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OBGYN Oral Boards > GYN > Flashcards

GYN Flashcards

AUB, adnexal mass, ectopic, molar,

1
Q

Contraindications to UAE

A

Hypersensitivity to contrast agent used in angiography
Malignancy
Coagulation disorders which cannot be corrected
Pregnancy
Infections or inflammation of the reproductive or urinary tract
History of pelvic irradiation
Hyperthyroidism
Renal failure
Women who are not ready to accept the approximately 3-20% risk of failure and subsequent absolute need for hysterectomy due to intractable pelvic pain or infection after UAE

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2
Q

How to dose NSAIDS for AUB ?

A
  • ibuproben 600mg daily

- naproxen 500mg at start of period, then 250-500mg BID for 4-5 days.

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3
Q

How to dose TXA for AUB?

A

1.3g TID up to 5 days

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4
Q

Vulvodynia treatment

A
  • eliminate triggers
  • topical anesthetic ointment
  • amitriptyline
  • pudendal nerve block
  • topical steroids
  • gabapentin
  • botox
  • PFPT
  • consider bx because 60% of dermatoses
  • refractory localized vulvodynia-can offer vestibulectomy.

try each one for 3-6 months

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5
Q

Lichen sclerosis histology

A

thinned epithelium, blunting of the rete ridges, chronic inflammatory infiltrate in the dermis

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6
Q

For which STDs does ACOG recommend expedited partner therapy?

A

Gonorrhea and Chlamydia

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7
Q

Painful ulcers DDx

A

Herpes

Chanchroid

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8
Q

Painless ulcers DDx

A

Lymphogranuloma venerium,
Syphillis,
granduloma inguanale
aka Donovanosis

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9
Q

Herpes

Exposure to onset
Symptoms

A
  • 4-6 days

- can have fevers, myalgias that last 3-4 days

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10
Q

Herpes
Describe the clinical course of the first outbreak

how long is viral shedding possible?

How long until antibodies appear?

A

worsening symptoms for 6-7 days then gradual improvement into week 2.

viral shedding until lesions are crusted over

12 weeks until antibodies

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11
Q

Recurrent Herpes
Describe the clinical course

How long is viral shedding possible?

A

prodrome 1-2 days before lesions, then lesions for 4-5 days until the lesions crust over

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12
Q

Herpes

How to test for it?

A

viral culture swab of unroofed lesion

OR

PCR for CNS
cytology is no longer recommended

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13
Q

Herpes

first time treatment?
recurrent treatment?
suppression treatment?

alt options, MOA, SE

A

Warm soaks, sitz baths, lidocaine jelly

First

  • acyclovir 400mg TID x 7-10 days
  • valacyclovir 1g BID x 7-10 days

Recurrent
acyclovir 800mg BID x 5 days
Valacyclovir 1g daily x 5 days

suppression
acyclovir 400mg BID
valacyclovir 1g daily

inhibits viral DNA polymerase by inserting into viral dNA and acting as a chain terminator, n/v/d, headache, rash, itching

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14
Q

Herpes in pregnancy

Risks to fetus if primary outbreak is in the first trimester?
When to start suppression?
criteria for c-section?
Chance of transmission?

A

chorioretinitis, microcephaly, skin lesions

36 weeks

active lesions, prodromal symptoms, or outbreak in the 3rd trimester.

  • 40-80% transmission if primary outbreak at delivery
  • 3% transmission if recurrent lesion at delivery
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15
Q

Chanchroid

organism?
presentation?
how to diagnose?
How to treat?

A

Haemophillus ducreyi

superficial ragged edge ulcer, red halo, necrotic exudate

clinical dx-VERY painful ulcer and lymphadenopathy
can do PCR

azithro 1g PO once
CTX 250mg IM once

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16
Q

What is a bubo?

When does it present?

A

painful lymphadenophathy seen in chanchroid and LGV

7-10 days after initial chancroid lesion or by itself with LGV

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17
Q

Lymphogranuloma venereum

organism?
presentation?
how to diagnose?
How to treat?

