ICR-GYN Issues

Question 1

Normal vaginal discharge

Answer 1

Clear to white

Question 2

Most common cause of vaginitis

Answer 2

Bacterial 50%, trichomonas 25%, yeast 25%

Question 3

Curdy discharge pH < 4.5, hyphae w/itching/burning

Answer 3

Candida

Question 4

Green-yellow discharge w/irritation

Answer 4

Trichomonas

Question 5

Gray-white odorous discharge w/ pH > 4.5

Answer 5

Bacterial vaginitis

Question 6

A woman presents with pain and pressure like she is sitting on something. She has difficulty voiding (has to put her fingers in the vagina), urinary incontinence and sexual difficulties. How do you treat her?

Answer 6

She has symptoms of pelvic relaxation. You can treat with pessary and surgery.

Question 7

What causes urge incontinence?

Answer 7

Detrusor instability

Question 8

What causes stress incontinence?

Answer 8

Anatomic loss of support from increased abdominal pressure

Question 9

What causes overflow incontinence?

Answer 9

Obstruction or loss of neurological control results in a constantly full bladder that dribbles

Question 10

What drugs can be used to treat urge incontinence?

Answer 10

Anticholinergics, muscarinic receptor antagonists and TCAs (paralyze detrusor)

Question 11

What drugs can be used to treat stress incontinence?

Answer 11

Anticholinergics, estrogen therapy, TCAs, pessary and surgery.

Question 12

What drugs can be used to treat overflow incontinence?

Answer 12

Muscarinic agonists, surgery and behavior modification

Question 13

Gynecologic differential for acute pelvic pain

Answer 13

Ruptured adnexal cysts, hemorrhagic adnexal cysts, ectopic pregnancy and infection

Question 14

Non-gynecologic differential for acute pelvic pain

Answer 14

Appendicitis, diverticulitis, ischemic bowel, bowel obstruction, UTI and kidney stones

Question 15

Differential for chronic pelvic pain

Answer 15

GYN: Endometriosis, pelvic congestion syndrome, degenerating fibroids, adenomyosis, dysmenorrhea and adhesions. Non-GYU: UTI, neurologic, psychiatric and abdominal wall conditions.

Question 16

A 20-30 year old woman presents with dysmenorrhea, dyspareunia, infertility and chronic pelvic pain. Her mother had a similar condition. What is your diagnosis?

Answer 16

Endometriosis

Question 17

Dysmenorrhea treatment

Answer 17

NSAIDs

Question 18

Endometriosis treatment

Answer 18

Progestins, GnRH agonists, surgery

Question 19

Adenomyosis treatment

Answer 19

Like endometriosis

Question 20

Test for GC/Chlamydia, treatment for GC/chlamydia PID?

Answer 20

NAAT. Treat for both conditions (ceftriaxone, azithromycin (1x) or doxycycline (7 days)

Question 21

A patient comes in with pelvic pain, fever, mucopurulent discharge, elevated ESR, elevated CRP. She has a history of GC/chlamydia cervicitis. Laparoscopy is shown below What is your diagnosis?

Answer 21

Note Fitz-Hugh-Curtis adhesions over the liver, typical of PID.

Question 22

Functional components of the normal menstrual cycle

Answer 22

Hypothalamic-pituitary unit, ovaries and endometrium.

Question 23

Most common cause of abnormal uterine bleeding?

Answer 23

Anovulation. Bleeding disorders in young patients, fibroids, atrophy and pregnancy complications are also common.

Question 24

Bleeding through super tampon with a pad longer than 7 days at normal intervals.

Answer 24

Menorrhagia > 80 mL

Question 25

Irregular menstrual intervals

Answer 25

Metrorrhagia

Question 26

Bleeding at intervals < 21 days

Answer 26

Polymenorrhea

Question 27

Bleeding at intervals > 40 days

Answer 27

Oligomenorrhea

Question 28

Treatment of acute dysfunctional uterine bleeding

Answer 28

High-dose estrogen followed by progestins.

Question 29

Treatment for chronic dysfunctional uterine bleeding

Answer 29

Progestins, OCPs, ablation and hysterectomy