GYN: Other 5%

Question 1

(RR)

what are the three d’s of presentation of pt w/ endometriosis?

Answer 1

dysmenorrhea
dyspareunia
dyschezia

Question 2

(RR)

PE findings for endometriosis

Answer 2

adenexal mass
or
fixed or retroverted uterus
or
uterosacral nodularity

Question 3

(RR)

how do we make definitive diagnosis for endometriosis? What is most common site for finding extrauterine tissue?

Answer 3

laparoscopy

MC site is ovaries

Question 4

(RR)

how do we treat endometriosis?

Answer 4

NSAIDs
COCs
depot medroxyprogesterone acetate
GnRH agonist
sx

Question 5

(RR)
“what is the mechanism of action of leuprolide?”

also - what is it used for?

Answer 5

“it is a gonadotropin-releasing hormone analogue. It acts to cause suppression of FSH and LH”

(PPP 397) –> ovulation suppression for endometriosis

Question 6

(SmartyPance)

what is the MOA for the most common treatment for women younger than 36 years of age who need induction of ovulation?

Answer 6

blocks the feedback inhibition of estradiol on the hypothalamus and pituitary leading to an increase in FSH

Clomiphene citrate (Clomid)

Question 7

(PPP 386)

what are three advantages of estrogen + progesterone oral contraceptives?

Answer 7

protects against:
osteoporosis,
ovarian CA
endometrial CA

Question 8

(PPP 386)

what is a disadvantage to estrogen + progesterone oral contraceptives?

Answer 8

increased hypercoagulability (DVT & PE)

Question 9

(PPP 386)

who is contraindicated for the use of estrogen + progesterone oral contraceptives?

Answer 9

hx of BREAST CA
smokers (smokers should stop if 35 + yrs)

also - no one w/ hx of ischemic heart disease, DVT, PE, stroke, migraines with aura or
anyone with SEVERE HTN (>160/100)

Question 10

(PPP 387)

what is the “norethindrone “mini pill””?

Answer 10

progesterone-only pill

Question 11

(PPP 387)

what are the advantages of progesterone-only pill?

Answer 11

SAFE DURING LACTATION
REDUCES RISK OF ENDOMETRIAL CA

no estrogen-related SE (so little effect on coag factors, bp, glucose, lipids)

Question 12

(PPP 387)

what are some AE of levonorgestrel IUD?

Answer 12

INCREASED RISK OF ECTOPIC PREGNANCY & PID
uterine perf
cramping/bleeding with menses
risk of spontaneous abortion if pregnancy occurs

Question 13

(PPP 387)

what are two advantages of copper IUD?

Answer 13

10 year duration of action

very effective contraceptive method

Question 14

(PPP 387)

what is an AE of copper IUD?

Answer 14

increased incidence of PID

Question 15

(PPP 388)

what is the MOA of danazol? when is it indicated?

Answer 15

MOA: hypoestrogenic and hyperandrogenic

Indications: suppress LH & FSH for endometriosis
fibrocystic breast disease
hereditary angioedema

Question 16

(PPP 388)

what are limitations and AE of danazol?

Answer 16

limited use due to hyperandrogenic adverse effects

AE: hyperandrogenic SE such as wt gain, acnes, hirsutism, virlization
hepatic dysfxn too

Question 17

(RR)

what is lichen planus of the vulva?

Answer 17

don’t know yet

Question 18

(RR)
what are the characteristics of lichen planus of the vulva? what are the five P’s of clinical presentation of lichen planus?

Answer 18

erosive, papular, or hypertrophic lesion on the vulva and may result in severe tissue destruction, pain, and urinary or sexual dysfunction

Pruitic
Planar
Purple
Polygonal
Papular

Question 19

(RR)

what is the tx for lichen planus of the vulva?

Answer 19

avoiding offending medications and applying topical corticosteroids