Breast Disorders
Which of the following is characterized by cyclical breast pain and a fluctuating mass?
Fibroadenoma
Fibrocystic Condition
Phyllodes Tumor
Puerpural Mastitis
What is tx?
Fibrocystic Condition
Tx: reassurance, well fitting bra, sports bra. If severe, Tamoxifen (SERM)
What part of the cervix is affected in cervical stenosis? What are some classic symptoms?
Internal os
SSx: Irregular bleeding, dysmenorrhea, infertility
The secretion of which of the following physiologically active compounds during menses is thought to be a causative factor in the development of primary dysmenorrhea?
Prostaglandins!
What is the most common cause of secondary amenorrhea?
Pregnancy!
A 30-year-old woman at 33-weeks gestation presents to the obstetrics ward for admission with contractions every five minutes. Her cervix is 3 cm dilated. The pregnancy has otherwise been normal, and evaluation of the fetal heart rate indicates no fetal distress. Which of the following treatments has the best potential to reduce morbidity and mortality associated with preterm delivery?
Betamethasone
Indomethacin
Magnesium sulfate
Penicillin
Betamethasone (speeds up fetal lung development)
A patient is diagnosed with puerpural mastitis. What antibiotic are you choosing? what pt education do you give?
Dicloxacillin or Keflex (Cephalexin) (MCC is S.aureus)
Cool compress, well fitting bra, NSAIDs for pain mgmt. Most importantly, CONTINUE BREASTFEEDING (prevent milk stasis) - even if its a pumpndump
Cervicitis can be diagnosed clinically based on presence of at least one of two findings. What are they?
What are 2 infectious causes and 2 non-infectious causes?
Mucopurulent cervical exudate, cervical friability
infectious: chlamydia, gonorrhea, trich, HSV
Non-infectious: IUD placement (mechanical irritation), douches (chem irritation)
In regards to Endometriosis, which is false?
A) It decreases risk of ovarian cancer
B) It is largely characterized, if symptomatic, by premenstrual pelvic pain
C) CA-125 can be elevated
D) Ovaries are the most common site
E) Treatment involves suppression of the HPG axis (w/add back therapy)
A) it increases the risk of ovarian cancer.
A 64-year-old G0P0 postmenopausal woman with a normal BMI, presents to the clinic with new-onset vaginal bleeding for one week. She states she went into menopause at age 53 and has not bled since, until now. What is the initial test to evaluate the endometrium?
Transvaginal Ultrasound
Which of the following screening recommendations for prenatal care is false?
A)Blood & Rh Type to be screened at first prenatal visit
B)Glucose challenge test at 24-28 weeks
C) Screen for Group B Strep at 16 weeks
D) Fetal Ultrasound at every visit
C & D
GBS should be tested at 35-37 weeks. If positive -> IV PCN just prior to labor
Fetal ultrasound only viable at >11 weeks.
What are the breast cancer screening guidelines according to USPSTF?
Mammogram every 2 years from 50-74
Individualize for 40-49 (eg. if african american)
If high risk (eg. BRCA positive) -> breast MRI
What is the most common symptom of vulvar cancer?
vular pruritis!!!! with associated unifocal plaque, mass or ulcer.
________ fibroids are more likely to cause mass effect symptoms while ________ fibroids are more likely to cause abnormal bleeding
Subserosal, Submucosal
A premenopausal woman was evaluated for abnormal uterine bleeding and diagnosed with endometrial hyperplasia without atypical cells. She desires children in the future. Which of the following is the preferred first-line treatment?
Combined hormonal oral contraceptive
Hysterectomy
Leuprolide
Levonogestrel IUD (mirena)
Levonogestrel IUD (mirena)
A 26-year-old G1P0 woman is admitted to the hospital for a spontaneous vaginal delivery. Her contractions are four minutes apart, and her cervix is 8 cm dilated. She has dilated over 1.5 cm in the last hour. What stage of labor is she in?
Stage I, active
a screening mammogram comes back abnormal showing "clustered pleomorphic calcifications", while the patient had a normal breast exam. What is the best next step?
