TrueLearn/Walls Flashcards
(979 cards)
1
Q
Treatment for DCIS
A
surgical removal (mastectomy or lumpectomy) w or w/o radiation/tamoxifen
2
Q
Risk of reoperation following a hyst/USO for persistent pelvic pain (endo)
A
30% (33%)
3
Q
What is the most appropriate tx of genital warts in pregnancy?
A
Trichloroacetic acid (TCA)
-immune based tx (no systemic absorption)
4
Q
What are the cryodestructive therapies for genital warts?
A
-Podophyllotoxin
-Podophyllum resin
-Flurouracil
5
Q
in an HIV pos pt, above what viral load is a c/s indicated and at what gestational age?
A
> 1,000copies @ 38 weeks
*transmission rates 1-2% if viral load < 1000 copies/mL regardless of route of delivery
6
Q
7 weeks with IUD in place:
A
Removal today (lowest risk of miscarriage)
*miscarriage rate is 50% if IUD left in place
7
Q
When do fetal red blood cells start to appear
A
7-8 weeks GA
8
Q
dz of thrombocytopenia, microangiopathic hemolytic anemia, renal abnl, fever, neuro sxs
A
TTP (thrombotic thrombocytopenic purpura (TTP)
9
Q
Cause of TTP
A
deficiency or antibody of ADAMTS13 (cleaves vWF multimers)
10
Q
Treatment of TTP
A
plasmapheresis to remove antibodies to ADAMTS-13 and replenish the depleted protease
*if severe, can add glucocorticoids, not gold standard. LDASA to prevent recurrence
11
Q
What additional structure should be removed when a unilateral cyst returns as mucinous adenocarcinoma?
A
Vermiform appendix (most likely site of extra-mullerian origin)
12
Q
What is the MC ovarian cancer diagnosed in pregnancy?
A
Dysgerminoma
13
Q
What is the MC benign ovarian tumor in pregnancy?
A
Mature cystic teratomas (benign)
MC malignant = dysgerminoma
14
Q
What is the MC epithelial ovarian carcinoma diagnosed in postmenopausal women?
A
Serous carcinoma
15
Q
At what age do you offer ppx BSO for BRCA1?
A
35-40
Chrom 17
Ovarian risk of 40%
16
Q
At what age do you offer ppx BSO for BRCA 2?
A
40-45
Chrom 13
Ovarian risk of 20% (10-27%)
17
Q
What is the incidence of fetal postmaturity syndrome in postterm pregnancies?
A
1-5%
-dec subq fat
-lack of vernix
-lack of lanugo
-Meconium staining
-oligo
18
Q
Timing of delivery for dichorionic twins
A
38 weeks
19
Q
Timing of delivery for monochorionic diamniotic twins
A
34- 37w6d
20
Q
Timing of delivery for monoamniontic twins
A
32 to 34 weeks
21
Q
At what gestational age range does the fetal growth rate in twins slow, compared to the rate in singletons?
A
28 to 32 weeks
22
Q
When should gonads be removed in a 18yo female with 46XY?
A
At completion of puberty
-malignancies rarely occurs before 20
-keep gonads until full breast development
23
Q
what percentage of people have a pos HSV2 serology?
A
26%
24
Q
monochorionic twin at 25 weeks pregnant. if 1 twin dies, what is the risk of the surviving twin having a neurologic abnl?
A
18%
25
Indications for thyroid function testing in pregnancy:
1. personal h/o thyroid disease
2. Family h/o thyroid disease
3. T1DM
4. Clinical suspicion of thyroid disease (goiter or nodules, not mild enlargement of the thyroid)
26
HbA1c level to diagnose diabetes in nonpregnant women w/o risks
>/= 6.5%
*fasting glucose 126 or higher
*2hr GTT > 200
27
Do white or black women have a higher risk of osteoporotic fracture?
White
28
Where does the vaginal artery branch from?
Uterine artery
29
What is the earliest age to consider herpes zoster in a healthy female patient?
50 yo
*2 doses, 2-6 months apart
30
What is the inheritance pattern of Fabry disease?
X-linked
-deficiency in alpha-galactosidase A
31
HbA1c that diagnosis dm?
6.5% or higher
32
Fasting plasma glucose level diagnostic of dm?
126 or higher
33
2 hr glucose tolerance test diagnostic of dm?
75g glucose load, level > 200 at one or 2 hour blood draw
34
What is the strongest risk factor for urinary incontinece?
obesity
35
Tx for heavy bleeding while on DMPA?
NSAIDs for 5-7 days or hormonal tx w 1.25 of conjugated estrogen for 10-20 days
*12% amenorrhea during first 3 months, 46% after 1 year
36
Where does the vaginal artery branch from?
The uterine artery
37
Anterior branches of the internal iliac?
1. superior vesicle
2. middle vesicle
3. inf vesicle
4. middle hemorrhoidal
5. obturator
6. Internal pudendal
7. sciatic
8. uterine
9. vaginal artery
*the vaginal artery can also branch from the uterine
38
Rec age to get recombinant zoster vaccine Shingrix?
50 years
39
Lysosomal storage disorder that is X-Linked?
Fabry disease
-def in alpha-galactosidase A > accumulation of glycosphingolipid in vasculature of brain, kidney, heart. Usually males
40
What vessel supplies the anterior abdominal wall?
sup/inf epigastric, musculophrenic, and deep circumflex iliac vessels
41
How is cervical cancer staged?
clinical: EUA, cysto, proctoscopy, CT, MRI, PET
42
Stage 0 cervical cancer:
Carcinoma in situ, abnl cells in innermost lining of cervix
43
Stage I cervical cancer:
invasive carcinoma that is strickly confined to the cervix
44
Stage II cervical cancer
Locoregional spread of the cancer beyond the uterus but not to the pelvic sidewall of lower 1/3 of the vagina
45
Stage III cervical cancer:
Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a nonfunctioning kidney that is incident to invasion of the ureter
46
Stage IV cervical cancer:
Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum
47
What procoagulatnt increases in pregnancy?
Fibrinogen
7, 8, 10
VW
PA1, PA2
48
What procoagulant decreases in pregnancy?
11, 13
49
What procoagulant stays the same in pregnancy?
2, 5, 9
50
What anticoagulant decreases in pregnancy?
Protein S (increases by trimester, but overall still decreases)
51
What anticoagulant stays the same in pregnancy?
Protein C, Antithrombin 3
52
Thyroid treatment by trimester
PTU - 1st (Hepatotoxic)
methimazole 2nd and 3rd T (aplasia cutis and esophageal/choanal atresia)
53
Side effects of PTU
liver toxicity, agranulocytosis (maternal)
54
Thyroid treatment in 2nd and 3rd trimester
Methimazole
55
Side effects of methimazole
Aplasia Cutis (if used before 2nd trimester)
56
peripartum management of women with APS WITH a history of thrombotic event vs NO history of thrombotic event:
h/o thrombotic event: ppx heparin in pregnancy + 6 weeks PP (ASA benefit unkn), transition to warfarin after deliv
NO h/o thrombotic event: ppx heparin and ASA while pregnant and for 6 weeks pp
57
What are CAPS (contraction associated proteins)?
expressed as a result of increase in myometrial activation/stimulation > initiation of labor:
-oxytocin receptors, connexin 43 (gap junctions), prostaglandin F2 alpha receptors, calcium channels
58
What is the role of NF - Kappa B's role in labor stimulation
protein that results in stimulation of the CAPs but induces inflammatory genes > induces progesterone withdrawal > parturition
59
How long does it take for the postpartum uterus to completely involute to prepregnancy size?
4 weeks (becomes 100g or less)
-cell size decreases along with involution of connective tissue
60
Anatomic boundaries of inguinal triangle (Hesselbach's triangle)
Rectus sheath, inguinal ligament, inferior epigastric vessels
*site of direct inguinal hernias
61
Where are indirect inguinal hernias located?
-at the internal inguinal ring (where round ligament exists the abdomen)
-lateral to inferior epigastric vessels
-MC type of hernias
62
This is a conservative tx option for SBO
Gastrografin: water soluble contrast, draws fluid into lumen of bowel > decreases edema and increases peristalsis
*dec hospital stay
63
Persistently elevated bHCG and bleeding after pregnancy...
GTN
64
GTN confined to the uterus
Stage I
65
GTN outside of uterus but limited to genital structures
Stage II
66
GTN that extends to lungs w or w/o known genital tract involvement
Stage III
67
GTN with mets past lung
Stage IV
68
Treatment of GTN for score 0 to 6:
single agent chemo
69
Treatment of GTN for socre of 7 or greater or stage IV
combination tx: EMACO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, vincristine/oncovin)
70
What is the only FDA approved treatment for acute abnormal uterine bleeding?
IV conjugated equine estrogen
71
How does IV estrogen work?
rapidly causing proliferation of the endometrium to prevent shedding
*works on most forms of dysfunctional bleeding
72
What is the prevalence o f obesity in the US among all individuals (BMI > 30)?
42.4%
73
What is the MC cause of neonatal thrombocytopenia?
Alloimmune thrombocytopenia
-caused from maternal alloimmunization to paternal inherited platelet antigens
74
Lifetime probability of UTIs in women?
60%
*11% of women report at least 1 physician dx UTI per year
75
What is the MC cause of pancreatitis during pregnancy?
Gallstones
outside of pregnancy: alcohol
76
Management of labial abscess in diabetic patient:
admission to Hospital, I&D, IV antibiotics
77
Drug of choice for anticoagulation in patients w a h/o heparin-induced-thrombocytopenia?
Fondaparinux
-binds to AT III and accelerates inhibition of factor Xa
78
Most common cause of secondary (delayed) postpartum hemorrhage?
retained POC (after 24 hours to 12 weeks PP)
79
What percentage of CO does the uterus receive at term?
17% (450 - 650ml/min)
80
What is the most common thrombophilia mutation?
Factor V Leiden
81
Management for singleton gestation w prior spontaneous preterm singleton birth
progesterone supplementation 16 - 24 weeks of gestation to reduce the risk of recurrent spontaneous preterm birth
82
Indication for history indicated cerclage:
-h/o 1 or more 2nd T preg loses 2/2 painless cervical dilation in absence of labor or placental abruption
-prior cerclage due to painless cervical dilation in 2 T
83
Exam indicated/rescue cerclage indication
painless cervical dilation in 2T
84
US indicated cerclage
-current singleton pregnancy, prior spontaneous preterm birth at < 34 weeks, short cervical length < 25mm before 24 weeks
85
What are the 2 mechanisms of the primary pathophys of PCOS?
1. intrinsic functional hyperandrogenism > ovarian dysfnx > anovulation/oligomenorrhea, hirsutism. LH excess is seen
2. 1/2 pts have insulin resistance > hyperinsulinism. Ovary is insulin sensitive despite liver/skeletal muscle resistance. + androgen production in ovary
86
Phase 1 of partuition
Quiescence:
- contractile unresponsiveness
-cervical softening
87
Phase 2 of parturition
Activation:
- Uterine preparedness for labor
- Cervical ripening
88
Phase 3 of parturition
Stimulation:
-uterine contraction
-cervical dilation
-fetal and placental expulsion
89
Phase 4 of parturition
Involution:
-Uterine involution
-cervical repair
-breastfeeding
90
Management of CIN2 in woman 21-24 years olf
repeat cytology and colpo at 6 month intervals for 1 year
-if both neg > cotesting 1 year
-if abnl/persistent dysplasia > repeat colpo/bx
91
Sxs of post-embolism syndrome:
Fever, nausea, pain, malaise
-self limited and resolve within 24 hours
92
Triad for AFE:
SUDDEN ONSET:
1. DIC
2. Hemodynamic compromise
3. Respiratory compromise
93
At what serum level of Mg would you most likely start to see respiratory depression?
12 mEq/L
94
Therapeutic range of Mag:
4 to 7 mEq/L
95
At what serum Mg level would you see loss of DTR?
8 mEq or greater
96
What is the antidote to MgSo4?
calcium gluconate
15 to 30 mL of a 10% solution slowly IV
97
What is the risk for development of GTN after a complete hydatidiform mole?
15%
*1-5% if partial mole!!
98
Type of Mole:
46 XX or 46 XY
Complete mole
**Complete set of chromosomes
99
Complete mole: absent or + fetal tissue:
Absent
100
Diffuse or focal swelling of chorionic villi in complete mole?
diffuse
101
p57 staining in complete mole?
negative
102
Risk of GTN in partial mole?
1-5%
103
Complete or partial mole:
69XXY, 69XYY, 69XXX
Partial
104
Fetal tissue absent or present in partial mole
Present
105
Focal or diffuse swelling of chorionic villi in partial mole?
Focal
106
p57 staining in partial mole:
positive
107
What percentage of FEV1 or Peak flow indicates adequate control of asthma during pregnancy?
80% or higher
108
Type of asthma and FEV1/Peak flow:
-sxs 2x/day or less per week
-nighttime awakening 2x or less per month:
Intermittent/well controlled
> 80%
109
Type of asthma and FEV1/Peak flow:
-sxs > 2x/day
-nighttime awakening > 2x/month
Mild persistent (not well controlled)
> 80%
110
Type of asthma and FEV1/Peak flow:
-sxs daily
-nighttime awakening > 1 per week
Moderate persistent (not well controlled)
60-80%
111
Type of asthma and FEV1/Peak flow:
-sxs throughout the day
-nighttime awakening 4 times or more per week
Severe persistent (poorly controlled)
< 60%
112
What is the percentage of neonates born between 23/0 and 23/6 who will survive WITHOUT disability to 18-22 months corrected age?
13%
113
Type 0 fibroids
pedunculated - intracavity
114
Type 1 fibroids
submucosal: < 50% intramural
115
Type 2 fibroids
Submucosal: > 50% intramural
116
Management of type 0 to type 1 fibroids
hysteroscopy
117
Management of type 2 - 7 fibroids:
Laparoscopic myomectomy
118
Equivocal scoring on BPP:
6/10:
-if < 37 weeks w normal AFI --> repeat testing in 24 hours w prolonged fetal monitoring
119
Location of the iliohypogastric nerve:
2cm medial and 1cm inferior to ASIS
-cant be injured during surgery
120
Result of injury to the iliohypogastric nerve?
Paresthesia of labia
numbess around pfannensteil incision
suprapubic numbess
121
Nerve injured with weakness in adduction of the thigh or numbness at medial/inner thigh
obturator nerve injury
122
Nerve injured with medial/anterior thigh paresthesias
femoral nerve injury
123
nerve injured with weakness of quad, inability to flex at hip or extend at the knee
femoral nerve injury
124
Vaccine schedule for HPV quadrivalent vaccine if given between 15 - 26 yo
- 3 doses: 0, 2, 6 months
125
Vaccine schedule for HPV quadrivalent vaccine if given between 9 - 14 yo
-TWO DOSES only: 0, 6-12 months
126
Algorithm for IV labetalol for SR BP:
*20mg IV
-recheck in 10 mins
*40mg IV
-recheck in 10 mins
*80mg IV
-recheck in 10 mins
**10mg hydralazine
127
SNRI vs SSRI for tx of vasomotor sxs with patients on tamoxifen
-tx w SNRI (venlafaxine) bc SSRIs have a theoretical risk of decreasing efficacy (SSRI inhibit cytochrome p450 pathway)
128
HDL and Triglyceride levels that warrant early GTT screening:
HDL < 35, or TG < 250
129
plt requirement prior to epidural/spinal anesthesia
> 70,000
130
plt requirement prior to c/s or surgical procedure:
> 50,000
131
When do steroids start to increase plts for ITP
4-14 days
132
1st line tx for ITP:
glucocorticoids, IVIG if steroids contraindicated or not effective
133
2nd line tx for ITP:
rituximab, thrombopoietin receptor agonists, immunosuppressive tx, anti-D immunoglobin
134
Protective factors for ulcerative colitis:
-smoking
-appendectomy
135
This type of disease is limited to the mucosal layer of the bowel (not submucosal) and almost always involves the rectum, then proximally the rest of the colon:
Ulcerative colitis
136
This type of disease has skip lesions- transmural lesions are a hallmark. Affects all areas of the GI tract including the mouth
Crohn disease
137
effects of smoking and appendectomy on crohn's disease
-smoking increases risk/rate of recurrence, appendectomy increases risk
138
Most common cause of pancreatitis in the US?
