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Clinic Flashcards

1
Q

Gonorrhea and Chlamydia screening

A

Annual for sexually actively ages 13-24

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2
Q

Diabetes screening

A

Annually if high risk
Every 3 years after age 45

HbA1c

  • 6.5% diabetes
  • 5.7-6.4% pre-diabetes
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3
Q

Cholesterol screening

A

Every 5 years beginning at age 40

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4
Q

Screening post hysterectomy for high-grade cytology or histology (CIN 2/3, AIS)

A

Annual screening for 3 years > every 3 years for 25 years

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5
Q

Regression rates of CIN 1 and 2

A

CIN 1: 60%

CIN 2: 40%

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6
Q

Negative predictive value of co-testing

A

99% for CIN 2/3

  • pap 50% sensitive
  • liquid cytology 76% sensitive
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7
Q

When is an ECC indicated during colposcopy?

A

No identifiable lesion
Unsatisfactory colposcopy
Pap with ASC-H, HSIL, AGC, or AIS
When considering ablative therapy for CIN 1/2

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8
Q

Treatment for positive margin on CIN 2/3 excision

A

Cotesting or colposcopy with ECC in 6 months > annual cotesting for 3 years

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9
Q

Screening options for colon cancer

A 
Yearly fecal blood cards
Sigmoidoscopy every 5 years
CT colonography every 10 years
Colonoscopy every 10 years
- start at 45 or 10 years before first degree family member
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10
Q

Follow up for abnormal colonoscopy

A

Benign polyps: 3-5 years

Atypical polyp: 3 years

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11
Q

Breast screening in BRCA 1/2 patients

A

Annual MRI starting at age 25
Annual mammography at age 30
- Consider tamoxifen and risk-reducing surgery
- 45-85% risk of breast cancer

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12
Q

High risk cholesterol

A

Total cholesterol > 240
LDL > 160
HDL < 40
Triglycerides > 885

Lifestyle changes and then statin

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13
Q

T-score

A

Standard deviation from mean peak bone density of normal young adult

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14
Q

Z-score

A

Standard deviation from reference population of same age, sex, and race

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15
Q

Lab work up for osteoporosis

A

CBC
CMP
Vitamin D level
Consider 24 hour urinary calcium, PTH, TSH

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16
Q

FRAX score

A

Estimates 10-year probability of hip fracture or major fracture for untreated patients using femoral neck bone mineral density and risk factors

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17
Q

Candidates for osteoporosis treatment

A

Osteoporosis
Postmenopausal
- osteopenia with hip fracture 3% or major fracture >20% by FRAX

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18
Q

Calcium requirements daily

A

Age 9-18: 1300 mg calcium
Age 19-50: 1000 mg calcium
Age 50+: 1200 mg calcium

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19
Q

Vitamin D requirement daily

A

1-70 years: 600 IU/day

70+ years: 800 IU/day

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20
Q

Risk reduction for fracture

A

No free rugs
Slip on shoes
Store objects at eye level
Optimize vision

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21
Q

Mechanism of bisphosphonates (Fosamax, Boniva, Reclast)

A

Inhibits bone resorption by osteoclasts

Same ultimate pathway as calcitonin

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22
Q

Mechanism of calcitonin

A

Binds to osteoclasts and inhibits bone resorption

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23
Q

Exercise recommendation for reducing heart disease

A

30 minutes 5 days a week

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24
Q

Emergency contraceptive options

A 
Up to 3 days
- Levonorgestrel 1.5 mg once
Up to 5 days
- Ulipristal 30 mg once
- Copper IUD
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25
Q

UTI treatment

A

Tmp-smx 100/800 bid x 3 days
Nitrofuratoin 100 mg bid x 7 days
Fosfomycin 3 mg once

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26
Q

Criteria for inpatient PID treatment

A 
Surgical emergency not excluded
Pregnancy 
No response to oral therapy
Peritonitis, n/v, high fever
Noncompliance with treatment
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27
Q

Amstels criteria for bacterial vaginosis

A

3 of 4:

