Female Reproductive System and Breast

Question 1

Lab confirmation of premature ovarian failure.

Answer 1

less than 40years with amenorhea for >3mo and elevated FSH levels

Question 2

describe HELLP

Answer 2

severe HTN + proteinuria + labs

systemic inflammation and activation of coag systme and complement cascade. platelets consumed and MAHA –> hepatocellular necrosis

Question 3

Acute abdominal/pelvic pain in women:
recurrent mild and unilateral mid-cycle pain prior to ovulation. pain lasts hours to days.

dx and U/s findings

Answer 3

mittelschmertz

no u/s findings

Question 4

Acute abdominal/pelvic pain in women:
amenorrhea, abd/pelvic pain and vaginal bleeding. psotive beta-hCG

dx and U/s findings

Answer 4

ectopic pregnancy

no intrauterine pregnancy seen

Question 5

Acute abdominal/pelvic pain in women:
sudden onset, severe, u/l lower abd pain; N/V.
u/l tender adnexal mass on exam

dx and U/s findings

Answer 5

ovarian torsion

enlarged ovary with decreased or absent blood flow

Question 6

Acute abdominal/pelvic pain in women:
sudden onset, severe, u/l lower abd pain immediately following strenuous or sexual activity

dx and U/s findings

Answer 6

ruptured ovarian cyst

pelvic free fluid

Question 7

Acute abdominal/pelvic pain in women:
fever, chills, vaginal discharge, lower abd pain and cervical motion tenderness

dx and U/s findings

Answer 7

PID

+/- tubo-ovarian abscess

Question 8

HPI: intense pruritis, dyspareunia, pain with defecation
PE: pale thin tissue and perianal thickening with fissures, spares vagina

Answer 8

lichen sclerosus - vulvar premalignant lesion

Question 9

possible lichen sclerosus dx - then what?

Answer 9

vulvar punch bx for definitive dx of vulvar SqCCa

Question 10

HPI: vulvovaginal dryness
PE: decreased vaginal diameter, loss of vaginal elasticity/rugae, thinning vulvar skin/loss of minora

Answer 10

atrophic vaginitis

Question 11

tx of lichen sclorosis v. atrophic vaginitis

Answer 11

lichen - high potency topical steroids

atrophic - low dose topical estrogen

Question 12

Acute: SOB, obstipation/constipation with vomiting, abd distension
Subacute: pelvic/abd pain, loating, early satiety

Answer 12

epithelial ovarian Carcinoma

Question 13

Tx of chlamydia +/- gonorrhea

Tx for PID

Answer 13

Empiric: azithro + ceftriaxone
Confirmed chlamydia: azithro
Confirmed gonorrhea: azithro + ceftriaxone

PID: ceftriaxone and doxycycline

Question 14

four non-modifiable risk factors for breast cancer

Answer 14

1. age
2. genetics or first degree relative with breast cancer
3. white race
4. early menarche or later menopause

Question 15

soft, mobile nontender cystic mass usually asx , found at 4 or 8 o’clock position at base of labium majora

dx
tx

Answer 15

bartholin duct cyst

tx: asx - no intervention
sx - i/d

Question 16

name two competitive inhibitors of E binding.
Indications for each
AE for both

Answer 16

Tamoxifen - breast cancer treatment
Raloxifene - postmenopausal osteoporosis
AE - hot flashes, venous thormboembolism, endometrial hyperplasia and carcinoma (tamoxifen)

Question 17

complications of PID (four)

Answer 17

tuboovarian abscess
perihepatitis
ectopic pregnancy
infertility

Question 18

Absolute CI to combined hormonal contraceptives

Answer 18

Migraine WITH aura
BP >160/100
>15 cigs/day and >35y
Hx of VTE
Hx of stroke or ischemic heart disease
Breast cancer
Cirrhosis, liver cancer
maojor surgery with prolonged immobilization
<3wks postpartum

Question 19

best emergency contraception option for 0-120 hours

Answer 19

copper IUD

Question 20

Definition of infertility on <35 v >/=35

Answer 20

<35 is 12mo

>/=35 is 6mo

Question 21

U/S findings of hyperechoic nodules and calcifications in a premenopausal women with adnexal fullness on PE and otherwise asx.

Answer 21

dermoid cyst (mature cystic teratoma)
B9 germ cell tumor.

Question 22

modifiable breast cancer risk factors (4)

Answer 22

alcohol
HRT
nulliparity
increased age at first brith

Question 23

FSH in menopause

Answer 23

increased

Question 24

T and E levels in PCOS

Answer 24

increased

Question 25

SOB, obstipation/constipation, vomiting, abd distention. askx adnexal mass

Answer 25

CA-125 incr

Epithelial ovarian Ca

Question 26

Multiparous >40y, dysmenorrhea, heavy menstrual bleeding. progression to chronic pelvic pain.

PE: boggy, tender, uniformly enlarged uterus

Answer 26

adenomyosis

Question 27

tx of endometriosis

Answer 27

NSAIDs +/- OCPs

or

Laparoscopy

Question 28

At what age is optimal fertility?

Answer 28

18y

Question 29

normal internal genetalia, ambiguous external/virilizaiton (clitoromegaly), undetectable serum estrogen levels

Dx

Answer 29

congenital aromatase deficiency

Question 30

HPI: postmenopausal bleeding
Imaging: U/S = thickened endometrium

Dx and path:

Answer 30

Dx: granulosa cell tumor of the ovary

path: estrogen secreting = endometrial hyperplasia or carcinoma, which causes postmeno bleeding

Question 31

tx for pts who desire lactation suppression

Answer 31

ice packs and ANALGESICs

Question 32

PCOS who wants to have children.

Answer 32

weight loss first, then if unsuccessful –> clomiphene citrate to induce ovulation