Gynae

Front 1

Dd of adnexal masses?

Back 1

Premenarchal=> ovarian cancer (germ cell)

Reproductive => physiologic , simple or complex cysts

Post menopausal => ovarian epithelial cancer

Front 2

Simple vs ovarian cysts?

Dx?

Back 2

Simple=> single fluid filled homogenous , resolves in 2-3 mon , size<10 cm

Complex=> loculated, lobulated, multiple spaces , no resolution, _> 10 cm size

2- TV US

Front 3

DD of complex cyst?

Back 3

TEET CT

Teratoma

Ectopic preg

Endometrioma

Tubo-ovarian abscess

Cancer

Torsion

Front 4

Simple cyst work up?

Back 4

<3cm=> no evaluation needed

3-10 cm => should be reimaged within 12 weeks

Front 5

Treatment of choice of teratoma/ dermoid cyst?

Back 5

Cystectomy without oophorectomy

Front 6

Labs in ectopic pregnancy?

Back 6

HCG => >2000

Abd US => no intra uterine mass

Front 7

Treatment of choice of teratoma/ dermoid cyst?

Back 7

Cystectomy without oophorectomy

Front 8

Labs in ectopic pregnancy?

Back 8

HCG => >2000

Abd US => no intra uterine mass

Front 9

Rx of ectopic pregnancy?

Back 9

MTX only if => <3cm+ hcg<5000 + no fetal heart sounds + mom not on folate

No rupture => salpingostomy

If rupture => salpingectomy

Front 10

Dx of endometriosis & endometrioma?

Back 10

1- suspected endometriosis => trial of OCP => gets better

2- endometrioma=> TV US, laparoscopy with laser ablation

Front 11

Tubo ovarian abscess CDC criteria?

Back 11

1- abd/pelvic pain +

2- 1 of 3:

CMT, Adnexal tenderness, uterine tenderness

Front 12

HPV serotypes associated with cervical cancer?

Back 12

16

18

30s

45

Front 13

Staging of cervical cancer?

Back 13

1- only ca that is clinically staged rather than surgically

2- 1a=> microscopic,

1b=> macroscopic,

2a=> Upper 2/3 vagina,

2b=> parametrial,

3a=> lower 1/3 vagina,

3b=> sidewall,

4a=> mets to bowel/bladder, 4b=> distant mets

Front 14

R/f for endometrial cancer in decreasing order of risk?

Back 14

AOTA NEL

1- anovulation

2- obesity

3- tamoxifen

4- age

5- nulliparity

6- early menarche & late menopause

Front 15

W/U of endometrial cancer?

NBSIM if precancer hyperplasia?

NBSIM if adeno ca?

NBSIM if mets?

Back 15

1- endometrial sampling, D&C , US if endometrial thickness <5mm

2- progesterone

3- TAH + BSO

4- TAH+ BSO+ chemo with carboplatin & paclitaxel

Front 16

Dx of stress incontinence?

Rx?

Back 16

A- clinical + Q tip test (rotation of urethra by more than 30’)

B-

1st line=> kegel exercises

2nd line=>

a- Poor surg Candidate =>Pessaries

b- surgery (Burch, MMK, anterior vaginal wall repair)

Front 17

Bladder urine volume at which urge to void starts?

& at which it begins to hurt?

Back 17

1- 250cc

2- >500 cc

Front 18

Motor urge incontinence AKA?

Dx?

Rx?

Back 18

1-hypertonic bladder

2- cystometry=> ill show contractions at all volumes

3- anti-spasmodics=> solifenacin

anti-muscarinics=> oxybutynin, propantheline

Front 19

Rx of overflow aka hypotonic bladder?

Back 19

1-Bethanechol with timed voids

2- regular & scheduled catherization

3- suprapubic catheters

Front 20

Rx of overflow aka hypotonic bladder?

Back 20

1-Bethanechol with timed voids

2- regular & scheduled catherization

3- suprapubic catheters

Front 21

Window of conception?

Back 21

5 days before ovulation through the day of ovulation. Daily sex recommended

Front 22

Sequence of w/u of infertility in men?

Back 22

ED=> semen analysis

Front 23

Sequence of w/u of infertility in men?

Back 23

ED=> semen analysis

Front 24

Sequence of w/u of infertility in women?

Back 24

MO AE

Hostile mucous=> ovulation => anatomy => endometriosis

Front 25

Sequence of w/u of infertility in men?

Back 25

ED=> semen analysis

Front 26

Sequence of w/u of infertility in women?

Back 26

Hostile mucous=> ovulation => anatomy => endometriosis

Front 27

Dx of hostile mucous?

Rx?

