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General Gyn Flashcards

1
Q

NIH diagnostic criteria for PCOS

A

Both required

  1. hyperandrogenism
  2. oligomenorrhea/amenorrhea
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2
Q

Rotterdam diagnostic criteria for PCOS

A

Must have 2 of 3

  1. Hyperandrogenism
  2. Oligomenorrhea/amenorrhea
  3. Polycystic ovaries
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3
Q

Androgen Excess Society diagnostic criteria for PCOS

A

Hyperandrogonism AND

Oligomenorrhea/amenorrhea OR polycystic ovaries

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4
Q

Lab tests for diagnosing PCOS

A 
Total testosterone and sex-hormone binding globulin ( or bioavailable and free T)
TSH
Prolactin
17-OHP
2-hr GTT
Fasting lipids
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5
Q

Definition of polystic ovaries

A
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6
Q

Definition of polystic ovaries

A

12 or more follicles measuring 2-9mm in diameter OR
Increased ovarian volume greater than 10cm3
(If there’s a follicle >10mm, repeat scan at presumed time of ovarian quiescence)

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7
Q

Metabolic syndrome

A 
Elevated blood pressure (>130/85)
Increased waist circumference (>35")
Elevated fasting glucose levels (>100)
Reduced HDL (<50)
Elevated triglycerides (>150)
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8
Q

How does insulin resistance relate to hyperandrogenism?

A

Hyperinsulinemia –> decreased levels of sex hormone binding globulin –> more bioavailable androgens

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9
Q

Women with PCOS are also at risk for:

A 
Metabolic syndrome
Insulin resistance (--> T2DM)
Nonalcoholic fatty liver disease
Obesity related disorders like sleep apnea
Cardiovascular disease 
Endometrial cancer
Depression
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10
Q

Who should be screened for nonclassical congenital adrenal hyperplasia?

A

Adult women with anovulation and hirsutism

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11
Q

In women with PCOS who is not attempting to conceive, what is the best medical maintenance therapy to treat menstrual disorders?

A

Combined OCPs
Progestin (often accompanied by AUB)
Metformin (decreases circulating insulin)

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12
Q

In women with PCOS who are not attempting to conceive, what is the best medical maintenance therapy to reduce the risks of cardiovascular disease and DM?

A

Lifestyle modification
Metformin
Statins
Combined OCPs

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13
Q

In women with PCOS who are attempting to conceive, which methods of ovulation induction are effective?

A 
Letrozole (aromatase inhibitor)
Clomid
Low-dose gonadotropins
Ovarian drilling
Metformin
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14
Q

Mechanism of action of spironolactone

A

Aldosterone antagonist

Also binds androgen receptor as antagonist

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15
Q

Flutamide mechanism of action

A

Androgen-receptor agonist

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16
Q

Finasteride mechanism of action

A

5-alpha-reductase inhibitor

Teratogen, need reliable contraception

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17
Q

Eflornithine mechanism of action

A

Inhibits ornithine decarboxylase
Topical
Improves outcome of laser

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18
Q

Can you use vaginal estrogen in patients with recent diagnosis of breast cancer or currently being treated for breast cancer?

A

Yes, but vaginal tablet or ring impregnated with estradiol would confer a lower systemic absorption than a cream.

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19
Q

Most effective form of emergency contraception

A

Copper IUD

Second is ulipristal acetate - SPRM

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20
Q

Antibodies in Graves disease

A

TSH receptor antibodies

can also test for increased radioactive iodine uptake

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21
Q

Mechanism of action of PTU/methimazole

A

Blocks organification of iodide –> decreases synthesis of thyroid hormon
(PTU also blocks peripheral conversion of T4 to T3)

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22
Q

Common supplement that can mask vitamin B deficiency

A

Folic acid supplementation (rule out vitamin B12 deficiency before starting supplements)

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23
Q

Definition of late latent syphilis

A

Asymptomatic, positive serologic test result greater than 12 months after infection

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24
Q

Treatment for primary, secondary, or early latent syphilis

A

Penicillin G 2.4 million units, IM x1

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25
Q

Treatment for late latent or tertiary syphilis or syphilis of unknown duration

A

Three doses of penicillin G 2.4 million units at one-week intervals

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26
Q

Tamoxifen mechanism of action

A

Selective estrogen receptor modulator
Blocks native estrogen effects on breast tissue
Stimulates estrogen receptors in endometrium

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27
Q

How does tamoxifen have a procoagulant effect?

