1 - Benign Gynecology

Question 1

time frame for amenorrhea

Answer 1

6 mo or more

Question 2

metrorrhagia

Answer 2

irregularly timed menstrual cycles

Question 3

causes of secondary dysmenorrhea

Answer 3

endometriosis
adenomyosis
fibroids
IUD
cervical stenosis
transverse vaginal septum
imperforate hymen

Question 4

2 MC presentations of endometriosis

Answer 4

pelvic pain

infertility

Question 5

MC site of endometriosis tissue

Answer 5

ovary

Question 6

“powder burn” lesions

Answer 6

endometriosis

Question 7

MCC secondary dysmenorrhea

Answer 7

endometriosis

Question 8

“chocolate cyst” on ovary

Answer 8

endometriosis

Question 9

when during cycle does endometriosis pain tend to be worst?

Answer 9

luteal phase

Question 10

first line and second line medical tx for endometriosis

Answer 10

1st line - NSAIDs and OCPs

2nd line - GnRH agonists and danazol

Question 11

non gynecologic causes of abnl uterine bleeding

Answer 11

thrombocytopenia, von Willebrands
thyroid dz, liver dz
hormones, anticoagulants, tamoxifen, IUDs

Question 12

sx of fibroids

Answer 12

abnl uterine bleeding, pelvic pressure, pain, urinary sx, abnl reproductive function(?controversy)

Question 13

how to evaluate abnl uterine bleeding

Answer 13

r/o pregnancy
endometrial biopsy if >35yo
saline infusion sonography
hysteroscopy

Question 14

hypothalamic amenorrhea caused by

Answer 14

GnRH def - can be in response to anorexia/hyperathleticism but not always

Question 15

pituitary amenorrhea causes

Answer 15

hyperprolactinemia
thyroid dz
excessive androgens from adrenals / Cushings

Question 16

PCOS - what is the pathophys/underlying abnormality

Answer 16

oligo/amenorrhea assoc w/ hyperandrogenism w/o other cause

hyperinsulinemia is important in development

Question 17

clinical features of PCOS

Answer 17

obesity
hyperandrogenism - acne, hirsutism, deepened voice, clitoromegaly
oligo/amenorrhea
acanthosis nigricans
hyperinsulinemia

Question 18

ovaries w/ thickened tunica and multiple small atretic follicles

Answer 18

PCOS

Question 19

mgmt of PCOS

Answer 19

wanna get pregnant? induce ovulation
if not, OCPs

wt loss helps, metformin for insulin resistance

Question 20

length of amenorrhea needed to define menopause

Answer 20

12 mo

Question 21

mean age of menopause? premature age cutoff?

Answer 21

51

<40

Question 22

tx of hot flashes

Answer 22

estrogen (combined therapy if they still have a uterus though!)

Question 23

c/i for estrogen replacement therapy

Answer 23

undiagnosed vaginal bleeding
breast cancer
endometrial cancer
active venous clot
active liver dz