Back 27

1- smush test (<6 cm) => hostile mucous the => look at secretions (No fern sign or sperm seen)

2- estrogen, artificial insemination

Front 28

Dx of anovulation associated infertility?

Rx?

Back 28

A-

1- basal temp rise,

2-endometrial bx on day 14-28=> sub nuclear vacoulization, 3-progesterone level at day 22,

4-h/o irregular mensis= h/o anovulation

B-

clomiphene , pergonal

Front 29

Dx of anovulation associated infertility?

Rx?

Back 29

1- basal temp rise, endometrial bx on day 14-28=> sub nuclear vacoulization, progesterone level at day 22, h/o irregular mensis= h/o anovulation

2- clomiphene , pergonal

Front 30

Dx & Rx of endometriosis?

Back 30

1- Exploratory laparoscopy & bx

2- med=> OCP + NSAIDS

Surg resection

Front 31

Def of menopause?

Back 31

Cessation of bleeding for 12 consecutive cycles

Front 32

Def of menopause?

Back 32

Cessation of bleeding for 12 consecutive cycles

Front 33

Vaginal atrophy Rx?

Hot flashes Rx?

Back 33

1- moisturizer (1st line) , estrogen cream (2nd line)

2- venlafaxine

Front 34

Def of menopause?

Back 34

Cessation of bleeding for 12 consecutive cycles

Front 35

Vaginal atrophy Rx?

Hot flashes Rx?

Back 35

1- estrogen cream

2- venlafaxine

Front 36

Osteoporosis PPX?

Screening?

Rx?

Back 36

1- vit D3 + calcium

2- dexa scan at 65 years (60 if smoker)

3- bisphosphonates

Front 37

Rx of vit D def?

Back 37

Vit D2 50000 units weekly

Front 38

Hormone profile in ovarian failure?

Back 38

Dec Estrogen

Inc FSH

Inc FSH/LH (LH doesn’t rise)

Front 39

Mc genotype of complete mole?

Pathophys?

Back 39

46 XX

Anucleate egg + sperm=> paternal chromosome duplicates

Front 40

Hints that preg is a molar pregnancy?

Back 40

1- super high b-HCG

2- uterus size-date discrepancy => uterus is growing too fast

3- hyperthyroidism

4- hyperemesis gravidarum (b-HCG can be >100,000)

Front 41

Staging of choriocarcinoma?

Rx?

Back 41

1=> uterus (fertility sparing=> MTX then Actinomycin D, fertility complete=> TAH)

2=> genitals(MTX, Actinomycin D, etoposide, carboplatin)

3=> mets to lungs only(SAA)

4=> mets to anywhere else

Front 42

Germ cell ca names & associated markers?

Back 42

DECT

Dysgerminoma=> LDH

Endodermal sinus=> AFP

Choriocarcinoma => b-hcg

Teratoma => struma ovarii

Front 43

Staging of choriocarcinoma?

Rx?

Back 43

1=> uterus (fertility sparing=> MTX then Actinomycin D, fertility complete=> TAH)

2=> genitals(MTX, Actinomycin D, etoposide, carboplatin)

3=> mets to lungs only(SAA)

4=> mets to anywhere else

Front 44

Germ cell ca names & associated markers?

Back 44

DECT

Dysgerminoma=> LDH

Endodermal sinus=> AFP

Choriocarcinoma => b-hcg

Teratoma => struma ovarii

Front 45

Px of germ cell cancers?

Rx?

Back 45

1- px in stage 1, in premenopausal

2- unilateral oophorectomy + chemo

Front 46

Staging of choriocarcinoma?

Rx?

Back 46

1=> uterus (fertility sparing=> MTX then Actinomycin D, fertility complete=> TAH)

2=> genitals(MTX, Actinomycin D, etoposide, carboplatin)

3=> mets to lungs only(SAA)

4=> mets to anywhere else

Front 47

Germ cell ca names & associated markers?

Back 47

DECT

Dysgerminoma=> LDH

Endodermal sinus=> AFP

Choriocarcinoma => b-hcg

Teratoma => struma ovarii

Front 48

Px of germ cell cancers?

Rx?

Back 48

1- px in stage 1, in premenopausal

2- unilateral oophorectomy + chemo

Front 49

Stomal tumors & associative hormones?

Back 49

Sertoli-Leydig=> testosterone

Granulosa-Theca => estrogen

Front 50

Staging of choriocarcinoma?

Rx?

Back 50

1=> uterus (fertility sparing=> MTX then Actinomycin D, fertility complete=> TAH)

2=> genitals(MTX, Actinomycin D, etoposide, carboplatin)

3=> mets to lungs only(SAA)

4=> mets to anywhere else

Front 51

Germ cell ca names & associated markers?

