Women's Health EOR Exam 2023 Questions with correct Answers (Graded A)

Dx of fibroadenoma - Answer- FNA biopsy Dx of fibrocystic mass - Answer- Ultrasound FNA biopsy - reveals straw colored fluid (no blood) What breast disease involves painful and tender breast lumps that is often bilateral and increases in discomfort during menses? - Answer- Fibrocystic disease Tx for fibroadenoma - Answer- None MC breast disorder, especially in 30-50 yo. - Answer- Fibrocystic breast disorder What type of benign breast disease involves breast masses that increase or decrease in size with menstrual hormone changes? - Answer- Fibrocystic breast disorder What is a major difference between fibrocystic disease and fibroadenomas as far as timing? - Answer- Fibroadenomas don't usually wax and wane with menstruation MC cause of mastitis - Answer- Staph aureus What are the two ways mastitis can be caused? How can the two be differentiated? - Answer- 1. Infection (Staph aureus MC) 2. Congestion (bilateral breast enlargement 2-3 days postpartum) Infection is unilateral Congestive is bilateral Mastitis with induration and fluctuance is a - Answer- Breast abscess Breast pain especially in one quadrant with tenderness, warmth, swelling, and nipple discharge - Answer- Mastitis due to infection Tx for infectious mastitis - Answer- Supportive: warm compresses, breast pump, anti-staph abx Mothers may continue to nurse or use breast pump Tx for congestive mastitis - Answer- Can breastfeed Ice packs, tight-fitting bras, analgesics Tx for breast abscess - Answer- I and D Stop breastfeeding from infected breast Causes of vaginitis (4) - Answer- Trichomoniasis Bacterial vaginosis (Gardnerella) Candidiasis Atrophy Sxs of vaginitis (4) - Answer- Vaginal burning, pruritus, pain, discharge Tx for trichomoniasis - Answer- Metronidazole Fishy odor of vaginal discharge is associated with what diagnostic finding? - Answer- Clue cells Bacterial vaginosis Trichomoniasis findings on diagnostic exam - Answer- Pear shaped flagellated protozoa Findings of trichomoniasis on pelvic exam - Answer- Strawberry cervix (cervical petechiae) Frothy yellow-green discharge Tx for trichomoniasis - Answer- Metronidazole Thick, curd-like/cottage cheese discharge - Answer- Candida What is the pH in bacterial vaginosis and trichomoniasis? What is the pH in candidiasis? - Answer- >5 - overgrowth causes increased vaginal pH Normal (3.8-4.2) - usually it is acidic Tx for candidiasis - Answer- Fluconazole PO What might PID lead to? (4) - Answer- Sepsis Ectopic pregnancy Infertility Reactive arthritis MC causes of PID - Answer- Chlamydia (#1) Gonorrhea Sxs of PID (6) - Answer- Pelvic/lower abdominal pain Dysuria Dyspareunia Vaginal discharge Nausea Vomiting What sign is associated with PID? - Answer- Chandelier sign - cervical motion tenderness Dx of PID - Answer- 1. abdominal tenderness 2. cervical motion tenderness 3. adnexal tenderness PLUS at least one of the following: positive gram stain fever WBC >10K pus on culdocentesis or laparoscopy PID tx as outpatient - Answer- Doxycycline + ceftriazone PID tx as inpatient - Answer- IV doxycycline + 2nd generation cephalosporin What does chlamydia cause in developing countries (rare in US)? - Answer- Lymphogranuloma venereum (LGV) Painless genetical ulcer and painFUL inguinal lymphadenopathy - Answer- Lymphogranuloma venereum (LGV) Dx of PID due to chlamydia and gonorrhea - Answer- Nucleic acid amplification (PCR test is best) Tx for chlamydia - Answer- Azithromycin OR Doxycycline Co treat for gonorrhea (Ceftriaxone) Tx for gonorrhea - Answer- Ceftriaxone Co treat for chlamydia (azithromycin or doxycycline) What is chancroid caused by? - Answer- Haemophilus ducreyi Soft, shallow, painful genital ulcer with painFUL inguinal lymphadenopathy - Answer- Chancroid What is the difference between Lymphogranuloma venereum and Chancroid? - Answer- LGV is painLESS Chancroid is painFULL Tx for chancroid - Answer- Azithromycin OR ceftriaxone, erythromycin, ciprofloxacin Syphilis tx in ALL stages - Answer- Penicillin (caused by spirochete treponema pallidum) One dose or three doses depending on stage Describe the initial infection of syphilis - Answer- Direct contact during sexual activity and contact with lesions (mucous membrane contact) May also be transmitted to fetus via placenta Forms chancre at inoculation site and from there goes to regional lymph nodes Primary syphilis includes what? - Answer- Chancre (painless ulcer at inoculation site) Characteristics of secondary syphilis (2) - Answer- Maculopapular rash often involving the palm and soles Condyloma lata esp. near chancre site, moist lesions Condyloma lata = Condyloma acuminata = Chancre = Chancroid = Gumma - Answer- Condyloma lata = secondary syphilis Condyloma acuminata = genital warts (HPV) Chancre = primary syphilis Chancroid = Haemophilus ducreyi Gumma = tertiary syphilis Characteristics of tertiary syphilis (4) - Answer- Gumma Neurosyphilis: headache, meningitis, dementia, incontinence, Tabes dorsalis, vision/hearing loss Cardiovascular: aortic regard, aortic aneurysm, aortitis Argyll-Robertson pupil What is associated with congenital syphilis? (3) - Answer- Hutchinson teeth Saddle-nose deformity ToRCH syndrome Dx of syphilis - Answer- Darkfield microscopy Screening tests (RPR, VDRL) Confirmatory tests (FTA-ABS) When do screening tests for syphilis become positive? - Answer- 4-6 weeks What is preferred if patient is allergic to penicillin for treatment of syphilis? - Answer- Still penicillin. Might need to desensitize. Side effect of treatment of syphilis with PCN - Answer- Jarisch Herxheimer reaction: myalgias and headaches due to acute febrile response due to rapid lysis of many spirochetes. Give antipyretics in the first 24 hours to reduce incidence of the reaction. All patients with syphilis should be tested for what? - Answer- HIV All patients with syphilis should be reexamined clinically and serologically when, if at all? - Answer- 6 months and 12 months after treatment What can HPV cause? - Answer- Cutaneous HPV: warts Mucosal HPV: genital warts (condyloma acuminata), cervical dysplasia/cancer and anogenital carcinoma Cauliflower-like lesions describes what? - Answer- Condyloma acuminata Dx of mucosal HPV - Answer- Whitening of lesion with acetic acid application 4 MC types of HPV that cause cervical cancer - Answer- 6, 11, 16, 18