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ABOG GYN > GYN > Flashcards

GYN Flashcards

1
Q

2hr GTT

What are the dia criteria for DM?

A

Fasting:

  • Normal is <100
  • 100-125 is c/w Pre DM
  • >=126 DM

2hr

>=200 is DM

140-199 PreDM

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2
Q
  1. The coccygeous muslce overlies the SSL and is a component of the lev ani muscle. T or F
  2. Components of the levator ani
  3. in a transobturator sling, what muscles are passed?
  4. Origin of Inf and superior epigastric arteries.
A
  1. True, but not a part of the lev ani
  2. Puborectalis, pubococcugeons, ilieo coccygeous
  3. photo
  4. They include the superior epigastric artery and the musculophrenic artery, both originating from the internal thoracic artery, and the inferior epigastric artery and the deep circumflex iliac artery, both originating from the external iliac arteries.
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3
Q

How do you manage anticoagulated patients preoperatively?

A
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4
Q
  1. AGC on PAP
  2. Atypical Endometrial cells on PAP
  3. You did the work up for AGC and it was all negative. What do you do now?
  4. What if they has specified AGC favor neoplasia and the results were all normal?
A
  1. Colpo, Ecc, Ebx if >=35 or risk factors
  2. Ecc + EBx (if normal, then do a colpo…start with looking at the most obvious glandular source)
  3. If no CIN2+, AIS, or CA -> cotest @1 and 2 yrs
  4. Excise
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5
Q
  1. What do you do if AIS on cytology?
  2. What do you do if AIS on biopsy?
  3. What do you do after CKC if margins positive?
  4. What do you do after CKC if margins negative?
  5. After a hyst, what is the follow-up?
  6. How does this all chage for fertility preservation?
A
  1. Colpo, ECC, Ebx if >35yo or risks!
  2. Everyone gets a cone!
  3. If margins positive, you re-excise even if a hyst is planned to rule out cervical CA.
  4. If margins negative, proceed to hysterectomy.
  5. HPV based test q1yr x3, then q3yr x25 yrs
  6. Once negative margins obtained, cotest + ECC q6m x3 years, then annually x2yrs. Hyst when done childbearing.
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6
Q
  1. What do you do after HSIL is confirmed on biopsy?
  2. What is the follow up if negative margins?
  3. What if positive margins?
A
  1. Excisional procedure.
  2. Negative margins: HPV based test at 6 months, if neg HPV based test annually x3 yrs, then Q3y X 25 years
  3. Repeat excision, or colpo + ECC @ 6 months
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7
Q
  1. How do you manage a young woman with CIN3?
  2. How do you manage CIN2 in <25?
  3. >=25 + fertility desired?
  4. Lets say <25yrs…what do we do and at what interval?
  5. How about >25yrs and desiring fertility?
  6. If results remain abnormal for __yrs, excision.
A
  1. TREAT!
  2. OBS is preferred if less than 25 years.
  3. If >25 and fertility desired, OBS is acceptable.
  4. Colpo + cyto @ 6m and 12m
  5. Colpo + HPV based test @ 6m and 12 m
  6. 2yr of persistent CIN2, RX!
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8
Q
A
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9
Q
  1. How do we screen HIV patients?
  2. 2019 ACS screening?
  3. When do we DC screening?
  4. What is the screening following a hyst for cervical disease (CIN2-3 / AIS)?
A
  1. Start w/in 1 year of sexual activ ity, latest 21yo, 3 in a row, then space q3yrs, can use HPV at 30 but never spaces > 3yrs
  2. <25yo no screening; 25-65 1ty HPV Q5 preferred, cotest q5 and cyto alone q3 also acceptable
  3. >65 if prior adequate screen if >=25 yrs from CIN2 or greater (this includes AIS)
  4. HPV based test q1yr x3, then q3yr x25 yrs
  5. t
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10
Q

ASCCP Unsatisfactory Cyto:

  1. What generally guides management?
  2. HPV neg…
  3. HPV +…unk genotype and >25
  4. HPV+..16/18
A
  1. HPV status
  2. Repeat in 2-4m, colpo if unsatisfactory again
  3. Colpo
  4. Colpo
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11
Q

CIN3 risk is used as the benchmark for the ASCCP 2019 quidelines.

  1. At what threshhold and above is colpo recommnended?
  2. At what threshhold can you treat expideted or colpo?
  3. How about expedited Rx?`
A
  1. >=4%
  2. 25-59
  3. 60-100%
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12
Q

Athlete Triad

  1. Definition
  2. 1st line Rx
A
  1. Menstrual dysf, low energy availability, and low BMD
  2. Corretion of the energy imbalance, ok to supp Ca/D, no OCP or bisphosphos or E

BUT, if evidence of dec bone density, could use Patch low doese E + cyclic P (no OCP, no bisphos…ocps can mask menses, these lowe doses will not)

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13
Q

Bartholin cyst in >40yo requires excision. T or F

A

True

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14
Q
  1. MOA of Ella.
  2. Plan B Kg above which efficacy drops
  3. T or F: highest risk of post sterilization regret is young age.
  4. Patch has dec effacy after __kg.
A
  1. SPRM; inhibits follic rupture
  2. BMI >25 (165lb)
  3. T
  4. 90kg
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15
Q

