test 3 deck 1

Question 1

pt. presents w/ no pain and enlarged tumor in vuvla-vaginal region. She is >40. treatment ___

Answer 1

bx.

Question 2

what is the evaluation for ovarian cysts w/ indeterminate, but probaly benign qualities (hemorrhagic cyst, mature cystic teratoma, endometrioma) pre/post menopausal?

Answer 2

premenopausal: TVS repeated 6-12 weeks if persistent then consider surgical evaluation

post menopausal surgical evalation

Question 3

when is a cyst considered functional?

Answer 3

>3cm w/ symptoms of pelvic pain, dullness and heaviness

Question 4

what is the difference between the benign stromal neoplasms granulosa-theca, sertoli-leydig, and ovarian fibroma?

Answer 4

granulosa theca: estrogen

steroli-ledic: testosterone

ovarian: no hormones

Question 5

most benignand malignant breast disease arise in the?

Answer 5

terminal duct-aciner structures (lobules)

Question 6

mastitis/ abscess that’s nonpuerperal requires what?

Answer 6

biopsy to exclude inflammatory breast cancer

peripheral abscess I&D (dont get better) and abx

subareolar abscess: duct excision/ sinus tract removal

Question 7

estrogen dependent, benign smooth muscle tumor, distinct autonomy from their surrounding. typcially ayspmptomatic, may have mass effect or cause infertility. on bimanual you note an increased size of the uterus. dx__ next step__

Answer 7

leioymoma, U/S

Question 8

what is the evaluation for a simple benign cyst postmenopausal that >7 cm?

Answer 8

mri/surgery evaluation

Question 9

what are the indications for surgery of leiomyomas?

Answer 9

1. rapid enlargement
2. severe pelvic pain
3. abnomral uterine bleeding w/ anemia
4. UTI
5. inability to evaluate adnexa
6. growth of fibroid after menopause
7. infertility

Question 10

smooth, clear, white/yellow rounded elevations on the cervix. dx__ trx__

Answer 10

nabothian cysts

no treatment for asymptomatic

Question 11

what is the MC breast mass ID’s in adolescent female

Answer 11

fibroadenoma

Question 12

pt. presents w/ contraction of scar tissue or adhesions w/ in the endocervical canal. They have a hx of treatments for CIN (LEEP/CKC), and are hypoestrogenic. They hav complaints of dysmenorrhea, amenorrhea, and infertility. DX__ trx__

Answer 12

cervical stenosis

cervical dialator, vaginal estrogen if hypostrogenic

Question 13

what to do w/ spontaneous discharge?

Answer 13

evaluate

Question 14

what is the preferred imagin for leiomyoma?

Answer 14

u/s

Question 15

pt presents post menopause/post oophorectomy. they are complaining of pain during sex, urinary symptoms, clear, yellow, blood tinged discharge. You perform a PAP and the their are changes (parabasal epithelial cells). On speculum you see a fiable vaginal epithelium, loss of rugae, and pale mucose. dx__ trx__

Answer 15

atrophic vaginitis,

topical estrogen (give progesterone if pt. has uterus)

Question 16

what stage does normal breat proliferation occur?

Answer 16

luteal phase of menstrual cycle (estrogen and progesterone increase)

Question 17

post menopausal woman presents w/ inflammation in the dermis of vulva. she has pruruitis, vulvar thickening, that has progressed to burning and dyspareunia. her vaginal skin looks like cellphane paper/tissue paper/ crinkled cigarette paper on gentle streching of skin. wk up__ trx__ concern__

Answer 17

biopsy, examine q12 mos,

treatment: symptomatic, topical corticosteroid, phototherapy if initiated w/ 1st 2 years reduces scarring

squamous cell carcinoma

Question 18

ovarian torsion is a __

Answer 18

emergency associated w/ ovarian mass typically >6cm, more commonly Right adenexa

Question 19

nests of endometrial glands and stoma embedded w/in the muscular uterine wall (actually in wall opposed to leiomyomas). Pt. presens w/ heavy abnormal uterine bleeding or dysmenorrhea in parous women between ages of 40-50. dx__ trx__

Answer 19

adenomyosis

hysterectomy (classicly), maybe GnRH agonists (danazol) or progestins

Question 20

pt. has bilateral breast pain, with multiple bilateral cysts that feels nodular. Increased tenderness especially premenstrual. you know this is aused by dialted ducts and acini invested w/ dense collagenous stroma. DX__ TRX__ PROG__

Answer 20

fibrocystic breast disease, premenstrual, decrease chocolate intake +/- caffeine, support bra

Question 21

ovarian cysts that suggest malignancy (irregular septations, nodule blood flow)?