  • pH > 4.5
  • positive KOH whiff test (10% KOH)
  • > 20% clue cells on saline microscopy
  • Homogenous, thin, white-gray discharge coating vaginal walls
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28
Q

Most common cause of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

  • measure with 17-ohp (elevated)
  • consider testing in secondary amenorrhea
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29
Q

Order of puberty

A 
Growth spurt
Breast development
Pubarche
Adrenarche
Menarche
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30
Q

Lab work up of hitsuitism

A

Total testosterone
DHEAS
17-OH progesterone

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31
Q

Reassuring endometrial stripe in post menopausal patient

A

4 mm or less

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32
Q

Treatment for recurrent bacterial vaginitis (3+ episodes in a year)

A

Twice weekly suppressive metronidazole gel for 16 weeks

After treatment of acute episode

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33
Q

Diagnosis of trichomonas

A

NAAT of vaginal, cervical, or urine specimens

- Microscopy only 50% sensitive

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34
Q

Treatment of trichomoniasis

A

Metronidazole 500 mg BID for 7 days

Tinidazole 2 gram in a single dose

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35
Q

Treatment of bacterial vaginosis

A 
Metronidazole 500 mg BID for 7 days
Metronidazole gel 0.75% daily for 5 days
Clindamycin cream 2% daily for 7 days
Tinidazole 2 mg daily for 2 days
Secnidazole 2 g orally once
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36
Q

Treatment of trichomoniasis with metronidazole allergy

A

Metronidazole desensitization

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37
Q

Treatment of uncomplicated vulvovaginal candidiasis

A

Fluconazole 150 mg once
Miconazole 4% for 3 days
Clotrimazole 2% for 3 days

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38
Q

Treatment of recurrent vulvovaginal candidiasis

A

Weekly fluconazole 150 mg for 6 months

After Fluconazole 150mg q72hrs for 3 doses

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39
Q

Treatment of severe vulvovaginal candidiasis

A

Topical intravaginal azole for 10-14 days

Fluconazole 150 mg every 72 hours for 2-3 doses

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40
Q

Treatment of C glabrata

A

Intravaginal boric acid (600 mg capsules) daily for 14 days

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41
Q

High potency topical corticosteroids

A

Triamcinolone 0.5%

Bethamethasone, clobetasol, halobetosol, fluocinonide 0.05%

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42
Q

Low potency corticosteroids

A

Hydrocortisone 1%, 2.5%

Desonide 0.05%

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43
Q

Component of lichen planus evaluation

A

Oral exam and referral to periodontist as needed

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44
Q

Labs for AUB

A

CBC, tsh, hCG, cervical cancer screening, chlamydia testing

- consider prolactin

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45
Q

PALM structural causes for AUB

A

Polyp
Adenomyosis
Leiomyoma
Malignancy and hyperplasia

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46
Q

COEIN for non-structural causes of AUB

A 
Coagulopathy
Ovulatory dysfunction 
Endometrial 
Iatrogenic
Not yet classified
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47
Q

Main Hpv strains causing condyloma

A

6 and 11

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48
Q

Complications of DES exposure

A

Vaginal adenosis (persistence of columnar epithelium in upper 1/3 of vagina, normally replaced by squamous) > clear cell adenocarcinoma

Müllerian duct derivative not replaced by Urogenital sinus derivatives

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49
Q

ACOG breast cancer screening recommendation

A

Mammogram: Every 1-2 years age 40-75

Clinical breast exam: Every 1-3 years aged 25-39, annually age 40+

50
Q

Lifetime risk of breast cancer for average woman

A

12% (1 in 8)

51
Q

Breast cancer risk factors

A

Chest radiation (eg Hodgkin’s lymphoma), smoking, obesity, alcohol use, age, nulliparity, not breastfeeding, early menarche, late menopause, prior biopsy with atypical hyperplasia (ducal or lobular) or lobular carcinoma in situ

