CtC: Pre: Gyne
Which two cell types must be present on a Pap test for it to be considered adequate?
(Endocervical and sqaumous) exocervix (squamous cells) and the endocervical canal.
A 20-year-old female presents for routine gynecological care. Her mother has a history of endometriosis. What is the patient's chance of developing endometriosis?
A first-degree relative of a patient with endometriosis has a 7 percent chance of being affected.
A 47-year-old G3P3 female status post-tubal ligation presents for an annual exam with complaints of menorrhagia. On exam there is a palpable abdominal mass, which is firm and nontender. Pelvic exam shows an enlarged uterus measuring 16 cm above the pubic symphysis. Urine human chorionic gonadotropin (hCG) is negative. What is the most likely diagnosis?
A leiomyoma or fibroid uterus is the most likely cause of the pelvic mass associated with menorrhagia.
A 56-year-old G3P3 female presents with a palpable breast lump, which she found on breast self-exam 3 days ago. Her mammogram last year was normal. Her family history is negative for breast cancer. On exam there is a 3 × 3-cm firm mobile mass under the left nipple. No nipple discharge is noted. What is the most appropriate next step?
Because her last mammogram was last year, the first step should be a mammogram. The patient's age places breast cancer high in the differential diagnosis.
A 17-year-old girl is seen by her pediatrician for complaints of periodic lower abdominal pain that she attributes to stress. She notes it lasts 2 days and is associated with bloating and constipation. Her family history is positive for irritable bowel syndrome in her mother. Menarche has not occurred. The patient denies sexual activity. Her exam shows a well-nourished female, 5′7″ tall and weighing 135 lb. She is a Tanner stage 5. Pelvic exam shows normal external genitalia, but the cervix is not visible. Her urine human chorionic gonadotropin (hCG) is negative. Which would be the next best step?
D: refer to a gynecologist. The presence of amenorrhea in a 17-year-old girl with full sexual development warrants evaluation. The pain and absence of a visible cervix suggest a vaginal septum with the pain caused by a menstrual flow that is unable to exit the vagina.
A 27-year-old G0P0 female presents with a 6-month history of dysmenorrhea. She has been married for 3 years and has not been using birth control. Her pain is unresponsive to acetaminophen and ibuprofen, and she has been consistently missing work for the first 2 days of her period. Exam shows an anteverted, anteflexed uterus of normal size. There is no cervical motion tenderness. The rectovaginal exam shows some palpable firm nodules posterior to the cervix. What is the most likely diagnosis?
Dysmenorrhea and infertility are hallmarks of endometriosis, as is nodularity in the uterosacral ligament.
A 16-year-old female presents with primary amenorrhea. Physical exam is unremarkable. The patient is Tanner stage 3, with height 5′8″ and weight 140 lb. What is the most likely diagnosis?
Given her age and Tanner stage, the most likely diagnosis is constitutional delay, although a full evaluation should be done.
A 19-year-old G0 female presents with a breast lump that she found yesterday. Her mother was recently diagnosed with breast cancer at age 53 and is undergoing chemotherapy. Her maternal aunt developed breast cancer at age 48. On exam there is a 2 × 2-cm nontender mobile mass in the upper outer quadrant of the left breast. What is the most appropriate next step?
Given this patient's age, the most likely diagnosis is a fibroadenoma, a benign lesion. Ultrasound is the test of choice because mammograms in this age group are difficult to interpret because of breast tissue density.
Which of the following are risk factors for developing breast cancer?
Increased exposure to estrogen is hypothesized to increase the risk of breast cancer. Early menarche, nulliparity, and late menopause all increase the duration of estrogen exposure.
A 33-year-old G3P2 female presents with a year-long history of amenorrhea. She is sexually active and uses her husband's vasectomy as birth control. Her past medical history is significant for two normal spontaneous vaginal deliveries. She also had a miscarriage, which was treated with a dilation and curettage (D&C) last year. Her pelvic exam shows a normal-sized uterus and both ovaries are nontender and normal size. What is the most likely diagnosis?
Asherman's syndrome refers to scarring of the endometrium following a D&C for a miscarriage or abortion. The most common presentation is amenorrhea.
A 73-year-old African American female presents with vaginal bleeding. It is not severe and occurs only after intercourse. She is not taking hormone replacement therapy (HRT). What is the most likely diagnosis?
Atrophic vaginitis. Postmenopausal women who are not taking HRT often have bleeding after intercourse because of thinning of the vaginal walls in the absence of estrogen. The patient still must be further evaluated to rule out endometrial cancer.
