Just Might Be On This Damn Exam Flashcards
Based on Review Session and Pat's Own Mouth (152 cards)
1
Q
Diagnostic test for identifying reasons for infertility, galactorrhea, and amenorrhea. Good at identifying possible hormone secreting tumor as well.
A
Serum Prolactin Level
2
Q
You think she might have something going on “down there”…you think it might be trichamonas or BV. How you gonna find out? What might you see?
A
Wet mount. Flagellated and motile trichomonads for trich. May see Clue cells for BV
3
Q
Oh crap…she’s positive for a qualitative Hcg test…but she is definitely NOT pregnant. What might this be?
A
Ovarian cancer!!!
4
Q
She’s trying to get pregnant, Hcg is present in qualitative Hcg test. What do you tell her?
A
Congrats!
5
Q
A woman has severe one sided abdominal pain, and has been suddenly spotting. A quantitative Hcg test is performed and Hcg is present but it is there in very low amounts. What might be happening?
A
Ectopic pregnancy or miscarriage
6
Q
She thinks she might be pregnant, a quantitative Hcg test is performed and she has HUGE levels…what might be happening?
A
Molar pregnancy or even twins. Better find out…cuz one might be awesome and one might suck!
7
Q
There is a thick, white, curdy discharge coming from her vagina. She’s in a bit of pain and is uncomfortable. What test might you perform? What might you find?
A
KOH smear. Hyphae and mycelia if candidiasis is the culprit.
8
Q
According to the amsel criteria…how you gonna know if someone has BV?
A
3 of 4 of the following: Graying/white vaginal discharge, pH>4.5, fishy WHIFF after KOH, presence of CLUE cells - it was the BV…in the vagina…with the lead pipe.
9
Q
How do you test gestational diabetes in the 3rd trimester?
A
GTT (glucose tolerance test)
10
Q
This test is commonly used to monitor infertility.
A
FSH.
11
Q
This might be elevated in women who have adrenal tumors, congenital adrenal hyperplasia, ovarian tumors, PCOS.
A
Testosterone
12
Q
Serum testosterone may be helpful in identifying what?
A
Ovarian tumors, virilizing conditions in women.
13
Q
This is the best test to determine if ovulation has occurred.
A
Serum progesterone level (on day 21 of the cycle)
14
Q
Low levels of progesterone indicate (decreased/increased) risk of spontaneous abortion and/or onset of menopause.
A
Increased
15
Q
Serum estrogen levels are checked to assess what?
A
Menstrual and fertility problems
16
Q
This test can the presence of absence of ovulation or the time of ovulation. If there is a non “frond-like” pattern on the slide, it means what?
A
Fern test. It would mean ovulation HAS occurred
17
Q
Wanna know if it’s chlamydia, gonorrhea, or E. Coli? What do you want to do?
A
Culture that vagina for bacteria
18
Q
Testing some Rh crap that I don’t understand
A
Coombs test
19
Q
Let’s talk about PAP’s. Not Blue Ribbon…but the other kind. Who gets screened for cytology and how often?
A
Women age 21-65, every 3 years.
20
Q
Who gets screened via co-testing on pap smear? Who often?
A
Women age 30-65, every 5 years if they want to cut down on visits.
21
Q
T/F You should screen women younger than 21
A
FALSE
22
Q
T/F You should screen a 28 year old for HPV
A
FALSE. Not til she’s 30 will you do co-test screenings
23
Q
T/F A woman who has had a hysterectomy with the removal of her cervix who has no history of cancer or pre cancer DOES NOT HAVE TO BE SCREENED AT ALL.
A
TRUE
24
Q
T/F Grandma has been screened every year and she’s been clear. Now she’s turning 65, to celebrate…you take her for a screening.
A
FALSE
25
T/F You find ASC-US or LGSIL but HPV is negative. You must do a colposcopy to find out wtf is going on!
FALSE
26
You've got a kid who lost her IUD…not at home…I mean inside. How you gonna take a look?
Pelvic US
27
How are you going to dx retroperitoneal lymphadenopathy associated with malignancies or identify the depth of myometrial invasion in endometrial carcinoma and extrauterine?
Pelvic/Abdomina CT
28
This procedure best EVALUATES ENDOCERVICAL CANAL, ENDOMETRIAL CAVITY and FALLOPIAN TUBE LUMINA. It's good at finding uterine abnormalities as well as tubal abnormalities when assessing fertility issues
Hysterosalpingogram (HSG)
29
I'm gonna take a look at the cervix proper...
