EOR - Women's Health Exam 2023 with complete solutions

What does endometrial cancer risk factors (ENDOMET) stand for? - Answer- E - Elderly N - Nulliparity D - Diabetes O - Obesity M - Menstrual Irregularity E - Estrogen Monotherapy T - HyperTension What are 4 risk factors for placenta previa? - Answer- 1. Multiple gestations 2. Previous placenta previa 3. Increase maternal age 4. Previous uterine procedures Painless bright red vaginal bleeding usually in 3rd trimester? - Answer- Placenta Previa What are 5 other fetal and placental complications with placenta previa? - Answer- 1. Malpresentation 2. Intrauterine growth restriction 3. Congenital anomalies 4. Vasa Previa 5. Velamentous umbilical cord What medication is an estrogen receptor modulator and reduces the risk of recurrence and death in patient with ER-positive breast cancer? - Answer- Tamoxifen What are the 4 T's of postpartum hemorrhage? - Answer- 1. Uterine aTony **MC** 2. Trauma to birth canal 3. Retention of fetal or placental Tissue 4. Coagulopathy ot Thrombin disorder What is puerperium? - Answer- postpartum period - begins after deliver of placenta and can last 8wks - 12months. What is uterine involution? - Answer- Contraction of uterus What causes uterine involution? - Answer- 1. myometrial muscles contract and constrict blood vessels which slows bleeding. 2. Thrombosis of large vessels at the placental site of the uterus. How do you treat postpartum hemorrhage? - Answer- 1. Uterine Massage 2. Oxytocin 3. Prostaglandins 4. Surgery What are 7 risk factors for Pelvic Organ Prolapse? - Answer- 1. Increased Parity 2. Advancing Age 3. Obesity 4. Menopausal Status - Decreasing Estrogen 5. Chronic Constipation 6. Connective Tissue Disorder 7. Chronic Cough How do you treat pelvic organ (uterine) prolapse? - Answer- 1. Kegels Exercises 2. Pessary 3. Surgery What PE finding will show with Primary Syphilis? - Answer- Painless "punched out" lesion on genitals What is the treatment for Primray Syphilis? - Answer- Penicillin G Benzathine: 2.4million units IM What is the treatment for Primary Syphilis in a patient with a penicillin allergy? - Answer- Doxycycline 100mg PO BID x 14 days What are the 4 criteria for bacterial vaginosis? 3 of 4 must be met. - Answer- 1. A think, white homogeneous discharge 2. Presence of clue cells on microscopic exam 3. pH of vaginal fluid > 4.5 4. Fishy odor to vaginal discharge before or after addition of 10% KOH "whiff test" What is the treatment for Bacterial Vaginosis? - Answer- Metronidazole 500mg PO BID x 7 Days What is the symptom transition for fibrocystic breast disease? - Answer- Symptoms PEAK before menstruation and IMPROVE after. How do you describe fibrocystic breast changes on an ultrasound? - Answer- Prominent fibroglandular tissue with small cysts but no discernable mass Do fibroadenomas increase your risk of breast cancer. - Answer- Yes, it increases risk by about 1.5 times How do you treat fibrocystic breast disease? - Answer- 1. Supportive well-fitting bra 2. Applying heat 3. OTC pain relievers How do you describe fibroadenoma breast changes on an ultrasound? - Answer- Well-circumscribed, uniform round masses with thin pseudocapsule. How do you describe lipomas on an ultrasound? - Answer- Subtle echogenic masses with reticular patterns and a well-defined thin capsule. What is the cause of fibrocystic breast disease? - Answer- **MC caused by fluctuating estrogen levels during menstrual cycles. What are the risk factors for placental abruption? - Answer- 1. Previous Abruption 2. HTN 3. Cocaine Use 4. Trauma 5. Multiparity 6. Smoking What is PAINFUL vaginal bleeding, third trimester of pregnancy, with a history of HTN and smoking, and labs that show hypofibrinogenemia? - Answer- Placental Abruption What is the procedure called to correct a rectocele or cystocele? - Answer- Colporrhaphy What is the ***MC pathogen responsible for Mastitis? - Answer- 1. S. aureus. 