A

Chlamydia trachomatis

painless ulcer w or w/o bubo, cervicitis, urethritis, groove sign

clinical vs. swab of ulcer or aspirate the bubo and send for chlamydia NAAT

Doxy 100 BID x 21 days
azithromycin 1g weekly x 3 weeks

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18
Q

Granuloma Inguinale aka donovanosis

organism?
presentation?
how to diagnose?
How to treat?

A

-klebsiella granulomatis
SLOW growing painless ulcer, beefy red, very vascular
-subQ granulomas, NO lymphadenopathy
-clinical of tissue smears

-azithromycin 1g weekly for at least 3 weeks and until lesions are healed

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19
Q

Syphilis

organism?
when to screen?

A

treponema pallidum

  • all pregnant women in 1st and 3rd trimester
  • MSM
  • HIV, taking PrEP, partner with syphilis
  • incarcerated, prostitution, males under 29 years
  • high local prevalence
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20
Q

Syphilis

How to diagnose?
next step after dx?

A

Screen with nontreponemal test: RPR (rapid plasma reagin) or VDRL (venereal dz research lab)
^use this to direct treatment as treponemal tests are positive for life

Confirm with treponemal test: flourescent treponemal antibody absorption or t. pallidum particle agglutination

report to health department

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21
Q

Causes of false positive RPR or VDRL

A

older age, pregnancy, cardiovascular disease, malaria, leprosy, recent immunizations

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22
Q

primary syphilis

incubation period
symptoms
how long until they resolve

A

painless chancre and lymphadenopathy 10-90 days from exposure

3-6 wks regardless of treatment

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23
Q

Secondary syphilis

onset timing
symptoms
how long until symptoms resolve

A

4-8 weeks after chancre

maculopapular rash/lymphanopathy, malaise, fever, condyloma lata

resolve after 2-6 wks regardless of treatment

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24
Q

Early Latent Syphilis

how to diagnose?

treatment

A
  1. +serology
  2. no past dx of syphilis
  3. no evidence of primary, secondary, or late
  4. suspect infection was in the last 12 months

must treat because of transplacental transmission

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25
Q

Late Latent Syphilis

how to diagnose?

A
  1. +serology
  2. no past dx of syphilis
  3. no evidence of primary, secondary, or late
  4. suspect infection was over a year ago
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26
Q

Tertiary syphilis

symptoms

A

gumma,
cardiovascular,
neurosyphilis,
benign late syphilis

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27
Q

symptoms of neurosyphilis

A

meningitis
pain
paresthesia
loss of DTR
ataxia
tabes dorsalis (demylenation of the dorsal nerve roots of the spinal cord-lightening pain down the leg)
Argyll Roberston pupil (accomodate to distance, but dont react to light)

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28
Q

Syphilis treatment

primary, secondary, early latent, late latent without neuro sx

A

primary, secondary, early latent: PCN G 2.4 mil units IM once

OR

Doxycycline 100mg BID x 14 days

Late latent without neuro sx or latent of unknown duration
-PCN G 2.4 mil units IM weekly x 3 OR doxy 100 mg BID x 28 days

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29
Q

Neurosyphillis

dx and rx

A

test CSF first

aqueous crystalline PCN G
3-4 mill units IV q4hr for 10-14 days

OR procaine PCN 2.4 mil units IM daily x 10-14 days PLUS probenicid 500mg 4x daily 10-14 days

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30
Q

you start treating syphilis and the patient breaks out in a rash and fever in the first 2-8 hrs.

Whats the management?

A

jarisch-herxheimer reaction from killing the spirochete, treat with tylenol

occurs 95% of the time in primary and secondary symphilis

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31
Q

Syphilis

How to follow patients after initiating treatment?

