Week 1 Flashcards
(100 cards)
1
Q
Dx criteria for metabolic syndrome
A
- Waist circumference >88cm
- Tx of trigs or trigs >150
- Hdl <50
- Treated htn or BP > 135/85
- Fasting glucose >100 or tx of dm
Any 3= metabolic syndrome
2
Q
First line treatment for fibromyalgia
A
- Educating the patient about the diagnosis
- Exercise program.
- Drug monotherapy: eg snri, pregabalin, gabapentin, cyclobenzaprine, amitriptyline
3
Q
A
4
Q
US findings concerning for ovarian malignancy
A
Cyst size greater than 10cm
Papillary or solid components
Irregularity of the mass
Presence of ascites
High Doppler velocimetry
5
Q
In what benign conditions can ca 125 be elevated
A
Leiomyomas
Endometriosis
Adenomyosis
PID
6
Q
ACOG recommends drills be conducted how often (eg hemorrhage, SD)
A
Quarterly
7
Q
Can you use combined birth control patch continuously?
A
No, bc it carries risk of estrogen accumulation and vte
8
Q
How long can a heathy, non smoking person without specific cvd risk factors continue cocps?
A
50-55
9
Q
Lynch syndrome associated with what cancers
A
Ovarian, endometrial, colon
Also: gastric, ureteral, biliary, pancreatic, glioblastoma, renal
10
Q
Li-fraumeni associated with what cancers
A
Breast, colon
Also: sarcoma, brain, adrenocortical
11
Q
Peutz Jeghers syndrome associated with what cancers
A
Breast, ovarian, colon
Also: cervical adenoma malignum, gi hamartomas, pancreatic, gastric, small bowel
12
Q
Risk of ovarian cancer in brca 1 vs 2
A
1: 39-46%
2: 12-20%
13
Q
Bone mineral density screening should be initiated in women at age 65 years. However, screening may be initiated in younger women who are post menopausal and have any of the following risk factors:
A
- Medical history of fragility fracture
- Weight less than 58kg
- Medical medications or medical conditions known to cause bone loss eg cushings or POF
- Current smoking.
- History of a parent with hip fracture.
- Alcohol.
- Rheumatoid arthritis.
- HIV
14
Q
What percentage of women hospitalized for hip fracture ultimately die from complication subsequent to the fracture
A
3-6%
15
Q
What pregnancy complications has asthma been associated with?
A
Pre-term delivery, placental, abruption, preeclampsia, postpartum hemorrhage
16
Q
At what point should you add an inhaled corticosteroid for asthma and pregnancy?
A
When patients fall into the mild persistent classification which occurs when there’s more than two days per week of albuterol requirement
17
Q
Use of systemic, corticosteroids, and pregnancy has been associated with what fetal outcomes
A
Fetal growth restriction. There is also a very small association with fetal cleft palette with first trimester exposure. But this has not been seen with inhaled corticosteroids.
18
Q
A
19
Q
What percentage of women with post menopausal bleeding will have endometrial cancer?
A
1-14%
20
Q
Mechanisms by which smoking is a strong risk factor for cervical cancer
A
- Smoking may decrease immune system defenses, thereby decreasing HPV clearance.
- Smoking may increase exposure to chemicals and toxins that damage cell DNA resulting in increased susceptibility to cancer processes.
21
Q
When should cervical cancer screening commence for HIV positive individuals?
A
Within one year of onset of sexual activity and no later than age 21
22
Q
Screening recommendations for Pap smear’s in setting of HIV
A
First Pap smear within one year of onset of sexual activity.
Next Pap smear in one year and then continue annually for three years if the results of three annual cervical cytology screenings are normal follow up screening as recommended every three years up to age 30 and then screening is continued to lifelong for those who are HIV positive
23
Q
A
24
Q
How many women will undergo surgery for pelvic organ prolapse or incontinence by age 80?
A
1/5
25
What vaccines are safe in pregnancy?
Influenza
T dap
Pneumococcal
Meningococcal
Hepatitis B
Hepatitis A
26
What vaccines are recommended in those with HIV?
