OB/GY

Question 1

Clear cell carcinoma of the vagina - large cells with abundant clear cytoplasm RISK FACTOR?

Answer 1

DES - diethylstilbestrol - synthetic estrogen used in the 40s to prevent miscarriage > discontinued in 1970 because of transplacental carcinogen potency for vaginal cancer (daughters of these women) and breast cancer (mothers).

Question 2

LEEP - loop electrosurgical excision procedure

Answer 2

Remove high-grade intraept lesions of the cervix

Question 3

Fibroadenoma - solid mass with well-defined borders and low clinical suspicion for malignancy - MANAGEMENT

Answer 3

Reassurance and follow-up examination in 6 months

Question 4

Risk factors for ENDOMETRIAL CANCER

Answer 4

Nulliparity, obesity, diabetes mellitus, late menopause, tamoxifen use…

Question 5

Phyllodes tumor - pathology

Answer 5

Leaf-like architecture of papillary projections of epthelium-lined stroma;
Lobular appearance on mammography (can be similar to fibroadenoma)

Question 6

Phyllodes tumor - clinical presentation

Answer 6

Painless breast lump: Lesion >3cm, rapidly enlarging with NO AXILLARY LYMPHADENOPATHY associated. 25% is malignant - surgery with wide margins is required

Question 7

Invasive ductal carcinoma - malignant cells in the ducts with micro calcification and stromal invasion - CLINICAL PRESENTATION

Answer 7

Most common form of breast cancer; painless breast mass, often associated with skin changes ( retraction, dimpling, edema), nipple retraction, bloody nipple discharge, and/or lymphadenopathy.

Question 8

Invasive lobular adenocarcinoma - malignant cells in lobules and monomorphic cells in single rows

Answer 8

10-15% of breast cancers; painless nodule, skin changes, nipple retraction, bloody nipple discharge, lymphadenopathy

Question 9

Intraductal papilloma - central, branching fibrovascular core with surrounding myoepithelial and epithelial cells.

Answer 9

Multiple/single, sometimes palpable lesions with serous or bloody nipple discharge (60-80%)

Question 10

Paget disease of breast

Answer 10

Erythematous and scaly rash affecting the nipple and areola, accompanied by pruritus, burning, nipple retraction, blood-tinged nipple discharge (Ductal Carcinoma)

Question 11

Fibrocystic breast disease - focal lesions of thick parenchyma or cysts

Answer 11

Most common benign condition of the breast - palpable breast mass; mastalgia, cyclic pain with menses and clear/white nipple discharge

Question 12

Cardiotocogram

Answer 12

Fetal heart rate range: 6-25bpm
Decelerations: diration <60s, abrupt <30s from onset to nadir, vary in shape, temporal relationship with uterine contractions, occur with <50% of uterine contractions over a 20-minute time period =intermittent variable decelartions

Question 13

Fat necrosis of the breast - oil cysts; foam cells and multinucleated giant cells

Answer 13

Benign; trauma related; exam and radio mimics malignancy - DOES NOT increase the risk of breast cancer > reassurance and follow-up

Question 14

Solitary malignant tumor treatment

Answer 14

Lumpectomy with axillary staging
Radiation

Question 15

Anastrozole

Answer 15

Postmenopausal women with HR + breast cancer

Question 16

Tamoxifen

Answer 16

Premenopausal HR+ breast ca

Question 17

Trastuzumab

Answer 17

HER2+ breast cancer

Question 18

Endometriosis definitive diagnosis

Answer 18

LAPAROSCOPY - Presumptive clinical diagnosis but inconclusive imaging findings, no response to medical therapy or to exclude malignancy
Presence of small bluish endometric lesions - POWDER-BURN

Question 19

Letrozole - aromatase inhibitor

Answer 19

First-line pharmacotherapy for ovulation induction in PCOS
Better than clomiphene

Question 20

Bromocriptine - dopamine agonist

Answer 20

Anovulatory infertility in hyperprolactinemia

Question 21

Topical clobetasol

Answer 21

Lichen sclerosus treatment

Question 22

Lichen sclerosus increases the risk of what type of cancer?

Answer 22

Vulvar squamous cell carcinoma

Question 23

Dyspareunia and pruritus in a postmenopausal woman with a white vulvar plaque on pelvic examination

Answer 23

Lichen sclerosus

Question 24

Topical estrogen

Answer 24

Atrophic vaginitis treatment

Question 25

UVA1 phototherapy
Topical tacrolimus

Answer 25

Improves lichen sclerosus symptoms, less effective than other therapies

Question 26

Pregnant women with syphilis allergic to penicillin

Answer 26

Desentization

Question 27

Syphilis treatment (non pregnant)

Answer 27

Doxy, ceftriaxone, azithromycin

Question 28

Adenocarcinoma (breast) - intraepithelial

Answer 28

Paget disease of breast - ductal carcinoma (niple-areola complex)
Erythematous, scaly, vesicular rash w/ pruritus, burning, and nipple retraction > ulcerates > blood-tinged nipple discharge