Gallstones
139
Most common type of uterine sarcoma:
Leiomyosarcoma
140
Tx for Chlamydia trachomatis (L1-L3)
Doxy 100mg PO BID x 21 days
141
tx for H. ducreyi
-aspiration of fluctuant buboes
-1g PO azithromycin x 1 OR
-250mg ceftiaxone IM x 1
142
Dx of persistent, painless, beefy red papules or ulcers w/o LAD. Dx by donovan bodies on wright stain or + Giemsa stain or bx of granulation tissue:
Calymmatobacterium (Klebsiella)
143
Tx of Calymmatobacterium (Klebsiella)
Azithromycin 1g PO Q weekly or 500mg PO QD
144
Timing of delivery for pregestational DM well controlled
Full term:
39/0 to 39/6
145
Timing of delivery for pregestational DM w/ vascular complications, poor glucose control, or prior stillbirth
late preterm/early term:
36/0 to 38/6
146
Delivery timing for GDM well controlled w diet/exercise
Full term:
39/0 to 40/6
147
Delivery timing for GDM well controlled on meds
Full term:
39/0 to 39/6
148
Delivery timing for GDM poorly controlled:
late preterm/early term
individualized
149
Hereditary cancer syndrome caused by defect in MLH1 and MSH2
Lynch syndrome
150
Lynch-related tumors:
-colorectal
-endometrial
-stomach
-ovarian
-pancreatic
-ureter/renal pelvis
-biliary tract
-brain (glioblastoma)
-sebaceous gland adenomas
-keratoacanthomas
-small bowel
**Not breast!
151
Recommendation for lipid profile assessment:
Start at age 20, repeat lipid assessment every 4 to 6 years
152
What is the most common congenital infection?
CMV
153
What does CMV avidity test
The maturity of the IgG antibody: low avidity = immature antibody or recent infection!
154
CMV: IgM pos, IgG pos w low avidity:
primary infection
155
CMV: IgM pos, IgG pos w high avidity
chronic infx
156
3 clinical features of suspected IAI:
Maternal leukocytosis
Fetal tachycardia
Purulent cervical discharge
**can lead to neonatal morbidity > increased risk of cerebral palsy
157
Best initial therapy for moderate to severe premenstrual syndrome
MODERATE TO SEVERE: SSRI or COC
if mild: stress reduction and exercise
158
Method of IOL for fetal demise at less than 28 weeks gestation w h/o previous uterine scar
-prostaglandins
< 24wks: prostaglandin
24-28 wks: may use prostaglandins, need more research
28 weeks or > : no prostaglandin
159
What percentage of infants will have long term sequelae following a neonatal central nervous system infection from HSV?
20%
160
What is the diagnostic and treatment modality for pelvic congestion syndrome
Pelvic venogram
161
inheritance that lacks gender bias w males and females equally affected and male to male transmission. 50% of siblings have it
Autosomal dominant
162
inheritance of Marfan, NF, and huntington's
AD
163
Inheritance that is lack of gender bias, males and females equally affected. 25% of the siblings are affected
AR
164
Inheritance of Phenylketonuria
AR
165
Inheritance that affects males more than females, females can be affected. Transmission is only mother to sons no father to son transmission
X - Linked recessive
166
What is the preterm birth rate in the United States?
10.2%
(delivery on or after 20/0 to 37/0)
167
Risk of developing Type 2 DM after being diagnosed with GDM
70% chance
168
Max fluid deficit for 1.5% glycine for HSC
1000cc
*low viscosity, electrolye poor
169
Max fluid deficit for 3% sorbitol for HSC
1000cc
*low viscosity, electrolyte poor
170
Max fluid deficit for 5% mannitol for HSC
1000cc
*low viscosity, electrolyte poor
171
Max fluid deficit for NS for HSC
2500cc
*low vis, electrolytes!
172
Max fluid deficit for LR for HSC
2500cc
*low visc, electrolyte containing
173
5 year failure rate for postpartum partial salpingectomy
6.3 pregnancies per 1000 procedures
174
Is a previous full thickness myomectomy an absolute or relative contraindication to an ablation
Absolute - myometrium may be too thin and serious complications if perforation were to occur
175
Is bleeding or clotting disorder and relative or absolute contraindication to an endometrial ablation?
Absolute
- if causing AUB need to be worked up to control their bleeding medically
176
Algorithm for oral nifedipine for SR BP
10mg oral nifedipine
-repeat BP in 20 mins
20mg oral nifedipine
-repeat BP in 20 mins
20mg oral nifedipine
-repeat BP in 20 mins
20mg IV labetalol
177
Points for CARPREG
1 point:
-history of prior cardiac event/arrhythmia
-NYHA class > II or cyanosis
-left heart obstruction (AV < 1.5cm)
-left ventricular EF < 40%
178
What is the risk of cardiac complication for 1 point from the CARPREG risk score?
1 point: 27%
0 points: 5%
1 point:
-history of prior cardiac event/arrhythmia
-NYHA class > II or cyanosis
-left heart obstruction (AV < 1.5cm)
-left ventricular EF < 40%
179
Which component of the BPP is the LAST to disappear in fetal distress?
AFI
180
Order of how things are lost on a BPP
NST > Breathing > Gross movement > Fetal tone > AFI
181
What thrombophilia is the most thrombogenic of all the thrombophilias?
Antithrombin III deficiency
Thrombosis risk of 11 - 40% per preg
*start heparin in pregnancy
182
MOA of antithrombin III
*natural anticoagulant
-inactivates thrombin and IXa, Xa, XIa, XIIa
183
What is the MC thrombophilia?
Factor V Leiden
184
What is the mortality rate of primary pulmonary artery HTN in pregnancy?
9-28%
*mean arterial pressure > 25 mm Hg at rest
*contraindication to pregnancy
185
What is the most sensitive test to diagnose chorioamnionitis by amniocentesis?
IL-6 by amnio
*better indication of microbial invasion than gram stain, glucose concentration, or WBC
*most specific (reliable) is amniotic fluid culture)
186
After lifestyle modifications, what is the next BEST recommended intervention to induce ovulation in a woman with PCOS?
Letrozole
*superior to clomiphene citrate
187
MOA of letrozole
Aromatase inhibitor: blocks peripheral conversion of T and androstenedione to estradiol and estrone > lower estrogen levels > increase in FSH from ant pituitary
*1st line tx for ovulation induction (not yet approved by FDA)
188
MOA of clomiphene citrate:
SERM: completely inhibits estrogen receptors in hypothalamus > disrupts negative feedback from estrogen increased GnRH from hypothalamus > stimulates pituitary to secrete FSH > growth of ovarian follicles
189
What type of sterilization has the lowest failure rate after 5 and 10 years
Postpartum partial salpingectomy
190
Dx of pt w vaginal bleeding and pos UPT, with intermediate trophoblasts w few syncytial elements on D&C:
Placental site trophoblastic tumor: need Hysterectomy
*doesn't respond to chemo
191
Risk o mortality in pregnant patient with congenital aortic stenosis
8%
192
What type of fibroid is a pedunculated intracavity fibroid?
Type 0
193
What type of ovarian tumor is likely to develop in a patient with androgen insensitivity after puberty?
Gonadoblastoma
-benign mixed tumors (mixed = dysgerminoma that THAT is malignant)
194
Tumor markers are dysgerminoma
bhcg and LDH
195
Which parenteral opioid analgesic used intrapartum is associate with the LEAST risk of resp depression in a newborn:
-Morphine
-Butorphanol (stadol)
-Meperidine (demerol)
-Remifentanil
Remifentanil
Meperidine: very bad, doesn't reverse with Narcan
196
What is the origin of the DNA used to perform maternal cell free DNA testing aneuploidy?
Placental cells
*need 4% fetal fraction for a good test
197
The main arterial blood supply to the breast originates from which artery?
-Aorta
-lateral thoracic artery
-internal thoracic artery
-Axillary
Axillary artery (umbrella term)
Axillary > thoraco-acromial branches and lateral thoracic (2/3 blood supply)
Subclavian > internal thoracic (medial 1/3 blood supply)
198
The most common presenting symptoms of vaginal carcinoma is:
* watery discharge and *painless vaginal bleeding (ans)
199
Treatment of hydrosalpinx seen at time of HSG
Doxy 100mg BID x 5 days
*treating possibility of worsening infx
200
Advantages of LMWH
-lowers risk of HIT
-Dec bone dens loss
-Predictable therapeutic range
*it has a long half life
201
MC cause of infertility:
Male factor (51%)
202
Which is not affected by estrogen in oral contraceptives?
-AT III
-Factor VII
-Factor X
-Fibrinogen
AT III
203
What procoagulants decrease in pregnancy?
13, 11
204
What anticoagulants decrease in pregnancy?
Protein S (but the test sucks in pregnancy - hard to follow)
205
What procoagulants stay the same in pregnancy?
2,5,9
206
What anticoagulants stay the same in pregnancy?
Protein C
207
What are the anticoagulants?
Protein C and S
*Letters!
208
Tx of scarring inflammatory disorder of the skin, oral mucosa, and vulvovaginal area. Erosive, friable patches, vaginal synechiae?
Lichen planus - treat with hydrocortisone acetate suppositories!!
209
Female with no secondary sex characteristics, streak gonads, and XY, no Testosterone
Swyer sydrome: XY but nonfunctioning Y
210
Most precise way to evaluate a pregnancy affected by alloimmunization is:
MCA dopplers
211
Next step after head entrapment after 28 weeks breech delivery
Duhrssen incisions: quick and will work
212
Quintero stages of TTTS:
1. Oli/poly (DVP < 2/ > 2)
2. Pee no more (donor)
3. Dopplers abnl
4. Ascites/hydrops
5. Death
213
Stage III Quintero TTTS?
Abnl dopplers
214
Stage I of Quintero TTTS?
1. Oli/poly
215
Stage II Quintero TTTS
2. Pee no more (no bladder seen in donor)
216
Stage IV Quintero TTTS
4. hydrops/ascites
217
Stage V Quintero TTTS
5: Death
218
Contraindication of Zolendronate
Renal failure
*IV bisphosphonate that is given 1 time per year if can't tolerate PO 2/2 GERD
*pregnancy, hypocalcemia, paralysis
219
Layers of the skull that a subgaleal hematoma is between?
Skull and epicranial aponeurosis
220
Cranial hematoma between periosteum and aponeurosis
subgaleal hematoma
221
Cranial hematoma between skull and periosteum
cephalahematoma
*cannot cross suture lines
222
Cranial hematoma between skin and galea aponeurosis
caput succadaneum
223
Cranial hematoma between skull and dura mater
epidural hematoma (inside near brain!)
224
Most thrombogenic thrombophilia in pregnancy
AT III Deficiency (AD)
225
Most common thrombophiia in pregnancy:
Factor V Leiden (AD)
226
This thrombophilia has a decreased risk if heterozygote, but increased risk if double hetero (homo)
Prothrombin G20210A (AD)
227
When do you transfuse if Hgb < 10:
if Hgb < 10 + s/s neuro (syncope) or s/s hypoxia
**Transfuse
228
Bromley criteria for adenomyosis
1. Heterogenous myometrium
2. Globular uterus
3. Cystic spaces (2mm or greater)
4. Indistinct border
*highly suggestive of adeno
229
What is the gold standard for clinical dx of adeno
MRI
230
Which of the following is the most suggestive of adenomyosis on US?
-Myometrial cysts
-Myometrial calcifications
-Myometrial liquification
-Hyperechoic masses
Cysts!
1. Heterogenous myometrium
2. Globular uterus
3. Cystic spaces (2mm or greater)
4. Indistinct border
231
Side effects of Addyi (Flibanserin)
-Expensive
-2 Drink > blackouts
232
Tx of 23 yo w elevated 17 - OHP levels:
Corticosteroids
-Adult onset CAH (21 hydroxylase def) > no corticosteroids (STRESSFULL need steroids to manage stress)
233
Next step if injury to bladder is in trigone?
cystotomy
*need to remove the function of the bladder so it can heal
234
Function of tamoxifen:
SERM
-dec breast tissue
-INC uterine tissue (endometrium)
235
Raloxifene and ospemifene effect on the endometrium:
NONE
SERMS:
Raloxifene (+ bone)
Ospemifene (vaginal tx)
236
When does the plt count return to normal with gestational thrombocytopenia?
6 - 8 weeks
237
S/p TAH/BSO w LNBX > grade 2 adenocarcinoma w myometrial invasion of < 50% w negative LNs . Tx:
Vaginal brachytherapy*
238
Which poses no risks during antepartum period if positive or negative?
-rubella
-Hb/Hct
-Hepatitis
-Syphillis
Hepatitis: worry about this during delivery
239
Test that holds highest value in eval of a 38 week fetal demise:
Thrombophilia
240
Assoc w postmen women and prepubertal girls, can see labial adhesions, white plaques/papules and tx w steroids. Seen w sexual abuse
Lichen sclerosus
241
Teratogenic window for Warfain in pregnancy?
6-12 weeks GA
6% teratogenic effect. 3% if < 5 mg/day
242
This is a steroid androgen antagonist used to treat hirsutism. Must follow Cr:
SpiRonolactone
(inhibits 5-a reductase)
R = renal function
243
Nonsteroidal androgen antagonist to treat hirsutism. Must check LFTs
FLutamide
L = LFTs
244
This is a suicide inhibitor to ornithine decarboxylase used for hirsutism
Eflornithine (topical!)
245
MC causes of IAI:
polymicrobial: Staph/strep), GBS, Gardnerella
*listeria is separate cause
246
Vessel at risk during sacrospinous ligament suspension:
Inferior gluteal
*pudendal artery is behind ischial spine
*superior/inferior gluteal is behind SSL
247
Muscle that lays anterior to sacrospinous ligament:
coccygeous
248
Muscle that lays posterior to sacrospinous ligament:
Piriformis
249
This vessel feeds the gluteus minimus and can be injured during SSL fixation
inferior gluteal
250
MOA of mirabegron
B3 agonist (BEG)
251
Side effects of Mirabegron:
Tachycardia
HTN
HAs
Diarrhea/constipation
252
What does the metanephros usually form in the female?
Kidney
253
Average pCO2 in the umbilical cord artery at term>
50 mmHg
[20 - [30 - 40 ] 50]
254
Best way to identify a genetic abnormality in a stillborn fetus?
Chromosomal microarray analysis
255
FHT of an anacephalic infant
Flat bc no parasympathetic/sympathetic sxs
256
Holoprosencephaly is associated with which chrom abnormality:
Trisomy 13 (close to 12 or WHOLE)
-Can live entire life - spectrum
*Patau syndrome
257
Most common skin condition in pregnancy:
PUPPS
periumbilical sparing
severe itching
258
Generalized itching in pregnancy, no rash
Pruritis gravidarium
259
Folliculitis or rash in pregnancy
Atopic eruption of pregnancy
260
Most important reason to treat preHTN or stage 1 HTN in pregnancy:
to reduce peripartum mortality
261
Thickened nuchal translucency with normal fetal karyotype is most likely due to what:
Structural defects (30% cardiac)
262
What type of hypersensitivity is SLE?
