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NR602 Final Which one best describes lesions associated with condyloma acuminatum? a. Verruciform b. Plaque-like c. Vesicular d. Bullous - Answer a 39yo female has completed course of amox for strep throat. LMP was 2wks ago, says it was normal. On exam, there's erythema of extern. genitalia w/small amount of white discharge. Micro wet prep reveals few clue cells, but many budding hyphae. No WBCs. Which one would be the most appropriate treatment? a. Metronidazole 500mg BID x7 days b. OTC hydrocortisone 1% cream TID c. Fluconazole tabs 150mg x1 dose d. Erythromycin 500mg TID x10 days - Answer c Woman c/o vaginal itching, white discharge. She is in good health except for recent abx for strep throat. Pelvic reveals tender vulvovaginal area w/edema and nonmalodorous white patches. Which is the most likely cause? a. Bacterial vaginosis b. Trichomonas c. Lactobacillus overgrowth d. Candidiasis - Answer d 18yo female c/o secondary amenorrhea. On exam, there is normal secondary sex characteristics and normal genitalia. Pregnancy is ruled out. What would necessitate further eval?
a. Elevated blood cholesterol levels b. Androgen deficiency c. Galactorrhea d. Hirsutism - Answer c 24yo female is dx'd w/primary dysmenorrhea. Which med would be used as first-line to help control symptoms? a. Antianxiety meds b. Progesterone-only contraception c. Oral steroids d. NSAIDs - Answer d Primary amenorrhea is best described as: a. Cessation of menstruation x6mo b. Failure of menstruation to occur by 17ho c. Failure of menstruation to occur by 13yo d. Cessation of menstruation x6mo after menarche - Answer c 25yo female c/o vaginal irritation and discharge. On exam, cervix is easily friable and erythematous. No adnexal tenderness. Wet prep reveals mobile protozoa on NS slide. This most likely represents: a. Trichomonas b. Mucopurulent cervicitis c. Bacterial vaginosis d. Gonorrhea - Answer a 16yo female has h/o secondary amenorrhea. Menarche at 10yo, regular cycles x2yrs, has not menstruated x4yrs. What is most frequent etiology of this problem?
a. Dysuria b. Leukopenia c. Cervical motion tenderness d. Abd pain - Answer b Which of the following are of a reproductive and pelvic origin? a. Salpingo-oophoritis (fallopian tube/ovary) secondary to PID b. Gynecologic malignancy c. Adhesions d. Myomata uteri - Answer a 25yo female c/o tender area near her introitus and to the L of her perineum. Very painful sex was first sign. Initially bump was very small, but now is ping- pong ball size. On exam, abscess is present on L medial side of labia minora and there's edema extending into perineum. What is dx? a. Lipoma b. Dermoid cyst c. Bartholin's cyst d. Skene's duct cyst - Answer c 49yo female c/o dark, watery brown vaginal discharge. Which best describes what might be seen on physical exam in pt's with cervical cancer? a. Ulcerated firm cervix b. Vague lower abd pain c. Enlarged tender femoral lymph nodes d. Soft, still shaped cervix - Answer a 22yo female c/o pelvic pain. Exam reveals cervical motion and uterine tenderness. Which supports PID dx?
a. Temp <100F b. Absence of WBCs in vag fluid c. Mucopurulent vag discharge d. Lab documentation of cervical infection w/E. coli - Answer c When educating pt about rationale for getting mammo, which statement is false? a. Mammo is cost-effective method to screen for breast cancer b. Mammo detects all breast cancers c. Mammo should be accompanied by breast exam d. Negative mammo should not delay biopsy of clinically suspicious mass - Answer b When educating women about breast cancer risk factors, which statement is incorrect? a. Pregnancy after 35yo b. Late menopause after 57yo c. Fibrocystic breast dz d. H/o maternal breast cancer - Answer c Which of the following statements is accurate regarding the usefulness of mammo in screening and detection of breast cancer? a. Mammo shouldn't be done if there is any breast pain or nipple retraction b. All women >40yo should have mammo on annual basis c. Mammo should be done annually for all women of child-bearing age d. Mammos should be performed annually after initial pregnancy, especially if women doesn't breastfeed - Answer b
a. Ovarian cysts b. Prostaglandin production c. Endometriosis d. Adenomyosis - Answer b 28yo female c/o breast tenderness, fatigue, abd bloating, fluid retention, irritability 1wk before her menses onset. What is most important info to obtain from this pt to determine if the pt has PMS? a. Severity of symptoms b. Occurrence of symptoms in menstrual cycle c. Frequency and number of symptoms over past 4mo - Answer b 35yo woman c/o 6mo h/o hypermenorrhea, backache, pelvic pressure. On exam, you discover 12wk size uterus w/irregular contour. What does this represent? a. Uterine cancer b. Dysfunctional uterine bleeding c. Uterine fibroid d. Fecal impaction - Answer c Female c/o vaginal itching and white discharge. Denies sexual activity or douching. In good health except for recurrent strep throat. Pelvic reveals tender vulvovag area w/edema and white patches. No odor. What is the most likely cause? a. Bacterial vaginosis b. DM c. Allergy to personal hygiene product d. Candidiasis after abx treatment - Answer d
