Clinic Flashcards
(121 cards)
1
Q
Gonorrhea and Chlamydia screening
A
Annual for sexually actively ages 13-24
2
Q
Diabetes screening
A
Annually if high risk
Every 3 years after age 45
HbA1c
- 6.5% diabetes
- 5.7-6.4% pre-diabetes
3
Q
Cholesterol screening
A
Every 5 years beginning at age 40
4
Q
Screening post hysterectomy for high-grade cytology or histology (CIN 2/3, AIS)
A
Annual screening for 3 years > every 3 years for 25 years
5
Q
Regression rates of CIN 1 and 2
A
CIN 1: 60%
CIN 2: 40%
6
Q
Negative predictive value of co-testing
A
99% for CIN 2/3
- pap 50% sensitive
- liquid cytology 76% sensitive
7
Q
When is an ECC indicated during colposcopy?
A
No identifiable lesion
Unsatisfactory colposcopy
Pap with ASC-H, HSIL, AGC, or AIS
When considering ablative therapy for CIN 1/2
8
Q
Treatment for positive margin on CIN 2/3 excision
A
Cotesting or colposcopy with ECC in 6 months > annual cotesting for 3 years
9
Q
Screening options for colon cancer
A
Yearly fecal blood cards Sigmoidoscopy every 5 years CT colonography every 10 years Colonoscopy every 10 years - start at 45 or 10 years before first degree family member
10
Q
Follow up for abnormal colonoscopy
A
Benign polyps: 3-5 years
Atypical polyp: 3 years
11
Q
Breast screening in BRCA 1/2 patients
A
Annual MRI starting at age 25
Annual mammography at age 30
- Consider tamoxifen and risk-reducing surgery
- 45-85% risk of breast cancer
12
Q
High risk cholesterol
A
Total cholesterol > 240
LDL > 160
HDL < 40
Triglycerides > 885
Lifestyle changes and then statin
13
Q
T-score
A
Standard deviation from mean peak bone density of normal young adult
14
Q
Z-score
A
Standard deviation from reference population of same age, sex, and race
15
Q
Lab work up for osteoporosis
A
CBC
CMP
Vitamin D level
Consider 24 hour urinary calcium, PTH, TSH
16
Q
FRAX score
A
Estimates 10-year probability of hip fracture or major fracture for untreated patients using femoral neck bone mineral density and risk factors
17
Q
Candidates for osteoporosis treatment
A
Osteoporosis
Postmenopausal
- osteopenia with hip fracture 3% or major fracture >20% by FRAX
18
Q
Calcium requirements daily
A
Age 9-18: 1300 mg calcium
Age 19-50: 1000 mg calcium
Age 50+: 1200 mg calcium
19
Q
Vitamin D requirement daily
A
1-70 years: 600 IU/day
70+ years: 800 IU/day
20
Q
Risk reduction for fracture
A
No free rugs
Slip on shoes
Store objects at eye level
Optimize vision
21
Q
Mechanism of bisphosphonates (Fosamax, Boniva, Reclast)
A
Inhibits bone resorption by osteoclasts
Same ultimate pathway as calcitonin
22
Q
Mechanism of calcitonin
A
Binds to osteoclasts and inhibits bone resorption
23
Q
Exercise recommendation for reducing heart disease
A
30 minutes 5 days a week
24
Q
Emergency contraceptive options
A
Up to 3 days - Levonorgestrel 1.5 mg once Up to 5 days - Ulipristal 30 mg once - Copper IUD
25
UTI treatment
Tmp-smx 100/800 bid x 3 days
Nitrofuratoin 100 mg bid x 7 days
Fosfomycin 3 mg once
26
Criteria for inpatient PID treatment
```
Surgical emergency not excluded
Pregnancy
No response to oral therapy
Peritonitis, n/v, high fever
Noncompliance with treatment
```
27
Amstels criteria for bacterial vaginosis
3 of 4:
- pH > 4.5
- positive KOH whiff test (10% KOH)
- > 20% clue cells on saline microscopy
- Homogenous, thin, white-gray discharge coating vaginal walls
28
Most common cause of congenital adrenal hyperplasia
21-hydroxylase deficiency
- measure with 17-ohp (elevated)
- consider testing in secondary amenorrhea
29
Order of puberty
```
Growth spurt
Breast development
Pubarche
Adrenarche
Menarche
```
30
Lab work up of hitsuitism
Total testosterone
