General Gyn Flashcards
(166 cards)
1
Q
NIH diagnostic criteria for PCOS
A
Both required
- hyperandrogenism
- oligomenorrhea/amenorrhea
2
Q
Rotterdam diagnostic criteria for PCOS
A
Must have 2 of 3
- Hyperandrogenism
- Oligomenorrhea/amenorrhea
- Polycystic ovaries
3
Q
Androgen Excess Society diagnostic criteria for PCOS
A
Hyperandrogonism AND
Oligomenorrhea/amenorrhea OR polycystic ovaries
4
Q
Lab tests for diagnosing PCOS
A
Total testosterone and sex-hormone binding globulin ( or bioavailable and free T) TSH Prolactin 17-OHP 2-hr GTT Fasting lipids
5
Q
Definition of polystic ovaries
A
6
Q
Definition of polystic ovaries
A
12 or more follicles measuring 2-9mm in diameter OR
Increased ovarian volume greater than 10cm3
(If there’s a follicle >10mm, repeat scan at presumed time of ovarian quiescence)
7
Q
Metabolic syndrome
A
Elevated blood pressure (>130/85) Increased waist circumference (>35") Elevated fasting glucose levels (>100) Reduced HDL (<50) Elevated triglycerides (>150)
8
Q
How does insulin resistance relate to hyperandrogenism?
A
Hyperinsulinemia –> decreased levels of sex hormone binding globulin –> more bioavailable androgens
9
Q
Women with PCOS are also at risk for:
A
Metabolic syndrome Insulin resistance (--> T2DM) Nonalcoholic fatty liver disease Obesity related disorders like sleep apnea Cardiovascular disease Endometrial cancer Depression
10
Q
Who should be screened for nonclassical congenital adrenal hyperplasia?
A
Adult women with anovulation and hirsutism
11
Q
In women with PCOS who is not attempting to conceive, what is the best medical maintenance therapy to treat menstrual disorders?
A
Combined OCPs
Progestin (often accompanied by AUB)
Metformin (decreases circulating insulin)
12
Q
In women with PCOS who are not attempting to conceive, what is the best medical maintenance therapy to reduce the risks of cardiovascular disease and DM?
A
Lifestyle modification
Metformin
Statins
Combined OCPs
13
Q
In women with PCOS who are attempting to conceive, which methods of ovulation induction are effective?
A
Letrozole (aromatase inhibitor) Clomid Low-dose gonadotropins Ovarian drilling Metformin
14
Q
Mechanism of action of spironolactone
A
Aldosterone antagonist
Also binds androgen receptor as antagonist
15
Q
Flutamide mechanism of action
A
Androgen-receptor agonist
16
Q
Finasteride mechanism of action
A
5-alpha-reductase inhibitor
Teratogen, need reliable contraception
17
Q
Eflornithine mechanism of action
A
Inhibits ornithine decarboxylase
Topical
Improves outcome of laser
18
Q
Can you use vaginal estrogen in patients with recent diagnosis of breast cancer or currently being treated for breast cancer?
A
Yes, but vaginal tablet or ring impregnated with estradiol would confer a lower systemic absorption than a cream.
19
Q
Most effective form of emergency contraception
A
Copper IUD
Second is ulipristal acetate - SPRM
20
Q
Antibodies in Graves disease
A
TSH receptor antibodies
can also test for increased radioactive iodine uptake
21
Q
Mechanism of action of PTU/methimazole
A
Blocks organification of iodide –> decreases synthesis of thyroid hormon
(PTU also blocks peripheral conversion of T4 to T3)
22
Q
Common supplement that can mask vitamin B deficiency
A
Folic acid supplementation (rule out vitamin B12 deficiency before starting supplements)
23
Q
Definition of late latent syphilis
A
Asymptomatic, positive serologic test result greater than 12 months after infection
24
Q
Treatment for primary, secondary, or early latent syphilis
A
Penicillin G 2.4 million units, IM x1
25
Treatment for late latent or tertiary syphilis or syphilis of unknown duration
Three doses of penicillin G 2.4 million units at one-week intervals
26
Tamoxifen mechanism of action
Selective estrogen receptor modulator
Blocks native estrogen effects on breast tissue
Stimulates estrogen receptors in endometrium
27
How does tamoxifen have a procoagulant effect?
