UWorld GYN

Question 0

Squamous cell carcinoma removal guidelines?

Answer 0

Removed surgically if: stage 1/2 and less than 2 cm in size

Irradiate if stage 1/2 and more than 2 cm in size

Question 1

Consider these if FSH and LH levels are:

1. Both under 5
2. FSH >40 and LH >25

Answer 1

1. pituitary dysfunction

2. Premature ovarian failure

Question 2

Vaginismus? Tx?

Answer 2

Involuntary psychological contraction of the perennial musculature

Kegel exercisers, dilators

Question 3

Medical therapy for endometriosis?

Answer 3

OCP, GnRH analogues, danazol

Question 4

Cervical mucus in different phases of menstruation?

Answer 4

follicular – thick, scant, acidic (no penetration of sperm)

Ovulatory phase – stretches to 6 cm, pH >6.5 (most basic), ferning when smeared on microscope

Lute phase – mucus becomes thicker and less stretchy, inhospitable to sperm

Question 5

Postmenopausal patient with ovarian mass – treatment?

Answer 5

Ultrasound for size of mass and Measure CA-125

If size less than 10 cm and CA-125 low, followed conservatively

Otherwise chemo or surgery

Question 8

Skin colored lesions on vulva – Diagnosis? Treatment of small lesions? Large lesions?

Answer 8

Genital warts (condyloma acuminata)

small lesions – acetic acid, podophyllin

Larger lesions – excision or fulguration (electric current)

Question 13

Adenomyosis? Age? Presents with? Physically exam findings? Management?

Answer 13

Invasion of endometrial glands into uterine muscle

Woman about 40; presents with dysmenorrhea and menorrhagia
PE – enlarged but symmetric uterus

Endometrial curettage to rule out endometrial carcinoma

Question 14

Discharge consistent with ovulation?

Answer 14

“Egg white like” thickening

Question 15

Interstitial cystitis?

Answer 15

Chronic condition of the bladder characterized by

Pelvic pain worsened my bladder filling, sexual intercourse, and relieved by avoiding

Question 16

Patient secondary amenorrhea – work up?

Answer 16

Beta HCG, if negative

1. Elevated Prolactin – normal TSH, creatinine, get MRI
2. Elevated FSH – ovarian failure
3. Elevated testosterone – PCOS
4. Elevated TSH – hypothyroidism
5. History of uterine procedures – estrogen/progestin stimulation test – if no withdrawal bleeding, rule out Ashermann ‘s

Question 17

Ovarian hyperstimulation syndrome – Cause? Symptoms? Associated symptoms?

Answer 17

Population-inducing drugs; abdominal pain due to ovarian enlargement

Ascites, respiratory difficulty, other systemic findings

Question 18

Secondary amenorrhea – diagnosis?

Answer 18

1. Beta hCG
2. TSH and prolactin
   A. If prolactin and TSH are elevated, treat for hypothyroidism
   B. If prolactin elevated TSH normal, r/o pituitary lesion
3. progesterone challenge test to assess estrogen production

Question 19

Management of primary dysmenorrhea?

Answer 19

1. Antiprostaglandin agents and NSAIDs
2. OCP
3. Cervical dilation

Question 20

Differential for abnormal uterine bleeding?

Answer 20

1. Vaginal
2. Cervical
3. Uterine – Fibroids, adenomyosis, cancer

Question 21

Treatment for dysfunctional uterine bleeding?

Answer 21

1. OCP or conjugated estrogens

2. If blood loss and abnormal vitals signs, IV conjugated estrogens

Question 22

Postmenopausal bleeding – differential?

Answer 22

Non-gynecologic – hemorrhoids, anal issues, rectal prolapse, G.I. tumors

Gynecologic – vaginal (atrophy, lesions), cervical (cancer), endometrial (hyperplasia, polyps, cancer)

Question 23

Postmenopausal bleeding – diagnosis?

Answer 23

One. Pap smear,

2. Digital rectal and a cold blood screening
3. Endometrial biopsy
4. Pelvic ultrasound for polyps and endometrial stripe
5. Hysteroscopy
6. D & C

Question 24

Hirsutism – differential?

Answer 24

1. Andrenal – Cushing’s, congenital adrenal hyperplasia
2. Non-neoplastic Ovarian – PCOS, theca lutein cyst, stroma hyperthecosis
3. Neoplastic – adrenal tumor, Stertoli-Leidig cell tumor, granulosa-cell tumor, luteoma pregnancy

Question 25

Treatment of hirsutism?

Answer 25

1. If adrenal - finisteride (inhibit 5am-reductase), Spironolactone
2. If ovarian – OCP, progesterone (decreases LH), GnRH agonist