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MCCQE1 > Gynecology > Flashcards

Gynecology Flashcards

1
Q

Reproductive age woman with post-coital bleeding. Dx?

A

Cervical cancer

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2
Q

Woman with red vulvar lesions. Dx?

A

Paget’s disease (vulvar cancer)

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3
Q

Woman with post-menopausal bleeding. Possible Dxs and next step?

A

Most alarming: Endometrial cancer

Most common: vaginal atrophy

Next step: Endometrial sampling

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4
Q

HPV strains related to cervical cancer

A

16, 18, 30s, 45

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5
Q

HPV strains related to warts

A

6, 11

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6
Q

Risk factors for cervical cancer

A

HPV infection, STDSs, smoking, sexual activity

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7
Q

Pap smear frequency in woman with previous normal pap smear

A

≥21 q3yrs if normal

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8
Q

When to stop cervical cancer screening?

A

≥70 with 3 consecutive normal pap smears

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9
Q

Pregnant woman. How to screen for cervical cancer?

A

Normally

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10
Q

If histerectomy, who to screen for cervical cancer?

A
  • Total cause by benign disease + no hx of HPV–> Stop
  • Total + hx of malignancy/HPV/dysplasia–> swab vaginal vault
  • Subtotal–> continue as normal
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11
Q

If immunocompromised, how often to screen for cervical cancer?

A

q1yr

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12
Q

ASCUS in pap smear. Next step?

A

Either repeat in 6 months or get the HPV DNA

If ASCUS or positive HPV DNA exam –> colpo
If normal or negative HPV DNA exam–> continue as nomal q3yr

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13
Q

Pap smear with abnormal results (ASC-H, LSIL, HSIL). Next step?

A

Colposcopy

If ectocervix only–> cryo or LEEP
If endocervix +/- endo–> Cone Bx

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14
Q

HPV vaccine ages?

A

Vaccine (Gardasil)

  • Girls 11-26
  • Boys 11-21
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15
Q

Risks factors for endometrial cancer?

A
  • Anovulation (POS)
  • Age
  • Nulliparity
  • Obesity
  • Early menarche
  • Late menopause
  • Hormone replacement therapy (HRT)
  • Tamoxifen
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16
Q

Protective factor for endometrial cancer?

A

Protective factor: progesterone (e.g., OCP)

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17
Q

Postmenopausal + obese on hormone replacement therapy with vaginal bleeding. Dx, next step?

A

Vaginal athrophy vs trauma vs Endometrial cancer

Bx (Endometrial sampling or dilation + curettage)

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18
Q

Premenopausal + PCOS with vaginal bleeding +/- dysmenorrhea. Dx?

A

R/O endometrial cancer

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19
Q

Patient with vaginal bleeding. You performed endometrial sampling and the results are negative. Next step?

A

Vaginal atrophy, give estrogen creams

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20
Q

Patient with vaginal bleeding. You performed endometrial sampling and the results are hyperplasia. Next step?

A

High-dose progesterone

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21
Q

Patient with vaginal bleeding. You performed endometrial sampling and the results are adenocarcinoma. Next step?

A

total abdominal hysterectomy + bilateral salpingo-oophorectomy

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22
Q

Patient with vaginal bleeding. You performed endometrial sampling and the results are adenocarcinoma. You also identify metastasis. Next step?

A

total abdominal hysterectomy + bilateral salpingo-oophorectomy + ChemoTx

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23
Q

Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
LDH is high.

Dx and tx?

A

Dysgerminoma (Germ cells tumor)

Tx: Unilateral salpingo-oophorectomy

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24
Q

Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
AFP is high.

Dx and tx?

A

Endodermal sinus cancer (Germ cells tumor)

Tx: Unilateral salpingo-oophorectomy

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25
Q

Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
BHCG is high.

Dx and tx?

A

Choriocarcinoma (Germ cells tumor)

Tx: Unilateral salpingo-oophorectomy

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26
Q

Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
No marker is high.

Dx and tx?

