Gynecology
Core concepts
Gynecology questions test pattern recognition across the menstrual cycle, abnormal uterine bleeding, pelvic masses, and gynecologic oncology. Know the PALM-COEIN classification for abnormal uterine bleeding and when endometrial sampling is mandatory (e.g., any postmenopausal bleeding, and abnormal bleeding in women over 45). Understand the evaluation of an adnexal mass by menopausal status, ultrasound features, and CA-125 - and its limits. Be fluent in cervical cancer screening and management (cytology, HPV co-testing, colposcopy thresholds) and in the staging and initial management of endometrial and ovarian cancer. Contraception counseling, including contraindications per condition (migraine with aura, smoking over 35, hypertension), is high-yield. Also review vulvovaginitis differentials and sexually transmitted infection treatment.
Traps
Common pitfalls: (1) ordering CA-125 as a screening test in average-risk women - it is not validated for screening; (2) missing that postmenopausal bleeding always warrants endometrial evaluation regardless of how scant; (3) confusing simple vs. complex endometrial hyperplasia and their progression risk; (4) recommending surgery for an asymptomatic simple ovarian cyst in a premenopausal woman when observation is appropriate; (5) forgetting that cervical cancer screening intervals differ by modality and age.
Worked example / rule of thumb
A 58-year-old with a single episode of vaginal spotting has a 4-mm endometrial stripe on transvaginal ultrasound. Postmenopausal bleeding with a thin stripe still warrants tissue sampling in most algorithms; a stripe ≤4 mm has high negative predictive value but does not replace clinical judgment when bleeding is recurrent. Rule of thumb: any postmenopausal bleeding gets evaluated - ultrasound first, then biopsy if the stripe is thick or bleeding persists.