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step II > amboss 7/3 > Flashcards

amboss 7/3 Flashcards

1
Q

what is the treatment for PID

A

intramuscular ceftriaxone and oral doxycycline

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2
Q

what is the presentation of trichomonas vaginalis

A

anaerobic, motile protozoan with flagella. Patients typically have foul-smelling, frothy, yellow-green, purulent vaginal discharge with a pH > 4.5.

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3
Q

hows vaginalis transmitted

A

Transmission of this disease occurs through unprotected sex.

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4
Q

what is the presentation of gardnerella vaginalis

A

grey discharge, foul smelling, clue cells and a positive whiff test

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5
Q

what is the whiff test

A

The Whiff test consists of applying potassium hydroxide to a slide with vaginal discharge, and is positive if this causes a fishy or amine odor.

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6
Q

which strains of HPV genital warts, or condylomata acuminata.

A

HPV strains 6 and 11 cause 90% of genital warts, or condylomata acuminata.

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7
Q

what is the presentation of atrophic vaginitis or old pussy

A

Receding pubic hair and a decreasing labial fat pad are typical. dyspareunia and vaginal dryness are usual complaints

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8
Q

what is a risk factor for bacterial vaginosis

A

vaginal douching

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9
Q

is bacterial vaginosis an STD

A

no

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10
Q

what increases the risk of relapse for vaginosis

A

douching, intercourse

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11
Q

first-line treatment for vulvovaginal candidiasis in pregnancy

A

Intravaginal clotrimazole is a topical antifungal agent. Treatment primarily aims at the relief of symptoms, as candidal vulvovaginitis is not associated with adverse outcomes in pregnancy.

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12
Q

what are the screening recommendations for STDs in women

A

The USPSTF recommends screening for N. gonorrhoeae and C. trachomatis infections in sexually active women < 25 years old. If they are not diagnosed and treated, these infections may cause pelvic inflammatory disease and potentially infertility.

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13
Q

what is the next step in someone with a positive VDLR and clinical signs of secondary syphilis

A

confirmatory test, usually with fluorescent treponemal antibody

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14
Q

what is the treatment of choice for syhilis

A

intramuscular penicillin G

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15
Q

what is the treatment of choice for syphilis in pregnancy

A

penicillin

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16
Q

what do you do when someone is allergic to penicillin

A

give them a desensitization dose.

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17
Q

is allergen desensitization safe during pregnancy

A

yes

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18
Q

what is an alternative to syphilis treatment

A

doxycycline

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19
Q

what is the first line treatment for chlamydial infection

A

oral azithromycin

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20
Q

can you use azithromycin in pregnancy

A

yes

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21
Q

what is the most common cause of unilateral bloody nipple discharge

A

intraductal papilloma

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22
Q

The combination of a painful breast lump and erythematous overlying skin in a postmenopausal woman should be taken to indicate

A

a malignancy until proven otherwise!

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23
Q

what is a phyllodes tumor

A

A large (> 3 cm), rapidly growing (i.e., progression over days-weeks) breast mass raises suspicion for phyllodes tumor. biopsy shows a leaf-like appearance under the microscope

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24
Q

An elevated CA-125 is highly suspicious

A

for ovarian malignancy in a post-menopausal woman with an adnexal mass.

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25
Q

what is age for ultrasound vs mammogram

A
  1. younger is ultrasound, older is mammo
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26
Q

what is first line therapy for people with invasive ductal carcinoma

A

breast conserving therapy with sentinel node biopsy

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27
Q

what is the treatment for breast cancer in a pregnant woman

A

surgical resection poses little risk.

chemotherapy can be given after the first trimester

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28
Q

what should be done for patients with a simple breast cyst

A

if it is symptomatic, then needle aspiration can reduce the symptoms; if asymptomatic then leave alone and reassure

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29
Q

what are the findings for turners syndrome

A

webbed neck, widely spaced nipples, normal uterus, streak ovaries (gonadal dysgenesis, primary amenorrhea), coarctation of the aorta

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30
Q

what causes congenital edema in turners

A

Dysfunction of the lymphatic system is characteristic of Turner syndrome and typically leads to congenital lymphedema of the hands and feet starting in the neonatal period

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31
Q

what is the cause of normal breast development, normal vaginal and ovarian development but NO uterus

A

mullerian duct agenesis

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32
Q

Patients with androgen insensitivity syndrome present

A

with primary amenorrhea, a blind vaginal pouch, an absent uterus on ultrasonography, and normal breast development. However, patients would not have pubic hair, since the growth of pubic hair is dependent on androgens. Ultrasonography would reveal undescended testicles.

