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Gynecology > General Gynecology > Flashcards

General Gynecology Flashcards

1
Q

What are absolute contraindications for UAE?

A

Asymptomatic
Pregnancy
Active infection
Malignancy

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2
Q

Can you use UAE for adenomyosis?

A

yes, for therapy-resistant adenomyosis

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3
Q

Does progesterone supplementation help pregnancy loss?

A

No benefit to decreasing sporadic miscarriage
Some benefit in women with 3+ losses

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4
Q

What is first-line treatment for gonorrhea?

A

ceftriaxone IM 250mg x1
1g PO azithromycin x1

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5
Q

In postmenopausal women without bleeding, what endometrial thickness prompts additional evaluation?

A

11mm (risk of malignancy 6.7%)

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6
Q

Who can get restrictive or diverting bariatric surgeries?

A

BMI >40
BMI >35 with co-morbidities

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7
Q

Orlistat

A

triacylglycerol lipase inhibitor, stops hydrolysis of triglycerides
side effects - diarrhea, flatulence
weight loss - 3%

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8
Q

Phentermine

A

noradrenergic sympathomimetic approved for weight loss
7-8% weight loss

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9
Q

Restrictive bariatric surgery vs malabsorption bariatric surgery

A

Sleeve gastrectomy - mechanical, lower weight loss, lower morbidity of surgery
Roux en Y - greater weight loss and control of comorbid conditions (diabetic)

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10
Q

When is breast biopsy indicated in a low risk woman?

A

BIRADS 4 or 5 (suspicious or suggestive of malignancy)

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11
Q

How do you manage BIRADS3 imaging in a low risk young woman?

A

Follow up in 6 months with repeat breast imaging and clinical breast exam

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12
Q

At what age does initial imaging of a breast mass switch from ultrasound to diagnostic mammogram?

A

30!

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13
Q

What is the work-up for persistent unilateral nipple discharge

A

Breast imaging - ultrasound <30, Diagnostic mammogram >30

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14
Q

Persistent unilateral nipple discharge + low risk BIRADS

A

Duct excision

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15
Q

Persistent unilateral nipple discharge + high risk BIRADS

A

Tissue biopsy

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16
Q

How do you initially treat a vulvar lesion not excluding invasive cancer?

A

wide local excision
0.5-1 margins

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17
Q

What are topical tx for vulvar HSIL

A

topical 5% imiquimod
16 weeeks
not FDA approved
other options: topical 5FU and cidofovir

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18
Q

What is the follow-up for VIN3 after WLE with negative margins?

A

6 and 12 months, then annually

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19
Q

Recurrence rate of VIN?

A

10-50%

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20
Q

Dovetail sign

A

Loss of anal skin creases anteriorly due to chronic 3rd degree lac of external anal sphincter

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21
Q

What is endoanal ultrasound used for?

A

Delineate defects of internal and external anal sphincter

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22
Q

How do you diagnose early syphilis?

A

Darkfield examination or direct fluorescent antibody testing of lesion exudate

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23
Q

What is the tx for syphilis?

A

Benzathine PCN
Non-pregnant PCN allergic - doxy alternative
Pregnant PCN allergic - desensitize

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24
Q

USPSTF recommendation for GC/CT screening

A

annually 24yo or younger
OR
older women with increased risk

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25
Q

What causes molluscum?

A

Poxvirus

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26
Q

Mondor disease

A

Superficial thrombophlebitis of veins of the anterior chest wall and breast
2/2 graumatic injury, breast surgery, or repetitive exercise

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27
Q

How do you treat Mondor disease?

A

warm compress
anti-inflammatory

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28
Q

Risk factors for endometriosis

A

mullarian anomalies, short menstrual cycles (<27 days), heavy/prolonged menstrual bleeding, and early menarche

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29
Q

What percent of pregnancies are unintended?

A

41% (as of 2011)
up to 75% among women <20 years old

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30
Q

What are risk factors for unintended pregnancy?

A

Age 18-24
income <100% of poverty level
Not completing high school
Non-hispanic black/AA
Cohabitating without marraige

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31
Q

What is the risk of pregnancy from a 1x unprotected intercourse?

A

2-5%

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32
Q

What are the types of emergency contraception?

A

Yuzpe method (COCPs)
Plan B (levonorgestrel)
Ella (ulipristal acetate)
Cu-IUD

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33
Q

What is one advantage of Ella over Plan B?

