Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OBGYN EOR > gyn > Flashcards

gyn Flashcards

1
Q

definition of primary amenorrhea

A

absence of menses by age 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

deginition of secondary amenorrhea

A

in a woman who has previously had mesnes it is the absences by 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

primary amenorrhea is divided into these four categories

A

gonadal dysgenesis (turner)

hypothalamic pit insufficiency

androgen insensitivity

imperforate hymen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

in a women with normal estrogen the most likely secondary cause of amenorrhea i

A

asherman’s syndrome (intrauterine synechiae)

or
PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

in women with hypoestrogen secondary amenorrhea is most likely due to these three casues

A

CNS tumor
hyperprolactinemia
or
PCOS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

diagnostic studies for secondary amenorrhea

A

first line is b HCG fr pregnancy
TSH
and prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

secondary tests ordered for secondary amenorrhea

A

FSH
estrogen
LH
and testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

primary dysmenorrhea is caused by

A

Primary is painful mensuration caused by
excess prostaglandin and leukotriene levels leading to painful uterine contractions nausea vomiting and diarrhea

onset is usually within 2 years of menarche

NO PATHOLOGICAL ABNORMALITY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Secondary dysmenorrhea (4)

A

painful mensuration caused by an identificale clinical condition usually of the uterus or the pelvis

endometriosis

adenomyosis (growth of endometrial tissue in the wall of the uterus)

uterine fibroids
PID
and IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

primary dysmenorrhea usually peaks during

A

late teens and early 20s and incidence of secondary dysmenorrhea increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the karyotype of turners

what are the hormones associated

A

45 XO

high FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment for tuenr’s syndrome

A

cyclic estrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the hypo pit insufficiency look like in a pt with primary dysmenorrhea

what is the treatment

A

NO breast development

46 XX

low FSH
low LH

give cyclic estrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what does androgen insensitivity look like in a pt with primary dysmenorrhea

A

46 XY

normal breast development

high testosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the treatment for androgen insensitivity

A

remove the testes and start estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how does sxs of secondary dysmenorrhea differe from sxs of primary dysmenorrhea

A

secondary symptoms are more likely to
include bloating
menorrhagia
dysparunia

and less likely related to the first day of lfow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

primary dysmenorrhea treatmetn

A

start NSAIDS just before the expected menses and continue for 2-3 days

OCP vitamin B
magnesium
ancupuncture
application of heat
regular exercise also help to reduce pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

for resistant cases of primary dysmenorrhea try

A

tocolytic agents
CCB
progestogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the tests done for evaluating secondary casuses of dysmenorrhea

A

hysteroscopy
D and C
larproscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is PMS syndrome what is the hypothesized cause

A 
abnormal levels of 
estrogen, 
progesteron 
cortisone
 prolactin and 
antidiuretic hormone as well s endogenous opiates melatonin serotinonin prostaglandins
vitamin and mineral deficiencies 
reactive hypoglycemia
menstural toxins 
pyschological social evolutionary and genetic factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

the reported incidence of PMS is

A

10-90% with 10% debilitated

prevalence is greatest during the fourth and fifth decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

association exists between PMS and

A

postpartum depression
perimenopausal depression
other affective disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

clinical features of PMS

A

Associated with the menstrual cycle and being 1 to 2 weeks before menses during the leutal phase and end 1 to 2 days after the onset of menses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what must exist in order to have PMS

A

a monthly symptom free period during the follicular phase from day 1 to ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

most common complaints with pms are

A

mood changes and psychological affects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PMS symptoms outside of mood changes

A

fluid retention edema weight gain breast pain

backache, constipation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

lifestyle modifications for PMS

A 
caffeine reudction
salt restriction
low fat
high complec carb intake
magnesium 
vitamin B
relaxation 
stress reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

drug treatment for PMS

A

pyridoxine (vitamin B6) and evening primrose oil show NO BENEFIT over placebo in clinical trial but relieve breast tenderness and depression in some women

calcium carbonate
magnesium
B6 and vitamin E supplementation have been shown to benefit some women

nsaids
SSRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what can be used to relieve breast tenderness in PMS

A

spironilactones

bromocroptine may relieve mastalgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what antianxiety medications can people use from PMS

A

buspirone or alprazolam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

vasomotor symptoms with menopause usually resolve within

A

2 to 3 years

3 to 6 weeks with estrogen replacement therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

urogenital atrophy can cause what kind of incontinence

A

urge incontinence

can also cause atrophic cystitis and easy bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

other than hot flashes and vaginal atrophy what other sxs do you see with menopause

A 
changes in sleep cycle 
skin becomes thin and loses elasticity 
increased facial hair 
hair lose
nails become brittle 
confusion nloss of mempry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

diagnostic studies for menopause

A

increased FSH greater than 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

menopause management

A

regular exercise
HRT but this increases the risk of cardiovascular disease breast cancer and cognitive changes

other potential risks include gallbladder disease and migraines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

CI to HRT (4)

A

Undiagnosed vaginal bleeding

acute vascular thrombosis

liver disease

history of endometrial of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what meds can be described for women at risk of steoperosis

A

Ca and vitamin D

bisphosphinates

SERMS (selective estrogen recpetor medulators)

or calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what alternative treatments are available for women in menopause

A

soy
black cohosh
ginseng can help relieve symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

DUB is defined as

A

abnormal bleeding in the absences of an anatomic lesion usually caused by a problem with the hypo pit ovarian system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

when is DUB most liekly to occur

A 
shortly after menarch or in peri-menopause
other causes include 
PCOS
exogenous obesity 
and adrenal hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

diagnostic studies for DUB

A 
b hcg
CBC 
PT
PTT
documentation of ovulation 
TSH
serum progesterone 
LFT
prolactin
serum FSH levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what would be done to investigate DUB