Bladder Injury

  1. Non-trigonal injury <1cm
  2. Non-trigonal injury >1cm
  3. Trigonal injury
A
  1. Expectant management (foley 1 week)
  2. Primary repair (foley for 1-2 weeks)
    • Running non-locked x1
    • Embricating x1
    • Retrograde fill w/ 300cc (vs cysto)
    • Foley 2 weeks
    • Plain vs CT urogram
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16
Q
  1. How to treat intraductal papilloma?
  2. What is the appearance of ductal ectasia?
  3. Pagets? Rx?
  4. What is the algorithm for nipple discharge work-up? What characteristics warrant age-appropriate imaging immediately
  5. T or F, in workup of discharge, always get an US, and a mmmo if >30 as well. T or F
  6. Periductal mastitis is associated w/ what risk factor?
  7. Inflammatory breast ca rx
A
  1. Excise.Generally, intraductal papillomas are surgically excised when they are identified by core biopsy due to the risk of areas of ductal carcinoma in-situ or atypia within the lesion.
  2. The discharge typically is very thick and sticky and either green or black in color but occasionally can become sero- sanguineous or bloody. Ductal ectasia is not associated with breast carcinoma, but the surrounding tissue may become fibrotic, causing a confusing palpable density.
  3. Paget disease of the breast is an intraductal carcinoma, which presents as a scaly skin lesion similar to eczema appearing on the nipple and spreading to the areola. Ulceration can be present, and there may be a clear yellowish exudate with crusting. Breast conserving surgery with radiation, mastectomy
  4. See photo.
  5. t
  6. smoking
  7. mastectomy, axillary dissection, neoadjuvant chemotherapy, and radiation therapy. Lymph node involvement is present in the majority of cases, even in the absence of physical exam findings. This explains why axillary dissection is indicated as part of treatment, and sentinel lymph node biopsy is not appropriate.
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17
Q
  1. Fibrocystic breast dz:

How does it present? How to rx?

A

Patient will be a woman 30 – 50-years-old

Complaining of intermittent breast pain and tenderness that peak before each menstruation

Ultrasound would show dense, prominent, fibroglandular tissue with cysts but no discernable mass

Most commonly caused by fluctuating estrogen levels during menstrual cycles

Treatment is well-fitting supportive bras, applying heat to the breasts or over-the-counter pain relievers. NOT OCPS.

Comments: Most common lesion of the breast. Fibrocystic changes are generally benign and do not increase risk for breast cancer

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18
Q
  1. Mammo recs from ACOG
  2. Clinical breast exam from ACOG
A
  1. offer at 40, recommend at 50
  2. Offer: Q yr at 40; Q1-3yr if 20-39
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19
Q
  1. ___therapy is the first-line treatment for patients with eating disorders.
  2. Second-line RX: __.
  3. Bupriprion is CI in patients with __ .
A
  1. CBT
  2. SSRI
  3. Bulimia; + seuzires
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20
Q

Calcium Recs if <50? >50?

Vid d recs <50? >50?

A

19-50: 1000mg; 600 D

51-70: 1200mg; 600 D

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21
Q
  1. 95% of cases of CAH are caused by ___ deficiency. This results in decreased levels of ___ & ___ and increased levels of ___.
  2. There are two types, classic, and non-classic. How do we test for it?
  3. Inheritance pattern?
  4. How does a neonate present? How do we treat it?
  5. What other enzyme def can casue virilization of a female?
A
  1. 21a, aldost/cortisol, androgens
  2. Use 17OP level, may need acth stim test
  3. Autosomal recessive
  4. hypotension, dec NA/gluc, inc K; vom, diarr, dec weight: FLUIDS, LYTES, STEROIDS
  5. 21-alpha-hydroxylase, 11-beta-hydroxylase, or 3-beta-hydroxysteroid dehydrogenases. resulting overproduction of androgens

Remember than in a patient with PCOS, late onset adult CAH is in the differential! 17ohp FASTING, FOLLICULAR PHASE, MORNING). level is greater than 200 ng/dLand less than 800 ng/dL, further testing with a cosyntropin (ie, adrenocorticotropic hormone) stimulation test shouldbe performed. A baseline 17-OHP greater than 800 ng/dL confirms the diagnosis and further testing is not necessary.

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22
Q

Rx for chancroid

A

azithro 1g

Or cftx 250mg

Isolation of the bacteria to confirm the disease is technically challenging and not always available, therefore, the diagnosis is primarily clinically made

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23
Q
  1. Chancroid geographic region
  2. Causative organism?
  3. Diagnosis (physical exam and lab)
  4. Rx
  1. Causative organism for LGV and geographic region.
  2. Diagnosis (physical exam and lab).
  3. RX
  1. Causative organism for GI/donovanosis
  2. Dx (physical exam and lab).
  3. Rx
  1. Of all ulcerative lesions, which does not have associated LAD?
A
  1. Africa/Caribbean
  2. H. Ducrey
  3. Eryhtematous base with clear borders, grey exudate + unilateral LAD (suppurative); special culture or PCR; school of fish
  4. Azithro 1g PO (or CFTX, or Cipro or Erythro
  1. Chlamydia L1-L3; tropics and subtropics (africa, india)
  2. Painless ulcer; + unilateral LAD (fibrosis + strictures); chlamidya serology + PCR
  3. Doxy 3w
  1. Kelbsiella
  2. Painless ulcer, bleeds easily, NO LAD; donovan bodies on microscopy
  3. Doxy 3wk
  1. No LAD with GI
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24
Q

Colon Cancer Screening Modalities

  1. Colonoscopy @ age __ q __ yrs. Stop at __ yrs.
  2. Flex sig q __ yrs.
  3. Fecal Immunochemical Test (FIT)
  4. FOBT
  5. What if you are high risk…when do you start?
  6. What if IBD?
  7. IN WHI, the E/P arm showed dec rates of colon Ca. T or F
  8. When do you start if 1st degree rel had cc?
A
  1. Colonoscopy @ age 45/50 q 10 yrs - 75yrs old.
  2. Flex sig q 5 yrs.
  3. Fecal Immunochemical Test (FIT) q1 year.
  4. FOBT (3 samples from 3 consec stools) q1year.
  5. 10yr before index case, or age 40.
  6. surveillance colonoscopy should be initiated 8 – 9 years after the onset of symptoms in individuals with a personal his- tory of inflammatory bowel disease and performed every 1–2 years thereafter.
  7. T. No effect in the E arm alone .
  8. at 40 or 10 yrs before dx
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25
Q
  1. Cushing syndrome has multiple etiologies. What are they?
  2. What are the stigmata?
  3. What tests can be used to dx?
A
  1. Oversecretion of cortisol, which could be related to oversecretion of
    • pituitary ACTH,
    • ectopic ACTH,
    • CRH from hypothalamus,
    • autonomous secretion by the adrenal gland.
  2. ​ see photo
  3. 24hr urinary cortisol, overnight dex supp, late night saliv cortisol
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26
Q