A

Teratoma (Germ cells tumor)

Tx: Unilateral salpingo-oophorectomy

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27
Q

Risks factors of epithelial cell ovarian tumors

A
  • Post-menopausal woman
  • Nulli/low parity
  • Genes: BRACA1/2, HNPCC

*note: OCP is protective

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28
Q

Post-menopausal woman with renal failure/small bowel obstruction/ascites and adnexal mass.

Transvaginal U/S shows complex cysts.

Dx, next step and tx?

A

Epithelial cell ovarian tumor

Next steps:

  • CT scan
  • Track with Ca-125

Tx: total abdominal hysterectomy + bilateral salpingo-oophorectomy + Chemo (placlitaxel)

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29
Q

Patient with BRCA1/2 (+). Workup for ovarian cancer?

A
  • Follow with Ca-125 and transvaginal U/S

- Ppx with total abdominal hysterectomy + bilateral salpingo-oophorectomy at age 35

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30
Q

Pregnant woman with size-date discrepancies, ↑↑ B-HCG (over 100.000), Hyperthyroidism symptoms, Hyperemesis gravidorum. On exam you either see a grape-like mass that protrudes through the cervix or identify an ddnexal mass.

Dx, next step, tx and f/u?

A

Complete vs imcomplete molar pregnancy

Next step: 1st: Transvaginal U/S showing snowstorm pattern

Tx: suction curettage

F/U: Weekly B-HCG for a year (becasue of risk of choriocarcinoma) + OCP x 12 months

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31
Q

Difference between complete mole and incomplete mole?

A

Complete mole:

  • Product of good fertilization with an abnormal empty egg (no cucleous)
  • Complete set of chromosomes (46)
  • Completely spermal

Incomplete mole:

  • Abnormal fertilization: two sperms fertilize one egg
  • Incompletely molar (there are fetal parts)
  • Abnormal set of chromosomes (69)
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32
Q

Patient who after a pegnancy (miscarriage, molar or normal), hyperemesis and sx of hyperthiroidism.
You ask for a B-HCG and is still elevated.

Dx, next steps and tx?

A

Choriocarcinoma

Next steps:

  • 1st: Transvaginal U/S
  • 2nd: Bx with curettage
  • 3rd: CT scan to stage
Tx: 
- Surgical
•	Total abdominal hysterectomy (stage I)
•	Debulking (stage II)
- Medical
•	Methotrexate (For all patients)
•	Actinomycin D (For all patients)
•	Cyclophosphamide (refractory disease)
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33
Q

Patient with pruritus in vulvar area. On physical you don’t see signs of infection but identify a black lesion.

Dx, next step, tx?

A

Squamous Cell Cancer vs Melanoma

Next step: Bx

Tx: vulvectomy + lymph node dissection (high risk of disemination)

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34
Q

Patient with pruritus in vulvar area. On physical you don’t see signs of infection but identify a red lesion.

Dx, next step, tx?

A

Paget’s disease of the vulva

Next step: Bx

Tx: wide local resection (lower risk of disemination)

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35
Q

Cause of vaginal squamous cell carcinoma?

A

HPV exposure

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36
Q

Patient with grape-like mass in the vaginal wall.
You do a Bx, which shows adenocarcinoma. Then you resect the lesion.
Cause of adenocacinoma in vagina?

A

Mother of patient received diethylstilbesterol (DES) during pregnancy

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37
Q

When should you do a laparoscopic removal of a complex ovarian cyst?

A

> 10 cm or < 10 cm but failed to resolve

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38
Q

Young teenage woman with weight gain/ abdominal fullness. The transvaginal U/S shows an enormous complex cyst.

Dx and tx?

A

Teratoma

Tx: conservative cystectomy (only remove the cyst)

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39
Q

Woman with dysmenorrhea, dyspareunia and infertility. You start OCP and NSAIDs and she get better.
Dx?

A

Endometriosis

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40
Q

Paitent with endometriosis. The ultrasound shows a complex ovarian cyst.

Dx and tx?

A

Endometrioma

Tx: Laparoscopy + laser ablation after seeing the chocolate cyst

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41
Q

Most common place of ectopic pregnancy?

