MCCQE1 Gynaecology Questions and Answers(A+ Solution guide)

If there is labial fusion due to 21-hydroxylase deficiency what is the treatment? what about if it is because androgen excesS? - Answer-tx: if too much-- then d/c androgens, if due to 21 hydroxylase: cortisol + reconstructive surgery How does vaginal atresia present - Answer-primary amenorrhea + cyclic abdominal pain Tx for vaginal agenesis? - Answer-surgery to creaste neovagina with mcindoe procedure Lichen sclerosis + atopic ecezema + lichen simplex chronicus are all treated with - Answer-topical steroids. Note 10% associated with cancer Lichen planus ( purple paules) is treated with - Answer-steroid suppository + surgery for adhesions vulvar psoriasis is treated with - Answer-topical steroids or UV lights vaginal adenosis ( red sports in upper 1/3 of vagna) - Answer-close f/u atrophic vaginitis tx - Answer-topical estrogen epidermal inclusion cyst tx - Answer-I+D or excision if infected sebaceous cyst tx - Answer-I+D or excision apocrine cyst tx - Answer-I+D or excision gartner duct cyst tx - Answer-excision What causes the pain associated with fibroids - Answer-fibroid outgrows blood supply Sx of leiomyomas? - Answer-menorrhagia, pelvic pain, presusremanagement of fibroids - 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? - Answer-vaginal bleeding between periods mgmt of endometrial polyps - Answer-dx: pelvic ultrasound and treatment is d/c + bx to r/o to cancer Risk and protective factors for endometrial hyperplasia - 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 - 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? - Answer-premenerchal, postmenopausal, greater than 8cm or a mass that persists 60 days. Tx ex lap for cancer