A. Congenital Lesions

The student will be able to:

1. Describe the diagnostic features and significance of:

- imperforate hymen

- anomalies of Mullerian tract development, both vaginal and uterine

2. Gonadal dysgenesis (XO and XY karyotype, mosaic)

3. Define the following terms;

- cryptomennorrhea

- hematometra

- hematosalpinx

- hematocolpos

- transverse and sagittal vaginal septum

- uterus didelphys

- septate uterus

- bicornuate uterus

4. List the causes for an undervirulized male and a virulized female newborn.

B. Inflammatory Lesions

I. Lower genital tract lesions

1. Cervix:

The student will be able to:

1. List the causes of a mucopurulent discharge.

2. Describe the normal variations in the appearance of the cervix.

3. Describe the methods of obtaining appropriate cultures in cases of mucopurulent discharge of the cervix.

4. Outline the management of mucopurulent discharge due to:

- chlamydia

- gonorrhea

- ureaplasma urealyticum

- ectropion.

2. Vagina:

The student will be able to:

1. Describe the physiologic causes of vaginal discharge.

2. Obtain a history for a patient presenting with vaginal discharge, and describe the appropriate physical examination and laboratory examination to establish the diagnosis including the use of saline and potassium hydroxide wet preparations.

3. State the significance of the odor, color, mucosal appearance and pH of vaginal discharge to determine diagnosis.

4. Outline the investigations and therapy for;

- bacterial vaginosis

- Trichomonas vaginitis

- yeast vaginitis

- human papilloma virus vaginal infections

- herpes

- syphilis

- foreign bodies

- atrophic vaginitis

- prepubertal vulvovaginitis

3. Vulva:

The student will be able to:

1. Describe the appropriate history and physical examination for a patient presenting with vulvar symptoms or signs.

2. List the differential diagnosis for vulvar pruritus including local and systemic etiologies, encompassing inflammatory lesions, dermatoses, dystrophy and neoplasia.

3. List the differential diagnosis for ulcerative lesions of the vulva.

4. Describe the appearance of lesions caused by sexually transmitted diseases on the vulva.

5. Outline the investigation and management of vulvar lesions described above.

6. Describe the diagnostic features, etiology and management of Bartholin's gland cysts and abscesses.

II. Upper genital tract lesions

The student will be able to:

1. List the differential diagnosis for pelvic pain.

2. Describe the etiologic factors for pelvic pain.

3. Differentiate the symptoms and physical findings in acute salpingitis, from those in acute appendicitis.

4. Describe the sequalae of acute salpingitis, including tubo-ovarian abscess and chronic salpingitis.

5. List and classify the micro-organisms that may be responsible for acute pelvic inflammatory disease.

6. Describe the diagnostic laboratory and ancillary testing to establish the diagnosis of acute pelvic inflammatory disease.

7. Outline the antibiotic regimes suitable for treatment of mild and moderate or severe pelvic inflammatory disease.

8. Provide patient education regarding prevention of salpingitis.

C. Neoplastic Lesions

I. Gestational trophoblastic disease

The student will be able to:

1. Describe the symptoms and physical examination findings suggestive of gestational trophoblastic disease.

2. Outline the investigations required to diagnose and manage this condition.

3. Discuss the principles of management and follow-up in these patients.

4. List the theories regarding the etiology of gestational trophpolastic disease.

D. Pre-invasive and Invasive Carcinoma of the Cervix

The student will be able to:

1. Perform a Papinicolaou smear with adequate sampling of the endocervix and ectocervix, including proper preparation and labeling of the smear.

2. Discuss the importance of cytologic screening in the prevention of invasive cervical cancer.

3. Discuss the limitations of the Pap smear as a screening procedure.

4. Outline the frequency of testing indicated for the population.

5. Describe the classification of the abnormal Pap smear.

6. Outline the management for each of the classifications of the abnormal pap smear including:

- indications for colposcopy with directed biopsy

- ablation involving laser

- cryotherapy

- electro cautery

- cone biopsy

- hysterectomy.

7. List the epidemiologic factors associated with increased risk for cervical dysplasia.

8. Outline the clinical staging system for invasive carcinoma of the cervix.

9. Describe the natural history of invasive carcinoma of the cervix, including the influence of the pathology of the cervical cancer.

