Office Gynecology: A Case-Based Approach
Proposed Table of Contents
Pelvic Pain
1. A 27 year old with recurrent visits for severe pelvic pain (evaluation and management of drug seeking; please
cover prescription registries)
2. A 25 year old with deep dysparunia (evaluation and management of levator spasm)
work-up)
entrapment)
5. A 26 year old with chronic pelvic pain and negative work-up (long term management)
6. A 30 yo with endometriosis with worsening pelvic pain despite continuous oral contraceptives (evaluation
and management, please discuss GnRH with add back)
of Adenomyosis)
Vaginal discharge and sexually transmitted infections
1. A 22 year old woman whose partner told her he was treated for gonorrhea (eval and management of
2. A 28 year old woman with metronidazole allergy and trichmonas infection (evaluation and management)
3. A 24 year old woman with mucopurulent cervicitis (evaluation and management including empiric treatment)
4. A 27 year old woman with trichomonas requesting a prescription for her partner (partner treatment including
state issues, resources for determining local rules)
5. A 33 year old woman with multiple visits for vaginal discharge and itching (evaluation and management of
recurrent vulvovaginal candidiasis)
6. A 24 year old with trichomonas in the first trimester of pregnancy (management, screening of high risk women
7. A 16 year old requesting confidential treatment for chlamydia exposure (states law regarding minors and
8. A 75 year old female complaining of greenish discharge (evaluation and management of atrophic vaginitis)
Amenorrhea and abnormal vaginal bleeding
1. A 32 year old woman with friable cervix (evaluation and management - focus on symptom relief when
2. A 26 year old with new onset postcoital bleeding (evaluation and management if initial eval shows cervicitis
3. A 28 year old with secondary amenorrhea and a family history of mental retardation (evaluation and
management of fragile x premutation)
4. A 27 year old runner with secondary amenorrhea (evaluation and management of hypothalamic amenorrhea)
5. A 38 year old with secondary amenorrhea 6 months after gastric bypass (pregnancy- focus resumption of
fertility after weight correction and issues in pregnancy)
6. A 25 year old with Mirena IUD, with new onset spotting and positive pregnancy test (management of
7. A 30 year old with irregular periods (eval and management of new diagnosis of hypothyroidism)
8. A 25 year old female reports midcycle spotting (eval and management when eval shows structural lesion:
endometrial polyp or septum)
Contraception and abortion
1. A 25 year old with no IUD string visible one year after placement (evaluation and management of IUD in
2. An HIV positive woman requesting oral contraceptive pills (counseling, discussion of drug interactions, MEC
3. A 42 year old woman with IUD and actinomyces on cervical cytology (eval and management)
4. A 25 year old woman with a history of pulmonary embolism on OCPs who desires contraception
5. A pregnant 22 year old who desires long-acting postpartum birth control (immediate postpartum LARC)
6. A 19 year old with nonpalpable contraceptive implant desiring removal (management)
7. A 24 year old with contraceptive implant placed 3 weeks ago presents with positive pregnancy test
8. An HIV positive woman requesting IUD (management)
9. A 23 year old presents 2 hours after sexual assault (evaluation and management)
10. A 35 year old woman BMI of 40 presents requesting oral contraceptive pills (efficacy of contraceptive
Breast problems
1. A 41 year old woman with bilateral clear nipple discharge (evaluation and management of physiologic
2. A 42 year old with palpable mass and normal mammogram (evaluation and management)
3. A 38 year old woman with new onset unilateral bloody nipple discharge (evaluation)
4. A 34 year old newly pregnant patient with a breast mass (breast cancer) (evaluation of breast mass in
pregnancy, initial cancer counseling)
5. A 29 year old woman with lacational mastitis and persistent fevers and erythema 48 hours after initiating
antibiotic therapy (abscess eval and management)
6. A 46 year old with pain, pruritis and an ulcerative lesion on her nipple (eval and management of Paget's
7. A 45 yo with unilateral green nipple discharge (eval of nipple d/c, management of duct ectasia)
8. A 35 yo with complaints of cyclic breast pain (evaluation and management of idiopathic mastodynia)
Cancer screening and prevention
1. A 22 year old with LSIL on initial cytology (counseling, management)
2. A 25 year old woman who has received a letter from an aunt recommending Lynch testing (cascade testing)
3. A 30 year old woman with positive margins on LEEP for HSIL (management)
4. A 25 year old woman whose mother is a known BRCA2 carrier (counseling, testing, management of positive,
negative tests and pt declining testing)
5. A 32 year old woman whose paternal aunt and grandmother had ovarian cancer (evaluation, management)
6. A 21 year old woman with a history of chest irradiation for lymphoma inquires about cancer screening
7. A 23 year old with HSIL on cytology (counseling, management)
8. A 32 year old with strong family history of breast cancer not linked to BRCA mutation (high risk beast cancer
9. A 25 year old with LSIL desiring HPV vaccination (counseling, management)
Vulvar disease
1. A 55 year old with white itchy lesion on vulva (eval of white lesions, initial management of lichen sclerosis)
2. A 55 year old with a new wart (eval of new onset lesions in older women, management of vulvar HSIL)
3. A 25 year old with perineal pain and inability to have intercourse (eval and management of vestibulodynia)
4. A 30 year old with new vulvar lesions (eval and initial management of condyloma accuminata)
5. A 50 year old with lichen sclerosis and fused labia with UTIs (complications of lichen sclerosis and
management of recalcitrant disease)
6. A 25 year old with recurrent candida vaginitis (eval and management of recurrences)