Back 51

DECT

Dysgerminoma=> LDH

Endodermal sinus=> AFP

Choriocarcinoma => b-hcg

Teratoma => struma ovarii

Front 52

Px of germ cell cancers?

Rx?

Back 52

1- px in stage 1, in premenopausal

2- unilateral oophorectomy + chemo

Front 53

Stomal tumors & associative hormones?

Back 53

Sertoli-Leydig=> testosterone

Granulosa-Theca => estrogen

Front 54

Epithelial ovarian cancers px?

Rx?

Back 54

1- px in stage 3, in post-menopausal

2- TAH + BSO => platinum based drug(paclitaxel, carboplatin)

Front 55

Management steps in women at inc risk of BRCA 1 ?

Back 55

Annual Ca-125 & TVUS=> prophylactic BSO at 35 after done having kids

Front 56

Age by which females should have secondary sex characteristics?

Menarche?

Back 56

Secondary sex characteristics => 13 years

Menarche=> 15 years

Front 57

Dd of breast + , uterus + infertility?

Back 57

Imperforate hymen

Anorexia/wt loss

Pregnancy b4 period

Front 58

Central cause of precocious puberty on LH stimulation test. NBSIM?

Back 58

MRI

If ca=> resection

If constitutional=> continuous leuprolide for 2-4 years

Front 59

Peripheral cause of precocious puberty recognised on GnRH stimulation test. NBSIM?

Back 59

1- US abd

2- US adrenal

3- testosterone

4- DHEAS (adrenal)

5- 17-OH-progesterone(CAH)

Front 60

Dd of breast + , uterus - infertility?

Back 60

Mullerian agenesis

Testicular feminisation/ androgen insensitivity

Front 61

Dd of breast - , uterus + infertility?

Back 61

Craniopharyngioma

Kallman

Turners

Front 62

Dd of breast -, uterus - infertility?

Back 62

Enzymatic deficiency

Front 63

Difference between androgen insensitivity & mullerian agenesis?

Back 63

AI => karyo= XY , testosterone is inc

MA=> karyo=XX, testosterone is normal

Front 64

Sequence of female sexual development?

Back 64

BAG M

Breast =8 years

Axillary hair =9 years

Growth spurt =10years

Menarche =11years

Front 65

Precocious & delayed puberty?

Back 65

Precocious => breast or axillary hair development <8

Delayed=> no secondary sex characteristics by age 13 OR no menarche by age 15

Front 66

W/u of precocious puberty?

Back 66

Wrist X ray=> GnRH stimulation test

Front 67

Wrist X ray considered positive when?

Back 67

Bone age 2 years greater than her chronological age

Front 68

GnRH stimulation test interpretation in w/u of precocious puberty?

Back 68

If increases LH=> its central

If no change in LH=> peripheral

Front 69

Secondary amenorrhea mc causes?

Associated tests?

Back 69

1- pregnancy => UPT

2- thyroid => TSH

3- prolactin => prolactin

Front 70

Sequence of w/u if all mc causes of secondary amenorrhea are negative?

Back 70

Progestin challenge => estrogen & progesterone => FSH,LH

Front 71

Findings associated with menopause?

Back 71

1- Inc FSH

2- absent follicles on US

Front 72

Positive UPT+ vaginal bleeding. NBSIM?

Back 72

TVUS=> ill either show ectopic or IUP or none at all

Front 73

Positive UPT+ vaginal bleeding. NBSIM?

Back 73

TVUS=> ill either show ectopic or IUP or none at all

Front 74

None at all in TV US in w/u of positive UPT + vaginal bleeding. NBSIM?

Back 74

Serum b-hcg (beta quant) =>

If _>1500 => ectopic pregnancy

If <1500=> repeat in 48 hrs(if doubles in 48 hrs=> IUP, if not=> treat as ectopic

Front 75

Rotterdam criteria of PCOS?

Back 75

2 of 3:

1- oligo and/or ovulation

2- chemical & biochemical signs of hyperandrogenism => inc testosterone, inc DHEAS, LH:FSH >3:1

3- polycystic ovary on US

Front 76

Rx of abnormal uterine bleeding?

Back 76

NSAIDS + OCPs

Front 77

Rotterdam criteria of PCOS?

Back 77

2 of 3:

1- oligo and/or ovulation

2- chemical & biochemical signs of hyperandrogenism => inc testosterone, inc DHEAS, LH:FSH >3:1

3- polycystic ovary on US

Front 78

Hirsute vs virilization?

Back 78

Hirsute => fat & hairy(male pattern)

Virilization=> above + amenorrhea + clitoromegaly+ inc muscle mass+ deepened voice

Front 79

Dx of fibroids?

