CURRENT DIAGNOSIS AND TREATMENT
OBSTETRICS AND GYNECOLOGY ALAN
COMPREHENSIVE STUDY QUESTIONS AND
ANSWERS
◉ What is the cause of injury in ovarian torsion?
Answer: Twisting leading to obstruction of VENOUS and lymphatic
flow → congestion → edema and ischemia// Arterial obstruction is
rare 2/2 dual blood supply.
◉ What is the most common finding on US with ovarian torsion?
Answer: MC: Ovarian enlargement// Other findings: loss of
echogenicity, pelvic free fluid, diminished blood flow
◉ What is the most common type of ovarian cyst?
Answer: Simple follicular cysts that are thin walled and fluid filled.
// Present in first 2 weeks of the menstrual cycle.
◉ What is the most likely type of ovarian cyst to bleed?
Answer: Corpus luteal cyst// Present in the last 2 weeks of the
menstrual cycle. It can cause significant hemorrhage.
,◉ What is the next step in management if you have high suspicion
for ovarian torsion but a normal ultrasound?
Answer: OB/Gyn consult for laparoscopy (gold standard)
◉ Diagnosis: Vaginal bleeding in postmenopausal woman
Answer: Gynecologic cancer until proven otherwise// Will need
outpatient TVUS and endometrial biopsy.
◉ What type of cancer is CA-125 a marker for?
Answer: Ovarian
◉ Classic presentations for ovarian, endometrial, and cervical
cancers
Answer: Ovarian: age 50s-60s, gradual subacute abd pain,
abdominal distention (ascites), CA-125+// Endometrial: vaginal
bleeding in postmenopausal women// Cervical: h/o HPV or HIV,
postcoital bleeding, abnormal cervix on pelvic exam
◉ What is the age range for administering the HPV vaccine?
Answer: 9-26 yrs
◉ What are the most common causes of vaginal bleeding in
prepubertal female?
, Answer: Vaginitis, anovulation, trauma or foreign body (malodorous
and slightly bloody)// **Consider vaginal foreign body (usually
toilet paper) in young girl who just started school and has bloody
foul smelling discharge.
◉ What are the most common causes of vaginal bleeding in
reproductive age female?
Answer: Menses, pregnancy, anovulation// Less likely fibroids,
exogenous hormones
◉ What are the most common causes of vaginal bleeding in
perimenopausal women?
Answer: Anovulation, fibroids, cervical and endometrial polyps,
thyroid dysfunction
◉ What are the most common causes of vaginal bleeding in
postmenopausal women?
Answer: Endometrial cancer, exogenous hormones, atrophic
vaginitis
◉ What are potential medications for non-pregnant vaginal
bleeding?
Answer: Mild/Moderate: combined OCP's, Progesterone, NSAIDs//
Severe: IV premarin (estrogen), TXA
OBSTETRICS AND GYNECOLOGY ALAN
COMPREHENSIVE STUDY QUESTIONS AND
ANSWERS
◉ What is the cause of injury in ovarian torsion?
Answer: Twisting leading to obstruction of VENOUS and lymphatic
flow → congestion → edema and ischemia// Arterial obstruction is
rare 2/2 dual blood supply.
◉ What is the most common finding on US with ovarian torsion?
Answer: MC: Ovarian enlargement// Other findings: loss of
echogenicity, pelvic free fluid, diminished blood flow
◉ What is the most common type of ovarian cyst?
Answer: Simple follicular cysts that are thin walled and fluid filled.
// Present in first 2 weeks of the menstrual cycle.
◉ What is the most likely type of ovarian cyst to bleed?
Answer: Corpus luteal cyst// Present in the last 2 weeks of the
menstrual cycle. It can cause significant hemorrhage.
,◉ What is the next step in management if you have high suspicion
for ovarian torsion but a normal ultrasound?
Answer: OB/Gyn consult for laparoscopy (gold standard)
◉ Diagnosis: Vaginal bleeding in postmenopausal woman
Answer: Gynecologic cancer until proven otherwise// Will need
outpatient TVUS and endometrial biopsy.
◉ What type of cancer is CA-125 a marker for?
Answer: Ovarian
◉ Classic presentations for ovarian, endometrial, and cervical
cancers
Answer: Ovarian: age 50s-60s, gradual subacute abd pain,
abdominal distention (ascites), CA-125+// Endometrial: vaginal
bleeding in postmenopausal women// Cervical: h/o HPV or HIV,
postcoital bleeding, abnormal cervix on pelvic exam
◉ What is the age range for administering the HPV vaccine?
Answer: 9-26 yrs
◉ What are the most common causes of vaginal bleeding in
prepubertal female?
, Answer: Vaginitis, anovulation, trauma or foreign body (malodorous
and slightly bloody)// **Consider vaginal foreign body (usually
toilet paper) in young girl who just started school and has bloody
foul smelling discharge.
◉ What are the most common causes of vaginal bleeding in
reproductive age female?
Answer: Menses, pregnancy, anovulation// Less likely fibroids,
exogenous hormones
◉ What are the most common causes of vaginal bleeding in
perimenopausal women?
Answer: Anovulation, fibroids, cervical and endometrial polyps,
thyroid dysfunction
◉ What are the most common causes of vaginal bleeding in
postmenopausal women?
Answer: Endometrial cancer, exogenous hormones, atrophic
vaginitis
◉ What are potential medications for non-pregnant vaginal
bleeding?
Answer: Mild/Moderate: combined OCP's, Progesterone, NSAIDs//
Severe: IV premarin (estrogen), TXA