A 
pap
endometrial biopsy 
ultrasonography
hyterosalpingography
hysteroscopy 
and or Dand C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

management of DUB

A

observation iron therapy and volume replacement may be needed
oral high dose estrogens might ald=so be indicated

a progesterin trial should be performed and if the bleeding stops the cycles are confirme d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

OCP for DUB

A 
older women without risk factors can be prescriped OCP
SHOULD NOT be used in 
women who smoke
have hypertension
DM
hx of vascular disease 
breast cancer
liver disease
focal headaches
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

what can you use in younger pts with DUB

A

cyclic progestins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

refractory cases of DUB might require

A

endometrial ablation of vaginal hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

leiomyoma are most common during

A

uterine fibroids are most common in the fourth decade of life in black women and those with positive family hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

fibroids depend on

A

estrogen and appear with increased frequency in

women with endometrial hyperplasia,
anovulatory states,

and estrogen producing ovarian tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

fibroids can be classified by

A

their location

subserous (deforming external serosa)

intramural (within uterine wall)

submucous (deforming the uterine cavity) .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what kind of fibroids cause bleeding

A

submucousa

bleeding is the most common symprom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what are the clinical features of fibroids

A

msot have no sxs
sometimes you can feel a enlarged uterine mass
some will have symptoms of a full pelvis

menorrhagia
metrorrhagia
intermenstural bleeding
dysmenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

what is the risk to pregnant women with leiomyoma

A

spontaneous abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

diagnostics for fibroids

A

D&C
saline hysteroscopy
hysterosalpinography
laparascopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

why would you get LFTs in a pt with dub

A

You rule out liver disease that would cause them to not make clotting factors. So the bleeding is because of coagulopathy issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

why are OCP CI with livr disease

A

The liver metabolizes estrogen, so its CI with liver disease.Is the bottom line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

liver disease that happens in pregnancy

A

Cause also in pregnancy when estrogen levels are extremely high it can precipitate intrahepatic cholestasis of pregnancy (ICP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

managment of leiomyoma

A

observation
symptomatic pts can undergo myomectomy, hysterectomy or D and C

can also do endometrial ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

how to use gnrh for leiomyoma

A

gnrh agonists and mifepristone may reduce tumor size in women with small leiomyoma

gnrh agonist may restore fertility

treatment is limited to 6 mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Medroxyprogesterone acetate what is it and how do we use it in PCOS

A

depot medroxyprogesterone acetate (DMPA) and sold under the brand name Depo- Provera

Medroxyprogesterone acetate given on the first 10 days of each month will promote regular shedding of the endometrium. If contraception is desired, a low dose oral contraceptive can be used.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

_________ is the most common type of endometrial carcinoma.

A

Adenocarcinoma is the most common type of endometrial carcinoma. In the US, 80% of endometrial carcinomas are of this type. Longer exposure to estrogen (i.e., early menarche, late menopause, and diabetes) is a risk factor for carcinoma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

_______ is a choice for a patient with symptomatic fibroids who would like to maintain fertility

A

Myomectomy is a choice for a patient with symptomatic fibroids who would like to maintain fertility and retain the uterus. There is, however, a significant risk for recurrence of leiomyomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

HSIL is associated with a high risk of ____

what is the managment

A

HSIL is associated with a high risk of CIN 2,3 or cervical cancer. In women 25 and older management with immediate colposcopy or LEEP is based upon these risks.

Immediate cervical ablation should not be performed because ablative procedures do not provide a specimen for diagnostic evaluation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

at what age group would you not do diagnostic procedure for HSIL

A

the recommendations for follow-up for abnormal cervical screening results differ for women ages 21 to 24 years from those for women 25 and older.
They advise a diagnostic excisional procedure only if abnormal results are severe or recurrent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

)________ is the safest and most effective method for termination of pregnancies up to 12 weeks. The majority of induced abortions in the US are via suction curettage.

A

Suction curettage is the safest and most effective method for termination of pregnancies up to 12 weeks. The majority of induced abortions in the US are via suction curettage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

when can you use misoprostil for an TAB

A

This patient is at 10 weeks and is therefore not eligible for medical abortion which is appropriate when a woman presents less than 49 days from LMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

first line treatment for HTN in pregnancy

A

methyldopa has the benefit of more research/studies and is recommended as the first-line treatment for hypertension in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

first-line treatment for hypertension in pregnancy.

A

Methyldopa has the benefit of more research/studies and is recommended as the first-line treatment for hypertension in pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

how can you differentiate cervical insufficiency vs SAB

A

his patient presents with cervical insufficiency. This is still a viable pregnancy because she has no abdominal cramping and she is now in the 2nd trimester but she is starting to dilate. A cervical cerclage is recommended between 13-16 weeks’ gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

when would you do a cervical cerclag

A

A cervical cerclage is recommended between 13-16 weeks’ gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is the workup for infertility in female

A

In the initial evaluation of the female partner, noninvasive procedures, such as the measurement of LH and mid-luteal phase progesterone (to determine ovulatory function) and TVUS (to rule out the possibility of fibroids or polycystic ovaries), are first-line investigations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

CI to cerclage

A

placement include bleeding of unknown etiology, infection, labor, ruptured membranes and fetal anomalies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

In patients with irregular cycles, secondary to chronic anovulation, or oligo-ovulation, combined oral contraceptive (COC) pills help to ….

