Gynecology Flashcards
1
Q
Reproductive age woman with post-coital bleeding. Dx?
A
Cervical cancer
2
Q
Woman with red vulvar lesions. Dx?
A
Paget’s disease (vulvar cancer)
3
Q
Woman with post-menopausal bleeding. Dx?
A
Endometrial cancer
4
Q
HPV strains related to cervical cancer
A
16, 18, 30s, 45
5
Q
HPV strains related to warts
A
6, 11
6
Q
Risk factors for cervical cancer
A
HPV infection, STDSs, smoking, sexual activity
7
Q
Pap smear frequency in woman with previous normal pap smear
A
≥21 q3yrs if normal
8
Q
When to stop cervical cancer screening?
A
≥70 with 3 consecutive normal pap smears
9
Q
Pregnant woman. Whot to screen for cervical cancer?
A
Normally
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
11
Q
If immunocompromised, who to screen for cervical cancer?
A
q1yr
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
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
14
Q
HPV vaccine ages?
A
Vaccine (Gardasil)
- Girls 11-26
- Boys 11-21
15
Q
Risks factors for endometrial cancer?
A
- Anovulation (POS)
- Age
- Nulliparity
- Obesity
- Early menarche
- Late menopause
- Hormone replacement therapy (HRT)
- Tamoxifen
16
Q
Protective factor for endometrial cancer?
A
Protective factor: progesterone (e.g., OCP)
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)
18
Q
Premenopausal + PCOS with vaginal bleeding +/- dysmenorrhea. Dx?
A
R/O endometrial cancer
19
Q
Patient with vaginal bleeding. You performed endometrial sampling and the results are negative. Next step?
A
Vaginal atrophy, give estrogen creams
20
Q
Patient with vaginal bleeding. You performed endometrial sampling and the results are hyperplasia. Next step?
A
High-dose progesterone
21
Q
Patient with vaginal bleeding. You performed endometrial sampling and the results are adenocarcinoma. Next step?
A
total abdominal hysterectomy + bilateral salpingo-oophorectomy
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
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
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
25
Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
BHCG is high.
Dx and tx?
Choriocarcinoma (Germ cells tumor)
Tx: Unilateral salpingo-oophorectomy
26
Teenage girl with adnexal mass and weight gain.
Transvaginal U/S showing complex cyst.
No marker is high.
Dx and tx?
Teratoma (Germ cells tumor)
Tx: Unilateral salpingo-oophorectomy
27
Risks factors of epithelial cell ovarian tumors
- Post-menopausal woman
- Nulli/low parity
- Genes: BRACA1/2, HNPCC
*note: OCP is protective
28
Post-menopausal woman with renal failure/small bowel obstruction/ascites and adnexal mass.
Transvaginal U/S shows complex cysts.
Dx, next step and tx?
Epithelial cell ovarian tumor
Next steps:
- CT scan
- Track with Ca-125
Tx: total abdominal hysterectomy + bilateral salpingo-oophorectomy + Chemo (placlitaxel)
29
Patient with BRCA1/2 (+). Workup for ovarian cancer?
- Follow with Ca-125 and transvaginal U/S
| - Ppx with total abdominal hysterectomy + bilateral salpingo-oophorectomy at age 35
30
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?
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
31
Difference between complete mole and incomplete mole?
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)
32
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?
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)
```
33
Patient with pruritus in vulvar area. On physical you don't see signs of infection but identify a black lesion.
Dx, next step, tx?
Squamous Cell Cancer vs Melanoma
Next step: Bx
Tx: vulvectomy + lymph node dissection (high risk of disemination)
34
Patient with pruritus in vulvar area. On physical you don't see signs of infection but identify a red lesion.
Dx, next step, tx?
Paget's disease of the vulva
Next step: Bx
Tx: wide local resection (lower risk of disemination)
35
Cause of vaginal squamous cell carcinoma?
HPV exposure
36
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?
Mother of patient received diethylstilbesterol (DES) during pregnancy
37
When should you do a laparoscopic removal of a complex ovarian cyst?
> 10 cm or < 10 cm but failed to resolve
38
Young teenage woman with weight gain/ abdominal fullness. The transvaginal U/S shows an enormous complex cyst.
Dx and tx?
Teratoma
Tx: conservative cystectomy (only remove the cyst)
39
Woman with dysmenorrhea, dyspareunia and infertility. You start OCP and NSAIDs and she get better.
Dx?
Endometriosis
40
Paitent with endometriosis. The ultrasound shows a complex ovarian cyst.
