OB / GYN Small group

Question 1

Classic presentation of androgen secreting tumor

What is measured for diagnosis?

Answer 1

• Classic presentation is normal periods for whole life and then SUDDENLY get “PCOS-like changes”, rather than gradual changes as does occur w/ PCOS.
• Check DHEAS level

Question 2

Why do women w/ PCOS have an increased risk of endometrial cancer? (2)

Answer 2

Due to lack of progesterone and repetitive endometrial proliferation.

Question 3

2 ways of examining fallopian tubes

Answer 3

• Gold standard is HSG (hysterosalpingogram). Catheter w/ iodinated dye + X rays.
• Can also examine fallopian tubes using US w/ contrast

Question 4

Diff Dx for primary amenorrhea (10)

Answer 4

• Constitutional growth delay, premature ovarian failure (Turner syndrome), AIS, Mullerian agenesis, deficiency in 5-alpha-reductase
• Hypogonadotropic hypogonadism (secondary hypogonadism)
• Hypergonadotropic hypogonadism (primary hypogonadism) due to ovarian dysgenesis/failure
• Eugonadotropic eugonadism due to PCOS
• Outflow obstruction
• Thyroid disease (multifactorial)

Question 5

Diff Dx for abnormal uterine bleeding

Answer 5

• PALM = structural causes, can be treated w/ surgery:
• Polyp (benign endometrial mass), adenomyosis (endometrial glands in the muscle layer; invade but not considered cancer), leiomyoma (fibroid), malignancy
• COEIN = non structural:
• Coagulopathy, ovulatory dysfunction (PCOS, thyroid disease, prolactin disorders), endometrial factors (infection, AVM), iatrogenic (hormonal drugs, coumadin), NOS (not otherwise specified: pregnancy, trauma)

Question 6

3 imaging techniques for fibroids

Answer 6

• Normal US
• Saline infused sonohistogram
• MRI – gold standard, but rare

Question 7

Enlarged endometrial stripe

Answer 7

> 4mm is a risk factor for cancer. Mainly done in post-menopausal women b/c they shouldn’t have built-up endometrium.

Question 8

Etiology of infertility in endometriosis

Answer 8

• Most commonly due to damaged cilia / inflammatory response in fallopian tubes so eggs can’t enter the uterus.
• Endometriosis also releases cytokines / growth factors that disrupt ovulation, sperm motility, fertilization, and implantation.

Question 9

Diff Dx for chronic pelvic pain (6)

Answer 9

Adenomyosis, fibroids (usually painless; only cause pain if very large causing compression or outgrowing its blood supply —> necrosis), interstitial cystitis, IBD, PID, MSK fasciitis

Question 10

What else can cause elevated CA125 besides ovarian cancer?

Answer 10

Abnormal liver

Question 11

Stereotypes for cervical / uterine / ovarian cancer pxs

Answer 11

• Cervical cancer: smoker, thin, dissheveled, don’t get routine care (missed Pap smears).
• Uterine cancers: middle aged, obese
• Ovarian cancer: nice old ladies w/ no other risk factors.