A

In patients with irregular cycles, secondary to chronic anovulation, or oligo-ovulation, combined oral contraceptive (COC) pills help to prevent the risks associated with prolonged unopposed estrogen stimulation of the endometrium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what would you do for a pt with anovulatory cycles and a CI to COC

A

Treatment with cyclic progestins for days 16 through 25 following the first day of the most recent menstrual flow is preferred when OCP use is contraindicated, such as in smokers older than age 35 and women at risk for thromboembolism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

how to treay leiomyoma bleeding

A

The heavy bleeding that typically accompanies fibroid tumors can be minimized by using intermittent progestin supplementation (depot methodroxyprogesterone acetate 150 mg IM every 28 days) and/or prostaglandin synthetase inhibitors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

treatment form chlamydial PID

A

One recommended outpatient treatment is Ofloxacin 400 mg once daily for 14 days; with or without metronidazole 500 mg twice daily for 14 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

what are symptoms of a ovarian cyst and what is indicated

A

Symptoms associated with a functional ovarian cyst include mild to moderate unilateral pain and alteration in the menstrual cycle. On occasion, rupture of the follicular cyst causes acute pelvic pain and may need laparoscopic surgery for complete evaluation. In most cases, pain control for 4 to 5 days is what is indicated as well as the consideration of contraception to suppress future ovarian cyst formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

A very firm ovarian mass estimated at 8 cm is found in a 33-year-old woman at her annual examination. what would you expect

A

The size and firmness of the ovarian mass suggests endometrioid carcinoma, a tumor in which the potential for malignancy is 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Based on the latest ASCCP guidelines women ages 21-24 years of age with LSIL should undergo repeat cytology at

A

Based on the latest ASCCP guidelines women ages 21-24 years of age with LSIL should undergo repeat cytology at 12 months. Those 25 and up with LSIL should undergo colposcopy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

what is the diagnosis of atrophy

ph

apperance

discharge

A

Atrophy is diagnosed by the presence of a thin, clear, or bloody discharge;

a vaginal pH of 5 to 7;

loss of vaginal rugae; and

the finding of parabasal epithelial cells on microscopic examination of a wet-mount preparation. These symptoms are all due to estrogen depletion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

AUB mneumonic

A

PALM COEIN

structural-
polyp
adenomyosis 
Leiomyoma 
Malignancy 
non structural -
coagulopathy 
Ovulatory dysfunction
endometrial
iatrogenic
not otherwise classified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what falls under the heading of irregular bleeding

A 
any change from normal 
HMB
HPMB
IMB
PMB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

risk factors for endometrial can

A 
nulliparity
infertility
late meno
DM
unopposed estrogen 
hypertension
gallbladder disease
chronic tamoxifen use

NOT RELATED TO SEXUAL HX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

to OCP have protective risk factors for endometrial Ca

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

what are the clincal features of endometrial ca aside from pmb

A

Obesity
htn
dm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

with PMB what tests should you run

A

ULS (Look at stripe)
pap
EMB (endometrial biopsy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what is the definitive choice for endometrial cancer diagnostic

A

endocervical curretage

but EMB has an accuracy of 90-95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

management of endometrial cancer

A

total hysterectomy combined with b/l salpingo-oopherectomy drives treatment and staging

radiotherapy may be indicated and chemo is used at advanced stages

reoccurrence is treated with high dose progestins and antiestrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

how does endometriosis manifest

A 
deep thrust dyspareunia
dyschezia
dysmenorrhea 
intermitten spotting 
pelvic pain
infertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

signs of endometriosis

A

tender nodularity of the cul-de-sac and uterine ligaments and a fixed uterus

the degree of symptoms does not correlate with the degree of disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

how do you diagnose endometriosis

A

usually it is a diagnosis of exclusion using the ULS to rule out other pathology but you can get a definitive diagnosis laparoscopically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

treatment for the relief of sxs in endometriosis

A

NSAIDs and prostoglandin synthesis

OCP
or progestins may relieve symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

surgical options for endometriosis

A

can resect larger endometriomas

can treat with danzol or a gnrh agonist around the time of surgery fro improved fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

predisposing factors to prolapse

A 
white
hispanic
obesity
chronic cough
constipation
repetitive heavy lifting

(anything that increases intra abdominal pressure)

COPD
asthma
ascites
pelvic tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

non surgical management of prolapse includes

A

weight reduction
smoking cessation
pelvic muscle exercises
use of vaginal pessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

surgical option for uterine prolapse

A

hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

name three different types of functional cysts

A

follicular
corpus luteum
lutein cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

clinical features of cysts

A

pain with menstruation
hemorrhage secondary to rupture
or
asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

management of cysts

A

follow for one or two cycles if small than 8cm

with large or persistent laprascopic evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

cysts in postmenopausal women are

A

malignant until proven otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

PCOS pts are at increased risk for

A

endometrial cancer because of unopposed estrogen and endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

how people describe uLS of PCOS

A

String of pearls or

oyster ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

who is at risk of ovarian ca

A 
family jc 
white 
older than 69 
nulliparious
positive hx of endometrial cancer

90% of cases are sporadic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

OCP are have or have not been proven to be preventative in ovarian cancer

A

have been preventative

5th MCC of cancer and the 2nd most common gynecological malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

symptoms of ovarian cancer

A 
ascites
abdominal distention
early satiety
changes in bowel habits
fixed mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

what is a sister mary joseph node

A

metastatic implant in the umbilicus can be associated with ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

diagnostic studies for suspected ovarian cancer

A

BRCA1 gene associated in 5% of cases
cancer antigen 125 can be used to follow

p53 tumor supressor gene
transvaginal or abdominal ultrasound is useful in distinguishing benign from potentially malignant masses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

definitive diagnoses of ovarian ca

A

biopsy but usually oophorectomy if you think it is malignant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

management of ovarian cancer

A

surgery
chemo
radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

what HPV strains are likely to be linked to condylomata acuminata

A

6 and 11

also known as genital warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

what also plays a role in the development of cervical carcinoma

A

intrepehtial neoplasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

risk factors for cervical cancer

A 
early age at first intercourse 
multiple sexual partners 
or high risk sexual partner 
history of sexually transmitted disease
low socioeconomic status 
cigarette smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

stages of cervical dysplasia

A

mild (CIN 1
Mod CIN2
and severe CIN 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

how many pts with CIN 3 progress to frank carcinoma

A

about 1/3 develop microinvasive or frank carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

difference between occurrence of CIN CIS and cancer

A

CIN 20s
CIS (in situ) 25-35
cervical cancer age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

sxs of advance or invasive carcinoma

A

abnormal vaginal bleeding
abnormal vaginal discharge
visible tumor

116
Q

when should you do pap smears

A

21 to 65

117
Q

types of cervical can

A

ACSUS (Cannot exclude HSIL)
LSIL
HSIL and squamous cell carcinoma are all squamous cell

glandular cells include
AGC 
endocervical cells
endometrial cells
glandular cell NOS

endocervical AIS

adenocacinoma (endocervical or extrauterine )

