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Board Review Flashcards

1
Q

Immunizations to avoid in pregnancy

A

Typhoid, HPV, Yellow Fever, Chicken Pox, MMR, Influenza (Nasal)
“The Happy Yellow Chicken Might Fly”

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2
Q

Medication options for urinary urgency, frequency, and PAIN

A

Interstitial Cystitis / Painfull Bladder Syndrome –> Can use Pentosan and any combination of the other meds

  • Pentosan Polysulfate (Elmiron) works in 3-6 mo’s
  • PFT
  • TCA’s
  • Antidepressants
  • Dimethyl Sulfoxide (DMSO) = bladder instillation FDA approved
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3
Q

Dose for add-back therapy

A

Norethindrone 5mg = progestin

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4
Q

Topics to address during wellness visits

A

ABCDEFGHI / L / VOS
Abuse, BCM, Cancer, Diet, Exercise, F*cking/Sexual health, Grief, Hot (menopause), Incontinence / Labs / Vaccinations, Osteoporosis, Safety

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5
Q

Bisphosphonate Therapy and Recommendations

A

Alendronate (Fosfamax) 70mg PO x1/week
- Consider drug holiday after 3-5 years (holiday up to 5 years). Take first thing in the morning, empty stomach with 8 oz water, remain upright for 30 min. Contraindications = can’t take as instructed, esophageal disease, renal failure

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6
Q

Zolendronic Acid Therapy and Concern

A

Zolendronic Acid (Reclast) 5mg IV x1/yr. Risk of osteonecrosis

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7
Q

Only vaginitis without an elevated pH

A

Vulvovaginal candidiasis

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8
Q

Criteria for recurrent BV and treatment regimen

A

3 separate infections/year. Treat acutely (metro gel 0.75%, 5g daily for 5d) and then suppressive therapy with Metro gel twice weekly for 4 months

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9
Q

Different criteria for complicated vulvovaginal candidiasis and different treatment reigmens - additional testing?

A

Complicated (severe features, immunocompromised, HIV, DM, Steroid use, recurrent, or C. Glabrata)

  • Recurrent (4x/year) = Fluconazole 150mg first + weekly doses for 6 months
  • Severe Features = Fluconazole 150mg for Day 1/4/7 or extended vaginal therapy for 14 days
  • Non-C. Albicans culture (e.g.: C. Glabrata) = Boric Acid 600mg for 14 days counsel about fatal if orally taken, keep away from children, need contraception
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10
Q

NRT (patch) counseling and dosing

A 
Easy to use on clean upper extremity or torso, long-acting, well-tolerated, increased risk of local irritation, insomnia, vivid dreams. Stop smoking at time of trmt initiation.
Dosing :
-21mg/patch/day x 4 weeks 
-14mg/patch/day x 4 weeks
-7mg/patch/day x 4 weeks
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11
Q

Estrogen formulations for menopausal vaginal-only treatment

A
  • Estradiol vaginal tablet 10mcg tab/day
  • Estradiol ring 0.05 mg/d
  • Conjugated estrogen cream 0.5-2g/d
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12
Q

Systemic HRT formulations for menopausal vasomotor symptoms

A

• Low-dose = Conjugated Estrogen 0.3 mg/d
- Prempro (Conjugated Estrogen 0.3 mg + MPA 1.5mg)
• Standard dose = Conjugated Estrogen = 0.6 mg/d
- Prempro (Conjugated Estrogen 0.6 + MPA 2.5mg)

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13
Q

Absolute contraindications for MTX

A

Sensitivity, breastfeeding, blood dyscrasia (anemia/leukopenia/thrombocytopenia), liver or renal disease, immunodeficiency, peptic ulcer disease, active pulmonary disease (not asthma), unstable, concern for ruptured, can’t follow-up

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14
Q

Different fluid distention mediums for hysteroscopy, their differences, and allowable fluid deficit [healthy/unhealthy]

A
  • Normal Saline = isotonic, electrolytes present, low viscosity [2.5L / 750mL] - use with bipolar electrocautery; risk of fluid overload
  • Hypotonic agents:
    • 1.5 Glycine / 3% Sorbitol = viscous, hypotonic, no electrolytes [1L/750mL] good for monipolar; increased risk of hypo-osmolar and hyponatremia complications
    • 5% Mannitol = viscous, isotonic, no electrolytes [1L/750mL] good for monipolar; less risk of hyponatremia
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15
Q

Definition of Migraine

A

A migraine is a headache lasting 4 to 72 hours and must have nausea, vomiting, or photophobia/phonophobia, as well as at least two of the following: unilateral location, pulsating quality, moderate to severe pain, and aggravation by routine physical activity.