Immune complex (type III)
263
What is a Type I hypersensitivity?
IgE - mediated
*asthma, seasonal allergies, anaphylaxis
264
What is a Type II hypersensitivity?
2 things: IgG and IgM
*AB directed
-blood transfusions, erythroblastosis fetalis, autoimmune hemolytic anemia
265
What is a Type III sensitivity
III = C3b = Ag-AB complexes deposit in tissues > compliment activation > inflm by neutrophils
Type III = C3b = 3 diseases
1) SLE 2) Glomerulonephritis 3) RA
266
3 diseases seen with Type III hypersensitivity reactions?
1. SLE
2. GN
3. RA
267
Deficit on superior anterior aspect of right thigh is what nerve injury?
Lateral femoral cutaneous
268
This is a mediation approved obesity in adolescents that are not responding to lifestyle modifications:
Orlistat or Tetrahydrolipostatin
*cuts fat into sizes that cannot be absorbed
*metformin is for T2DM
269
This space is entered in performing a SSLF
Pararectal fossa
270
What are the 5 pelvic spaces:
1. vesicovaginal
2. rectovaginal
3. Paravesical
4. Obturator
5. Pararectal
271
A deep sulcal tear in the vagina can open up what pelvic space
Pararectal space (will see fat)
272
What are the boundaries of the pararectal space?
ant: uterine artery
lat: internal iliac
medial: ureter
273
What is the main goal of tx of precocious puberty:
Slow skeletal maturation
274
Tx of central precocious puberty:
Lupron (GnrH agonist)
275
Tx of peripheral precocious pubery:
Aromatase inhibitor
276
An increase in placental lacunae can be an indication of what:
Placenta accreta
277
Measles during pregnancy is assoc with which of the following:
-Ventriculomegaly
-Hepatosplenomegaly
-Nonimmue hydrops
-Fetal Demise
Fetal demise!
-PTD, low birth weight, fetal demise
278
What metabolite does MESNA block and what does it prevent:
Blocks Acrolein
*prevents hemorrhagic cystitis
279
What does isofoamide cause?
Acrolein > hemorrhagic cystitis
*mesna blocks acrolein
280
Which of the following does not cause ovarian failure?
-Chorambucil
-Isofamide
-Cisplatin
-Cyclophosphamide
*cisplatin
281
This nerve innervates the quads. L2, L3, L4. If injured, can't climb stairs
Femoral
* +1/4 patellar reflexes
282
What are the 4 F's of the Peroneal nerve:
1. Foot drop
2. Four roots: L3, 4, S1, 2)
3. Fin (yellow fin)
4. Fibular head
283
MC bug if a infant presents with red discharge:
Shigella
284
Which ventricle will be enlarged if there is a Pulm embolism:
RV
285
This nerve can be injured with TVT placement
ilioinguinal
286
Effective surgical tx for EIN:
Simple Hyst- FIRST LINE tx
287
Inheritance of Androgen insensitivity:
X-linked recessive (2/3) or spontaneous mutations (1/3)
288
Which is not associated with PP depression:
-Older maternal age
-Smoking
-physical/verbal abuse
-HEG
Older maternal age
-more relationships, more stability
289
Definition of PP blues
< 2 2wks
290
Definition of PP depression
> 2 weeks
291
Hormonal tx for transgender female:
Estrogen + spironolactone (gynecomastia side effect)
292
This mediation can reduce vertebra fractures in pts with BRCA mutations:
-Calcitonin
-Bisphosphonates
-Raloxifene
-Denosumab
Raloxifene (+ bone)
293
For the OA fetal head, appropriately applied forceps blades are placed:
1. Equidistant from the sagittal and lambdoidal sutures
2. Equidistant on the parietal bones
3. Symmetrical to the coronal suture
4. Symmetrical to the sagittal and coronal suture
1 - Equidistant from the sagittal and lamboidal sutures
294
Time between last dose of LMWH and spinal?
Can be as early as 2
295
74yo w 10cm mass, has PMB, w recent EMB showing EIN. What tumor markers will be positive?
Inhibin B
**Granulosa cell tumor: GRANNY!!
-*the Granny named Rosy (rosette) used to lose her inhibitions (inhibin B) bc she was a CALL girl (Call-exner bodies) and she had to drink a lot of coffee to get up (coffee bean nuclei/nuclear grooves)
**Microfollicular pattern w numerous small cavities that contain eosinophilic fluid
296
Which is assoc w Kallman Syn (X-linked mutation):
-cardiac defect
-Cleft lip/palate
-Scoliosis
-Cataracts
*Cleft lip/palate
*facial anl, anosmia, long extremities, qdec GnRH
297
Next step if pt at 12 week GA had cfDNA resulted as uninterpretable:
US and dx testing
*assuming everything was done correctly, need more diagnostic testing
298
Side effect of Anastrozole
NASTY to bones
*aromatase inhibitor, can be used for breast cancer treatment
299
Fish recommendation in pregnancy:
2-3 servings of 8-12 ounces
*ans was 3 servings, 12 oz
300
What type of vaginal repair is recommended if there is a 30% laceration of the external anal sphincter?
End to end - can't do an overlapping because it is not a full thickness laceration
301
Meds used for HIV post exposure prophylaxis
Tenofovir, Emtricitabine, Raltegravir
302
What is ligated during vasectomy?
Ductus (vas) deferens
303
At what PCO2 should intubation be performed in pregnancy?
PcO2 > 42mmHG
304
Trick to remember is suture absorbable or not:
If D or G in word = DONE GONE
**absorbable
305
Type of suture: poliglecaprone 25
absorbable monofilament
306
Type of suture: polyglactin 910:
absorbable vicryl braided
307
At what creatinine should you give the loading dose of Mg followed by only 1gm/hr
Cr 1.0 - 1.5 OR oliguria ( UOP < 30ml for more than 4 hours)
308
Association of elevated AFP (3.5MoM)
-FGR
-Trisomy 18
-Fetal death < 24 weeks
-Fetal death > 24 weeks
Fetal death before 24 weeks
309
What makes AFP in fetus?
Liver and yolk sac
310
When does AFP peak in maternal circulation?
13 to 16 weeks
311
Most common complication in McCall's culdoplasty:
Dyspareunia - extra sutures in vagina
312
4 C's of cervical cancer:
-CLINICAL staging
-CAUSE is CERVICAL HPV
-CISPLATIN is tx
-CIGARETTES are high risk factor
313
Cervical cancer treatment for invasion < 3mm
CKC or simple hyst
*1A1
314
Treatment of cervical cancer that has invasion of 3 or more mm to < 5mm
Radical hyst
-1A2 to 1B3
315
What is 2A stage of cervical cancer & tx:
-Upper 2/3 vagina
-cisplatin + radiation
316
What is 3A stage of cervical cancer and tx:
lower 1/3 of vagina
-cisplatin and radiation
317
When will you use cisplastin and radiation for tx of cervical cancer:
Stages 2A to 4A
*upper 2/3 vagina to rectal/bladder mucosa
*combination increases survival by 30-50%
318
Treatment of 4B cervical cancer:
*further mets > palliative radiation chemo
319
What are the two types of carrier mediated transport systems?
Facilitated diffusion and active transport
320
How are the heavy minerals transported across the placenta?
-Iron, AAs, Calcium, phos, iodine
Active transport (carrier mediated)
321
How are the sugars transported across the placenta?
-Glucose, sucrose, fructose, lactate
Facilitated diffusion (carrier mediated)
322
Most necessary step after 30 wk gravid uterus comes to ED after gunshot wound to abdomen, VSS Wound in LUQ above the uterus. FHR Cat I with contractions:
Laparotomy
323
Where in the fetus is Hbg F produced?
Liver
324
Where in the fetus is Hb Gower 1, 2, and portland produced?
Yolk sac
325
Superficial epigastric artery is a branch of:
The femoral artery
326
What testing methodology detects trisomies?
Targeted single variant!
327
The fetal heart completes morphological development at what gestational age?
5- 8 weeks
5: tube
6-7: horseshoe
8: morph development complete
328
What type of breech presentation is most susceptible to cord prolapse?
Footling breech
-cor can be anywhere around there
329
Frank breech position is like what?
Foot frank face
*like pike
330
What is the most predictive ultrasound finding of a placenta accreta?
Placenta previa
*a previa is present in more than 80% of accretas
331
Minimal invasion of cervical cancer to recommend LN dissection:
3mm
IAI = < 3mm CKC/simple hyst
IA2 = 3-5 mm = radical hyst
332
When does bHCG normalize after the evacuation of a complete mole?
8 weeks (2 months)
333
What is the regular recommended dose of folic acid?
0.4mg or 400mcg
334
Type of pessary for SUI with small vaginal introitus:
Hodge (manually shapeable)
*has metal > no MRI
335
Need to avoid MRIs in what type of pessaries:
Hodge and Gehrung (waterslide shape)
*both have metal
336
Most cost effective test for dx of AIS vs MA:
Testosterone:
AIS: XY (M test level)
MA: XX (F test level)
337
What is the most common genetic cardiac disease?
Hypertrophic cardiomyopathy
338
What percentage of brow presentation will convert to face presentation?
30%
From BROW to FACE: 30%
From FACE to VTX 20%
339
Can you delivery mentum anterior or posterior vaginally?
Mentum anterior: MAMA - Men. Ant
340
Serous tubal and tubal intraepithelial lesions in transition are most frequently seen in which part of the tube?
FIMBRIA
341
most common way endometroid adenocarcinoma spreads?
Direct extension
342
This type of malpractice covers all incidents during a poly period regardless of when it was reported:
Occurrence: covers when it OCCURED. Doesn't matter when reported
343
This type of malpractice covers the incidence depending on if it is reported when you had the insurance that covered it
Claims-made
344
Type of breast cancer if ductal cells in dermal lymphatics:
INFLM breast cancer
345
Blood flow to term uterus:
400-650ml/min
346
What phase of cell division are oocytes arrested between birth and ovualtion:
Prophase I
*PROs - get benched from birth to puberty
347
Cytogenetic karyotype is performed on chromosomes arrested in what phase of replication?
Metaphase
348
Next step after ASCUS pap in 28 yo:
HPV typing
349
Management of 35yo 28 wks pregnant w SCC on cone with 1mm stromal invasion?
Repeat colpo
350
Cause of late onset FGR:
placental insuff (HTN, etc)
351
Cause of early onset FGR:
-aneuploidy, infx, structural (heart) defect)
352
This FDA approved tx for osteoporosis increases osteoblasts and stimulates bone formation:
Recombinant parathyroid hormone (Teriparatide)
-daily SQ injection
-2 year duration
-can cause osteosarcoma if used longer
353
This medication for osteoporosis inhibits osteoclasts actions
Calcitonin
354
This drug for osteoporosis slows osteoclast formation
Zolendronate
-inhibits bone resorption
355
Which is most valuable in detecting a gas embolus intraop:
-Hypotension
-cardiac arrhythmia
-end tidal CO2
-pulse ox
*end tidal Co2
- there will be a fall in end-tidal CO2, increase in dead space, and worsening of ventilation-perfusion mismatching
356
Which of the following is most liekyl to result in bone resorption?
-Diuretics
-CCBs
-Digoxin
-Lithium
Lithium!! > osteoporosis
357
Which muscle contributes to the anal canal's resting pressure and fecal continence:
Internal anal sphincter
*Internal = Involuntary
358
Specific marker seen with abnl or pathologically adherent placenta?
PaPP-A: pregnancy-associated plasma protein A
359
Inheritance of BRCA:
AD
360
Risk of ovarian cancer with BRCA 1?
40%
361
Risk of ovarian cancer with BRCA2?
20%
362
What medication should be avoided in pts receiving a full opioid agonist during labor?
Stadol or Butorphanol
*Can diminish the effect of the opioid agonist
363
4 findings that are diagnostic of early pregnancy loss:
1. CRL 7mm or more with no HB
2. Mean gest sac 25mm or more with no embryo
3. no fetal HB AND no embryo 2 or more weeks post scan showing gestational sac and no yolk sac
4. no fetal HB AND no embryo 11 days or more after a scan with a gestational sac and yolk sac
364
What percentage of early pregnancy loss is 2/2 fetal chromosomal abnormalities:
50%
365
Protein/Carb/Fat recs in pregnant diabetic:
P: 15-30%
C: 40-50%
F: 20-35%
366
Leading cause of blindness in 24 to 74 year olds:
Retinopathy - 2/2 DM
367
What are normal triglycerides:
< 150mg/dL
368
How long should exposed and asx male and females wait to have intercourse after Zika exposure?
Males: 12 weeks
Females: 8 weeks
369
Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:
APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5
370
Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:
APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5
371
Newborn is pale, poor cry, grimaces, some flexion, HR 160. APGAR at 1 min:
APGAR
-Appearance: pale: 0
-Pulse: > 100: 2
-Grimace: poor cry: 1
-Activity: some flexion: 1
-Respiration: poor cry: 1
5
372
What type of cancer is theoretically increased when using OCPs?
CERVICAL:
-inc sexual activty w dec condom use --> STIs (HPV)
*more exposure, ectropion is exposed, transformation zone is exposed --> inc risk of cervical cancer
373
Two or more cell populations w diff chromosomal complements present within the same embryo:
Mosaicism
374
Uniparental disomy:
both members of pair of chromosomes are from 1 parent
*molar = all father
375
Gamete specific gene silencing where only 1 allele from mother or father is expressed
Imprinting
*Prader-Willi
*Angelman
376
Tx for K. granulomatis:
Azithromycin 1gm/week or 500mg QD for 3 weeks
**Donovan bodies
377
What is the most practical marker of reproductive aging?
AMH
Nml: 1 to 4
378
Gestational threshold for lung hypoplasia:
24 weeks (if delivered at 24 weeks or less can have lung hypoplasia)
379
Most common aneuploidy associated with SAB:
45 XO (mc aneuploidy)
*trisomy 16 is MC trisomy associated with SAB
380
MOA of decreased uteroplacental blood flow if intraperitoneal insufflation > 15mmHg
*increase in placental vessel resistance
-decreased CO > hypotension > dec placental perfusion > increased resistance
381
Anesthesia induction agents:
Ketamine, propofol, etomidate
382
TOC vs retesting timing for CT in preg:
TOC: 4 weeks
Retesting: 12 weeks (do even if TOC was neg and sex partners treated)
383
Virchow's triad:
1. statis
2. endothelial injury
3. hyper-coagulopathy
384
Risk of renal disease in DM:
35%
*Higher than HTN, GN, polycystic kidney disease
385
Crohn's or UC: perianal involvement:
Crohn's
*Crohn's has no home and SKIPS down the COBBLESTONE through ALL ZONES (transmural)
386
Sciatic nerve bundle:
L4- S3
387
Common fibular nerve bundle (peroneal):
L4 - S2
388
Tibial nerve bundle:
L4 to S3
389
Pudendal nerve bundle:
S2- S4
390
Cancer associated with Paget's disease of the breast:
Ductal carcinoma
391
What is a best overall predictor of sperm function in a semen anaylsis
Morphology
392
Markers of osteoblastic activity:
-Osteocalcin
-Alk phos
-Procollagen peptide
393
Markers of bone resorption
-Hydroxyproline
-Pyridinoline
-Deoxypyridoline
-N-telopeptide
-C-telopeptide
394
What happens to UA resistnce in a normal pregnancy?