Back 79

1st test=> TV US

Best test=> hysteroscopy

Front 80

Rx of fibroids?

Back 80

MEDICAL

1st line=> OCPs = levonorgestrel IUD

For pain control => NSAIDS

SURGICAL

If want kids=>myomectomy

If don’t want kids=> Hysterectomy

Front 81

Dd of hirsute?

Back 81

1- PCOS

2- CAH

3- familial hirsutism

Front 82

Dd of virilization?

Back 82

Sertoli-Leydig tumor

Adrenal tumor

Front 83

Classical vs Non-classical CAH?

Back 83

Classical=> at birth have ambiguous genitalia + hyponatremia

Non-classical => at puberty with 1 amenorrhea + virilization

Front 84

Dd of 1 amenorrhea with absent uterus?

Back 84

1- AIS

2- Abnormal mullerian development

Front 85

AIS vs 5-æ reductase def?

Back 85

AIS=> No axillary& pubic hair+ cyptorchid testis+ no penis/scrotum + no uterus/ovaries+ breast development

5æ-reductase def=> internal male+ external female+ virilization on puberty

Front 86

Test:DHT in 5-æ reductase def?

Back 86

>20

Front 87

Additional investigations done in Turner syn?

Back 87

1- skeletal X-ray=> to determine bone age

2- thoracic MRI=> to evaluate for aortic narrowing

Front 88

Aromatase def Px?

Back 88

At birth=> Virilization of mother+ normal internal & ambiguous external genitalia

Later in life=> undetectable estrogen +osteoporosis+ delayed puberty+ Inc gonadotropins that cause polycystic ovaries

Front 89

Pre menstrual syn vs mood disorder?

Back 89

PMS=> Sx occur only in luteal phase (1-2 wks before menstrual cycle)

Mood disorder=> sx occur throughout the cycle

Front 90

Rx of premenstrual cycle?

Back 90

1- SSRIs => fluoxetine

2- OCPs

3- caffeine reduction

Front 91

W/u of infertility due to aging?

Back 91

1- Early follicular phase FSH

2- Inhibin B levels

3- clomiphene challenge test

Front 92

Dd of dysmenorrhea?

Back 92

PEFAP

1 dysmenorrhea

Endometriosis

Fibroids

Adenomyosis

Pelvic congestion

Front 93

Testosterone & DHEA-S levels associated with voice change?

Back 93

Testosterone=> >150 ng/dl

DHEA-S => >700 ugm/dl

Front 94

Dd of Virilization?

Back 94

Sertoli-leydig(ovarian ca)

Adrenal ca

Front 95

Associated investigation in patients with genital tract abnormality?

Back 95

Renal US

Front 96

Rx of AIS?

Back 96

1- gender identity counseling

2- gonadectomy after puberty

Front 97

2 amenorrhea definition?

It's W/U?

Back 97

1-Absence of menses >3 months

2- FSH,TSH,HCG, Prolactin

Front 98

ToA U/S findings?

Back 98

Complex thick walled Mass with air fluid levels involving tubes & ovary

Front 99

Menopause definition?

Back 99

Absence of menses for 12 months

Front 100

Androgen insensitivity syndrome pathophys?

Back 100

X linked mutation

Front 101

W/U of which additional system in Mullerian agenesis?

Back 101

Renal tract U/S

Front 102

Dzs associated with primary ovarian insufficiency?

Back 102

1- Turner syn

2- Fragile X syn

3-galactosemia

4-Autoimmune oophoritis

5- anti-cancer drug

6- pelvic radiation

Front 103

Management of AIS?

Back 103

1-Gender assignment

2-Gonadectomy after puberty

3- estrogen supplementation after Gonadectomy

Front 104

Testo/DHT ratio in 5-æ reductase deficiency?

Back 104

>20

Front 105

Mutation associated with 5-æ reductase deficiency?

Back 105

SRD5A2

Front 106

MC STD in USA?

Back 106

HPV

Front 107

Dzs that should be ruled out in evaluation of premenstrual syndrome?

Back 107

1- mood disorder

2- hypothyroidism

Front 108

MCC of hirsutism?

Back 108

PCOS

Front 109

W/u of virilization?

Back 109

Total testosterone

17-OH progesterone

DHEA-S

Front 110

Dd of virilization?

Back 110

Sertoli-leydig ovarian cancer

Adrenal tumor

Front 111

AUB definition?

Back 111

Any deviation from:

Every 24-38 days

Lasting ≤7 days

Front 112

W/u of AUB in premenopausal?

