Women's Health EOR Exam Questions with 100% Correct Answers

In reproductive age _____% of neoplasms are benign Correct Answer 90% ---risk increases with age Most common benign ovarian neoplasm Correct Answer dermoid cystic teratomas Reasons to remove a benign cysts Correct Answer risk of torsion or malignant transformation Most common gynecological cancer Correct Answer endometrial Second most common gynecological cancer Correct Answer ovarian Highest mortality of all gynecological cancers Correct Answer ovarian Risk factors Correct Answer *fam hx = 7% lifetime risk* - increased # of ovulatory cycles (infertility, nulliparity, >50y, late menopause) - BRCA1/BRCA-2 - Peutz-Jehgers - Turner's syndrome Peutz-Jehgers Correct Answer Peutz-Jeghers syndrome (PJS) is an autosomal dominant inherited disorder characterized by intestinal hamartomatous polyps in association with a distinct pattern of skin and mucosal macular melanin deposition. Patients with Peutz-Jeghers syndrome have a 15-fold increased risk of developing intestinal cancer compared with the general population. Protective factors against ovarian CA Correct Answer - OCP's - high parity - total abdominal hysterectomy Clinical Manifestations Correct Answer - *rarely symptomatic until late in the stage--mets* - 40-60yo - abdominal fullness/distention - back or abdominal pain - early satiety - urinary frequency - irregular menses - menorhagia - postmenopausal bleeding - constipation (from intestinal compression) PE on Ovarian CA Correct Answer - palpable abdominal or ovarian mass (solid, fixed, irregular *+/- ascites* - sister mary joseph's node: mets the umbilical lymph nodes sister mary joseph's node Correct Answer Diagnosis: biopsy findings Correct Answer - 90% epithelial - germ cell in <30yo - transvaginal u/s useful screening in high-risk patients - mammography to look for primary in breast Management of ovarian CA Correct Answer - total hysterectomy + BSO + selective lymphadenectomy - surger: tumor debulking. *Serum CA-125 levels used to monitor treatment* - chemo: *paclitaxel (Taxol) + Cisplatin or Carboplatin. 3 elements of PCOS Correct Answer - ammenhoria (anovulation) - obesity - hirstuisism (androgen excess) PCOS is due to Correct Answer insulin resistance - exact mechanism unknown but abnormal function of hypothalamus-pituitary-ovarian axis leads to inc insulin, increase LH-driven, increase in ovarian androgen production Clinical manifestations of PCOS Correct Answer - menstrual irregularity (secondary amenorrhea or oligomenorrhea) - increase androgens: hirsutis, - insulin resistance: Type II DM, obesity, HTN Physical Exam of PCOS Correct Answer - bilateral enlarged, smooth, mobile ovaries on bimanual - acanthosis nigricans PCOS LH to FSH ratio Correct Answer > 3 to 1 (normally 1.5 to 1) What to exclude when suspecting PCOS Correct Answer - thyroid - pituitary adenoma (prolactin levels) - ovarian tumors - cushing's syndrome (dexamethasone suppression test) Lab findings in PCOS Correct Answer - incr testosterone - incr DHEA-S (intermediate of testosterone) Diagnosis of PCOS tests Correct Answer - GnRH agonist stimulation test: rise in serum hydroxyprogesterone