WH Clin Med + Clin Med Buzzwords

Question 1

In which quadrant of breast do we find 50% of breast cancers?

Answer 1

UO

upper outer quadrant

Question 2

what is second most common quadrant for finding breast cancer?

Answer 2

UI

upper inner quadrant

Question 3

What are the 5 P’s of taking a sexual history?

Answer 3

Past (past STD history, that is)
Partners
Practices
Protection
Pregnancy Prevention

Question 4

pregnancy history - when saying a woman is P2G2…what does ‘P’ stand for? What does it mean?

Answer 4

P = para

- this is defined by the number of times the woman has emptied her uterus

Question 5

pregnancy history - when saying a woman is P2G2…what does ‘G’ stand for? What does it mean?

Answer 5

G = gravida

- this is defined by the total number of pregnancies a woman has had

Question 6

NORMALS

normal menstrual flow volume

Answer 6

80 mL or less

Question 7

NORMALS

frequency of changing of pads/tampons on heavy flow days

Answer 7

Q 3 hrs

Question 8

NORMALS

pads/tampons in a cycle

Answer 8

21 or less

Question 9

NORMALS

is changing a pad/tampon in middle of night normal?

Answer 9

“seldom” is the ideal answer to that question

Question 10

NORMALS

large clots - normal or abnormal?

Answer 10

clots should be 1” or less

Question 11

NORMALS

duration of menstrual cycle

Answer 11

2-7 days

average = 4 days

Question 12

NORMALS

menstrual cycle length

Answer 12

28 days, +/- 7 days

Question 13

NORMALS
# of pads/tampons per day in a normal cycle

Answer 13

5-6

Question 14

Fecundity vs fecundability - difference in these definitions

Answer 14

Fecundity = probability of achieving live offspring

Fecundability = probability of achieving pregnancy in one menstrual cycle

Question 15

define infertility

Answer 15

infertility =

inability to conceive

Question 16

parameters for considering infertility

Answer 16

frequent unprotected sexual intercourse…

…for women <35 y/o, for 12+ months
…for women >35 y/o, for 6+ months

Question 17

What is the most common cause of female infertility?

Answer 17

ovulatory dysfunction

Question 18

What are we looking for when doing a semen analysis for infertility? (8 factors)

Answer 18

Volume & pH
Concentration
Total sperm count
Total motility 
Morphology
Debris & agglutination
Leukocyte count
Immature germ cells

Question 19

What is most common tubal factor for infertility?

Answer 19

Occlusion - fimbrial

Question 20

What is the gold standard for diagnosis for female infertility tubal factors?

Answer 20

Laparoscopy w/ chromotubation = gold dx standard

Question 21

age of first cervical cancer screening?

Answer 21

25 years old

Question 22

age range for cervical cancer screening?

Answer 22

25 years - 65 years

Question 23

primary dysmneorrhea only occurs _____

Answer 23

…during ovulatory cycles

Question 24

define primary dysmenorrhea

Answer 24

menstrual pain in the absence of pelvic disease

Question 25

define secondary dysmenorrhea

Answer 25

“secondary may be due to causes such as endometriosis, adenomyosis, leiomyomata and PID”

Question 26

primary dysmenorrhea treatment

Answer 26

heat of lower abdomen
physical exercise
NSAIDs (start with ibuprofen, best given 1-2 days before menstruation begins)
COC, for those desiring contraception

Question 27

pathophysiological mechanism associated with primary dysmenorrhea

Answer 27

prostaglandin induction of uterine contraction

Question 28

a teenager presents with heavy menstrual bleeding and near syncope, with signs of anemia

what physical exam components should be performed?

Answer 28

HEENT - look in eyes, check for pallor, check for bleeding gums
skin
C/V
pulm
pelvic exam
O2 saturation
capillary refill check

Question 29

a teenager presents with heavy menstrual bleeding and near syncope, with signs of anemia

what diagnostic studies are needed?

Answer 29

hCG - see if she’s pregnant

Total Testosterone - might give a clue for PCOS

CBC with differential and actual platelet count

PT and PTT, Fibrinogen

Question 30

for a pt who presents with heavy menstrual bleeding, near sycope, signs of anemia…

…basically, anovulatory abnormal vaginal bleeding caused by a coagulopathy coupled with orthostatic hypOtension…

…what treatment is required?

Answer 30

admit! this pt is sick, needs to be in ER

get Hematology and Gyn consults

• IV fluids
• O2
• type her blood (in case transfusion is necessary)
• check for clotting factors (think Von Willebrand)
• try treating with hormonal therapy (IV estrogen or oral conjugated estrogen)

Question 31

what is first line imaging choice for evaluation of acute pelvic pain?

Answer 31

transvaginal ultrasound

Question 32

who is most at risk for molar pregnancy?

Answer 32

old and young - extreme ends of ovulation spectrum

women who have hx of molar pregnancy

Question 33

treatment of molar pregnancy

Answer 33

D&C (i.e. “surgical uterine evacuation)

long term care -
- hCG levels drawn for one year (these can turn into cancer)

Question 34

ultrasound is first-line imaging choice for evaluation of acute pelvic pain in what three situations?

Answer 34

1) pregnancy (includes suspected non-gynecologic condition)
2) non-pregnant women w/ suspected obstetric or gynecologic condition
3) abnormal uterine bleeding (AUB) in pre- or post-menopausal women

Question 35

what are common symptoms for molar pregnancy?

Answer 35

hyperemesis (or hyperemesis gravidarum), due to high beta-hCG levels

hypertension

pre-eclampsia before 20 weeks (HTN + proteinuria)

Question 36

molar pregnancy findings on ultrasound

Answer 36

“snowstorm” or “cluster of grapes”

Question 37

list the seven PROBABLE pregnancy signs

Answer 37

abdominal enlargement
ballottement (French for “a tossing about”, tap the cervix, fetus may bounce up and then float back down to tap the finger back)
Braxton-Hicks
Goodells sign (cervix gets soft and velvety)
Palpation of fetus
pregnancy test
uterine enlargement