Womens Health

Question 1

The long term sequel are of chronic anovulation includes unopposed estrogen stimulation of the endometrium putting with PCOS women at 3xs risk for

Answer 1

Endometrial cancer

Also associated with increased lipid abnormalities

Question 2

All women diagnosed with PCOS must be screened for

Answer 2

Diabetes

Hyperlipidemia

Question 3

Treatment of women with PCOS should address 4 areas

Answer 3

1) chronic anovulation
2) androgen excess
3) insulin resistance
4) lipid abnormalities

Question 4

First line of therapy for PCOS

Answer 4

Biguanide Metformin

Question 5

PCOS patients suffering from infertility should be treated with🤔

Answer 5

Clomiphene ovulation induction

Combined oral contraceptive pills are an ideal first line treatment in patients who also desire conception

Question 6

Dysrythmia almost universally associated with patients with anorexia nervosa

Answer 6

Sinus bradycardia

Question 7

Regional analgesia in laboring patients increases the risk of?

Answer 7

Vacuum or forceps assisted delivery

Question 8

Patients with diarrhea predominant OR MIXED presentation IBS should be tested for?

Answer 8

Celiac disease

Question 9

A diagnosis of migraine with aura is considered an unacceptable risk for

Answer 9

Combined Oral contraceptives

Question 10

Sevelamer is a synthetic agent of phosphate binders class works by?

Answer 10

Blocking intestinal absorption of phosphate, which lowers parathyroid hormone secretion

Question 11

Uricosuric acid, cystine, calcium oxalate stones tend to form in?

Answer 11

Acidic urine

Question 12

In patients with hyperthyroidism to avoid worsening of orbitopathy recommended treatment?

Answer 12

Treat with methimazole prior to radioactive iodine ablation

Question 13

Treatment that leads to most effective weight reduction and long term management in morbidly obese

Answer 13

Bariatric surgery

Question 14

The major source of serum BNP

Answer 14

The cardiac ventricles

Question 15

Condition characterized by chronic anovulation and hyperandrogenism

Answer 15

PCOS

Question 16

In women 30-65 years old, screening for cervical cancer with cervical cytology and HPV testing is recommended every

Answer 16

5 years

Question 17

Anovulatory amenorrhea is abnormal uterine bleeding that typically results from

Answer 17

Endocrinopathy i.e.; PCOS

Mechanism of abnormal bleeding related to unopposed estrogen

Question 18

Imaging recommended to evaluate the uterus in patient with history of abnormal uterine bleeding

Answer 18

Transvaginal US MORE ADVANCED IMAGINGthen
Saline infusion sonohysterography
Or
Hysteroscopy

Question 19

Endometrium that is too thin because of heavy continuous bleeding. What is treatment?

Answer 19

estrogen followed by progestin

Question 20

Treatment too thick endometrium

Goal of therapy?

Answer 20

Treat with Progestins or OCPs to reduce thickness of the endometrium

Question 21

Abnormal uterine bleeding emergency management

Answer 21

IV conjugated estrogen- 25mg q 4hours until bleeding slows

Oral conjugated estrogen 10 mg/ day

Question 22

Determination of adequate estrogen in amenorrhea is established by?

Answer 22

Progestin challenge test

5-10 mg medroxyprogesterone acetate po q day X 10 days

ANY. Bleeding within 2-7 days is positive

Question 23

Anovulatory amenorrhea is amenorrhea in women with adequate estrogen (+ progestin challenge) occurs because

Answer 23

Progesterone is NOT being adequately produced in the LUTEAL phase

Treat with progestin 10 mg q day 7-10 days every month or OCPs

Question 24

Amenorrhea with nL TSH, Prolactin, and NEGATIVE withdrawal bleed with progestin challenge ➡️ no bleed with both estrogen and progestin challenge

Answer 24

Outflow tract obstruction

Question 25

Management of PCOS | HIRSUTISM?

Answer 25

OCPs Spironolactone Fin astride

Question 26

Management of PCOS | Insulin resistance?

Answer 26

Metformin

Question 27

Management PCOS Infertility Meds that promote ovulation induction?

Answer 27

Clomiphene Metformin Pioglitazone

Question 28

Management of PCOS | Oligomennorhea and amenorrhea?

Answer 28

OCPs | Monthly progesterone

Question 29

First test when evaluating premenopausal bleeding?

Answer 29

Endometrial biopsy

Question 30

Single most important histological finding on endometrial biopsy

Answer 30

Cytological atypia

Question 31

Management In reproductive women with Cytological atypia on EMB

Answer 31

High dose progestins, megace (megestrol) or depo provera for 3 months then rebiopsy

Question 32

Management in reproductive women with no Cytological atypia but simple endometrial hyperplasia with abnormal bleeding

Answer 32

Progestin withdrawal for 6 months then rebiopsy MPA (provera), megestrol (megace), levonorgestrel IUS (mirena- induces amenorrhea and may cause atrophy) or sequential HRT - prevents hyperplasia but no contraception

Question 33

Irregular bleeding is common after HRT is initiated and improves within

Answer 33

6-12 months for most women

Question 34

Preferred treatment for vaginal dryness/ atrophy of the vagina

Answer 34

Vaginal estradiol ring worn for 90 days

Question 35

52 year old currently takes no meds refuses estrogen replacement therapy. What is considered most effective in relieving her menopausal symptoms?

Answer 35

Venlafaxine ( Effexor)

Question 36

All pregnant women should be screened for anemia? What level of Hgb is considered iron deficiency anemia in first trimester?

Answer 36

First trimester- Hgb

Question 37

USPSTF recommends ALL pregnant women be screened for

Answer 37

HIV Hepatitis B Syphilis

Question 38

USPSTF recommends ALL pregnant women less than 25yo and with high risk sexual behaviors (>1sexual partner) be screened for

Answer 38

Chlamydia and gonorrhea

Question 39

When should women with active recurrent genital herpes should be offered suppressive viral therapy at or beyond

Answer 39

36 weeks of gestation Acyclovir 400 mg tid Valcyclovir 500mg po bid daily

Question 40

How long must OCPs be taken before they become effective

Answer 40

1 month

Question 41

The imaging study for evaluation of pelvic mass is?

Answer 41

Ultrasound

Question 42

The most common class of organisms associated with BV

Answer 42

Anaerobic bacteria

Question 43

Women with ASC-US who test positive for high risk HPV SHOULD UNDERGO

Answer 43

Colposcopy

Question 44

HPV types associated with genital warts

Answer 44

6&11

Question 45

Which part of the cervix is most vulnerable today's plastic changes

Answer 45

The squamocolumnar junction

Question 46

Indications for estrogen therapy/ estrogen combined with daily or cyclic progestin/progesterone therapy

Answer 46

1) treatment mod- severe vasomotor symptoms 2) treatment mod to severe vulvar and vaginal atrophy 3) prevention of post menopausal osteoporosis

Question 47

USPSTF recommends biennial (every other year) mammography for women ages

Answer 47

50-74 Stop screening at age 75

Question 48

The American cancer society recommends along with mammography that screening breast MRIs be performed in 5 groups. What are the 5 groups?

Answer 48

Women BRCA1&2 gene mutations Women 1st degree relatives w/BRCA1&2 gene mut who have not had genetic testing Women who underwent radiation to chest aged 10-30 for hodgkins Women lifetime risk Women known hereditary breast cancer syndrome

Question 49

What is the preferred initial test for a patient with painless post menopausal bleeding

Answer 49

Transvaginal ultrasonography