Kaplan High Yield Gyn

Question 1

pts with PMS/PMDD experience their symptoms during what part of the menstrual cycle?

Answer 1

luteal phase (2nd half)

Question 2

time requirements to dx PSM/PMDD

Answer 2

• occurred for 2 consecutive cycles
• occurs during the luteal phase (2nd half of cycle)
• no sx during the follicular phase (1st half)
• causes dysfunction in life (work, relationships, family, etc)

Question 3

tx options for PMS/PMDD

Answer 3

• dec consumption of caffeine, alcohol, cigarettes, chocolate
• inc aerobic exercise
• SSRIs (for severe sx)

Question 4

menopause =

• age of onset
• dx
• tx

Answer 4

= cessation of menses

• 48-52
• dec estrogen, inc FSH (primary oocytes are less sensitive to FSH –> inc)
• hormone replacement therapy (= estrogen +/- progesterone)

Question 5

contraindications to HRT

Answer 5

• hx of DVT, PE

- hx of endometrial or breast cancer (estrogen-dependent cancers)

Question 6

poscoital bleeding is _________ until proven otherwise

-tests?

Answer 6

cervical cancer

-speculum exam/ pap smear to rule it out

Question 7

types of uterine bleeding

• menorrhagia
• hypomenorrhea
• metrorrhagia
• menometrorrhagia
• oligomenorrhea
• postcoital bleeding

Answer 7

• heavy, long menses
• light menses; spotting
• intermenstrual bleeding; normal volume
• irregular time intervals, amount, and duration of bleeding
• long menstrual cycle (>35 days long)
• after intercourse

Question 8

anovulatory bleeding: explain.

Answer 8

• production of estrogen by ovary –> stimulates growth of endometrium
• no corpus luteum is formed –> no progesterone is formed –> no withdrawal bleeding from endometrium
• endometrium outgrows it’s blood supply –> bleeding

Question 9

women over 35 years should get an ________ if they have abnormal bleeding.

Answer 9

endometrial biopsy

Question 10

anovulation tx

Answer 10

• OCPs
• cyclic progesterone
• D&C (for hypertrophic uterus that bleed)
• IV estrogen (for atrophic uterus that bleed)
• endometrial ablation
• hysterectomy

Question 11

types of hysterectomy

• subtotal
• total
• radical

Answer 11

• body of uterus
• uterus + cervix
• for pelvic malignancies: uterus + cervix + top part of vagina + tissue on the side of the uterus

Question 12

OCPS dec the risk of? inc the risk of?

Answer 12

• dec risk of: breast or endometrial cancer (estrogen-dependent carcinomas)
• inc risk of: thromboembolism

Question 13

labial fusion causes

Answer 13

increased androgen

• endogenous (21-beta hydroxylase deficiency)
• exogenous

Question 14

Lichen sclerosus px, risks for, tx

Answer 14

• white, thin skin from labial to perianal region
• inc risk of cancer in postmenopausal women
• tx: topical steroids

Question 15

Lichen simplex chronicus px, tx

Answer 15

• chronic vulvar pruritis + hyperkeratosis (raised white lesion)
• tx: sitz bath, lubricants

Question 16

Lichen planus px, tx

Answer 16

• pruritis, papule, purple, polygonal

- tx: topical steroids

Question 17

Bartholin gland cyst definition, px, tx

Answer 17

=obstructed glands on 5/7 o’clock position of vulva

• px: pain, tenderness, dyspareunia, inflammation
• tx: I&D, marsupialization, excision

Question 18

normal pH of vaginal canal? how is it kept this way?

Answer 18

• pH < 4.5

- Lactobacillus keeps it there

Question 19

types of vaginitis?

Answer 19

• bacterial vaginosis (Gardnerella)
• candidiasis
• trichomonas (Trichomonas vaginalis)

Question 20

bacterial vaginosis px, dx, tx

Answer 20

• px: gray-white discharge + fishy odor
• dx: Amsel criteria; pH>4.5 + clue cells on microscopy + positive whiff test with KOH + discharge
• tx: metronidazole or clindamycin

Question 21

candidiasis px, dx, tx

Answer 21

• px: white cottage cheese discharge
• dx: pseudohyphae on microscopy with KOH
• tx: miconazole, clotrimazole, econazole, nystatin

Question 22

trichomonas px, dx, tx

Answer 22

• px: green frothy discharge
• dx: motile flagellates on microscopy
• tx: metronidazole –for pt AND partner

Question 23

Paget disease of the vulva definition, population, px, dx, tx, risk

Answer 23

• intraepithelial neoplasia
• postmenopausal women
• px: vulvar soreness + pruritis + red lesions with superficial white coating
• dx: biopsy
• tx: radical or modified vulvectomy (bilateral vs unilateral lesion)
• risk: concurrent colon or breast cancer

Question 24

squamous cell carcinoma of the vulva px, dx, tx

Answer 24

• px: pruritis + bloody vaginal discharge + ulcerated lesion/ cauliflower-like lesion
• dx: biopsy
• tx: vulvectomy +/- lymphadenectomy

Question 25

adenomyosis definition, px, risk factors, dx, tx

Answer 25

=invasion of endometrial glands into the mymetrium (muscle)

• px: dysmennorhea + menorrhagia
• risk factors: endometriosis, uterine fibroids
• dx: clinical, MRI
• tx: hysterectomy

Question 26

endometriosis definition, px, dx

Answer 26

=implantation of endometrial tissue outside the uterine cavity; ovary, pelvic peritoneum commonly

• px: cyclical pelvic pain 1-2 weeks before menses + nodular uterus/ adnexal mass + infertility (secondary to scarring)
• dysmenorrhea + dyspareunia

-dx: direct visualization during laparascopy

Question 27

endometriosis tx (mild, severe, infertile)

Answer 27

• mild: NSAIDs, OCPs
• severe: leuprolide, danazol –> dec FSH/LH
• infertile: hysterectomy +/- BSO

Question 28

polycystic ovarian syndrome px, dx, tx

Answer 28

• px: amenorrhea/ irregular menses + hirsutism + obesity + acne + DB type 2
• dx: US of bilaterally enlarged ovaries with multiple cysts; inc free testosterone; inc androgens
• LH:FSH ratio > 3:1 (FSH is inhibited by peripheral estrogen production)

-tx: weight loss, OCPs, clomiphene, metoformin, spironolactone