2. S. viridans What are the ***MC symptoms of Mastitis? - Answer- Swollen / Painful / Red breast / Fever How do you manage mastitis? - Answer- 1. Continue Breastfeeding 2. Cool / Warm compress 3. ABX - Dicloxaxcillin 500mg QID Define Primary Dysmenorrhea - Answer- Crampy midline lower abdominal or pelvic pain during menses without another disease process. What causes primary dysmenorrhea? - Answer- Prostaglandins released from the endometrium at the beginning on menses causes intense uterine contractions. What are some common symptoms of dysmenorrhea - Answer- At what age does secondary dysmenorrhea normal start? - Answer- 25 or older What is Pelvic Congestion Syndrome (PCS)? - Answer- Common in women aged 20-45. (Often called *** Ovarian Reflux) When varicose veins develop around the ovaries, (Prevalence of 40% of chronic pain). What are symptoms of Pelvic Congestion Syndrome (PCS)? - Answer- 1. Pelvic pain that is worse as day goes on 2. Pain goes away after a night of rest 3. Pelvic or back pain often is worse in women who sit or stand all day. 4. Pain worse with intercourse 5. Pain after bicycling or horseback riding How do you diagnose and treat PCS or Ovarian Reflux? - Answer- 1. Trans-vaginal Ultrasound (Glod Standard) 2. TX: NSAIDs / Surgical Intervention What are common symptoms of Premenstrual Syndrome (PMS)? - Answer- Mood Swings / Irritability / Anxiety / Depressed Mood / Abdominal Bloating / Breast Pain / HA / Nausea / Fatigue How do you treat Premestrual Syndrome (PMS)? - Answer- 1. Decrease Caffine intake 2. exercise 3. stress reduction 4. NSIADs 5. SSRI's 6. OCP's What is the treatment for a first or second degree vaginal laceration with infection? - Answer- Debriding and leaving the wound open, pain management, and addition of antibiotics. What is the treatment for initial care of a perineal tear without complications? - Answer- Topical anesthetics, squirt bottle, and sitz bath. Define Menorrhagia - Answer- menses > 7 days or 60mL blood loss or ocurring < every 21 days Define Metrorrhagia - Answer- Bleeding at irregular times Define Menometrorrhagia - Answer- Heavy irregular vaginal bleeding Abnormal uterine bleeding - Answer- Abnormal vaginal bleeding due to anovulation Postcoital Bleeding - Answer- Vaginal bleeding after intercourse suggesting cervical pathology Postmenopausal bleeding - Answer- Any bleeding that occurs > 6 months after cessation of menses What is an endometrioma? - Answer- Benign adnexal mass caused by ectopic growth of endometrial tissue. What is a mature cystic teratoma? - Answer- (Dermoid Cyst) benign form cell tumor and the most common benign ovarian neoplasm in the second and third decades of life. What is an ovarian sex cord-stromal tumor? - Answer- Is a rare and heterogeneous group of benign malignant neoplasm growing from the cell which surround oocytes. A pelvic ultrasound that reveals a complex mass on the ovaries but does not reveal ascities indicates which two possible disorders? - Answer- Mature cystic teratoma / Endometrioma What are the symptoms of sex cord-stromal tumor? - Answer- 1. Average age of onset is 50 2. Excess estrogen levels 3. Hot flashes 4. Breast tenderness 5. Nausea What is the tumor marker for ovarian cancer? - Answer- CA 125 What are the symptoms for ovarian cancer? - Answer- 1. Vague gastrointestinal symptoms 2. Early satiety 3. Bloating 4. Dyspepsia How would you describe Fibrocystic breast changes on PE? - Answer- Dense breast tissue with rope-like texture and cobblestoning upon palpation with mild tenderness on deep palpation. What are the requirements for Methotrexate treatment in ectopic pregnancy? - Answer- 1. Hemodynamically Stable 2. No evidence of rupture 3. Ability and willingness to comply with post-treatment monitoring 4. Ectopic gestational sac < 4cm 5. No fetal cardiac activity on U/S What does HELLP syndrome stand for? - Answer- H - Hemolytic Enemia EL - Elevated Liver Enzymes LP - Low platelets What are Wickham striae? - Answer- White striae within involved areas or a serpentine white border classically found in lichen planus. What are the clinical sign and reported symptoms of atrophic vaginitis? - Answer- Vaginal Dryness / Postmenopausal women due to loos of estrogen / Dryness / burning / pruritus / dyspareunia / bleeding What are the PE findings of atrophic vaginitis (Genitourinary Syndrome of Menopause)? - Answer- Pale / Dry / Shiny Epithelium Where is a "chocolate" cyst located? - Answer- Endometriod (Old cyst filled with blood) What is the most common ovarian mass, it is nonneoplastic, and often regress spontaneously? - Answer- Follicular Ovarian Cysts What is the most common ovarian mass in pregnancy, it is nonneoplastic, and often regress spontaneously? - Answer- Corpus Luteum Cyst Which patients are at higher risk of developing breast abscesses? - Answer- 1. Lactating mothers who have untreated mastitis 2. Those with virulent