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Obgyne Flashcards

1
Q

Cervicitis is found, send swab for 4 ?

A

1- Chalmydia (NAAT)
2- Gonorrhea (NAAT)
3- Bacterial Vaginosis
4- Trchiomoniasis

Ceftriaxone 500mg or 1000mg IM once ( < or > 150 kg )
+ Doxycycline 100mg BID for 1 week
Or if pregnant give azithromycin 1g ( to cover chlamydia )

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2
Q

Pap smear after cervical removal indication?

A

History of cervical CIN grade 2 or greater

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3
Q

HRT candidates ( name 6 )

A

1- Age <60
2- Within 10 years of Menopause
3- Moderate to severe hot flashes
4- Not responding to behavioral intervention
5- Healthy without contraindications
6- Primary ovarian failure or early menopause

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4
Q

HRT and risk of endometrial cancer

A
  • unopposed estrogen increase the risk
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5
Q

HRT and risk of breast cancer

A
  • risk increased with COC
  • estrogen alone is okay ( possible reduction in breast cancer was observed )
  • micronized progesterone instead of medroxyprogestrone
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6
Q

HRT and risk of ovarian cancer

A
  • inconsistent risk. Possible increase if >10 years of usage
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7
Q

HRT and colon cancer

A

Lower the incidence of colon cancer and related morality

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8
Q

HRT and fracture

A

Lower the risk of fracture

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9
Q

Risky 2 conditions in HRTv

A

1- VTE
2- Stroke

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10
Q

CAD and HRT

A

1- with COC
2- unopposed estrogen was okay

Generally no risk observed if started <60 years old

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11
Q

Define Anemia of pregnancy depends on trimester (1st and 3rd - 2nd )

A

1st and 3rd: Hg <11
2nd: Hg <10.5

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12
Q

Physiological changes in pregnancy?

A
  • Insulin resistance [ mild fasting hypoglycemia, postprandial hyperglycemia, GLUCOSURIA ]
  • increased GFR [ decrease BUN and creatinine ]
  • increase Tidal Volume “amount of air breathed in or out” [ decreased PCo2 creating mild respiratory alkalosis ]
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13
Q

HSV in pregnancy, C/S indications

A

Active genital ulcer at the time of labor onset or membrane rupture

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14
Q

HSV in pregnancy, primary or recurrent risk of transmission

A
  • primary: 30-50%
  • Recurrent or primarily acquired during the first half of pregnancy: <1%
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15
Q

Antiviral for HSV in pregnancy indications

A
  • Usually prescribed at 36w to decrease presence of active lesions at the onset of labor
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16
Q

Tubal sterilization ( risk factors for regret, most effective procedure, ovarian ca and menses? )

A

1- Postpartum and young age tubal sterilization risk factors for increased regret
2- Postpartum partial salpingectomy has the lowest pregnancy rate (most effective)
3- it decrease risk of ovarian cancer and don’t affect menstruation

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17
Q

UTI treated with Bactrium (TRI/SULFA), how it will interact with OCPS?

A
  • No interaction
  • The only Antibiotic affect OCPs is Rifampin (non hormonal contraceptive is recommended while using Rifampin)
18
Q

Complicated VAGINAL CANDIDA INFECTION FIVE CRITERIA

A

1- Immunocompromised ( Uncontrolled DM, HIV,..)
2- Pregnant
3- severe debiliating symptoms
4- candida species other than albicans
5- >4 Episodes per year (recurrent infection)

19
Q

Complicated Candida treatment

A
  • Less likely to respond to short course oral or topical therapy
  • EITHER oral fluconazole 150mg 2-3 sequential doses 3 days apart
    OR
    Topical prolonged therapy (1-2weeks)
20
Q

Candida glabarta treatment

A

Vaginal boric acid suppositories (70% success rate)

21
Q

Postpartum and RA Incidence?

A
  • x5 fold increased risk of new onset RA ( DUE TO HEIGHTENED INFLAMMATORY ACTIVITY )
  • risk is higher after the first pregnancy
  • RA Typically improved or stabilized at pregnancy period
22
Q

GDM screening

A
  • 24-28 weeks ( first prenatal visit if risk factors present )
  • Two steps approach: 50g NON FASTING OGTT for screening.
  • If after one hour plasma glucose is 130 or more proceed with 100g fasting oral glucose challenge test for confirming
    *( fasting 95,1h 180, 2h 155, 3h 140) 2/4 considered diagnostic
  • One step approach: 75g fasting, 1hr, 2hr. If ANY of the following met
    Fasting 92, 1h 180, 2h 153

Postpartum: 1-3m screening 75g OGTT, to be measured 2hr after, 200 is diagnostic (the most sensitive test overall for DM screening)

23
Q

Pneumococcal routine vaccination

A

Age: 65 or 19-64 immunocompromised

One dose of: PCV20
Two doses one year apart: PCV15 and PPSV23

If previsouly received PPSV23 or 13 > PCV 15-20

“Minimum 2 months if immunocomrpomised, Cochlear implant, or CSF leak “

24
Q

Asthma prognosis in pregnancy?

A

1/3; worse
1/3: improved
1/3: unchanged

25
Q

Average age of menupause?