DVT PPx in GYN Surgery

  1. Who gets no specific PPX + early mobilization? (LOW RISK)
  2. What do Mod and High risk patients get?
  3. At what point is heparin added to SCDs? (HIGH RISK)
A
  1. Surg < 30’, <40yo, no risk factors. LOW RISK
  2. SCDs or pharmacotherapy
  3. Majors + >60 + Prior VTE, cancer, or hypercoag state. HIGH RISK
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27
Q

EIN

  1. What are the three classifications?
  2. If EIN, what is the next step?
  3. How do you treat BEH?
  4. How do you treat EIN? What if desires future fertility?
  5. Approximately __% of patients who received a diagnosis of complex atypical hyperplasia were found to have concomitant carcinoma diagnosed on hysterectomy.
A
  1. Benign endometrial hyperplasia, EIN, AdenoCA
  2. If EIN, must D&C to rule out CA!
  3. Must treat BEH: prov, megace, aygestin, microg progest, IUD; EBX q3months!
  4. Surgery, must be ready to stage and have ONC on backup.
  5. 40%
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28
Q

Endo Rx:

  1. MOA for Elagolix? SE?
  2. Lupron MOA. SE? Addback when and with what?
  3. Letrazone MOA. Add back when?
  4. Laparoscopic ovarian cystectomy may be
    recommended for women with endometriomas larger than __ cm in diameter to improve fertility.
A
  1. GNRH antagonist. 150mg QD. hot flushes, night sweats, beeding, HA, nausea, suicidal ideation
  2. GNRH agonist. 3.75QM or 11.25 Q3m. Hot flushes, night sweats, moody, bone loss, HA, nausea. Add back reduces bone loss, usually start @ 6m with norethidrone 5mg or prov 2.5mg
  3. 3cm
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29
Q
  1. Highest incidence CA.
  2. Highest mortality.
  3. first acog visit at age
A
  1. Br
  2. lung
  3. 13-15 When you become a teen!
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30
Q
  1. Dietary fiber daily amount recommended
  2. 1st line rx for fecal incontinance (which meds)
  3. Age is the most important risk factor fo fecal incontinence. What are others?
  4. ___is the STRONGEST risk factor for urinary incontinence.
A
  1. 20-35mg
  2. Loperamide/Immodium (FIRST), opiate that does not cross BBB

Then consider Diphenoxylate (lamotil), opiate derivative that can be addictive and has antichol SE

  1. Obesity
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31
Q
  1. What is the karyotype for CAIS, 5a reduct, Sweyer?
  2. In CAIS, how is development of Wolfian and Mullerian structures affected, and how does this determine the phenotype? What do we do with the testes and why? T levels?
  3. In 5a reductase def, whendo we remove the testicles? Why?
  4. What is the molecular hallmark of Sweyer syndrome? What do we do with goads and when and why?
  5. What two enzymatic def also present as femenized males?
  6. Which condition is frequenlty confused with MRKH because of the lack of Mullerian structures?
  7. You take the tested out right away except in?
  8. What is a gonadoblastoma
A

CAIS

  • XY, X-linked recessive
  • SRY present: AMH leads to mullerian duct degeneration, testosterone is made but cannot bind, so no wolffian structures; DHT is made but also cannot bind, so female external genitalia.
  • Leave testes in place to allow for femenization. At puberty, T is made (T –> E (femenization)), but no pubic hair development as no functional R.
  • Normal testes, normal breasts
  • When puberty complete, remove testes (dysgerm/gonodoblast risk)
  • Normal to high T

5a reductase

  • XY -> SRY -> No mullerian structures, Wolffian duct develops, but no DHT to form external genitalia.
  • Raised as female, but masculinized at puberty. Remove testes before puberty!

Sweyer

  • No SRY –> all mullerian structures develop
  • No T –> female ext genitalia
  • Streak gonads - > Take them out ASAP
  • Sparce pubic hair from adrenal androgens
  • Raised as female
  • an individual with Swyer syndrome presents with delayed puberty, no breast development, and a +uterus and +vagina
  1. 3Bhydroxysteroid, 17Bhydroxysteroid
  2. CAIS
  3. CAIS (leave so they femenize at puberty from aromatization of T)
  4. Gonadoblastomas are benign or in situ germ cell ovarian neoplasms composed of germ cells and sex cord stroma that can develop into a dysgerminoma, which is malignant. Gonadoblastomas can also contain components of other types of germ cell malignancies, such as immature teratoma, yolk sac tumor, embryonal carcinoma, or choriocarcinoma.
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32
Q

Vesico-Vaginal Fistula Management:

  1. At what size cutoff can they be expectantly managed?

Recto-Vaginal Fistula Management:

  1. How/when is it repaired?
A
  1. 1cm. Expectant. CBD 4-6 weeks.
  2. early vs late repair; after repair and drainage, cystogram

Recto-Vaginal Fistula Management:

  1. <4mm obs
  2. >=5mm operate using a simple layered approach if no infection
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33
Q

Fragile X

What is the premuation? Inheritance pattern? How do they Conceive?