It progressively decreases throughout pregnancy
395
CST result of intermittent late decels or significant variable decels:
Equivocal-suspicious
*CST must have 3 ctx in 10 minutes, lasting at least 40 sec
396
CST result of FHR decels that occur in the presence of contractions more frequency than every 2 minutes or lasting longer than 90 sec:
Equivocal
397
CST result of late decels after 50% or more of contractions (even if ctx freq is less than 3 in 10)
Positive
398
Tx of multifocal VAIN III:
Co2 laser
I and II: lower 1/3 and 2/3 of epithelium
III: more than 2/3 epithelium
399
Tx of VAINIII that is not multifocal, cannot be fully visualized, poss disease in vaginal vault and lateral fornices, and invasive disease has not been excluded:
surgical excision
-wide local excision, partial vaginectomy
400
Treatment of Stage II endometrial adenocarcinoma with less than 50% invasion and less than 2cm?
TAH/BSO w LN sampling**
401
Which HPV strain has the highest carcinogenic potential?
16
402
What generation is Ancef?
1st gen cephalosporin
*Cefazolin
403
When to redose ancef/cefazolin?
1) time: 3.6hrs (2 x 1/2 life which is 1.8)
2) EBL 1500 or greater
404
Management of positive margins on a LEEP or cone:
repeat testing (cytology/ECC and colpo in 4-6 months) > if persistenly CIN2/3 = repeat dx or tx
405
What is the most common post-op complication seen with SSLF
Anterior vaginal wall prolapse
+ dyspareunia
406
What is Ristocetin cofactor activity test used for?
vWF - bleeding disorder, NOT thrombotic workup!
407
Tx of Type I and Type II VWD
DDVAP (Desmopressin)
-Type I : Quantitative (AD)
-Type II: Qualitative (have vwf but not functioning, AD or AR)
408
Tx of type III vWD:
vwf!
This is a profound deficiency or complete absence of vWF (AR)
409
what is a low urethral closing pressure indicate:
*intrinsic urethral issue. Pressure < 60mmHg
Tx: sling or bulking agent bc failing!
410
Leading cause of septic shock in pregnancy:
Pyelonephritis
411
1) % of untreated UTI that get pyelo _
2) % of pyelo that get septic _
1. 40%
2. 20%
*devastating complication of sepsis in pregnancy > ARDS
412
MC intraop complication assoc w abdominal sacral colpopexy:
Hemorrhage!
*bleeding retracts in the sacral plexus and hard to control
**thumbtack
413
Most common gyn malignancy in preadolescent females?
Germ cell (epithelial tumors)
414
Most common gyn malignancy found in adolescent/reproductive females?
Serous tumor
415
Back up method if progesterone implant inserted within 5 days of bleeding
None needed
416
Backup method if progesterone implant inserted > 5 days since menstrual bleeding?
additional backup for 7 days
417
most likely cause of a chronic cough:
-PNA
-bronchitis
-GERD
-PUD
GERD!
-chronic cough
-sore throat
-chronic laryngitis
-sleep apnea
-non cardiac chest pain
418
Which is a physical exam finding in pt with AIS
-clitoromegaly
-small uterus
-blind vaginal pouch
-tanner stage 1 breasts
-bling vaginal pouch
419
Which is not a germ cell tumor:
-dysgerminoma
-endodermal cell
-choriocarcinoma
-granulosa cell tumor
Granulosa cell tumor
*all others are
420
What are the germ cell tumors?
1. Benign cystic teratomas
2. Dysgerminomas
3. Choriocarcinoma
4. Endodermal sinus tumor
5. Embryonal
6. Polyembryoma (rare)
7. Gonadoblastoma
421
Dysgerminoma markers (Germ cell tumor)
bhcg, LDH
*distant germans (dysgerminoma) Betta (b-hcg) have long distance (LDH)
422
biomarkers in Yolk sac/endodermal tumor (Germ cell tumor)
AFP
Schiller Duvall bodies
*Egg yolks (yolk sac) can only be Awesome Fresh Picks (AFP) if you leave them in the Chiller (SD bodies)
423
Biomarkers for immature teratoma (germ cell tumor)
AFP, Ca 125
Immature ladies Are From Pasadena (AFP) California (Ca 125)
424
Biomarkers for embryonal carcinoma (germ cell tumor)
b-hcg, AFP
*embryo are Betta (bhcg) As Fresh Picks (AFP)
425
What Which germ cell tumor can be bilateral?
Mature cystic teratomWhat a (12-15% can be bilateral)
*bilateral and benign
*most germ cell tumors are unilateral
426
How many weeks after fertilization does the neural tube form?
3 - 4 weeks
427
Top 3 most common causes of morbidity with a shoulder dystocia:
1. Brachial plexus injury (65%)
2. Clavicle fracture (38%)
3. Fracture of the humerus (17%)
428
At what point in pregnancy was the infection if a pt has limb hypoplasia and skin scarring?
2nd trimester
*Congenital Varicella
429
if unsure of stage of tx, and retreating a pt for syphillis, how long will it take for a decrease of titer to know the tx was successful?
6 months
-retreat with Benzathine PCN x 3 doses
-will take 6 months to decrease titer to 1:4 which is proven successful tx
430
This is an absolute contraindication for methylene blue use during an eval of ureteral patency?
G6PD def
431
Which does not cause hemolytic disease of the newborn?
-Kidd Jka
-Rh C
-Kidd Jkb
-Diffy Fya
Kidd Jk B
*A = awful
*B = better
*Kidd, Kell (kills) Duffy A
E, D, C table
432
This cancer is most diagnosed in pregnancy and this cancer is the one that pregnant women are most likely to have:
1. Cervical (getting paps)
2. Breast
433
Reasons to bx a bartholin gland cyst:
-solid components
-cyst/abscess wall fixed to surrounding tissue
-mass is persistent
-pt is postmenopausal (can also do if > 40 yo)
434
When do bhcg levels plateau at 100,000 in a normal pregnancy?
10 weeks
435
Does delayed cord clamping decrease the incidence of sepsis?
NO!
-improves blood count
-decreases need for transfusion
-lowers rates of intraventricular hemorrhage
436
Management of pregnant woman w Listeria exposure but no s/s
Observe
437
Management of pregnancy woman with Listeria exposure and + s/s (no fever)
Test and monitor (can start augmentin)
438
Management of pregnant woman w Listeria exposure, + s/s, + fever:
test & treat
-blood cultures, Hospitalize for IV Amp 2g q 4 hours
439
Correct chest compressions to breaths per minute in resuscitation of term neonate?
90 compressions to 30 breaths (3:1 ratio)
440
Resuscitation of neonate if HR < 100:
Ventilation measures (MR SOPA)
-Mask
-Reposition
-Suction
-O2 increase
-Pressure
-Airway
441
Resuscitation of neonate if HR < 60:
-Consider ETT/Mask
-Chest compressions
-Airway
-Epi
442
What type of anemia is thalassemia?
(microcytic or macrocytic)
Microcytic
443
Megaloblastic vs nonmegaloblastic anemia:
Megaloblastic: B12 or folate
**due to a nuclear maturation issue
Non-megaloblastic are other types (MDS)
**all macrocytic
444
Which of the following actors in best in determining the prognosis of breast cancer?
-# of lymph nodes
-Presence of estrogen/progesterone receptors
-Histologic grade
-Stage of disease
*Stage
**need stage to know prognosis
445
Which tumor marker does not change in pregnancy
LDH!
AFP: inc in abnl/nml pregnancies
CEA: colon cancer/bad sens/spec in preg
CA125: trash
446
Does inhibin A or B peak in the midluteal phase only?
Inhibin A
A= peaks After ovulation
B = peaks before
447
What are the 2 types of vulvar cancer:
Differentiated and ususal
Diff:
-age dep (> 70)
-h/o dermatosis
-Lichen
Usual:
-HPV, STI, cig smoking, younger age, high risk behavior
448
Tx option for stage IBI squamous cell carcinoma:
Radical hyst
449
Does pulm HTN or Aortic stenosis have a worse maternal prognosis?
Pulm HTN: 50% mortality rate
AS: 15% mortality rate
450
What to do if imiquimod tx is not helping with genital warts:
Add IL-10
451
Treatment of stage II invasive carcinoma of the vagina:
Radiation therapy
452
MOA of RhoGAM:
Blocking D antigenic determinants on the erythrocyte membranes
453
Treatment of pediculosis pubis:
(pubic lice)
**Permethrin 5% cream or
Tx: topical permethrin or topical pyrethrins w piperonyl butoxide
454
Incidence and carrier frequency of:
-CF
-FXS
-SMA
Incidence/CF
CF: 1/2500 > 1/25
FXS 1/4000 > 1/250
SMA: 1/10,000 > 1/40
455
Definition of perinatal period:
20 weeks GA to 28 days PP
*neonatal is 1 day to 28 days
456
LDL goal:
< 100mgdl
457
Fecundity vs Fecundability:
Fecundity: fertility
Fecundability: Achieving a pregnancy
458
When does Fecundity decline?
steep decline at age 32
459
What is the parameters that need to be met regarding discordance for the safe extraction of a second breech twin, assuming presenting twin is smaller?
Discordance 22%, 2nd twin 1550g
- 28 weeks
- 2nd nonvertex twin > 1500g
- if presenting twin smaller, discordance < 20-25%
460
First step in intraop cautery injury to middle third of ureter at IP ligament during TLH/BSO
Pass stent w contrast
461
Fluid cutoff for HSC using monopolar sxs:
1000ml
-glycine, sorbitol, mannitol!
*if fluid overload > cerebral edema
462
Effects of fluid overload in electrolyte rich fluids during HSC?
pulm edema --> start CPR!
*max def 2000 to 2500ml
463
Location of Nexplanon insert device:
8-10cm from medial epicondyle, 3-5cm from sulcus
464
% of neurologic complication assoc w death of a monochorionic twin in 2T
Mono: % neuro complication: 18%
Mono: % death of 2nd twin: 15%
465
% of neurologic complication assoc w death of dichorionic twin in 2T?
Di: % neuro complication: 1%
Di: % death of 2nd twin: 3%
466
Placenta site trophoblastic tumors MC present following what:
A TERM gestation
Dx: endometrial bx
467
Treatment of placenta site trophoblastic tumor w NO mets vs Mets:
No mets: Hyst
Mets: chemo/radiation
468
Days in cycle that implantation occurs?
Day 20 to 24
*Day 14 = ovulation
need some days to meet and travel > 20-24 is implantation
469
Contraindications of bremelanotide:
UNCONTROLLED HTN
(can use if controlled)
--- or ---
known CVD
*this is Vylessi - melanocortin receptor agonist, used for tx of HSDD in premenopausal women, injection given 45 mins prior to intercourse
*not approved for postmenopausal women
470
Mass suspicious for teratoma during term CS. Management:
Cystectomy
*if simple cyst: leave
*if poss path: cystectomy
471
Management of exposed gyn mesh (< 1cm and 1cm or greater):
< 1cm: estrogen and re-eval
1cm or greater: excision and estrogen
472
Most common early post op complication of LN dissection in groin:
Lymphocyst formation: 40% of cases
Lymphedema is a late complication
473
MOA of Trichloroacetic acid:
Coagulation of tissue proteins
*safe during pregnancy
474
MOA of 5-fluroauricil for warts
interferes w DNA synthesis
475
MOA of imiquimod for vaginal warts
stimulates local cytokine production
476
MOA of podofilox for vaginal warts
breakdown of intercellular junctions
477
Is Antithrombin III a procoagulant or anticoagulant?
Anticoagulant
*so decreasing its level (tamoxifen) is procoagulant!
478
Anatomic support to vagina:
Anatomic support to uterus:
Vagina: Uterosacral
Uterus: Cardinal ligament
479
Risk of neonatal death with uterine rupture:
5%
480
tx for hyperkalemia?
IV calcium gluconate
*peaked T waves
481
Major criteria for TSS:
1. fever
2. rash
3. hypotension (* watch out for orthostatic hypotension on Qs)
Minor Criteria:
-GI sxs
-myalgias
-erythema of mucus membranes
482
MC complication following TOT sling vs TVT:
TOT: pain
TVT: vesicle/vessel injury
483
inheritance of dz associated with fused labioscrotal folds seen at delivery of neonate:
AR!!!
*CAH!
484
Age that max bone density is achieved in women:
19 yo
485
% of pts that have cHTN that develop preE:
25%
*cHTN --25%--PreE
*gen pop -- 3% --PreE
486
DEXA and FRAX score used to treat patients w pharmacotherapy:
if T score
487
What is the Gail model 5 year cut off for chemo prevention
1.67%
*if higher> use chemo
488
What hormone in pregnancy causes increased insulin sensitivity?
Estriol
489
What hormone in pregnancy causes increased insulin resistance?
HPL, TNFa, prolactin, progesterone
490
Which is not assoc with chorioangioma > 5cm
-nml preg
-AV shunting
-fetal anemia
-thrombosis
*thrombosis
491
Disruption of pubourethral ligament =
hypermobile urethra
492
Disruption of pubocervical fascia from the acrus tendinous fascia pelvis:
Paravaginal defect - a lateral anterior vaginal wall defect
493
Detachment of endocervical facia from the pubocervical ring:
Cystocele
494
Med used for tx of hyperthyroidism in pt w molar pregnancy to prevent pulm edema?
B-adrenergic blocker
**BLOCK hormone peripherally and dec HR to prevent pulm edema
495
What nerves are involved in Erb's palsy:
C5-C6
*waiter tip (hire a waiter, higher lesion than Klumpke)
496
What nerves are involved in Klumpke's?
C8-T1
*K(c)law hand
497
Effect of placenta previa on fetal lie:
Increased risk of transverse lie
498
What is the MC type of breast cancer?
Infiltrating DUCTAL carcinoma
80%
*lobular is the 2nd MC
499
This type of study answers questions about risk factors and disease and prognosis:
Prospective cohort study
500
BMI associated with FGR:
> 50
501
Antiepileptics to avoid in pregnancy:
Phenobarbital, valproic acid, phenytoin, carbamazepine
*keep keppra, leave lamotrigine, don't ox oxcarbazepine
502
Treatment of thyroid storm:
PID!
-PTU
-Iodine
-Dexamethasone
503
Tx for ex lap in 19 year w frozen path showing Schiller-Duval bodies:
Right adnexectomy and chemo
*Endodermal tumor
19 year old!
504
Which is not an extraintestinal manifestation of crohn's disease?
-Glaucoma
-VTE
-renal calculi
-B12 def
Glaucoma!
-VTE
-Renal calic
-B12
-Pulm sclerosing cholangitis
-osteoporosis
-pulm involvement
-amylodosis
505
By how long does epidural anesthesia prolong the 2nd stage of labor?
7.6 mins
506
By how much does a ppx BSO reduce the risk of breast cancer in pt with BRCA2/BRCA1:
BRCA2: 46%
BRCA 1: 57%
*all > 50%
507
Origin of the obturator artery:
Internal iliac
508
Contraindication to Palmer's point entry:
h/o splenectomy
509
Is a dopamine agonist or antagonist a first line tx for a prolactin excreting microadenoma?
Dopamine AGONIST
(carbergoline or bromocriptine)
510
This medication is associated with increased intracranial pressure and cerebral edema in women:
sodium nitroprusside
*use only for emergencies and for shortest time 2/2 increased cyanide and thiocyanate toxicty to women and fetuses
511
First line tx for premenstrual syn:
SSRIs
512
How many additional calories are recommended in the 1st, 2nd, 3rd trimesters of pregnancy?