A

Increases antithrombin III and protein C

not recommended in women with history of VTE

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28
Q

Who has an increased risk of endometrial neoplasia when taking tamoxifen?

A

Postmenopausal women

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29
Q

What is tamoxifen’s affect on bone?

A

Lower rates of osteoporosis due to antiosteoclast activity

Maybe premenopausal women have decreased bone mineral density, but no increase in fractures

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30
Q

Indications for laparoscopy in adolescents with pelvic pain

A 
Chronic pain unresponsive to OCPs and NSAIDs
Diagnostic dilemma (PID vs appy)
Identified pelvic mass
Painful irregular vaginal bleeding
Progressive dysmenorrhea
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31
Q

Is well-controlled hypertension a contraindication to estrogen containing methods of contraception?

A

Yes, use progesterone-only

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32
Q

Number needed to treat (NNT)

A

100 / (exposure with desired outcome) - (no exposure with desired outcome)

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33
Q

Absolute risk reduction

A

An quantity by which some outcome is reduced
Not a ratio
(exposure with desired outcome) - (no exposure with desired outcome)

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34
Q

Relative risk reduction

A

Absolute risk reduction / baseline rate of event in question

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35
Q

Relative risk

A

100 - relative risk reduction

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36
Q

Which lower genital tract anomalies should be transected in the OR?

A 
Imperforate hymen
(semiperforate hymen, septums can be done in the office)
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37
Q

Which lifestyle modification decreases blood pressure the most?

A

Weight loss

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38
Q

In order to be considered eligible for Medicaid EHR program, the proportion of the OBGYN’s private practice patient volume covered by Medicaid must be:

A

30%

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39
Q

Does Depo decrease bone mineral density?

A

Yes 5% after 5 years of use

But this is recoverable after Depo is discontinued

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40
Q

What is the single dose regimen treatment for bacterial vaginosis?

A

Secnidazole 2g PO x1 (oral granules)

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41
Q

First line treatment for cyclic nonfocal mastalgia

A

Supportive bra and NSAIDs

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42
Q

Danazol

A

Androgen that suppresses pituitary gonadotropin release
Only FDA approved drug for cyclic mastalgia
(but not first line due to side effects - weight gain, menstrual irregularity, hot flashes, voice deepening, acne, hirsutism)

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43
Q

Postembolization syndrome

A

30-40% of embolizations, results from tissue ischemia and necrosis leading to an inflammatory reaction
Pain, nausea, fever, elevated WBC
Peaks 1-2 days after procedure and resolves within 8 days

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44
Q

Fractional excretion of sodium < 1

A

Prerenal etiology of oliguria (decreased renal perfusion)

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45
Q

Ovarian mass with elevated LDH and b-hCG

A

Dysgerminoma

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46
Q

What should patients do with their basal (long-acting) insulin preoperatively

A

Decrease dose the night before to prevent hypoglycemia while NPO

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47
Q

Helpful to prevent pregnancy loss in women with recurrent (>3 consecutive) pregnancy loss

A

Progesterone supplements

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48
Q

Treatment for fibroids in a smoker that wants to delay surgery

A

Leuprolide acetate

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49
Q

Age when varicella is given

A

First dose 12-15 months
Second dose 4-6 years
7 and older who do not have evidence of immunity

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50
Q

Treatment for exposure to varicella, still asymptomatic

A

Vaccination

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51
Q

First line for GERD treatment

A

PPI

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52
Q

When should DEXA scan be performed

A

Age 65

Or if FRAX 10yr fracture risk is 9.3% or greater

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53
Q

Treatment of osteoporosis should be initiated when:

A

T-score of -2.5 or less
FRAX score with 10yr risk of 3% or greater for hip fracture
FRAX score with 10yr risk of 20% or greater for major osteoporotic fracture

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54
Q

Used for the prevention of osteoporotic fractures AND reduction of breast cancer risk

A

Raloxifene

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55
Q

Omnibus Final Rule

A

Addresses provisions of HITECH act

Attempt to standardize EHR capabilities across platforms and provide funding for “meaningful use” of EHR

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56
Q

Primary risk of tamoxifen and raloxifene

A

Thromboembolic events

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57
Q

Why is raloxifene better than tamoxifen for menopausal patients

A

Tamoxifen has increased risk of VTE, endometrial neoplasia, and cataracts

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58
Q

She had positive blood cultures in the hospital, but she’s on oral antibiotics and feeling much better now, would you repeat the blood cultures?