118
Q

management of cervical lesions

A

mild may resolves spontaneously or preeinvasice can be treated with LEEP

conization is used when the neoplasm is larger (more likely to lead to an incompetent cervix than leep)

hysterectomy or lymphadenectomy is indicated for larger

119
Q

when is the hpv vaccine offered

A

males age 13-21
females 13-26
anybody immunocompromised 22-26

11
6
16
18

these cause 70% of cervical cancers and 90% of genital warts

boosters may be needed every 5 years but that recommendation is not final

120
Q

most vulvular malignancies are

A

SSC

and occur in OM women

121
Q

who is at increased risk of vuvular malignances

A

women with exposure to diethylbestrol (DES) in utero

prescribed between 1940-1971 to pregnant women

122
Q

what % of vaginal neoplasms are MET

A

80%

may arise from the urethra, bartholin gland, rectum, bladder, endometrial cavity, endocervix , kidney, or distant site

123
Q

vuvular ca are most commonly found in women with these rf

A

obese
HTN
DM
arteriosclerosis

124
Q

vuvular cancer in young women is associated with

A

HPV infections and smoking 25% of these pts have cervical carcinoma

125
Q

most vaginal intraepithelial neoplasms occurin the

A

upper one third of the vagina and are asymptomatic

most common presenting problem is PM bleeding or bloody discharge

126
Q

diagnostic studies for vaginal and vuvular neoplsasms

A

application of acetic acid or staining with toludine blue may help with biopsies of suspicious lesions

vaginal biopsy should be directed with colposcopy or lugol staining

127
Q

clear cell adenocarcinoma is diagnosed by

A

careful inspection and palpation of the vagina and cervix followed by biopsies

128
Q

management of early vulvular neoplasms

A

local excision
topical 5 fluorouracil
and laser therapy are used for early vuvular lesions

129
Q

treatment of vaginal neoplasms

A

excision

primary vaginal cancer is treated with radiation

130
Q

for clear cell lesions (adenocarcinoma) of the vagina what is the treatmetn

A

radical hysterectomy and vaginectomry or radiation therapy

131
Q

mastodynia is commonly seen in women who

A

are taking contraceptive pills or HRT

treat with reassurance
vit B6
bromocriptine
HRT

132
Q

do you culture mastitis?

A

no 50% of the time it is staph areus

133
Q

treatment of mastitis can be with dicloxacillan or

A

nafcillian
cloxacillan or cephalosporin and warm or cool compress

surgical treatment may be required for abscess
it does say you can aspirate abscess

might see fever, erythema, tender fluctuant mass in one quadrant

abscess will form if untreated

134
Q

fibrocystic changes are commonly seen in this gae group

A

30-50

usually they are bilateral pain
size fluctuatuin with cycle
multiple lesions distinguish fibrocystic changes from carcinoma

135
Q

in a suspected cyst of the breast you should

A

FNA

diagnostic and therapeutic

usually cysts contain straw colored fluid

136
Q

treatment for fibrocystic breasts

A

supportive bra
heat or ice on breasts
OTC analgesics

caffeine restriction is controversial

some pts respond to low salt diets
vit E
premenstrual hydrochlorothyiazide

137
Q

fibroadenomas are common in

what is characteristic about them

A

AA women and young women

they are round firm smooth discrete, mobile, and non-tender

138
Q

when should you biopsy a fibroadenoma

A

women younger than 25

may be excised or managed expectantly otherwise

139
Q

characteristics of breast cancer

A

fixed, irregular, painless mass, most commonly in upper outer quadrant

140
Q

other than the age what differentiates fibroadenoma from cysts

A

fibroadenoma are more rubbery and lobular or smooth
really mobile
cysts are sift tense or hard and ca be failru mobile

141
Q

mcc in women

A

breast (and skin)

second leading cause of death in women

142
Q

risk factors

A

BRCA1 and BRCA2 are really only seen in 5-10% of cases

nulliparity
early menarche
late menopause
long term estrogen or radiation exposure
delayed childbearing

first degree relative with breast cancer ESPECIALLY if it was premenopausal or bilateral in two of thos relatives

143
Q

relationship between rbeast cancer and endometrial cancer

A

breast cancer increases the risk of endometrial cancer and vice versa

144
Q

most common type of breast cancer

A

IDC 80-85%

the remainder are lobular

145
Q

what predisposes pts to IDC

A

lobular CIS and ductal hyperplasia predispose to cancer

146
Q

pagets is a

A

DUCTAL disease that presents as eczematous lesion of the nipple

147
Q

what % of breast cancers are estrogen recptor positive

A

ALL ILCS

2/3 DCIS

148
Q

most common presentation of breast cancer

A

single nontender firm mobile mass in

45% upper outer quadrant
25% under the nipple and areola

149
Q

most guidelines recommend mammograms

A

1-2years between 50-75

screening women earlier is controversial because of the high rate of positives and should be individualized

150
Q

daignostic studies for suspected breast cancer

A

fine needle
stereotactic core needle biospy is highly accurate
might need open biopsy

all should undergo recptor analysis testing and histological anaylsis

oncotype DX test is used to help determine the need fro chemotherapy in women with stage I or II hormone receptor positive cancer and looks at 21 genes with the tumor to determine the likelihood of the cancer reoccurring or spreading