1st: 0
2nd: 350
3rd: 450
513
Biggest risk factor for breech presentation:
Preterm gestation
514
Serum analyte levels on Quad screen for down syndrome:
DOWN low unless they are HI
(hcg and inhibin A are high -- AFP, estradiol are low)
515
Intrapartum management of AS and MS:
Aortic stenosis - WET
Mitral stenosis - DRY
WAS = wet
516
Delivery for cHTN , uncomplicated, no meds:
38/0 to 39 6/7
517
Delivery for cHTN, uncomplicated, controlled ON meds:
37/0 to 39 6/7
518
Delivery for cTHN, difficult to control, w freq medication adjustments:
36 0 to 37 6/7
519
Delivery of gHTN without SR BP or PreE without SF
37/0 or at dx if later
520
Delivery of gHTN w SR BP or preE with SF (stable maternal/fetal conditions)
34/0 or at time of dx
521
Delivery of preE with SF, unstable or complicated, after fetal viability (SIPE and HELLP), AND preE with SF, before viability
Soon after maternal stabilization
522
Testing of HSV lesion in pregnancy:
Viral test (PCR* vs Culture) and type specific serologic testing
523
Cancer seen with exposure to DES:
Clear cell adenocarcinoma
524
Do neonates with NAS have seizures?
NO! Shake but no seizures!!!
*tremors, hyper-reflexive, fevers, poor feeding, etc.
525
NAS syndrome lengths in methadone vs buprenorphoine/heroin:
occurs earlier (24 hours) and lasts longer
-dose dependent
526
Lowest cut off for umbilical artery pH that confers neonatal encephalopathy was NOT related to intrapartum hypoxia:
7.2
*if cord pH is at least 7.2, and there is hypoxia, then it was probably due to something else!
527
Most states require that physicians who take a leave of absence greater than how many months need to participate in physician re-entry program?
24 months!
528
1st line med for tx of post op PE in a healthy woman:
LMWH or fondaparinux
-*monitor only if obesity, low BMI, renal insuff, preg
*LMWH = lower mortality, fewer thromboembolic events, less major bleeding than UFH
529
MC cause of death following a UAE
Septicemia
530
This is the only modality to decrease mortality or the best tx for pulmonary arterial hypertension caused by chronic obstructive disease?
Oxygen therapy
531
Max dose of lidocaine WITH epi:
7mg/kg
532
Max dose of lidocaine W/O epi:
4mg/kg
533
Earliest sign of lidocaine toxicity:
circumoral numbness and tongue paresthesia
534
Which is assoc with nec fas: alcoholism or smoking?
alcoholism
*smoking is NOT!!!
535
Risk factors associated w nec fasc that are specifically seen in women:
Pregnancy, childbirth, preg loss, gyn procedures
536
What medications are seen with nec fasc?
Sodium-glucose cotransporter 2 inhibitors:
-flozins
537
What is the MC gyn cancer worldwide?
Cervical cancer!!!
4th mc cancer in women
MC gyn cancer in the US: Type I Endometrial cancer (developed countries)
538
What are the 4 most common cancers in women worldwide?
1. Breast
2. Lung
3. Colorectal
4.Cervical
539
Equation of Fetomaterna hemorrhage to determine vials needed for Rhogam:
Vials = (dec perc of fetal cells on KB x mat blood vol) / 30 ml
OR
(fetal cells in maternal circulation) / (fetal blood covered by RhoGAM)
540
tracing of a false positive NST and percentage of false positive NSTs:
false pos = nonreactive
**think of it like screening
rate: 55-90%
541
What is the false negative rate of an NST and what is the tracing?
Tracing: reactive
rate: 0.2 to 0.65
*this would mean there is a reactive tracing but stillbirth within 7 days
542
timing of delayed PP hemorrhage:
> 24 hours UP TO 12 WEEKS!!!!
543
Options for tx if pt preg and corpus luteum removed prior to 10 weeks GA?
1. Weekly 17 OHP through 10 weeks
2. Oral micronized prog @ 200-300mg through 10 weeks
3. 8% prog vaginal gel PLUS 100-200 micron progesterone orally
544
How should pts with weak D blood type be treated?
As Rh neg!
*don't recommend genotyping
545
When to start PEP for HIV after a sexual assault
ASAP but no later than 72 hours after exposure
546
Risk of accreta in pt with known previa and 3 prior c/s:
61%
4 prior: 67%
5 prior: 67%
547
Risk of accreta in pt with known previa and # c/s:
Primary: 3.3%
2nd: 11%
3rd: 40%
4th: 61%
5th: 67%
6th: 67%
548
Diagnostic criteria for HEG
1. dehydration
2. electrolyte abnl
3. intractable vomiting
4. wt loss > 5% of prepregnancy weight
549
What is the most common complication of urinary Botox injections?
UTIs!!! - 33% have UTI
only 5% have urinary retention
550
This US finding most reliably defines an intrauterine pregnancy:
Yolk sac
*double decidual sign is not as reliable - can be a pseudogestational sac
551
What is the lifetime incidence of depression for women in the US?
17%
552
This triad is pathognomonic for tubal carcinoma
1. abdominal pain
2. vaginal bleeding
3. vaginal discharge (hydrops tubae - serous/yellow/copious)
*vag bleeding and d/c are the MC sxs
553
Latzko technique:
-repair for simple vesicovaginal fistulas
-use small probe to bring fistula to introitus, incise vaginal epithelium, vaginal flaps are raised and removed and then closed in 2 layers
*wait 6-12 weeks after surgery to repair to dec granulation tissue
**Highest chance of closure at 80-90%
554
What endometrial strip measurement on TVUS for a postmenopausal woman should prompt a workup to rule out malignancy?
> 4mm SO 5mm NOT 4mm
less than or EQUAL to 4mm is OKAY
555
thought on 2nd line chemo for ovarian cancer:
NOT CURATIVE
**purely palliative
556
Tests used to stage cervica cancer:
-EUA
-cysto
-proctoscopy
-CT
-MRI
-PET
557
These emergency contraception options are effective up to 5 days after intercourse:
-Copper IUD
-Levonorgestrel 52mg
-Ulipristal 30mg
558
Rec for vax if pt received Pneumovax23 prior to age 65 and is immunocompetent?
Give another dose at age 65 or older, at least 5 years from last dose
559
Ideal laparoscopic entry in pt in 1st trimester:
Intraumbilical entry
*prior to completion of 1st trimester
560
initial management of cervical ectopic pregnancy when future fertility is desired:
Methotrexate
561
Hemoglobinopathy associated with fetal hydrops?
hb Barts or alpha globin gene deletion!
Genotype: --/-- results in severe microcytic anemia, hydrops, feta demise in utero
562
Failure rate of copper IUD:
0.8%
*never need backup contraception
*avoid placement in PID/septic abortion
*screen for STIs at time of placement but don't wait for results. if pos just treat while in place
*most effective type of emergency contraception
563
What type of contraception has a failure rate of 0.05%?
Nexplanon
564
Management of acute PE:
LMWH wt based BID or IV heparin
*eventually transition to warfarin for 3 moths for DVT and 6 months for PE
565
absolute contraindications to aspirin use in pregnancy:
1. hypersensitivity to salicylates or NSAIDs
2. Nasal polyps
3. Asthma with aspirin induced bronchospasm
566
Most commonly injured nerve during abdominal hysts:
Femoral nerve
**during retractors placed on psoas muscles
567
Treatment of gonorrhea when Chlamydia has been exlcuded:
IM ceftriaxone:
< 150kg: 500mg IM
> 150kg: 1000mg IM
568
Management of dopamine agonist (bromocriptine and cabergoline) for prolactinoma once patients are found to be pregnant:
d/c when pt found to be pregnant
*regularly screen pts for visual changes to monitor tumor growth
*do not monitor prolactin levels during pregnancy
569
Why irrigate after rupture of a dermoid cyst?
To avoid acute and chronic pain
570
How long after the LH surge on a home OPK kit occur?
14 - 26 hours
*Peak fertility days are the day the LH surge is detected and the following 2 days
571
Criteria to diagnose metabolic syndrome:
3 out of 5:
1. waist circumference > 88cm
2. Triglycerides >/= 150
3. HDL /= 100
572
What is the most common mode of transmission of Hep C:
IV drug use
573
Fetal monitoring after blunt abdominal trauma:
Min 4 hours
If ctx > 24 hours!
574
Dx testing at 10-14 weeks vs 14-20 weeks after an elevated nuchal translucency testing:
10-14 weeks: CVS
14- 20: Amniocentesis
*Abnormal nuchal translucency is > 3mm
575
Percentage of women who are carrier of GBS:
20% (10-30%)
576
What is the anti-inflm MOA of NSAIDS:
inhibition of Cox 2
*most inhibit both COX1 and COX2
577
This is a first line drug for tx hirsutism:
COCs
*none are FDA approved
*increases SHBG binds to testosterone
578
New 2018 FIGO cervical cancer staging criteria that can be used:
CT scan or ANY imaging modality
-remember 4 C's:
Clinical, Cause is cervical HPV, Cisplatin, Cigarettes
579
Best next step if hemodynamically unstable pt w suspected ruptured ectopic pregnancy:
Immediate surgery and salpingectomy
*Laparotomy vs laparoscopy based on surgeon preference
580
Placenta of stillbirth foul-smelling with multiple abscess. Mom s/p flu like sxs:
Listeria
**ABSCESSES
*hematogenous spread to placenta
581
Percentage of pregnancies with a nuchal cord:
20-34%
582
Med likely associated with external ear malformations, cleft palate, micrognathia, conotruncal heart defects, brain abnl:
Isotretinoin for acne
**Cat X - use 2 forms of contraception
583
Anomaly associate w apical displacement of the tricuspid valve:
Ebstein anomaly = Lithium use
584
Anomaly assoc w fingernail hypoplasia, craniofacial abnormalities, cardiac defects, and developmental delay:
Fetal hydantoin syndrome: seen w exposure to seizure meds (phenytoin)
585
Longest lasting of the absorbable sutures:
Polydioxanone (PDS)
*50% tensile strength at 4 weeks
586
This pelvic shape is the least common and most associated w transverse lie:
Platypelloid
**platypus has a flat, long tail (transverse)
587
This is the classic female shape and the MC
Gynecoid!!
588
This is the pelvic shape that is least favorable for a vaginal delivery and associated with CPD:
Android
(heart: I heart phones - LOP or ROP usually)
589
This pelvic shape is associated with OP position:
Anthropoid
(anthropods walked, tall skinny pelvis, direct OP)
590
Percentage of mature teratomas that will develop into squamous cell cancers:
0.2 to 2%
**originates from the ectoderm layer
Risks of malignant transformation:
-over 45 yo
-tumor size > 10 cm
-rapid growth
591
Trisomy vs Triploidy:
Trisomy: Extra copy of one chromosome
Triploidy: Extra set of chromosomes (moles, etc)
592
Screening for colon cancer in pt with a h/o Lynch syndrome or HNPCC:
-colonoscopy every 1-2 years starting at age 20-25
OR
-every 2-5 years before the earliest cancer dx in the family
**AD
593
Lynch syn genes:
AD:
MLH1, MSH2, MSH6, PMS2, EPCAM
594
Leading cause of chronic liver disease in US:
Hep C
595
At what gestational age is a VAVD contraindicated?
prior to 34 weeks
596
Best method for operative delivery if fetus is 33 weeks:
Forceps
*preferred for vaginal deliv if < 34 weeks
597
Contents of cryo:
Factor VIII, Factor XIII
vWD, fibrinogen
598
T score for Osteoporosis:
< - 2.5
* -1 to -2.5 is low bone mass
599
Does pregnancy change the course of HIV?
No
*no increase or decrease of HIV-related illnesses
600
What factor can be tested for screening of vWD?
Factor VIII (it would be low if VWD present)
*vWF binds to Factor VIII and presents its degradation so def = degradation
601
When prevalence changes, what else changes in a test:
*Pos and negative predictive values
*specificity and sensitivity do not change
602
What is a short cervical length:
< 2.5cm
603
What most value approximates the sensitivity of maternal serum AFP for the detection of an open neural tube defect:
open NTD: 65-80%
for anencephaly > 95%
*when it is elevated to 2.5 MoM or greater
604
Risk of developing endometriosis if pt has a family history of endo:
if 1st degree relative> 7 to 10 x increased risk of developing endo!
605
RFs for endo:
-early menarche before age 11
-shorter menstrual cycles
-heavy prolonged periods
606
Incidence of endo in reproductive age
6-10%
607
Management of cystotomy that is < 1cm vs > 1cm:
*< 1cm: conservative management/closure, 1-3 days of bladder decompression
* > 1cm: Intraop closure of injury followed by bladder decompression for 7 to 10 days
608
What suture has the strongest INITIAL tensile strength:
Absorbable synthetic suture
*highest required knot pull tensile strength at ANY size
609
MC stage at diagnosis of endometrial cancer:
Stage I
*MC gyn malignancy and is dx at stage I in 73% of patients
610
Stage of endometrial cancer that is < 50% myometrial invasion:
Stage IA
611
Stage of endometrial cancer that is > 50% myometrial invasion:
Stage IB
612
Stage of endometrial cancer that invades the cervix:
Stage 2
613
Stage of endometrial cancer that invades the ovary and uterine serosa
Stage 3A
614
Stage of endometrial cancer that invades the vaginal parametrium:
Stage 3B
615
Stage of endometrial cancer that invades the para-aortic LNs:
Stage 3C2
(2 words: para-aortic = C2)
616
Stage of endometrial cancer that invades the pelvic LNs:
Stage 3C1
(1 word = pelvic = C1)
617
Dx of chronic pelvic pain, assoc w dysuria w negative urine cultures:
Interstitial cystitis or painful bladder syndrome (PBS)
*Hunner's ulcers are pathognomonic
618
Tx of interstitial cystitis:
dietary changes (avoid acidic, alcohol, soda, spicy foods, artificial sweeteners) and pentosan polysulfate sodium (Elmiron)
*Elmiron is the only FDA approved oral drug for IC
619
This is universal finding on MRI in a pt with eclampsia:
Parietal and occipital lobe edema (PRES)
*hallmark: Hyperintense T2 lesions representing edema in the subcortical and cortical regions of the parietal and occipital lobes (edema in the white and gray matter junction)
*reversible findings!
620
10 year CVE risk and who should start a statin?
risk < 5%: occasionally
Risk 5 to 7.5: often should be
Risk > 7.5%: DEFINITELY!!!
*CVE takes into account, age, sex, BP, smoker, total cholesterol, HDL, LDL, h/o DM, HTN meds
621
Isotonic liquid medias:
NS, Mannitol, LR
622
Hypotonic fluid that can be used with monopolar energy:
Glycine, glucose, dextrose
623
What are the two fluid medias that have electrolytes and cannot be used with monopolar energy?
Normal saline and LR
*isotonic and + electrolytes
624
Contraindications to breastfeeding in US:
1. Infant galactosemia
2. HIV (even if VL 0, also NOT CI in developing countries)
3. Human Tcell lymphoblastic virus I and II
4. Current illegal drug use or alc use
5. active untreated TB (airborne transmission w close contact w infant)
6. methotrexate
*hep B and C are NOT contraindications!
625
When should colorectal screening start (USPSTF)
45 year old
626
Branches of the posterior division of the internal illiac artery:
I Love Sex
-iliolumbar
-lateral sacral
-superior gluteal
627
Branches of the anterior portion of the internal iliac artery:
8
1. Superior vesicle (obliterated umbilical)
2. obturator
3. inferior vesicle
4. middle rectal
5. internal pudendal
6. inferior gluteal
7. uterine > vaginal
SO IM [IP] IGU(V)
[ ] lesser foramen
628
What artery goes through the lesser sciatic foramen
*internal pudendal
629
What arteries go through the greater foramen?