10.Describe the principles of management of invasive cervical carcinoma including:

- radiation therapy

- surgery

- chemotherapy.

E. Endometrial Cancer

The student will be able to:

1. Define post-menopausal bleeding and provide a differential diagnosis.

2. Describe techniques to obtain a histologic sample of the uterine cavity.

3. Give the rationale for performing a fractional D and C.

4. List the risk factors for development of endometrial cancer.

5. Outline the staging system for endometrial cancer and discuss its significance.

6. Describe the pathology for adenocarcinoma of the uterus and list the other pathologic types of cancer of the uterus.

7. Describe the principles of surgical, radiation and hormonal therapies for endometrial cancer.

F. Ovarian Neoplasms

The student will be able to:

1. Describe a histopathologic classification for both benign and malignant ovarian tumors.

2. Outline the staging system for carcinoma of the ovary.

3. Discuss the differential diagnosis for an adnexal mass in an adolescent or young adult and in a peri-menopausal woman.

4. Describe how the investigation and surgical management would differ in these two women and explain why.

5. Outline a plan of management for epithelial ovarian cancer.

6. Describe the natural history for epithelial ovarian cancer.

G. Functional Ovarian Cysts

The student will be able to:

1. Explain the physiologic basis for the development of functional ovarian cysts.

2. Describe the clinical presentation of these cysts.

3. Describe the investigations used to differentiate these cysts from complications of pregnancy and other ovarian neoplasms.

4. Outline expectant management of the functional ovarian cyst and indicate when they should be managed surgically.

H. Malignant and Pre-Malignant Diseases of the Vulva

The student will be able to:

1. List the indications for and describe the procedure for vulvar punch biopsy.

2. Describe the classification for vulvar intra epithelial neoplasias and outline their management.

3. Describe the classification of vulvar dystrophies and their investigations and management.

4. Outline the clinical staging system for invasive carcinoma of the vulva and discuss its significance.

5. Describe the symptoms and clinical course of untreated disease.

6. Discuss the principles of management of invasive vulvar carcinoma.

I. Uterine Leiomyomata (fibroids)

The student will be able to:

1. Describe the symptoms and physical findings associated with uterine fibroids.

2. Describe the methods to confirm the diagnosis of uterine fibroids.

3. Discuss the indications for medical therapy, myomectomy and hysterectomy.

4. Describe the complications that may arise during pregnancy or prior to conception.

5. State the incidence of malignancy occurring in uterine fibroids.

J. Pelvic Relaxation and Urogynecologic Problems in the Female

The student will be able to:

1. Describe the symptoms, signs, differential diagnosis, ancillary tests and possible therapies for urinary incontinence.

2. List the etiologic factors which predispose to this condition.

3. Provide patient education and instruction regarding:

- pelvic exercise

- role of hormone replacement therapy

- use of pessaries

- drugs with action on bladder function

- appropriate referrals as necessary.

4. Define the following forms of pelvic relaxation and name the appropriate corrective operative measure for each;

- cystocele

- rectocele

- enterocele

- uterine descensus (prolapse)

- post-hysterectomy vault prolapse

5. List the differential diagnosis for:

- intermittent incontinence

- continuous incontinence.

6. Describe the tests routinely used to evaluate urinary incontinence including:

- cystometrogram

- urethral pressure profile

- uroflowmetry

- electromyography

- radiographic voiding cystourethogram.

7. Outline the diagnosis and management of urinary tract infections including:

- symptoms and signs

- microbiology

- therapy

- prevention

K. Perimenstrual Disorders

I. Dysmenorrhea

The student will be able to:

1. Define primary and secondary dysmenorrhea.

2. List the causes for secondary dysmenorrhea.

3. Explain the pathophysiology for primary and secondary dysmenorrhea.

4. Outline a course of investigation and management for dysmenorrhea, including the

differentiation between primary and secondary dysmenorrhea.

II Premenstrual Syndrome

The student will be able to:

1. Describe the symptoms and signs in a patient with PMS.

2. List the differential diagnosis for a patient presenting with suspected premenstrual syndrome.

3. Describe a method for recording the symptomatology of a patient.

4. Outline a plan of management for a patient which may include:

- explanation

- stress management

- diet

- exercise

- medication.