Treat as malignancy via lumpectomy/mastectomy
Reassurance, this is a normal finding
Repeat mammogram in 1 year
Recommend BRCA testing
Treat as malignancy via lumpectomy/mastectomy
This is describing Ductal Carcinoma In situ (DCIS). 1-3% of DCIS is associated with invasive cancer.
A patient comes to you complaining of dysuria. On exam, you notice well demarcated white plaques in a figure 8 pattern, with some associated erosions and fissures. How do you treat this? What is the biggest concern if this goes untreated?
This is describing vulvar lichen sclerosus, which has a 3-5% chance of developing into SCC without treatment
Clobetasol (steroid) 0.05% ointment QHS x6-12 wks, then 1-3x/week for life (maintenance)
What is the biggest cause of endometrial hyperplasia/cancer?
unopposed estrogen tx or stimulation (obesity, chronic anovulation, HRT, PCOS, etc).
A 46-year-old woman presents with years of abnormal uterine bleeding. She has a history of ductal carcinoma in situ, hypertension, and iron deficiency anemia. An endometrial biopsy reveals normal endometrial tissue, and her transvaginal ultrasound reveals a normal, 6 cm uterus without leiomyomata or endometrial polyps. Which of the following medical management approaches is appropriate to treat her bleeding?
Combination oral contraceptive pill
Copper intrauterine device
Levonorgestrel intrauterine device
Naproxen
Levonogestrel IUD (Mirena IUD)
w/ history of DCIS -> shouldn't get estrogen.
Copper causes heavier, more painful menses. probs wouldnt help
Explain the difference in the types of spontaneous abortions.
Threatened abortion
Inevitable abortion
Missed abortion
Septic abortion
Threatened abortion - uterine bleeding <20 weeks, with closed cervix and no passage of PoC
Inevitable abortion - uterine bleeding <20 weeks, dilated cervix, no PoC passage
Missed abortion - Nonviable pregnancy retained in uterus without dilation or passage
Septic abortion - embryonic/fetal demise with intrauterine infection.
What are some potential signs of spontaneous abortions?
Surprise!!!
Name the causes of AUB (PALM-COEIN)
Polyp
Adenomyosis
Leiomyoma
Malignancy
Coagulopathy
Ovulatory dysfunction
Endometriosis
Iatrogenic
Not yet classified
A 34 y/o patient presents complaining of vaginal discharge. Discharge is noted to be thick and white (CURD LIKE), and she complains of intense pruritis. What would you expect the following to show:
Wet mount
Vaginal pH
Odor
What is the preferred treatment for this patient?
Wet mount - buds & hyphae
Vaginal pH - <4.5
Odor - amine (fishy)
Vaginal Azole cream x7 days (PO contraindicated in preggos)
A 29 y/o patient presents for a GU check up. On exam, you notice a small adnexal mass and patient reports mild tenderness, but has not had any pain or symptoms recently. on Transvaginal ultrasound, a simple fluid filled mass is visualized on the ovary. What is the best next step?
Mirena IUD
Prophylactic Salpingo-oophorectomy
Order labs including CA-125
Repeat US in 6 weeks.
Repeat US in 6 weeks.
This was describing a follicular ovarian cyst. If asymptomatic, recommend serial US (can resorb spontaneously).
Ovarian Cx would more likely be a complex/septated mass.
A 65-year-old postmenopausal woman with obesity presents with abnormal bleeding for the past several months. She reports no pelvic pain. She has a history of breast cancer that was treated with tamoxifen 5 years ago and has been in remission. Physical examination reveals normal-appearing cervix and normal-sized uterus. Which of the following is the most likely explanation for her symptoms?
Cervical Cx
Endometrial Cx
Ovarian Cx
Leiomyoma
Endometrial Cx
"Early in the disease process, pelvic examination may be normal with a normal-appearing cervix and a normal-sized uterus"
Tamoxifen reduces breast cx risk, but increases endometrial, ovarian cx risk.
Which of the following diagnoses is most likely in a gravid woman presenting in her 18th week of pregnancy with hypertension, emesis, proteinuria, and a beta-human chorionic gonadotropin level of > 100,000 mIU/mL?
Choriocarcinoma
Gestational diabetes
Hydatidiform mole
Preeclampsia
Hydatidiform mole
Classic symptoms are excessively high hCG, unusually large uterus, preeclampsia BEFORE 20 weeks.