Those with the CD four count greater than 200:
Influenza
Tdap
Pneumococcal
Meningococcal
Hepatitis B
Hepatitis a
HPV
Varicella
MMR
For CD four count less than 200 avoid live attenuated vaccines so no varicella or MMR
27
How long after delivery can postpartum preeclampsia and eclampsia occur?
Six weeks after delivery
28
At what point with suspected PIH can you diagnose, chronic hypertension after childbirth?
If elevated blood pressure is persist after 12 weeks postpartum
29
In the US an estimated what percent of individuals aged 14 to 49 have serologic evidence of HSV two
21%
30
Consistent and proper condom use has been reported to decrease the risk of partner infection in the setting of hsv by what percent
96%
31
Define:
Early term
Full term
Late term
Post term
Early term: 37 to 38+6
Full term : 39 to 40+6
Late term: 41 to 41+6
Post term: 42+
32
How many inductions after 40 weeks required to prevent one perinatal death
436
33
Risks associated with post maturity
Oligohydramnios, fetal macrosomia, and low Apgar score.
Post maturity syndrome, complicates up to 20% of poster pregnancies.
Maternal risks include increased risk of cesarean birth, perennial, laceration, obstetric hemorrhage
34
How long does HPV related cervical dysplasia take to progressive cancer?
3-7 years
35
36
LCIS tends to be unilateral or bilateral?
Tends to be bilateral and multifocal
37
Risk of invasive breast cancer in those with LCIS
Five years: 3 to 5%
10 years: 5 to 10%
10% after 10 years.
15% after 15 years
25% after 20 years
38
Breast cancer, chemo prevention for LCIS
Pre-menopausal: tamoxifen.
Post menopause:
– no uterus, no Osteo: Services or AI
– Plus or minus uterus – plus Osteo: raloxifene
– plus uterus/minus Osteo: raloxifene or AI
AI = aromatase inhibitor, e.g. anastrozole
39
40
What are the different major categories of benign breast lesions?
Nonproliferative: e.g., simple cyst, mild hyperplasia.
Proliferative wo atypia: fibroadenoma, introduction, Paloma, moderate or florid, hyperplasia, radial scar.
LCIS
Atypical hyperplasia
41
What percentage of adolescence who undergo laparoscopy to treat chronic pelvic pain have endometriosis?
62 to 75%
42
Preferred diagnostic method for chlamydia and gonorrhea
NAAT
43
What percent of clinically recognized pregnancies result in early pregnancy loss
10%
44
Mechanism of action of mifepristone
19 – NOR steroid that act as competitive progesterone, receptor antagonist and corticosteroid receptor antagonist. It primes myometrium and cervix for prostate landing activity.
45
Mechanism of action of dinoprostone
Synthetic form of prosthetic landing, E2. Used for cervical ripening.
46
Mechanism of action of methylergonovine
Semisynthetic ergot alkaloid used primarily for prevention/control of postpartum hemorrhage
47
MOA of methotrexate
Folic acid antagonist
48
What percentage of those with ectopic pregnancy have no identifiable risk factors?
50%
49
Risk factors for ectopic pregnancy
Prior ectopic, damage to tubes, prior pelvic surgery
50
Next step if hCG did not fall by at least 50% 12 to 24 hours after manual aspiration and setting of suspected, but not definite IUP and no chorionic villa identified on aspiration
Repeat hCG. It could still be failed IUP. If plateau’s – rises, suspect ectopic and consider methotrexate.
51
What is oral pyogenic granuloma and in what percentage of pregnancies does it occur?
It is a smooth or lobulated, exophytic and erythematous lesion prone to ulceration and bleeding. It occurs in 5% of pregnancies
52
What is the most common cause of hypothyroidism, what are the antibodies?
Auto immune thyroiditis. 90% of these will have anti-thyroglobulin and anti-thyroid peroxide antibodies.
53
Medications that affect thyroid function
Tyrosine kinase inhibitors (imatinib)
Beta blockers
Lithium
Amiodarone
Ethionide
54
What is the prevalence of heavy menstrual bleeding in adolescence?
