Gynecologic Procedures

Question 1

What should you do if a pt is diagnosed with HSIL on pap?

Answer 1

Immediate colposcopy with directed biopsy and then LEEP procedure to remove the entire transformation zone and dysplastic areas identified during colposcopy?

Question 2

When is a radical hysterectomy an option?

Answer 2

patients with invasive cervical carcinoma stage Ia2 through IIa

Question 3

What is the rate of progression of HSIL to invasive cancer?

Answer 3

12-30%

Question 4

What does LEEP stand for?

Answer 4

Loop electrosurgical excision procedure

Question 5

What are possible complications of a LEEP procedure?

Answer 5

infection, bleeding, cervical stenosis, persistent disease and possibly risk for preterm delivery

Question 6

What is Asherman’s syndrome?

Answer 6

development of intrauterine adhesions

Question 7

When should you biopsy a vulvar lesion?

Answer 7

when it is unresponsive to therapy

Question 8

When IUD strings are not visible and IUD hook did not work, how should you proceed?

Answer 8

Hysteroscopy so it can be removed under direct visualization; abdominal flat plane indicated if IUD not visualized on ultrasound to determine if it had fallen out or migrated; if IUD seen outside uterus, laparoscopy could be offered to remove

Question 9

What is best way to work up incidental finding of adnexal mass?

Answer 9

pelvic ultrasound

Question 10

What are contraindications for etonogestrel implant?

Answer 10

pregnancy, personal history of breast cancer or other hormonally sensitive cancers, history of thrombosis, history of liver tumors or liver disease and vaginal bleeding without explanation

Question 11

How do endocervical polyps present and how are they treated?

Answer 11

benign finding and commonly presents with spotting and bleeding between periods; polyps common in women in their 40s and 50s and rarely malignant; exam might reveal small fleshy mass with a stalk arising off of cervix; treat with polypectomy