GYN

Question 1

Who needs stress dose steroids

Answer 1

Patients who take more than 20 mg/day of prednisone for more than 3 weeks
Patients who take more than 2 mg/day of dexamethasone for more than 3 weeks
Patients who take more than 80 mg/day of hydrocortisone for more than 3 weeks
Any patient with clinical Cushing syndrome

Question 2

How much stress dose steroids? Minor procedure

Answer 2

Local anesthesia

Take usual morning steroid dose. No extra supplementation is necessary

Question 3

How much stress dose steroids? Moderate procedure

Answer 3

Take usual morning steroid dose. Administer 50 mg hydrocortisone IV just prior to the procedure and 25 mg every 8 hours for 24 hours. Resume usual dose thereafter.

Question 4

How much stress dose steroids? Major procedure

Answer 4

Take usual morning steroid dose. Administer 100 mg hydrocortisone IV just prior to the procedure and 50 mg every 8 hours for 24 hours. Taper dose by half per day until maintenance dose is reached

Question 5

MTX absolute contraindications

Answer 5

Intrauterine pregnancy
Breastfeeding
Hemodynamic instability
Ruptured ectopic
Active pulmonary, renal, or liver disease
Peptic ulcer disease
Moderate to severe anemia, thrombocytopenia, or leukopenia
Inability to follow up
Allergy to methotrexate

Question 6

MTX relative contraindications

Answer 6

Presence of cardiac activity
> 4 cm size of ectopic pregnancy
Refusal of blood products
High initial hCG concentration

Question 7

Endometrial ablation absolute contraindications

Answer 7

Current pregnancy
Desire for future fertility
Active pelvic infection
IUD in place
Endometrial hyperplasia or cancer
Cervical cancer
Previous full thickness myomectomy
Bleeding or clotting disorder
Undiagnosed adnexal masses

Question 8

Endometrial ablation relative contraindications

Answer 8

Previous endometrial ablation
Thin myometrium due to prior surgeries
Complete cervical stenosis
Anatomical variations in uterine size or shape
Cavity length greater than 12 cm

Question 9

When does postop abscess need drainage?

Answer 9

> 7cm

Consider 2-7cm

Question 10

diabetic med contraindicated postop

Answer 10

metformin
- renal hypoperfusion

Question 11

vulvar lesion and mouth sores

Answer 11

lichen planus

Question 12

vulvar lesion white patches

Answer 12

lichen sclerosus

Question 13

itchy vulvar lesion

Answer 13

lichen simplex chronicus

• itch scratch cycle, worse at night

Question 14

lichen planus description

Answer 14

pruritic papules and plaques result in erosion and ulceration
— erythematous or violaceous, flat-topped, shiny polygonal papules
- wickham striae (fine white lacey reticulted pattern on buccal mucosa)

Question 15

lichen sclerosus description

Answer 15

cigarette paper skin
- white plaques, atrophic papules

Question 16

lichen simplex chronicus

Answer 16

• chronic eczematous disease from itch-scratch-itch cycle
• worse at night

Question 17

vulvar dz: thickening with gray, leathery tissue

Answer 17

lichen simplex chronicus

Question 18

psoriasis description

Answer 18

thick dull red plaques covering mons or labia, may have silver scale

Question 19

necrotizing fasciitis abx

Answer 19

1. carbapenem or beta lactam/lactamase inhibitor
   +
2. clindamycin (for antitoxin effects
   +
3. vancomycin (MRSA coverage)

Question 20

Local anesthetic toxicity management

Answer 20

stopping the injection, calling for help, arranging for cardiopulmonary bypass, managing the airway, suppressing seizures with a benzodiazepine, managing arrhythmias, administering lipid rescue, and transferring the patient to a monitored setting