A

Ella (ulipristal) delays ovulation before or during LH surge; levonogestrel delays only prior to LH surge

Neither effective at LH peak or later

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34
Q

What is the dosing and efficacy of Plan B?

A

1 step - 1.5mg LNG x1
2 step: 0.75 LNG q12

Can give up to 72 hours (off label 5 days)

2.5% pregnancy rate
Less effective in obese women (up to 5.8% pregnancy)

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35
Q

What is the dosing and efficacy of Ella?

A

30mg ulipristal acetate x1

Can give up to 120hr
Avoid progestins x5 days

1.2-1.8% pregnancy rate

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36
Q

What is the Yuzpe method?

A

Combine OCPs to take 100-120mcg ethinyl estradiol and 0.5-0.6mg LNG

2 doses, q12h

High nausea effects

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37
Q

What is the effectiveness and use of Cu-IUD as emergency contraception?

A

Place up to 12hr after intercourse
0.1% rate of pregnancy

38
Q

What is the modified for multiple procedures at the same time?

A

55

39
Q

What is the modifier for multiple separate procedures on the same day?

A

25

40
Q

What is the modifier for unsuccessful procedure?

A

53

41
Q

What is the modifier for difficult procedure?

A

22

42
Q

What is the modifier for assistant attending surgeon?

A

80

43
Q

What are the genetics of a partial mole?

A

69 XXX or 69 XXY

44
Q

What are the genetics of a complete mole?

A

46XX or 46XY

45
Q

What are absolute contraindications to methotrexate?

A

IUP
immunodeficiency
sensitivity to MTX
active pulmonary, peptic ulcer, hepatic, or renal disease
moderate anemia/thrombocytopenia
breastfeeding
ruptured / hemodynamically unstable
unable to follow-up

46
Q

What are relative contraindications to methotrexate?

A

cardiac activity

refusal to accept blood transfusion

ectopic >4cm

high initial hCG concentration

47
Q

What is the recurrence risk of ectopic pregnancy?

A

1 prior - 10%
2 or more prior - 25% or more

48
Q

Which medications may cause galactorrhea?

A

Antipsychotics
Metoclopromide
Verapamil
COCPs
methyldopa

49
Q

Cigarette paper skin on the vulva
Loss of architecture

A

Lichen sclerosus

50
Q

Violaceous papules and plaques on the vulva
w/ erosions or ulcerations

A

Lichen planus

51
Q

Amsel criteria

A

pH >4.5
Clue cells
Thin white-grey discharge
Positive whiff test

52
Q

Which treatments for condyloma are safe in pregnancy?

A

cryotherapy
trichloroacetic acid

53
Q

When is peak bone density for women?

A

19 years old

54
Q

What’s the difference between a T score and a Z score?

A

T score = bone marrow density compared to young healthy cohort

Z score = bone marrow density compared to age-matched women

55
Q

What is the T-score criteria for osteopenia and osteoporosis?

A

Osteopenia: less than -1 to -2.5
Osteoporosis: less than -2.5

56
Q

Who merits treatment for low bone density?

A

Osteoporosis (T20% risk of major fracture in next 10 years or >3% risk of hip fracture)
History of low trauma fracture

57
Q

What is the first line treatment for osteoporosis?

A

Bisphosphonates

58
Q

What are second-line tx for osteoporosis?

A

Raloxifene - good for younger pts or high breast cancer risk
Denosumab - RANK-L inhibitor
Hormone therapy
Calcitonin
PTH

59
Q

How often do you screen for cervical cancer in HIV+ women?

A

Yearly, w/in 1 year of first sexual activity or w/in 1 year of HIV dx if sexually active

Continue through lifetime

60
Q

How often do you screen women who had DES exposure in pregnancy

A

Annually

61
Q

When should you sample the endometrial lining in a post-menopausal women?

A

AUB and stripe >4mm
incidental finding and stripe >11mm

62
Q

When is bariatric surgery recommended?

A

BMI >40 or >35 with medical comorbidities with diet/exercise/meds unsuccessful

63
Q

What is the most common endometrial abnormality in a woman on tamoxifen?

A

endometrial polyps (incidence 8-36%) followed by hyperplasia (1.3-20%)

64
Q

What genetic abnormalities cause primary ovarian insufficiency?