Dx and tx?
Endometrioma
Tx: Laparoscopy + laser ablation after seeing the chocolate cyst
41
Most common place of ectopic pregnancy?
Ampulla
42
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?
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)
43
Women with severe spontaneous abdominal pain who now is toxic.
Dx, next step, tx?
Torsion of the Ovary
Dx: U/S with doppler
Tx: untwist ovary surgical emergency
44
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?
Pelvic Inflammatory Disease + Tuboovarian Abscess
Tx:
• IV Cefoxitin + doxycycline + metronidazole OR…
• IV Clinda + gentamycin
• Surgical drain if no improvement
45
Definition of post-partum hemorrhage
o 500 cc post-vaginal partum
| o 1000 cc post-c-section
46
Management of postpartum hemorrhage
Non-surgical:
- Uterine massage
- Oxytocin/ methylergonovine/ Carboprost
- Balloon tamponade
- Tranfuse PRN
Surgical:
- Uterine arteries ligation
- Intern iliac ligation
- TAH
47
Classfication of uterine prolapse
I: in vaginal canal
II: At the vaginal opening
III: out of vagina but not inverted
IV: Inverted out of vagina
48
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?
Stress incontinence
Tx:
- Kegel exercises
- Pessaries
- Surgery
49
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?
Hypertonic, motorurge, overactive bladder
Tx: Antispasmodics like Oxybutynin
50
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?
Hypotonic/overflow/neurogenic bladder
Tx:
- Bethanechol
- Intermittent vs chronic catheter
51
Patient with frequency, dysuria, urge, but no nocturnal sx.
Dx and possible causes?
Irritated bladder
Stones, cancer, UTI
52
Patient with Hx of Chron's/ abdominal sx with constant continuous urinary leak + normal function.
Physical: evidence of fistula
Next steps?
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
53
Patient with white, thick, adherent vaginal discharge. No odor.
Hyphae in KOH
Dx and tx:
Candida
Tx:
- OTC: topical antifungal
- Oral: Fluconazole
54
Patient with Fishy smell vaginal discharge. On physycal you see a think, grey-white, copious discharge. discharge.
Clue cells in saline
(+) Whiff test in KOH
Dx and tx?
Gardnerella (Bacterial vaginosis)
Tx: Metronidazole (first try topical then oral)
55
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?
Trichomonas
Tx:
- Metronidazole (PO)
- Treat both partners
56
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?
Cervicitis
Tx: ceftriaxone x 1 IM
57
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?
Cervicitis
Tx: doxycycline or azithromycin
58
Patient with pelvic/abd pain, Fever, and mucopurulent vaginal discharge.
Physical showing cervix motion tenderness/adnexal tenderness/uterine tenderness.
Dx and tx?
PID
Tx:
In-patient (pregnant or can’t eat/drink): cefoxitin + doxycycline IV
• Backup: clindamycin + gentamicin
Outpatient: ceftriaxone x1 IM + doxycycline + metronidazole
59
Couple who cannot get pergnant after 1 year. You have already rouled out male-related problems.
Next step?
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
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?
Consider anovulation
Tx: Clomiphene (prefered) or pergonal
61
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.
Next step?
Hysterosalpingogram to rule out anatomic problems
62
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?
Diagnostic laparoscopy to rule out endometriosis
63
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.
Normal Diagnostic laparoscopy
Next step?
Unexplained infertility
Options:
• Adoption (answer in the test)
• Surrogate
• Artificial insemination
64
Patient with Hirsutism and metabolic syndrome.
Slightly elevated testosterone and normal DHEA-S.
Dx, next steps and tx?
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
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?
Sertoli-Leydig tumor
Tx: Unilateral oophorectomy (no more management needed as the tumor is generally benign)
66
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?
Adrenal tumor
Next step: Adrenal vein sampling: to confirm laterality
Tx: resection
67
Female patient with hisutism.
Testosterone is nomal, but DHEA-S is slighly high.
CT/MRI: Bilateral adrenal hyperplasia
Dx, next step, tx?
Congenital adrenal hyperplasia (CAH)
Next step: get 17-OH-progesterone in urine (should be high)
Tx: Cortisol and/or Fludrocortisone
68
Patient with hisutism.
Testosterone is nomal, DHEA-S is normal, imaging is normal, lab work is normal.
Dx?