A

Ampulla

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42
Q

Patient with amenorrhea/spotting, abdominal pain, and positive pregnancy test.
• BHCG > 2000 (< 2000 repeat the BHCG)
• U/S showing an empty uterus

Dx and next step?

A

Ectopic pregnancy

Tx:
• Salpingostomy: if no rupture
• Salpingectomy: if rupture
• Methotrexate: Only in early pregnancy (BHCG < 5000 + No fetal heat tones + gestational size < 3 cm)

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43
Q

Women with severe spontaneous abdominal pain who now is toxic.

Dx, next step, tx?

A

Torsion of the Ovary

Dx: U/S with doppler

Tx: untwist ovary surgical emergency

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44
Q

Patient with abd/pelvic pain. On physical exam has cervical movement tenderness or adnexal tenderness or uterine tenderness. Fever +/- ↑WBC

U/S showing a complex cyst

Dx and tx?

A

Pelvic Inflammatory Disease + Tuboovarian Abscess

Tx:
• IV Cefoxitin + doxycycline + metronidazole OR…
• IV Clinda + gentamycin
• Surgical drain if no improvement

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45
Q

Definition of post-partum hemorrhage

A

o 500 cc post-vaginal partum

o 1000 cc post-c-section

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46
Q

Management of postpartum hemorrhage

A

Non-surgical:

  • Uterine massage
  • Oxytocin/ methylergonovine/ Carboprost
  • Balloon tamponade
  • Tranfuse PRN

Surgical:

  • Uterine arteries ligation
  • Intern iliac ligation
  • TAH
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47
Q

Classfication of uterine prolapse

A

I: in vaginal canal
II: At the vaginal opening
III: out of vagina but not inverted
IV: Inverted out of vagina

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48
Q

Patient who has incontinence after she sneezes, coughs or laughs. No urge or nocturnal sx. She has history of 5 pregnancies.

On physical you perform the q-tip test and the tip elevates more than 30 degrees when she coughs.

Dx and tx?

A

Stress incontinence

Tx:

  • Kegel exercises
  • Pessaries
  • Surgery
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49
Q

Patient who is always looking for a bathroom, but when they go it’s just a little bit. The patient referres urge and nocturnal symptoms.

Normal physical exam and uronalysis.
Cystometry show spastic constractions at all volumes.

Dx and tx?

A

Hypertonic, motorurge, overactive bladder

Tx: Antispasmodics like Oxybutynin

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50
Q

Patient with Hx of multiple sclerosis who has urinart leakage regularly throughout the day including durng the night.

Distended bladder on physical exam and FND. Normal uronalahysis.

Cystometry shows no contractions.

Dx and tx?

A

Hypotonic/overflow/neurogenic bladder

Tx:

  • Bethanechol
  • Intermittent vs chronic catheter
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51
Q

Patient with frequency, dysuria, urge, but no nocturnal sx.

Dx and possible causes?

A

Irritated bladder

Stones, cancer, UTI

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52
Q

Patient with Hx of Chron’s/ abdominal sx with constant continuous urinary leak + normal function.

Physical: evidence of fistula

Next steps?

A

Tampon test: put tampon where you think there is a fistula. Then inject blue dye and wait to see if tampon get the dye

Fistulectomy

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53
Q

Patient with white, thick, adherent vaginal discharge. No odor.

Hyphae in KOH

Dx and tx:

A

Candida

Tx:

  • OTC: topical antifungal
  • Oral: Fluconazole
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54
Q

Patient with Fishy smell vaginal discharge. On physical you see a thick, grey-white, copious discharge.

Clue cells in saline
(+) Whiff test in KOH

Dx and tx?

A

Gardnerella (Bacterial vaginosis)

Tx: Metronidazole (first try topical then oral)

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55
Q

Patient with Itchy and recurrent vaginal discharge. On physical you see a yellow-green and frothy d/c, and strawberry cervix.

Motile, flagellated microorganism in saline

Dx and tx?

A

Trichomonas

Tx:

  • Metronidazole (PO)
  • Treat both partners
56
Q

Patient with muco-purulent discharge/ On physicial she has cervical motion tenderness. No more signs/sx of PID. No fever, no abd pain.

(+) PCR for gonorrhea

Dx and tx?

