MCCQE1 Gynecology| 182 Questions| With
Complete Solutions
If there is labial fusion due to 21-hydroxylase deficiency what is
the treatment? what about if it is because androgen excesS?
correct answer: tx: if too much--> then d/c androgens, if due to
21 hydroxylase: cortisol + reconstructive surgery
How does vaginal atresia present correct answer: primary
amenorrhea + cyclic abdominal pain
Tx for vaginal agenesis? correct answer: surgery to creaste
neovagina with mcindoe procedure
Lichen sclerosis + atopic ecezema + lichen simplex chronicus
are all treated with correct answer: topical steroids. Note 10%
associated with cancer
Lichen planus ( purple paules) is treated with correct answer:
steroid suppository + surgery for adhesions
vulvar psoriasis is treated with correct answer: topical steroids
or UV lights
vaginal adenosis ( red sports in upper 1/3 of vagna) correct
answer: close f/u
atrophic vaginitis tx correct answer: topical estrogen
,epidermal inclusion cyst tx correct answer: I+D or excision if
infected
sebaceous cyst tx correct answer: I+D or excision
apocrine cyst tx correct answer: I+D or excision
gartner duct cyst tx correct answer: excision
What causes the pain associated with fibroids correct answer:
fibroid outgrows blood supply
Sx of leiomyomas? correct answer: menorrhagia, pelvic pain,
presusre
management of fibroids correct answer: leave alone if asx
temporary shrinkage w/ ↓E (progesterone, danazol, leuprolide)
Tx myomectomy if fertility desired
Tx hysterectomy (definitive)
Tx uterine artery embolization if bad surgical candidate
how do endometrial polyps present? correct answer: vaginal
bleeding between periods
mgmt of endometrial polyps correct answer: dx: pelvic
ultrasound and treatment is d/c + bx to r/o to cancer
Risk and protective factors for endometrial hyperplasia correct
answer: Risk factors: ↑E levels - unopposed E therapy (↑E w/o
P) tamoxifen use (weak E)
, obesity/HTN/DM (↑aromatase in fat cells) PCOS/chronic
anovulation (↑E w/o P) nulliparity (↑total cycles)
early menarche/late menopause (↑total cycles) granulosa cell
tumor (↑E synthesis)
Protective factors: COC/POP/combination HRT (↑P) multiparity
(↓total cycles)
diet and exercise (↓fat cells)
Endometrial hyperplasia tx correct answer: Management: Dx
endometrial bx or D+C → Tx progestins for 3 mo + repeat endo
bx; hysterectomy if complex/atypia
What is considered a high risk ovarian mass? correct answer:
premenerchal, postmenopausal, greater than 8cm or a mass that
persists >60 days. Tx ex lap for cancer
What is the difference between follicular cysts, corpus luteam
cysts, theca-lutein cyst, chocolate cyst, and PCOS? correct
answer: 1. Follicular cysts: MC ovarian cyst, due to unruptured
follicle, usually asx
2. Corpus luteum cysts: due to hemorrhage into persistent corpus
luteum, presents as dull abd pain (unruptured) or acute abdomen
(ruptured) M
3. Theca-lutein cysts: multiple/bilateral due to FSH/LH
stimulation; associated w/ moles and choriocarcinoma
4.Chocolate cysts: ovarian endometriosis
PCOS: enlarged ovaries w/ multiple subcortical cysts
Complete Solutions
If there is labial fusion due to 21-hydroxylase deficiency what is
the treatment? what about if it is because androgen excesS?
correct answer: tx: if too much--> then d/c androgens, if due to
21 hydroxylase: cortisol + reconstructive surgery
How does vaginal atresia present correct answer: primary
amenorrhea + cyclic abdominal pain
Tx for vaginal agenesis? correct answer: surgery to creaste
neovagina with mcindoe procedure
Lichen sclerosis + atopic ecezema + lichen simplex chronicus
are all treated with correct answer: topical steroids. Note 10%
associated with cancer
Lichen planus ( purple paules) is treated with correct answer:
steroid suppository + surgery for adhesions
vulvar psoriasis is treated with correct answer: topical steroids
or UV lights
vaginal adenosis ( red sports in upper 1/3 of vagna) correct
answer: close f/u
atrophic vaginitis tx correct answer: topical estrogen
,epidermal inclusion cyst tx correct answer: I+D or excision if
infected
sebaceous cyst tx correct answer: I+D or excision
apocrine cyst tx correct answer: I+D or excision
gartner duct cyst tx correct answer: excision
What causes the pain associated with fibroids correct answer:
fibroid outgrows blood supply
Sx of leiomyomas? correct answer: menorrhagia, pelvic pain,
presusre
management of fibroids correct answer: leave alone if asx
temporary shrinkage w/ ↓E (progesterone, danazol, leuprolide)
Tx myomectomy if fertility desired
Tx hysterectomy (definitive)
Tx uterine artery embolization if bad surgical candidate
how do endometrial polyps present? correct answer: vaginal
bleeding between periods
mgmt of endometrial polyps correct answer: dx: pelvic
ultrasound and treatment is d/c + bx to r/o to cancer
Risk and protective factors for endometrial hyperplasia correct
answer: Risk factors: ↑E levels - unopposed E therapy (↑E w/o
P) tamoxifen use (weak E)
, obesity/HTN/DM (↑aromatase in fat cells) PCOS/chronic
anovulation (↑E w/o P) nulliparity (↑total cycles)
early menarche/late menopause (↑total cycles) granulosa cell
tumor (↑E synthesis)
Protective factors: COC/POP/combination HRT (↑P) multiparity
(↓total cycles)
diet and exercise (↓fat cells)
Endometrial hyperplasia tx correct answer: Management: Dx
endometrial bx or D+C → Tx progestins for 3 mo + repeat endo
bx; hysterectomy if complex/atypia
What is considered a high risk ovarian mass? correct answer:
premenerchal, postmenopausal, greater than 8cm or a mass that
persists >60 days. Tx ex lap for cancer
What is the difference between follicular cysts, corpus luteam
cysts, theca-lutein cyst, chocolate cyst, and PCOS? correct
answer: 1. Follicular cysts: MC ovarian cyst, due to unruptured
follicle, usually asx
2. Corpus luteum cysts: due to hemorrhage into persistent corpus
luteum, presents as dull abd pain (unruptured) or acute abdomen
(ruptured) M
3. Theca-lutein cysts: multiple/bilateral due to FSH/LH
stimulation; associated w/ moles and choriocarcinoma
4.Chocolate cysts: ovarian endometriosis
PCOS: enlarged ovaries w/ multiple subcortical cysts