32yo woman c/o postcoital bleeding. Which would not be included in the initial assessment? a. Pap smear b. Uterine biopsy c. Pelvic ultrasound d. CBC w/diff - Answer b What phase of menstrual cycle begins with menses cessation and ends w/ovulation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase - Answer b What phase of menstrual cycle begins with ovulation and ends w/menstruation? a. Ovulatory phase b. Follicular phase c. Proliferative phase d. Luteal phase - Answer c Name 4 structural abnormalities that are causes of dysfunctional uterine bleeding. - Answer PALM: Polyps Adenomyosis Leiomyoma Malignancy
Post-coital bleeding Passing clots/tissue Dizziness Hot flashes Temp intolerance Uterine/cervical tenderness What are some objective findings for DUB? - Answer Excessive bleeding on exam Hypotension Tachycardia Diaphoresis Vag atrophy Mass Trauma Enlarged uterus/adnexa Hirsutism Thyromegaly Bruising Galactorrhea What are some diff dx's for DUB? - Answer PALM-COEIN Traumatic injury Pregnancy-related bleeding (ectopic, SAB, placenta previa/abruptio) What are some diagnostic lab studies for DUB? - Answer -*Serum hCG: always do first before examining pt of menstruating age w/vag bleeding -CBC -ABO/Rh if preg. suspected/severe bleeding -STD tests/wet prep
-Cervical cytology -CMP (w/renal & liver panel) -Coags -If hx indicates: screen for bleeding disorders for DUB at menarche. -If hx indicates: thyroid panel -Endometrial bx What are some diagnostic imaging studies for DUB? - Answer -TVUS: first-line if imaging needed -Saline infusion sonohysterography (helpful for leiomyoma) -Hysteroscopy (can be used for guided endometrial bx) -MRI What are some diagnostic studies for polyps in DUB? - Answer -TVUS -Saline infusion sonography -Hysteroscopy What are some diagnostic studies for adenomyosis in DUB? - Answer TVUS or MRI What are some diagnostic studies for leiomyomas in DUB? - Answer TVUS What are some diagnostic studies for malignancy in DUB? - Answer Bx/pathology What are some diagnostic studies for coagulopathies in DUB? - Answer Labs What are some surgical options for DUB? - Answer -Varies depending on dx, age, fertility status/desire -If bleeding severe/pregn. related: D&C or hysterectomy in extreme cases -Hysteroscopic removal of polyps -Endometrial ablation -Hysterectomy -Traumatic repair What are some pharm options for DUB? - Answer -NSAIDs (cyclic DUB)
What is the expected course of acute DUB? - Answer Once bleeding stabilized: transition to maintenance therapy prn What is expected course of chronic DUB? - Answer Treatment should progress until DUB controlled; may required more testing, dosage adjustments, referral for treatment options What are possible complications of DUB? - Answer -Anemia -Break through bleeding -VTE -Uterine artery embolization/polypectomy: maybe issues w/infertility -Premature ovarian failure secondary to hysterectomy What is the average age of menarche for Caucasians? - Answer 12.6y What is average age of menarche for African-Americans? - Answer 12.1y What is average age of menarche for Latinas? - Answer 12.2y What does higher BMI in childhood result in regarding puberty? - Answer Earlier onset Timing and progression of puberty are related to... - Answer Environmental factors, including: -Socioeconomic conditions -Nutrition -Access to preventive healthcare At what average age do secondary sexual development occur? - Answer 9y Menarche usually occurs w/in ______________ after thelarche (breast buds). - Answer 2-3y When should dx/referral be made for primary amenorrhea? - Answer -Any adolescent w/out menarche by 15yo -Any adolescent w/out menarche 3y after thelarche What are some things that can cause menstrual irregularities? - Answer - Disturbances in normal hormone release -Significant wt loss
-Strenuous exercise -Substantial changes in sleep/eating habits -Severe stressors Most cycles range from ___________. - Answer 21-34 days When is woman's normal cycle length usually established? - Answer Around 6th gynecological yr, ~19-20yo What are the 2 cycles that occur simultaneously in the menstrual cycle? - Answer Ovarian and endometrial What cycle are follicular, ovulation, & luteal phases? - Answer Ovarian What phase is menstrual days 1-14 in ovarian cycle? - Answer Follicular Prominent hormones: FSH, estrogen Description: maturation of ovarian follicle What phase is menstrual day 14 in ovarian cycle? - Answer Ovulation Prominent hormones: LH Description: ovulation 36h after LH surge; increased basal body temp What phase is menstrual days 15-28 in ovarian cycle? - Answer Luteal Prominent hormones: Progesterone, estrogen Description: follicle becomes corpus luteum What cycle are menses, proliferative, & secretory phases? - Answer Endometrial/ovarian What phase is menstrual days 1-5 (variable) in endometrial phase? - Answer Menses (part of proliferative phase)
