Cases

Question 1

27yo female presents to office complaining lump on one side of her vagina. Several wks and causes slight discomfort during sex. No new sexual partners and no other vaginal/systemic sx. PE: 1.5cm area of swelling in left posterior labia majora. Firm, well circumscribed, minimally tender no changes noted on the skin. No vaginal discharge or other lesions are noted. LIkely dx?

Answer 1

bartholin gland duct cyst

Question 2

29yo female comes to the ED w/ abrupt onset of left lower quadrant pain 1.5hrs ago while moving furniture. Pain is 100/10. Hx of vomiting. Not sexually active and no significant PMH. Fullness, extreme tenderness in left adnexa. What is the likely dx?

Answer 2

Torsion of the left ovary

Question 3

23yo female presents complaining of amenorrhea for 3mo. Increasing facial hair, wt gain. PMH: menarche 13yo. PE: well developed, slightly obese, BMI 29. Amenorrhea can be tx with what?

Answer 3

progesterone administration

Question 4

27 yo female complains of yrs of menstraul irregularity and increasing facial and chest hair. PMH: ovarian cyst and left cytectomy. Non smoker/drinker. Labs: negative uCG, increased LH, low FSH. Wants fertility and does not respond to clomiphene. Next choice?

Answer 4

metformin

Question 5

47yo female presents w/ excessive menstrual flow for 2mo. Mid cycle bleeding and periods lasting 9 days. Cx?

Answer 5

Anovulatory uterine bleeding

pt is perimenopasual - unopposed estrogen

Question 6

25yo female has regular cycle, occurring q30days and lasting 3-4 days. Mild cramping day 1-2 that is easily relieved by ibuprofen/acetaminophen. When is she ovulating?

Answer 6

16

Question 7

26 yo female nursing complaining 2-3 days of increasing pain and rendess in her left breast. Able to continue breast feeding and good milk supply. 4 wks postpartum. She complains of some general fatigue, no HA, body aches, fever. Current: P 80, T99.1F, BP 120/70, CV RRR, lungs CTA. Left breast 5cm area, upper outer quadrant 2cm mass, tender to touch. Milk expressed - non purulent. Cx of infxn?

Answer 7

s. aureus

Question 8

23yo complains of chronic pelvic pain. Worse w/ intercourse, several days before period and throughout period. G0P0, LMP 2 wks ago. Married and 1 partner for 3 yrs. Sx is increasing overtime. Tx?

Answer 8

combined OCP

Question 9

23yo complains of chronic pelvic pain. Worse w/ intercourse, several days before period and throughout period. G0P0, LMP 2 wks ago. Married and 1 partner for 3 yrs. Sx is increasing overtime. Tx?

Answer 9

combined OCP

Question 10

A 25 year old female patient has a family history of ovarian cancer-her mother had ovarian cancer at 45 years of age.
She wants to know how and when she should start screening for ovarian cancer. What is the best answer for this patient?

Answer 10

First stop-genetic testing…did her mother have this done? If so, what were the results?
The most effective screening for high risk patients is seen when CA 125 AND transvaginal ultrasound are combined with family history (genetic testing will help define whether or not this is truly familial ovarian cancer syndrome or not) and symptoms.

Question 11

In the State of Oregon, which sexually transmitted infections need to be reported to the public health department, who does the reporting and when?

Answer 11

Chlamydiosis
Gonococcal infections
HIV (does not apply to anonymous testing) and AIDS
PID acute, non-gonococcal
Syphilis

Question 12

A 24 year old female is complaining of painful, burning, bumps on her labia. Your exam reveals mild right sided inguinal adenopathy and reddish-based, clustered, vesicular lesions on her right labia. What is the test of choice to determine your diagnosis?

Answer 12

Viral culture — If active genital lesions are present, the vesicle should be unroofed for sampling of vesicular fluid for culture.

Question 13

This diagnosis is typically made in an afebrile female between the ages of 35-55, who presents with normal appearing breasts with nipple discharge which may be clear to bloody.
What is this diagnosis?

Answer 13

Intraductal Papilloma

Question 14

This diagnosis is typically made in an afebrile female between the ages of 35-55, who presents with normal appearing breasts with nipple discharge which may be clear to bloody.
What is this diagnosis?

Answer 14

Intraductal Papilloma

Question 15

54 yo female post radiation for cervical cancer, bladder irritability, recurrent UTI, urinary incontinence - RF?

Answer 15

radiation
recurrent UTI
urinary incontinence

Question 16

36yo 4 mo post partum, leaks when sneeze - who tx?

Answer 16

tx in office - no refer

Question 17

36yo 4 mo post partum, leaks when sneeze - who tx?

Answer 17

tx in office - no refer