Back 112

1-First r/o pregnancy with HCG

2- 1ST line tests=> CBC, TSH, Coagulation studies

3- FSH,LH , Androgens, Prolactin

4- pelvic US

5- Endometrial bx

Front 113

W/u of AUB in post-menopausal?

Back 113

TV US=> Endometrial bx

Front 114

Rx of AUB in premenopausal?

Back 114

Any one of these

1- COCP

2- Cyclic/ continuous progestins

3- IV Estrogens

Front 115

Medical Rx of endometriosis?

Back 115

1- NSAIDS

2-OCP

3- GnRH analogs=> leuprolide

4- aromatase inhibitors=> anastrazole

Front 116

Indications for surgical Rx In endometriosis?

Back 116

1- CI to med Rx

2- need for definitive dx

3- hx of infertility

4- concern for malignancy or adnexal mass

Front 117

Rx of fibroids?

Back 117

OCPs=> Myomectomy, uterine A embolization, hysterectomy

Front 118

Typical px of endometriosis vs adenomyosis?

Back 118

ENDOMETRIOSIS=> 25-35 yr with 3Ds of dyspareunia, dysmenorrhea, dyschezia

ADENOMYOSIS=> >40 multiparous with new onset menorrhagia, dysmenorrhea

Front 119

Uterine dimensions in adenomyosis?

Back 119

Enlarged but remains smaller than 12 week size(below pubic symphysis)

Front 120

BRCA mutation inheritance pattern?

Back 120

AD

Front 121

Methods to counter BRCA 1& 2?

Back 121

1- age at 1st live birth <30

2- breastfeeding

3- OCP

4- Tubal ligation

5- BSO

Front 122

Conditions other than ovarian cancer that increase CA-125?

Back 122

1- endometriosis

2- leiomyomata

3- lupus

Front 123

Histo in granulosa cell tumor?

Back 123

Call-exner bodies=> cells in rosette pattern

Front 124

Ludwig angina?

Back 124

Infection of submandibular space

Front 125

MCC of Ludwig angina?

Back 125

Dental infections in mandibular molars

Front 126

Rx Ludwig angina?

Back 126

1- amox-clav

Clinda

2- removal of inciting tooth

3- mechanical airway if compromised

Front 127

Abnormal cervical epithelium appearance on colposcopy?

Back 127

1- punctation

2- mosaicism

3- white epithelium

4- abnormal vessels

Front 128

Causes of unsatisfactory colposcopy?

NBSIM?

Back 128

1- metaplastic epithelium enters canal=> endocervical curettage

2- abnormal epithelium enters canal=> narrow & deep cone bx

Front 129

Indication for endocervical curettage?

Back 129

Metaplastic epithelium enters canal

Front 130

Types of cone bx?

Back 130

1- narrow & deep

2- wide & shallow (via LEEP)

Front 131

Indications for narrow & deep cone?

Back 131

Abnormal epithelium enters canal

Front 132

Indications for shallow and wide cone bx?

Back 132

Pap smear is worse than bx

Front 133

SEs of deep cone bx?

Back 133

1- cervical insufficiency

2- cervical stenosis

Front 134

Fu after LEEP & cryotherapy?

Back 134

Pap smears every 3-6 months for 2 years

Front 135

Rx of CIN?

Back 135

Front 136

Grades of uterine prolapse?

Back 136

Front 137

Type of vaginal prolapse?

Back 137

Front 138

Dx of vaginal prolapse?

Back 138

Observation at time of Pelvic exam=> pt Inc intra-abd pressure

Front 139

Cystocele triad?

Back 139

Front 140

Rectocele triad?

Back 140

Front 141

Management of pelvic organ prolapse?

Back 141

Front 142

Cystometric volume measurements?

Back 142

Front 143

Type of urinary incontinence?

Characteristic findings?

Dx?

Rx?

Back 143

Front 144

Bypass/ fistula incontinence triad?

Back 144

Front 145

Inc vaginal discharge dd?

Dx?

Rx?

Back 145

Front 146

Azole that can't be used in 1st trimester?

SE?

Back 146

1- fluconazole

2- meningitis

Front 147

1- Asymptomatic fungus on pap smear?

2- Asymptomatic trichomoniasis on pap smear?

NBSIM?

Back 147

1- no Rx

2- Rx

Front 148

Wu of a female with vulvar Pruritus & a lesion?

Back 148

Front 149

Mean Age at which gyne cancers are diagnosed?

Back 149

1- Cervical=> premenopausal

2- Endometrium, vulva, ovary=> post menopausal

Front 150

Management of vulvar carcinoma?

Back 150

Noninvasive=> imiquimod or laser ablation therapy

Front 151

Nabothian cyst pathophys?

Located on?