A

51.4

26
Q

Early menopause verses. Primary ovarian insufficiency or premature ovarian failure

A
  • 40-45 years old: Early menopause
  • <40 years old: POI
27
Q

When vasomotor symptoms and urogenital atrophy occurs?

A
  • Vasomotor: may occur in the phase prior to the onset of LMP
  • Atrophy: typically in the late postmenopausal period
28
Q

DMPA (depot medroxyprogesterone acetate)

A

1- Injectable only progestin

2- given every 3 months

3- long acting and reversible

4- preferred in SCA AND ANTI-EPILEPTIC AND SMOKER AND CONTRAINDICATIONS TO ESTROGEN LIKE BREASTFEEDING

5- 1-2% decline in BMD every year.
All society advise advantages outweigh theoretical concerns about BMD loss.
BMD recover once DMPA STOPPED

6- Proven 5% of body weight GAIN

7- Amenorrhea, infrequent bleeding, spotting, prolonged bleeding

8- Check prolactin if GALACTORRHEA OCCURED

9- Recommendation to prescribe 1300 mg calcium + 600 IU vitamin D3 daily

10- No longer recommendation to DEXA, or limiting injections for 2 years only

29
Q

UTI in pregnancy complications

A
  • premature birth and low birth weight, increased perinatal mortality, increase incideince of HTN and chorioamniotitis
30
Q

FDA Pregnancy categories?

A

A
Appropitate human studies showed safety

B
Human study showed safety and Animal showed issues
Animal study showed safety and Human study in insuffienct

C
Insufficient human study ( and animal study showed issues or was insufficient )

D
Human study showed risk, with or without animal studies, but the drug may be imp

X
NO SITUATION TO JUSTIFY IT USE. CI

31
Q

UTI in pregnancy (1st, 2nd, and 3rd line)

A

1st line:
TNF
Tri-sulfa ( c )- Three days
Nitrofurantion ( b )- Five days
Fosfomycin ( b )- single day

2nd line (C):
Ciprofloxacin
Levofloxacin

3rd line (B):
Augmentin
Cefpodoxime
Cephalexin
Cefdinir

Notes:

  • For Nitro and trisulfa: try to search for alternative in first trimester and near term
  • For Nitro and Fosomycin: Not in pyelonephritis
32
Q

Absolute Contraindications to COC

A

1- Current breast cancer
2- Acute DVT, or history of DVT with high risk of recurrence
3- Postpartum <3 weeks
4- Major surgery with prolonged immoblization
5- Age 35 years PLUS smoking 15 Ciggrate per day
6- History of Stroke or MI
7- Migrane with aura
8- Solid organ transplant
9- SLE with positive or unknown antiphospholipid antibodies
10- DM >20 years duration or with microvascular/macrovascular complications
11- HTN >160/100 or with Vascular disease
12- Peripartum cardiomyopathy
13- Complicated VHD
14- Liver: acute or flare of viral hepatitis, severe cirrhosis adenoma, malignant liver tumor
15- Acute porphyria

33
Q

CHC first line in older adults

A

Ethinyl estradiol 20mcg/ 1mg norethisterone ( Loestrin 20 ), lowest dose pill with safest progestron

34
Q

What is the dominant clinical feature of Vulvovaginal candidiasis?

A
  • Vulvular pruritis
35
Q

Wet prep by adding 10% KOH, what will show in case of Candidiasis?

A
  • Hyphea
36
Q

Candidiasis in pregnancy treatment

A
  • First line: Topical azole

intravaginal suppository: Miconazole 100, 200, 1200mg for 7,3,1 day

Cream:
Miconazole 2%, 4% for 7,3 days
Clotrimazole 1%, 2% for 7-14,3 days

  • 2nd line: Oral fluconazole (not recommended in the first trimester > increased incidence of miscarriages)
37
Q

Intrahepatic cholestasis of pregancny management

A
  • Ursodeoxycholic acid + consider early delivery
38
Q

DVT In pregnancy treatment?

A
  • LMWH is the Drug of choice for Pregnant with DVT or PE
  • Should be stopped 24h before the use of epidural anesthesia during delivery
39
Q

Preeeclampsia

A
  • New onset hypertension (140/90) or worsening hypertension “superimposed preeclampsia” + Either Proteinuria (24hr protein urine excretion 0.3g) or Sign or symptoms of end organ damage.

-

40
Q

According to ACOG, what is the threshold and goal in initiate Anti-HTN medication

A

1- Systolic 160 ( goal is 120-160)
2- Diastolic 105 (goal is 80-105)

Labetalol, Nifedipine, methyldopa, hydralazine

41
Q

Acute hypertension during pregnancy treatment?

A

First line is labetalol.
If CI as asthma; use hydralazine
Nicradapine or nifedipine is acceptable alternative

42
Q

ANC dates

A

1- Pelvic dating Ultrasound: 7-12w
2- AFP + Nuchal translucency: 10-13w
3- Blood chromosomal screening: 15-18w
4- Urine dipstick for proteins: 20w
5- Anatomy scan: 18-22w
6- GDM: 24-28w
7- GBS swab: 36-37w
8- Tdap: 27-36w
9- Anti-D: at 28w or at 28 AND 34w- within 72hrs of delivery
10- visits
10-28: monthly
28-36: 2-3 weeks
After: weekly or more

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