Gynecology

Question 1

How is lichen sclerosis treated?

Answer 1

High-potency topical steroids

Question 2

What is vestibulodynia?

Answer 2

A constellation of symptoms related to the vulvar vestibule - severe pain on vestivular touch or attempted vaginal entry, tenderness to pressure and erythema of various degrees. Often, a primary or inciting event cannot be determined.

Question 3

What are treatments for vestibulodynia?

Answer 3

Tricyclic antidepressants, pelvic floor rehab, biofeedback, and topical anesthetics. Surgery is reserved for severe cases

Question 4

What is lichen simplex chronicus?

Answer 4

Easy irritation and itching of the vulva due to chronic scratching and rubbing (damage to the skin leads to loss of the protective barrier). Leads to a perpetual itch-scratch-itch cycle. Treatment is with short-course of high-potency topical corticosteroids.

Question 5

What is the treatment for vulvadynia?

Answer 5

Estrogen cream and clobetasol (high potency steroid)

Question 6

What are risk factors for pelvic organ prolapse?

Answer 6

Increasing parity, increasing age, obesity, connective tissue disorder (e.g. Ehlers-Danlos), chronic constipation, and a family history (2.5 fold increase). There is unclear evidence about whether hysterectomy increases the risk for bladder prolapse.

Question 7

What straining Q-tip angle is associated with urethral hypermobility?

Answer 7

> 30 degrees

Question 8

What procedure has the best 5-year success rates for treating genuine stress incontinence (loss of urine due to increased intra-abdominal pressure in the absence of detrusor contraction)?

Answer 8

Retropubic urethropexy (e.g. tension-free vaginal tape and other sling procedures)

Question 9

How are cystoceles fixed?

Answer 9

Fixing defects in the pubocervical fascia or reattaching it to the sidewall

Question 10

What is colpoclesis?

Answer 10

A procedure to fix vaginal prolapse - the vagina is surgically obliterated and can be performed quickly without need for general anesthesia. good for patients with high surgical morbidities (e.g. uncontrolled diabetes).

Question 11

What is a good, relatively non-invasive first step for correcting pelvic floor prolapse?

Answer 11

Insertion of a pessary

Question 12

What Is nodularity along the back of the uterus along the uterosacral ligaments suggestive of?

Answer 12

Endometriosis

Question 13

How is endometriosis managed?

Answer 13

Initially medically with OPCs or progestin-only methods (but note the estrogen-containing methods are more effective) plus NSAIDs, then laser ablation may be considered if that fails and a woman does not want a hysterectomy. Hysterectomy is definitive treatment. GnRH agonists mays also be tried but they are only good for short term use.

Question 14

How is endometriosis diagnosed definitively?

Answer 14

Exploratory laparoscopy and biopsy

Question 15

What are symptoms of interstitial cystitis?

Answer 15

Due to chronic inflammation of the bladder - recurrent irritative voiding symptoms of urgency and frequency (in the absence of objective evidence of another disease process), pelvic pain, dyspareunia. May be due to autoimmune causes

Question 16

What are treatments for uterine polyps?

Answer 16

Observation, medical management with progestin, curettage, surgical removal (polypectomy) via hysteroscopy or hysterectomy. Note that observation is not recommended for polyps > 1.5 cm. In women with infertility, polpectomy is recommended.

Question 17

How is abnormal uterine bleeding evaluated?

Answer 17

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not otherwise classified

Question 18

What should be done in all women over 40 with irregular bleeding?

Answer 18

An endometrial biopsy to r/o endometrial carcinoma

Question 19

Do subserosal fibroids cause pain with menstruation?

Answer 19

No

Question 20

At pH do uric acid vs. calcium oxalate stones form?

Answer 20

Low pH of uric acid

High pH for calcium oxalate

Question 21

What is the most common symptom of uterine fibroids?

Answer 21

Heavy menstrual bleeding

Question 22

What are the 3 main symptoms of endometriosis?

Answer 22

The “3 Ds”: dysmenorrhea, deep dyspareunia, and dyschezia (pain with defecation)

Question 23

In a postmenopausal woman with abnormal uterine bleeding, at what endometrial stripe size on ultrasound should a endometrial biopsy be performed?

Answer 23

> 4mm

Question 24

What is a Gartner duct cyst?

Answer 24

Results from incomplete regression of the Wolffian duct during fetal development. These cysts may be single or multiple and are submucosal along the lateral aspects of the upper anterior vagina.

Question 25

What are the cardinal ligaments?

Answer 25

They attach the uterine cervix to the pelvic sidewalls. The uterine arteries traverse these ligaments

Question 26

Where is the most common location for ureteral injury during a hysterectomy?

Answer 26

At the cardinal ligament - the ureter is only 2-3 cm lateral to the cervix. The ureter is just under the uterine artery which traverses the cardinal ligament (“water under the bridge”)

Question 27

What is procidentia?

Answer 27

When the entire uterus is prolapsed out of the patient’s introitus

Question 28

What kind of incontinence are patients with diabetes at risk for?

Answer 28

Overflow - due to neurogenic bladder

Question 29

Is nulliparity or multiparity more associated with PID?

Answer 29

Nulliparity

Question 30

What are treatments for vulvodynia?

Answer 30

Topical lidocaine, estrogen, or steroids. Tricyclic antidepressants may also be used