Obstetrics and Gynecology Flashcards

A 19-year-old sexually active woman presents with mucopurulent cervical discharge, cervical motion tenderness, and bilateral adnexal tenderness. She has no IUD. Per current CDC guidelines, what is the recommended outpatient treatment for pelvic inflammatory disease?

Answer: Ceftriaxone 500 mg IM once + doxycycline 100 mg PO BID x 14 days + metronidazole 500 mg PO BID x 14 days

CDC guidelines recommend ceftriaxone (for gonorrhea) plus doxycycline (for chlamydia) plus metronidazole (for anaerobes/BV) for outpatient PID treatment.

A 52-year-old woman reports urine leakage with coughing, sneezing, and exercise. Pelvic exam is normal. Urodynamic testing confirms stress urinary incontinence. What is the most appropriate initial management?

Answer: Pelvic floor muscle training (Kegel exercises)

Pelvic floor muscle training is the first-line conservative therapy for stress urinary incontinence, with strong evidence for improving urethral sphincter function.

A 65-year-old postmenopausal woman presents with a bulge protruding from her vagina, urinary frequency, and difficulty with defecation. Exam shows the uterus and anterior vaginal wall descending below the hymenal ring. What is the diagnosis?

Answer: Uterine prolapse with anterior vaginal wall defect (cystocele)

Descent of the uterus and anterior vaginal wall beyond the introitus with bladder symptoms represents uterine prolapse with an associated cystocele.

A 23-year-old woman presents with 3 months of secondary amenorrhea. She is not pregnant; TSH and prolactin are normal; serum FSH and LH are low. She has lost 14 lbs while training intensively for a marathon. What is the most likely diagnosis?

Answer: Functional hypothalamic amenorrhea

Low gonadotropins with amenorrhea in the setting of excessive exercise and weight loss indicates functional hypothalamic amenorrhea due to suppressed GnRH pulsatility.

A 17-year-old girl has cyclic pelvic pain each month but has never had menstrual flow. She has normal breast development and pubic hair. Exam reveals a bluish, tense, bulging membrane at the vaginal introitus. What is the diagnosis?

Answer: Imperforate hymen with hematocolpos

Imperforate hymen causes hematocolpos (accumulated menstrual blood), presenting as cyclic pain without external bleeding and a characteristic bluish bulging membrane at the introitus.

A 45-year-old woman has menorrhagia and a uterus enlarged to 12-week size with an irregular contour. Ultrasound shows multiple intramural hypoechoic masses consistent with fibroids. She strongly desires uterine preservation. What is the best surgical treatment option?

Answer: Abdominal myomectomy

Myomectomy (surgical excision of fibroids while preserving the uterus) is the surgical treatment of choice when uterine preservation is desired.

A 60-year-old postmenopausal woman has a 2-year history of vulvar pruritus. Exam shows white, atrophic, crinkled plaques. Biopsy shows epidermal thinning with a band of homogeneous collagen (sclerosis) in the upper dermis. What is the diagnosis?

Answer: Lichen sclerosus

Lichen sclerosus is characterized by white atrophic plaques and the pathognomonic biopsy finding of epidermal thinning with a homogeneous sclerotic (hyalinized) collagen band in the dermis.