151
Q

METS workup is recommended for these stages of breast cancer

A

III and above

152
Q

what is tamoxifen used for

A

to treat women with estrogen receptor positive disease and postmenopausal women

153
Q

if someone wanted to use periodic abstinence as a contraceptive method how would you instruct them to do so

A

abstinence from 4 to 5 days before ovulation until 2-3 days after ovulation

high level of motivation required to track basal bofy temperature and ovulation cycle

failure rate 25%

calendar mehtods are based on the predictably of the lutal phase which has a 35% failure rate

154
Q

when is the patch CI

A

in women over 200lb

155
Q

vaginal ring can only be used in

A

nulliparious women

156
Q

how long can it take for ovulation to return after depot injection

A

can take up to 18 months

157
Q

when do you usually see withdrawl bleeding with the pill `

A

3 to 5 days after the last pill

158
Q

how does measuring basal body temperature work as a method of contraception

A

need to measure your temperature before undertaking any activity at all
a slight drop in temperature will occur 24 to 36 hours after ovulation THEN a rise of .3 to .48 degrees occurs remaining at a plateau for the rest of the cycle

159
Q

fertile mucus resembles a

A

egg white

160
Q

what is the most reliable “natural’ method of famil planning

A

symptothermal combining cervical mucus and basal body temperature

161
Q

what are the advantages of combo birth control

A

lower rates of benign breast disease, IDA, and PID as well as fewer ovarian cysts (dysmenorrhea and menorrhagia )

improvements in hirsutism acne and symptoms of endometriosis

may also protect against RA

162
Q

disadvantages of COC

A 
abnormal lipids 
potential increase in breast cancer 
RARELY
HTN
cholelithiasis
benign liver tumors
163
Q

adverse reactions to COC

A 
missed periods 
intermenstrual bleeding
bloating
acne 
nausea
HA
weight gain

msot resolve within the first few months and are rare with low dose

164
Q

most common injection

A

medroxyprogesterone acetate 150mg Q 90 days

165
Q

black box warning for medroxy p

A

may lead to calcium loss, bone weakness, osteoperosis, and should only be used for 2 years

after 2 years need to give Ca
after 5 years need DEXA

166
Q

when can you expect return to fertility with medroxyp

A

18 months

167
Q

CI to IUD

A

salpingitis hx
undiagnosed AUB
acute infection
and suspected gyn malignancy

168
Q

what are the relative CI to the IUD

A 
immunosupression
previous ectopic pregnancy or sexually transmitted disease 
multiple sexual partners
sever dysmenorrhea
uterine abnormalities
anemia
valvular heart disease
and 
youg age
169
Q

name of common spermacides

A

nonoxynol-9

octoxynol-3

170
Q

ovulatory factors for infertility are defined by

A

central
peripheral
metabolic

171
Q

pelvis factors in infertility

A

infection
sturctural
endometeriosis

172
Q

cervical factors in infertility

A

congenital

aquired

173
Q

most common cause of infertility

A

ovulatory disorders

174
Q

diagnostic workup for infertility

A

semen analysis before anything

then
basal body temp
ovulation prediction tests
and progesterone level

175
Q

after the initial hormone tests what is the workup for infertility

A

luteal phase endometrial biopsy
FSH levels
prolactin
thyroid stimulating hormone tests may be helpful

176
Q

how does hysterosalpingography determine infertitlity

A

looks at tubal abnormalities

177
Q

treatments for infertitlity

A

clomiphene citrate 50-100 mg for 5 days beginning on day 3,4, or 5 of the cycle
should be given to anovulatory women to promote ovulation

178
Q

when would you use artificial insemination

A

for couples with abnormal postcoital tests

179
Q

different types of assisted technologies for infertility

A

in vitro
gamete intrafallopian transfer
zygote intrafallopian trasnfer
surrogate

180
Q

PID incompasses

A

acute salpingiits
IUD relate pelvic cellulitis
TOA
pelvic abscess

181
Q

clinical presentation of PID

A 
lower abdominal pain b/l 
nausea with or without V 
HA
lower back pain 
\+/- fever
182
Q

adnexal mass with pain think

A

TOA

183
Q

other than cervical motion tenderness what would you expect to see in a pt with PID

A

can see bartholin or skene glands abscess

184
Q

what should you do in a PID workup

A

DNA probes for gonorrhea and chlamydia

trans vag YLS help differentiate acute from chronic inflammation in the presence of adnexal mass

diagnostic culdocentesis or laparoscopy may be required

185
Q

treatment for PID- outpatient

A

women with mild disease can be treated as outpatients

A single intramuscular dose of a long-acting cephalosporin plus doxycycline (100 mg orally twice daily for 14 days)

186
Q

inpatient treatment of PID

A

Cefoxitin (2 g intravenously every six hours) or cefotetan (2 g intravenously every 12 hours) plus doxycycline (100 mg orally or intravenously every 12 hours).

187
Q

who gets admitted for PID

A

lack of response or tolerance
PREGNANCY
inability to take oral medications due to nausea or illness
complicated PID (TOA or abscess)
possible need for surgical intervention or diagnostic exploratory

188
Q

primary syphillis is characterized by

A

chancre which is a PAINLESS ulcer with e CLEAN base and firm indurated margins

develops at the site of inoculation most commonly genital area
associated with rubber discrete non tender lymphadenopathy

189
Q

secondary syphillis

A 
involves skin 
mucuous membrane
eye
bone
kidneys
CNS
or liver

there maybe relapsing lesions during early latency

190
Q

late or tertiary syphilis

A

includes hummatous lesions involving skin, bones and viscera

cardiovascular disease
nervous system
and opthalmic lesions

191
Q

neruosyphilis

A

neruosphyilis can result in asymptomatic disease, meningovascular syphilis (chronic meningitis)
generalized paresis or tabes dorsalis (chronic progressive degeneration of parenchyma )