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16
Q

Women with DM who can NOT have CHC’s

A
  • Any -opathy (retinopathy, nephropathy, opthalmopathy)
  • H/o 20+ years of DM
  • Any other CVD RF’s (tobacco, HTN, etc. )

Good population to recommend endometrial protection with Progesterone

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17
Q

What BCM concerns exist for those with SLE

A

There are special considerations for women with antiphospholipid antibodies (CHC), nephritis (CHC), vascular disease (CHC), or severe thrombocytopenia (new progesterone or Cu-IUD).

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18
Q

Describe borders of peri-rectal avascular space

A

Bounded medially by ureter, laterally by the internal iliac artery, and the cardinal ligament at the apex

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19
Q

What thrombophilias likely have multiple mutations?

A

Protein S (30%), Protein C (15%), Factor V Leiden (15%)

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20
Q

Name thrombophilias and their risk of thrombosis

A 
Antithrombin III (30-50%!!!!!) 
Prothrombin G20210A 
Factor V Leiden 
Protein C
Protein S
Anti-Phospholipid Syndrome 
All others can quote 5% risk!
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21
Q

Work up consideration for non-pregnant patient for PE

A

If likely PE (modified Wells criteria), can consider going straight to CTA. If unclear, can get a D-Dimer and if > 500, then can get CTA

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22
Q

How does Heparin work? Lovenox?

A

Heparin binds to AT III, which prevent Factor X going to Xa…which now doesn’t allow prothrombin to become thrombin

Lovenox is a FactorXa inhibitor, doing the same which now doesn’t allow prothrombin to become thrombin

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23
Q

Heparin and Lovenox treatment regimens for PE and DVT. Treatment timeframe? How to monitor Coumadin?

A

Heparin - Load with 5k-10k [more specifically, 100u/kg (DVT) 150u/kg (PE)], transition 1200u/hr for 5 days or when stable, then transition to Coumadin OR Heparin 10k BID for pregnancy AFTER establishing PTT 1.5-2.5x

Lovenox - 1mg/kg BID (or once daily dosing with 1.5mg/kg) SC QD for 3 days –> switch to Coumadin

Treat DVT for 3 months and PE for 6 mo’s. Monitor Coumadin with PT >2.5 (need to go to a clinic for this)

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24
Q

Risk of Coumadin and Heparin - how to reverse?

A

Coumadin risks = fetal limb and nasal hypoplasia, stippled epiphyses –> reverse with Vitamin K

Heparin = thrombocytopenia and osteoporosis (long-term) –> reverse with protamine sulfate

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25
Q

Layers of the abdominal wall

A

Skin/Epidermis
Subcutaneous fat
Superficial Fascia (Campers / Scarpas)
Abdominal muscle and fascia complex (EO/IO/TA)
-Midline
~Above the arcuate line (IO splits above and below rectus abdominus)
~Below the arcuate line (all aponeurosis go above the rectus abdominus)
- Transversalis Fascia
- Pre-peritoneal fat
- Peritoneum

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26
Q

Screening for ovarian cancer consider for BRCA

A

Can consider CA-125 and TVUS from 30-35yo with BRCA until they choose to do risk-reducing BSO

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27
Q

Screening for endometrial cancer consideration for Lynch - when discuss Hyst/BSO?

A

Consider EMB every 1-2yrs starting at 30-35yo. Hyst/BSO discussion at age 40yo

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28
Q

Risk-reducing BSO in BRCA reduces ovarian and breast cancer risk by?

A

80% reduction in ovarian cancer / 30-100% reduction in breast cancer

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29
Q

Medication dosing for fibroid management (bleeding only specifically)

A

GnRH Agonist –> Elagolix 300mg BID with add-back (ethinyl estradiol 1mg / 0.5 norethindrone); can use up to two years

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30
Q

Medication dosing for fibroid bridging medication to menopause, procedure, or surgery

A

GnRH Agonist –> Lupron 3.75mg IM (1mo) or 11.25mg IM (3mo) with add-back (conjugated estradiol 0.625 mg + 5mg norethindrone); can use 6mo (w/o add-back) or 1yr (w/ add-back)

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31
Q

MCC of solid breast mass

A

Fibroadenoma

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32
Q

MCC of bloody nipple discharge

A

Intraductal papilloma (benign)

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33
Q

False positive rate of mammogram and age to start (general pop.)