A

Cervicitis

Tx: ceftriaxone x 1 IM

57
Q

Patient with muco-purulent discharge/ On physicial she has cervical motion tenderness. No more signs/sx of PID. No fever, no abd pain.

(+) PCR for chlamydia

Dx and tx?

A

Cervicitis

Tx: doxycycline or azithromycin

58
Q

Patient with pelvic/abd pain, Fever, and mucopurulent vaginal discharge.

Physical showing cervix motion tenderness/adnexal tenderness/uterine tenderness.

Dx and tx?

A

PID

Tx:
In-patient (pregnant or can’t eat/drink): cefoxitin + doxycycline IV
• Backup: clindamycin + gentamicin
Outpatient: ceftriaxone x1 IM + doxycycline + metronidazole

59
Q

Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems.
Next step?

A

Assess hostile mocus with the smuch test: couple has sex around ovulation. Mucus put between two slides then you separate them. Hostile mocus if

  • < 6 cm before breaking
  • No sperm

Tx: Strogen or intrauterine artificial insemination

60
Q

Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems. You also rule out hostile mocus with the Smuch test
Next step?

A

Consider anovulation

Tx: Clomiphene (prefered) or pergonal

61
Q

Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems. You also rule out hostile mocus with the Smuch test. The couple continue with infertility despite woman taking clomiphene.
Next step?

A

Hysterosalpingogram to rule out anatomic problems

62
Q

Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems. You also rule out hostile mocus with the Smuch test. The couple continue with infertility despite woman taking clomophene.
Normal Hysterosalpingogram.
Next step?

A

Diagnostic laparoscopy to rule out endometriosis

63
Q

Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems. You also rule out hostile mocus with the Smuch test. The couple continue with infertility despite woman taking clomiphene.
Normal Hysterosalpingogram.
Normal Diagnostic laparoscopy
Next step?

A

Unexplained infertility

Options:
• Adoption (answer in the test)
• Surrogate
• Artificial insemination

64
Q

Patient with Hirsutism and metabolic syndrome.
Slightly elevated testosterone and normal DHEA-S.

Dx, next steps and tx?

A

PCOS

Next steps:

  • U/S: Bilateral ovarian follicles
  • LH/FHS > 3:1

Tx:

  • Non-medical: Exercise, weight loss
  • Insulin resistance: Metformin
  • If doesn’t want to get pregnant: OCP/IUD
  • To promote ovulation: Clomiphene
  • Antiandrogens: Spironolactone
65
Q

Female patient with hisutism, clitoromegaly and deepened voice.
Testosterone is really elevated, but DHEA-S is nomal.

TV U/S: Unilateral tumor of ovary

Dx and tx?

A

Sertoli-Leydig tumor

Tx: Unilateral oophorectomy (no more management needed as the tumor is generally benign)

66
Q

Female patient with hisutism, clitoromegaly and deepened voice.
Testosterone is nomal, but DHEA-S is really high.

CT/MRI of abdomen: Unilateral adrenal adenoma.

Dx, next steps and tx?

A

Adrenal tumor

Next step: Adrenal vein sampling: to confirm laterality

Tx: resection

67
Q

Female patient with hirsutism.
Testosterone is normal, but DHEA-S is slighly high.

CT/MRI: Bilateral adrenal hyperplasia

Dx, next step, tx?

A

Congenital adrenal hyperplasia (CAH)

Next step: get 17-OH-progesterone in urine (should be high)

Tx: Cortisol and/or Fludrocortisone

68
Q

Patient with hisutism.
Testosterone is nomal, DHEA-S is normal, imaging is normal, lab work is normal.

Dx?

