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OBGYN USMLE Step 3 > Section 5: Gynecology 1 > Flashcards

Section 5: Gynecology 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

List 5 benign breast diseases

A
  1. Fibroadenoma
  2. Fibrocystic disease
  3. Intraductal papilloma
  4. Fat necrosis (think of this with trauma to the breast)
  5. Mastitis (inflamed, painful breast in women who are breastfeeding)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13685-13704). Kaplan Publishing. Kindle Edition.

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2
Q

List 6 primary malignant breast diseases

A
  1. Ductal carcinoma in situ (DCIS)
  2. Lobular carcinoma in situ (LCIS)
  3. Invasive ductal carcinoma
  4. Invasive lobular carcinoma
  5. Inflammatory breast cancer
  6. Paget’s disease of the breast/ nipple

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13685-13704). Kaplan Publishing. Kindle Edition.

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3
Q

Nipple Discharge (ND)

  1. Most common cause of unilateral nonbloody nipple discharge
  2. When is cancer more likely with (1)
  3. Circumstances when further work up is required ND
A
  1. Intraductal papilloma
  2. When there is a palpable mass, involement of more than one duct or bloody discharge
  3. ND requiring further workup
    • Unilateral
    • Spontaneous
    • Bloody
    • Associated with mass

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13685-13704). Kaplan Publishing. Kindle Edition.

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4
Q

Nipple Discharge

List the diagnostic steps

A

Mammogram: Look for underlying masses or calcifications

Surgical duct excision: Perform this for definitive diagnosis

Cytology is not helpful in the diagnosis and is never the answer for nipple discharge

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13705-13724). Kaplan Publishing. Kindle Edition.

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5
Q

List (1) the diagnosis and (2) Rx of the following condition:

  • Female
  • 20– 50 years old
  • Cyclical, bilateral painful breast lump( s). Pain will vary with the menstrual cycle
  • Cyst with sharp margins and posterior acoustic enhancement on ultrasound
  • Collapse on fine-needle aspiration FNA
A
  1. Fibrocystic Disease
  2. Oral contraceptive pills/ medications (OCP)
    • In patients with severe pain, danazol may be used

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13705-13724). Kaplan Publishing. Kindle Edition.

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6
Q

List (1) the diagnosis, (2) diagnostic test and (3) Rx of the following condition:

  • Discrete, firm, nontender, and highly mobile breast nodule
  • FNA will show epithelial and stromal elements
A
  1. Fibroadenoma
  2. Ultrasound or Mammography if older than 40 years; FNA biopsy
  3. Surgery (diagnostic and curative)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13705-13724). Kaplan Publishing. Kindle Edition.

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7
Q

A 30-year-old woman complains of bilateral breast enlargement and tenderness, which fluctuates with her menstrual cycle. On physical examination, the breast feels lumpy, and there is a painful, discrete 1.5-cm nodule. A fine-needle aspiration is performed, and clear liquid is withdrawn. The cyst collapses with aspiration. Which of the following is the next step in management?

a. Clinical breast exam in 6 weeks
b. Core needle biopsy
c. Mammography
d. Repeat FNA in 6 weeks
e. Ultrasound in 6 weeks

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13725-13746). Kaplan Publishing. Kindle Edition.

A

A. Clinical breast exam in 6 weeks is appropriate follow-up for a cystic mass that disappears after FNA. If the mass recurs on the 6-week follow-up, FNA may be repeated, and a core biopsy can be performed

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13725-13746). Kaplan Publishing. Kindle Edition.

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8
Q

True or False:

Never diagnose a simple cyst on clinical exam alone. Diagnosis must be confirmed with either ultrasound or FNA

A

True

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9
Q

Indications for ultrasound in breast mass

A
  • First step in workup of a palpable mass that feels cystic on exam
  • Imaging test for younger women with dense breasts

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13747-13771). Kaplan Publishing. Kindle Edition.

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10
Q

Cystic Breast Mass

Indications for mammography (> 50 years) and Biopsy

OR

Biopsy alone if < 40 years

A
  • Cyst recurs > twice within 4 to 6 weeks
  • There is bloody fluid on aspiration
  • Mass does not disappear completely upon FNA
  • There is bloody nipple discharge (excisional biopsy)
  • There are skin edema and erythema suggestive of inflammatory breast carcinoma (excisional biopsy)

Mammogram should be done before biopsy. Biopsy distorts radiography

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13747-13771). Kaplan Publishing. Kindle Edition.