DHEAS
17-OH progesterone
31
Reassuring endometrial stripe in post menopausal patient
4 mm or less
32
Treatment for recurrent bacterial vaginitis (3+ episodes in a year)
Twice weekly suppressive metronidazole gel for 16 weeks
| After treatment of acute episode
33
Diagnosis of trichomonas
NAAT of vaginal, cervical, or urine specimens
| - Microscopy only 50% sensitive
34
Treatment of trichomoniasis
Metronidazole 500 mg BID for 7 days
| Tinidazole 2 gram in a single dose
35
Treatment of bacterial vaginosis
```
Metronidazole 500 mg BID for 7 days
Metronidazole gel 0.75% daily for 5 days
Clindamycin cream 2% daily for 7 days
Tinidazole 2 mg daily for 2 days
Secnidazole 2 g orally once
```
36
Treatment of trichomoniasis with metronidazole allergy
Metronidazole desensitization
37
Treatment of uncomplicated vulvovaginal candidiasis
Fluconazole 150 mg once
Miconazole 4% for 3 days
Clotrimazole 2% for 3 days
38
Treatment of recurrent vulvovaginal candidiasis
Weekly fluconazole 150 mg for 6 months
| After Fluconazole 150mg q72hrs for 3 doses
39
Treatment of severe vulvovaginal candidiasis
Topical intravaginal azole for 10-14 days
| Fluconazole 150 mg every 72 hours for 2-3 doses
40
Treatment of C glabrata
Intravaginal boric acid (600 mg capsules) daily for 14 days
41
High potency topical corticosteroids
Triamcinolone 0.5%
| Bethamethasone, clobetasol, halobetosol, fluocinonide 0.05%
42
Low potency corticosteroids
Hydrocortisone 1%, 2.5%
| Desonide 0.05%
43
Component of lichen planus evaluation
Oral exam and referral to periodontist as needed
44
Labs for AUB
CBC, tsh, hCG, cervical cancer screening, chlamydia testing
| - consider prolactin
45
PALM structural causes for AUB
Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia
46
COEIN for non-structural causes of AUB
```
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet classified
```
47
Main Hpv strains causing condyloma
6 and 11
48
Complications of DES exposure
Vaginal adenosis (persistence of columnar epithelium in upper 1/3 of vagina, normally replaced by squamous) > clear cell adenocarcinoma
Müllerian duct derivative not replaced by Urogenital sinus derivatives
49
ACOG breast cancer screening recommendation
Mammogram: Every 1-2 years age 40-75
| Clinical breast exam: Every 1-3 years aged 25-39, annually age 40+
50
Lifetime risk of breast cancer for average woman
12% (1 in 8)
51
Breast cancer risk factors
Chest radiation (eg Hodgkin’s lymphoma), smoking, obesity, alcohol use, age, nulliparity, not breastfeeding, early menarche, late menopause, prior biopsy with atypical hyperplasia (ducal or lobular) or lobular carcinoma in situ
52
GAIL breast cancer risk model
Age, race, history of biopsy, menarche, age at 1st birth, 1st degree family history of breast cancer > risk of breast cancer in next 5 years
- not valid under age 35
53
Clomid mechanism of action
SERM: anti estrogen properties at hypothalamus > increased GnRH pulsatility > increased FSH/LH
54
Clomid dosing and side effects
50 mg for 5 days starting on 5th cycle day
| - multiples (5-10%), mood changes, ovarian cysts
55
Mechanism and examples for GnRH agonists
Disrupt pulsatile GnRH signaling
| - constant GnRH signaling > initial increase in FSH/LH > negative feedback loop and down regulation
56
Treatment for genital warts
HPV vaccine!
```
Trichloroacetic acid (TCA)
Podophyllin (provider applies)
Aldara (imiquiod): three times weekly up to 16 weeks
```
57
Treatment for mastitis
Dicloxacillin 500 mg four times daily
Clindamycin 450 mg TID
- Avoid Bactrim if breastfeeding and infant < 1 month old
58
What is the contraceptive mechanism of OCPs?