Colposcopy
30
I'm gonna stick a needle in the pouch of douglas to figure out what type of inwraperitoneal lesion we're dealing with here folks...
Cultocentesis
31
Gonna take a "LEEP" of faith and remove some vulvar and cervical lesions. While I'm at it, I'll remove some vulvar condylomata and cervical dysplasias.
Loop electrocautery excision procedure
32
FDA says the fetus will be jacked up if I give this drug…regardless of benefit.
Category X
33
FDA says that nothing should come between me and this drug…it seems to be safe
Category A
34
FDA says it doesn't look good, doesn't look bad…but no animal fetuses have been hurt and no women have even been tested
Category B
35
FDA says animal fetuses have suffered a little, but no human tests have been performed. However, benefits might outweigh the risks.
Category C
36
FDA says tests have been done on humans and the results weren't very good for the fetuses, but still…in extreme cases…benefits may outwit the risks.
Category D
37
Best medication for osteoporosis, Paget's disease, and bone metastases
Bisphosphonates.
38
T/F Bisphosphonates should be taken with food
FALSE. Need to have an empty stomach
39
T/F Calcitonin is good at reducing bone resorption as a second line drug for osteoporosis but it does not reduce pain associated with osteoporotic fractures and vertebral fractures
FALSE. It's good at reducing that pain
40
Most common side effects of bisphosphonates
Esophogitis, abdominal pain, diarrhea
41
Weight bearing exercise, smoking cessation, vitamin D and calcium supplementation, and glucocorticoid avoidance will help reduce...
Osteoporosis
42
Women over 50 should take 1000, 1100, 1200, 1300, or 1400mg/day of calcium. Young women age 9-18 should take how much?
\>50 = 1200mg/day 9-18 = 1300mg/day 19-50=1000mg/day
43
How do you stimulate withdrawal bleeding in a woman who is not pregnant but who has no menses?
Progesterone challenge. If you do it and there is withdrawal bleeding then an ovulation is the problem causing her lack of menses. If it doesn't stimulate bleeding, then something else is wrong.
44
Who do you give clomephine citrate to?
Women who respond to progestin challenge with bleeding who want to get pregnant
45
T/F HRT is indicated for use to prevent osteoporosis
FALSE
46
T/F It is safe to use HRT's for longer than 5 years in most cases.
FALSE
47
T/F Breast cancer is an absolute contraindication for estrogen use
FALSE (according to Pat)
48
You've got hot flashes, I've got some natural, alternative stuff for ya…here…try some \_\_\_\_
Black cohosh, flaxseed, vitamin E
49
This natural stuff is an important modulator of hormone metabolism
Flaxseed
50
\_\_\_\_ has been touted as an alternative therapy to HRT
Soy…yeah…soy
51
Put this natural stuff on your dry vagina...
Vitamin E oil
52
Who do you treat most often with conjugated estrogens, estradiol, and estrone sulfate (Premarin, Estring)?
Menopausal women
53
The most potent estrogen therapy
Estradiol
54
For a women with an intact uterus, _____ is always included with the estrogen therapy because the combination reduces the risk of endometrial carcinoma associated with unopposed estrogen
Progestin
55
For women who have undergone hysterectomy, unopposed ____ therapy is recommended
Estrogen
56
Plan be treatment med is \_\_\_\_. Treatment is should be administered within \_\_\_\_hrs after intercourse.
Levonorgestrel, 72 hours.
57
Preven medication is ____ and should be administered within \_\_\_\_hrs after intercourse.
Estradiol and Levonorgestrel. 72 hours.
58
Nausea is worse with (Plan B, Preven).
Preven
59
IUD's should be inserted within ____ after intercourse to be effective for emergency contraception
7 days
60
Ortho Evra is a \_\_\_\_
Birth control patch
61
A patch and ring both have \_\_\_\_% effectiveness
92-99%
62
It is very important to do what before inserting an IUD?
CHECK FOR PREGNANCY!!!
63
What factor most affects the benefits of a patch?
Obesity. Should be below 90kg
64
What can you do if your male partner is bothered by your IUD?
Remove it for intercourse but replace it within 3 hours.
65
Who should NOT use a nuvaring?
Smokers, young girls who have not reached normal menarche age, women who are pregnant
66
How often do people get Depo shots?
Every 3 months
67
What is implanon?
A contraceptive implant
68
ACHES stands for ____ and is used for \_\_\_\_
Abdominal pain, Chest discomfort, Headaches, Eye problems, Serious pain in arms or legs. Used to assess pts prior to contraceptive treatment
69
A woman who is going on hormonal contraceptives should not be or suffer from...