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11
Q

True or False:

Fine-needle aspiration or core biopsy is needed for a palpable mass

A

True. May be done after ultrasound or instead of ultrasound.

Core biopsy is superior to FNA

Cytology: – Any aspirate that is grossly bloody must be sent for cytology. Observation with repeat exam in 6– 8 weeks: – Cyst disappears on aspiration, and the fluid is clear.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13747-13771). Kaplan Publishing. Kindle Edition.

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12
Q

Breast Mass:

Indication(s) for cytology

A

Grossly bloody aspirate

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13747-13771). Kaplan Publishing. Kindle Edition.

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13
Q

Breast mass:

Indications for observationn with repeat exam in 6-8 weeks

A
  • Cyst disappears on aspiration, and the fluid is clear
  • Needle biopsy and imaging studies are negative

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13772-13792). Kaplan Publishing. Kindle Edition.

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14
Q

A 47-year-old woman completes her yearly mammogram and is told to return for evaluation. The mammogram reveals a “cluster” of microcalcifications in the left breast. What is the most appropriate next step in management?

a. Excision biopsy
b. Core needle biopsy
c. Repeat screening mammogram in 6 months
d. Repeat screening mammogram in 12 months
e. Ultrasound

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13772-13792). Kaplan Publishing. Kindle Edition.

A

B. A cluster of microcalcifications are mostly benign; however, approximately 15– 20 percent represent early cancer. The next step in workup is core needle biopsy under mammographic guidance

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13772-13792). Kaplan Publishing. Kindle Edition.

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15
Q

Both ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) increase the risk of invasive disease.

If biopsy reveals DCIS, what is the next step?

A

Surgical resection with clear margins (lumpectomy; i.e., breast conserving surgical resection) and give radiation therapy (RT) and tamoxifen for 5 years to prevent the development of invasive disease

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13772-13792). Kaplan Publishing. Kindle Edition.

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16
Q

Both ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) increase the risk of invasive disease.

If biopsy reveals LCIS, what is the next step?

A

Tamoxifen alone given for 5 years to reduce risk of development of breast cancer.

It is not necessary to perform surgery

LCIS is classically seen in premenopausal women

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13772-13792). Kaplan Publishing. Kindle Edition.

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17
Q

Tamoxifen:

  1. List risks associated with its use
  2. List contraindications
A
  1. Risks associated with tamoxifen use
    • Endometrial carcinoma
    • Thromboembolism
  2. Contraindications:
    • Patient is active smoker
    • Previous thromboembolism
    • High risk for thromboembolism

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13792-13812). Kaplan Publishing. Kindle Edition.

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18
Q

True or False:

  1. Invasive ductal carcinoma (IDC) is the most common form of breast cancer
  2. IDC is unilateral
  3. IDC metastasizes to bone, liver, and brain
  4. Invasive lobular carcinoma (ILC) accounts for 10 percent of breast carcinomas
  5. ILC tends to be multifocal (within the same breast) and is bilateral in 20 percent of cases
  6. Inflammatory breast cancer is uncommon, grows rapidly, and metastasizes early
  7. Paget’s disease of the breast/ nipple presents with a pruritic, erythematous, scaly nipple lesion. It’s often confused with dermatosis-like eczema or psoriasis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13792-13812). Kaplan Publishing. Kindle Edition.

A
  1. True. (85 percent of all cases)
  2. True
  3. True
  4. True
  5. True
  6. True. Look for a red, swollen, and warm breast and pitted, edematous skin (classic peau d’orange appearance)
  7. True. Look for an inverted nipple or discharge

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13792-13812). Kaplan Publishing. Kindle Edition.

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19
Q

List the established risk factors for breast cancer

A
  1. Age ≥ 50 years old
  2. Familial BRCA1/ BRCA2 mutation carrier
  3. Benign breast disease, especially
    • Cystic disease
    • Proliferative types of hyperplasia
    • Atypical hyperplasia
  4. Exposure to ionizing radiation
  5. First childbirth after age 30 or nulliparity
  6. Higher socioeconomic status
  7. History of breast cancer
  8. History of breast cancer in a first-degree relative
  9. Hormone therapy
  10. Obesity (BMI ≥ 30 kg per m2)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13812-13831). Kaplan Publishing. Kindle Edition.

20
Q

Indications for BRCA1 and BRCA2 gene testing

A
  • Family history of early-onset (< 50 years of age) breast cancer or ovarian cancer
  • Breast and/ or ovarian cancer in the same patient
  • Family history of male breast cancer
  • Ashkenazi Jewish heritage

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13812-13831). Kaplan Publishing. Kindle Edition.