Superior gluteal (post division)
inferior gluteal (ant division)
internal pudendal (ant division)
630
Lyphmatic drainage of the upper 1/3 of the vagina:
Iliac
631
Lymphatic drainage of the middle 1/3 of the vagina:
Hypogastric/internal iliac
632
Lymphatic drainage of the lower 1/3 of the vagina:
Inguinal LN
633
What is the vaginal arterial supply
Upper: cervical branch of uterine (cuff bleeding)
Middle: inf. vesicle
Lower: internal pudendal and middle hemorrhoidal
634
What nerves are associated with perineal pain?
S2, S3, S4
635
Where does the herpes virus reside and in what phase?
LATENT phase in the DORSAL ROOT GANGLIA of S2 - 4
636
Tx of chlamydia:
Doxycycline 100mg BID x 7 days
637
Tx of Lymphogranuloma Venereum
Doxycycline 100mg BID x 21 days
*CT L1, L2, and L3 serotypes
638
Dx for Lymphogranuloma venerum:
1. culture (of drainage)
2. complement fixation ab titer (MC method). if titers > 1:64 then active infection
**DON't DO FREI SKIN TEST (low sens)
639
Tx of Chancroid (H. Ducreyi)
Erythromycin base x 7 days
640
How long into a maternal code is a c/s indicated?
4-5 minutes of arrest
641
Next step for 21yo w ASCUS:
either reflex HPV or repeat cytology ONLY in 12 months
642
1st line tx for complicated UTI
Floroquinolone
*macrobid doesn't achieve high levels outside of bladder
643
Tx of HSIL pap if > 25 yo
colpo or excisional procedure
*if under 25 --> Colpo
644
What induration is pos for a TB skin test if immunocompromised?
5 or more mm induration
645
What induration is considered pos on a TB skin test for IV drug users, moved/working/living in HR area, < 4 yo
10 or more mm
646
What induration is considered pos for a TB skin test if there are no known risk factors?
15 mm or more
647
How is the dx of inflm breast cancer mainly made?
Clinically!
648
What happens to angiotensinogen during pregnancy?
Elevated estrogen > elevated angiotensinogen > maintains BP (esp during 1st trimester)
649
Explain the Renin-Angiotensin casade:
Kidney and liver release angiotensinogen. ACE converts angiotensinogen I to II which increases aldosterone secretion by the adrenal cortex > stimulates Na and H2O absorption by the nephrons
650
At what gestational age does iodizing radiation have an all or nothing effect on a fetus?
before implantation: 0-2 weeks after conception or 2-4 weeks GA
651
What is the best next step in a pregnant pt with HAs and a macroadenoma?
Visual field testing -- do this to determine if imaging needed
-HAs are common!
652
Risk of PID in pt with IUD in place?
< 1%
*same as if no IUD in place
-tx infection withOUT removing IUD
653
Tx of maternal varicella at term?
Oral acyclovir within 24 hours
-Don't need to deliver ASAP
654
What type of suture is Mersilene (for cerclage)
uncoated polyester
*low inflm response
655
MC cause of vaginal bleeding in patients with tamoxifen
polyps
-do SIS
656
What is the most reliable characteristic of the placenta detaching in the 3rd stage of labor?
umbilical cord lengthening
657
When should twin to twin transfusion syndrome screening start in monochorionic twins?
16 weeks and recur every 2 weeks
658
Tx for heterozygous factor V Leiden in pregnancy?
No tx
only tx if personal h/o VTE
659
Daily intake of vit D in pregnancy?
600 IU
660
prevalence of uterine sarcoma during a surgery for a presumed leiomyoma:
0.05 to 0.28%
*rare but relevant risk
661
Effect on fetal thyroid if mom exposed to radioiodine < 12 weeks GA?
Probably nothing bc fetus doesn't make thyroid hormone until 12 weeks
*if after 12 weeks: fetal thyroid would concentrate the iodine and destroy the gland > hypothyroidism
662
Dx if negative low dose dexamethasone test and pos high dose dexamethasone test for pt with Cushing's d/o?
*pituitary tumor
-the high dose DOES stop the pituitary from making cortisol so the hormone is being made at the level of the pituitary gland
663
After delivery, when is the uterus no longer palpable on exam?
no longer palpable at 2 weeks
*at pre-pregnancy wt/size at 4 weeks (100g)
664
Fetal and maternal complications associated with inadequately treated hypothyroidism in pregnancy:
--spontaneous abortion
-low birth weight/preterm delivery
-neurodevelopmental delays
-placental abruption/fetal demise
-PreE/gHTN
665
Fetal association seen with Graves disease:
Fetal thyrotoxicosis
666
What is the MC complication following gyn laparoscopic surgery?
Bleeding complications
667
The plt inhibition function of NSAIDs is mediated by what?
COX1
*COX2 is inflammation
*also reversible inhibition. ASA is IRREVERSIBLE
668
What are the strongest predictors of bone fracture?
- age
-h/o prev low impact bone fracture
-bone mineral density
669
Relative contraindications to methotrexate use for ectopic?
-cardiac activity
-high bHCG
-ectopic > 4cm
-refusal of blood transfusion
*all relative contraindications
670
Baseline prevalence of NTD in the US:
5 in 10,000 live births, stillbirths, terminations
*1 in every 2,250 " "
671
Next best step when intrauterine adhesions are suspected?
HSG
672
Cut off value for Ca125 in postmenopausal women?
35
673
Action of hormone activin (HPO axis)
increases FSH
674
action of hormone follistatin (HPO axis):
inhibits FSH production
(STAT - inhibits)
675
Action of hormone inhibin:
inhibits FSH
676
Action of hormone leptin?
Regulated eating behavior - often asked!!!
this will be LOW in anorexia
677
Action of hormone ghrelin?
Stimulates growth hormone (GHrelin = GH = growth hormone)
678
What is Fontan circulation?
univentricular heart
*fontan operation performed in infants born w univentricular circulation. Prolongs life, reduces risk of PAH, can still be at increased risk for PAH compared to general population
679
Definition of pulmonary HTN (PAH):
Mean pulm arterial pressure > 25mmHg at rest
-high risk of maternal morbidity/mortality if pregnancy occurs
680
Absolute contraindications to UAE:
Pregnancy
Asymptomatic fibroids
Uterine malignancy
PID
*relative c/i: postmenopausal, desire for future pregnancy, c/i to radiologic contrasts, subserosal or submucosal fibroid w a thin stalk, large vol fibroids
681
Rome criteria dx for IBS:
recurrent abdominal pain on at least 1 day per week on avg for 3 months w 2 or more:
-improvement w defecation
-assoc w a change in stool freq
-associ w change in stool form
682
Definition of immediate postpartum IUD placement:
Insertion within 10 minutes of delivery of the placenta
*Early is > 10 minutes and < 1 week PP
*Delayed is 1 week to 6-8 weeks
*interval is not related to timing of delivery
683
Rare of postplacental expulsion of levonorgestrel IUDs vs copper IUDs
Levonorgestrel IUDs have 2 fold increased expulsion rate
684
What is a normal pCO2 on umbical artery values?
49 +/- 8 (41-57)
**if High > respiratory acidosis
685
When do you add ampicillin for endometritis tx?
If known GBS colonization or if initial tx failure w gent/clinda and no improvement in 48 to 72 hours
686
Diagnostic gold standard or PE, regardless of pregnancy?
Spiral CT
687
Top 3 vaginal infections associated with preterm birth:
1. Bacterial vaginosis (stronger if detected early in preg, before 16 weeks)
2. Neisseria gonorrhoeae
3. Asymptomatic bacteriuria
688
Tx of primary syphillis:
Benzathine PCN G 2.4 million units IM x 1
*only desensitization if rxn: urticaria, angioedema, anaphylaxis, bronchospasm, hypotension and pos skin test testing
*maculopapular rash is not a reason to have desensitization
689
What is the most common etiology of nonimmune hydrops?
Cardiovascular abnormalities
(structural, arrhythmias, cardiomyopathies, cardiac tumors, vascular abnormalities)
*infectious is NOT the mc cause
690
What is the upper limit of vit D that is safe to take in pregnancy?
up to 4,000 IU
*vegetarian dose: 1000-2000IU
*rec daily intake in preg: 600 IU
691
At what gestational age is nuchal translucency measurement most sensitive in screening for aneuploidy?
13 weeks
692
BMI of class I obesity:
30 - 34.9 kg/m2
693
BMI of class II obesity?
35 - 39.9 kg/m2
694
BMI of class III obesity?
40 kg or higher
695
BMI of overweight:
25 to 29.9 kg/m2
696
What is the most common karyotype of a partial mole?
69 XXX
**girls girls girls rule the world!!!
*can be 69XXX, 69XXY, or rarely 69XYY
697
how much does a personal history of a VTE increase the risk of VTE in pregnancy?
3-4 fold
(3.5 times)
Other risks: obesity, HTN, DM, smoking, hypercholesteremia
698
most common cause of mild to moderate poly and most common cause of severe poly?
mild to moderate: idiopathic (MVP 8-15.9, AFI 24 to 34.9)
severe: fetal anomalies (MVP > 16, AFI 35 or greater)
699
Management of pts taking ACE-I prior to surgery:
hold for 24 hours before surgery to reduce the risk of periop hypotension
-if d/c have a lower risk of all-cause mortality, MI, or stroke when compared to those who continue it
700
Rec for cleaning vaginal probes between pts:
-wipe gel, rinse w soap/water, soak FOR 2 MINUTES IN 500 PPM CHLORINE, rinse again, air dry
701
Does functional residual capacity increase or decrease in pregnancy?
decrease!
*the amount of air remaining after a normal exhalation
702
Does inspiratory capacity increase or decrease in pregnancy:
increase!
*the max amount of air that can be inhaled
703
Which pulm function parameters in pregnancy stay the same?
-Forced expiratory volume in 1 sec (FEV1)
-Forced vitals capacity (FVC)
-FEV1/FVC ratio
-Peak expiratory flow rate
704
MC cause of post op fever occurring 3-5 days after surgery?
UTI
Causes of post op fever:
*wind (1-2 d) , water (2-5 d), wound (5-7 d) walking (5 + day), wonder drugs (anytime)
705
Average risk of GTN following uterine evacuation?
15%
(after tx of a complete mole)
can be 35% if high ris w any of these: HCG > 100,000, theca lutein cysts > 6cm, enlarged uterus
706
MC way to contract toxoplasmosis:
undercooked pork and lamb products
707
Antibiotics requirements in ob D&C or D&E?
Doxycycline 200mg
708
Contraindications for COCs:
- > 35 yo and smoke
- high BP or h/o stroke
- h/o heart attack
- h/o DVT
- h/o migraines w aura
- breast cancer or h/o breast cancer
709
1st line tx for complicated cystitis:
Fluoroquinolones (complicated cystitis: dm, renal anomalies)
Doses: cipro 500 mg BID, levo 750mg PO QD, Cipro XL 1000mg PO 7 - 12 days
710
Most common drug associated with acute pancreatitis?
Thiazides!
-acetaminophen, metronidazole, fibrates, statins, clomiphene, premarin, ACE-I, omeprazole
711
Rec to prevent postop VTE in a moderate risk pt:
Anticoag:
-low dose UFH: 500-u q 12
-LMWH: 2500 u dalteparin or 40mg lovenox OD
-compression stockings
712
Initia
713
Initial management of a patient with eclampsia:
-left lateral decubitus position
-administer supplemental O2 via nonrebreather
-raising padded bed rails
-monitor vital signs
714
MC location of endometrial implants after a TLH with BSO:
large and small bowel
*recurrent rate of 15%
715
How long should oxytocin be administered after membrane rupture before a pt is diagnosed with a failed IOL after ROM?
12 - 18 hours
Criteria for failed IOL:
1. up to 24 hours of longer of attempts to induce labor
2. amniotic membranes ruptured
3. 12 - 18 hours of oxytocin administration after membranes ruptured
716
Definition of active phase arrest:
6 or more cm dilated and ROM w no cervical change:
1. after 4 hours of adequate ctx (MVU > 200) OR
2. after 6 hours of inadequate ctx
717
Maternal consequences of inadequately treated hyperthyroidism:
preE and heart failure
Neonatal:
-low birth wt
-iatrogenic PTB
-IUFD
718
Best timing of menstrual cycle to have a dx hysteroscopy?
Early follicular phase
-avoid menses/bleeding
-secretory/luteal phase will be confusing 2/2 thick lining
719
HPV is associated with what percentage of cervical cancers?
91%
**ALMOST ALL OF THEM!!!
720
Exercise recommendation for postpartum patients?
moderate intensity aerobic exercise for 150 minutes weekly
721
What type of cancer does hormone replacement therapy actually decrease?
Colorectal cancer
722
Risk of VTE in pregnancy or postpartum state if heterozygote for FVL and personal h/o VTE:
10%
*FVL is the MC inherited thrombophilia
*if no personal h/o of VTE then 0.5 to 1.2% risk of VTE
723
Most common side effect of lisinopril use in 1st and 2nd trimester:
Renal impairment!
**Anuria and oligohydramnios can be present in 50% of cases > pulm hypoplasia, resp disease
724
How is vaginal cancer staged?
Clinically!
(cysto, proctoscopy, IV pyelo)
*PET can be useful in planning tx but not for staging
725
Carrier frequency of FVL in White patients:
5.27%
726
Positive predictive value for fetal fibronectin for pts 24 to 34 weeks gestational age with ctx:
30%
*low positive predictive value, high negative predictive value (99%)
727
This can predict ovulation prospectively:
Urine LH tests (pos 36 hours before the oocyte is released)
*Basal body temp, prog level: all pos after ovulation
728
Percentage of patients that have xerostomia while taking oxybutynin for urge incontinence:
30%
(dry mouth)
729
Optimal interpregnancy interval:
18 months
730
Pruritic, purple papules, painful vaginal mucosal erosions with white lacy wickham striae. + extragenital lesions, + vaginal involvement:
Lichen planus
* + risk of squamous cell carcinoma
731
Porcelain-white papules or plaques, thin/crinkling cigarette paper skin, fusion of labia minora. Rare extragenital lesions, no vaginal involvement:
Lichen sclerosus
*+ risk of SCC
732
Thick, leathery skin, pruritic plaques and excoriations, + extragenital lesions, no vaginal involvement
Lichen Simplex Chronicus
* no risk of SCC
733
US findings of congenital varicella:
-fetal hydrops
-hyperechogenic foci in liver/bowel
-cardiac malformations
-limb deformitis
-microcephaly
-FGR
734
What virus is congenital hearing loss associated with?
CMV
735
What virus is associated with periventricular calcifications and placentomegaly:
Toxoplasmosis
736
Tx of gonorrhea if cephalosporin allergy
240mg IM gentamicin + 2g oral azithromycin once
737
systemic steroids and vulvar psoriasis:
Systemic steroids may cause a REBOUND flare-up
-vulvar psoriasis does not involve the vagina, and ppl do have lesions elsewhere
738
MOA of ulipristal acetate:
inhibits follicular rupture
*levonorgestrel pills DELAY follicular development (not rupture)
739
MOA of COCs as emergency contraception:
inhibiting ovulation
740
MOA of copper IUD for emergency contraception:
affects sperm viability
741
What is the risk of concurrent high risk uterine carcinoma in women w a biopsy of EIN:
10%
742
How much of the endometrium is sampled during EMB?
5-15%
743
What is the definition of pelvic engagement?
Passage of the widest presenting part in vertex position, when the BPD passes through the pelvic inlet
744
At what plt count should medical treatment for ITP be started if pt is asymptomatic and approaching scheduled repeat c/s
less than 50,000
745
When to treat ITP?