A

Check titers at 6 and 12 months

Primary and secondary syphilis: expect to see a 4 fold drop (1:16–> 1:4) at 6 months
8-fold drop at 12 months

Early latent syphilis: check titers at 6, 12, 24 months
4-fold drop 12 months

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32
Q

You treat syphilis appropriately, but titers are not decreasing. next steps

A

check HIV, re-treat, CSF exam

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33
Q

your patient informs you that a previous partner was dx with syphilis within the last 90 days. What do you tell her?

A

treat her since her exposure was within the last 90 days.

If greater than 90 days, but we don’t have serology on her, then treat her.

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34
Q

Pubic lice

organism
diagnosis
treatment

A

pediculosis pubis

permethrin 1% cream
OR
malathion 0.5% lotion
OR ivermectin 250mcg/kg,PO, repeat in 7-14 days

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35
Q

Warts

organism
diagnosis
treatment

A

HPV 6 and 11 most commonly

clinically, can have maternal transmission up to 3 years

Pt applied: imiquimod 3.75% of 5% OR podofilox 0.5%

Doctor applied: Trichloracetic acid in the office OR cryotherapy or excision.

Tca is 1x for 4-6 weeks or until they go away

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36
Q

Chlamydia

presentation
diagnosis
treatment

A

asymptomatic, mucopurulent cervicitis, PID, endometritis

NAAT swab of cervix or urine
screen all sexually active women under 25 or older with risk factors

doxy 100mg BID x 7 days or azithro 1g once
TOC in 3 months and at next well woman

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37
Q

Chlamydia in pregnancy

fetal risks
treatment

A

chlamydia PNA, conjunctivitis

azithro 1g PO x 1 or amox 500mg TID x 7 d
TOC in 3-4 weeks

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38
Q

Gonorrhea

presentation
diagnosis
treatment

A

mucopurulent discharge, dysuria, AUB, bartolin’s/skene’s abscesses, conjuctivitis

NAAT of cervical swab, urine, or self-swab

CTX 500mg IM once (1g IM if >150kg)
OR gentamicin 240mg IM +azithromycin 2g PO

ONLY add chlamydia treatment if you have not ruled out chlamydia dx.

TOC in 2wks only if pharyngeal infection.

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39
Q

you treat for gonorrhea, but TOC is still positive. Next step?

A

send culture and get sensitivities.

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40
Q

Name the reportable STIs.

A

syphilis, gonorrhea, CMT, chanroid, and HIV,

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41
Q

trichomonas

presentation
diagnosis
treatment

A

can be asymptomatic for YEARS

strawberry cervix, yellow/green/frothy discharge

NAAT testing

metronidazole 500mg BID x 7 days OR tinidazole 2g PO once
no ex for 7 days
TOC in 3 months

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42
Q

Trich TOC still positive. Next steps

A

assess for reinfection
treat with tinadazole 2g PO daily and tinadazole 500mg BID per vagina for 14 days

if still positive, talk to CDC and ID

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43
Q

PID

diagnosis
treatment outpatient

A

lower pelvic pain PLUS
uterine tenderness or adnexa tenderness or cervical motion tenderness

CTX 500mg IM AND
Doxy 100mg BID x 14 days
Metronidazole 500mg PO BID x 14 days

OR replace CTX with cefoxitin 2g IM wi/probenecid 1g PO x 1

f/u in 2-3 days, then 1 month

44
Q

PID inpatient treatment

A

CTX 1g IV q24hrs AND
doxy 100mg PO or IV BID AND
metronidazole 500mg PO or IV BID

OR

clindamycin 900mg IV q 8hrs
gent 2mg/kg loading dose followed by 1.5mg/kg q8hrs

45
Q

PID when to operate

A

no improvement after 3-4 days of IV abx
ruptured abscess
acute abdomen
sepsis

consider IR for drainage

46
Q

HIV

health maintenance

A

CD4 q 3-6 months
viral load q 3-6 months and 1 month after changing meds

check all of the following
PPD, syphilis, toxo IgG, CMV igG,

vaccine
pneumococcal
flu
Hep B
H. influenzae B
Hep C
47
Q

HIV

clinical course

A

window course
4-8 wks asymptomatic

Seroconversion
-flu-like symptoms, rash,
-abs development
-

clinical latency-asymptomatic

48
Q

HIV when to section

when is vaginal delivery okay?