A

Familial hirsutism

Other than cosmetic, no tx needed

69
Q

Causes of vaginal bleeding in premenalchial age

A

Most common: Foreign body
Most alarming: Sexual abuse
Other: Precocious puberty

Dx: Speculum exam under anesthesia

70
Q

Causes of vaginal bleeding in reproductive age

A

Most common: Pregnancy
Most alarming: Anatomy, Dysfunctional (abdnomal) uterine bleeding, Cervical cancer

Dx: Urine pregnancy test

71
Q

Causes of vaginal bleeding in post-menopausal age

A

Most common: Vaginal atrophy
Most alarming: Endometrial cancer
Other: Hormone replacement therapy

Dx: Endometrial sampling

72
Q

Mangement of fife-threatening acute uterine bleeding

A

2 large bore IVs
IVF boluses
Transfuse PRN (if Hgb < 7 after IVF or orthostatism)
IV estrogen
Surgical intervention (if estrogen doesn’t work)
• Intracavitary tamponade
• Dilatation and curettage (preferred)
• Uterine artery embolization (for AV malformations and fibroids)
• TAH

73
Q

Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: closed
U/S: live baby

Dx and tx?

A

Threatened abortion

Tx: bed rest

74
Q

Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: open
U/S: dead baby

Dx?

A

Inevitable abortion

75
Q

Pregnant patient with vaginal bleeding.
Passage of contents: +
Cervical os: open
U/S: retained parts

Dx?

A

Imcomplete abortion

76
Q

Pregnant patient with vaginal bleeding.
Passage of contents: +
Cervical os: closed
U/S: nothing intra utero

Dx?

A

Complete abortion

77
Q

Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: closed
U/S: dead baby

Dx and tx?

A

Missed abortion

Tx:

  • Misoprostol + Oxitocin or D/C
  • If Rh-, give IV IG
78
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive

Next step?

A

BHCG-quant

79
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive

BHCG-quant > 1500

Dx?

A

Ectopic pregnancy

80
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive

BHCG-quant < 1500

Next step?

A

Have the patient repeat the BHCG-quant in 48 hours.

If it fails to double: Ectopic
If it doubles: intrauterine pegnancy

81
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.

TV US: shows fibroids

Tx?

A

Meds: OCP +/- NSAIDs

Surgery: myomectomy vs TAH
- If too big, shrink the fibroid with leuprolide (turns off estrogen) before intervention

82
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.

TV US: Symmetric and smooth proliferation of glandular tissue into the myometrium

Dx and tx?

A

Adenomyosis

Tx:

  • Meds: OCP +/- NSAIDs
  • Surgery: TAH
83
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.

TV US: polyps
Tx?

A

surgery (hysteroscopic polypectomy)

84
Q

Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.

TV US: Normal

You have rouled out all possible causes of vaginal bleeding

Dx and tx?

A

Dysfunctional (abnormal) uterine bleeding

Tx:
• Meds: OCP/IUD +/- NSAIDs
• Surgery: ablation or TAH

85
Q

Normal progression of puberty in a woman?

A

Breast (8) –> axillary hair (9) –> growth (10) –> menarche (11)

86
Q

Female patient with Breats buds and axilary hair at 6 years.
Next step?

A

Wrist X-ray

If bone age is 2 years greater that chonological= precocious puberty

87
Q

Female patient with Breats buds and axilary hair at 6 years.
Wrist X-ray: bone age is 2 years greater that chonological

Next step?

A

GnRH (Leurpolide) stimulation test

88
Q

Female patient with Breats buds and axilary hair at 6 years.
Wrist X-ray: bone age is 2 years greater that chonological
GnRH (Leurpolide) stimulation test resulting in ↑LH

Dx and next step?

A

Precocious puberty (Central issue)

Next step: MRI

89
Q

Female patient with Breats buds and axilary hair at 6 years.
Wrist X-ray: bone age is 2 years greater that chonological
GnRH (Leurpolide) stimulation test resulting in no change of LH

Dx and next step?

A

Peripheral issue

Next steps:

  • U/S of adrenals
  • TV U/S
  • Testosterone
  • DHEA-S
  • 17-oh-Progesterone
90
Q

Female patient with no secondary characteristic by 13 or no bleeding by 15.

Next step?

A

Bone age, FSH, LH

91
Q

Female patient with no secondary characteristic by 13 or no bleeding by 15.

↑LF, ↑FSH

Dx and next step?

A

Hypergonadotropic hypogonadism

Next step: karyotype

92
Q

Female patient with no secondary characteristic by 13 or no bleeding by 15.