52
Q

GAIL breast cancer risk model

A

Age, race, history of biopsy, menarche, age at 1st birth, 1st degree family history of breast cancer > risk of breast cancer in next 5 years
- not valid under age 35

53
Q

Clomid mechanism of action

A

SERM: anti estrogen properties at hypothalamus > increased GnRH pulsatility > increased FSH/LH

54
Q

Clomid dosing and side effects

A

50 mg for 5 days starting on 5th cycle day

- multiples (5-10%), mood changes, ovarian cysts

55
Q

Mechanism and examples for GnRH agonists

A

Disrupt pulsatile GnRH signaling

- constant GnRH signaling > initial increase in FSH/LH > negative feedback loop and down regulation

56
Q

Treatment for genital warts

A

HPV vaccine!

Trichloroacetic acid (TCA)
Podophyllin (provider applies)
Aldara (imiquiod): three times weekly up to 16 weeks
57
Q

Treatment for mastitis

A

Dicloxacillin 500 mg four times daily
Clindamycin 450 mg TID
- Avoid Bactrim if breastfeeding and infant < 1 month old

58
Q

What is the contraceptive mechanism of OCPs?

A

Estrogen: negative feedback at pituitary > suppress FSH production > decreased follicular development
Progesterone: Decrease GnRH pulsatility > suppress LH production, change cervical mucus

59
Q

Benign etiologies of postmenopausal bleeding

A

Fibroids, polyps, vaginal atrophy, urinary or rectal bleeding

60
Q

Outpatient treatment of PID

A

Ceftriaxone 500 mg IM
Doxycycline 100 mg BID x 14 days
Metronidazole 500 mg BID x 14 days

61
Q

Laboratory work up of primary ovarian insufficiency

A

FSH, estradiol, TSH, prolactin, anti-adrenal antibodies, consider TPO antibodies, Karyotype, FMR1 permutation
- Elevated basal FSH 30-40 mIU/mL x 2 one month apart

62
Q

Kegel’s instructions

A

Squeeze for 10 seconds, release, do 30-40 per day

63
Q

Mechanism and side effects of bromocriptine

A

Dopamine receptor agonist

- nausea, postdural hypotension, mental fogginess, impulse control issues

64
Q

Q-tip test for urethral hypermobility

A

Q-tip lubricated with anesthetic gel inserted into urethra > woman asked to cough and strain
- 30+ degree angle = urethral hypermobility

65
Q

Embryologic origin of ovaries

A

Urogenital ridge

66
Q

Go to ocp

A

Loestrin 1/20

  • 1 mg norethinodrone
  • 20 mcg ethinyl estradiol
67
Q

Solution for mid-cycle bleeding

A

Increase estrogen mcg

68
Q

OCP solution to bleeding pre cycle

A

Triphasic progesterone pill

- Increases progesterone dose each week

69
Q

Age for shingles vaccine

A

50 years

70
Q

Li-Fraumeni (p53) cancer screening

A

Breast screening starting at age 20
Annual whole body MRI
Colonoscopy starting at age 25

71
Q

Cowden/PTEN cancer screening

A

Breast cancer screening starting at age 30
Endometrial cancer screening starting at age 35
Colonoscopy starting at age 35
Annual thyroid ultrasound

72
Q

Dexa screening after bisphosphonate treatment

A

2 years on treatment

Prior to stopping bisphosphonate

73
Q

Lynch syndrome cancer screening

A 
Colonoscopy starting at age 20-25, repeat every 1-2 years
Endometrial biopsy starting at age 35
UA starting at age 35
Standard breast cancer screening 
Consider pancreatic cancer screening
74
Q

Contraindications to HRT

A 
Untreated hypertension 
Active liver disease
Active or recent arterial thromboembolic disease
Previous VTE unless on anticoagulation 
Undiagnosed vaginal bleeding
History of breast cancer
75
Q

Vasopressin dosing

A

5 units in 10 mL saline

76
Q

Acetic acid concentration

A

5%

77
Q

Progesterone IUD dosing and duration of use

A

Mirena, Liletta: 52 mg for 7 years
Kyleena: 19.5 mg, 5 years
Skyla: 13.5 mg, 3 years