A
  • viral load >1000 copies/mL or unknown viral load, section at 38 weeks
  • viral load <1000 on meds you can go 39wks
49
Q

Flibanserin

Use
MOA
SE
Contraindications

A

Female sexual interest/arousal disorder.

serotonin receptor agonist and antagonist
100mg PO Qhs

weight loss, somnolence, dizziness, nausea

contraindications 
post-menopausal women
EtOH within 2 hours of med
liver disease
CYP3A4 inhibitors-erythromycin, diltiazem, verapamil, grapefruit
50
Q

Bremalanotide

Use
MOA
SE
Contraindications

A

Female sexual interest/arousal disorder

SubQ prn 45 mins before sex, 1 dose per 24hrs

nausea/flushing/site reaction, slows gastric emptying

contraindication: HTN, post-menopausal women

51
Q

treatment for post menopausal women with female sexual/arousal disorder.

A

short term trnsdermal testosterone can be considered per ACOG, not FDA approved

300mcg T patch, assess at 6 weeks, discontinue by 6 months if no help.

52
Q

Menopausal-related sexual dysfunction medication options

A
  • ospemefine

- Prasterone

53
Q

Side effects of HRT

A 
AUB
breast tenderness
nausea
bloating
hair loss
fluid retention in arms and legs
dizziness
54
Q

Absolute Contraindications to HRT

A

Active or recent clots
undiagnosed AUB
breast cancer
estrogen dependent neoplasm

55
Q

Relative contraindications to HRT

A 
previous clot
liver dz
gallbladder dz
endometriosis
migraine with aura
smoking
severe hypertriglyceridemia
56
Q

When to start HRT

A

age under 60 within 10 years of the stat of menopause

57
Q

How to prescribe HRT?

A

Many different ways, pick one

estradiol 1mg PO daily OR

  1. 05 transdermal ethinyl estradiol daily, replace patch weekly OR
  2. 625mg conjugated equine estrogen PO

if she has a uterus, add progestin
PO: estradiol/drosperinone 1mg/0.5mg daily
Transdermal: estradiol 0.45mg/0.015mg oer day, replace patch weekly
or ADD: LNG-IUD (6 yrs) or prometrium 100mg PO daily

58
Q

WHI

What age group?
What risk factors did patients have?
Which hormone dosing?
what was it assessing?

A
  • 50-79 years, menopausal x 10 years
  • BMI 28.5, 40% smokers, 40% HTN
  • conj equine estrogen 0.625mg and medroxyprogesterone 2.5mg
  • assessed for heart dz, bone frax, breast and colon cancer
  • All HRT increases risk of clots/stroke and decrease risk of fracture
  • E+P group: increased MI risk and breast cancer, decreased risk of colon cancer
  • E only: insignificant decreases risk of breast cancer, no impact on MI and colon cancer
59
Q

Do not give SSRI in combination of which chemoprevative drug

A

tamoxifen
give venlafaxine- SNRI is safer
paroxetine is a CYP P450 inhibitor

60
Q

At what frax score do you move to a DEXA?

A

9.3% risk of major fracture

fracture risk assessment tool
dual energy xray absorptometry

61
Q

At what, FRAX score do you start treatment

A

3% hip

20% overall

62
Q

Treatment options for vaginal atrophy

A
  • lubricants, conservative
  • vaginal estrogen
  • Ospemefine
  • Prasterone
63
Q

What is ospemefine?
MOA
contraindications
do you need progestin?