Normal LF, normal FSH

Dx and next step?

A

Hypogonadotropic hypogonadism

Next steps:

  • UPT
  • Prolactin
  • TSH, T4
  • CBC
  • ESR
  • LFTs
  • MRI
93
Q

50 y-o female patient with Hot flashes, Vaginal atrophy, Frequent UTIs, ↓libido, and Mood swings.

Dx and tx?

A

Menopause (no diagnostic exams needed)

Tx:
- Venlafaxine (SSRI) for hot flashes 
- Estrogen creams for vaginal atrophy
- Screen with LDL and give statin if necessary
-Ppx of osteoporosis with Vit D + Ca
-If Vit D deficiency: Vit D 50,000 IU q week
-Dexa scan at 65 (60 if smoker)
o	If osteoporosis, give bisphosphonates 
- Exercise
94
Q

40 y-o female patient with Hot flashes, Vaginal atrophy, Frequent UTIs, ↓libido, and Mood swings.

Dx and Next step?

A

Premature ovarian failure/ premature menopause

Nex step (confirm Dx):

  • ↓Estrogen
  • ↑FSH
  • Absence of follicles in U/S
95
Q

16 y-o female patient with no secondary sex characteristics, no menarche and anosmia.

Dx?

A

Kallmann’s Syndrome

96
Q

16 y-o female patient with no secondary sex characteristics and no menarche. Normal female external genitalia on physical exam.

  • TV U/S: normal
  • ↓FSH, ↓LH

Next step?

A

MRI to differentiate between Kallmann’s Syndrome and craniopharyngioma

97
Q

16 y-o female patient with no secondary sex characteristics and no menarche. Normal female external genitalia on physical exam.

  • TV U/S: normal
  • ↓FSH, ↓LH
  • MRI: normal

Dx and tx?

A

Kallmann’s Syndrome (hypothalamic deficiency)

Tx: Estrogen and progesterone substitution

98
Q

16 y-o female patient with no secondary sex characteristics and no menarche.

  • TV U/S: normal
  • ↓FSH, ↓LH
  • MRI: pituitary mass

Dx and tx?

A

Craniopharyngioma (Deficiency at the anterior pituitary)

Tx: Estrogen and progesterone substitution + Surgery to resect mass

99
Q

16 y-o female patient with secondary sex characteristics but no menarche so far. Normal female external genitalia on physical exam.

  • Karyotype: XX
  • TV U/S: No uterus and tubes
  • Normal FSH, LH
  • Normal testosterone

Dx and tx?

A

Mullerian Agenesis (idiopathic)

Tx: Surgery to elevate the vagina

100
Q

16 y-o female patient with secondary sex characteristics but no menarche so far. Normal female external genitalia on physical exam.

  • Karyotype: XY
  • TV U/S: No uterus and tubes, but shows undescended testes
  • Normal FSH, LH
  • ↑ testosterone

Dx and tx?

A

Androgen insensitivity

Tx:

  • Surgery to elevate the vagina
  • Orchiectomy after age of 21 to prevent testicular cancer, but allow the full development of secondary sex characteristics
101
Q

16 y-o female patient without secondary sex characteristics and no menarche. On physicial you note webbed neck, broad-spaced nipples, shield-lek chest, and normal female external genitalia.

Dx, what do you expect to see on labs and tx? Additional test?

A

Turner’s syndrome

  • Karyotype: XO
  • ↑ FSH, LH
  • TV U/S: streak ovaries (rudimentary athrophic ovaries)

Tx: Estrogen and progesterone substitution

F/U: Echocardiogram!!!
- Association of Turner’s with coarctation of the aorta and aortic stenosis

102
Q

16 y-o female patient without secondary sex characteristics and no menarche. On physicial you note webbed neck, broad-spaced nipples, shield-lek chest, and normal female external genitalia.

What cardipaties you should keep in mind for this patient?

A

Association of Turner’s with coarctation of the aorta and aortic stenosis

103
Q

Female patient in reproductive age with amenorrhea.

Next step?

A

UPT
TSH
Prolactin

(most common causes are pregnancy, hypothyroidism and hyperprolactinemia)

104
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
↑Prolactin

Next step?