What is a Bartholin's gland cyst/abscess? - Answer Obstruction of one or both Bartholin glands, resulting in pus that forms lump/abscess. Where are Bartholin glands located? - Answer Bilat to opening of vagina What are typical characteristics of Bartholin's gland cyst/abscess? - Answer 1-3cm, unilat What is etiology for Bartholin's gland cyst/abscess? - Answer -Most common >60yo -Mechanical irritation from tight fitting undergarments resulting in chronic inflammation -STDs What are some risk factors for Bartholin's gland cyst/abscess? - Answer - Vulvovaginal infection -Poor perineal hygiene What are some assessment findings of Bartholin's gland cyst/abscess? - Answer -Firm labia mass/cyst -Erythema -Induration -Labia minora edema -Low grade fever -Possible purulent drainage What are some diff dx for Bartholin's gland cyst/abscess? - Answer - Sebaceous cyst -Malignancy/tumor What are some diagnostic studies for Bartholin's gland cyst/abscess? - Answer -Usually none unless other infection suspected -C/S of cyst contents -Cx for STD, esp. gonorrhea & chlamydia What is the most common causative organism of Bartholin's gland cyst/abscess? - Answer Aerobic bacteria E. coli
What are some preventive measures for Bartholin's gland cyst/abscess? - Answer -Loose breathable garments -Good perineal hygiene -Early treatment What are some nonpharm treatment options for Bartholin's gland cyst/abscess? - Answer -None needed if only 1-2mm & asymptomatic -Exclude possible carcinoma if >40yo -Local moist heat -Warm sitz baths/tepid water soak 3-4 times/day -I&D w/Word cath of fluctuant abscess if refractory to initial treatment (no sex until cath removed) -Possible marsupialization (permanent surgical opening allowing drainage) What is the goal of treatment for Bartholin's gland cyst/abscess? - Answer To facilitate drainage of cyst contents What are some pharm options for Bartholin's gland cyst/abscess? - Answer -If high risk/recurrent: Augmentin for E. coli/Strep, clinda for Staph (incl. MRSA) -Treat for any STD -NSAIDs When is consultation/referral recommended for Bartholin's gland cyst/abscess? - Answer Surgical or gyn consult if large cyst or unresponsive to treatment What are follow up recommendations for Bartholin's gland cyst/abscess? - Answer Re-eval in 7-10days What is expected course of Bartholin's gland cyst/abscess? - Answer - Complete resolution w/appropriate treatment -1 of 10 will recur What are possible complications of Bartholin's gland cyst/abscess? - Answer Cellulitis What is description of breast cancer? - Answer -Malignant breast tumors -Primarily female, but can be in males
-Late findings: wt loss, anorexia, bone pain, anemia What are some diff dx for breast ca? - Answer -Breast cysts -Fibroadenoma -Sclerosing adenosis -Intraductal papilloma -Hyperplasia -Radial scars -Mastitis What are some diagnostic studies for breast ca? - Answer -Mammo -US (differentiates fluid-filled cyst from solid mass) -MRI -Breast thermography (digital infrared thermal imaging) -Fine needle or core bx -Incisional or excisional bx What are some preventions for breast ca? - Answer -Screening (varies by expert organization) -More frequent mammo or MRI for higher risk women -Annual screening starting at 40yo (ACOG, ACOR, ACS, NCCN) -Biennial screening 50-74yo (USPSTF) If a woman has a breast mass but a normal mammo, what should be done? - Answer NOT normal to have mass w/normal mammo; further imaging/eval needed. What are some nonpharm options for breast ca? - Answer -Genetic testing -Tumor characteristic assessment -Baseline bone scan -CT abd/chest -Breast conserving surgery (lumpectomy) -Mastectomy (radical or prophylactic)
-Radiation -Sentinel lymph node bx -Axillary node dissection What are some pharm options for breast ca? - Answer Hormonal therapy: -Tamoxifen -Raloxifene -Ca/Vit D suppl. recommended -Anastrozole -Letrozole Chemo (adjuvant or neoadjuvant) Radiation: -Begin 4-6w after surgery or chemo -Whole breast and accelerated partial breast. When is consultation/referral recommended for breast ca? - Answer All palpable masses to surgeon for eval & bx if indicated What is recommended follow up for breast ca? - Answer -H&P q3-6mo x3y after treatment, then q6-12mo x2y -All women should do BSE -Reg gyn follow-up (tamoxifen increases risk for endometrial ca; any vag bleeding should be eval'd) -Mammo q6-12mo for surveillance, yearly once stability of mammo findings achieved -MRI yearly if meets certain risk criteria What is expected 5-year survival rate for noninvasive and Stage I breast ca?
- Answer Non (tumor <1cm w/no ax node involvement) & Stage I (tumor >1cm w/no ax node involvement) = 100%
