Gynecology

Question 1

Age of thelarche and menarche

Answer 1

thelarche: btwn 8-11
menarche: btwn 10-16

Question 2

Tx of menopause

Answer 2

HRT (combined estrogen and progest)
Contraindicated: vaginal bleeding, breast cancer, hx thromboembolism, liver disease, hypertriglceridemia
Non-HRT: SSRI/SNRI, clonidine, gabapentin

Question 3

workup, tx of primary amenorrhea

Answer 3

w/u: pregnancy test, bone age radiograph (constitutional delay?), FSH/LH, ultrasound for ovaries, karyotype if no uterus; prolactin, MRI if uterus
tx: (hypogonadism only) low dose estrogen 12-18mo, cyclic estrogen/ progesterone

Question 4

Defn, workup of secondary amenorrhea

Answer 4

6 consecutive months, no menses (menarche passed)
w/u: pregnancy test, TSH, prolactin
progestin challenge: + challenge (bleeding on withdrawal): anovulation (eg PCOS)
-challenge (no bleeding): uterine or estrogen abn
signs hyperglycemia or hyptoension: dexa suppr to rule out CAH, cushing, addison
virilzation: testosterone, DHEAS, 17-hydroxyprog (PCOS, CAH, cushing, tumor)

Question 5

noncyclical pain, menorrhagia, enlarged uterus: dx and tx

Answer 5

adenomyosis
tx: NSAID/OCP/ progestins
endometrial ablation, hysterectomy

Question 6

Guidelines for endometrial bx in women with abnormal uterin bleeding

Answer 6

endometrium >4mm

>35yo with risk factors (obesity, DM)

Question 7

Tx AUB: acute, ovulator, anovulator

Answer 7

Acute: high dose IV estrog, D&C w/in 12-24h
Ovulatory: NSAID, OCP, mirena
Anovulatory: Progestin x10d, desmopressin (vWF/ VIII), OCP, mirena

Question 8

Newborn female infant with ambiguous genitalia and salt wasting

Answer 8

21-hydroxylase deficiency

Question 9

Dx criteria and tx of PCOS

Answer 9

(req 2/3)
1. polycystic ovaries
2.oligo/anovulation
3/ clinical or biochemical evidence of hyperandrogenism (testosterone, DHEAS, DHEA)
Tx: OCP, progestin, metformin (if not trying to conceive)
clomiphene +/- metformin (trying to conceive)
Hirsutism: OCP, antiandrogen (spironolactone, finasteride), metformin

Question 10

Fluctuant mass 1-4 cm at inferior portion labium nimus: dx and tx

Answer 10

bartholin cyst
If symptomatic: aspiration and I&D if symptomatic; word catheter insertion
Abx only if celluitis

Question 11

Abx regimens for PID

Answer 11

Outpatient:
Regimen A: Ceftriaxone IM or Cefoxitin plus probenecid
+doxycycline x14d +/-metronidazole 14d
Regimen B: oxafloxicin or levofloxacin x14d +/- metronidazole 14d
Inpatient: cefoxitin or cefotetan plus doxy x14d
clindamycin + gentamicin x14d

Question 12

Perhepitits, RUQ pian, abn liver fxn, shoulder pain with hx of PID

Answer 12

fitz hugh curtis

Question 13

Abrupt onset of fever (>102), vomiting watery diarrhea, macular erythematous rash in female: dx and tx

Answer 13

TSS
Rapid rehydration
Antistaph (nafcillin, oxacillin, vanc)
corticosteroids to reduce severity/ fever

Question 14

Tx leiomyoma

Answer 14

NSAID, OCP
medroxyprogestrone acetate or danazol to stop or slow bleeding
GnRH analogs (leuprolide or nafarelin) to decr size
myomectomy or hysterectomy or uterine artery embolization

Question 15

Types of endometrial cancer and etiology

Answer 15

Type I (endometrioid): unopposed estrogen
Type II (serous): unrelated to estrogen, p53 mut, older age; poor prognosis

Question 16

Types of HPV assoc with diff types cancer

Answer 16

HPV 16: SCC

HPV 18: adenoca

Question 17

vulva: pruritic or painful white, pigmented, raised, thickned, or ulcerated lesion: workup and tx

Answer 17

possible vulvar cancer: punch bx

Tx: topical chemo, laser abl, WLE, or vulvectomy

Question 18

Inhibin producing ovarian mass

Answer 18

granulosa cell

Question 19

LDH producing ovarian mass

Answer 19

dysgerminoma

Question 20

AFP producing ovarian mass

Answer 20

endodermal sinus or embryonal carcinoma

Question 21

criteria for tx of ovarian mass (by age)

Answer 21

premenarchal : >2cm-> close monitoring
Premenopausal: 8-10cm and complex/ unchanged: surgical exc
Postmenopausal: asymptomatic,

Question 22

Presents as “a bunch of grapes” in the vagina of pediatric patient

Answer 22

sarcoma botyroides (rhabdomyosarcoma)

Question 23

Etiologies + treatments precocious puberty

Answer 23

Central: leuprolide
Peripheral:
-ovarian cyst: none, will regress
-CAH: glucocorticoids
-Adrena/ovarian tumor: excision
-Mccune albright: toamoxifen or ketoconazle/testolactone