Gynecology

Question 1

Nodular uterus with adnexal mass

Answer 1

Endometriosis

Question 2

Boggy, soft, symmetrically enlarged uterus

Answer 2

Adenomyosis

Question 3

Treatment for tubo-ovarian abscess

Answer 3

Ceftriaxone + doxycycline + MTZ

Question 4

Amenorrhea: Patient with normal breasts but no uterus

Answer 4

Mullerian agenesis (XX, normal FSH and LH) or androgen insensitivity (XY, increased testosterone)

Question 5

Amenorrhea: patient with no breasts but has a uterus

Answer 5

Craniopharyngioma (Low FSH and LH => low estrogen; bitemporal hemianopsia), Kallman syndrome (Low GnRH => Low FSH, LH, and estrogen; anosmia), Turner (Low estrogen => high FSH and LH)

Question 6

Causes of secondary amenorrhea

Answer 6

Hypothyroidism (Increased TRH inhibits the anterior pituitary => Low FSH, LH, and estrogen)

Pituitary tumor

Question 7

Treatment for ectopic pregnancy

Answer 7

Rupture: salpingectomy
Not ruptured: salpingostomy
No heart tones, zygote <3.5 cm, HCG < 5000: methotrexate

Question 8

Treatment for abortions

Answer 8

1st trimester and hemodynamically stable: misoprostol
Missed abortion/3rd trimester: oxytocin
Hemodynamically unstable or retained contents: Suction/D&C

Question 9

Threatened abortion

Answer 9

Closed os; no contents; live baby on US

Question 10

Inevitable

Answer 10

Open os; no contents passed; dead baby on US

Question 11

Incomplete

Answer 11

Open os; contents have passed; retained parts of baby on US

Question 12

Complete

Answer 12

Closed os; contents have passed; no baby on US

Question 13

Missed

Answer 13

Closed os; no contents have passed; dead baby on US

Question 14

Precocious puberty work up

Answer 14

1) GnRH stimulation test
2) if LH increases it’s central precocious puberty and get an MRI to determine if it’s a pituitary tumor or a constitutional problem that needs to be treated with leuprolide
3) if LH does not increase or change after test it is either a testicular tumor, CAH, or a cyst

Question 15

Virilization: adrenal tumor vs CAH

Answer 15

Adrenal tumor: full virilization; very high DHEAS and you need a CT scan with adrenal vein sampling to diagnose

CAH: hisutism; high DHEAS and you need a CT scan and urine 17 OH progesterone levels to diagnose; treat with cortisol and fludrocortisone

Question 16

What are indications for endometrial biopsy

Answer 16

> 45 with abnormal uterine bleeding or postmenopausal bleeding

<45 with abnormal uterine bleeding + hx of unopposed estrogen/failed medical management/HNPCC (Lynch syndrome)

> 35 with atypical glandular cells on pap

Question 17

McCune Albright

Answer 17

gonadotropin independent precocious puberty
Hyperfunctioning endocrine system
Cafe au lait spots, polyosteotic fibrosis and dysplasia

Question 18

Turner syndrome labs and features

Answer 18

Low estrogen; high FSH and LH

Bicuspid aortic valve or coarctation of the aorta => aortic stenosis

Question 19

Depo shot (IM birth control)

Answer 19

Medroxyprogesterone

SE: weight gain

Question 20

Levonorgestrel

Answer 20

IUD that thickens cervical mucus and impairs implantation though decidulization of endometrium

Same as plan B which should be taken within 72 hours of unprotected intercourse

SE: ectopic, amenorrhea

Question 21

Lichen sclerosus vs planus

Answer 21

Sclerosus: increased risk of cancer; does not affect the vagina; sandpaper quality

Lichen plaus, purple, pruritic, papules

Question 22

Bartholin cyst vs gartner cyst

Answer 22

Bartholin: lateral sides of the labia
Gartner: lateral aspects of the upper anterior vagina

Question 23

Adenomyosis vs endometriosis pathology

Answer 23

Adneo: invasion of endometrial glands into the myometrium

Endo: implantation of endometrial tissue outside the endometrial cavity (ectopic)

Question 24

Cyst that is associated with molar pregnancy

Answer 24

Theca lutein