III Abnormal Uterine Bleeding

The student will be able to:

1. List the specific causes for abnormal uterine bleeding including: pregnancy and its complications including;

- abortion

- ectopic gestation

- trophoblastic disease tumors including carcinoma of the cervix and endometrium, polyps of the cervix and endometrium, endometrial hyperplasia, uterine fibroids, adenomyosis, and endometriosis, hormone producing tumors of the ovary

- inflammation and trauma including endometritis, intra-uterine devices, tuberculosis

2. Define dysfunctional uterine bleeding.

3. Define the following terms;

- menorrhagia

- polymenorrhea

- metrorrhagia

- hypomenorrhea

- oligomenorrhea

- primary amenorrhea

- secondary amenorrhea

4. Describe the physiology of the disturbance of the normal menstrual pattern, which is seen in dysfunctional uterine bleeding.

5. Outline the approach to the evaluation and diagnosis of abnormal uterine bleeding, stating the difference in approach based on age (adolescence, reproductive years, menopause and post menopause).

L. Endometriosis and Adenomyosis

I. Endometriosis

The student will be able to:

1. Describe the symptoms and physical findings suggestive of endometriosis.

2. List the theories of pathogenesis of endometriosis.

3. List the common sites of endometrial implants and describe their pathologic appearance.

4. Describe the diagnostic methods used to confirm a diagnosis of endometriosis.

5. Discuss the relative risks and benefits of medical and surgical treatment for endometriosis.

II. Adenomyosis

The student will be able to:

1. Describe the symptoms and signs suggestive of adenomyosis.

2. Describe the pathologic features of adenomyosis.

3. Outline the methods of management of adenomyosis.

M. The Climacteric

The student will be able to:

1. Describe the physiologic changes in the hypothalamic-pituitary-ovarian axis which occur in menopause.

2. List the symptoms, signs and health risks associated with these physiologic changes.

3. Outline methods of management including hormone replacement therapy, and therapy directed to maintenance of trabecular bone.

4. List the indications and contra-indications for hormone replacement therapy.

5. List the options available for hormone replacement therapy.

6. Counsel a patient regarding the risks and benefits of hormone replacement therapy.

7. Discuss the psycho social effects which may occur for an individual menopausal patient.

N. Pediatric and Adolescent Gynecology

The student will be able to:

1. List the differential diagnosis for vaginal bleeding in a prepubertal female and outline how a diagnosis would be made, including the indications for a vaginal inspection.

2. List the differential diagnosis for vaginal discharge in a prepubertal female and describe how to obtain cultures for the patient where indicated.

3. Identify the situations where sexual abuse may be suspected and outline the reporting and investigation protocols for your own community.

4. Label on a diagram of prepubertal female the following anatomic structures:

- clitoris

- labia majora

- labia minora

- posterior fourchette

- fossa navicularis

- hymen (crescentic, circumferential and cribriform)

- urethra

- peri-urethral pillars

- perineal body

- perianal area

5. Describe indications for and technique of examination of the genitalia in prepubertal females.

6. Describe the contents of an adolescent medical history, including a sexual and social history, which would illustrate risk factors for adverse outcomes.

7. Counsel an adolescent requesting confidential family planning.

O. Sexually Transmitted Diseases

The student will be able to:

1. List the specific infectious agents, which are sexually transmitted and state their prevalence in

the local community.

2. Describe the presenting syndromes for the sexually transmitted diseases including;

- mucopurulent cervicitis

- adnexal pain and/or masses

3. Systemic manifestations including;

- skin lesions

- arthritis

- peri-hepatitis

- acquired immune deficiency syndrome

4. Describe the principles of diagnosis and management of sexually transmitted diseases, including the requirements to report certain diseases and the effects of reporting.

5. Identify the risk factors for acquiring a sexually transmitted disease.

6. Counsel an individual patient regarding behavioral modifications to reduce the risk of acquiring a sexually transmitted disease and methods of preventing transmission.

7. Discuss the psychosocial impact of sexually transmitted diseases on a woman and her partner.