, observe initially and follow up closely with an annual cotest

Question 31

In any instance when a cytology report comes back unsatisfactory, what is the next best step?

Answer 31

repeat cytology

Question 32

If a patient is postmenopausal and starts having abnormal vaginal bleeding, what do we assume it is until proven otherwise?

Answer 32

endometrial cancer

Question 33

T/F ovarian cysts are only found in women who have their menses.

Answer 33

false, women of all ages can get ovarian cysts.

Question 34

What is the most likely cause of a female developing hyperandrogenic symptoms (facial hair development, acne, male pattern baldness)?

Answer 34

PCOS

Question 35

What are key PE findings for a patient with suspected adenomyosis?

Answer 35

A tender uterus that is BOGGY and ENLARGED (uterus size comparable to a woman who is several weeks pregnant)

Question 36

What are the steps when looking at pap results?

Answer 36

1. Look and see if there were sufficient cells for testing. 2. Pathology of the cells. 3. HPV positive or negative.

Question 37

What are patient's with PCOS at risk to develop?

Answer 37

Diabetes mellitus

Question 38

Most common cause of cervical cancer

Answer 38

HPV 16, 18, 31, 45

Question 39

Symptoms of ovarian cancer?

Answer 39

Often asymptomatic, but can have swollen abdomen, wt loss, constipation/bowel obstruction, ascites, and pleural effusion

Question 40

You are urgently evaluating a pregnant patient (first trimester) for bleeding and pain. What must be immediately considered and ruled out?

Answer 40

ectopic pregnancy

Question 41

when do you do polypectomy for ovarian polyp

Answer 41

symptomatic, increased risk of endometrial cancer, or if unclear on ultrasound

Question 42

what are common physical exam findings of adenomyosis

Answer 42

tender, boggy, enlarged uterus

Question 43

What is the most likely cause of a female developing hyperandrogenic symptoms (facial hair development, acne, male pattern baldness)?

Answer 43

PCOS

Question 44

What is the number one prevention factor in preventing HPV and cervical cancer?

Answer 44

Getting vaccinated when eligible!

Question 45

What is the number one prevention factor in preventing HPV?

Answer 45

Getting vaccinated when eligible!

Question 46

What is LSIL (low-grade squamous intraepithelial lesion) typically caused by?

Answer 46

HPV - typically self-resolves

Question 47

what is the recommended screening for cervical cancer for 30-65

Answer 47

cytology + HPV every 5 years

Question 48

what is the most common type of ovarian cancer in children?

Answer 48

germ cell

Question 49

What are key PE findings for a patient with suspected adenomyosis?

Answer 49

A tender uterus that is BOGGY and ENLARGED (uterus size comparable to a women who is several weeks pregnant)

Question 50

What is the first line treatment for a woman who presents with fibroids (leiomyomas) with bulk symptoms and does not desire pregnancy?

Answer 50

GnRH analogs (leuprolide)

Question 51

What is the most immediate concern for a thickened endometrial lining and must be ruled out before considering any other diadnosis?

Answer 51

Endometrial Cancer

Question 52

What does ASC-US stand for?

Answer 52

Atypical Squamous Cells of Undetermined Significance

Question 53

Postmenopausal bleeding is what until proved otherwise?

Answer 53

endometrial cancer

Question 54

What is the ovarian morphology index useful for?

Answer 54

predicting benign masses

Question 55

What are some symptom management options for PCOS?

Answer 55

Weight Loss Spironolactone Metformin (If insulin resistance).

Question 56

What does NILM Stand for?

Answer 56

Negative for Intraepithelial Lesion or Malignancy

Question 57

Treatment for simple ovarian cyst?

Answer 57

Watchful waiting and surveillance.

Question 58

How can you prevent new cysts from forming?

Answer 58

Oral Contraceptives

Question 59

When would you consider surgery for a simple ovarian cyst?

Answer 59

Hemorrhagic or large and associated with bulk symptoms.

Question 60

What is a general risk factor for the development of ovarian cancer?

Answer 60

Anyone with more menses over their lifetime

Question 61

What are the general prevention and screening measures for cervical cancers?

Answer 61

Vaccination, Pap smear +/- HPV testing

Question 62

What are the three types of imaging ordered to help diagnose leiomyomas?

Answer 62

TVUS, SIS, MRI

Question 63

What does Endometrioma decidualization do?

Answer 63

Prepares the endometrial lining for pregnancy.

Question 64

For cervical cancer screening in women ages 21-29, what test do you order and how often?

Answer 64

Cytology ONLY q3 years (reflex HPV)

Question 65

What is the most common type of abnormal pap smear?

Answer 65

ASC-US

Question 66

what is the gold standard to diagnose breast cancer?

Answer 66

biopsy!

Question 67

a 32 year old female has an estrogen receptor positive tumor which requires systemic therapy. What will most likely be given to her for treatment?

Answer 67

Tamoxifen QD for 10 years.

Question 68

a 75 year old female has a progesterone receptor positive tumor which requires systemic therapy. what is the best treatment?

Answer 68

Aromatase inhibitors QD for 5 years.