A

FMR1 gene premutation (between 55 and 200 repeats), and the syndrome has an X-linked dominant inheritance pattern.

IVF donnor egg

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34
Q

Endoscopic evaluation with biopsies is warranted in the presence of alarm symptoms for GERD, such as?

A

(ie, dysphagia, bleeding, weight loss, anemia, recurrent vomiting) as well as for screening of patients at high risk of complications.

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35
Q
  1. What is the threshold for workup of assymptomatic low risk never smoking women aged 35-50: __ RBC/HPF.
  2. What is the initial workup for bladder CA?
  3. What are the strongest predictors of urologic cancer?
A
  1. 25
  2. Cysto + CT urography
  3. being older than 60 years, having a history of smoking, and having gross hematuria are the strongest predictors of urologic cancer.
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36
Q

How do the following Rx for hirsutism work?

  1. OCP
  2. Spiranolactone
  3. Eflornithine
  4. Fonasteride
  5. Flutamide
A
  1. SHBG inc (oral, no patch or ring), dec lh which dec androgens, inhibit skin 5a reduct
  2. aldost antagonist (fem of male fetus); do not use if dec liver or kidney funct; R antagonist
  3. irreversible inhibitor of the enzyme ornithine decarboxylase
  4. 5s reduc inhi
  5. androgen r blockade (hepatotox, dry skin)
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37
Q
  1. What two agents are approved for PREP?
  2. What side effects is Truvada associated with?
  3. What criteria must be met prior to initiation of PREP?
  4. Postexposure prophylaxis for HIV exposure includes __days of HAART therapy.
  5. Prophylaxis should be initiated within __ hours of exposure to HIV. If this the case for all patients?
  6. Following a sexual assault in a victim with no or unknown history of previous hepatitis B vaccinations, the hepatitis B vaccine without HBIG should be given. T or F.
  7. All adults and adolescents age __ should be tested at least once for HIV Annually for anyone who has unsafe sex or shares injection drug equipment
  8. Screening for HIV is done with a 4th gen immunoassay. Confirmatio is with __.
A
  1. Truvada (emtricitabine/tenofovir disoproxil fumarate) and Discovy (emtricitabine & tenofovir alafenamide).
  2. Osteoporois and renal damage
  3. Chart
  4. 28
    1. Expectant management is inappropriate in high risk settings with high HIV prevelance. in certain geographical areas of the United States, expectant management could be entertained with repeat HIV at 6w, 3m, 6m.
  6. Following a sexual assault, STI prophylaxis against trichomoniasis, chlamydia, and gonorrhea should be provided to the patient. In patients who have not received hepatitis B vaccinations or in those with an unknown history of vaccination, the hepatitis B vaccine without HBIG should be administered. Following a clinical exam and patient history, prophylaxis against HIV may be provided to the patient as well. Currently, there are no recommendations on providing prophylaxis for hepatitis C to a sexual assault victim.
  7. 15-64
  8. HIV1/2 differentiation assay.
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38
Q

HSV Discordance

  1. If patient has it and partner does not, who gets suppressed? Pt? Prtner? Both?
A
  1. Patient only
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39
Q

When are anti HTN agents indicated in stage 1 HTN?

A

Antihypertensive medication is recommended for primary prevention of cardiovascular disease (CVD) (i.e., coronary heart disease, heart failure, and stroke) in patients with stage 1 hypertension (blood pressure 130–139/80–89 mm Hg) and an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of ≥ 10%. These medications are also recommended for patients with stage 1 hypertension and a history of CVD, and all patients with stage 2 hypertension (blood pressure ≥ 140/90 mm Hg). Calcium channel blockers (CCB), like amlodipine, have been shown to be highly effective in lowering blood pressure and reducing the risk of stroke. In the general population, they lower the risk by 36% and, along with thiazide diuretics, are the preferred choice for initial single-drug therapy for African American patients.

40
Q
  1. What meds can lead to elevated P?
  2. What labs/w-up does one order?
  3. What dictates whether a microP is Rxed?
  4. How is a microprolactinoma managed in pregnancy?
  5. How is a macroprolactinoma managed in pregnancy?
  6. T or F. 1/3 of macroprolactinomas advance in pregnnacy?
  7. Do you follow P levels in Pregnancy?
  8. If needs rx in preg, which med to use?
  9. Can women breastfeed with dopamine agonist rx?
A
  1. antipsychotics/antidepessants, antiemetics, opiates, antiacids
  2. fasting P, hcg, TSH, CMP, med list, MRI
  3. symptoms; all macro need Rx and lab eval of other pit hormones + visual field testing
  4. Discontinue medication.
  5. Larger tumors abutting the optic chiasm require continued rx with dopamine agonists during pregnancy. for smaller tumors away from the chaism, can DC meds as in microadenomas.
  6. T
  7. No. Asx about sx only.
  8. Bromocriptine has more safety data (n/v, hypoT..so outside preg we use cabergoline)
  9. Cannot BF with D agonist
41
Q

IBS ROME III Criteria

Rx

A

Recurrent abdominal pain or discomfort and a marked change in bowel habit for at least 6 months, with symptoms experienced on at least 3 days of at least 3 months and two or more of the following:

  • Pain is relieved by a bowel movement
  • Onset of pain is related to a change in frequency of stool
  • Onset of pain is related to a change in the appearance of stool

Therapeutic Doc-Pt relationship. High fiber diet.

42
Q

imperf hymen optimal time for correction

A

after puberty to allow for endogenous E exposure

43
Q

T or F: Monofollicular development is a characteristic feature of clomiphene citrate, whereas multifollicular development is associated with letrozole.

Days ___ are the most fertile days of an idealized 28-day cycle.