A

10% - start at age 40yo (annual)

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34
Q

MC types of cancer DEATH for women

A

Lung > Breast > Colon > Pancreas > Ovary

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35
Q

Types of epithelial ovarian cancers

A

Mucinous, Serous, Clear-cell, Endometrioid

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36
Q

Types of Germ Cell Tumors

A

Choriocarcinoma, Dysgerminoma, Endodermal Sinus Tumor/Yolk-sac tumor, Teratoma

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37
Q

Types of Sex-Cord/Stromal tumors

A

Fibroma, Thecoma, granulosa cell, sertoli-leydig,

38
Q

What tumor markers reasonable for adnexal masses and:

  • young age?
  • bleeding, thickened ES?
  • hirsutism or androgen signs?
  • really large mass?
A

BhCG / LDH / AFP / - young age
Estrogen and Inhibin - bleeding, thickened ES
Androgen - hirsutism or androgen signs
CEA - really large mass

39
Q

Tumor marker associations:

  • BhCG
  • LDH
  • AFP
  • Estrogen and Inhibin
  • Androgen
  • CEA
A
  • BhCG = choriocarcinoma
  • LDH = Dysgerminoma
  • AFP = Endodermal sinus tumor/Yolk-sac
  • Estrogen and Inhibin = Granulosa Cell tumor
  • Androgen = Sertoli-Leydig, Thecoma, Fibroma
  • CEA = Mucinous cystadenoma
40
Q

Management of Dysgerminoma

A

USO for young patients, continue to follow with LDH and HCG

41
Q

Endodermal Sinus Tumor/Yolk Sac tumor marker and path

A

AFP and Schiller-Duval Bodies

42
Q

Granulosa cell tumor marker and path

A

Inhibin + estrogen and Coffee-bean nuclei + Call-Exner Bodies (starry sky)

43
Q

Brenner Tumor path

A

Coffee-bean nuceli

44
Q

Krukenburg tumor path

A

Signet-ring cells

45
Q

Dysgerminoma tumor marker and path

A

LDH/HCG and “fried egg” appearance (lymphocytes)

46
Q

LMP tumors and Serous Tumor path

A

Psammoma Bodies

47
Q

Causes of false positive RPR

A

Malaria, Debilitation, Mycoplasma Pneumonia, SLE, Smallpox vaccination, HIV, Thrombocytopenia, Pregnancy

48
Q

Treatment goal of Syphilis for titers over one year

A

4-fold decrease by 3 months; 8-fold decrease by 6 months; undetectable by one year

49
Q

DDX for vulvo-vaginal ulcer - how to differentiate?

A

Syphilis, Chancroid, HSV, Lymphogranuloma Venereum, Granuloma Inguinale, Vulvar Cancer

Painful ulcer:
- Yes = HSV (multiple vesicles) / Chancroid (multiple) [=Hemophilus Ducreyi]
- No = Syphilis / LGV / GI
~Painful LAD?
-Yes = LGV [=Chlamydia]
-No = Syphilis (singular chancre) / GI (multiple) [= Klebsiella]

50
Q

When to excise or biopsy bartholin gland?

A

Age > 40yo or with multiple infections to rule out adenocarcinoma

51
Q

Conditions needed for testing Prolactin?

A

Early morning, fasting, before exercise/intercourse

52
Q

Medications for Prolactinoma

A

Cabergoline (preferred) and Bromocriptine = Dopamine agonist

53
Q

Tests/evals for Galactorrhea

A

TSH, PRL, visual field test, ask about medications (metoclopromide, antipsychotics, antidepressants), nipple stimulation

54
Q

What symptoms to stop Clomid for

A

Headache, blurry vision, eye pain

55
Q

Listeria treatment

A
  • If asymptomatic, just observe
  • If mild symptoms (afebrile), can expectantly manage or treat
  • If severe symptoms and/or febrile, IV Ampicillin (if PCN allergic, can give Bactrim)
56
Q

Workup for Recurrent Pregnancy Loss

A

“ULIGI”
Uterine (septate) = 3D US, MRI, HSG
Lifestyle/PMH = EtOH, smoking, substance abuse
Infectious (TORCH)
Genetic (couple karyotype) = Robertsonian translocation, Fragile X
Immune (APLS labs) = APLS, Thyroid dysfunction

57
Q

Risks associated with Complete Molar Pregnancy

A
  • 15-25% risk of GTN
  • 5% metastatic GTN
  • 10x fold increase risk for future pregnancy
58
Q

Factors used in FIGO system to assess low-risk vs high-risk GTN

A

Age, time since last pregnancy, last type of pregnancy (term vs SAB), pretreatment BhCG, evidence of mets, size of mets, number of mets, previously failed treatment