192
Q

tabes dorsalis

A

manifests with impaired proprioception, loss of vibratory sense, argyll robertson pupil (reacts to life but does not accommodation )

or tabes dorsalis crises (sever pain and neurological decompensation)

193
Q

if not treated congenital syphilis may develop

A 
interstitial keratitis 
hutchinson teeth
saddle nose
deafness
CNS abnormalities
194
Q

diagnostic studies for syphilis

A

T. pallidum may be identified using dark field microscopy but the technique is difficult

IMMUNOFLUORESCENT staining techniques are more reliable and the organism CAN’T be cultured

SEROLOGICAL TESTING is the recommended methor for diagnosis

195
Q

Specific testing for tertiary syphilis includes

A

LP
joint fluid analysis
biopsy

196
Q

treatment for syphilis

A

PCN g 2.4 million units IM

late and latent and tertiary syphilis requires weekly THREE weekly injections

197
Q

treat neurosyphilis with

A

aqueous PCN q 4 hours for 10-14 days may be followed with three weekly doses of PCN G

198
Q

what is the Jarisch Herxheimer reaction

A

fever and toxic state that may occur after sudden massive destruction of spirochetes
to prevent this antipyretics should be administered during the first 24 hours of treatment

199
Q

what do you need to do after discovering a pt has syphillis

A

careful f/u

report

200
Q

incubartion period of gonorrhea

A

2-8 days after exposure

201
Q

highest incidence of gonorrhea is in

A

15 to 29 year olds

202
Q

male complaints with gonorrhes

A

burning with urination
serous or milky discharge

1 to 3 days later urethral pain is more pronounced and discharge becomes yellow, creamy, profuse, and occasionally tinged with blood

203
Q

without treatment of gonorrhea in men

A

infection may regress and become chronic or progress to involve the prostate, epididymis, and periurethral glands with acute, painful inflammation

and result in prostatitis and urethral strictures

204
Q

symptoms of gonorrhea in women

A

many remain asymptomatic or may develop dysuria, urinary frequency and urgency and a purulent urehtral discharge

vaginitis and cervicitits are common

205
Q

honococcal bacteremia is associated with

A

peripeheral skin lesions

septic arthritis of the knee, ankle, or wrist

206
Q

gonococcal conjunctivitis looks like

A

unilterla copious purulent discarge

at risk of globe rupture

207
Q

diagnostic studies for gonorrhea

A

gram stain of urethral discharge shows diploccoci

smears are less often positive in women
cultures are essential

208
Q

treamtnet of gonorrhea

A

iM Ceftriazone OR

oral cefixime

doxy or azithro NEED to be administered simultaniously regardless of chlamydial infection

NEED TO REPORT

209
Q

LYMPHANGRUNULOMA venerum

A

starts withs a vesciular or ulcerative lesion (may go unnoticed)

this infection spreads to the lymph nodes causing inguinal buboes
may fuse and break down resulting in mutliple draining sinuses and scarring

210
Q

dx of chlamydia

A

usually clinical

can do ELISA or DNA

211
Q

trichamonas affects the

A

vagina
skene gland
lower urinary tract of femals AND genitourinary tract of males

212
Q

yellow frothy discharge and vaginal erythema and red macular lesions on cervix thing

A

trichomonas

213
Q

dose of metronidazol for trich

A

2 G

may need to be repeated

214
Q

Dose of metronidazol for trich

A

2 G

May need to be repeated

215
Q

treatment of Lymphogranuloma venereum

A

LGV proctitis should be treated with doxy +ceftriaxone

if anorectal chlamydia continue with doxy

216
Q

pregnant pts with LGV treat with

A

erythromyocin or azithromyocin

217
Q

risk factors for vaginal candidiasis

A 
age extremes 
pregnanct
uncontrolled DM
corticosteroids
HIV disease
218
Q

symptoms of candidiasis

A

pruririts burning dysparunia and white flocullent discharge

219
Q

two treatments for bac vag in non pregnant pt

A

clindamycin or metronidazole

500 mg twice daily for seven days

single dose has lower efficacy

220
Q

symptomatic pregnant women treatment

A

metronidazole 500mg 2 times daily for 7 days

250 mg three times daily for seven days

clindamycin 300 mg twice daily for seven days

221
Q

what is premenstrual dysmorphic disorder

A

According to the American Psychiatric Association DSM-5, mood swings, anger, irritability, sense of hopelessness or tension, and anxiety or feeling on edge associated with severe premenstrual syndrome symptoms is defined as premenstrual dysphoric disorder.

222
Q

why can’t you give BC with estrogen to pts with hx of seizure disorder

A

Certain antiepileptic drugs induce hepatic metabolism of estrogen (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, and topiramate)
This can potentially lead to failure of any contraceptive that contains estrogen. Therefore progestin only birth control methods would be beneficial to this patient.

223
Q

complaint of painful vulvar ulcers and a swollen inguinal lymph node

A

Gram negative coccobacillus

canchroid

224
Q

management of canchroid

A

zithro
ceftriaxone
cipro

225
Q

Which organism causes condyloma latum?

A

Treponema pallidum (syphilis).

226
Q

Enterocele what is it and what is the managment

A

is the descending of the small intestine into the lower pelvic cavit
Operative management of an enterocele with an anterior colporrhaphy

227
Q

rectocele tx

A

rectocele with a posterior colporrhaphy

228
Q

In addition to gabapentin, what are some medications useful in treating the vasomotor symptoms of menopause?

A

Answer: Selective serotonin reuptake inhibitors and clonidine have some utility in managing vasomotor symptoms during menopause.

229
Q

what is intrahepatic cholestasis of pregnancy and how does it present what are the risks

A

characterized by pruritus which is often concentrated in the palms of the hands and soles of the feet. Serum bile acids are almost always elevated and there is a significant increase in intrauterine fetal demise.

