GYN MTB

Question 1

DSM-V for PMDD (premenstrual dysphoric disorder)

Answer 1

-symptoms present for 2 consecutive cycles
-symptom-free period of 1 week in the 1st part of the cycle (follicular phase)
-symptoms present in second half of cycle (luteal phase)
-dysfunction in life
tx: reduce caffeine, etOH, smoking, chocolate
DO exercise, if refractory: SSRI

Question 2

menopause hormone levels

Answer 2

oocytes produce less estrogen and progesterone
both LH, FSH start to rise (^FSH is diagnostic)
begins with irregular menstrual bleeding

Question 3

contraindications of hormone replacement therapy (HRT)

Answer 3

estrogen-dependent carcinomas (breast or endometrial)

hx of DVT/PE

Question 4

etiology of menorrhagia

Answer 4

(heavy, prolonged bleeding)

endometrial hyperplasia, fibroids, DUB, IUD

Question 5

metrorrhagia etiologies

Answer 5

(intermenstrual bleeding)

endometrial polyps, endometrial/cervical cancer, exogenous estrogen admin

Question 6

menometrorrhagia etiologies

Answer 6

endometrial polyps, endometrial/cervical cancer, exogenous estrogen admin, malignant tumors

Question 7

oligomenorrhea

Answer 7

(cycles longer than 35 days, so less periods)

pregnancy, menopause, anorexia/weight loss, estrogen-secreting tumor

Question 8

causes of post-coital bleeding

Answer 8

cervical cancer (until proven otherwise), cervical polyps, atrophic vaginitis

Question 9

how anovulatory cycles occur

Answer 9

ovary produces estrogen, but no corpus luteum is formed so no progesterone produced and no “withdrawal bleeding” (withdrawal from progesterone causes bleeding)
continuously high estrogen causes endometrium to keep growing and bleeding only occurs when endometrium outgrows blood supply

Question 10

rule out systemic causes of anovulation

Answer 10

hypothyroidism, hyperprolactinimia

carcinoma: EMB if over 35 yo

Question 11

DUB is severe if ?

how to treat?

Answer 11

pt is anemic, not controlled on OCPs, or lifestyle is compromised
tx: endometrial ablation or hysterectomy

Question 12

OCPs reduce the risk of ?

Answer 12

ovarian and endometrial carcinoma, ectopic pregnancy

slight increase in thromboembolism risk

Question 13

most common cause of labial fusion

Answer 13

21-B hydroxylase deficiency (excess androgens)

tx: reconstructive sx

Question 14

pts with chronic irritation develop raised white lesion (hyperkeratosis) think ?
how to treat?

Answer 14

squamous cell hyperplasia

tx: sitz baths or lubricants (relieve itching)

Question 15

if flat, violet papules, 30-60 yo, think?

Answer 15

lichen planus

tx: topical steroids

Question 16

bartholin gland cyst treatment

Answer 16

I/D, if recur may need marsupialization: open space kept open with sutures

Question 17

dx/tx for candidiasis

Answer 17

pseudohyphae on KOH

miconazole, clotrimazole, econazole, nystatin

Question 18

red vulvar lesion with superficial white coating +vulvar soreness and pruritis think?

Answer 18

Paget disease: intraepithelial neoplasm

tx: radical vulvectomy if bilateral (modified if u/l)

Question 19

pruritis, bloody vaginal discharge, postmenopausal bleeding think ?

Answer 19

squamous cell carcinoma
may be small ulcerated lesion to large cauliflower like lesion
dx: biopsy

Question 20

SqCC staging

Answer 20

0: carcinoma in situ
I: limited to vaginal wall less than 2cm
II: limited to vulva or perineum more than 2cm
III. tumor spreading to lower urethra or anus, u/l LN present
IV. tumor invasion into bladder, rectum, or b/l LNs
IVa. distant metastasis

Question 21

dysmenorrhea and menorrhagia + large, globular, boggy uterus, think?
how to dx/tx?

Answer 21

adenomyosis (invasion of endometrial glands into myometrium)

dx: MRI??
tx: hysterectomy (also definitive dx)

Question 22

cyclic pelvic pain 1-2 wks before menstruation and pks 1-2 days before menstruation (+ ends with menstruation) + nodular uterus and adnexal mass +/- abnormal bleeding

Answer 22

endometriosis (implantation of endometrial tissue outside endometrial cavity, most commonly ovary and pelvic peritoneum)
dx: direct visualization via laparoscopy (“chocolate cysts”

Question 23

endometriosis treatment

Answer 23

tx: NSAIDs, OCPs
danazole (androgen derivative), Lupron (GnRH agonist)(both decrease LH, FSH, Lupron suppresses estrogen if given continuously)
surgery possibly TAH BSO if refractory

Question 24

hormone derangements in PCOS

Answer 24

^testosterone leads to ^estrogen formation outside ovary, which stimulates LH secretion while inhibiting FSH secretion leading to LH:FSH ration more than 3:1

Question 25

what treatments will do what for PCOS

Answer 25

weight loss: decrease insulin resistance
OCPs: control amount estrogen/progestin, therefore controls androgens and prevents endometrial hyperplasia
clomiphene, metformin: if wish to conceive