Pregnant, over 35 and smoker, breast cancer, undiagnosed vaginal bleeding, thromboembolic disorders, uncontrolled HTN, DM with vascular disease
70
Dilation and aspiration surgical abortions are done between \_\_\_\_
7-15 weeks
71
Dilation and evacuation surgical abortions are done between \_\_\_\_
16-24 weeks
72
Mifepristone does what?
Aborts fetuses \< 8 weeks gestation
73
APGAR is measuring….
Appearance (color) 0-2, Pulse (absent, 100) 0-2, Grimace (none, grimace, crying) 0-2, Activity (movement) 0-2, Respirations (absent, slow/irregular, good) 0-2
74
The most popular obstetric nerve block is...
Pudendal
75
You're going to perform an episiotomy on a pt who has not received any pain medication or anesthesia. What will you consider?
Pudendal anesthetic
76
You're in a hurry, the baby's vital signs are plummeting and the mother is in distress…what will you do in a hurry with regard to anesthesia?
Spinal
77
A 60yo is postmenopausal and white, she has been taking large amounts of unopposed estrogen for fun because she thought it was candy (dumb but you get the idea…she's been taking estrogen for too long). You perform an assessment and notice a large uterus and also some notice some unexplained abnormal uterine bleeding. PAP was negative. What might this be? Is it common?
Endometrial cancer. It's the most common type.
78
With vulvar cancer, is usually what type?
Small cell carcinoma!
79
What is the common offender with vulvar cancer?
HPV (40-60%)
80
A 50yo postmenopausal woman has a history of smoking and HPV, as well as a history of genital warts, vulvar irritation, pruritus, and some local discomfort and bleeding in the vagina. The area is beginning to look a little like cauliflower. What are you thinking? How so you screen for it? How do you know if you're right?
Vulvar cancer. Screening is not reliable. Biopsy it if found and surgically remove it if dx is confirmed.
81
A 50yo pt presents with vague GI discomfort. During your assessment you note a solid, fixed, adnexal mass. Labs show elevated CA125, hCG, lactate dehydrogenase, and alpha-fetoprotein. What are you thinking? Should you have screened for it?
Ovarian cancer. No screening is recommended.
82
Cervical cancer is most common woman \> \_\_\_\_yo and is mediated by \_\_\_\_. A pt presents early with ____ bleeding and a \_\_\_\_cervix.
40. HPV. Postcoital bleeding, friable
83
Beginning of breast development
Thelarche
84
Look mom…pubes.
Pubarche
85
I'm having a period, but you can't see it because it's blocked.
Crypto-menarrhea
86
One sided lower abdominal pain associated with the time an egg is released from the ovary.
Mittelschmerz
87
My periods don't seem as heavy and don't last as long.
Hypo-menorrhea
88
Too much menstrual bleeding and for too darn long.
Menorrhagia/hyper-menorrhea
89
I just have my first period.
Menarche
90
My cycles happen at least 35 days apart
Oligo-menorrhea
91
My periods are regular but sort of more frequent than most people.
Poly-menorrhea
92
28 weeks gestation to 7 days of life
Peri-natal
93
Up to 6 weeks after birth
Post-natal
94
Days 1-5 of cycle
Menstrual uterine phase of follicular ovarian phase
95
Days 15-28 of cycle
Secretory uterine phase of luteal ovarian phase
96
Days 6-14 of cycle
Proliferative uterine phase of follicular ovarian phase
97
On about what day of the cycle does ovulation occur?
12-14 or so
98
Estrogen and progesterone are low during this phase of the cycle causing the endometrium to do what?
Menstrual phase. Slough
99
An increase in estrogen causes SURGE OF LH which triggers ____ during this this phase...
Ovulation
100
During this phase of the cycle, estrogen and progesterone are secreted by the corpus luteum which make the environment ripe for baby life.
Secretory phase
101
As estrogen increase, the endometrium is stimulated to ____ during this phase by the same name...
Proliferate
102
Who gets tested/screened for what and when?