Increases antithrombin III and protein C
| not recommended in women with history of VTE
28
Who has an increased risk of endometrial neoplasia when taking tamoxifen?
Postmenopausal women
29
What is tamoxifen's affect on bone?
Lower rates of osteoporosis due to antiosteoclast activity
| Maybe premenopausal women have decreased bone mineral density, but no increase in fractures
30
Indications for laparoscopy in adolescents with pelvic pain
```
Chronic pain unresponsive to OCPs and NSAIDs
Diagnostic dilemma (PID vs appy)
Identified pelvic mass
Painful irregular vaginal bleeding
Progressive dysmenorrhea
```
31
Is well-controlled hypertension a contraindication to estrogen containing methods of contraception?
Yes, use progesterone-only
32
Number needed to treat (NNT)
100 / (exposure with desired outcome) - (no exposure with desired outcome)
33
Absolute risk reduction
An quantity by which some outcome is reduced
Not a ratio
(exposure with desired outcome) - (no exposure with desired outcome)
34
Relative risk reduction
Absolute risk reduction / baseline rate of event in question
35
Relative risk
100 - relative risk reduction
36
Which lower genital tract anomalies should be transected in the OR?
```
Imperforate hymen
(semiperforate hymen, septums can be done in the office)
```
37
Which lifestyle modification decreases blood pressure the most?
Weight loss
38
In order to be considered eligible for Medicaid EHR program, the proportion of the OBGYN's private practice patient volume covered by Medicaid must be:
30%
39
Does Depo decrease bone mineral density?
Yes 5% after 5 years of use
| But this is recoverable after Depo is discontinued
40
What is the single dose regimen treatment for bacterial vaginosis?
Secnidazole 2g PO x1 (oral granules)
41
First line treatment for cyclic nonfocal mastalgia
Supportive bra and NSAIDs
42
Danazol
Androgen that suppresses pituitary gonadotropin release
Only FDA approved drug for cyclic mastalgia
(but not first line due to side effects - weight gain, menstrual irregularity, hot flashes, voice deepening, acne, hirsutism)
43
Postembolization syndrome
30-40% of embolizations, results from tissue ischemia and necrosis leading to an inflammatory reaction
Pain, nausea, fever, elevated WBC
Peaks 1-2 days after procedure and resolves within 8 days
44
Fractional excretion of sodium < 1
Prerenal etiology of oliguria (decreased renal perfusion)
45
Ovarian mass with elevated LDH and b-hCG
Dysgerminoma
46
What should patients do with their basal (long-acting) insulin preoperatively
Decrease dose the night before to prevent hypoglycemia while NPO
47
Helpful to prevent pregnancy loss in women with recurrent (>3 consecutive) pregnancy loss
Progesterone supplements
48
Treatment for fibroids in a smoker that wants to delay surgery
Leuprolide acetate
49
Age when varicella is given
First dose 12-15 months
Second dose 4-6 years
7 and older who do not have evidence of immunity
50
Treatment for exposure to varicella, still asymptomatic
Vaccination
51
First line for GERD treatment
PPI
52
When should DEXA scan be performed
Age 65
| Or if FRAX 10yr fracture risk is 9.3% or greater
53
Treatment of osteoporosis should be initiated when:
T-score of -2.5 or less
FRAX score with 10yr risk of 3% or greater for hip fracture
FRAX score with 10yr risk of 20% or greater for major osteoporotic fracture
54
Used for the prevention of osteoporotic fractures AND reduction of breast cancer risk
Raloxifene
55
Omnibus Final Rule
Addresses provisions of HITECH act
| Attempt to standardize EHR capabilities across platforms and provide funding for "meaningful use" of EHR
56
Primary risk of tamoxifen and raloxifene
Thromboembolic events
57
Why is raloxifene better than tamoxifen for menopausal patients
Tamoxifen has increased risk of VTE, endometrial neoplasia, and cataracts
58
She had positive blood cultures in the hospital, but she's on oral antibiotics and feeling much better now, would you repeat the blood cultures?