Answer 21

surgical evlation

Question 22

are palpable nodular breast tissue a breast cancer risk by itself?

Answer 22

not a breast cancer risk by itself

Question 23

green galactorrhea is related to ___ ___

Answer 23

cholesterol dieposides

Question 24

pt. presents w/ non-neoplastic morphologic alteration of the vulvar skin related to chronic irriation. results from intense itch/scratch cycle that even wakes her from sleep. the patient started w/ excoriations and erythema that progressed to a greyish/leathery appearnace that extends past the labia major(MC). dx__ treat__

Answer 24

lichen simplex chronicus

eliminate triggers (clothing, heat, chemicals in laundry/hygiene products, food sensitivty), lubricate (petroleum jelly, vegetable oil), antihistamines, gloves at night

Question 25

pt. presents w/ severe pain, difficulty walking, sitting or having intercourse. she has a tumor in vulva region. she is under 40. dx\_\_ trx\_\_

Answer 25

bartholin's abscess, I&D w/ packing or **word catheter** **abx:** **if** recurrent **or** high risk for complicated infection (pregnant, cellulitis, systemic infection, immunosuppressed) culture for MRSA **Augmentin/Clindamycin,** screen for chlamydia/gonorhea

Question 26

what is the MC symptom for endometrial polyps and what are the imaging studies?

Answer 26

metrorrhagia TVUS intially then sonohysterography

Question 27

what cervix size is needed for sufficient flow?

Answer 27

5mm if \<2mm there may be retrograde flow and you have to worried about retrograde flow

Question 28

pt. presents w/ progressive sharp lower abdominal pain, low grade fever, N/V. you suspect ovarian torsion. what is the treatment?

Answer 28

salvage, resect tumor, possible oophorectomy

Question 29

for **vulvar disease** your patients will commonly present w/ \_\_\_. your working diagnosis is \_\_, alway ___ suspicious lesion, and teach your patients to \_\_\_.

Answer 29

itching, cancer, biopsy, look

Question 30

treatment for fibroadenoma?

Answer 30

benign

Question 31

what is the evaluation for a simple ovarian cyst with bengin qualites pre menopausal that \>5 cm, but \<=7 cm?

Answer 31

TVS repeated in 6-12 to document resolution then yearly TVS

Question 32

**autoimmune disorder of t-cells**. pt presents **after drug use w/ NSAIDS, B-blockers, methyldopa, penicillamine, quinine**. They have intense vaginal itching, burning pain, dyspaerunia and postcoital bleeding. They have purple, pruruitic, polygonal, papules and plaques. They are erosive, papulosquamous and hypertrophic. They are located on both the **vagina and gingiva**. DX\_\_ trx\_\_

Answer 32

lichen planus topical steroids-\> clobetasol, vaginal hydrocortisone

Question 33

imaging study for adenomyosis?

Answer 33

TVUS, then MRI for differentiation

Question 34

what is the treatment for leimyomas?

Answer 34

observe, COCPs to reduce bleeding, GnRH agonist for pre-op surgery

Question 35

what is the MC pelvic tumor in women?

Answer 35

leiomyomas "fiborids"

Question 36

what is the evaluation for simple cyst w/ benign qualities \<=5 cm but \>1cm postmenopausal?

Answer 36

CA125, if normal then TVS repeated in 6-12 weeks. Then yearly TVS

Question 37

what is the evlation for a simple ovarian cyst w/ bengin qualities \>7 cm premenopausal?

Answer 37

mri/surgical evaluation

Question 38

treatment for intertrigo? Most often found in genitocurual folds, also in inguinal and intergluteal regions

Answer 38

treatment: drying agents, inflammation (topical steroid), infection (nystatin), weight loss, light weight clothing

Question 39

hyperlastic overgrowth of endometrial lining on a stalk?

Answer 39

endometrial polyps

Question 40

pt. presents w/ rash following vaginal trauma. its adherent silver scale, but in skin folds are more red w/ fine scale. DX\_\_ TRX\_\_\_

Answer 40

inverse psoriasis emollients, steroids, dovenex after control

Question 41

what is the treatment for cervical polyp?

Answer 41

benign, but still need to go to pathology small, pedunculated, remove w/ forceps sessile, remove w/ forceps and cauterize

Question 42

what is the surgical treatment for ovarian cysts?

Answer 42

cystectomy, unilateral salpingo-oophorectomy, TAH/BSO for malignancy

Question 43

what is the MC ovarian neoplasma?

Answer 43

benign cystic teratoma (dermoid cyst), presents risk of torsion

Question 44

breast pain that follows cycle is what?

Answer 44

mastalgia, normal, if **noncyclic** investigate for cancer