Gynecology

Question 1

• fibroadenoma
• fibrocystic disease
• intraductal papilloma
• fat necrosis
• mastitis

Answer 1

benign breast disease

Question 2

• ductal carcinoma in situ (DCIS)
• lobular carcinoma in situ (LCIS)
• invasive ductal carcinoma
• invasive lobular carcinoma
• inflammatory breast cancer
• Paget’s disease of breast/nipple

Answer 2

malignant breast disease (breast cancer)

Question 3

causes of enlarged uterus

Answer 3

1. pregnancy
2. leiomyoma
3. adenomyosis

Question 4

ALL postmenopausal bleeding is what until proven otherwise?

Answer 4

endometrial carcinoma

Question 5

when do you start screening for cervical cancer?

Answer 5

21 yoa regardless of onset of sexual activity

Question 6

frequency of cervical cancer screening if LESS than 30 yoa?

Answer 6

every 3 years w/ cytology ONLY

Question 7

frequency of cervical cancer screening if MORE than 30 yoa?

Answer 7

every 3 years w/ cytology ONLY, OR every 5 years w/ cytology AND HPV

Question 8

PAP screening is NOT recommended for?

Answer 8

• greater than 65 yoa w/ recent normal PAP smear

- women w/ total hysterectomy for benign disease

Question 9

management of ASCUS on PAP smear if f/u is CERTAIN

Answer 9

repeat PAP smear in 3-6 months AND order HPV DNA typing

Question 10

management of ASCUS on PAP smear if f/u is UNCERTAIN

Answer 10

colposcopy and biopsies

Question 11

management of ASCUS if REPEAT PAP smear again shows ASCUS or HPV 16 and 18 are found

Answer 11

colposcopy and biopsies

Question 12

give quadrivalent HPV recombinant vaccine (Gardasil) to?

Answer 12

all females 8-26 yoa

Question 13

INITIAL w/u for pelvic pain

Answer 13

1. pelvic exam
2. cervical cultures
3. ESR
4. WBC (BC if fever is present)
5. US

Question 14

cervicitis management

Answer 14

• cervical cultures

- single dose azithromycin PO and ceftriaxone IM

Question 15

acute salpingo-oophoritis management

Answer 15

• cervical cultures
• single dose doxycycline PO and ceftriaxone IM (outpt)
• cefotetan or cefoxitin IV and doxycycline IV (inpt)

Question 16

chronic pelvic inflammatory disease treatment

• infertility
• dyspareunia
• h/o ectopic pregnancy or abnormal vaginal bleeding
• NEGATIVE cervical cultures and labs
• US = B/L cystic pelvic masses (hydrosalpinges)

Answer 16

lysis of tubal adhesions

Question 17

tuboovarian abscess treatment

Answer 17

• cefoxitin and doxycycline IV

- exlap +/- TAH and BSO (total abdominal hysterectomy bilateral salpingo oophorectomy), or percutaneous drainage

Question 18

primary dysmenorrhea treatment

• crampy lower abd pain
• N/V, and diarrhea during menstruation
• excessive endometrial PG F2

Answer 18

• NSAIDs

- combination OCP (2nd line)

Question 19

MCC of secondary dysmenorrhea

Answer 19

endometriosis

Question 20

endometriosis treatment

Answer 20

continuous PO progesterone

Question 21

secondary amenorrhea w/u

Answer 21

1. B-hCG (pregnancy test)
2. TSH
3. prolactin
4. progesterone challenge test
5. estrogen-progesterone challenge test

Question 22

LH:FSH ratio in PCOS (polycystic ovarian syndrome)

Answer 22

3:1

Question 23

treatment for PCOS

Answer 23

• OCP
• spironolactone
• clomiphene
• metformin

Question 24

when is HRT the answer?

Answer 24

• menopausal vasomotor symptoms (hot flashes)
• genitourinary atrophy
• dyspareunia

Question 25

when is HRT NOT the answer?

Answer 25

• treatment of osteoporosis
• h/o breast or endometrial cancer
• liver disease
• active thrombosis
• unexplained vaginal bleeding