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33
Q

what is the presentation of 5-α reductase deficiency

A

results in reduced amounts of DHT. thus the genitalia form as masculine-feminine, there is no breast development, no uterus or ovaries. the person is genetically male, but has a vagina

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34
Q

when do girls undergo normal pubertal changes and what are they

A

between 8-11. they will begin to develop breasts, have pubic and axillary hair, and begin to have oily skin

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35
Q

what is the presentation of aromatase deficiency

A

Individuals with aromatase deficiency are unable to convert androgens to estrogens. Therefore, karyotypically female (46 XX) patients are born with ambiguous external genitalia and present with female pseudohermaphroditism. They have normal internal genitalia. At the time of puberty, they fail to develop secondary sexual characteristics and typically present with amenorrhea (due to the development of ovarian cysts that impair ovulation) as well as features of virilization due to increased testosterone (e.g., severe acne, hirsutism). Mothers of affected children may develop similar features during pregnancy due to fetal androgens crossing the placenta. In addition to these abnormalities of sex development, female as well as male individuals frequently have a tall stature due to a delayed fusion of the epiphyseal growth plates and signs of osteoporosis (e.g., bone fractures after minor trauma), caused by estrogen deficiency.

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36
Q

what can obesity cause

A

precocious puberty

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37
Q

what is the typical developmental course for females

A

thelarche, pubarche, menarche

tits, pits, mits, lips

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38
Q

what is the presentation of central precocious puberty

A

secondary sex charcterisitics, elevated bone age with a positive GnRH stimulations test.

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39
Q

what is the next step after diagnosis of central precocious puberty

A

MRI brain

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40
Q

what are the treatments fo choice for central precocious puberty

A

MRI brain, luprolide to suppress testosterone and estrogen then excision of the tumor

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41
Q

Recurrent midcycle, unilateral, lower abdominal pain in an adolescent girl is suggestive of

A

mittelschmerz.

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42
Q

what is the presentation of congenital adrenal hyperplasia

A

can also lead to peripheral precocious puberty as the excess adrenal androgens are aromatized to estrogen in the ovaries. However, due to a general excess in androgens, females are often born with ambiguous or male external genitalia, and virilization during puberty is common. This girl has normal external genitalia and no evidence of virilization (e.g., male-pattern hair growth).

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43
Q

what is precocious puberty without central findings

A

granulosa cell tumor

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44
Q

what are the two types of emergency contraception

A

include levonorgestrel or ulipristal acetate.

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45
Q

what is the most effective emergency contraception

A

copper-containing IUD.

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46
Q

what is the drawback of a copper IUD

A

typically only given when the woman does not want to get pregnant

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47
Q

what is the appopriate work up for primary amenorrhea

A

pregnancy test, ultrasound, FSH and LH

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48
Q

what are the treatments for primary dysmenorrhea

A

NSAIDs and OCPs

49
Q

what is first line therapy for abnormal uterine bleeding

A

conjugated estrogen

50
Q

what is second line therapy for AUB

A

tranexamic acid

51
Q

what is the flow of diagnostics for a patient with precocious puberty

A

must determine bone age first. sifters greater than a year difference then look to LH/FSH. if equivocal or low then GnRH for determining central vs peripheral
IF LH/FSH is HIGH, then MRI

52
Q

Can you give Bactrim to breast feeding women?

A

no…due to the risk of kernicterus

53
Q

what do you treat mastitis with

A

can use cefalexin, dicloxacillin

54
Q

what is the most likely cause of mastitis

A

MSSA

55
Q

what is the initial treatment for mastitis

A

cold compresses, NSAIDs, continue breast feeding

56
Q

what is the treatment for fat necrosis of the breast

A

reassurance, no further workup

57
Q

what is the presentation of fat necrosis

A

presence of a lump, oil cysts, foamy cells with multinucleated giant cells

58
Q

what is first line therapy for PCOS patients to achieve pregnancy

A

letrozole therapy

59
Q

what is the treatment for bartholin gland abscess

A

I and D; fistulization with a Word catheter is also an appropriate treatment

60
Q

what is the first line test for AUB

A

endometrial biopsy

61
Q

wha tis the treatment of choice for lichen sclerosis

A

rule out cancer and then treat with topical corticosteroids or clobetasol

62
Q

what is the presentation of lichen sclerosis

A

postmenopausal with dyspareunia and pruritis with white vulvar plaque

63
Q

what is the cause of exercise-induced amenorrhea

A

functional hypothalamic amenorrhea. there is reduced GnRH release from the hypothalamus