59
Q

Indications for screening for underlying bleeding disorders

A
  • HMB since menarche
  • One of the following: (1) PPH (2) bleeding with surgery (3) bleeding with dental work
  • Two of the following:
    ~Bruising 1-2x/month
    ~Epistaxis 1-2x/month
    ~Gum bleeding 1-2x/month
    ~Family hx of bleeding symptoms
60
Q

Supplements associated with bleeding

A

Ginko, Ginseng, Motherwort

61
Q

Contraindications to BF’ing

A

Active HIV, active breast lesions of HSV, TB, Lithium use, substance abuse, chemo use

62
Q

Newborn effects associated with SSRI’s

A

Jitteriness, TTN, admission to NICU, persistent pulmonary HTN

63
Q

Recommendations for weight gain in pregnancy

A
  • BMI < 18.5 (underweight) = 30-40lbs / 1lb per week in 2nd/3rd trimester
  • BMI 18-25 (normal) = 25-35lbs / 1lb per week in 2nd/3rd trimester
  • BMI 25-29.9 (Overweight) = 15-25lbs / 0.6 lb per week in 2nd/3rd trimester
  • BMI 30 (Class I) and above = 10-20lbs / 0.5lb per week in 2nd/3rd trimester
64
Q

Treatment for MRSA

A

Vancomycin IV or Bactrim (Trimethoprim/Sulfamethoxazole)

65
Q

Wound with pain out of proportion, crepitus on exam, loss of sensation, maybe with sepsis/DIC…diagnosis, pathogen, and treatment

A
  • Necrotizing Fasciitis
  • Typically polymicrobial (gram Pos/Neg and anaerobes) > Group A Strep is a big offender > Clostridium
  • Surgical debridement + broad spectrum antibiotics + sepsis resuscitation
  • -> Clindamycin (helps shut down toxin production with Group A Strp) + Zosyn [Pipperacillin/Tazobactim] is good broad spectrum beta-lactam (or can use Meropenem) + Linezolid (better than Vanco because it stops toxin productin, is not nephrotoxic, and better availability - but Vancomycin still is an option).
66
Q

Differential for concerning wounds (specific types)

A
  • Toxic Shock Syndrome (diffuse erythroderma, prominent gastrointestinal symptoms) –> streptococcal infexn (Group A Strp)
  • Necrotizing Fasciitis
  • Fournier’s gangrene is a necrotizing soft tissue infection of the perineum
67
Q

Treatment recommendations for cervical cancer staging

A
  • Stage IA1 = Cone / Simple Hysterectomy
  • Stage IA2 = Rad Hyst + Nodes
  • Stage IB - IIA = Rad Hyst + Nodes OR Radiation + Cisplatin
  • Stage IIB and Up = Radiation + Cisplatin
68
Q

When do to an ECC?

A
  • Unsatisfactory (can’t see all of TZ; can see all of lesion)
  • If considering ablative procedure
  • If pap shows ASC-H, HSIL, AGC, or AIS
  • Discrepant pap smear and colpo
69
Q

Overall principle of pap smear management (broad theme)

A

For women 25 yrs+, consider the immediate risk of CIN 3+ and the 5-year risk of CIN3+:

  • If the risk for CIN3+ is >= 4%, going to Colpo or Treat
  • If the risk is <4%, consider 5-year risk to help determine if retest in 1 / 3 / or 5 years
70
Q

Surveillance timeframe after treatment of HSIL/ CIN2/3, or AIS

A

3 years

71
Q

When to consider CKC over LEEP

A

If patient is s/p BTL, completed childbearing, inadequate colposcopy, discrepancy between cytology and histology, or results of CIS/AIS, +ECC, + margins on prior LEEP or if can’t redo LEEP because too little cervix left

72
Q

Expedited partner therapy for if they won’t come in for Gonorrhea treatment?

A

Cefixime 800mg (if they won’t come for Ceftriaxone 500mg IM x1); can also offer Azithromycin 1g for Chlamydia too

73
Q

Fecundity at ages: < 31, 31-35, >35

A

75%, 65%, 55%

74
Q

Treatment options of hirsutism

A
  1. OCP –> increases SHB-globulin which binds androgens
  2. Cosmetic Laser therapy - (dark hair light skin = best candidates) the melanin absorbs the laser wavelength of light which selectively damages the follicle without harming surrounding tissue
  3. Antiandrogen Therapy: (need contraception with antiandrogens)
    •Eflornithine - blocks ornithine decarboxylase
    -SE: stinging burning at site of application
    •Finasteride - 5-alpha reductase inhibitor (blocks testosterone –> DHT)
    -1mg QD
    •Flutamide - androgen receptor blocker
    -125mg QD
    •Spironolactone: diuretic, aldosterone antagonist, binds androgen receptor, slight effect on 5-alpha reductase too (cautious to use in those with renal problems because can exacerbate hyperkalemia)
    -25-100mg BID
    -SE: orthostatic hypotension
75
Q