A

Pill for FDA-approved moderate-severe dyspareunia in postmenopausal women

Estrogen agonist/antagonist
CI: same as HRT
Progestin not need if under 1 year

64
Q

What is prasterone?
MOA
contraindications

A

vaginal insert for

65
Q

What is prasterone?
MOA
contraindications

A

vaginal insert for mod-sev dysparuenia in post menopausal women

steroid-dehydroepiandrosterone 6.5mg qhs
same CI as HRT

66
Q

You have diagnosed osteoporosis.

Next step?

A

consider other causes of osteoporosis
order CBC, CMP, TSH, 24 hr urinary calcium level, 25-hydroxyvitamin D level

consider celiac panel, serum protein electrophoresis

67
Q

Which patients should not calculate a FRAX for?

A

<40
already on meds
already osteoporotic
prior hip or vertebral fractures

68
Q

who gets a FRAX?

A

low bone density or osteopenia on DEXA–>if FRAX is 3% hip or 20% major–> start med
Patient is worried, but does not meet DEXA criteria

69
Q

Who gets DEXA?

A 
65+
history of fragility frax
<127lbs
smoker
EtOH
Rheumatoid Arthritis
parent with history of hip fracture
70
Q

Bisphosphonates

MOA
CI
alterntives

A

inhibit osteoclast activity

CI: for orals, cannot sit up for 30 minutes after. esophagitis, renal impairment, hypocalcemia, hx of rous en Y gastric bypass,

alternatives: denosumab, raloxifene, tamoxifen (not FDA approved), HRT, nasal salmon calcitonin, recombinant human parathyroid hormone
- ab to RANK-L, 60mg SC q6 months

71
Q

MOA and CI for the following alternative osteoporosis treatments

denosumab
raloxifene
nasal salmon calcitonin
recombinant human parathyroid hormone

A

Denosumab: -ab to RANK-L, 60mg SC q6 months, may be need lifelong due to relapse

Raloxifene-SERM, inhibit bone resorption, SE-VTE/vasomotor, good for ppl who need breast cancer ppx

Nasal salmon calcitonin-inhibits osteoclasts, must be at least 5 years out

rPTH-activates bone formation, can only use for 2 years, only for severe dz

72
Q

What do you include in a comprehensive well women visit?

A 
Any specific patient concerns
update med/surgical hx, GYN, family hx
medications
tobacco, etoh, substance abuse
personal safety
immunizations
cancer/health screening
73
Q

What does BiRADs stand for?

what is the probability of malignancy with each score?

A

Breast Imaging-Reporting Data system

0-need more evaluation
1-0%
2-0%
3- <2%
4- 20%
5- 90%
6-100%
74
Q

Who gets breast MRI?

A

> 20% lifetime risk of breast cancer
BRCA1 or BRCA2
first degree relative with BRCA and pt has not been tested
chest radiation therapy between 10-30 yo

Li-fraumeni
Cowden
Bannayan-Riley-Ruvalcaba

75
Q

Who to refer for bariatric surgery?

A

BMI >40

BMI >35 with medical co-morbidities

76
Q

who gets breast cancer chemo prevention?

When to use tamoxifen vs raloxifene?

A

Gail model 5 yr risk >/= 1.7% or lifetime risk of >/= 20%

anybody can get tamoxifen, but only postmenopausals can get raloxafene

REMEMBER -raloxafene is good for osteoporosis.

77
Q

Lipid screening by age

A

9-11- once
18-21 once
40-75- every 5 yrs.

consider starting a low-moderate dose statin based on elevated risk

78
Q

Went to stop pap?

A

65 with negative paps for the last 10 years

79
Q

When to start pap in the following populations?

DES
HIV
Cancer/immunocompromised

A
  • DES, annual cytology starting at age 21
  • HIV-within one year of being sexually active, start with cytology alone and if normal for 3 years, then you can mov to standard testing.

cancer/immuno…treat like HIV

80
Q

HNPCC

when to do risk reducing surgery and what are you doing?