In intrahepatic cholestasis of pregnancy the number of adverse fetal outcomes increase as serum bile acid levels rise

230
Q

What is the first line intravenous antibiotic therapy for patients with endometritis?

A

Clindamycin and gentamicin.

231
Q

most common symptom of vaginal cancer

A

Vaginal bleeding

232
Q

multiple 0.5 cm to 1.5 cm oval ulcers with sharply defined borders and a yellowish-white membrane.

A

Behçet’s syndrome included recurring genital and oral ulcerations and relapsing uveitis. The genital and oral ulcers are classically painful with a necrotic center and surrounding red rim.
more common in Japan, Korea, and the Eastern Mediterranean area, and affects primarily young adults

233
Q

whiff test is done by

A

potassium hydroxide wet preparation of a sample.

234
Q

ovarian cancer in post menopausal women is usually

A

epithelial

235
Q

ovarian cancer in pre mensstrual is usually

A

germ

236
Q

women of any age can get this type of ovarian cancer

A

stromal

237
Q

The diagnosis of cervical insufficiency is usually based on

A

The diagnosis of cervical insufficiency is usually based on history of recurrent midtrimester loss, risk factors, and a transvaginal ultrasound measurement of cervical lengt

238
Q

what is the difference between the treatment for bacterial vaginosis and

A

Metronidazole 2 g PO (D) is therapy for trichomonas vaginitis. Although metronidazole is an appropriate medication for treatment of BV, the one time dosing is not sufficient.

for BV can also do
CLINDA 300 x 1o days

239
Q

suboptimally cytoreduced disease after surgical cytoreduction for epithelial ovarian cancer

what is the treatment

A

Carboplatin and paclitaxel intravenously is the preferred first-line chemotherapy in women who have suboptimally cytoreduced disease after surgical cytoreduction for epithelial ovarian cancer.

240
Q

The color varies; warts may be white, skin-colored, erythematous (pink or red), violaceous, brown, or hyperpigmented. Anogenital warts are usually soft to palpation and can range from 1 mm to more than several centimeters in diameter. The warts are typically asymptomatic but can occasionally be pruritic.

flat dome shaped or cauliflower appearance

A

rst-line patient-applied therapies include imiquimod, podophyllotoxin, and sinecatechins. First-line clinician-administered treatments are cryotherapy, trichloroacetic acid, surgical excision, electrosurgery, and laser therapy.

241
Q

dense breast tissue, with rope-like or cobblestoning texture to the bilateral breasts with cyclical pain that is associated with menstruation

A

Fibrocystic breast changes

242
Q

rare and usually present as firm, mobile, well-circumscribed, rapidly growing masses that usually involve one breast.

A

Phyllodes tumors

243
Q

test for gonorrhea

A

Gram stain of the ulcer exudate showing gram-negative rods

244
Q

______is the treatment of choice in hemodynamically unstable patients with heavy uterine bleeding. If bleeding persists, the next step in treatment would be the use of intravenous conjugated_______

A

Uterine curettage is the treatment of choice in hemodynamically unstable patients with heavy uterine bleeding. If bleeding persists, the next step in treatment would be the use of intravenous conjugated equine estrogen.

245
Q

how do you distinguish premenstural dysmorphic disorder

A

rm of PMS in which symptoms of anger, irritability, and internal tension are prominent. Symptom onset is usually in the early 20s. Premenstrual irritability is the most common symptom. DSM-5 diagnostic criteria for premenstrual dysphoric disorder requires prospective documentation of physical and behavioral symptoms (using diaries) being present for most of the preceding yea

symptoms must be present for more of than a year

246
Q

what is the treatment fo rtwin to twin transfer

A

As the mother is 20 weeks pregnant, the best intervention would be fetoscopic laser ablation.

247
Q

A 24-year-old woman presents with fever, chills, and painful lumps to the groin area for the past three weeks

what is the treatment

A

Lymphogranuloma venereum

doxy

248
Q

how do you diagnose syphilis

A

Initial screening is performed with a nontreponemal test (eg, RPR). This is a quantitative test (reported as a titer of antibody) and reflects the activity of the infection.

FTA-ABS is used to confirm but will give FALSE POSITIVE
if already infected

Rapid plasma reagin (RPR) (D) are nonspecific tests that reflect the activity of the infection. Titers are followed after treatment to monitor therapeutic response.

249
Q

initial visit what is the most accurate way to date the preganncy

A

CRL

250
Q

when would you use cytotoxic chemotherapy for ER positive tumors

A

cytotoxic chemotherapy (A). Chemotherapy may also be used for ER-positive tumors with high-risk characteristics, such as a high-grade tumors, large size (≥ 2 cm)

otherwise endocrine therapy

Tamoxifen, an estrogen receptor modulator, significantly reduces the risk of recurrence and death in patients with ER-positive disease

251
Q

A 42-year-old woman with a history of hypertension and a body mass index of 32 presents to the office with her fourth incidence of vaginal candidiasis in the past year. Besides a wet mount and fungal culture, which of the following screening test should be ordered?

A

Glycated hemoglobin (also called A1C)

252
Q

A 32-year-old woman presents to the ED at 39 weeks of gestation in active labor. Her axillary temperature is 98.6°F, pulse is 88 beats per minute, and blood pressure is 120/80 mm Hg. Upon vaginal examination, an umbilical cord is noted to be protruding from the cervix which is dilated to five centimeters. While awaiting a surgical suite for an emergency cesarean section, which of the following agents would be most appropriate to administer?

A

umbilial cord prolapse —>

Emergency cesarean section is the standard obstetrical management. If a delay in cesarean section is anticipated, such as waiting for an open surgical suite or transporting the patient from a remote location, the tocolytic terbutaline 0.25 mg can be given subcutaneously to decrease uterine contractions and alleviate pressure on the cord.