A
  1. False. Rememebr we use letraazole in PCOS..these pts do not ovulate, we just need to get one egg out!

9-14

44
Q
  1. What type of trigger is associated with OHSS?
  2. In a hypo/hypo patient, what is the best OI agent.
  3. How to treat unexplained infert?
  4. What treatment as the highest risk of multiples?
A
  1. HCG; luprolide is better avoid OHSS.
  2. urinary human menopausal gonadotropins (fsh alone wont do much without LH, which is needed for androgen production in theca cells)
  3. OI + IUI (better than OI alone)
  4. OI with gonadotropins + IUI
45
Q

1ry, 2ry, 3ry prevention.

A
  1. Primary prevention refers to preventing a disease process before it occurs through prevention of exposures that may cause the disease.
  2. Secondary prevention decreases the effect of a disease or injury that has already occurred. ID disease before problems are serious.
  3. Tertiary prevention refers to interventions that reduce or eliminate long-term impairments or disabilities, minimize suffering, and promote lifestyle adjustments for chronic conditions.
46
Q

Lipid levels normals

What med targets low HDL?

At what AVCD risk do we consider statins?

TPA cannot be given if:

A
  1. Total Chol < 200; LDL < 100; HDL <50
  2. Niacin targets low HDL
  3. 7.5%

TPA

->4.5hrs

recent bleeding

SAH, BP 185/110, active bleeding

glucose derrangements

warfarin with inc INR, hep with inc PTT or dec plt

evidence of bleed on head CT

47
Q

Who gets a spiral CT for lung cancer screening?

A

Patients aged 55–80 years with a significant smoking history (30 packs-per-year history).

48
Q
  1. Leuprolide acetate induces amenorrhea in most women and results in decreased size of a leiomyomatous uterus by as much as __% after 3 months of use.
  2. Adverse effects of leuprolide acetate include:
A

60%

Adverse effects of leuprolide acetate include vasomotor symptoms, vaginal dryness, and joint aches.

49
Q
  1. Cyclic mastalgia usually presents during what part of menstrual cycle? Uni or bilat?
  2. Rx 1st line?
  3. Danazol is FDA pproved for Rx fo noncyclical mastitis. T or F
A
  1. Uniformly benign. It presents as pain in the late luteal phase of the menstrual cycle, resolves with the onset of menses, and is usually bilateral and diffuse, as in the described patient
  2. NSAIDs. Not OCPS.
  3. Danazol is FDA approved. Check LFTs. can be used for fibrocystic beeast dz too. Tamoxifen can be used but is not approved for this.
50
Q

What EMS measurement is concerning after a med ab?

A

>=3cm

51
Q

Metabolic Syndrome Criteria

When do we screen for Lipids? DM? TSH?

A

the presence of any three of the five criteria listed constitutes a diagnosis of metabolic syndrome…Screen again q 1-2 years.

Lipids: start at 45yo. Q5y

Those with a 10-year risk of >20% are treated with statins and those with 10-year risks 10%-20% may also benefit from statin therapy. In general, statin therapy reduces the relative risk of cardiovascular events by 20%-25% when used as primary prevention.

DM: start at 45yo. q3y.

TSH: ?

52
Q
  1. femoral
  2. obturator
  3. sciatic
  4. common peroneal
  5. ilioinguinal
  6. iliohypogatric
  7. genitofemoral
A
  1. Femoral: L2-L4
    • m: dec quad strength, no pat reflec
    • s: dec ant thigh, medial leg and thigh, no patellar reflex
    • i: deep retractors, excessive hip flexion
    • CANT WALK UPSTAIRS
  2. Obturator
    • cant adduct thigh
    • dec sens over medial thigh
    • i: paravaginal defect, transobt tape, LND
  3. Sciatic L4-S3
    • dec hamstring strength
    • burning pain down the posterior thigh
    • no achiles reflex
    • SSLF, hip flex with extended knee
  4. Common peronial
    • foot drop, inversion
    • dec sens ant leg and dorsom of foot
    • fixed pressure at fibular head
  5. iliohypogastric (most common injury at time of pfann)
    • mons, labia, inner thigh
  6. ilioinguinal
    • dec sens inguinal and suprapubic areas
    • suture after LTCS
  7. Genitofemoral
    • dec sens over femoral triangle+ labia
    • Injury most commonly occurs during external iliac lymph node dissection or resection of a large sidewall
53
Q
  1. What are the exercise recs for all?
  2. When can you offer meds?
  3. 1st line med? MOA? side effects?
  4. When do you offer bariatric sx?
  5. XR meds should be avoided in bariatric surg pts.
A
  1. 150min / week. 75 min if vigorous
  2. Fail 5% body weight loss in 6m
  3. orlistat (panc lipase inhibitor, dec fat abs; inc cramps, flatulance, fecal incont)
  4. BMI>35 w/ comorm, or >40 with none
  5. true; consider non-ocps, wait 1-2yrs before concetion (18m)
54
Q
  1. You just had an occupational expusure to HepC:
    • What is the sequence of steps?
    • What is the approved PEP for HepC?
  2. You just had an occupational expusure to HepB:
    • What is the sequence of steps?
  3. You just had an occupational expusure to HIV.
    • What is the sequence of steps?
A
  1. Test the pt and worker for hepB ab. If worker postive for AB, then chek RNA, if positive, worker alread had chronic hep C. If negative AB, worker needs f/u testing for RNA in 3 weeks. If positive then, Rx! if neg, stop!
  2. Try to establish immunity be sending a HepBSAb. If not immune, innitiate HepB vaccine series immeiately
  3. TBD
55
Q
  1. MOA of bisphosphonates.
  2. CI if?
  3. If can’t do PO, what can they do?
  4. MOA of denosumab (Prolia)
  5. nasal calcitonin, who can use?
  6. MOA of teraperetide (Forteo)
  7. Raloxefine is a good choice for a young postmenopausal woman with a planned switch at 60yo. T or F
  8. All bisphosphonates dec risk of vertebral fractures, and alandronate and zeledronic acid also dec risk of hip rx. T or F
A
  1. inhibition of osteoclasts
  2. renal or GI issues or hypoCA
  3. zeledronic acid (CI if renal dz)
  4. rank ligand: subQ, Q6M
  5. those 5 yrs post menopause, not practical. The use of calcitonin in the treatment of osteoporosis is controversial because it has been shown to reduce the risk of fractures less than other agents. It has minimal effects of bone mineral density and is not used as first-line therapy.
  6. rPTH; builds bone! severe dz only, 2yr use only
  7. T
  8. T
56
Q