Question 29

Unilateral solid benign tumor + pregnancy + virilization

Answer 29

Sertoli-Leydig cell tumor

Question 30

Benign tumor uni/bilateral >4cm + pregnancy (bHCG) + with or without virilization + with or without mass-related features (risk of ovarian torsion)

Answer 30

Luteoma (androgen-prod lutein cells)

Question 31

Fitz-Hugh-Curtis syndrome

Answer 31

A syndrome characterized by inflammation of the liver capsule that occurs in women as a complication of pelvic inflammatory disease. Clinical features include fever, nausea, vomiting, right upper quadrant pain, and/or pleuritic chest pain.

Question 32

USPSTF HPV recommendations

Answer 32

21-29yrs: solitary Pap smear every 3 years
30–65 years: HPV/Pap smear cotesting every 5 years

Question 33

USPSTF mammography recommendations

Answer 33

50–74 years: mammography every 2 years between
>40 years: several risk factors

Question 34

Pelvic pressure and/or pain, which worsens on standing or walking, in the presence of posterior vaginal wall protrusion and lax sphincter tone on pelvic examination, increased vaginal discharge

Answer 34

Enterocele (upper 1/3rd of the posterior vaginal wall) or Rectocele (middle 1/3rd of the posterior vaginal wall)

Question 35

Enterocele risk factors

Answer 35

multiparity, postmenopausal status, and prior pelvic surgery.

Question 36

Patients with endometrial cancer who do not wish to preserve fertility or have reached menopause - MANAGEMENT

Answer 36

Total hysterectomy and bilateral salpingo-oophorectomy (TAH/BSO)

Question 37

High-dose progestins

Answer 37

Young patients with early-stage endometrial cancer confined to the uterus who desire future pregnancies.

Question 38

Solitary intraductal papillomas

Answer 38

Unilateral bloody nipple discharge, absence of associated breast skin changes or axillary lymphadenopathy and the ultrasound finding of a dilated duct enclosing a well-defined solitary mass

Question 39

Breast US - well-defined solitary mass within a dilated mammary duct

Answer 39

Main differential diagnoses are intraductal papilloma, ductal carcinoma (especially papillary carcinoma), and inspissated secretions (do not vasc.

Question 40

Papillary carcinoma of the breast - bloody discharge from the nipple and an intraductal mass on ultrasound.

Answer 40

Usually occurs in postmenopausal women, with a peak incidence in the seventh decade.

Question 41

Chancroid -Haemophilus ducreyi (painful inguinal lymphadenopathy) LESIONS

Answer 41

women - multiple purulent lesions that are 1–2 cm in size, clearly demarcated with a greyish necrotic base, and typically very painful.
men - single lesion is common.

Question 42

Granuloma inguinale - donovan bodies - Klebsiella granulomatis- painless - LESIONS

Answer 42

Nodules that eventually ulcerate to form large, beefy-red lesions that bleed easily; regional lymph nodes are typically spared

Question 43

Chancre

Answer 43

Solitary (or multiple) painless ulcer with indurated borders; bilateral nontender regional lymphadenopathy

Question 44

Lymphogranuloma venereum (LGV)

Answer 44

Transient papule that is painless and heals rapidly without scarring. Painful suppurative lymphadenopathy is seen 2–6 weeks after the papule heals, with systemic symptoms like fever, malaise, and chills.

Question 45

Genito-pelvic pain/penetration disorder

Answer 45

Difficulty with vaginal penetration, vulvovaginal or pelvic pain during intercourse, anticipatory anxiety, and pronounced tightening of the pelvic floor muscles

Question 46

Vulvodynia

Answer 46

Soreness and burning of the vulva that may be present continuously or triggered by touch or pressure (e.g., sexual intercourse, tampon use).

Question 47

Endometrial biopsy indications

Answer 47

Postmenopausal patients with any uterine bleeding; those ≥ 45 years of age with frequent, heavy, or prolonged bleeding; and those < 45 years of age with persistent bleeding (≥ 6 months) and risk factors for endometrial cancer

Question 48

Hysteroscopy with uterine dilation and curettage

Answer 48

Used to manage acute heavy AUB in patients who do not respond to medical treatment within 12–24 hours.

Question 49

Hysteroscopic polypectomy

Answer 49

symptomatic endometrial polyps, asymptomatic polyps > 1.5 cm in diameter in premenopausal women; infertility, multiple polyps, polyps that have prolapsed through the cervix, polyps in postmenopausal women, and polyps in women with risk factors for endometrial hyperplasia or carcinoma

Question 50

Premenopausal women with asymptomatic endometrial polyps and without risk factors for endometrial hyperplasia

Answer 50

Follow-up with transvaginal ultrasonography in 6 months

Question 51

(SSRIs)

Answer 51

first-line therapy for PMDD