A 22-year-old G0 female presents to the emergency department with abdominal pain that has been increasing for the past 3 days. She describes the pain as crampy with increased intensity with activity. She is sexually active and uses oral contraceptives for birth control. Her vital signs are temperature 101.3°F, blood pressure 134/78, pulse 84, and pain level 7/10. Her abdomen has normal bowel sounds with no masses or distention. She is tender in both lower quadrants with rebound tenderness and guarding. Pelvic exam shows normal external genitalia with a normal cervix. The uterus is normal sized with cervical motion tenderness and bilaterally tender adnexa. What is the best management of this patient? Normal values Pulse: 60-100 beats/minute Blood pressure: Systolic 90-120, diastolic 60-80 Temperature: 98.6°F
Inpatient, cefoxitin, clinda, gent. this patient has pelvic inflammatory disease (PID), which warrants inpatient therapy because her temperature is greater than 100.4°F and she has signs of peritonitis in the rebound and guarding. Given that she has not had children, preserving fertility with IV therapy is a goal. Treatment with IV cefoxitin alone does not provide the broad-spectrum coverage needed for PID.
What is a well-known potential side effect of tamoxifen?
It is associated with a six- to seven-fold increase in endometrial cancer.
Which of the following contraceptive methods offers the most protection against sexually transmitted diseases?
Latex condoms offer the most protection against sexually transmitted diseases in addition to protection against pregnancy.
A 25-year-old G1P1 female presents to the emergency department with right lower quadrant pain of 4 hours duration. On pelvic computed tomography (CT) scan, a tooth-shaped object is noted in an enlarged right ovary. What is the most likely diagnosis?
Mature teratomas or dermoid cysts contain the cell layers of tissue (ectoderm, mesoderm, and endoderm) and often contain differentiated structures from these layers such as bone, teeth, and hair. The other cysts are common in this age group but would not contain a tooth.
What does the term metrorrhagia refer to?
Metrorrhagia refers to bleeding that occurs at irregular intervals but that is not excessive.
What is the most common type of ovarian cancer in the United States?
Most ovarian cancers are of epithelial origin, and of those, serous carcinomas account for 40 percent to 50 percent of the ovarian epithelial carcinomas.
A 78-year-old G5P5 woman presents for a routine annual pelvic exam. She has noted some weight gain recently but has no other complaints. On exam, her abdomen is soft, nontender, and slightly obese with no palpable masses. Her liver span is 12 cm in the midclavicular line. She has a negative Murphy's sign. Her pelvic exam shows atrophic genitalia with a lack of rugation of the vaginal walls and a small, nontender, mobile uterus. Her left ovary is palpable, mobile, and nontender. The right ovary is not palpable. What physical finding is abnormal in this patient?
Palpation of an ovary raises the question of ovarian cancer, which should be ruled out in this patient.
A 57-year-old woman presents for a routine gynecological exam without any complaints. She has been menopausal since age 54. She does have a family history of breast cancer and her mammogram 2 months ago was normal. Review of systems reveals occasional spotting with intercourse. Her exam is unremarkable, and a transvaginal ultrasound shows an endometrial lining of 9 mm. What do you recommend?
Postmenopausal bleeding may present as postcoital bleeding and is the hallmark of endometrial cancer. Endometrial Biopsy
A 75-year-old woman presents with postmenopausal bleeding. Her endometrial biopsy shows well-differentiated endometrial cancer. What is the best treatment for her?
Removal of the uterus and both ovaries is the first step in staging the endometrial cancer.
A 28-year-old G1P1 female presents for evaluation of amenorrhea of 14 months duration. She delivered a baby 10 months ago by normal spontaneous vaginal delivery. Her pregnancy was complicated by gestational diabetes and a postpartum hemorrhage requiring several transfusions. She was unable to breastfeed, and her human chorionic gonadotropin (hCG) is negative. What is the most likely etiology for her amenorrhea?
Severe postpartum hemorrhage can cause hypotension, which may cause necrosis of the anterior pituitary gland and lead to postpartum panhypopituitarism, also known as Sheehan's syndrome.
After an episode of unprotected intercourse, when should emergency contraception be administered?
The first dose of emergency contraception should be administered within 72 hours.
What is the most common benign ovarian cyst of epithelial origin?
The most common benign type of ovarian tumor is epithelial, and of these, the serous type is the most common. It accounts for 50 percent to 70 percent of all benign ovarian neoplasms.
What is the normal pH of the vagina in reproductive-age women?
pH 3.5 to 4.0
For menopausal patients with symptomatic atrophic vaginitis, what is the treatment of choice?
treatment of choice is local application of estrogen to reduce the systemic risks of estrogen.