Bone density should be screened in postmenopausal women younger than 65 years if __ risk factors are noted?

FRAX individuals with risk factors and DXA if __% overall risk fracture.

Cutoffs for osteoporosis.

T or F: Peak bone mass at 30 is the strongest predictor of bone mass at 50. T or F

Weight for high risk cut off?

Who gets rx in setting of osteopenia?

What labs are indicated to rule out 2ry causes of osteop?

A

Medical history of a fragility fracture, Body weight less than 57.6 kg (127 lb), Medical causes of bone loss (medications or diseases), Parental history of hip fracture, Current smoker, Alcoholism, Rheumatoid arthritis

9.3%

A T-score of greater than –1.0 is considered to indicate no increased risk of fracture, whereas a score of –2.5 or less defines osteoporosis and usually is the value at which definitive therapy is recommended. A T-score of –1.0 to greater than –2.5 is considered to indicate low BMD and to correlate with a slightly increased fracture risk.

True

127lb

In the setting of osteopenia, bisphosphonate therapy is not warranted unless the fracture risk assessment (FRAX) tool shows a 10-year risk of major osteoporotic fracture ≥ 20% or a 10-year risk of hip fracture of ≥ 3%.

1st line: CBC, BMP, 24hr urin ca, vit d, TSH

2nd line: celiac panel, serum protein electroph

57
Q

Initial Rx for otitis media __.

If resistant: __.

A

The initial treatment for acute otitis media is amoxicillin.

If resis: augmentin

58
Q
  1. Dx criteria of PBS
  2. Management
A
  1. unpleasant sensation related to bladder, associated w/ LUTS > 6 weeks, NO infection
  2. Education! Self-care. Stress management, PT (FIRST LINE); elmiron and amytryp (2nd LINE)

No routine use of cysto, KCL.

59
Q

What agents besides metformin can be used for PCOS rx?

what are the benefits of metformin?

A

thiazolidinediones like pioglitazone, rosiglitazone, and the biguanide metformin, also improve ovulation rates and increase circulating sex hormone-binding globulin, lowering bioavailable androgen.

dec circulating androgen levels, improved ovulation rate, and improved glucose tolerance.

60
Q
  1. How do we Rx labial agglut?
  2. How does a prolapsed urethra present? rx?
  3. Rx lichen sclerosus in a child
  4. Common causes of vaginitis in peds.
A
  1. Usually resolves on its own with endog E production at 5-6yo, treat only symptomatic patients; if rx, use E cream
  2. pianless bleeding, friable mass age 5-8, chronic constaption or lung dz, AA. doughnut shapped mass on exam. Rx: treat underlying cause, sitz baths, topical E.
  3. do not biopsy. educate, avoid irritants. The initial management of vulvar LS children is similar to the management of the disease in adults. A superpotent topical corticosteroid is the preferred first-line therapy.
  4. GAS (Streptococcus pyogenes), Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, and Moraxella catarrhalis.

Pelvic exam not indicated <21yo unless sig med history

61
Q
  1. Oral meds should be withheld the AM of surgery. T or F
  2. What do you do with long actin insulin?
  3. How long is merformin held?
  4. Goal periOP FSG.
  5. T1DM, what do you do with their meds?
  6. At what FSG do you cancel surgery?
A
  1. True
  2. give half the dose in the AM, or pump basal dose
  3. Taken until the night before
  4. 80-180

T1: hold meds and drip

Cancellation of surgery should be considered in non-emergent cases where blood glucoses are 400-500 mg/dL.

62
Q
  1. Inpt rx of PID
  2. Outpt PID Rx
A

Inpatient PID Rx:

  1. Cefox + doxy
  2. cefotetan + doxy
  3. gent + clinda
  4. unasyn + doxy

Outpatient PID Rx:

  1. Ceftx + doxy +/- flagyl
  2. Ceftx + azithro 1g x2 doses 1 week appart
  3. Cefoxitin x1 + Prebenecid + doxy (+/- flagyl)
63
Q
  1. What phase of menses affected in PMS?
  2. What is PMDD?
  3. How is PMS dx?
  4. Initial Rx?
  5. What is first line med rx?
A
  1. Luteal -> menses onset
  2. In premenstrual dysphoric disorder, symptoms are more severe and debilitating and consistently involve affective symptoms that affect the patient’s relationships and functioning, socially and at school or work.
  3. The American College of Obstetricians and Gynecologists recommends diagnosing PMS based on prospective symptom diaries to confirm that the symp- toms occur during the luteal phase.
  4. The goal of treatment is symptom relief and often begins with dietary changes, exercise, and stress reduction.

SSRI, taken daily or only during the luteal phase of menstruation, constitute first-line medical therapy for severe PMS or premenstrual dysphoric disorder if no BCM disired. COC if BCM desired.