A

45X Turner
Fragile X
17-alpha-hydroxylase def
aromatase deficiency
galactosemia

65
Q

What are defining features of moderate ovarian hyperstim?

A

mild features (nausea/vomiting, enlarged ovaries, diarrhea, abd distension)
+ ultrasound evidence of ascites
+ hematocrit >41%
+ WBC >15

66
Q

What are features of severe OHSS?

A

moderate features plus:
- clinical evidence of ascites or hydrothorax
- end-organ damage: dyspnea, oliguria, intractable n/v, tense ascites, low BP, syncope, severe pain
- Hct >51
- WBC > 25
- Electrolyte abnormalities: elevated Cr >1.6, Na < 135, K > 5, elevated LFTs

67
Q

How long after bariatric surgery should you wait to attempt pregnancy?

A

12-18 months

68
Q

What genetic complication is unique to ICSI?

A

Imprinting disorders
Especially Beckwith-Wiedemann syndrome

69
Q

What are indications for ICSI?

A

Moderate-severe male factor infertility
Surgical retrieved sperm
Pre-implantation genetic diagnosis / aneuploidy screening
Cryopreserved oocytes
Prior failed fertilization

70
Q

How do you treat hydrosalpinx prior to IVF?

A

Salpingectomy

71
Q

Should you treat an endometrioma surgically to improve fertility?

A

Surgical tx reduces ovarian reserve - HOWEVER surgical removal of Stage I/II improves fertility by RCTs

72
Q

What is the most common complication of hysteroscopy?

A

uterine perforation (0.7-3%)

73
Q

Painful ulcer with tender unilateral suppurative lymph nodes

A

Chancroid (haemophilus ducreyi)

74
Q

Nonpainful ulcer with unilateral tender suppurative lymph nodes

A

LGV - chlamydia trachomatis L1-3

75
Q

Nonpainful ulcer with firm non-suppurative bilateral lymph nodes

A

Syphilis

76
Q

Painful ulcers with firm non-suppurative lymph nodes

A

HSV

77
Q

Donovan bodies

A

Granuloma inguinale / Klebsiella granulomatous

78
Q

What is the likelihood that endometrium is covering an Essure and it is not visible hysteroscopically?

A

25%

79
Q

Which is better for fertility, endometrioma drainage or removal?

A

Unclear, unless if >4cm then cystectomy is better than drainage

80
Q

What gives false positive serum hCG?

A

heterophile antibodies
especially in women with exposure to animals (lab workers, farms).

Get a urine hCG to compare

81
Q

Why would someone undergo gamete intra-fallopian transfer?

A

Fertilization occurs in vivo
For patients with objection to IVF
Involves laparoscopy, live birth rates are lower than IVF

82
Q

Chronic endometritis

A

AUB, abdominal pain, CMT/uterine tenderness
Histology: plasma cells on embx/hysteroscopy
Tx: doxy 100mg BID x10-14 days or azithro 500mg x1 + 250mg x4 days

83
Q

Mirabegron

A

Beta3 adrenergic receptor agonist
Side effecct - HTN

84
Q

Coaptite

A

Urethral bulking agent
used to tx stress urinary incontinence

85
Q

Frankenhauser plexus

A

uterovaginal plexus
4 and 8 o’clock at cervical base

86
Q

Add back progestin therapy with GnRH agonists

A

Reduces bone loss and vasomotor symptoms
Norethindrone acetate 5mg PO daily (only FDA approved regimen)

Ok to start with initiation of GnRH in young patients

87
Q

Steps of implantation

A

Apposition - embryo contact with endometrium
Adhesion - embryo adheres to endometrium
Invasion - embryo embeds in endometrium

88
Q

When is DXA scan for bone mineral density recommended?

A

65+ years
<65 years, post-menopausal, and if FRAX is >8.4%

89
Q

Which measurements are most accurate for DXA scans?

A

Hip
Lumbar spine

90
Q

Who should you calculate a FRAX score for?

A

Post-menopausal patients
<65 years old
One risk factor for osteoporosis

91
Q

What is the recommended daily allowance for calcium?

A

1000mg/day 19-50yo
1200mg/day 51yo+

92
Q

What is the daily recommended allowance for vitamin D?

A

600 IU/day up to 70
800 IU/day >70

Gynecology (3 decks)

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