A

No

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59
Q

Do you biopsy a thick endometrium in an asymptomatic postmenopausal woman?

A

No

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60
Q

The first step in creating an office safety program is to

A

Designate a medical director for safety

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61
Q

Pap screening for HIV+ women

A

Initiate a year after starting sexual activity, if normal then yearly cytology

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62
Q

Most effective emergency contraception

A

Copper IUD

then ulipristal - antiprogestin, then oral levonorgestrel

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63
Q

After obturator sling, patient can’t rotate hip outward

A

Obturator internus injury

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64
Q

Risks for surgical site infections

A

Abdominal&raquo_space; laparoscopic&raquo_space; vaginal
Length of procedure > 3 hours
Blood transfusion

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65
Q

Next test for “burning” or tender vulvar pain with swab test

A

Fungal culture

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66
Q

Next step after insufficient sample on EMB (for single episode PMB)

A

TVUS for endometrial stripe

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67
Q

Postprocedure contraceptive recommendation after hysteroscopic sterilization

A

Contraception for at least 3 months until HSG or targeted ultrasound confirms bilateral occlusion

68
Q

Best treatment for vasomotor symptoms of menopause in women with a uterus

A

Combined estrogen and progesterone

69
Q

Risk of copper IUD

A

Irregular bleeding

PID (and subsequent tubal damage) in patients with multiple sex partners

70
Q

How long is ulipristal acetate effective as emergency contraception after intercourse

A

5 days

71
Q

A hospital surgical proctor:

A

Receives institutional compensation for protctoring
Completes written evaluation of new faculty
Can recommend termination of a procedure if unsafe

72
Q

Nonviable pregnancy of unknown location, but not enough information to warrant methotrexate?

A

Surgical evacuation of the uterus

73
Q

Best treatment for c.diff in patients who are at high risk of recurrence (on concomitant antibiotic therapy, severe infection, advanced age)

A

Fidaxomicin

74
Q

Safest mood stabilizer for breastfeeding

A

Valproic acid

75
Q

Minimum evaluation for low back pain

A

Neuro exam

76
Q

Primary amenorrhea, no breast development or pubic hair, next test?

A

FSH

77
Q

Concern in older adults wiht ibuprofen

A

Renal injury

78
Q

Medications with bone loss/fracture risk

A

DMPA
SSRIs
PPIs
Antiepileptics

79
Q

Absolute contraindications to endometrial ablation

A

Pregnancy
Known endometrial cancer
Active pelvic infection
Desire to maintain fertility

80
Q

Relative contraindications to endometrial ablation

A

Congenital uterine anomalies
Enlarged uterine cavity
Conditions that create myometrial thinning (previous uterine surgery, myomectomy, cesareans)
Conditions that may increase the risk of future endometrial cancer or hyporplasia

81
Q

Reasons to perform BSO during benign hysterectomy

A

Decreases risk of ovarian cancer

Decreases risk of reoperation (moreso than cancer)

82
Q

Vaginismus

A

Involuntary contraction of the pelvic floor, inhibiting entry into the vagina

83
Q

Hysterectomy for CIN, how often and how long to do vaginal cytology?

A

Every three years until 20 years post-hyst

84
Q

Osteoporosis treatment for women in their 50s

A

Estrogen agonist/antagonist while in their 50s
Then switch to bisphosphonates in their 60s (decreases amount of time exposed to these drugs because of bad side effects)

85
Q

Improves MI risk perioperatively in high risk patients

A

Beta blockers

86
Q

Stop hysteroscopy if fluid deficit is greater than

A

1000mL

87
Q

Treatment for DCIS

A

Lumpectomy

Mastectomy felt to be too aggressive despite lower recurrence rate

88
Q

AIS treatment in patients who have completed childbearing

A

Hysterectomy

89
Q

How often should lipid screening be performed

A

Every 5 years after 45

90
Q

How often should diabetes screening be performed

A

Every three years after 45

91
Q

Treatment for bone loss in adolescents with functional hypothalamic amenorrhea

A

Transdermal estradiol with cyclic oral progestin

92
Q

Risk factors for vitamin D deficiency

A 
Darker skin
Vegetarian diet
Obesity
Bariatric surgery
Limited sun exposure
93
Q

