2nd Time Flashcards
100/ the difference btwn event rates in exposure group vs control group =
NNT = theoretical # of pts who would need to receive a given Tx/intervention in order for one of those pts to benefit from it
Odds ratios are typically used in what kinds of studies?
Case-control
Relative risk used in what kinds of studies?
Cohort and randomized controlled studies
A measure of the effect of the exposure being studied. Simply a ratio of the percentage of exposed ppl who experience the outcome divided by the percentage of controls that experience the outcome
Relative risk
Tx of genital warts can be deferred until after delivery but there are options for Tx in pregnancy if pt desires, such as?
Cryotherapy, trichloroacetic acid
Why is 5- fluorouracil contraindicated in preg?
Bc it is a pyrimidine antimetabolite and interferes w DNA synthesis
MC Sxs of urethral caruncle are light bleeding and dysuria, 1st line Tx?
Topical estrogen cream for 2-3 months for symptomatic pts, but this Tx is NOT necessary if pt is asymptomatic
Routine vaccination for pneumococcus should begin at what age in immunocompetent adults?
65yrs
Adults should receive one dose of herpes zoster vaccine regardless of h/o prior shingles or chxn pox infection at what age?
60yrs or older
1st line Tx for Gonorrhea in adult?
Alternative?
Ceftriaxone IM x1
(500mg for pts <150 kg; 1g for pts >150kg); if ceph allergy- gent + Azithro
1st line Tx for Chlamydial infection?
Alternative?
Doxycycline 100mg BID for 7days ;
Azithro 1g PO x1
Tx for Gonorrhea in adult with cephalosporin allergy?
Gent IM x1 PLUS Azithro 2g PO x1
Cervical screening reccs for pts w HIV
Cytology only screening! begin within 1yr of 1st insertional sexual activity
• Cont cytology only annually for 3 yrs
-> if all nml can incr interval to 3yrs
• Cont every 3 yrs (cytology only) until the age of 30 years
• Cytology alone or cotesting every 3yrs after the age of 30 yrs for the pt’s lifetime
Pt is postop from transobturator sling and now has pain w rotation of her thigh away from her body, muscle most likely injured?
Obturator internus
Initial work up of AGC on cytology?
Colpo with ECC, & if pt is 35 or older or younger w risk factors for endometrial Ca. Then EMB is needed as well
Perioperative blood transfusion during hysterectomy is associated with an increased risk for what postop complication?
SSI
If single dose reg of MTX is given for Tx of ectopic, how do you monitor to know if another dose is needed?
Measure hCG on day 4 & 7, there should be a 15% drop in hCG, if there is appropriate drop monitor weekly, but if less than a 15% drop is seen at any of these times reevaluate plan and if stable give another dose and trend labs again
MC Tx for DCIS?
Breast conserving urgent ie Lumpectomy followed by radiation to reduce risk of local recurrence
Most appropriate ABX for Px for operative laparoscopy?
None
Most appropriate ABX for Px for laparotomy?
None
The pulmonary factor that may preclude adequate ventilation of a morbidly obese pt in trendelenburg is an increase in what?
Airway resistance
(All the others ie chest wall compliance, fxnal residual capacity, fxnal vital capacity, total lung volume are all decreased)
When this is combined with conjugated equine estrogen, endometrial stimulation from the estrogen is inhibited thus progestins are not needed
Bazedoxifene
When this is coadministered with conjugated equine estrogen, it offers endometrial and breast protection from estrogenic stimulation while still allowing the benefits on Vasomotor Sxs & bone health
Bazedoxifene ( a selective estrogen receptor modulator)
What is the indicated coding modifier when a single procedure and E/M service are performed at the same visit?
Modifier 25
What is the indicated coding modifier when multiple procedures were performed in addition to a problem visit?
Modifier 51
What is the indicated coding modifier when a procedure is performed bilaterally?
Modifier 50
What is the leading cause of morbidity and mortality in adolescents?