64
Q
  1. Most common cause of community-acquired pneumonia:
  2. Rx CAP
A
  1. Strep pneumo
65
Q
  1. POP-Q points and grid.
  2. Stages
  3. BW stages
A
  1. See Photo.

stage 1: leading age

stage 2: leading edge -1 +1

stage 3: leading edge +1, but < TVL -2

grade 4: > TVL -2

BW:

stage 1: descent halfway to hymen

stage 2: to the hymen

stage 3: halfway past hymen

stage 4: max possibel descent

66
Q
  1. Characteristics?
  2. Timing?
  3. Rx
A

The symptoms of postembolization syndrome, which is common after uterine artery embolization, include pain, fever, nausea, and malaise. The uterine tissue ischemia and necrosis cause an inflammatory process, leading to one or more of the symptoms associated with postembolization syndrome. Generally is not associated with purulent vaginal discharge.

Peak 1–2 days post procedure and usually resolve within 7 days. Symptoms that last longer should be evaluated for infection.

Prophylactic perioperative use of analgesics, antipyretics, and antiemetics often are used to limit the symptoms of postembolization syndrome.

67
Q

Which procedures require ABX?

A

hysterectomy, colporrhaphy, and pelvic reconstruction procedures including those using mesh

68
Q
  1. What is the standard progression of pubertal events?
  2. When do we worry and initiate workup?
  3. What are the two general types?
  4. DDx for the dependant type.
  5. DDx for the independent type.
  6. What is a GnRH challenge test (in which instance is it postive)
  7. GnRh dep process is treated with?
  8. MCune albright rx with?
  9. What happends to bone in in most cases of precocious puberty? What is the exeption?
  10. Benign variants include isolated thelarchy or puberche, in which cases bone age is ___.
  11. Premature thelarche tends to be gonadotropin-independent and is not progressive. The most important diagnosis to rule out is true precocious puberty, which is marked by acceleration of linear growth and pubertal elevation of gonadotropins. What test can be done?
A
  1. Thelarche, Adrenarche, growth spurt,menarche (TAGM)
  2. <6yo w/ thelarche or adrenarche OR <8yo with both
  3. GNRH dep and GNRH indep
  4. Constitutional/Ideopathic or CNS pathology (hemartoma, cranipharyng, GH def, hydroceph, trauma, CNS infection. (MRI)
  5. Think ovarian tumors (functinoal cysts, granulosa cell, leydig, gonodoblast), adrenal tumor, CAH, McCune Albright, hypothyroidism, environmental
  6. GNRH is given, and LH is measured and increases if GNRH dependent. If peripheral, then brain will not respons
  7. Lupron.
  8. Aromatase inhibitors
  9. Advanced, not the case in hypothyroidism (delayed). Patients with secondary sexual characteristics should have radiographic assessment of bone age. An advance in bone age (greater than two standard deviations beyond chronological age) suggests precocious puberty.
  10. Not advanced.
  11. bone age.
69
Q
  1. What should trigger an evaluation for delayed puberty?
  2. What is the first step once you determine an eval is needed? What other 3 tests are always included?
  3. There are no breasts on exam…what is next and what is the ddx?
  4. There are breasts on exam…what is the ddx?
A
  1. No menarche by age 15 years (“bleed by 15”), no menarche within 3 years of thelarche, or no thelarche by age 13 years (“tits by 13”).
  2. Determine E status on exam (and draw TSH, Prolactin, HCG)!!!!
  3. NO BREASTS –> Draw an FSH:
    1. FSH High: Think issue with gonads!
      1. PCOS
      2. Genetic: Turner’s (XO), Fx prem, Sewyer (XY), 17a-hydrox deficiency (ideopathic most common)
      3. Acquired: chemo, rad, surg
      4. Autoimmune
    2. FSH Low: –> MRI
      1. immature HPO axis (most common)
      2. hypothalamic suppresison (exercise, stress, weight loss)
      3. hypothyroidism, prolactinoma
      4. PCOS
      5. Kallman
      6. tumor (cranyopharyng most common) , brain injury, infection
      7. Sheehan
      8. Cushing
      9. Empty sella
  4. BREASTS
    1. Think structural: imperf hymen, transv septum, aquared cvx stenosis
    2. Mullerian agenesis
    3. Complete AIS
    4. 5 alpha reductase
    5. think dysfunciton (PCOS! TSH! prolactin!)

A patient with gonadal dysgenesis requires supplemen- tal hormonal treatment to initiate or complete her pubertal development and enhance bone health.

70
Q

T or F The 2017 ACC/AHA guidelines suggest that the BEST method for diagnosing hypertension involves ambulatory blood pressure monitoring. T or F

A

True

Stage 1 hypertension: 130-139 mm Hg or 80-89 mm Hg diastolic
Stage 2 hypertension: Systolic >140 mm Hg or diastolic >90 mm Hg.

71
Q

Raloxefine

Raloxifene is a SERM approved by the U.S. Food and Drug Administration for the prevention and treatment of osteoporosis, but fracture risk reduction has consistently been proved only for __ fractures.

T Or F: Raloxefine is approved for reductiong of the risk of invasive breast cancer in postmenopausal women.

What side effects to we worry about?

A

Spinal

True.

Raloxifene has a similar thromboembolic disease risk to that posed by estrogen, and women may experience an increase or reappearance of vasomotor symptoms.

72
Q
  1. What are the components of the ROMA?
A
  1. CA125, HESP 4, menopausal status
73
Q

Treatment for

  1. Female sexual interest and arousal disrorder?
  2. Sexual aversion d/o?
  3. Sexual arousal d/o?
  4. Female orgasmic d/o?
  5. genitopelvic pain and penetration d/o?
  6. vulvodynia?
A
  1. dec int or arousal >6m; ssri. antihist, antichol, psychotropic, tca, ocp; flibanserin (5HT R ag/ant) or Bremalanotide. Both only in preM women.
  2. Aversive responce to genital contact (Rx: psychotherapy and antidepressants)
  3. innability to attain or maintain suff arousal (address inciting factors)
  4. persistent or recurrent delay in or abscese of orgasm (Rx: masturbation, increaseed stim, inc comunication)
  5. lubrication, pelvic floor PT
  6. vulval pain >3m no ID cause (rule out other causes: breastfeeding, stop OCP/P, topical E rx)
74
Q

Sheehan syndrome, workup includes:

Women with hypogonadism due to pituitary disease who are not interested in fertility should be treated with:

If a woman with a history of Sheehan syndrome wishes to conceive, what is the only available treatment for ovarian stimulation?