complicated mastitis 3. Those with recurrent bouts of mastitis What are some factors that reduce the risk of endometriosis? - Answer- 1. Multiple Births 2. Extended intervals of lactation 3. Late menarche 4. Increased consumption of of Omega-3's 5. Regular exercise What are some factors associated with increased risk of endometriosis? - Answer- 1. Nulliparity 2. Prolonged exposure of endogenous estrogen (Early Menarche) 3. Heavy bleeding w. short cycles 4. Mullerian anomalies 5. Tall w. Low BMI 6. High trans unsaturated fats. At what week of gestation does transverse lie become a threat? - Answer- After 37 weeks gestation What is a Cervical Cerclage? - Answer- Procedure to stitch the cervix to prevent premature delivery or miscarriage. Stitch as close to the internal os as possible. When is a cervical cerclage appropriate? - Answer- Pregnant women between gestation age (12 - 14 weeks) who have a chart cervix , cervical insufficiency, or previous preterm labor. What position do you place the patient in with a prolapsed umbilical cord? - Answer- Trendelenburg position or Knee-To-Chest position What medical intervention do you give for a prolapsed umbilical cord? - Answer- Tocolytic terbutaline 0.25mg Subcutaneously What does tocolytic terbutaline do for a prolapsed umbilical cord? - Answer- It decreases uterine contractions which alleviates pressure on the cord What is the purpose of IM dexamethasone in a preterm labor. - Answer- Aids in fetal lung maturation What is the purpose of IV ampicillin during pregancy? - Answer- It is use in the presence of premature rupture of membranes (PROM) to reduce risk of infection What is the treatment for umbilical cord prolapse? - Answer- 1st line - Emergent C-section What breastfeeding practice is most likely to increase the risk of mastitis? - Answer- Long periods of time between feedings What are some of the major OCP contraindications? - Answer- 1. Age > 35 2. Cancer 3. Cirrhosis 4. Heart Disease 5. Hx of stroke or valvular disease 6. HTN 7. Migraine 8. Venous thromboembolism What anatomical structure denotes the transition of the pelvis to the lower limb? - Answer- Inguinal Ligament (Poupart's Ligament or Fallopian Ligament) What is an inguinal "Groove" sign? - Answer- Inflamed superficial and deep inguinal lymph nodes - Seen during Lymphogranuloma venereum. What pathogen is responsible for Lymphogranuloma venereum? - Answer- Chlamydia trachomatis serotype L1, L2 and L3. What is the pathophysiology of Lymphogranuloma venereum? - Answer- Lymphangitis which subsequently lead to areas of necrosis within the lymph nodes causes abscess formation. What are the three stage of Lymphogranuloma venereum? - Answer- Primary - 3 to 21 day incubation (Small, painless, transient genital lesions) Secondary - 7 to 30 days after primary lesion resolves. (Regional lymphadenitis - unilateral painful firm adenopathy) - Groove Sign Late - Fibrosis and strictures in the anogenital tract - infertility and genital elephantiasis What is the treatment for Lymphogranuloma venereum? - Answer- 1. Doxycycline 100mg PO BID x 21 days 2. Erythromycin 500mg QID x 21 days What is a FRANK breech presentation? - Answer- Hips flexed & knees extended. Feet adjacent to head. ****MC What is a COMPLETE breech presentation? - Answer- Both hips and knees flexed What is an INCOMPLETE breech presentation? - Answer- One of both hips not completely flexed presenting part may be buttock or one or both feet. What is the causative pathogen which causes a painful chancroid? - Answer- Haemophilus ducrey What are the four criteria needed to diagnose a chancroid? - Answer- 1. One or more painful genital ulcers 2. Negative polymerase chain reaction for herpes simplex 3. No evidence of Treponema pallidum on darkfield microscopy 4. Clinical sins and symptoms of chancroid What is the treatment for Chancroid? - Answer- Any of the following: 1. Azithromycin 1G PO 2. Ceftriaxone 250mg IM 3. Ciprofloxacin 500mg PO 4. COnsider emperic treatment for syphilis What is a bubo? - Answer- Fluctuant lymphadenitis associated with genital infections such as chancroid What four characteristics defines a normal menstrual cycle? - Answer- 1. Frequency 2. Regularity 3. Duration 4. Volume What does PALM-COEIN stand for regarding Abnormal Uterine Bleeding? - Answer- P - Polyp A - Adenomyosis L - Leiomyoma M - Malignancy / Hyperplasia C - Coagulopathy O - Ovulatory Dysfunction