A

hyst BSO at 35-40 after childbearing

81
Q

alternative to colonscopy

A

flex sig q 5 years

stool guiac-2 samples from 3 consecutive BMs

82
Q

When to give pneumococcal vaccine

A

65+
pneumococcal conjugate vaccine (PVC13)
pneumococcal polysaccharide vaccine (23)

give PVC13 then PPSV23 6-12 months later, ok in pregnancy

83
Q

When to give zoster vax?

A

2 doses 2-6 months apart in every 50+ regardless of natural immunity.

84
Q

How long is liletta FDA approved for?

A

6 yr

85
Q

OCPs

Patient wants control of acne.
which progesterone class do you give?
A

third gen because it has fewer androgen side effects

ex desogestrel, norgestimate

86
Q

OCPs

Patient has PMS.
which progesterone class do you give?
A

4th gen

Drosperonone bc FDA for PMS

87
Q

OCPs

Patient missed one pill.

recs?

A

Take the missed pill now, take the next pill at the usual time and use condoms for 7 days

88
Q

OCPs

Patient missed two pills.

recs?

A

Take two pills now. take another two pills tomorrow at the usual time, continue with the pack and use condoms for 7 days.

89
Q

OCPs

Patient missed three pills.

recs?

A

toss the pack and start a new pack, use condoms for 7 days.

90
Q

Contraception failure rates

Etonogestrel implant
Hormonal IUD
Copper IUD
vasectomy
Combination OCP
Tubal ligation
Male Condom
A 
Etonogestrol implant 0.05%
Copper IUD 0.08%
Hormonal IUD 0.2%
Vasectomy 0.15%
Combination OCP 9%
Tubal ligation 18-37/1000
Male condom 18%
91
Q

relative CI to MTX for ectopic

A

4+cm
heartbeat present
hcg 5000+

jehovahs witness or anemic

92
Q

Diagnostic features of failed IUP

A

CRL 7mm without HB
GS 25mm + without HB
no embryo with HB 2 wks after GS with no yolk sac
no embryo with HB 11 days after GS WITH yolk sac

93
Q

Absolute contraindications to endometrial ablation

A

pregnancy, known or suspected endometrial hyperplasia or cancer, desire for future fertility, active pelvic infection, IUD currently in situ, and being post-menopausal

94
Q

histology of squamous cell hyperplasia of the vulva

gross appearance

age

treatment

A

thickened epithelium, no inflammatory infiltrate

grossly-leathery appearance

age 30-60

triamcinolone and antihistamines

95
Q

Top three causes of death by age

1-19

A

accidents
cancer
suicide

96
Q

Top three causes of death by age

20-44

A

accidents
cancer
heart dz

97
Q

Top three causes of death by age

45-64

A

cancer
heart dz
accidents

98
Q

Top three causes of death by age

65-85

A

cancer
heart dz
chronic lung disease

99
Q

painless bleeding, 6 year old, chronic constipation and asthma, presents with a mass at the introitus

most likely dx

A

urethral prolapse

rx underlying cause, sitz baths, estrogen cream BID for 1-4 weeks

100
Q

IBS Rome criteria

A

recurrent abdominal pain

  • onset 6 months ago
  • 1 day/wk for 3 months
  • associated with 2 or more of the following:
  • relation to defecation
  • associated with change in stool frequency
  • associated with change in stool appearance
101
Q

describe the bristol stool form scale

A

1 to 7

1 hard
4 is normal
7 watery

102
Q

IBS subtypes

A

Diarhea
conspit
mixed
untyped

103
Q

IBS work up

A

CBC
chem for volume depletion
WBC, stool cx, ova and parasite, c. diff

rule out colon cancer symtpoms

104
Q

IBS D meds

A

antimotility
loperamide, diphenoxylate

anticholinergics
belladonna, dicyclomine, hycosamine for bloating and gas

HIGH fiber diet (25-35 grams/day)

105
Q

IBS C meds

A

lubiprostone, linaclotide

HIGH fiber diet (25-35 grams/day)

OBGYN Oral Boards (6 decks)

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