Familial hirsutism
Other than cosmetic, no tx needed
69
Causes of vaginal bleeding in premenalchial age
Most common: Foreign body
Most alarming: Sexual abuse
Other: Precocious puberty
Dx: Speculum exam under anesthesia
70
Causes of vaginal bleeding in reproductive age
Most common: Pregnancy
Most alarming: Anatomy, Dysfunctional (abdnomal) uterine bleeding, Cervical cancer
Dx: Urine pregnancy test
71
Causes of vaginal bleeding in post-menopausal age
Most common: Vaginal atrophy
Most alarming: Endometrial cancer
Other: Hormone replacement therapy
Dx: Endometrial sampling
72
Mangement of fife-threatening acute uterine bleeding
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
Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: closed
U/S: live baby
Dx and tx?
Threatened abortion
Tx: bed rest
74
Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: open
U/S: dead baby
Dx?
Inevitable abortion
75
Pregnant patient with vaginal bleeding.
Passage of contents: +
Cervical os: open
U/S: retained parts
Dx?
Imcomplete abortion
76
Pregnant patient with vaginal bleeding.
Passage of contents: +
Cervical os: closed
U/S: nothing intra utero
Dx?
Complete abortion
77
Pregnant patient with vaginal bleeding.
Passage of contents: none
Cervical os: closed
U/S: dead baby
Dx and tx?
Missed abortion
Tx:
- Misoprostol + Oxitocin or D/C
- If Rh-, give IV IG
78
Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive
Next step?
BHCG-quant
79
Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive
BHCG-quant > 1500
Dx?
Ectopic pregnancy
80
Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is positive.
TV US: inconclusive
BHCG-quant < 1500
Next step?
Have the patient repeat the BHCG-quant in 48 hours.
If it fails to double: Ectopic
If it doubles: intrauterine pegnancy
81
Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.
TV US: shows fibroids
Tx?
Meds: OCP +/- NSAIDs
Surgery: myomectomy vs TAH
- If too big, shrink the fibroid with leuprolide (turns off estrogen) before intervention
82
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?
Adenomyosis
Tx:
- Meds: OCP +/- NSAIDs
- Surgery: TAH
83
Female patient in reproductive age with vaginal bleeding. Urinary pregnancy test is negative.
TV US: polyps
Tx?
surgery (hysteroscopic polypectomy)
84
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?
Dysfunctional (abnormal) uterine bleeding
Tx:
• Meds: OCP/IUD +/- NSAIDs
• Surgery: ablation or TAH
85
Normal progression of puberty in a woman?
Breast (8) --> axillary hair (9) --> growth (10) --> menarche (11)
86
Female patient with Breats buds and axilary hair at 6 years.
Next step?
Wrist X-ray
If bone age is 2 years greater that chonological= precocious puberty
87
Female patient with Breats buds and axilary hair at 6 years.
Wrist X-ray: bone age is 2 years greater that chonological
Next step?
GnRH (Leurpolide) stimulation test
88
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?
Central issue
Next step: MRI
89
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?
Peripheral issue
Next steps:
- U/S of adrenals
- TV U/S
- Testosterone
- DHEA-S
- 17-oh-Progesterone
90
Female patient with no secondary characteristic by 13 or no bleeding by 15.
Next step?
Bone age, FSH, LH
91
Female patient with no secondary characteristic by 13 or no bleeding by 15.
↑LF, ↑FSH
Dx and next step?
Hypergonadotropic hypogonadism
Next step: karyotype
92
Female patient with no secondary characteristic by 13 or no bleeding by 15.
Normal LF, normal FSH
Dx and next step?
Hypogonadotropic hypogonadism
Next steps:
- UPT
- Prolactin
- TSH, T4
- CBC
- ESR
- LFTs
- MRI
93
50 y-o female patient with Hot flashes, Vaginal atrophy, Frequent UTIs, ↓libido, and Mood swings.
Dx and tx?
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
40 y-o female patient with Hot flashes, Vaginal atrophy, Frequent UTIs, ↓libido, and Mood swings.
Dx and Next step?
Premature ovarian failure/ premature menopause
Nex step (confirm Dx):
- ↓Estrogen
- ↑FSH
- Absence of follicles in U/S
95
16 y-o female patient with no secondary sex characteristics, no menarche and anosmia.
Dx?
Kallmann’s Syndrome
96
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?
MRI to differentiate between Kallmann’s Syndrome and craniopharyngioma
97
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?
Kallmann’s Syndrome (hypothalamic deficiency)
Tx: Estrogen and progesterone substitution
98
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?