No
59
Do you biopsy a thick endometrium in an asymptomatic postmenopausal woman?
No
60
The first step in creating an office safety program is to
Designate a medical director for safety
61
Pap screening for HIV+ women
Initiate a year after starting sexual activity, if normal then yearly cytology
62
Most effective emergency contraception
Copper IUD
| then ulipristal - antiprogestin, then oral levonorgestrel
63
After obturator sling, patient can’t rotate hip outward
Obturator internus injury
64
Risks for surgical site infections
Abdominal >> laparoscopic >> vaginal
Length of procedure > 3 hours
Blood transfusion
65
Next test for "burning" or tender vulvar pain with swab test
Fungal culture
66
Next step after insufficient sample on EMB (for single episode PMB)
TVUS for endometrial stripe
67
Postprocedure contraceptive recommendation after hysteroscopic sterilization
Contraception for at least 3 months until HSG or targeted ultrasound confirms bilateral occlusion
68
Best treatment for vasomotor symptoms of menopause in women with a uterus
Combined estrogen and progesterone
69
Risk of copper IUD
Irregular bleeding
| PID (and subsequent tubal damage) in patients with multiple sex partners
70
How long is ulipristal acetate effective as emergency contraception after intercourse
5 days
71
A hospital surgical proctor:
Receives institutional compensation for protctoring
Completes written evaluation of new faculty
Can recommend termination of a procedure if unsafe
72
Nonviable pregnancy of unknown location, but not enough information to warrant methotrexate?
Surgical evacuation of the uterus
73
Best treatment for c.diff in patients who are at high risk of recurrence (on concomitant antibiotic therapy, severe infection, advanced age)
Fidaxomicin
74
Safest mood stabilizer for breastfeeding
Valproic acid
75
Minimum evaluation for low back pain
Neuro exam
76
Primary amenorrhea, no breast development or pubic hair, next test?
FSH
77
Concern in older adults wiht ibuprofen
Renal injury
78
Medications with bone loss/fracture risk
DMPA
SSRIs
PPIs
Antiepileptics
79
Absolute contraindications to endometrial ablation
Pregnancy
Known endometrial cancer
Active pelvic infection
Desire to maintain fertility
80
Relative contraindications to endometrial ablation
Congenital uterine anomalies
Enlarged uterine cavity
Conditions that create myometrial thinning (previous uterine surgery, myomectomy, cesareans)
Conditions that may increase the risk of future endometrial cancer or hyporplasia
81
Reasons to perform BSO during benign hysterectomy
Decreases risk of ovarian cancer
| Decreases risk of reoperation (moreso than cancer)
82
Vaginismus
Involuntary contraction of the pelvic floor, inhibiting entry into the vagina
83
Hysterectomy for CIN, how often and how long to do vaginal cytology?