253
Q

A male child born at 40 weeks of gestation has an Apgar score of 4 at birth. He is gasping for air and has a pulse of 68. Which of the following would be the best choice for initial clinical intervention in this patient?

A

pp vrntilation

Neonates who persistently show respiratory distress and a heart rate under 60 beats per minute despite positive airway pressure or intubation should receive chest compressions and may also need intravenous epinephri

254
Q

An 18-year-old woman presents to the clinic for her annual preventive health examination. She is asymptomatic. There is a new palpable left-sided adnexal mass on pelvic exam. Which of the following imaging modalities is best to initially characterize the mass?

A

MRI for teratoma

255
Q

A 32-year-old woman is having abnormal uterine bleeding for several weeks after a normal vaginal delivery. Serum human chorionic gonadotropin (hCG) levels are tested and found to be elevated. They remain elevated at persistently low levels when retested after two months. A pelvic ultrasound reveals a hyperechoic intrauterine mass. Which of the following is the most likely diagnosis?

A

Placental site trophoblastic tumors cause very low, persistent levels of hCG. These are malignant tumors that most commonly occur after a non-molar abortion or pregnancy.

256
Q

She states she does not remember the date of her last menstruation and that her cycles are irregular. A home pregnancy test this morning was negative as is the in-office urine pregnancy test. Which of the following is the best next step in confirming pregnancy?

A

A urine pregnancy test 14 days after last intercourse would minimize the possibility of a false negative. False negatives are most likely caused by performing the test too soon after conception. A serum test is the most sensitive test, but results are not immediately available and there is an increased cost associated with the serum test. A repeat urine test is readily available and may eliminate the need for the serum test.

257
Q

hormones in menopause

A

A decrease in estrone, decrease in estradiol, and an increase in testosterone

258
Q

trichimonas pH.

A

Trichomoniasis presents with vulvar pruritus and a profuse, frothy, greenish, foul-smelling vaginal discharge with a pH usually exceeding 5.0.

Bacterial vaginosis presents with malodorous, gray-white discharge. The pH is typically 5.0-5.5.

259
Q

A 35 year-old female presents with a solitary breast mass. Fine needle aspiration reveals bloody fluid with no malignant cells. What is the next best step in the care of this patient?

A

Excisional biopsy is the next step in cases of bloody fluid, residual mass or thickening.

260
Q

progesterone controls the growth of what in the breasrt

A

growth of the lobules and alveoli is under the influence of progesterone.

261
Q

estrogen controls the growth of what in the breast

A

proliferation of the mammary ducts Proliferation of the mammary ducts is under the influence of estrogen.

262
Q

PAINLESS papule
shallow ulceration/erosion

NONindurated

A

primary LGV

263
Q

what is secondary LGV

A

10-30 days after exposure secondary LGV leads to buboes (grossly enlarged tender nodes) and can lead to the GROOVE SIGN

264
Q

what is the groove sign

A

seperation of the lymph nodes by the inguinal ligament seen with LGV which is causes by chlamydia trachomatis

265
Q

how do you confirm LGV

A

through titers

266
Q

what is the treatment for lGV

A

Doxy

267
Q

soft PAINFUL ulcer of the vulva

tender with ragged edges on a necrotic base and tender lymphadenopathy

A

cancroid

268
Q

what is the organism that causes cancroid

A

Haemophilusducreyi small gram negative rod

gram stain seen as “school of fish”

after ruiling out syphilis and herepes you can biopsy or culture to help establish the diagnoses

269
Q

treatment for cancroid

A

azithromyocin or intramuscular cerftriaxone

270
Q

primary syphilis generally presents as

A

RAISED borders indurated (hard) base
NON TENDER chancre
papule

usually arise 3 weeks after exposure and disapear spontaneously

271
Q

what are the painful genital ulcesr

A

chancroid and HSV

272
Q

what are the painless genital ulcers

A

syphilis(indurated)
LGV (non indurated with lymphadenopathy)
granuloma inguinale (beefy red bleeds easily)

273
Q

what would you do if you suspected syphilis but the VDRL and RPR were negative

A

might be early do darkfield microscopy

274
Q

what is the treatment for syphilis

A

IM PNC

if latent or unknown do IM q 3 wks

275
Q

All postmenopausal women above the age of ___ should be screened for osteoporosis (i.e., using the DEXA scan to measure bone mineral density).

A

All postmenopausal women above the age of 65 should be screened for osteoporosis (i.e., using the DEXA scan to measure bone mineral density).

276
Q

what is carbaprost and what are the CI

A

Carboprost, a prostaglandin analog that stimulates uterine contractility, may cause significant bronchospasm and is contraindicated in patients with asthma.

277
Q

What is methylergonovine and what are the contraindications

A

Hypertension (C) and coronary artery disease (B) are contraindications to the use of methylergonovine, another common uterotonic agent which causes vasospasm

278
Q

treatment for a patient with a TOA

A

Cefoxitin and doxycycline are an appropriate antibiotic regimen for a patient with a tubo-ovarian abscess

279
Q

firm uterus with PPH think

what is the tx

A

retained placenta

D and C
hysterectomy

280
Q

nml uterus with PPH think…

what is the tx

A

think laceration
pressure–>
sutures

281
Q

absent uterus and pph

what is the treatment

A

uterine involution

first try to replace
tocolytics then oxytocin

282
Q

what if you have a pph that can not be resolved

A

2 large bore IVS

IV estrogen

uterine artery ligation (OB)
uterine artery embolization (IR)
TAH (OB)

283
Q

in women over 45 and older with AUB

A

only in pos

284
Q

difference between adenomyosis and leimyoma

A

adenomyosis is sift and tender with a globular boggy uterus

leiomyoma is non tender and irregular firm

285
Q

inpatient mngmt of PID

A

Ceft +doxy

or Clindamycin and \gentamycin

OBGYN EOR (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions