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Outpatient Flashcards

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1
Q

Lichen planus

A

Wickham striae
Oral and non-genital lesions
Erythematous shiny plaques, ulcers, loss of architecture
Rx high dose topical steroids, tacrolimus

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2
Q

Lichen simplex chronicus

A

Vulvar irritation> persistent scratching
Scaly plaques, thickened leathery appearance
Rx hygiene, treat underlying cause, topical steroids

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3
Q

LNG-IUD failure rate

A

0.2%

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4
Q

Copper IUD failure rate

A

0.8%

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5
Q

Nexplanon failure rate

A

0.05%

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6
Q

Vasectomy failure rate

A

0.15%

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7
Q

Female sterilization failure rate

A

0.5%

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8
Q

Depo failure rate

A

6%

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9
Q

OCP/patch/ring failure rate

A

9%

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10
Q

Diaphragm failure rate

A

12%

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11
Q

Metabolic syndrome

A

Presence of 3/5 of the following:
- waist circ >88 cm or 35 in
- TG >150 or on meds for elevated TGs
- HDL <50 or on meds
- BP >130/85 or on meds
- fasting BG >100 or on meds

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12
Q

BRCA1/2 cancer risks

A

Breast
- BRCA1 55-70%
- BRCA2 45-70%
Ovarian
- BRCA1 35-45%
- BRCA2 15-20%

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13
Q

Criteria for annual breast MRI screening

A
  • 1st degree relative of carrier for breast CA mutation
  • 20% lifetime risk of breast CA
  • Chest radiation between 10-30yo
  • 25-29yo with BRCA variant
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14
Q

IBS diagnostic criteria

A

Recurrent abdominal pain 1+ day/wk in past 3 months with 2+ of the following:
- related to defecation
- change in stool frequency
- change in form of stool

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15
Q

Most common causes of vaginitis prior to puberty

A
  1. improper hygiene
  2. sexual abuse
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16
Q

Medications that can cause hyperprolactinemia

A

Elevations to 25-100 ng/mL
- Antipsychotics
- Domperidone
- Metoclopramide
- Methyldopa
- Verapamil
- Opioids