64
Q

what is the treatment for premenstrual dysmorphic syndrome

A

SSRIs

65
Q

what is the second line therapy for premenstrual dysmorphic syndrome

A

OCPs

66
Q

what is the presentation of PMD

A

recurrent episodes of headaches, sleeping and concentration problems, and mood swings. These symptoms occur every month around the same time, preceding her menstrual period, which indicates premenstrual syndrome. Behavioral changes severe enough to cause a disturbance of her daily functional capacity suggests a diagnosis of premenstrual dysphoric disorder (PMDD).

67
Q

what is given to women with leiomyomas

A

luprolide to reduce the size prior to surgery

68
Q

is CT used in the diagnosis of endometriosis

A

no.

69
Q

what is the diagnostic work flow for endometriosis

A

pelvic exam, ultrasound, laparoscopy

70
Q

what is physiologic leukorrhea

A

non-purulent and does not have a strong odor. It is not irritating and therefore does not cause pruritus. Physiologic leukorrhea is typically seen at the onset of puberty (due to a surge in the levels of estrogen), around the time of ovulation (due to a peak in estrogen levels), prior to menstruation (due to pelvic congestion), and during pregnancy.

71
Q

in a patient > 24 years old with atypical squamous cells of undetermined significance (ASC-US) detected on Pap smear, what is the next step

A

HPV testing is the recommended next step in management.

72
Q

what is the presentation of adenomyosis

A

a benign disease characterized by the presence of endometrial tissue within the uterine wall. Typical symptoms include dysmenorrhea, menorrhagia, and chronic pelvic pain that worsens during menstruation. The displaced endometrial tissue can be seen as uniform uterine enlargement and diffuse thickening of the myometrium on transvaginal ultrasound and MRI.

73
Q

what is endometrial hyperplasia

A

An abnormal thickening of the uterine lining caused by the proliferation of endometrial glands due to estrogen stimulation and insufficient progestin stimulation. Characterized by abnormal uterine bleeding. Suspected when endometrial thickness is > 5 mm on ultrasound in a postmenopausal woman.

74
Q

Endometrial hyperplasia with atypia can progress to

A

endometrial cancer.

75
Q

endometrial hyperplasia Confirmed with endometrial biopsy showing

A

glandular proliferation and a > 50% gland-to-stroma ratio.

76
Q

when are combined OCPs contraindicated

A

in women over 35 that smoke

77
Q

what can be used to treat HER2 positive cancer

A

trastuzumab

78
Q

what should be done before initiating treatment for breast cancer

A

echocardiogram

79
Q

what is the next step if there is a high grade lesion on pap smear

A

colposcopy

80
Q

when is LEEP used

A

in an older patient with high grade lesion >24

81
Q

what is the presentation of adenomyosis

A

boggy tender uterus that is increased in size

82
Q

what is the presentation of endometritis

A

fever, abdominal pain, tender uteruse

83
Q

what is the presentation of vaginal clear cell carcinoma

A

red fleshy pedunculated lesions that have cells with large clear cytoplasm

84
Q

what is the best known risk factor for vaginal clear cell carcinoma

A

Diethylstilbestrol (DES) is a synthetic estrogen

this was given to pregnant mothers and their daughters developed cancer in the next generation

85
Q

what is a risk factor for squamous cell carcinoma of the vagina

A

cigarette smoking

86
Q

genitopelvic pain/penetration disorder (penetration disorder) is characterized by

A

persistent or recurrent difficulties during sexual intercourse. Characteristic symptoms include difficulty with vaginal penetration, vulvovaginal or pelvic pain during intercourse, anticipatory anxiety, and pronounced tightening of the pelvic floor muscles during attempted vaginal penetration.

87
Q

what is the difference btetwqeen genitopelvic pain disorder and psychogenic dyspareunia

A

there is pelvic floor muscle tightening in genitopelvic pain

88
Q

what is the most common type of vaginal cancer

A

squamous cell carcinoma 75%

89
Q

what are the high risk HPV types

A

`16 and 18

90
Q

what is the next step after a positive pregnancy test

A

need to have a quantitative beta to determine how long pregnancy. must confirm proper uterine pregnancy with transvaginal ultrasound.

