SAMPs Flashcards
Abnormal Uterine Bleeding (AUB)
A 37-year-old woman presents with irregular, heavy menstrual bleeding over the past six months.
a) List three potential causes of abnormal uterine bleeding in this patient.
b) Identify one initial investigation you would perform.
c) What is the first-line medical treatment for heavy menstrual bleeding?
a. PCOS, POF, fibroids, ?thyroid disease
b. ?transvaginal ultrasound
c. combined oral contraceptives or tranexamic acid
Abnormal Uterine Bleeding (AUB)
A 46-year-old woman with a BMI of 35 has been experiencing heavy and irregular bleeding for the past year.
a) Name two non-hormonal management options for her bleeding.
b) If she is not a candidate for non-hormonal therapy, what is one hormonal option you could offer?
c) Under what circumstance would you consider an endometrial biopsy?
a. weight loss, NSAIDs
b. IUD (Mirena)
c. risk factors for endometrial cancer (eg past radiation)
Contraception
A 29-year-old woman is interested in starting a contraceptive method that doesn’t require daily attention.
a) Name three long-acting reversible contraceptive (LARC) options.
b) Which one would be preferred if she has a history of heavy menstrual bleeding?
c) What is one contraindication for the copper IUD?
a. Copper IUD, Mirena (Progestin IUD), Nexplanon
b. Mirena
c. Menorrhagia, pregnancy, Wilson’s Disease
Contraception
A 36-year-old woman is a smoker and has migraines with aura. She is interested in hormonal contraception.
a) Which form of hormonal contraception is contraindicated for her?
b) Name one suitable alternative.
c) Explain why combined hormonal contraceptives are contraindicated in this patient.
a. Combined hormonal contraceptives
b. Mirena IUD
c. Increased risk of VTE
PCOS
A 25-year-old woman presents with irregular menstrual cycles, hirsutism, and acne. Her BMI is 32. You suspect PCOS.
a) List two diagnostic criteria for PCOS.
b) Name one investigation you would order to confirm this diagnosis.
c) What is the first-line treatment for menstrual irregularities in PCOS?
a. Rotterdam criteria : Polycystic ovaries on u/s, Hyperandrogenism (clinic or lab), Oligomenhorrhea
b. transvaginal ultrasound
c. COC
PCOS
A 25yo PCOS patient w/ a BMI of 32 expresses concern about future fertility.
a) Name one lifestyle modification you would recommend to improve her chances of conception.
b) What is the first-line pharmacologic agent for ovulation induction in PCOS?
c) What is one long-term health risk associated with PCOS?
a. weight loss
b. clomiphene citrate (or Letrozole/Femara)
c. Type 2 diabetes
Menopause and HRT
A 52-year-old woman with no significant past medical history presents with hot flashes and night sweats. She is interested in learning about hormone replacement therapy.
a) List two benefits of HRT for menopausal symptoms.
b) Name one potential risk of HRT.
c) What is the recommended duration for HRT use?
a. decrease vasomotor symptoms, osteoporsis prevention
b. increased risk of coronary artery disease
c. ?<5y or lowest dose for lowest time period
Menopause and HRT
A 52-year-old woman menopausal woman has a strong family history of breast cancer and decides against HRT.
a) Name two non-hormonal treatments for vasomotor symptoms of menopause.
b) What advice would you give her regarding calcium and vitamin D intake?
c) If she develops vaginal dryness, what would be a safe treatment option?
a. SSRIs (venlafaxine), gabapentin
b. Ca 1200mg/dandVit 1000u/d
c. Replens moisturizer
Cervical Cancer Screening
A 24-year-old woman asks about cervical cancer screening. She has been sexually active since age 18.
a) According to Canadian guidelines, at what age should cervical cancer screening begin?
b) How often should she undergo screening if previous tests were normal?
c) Name one factor that would necessitate more frequent screening.
a. 25
b. q 3 years
c. immunocompromised state (HIV-positive)
Cervical Cancer Screening
A 55-year-old woman with a history of a total hysterectomy for benign disease asks if she needs to continue cervical cancer screening.
a) Does she need further Pap tests? Explain.
b) What advice would you give her about other gynecologic health monitoring?
c) Under what circumstance would screening still be recommended for a post-hysterectomy patient?
a. No, if the hysterectomy was for benign disease and there’s no history of high-grade cervical dysplasia.
b. ?Continue regular pelvic exams if indicated.
c. History of cervical dysplasia or cancer
Endometriosis
A 30-year-old woman presents with chronic pelvic pain, dysmenorrhea, and deep dyspareunia. You suspect endometriosis.
a) List two other symptoms commonly associated with endometriosis.
b) Name one imaging modality that can help in evaluating endometriosis.
c) What is the first-line treatment for pain management in endometriosis?
a. infertility, Bowel/bladder pain or dysfunction
b. pelvic ultrasound vs laparoscopy
c. COC
Endometriosis
A patient with endometriosis expresses concern about her fertility.
a) What percentage of women with endometriosis may experience infertility?
b) Name one fertility treatment option for women with endometriosis.
c) How does endometriosis contribute to infertility?
a. 30-40%
b. IVF
c. Adhesions and inflammation disrupt normal pelvic anatomy and tubal function.
PID
A 21-year-old woman presents with lower abdominal pain, fever, and a foul-smelling vaginal discharge. You suspect PID.
a) List two physical exam findings you may observe.
b) Name one pathogen commonly associated with PID.
c) What is the recommended outpatient treatment regimen for PID?
a. cervical motion tenderness adnexal tenderness
b. Chlamydia trachomatis or Neisseria gonorrhoeae
c. Ceftriaxone IM plus doxycycline PO with or without metronidazole
Endometriosis
The patient asks about potential complications of PID.
a) Name one long-term reproductive complication of PID.
b) How does PID increase the risk of ectopic pregnancy?
c) What advice would you give her regarding partner notification and treatment?
a. infertilty
b. Scarring in the fallopian tubes due to inflammation
c. Sexual partners should be notified, tested, and treated to prevent reinfection.
Ovarian Cysts
A 32-year-old woman presents with right-sided pelvic pain. An ultrasound shows a 3 cm simple ovarian cyst.
a) What is the typical management for a simple ovarian cyst of this size?
b) When would you consider surgical intervention for an ovarian cyst?
c) Name one feature on ultrasound that might suggest a cyst is malignant.
a. No follow up
b. Cyst >5 cm, persistent or symptomatic cyst, or suspicious features
c. Solid components, septations, irregular borders, or increased blood flow
