Gynecology

Question 1

First step in evaluation of primary amenorrhea?

What is the second step, depending on the outcome of the first?

Answer 1

First step: Pelvic exam and/or US to assess for presence of a uterus
If present, next step is FSH (primary ovarian failure vs. central)
If absent, next step is karyotype (mullerian agenesis XX vs. AIS XY)

Question 2

Labs to get for secondary amenorrhea after pregnancy has been ruled out

Answer 2

Prolactin, TSH, FSH

Question 3

Female with normal internal genitalia, external virilization, high FSH/LH, and undetectable estrogen?

Answer 3

Aromatase deficiency (will also be elevated androgen)

Question 4

When is endometrial biopsy needed for AUB?

Answer 4

• Any woman over 45 (or postmenopausal)
• Younger women with unopposed estrogen (obseity, anovulation)
  (Also Lynch syndrome)

Question 5

Common AEs of OCPs

Answer 5

1. Hypertension
2. VTE
3. Hepatic adenoma

Question 6

Most effective form of emergency contraception

Answer 6

Copper IUD

Levanorgestrel/plan B and ulipristal are other options

Question 7

Treatment for infertility in PCOS

Answer 7

Clomophene citrate (SERM that is antiestrogen at hypothalamus)

Question 8

What can differentiate endometriosis from adenomyoses

Answer 8

Heavy menstrual bleeding seen in adenomyosis only
(Will also see boggy, tender, enlarged uterus).
(Adenomyosis usually seen in older multiparous women, endometriosis in younger nulliparous women)

Question 9

Differences in involvement in lichen sclerosis and atrophic vaginitis

Answer 9

Lichen sclerosis is skin only: vulvar and perianal skin. Vagina is spared

Atrophic vaginitis is vulva and vagina

Question 10

Treatment for lichen sclerosus

Answer 10

1. High-potency topical steroids

2. Punch biopsy to rule out SCC

Question 11

What complications can atrophic vaginitis lead to?

Answer 11

Incontinence and recurrent UTIs (decreased urethral closure pressure and compliance)

Question 12

Vaginal pH of different vaginal infections

Answer 12

BV and Trich: both abnormally alkalina, >4.5

Candida: normally acidic, <4.5

Question 13

DIfference between BV and Trich discharge

Answer 13

BV is off-white and fishy odor.
Trich is frothy and yellow-green.
(Both are thin, malodorous, with alkalin (>4.5) pH)

Question 14

Treatment for Candidal vaginitis

Answer 14

Oral fluconazole (or topical intravaginal nystatin)

Question 15

Work-up for atypical glandular cells on pap

Answer 15

1. Colposcopy
2. Endocervical curettage
3. Endometrial biopsy if over 35 (could be endometrial cancer)

Question 16

Complications of cervical conization

Answer 16

Cervical stenosis or cervical incompetence

Question 17

Initial tests for a postmenopausal woman with ovarian mass

Answer 17

US and CA-125
(CA-125 nonspecifc (also fibroids and endometriosis), but in postmenopausal woman ovarian cancer is more likely and others are less likely, increasing specificity somewhat)
(Get and MRI/CT if either abnormal)

Question 18

What, if anything, is produced by granulosa cell ovarian tumors

Answer 18

Estrogen (get an endometrial biopsy in a postmenopausal woman)

Question 19

What, if anything, is produced by dysgerminoma ovarian tumors?

Answer 19

LDH or HCG

Question 20

What, if anything, is produced by Sertoli-Leydig ovarian tumors

Answer 20

Androgens

Question 21

Breast dimpling and pitting with itching

Answer 21

Inflammatory breast cancer

Question 22

AEs of SERMs

Answer 22

1. Hot flashes (CNS antiestrogen)
2. Thromboembolism
3. For tamoxifen only, endometrial cancer

Question 23

Main toxicity of trastuzumab

Answer 23

Cardiomyopathy, usually reversible

Question 24

Screening for BRCA-positive woman without mastectomy

Answer 24

Annual mammograms and MRI

Question 25

Unilateral bloody discharge with no associated mass or lymphadenopathy on exam or imaging. Next step?

Answer 25

Likely intraductal papilloma. But still need biopsy to rule out infiltrating ductal carcinoma.

Question 26

Fixed breast mass with skin retractions with fat globules and foamy histiocytes on biopsy

Answer 26

Fat necrosis