Accident trauma
Pt presents with h/o rape, needs to be within what timeframe since exposure to initiate PEP? If PEP is indicated it will be a how many drug regimen?
72hrs;
3 drug reg (RET)
Postmenopausal pt presents w UTI and has had 3 documented UTIs in past yr not assoc w intercourse, you prescribe 3 days of ABX for UTI, best next step in mngmt after this ABX course?
Daily ABX Px
A 2-dose HPV vaccination schedule is recommended for people who get the first dose before when??
their 15th birthday
The lichens can be confused however unlike the other this one can involve the vaginal epithelium which can become red, eroded, inflamed, and deep erosions can appear in the post vestibule & often extend to labia.
Lichen Planus can, Bx is mainstay of dx
Pts w this tumor (median age 19) will present w acute pain & a large adnexal mass (10-30cm) solid & often heterogenous from hemorrhage/necrosis, grow rapidly?
The tumor marker that will be elevated in 85-100% of pts is??
Yolk sac tumors (ie endodermal sinus tumors) ;
AFP
Pts w this tumor (median age 19) will present w pain (50-85%), fever (10-25%), vaginal bleeding (10%) +/- ascites, masses are solid, lobular, & can be bilateral (10-20%) ? Serum markers??
Dysgerminomas ;
LDH (best, highly elevated), b-hCG, alk phos
This non hormonal option for hot flushes has been shown to decrease pain scores in pts w chronic pelvic pain, side effect of drowsiness so can also help w sleep disturbance & night sweats
Gabapentin
Women with previous thoracic radiation should have mammo when?
8-10 yrs after completion of radiation but no earlier than age 25, starting at 25 should have annual mammo or MRI, and clinical evaluation q6-12mos
Suspect what familial cancer syndrome if pt has breast Ca. At a young age and relatives with rare cancer diagnoses at a young age (assoc w sarcomas but not w any other gyn ca.)
Li-Fraumeni syndrome (mutation in tumor suppressor gene TP53)
Idarucizumab can be used as a reversal agent for what anticoagulant? Which has what MOA?
Dabigatran ( which is a direct oral thrombin inhibitor)
When used post-op in the bariatric population, this was shown to be more reliable than lovenox and it does not interact with aspirin or NSAIDs (should be avoided in severe renal insufficiency)
Fondaparinux
4 Findings diagnostic of early pregnancy loss
- CRL of 7mm or more and no heartbeat
- Mean sac diameter of 25mm or more and no embryo
- absence of embryo with heartbeat 2+ wks after a scan with gestational sac w/o yolks sac
- absence of embryo with heartbeat 11days after a scan with gest sac with a yolks sac
What type of twins result when embryo divides: Before day 4? On days 4-8? 9-13? After day 13?
Before d 4: Di-Di
4-8: monoch- diamniotic
9-13: mo-mo
After day 13: conjoined
Low PAPP-A has a PPV for what preg complication?
SGA fetus
Elevations in what 2 serum markers in 2nd trimester are assoc w preg complications including gHTN, preE, IUGR, PTD, FDU?
bhCH and AFP both greater than 2.0 MoM
Methylprednisolone use in the 1st trimester has been assoc w what malformation thus should be avoided prior to 10wks GA
Fetal oral clefts
The lab most characteristic of AFLP?
Elevated ammonia (which causes neurolog Sxs)
Suspect active TB infection-> get what test for Definitive Dx?
Sputum Cx
MCC assoc w fibroids?
Cesarean delivery
Apparently this method may be better for cervical ripening prior to D&E than misoprostol for GA of 20-24wks
Osmotic dilators
Pts who have not undergone thelarche by age 13yrs require evaluation, most appropriate next step ?
In patients without breast development the FSH level should be measured—> if elevated evaluate karyotype! (MC chromosome abnormality is turners)
In general, routine colorectal cancer screening should be discontinued at what age
75yo