Medications for acute bleeding

A
  • IV conjugated estrogen 25mg every 6hrs for 24hrs
  • Oral OCP with 35mcg of ethinyl estradiol TID x7days
  • Medroxyprogesterone acetate 20mg PO TID x7days
  • TXA 1.3mg PO TID x5 days
76
Q

Clostridium Difficile RF’s and Abx treament

A
  • Extremes of age, nursing home, prolonged hospitalization, recent surgery or antibiotic use (Clindamycin, Ampicillin, Cephalosporin, Fluoroquinolones)
  • Treatment
    •Firstline:
    -Oral Vancomycin (IV doesn’t achieve colonic penetration) 125mg q6hrs x10 days
    -Fidaxomicin 200mg BID x10 days
    •Second line = Metronidazole 500mg TID x10days
77
Q

Vulvar hematoma likely from what blood supply?

A

Pudendal artery or contributing branch

78
Q

Levator ani muscles

A

Puborectalis / Pubococcygeus / Iliococcygeus

79
Q

When to treat hyperlipidemia?

A
  • LDL > 190
  • Present CVD
  • All Diabetics 45-75yo
    • If 10-yr CVD risk score > 7.5% = high-intensity, < 7.5% = moderate intensity statins
    o High-intensity statin = goal reduction of > 50% LDL decrease
    o Moderate-intensity statin = goal reduction of 30-50% LDL decrease
    o Atorvastatin start 40mg for mod-high intensity, otherwise 20mg PO
     SE’s: myalgia, temporary increase in LFT’s
     10-yr CVD risk > 7.5%
     Pooled Cohort Equation from the ACC – looks at age, race, gender, age, lipid levels, BP, and medical history to assess 10-yr risk for CVD
80
Q

Cardinal movements

A

Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation and Restitution, and Expulsion

81
Q

% of NST that are non-reactive 24-28 weeks vs 28-32weeks

A

24-28 weeks = 50%

28-32 weeks = 15%

82
Q

Etiologies of secondary PPH and definition

A

PPH 24hrs - 12 weeks

  • placental site subinvolution
  • infection
  • coagulopathy
  • retained POC
83
Q

What is methergine

A

Ergot alkaloid

84
Q

What minor RBC antigens are concerning for hemolytic disease of the newborn if antibodies develop

A

Anti-Kell, anti-Rh c, anti-Rh E, and anti-Duffy and anti-Kidd antibodies are worrisome

85
Q

RF’s for Breast Cancer

A
  • Fam history of ovary, breast cancer and other syndrome-associated cancers (pancreatic, prostate)
  • Early menarche / late menopause
  • Not breastfeeding
  • Nulliparity
  • Increase Age and BMI
  • Alcohol and smoking
  • HRT with estrogen AND progesterone
  • Breast biopsy with:
    1. Atypical hyperplasia
    2. Lobular carcinoma in-situ
86
Q

When to do work-up for hematuria

A

RBC count is > 25 per high-power field

87
Q

When to start transgender hormonal manipulation? Risks of treatment?

A

Start after Tanner Stage 2 with Testosterone (for F to M vs Spironolactone for M to F); risk of testosterone = hyperlipidemia, hypertension, hepatitis, polycythemia

88
Q

Type of surgical prep for abdomen and vagina

A

Skin: chlorhexidene-alcohol scrub for 2 min / drytime = 3 min
~ If use providone-iodine, scrub for 5 min, then paint abdomen with same soln and let dry for 3 min
Vagina: 4% Chlorhexidine gluconate or providine-iodine

89
Q

ERAS talking points:

A
  • PreOp counseling
  • Early ambulation the same day of surgery (sitting in chair to standing)
  • Stepwise pain control:
    ~ scheduled NSAIDs -> if can’t take NSAID, use Toradol)
    ~ scheduled Tylenol unless hepatic failure
    ~ Gabapentin
    ~ Opioids only for breakthrough
  • Foley and drains removed within 24 hrs
  • Allow diet and PO intake as tolerated
90
Q

Non-pregnant BP stages:

A

Normal: SBP < 120 DBP < 80
Elevated: SBP 120-129 DBP 80
Stage 1: SBP 130-139 DBP 80-89
Stage 2: SBP >140 DBP >90

Chronic HTN = > 12 weeks postpartum

91
Q

When to cosnider secondary HTN eval?

A

If HTN before the age of 30yo, HTN resistant to treatment, more sudden onset

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