Miscellaneous

Question 1

Premenstrual disorder

Answer 1

Dx of exclusion
Symptoms present for 1 year and on 2 months of prospective year with symptom recording
Cyclic symptoms that are limited to premenstrual phase and first few days of menses

Question 2

Premenstrual syndrome

Answer 2

Cyclically occurring physical or mood symptoms (or both)
- irritability, bloating, mood swings, lethargy, breast tenderness, anxiety, tension, feelings of rejection
- Occur in luteal phase
- resolve during or shortly after menses

Question 3

Premenstrual dysphoric disorder

Answer 3

Type of depressive disorder
Characterized by cyclic recurrence of changes in affect (severe)
- mood lability, irritability, dysphoria, anxiety
Symptoms in luteal phase and subside with menses

Associated with lower quality of life, interpersonal difficulties, relationship stress, increased visits to healthcare personnel

Question 4

What is the tx of PMDD

Answer 4

Exercise
Calcium (1000-1200)
Acupuncture
SSRI
Cognitive behavioral therapy
OCPs
NSAIDs
GnRH agonists + add back
BSO with or without hysterectomy
Referral to psych

Question 5

What are the consequences of DES use

Answer 5

Clear cell adenocarcinoma of vagina or cervix
Ectropion
Uterine anomalies
Vaginal adenosis (metaplastic cervical or endometrial tissue in the vagina)
Increased risk of 1st trimester loss

Question 6

Melanoma

Answer 6

2-10% of vulvar cancers
Associated with BRCA 2

Question 7

What are characteristics of melanoma

Answer 7

ABCDs

Asymmetry
Borders are irregular, bleeding
Color is uneven,
Diameter >6mm

Question 8

What is the differential diagnosis of diarrhea

Answer 8

Bacterial
- Campylobacter, shigella, salmonella
- E.coli
- Vibrio, listeria
- Staph aureus, bacillus cereus
- Clostridium perfringens

Viral– most cases
- Rotavirus, norovirus, enteric adenovirus

Parasitic
- Giardia, microsporidiosis

Iatrogenic
- Medications, radiation

Inflammatory bone disease
- UC, Crohn’s

Ischemic
- Bowel ischemia

Other
- IBS

Question 9

How do you evaluate diarrhea

Answer 9

History– travel, exposures, other sick people
Vital signs
Physical– abdominal exam, rectal exam
Labs– CBC, CMP
Stool studies if longer than 3-7 days
C. diff testing
Imaging (X-ray or acute abdominal series)

Question 10

How do you treat diarrhea?

Answer 10

Supportive care– fluid replacement and electrolytes with iso-osmotic oral solutions

Antimotility agents
- Loperamide (Imodium)

Acute, non-bloody diarrhea that are not associated with travel do not need antibiotics

Travelers diarrhea–> quinolone, Zithromax, rifaxamin