Back 151

1- incomplete metaplasia=> above layers stratified squamous, below columnar

2- transformation zone

Front 152

Dx criteria of cervicitis?

Back 152

mucopurulent cervical discharge or

Friable cervix=> columnar epithelium bleeds spontaneously or with Q tip

Front 153

Types of cancers associated with HPV 16 & 18?

Back 153

16=> SCC

18=> Adeno ca

Front 154

Bethesda 3 pap smear classification?

Back 154

Front 155

Cytology corresponding to bx findings?

NBSIM if findings not corresponding to each other?

Back 155

2- wide & shallow bx

Front 156

Summary of W/U of cervical lesions?

Back 156

Front 157

Patterns of menstrual/ intermenstrual bleedings?

Associated causes?

Back 157

1- regular menstrual bleeding=> predictable+ associated with spasms

2- regular menstrual bleeding+ unpredictable intermenstrual bleeding=> cervical/vaginal/endomet anatomic lesion

3- irregular frequency, duration ,amount=> hormonal problems esp anovulation

Front 158

Rx of Stage 1 cervical cancer?

Back 158

Front 159

Rx of cervical neoplasia in preg?

Back 159

Front 160

Leiomyoma appearance on US?

Back 160

Front 161

Natural hx of leiomyoma?

Back 161

Front 162

Types of leiomyoma degeneration?

Back 162

1- calciferous

2- cystic

Front 163

Rx of adenomyosis?

Back 163

1-If prominent sx bleeding=> LNG-IUS, OCP

2- If prominent sx pain=> hysterectomy

Front 164

Wu of postmenopausal bleeding?

Back 164

Front 165

Most common stage at which following are dx?

1- endomet ca

2- ovarian

Back 165

1- stage 1

2- stage 3=> 15% survival

Front 166

Which of gyne ca is staged clinically?

Back 166

Cervical

Front 167

Stage 1 of endomet ca?

Back 167

Front 168

Rx of endomet ca?

Back 168

Front 169

Natural hx of unopposed estrogen stimulation on endomet?

Rx?

Back 169

Front 170

Functional ovarian cyst triad?

Back 170

Front 171

Prepubertal pelvic mass dx?

Rx?

Prognosis?

Back 171

Front 172

Wu of premenopausal pelvic mass?

Back 172

Front 173

Wu of postmenopausal pelvic mass?

Back 173

Front 174

Ovarian ca sx prior to dx?

Back 174

3 months=> 75% pts have GI sx

6months=> 50% have pain

Front 175

Condition associated with delivering a child thru HPV infected birth canal?

Back 175

Laryngeal papillomatosis

Front 176

Conditions with cervical motion tenderness?

Back 176

1- PID

2- Ectopic pregnancy

3- endometriosis

Front 177

Acute PID?

Chronic PID?

Back 177

1- salpingo-oophoritis

2- post inflammatory pelvic adhesions

Front 178

Medical Rx of endometriosis?

Back 178

NOLA

1- NSAIDS

2- OCPs

3- Leuprolide (GnRH+)

4- Aromatase inhibitors

Front 179

Surgical Rx of endometriosis?

Back 179

Front 180

Barrier/spermicides contraception advantages?

Disadvantages?

Back 180

Front 181

Moa of steroid contraception?

Back 181

Front 182

Estrogen used in steroid contraception?

Back 182

Ethinyl estradiol

Front 183

Non-contraceptive benefits of steroid contraception?

Back 183

PEDD

Mostly are due to progestin component

1- Dec dysmenorrhea

2- Dec DUB

3- Dec PID

4- Dec ectopic pregnancy

Front 184

Cancer Inc/Dec with OCPs?

Back 184

Front 185

IUD tail couldn't be found. NBSIM?

Back 185

Front 186

Preg test positive with IUD present in uterine cavity. NBSIM?

Back 186

Take out IUD to Dec risk of spontaneous abortion

Front 187

Ideal candidates for different contraception methods?

Back 187

Front 188

Chemical messengers associated with human sexual response?

Back 188

Serotonin=> inhibits

Dopamine=> stimulates

Testosterone=> sets threshold

Front 189

Excitement phase of sex in men vs women?

Back 189

Front 190

Most common female sexual dysfunction?

In males?

Back 190

1-Low sexual desire

2- Premature ejaculation

Front 191

Post sexual assault ppx?

Back 191

Front 192

Dd of premenarchal bleeding?

Back 192

Front 193

Wu of premenarchal bleeding?

Back 193

1- look for vag foreign body=>pelvic exam under sedation

2- looking for Early cause of estrogen production=> CT/MRI head, abdomen, pelvis

Front 194

Wu of abnormal menstrual bleeding?