21
Q

List the breast cancer screening guidelines per the U.S. Preventive Services Task Force (USPSTF)

A
  • Mammogram every 1– 2 years recommended for ages 50– 74
  • Screening before age 50 is no longer routinely recommended
  • Women < 50 should only consider mammographic screening based on high individual risk for early onset breast cancer
  • Teaching breast-self exam is no longer encouraged
  • Clinical breast exams are no longer routinely advised

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13832-13852). Kaplan Publishing. Kindle Edition.

22
Q

Breast cancer treatment

  1. Primary treatment of invasive carcinoma when tumor size < 5 cm
  2. True or Fasle: Sentinel node biopsy is preferred over axillary node dissection
  3. Hormonal tests to do with breast cancer management
  4. Primary treatment of inflammatory, tumor size > 5 cm, and metastatic disease
A
  1. Lumpectomy + radiotherapy ± adjuvant therapy ± chemotherapy
  2. True
  3. Always test for
    • Estrogen and progesterone receptors
    • HER2/ neu receptor protein
  4. Systemic therapy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13832-13852). Kaplan Publishing. Kindle Edition.

23
Q

A 68-year-old woman visits her primary care physician with a solid peanut-shaped hard mass in the upper outer quadrant of the left breast. A biopsy of the lesion reveals “infiltrating ductal breast cancer.” What is the next step in management?

a. Lumpectomy plus radiotherapy
b. Modified radical mastectomy
c. Modified radical mastectomy plus radiotherapy
d. Neoadjuvant chemotherapy plus lumpectomy plus radiotherapy
e. Tamoxifen and radiotherapy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13832-13852). Kaplan Publishing. Kindle Edition.

A

A. Breast-conserving surgical therapy (lumpectomy) plus radiotherapy is the standard of care for invasive disease. There is no survival benefit with modified radical mastectomy.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

24
Q

Breast cancer Rx

Contraindications to breast-conserving therapy

A
  • Pregnancy
  • Prior irradiation to the breast
  • Diffuse malignancy or ≥ 2 sites in separate quadrants
  • Positive tumor margins
  • Tumor > 5 cm

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

25
Q

Breast cancer Rx

Indication for hormonal therapy

  1. True or False: There is the greatest benefit when both ER + and PR + receptors are present
  2. True or False: Therapy is nearly as good when there are only ER + estrogen receptors
  3. True or False: Adjuvant hormonal therapy has the least benefit when only PR + receptors are present.
A

In any hormone receptor-positive (HR +) tumors, regardless of age and regardless of menopausal status, stage, or type of tumor

  1. True
  2. True
  3. True

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

26
Q

Tamoxifen competitively binds estrogen receptors

What is the five-year treatment effect on disease recurrence and mortality

True or False: May be used in pre- or post-menopausal patients

A

50 percent decrease in the recurrence, 25 percent decrease in mortality

True. May be used in pre- or postmenopausal patients. Aromatase inhibitors (anastrozole, exemestane, letrozole) block peripheral production of estrogen.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

27
Q

Aromatase inhibitors (AI) block peripheral production of estrogen.

  1. List 3 examples of AI
  2. Indication
  3. Adverse effect

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

A
  1. Examples of AIs:
    • Anastrozole
    • Exemestane
    • Letrozole
  2. HR+ postmenopausal women
  3. Osteoporosis

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13852-13868). Kaplan Publishing. Kindle Edition.

28
Q

List alternative Rx or additional Rx to Tamoxifen in premenopausal women

A
  • LHRH analogs (e.g., goserelin)
  • Ovarian ablation (surgical oophorectomy or external beam RT)

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13869-13896). Kaplan Publishing. Kindle Edition.

29
Q

List the benefits of tamoxifen

A
  • ↓ incidence of contralateral breast cancer
  • ↑ bone density in postmenopausal women
  • ↓ fractures
  • ↓ serum cholesterol
  • ↓ cardiovascular mortality risk

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13869-13896). Kaplan Publishing. Kindle Edition.

30
Q

Adverse effects of tamoxifen

A
  • Exacerbates menopausal symptoms
  • ↑ ↑ risk of endometrial cancer (1% in postmenopausal women after 5 yrs therapy)
  • ↑ ↑ risk of thromboembolism

All women with a history of tamoxifen use and vaginal bleeding need evaluation & endometrial biopsy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13869-13896). Kaplan Publishing. Kindle Edition.