1) Cytology alone = 21-65 every 3 years 2) Cytology + HPV (cotest) = 30-65 every 5 years 3) Screening can stop = \>65yo with good history of screening 4) Screening after hysterectomy = STOP 5) Bimanual exam = no recommendation. Up to pt and provider 6) Women with HPV vaccine = screen them anyway 7) Breast exam = USPSTF - don't. ACOG - Annual CBE \> 40yo. CBE 20-39 every 1-3 years 8) Mammography = USPSTF - biannual 50-74. ACOG - \>40 9) HIV = USPSTF - screen anyone at risk and anyone pregnant. ACOG - screen 19-64 10) STI's = USPSTF - screen all sexually active women for gonorrhea. ACOG - screen any sexually active woman age 25 or younger for gonorrhea and chlamydia
103
Key to PMS diagnosis
Must occur in luteal phase, must have 7 consecutive symptom free days in follicular phase, must occur in at least 2 consecutive cycles, symptoms must be severe
104
What % of women experience PMS?
Up to 75%
105
The absence of menses in a 13yo in the absence of normal growth or sexual development OR in a 15yo in the presence of normal growth and sexual development.
Primary amenorrhea
106
97% of women have their periods by age \_\_\_\_
15
107
Absence of menses for 3 cycles or 6 consecutive months in a woman who has previously menstruated.
Secondary amenorrhea
108
Most likely etiologies of primary amenorrhea
Hypothalamic/pituitary disfunction. No GnRH = no FSH or LH, Turners, other genetic issues.
109
Most common cause of secondary amenorrhea
PREGNANCY!!!
110
Common causes of DUB (after pregnancy, cancer, and other systemic diseases are ruled out) are...
Anovularion, PCOS, fibroids, polyps, etc
111
How do you treat DUB?
OCP, IUD, DEPO, myotomy to remove fibroids (if cause), hysterectomy to be considered
112
What are the there types of dysmenorrhea and what are their causes?
Primary - no organic cause, secondary - pathologic (endometriosis, adenomyosis, PID, fibroids, etc), Membranous - cast of endometrium comes off all at once.
113
Pt is experiencing nausea, vomiting, diarrhea, and HA. She has pelvic tenderness over her uterus. It's her FIRST DAY of her period. SHE IS NOT PREGNANT. What are you thinking. How will you treat her?
Dysmenorrhea. NSAIDs
114
MOA, failure rate (theoretical), failure rate (real life) - Male condom
Mechanical barrier, 2%, 10-30%
115
MOA, failure rate (theoretical), failure rate (real life) - Female condom
Mechanical barrier, 2.6%, 15-20%
116
MOA, failure rate (theoretical), failure rate (real life) - Vaginal diaphragm
Mechanical barrier, 6%, 15-20%
117
MOA, failure rate (theoretical), failure rate (real life) - Cervical cap
Mechanical barrier - 6%, 15-20%
118
MOA, failure rate (theoretical), failure rate (real life) - Natural family planning
Prediction - 10-25%, 5%
119
MOA, failure rate (theoretical), failure rate (real life) - Spermicides
Toxic effect on sperm, 15%, 30%
120
MOA, failure rate (theoretical), failure rate (real life) - IUD
Copper wire, LARC, inflammation response preventing motility, toxic to sperm, 0.6%, 0.8%
121
MOA, failure rate (theoretical), failure rate (real life) - Pull out method
Just pull and pray - 0%, 100% hahaha…dudes who try this are now dads...
122
MOA, failure rate (theoretical), failure rate (real life) - Sterilization
Tubal ligation, vasectomy - \<1% across the board
123
An old woman and young girl present with severe pruritus! (extragenital manifestations generally nonpruritic) dyspareunia, dysuria, and painful defecation. On exam you note erythema and hypo pigmentation that looks like it is becoming more like porcelain-white plaques with sharp borders
Lichen sclerosis
124
A female pt presents with thin-walled vesicles and bullae around her vaginal area that display reddened edges and crusted surfaces after rupture. How would you treat it?
Impetigo. Treat with mupirocin ointment and or oral dicloxacillin
125
A female pt presents with periodic painful swelling on either side of the introitus and consequent dyspareunia. What might this be?
126
A female presents with istinctive shiny, flat-topped papules, symmetrically dispersed on flexor surfaces, trunk, and linear scratch marks (Koebner phenomenon) on anterior wrists and legs. They appear to be papules, that are purple, and polygonal, and pruritic. You look closely and see fine white streaks (Wickham striae) as well. She says there is a problem "down there" too...so you have a look and you see painful lesions of the buccal and vaginal mucosa.
127
A woman who has a history of using perfumed pads as well as chronic vulvovaginal infections presents with solid plaque of lichenification around her vaginal area that is a "pleasure to scratch" (wow)...
Lichen simplex chronicus. Gotta stop the scratching!!!