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17
Q

21-hydroxylase deficiency inheritance

A

Autosomal recessive

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18
Q

Duchenne’s muscular dystrophy inheritance

A

X-linked recessive

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19
Q

PTU side effect

A

Agranulocytosis

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20
Q

Kallman syndrome

A

Primary amenorrhea
Anosmia
Hypogonadotropic hypogonadism
Cleft lip/palate

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21
Q

Sensitivity formula

A

a/a+c
test’s ability to correctly identify pts with a disease

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22
Q

Specificity formula

A

d/b+d
test’s ability to correctly identify pts without a disease

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23
Q

PPV

A

a/(a+b) x100
likelihood that a pt with a positive test actually has the disease

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24
Q

NPV

A

d/(c+d) x100
likelihood that a pt with a negative test is disease free

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25
Odds ratio
ad/cb
26
Accuracy
(a+d)/(a+b+c+d) x100
27
FMR1 trinucleotide repeats (intermediate, premutation, full mutation)
CGG repeats, fragile X syndrome Unaffected: <45 Intermediate: 45-54 Premutation: 55-200 Full mutation: >200
28
Fragile X syndrome
Most common form of intellectual disability, X-linked Males with long narrow face, prominent ears, large testes, joint/skin laxity, hypotonia, speech delay, MVP Premutation associated with female premature ovarian insufficiency, male tremor/ataxia
29
HSV vertical transmission rates (primary vs. recurrence)
Primary: 40-80% Recurrence: 1.3-3%
30
Copper IUD failure rate
Typical 0.8% Perfect 0.6%
31
LNG-IUD failure rate
0.2%
32
Nexplanon failure rate
0.05%
33
CHCs and POPs failure rate
9% typical 0.3% perfect
34
Female sterilization failure rate
0.5%
35
Male sterilization failure rate
0.15% typical 0.1% perfect
36
TTP
Absence of ADAMTS-13 (vWF cleaving protease) Symptoms: hemolytic anemia (schistocytes, elevated bili), thrombocytopenia, neuro abnormalities, fever, renal dysfunction Rx plasmapheresis
37
Androgen insensitivity vs. Swyer
Both 46 XY female phenotype, absent body hair AIS: - nonfunctional androgen-R, normal male testosterone, absent AMH/uterus/cervix, +breast development - remove testes after puberty Swyer: - SRY mutation, streak gonads, low testosterone, absent AMH/breasts, uterus/cervix present - remove testes at diagnosis
38
MRKH
46 XX, female phenotype - no paramesonephric development> absent uterus/cervix/AMH - Breast development and body hair present
39
NSAID mechanism of action
Inhibits COX1 and COX2 - COX1 affects platelet aggregation, GI mucosal integrity, renal function - COX2 affects growth, regulation of female reproduction, bone formation, renal function
40
Gonorrhea treatment
Single dose of ceftriaxone 500 mg IM (1000 mg if >150 kg or 300 lbs) - If chlamydia not excluded include doxy 100mg BID x7d Cephalosporin allergy: gent 240mg IM + azithro 2g PO - EPT: cefixime 800mg PO +/- doxy depending on chlamydia status
41
Adnexal mass malignant features
- Irregular solid tumor - Ascites - 4+ papillary structures - Irregular, multilocular, solid, diameter 10+ cm - High color doppler content
42
Adnexal mass benign (B) features
- Unilocular - Solid components, largest <7cm - Acoustic shadows - Smooth multilocular - No doppler flow
43
Amsel criteria
Thin gray discharge pH >4.5 Positive whiff >20% clue cells
44
MDD diagnosis
5 or more symptoms lasting for at least 2 weeks - one must be depressed mood or diminished interest
45
Bisphosphonates
Antiresorptive/osteoclast inhibition, used for osteoporosis prevention and treatment - side effects: GI upset, atypical femoral fractures, osteonecrosis of jaw
46
Denosumab
Osteoporosis treatment, blocks RANKL (osteoclast) - Side effects: rash, infections, atypical femoral fractures, osteonecrosis of jaw, hypocalcemia
47
Raloxifene
Osteoporosis prevention and treatment, SERM (agonist at bone, antagonist at uterus/breast) - Side effects: VTE, vasomotor symptoms
48
Ulipristal mechanism, timing
30 mg, SPRM (selective progesterone receptor modulator) Inhibits follicle rupture to delay ovulation up to 5d after unprotected intercourse
49
Plan B mechanism/timing
Progesterone/levonorgestrel 1.5 mg once or 0.75mg x2 Delays follicle development Up to 3d after unprotected intercourse
50
HPV vaccine timing
Ideally begin between 11-12y Give as early as possible if hx sexual abuse starting at 9yo <15yo: 2 doses at 0 and 6-12 months 15-45yo: 3 doses at 0, 1-2, and 6 months
51
Risk factors for early bone density screening <65y
History of fragility fracture Weight <127 lb Secondary causes of bone loss History of parental hip fracture Smoker, Alcoholism Rheumatoid arthritis
52
Pneumococcal vaccine recs
2 regimens: either 1 dose of PCV15 then PPSV23 1 year later OR 1 dose of PCV20 - all pts 65+ yo - immunocompromised - medical risk - alcoholism, heart/liver/lung disease, renal failure, smoking, diabetes
53
Methimazole mechanism and fetal risks
Inhibits TPO - fetal effects: aplasia cutis, esophageal atresia, choanal atresia - agranulocytosis rare - transition from PTU in second trimester
54
PTO mechanism and fetal risks
Inhibits TPO and conversion of T4 to T3 - side effect: hepatotoxicity - agranulocytosis rare
55
Outpatient PID treatment
Ceftriaxone 500mg (1g if >150 kg) + doxy 100mg BID x14d + flagyl 500mg BID x14d
56
Sexual assault prophylaxis
Treat chlamydia, gonorrhea, trich - HIV if high risk - hep B vaccine if non-immune Chlamydia: doxy x7d preferred, azithro x1 alternative Gonorrhea: IM ceftriaxone preferred, IM gent+azithro x1 if allergic to penicillin trich: flagyl x7d
57
NYHA functional classes
I: cardiac disease without limitation of physical activity II: slight limitation of physical activity; ordinary activity leads to fatigue, palpitations, dyspnea, angina. Comfortable at rest III: marked limitation of physical activity; less than ordinary activity causes symptoms. Comfortable at rest IV: inability to carry on any physical activity without discomfort; symptoms can occur at rest, worse with activity
58
Ulcerative colitis
Mucosal layer only Almost always involves the rectum Protective factors: smoking, appendectomy
59
Crohn's disease
Skip lesions, transmural involvement - All areas of GI tract (mouth to proximal colon) - Increased risk with smoking, appendectomy increases risk
60
Normal hCG rise in early pregnancy
Up to 1500: 49% 1500-3000: 40% >3000: 33% Discriminatory level 3500
61
DCIS breast biopsy management
Mastectomy with or without radiation Endocrine therapy if ER+
62
Lymphogranuloma venereum
C. trachomatis L1-3 Urethritis, inguinal lymphadenopathy, rectal ulcers/pruritis Rx doxy 100 BID x21d
63
H. ducreyi
Painful, non-indurated ulcer with friable base and exudate, tender lymphadenopathy Rx aspiration of buboes, Rx azithro or ceftriaxone IM x1
64

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