31
Q

Breast Cancer Rx

Indications for chemotherapy

Indications for Trastuzumab

A

Indications for chemotherapy

  • Tumor size > 1 cm
  • Lymph node-positive disease

Indications for Trastuzumab

  • It is indicated for metastatic breast cancer overexpressing HER2/ neu.

Trastuzumab is a monoclonal antibody directed against the extracellular domain of the HER2/ neu receptor and is used to treat and control visceral metastatic sites.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13869-13896). Kaplan Publishing. Kindle Edition.

32
Q

Invasive breast cancer

List the Rx for the following specific scenarios:

  1. HR-negative, pre- or postmenopausal woman
  2. HR-positive, premenopausal woman
  3. HR-positive, postmenopausal woman
A
  1. Chemotherapy ± RT alone
  2. Chemotherapy ± RT + tamoxifen
  3. Chemotherapy ± RT + aromatase inhibitor

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13897-13919). Kaplan Publishing. Kindle Edition.

33
Q
  1. What is the first test to order for an enlarged uterus?
  2. Asymmetric and nontender uterus = ?
  3. Symmetric and tender uterus = ?
  4. True or False: Never give estrogen alone to a woman with a uterus
  5. True or False: All reproductive age women with chronic anovulation (e.g., PCOS) are at high risk of endometrial carcinoma
A
  1. Beta-hCG
  2. Leiomyoma
  3. Adenomyosis
  4. True. Always combine with progestins to prevent unopposed endometrial stimulation
  5. True. Give progestins to prevent endometrial hyperplasia and cancer.

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13995-14019). Kaplan Publishing. Kindle Edition.

34
Q

A 65-year-old obese patient complains of vaginal bleeding for 3 months. Her last menstrual period was at age 52. She has no children. She has type 2 diabetes and chronic hypertension. Physical examination is normal with a normal-sized uterus and with no vulvar, vaginal, or cervical lesions. What is the next step in management?

a. Begin progestin therapy
b. Begin estrogen and progestin therapy
c. Perform an endometrial biopsy
d. Perform a Pap smear and endocervical sampling
e. Prescribe topical estrogen cream

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13995-14019). Kaplan Publishing. Kindle Edition.

A

C. The most common cause of postmenopausal bleeding is vaginal or endometrial atrophy, but the most important diagnosis to rule out is endometrial carcinoma (the most common gynecologic malignancy).

All postmenopausal bleeding is suspected endometrial carcinoma until proven otherwise

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13995-14019). Kaplan Publishing. Kindle Edition.

35
Q
  1. First step in management of any patient with postmenopausal bleeding
  2. The most important risk factors for endometrial carcinoma are unopposed estrogen states. List them.
  3. True or False: All postmenopausal bleeding is suspected endometrial carcinoma until proven otherwise

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13995-14019). Kaplan Publishing. Kindle Edition.

A
  1. Endometrial biopsy
  2. Important risk factors for endometrial carcinoma:
    • Obesity
    • Nulliparity
    • Late menopause/ early menarche
    • Chronic anovulation
  3. True

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 13995-14019). Kaplan Publishing. Kindle Edition.

36
Q

A 31-year-old woman is taken to the emergency department complaining of severe, sudden lower abdominal pain that started 3 hours ago. On examination, the abdomen is tender, no rebound tenderness is present, and there is an adnexal mass in the cul-de-sac area. An ultrasound evaluation shows an 8-cm left adnexal mass. Beta-hCG is negative. What is the next step in management?

a. Appendectomy
b. Give high-dose estrogen and progestin
c. Laparoscopic evaluation of ovaries
d. Observation
e. Perform oophorectomy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14071-14090). Kaplan Publishing. Kindle Edition.

A

C. Sudden onset of severe lower abdominal pain in the presence of an adnexal mass is presumed to be ovarian torsion. Laparoscopy and detorsioning of the ovaries is needed. If blood supply is not affected, cystectomy can be done. If there is necrosis, oophorectomy is needed. She should then receive a 4-week follow-up and yearly evaluation to ensure there is complete resolution

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14090-14122). Kaplan Publishing. Kindle Edition

37
Q

Prepubertal or Postmenopausal Ovarian Mass

Any ovarian enlargement in prepubertal or postmenopausal women is always suspicious for an ovarian neoplasm

List the risk factors for ovarian mass

A
  • BRCA1 gene
  • Positive family history
  • High # of lifetime ovulations
  • Infertility
  • Use of perineal talc powder

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14090-14122). Kaplan Publishing. Kindle Edition.