A

MRI

If prolactinoma–> Give dopamine agonist (Ropinirole)
If negative –> check meds (dopamine antagonists–atypical antipsychotics)

105
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin

Next step?

A

Progestin challenge

If she bleeds–> Anovulation (PCOS)

106
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge

Next step?

A

Estrogen and progesterone challenge

If she doesn’t bleed–> Endometrial dysfn (e.g., Asherman’s or ablation)

107
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Bleeds after estrogen and progesteron challenge

Next step?

A

FSH/LH ratio

108
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Bleeds after estrogen and progesteron challenge
↑FSH/LH

Next step?

A

Ultrasound

If + follicules –> Savage syndrome (resistant ovary)–> Sx relief +/- HRT

If no follicules–> Premature ovarian failure–> Sx relief

109
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Bleeds after estrogen and progesteron challenge
Normal FSH/LH

Next step?

A

Brain MRI

If pituitary problem (e.g., adenoma, sheehan’s, apoplegy)–> Surgery +/- Ropinirole

110
Q

Female patient in reproductive age with amenorrhea.

Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Bleeds after estrogen and progesteron challenge
Normal FSH/LH 
Normal MRI

Next step?

A

Evaluate and treat anorexia, emotrional stress, excessive weight loss

111
Q

The first test to perform when a woman presents with

amenorrhea.

A

B-hCG; the most common cause of amenorrhea is

pregnancy.

112
Q

Term for heavy bleeding during and between menstrual periods.

A

Menometrorrhagia.

113
Q

Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.

A

Asherman’s syndrome

114
Q

Therapy for polycystic ovarian syndrome.

A

Weight loss and OCPs.

115
Q

Medication used to induce ovulation.

A

Clomiphene citrate.

116
Q

Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.

A

Endometrial biopsy.

117
Q

Indications for medical treatment of ectopic pregnancy

A

Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation.

118
Q

Medical options for endometriosis

A

OCPs, danazol, GnRH agonists

119
Q

Laparoscopic fi ndings in endometriosis.

A

“Chocolate cysts,” powder burns

120
Q

The most common location for an ectopic pregnancy.

A

Ampulla of the oviduct.

121
Q

How to diagnose and follow a leiomyoma.

A

Ultrasound.

122
Q

Natural history of a leiomyoma.

A

Regresses after menopause.

123
Q

A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.

Dx, tx?

A

Trichomonas vaginitis.

Tx:
Metronidazole (PO)
Treat both partners

124
Q

Treatment for bacterial vaginosis.

A

Oral or topical metronidazole.

125
Q

The most common cause of bloody nipple discharge.

A

Intraductal papilloma

126
Q

Contraceptive methods that protect against PID.

A

OCPs and barrier contraception

127
Q

Unopposed estrogen is contraindicated in which cancers?

A

Endometrial or estrogen receptor– (+) breast cancer.

128
Q

A patient presents with recent PID with RUQ pain.

A

Consider Fitz-Hugh–Curtis syndrome.

129
Q

Breast malignancy presenting as itching, burning, and erosion of the nipple.

Dx?

A

Paget’s disease

130
Q

Annual screening for women with a strong family history of ovarian cancer.

A

CA-125 and transvaginal ultrasound.

131
Q

A 50-year-old woman leaks urine when laughing or

coughing. Nonsurgical options?

A

Kegel exercises, estrogen, pessaries for stress incontinence.

132
Q

A 30-year-old woman has unpredictable urine loss.

Examination is normal. Medical options?

A

Anticholinergics (oxybutynin) or β-adrenergics (metaproterenol) for urge incontinence.

133
Q

Lab values suggestive of menopause.

A

↑ serum FSH.

134
Q

The most common cause of female infertility.

A

Endometriosis.

135
Q

Two consecutive findings of atypical squamous cells of undetermined significance (ASCUS) on Pap smear.

Follow-up evaluation?

A

Colposcopy and endocervical curettage.

136
Q

Breast cancer type that ↑ the future risk of invasive carcinoma in both breasts.

A

Lobular carcinoma in situ.

MCCQE1 (19 decks)

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