78
Q

Alternative treatments for bacterial vaginosis

A

Vaginal metronidazole 0.75% gel 5g daily for 5 days
Vaginal Clindamycin 2% daily for 7 days
Oral Clindamycin 300 mg BID for 7 days

79
Q

Estrogen dosing in HRT

A

17-beta estradiol
- oral 1 mg/day
- transdermal 0.05 mg/day
Consider starting at double dose (2 mg/0.1 mg) post-rrBSO

80
Q

Progesterone dosing in HRT

A

Micronized progesterone 100 mg daily

- Cyclic: 200 mg/day for 12 days a month

81
Q

Vaginal estrogen dosing for Atrophy

A

Ring: 7.5 mcg estradiol for 3 months
Tablets: 10 mcg estradiol
Creams: 0.1-0.625 mg estradiol per gram cream

82
Q

Preferred HRT

A

Climara Pro (weekly patch)
- 0.045 mg estradiol
- 0.015 mg levonorgestrel
Per day

83
Q

Timing of HPV vaccination

A

0, 2 and 6 months

84
Q

Findings and timing of secondary syphillis

A 
Condyloma Lata
Maculopapular rash (Coxsackie, Rocky Mountain spotted fever other causes of palms and soles rash)
6 weeks to 6 months after chancre
85
Q

Chantix (varencline) dosing

A

12 week course

  • pick a quit date 1 week after starting
  • 0.5 mg QD-BID for week 1
  • 1 mg BID for weeks 2-12
86
Q

Outpatient treatment of pneumonia

A

Cefdinir 300 mg BID

Azithromycin 500 mg QD

87
Q

Contraindications to oxybutynin

A

Closed angle glaucoma, history of impaired gastric emptying or urinary retention

88
Q

Sprintec components

A 
35 mcg (0.035 mg) ethinyl estradiol
0.250 mg norgestimate
89
Q

Criteria for metabolic syndrome

A 
Elevated BP
Increased abdominal girth
Elevated triglycerides 
Low HDL
Elevated fasting blood sugar
90
Q

Causes of hirsuitism

A 
PCOS
Congenital adrenal hyperplasia 
Androgen secreting tumors: Sertoli Leydig tumor, thecoma
Androgen medication ingestion
Familial
Cushing’s syndrome
91
Q

Genetic causes of Down’s syndrome

A

Non-disjunction

Translocation

92
Q

Definition of recurrent vulvovaginal candidiasis

A

4+ episodes of symptomatic infection within one year

93
Q

Treatment for recurrent candida vulvovaginitis

A

Fluconazole 150 mg every 72 hours for 3 days

- weekly Fluconazole for 6 months

94
Q

Definition of osteopenia

A

T-score -1 to -2.5

- Bisphosphonate if FRAX hip fracture > 3% or other major fracture > 20%

95
Q

RNA hepatitis viruses

A

Hepatitis A

Hepatitis C

96
Q

DNA hepatitis virus

A

Hepatitis B

97
Q

Mild vs moderately persistent asthma

A

Mild persistent: Symptoms 2-6 times per week, no activity limitations, FEV1 80+%
Moderate persistent: daily symptoms, weekly or more nighttime awakening, FEV1 60-80%, activity limited
- Add daily salmeterol to daily corticosteroid inhaler

Give pneumococcal vaccine!

