Gynecology

Question 1

A 37 y/o F presents with menorrhagia for 2 months. Her menses were previously regular. Name the wide differential.

Answer 1

Polyps
Adenomyosis
Leiomyoma 
Malignancy
Coagulopathies
Ovarian dysfunction
Iatrogenic
Endometriosis 
No idea

Question 2

Patient presents with abnormal vaginal bleeding, could be of child bearing age or not, what diagnostics do you order?

Answer 2

1. Labs: pT, PTT, INR, VWF test, FSH/LH, Testosterone
2. Imaging: transvaginal US
3. Poss biopsy-depending on presentation

Question 3

What is the work up for PCOS?

Answer 3

1. Labs: LH:FSH is a 3:1 ratio; elevated testosterone

2. Imaging: transvaginal US shows “string of pearls” cysts

Question 4

What are the criteria for PCOS diagnosis?

Answer 4

Rotterdam Criteria: 2/3

1. Oligomenorrhea OR amenorrhea
2. Clinical or biochemical evidence for hyperandrogenism
3. Polycystic ovaries

Question 5

Growth of leiomyomas/uterine fibroids depends on what hormone?

Answer 5

Estrogen

Question 6

What are the treatment options for leiomyomas?

Answer 6

1. If fertility is desired = myomectomy
2. TAH is the definitive treatment
3. Majority of women are asymptomatic and do not need treatment.

Question 7

How do we describe adenomyosis on PE and what are the diagnostic criteria and tx?

Answer 7

• Symmetrical globular or boggy uterus
• Mostly a clinical dx, can do transvaginal US
• TAH is the definitive tx

Question 8

What is the classic triad for endometriosis?

Answer 8

1. Cyclic premenstrual pelvic pain
2. Dysmenorrhea
3. Dyspareunia

Question 9

Most common sire for endometriosis?

Answer 9

Ovaries

Question 10

Patient presents with vaginal itching, dysuria, dyspareunia and thick, curdy, white vaginal discharge. Vaginal pH <4.5. No KOH amine odor. What is the diagnosis? What would you see on wet mount?

Answer 10

Vaginal candidiasis

Psuedohyphae

Question 11

Chlamydia treatment

Answer 11

1. Doxycycline 100 BID x7 days

2. Azithromycin 1 dose (first line during pregnancy)

Question 12

What is the Hegar sign?

Answer 12

Softening of the uterus at junction (isthmus) with cervix on bimanual exam

Question 13

What is the Goodall sign?

Answer 13

Softening and cyanosis of the cervix

Question 14

What is the Chadwick’s sign?

Answer 14

Blueish/purple cervix/vagina

Question 15

What abx is directly needed to treat gonorrhea? What should be added to cover chlamydia?

Answer 15

Ceftriaxone 250mg IM

+ Doxy or Azithromycin for chlamydia

Question 16

A painLESS genital ulcer that is associated with painful LAD found in subtropical areas is most likely

Answer 16

Lymphogranuloma Venereum

Question 17

What is the treatment for lymphogranuloma venereum?

Answer 17

Doxycyline 100 BID x 21d
OR
Azithromycin 1g weekly x3w

Question 18

PainFUL genital ulcer associated with LAD is most likely what? What is the treatment of choice?

Answer 18

Chancroid

Azithromycin 1g x1 dose or Ceftriaxone 250 IM

Question 19

What spirochete causes syphilis?

Answer 19

Treponema Pallidum

Question 20

What is the definitive diagnosis of syphilis?

Answer 20

FTA-ABS = fluorescent treponemal antibody absorption

Question 21

PainLESS ulcer NOT associated with LAD?

Answer 21

Syphilis

Question 22

Vaginal discharge, pH >4.5

Answer 22

Bacterial Vaginosis

Question 23

Vaginal discharge, pH >5

Answer 23

Trichomoniasis

Question 24

Vaginal discharge, puritis, pH < 4.5

Answer 24

Candidiasis

Question 25

MC breast cancer

Answer 25

Infiltrating ductal carcinoma