Every three years until 20 years post-hyst
84
Osteoporosis treatment for women in their 50s
Estrogen agonist/antagonist while in their 50s
Then switch to bisphosphonates in their 60s (decreases amount of time exposed to these drugs because of bad side effects)
85
Improves MI risk perioperatively in high risk patients
Beta blockers
86
Stop hysteroscopy if fluid deficit is greater than
1000mL
87
Treatment for DCIS
Lumpectomy
| Mastectomy felt to be too aggressive despite lower recurrence rate
88
AIS treatment in patients who have completed childbearing
Hysterectomy
89
How often should lipid screening be performed
Every 5 years after 45
90
How often should diabetes screening be performed
Every three years after 45
91
Treatment for bone loss in adolescents with functional hypothalamic amenorrhea
Transdermal estradiol with cyclic oral progestin
92
Risk factors for vitamin D deficiency
```
Darker skin
Vegetarian diet
Obesity
Bariatric surgery
Limited sun exposure
```
93
Common method of confirming completion of medical management of miscarriage
Ultrasound 7-14 ays after misoprostol: absence of GS and endometrial thickness <30mm
94
Medication that has shown possible association with vulvodynia
OCPs
95
How to evaluate acute diverticulitis
CT
96
Most common (75%) of all cases of pediatric vulvovaginitis
Nonspecific vaginitis
97
Requirements of the American Institute of Ultrasound in Medicine (AIUM)I
If you've completed residency more than 3 years ago, in the last 36 months, must have attained:
1. at least 30 AMA Physicians Recognition Award Category 1 Credits
2. Supervised, interpreted, and reported at least 300 diagnostic obstetric US exams
98
65 yo with lifetime negative cervical cancer screening, cytology is negative but insufficient cells
Do HPV testing
99
Exemptions to Physician Payments Sunshine Act
```
CME
Buffet meals
Samples for patient use
Educational materials for patient use
Loan of medical devices <90 days
Transfer of anything of value to a physician when physician is a patient
Discounts
Charity care
Anything less than $10 unless aggregate amount exceeds $100
```
100
When should colon cancer screening begin in African Americans
45 years old
101
When should colonoscopies be discontinued
75 if normal in last 10 years
102
Pneumococcal vaccine recommendation for vaccine naive individuals 65 and older
PCV13 at 65, then PPSV23 6-12 months later
103
Pneumococcal vaccine recommendation for individuals who previously received PPSV23 at 65 years or older
PCV13 after one year from PPSV23
104
Pneumococcal vaccine recommendation in individuals who previously received PPSV23 before age 65 and who are now 65 or older
Wait at least a year and do PCV13 at 65, then PPSV23 6-12 months later
105
Pulmonary changes during Trendelenberg positioning
```
Airway resistance increases
Chest wall compliance decreases
Functional residual capacity decreases
Functional vital capacity decreases
Total lung volume decreases
```
106
First step i evaluation of nonpalpable contraceptive implant
Urine pregnancy test
107
Advantage of bazedoxifene in patients taking estrogen
Prevents bone loss and protects endometrium
108
When should post-exposure prophylaxis for HIV be given in sexual assault victims?
In the first 72 hours
109
Postexposure prophylaxis for sexual assault
28 day course of three drug regimen (tenofovir, emtricitabine, and raltegravir)
110
Prophylaxis for recurrent UTI in postmenopausal women
Daily antibiotic
| not enough evidence for estrogen yet
111
HPV vaccine before age 15
Two doses, 6-12 months apart
112
HPV after age 15
Three dose regimen, second dose 1-2 months after the first and the third given 6 months after the first
113
HPV vaccine not FDA approved for individuals over
26 years old
114
Vulvar itching that began with an inciting fungal infection or other event
Scaling and lichenified plaques
Erosions and ulcers
Hyper and hypo pigmentation
Biopsy shows thickened rete ridges, thickened granular layer, hyperkeratosis
Lichen simplex chronicus
115
Vaginal pruritis, irritation
Thinned, crinkly white skin
Figure of eight appearance
Biopsy shows markedly thinned epithelium and blunting of rete ridges, sometimes hyperkeratosis
Lichen sclerosus
116
Inflammatory of mucosa and genital tract
White reticulate lacy, fernlike
Adhesions of labia
Biopsy shows degeneration of basal layers, lymphocytic infiltrate of the dermis, epidermal acanthosis
Lichen planus
117
Elevated in granulosa cell tumors
Inhibin B
118
Yolk sac tumor presentation
Acute abdominal pain and a huge pelvic mass
119
Elevated in yolk sac tumor (endodermal sinus tumor)
AFP
120
Dysgerminoma presentation
Abdominal pain, fever, ascites
121
Elevated in dysgerminoma
LDH, hCG
122
Screening for prostate cancer in transgender females
Offer PSA screening after age 50 if they transitioned after 20
123
Class 1 recommendation for contraception in patients with SLE, APLS, etc
Copper IUD
124
What medication is most likely employed for adolescent obesity which is not responding to lifestyle changes?