Estrogen: negative feedback at pituitary > suppress FSH production > decreased follicular development
Progesterone: Decrease GnRH pulsatility > suppress LH production, change cervical mucus
59
Benign etiologies of postmenopausal bleeding
Fibroids, polyps, vaginal atrophy, urinary or rectal bleeding
60
Outpatient treatment of PID
Ceftriaxone 500 mg IM
Doxycycline 100 mg BID x 14 days
Metronidazole 500 mg BID x 14 days
61
Laboratory work up of primary ovarian insufficiency
FSH, estradiol, TSH, prolactin, anti-adrenal antibodies, consider TPO antibodies, Karyotype, FMR1 permutation
- Elevated basal FSH 30-40 mIU/mL x 2 one month apart
62
Kegel’s instructions
Squeeze for 10 seconds, release, do 30-40 per day
63
Mechanism and side effects of bromocriptine
Dopamine receptor agonist
| - nausea, postdural hypotension, mental fogginess, impulse control issues
64
Q-tip test for urethral hypermobility
Q-tip lubricated with anesthetic gel inserted into urethra > woman asked to cough and strain
- 30+ degree angle = urethral hypermobility
65
Embryologic origin of ovaries
Urogenital ridge
66
Go to ocp
Loestrin 1/20
- 1 mg norethinodrone
- 20 mcg ethinyl estradiol
67
Solution for mid-cycle bleeding
Increase estrogen mcg
68
OCP solution to bleeding pre cycle
Triphasic progesterone pill
| - Increases progesterone dose each week
69
Age for shingles vaccine
50 years
70
Li-Fraumeni (p53) cancer screening
Breast screening starting at age 20
Annual whole body MRI
Colonoscopy starting at age 25
71
Cowden/PTEN cancer screening
Breast cancer screening starting at age 30
Endometrial cancer screening starting at age 35
Colonoscopy starting at age 35
Annual thyroid ultrasound
72
Dexa screening after bisphosphonate treatment
2 years on treatment
| Prior to stopping bisphosphonate
73
Lynch syndrome cancer screening
```
Colonoscopy starting at age 20-25, repeat every 1-2 years
Endometrial biopsy starting at age 35
UA starting at age 35
Standard breast cancer screening
Consider pancreatic cancer screening
```
74
Contraindications to HRT
```
Untreated hypertension
Active liver disease
Active or recent arterial thromboembolic disease
Previous VTE unless on anticoagulation
Undiagnosed vaginal bleeding
History of breast cancer
```
75
Vasopressin dosing
5 units in 10 mL saline
76
Acetic acid concentration
5%
77
Progesterone IUD dosing and duration of use
Mirena, Liletta: 52 mg for 7 years
Kyleena: 19.5 mg, 5 years
Skyla: 13.5 mg, 3 years
78
Alternative treatments for bacterial vaginosis
Vaginal metronidazole 0.75% gel 5g daily for 5 days
Vaginal Clindamycin 2% daily for 7 days
Oral Clindamycin 300 mg BID for 7 days
79
Estrogen dosing in HRT
17-beta estradiol
- oral 1 mg/day
- transdermal 0.05 mg/day
Consider starting at double dose (2 mg/0.1 mg) post-rrBSO
80
Progesterone dosing in HRT
Micronized progesterone 100 mg daily
| - Cyclic: 200 mg/day for 12 days a month
81
Vaginal estrogen dosing for Atrophy
Ring: 7.5 mcg estradiol for 3 months
Tablets: 10 mcg estradiol
Creams: 0.1-0.625 mg estradiol per gram cream
82
Preferred HRT
Climara Pro (weekly patch)
- 0.045 mg estradiol
- 0.015 mg levonorgestrel
Per day
83
Timing of HPV vaccination
0, 2 and 6 months
84
Findings and timing of secondary syphillis
```
Condyloma Lata
Maculopapular rash (Coxsackie, Rocky Mountain spotted fever other causes of palms and soles rash)
6 weeks to 6 months after chancre
```
85
Chantix (varencline) dosing
12 week course
- pick a quit date 1 week after starting
- 0.5 mg QD-BID for week 1
- 1 mg BID for weeks 2-12
86
Outpatient treatment of pneumonia
Cefdinir 300 mg BID
| Azithromycin 500 mg QD
87
Contraindications to oxybutynin
Closed angle glaucoma, history of impaired gastric emptying or urinary retention
88
Sprintec components
```
35 mcg (0.035 mg) ethinyl estradiol
0.250 mg norgestimate
```
89
Criteria for metabolic syndrome
```
Elevated BP
Increased abdominal girth
Elevated triglycerides
Low HDL
Elevated fasting blood sugar
```
90
Causes of hirsuitism
```
PCOS
Congenital adrenal hyperplasia
Androgen secreting tumors: Sertoli Leydig tumor, thecoma
Androgen medication ingestion
Familial
Cushing’s syndrome
```
91
Genetic causes of Down’s syndrome
Non-disjunction
| Translocation
92
Definition of recurrent vulvovaginal candidiasis
4+ episodes of symptomatic infection within one year
93
Treatment for recurrent candida vulvovaginitis
Fluconazole 150 mg every 72 hours for 3 days
| - weekly Fluconazole for 6 months
94
Definition of osteopenia
T-score -1 to -2.5
| - Bisphosphonate if FRAX hip fracture > 3% or other major fracture > 20%
95
RNA hepatitis viruses
Hepatitis A
| Hepatitis C
96
DNA hepatitis virus
Hepatitis B
97
Mild vs moderately persistent asthma
Mild persistent: Symptoms 2-6 times per week, no activity limitations, FEV1 80+%
Moderate persistent: daily symptoms, weekly or more nighttime awakening, FEV1 60-80%, activity limited
- Add daily salmeterol to daily corticosteroid inhaler
Give pneumococcal vaccine!