91
Q

what is the beta hCG threshold for transvaginal ultrasound

A

2500

92
Q

what is the beta hCG threshold for abdominal ultrasound

A

6500

93
Q

how much does b-hCG increase

A

doubles every 2.5 days

94
Q

when is an HIV test recommended

A

once between the ages of 13-64

95
Q

Screening for high blood pressure should be performed

A

annually in patients > 40 years and for those who are at an increased risk of developing hypertension.

96
Q

A Pap smear should be conducted to screen for cervical cell dysplasia every

A

3 years starting at 21 years or every 5 years at 30 years, if combined with HPV testing.

97
Q

Blood glucose levels are only routinely checked

A

in obese individuals aged 40–70 years.

98
Q

Individuals at increased risk of cardiovascular disease should have a

A

screening serum lipid profile in adults of age 45–75 year.

99
Q

Mammography is usually performed every

A

2 years in women between 50–74 years of age to look for suspicious nodules.

100
Q

To screen for colorectal cancer,

A

either colonoscopy every 10 years, an annual fecal occult blood test, or sigmoidoscopy every 5 years is indicated in every adult ≥ 50 years of age.

101
Q

A DEXA scan for osteoporosis should be performed

A

in postmenopausal women younger than 65 years who have at least one risk factor for osteoporotic fractures.

102
Q

what are the risks of OCPs

A

hypertension, hepatic adenoma, thromboembolism, hyperlipidemia

103
Q

are fine needle aspirations performed on ovaries

A

no. they are absolutely contraindicated in ovarian masses to avoid the risk of spreading malignancy in the perineum

104
Q

what is a luteoma

A

Luteomas are rare benign tumors that develop from androgen-producing lutein cells. Although the majority of patients are asymptomatic, luteoma can manifest with features of virilization such as facial acne and hirsutism,
they are often bilateral multi nodular ovarian masses and often go away after birth

105
Q

what is the most common cause of prolonged postpartum bleeding

A

uterine atony

106
Q

what is the treatment for uterine atony

A

massage, oxytocin, and tranexamic acid, uterine tamponade can be used iff medical therapy does not work

107
Q

what is diminished ovarian reserve

A

characterized by a decline in functioning oocytes and is most often a normal part of aging, although it can also be the result of an underlying disease or injury to the ovaries. DOR is present in about 10% of women who undergo IVF and does not cause any symptoms, although a shortening of the menstrual cycle is sometimes observed.

108
Q

what is ashermans syndrome

A

sherman’s syndrome is characterized by endometrial adhesions and/or fibrosis mostly caused by dilation and curettage.

109
Q

what is the test for PCOS

A

progesterone withdrawal test. if bleeding, then most likely anovulatory

110
Q

when should HPV vaccination be given

A

As a part of the routine immunization schedule, 2 doses of HPV vaccine should be administered 6 months apart to all individuals 11–12 years of age. Current guidelines also recommend vaccination with 3 doses of nine-valent HPV vaccine for all unvaccinated female patients 13–26 years of age. Although the FDA has approved the HPV vaccine for patients up to age 45, it is not routinely recommended for patients > 26 years old by the CDC.

111
Q

what is vaginismus

A

Sharp intracoital pain on attempted penetration (e.g., intercourse, tampon insertion) in an otherwise healthy young female suggests genito-pelvic pain disorder (vaginismus).

112
Q

what is the treatment for Genito-pelvic pain syndrome

A

physical therapy

113
Q

what should be done for a 21-24 year old with a low grade squamous intraepithelial lesion

A

Pap smear should be repeated twice at 12-month intervals in patients 21–24 years of age whose previous Pap smear has shown LSIL.

114
Q

is weight gain a SE of OCP

A

no.

115
Q

what can be done for acne in women

A

OCPs have shown effectiveness in treating acne

116
Q

In women > 24 years of age with HSIL cytology next step

A

an immediate loop electrosurgical excision is generally acceptable.

117
Q

what is a contraindication for LEEP

A

pregnancy

118
Q

what are the treatments for hyemesis gravidarum

A

pyridoxine and doxylamine (H1 antagonist)

step II (22 decks)

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