-symp (epistaxis or bruising) - regardless of plt count
-plt count < 30,000 even if asymptomatic
-prior to epidural or spinal anesthesia (plt > 70,000)
-prior to c/s (plt > 50,000K)
746
What is treatment if ITP (Immune thrombocytopenic purpura)
First line:
-Glucocorticoids, IVIG (if steroids are contraindicated)
2nd line: rituximab, Thrombopoietin receptor agonists, immunosuppressive therapy, anti-D immunoglobulin
Refractory: Splenectomy
Emergency: plts transfusion
747
The risk of fetal structural congenital anomalies increase among obese women with the exception of what:
Gastroschisis - this is actually reduced!
(**Just think there is more fat on the baby or something!)
748
What is the effect of cell free DNA results on obesity?
MC to have test failures of "no-call" results
749
most likely HSC fluids to cause hyponatremia?
3% sorbitol and 1.5% glycine
-both hypoosmolar
*need preop, intraop and 4 hour post op serum sodium levels if these are used!
750
When does a DEXA scan need to be ordered:
AGE 65!!!
751
percentage of frank virilization with Sertoli-Leydig tumors?
30-35%
*this is a sex cord stromal tumor that originates from the ovarian matrix
-avg age is 25 yo
-unilateral, 50% of pts have abdominal pain or palp mass, 1/3 have virilization, additonal 10% have signs of androgen excess
752
Tx of a sertoli-leydig tumor:
-removal for definitive tx
15-20% are malignancy
**3-7cm solid tumor, multilocular tumors w mixed areas, purely solid areas, and tightly packed small cyst locules
753
This neurotransmitter binds to M3 muscarinic receptor for bladder contraction:
Acetylcholine
Ach binds to M3 receptors > bladder ctx/increased pressure on urethra
*inhibitory input to urethral smooth muscle by NO for bladder relaxation
754
Most common histological cell type of endometrial cancer
Endometrioid adenocarcinoma
755
When to restart ppx anticoagulation after a c/s vs vaginal delivery:
C/S: 6-12 (if neuraxial/spinal: 24 hours)
Vaginal delivery: 4 to 6
756
This Mullerian anomaly has the greatest risk of miscarriage and is the most common:
Septate uterus
*miscarriage rate > 60%, accounts for over 80% of anomalies among pts w RPL
757
What hormone inhibits alpha-lactalbumin (main stimulator of lactose synthase)
Progesterone
(also inhibits prolactin)
*when progesterone decreases after delivery > these hormones inc milk production
758
Management of exposure to rubella in pregnancy if unvaccinated:
-watched carefully
-if sxs develop> maternal serum testing and amnio
**80% of women w rubella infx in first 12 weeks of pregnancy have an affected fetus, 25% if end of 2nd trimester
759
Most common cause of respiratory distress in a patient with pyelo?
ARDS
*endotoxin related injury (completely reversible)
760
Prevalence of T2DM if women over the age of 30 with PCOS?
12%
*glucose intolerance is 40% if > 30 w PCOS
761
Next best step in treating a patient with suspected septic abortion after a recent elective termination, after ensuring hemodynamic stability:
IV clindamycin900mg and gentamicin 5mg/kg IV
(or cefoxitin 2g IV q 6 hrs or cefotetan 2g IV q 12 hours + doxy 100mg PO/IV q 12)
*tx with broad spectrum abx while bringing patient to OR for suction D&C
762
Percentage of shoulder dystocia in all vaginal deliveries?
0.2 to 3%
763
This fetal finding is pathognomonic for CMV:
Petechiae
764
Heat intolerance, excessive sweating, palpitations, diarrhea: hypo or hyperthyroid:
Hyperthyroid!!!
765
Most likely to be a risk factor for developing endometritis:
-AMA
-GBS
-Precip labor
-Immediate spon. ROM
-C/S
C/S!!!
-complicates 5-35% of c/s deliveries
Others
-prolonged ROM
-GBS pos
-young age
-prolonged labor
-multiple vaginal exams
-low SES
-BV infections
766
35 weeks in labor with GBS unk status. Management:
GBS ppx AND steroids
-Give for late preterm 34 to 36/6 to decrease resp morbidity. Don't give tocolytics
*don't give if DM or multi-fetal gestation
767
This is multiple blisters that burst on gentle palpation:
Pemphigus vulgaris
*AutoAbs to desmogleins that are part of the desmosomes that hold cells together
Skin AND mucous membranes (Different than bullous pemphigoid(
Tx: oral/topical steroids
768
Lesions due to auto-ab against hemidesmosomes that hold interstellar junctions to the basement membranes. Do not rupture w gentle palpation:
Bullous pemphigoid (BELOW the surface - not on the skin)
-do NOT rupture w gentle palpation
Tx: high-potency steroids
769
When should HAART be given for postexposure ppx and for how long:
-more effective if given within 72 hours of exposure
-28 day course
770
Electrolyte abnormality seen with massive transfusions:
Hyperkalemia!!!
-can also have hypocalcemia
*from packed RBCs and citrate
-hyperkalemia (tissue damage/hemolysis)
-hypocalcemia due to citrate toxicity
-metabolic acidosis 2/2 LA and dec removal of citrate
-hypothermia
-TRALI
771
What is the most commonly reported sentinel event?
Falls
*Not delay in tx*
772
1st line medical tx for osteoporosis
bisphosphonates (after lifestyle modifications)
options: alendronate, risedronate, ibandronate, zoledronate
773
What is considered successful tx of an ectopic pregnancy using the single dose protocol?
15% or more decline on days 4 to 7
then: follow weekly, and as along as 15% decline, surveillance can be continued
-if < 15%, repeat dose
*tx day is day 1
*the bhcg levels actually RISE during day 1 to 4 due to rupture in ectopic syncytiophoblasts
774
What kind of vaccine in the HPV vaccine?
Viral capsid protein
775
What is the percentage of endometriosis in couples with infertility?
40%
776
Surgical staging for ovarian and fallopian tube cancers:
TAH, BSO, pelvic washings, peritoneal biopsies, paraaortic and pelvic LN dissection, partial/total omentectomy
*overall prognosis is improved if immediate surgical staging/debulking is performed by gyn onc
777
Prevalence of DM in the US:
10.5%
778
Stage II pelvic organ prolapse:
Leading point is -1cm to 1cm of the hymen!!!!
Stage 1: < -1cm
Stage III: > +1cm but not within TVL - 2
Stage IV: >/= TVL - 2
779
Green nipple discharge:
Ductal ectasia (noncancerous)
780
Bloody nipple discharge:
intraductal papilloma (noncancerous)
781
What is used in the Gail Breast Risk model:
-age
-# breast bx done and presence of atypical hyperplasia
-# primary relatives w BC when age they had first child
Does NOT take into account: other cancers, 2nd degree + relatives, BC in paternal relatives
782
Who has the highest RR of breast cancer using the gail breast risk model?
having 2 more more relatives with breast cancer who had their children young (20s)
Risk 6.88
783
WHI showed that estrogen/progesterone increased what:
risk of breast cancer, clots/strokes, and heart attack
784
WHI showed that estrogen/progesterone decreased risk of what:
colorectal cancer and risk of fractures
785
What are the absolute contraindications for HRT?
-h/o breast cancer
-h/o endometrial cancer
-severe active liver disease
-hypertriglyceridemia
-thromboembolic disorders
-undiagnosed vaginal bleeding
786
What is the Amsel criteria:
3 out of the 4 for dx of BV:
1. gray/white d/c
2. Vaginal pH > 4.5
3. Positive whiff test
4. at least 20% epithelial clue cells
787
What is normal vaginal pH:
3.3 to 4.5
788
Which type of yeast can be treated by any of the formulations?
C. albicans
*and MC
789
What type of yeast is resistant to terconazole:
C. Parapsilosis
*terrified of parasailing
790
What type of yeast is resistant to Nystatin?
C. Krusei
*tx w miconazole or clotrimazole
**don;t take Krusei at Nyght
791
most common cause of death for 13 to 18 yo:
Accidents
#2 in 19 to 39
792
Patient with what medical conditions should receive the pneumococcal vaccine between the ages of 19 and 64?
-alcoholism
-chronic lung/liver/heart disease
-DM
-SCD or other hemoglobinopathies
-Smokers
*also inc risk of meningitis, cochlear implants OR immunocompromised pts
793
What is the hgb goal and HbS percentage goal for a pregnant patient with SCD?
Hgb 10 and HbS of 40%
*reduced incidence of sickle cell crisis
794
Best option for a IOL of a stillbirth at 24 to 28 weeks GA with previous hysterotomy?
Mifepristone followed by vaginal misoprostol
*can use high dose oxy or misoprostol alone
795
Treatment of pos TB skin test and neg CXR during pregnancy:
delay treatment to 2-3 months postpartum (if low risk)
*isoniazid for 9 months*
*if high risk (HIV, immunosuppressed, recent exposure, can tx during preg)
*this is latent TB
796
Tx of active TB in pregnancy:
Isoniazid w B6 and rifampin for 9 months, +/- ethambutol
*pos skin test and pos CXR
797
What is the most common stage at which endometrial cancer is diagnosed at?
IB
> 50% of the myometrium
73% of pts are diagnosed in stage I
798
outpatient tx for PID
-ceftriaxone 500/1000mg IM x 1 dose ( 150kg)
-Doxycycline 100mg BID x 14 days
-Flagyl 500mg BID x 14 days
799
inpatient tx for PID:
cefoxitin 2g IV q 6 hours (or ceftriaxone or cefotetan) +
Doxycycline 100mg BID
until clinical improvement for 24 hours then transition to PO
800
Who needs to be inpatient for PID tx:
-pregnancy
-severe clinical illness
-lack of response to oral abs
-TOA
-persistent N/V
-inability to adhere to therapy
-possible need for surgical intervention
801
Most common presenting sxs of rhabdomyosarcoma?
vaginal bleeding!!
*mass at introitus is occasionally seen
Tx w VAC chemo (vincristine, actino-D, cyclophosphamide)
802
Endpoints of septoplasty procedure:
-level line between tubal ostia
-bleeding
-increased vascularity
-serosal transillumination
803
This is uncontrolled muscle clenching of the vaginal and perineum, interfering with sexual and vaginal penetration
Vaginismus
804
This mullerian anomaly has the highest rate of 1st and 2nd trimester miscarriage of all the anomalies:
Uterine septum
805
complication of banana-like uterine cavity w noncommunicating mass containing thick stripe similar to an endometrial lining?
This is a Class II Mullerian anomaly (unicornuate uterus) and risk of rupture of accessory horn at less than 20 weeks
*if pregnancy in the access horn
806
Difference between complete vs LeFort Colpocleisis:
Lefort: retains some vaginal mucosa leaving lateral canals for drainage
Complete: Entirely removes vaginal mucosa tissue with NO canals
*increased likelihood of SUI following procedures
807
Efficacy of OCP, depot leuprolide, and danazol for endometriosis
Lupron and Danazol have similar efficacy (gnrh agonist and antiestrogenic MOA)
-Better efficacy than OCPs
808
discomfort arising in some individuals from the incongruence between gender identity and their external sexual anatomy at birth:
Gender dysphoria or gender identity disorder
809
This medication inhibits aldehyde dehydrogenase:
Disulfiram
-pts feel fatigue, nausea, HA if relapse w alcohol
810
1st line tx for alcohol dependence:
naltrexone and acamprosate
1. opioid receptor antagonist
2. modulates glutamate neurotransmission at M5G receptors
811
most sensitive and specific US findings of ovarian torsion:
ovarian edema and relative enlargement of the ipsilateral ovary
812
outcome of operative laparoscopy on livebirth rate or ongoing pregnancy rate compared w dx lap for endometriosis:
doubles the live birth rate
813
Is bleeding into a vulvar hematoma usually arterial or venous?
Venous
814
Management of a vulvar hematoma:
if stable: foley cath, ice pain, pain management
815
Risk of placenta accreta w 3 prior c/s if no previa:
2%
No previa:
primary c/s: 0.24
1 prior: 0.31
2 prior: 0.57
3 prior: 2.13
4 prior: 2.33
5 or more: 6.74
816
Tx for curative intent for central recurrence of cervical cancer in pts who previously had radiation therapy:
Pelvic exenteration
817
Earliest age to give the meningococcal vaccine?
11-12 yo
818
Management of a serosal bowel injury:
Single layer closure
819
This is a repair of a ureter injury that is for a middle 1/3 injury, close to the pelvic brin. It encompasses the ureteral repair:
Boari flap
820
This is a repair for the upper or middle 1/3 ureter and is end to end:
Uretero-uretostomy: end to end or spatulating (tension repair)
821
This ureter repair is for an injury that is within the pelvic brim, 6cm or less from the bladder implantation:
ureteroneocystotomy
822
This ureter repair mobilizes the bladder to the psoas muscle to reduce tension on the repair:
Psoas hitch
823
Most common blood type:
O+
824
Least common blood type:
ABneg
825
Universal donor blood type:
O neg
826
Universal recipient blood type:
AB pos
827
Make up of whole blood:
55% plasma
1% WBC/plts
45% RBCs
828
Factors that trigger extrinsic pathway:
damage to a vessel
829
Tx for a pt presenting to the ED > 72 hours after a sexual assault:
-ceftriaxone, doxycycline, metronidazole
-emergency contraception
*no HIV ppx since > 72 hours
*hep B vaccine if not immune
830
Components of functional status (capacity for surgery)
-nutritional status, eating, feeding
-continence
-transferring
-dressing
-bathing
831
What is the most effective method used to prepare a stenotic cervix for HSC?
laminaria (more effective than misoprostol)
832
This is an action done in the best interested of the patient:
Beneficence: providing the best tx for a pt regardless of ability to pay
833
This is the right of a pt to make their own decisions without interference from other health care staff or family
Autonomy (ensuring they have a translator available if needed so they fully understand)
834
Woman with POI 2/2 mutation in the FMR1 gene. What is the most likely # of CGG repeats she has?
55 to 200**
Fragile X premutation can present with premature ovarian insuff
*can transmit a full mutation to the next generation
835
Does lisinopril increase urinary incontience?
Yes - dry cough > increases incontience
836
Effect of haloperidol on incontinence:
dopamine receptor blockade weakens internal urethral sphincter
837
MC cause of NON-mechanical small bowel obstruction:
small bowel adynamic ileus
838
What is the total iron requirement for normal pregnancy?
1000mg
300 is what the fetus requires
839
Risk of NTD if 1 parent with NTD:
4.5%
840
Risk of NTD if 1 parent and 1 sibling affected?
12%
841
Risk of NTD if 2 parents with NTD and no siblings:
30%
842
Risk of NTD if 2 parents with NTD and 1 affected sibling:
33%
843
This side of the coagulation cascade is the result of a disruption within the lumen of the vessel
intrinsic pathway
844
What coagulation factor combines both the intrinsic and extrinsic pathway?
10
*perfect 10*
845
MOA of heparin:
heprIN - thrombIN>>
*direct thrombIN INhibitor
*effect on INdirect coagulation pathway
*binds factor Xa with AT3 inactivating the factor. The chain length is not long enough to bind thrombin
846
What is monitoring for heprin?
PTT
TT and can make H (Heparin)
847
What is the antidote for heparin:
Protamine sulfate
848
Autoantibodies that are directed against endogenous plt factor 4 in complex with heparin > arterial and venous thrombosis
Heparin induced thrombocytopenia
849
half life of heparin:
90 mins
850
half life of LMWH
3-7 hours
851
What lab is done to monitor LMWH
Anti-Factor Xa
852
Where do flouroquinolones act at the cell level:
DNA gyrase
853
Where in the cell does nitrofurantoin act:
DNA
854
Where in the cell does rifampin act?
RNA polymerase
855
Where in the cell does PCN, Vanc, Bacitracin, cephalosporins, carbapenems act?
