Gyn conditions

Question 1

What is normal post-void residual volume?

Answer 1

50-60 cc

Question 2

What defines overflow incontinence?

Answer 2

Post-void residual volume of >300 cc

Question 3

How do you measure urethral hypermobility?

Answer 3

straining Q-tip angle >30 degrees from horizontal

Question 4

What is “urethral bulking”?

Answer 4

artificially inflates the submucosa of the bladder neck to treat intrinsic sphincteric deficiency

Question 5

What is the MOA of tolterodine?

Answer 5

bladder selective muscarinic antagonist

Question 6

Who should NOT use tolterodine?

Answer 6

contraindicated in pts with narrow-angle glaucoma

Question 7

What medications can be used for detrusor overactivity?

Answer 7

beta-3 adrenergic receptor agonists (Mirabegron)

antimuscarinic (Tolterodine)

Question 8

Who should NOT use Mirabegron?

Answer 8

contraindicated in pts with HTN, end-stage renal dz, liver dz

Question 9

Cystoceles are repaired by fixing defects in what fascia?

Answer 9

pubocervical fascia - reattach to the sidewall

Question 10

Rectoceles are repaired by fixing defects in what fascia?

Answer 10

rectovaginal fascia

Question 11

What is colpocleisis and what is it used for?

Answer 11

closure of the vagina

used to treat vaginal prolapse

Question 12

What is the best treatment for PCOS?

Answer 12

OCPs - treats both hirsutism and irregular menses

Question 13

What size polyp indicates polypectomy versus observation?

Answer 13

> 1.5 cm

Question 14

What is the mechanism for increased androgen production in PCOS?

Answer 14

increased LH production –> increased stim of theca cells –> increased androgen production

Question 15

What is the recommended Ca intake for postmenopausal women?

Answer 15

1200 mg

Question 16

Ovaries stop producing ___ after menopause.

Answer 16

estrogen

Question 17

Menopausal ovaries continue to produce what?

Answer 17

androgens

which then can be converted into estrogen in the periphery

Question 18

Combination HRT increases risk of __ cancer and decreases risk of ___ cancer.

Answer 18

1 - breast

2 - colon

Question 19

How does HRT affect lipid panel?

Answer 19

increases HDL and decreases LDL

Question 20

What T-score on DEXA indicates osteopenia?

Answer 20

-1 to -2.5

Question 21

What T-score on DEXA indicates osteoporosis?

Answer 21

less than -2.5

Question 22

What type of carcinoma accounts for 90% of vulvar cancers?

Answer 22

squamous cell

Question 23

What increases the risk for squamous cell carcinoma?

Answer 23

smoking
HPV infection
lichen sclerosus

Question 24

How does verrucous carcinoma of the vulva present?

Answer 24

cauliflower-like lesion

Question 25

What is TCA used to treat?

Answer 25

genitl warts

Question 26

What is the best treatment choice for VIN 2?

Answer 26

laser treatment

Question 27

How is Paget's disease of the vulva described?

Answer 27

fiery red mottled background with whitish hyperkeratotic areas

Question 28

What are risk factors for vulvar cancer?

Answer 28

HPV exposure, smoking, vulvar dystrophy (lichen sclerosis), immunocompromised

Question 29

What are risk factors for cervical cancer?

Answer 29

HPV exposure, early-onset sexual activity, multiple sexual partners, immunosuppression, smoking, low socioeconomic status, lack of regular pap tests

Question 30

What are high and low risk` strains of HPV?

Answer 30

high - 16 and 18 | low - 6 and 11

Question 31

What is a white plaque on the cervix called?

Answer 31

leukoplakia - biopsy!!

Question 32

When should women stop receiving cervical cancer screening?

Answer 32

65 yo if no h/o moderate or severe dysplasia and three negative pap tests in a row or two negative co-tests within the past 10 years

Question 33

What are medical treatment options for bleeding due to leiomyomas?

Answer 33

GnRH agonists, OCPs, NSAIDs

Question 34

What is the optimal time period recommended for GnRH agonist treatment?

Answer 34

short! 3-6 months | typically used prior to surgical procedure

Question 35

What are risk factors for endometrial carcinoma?

Answer 35

nulliparity, obesity, late menopause, HTN, unopposed E

Question 36

What are the top 5 cancers in women?

Answer 36

Breast > lung > colon > uterine > thyroid | Gyn: uterine > ovary > cervix > vulva > vaginal

Question 37

Granulosa cell tumors secrete what hormone?

Answer 37

estrogen

Question 38

What is the most common cause of post-menopausal bleeding?

Answer 38

atrophy - either vagina or endometrium | but be concerned for endometrial cancer

Question 39

What are risk factors for ovarian cancer?

Answer 39

nulliparity, fhx, early menarche, late menopause, white race, increasing age

Question 40

What type of contraception appears to provide protection against ovarian cancer?

Answer 40

OCPs - cause anovulation

Question 41

In women <30 yo, what is the most common ovarian neoplasm?

Answer 41

germ cell tumors

Question 42

In women > 30 yo, what is the most common ovarian neoplasm?

Answer 42

epithelial cell tumors

Question 43

Intermenstrual spotting + abdominal pain + vomiting + slightly elevated transaminase levels

Answer 43

perihepatitis from PID

Question 44

Primary ovarian insufficiency refers to menopause before ___

Answer 44

age 40

Question 45

What is Uterine synechiae?

Answer 45

Asherman syndrome

Question 46

How does obesity affect ovulation?

Answer 46

increased insulin resistance and hyperglycemia --> decreased sex hormone-binding globulin --> elevated androgen --> aromatized in adipose tissue to estrone --> suppression of LH surge and ovulation

Question 47

What is the MOA of tamoxifen?

Answer 47

estrogen receptor antagonist at the breast agonist in the uterus

Question 48

How does tamoxifen affect bone density?

Answer 48

estrogen-like activity at the bone --> strengthens the bone density

Question 49

How does Raloxifene affect the uterus?

Answer 49

estrogen ANTAGonist effect

Question 50

What are adverse effects of raloxifene?

Answer 50

VTE

Question 51

What is the diagnostic test for vulvar lichen sclerosis?

Answer 51

Vuvlar punch biopsy

Question 52

What do atypical glandular cells on pap test indicate?

Answer 52

could be either cervical or endometrial adenocarcinoma - have to evaluate endometrium

Question 53

In a patient with adenomyosis, is the uterus symmetric or irregularly shaped?

Answer 53

symmetric!