OB CMS questions

[ShahRukhKhan]

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Hi guys,

Tried searching through some threads/online but wasn't finding an answer. This is from ob cms form 1:

1) 32 y/o woman w/ 2 month history right-sided pelvic pain. Pain severe during menses. LMP 3 weeks ago. Exam shows tenderness to palpation and fullness in right adnexa. Ultrasound shows 5cm simple cyst on right adnexa. She's anxious to pay for treatment. Best next step?
a)reassurance + followup
b) contraceptivs and repeat pelvic exam in 6 weeks

-simple cyst makes me think reassure but the cyst being symptomatic is whats throwing me off. Online search points to B but onlinemeded says ocp's arent used anymore.

2) 47 y/o woman w/ left breast lump. Started estrogen therapy 3 months ago at which time mammorgram was normal. left UOQ mobile, cyst like structure noted. next best step?
a) repeat mammo
b) decrease estrogen dose
c) stop therapy
d) FNA
e) excision cyst

-online search is pointing to D but im confused on this. Uptodate states that mammogram is best imaging study performed even if recent mammogram was negative.

clarification on both of these would be great! thanks so much.

 

[byaaaaaaah23]

Not sure for the first one, but for the second I would FNA. No point in repeating mammogram pretty much ever. Wouldn't change therapy without diagnosing this first. And I would never excise prior to FNA.