Back 194

Front 195

Cause of AUB?

Back 195

Front 196

Adult breast reads into?

Pubic hair ?

Back 196

1- there is estrogen

2- there are androgen receptors

Front 197

Inheritance pattern of androgen insensitivity syn?

Back 197

X linked recessive

Front 198

Rx of mullerian agenesis?

Back 198

1- no hormones

2- create vagina

3- IVF -surrogate

Front 199

Rx of AIS?

Back 199

1- estrogen

2- create vagina

3- remove testis

Front 200

Secondary amenorrhea dd?

Back 200

1- preg

2- anovulation

3- estrogen def

4- outflow tract lesion

Front 201

Wu of secondary amenorrhea?

Back 201

Front 202

Secondary amenorrhea pathophys based on FSH?

Back 202

Front 203

Incomplete vs complete precocious puberty?

Back 203

Front 204

Constitutional /idiopathic precocious puberty triad?

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CNS lesion associated precocious puberty triad?

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McCune Albright syn associated precocious puberty triad?

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Wu of PMS?

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Dx of PMS?

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Clusters of PMS?

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Rx of PMS?

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Meds box => not recommended

OCP=> YAZ ie 24-4

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Types of hair that are converted in hirsutism?

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Vellus hair=> terminal

Due to androgens

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Lab Wu of hirsutism?

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If all are normal=> it's assumed hirsutism is due to Inc DHT as it can't be measured

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Diagnostic Wu of hirsutism vs virilization?

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LH :FSH normal?

In PCOS?

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1- 1.5:1

2- 3:1

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Management of PCOS?

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Chronic anovulation in PCOS leads to?

Rx?

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Inc testosterone in PCOS leads to?Rx?

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Wu of infertility?

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NBSIM if Semen analysis is abnormal?

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NBSIM if infertility due to tubal dz?

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Def of amenorrhea?

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Clinical=> lack of menses for one year

Lab=> serial elevated FSH for 3 months

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Cf in menopause?

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MCC of death in no postmenopausal women?

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CVD

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E+P vs E only HRT?

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Proven benefits of menopausal hormone therapy & only indications?

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Rx of menopause associated osteoporosis?

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1st line=> bisphosphonates & SERMs

2- most benefit if age <60 & if within 10 years of menopause

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Breast cancer size correlating to visible only on mammogram vs only palpable by exam?

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Fibroadenoma px?

Dx?

Rx?

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Microcalcifications on mammogram. NBSIM?

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20 % are early cancer

Stereotactic core needle bx

OPD radiology

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Criteria for excisional/ open bx?

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1- bloody cyst fluid

2- breast mass persists after aspiration

3- bloody nipple fluid

4- edema, Erythema

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Mc breast cancer?

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Infiltrating ductal cancer

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1-DCIS dx. NBSIM?

2-LCIS?

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1-Prophylactic Sub-cutaneous mastectomy

2- serial mammograms/MRI

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Paget dz px?

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Relative risk of breast cancer?

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Management of breast cancer m

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Vulvar Lichen planus px?

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erosive variant (mc)=> prurituc, erosive glazed purple Papules with white reticular lines

Vaginal invol± stenosis

Painful oral ulcers

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Rx of vulvar lichen planus?

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Topical high potency corticosteroid

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Lichen simplex chronicus?

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Chronic scratching=> thickened leathery skin

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Rx of atrophic vaginitis?

Lichen sclerosis?

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1- 1st line=> vaginal moisturizer & lubricant

2nd line=> low dose estrogen

2- high dose vaginal steroids

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Dx of lichen sclerosis?

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Punch bx for definitive dx & ro malignancy as it's a premalignant Vulvar SCC

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Rx of adhesions / scarring secondary to lichen sclerosis?

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Vulvoperineoplasty

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C. Lata vs c. Accuminata?

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C Lata=> broader base+ smooth surface

C accuminata=> exophytic, dry appearing verrucous

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Px of lichen sclerosis?

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1-Intense pruritus

2-White vulvar plaque

3-Loss of labia majora, minora, clitorris, introitus, perianal region=> dysuria+ dyspareunia+ dyschezia

4- perianal figure of 8 involvement

5- spares vagina

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Rx of c accuminata?

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1-Chemical=> podophyllin, trichloroacetic acid

2- immunologic=> imiquimod

3- surg=> cryo+ laser+ excision

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Labial adhesions epidemiology?

Rx?

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1- prepubertal girls due to Dec estrogen

2- topical estrogen

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Estrogen receptors are located in Genitourinary system?

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1-Bladder trigone

2- urethra

3- pelvic floor muscles

4- endopelvic fascia

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Dx of vesicovaginal fistula?

