Adnexal Masses, Incontinence, GYN infections, Infertility

Question 1

Simple ovarian cyst pathogenesis

Answer 1

Fluid filled follicle that is FSH/LH responsive

Question 2

How to diagnose adnexal mass

Answer 2

Transvaginal US

Question 3

How to treat simple ovarian cyst?

Answer 3

Put patient on OCP for 2 months, check for resolution. If it doesn’t resolve, get a CT scan

Question 4

How to treat simple ovarian cyst that doesn’t resolve on 2 months of OCP or is >7 cm?

Answer 4

Get a ct scan

Question 5

Endometrioma/endometriosis pathogenesis?

Answer 5

Retrograde flow, glandular tissue deposits outside of endometrial cavity. Estrogen responsive

Question 6

How does patient with endometriosis present?

Answer 6

Dysmenorrhea, dyspareunia, infertility

Question 7

How to diagnosis endometriosis

Answer 7

OCP trial, then laparoscopy

Question 8

How to treat endometriosis?

Answer 8

Scope with laser ablation (if OCP/leuprolide doesn’t work)

Question 9

Ectopic pregnancy pathogenesis

Answer 9

Salpingitis leads to stricture, egg fertilized and implants there.

Question 10

How does patient with ectopic pregnancy present?

Answer 10

With vaginal bleeding and a positive urine pregnancy test

Question 11

Tuboovarian abscess pathogenesis?

Answer 11

PID, normal flora leads to abscess

Question 12

How does a patient with a tuboovarian abscess present?

Answer 12

Lower abdominal pain, fever, and leukocytosis

Question 13

How to treat tuboovarian abscess?

Answer 13

Amp-gent and flagyl

Question 14

Torsion pathogenesis

Answer 14

Cyst in ovary causes it to twist and have ischemia

Question 15

How does patient present with torsion?

Answer 15

With sudden onset pain with fever and leukocytosis

Question 16

How to diagnose torsion

Answer 16

US

Question 17

How to treat torsion

Answer 17

Untwist, if pinks up, nothing, if doesn’t pink up, take it out.

Question 18

Stress incontinence pathogenesis

Answer 18

Big or multiple births that stretch cardinal ligament. Causes cystocele or rectocele where pressure is transferred to bladder. Patient sneezes and pees.

Question 19

How to treat stress incontinence

Answer 19

Pelvic sling

Question 20

Hypertonic/urge incontinence

Answer 20

You know this

Question 21

Hypotonic/overflow incontinence

Answer 21

You know this

Question 22

How to treat hypotonic/overflow incontinence?

Answer 22

Bethanecol or catheterization

Question 23

Can vaginal atrophy cause incontinence?

Answer 23

Yup

Question 24

Irritative bladder pathogenesis

Answer 24

Irritation or inflammation caused by stones, UTI, or cancer. No nocturnal symptoms but urge present.

Question 25

Difference in treating trichomonas vs gardnerella?

Answer 25

Can treat trich only with ORAL metronidazole. Gardnerella can be treated with cream.

Question 26

Infertility algorithm

Answer 26

Look at male factors first, then do post coital test. If cervical mucus doesn’t stretch past 6 in middle of cycle then there is hostile mucus which must be treated with estrogen or artificial insemination. If mucus is normal, assess ovulation. If anovulatory use clomiphene or pergenol. If ovulation normal (withdrawal bleeding with progestin challenge), assess anatomy with hysterosalpingogram. If that’s normal, look for endometriosis with ex-laparoscopy.

Question 27

How does clomiphene work?

Answer 27

Disinhibits GnRH to stimulate HPOE axis

Question 28

How does pergenol work?

Answer 28

Acts like FSH/LH