structural/other (10%)

Question 1

what is an enterocele

Answer 1

pouch of douglas (small bowel) prolapses into upper vagina

Question 2

tx for prolapse (cystocele, enterocele, rectocele, uterine)

Answer 2

ppx- kegals, wt control

nonsurgical- pessaries (sx relief), estrogen tx (improves atrophy)

surgical- hysterectomy, uterosacral or sacrospinous ligament fixation

Question 3

what is the presentation of ovarian torsion

Answer 3

sharp sudden then waxing, non-radiating pain

n/v/d

Question 4

what is the dx of ovarian torsion

Answer 4

doppler

Question 5

what is the tx for ovarian torsion

Answer 5

emergent laparoscopy

Question 6

what is the usu onset of endometriosis

Answer 6

35yo+

Question 7

what is the MC site of endometriosis

Answer 7

ovaries

Question 8

what is the classic triad of endometriosis

Answer 8

cyclic premenstrual pelvic pain +/- LBP
dysmenorrhea
dyspareunia

Question 9

what does PE usu show w endometriosis

Answer 9

usu normal +/- fixed, tender adnexal masses

Question 10

what is the definitive dx of endometriosis

Answer 10

laparoscopy- raised patches of thick, discolored scarred or powder burn

Question 11

what are tx options for endometriosis

Answer 11

ovulation suppression- OCPs + NSAIDs, progesterone, leuprolide, danazol

surgery- lap w ablation (if fertility desired), hysterectomy if not desired

Question 12

MOA of progesterone in tx of endometriosis

Answer 12

suppresses GnRH –> endometrial atrophy + suppressed ovulation

Question 13

MOA of leuprolide

Answer 13

GnRH analog –> pituitary FSH/LH suppression

Question 14

MOA of danazol

Answer 14

testosterone induces pseudomenopause –> suppresses FSH + LH

Question 15

RFs for endometriosis

Answer 15

famhx
nulliparity
early menarche

Question 16

what is an endometrioma

Answer 16

involves ovaries, large enough to be considered a tumor

usu CHOCOLATE-COLORED (old blood)

Question 17

what size cyst should be removed?

Answer 17

> 8cm or if symptomatic

Question 18

what causes a follicular ovarian cyst

Answer 18

follicle fails to rupture + continues to grow

Question 19

what does US show w follicular ovarian cyst

Answer 19

smooth, thin-walled, unilocular

Question 20

what should be done for follicular ovarian cyst

Answer 20

nothing unless >8cm or symptomatic- usu resolve spontaneously 2-3mo

Question 21

what causes a corpus luteal ovarian cyst

Answer 21

C/L fails to degenerate after ovulation

AKA hemorrhagic cyst

Question 22

what does US show w corpus luteal ovarian cyst

Answer 22

complex, thicker walled w peripheral vascularity (RING OF FIRE - also in ectopic, check B-hCG)

Question 23

what causes a theca lutein ovarian cyst

Answer 23

excess B-hCG –> hyperplasia of theca interna cells

Question 24

what does US show w theca lutein ovarian cyst

Answer 24

bilateral, septations don’t show enhancement on US

Question 25

what is leiomyoma

Answer 25

uterine fibroid- benign smooth musc tumor | regress after menopause (related to estrogen)

Question 26

what is the MC benign gyn lesion

Answer 26

leiomyoma

Question 27

when are fibroids MC

Answer 27

35yo+, african american

Question 28

what does PE show if pt has fibroids

Answer 28

large, irregular hard palpable mass in abd/pelvis ASYMMETRIC FIRM NONTENDER

Question 29

what does fibroid look like on US

Answer 29

focal heterogenic mass w shadowing

Question 30

tx for fibroids

Answer 30

observe medical- inhibit estrogen- leuprolide (GnRH agonist --> inhibits GnRH secretion, most effective med), progestins (cause endo atrophy to decrease bleeding) surgical- TAH (definitive), myomectomy (preserve fertility)

Question 31

When is adenomyosis MC

Answer 31

later reproductive years

Question 32

presentation of adenomyosis

Answer 32

progressively worsening bleeding + pain, +/- infertility PE- SYMMETRIC, TENDER, SOFT/BOGGY

Question 33

definitive dx of adenomyosis

Answer 33

hysterectomy

Question 34

tx for adenomyosis

Answer 34

TAH (only effective) | conservative if fertility desired (analgesics, low dose OCPs)

Question 35

what is infertility

Answer 35

fail to conceive s/p 1yr, 6mo if mom 35yo+

Question 36

MC pathogens in bartholin cyst

Answer 36

e. coli s. aureus n. gon

Question 37

presentation of bartholin cyst

Answer 37

unilateral vulvar mass inflamed + edematous + tender if infected contender if non-infected