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1- PE=> urine leaking to vagina, area of granulation tissue

2- cystourethroscopy for small fistulas

3- dye test for small fistulas

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Desquamative inf vaginitis px?

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Perimenopausal female

1- copious watery discharge

2- erythematous, inflamed vagina

3- predominance of WBCs & absence of lactobacilli on wet mount microscopy

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Rx Desquamative inf vaginitis?

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Topical clindamycin

Topical CS

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Dx criteria of vaginismus?

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Rx of vaginismus?

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1- relaxation

2- kegel exercise

3- vaginal dilators

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Pathophys of urethral diverticulum?

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Recurrent periurethral gland infection

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Features suggestive of metastasis in vaginal cancers?

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1- pelvic pain

2- urinary sx=> hematuria

3- bulk sx=> constipation

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Indications of IVF?

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1- ICSI

2- Tubal pathology

3- unexplained infertility

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Wu of infertility due to aging?

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1- FSH on day 3

2- clomiphene challenge test

3- inhibin B levels

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Ovulatory phase mucus characteristics?

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1- clear thin & profuse

2- stretches to 6cm when lifted vertically

3- pH 6.5 or greater (more basic than other phases)

4- ferning

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Pts with ... Cfs should be evaluated for secondary dysmenorrhea?

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Pain characteristic of primary dysmenorrhea?

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Crampy lower abd/back pain during menses for first 2-3 days

Can radiate to back & thighs

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Rfs for Primary dysmenorrhea?

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1- menarche at age <12

2- heavy long menstrual periods

3- sexual abuse

4- tobacco use

5- BMI <20

6- Age <30

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1 dysmenorrhea natural hx ?

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Starts in adolescent & generally improves with age esp after child birth

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Rx of 1 dysmenorrhea?

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1-1st line in Non-sexually active=> NSAIDs

2-1st line in sexually active=> OCP

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Isolated Hirsutism vs Hirsutism associated with virilization?

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1-Isolated=> progresses over years

2-Associated with virilization=> progression within months+ male pattern baldness

Front 263

Testosterone & DHEA-S levels associated with voice change?

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Testosterone>150

DHEA-S >700

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Beta hcg functions?

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1- maintain corpus luteum of preg

2- promotion of male sexual differentiation

3- stimulation of maternal thyroid gland

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Rfs for ovarian torsion?

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1- ovarian mass >5cm

2- women of any reproductive age

3- infertility Rx with ovulation induction

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Ligaments around which ovary torses ?

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1- Infundibulopelvic /suspensory ligament

2- utero-ovarian ligament

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Dd of enlarged uterus?

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1- preg

2- leiomyoma

3- adenomyosis

4-leiomyosarcoma

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Mullerian agenesis syn associated with abnormalities in?

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Renal US => duplicated ureter

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Normal endometrial stripe thickness in postmenopausal?

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≤4 mm

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Though less likely but MG pts can have flare during which time in a preg?

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1- 1st trimester

2- postpartum

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Seizures prophylaxis in MG patient for preeclampsia with severe features?

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Valproic acid (as Mgso4 is CI)

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Id structures?

Id condition?

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Front 273

Folic acid supplementation requirement in

1- avg risk

2- high risk (eg)

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1- 0.4 mg daily

2- 4 mg daily (prior affected preg, antiepileptic use)

Front 274

Features suggesting delayed postpartum hemorrhage rather than lochia?

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1- passage of large clots

2- Inc pad count ie saturation if ≥1 pad/hr for ≥2 consecutive hrs

3- signs & sx of anemia ie dizziness, chest pain

4- Pe can show uterine atony features ie boggy uterus

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Management of breast pain?

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1- Definition of Recurrent cystitis in women

2- Rfs

3- rx

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Post expo ppx for sexual assault?

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Rx of menopause?

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Mild vasomotor sx of menopause?

Rx?

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1-dont interfere with daily activities

2- Behav modification=> wt loss, wearing layers

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E+P postmenopausal therapy associated with Inc risk of ?

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Breast cancer with long-term use of >3-5 year

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Non hormonal therapy used in menopause Rx when estrogen is CI ?

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1- SSRI

2- when not responsive/can't use (eg when using tamoxifen) => clonidine, gabapentin

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Bleeding after progesterone withdrawal shows?

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Amenorrhea due to anovulation

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No bleeding after progesterone withdrawal. Probable causes?

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Breast cyst management algorithm?

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CI to Cu IUD?

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CI to progestin IUD?

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1- active liver dz

2- active breast cancer

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Patient with positive preg test wants emergency contraception?

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Not candidate for emergency contraception as implantation has already occurred