Tetrahydrolipstatin
125
What are the most likely organisms implicated in genital pruritis and vaginal discharge
Respiratory organisms
126
How many milliliters does a super plus tampon hold
15-18
127
Medical treatments for acute menstrual bleeding in adolescents
Conjugated equine estrogen
Medroxyprogesterone acetate
Tranexamic acid
Combined oral contraceptives
128
Type of suture for Pomoroy
0-plain catgut
129
Poliglecaprone type of suture
Monofilament absorbable
130
Most common treatment/procedure for endometrioma
Excision/stripping
131
What drug should be avoided in patients receiving a full opioid agonist
Butorphanol
132
Androgen sensitive skin areas
```
Thighs
Face
Back
Sternum
(NOT AXILLARY)
```
133
Relative risk for what cancer is increased when taking OCPs
Cervical
134
Medication for chronic neuropathic pain
Gabapentin and pregabalin
135
Factor that has been associated with later menopause
High parity
136
Medication for osteoporosis that increases osteoblasts and stimulates bone formation
Recombinant PTH
137
What is most valuable in detecting a gas embolus intraoperatively
End tidal CO2
138
Mood stabilizer that is most likely to result in bone resorption
Lithium
139
Treatment of a flat dome shaped umbilicated lesion of the vulva
Intralesional interferon
Podofilox
Imiquimod
Curettage
140
Hormone that increases only in mid lutéal cycle
Inhibin A
141
HLA-DR4
Rheumatoid arthritis
142
Colposcopic finding most indicative of invasive cervical carcinoma
Atypical vessels
143
Most common presentation of erosive lichen plan is
Dyspareunia
144
Next step in management of 9yo with mass posterior to the areola
Observation
145
Goal LDL
Less than 100
146
Treatment for breast budding after giving estrogen for labial adhesions in a child
Bêta méthadone créma
147
What age does a woman gain maximum bone density
19
148
Most important treatment in panhypopituitarism
Cortisol
149
Chronic pelvic pain with history of DV, extra screening?
Depression
150
Antibiotic that decreases serum concentration of OCPs
Rifampin
151
Components in the treatment of thyroid storm
PTU
Iodine
Beta blocker
Dexamethasone
152
Extraintestinal manifestations of Crohns
VTE
Renal calculi
Osteoporosis
B12 deficiency
153
Androgens produced by the ovary
Testosterone
Androstenedione
DHT
DHEAS
154
Which phase of cell cycle does protein synthesis, RNA synthesis, and DNA repair occur
G1
155
VIN III with 0.9mm invasive carcinoma and clear margins?
Observation
156
E6
P53
157
E7
Rb
158
Bone formation markers
Osteocalcin
Bone specific alk phos
Procollqgen type 1
N terminal pro peptide
159
Other pathology you might find at time of surgery for endometriosis
Unicornuate uterus
160
Most likely side effect of paroxetine
Neuro
161
Urogénital sinus gives rise to
Urinary bladder
Hymen
Lower vagina
Paraurethral glands
162
Progestins derived from 19-nortestosterone
Levonorgestrel
Norethindrone
Norgestimate
Desogesterol
163
Risk factors for HIT
Heparin >4days
UFH
Female
Surgery
164
Most frequently encountered problems associated with TPN
Catheter tip infections
165
Most common sex hormone aneuploidy
Klinefelters XXY
166
Mechanism of action of heparin
Inactivation of thrombin