Question 69

True or false: Survival is the same regardless of mastectomy or breast conservation

Answer 69

True

Question 70

What type of biopsy is the best for breast cancer diagnosis

Answer 70

core biopsy

Question 71

what are the indications for an MRI for breast cancer?

Answer 71

Known BRCA1 or BRCA2 mutation carrier Untested first-degree relative of known mutation carrier Radiation to chest, especially ages 10-30 Other genetic abnormality (Li-Fraumeni, Cowden’s, etc.) Lifetime risk >20% by models based on family history

Question 72

What is the surveillance recommendation for patients w/ a previous mastectomy?

Answer 72

Chest Breast Exam only

Question 73

What carbohydrate antigen (Cancer Antigen) is best for detecting ovarian cancer?

Answer 73

Ca 125

Question 74

What are some treatment options for Early stage (1A, 1B1) Cervical cancer?

Answer 74

modified radical hysterectomy with pelvic lymphadenectomy OR radiation if not a surgical candidate.

Question 75

What is the Classification System used for abnormal uterine bleeding in non-pregnant, reproductive age women?

Answer 75

PALM-COEIN

Question 76

What is each classification within PALM-COEIN mnemonic for abnormal uterine bleeding in non-pregnant, reproductive-age women?

Answer 76

Polyp Adenomyosis Leiomyoma Malignancy (& hyperplasia) ``` Coagulopathy Ovulatory Dysfunction Endometrial Iatrogenic Not yet Classified ```

Question 77

What is the recommendation for breast cancer screening?

Answer 77

Annually starting at 40 years old beginning with a mammogram

Question 78

Tamoxifen is a hormonal therapy that can be used for breast cancer treatment. What are some side effects of Tamoxifen?

Answer 78

``` Vasomotor symptoms (hot flashes) Thrombotic events Endometrial stimulation ```

Question 79

A 25 y/o patient presents with a mass in her right breast. What is the first line imaging to order for this patient?

Answer 79

U/S (pt is under 30)

Question 80

What is the most common type of breast cancer?

Answer 80

infiltrating ductal carcinoma

Question 81

What are some protective factors against endometrial cancer?

Answer 81

OCPs, parity, breastfeeding, smoking, weight loss

Question 82

What are some protective factors against ovarian cancer?

Answer 82

Things that lower ovulation: multiparous, breastfeeding, contraceptives ( at least 5 years), tubal ligation

Question 83

What are the indications for a screening MRI for a patient with a potential breast cancer?

Answer 83

1) Known BRCA2 mutation 2) First degree relative w/ known BRCA2 mutation 3) Radiation to chest during ages 10-30 4) Known genetic abnormality (Li-Fraumeni, Cowden's) 5) Lifetime risk >20% by models based on FHx

Question 84

What is the first diagnostic technique that should be obtained for a pregnant patient with a breast mass?

Answer 84

Order an US, but radiologists may change the order to a diagnostic mammogram based on what they see that day

Question 85

What is the MC type of benign breast tumor?

Answer 85

Fibroadenoma

Question 86

How does Intraductal Papilloma present?

Answer 86

With bloody, serous, or turbid discharge from the nipple

Question 87

What updated patient education is considered regarding the self breast exam?

Answer 87

A monthly self breast exam is no longer recommended by the USPSTF. Instead breast awareness is encouraged to recognize any changes and get them checked out early.

Question 88

What is the treatment for symptomatic fibrocystic breast?

Answer 88

NSAIDS, heating pad, Supportive bra, OCPs

Question 89

A 36 yo female was previously treated for Mastitis for 7 days, but continues to have a tender, enlarged, and erythematous right breast. What should you be concerned about?

Answer 89

Inflammatory breast cancer

Question 90

What is the 1st line treatment for Leiomyoma in a patient NOT desiring pregnancy, but with bulk symptoms?

Answer 90

Uterine artery embolization | GnRH analogs

Question 91

A patient presents with irregular menses, hirsutism and weight gain. A TVUS is completed. What finding might you expect?

Answer 91

"string of pearls"

Question 92

what kind of benign ovarian cyst may form as a result of IVF therapy?

Answer 92

Theca lutein cysts

Question 93

A patient presents to the ER with acute onset of pelvic pain localized to the R side. She endorses abdominal bloating and pain with her LNMP 3 days ago. TVUS is performed and a cyst with a lattice-like internal structure is seen. What benign ovarian cyst is consistent with this presentation?

Answer 93

Hemorrhagic cyst

Question 94

What is the treatment of choice for mastitis?

Answer 94

Dicloxacillin and continued breastfeeding or pumping

Question 95

A white milky discharge of the breast is indicative of what?

Answer 95

galactorrhea

Question 96

True or False: A patient who has received the HPV vaccine, does NOT need to get a pap smear.

Answer 96

False

Question 97

What is the preferred treatment for a 23 year old female with CIN 2?

Answer 97

Observe with cytology and colposcopy

Question 98

``` Which of the following is NOT considered a risk factor for ovarian cancer? A. long term estrogen B. endometriosis C. genetics D. age <50 ```

Answer 98

D. age <50

Question 99

What is the first step for the workup of ovarian cancer?

Answer 99

UPT, followed by pelvic US or contrasted CT of abdomen and pelvis