7. A 35 year old woman complaining of a "knot" in the vulva (evaluation and management of Bartholin's Cyst)
8. A 26 year old female with painful urination, lympthadenopathy, and multiple painful lesions on labia minora
and major (evaluation and management of first episode herpes)
Infertility
1. A couple with Medicaid and no conception after 2 years (cost conscious infertility evaluation)
2. A 33 year old with infertility (initial eval, counseling if bilateral hydrosalpinx found)
3. A 36 year old with prior BTL desiring another pregnancy (counseling)
4. A 26 year old with irregular menses and infertility (PCOS) (fertility related eval, management- do not go into
5. A 24 year old with requiring bone marrow transplant who desired fertility preservation (counseling)
6. A 32 yo with a 3 cm endometrioma and infertility (counseling, management)
7. A 32 year old G3P0A3 who presents for evaluation after recurrent pregnancy loss (evaluation)
Preconception planning
1. A couple planning pregnancy who just returned from Brazil (counseling and eval for Zika)
2. A 26 year old with a history of depression planning pregnancy (counseling, management)
3. A 25 year old with a history of DVT presents for preconception counseling (evaluation, management)
4. A woman with a family history of muscular dystrophy planning pregnancy (counseling, testing)
5. A 25 year old Ashkenazi Jewish woman who desires pregnancy (counseling, testing)
6. A 32 yo with HIV, viral load undetectable, desires pregnancy (counseling, evaluation)
7. A 40 year old with chronic hypertension on altenolol planning pregnancy (age and hypertension preconception
counseling, evaluation)
8. A 30 year old with history of diabetes controlled on oral agents planning pregnancy (counseling, evaluation)
Pediatric and adolescent problems
1. An 18 year old referred for HSIL on an inappropriately performed cytology (counseling, management, correct
3. A 14 year old with large labia (labial hypertrophy counseling and management)
4. A 16 year old with acne, hirsutism, and irregular menses (PCOS initial evaluation, counseling and
5. An 8 year old with persistent vulvar itching (lichen sclerosis eval and management - limit to childhood)
6. A 4 year old with recurrent vulvar discharge and itching (evaluation and management of non-specific
7. A 12 year old with painful vulvar ulcers (evaluation and management of Lipschutz ulcer)
8. A 6 year old with vaginal bleeding (evaluation and management of urethral prolapse in child)
9. A 15 year old who is unable to use a tampon (evaluation and management septate hymen)
10. A 6 year old girl with breast development (precocious puberty evaluation)
11. A 15 year old with primary amenorrhea (gonadal dysgenesis evaluation and management)
13. 13 year old with primary menorrhea and cyclic abdominal pain. (imperforate hymen evaluation and
14. 17 year old female with secondary amenorrhea (anorexia diagnosis and management)
Pelvic masses and cysts
1. A 53 year old with 3 cm dermoid noted as incidental finding on CT (evaluation and management)
2. A 10 year old with vaginal spotting and a pelvic mass (eval of bleeding in 10 yo, management of granulosa cell
3. A 60 year old with a 4cm simple ovarian cyst (evaluation and management)
4. A 25 yo with a 2 cm simple asymptomatic cyst noted incidentally on ultrasound (evaluation and management)
5. A 25 year old with endometriosis with a 4 cm endometrioma (evaluation and management)
6. A 60 year old with a complex 4 cm cyst (evaluation and management)
7. A 25 year old with abrupt onset of pelvic pain, nausea and vomiting, and adnexal mass (torsion evaluation and
8. A 30 year old with fever, abdominal pain, vaginal discharge and adnexal mass (tubo ovarian abscess
9. A 45 year old who complains of pelvic pain one year after TLH/BSO for endometriosis (ovarian remnant
10. A 21 year old G1 at 5 weeks EGA with left lower quadrant pain (PUL evaluation )
11. A 21 year old G1 at 5 weeks EGA with right lower quadrant pain (ruptured corpus luteum cyst evaluation and
Incontinence and prolapse
1. A 30 year old 6 weeks after vaginal delivery with flatal incontinence (evaluation and initial management)
2. A 46 year old with leakage of urine (stress urinary incontinence- evaluation and initial management)
3. A 50 year old with microscopic hematuria and negative urine culture (evaluation)
4. A 55 year old with urinary urgency and negative urinalysis and culture (urge incontinence- evaluation and
5. A 30 year old with frequency, urgency, nocturia and pressure relieved by urination, no infection (painful
bladder syndrome- evaluation and initiial management)
6. A 25 year old with recurrent urinary tract infections (evaluation and management)
8. An 80 year old with total procidentia presenting with vaginal irritation (evaluation and initial management)
9. A 60 year old presents with difficulty with defecation (posterior wall defect- evaluation and initial
Behavioral, sexual, and social health
1. A 25 year old with recurrent STDs (human trafficking victim- evaluation and referral)
2. A 41 year old with loss of interest in having sex (evaluation and management)
3. A 28 year old transgender woman requesting Well Woman Visit (evaluation and management)
4. A 35 year old female to male transgender with vaginal spotting on testosterone (evaluation and management)
5. A 23 year old female who reports inability to consumate her marriage due to vaginal pain (vaginismus due to
sexual abuse- evaluation and management)
6. A tearful 32 year old two weeks requesting sleeping aid two weeks after delivery (postpartum depressionMenopause and aging
1. A 50 year old breast cancer survivor with severe hot flashes (management)
2. A 56 year old with dyspareunia (vulvovaginal atrophy- management)
3. A 60 year old with FRAX score of 10% probability of osteoporotic fracture (evaluation and management)
4. A 45 year old with menses every 60-90 days and hot flashes (using oral contraceptives in perimenopausal
5. A 70 year old victim of elder abuse (management)