What must be on your differential?
34 to 37%
There’s a much higher incidence of congenital or acquired bleeding disorder. 36% of them have von Willebrand‘s disease.
55
What is the function of von Willebrand factor?
It functions in both platelet binding and aggregation as well as transport/function of factor VIII (key to intrinsic)
56
57
What are the different types of von Willebrand’s brands disease?
1. Mildest, most common: AD, quantitative deficiency in VWF.
2. Caused by qualitative or function defect in VWF activity, most commonly autosomal dominant
3. Most severe, autosomal, recessive, complete absence.
58
How do NSAIDs work to decrease menstrual bleeding?
The inhibit cyclooxygenase which leads to a decrease in prostaglandin production and later thromboxane A2 and prostacyclin ratio this leads to a relative increase in thromboxane A1, resulting in increase platelet aggregation and vasoconstriction
59
60
61
Appropriate initial evaluation/management of lichan sclerosis
If patient’s presentation is classic, and there are no area suspicious for neoplasia, you can begin with uric treatment with clabetasol with close follow up or you may start with a biopsy. Either is acceptable
62
In what percentage of patients does clobetasol improve symptoms of lichen sclerosis? And what are the symptoms of lichen sclerosis?
96%
Symptoms include pruritis, irritation, burning, tearing, painful intercourse
63
64
What are the interventions that have been shown to reduce the risk of third or fourth- degree perennial lacerations?
Perineal massage and warm perennial compresses during pushing.
65
What percentage of patients will sustain an obstetrical laceration at the time of vaginal delivery?
50 to 80%
66
Risk factors for oasis
Oasis = obstetric, anal sphincter injuries
Operative vaginal deliveries forceps greater than vacuum
Midline episiotomy
Asian ethnicity
Primiparity
epidural anesthesia.
fetal OP position
Family history
67
Most common thrombophilia and it’s inheritance pattern
Factor V Leiden , AD
99% of people are heterozygous
68
What is the second most common thrombophilia?
Prothrombin G20210A
Also AD and most people are heterozygous
69
Who should be tested for antiphospholipid anybody syndrome?
– Those with evidence of new or previously unexplained arterial or Venus thrombosis
- One or more unexplained fetal losses after 10 weeks of gestation
– One or more episodes of severe preeclampsia before 34 weeks of gestation
– Three or more spontaneous pregnancy losses before 10 weeks of gestation
70
What is the risk of BTE in pregnancy for someone with factor five lead in heterozygous versus homozygous?
No, prior history of vte:
Heterozygous: .5 to 3.1%
Homozygous 2.2 to 14%
Prior history of vte:
Heterozygous 10% next homozygous 17%
71
What thrombophilia testing is not reliable during pregnancy?
Protein s deficiency
72
For factor five and prothrombin gene mutation, what kind of test is reliable in the setting both of acute thrombosis and anticoagulation therapy?
DNA analysis
73
What the preferred bariatric surgery in those with diabetes
Roux en y
74
What vaginitis has ph > 4.5, microscopy with copious polymorphic neutrophils and parabasal cells
On pe: copious yellow or green discharge and usually postmenopausal
Desquamative inflammatory vaginitis
Tx is vaginal clindamycin
75
76
3a,b,c perineal lac
A: less than 50% of the external interest feature
B: more than 50% of external anal sphincter
C: both external anal, sphincter and internal anal sphincter, torn, but anal epithelium intact.
77
What is the inheritance pattern of the most common inherited thrombophilia?
AD, factor V Leiden
78
What is the second most common inherited thrombophilia?
Prothrombin g20210A
79
What history should prompt you to get antiphospholipid anybody testing?
-Those with unexplained arterial or Venus thrombosis
-One or more unexplained fetal losses after 10 weeks of gestation
-One or more episodes of severe preeclampsia before 34 weeks
-3 or more spontaneous pregnancy losses before 10 weeks
80
What thrombophilia can’t you test reliably in pregnancy?