Common method of confirming completion of medical management of miscarriage

A

Ultrasound 7-14 ays after misoprostol: absence of GS and endometrial thickness <30mm

94
Q

Medication that has shown possible association with vulvodynia

A

OCPs

95
Q

How to evaluate acute diverticulitis

A

CT

96
Q

Most common (75%) of all cases of pediatric vulvovaginitis

A

Nonspecific vaginitis

97
Q

Requirements of the American Institute of Ultrasound in Medicine (AIUM)I

A

If you’ve completed residency more than 3 years ago, in the last 36 months, must have attained:

  1. at least 30 AMA Physicians Recognition Award Category 1 Credits
  2. Supervised, interpreted, and reported at least 300 diagnostic obstetric US exams
98
Q

65 yo with lifetime negative cervical cancer screening, cytology is negative but insufficient cells

A

Do HPV testing

99
Q

Exemptions to Physician Payments Sunshine Act

A 
CME
Buffet meals
Samples for patient use
Educational materials for patient use
Loan of medical devices <90 days
Transfer of anything of value to a physician when physician is a patient
Discounts
Charity care
Anything less than $10 unless aggregate amount exceeds $100
100
Q

When should colon cancer screening begin in African Americans

A

45 years old

101
Q

When should colonoscopies be discontinued

A

75 if normal in last 10 years

102
Q

Pneumococcal vaccine recommendation for vaccine naive individuals 65 and older

A

PCV13 at 65, then PPSV23 6-12 months later

103
Q

Pneumococcal vaccine recommendation for individuals who previously received PPSV23 at 65 years or older

A

PCV13 after one year from PPSV23

104
Q

Pneumococcal vaccine recommendation in individuals who previously received PPSV23 before age 65 and who are now 65 or older

A

Wait at least a year and do PCV13 at 65, then PPSV23 6-12 months later

105
Q

Pulmonary changes during Trendelenberg positioning

A 
Airway resistance increases
Chest wall compliance decreases
Functional residual capacity decreases
Functional vital capacity decreases
Total lung volume decreases
106
Q

First step i evaluation of nonpalpable contraceptive implant

A

Urine pregnancy test

107
Q

Advantage of bazedoxifene in patients taking estrogen

A

Prevents bone loss and protects endometrium

108
Q

When should post-exposure prophylaxis for HIV be given in sexual assault victims?

A

In the first 72 hours

109
Q

Postexposure prophylaxis for sexual assault

A

28 day course of three drug regimen (tenofovir, emtricitabine, and raltegravir)

110
Q

Prophylaxis for recurrent UTI in postmenopausal women

A

Daily antibiotic

not enough evidence for estrogen yet

111
Q

HPV vaccine before age 15

A

Two doses, 6-12 months apart

112
Q

HPV after age 15

A

Three dose regimen, second dose 1-2 months after the first and the third given 6 months after the first

113
Q

HPV vaccine not FDA approved for individuals over

A

26 years old

114
Q

Vulvar itching that began with an inciting fungal infection or other event
Scaling and lichenified plaques
Erosions and ulcers
Hyper and hypo pigmentation
Biopsy shows thickened rete ridges, thickened granular layer, hyperkeratosis

A

Lichen simplex chronicus

115
Q

Vaginal pruritis, irritation
Thinned, crinkly white skin
Figure of eight appearance
Biopsy shows markedly thinned epithelium and blunting of rete ridges, sometimes hyperkeratosis

A

Lichen sclerosus

116
Q

Inflammatory of mucosa and genital tract
White reticulate lacy, fernlike
Adhesions of labia
Biopsy shows degeneration of basal layers, lymphocytic infiltrate of the dermis, epidermal acanthosis

A

Lichen planus

117
Q

Elevated in granulosa cell tumors

A

Inhibin B

118
Q

Yolk sac tumor presentation

A

Acute abdominal pain and a huge pelvic mass

119
Q

Elevated in yolk sac tumor (endodermal sinus tumor)

A

AFP

120
Q

Dysgerminoma presentation

A

Abdominal pain, fever, ascites

121
Q

Elevated in dysgerminoma

A

LDH, hCG

122
Q

Screening for prostate cancer in transgender females

A

Offer PSA screening after age 50 if they transitioned after 20

123
Q

Class 1 recommendation for contraception in patients with SLE, APLS, etc

A

Copper IUD

124
Q

What medication is most likely employed for adolescent obesity which is not responding to lifestyle changes?

