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General Gynecology Flashcards

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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
What causes molluscum?
Poxvirus
26
Mondor disease
Superficial thrombophlebitis of veins of the anterior chest wall and breast 2/2 graumatic injury, breast surgery, or repetitive exercise
27
How do you treat Mondor disease?
warm compress anti-inflammatory
28
Risk factors for endometriosis
mullarian anomalies, short menstrual cycles (<27 days), heavy/prolonged menstrual bleeding, and early menarche
29
What percent of pregnancies are unintended?
41% (as of 2011) up to 75% among women <20 years old
30
What are risk factors for unintended pregnancy?
Age 18-24 income <100% of poverty level Not completing high school Non-hispanic black/AA Cohabitating without marraige
31
What is the risk of pregnancy from a 1x unprotected intercourse?
2-5%
32
What are the types of emergency contraception?
Yuzpe method (COCPs) Plan B (levonorgestrel) Ella (ulipristal acetate) Cu-IUD
33
What is one advantage of Ella over Plan B?
Ella (ulipristal) delays ovulation before or during LH surge; levonogestrel delays only prior to LH surge Neither effective at LH peak or later
34
What is the dosing and efficacy of Plan B?
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)
35
What is the dosing and efficacy of Ella?
30mg ulipristal acetate x1 Can give up to 120hr Avoid progestins x5 days 1.2-1.8% pregnancy rate
36
What is the Yuzpe method?
Combine OCPs to take 100-120mcg ethinyl estradiol and 0.5-0.6mg LNG 2 doses, q12h High nausea effects
37
What is the effectiveness and use of Cu-IUD as emergency contraception?
Place up to 12hr after intercourse 0.1% rate of pregnancy
38
What is the modified for multiple procedures at the same time?
55
39
What is the modifier for multiple separate procedures on the same day?
25
40
What is the modifier for unsuccessful procedure?
53
41
What is the modifier for difficult procedure?
22
42
What is the modifier for assistant attending surgeon?
80
43
What are the genetics of a partial mole?
69 XXX or 69 XXY
44
What are the genetics of a complete mole?
46XX or 46XY
45
What are absolute contraindications to methotrexate?
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
What are relative contraindications to methotrexate?
cardiac activity refusal to accept blood transfusion ectopic >4cm high initial hCG concentration
47
What is the recurrence risk of ectopic pregnancy?
1 prior - 10% 2 or more prior - 25% or more
48
Which medications may cause galactorrhea?
Antipsychotics Metoclopromide Verapamil COCPs methyldopa
49
Cigarette paper skin on the vulva Loss of architecture
Lichen sclerosus
50
Violaceous papules and plaques on the vulva w/ erosions or ulcerations
Lichen planus
51
Amsel criteria
pH >4.5 Clue cells Thin white-grey discharge Positive whiff test
52
Which treatments for condyloma are safe in pregnancy?
cryotherapy trichloroacetic acid
53
When is peak bone density for women?
19 years old
54
What's the difference between a T score and a Z score?
T score = bone marrow density compared to young healthy cohort Z score = bone marrow density compared to age-matched women
55
What is the T-score criteria for osteopenia and osteoporosis?
Osteopenia: less than -1 to -2.5 Osteoporosis: less than -2.5
56
Who merits treatment for low bone density?
Osteoporosis (T20% risk of major fracture in next 10 years or >3% risk of hip fracture) History of low trauma fracture
57
What is the first line treatment for osteoporosis?
Bisphosphonates
58
What are second-line tx for osteoporosis?
Raloxifene - good for younger pts or high breast cancer risk Denosumab - RANK-L inhibitor Hormone therapy Calcitonin PTH
59
How often do you screen for cervical cancer in HIV+ women?
Yearly, w/in 1 year of first sexual activity or w/in 1 year of HIV dx if sexually active Continue through lifetime
60
How often do you screen women who had DES exposure in pregnancy
Annually
61
When should you sample the endometrial lining in a post-menopausal women?
AUB and stripe >4mm incidental finding and stripe >11mm
62
When is bariatric surgery recommended?
BMI >40 or >35 with medical comorbidities with diet/exercise/meds unsuccessful
63
What is the most common endometrial abnormality in a woman on tamoxifen?
endometrial polyps (incidence 8-36%) followed by hyperplasia (1.3-20%)
64
What genetic abnormalities cause primary ovarian insufficiency?
45X Turner Fragile X 17-alpha-hydroxylase def aromatase deficiency galactosemia
65
What are defining features of moderate ovarian hyperstim?
mild features (nausea/vomiting, enlarged ovaries, diarrhea, abd distension) + ultrasound evidence of ascites + hematocrit >41% + WBC >15
66
What are features of severe OHSS?
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
How long after bariatric surgery should you wait to attempt pregnancy?
12-18 months
68
What genetic complication is unique to ICSI?
Imprinting disorders Especially Beckwith-Wiedemann syndrome
69
What are indications for ICSI?
Moderate-severe male factor infertility Surgical retrieved sperm Pre-implantation genetic diagnosis / aneuploidy screening Cryopreserved oocytes Prior failed fertilization
70
How do you treat hydrosalpinx prior to IVF?
Salpingectomy
71
Should you treat an endometrioma surgically to improve fertility?
Surgical tx reduces ovarian reserve - HOWEVER surgical removal of Stage I/II improves fertility by RCTs
72
What is the most common complication of hysteroscopy?
uterine perforation (0.7-3%)
73
Painful ulcer with tender unilateral suppurative lymph nodes
Chancroid (haemophilus ducreyi)
74
Nonpainful ulcer with unilateral tender suppurative lymph nodes
LGV - chlamydia trachomatis L1-3
75
Nonpainful ulcer with firm non-suppurative bilateral lymph nodes
Syphilis
76
Painful ulcers with firm non-suppurative lymph nodes
HSV
77
Donovan bodies
Granuloma inguinale / Klebsiella granulomatous
78
What is the likelihood that endometrium is covering an Essure and it is not visible hysteroscopically?
25%
79
Which is better for fertility, endometrioma drainage or removal?
Unclear, unless if >4cm then cystectomy is better than drainage
80
What gives false positive serum hCG?
heterophile antibodies especially in women with exposure to animals (lab workers, farms). Get a urine hCG to compare
81
Why would someone undergo gamete intra-fallopian transfer?
Fertilization occurs in vivo For patients with objection to IVF Involves laparoscopy, live birth rates are lower than IVF
82
Chronic endometritis
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
Mirabegron
Beta3 adrenergic receptor agonist Side effecct - HTN
84
Coaptite
Urethral bulking agent used to tx stress urinary incontinence
85
Frankenhauser plexus
uterovaginal plexus 4 and 8 o'clock at cervical base
86
Add back progestin therapy with GnRH agonists
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
Steps of implantation
Apposition - embryo contact with endometrium Adhesion - embryo adheres to endometrium Invasion - embryo embeds in endometrium
88
When is DXA scan for bone mineral density recommended?
65+ years <65 years, post-menopausal, and if FRAX is >8.4%
89
Which measurements are most accurate for DXA scans?
Hip Lumbar spine
90
Who should you calculate a FRAX score for?
Post-menopausal patients <65 years old One risk factor for osteoporosis
91
What is the recommended daily allowance for calcium?
1000mg/day 19-50yo 1200mg/day 51yo+
92
What is the daily recommended allowance for vitamin D?
600 IU/day up to 70 800 IU/day >70

Gynecology (3 decks)

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