128
You can't see anything wrong with this 20 yo patient, but she complains of severe vaginal burning, rawness, irritation, dryness, and hyperpathia (pain provoked by very light touch) and i
ntroital pain on vestibular or vaginal entry. What might this be? What should you do about it?
Vulvodynia. 3 level plan = 1) pelvic floor physical therapy, hygeine, topical lidocaine, soothing oils. 2) TCA (amytriptyline, pregabalin, gabapentin) 3)
129
Mucus filled lump on surface of cervix. It is a normal finding
130
Female pt is parous (hx of childbirth), middle aged woman with menorrhagia and dysmenorrhea w/symmetrically enlarged uterus. She is having some pain and cramping. What is it and how should you treat it?
Adenomyosis. Hysterectomy
131
A 30yo black woman presents with being abnormal uterine bleeding and iron deficiency anemia associated with it. Benign tumor fibroids that have grown in her uterus are the cause. You note a mass on exam. What is this called? How would you treat it? What should you rule out first before you get carried away?
Leiomyoma. Surgery. Pregnancy
132
Biggest culprits to cause PID
Untreated gonorrhea or chlamydia
133
A female pt presents with pelvic and lower abd pain as well as cervical motion tenderness, u
terine tenderness, and a
dnexal tenderness. What is it? How would you treat it?
## Footnote
PID. Ceftriaxone, Doxy, Metro (for BV)
134
How do you treat gonorrhea?
IM ceftriaxone PLUS azithromycin
135
Syphillis
Primary
Painless genital sore (chancre
Painless lymphadenopathy
Secondary
Bilateral papulosquamous lesions, often on hands/feet
Lymphadenopathy
Tertiary
Cardiac, neurologic, ophthalmic, and auditory lesions
Gumma
136
Treat syphillis with?
PCN
137
Pt presents with malodorous, purulent, frothy dc, dyspareunia, and vulvovaginal erythema. What is it? How would you treat it?
Trich. METRO
138
Painless fishiness...with offwhite vaginal discharge. What is it? What will you do about it?
BV. Metro
139
A pt presents with small, but coalescing white papillomatous growths on the vagina, cervix, vulva, oropharynx, perineal and perianal areas. What is it? What to do?
## Footnote
Condylomalata
140
A female pt presents with pruritis, dyspareunia, vulvar erythema, fissures, and a curd-like dc. What is it? How will you know? What will you do?
Candidiasis. KOH. Fluconazole
141
Which of the following are transmitted vertically from mother to fetus?
Syphillis
Trich
HSV
Gonorrhea
Chlamydia
Hep B
Hep C
HIV
Syphillis - yes
Trich - yes by passage through infected vagina
HSV - 30-50% transmission if mother is infected near time of delivery
Gonorrhea - yes...bad - with chlamydia...cause most neonatal conjuctivitis
Chlamydia - yes...bad - woth gonorrhea...cause most neonatal conjuctivitis
Hep B - 20% transmission if mother is HBsAG positive and 90% if mother is both HBsAG and HBeAG positive
Hep C - yes. Not transferred in breastmilk
HIV
142
T/F Infertility is defined by the inability for a couple to conceive within 1 year
True...but only if the couple is having sex:)
143
When menstual bleeding has ceased for 1 year, _____ is said to have occured.
144
Average age of menopause is \_\_\_\_
145
The most common cause of cyclic breast pain or mastalgia in reproductive age women that happens as a r
esult of hormonal imbalance that may produce asymptomatic breast lumps that are discovered by palpation
## Footnote
Fibrocystic changes
146
Most common cause of mastitis?
Staph infection associated with
147
T/F Lactational mastitis is more common than non-lactational mastitis
148
A woman has a unilateral engorged swollen breast and a sore or fissured nipple. There is
redness, tenderness, and local warmth. She is starting to complain of
fever, chills, and malaise and the pain
is now extending beyond the indurated area
149
A woman just had mastitis that didn't clear...it looks the same...bu for the pitting edema over the inflamed area and a degree of fluctuation.
Breast abscess
150
A postpubescent black woman presents with a round, firm, discrete, relatively movable, non-tender mass 1–5 cm in diameter in her breast.
## Footnote
Fibroadenoma
151
A 45yo female presents with a breast mass on palpation that is mobile with well-defined margin
## Footnote
152
A woman presents with eczematoid eruption and ulceration that arises from the nipple and is
spreading to the areola. She is experiencing pain, itching, and/or burning. You note a superficial erosion or ulceration of the breast.
Paget's disease of the breast