Cell wall
856
Where in the cell does chloramphenicol, macrolides, clinda, and linezolid act?
Ribosome 50s
857
Where in the cell does aminoglycosides and tetracyclines act?
Ribosome 30s
858
MOA of trimethoprim-sulfamethoxazole
Trimethoprim: inhibits reduction of DHFA to THFA
Sulfamethoxazole: competes w PABA to inhibit synthesis of DHFA
859
These medications act at the level of the cell membrane:
antifungals
(polymixin, amp B, ketoconazole, triazoles, fluconazole, clotirmazole, terbinafine, 5-FU)
860
Abx for vaginal sling placement:
Cefazolin
861
This wound class is surgically sterile w/o exposure to GI/GU or foreign nonsterile debris:
Class I
*no antibiotics
862
This wound class is clean contaminated (intentional controlled entry to GI/GU):
Class 2
*hysterectomy
*yes abx!
863
This wound class is contaminated (acute inlm, nonsterile debrisin field)
Class 3 (clean contaminated)
*enterotomy
*yes abx
864
This would class is dirty, infection (abscess management)
Class 4
*ruptured TOA
*yes abx!
865
Type of shock: low PCWP, low CO, high SV:
Hypovolemic shock
866
Type of shock: low SVR:
septic**
things are 3rd spacing
867
Type of shock: low CO, high PCWP:
Cardiogenic
868
This is the only point on the POP-Q that is not measured after a total hyst:
D!
869
This measurement of popQ is measured in rest at supine position:
TVL
870
This POP-Q has the least variability in measurement between providers:
gH
871
Nerve injured with sxs: numbness of anteromedial thigh, weak external rotation, weak adduction:
Obturator, L2-L4
sensory & motor
freq: 20-30%
872
Nerve injury w sxs: numbness to anteromedial thigh, weak leg extension, wea flexion of hip, absent knee jerk:
Femoral, L2-4
*sensory and motor
Freq: 11-30%
873
Nurve injury: numbness/burning pain upper labia and thigh:
Genitofemoral, L1-L2
Sensory only
Freq: 17%
874
Nerve injury: numbness foot/leg, foot drop, buttock pain, post/lateral leg pain:
lumbosacral/sciatic, L4- S3
*sensory and motor
Freq: 10%
875
Nerve injury: sharp, cutting pain, usually delayed pain lower ab:
ilioinguinal/iliohypogastric, T12-L1
*sensory
Freq: 7%
876
Nerve injury sxs: numbess, lateral thigh or hyperesthesia:
Lateral femoral cutaneous, L2-L3
Sensory
Freq: 6%
877
What is the goal of BP reduction in the first 2 hours after HTN emergency?
-10-15% over 30-60 mins
and continued reduction over next 23 hours
if pt starts at 200, goal = 170-180
*a bigger decrease will cause hypoperfusion
878
Treatment of transfusion related citrate toxicity:
Calcium chloride OR calcium gluconate
*citrate causes hypocalcemia
879
Management of subclinical hypothyroidism (nml T4, elevated TSH):
repeat tests in 1-3 months
*if TSH > 15, repeat in 1-2 weeks
Tx controversial/considered if repeat testing is the same (can tx if preg)
880
1st line tx of uncomplicated UTIs:
Nitrofurantoin or TMP-SMX
*complicated will be fluoroquinolones
881
What is the hepatitis screening test performed in all pregnant patients?
Hep B surface antigen
*pos in acute and chronically infected pts
882
What hepatitis B lab will be positive if a pt is immune due to vaccination?
Anti-Hep B surface
883
What is the most common symptom of coronary artery disease in women?
Chest pain
884
What is the most serious long term complication associated with VAVD:
intracranial hemorrhage
**most serious --bleeding into the brain may lead to permanent death or damage
885
What is the best imaging modality for a suspected urethral diverticulum?
MRI
886
most common food borne pathogen causing nonbloody diarrhea?
S. Aureus
887
Definition of midforceps:
fetal station above +2
888
Management of pt at 18 weeks gestation withOUT a h/o preterm birth and an incidentally found shortened cervix:
Nightly vaginal progesterone
*if h/o PTB, US indicated cerclage
889
5 year failure rate of pp tubal and levonorgestrel IUD:
PP tubal: 6.3 per 1000
L-IUD: 5-11 per 1000
890
What is the limiting dimension of the pelvis?
Interspinous diameter
*distance between ischial spines (smallest dimension of the female pelvis)
891
Risk of uterine rupture in patients with a single low transverse c/s:
0.5%
1-2% if h/o 2 prior c/s deliveries
892
What is the best diagnostic modality for identifying the location of a fistulous tract between the bladder and vagina?
Cystourethroscopy
-directly visualizes the abnormality and assesses the bladder
*dye test can confirm its presence
893
Most important risk factor for development of epithelial ovarian cancer in the general population:
Age
894
Definition of pregnancy that is 41/0 to 41 6/7:
Late term
**postterm is at 42/0 and beyond
895
What comorbidities is a pt with PCOS at risk for?
T2DM
OSA!!!
HLD
metabolic syndrome
NAFLD
896
Treatment of fever, pain at incision 7 days post hyst:
Vanc (likely cellulitis)
897
What are the ONLY two indications for testing for thrombophilia:
personal h/o and 1st degree relative w inherited thrombophilia
898
Management of HELLP
Proceed w immed
899
Management of HELLP:
Proceed w immediate delivery
-don't wait for steroids
900
Affect of neuraxial analgesia on herpes:
Can reactivate oral herpes
*maybe due to irritation of trigeminal nerve from facial scratching due to neuraxial opioid-induced pruritus
901
What is dull/dense white epithelium a finding consistent with on colpo using acetic acid?
high grade dysplastic lesions
-also SHARP/Straight (not feathery)
-coarse, dilated, nonuniform vessels
902
What is the rate of PTB in twins?
60%
903
Most common site of metastatic GTN:
lung - 80%
904
What is the gold standard for screening for Cushing syndrome?
24 hour free cortisol
905
Intrapartum management of pulm hypertension?
avoid hypotension, vol depletion, hypoxemia (cont pulse ox >90%)
906
How long can conservative management w no improvement for a SBO ocur before surgical management is recommended?
5 days!
907
Pt > 26 yo w pos ECC showing high grade dysplasia:
Excisional procedure
908
Who is able to get a physical exam indicated cerclage?
no prior PTB: if digital/speculum exam reveals cervical dilation (1-4cm_ < 24 weels
Prior PTB if digital/speculum reveals cervical dilation < 24 weeks
*Dilation is 1-4 cm
909
Who is a candidate for a US based cerclage?
no prior PTB: CL < 10mm before 24 weeks
Prior PTB: CL < 25mm before 24 weeks
910
Prevalence of IPV in pregnancy:
5 to 20%
911
Closure of a active wound infection:
secondary closure
912
What increases the risk of sudden cardiopulmonary arrest in a pregnant pt with Eisenmenger syndrome?
Hypotension
*anything that causes a reduction in preload
*pt have a 50% risk of dying during their pregnancy
913
1 year failure rate of Mirena:
0.2%
914
Describe the normal physiologic events during the menstrual cycle that are responsible for the development of fibrocystic change in the breast:
Theca externa producing large amounts of progesterone to stimulate glandular growth
915
This gives rise to the bladder (except trigone), the bulbourethral glands, the urethra, and the lower 2/3's of the vagina
Urogenital sinus
916
This gives rise to the oviducts, uterus, and upper 1/3 of the vagina:
Paramesonephric ducts
917
Best next step in a newborn born with enlarged clitoris:
Electrolyte testing!!!
-ddx: CAH
*would have an elevated 17-hydroxyprogesterone but that is not the next best step!
918
Unique complication of presacral neurectomy:
Urinary retention and constipation
*Temporary -urinary retention resolves in 1to 2 weeks, constipation in 6 wks
**NOT life threatening hemorrhage
919
Does multiparity increase or decrease the risk of cervical cancer?
INCREASE
(early age at first birth, increased parity > increased exposure to HPV)
920
Incidence of twin gestation in the US
33 in 1,000 births
921
Should you do manual extraction of retained POC of a septic abortion in the ED?
No- high risk for hemorrhage, stabilize, start antibiotics, and take to OR
922
This is the pregnancy rate following excision of an endometrioma:
56-65%
Excision: 60%, drainage/ablation = 23%
923
Tx of gonorrhea and chlamydia if pregnant:
Ceftriaxone and azithromycin (not doxy)
924
What branches are the most commonly injured in a vulvar hematoma:
branches of pudendal artery
-inferior rectal
-transverse perineal
-posterior labial
925
Diagnostic step in diagnosing premenstural syndrome:
symptom diary
-should have sxs 5 or more days prior to onset of menses and resolve within 4 days after onset of menses
926
Treatment of breast abscess in the setting of mastitis:
I&D - treat the ABSCESS!!!
*also suspect if tissue is fluctuant or if pt's sxs do not improve after 2-3 days of tx
*can tx w Vanc of Trimethoprim-sulfamethoxazole (dicloxacillin when no abscess)
927
Risk of breast cancer if mother/sister with breast cancer?
Increased relative risk of 2.6%
928
GA and cervical dx to define preterm labor:
regular uterine ctx w cervical change (effacement or dilation) or regular ctx w cervical dilation of at least 2cm on initial presentation at 20/0 to 36 6/7
929
Failure rate of ParaGard for typical use vs perfect use in 1st year:
Typical use: 0.8
Perfect use: 0.6
930
Failure rate of Levonorgesterol IUD for typical use vs perfect use in 1st year:
Typical use: 0.2
Perfect use: 0.2
931
Failure rate of Implant for typical use vs perfect use in 1st year:
Typical use: 0.05
Perfect use: 0.05
932
MC type of epithelial ovarian cancer:
Serous!!!
Serous cystadenocarcinoma is the MC type of ovarian cancer
933
When to start OCPs after delivery:
4-6 weeks (due to effect on milk supply and increased risk of VTE)
934
Hormone involved in hyperandrogenism in PCOS:
LH!!
inc peripheral estrogen > decreased FSH, inc LH
935
Treatment of asymptomatic bacteria vaginosis in pregnancy:
NO TREATMENT in pts without a h/o preterm birth
*asymp women should NOT be screened for BV and tx is NOT recommended
936
Max intraabdominal pressure allowed in order to ensure central venous return and diaphragmatic excursion during laparoscopic surgery:
20-24mmHg
standard is 12mmHg
937
if a pt with a known BRCA2 mutation undergoes a ppx BSO, how much is her risk of epithelial ovarian cancer reduced by?
80% for ovarian cancer
40-100% for breast cancer
70% for all cause mortality
*all BRCA carriers
938
What stage are most epithelial ovarian tumors diagnosed in?
Stage III
939
What is the safest entry point in a pt with numerous pelvic and abdominal surgeries?
Palmer's point
940
What is the percentage of DM among adults in the US?
14.8%
941
What strain of HPV is most commonly associated with cervical adenocarcinoma?
18!
16 is more common w squamous
942
What ethnicities are MOST likely to have a Rhesus negative blood type?
White! ME!
943
Risk of uterine rupture during labor in a pt w a h/o prior classical hysterotomy scar?
1-12 %
944
Most common presenting sxs of fallopian tube cancer?
Hydrops tubae profluens (copious serosanginous vaginal discharge)
945
Tx of CIN I if > 24 yo and not pregnant:
1 year f/u
946
Tx of CIN II if > 24 yo and not pregnant:
excisional procedure
947
tx for CIN II if > 24 yo and concern for pregnancy:
colpo and HPV based testing at 6 adn 12 months
948
Tx of CIN III if > 24 yo and not pregnant:
Excisional procedure
949
Thermal spread of monopolar vs bipolar energy:
monopolar 3.5mm
bipolar 2mm
950
Malignant features on the IOTA US rules for adnexal masses:
-Irregular solid tumor
-ascites
-4 or more papillary structures
-irregular multilocular solid tumor w greatest diameter of 10 or more cm
-very high color content on Doppler
951
MOA of methimazole:
inhibits thyroid peroxidase
952
Use of OCPs in pts with SLE:
Don't do it!!!
SLE pts have an increased risk of heart disease, stroke, VTE
*don't give if APA pos or unknown status. Need to test for antiphospholipid antibodies before starting hormonal contraception
953
Tx of acute/early/mild hidradenitis suppurativa:
Topical clindamycin (1st line)
-oral tetracyclines
-warm compresses
-intralesional corticosteroids
-surgically unroofing lesions
954
Tx of chronic hidradenitis suppurativa:
(scarring w fistulous tracks) > Wide operative excision
955
wt gain in pregnancy if underweight (BMI < 20)
28 to 40 lbs
956
wt gain in pregnancy if normal BMI (20-25)
25 to 35 lbs
957
Wt gain in pregnancy if overweight (BMI 25-30)
15-25 lbs
958
Wt gain in pregnancy if obese (BMI > 30):
11- 20 lbs
959
Novasure (radiofrequency) can be used if there is a submucosal fibroid of what size?
3cm or less
*must sound to at least 6cm, no more than 10cm (Ut length 4cm)
*uterine width 2.5cm or greater
960
What muscles make up the perineal body?
superficial transverse perineal muscles
bulboCAVERnousos
external anal sphincter
961
When does a fever occur during alcohol withdrawal?
48-96 hours after last drink
962
When do the decidua parietalis and decidua capsularis fuse?
At 3 to 4 months gestation
*the decidua capsularis (covers the blastocyte) and the rest of it is the parietalis
*the blastocyst implants into the decidua basalis, covered by the capsularis. The rest is the parietalis
963
most common side effect of copper IUD?
Dysmenorrhea and heavy menstrual bleeding
964
risk of rupture of endometriomas and OCPs
They can cause an increased risk of rupture in large endometriomas
*overall decrease sxs in 80% of pts
965
What is the most common presenting sign or sxs of CAD in women younge than 45yo?
Myocardia infarction
966
Definition of macrosomia EFW:
4,000 to 4500g
*4500g rec c/s if DM
*5000g rec c/s if no DM
967
MOA and contraindications to Mirabegron:
MOA: B3 adrenergic receptor agonist (detrusor muscle of bladder) - relaxes detrusor muscle, increases bladder capacity
C/I: uncontrolled HTN, ESRD, significant liver impairment
968
Risk of shoulder dystocia if EFW > 4500g and maternal diabetes:
20-50%
*if > 4500g w/o DM then 10-25%
969
Smoking decreases the risk of this type of cancer:
Endometrial cancer
*smoking and OCPs
970
Definition for SAB:
< 20 weeks and less than 500g
971
Risk of stillbirth in a fetus with EFW < 10% for GA?
1.5%
if EFW < 5% = 2.5%
972
Risk of newborns developing GBS disease if mom GBS + and untreated:
1-2%
*First 7 days
973
What percentage of women with pregestational DM also have cHTN?
5 - 10%
974
What is the most common way for ovarian cancer to spread?
Exfoliation or Transcoelomic ---through the peritoneal cavity
*the carcinoma exfoliates malignant cells into the peritoneal cavity
975
What factors are most consistent w HPV-independent vulvar cancers?
*older women so not HPV related
-vulvar dystrophy
-lichen sclerosus
*not associated w smoking
976
What stage is given to a pt wh is stage IA but the ovarian capsule ruptures during removal?
IC now
-now high risk of recurrence
977
Treatment for placental site trophoblastic tumor:
Hyst!! MAINSTAY
978
Reasons to get an MRI for breast cancer screening:
-BRCA carrier
-Strong family h/o (1st degree relative)
-h/o chest radiation
*anything that increases risk >20-25%
979
Relative risk of developing breast cancer with a diagnosis of atypical ductal hyperplasia?
5.0