Protein S deficiency
81
How long can orlistat and phentermine be used for weight loss
Orlistat: longer than 1 year
Phentermine: up to 12 weeks
82
83
Classifications of obesity
Underweight: less than 18.5
Normal weight: 18.5 to 24.9
Overweight 25.0 29.9
Class one obesity 30.0 to 34.9
Class two obesity 35.0 39.9
Class three obesity, 40 or greater
84
How to diagnose desquamative inflammatory vaginitis
History, physical exam, and examination of vaginal fluid. My cross microscopy of vagina fluid demonstrates copious polymorphic neutrophils and para basal cells. Pair of basal cells are vaginal epithelial cells that have become rounded and smaller in the absence of estrogen. The vaginal pH is increased.
85
What population is desquamative inflammatory vaginitis most commonly seen in
Postmenopausal patients
86
Treatment for desquamative inflammatory vaginitis
Vaginal clindamycin, cream or hydrocortisone 10% cream
87
For a patient who takes St. John’s wart for their depression what do you need to counsel them on regarding their contraception?
St. John’s Wort appears to be a hepatic metabolic enzyme inducer which lowers the efficacy of oral contraceptive pills
88
What SSRI can be associated with heavy menstrual bleeding
Fluoxetine (this is the most commonly used SSRI in adolescence as it is the only FDA approved SSRI in that each group.)
89
Diagnostic criteria for female sexual dysfunction
Personal distress persisting for at least six months in one or more of the areas of desire, arousal, orgasm, or pain
90
Medication classes known to affect female sexual function:
psychotropic medications, antihypertensive, histamine blockers, hormone containing treatments
91
Which corticosteroid is the preferred first line for lichen sclerosis
The ultra high potency clobetasol propionate
Treat in blast fashion with daily dose for approximately four weeks, followed by a taper to a milder corticosteroid for 2 to 3 months of maintenance therapy
92
What is lichen sclerosis and what is the first line treatment? 
A chronic lymphocyte mediated inflammatory dermatologic condition.
Corticosteroids
93
What should the follow up for lichen and sclerosis be? 
Follow up should be diligent. Patient should be seen within 1 to 3 months of initiating therapy and then routine examination and approximately every six months.
94
95
Arm symptoms in setting of Gerd that would indicate prompt endoscopic evaluation
-. Dysphasia (difficulty swallowing)
-Odynophasia (painful swallowing)
-Anemia
-Gastrointestinal bleeding
-Unexplained weight loss
-new onset symptoms and individuals older than 60 years
-anorexia
-persistent/refractory vomiting
-family history of first- degree relative with gastrointestinal malignancy
96
Prevalence of Helicobacter pylori
Nearing 30% in the United States. It is estimated that 1/2 of the world‘s population will be infected with H pylori at some point in their lifetime.
97
2 most common causes of gastric and do ordinal ulcers
1. NSAIDs
2. H pylori
98
Five core principles of trauma informed care
- Choice: informing a patient of their option so they can choose their preference
- collaboration: incorporating the patient, their family, staff and other healthcare professionals and into treatment planning
- patient empowerment: using a patient’s strength to empower them in their own treatment
- safety: creating an environment that ensures their physical and emotional safety
- trustworthiness: communicating clear expectations about proposed treatments, who will be involved, and how care will be provided
99
Is it ever appropriate to defer colonoscopy or biopsy for an abnormal Pap smear in the setting of pregnancy?
Actually, yes, the 2019 ASCCP guidelines allowed deferral for abnormal cytology results such as LSIL in those with previous negative HPV testing or colposcopic examinations during which visual evidence of CIN2 or CIN3 was not found.
100
Emergency contraceptives, effectiveness and obesity, length after intercourse that they are effective
Levonorgestrel pill: labeled up to 72 hours after unprotected intercourse and has some evidence to be effective up to 120 hours. This is much less effective than those who are overweight and obese.
Uliptistal acetate 30 mg effective up to 120 hours after I’m protected intercourse is also affected by obesity .
Copper IUD: effective up to five days after unprotected intercourse. Not affected by obesity. 