A

Tetrahydrolipstatin

125
Q

What are the most likely organisms implicated in genital pruritis and vaginal discharge

A

Respiratory organisms

126
Q

How many milliliters does a super plus tampon hold

A

15-18

127
Q

Medical treatments for acute menstrual bleeding in adolescents

A

Conjugated equine estrogen
Medroxyprogesterone acetate
Tranexamic acid
Combined oral contraceptives

128
Q

Type of suture for Pomoroy

A

0-plain catgut

129
Q

Poliglecaprone type of suture

A

Monofilament absorbable

130
Q

Most common treatment/procedure for endometrioma

A

Excision/stripping

131
Q

What drug should be avoided in patients receiving a full opioid agonist

A

Butorphanol

132
Q

Androgen sensitive skin areas

A 
Thighs
Face
Back
Sternum
(NOT AXILLARY)
133
Q

Relative risk for what cancer is increased when taking OCPs

A

Cervical

134
Q

Medication for chronic neuropathic pain

A

Gabapentin and pregabalin

135
Q

Factor that has been associated with later menopause

A

High parity

136
Q

Medication for osteoporosis that increases osteoblasts and stimulates bone formation

A

Recombinant PTH

137
Q

What is most valuable in detecting a gas embolus intraoperatively

A

End tidal CO2

138
Q

Mood stabilizer that is most likely to result in bone resorption

A

Lithium

139
Q

Treatment of a flat dome shaped umbilicated lesion of the vulva

A

Intralesional interferon
Podofilox
Imiquimod
Curettage

140
Q

Hormone that increases only in mid lutéal cycle

A

Inhibin A

141
Q

HLA-DR4

A

Rheumatoid arthritis

142
Q

Colposcopic finding most indicative of invasive cervical carcinoma

A

Atypical vessels

143
Q

Most common presentation of erosive lichen plan is

A

Dyspareunia

144
Q

Next step in management of 9yo with mass posterior to the areola

A

Observation

145
Q

Goal LDL

A

Less than 100

146
Q

Treatment for breast budding after giving estrogen for labial adhesions in a child

A

Bêta méthadone créma

147
Q

What age does a woman gain maximum bone density

A

19

148
Q

Most important treatment in panhypopituitarism

A

Cortisol

149
Q

Chronic pelvic pain with history of DV, extra screening?

A

Depression

150
Q

Antibiotic that decreases serum concentration of OCPs

A

Rifampin

151
Q

Components in the treatment of thyroid storm

A

PTU
Iodine
Beta blocker
Dexamethasone

152
Q

Extraintestinal manifestations of Crohns

A

VTE
Renal calculi
Osteoporosis
B12 deficiency

153
Q

Androgens produced by the ovary

A

Testosterone
Androstenedione
DHT
DHEAS

154
Q

Which phase of cell cycle does protein synthesis, RNA synthesis, and DNA repair occur

A

G1

155
Q

VIN III with 0.9mm invasive carcinoma and clear margins?

A

Observation

156
Q

E6

A

P53

157
Q

E7

A

Rb

158
Q

Bone formation markers

A

Osteocalcin
Bone specific alk phos
Procollqgen type 1
N terminal pro peptide

159
Q

Other pathology you might find at time of surgery for endometriosis

A

Unicornuate uterus

160
Q

Most likely side effect of paroxetine

A

Neuro

161
Q

Urogénital sinus gives rise to

A

Urinary bladder
Hymen
Lower vagina
Paraurethral glands

162
Q

Progestins derived from 19-nortestosterone

A

Levonorgestrel
Norethindrone
Norgestimate
Desogesterol

163
Q

Risk factors for HIT

A

Heparin >4days
UFH
Female
Surgery

164
Q

Most frequently encountered problems associated with TPN

A

Catheter tip infections

165
Q

Most common sex hormone aneuploidy

A

Klinefelters XXY

166
Q

Mechanism of action of heparin

A

Inactivation of thrombin

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