98
Q

Ways to exclude pregnancy without a test

A 
No sex since last normal menses
Reliable method of contraception 
7 days from LMP
4 weeks postpartum 
Amerorrheic and exclusive breastfeeding (80%) within 6 months postpartum 
Within 7 days of pregnancy loss
99
Q

Antiphospholipid labs

A

Lupus anticoagulant
Anticardiolipin
Anti-beta-2-glycoprotein

100
Q

Clinical diagnosis of antiphospholipid syndrome

A

One arterial thrombosis
Death of normal fetus 10+ weeks gestation
Preterm delivery for pre-eclampsia
3 or more unexplained losses <10 weeks

101
Q

Non-hormonal treatment options for hot flashes

A

Alpha-agonist: Clonidine 0.1 mg BID

SNRI: Paroxetine

102
Q

Non-FDA approved options for orgasmic disorders

A

Testosterone patch or cream
Bupropion
Phosphodiesterase inhibitors (sildenafil)
Seratonin receptor agonist (filbanserin)

103
Q

Treatment for Syphillis with penicillin allergy

A

Doxycycline

Ceftriaxone

104
Q

Non-hormonal treatments of vulvovaginal atrophy

A

Lubricants
Moisturizers: hyaluronic acid, poly acrylic acid
Vaginal suppositories: Vitamin E, vitamin D
Lidocaine 4% solution
- consider vaginal DHEA if vaginal estrogen not an option

105
Q

Ultrasound findings of adenomyosis

A

Heterogeneous myometrium
Myometrial cysts
Asymmetrical myometrial thickness
Subendometrial echogenic linear striations (“Venetian blind”)

106
Q

Lynch syndrome proteins

A

MSH2
MSH6
MLH1
PMS2

107
Q

Follow up of BIRADS 3-5

A

3: 0-2% risk malignancy, 6 month repeat imaging
4: 2-95% risk malignancy, tissue diagnosis
5: >95% risk malignancy, tissue diagnosis

108
Q

EPT for gonorrhea

A

Cefiximine 800 mg PO

109
Q

Ultrasound finding of hydrosalpinges

A

Tubular sonolucent cysts

110
Q

Sex cord stromal tumors

A 
Fibroma
Thecoma
Fibrosarcoma
Granulosa cell tumors
Sertoli cell tumors
Sertoli-Leydig tumors
- no need for standard nodal assessment
111
Q

Elagolix mechanism and dosing

A 
GnRH antagonist
- Start at 150 mg daily (endometriosis)
- Max dose 300 mg BID (fibroid dosing)
- Max length 24 months
Give calcium and vitamin D supplements
112
Q

PCOS diagnostic criteria

A

Hyperadrogenism (hirsuitism, acne or levels)
Oligomenorrhea or amenorrhea
Polycystic ovaries on ultrasound
- 2/3 for Rotterdam

113
Q

Sperm parameters

A 
Volume: 1.5 mL
Concentration: 15 million/mL
Total sperm: 40 million
Morphology: 4%
Total motility: 40%
114
Q

Medications for hirsuitism

A

COCs
Spironolactone (diuretic and aldosterone antagonist)
Flutamide (androgen-receptor agonist)
Finasteride (5-alpha-reductase inhibitor)

115
Q

Infertility work-up

A

FSH (> 10 IU/L diminished ovarian reserve)
Estradiol (>80 pg/mL diminished ovarian reserve)
Confirm ovulation (+LH, midluteal progesterone >3 ng/mL)
TVUS with antral follicle count
HSG
Semen analysis

116
Q

Most common cause of bloody nipple discharge

A

Benign intraductal papilloma

117
Q

PREP regimens

A

Once daily tenofovir-disoproxil

- same drug with addition of integrase inhibitor used for post-exposure prophylaxis

118
Q

Von willebrand testing

A

PTT, von willebrand antigen, von willebrand activity, ristocetin co-factor, factor 8 activity

119
Q

Available progesterone-only contraceptive pills

A

Norethindrone 0.35 mg
Drospirenone 4 mg (higher VTE risk)
Desogestrel 75 mcg
- First 2 are taken continuously

120
Q

Covid vaccination schedule

A 
Moderna 4 weeks apart
Pfizer 3 weeks apart
- 1 month booster for immunocompromised patients
- Spike proteins create antibodies 
- 5 month booster for everyone else
J&J
- booster at 2 months
- adenovirus encodes spike protein
121
Q

Findings of sarcoma on imaging

A

Heterogeneity
Increased blood flow
Central necrosis
Lack of calcifications (seen with fibroids)

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