Female FR...2

Question 1

A postmenopausal woman presenting with AUB and a large ovarian mass most likely has?

Answer 1

Granulosa cell tumor - sex cord stromal tumor- secrets estradiol-> endometrial hyperplasia
- can present with precious puberty in adolescents

Question 2

A 55 yr old- sparse pubic hair n fissures over the vestibule; multiple areas of petechiae on the vagina; the cervix is flush with the vaginal wall. Minimal clear vaginal discharge but no active bleeding. Vaginal ph is 6
Dx?

Answer 2

Genito urinary syndrome of menopause ( atrophic vaginitis)- LOSS OF ELASTICITY due to low estrogen levels
- vaginal PH>4.5 is suggestive

Question 3

An asthmatic pt developed PPH secondary to uterine atony 30min after delivery. High dose oxytocin n uterine massage do not resolve the bleeding
Next step is?

Answer 3

Tranexamic acid- an antifibrinolytic agent that prevents the breakdown of clots to achieve hemostasis.
- if this fails, second line uterotonics like carboprost, methylergonovine r used but as this pt is asthmatic, carboprost is contraindicated.

Question 4

Tamoxifen is? Uses n risks associated with it

- most common side effect

Answer 4

Estrogen receptor modulator

• antagonist in the breast- preferred adjuvant in premenopausal with breast ca
• agonist in the endometrium-> hyperplasia/ca risk. Second line adjuvant in postmenopausal ( aromatase inhibitors r first line)
• most common side effect is HOT FLASHES ( antiestrogenic effect in the CNS)

Question 5

Unilateral ovarian mass in a 17yr old, u/s shows 8 cm ovarian cyst with calcification n hyperechoic nodules
The best next step is?

Answer 5

Dx- dermoid ( mature cystic teratoma)

- surgical removal to reduce the risk of ovarian torsion

Question 6

In a woman>40 yr - dysmenorrhea, heavy menstrual bleeding, chronic pelvic pain, boggy tender symmetrically enlarged uterus
Dx?

Answer 6

Adenomyosis - endometrial glands n stroma in the myometrium

Question 7

A woman comes for her postpartum checkup at 6 wks. She has a hx of heavy menses with anemia for which iron tabs were prescribed but she doesn’t take them regularly. She often forgot her prenatal vitamins too. She wants contraception with no wt gain side effect
Which one is appropriate?

Answer 7

Levonorgestrel containing intrauterine device.- amenorrhea is a side effect, which may help this lady with heavy menses

• copper IUD is not recommended because it can cause heavy menses( aggravates her anemia)
• OCP- she’s not good at taking oral medications ( forgets…)

Question 8

A postmenopausal woman presenting with vulvar pain;
-p/e- gingivae have lacelike reticular appearance, multiple white plaques on the tongue n palate,
-diffusely erythematous vulva, labia minors have multiple, gazed brightly erythematous erosion bordered by white striae
-speculum- friable, erythematous vaginal epithelium with serosanginous discharge.
Dx

Answer 8

Lichen planus- erosive type

Question 9

Congenital aromatase deficiency is characterized by?

Answer 9

Prevents conversion of androgens to estrogens

• normal female internal genitalia, external genitalia virilization, undetectable serum estrogen levels
• in adolescence, pts have delayed puberty, osteoporosis( present with fractures), no breast, high FSH n LH ( low estrogen) resulting in polycystic ovaries

Question 10

The first line test for evaluation of a palpable adnexal mass is?

Answer 10

Pelvic u/s

Question 11

A 19yr old presenting with lower abdominal pain, which started suddenly this morning, vomiting, tender lower abdomen more on the left
U/S- complex left adnexal mass without Doppler flow, small free fluid.
Dx
Best next step

Answer 11

Ovarian torsion
Laparoscopy - cystectomy n detorsion
If obvious adnexal necrosis or suspected malignancy- salpingoopherectomy

Question 12

An 18 yr old nulligravida comes for emergency contraception. Pregnancy test is negative. No menstrual or other abnormalities. The best method is?

Answer 12

Copper containing IUD- it is the most effective emergency contraception method.
- if the pt had heavy menstrual bleeding cycles, ulipristal would have been used

Question 13

An 8 yr old comes after her mother noticed bloody spotting in the girl’s underwear. Multiple 2mm raised fleshy papules r noted on the vulva and anus that bleed on contact with cotton swab
The girl should be evaluated for?

Answer 13

Sexual abuse

• anogenital wart/condylomata acuminata- usu asymptomatic but can also present like this pt.
• caused by low risk HPV types 6 n 11
• self resolves

Question 14

Patients who undergo cervical conization for CIN3 and have surgical margins free of disease, how should their follow up look like?

Answer 14

More frequent cervical ca screening with repeat Pap n HPV cotesting at ONE n TWO yrs- because they remain at risk for recurrent disease

Question 15

Screening for ovarian Ca?

Answer 15

No screening for asymptomatic, average risk pts without adnexal mass. If there is a strong family hx, BRCA1 n BRCA2 gene testing can b offered

Question 16

A pt with GDM, any postpartum evaluation for hyperglycemia?

Answer 16

Yes, they should b evaluated 6-12 wks postpartum with 2hr (75 g) oral glucose tolerance test

Question 17

A 42 yr old primigravida at 36 wks gestation comes for evaluation. BP measured on two occasions 5 hours apart- 140/90, 146/92. U/A shows 1+ protein
The best next step to confirm the dx is?

Answer 17

Urine protein-to-Cr ratio or 24hr urine protein

Question 18

A 34 yr old comes with secondary amenorrhea for 3 months. She has a hx of NHL for which she received chemotherapy 5yrs ago. FSH LH TSH PROLACTIN levels will look like?

Answer 18

Chemotherapy causes primary ovarian insufficiency ( hypergonadotrophic hypogonadism)- high FSH LH , normal prolactin and TSH

Question 19

A pt has CIN3 on endocervical curettage. The next step in the mx?

Answer 19

Cervical conization

Question 20

A 27yr old comes with 8 months of pelvic pain exacerbated by exercise n sexual activity. U/S shows unilocular mass with homogeneous low level echoes
Dx?

Answer 20

Endometrioma ( endometriosis of the ovaries )

Question 21

A 60 yr old comes with urinary urgency followed by involuntary loss of urine. No loss of urine with coughing or sneezing. Vulvar skin shows reduced elasticity with labia minora retraction. Dry vaginal mucosa. Postvoid residual urine testing is normal
Cause of her sxs?

Answer 21

Estrogen deficiency - as part of genitourinary syndrome of menopause it can cause urogenital atrophy—> dysuria, incontinence, …

Question 22

A 30yr old female comes with urinary incontinence. She has no dysuria but has frequency n urgency. U/A shows positive leukocyte esterase, no other abnormalities. Next step in the mx of this patient?

Answer 22

Antibiotics for UTI