blueprints questions Flashcards
nL endometrial strip in pre-menopause
12 mm
what are risk factors for hyperplasia?
DM2 obesity HTN PCOS oligomenorrhea
what is the lowest titer to begin serial amniocentesis to check for RBC hemolysis?
1:16
what pathology commonly presents after evacuation of a molar pregnancy?
metastatic persistent gestational trophoblastic disease (choriocarcinoma > invasive molar pregnancy)
how often do you check titers once RH sensitization is discovered?
every 4 wks
fetal testing b/w 16-20 wks
d/c if fetal Rh testing is negative
what are 2 indications to proceed with immediate delivery in the setting of severe pre-eclampsia?
- severe symptoms (headache, RUQ pain)
- HEELP syndrome
What is most likely to improve chances of conception in an endometriosis pt?
Surgical removal of implants leading to fibrosis
What are risks assoc. w/ persistent + hep B antigen?
Vertical transmission at birth
How to manage HepB+ mom?
Placental barrier to antenatal transmission
Neonate given hep B vaccine + HBIG at birth
c/s doesn’t incr. risk
what is treatment for BV in pregnancy?
Metronidazole
What are indications for SBE antibiotic prophylaxis during pregnancy?
Ampicillin for mechanical/prosthetic valves / unreapried cyanotic lesions + infxn that may cause bactermia (chorio/pyelo)
What is the risk assoc. w/ breast feeding & Hep B/HepC+ moms?
No higher than baseline (highest risk, 4% assoc. w/ vaginal delivery)
What must be supplemented in breast milk?
Vit D (400 IU)
What is assoc. w/ a bicornuate uterus?
malpresentation, 2nd trim loss, preterm labor / delivery
What is assoc. w/ a uterine septum (fertility)?
Infertility (avascular septum = poor implantation site)
how to manage breast mass in women > 30 yo?
core-needle biopsy
when to use needle/wire-guided excision?
seen on imaging, but not palpable
how to manage solid breast mass in women < 30 yo?
FNA
what is risk of ectopic after 1 ectopic pregnancy? after >1 ectopic
1 = 10%
2 >25%
how to diagnose h. ducreyi?
r/o syphilis / HSV
how to treat chancroid?
many options; treat partners also ceftriaxone 250 IM once azithromycin 1 g PO cipro 500 mg BID x 3d erythromycin 500 mg QUID
what is fitzhugh-curtis syndrome?
perihepatitis from ascending PID
how does fitzhugh-curtis sydrome present?
RUQ / pleuritic pain + PID
how is fitzhugh-curtis syndrome diagnosed?
gold standard = violin-string adhesions b/w anterior liver capsule + anterior abdominal wall/diaphragm
How is VIN stratified?
Usual vs. differentiated
Usual = HPV + full-thickness atypia
Differentiated – related to inflammatory dermatosis (lichen sclerosis vs. planus)
What meds can contribute to male infertility?
Cimetidine
Sulfasalazine
Spironolactone
How to manage a eclamptic woman on Mg who seizes again?
Rebolus w/ Mg (assumption: seizure = low serum Mg
With idiopathic infertility, what is the likelihood of conception in 3-5 yrs?
60% - expectant management acceptable
Most therapies have no higher success rates than no treatment
What is target range for fasting blood glucose / 1 hr post-prandial values?
< 90 mg/L
1-hr < 140
2 hrs < 120
When to initiate insulin?
25-35% of glucose elevated à give meds
What additional screening is needed for +Paget’s disease of the vulva?
Screening for invasive adenocarcinoma (not a known invasive squamous cell carcinoma)
What is recommended treatment for Paget’s disease?
Excision, though ablation is acceptable
How is endometrial cancer staged?
TAH, BSO, pelvic/para-aortic lymphadenectomy (if invasion > 1/3 myometrial thickness)
LCIS (lobular carcinoma) is what type of lesion?
Pre-malignant à indicates subsequent risk for: intraductal, invasive ductal, lobular carcinoma Subsequent cancers may be on either side Found incidentally (not seen on mammo / not palpable)
Most common benign cause for bloody nipple discharge?
Intraductal papilloma
When are pts counseled to schedule 36-37 wk c/s for concern about risk of uterine rupture?
hx of:
- myomectomy requiring cavity entry
- previous classical c/s
- major uterine surgery (corneal wedge resection for ectopic pregnancy)
How does leuprolide work for endometriosis?
GnRH agonist –> provides tonic GnRH stimulation –> medical menopause
Treatments for CIN 2,3
LEEP
when to LEEP (if not CIN 2/3)
CIN1 persist > 2 yrs
HGSIL PAP w/ discrepancy from biopsy of 2 grades
Excision vs. ablation for treatment of abnL colpo?
Ablation acceptable for Cin1
Excise if:
-unsatisfactory colpo, ECC+
What is risk of ASCUS+HPV progression to CIn2/3?
10% –> should do further testing if ASCUS + HPV status known
LSIL + Pregnancy?
likely colpo, but not going to LEEP someone