38
Q

Prepubertal or Postmenopausal Ovarian Mass

Any ovarian enlargement in prepubertal or postmenopausal women is always suspicious for an ovarian neoplasm

List the factors protective against ovarian mass

A

Conditions that decrease # of ovulations

  • Oral contraceptive pills (OCPs)
  • Chronic anovulation
  • Breastfeeding
  • Short reproductive

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14090-14122). Kaplan Publishing. Kindle Edition.

39
Q

Prepubertal or Postmenopausal Ovarian Mass

Any ovarian enlargement in prepubertal or postmenopausal women is always suspicious for an ovarian neoplasm

List the initial workup of an ovarian mass

A
  • ß-hCG
  • Ultrasound
  • Laparoscopy/ laparotomy if complex or > 7 cm

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14090-14122). Kaplan Publishing. Kindle Edition.

40
Q

A 68-year-old woman presents with weakness and bloated feeling in her abdomen. She is found to have abdominal distention, shifting dullness, and a large right adnexal mass. Pelvic ultrasound reveals a 7-cm irregular and solid mass in the right ovary. Which of the following is the next step in the management?

a. Abdominal paracentesis
b. CT of the abdomen
c. Endometrial biopsy
d. Laparoscopy
e. Laparotomy

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14090-14122). Kaplan Publishing. Kindle Edition.

A

B. In a postmenopausal woman with abdominal distension, an ovarian mass, the first step is CT of the abdomen to evaluate the mass and confirm the presence of ascites (indicating peritoneal seeding). If ascites is present, the next step is laparotomy, oophorectomy, and surgical staging. Oophorectomy may be done by laparoscopy if no ascites is present

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14122-14145). Kaplan Publishing. Kindle Edition.

41
Q

State the diagnosis and list the tumor markers based on the following scenarios:

  1. A 9-year-old girl presents with right adnexal pain and complex cystic mass on ultrasound
  2. A 67-year-old woman presents with progressive weight loss, distended abdomen, and left adnexal mass
  3. A 58-year-old woman presents with postmenopausal bleeding. Endometrial biopsy shows endometrial hyperplasia. Pelvic ultrasound reveals a right ovarian mass
  4. A 48-year-old woman complains of increased facial hair and deepening of her voice. An adnexal mass is found on examination
  5. A 64-year-old woman with history of gastric ulcer and recent worsening dyspepsia presents with weight loss and abdominal pain. An adnexal mass is found

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14146-14169). Kaplan Publishing. Kindle Edition.

A
  1. Germ cell tumor: These are most common in young women and present in early-stage disease. The most common malignant epithelial cell type is dysgerminoma. Tumor markers: LDH, ß-hCG, a-FP
  2. Epithelial tumor: This is the most common ovarian cancer in postmenopausal women. The most common malignant subtype is serous. Tumor markers: CA-125, CEA
  3. Granulosa-theca (stromal tumor): This ovarian tumor secretes estrogen and can cause endometrial hyperplasia. Tumor markers: Estrogen
  4. Sertoli-Leydig cell (stromal tumor): This ovarian tumor secretes testosterone. Patients present with masculinization syndromes. Tumor markers: Testosterone
  5. Metastatic gastric cancer to the ovary (Krukenberg tumor) Tumor markers: CEA

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14146-14169). Kaplan Publishing. Kindle Edition.

42
Q

Outline the management of ovarian mass

A
  • Sonogram (and CT scan for postmenopausal women)
  • Biopsy via laparoscopy for simple cysts suggestive of malignancy (no septations or solid components) or postmenopausal without ascites
  • Tumor markers
  • Cystectomy for benign tissue
  • Premenstrual women: Salpingo-oophorectomy
  • Postmenopausal women: Total abdominal hysterectomy (TAH); bilateral salpingo-oopherectomy (BSO) and postoperative chemotherapy for malignant tissue

Fischer, Conrad (2012-09-22). Master the Boards: USMLE Step 3 (Kaplan Medical Usmle Master the Boards Step 3) (Kindle Locations 14169-14190). Kaplan Publishing. Kindle Edition.

43
Q

Compare leiomyoma and adenomyosis based on their symptoms, pelvic exam, sonogram, hysteroscipy and histology

A

Comparison

44
Q

Compare the management of leiomyoma and adenomyosis based on observation/medical Rx, Presurgical shrinkage, myomectomy, embolization of vessels, and hysterectomy

A

Comparison

45
Q

Outline the maganement of postmenopausal bleeding based on pelvic exam, hysteroscopy, and ultrasonography

A

Mgnt

46
Q

Outline

A

Here

OBGYN USMLE Step 3 (7 decks)

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