Name that structure (Anatomy) | Working hard, but how? (Medications) | The Great Change (Menopause) and Osteoporosis | 50 Shades of Grayscale (Ultrasound Images) | Potpourri |
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Artery of Sampson
What is the vessel that runs beneath the round ligament?
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Preventing fertilization through inhibition of sperm
Your patients chooses a copper IUD for contraception. How does this work as contraception?migration/viability
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Assess for presence/absence of uterus, will dictate need for progesterone component. Estrogen +/- progestin is standard.
Your patient is having significant vasomotor symptoms and is interested in starting HRT. What HRT will you start her on and at what dose?
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Doxycycline (hydrosalpinges)
This patient is undergoing an HSG for her infertility work-up and this is the HSG finding. What medication should you prescribe for this patient?
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Provide reassurance, no treatment is indicated.
You saw a healthy 29yo G1P1 for her annual exam and routine cervical cancer screening. She is using Copper IUD for contraception and denies complaints with her menstrual cycle. Her recent cytology results indicate the presence of Actinomyces. What is the most appropriate management for this patient?
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Left renal vein
What venous structure does the left ovarian vein drain into?
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Lupron/leuprolide - GnRH agonist
You want to give a patient an injection to cease her AUB-L and shrink her uterine size in preparation for surgery - how does this medication work to achieve this?
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SNRIs/SSRIs, clonidine, gabapentin.
Bonus points (+100): if the patient did not have breast cancer, but was BRCA+, what would you recommend for treatment of vasomotor sx?
Your patient is having significant vasomotor symptoms and is interested in starting medication for this; she has a personal history of ER/PR+ breast cancer. What are her potential treatment options?
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FIGO grade 1 submucosal fibroid
This patient presented to the OGES with symptomatic anemia and abnormal uterine bleeding. Her exam reveals ongoing oozing from the cervical os and her ultrasound is pictured. What is FIGO classification for the structure seen in this image?
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Endometrial atrophy
A 56yo postmenopausal woman reports 2 episodes of light vaginal bleeding in the last month. Physical exam is unremarkable. Pelvic ultrasound notes regular-appearing endometrial stripe with thickness 3mm. What is the most likely cause of her bleeding?
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External iliac vein
When placing a lateral trocar during laparoscopy, what is the origin of the artery you are most worried about injuring?
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Antifibrinolytic - blocks lysine binding sites on plasminogen molecules, preventing plasminogen from binding with formed plasmin/fibrin, ultimately stabilizinng the formed fibrin meshwork (clot).
A patient comes in with acute AUB and you decide to treat her with tranexamic acid (TXA). What is the mechanism by which this medication works?
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Screen all postmenopausal pts over the age of 65. Earlier if they have risk factors for fracture.
Your patient has started to experience hot flashes and she tells you her mother had osteoporosis - when will you start screening this patient's bone mineral density?
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Mature cystic teratoma contains tissue from ectodermal, mesodermal and endodermal origin
Bonus points (+100): if this patient also had the finding of new hyperthyroidism on labs, what might be your diagnosis?
A patient presents to the OGES with acute onset LLQ pain and nausea/vomiting. What is the type of mass pictured here usually comprised of?
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Diagnostic laparoscopy with left ovarian cystectomy
A 19yo nulligravid woman presents with an 8h history of acute-onset, severe, intermittent left lower quadrant pain with nausea/vomiting. On exam, she has abdominal guarding with rebound tenderness to palpation on L side. US shows 7cm enlarged L ovary with loss of arterial/venous blood flow to L adnexa. Her HCG is negative. What is the next best step in management?
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Paravesical and pararectal spaces
If you were planning to ligate the uterine artery at its origin, what avascular spaces of the pelvis do you typically need to identify?
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Selective estrogen receptor modulator (SERM). Antiestrogenic effect on breast tissue, estrogenic effect on uterus.
Your patient is receiving tamoxifen for breast cancer from her Oncologist. What kind of drug class is this, and what is its effect on the uterus?
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1) Aerobic activity/weight-bearing exercise and 2) consume recommended daily allowance for vitamin D/calcium.
Your patient is worried about developing osteoporosis and asks you about strategies for prevention - how do you counsel this patient?
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Endometriosis/bilateral endometriomas
You are pre-opping a patient in Gyn D Clinic for her upcoming hysterectomy for chronic pelvic pain (CPP). She has known bilateral adnexal masses. Based on the ultrasound image, what is the most likely etiology for this patient's pain complaints?
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HCG
A 25yo G2P1 with dichorionic/diamniotic twins is noted to have bilateral, multiseptated cystic adnexal masses on early ultrasound. These cysts are most likely the result of unusually high serum levels of what hormone?
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Obturator internus
A patient is 2wks s/p transobturator (TOT) sling placement and complains of pain and difficulty with lateral rotation of her hip away from her body - what was most likely injured?
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Selective progesterone receptor modulator. Inhibits or delays ovulation.
Your patient is prescribed Ulipristal acetate for emergency contraception several days after having unprotected intercourse. How does this medicine work?
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Osteopenia. Should perform FRAX calculation to determine need for treatment.
Your patient undergoes a DEXA scan, and her T-score returns as -2.0. What is her diagnosis and treatment plan?
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Interstitial ectopic pregnancy
A patient presents to the OGES with RLQ pain and +UPT. Based on this ultrasound image, what is the suspected diagnosis?
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Myometrial cysts, heterogeneous myometrium, asymmetric myometrial thickness, subendometrial echogenic linear striations.
A patient presents to Gyn Clinic with AUB complaints and worsening pelvic pain since her last delivery. If the patient's ultrasound report notes suspected adenomyosis, what signs would you expect to see on imaging to make this diagnosis?
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