Craniopharyngioma (Deficiency at the anterior pituitary)
Tx: Estrogen and progesterone substitution + Surgery to resect mass
99
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?
Mullerian Agenesis (idiopathic)
Tx: Surgery to elevate the vagina
100
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?
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
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?
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
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?
Association of Turner's with coarctation of the aorta and aortic stenosis
103
Female patient in reproductive age with amenorrhea.
Next step?
UPT
TSH
Prolactin
(most common causes are pregnancy, hypothyroidism and hyperprolactinemia)
104
Female patient in reproductive age with amenorrhea.
Negative UPT, normal TSH
↑Prolactin
Next step?
MRI
If prolactinoma--> Give dopamine agonist (Ropinirole)
If negative --> check meds (dopamine antagonists–atypical antipsychotics)
105
Female patient in reproductive age with amenorrhea.
Negative UPT, normal TSH
Normal Prolactin
Next step?
Progestin challenge
If she bleeds--> Anovulation (PCOS)
106
Female patient in reproductive age with amenorrhea.
Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Next step?
Estrogen and progesterone challenge
If she doesn't bleed--> Endometrial dysfn (e.g., Asherman's or ablation)
107
Female patient in reproductive age with amenorrhea.
Negative UPT, normal TSH
Normal Prolactin
Negative progestine challenge
Bleeds after estrogen and progesteron challenge
Next step?
FSH/LH ratio
108
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?
Ultrasound
If + follicules --> Savage syndrome (resistant ovary)--> Sx relief +/- HRT
If no follicules--> Premature ovarian failure--> Sx relief
109
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?
MRI
If pituitary problem (e.g., adenoma, sheehan's, apoplegy)--> Surgery +/- Ropinirole
110
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?
Evaluate and treat anorexia, emotrional stress, excessive weight loss
111
The first test to perform when a woman presents with
| amenorrhea.
B-hCG; the most common cause of amenorrhea is
| pregnancy.
112
Term for heavy bleeding during and between menstrual periods.
Menometrorrhagia.
113
Cause of amenorrhea with normal prolactin, no response to estrogen-progesterone challenge, and a history of D&C.
Asherman’s syndrome
114
Therapy for polycystic ovarian syndrome.
Weight loss and OCPs.
115
Medication used to induce ovulation.
Clomiphene citrate.
116
Diagnostic step required in a postmenopausal woman who presents with vaginal bleeding.
Endometrial biopsy.
117
Indications for medical treatment of ectopic pregnancy
Stable, unruptured ectopic pregnancy of < 3.5 cm at < 6 weeks’ gestation.
118
Medical options for endometriosis
OCPs, danazol, GnRH agonists
119
Laparoscopic fi ndings in endometriosis.
“Chocolate cysts,” powder burns
120
The most common location for an ectopic pregnancy.
Ampulla of the oviduct.
121
How to diagnose and follow a leiomyoma.
Ultrasound.
122
Natural history of a leiomyoma.
Regresses after menopause.
123
A patient has ↑ vaginal discharge and petechial patches in the upper vagina and cervix.
Trichomonas vaginitis.
124
Treatment for bacterial vaginosis.
Oral or topical metronidazole.
125
The most common cause of bloody nipple discharge.
Intraductal papilloma
126
Contraceptive methods that protect against PID.
OCPs and barrier contraception
127
Unopposed estrogen is contraindicated in which cancers?
Endometrial or estrogen receptor– (+) breast cancer.
128
A patient presents with recent PID with RUQ pain.
Consider Fitz-Hugh–Curtis syndrome.
129
Breast malignancy presenting as itching, burning, and
| erosion of the nipple.
Paget’s disease
130
Annual screening for women with a strong family history of ovarian cancer.
CA-125 and transvaginal ultrasound.
131
A 50-year-old woman leaks urine when laughing or
| coughing. Nonsurgical options?
Kegel exercises, estrogen, pessaries for stress incontinence.
132
A 30-year-old woman has unpredictable urine loss.
| Examination is normal. Medical options?
Anticholinergics (oxybutynin) or β-adrenergics
| (metaproterenol) for urge incontinence.
133
Lab values suggestive of menopause.
↑ serum FSH.
134
The most common cause of female infertility.
Endometriosis.
135
Two consecutive fi ndings of atypical squamous cells
of undetermined signifi cance (ASCUS) on Pap smear.
Follow-up evaluation?
Colposcopy and endocervical curettage.
136
Breast cancer type that ↑ the future risk of invasive
| carcinoma in both breasts.
Lobular carcinoma in situ.
