OBGYN #6 (Current)

Question 1

Polycystic Ovarian Syndrome is also known as Stein-Leventhal Syndrome. What is the pathophysiology of this syndrome?

Answer 1

• Increased LH leads to increased testosterone production

- Decreased FSH production leads to follicular degeneration and bilateral cystic ovaries

Question 2

Symptoms of PCOS

Answer 2

• Menstrual dysfunction
• Increased androgen: hirsutism
• Insulin resistance: DMII, obesity, hypertension, acanthosis nigracans

Question 3

What are the ovaries like in PCOS?

Answer 3

Bilaterally enlarged, smooth and mobile

Question 4

What do labs for PCOS show?

Answer 4

Increased testosterone

Increased LH: FSH ratio (3:1)

Question 5

On pelvic US, what is shown with PCOS?

Answer 5

Multiple ovarian cysts (string of pearls sign)

Question 6

Management of PCOS

Answer 6

• Lifestyle modifications: diet, exercise, weight loss
• Combination OCP
• Spironolactone if persistent after OCP

Question 7

What cancer is associated with the highest mortality of all gynecologic cancers?

Answer 7

Ovarian Cancer

Question 8

Risk factors for ovarian cancer

Answer 8

• Increased number of ovulatory cycles (nulliparity, early menarche, late menopause)
• BRCA1 and BRCA2
• Caucasian

Question 9

Symptoms of ovarian cancer

Answer 9

• Rarely symptomatic until late in disease course (METS)
• Increasing abdominal girth + weight loss
• Early satiety
• Irregular menses
• Postmenopausal bleeding

Question 10

Initial test of choice for ovarian cancer

Answer 10

Pelvic US

Question 11

Other diagnostics for ovarian cancer

Answer 11

Baseline CA-125 levels
CT scan for staging
Pap smear
Colonoscopy

Question 12

What type of ovarian cyst is MC

Answer 12

Follicular cyst

Question 13

A transvaginal US is used to evaluate an ovarian cyst. However, what does a benign ovarian cyst look like?

Answer 13

Anechoic, unilocular fluid-filled

Question 14

Management if the ovarian cyst is < 8 cm

Answer 14

Supportive: most < 8 cm are functional and spontaneously resolve
Repeat US after 1-2 cycles

Question 15

If the cyst is more than 8 cm or if the patient is postmenopausal, what are the options for treatment?

Answer 15

Laparoscopy or laparotomy

Question 16

Adenomyosis is

Answer 16

Islands of endometrial tissue in the myometrium (muscular layer of uterine wall)

Question 17

What is seen on physical exam of a person with adenomyosis?

Answer 17

Symmetrically enlarged boggy uterus (may be tender)

Question 18

What is the only therapy for a patient with adenomyosis?

Answer 18

Total abdominal hysterectomy

Question 19

What is the MC benign gynecologic tumor?

Answer 19

Leiomyoma

Question 20

Leiomyomas are 5x more common in

Answer 20

African Americans

Question 21

Growth of a leiomyoma is _____ and therefore, may increase in size in relation to the menstrual cycle but regress after menopause

Answer 21

estrogen dependent

Question 22

A transvaginal US is the MC modality used to assess a leiomyoma, and most are ok with just being observed. However, what other treatments exist?

Answer 22

• Hysterectomy is the definitive treatment

- Myomectomy if fertility is desired

Question 23

Average age of menopause in the US

Answer 23

50-52 years old

Question 24

Symptoms of menopause

Answer 24

-Estrogen deficiency (hot flashes, sleep disturbances, mood changes, osteoporosis, dyspareunia, vaginal atrophy, urinary incontinence)

Question 25

Most sensitive and initial test for menopause

Answer 25

``` FSH assay ( > 30) -Increased LH and decreased estrogen ```

Question 26

Treatment for menopause if no uterus and if there is a uterus present

Answer 26

No uterus: Estrogen only | Uterus present: Estrogen + Progestin

Question 27

Explain what premenstrual syndrome is

Answer 27

Symptoms occurring 1-2 weeks before menses (luteal phase) and relieved within 2-3 days of onset of menses -Plus 7 symptom free days during follicular phase at least

Question 28

Treatment for PMS

Answer 28

- Stress reduction and exercise (most beneficial) - NSAIDS, Vitamin B6 And E - SSRI are first line - OCP's if they do not want to take SSRI

Question 29

What are the movements of labor, in order (EDFIEE)

Answer 29

``` Engagement Descent Flexion Internal Rotation Extension External Rotation ```

Question 30

What is gestational trophoblastic (molar pregnancy)

Answer 30

Neoplasm due to placental development with trophoblastic tissue (not maternal in origin)

Question 31

A complete molar pregnancy is (______) and occurs when

Answer 31

Diploid 46XX All paternal chromosomes lead to absence of fetal tissue. Empty egg with no DNA that is fertilized by 1 or 2 sperm

Question 32

A partial molar pregnancy (____) is characterized by

Answer 32

Triploid 69XXX or XXY An egg is fertilized by 2 sperm. Not viable.

Question 33

Physical exam findings of a patient with molar pregnancy

Answer 33

Uterine size and date discrepancies

Question 34

A pelvic US for molar pregnancy shows

Answer 34

central heterogenous mass with multiple discrete anechoic spaces (snowstorm or cluster of grapes)

Question 35

Beta hCG is _____ with a complete molar pregnancy

Answer 35

markedly elevated

Question 36

Mainstay of treatment for molar pregnancy

Answer 36

Surgical uterine evacuation as soon as possible

Question 37

What should you also do if the patient has a molar pregnancy?

Answer 37

Obtain chest radiographs to look for METS (Choriocarcinoma)