98
Ways to exclude pregnancy without a test
```
No sex since last normal menses
Reliable method of contraception
7 days from LMP
4 weeks postpartum
Amerorrheic and exclusive breastfeeding (80%) within 6 months postpartum
Within 7 days of pregnancy loss
```
99
Antiphospholipid labs
Lupus anticoagulant
Anticardiolipin
Anti-beta-2-glycoprotein
100
Clinical diagnosis of antiphospholipid syndrome
One arterial thrombosis
Death of normal fetus 10+ weeks gestation
Preterm delivery for pre-eclampsia
3 or more unexplained losses <10 weeks
101
Non-hormonal treatment options for hot flashes
Alpha-agonist: Clonidine 0.1 mg BID
| SNRI: Paroxetine
102
Non-FDA approved options for orgasmic disorders
Testosterone patch or cream
Bupropion
Phosphodiesterase inhibitors (sildenafil)
Seratonin receptor agonist (filbanserin)
103
Treatment for Syphillis with penicillin allergy
Doxycycline
| Ceftriaxone
104
Non-hormonal treatments of vulvovaginal atrophy
Lubricants
Moisturizers: hyaluronic acid, poly acrylic acid
Vaginal suppositories: Vitamin E, vitamin D
Lidocaine 4% solution
- consider vaginal DHEA if vaginal estrogen not an option
105
Ultrasound findings of adenomyosis
Heterogeneous myometrium
Myometrial cysts
Asymmetrical myometrial thickness
Subendometrial echogenic linear striations (“Venetian blind”)
106
Lynch syndrome proteins
MSH2
MSH6
MLH1
PMS2
107
Follow up of BIRADS 3-5
3: 0-2% risk malignancy, 6 month repeat imaging
4: 2-95% risk malignancy, tissue diagnosis
5: >95% risk malignancy, tissue diagnosis
108
EPT for gonorrhea
Cefiximine 800 mg PO
109
Ultrasound finding of hydrosalpinges
Tubular sonolucent cysts
110
Sex cord stromal tumors
```
Fibroma
Thecoma
Fibrosarcoma
Granulosa cell tumors
Sertoli cell tumors
Sertoli-Leydig tumors
- no need for standard nodal assessment
```
111
Elagolix mechanism and dosing
```
GnRH antagonist
- Start at 150 mg daily (endometriosis)
- Max dose 300 mg BID (fibroid dosing)
- Max length 24 months
Give calcium and vitamin D supplements
```
112
PCOS diagnostic criteria
Hyperadrogenism (hirsuitism, acne or levels)
Oligomenorrhea or amenorrhea
Polycystic ovaries on ultrasound
- 2/3 for Rotterdam
113
Sperm parameters
```
Volume: 1.5 mL
Concentration: 15 million/mL
Total sperm: 40 million
Morphology: 4%
Total motility: 40%
```
114
Medications for hirsuitism
COCs
Spironolactone (diuretic and aldosterone antagonist)
Flutamide (androgen-receptor agonist)
Finasteride (5-alpha-reductase inhibitor)
115
Infertility work-up
FSH (> 10 IU/L diminished ovarian reserve)
Estradiol (>80 pg/mL diminished ovarian reserve)
Confirm ovulation (+LH, midluteal progesterone >3 ng/mL)
TVUS with antral follicle count
HSG
Semen analysis
116
Most common cause of bloody nipple discharge
Benign intraductal papilloma
117
PREP regimens
Once daily tenofovir-disoproxil
| - same drug with addition of integrase inhibitor used for post-exposure prophylaxis
118
Von willebrand testing
PTT, von willebrand antigen, von willebrand activity, ristocetin co-factor, factor 8 activity
119
Available progesterone-only contraceptive pills
Norethindrone 0.35 mg
Drospirenone 4 mg (higher VTE risk)
Desogestrel 75 mcg
- First 2 are taken continuously
120
Covid vaccination schedule
```
Moderna 4 weeks apart
Pfizer 3 weeks apart
- 1 month booster for immunocompromised patients
- Spike proteins create antibodies
- 5 month booster for everyone else
J&J
- booster at 2 months
- adenovirus encodes spike protein
```
121
Findings of sarcoma on imaging
Heterogeneity
Increased blood flow
Central necrosis
Lack of calcifications (seen with fibroids)