A

Sheehan syndrome, workup includes estradiol and follicle-stimulating hormone levels, which would both be low. Magnetic resonance imaging (MRI) will show a small pituitary within a normal-sized sella and will sometimes be read as an empty sella.

Women with hypogonadism due to pituitary disease who are not interested in fertility should be treated with estrogen therapy, typically with transdermal estradiol similar to patients with premature ovarian failure. Cyclic progesterone should be added for endometrial protection in any woman with a uterus.

If a woman with a history of Sheehan syndrome wishes to conceive, gonadotropin therapy (exogenous luteinizing hormone and follicle-stimulating hormone) is the only available treatment for ovarian stimulation.

75
Q
  1. Sinusitis 1st line Rx.
  2. Most common pathogens
  3. When to give abx?
  4. What abx?
  5. pcn allergic?
A
  1. Analgesics/antipyretics and decongestants.
  2. Step Pne and H. Influenzae
  3. persistence of symptoms beyond 10 days, severe symptoms (high fever of at least 39°C [102°F], purulent nasal discharge, or facial pain lasting for at least 3–4 consecutive days from the beginning of theillness; worsening of symptoms with new onset of fever, headache, or increased discharge initiated by a typical upper respiratory infection that was improving in the initial 5–6 days (“double sickening”)
  4. Augmentin:The addition of clavulanate improves coverage for ampicillin-resistant Haemophilus influenzae and Moraxella catarrhalis.
  5. doxy
76
Q

Hormonal contraception is MEC __ in Lupus pts that have antiphosplipids. In pts with no antiphos, MEC __.

A

3, 2

77
Q

Semen Analysis Parameters

A

1.5 ml

15 million / ml concentration & 40 million total

4% morphology

40% total motility

32 % forward progression

78
Q

XY (SRY) Testes –> Sertoli + Leidig. What do each make? What ducts form/degen?

T –> DHT (what enzyme?)

Female external genitalia results from?

A

Sertoli -> AMH -> Mullerian ducts degenerate

Leidig -> Testosterone -> Wolffian Duct Develops

5a reductase

No Y, No SRY, T synthesis defect, androgen R defect, 5 alpha reductase def

(No T (no SRY or no Y chromosome), unable to covert T, unable to bind T)

79
Q
  1. SSRI use is associaed with what fetal and neonatal risks?
A

Fetal: Paroxetine increases fetal cardiac malf risk

Neonatal: jitteriness, TTN, resp distress, NICU admit, PersPulmHTN

80
Q
  1. NNT
  2. Ab Risk Red
  3. Rel Risk Red
  4. Odds ratio
  5. Using 4 mm or less as a cut-off, there is a 99.6–100% ___ to exclude adenocarcinoma on PMB.
A
  1. NNT: 100/(difference in event rates)
  2. ARR: Not a ratio, but the actual quantitiy by which some outsome is reduced (e.g. 98.9% in the intervention group - 98.7% in the non-tervention group=0.2%).
  3. RRR: Absolute risk reduction / baseline rate of the event in question (a ratio of the % of people who experience the outcome / percentage of controls that experience the outcome)
  4. Odds ratio: outcome of odds in 1 group / odds in another (case control studies)
  5. NPV
81
Q

polyglactin is what suture?

polypropylene suture is permanent T or F

Polydioxanone is permanent. T or F

A

VICRYL

True (PROLINE)

F: PDS is slowly absorbed

82
Q
  1. MOA for tamoxifen
  2. If a womens risk of Br Cancer is >1.6% for the next 5 years, or lifetime risk of >20%, she is a candidate for tamoxifen chemoprevention. T or F.
  3. What are the adverse SE?
  4. PMP users have lower rates if osteoporosis because of its antiosteoclast activity. T or F
  5. T or F: Aromatase inhibitors, such as anastrozole, have not been approved for breast cancer chemoprevention.
  6. Tamoxifen and raloxifene have been approved in postmenopausal women, and tamoxifen has been approved for use in premenopausal women only. T or F
  7. Tamoxifens and SSRI interfere. T or F
  8. What if wants to conceive while tamoxifen?
  9. Raloxifene is not used in premenopausal women because it can cause ovarian stim. t or f
A
  1. SERM
  2. T
  3. VTE; EndoCA (mostly in postmenopausal women); vaginal discharge, sleep disturbance, cataracts
  4. True
  5. False, but! arom inh inc bone loss and fractures in PM women
  6. True
  7. True
  8. Cant. Must wait 5 yrs +3m grace period. Craniofacial malformations and ambiguous genitalia
  9. T
83
Q
  1. How do you differentiate gestational thyroid toxicosis from hyperthyroidism in pregnancy?
  2. How do you treat gestational thyroid toxicosis?
  3. What is the preferred treatment for patients with Graves disease and severe ophthalmopathy?
  4. when do you start TSH screening and how often?
  5. The workup of a thyroid nodule begins with __. What characterisitcs are c/f malig?
  6. What do you do with purely cystic nodules?
  7. If c/f malignancy, what do yuo do?
A
  1. antithyropid R antibodies
  2. you dont.
  3. thyroidectomy and glucocorticoids.
  4. age 50, Q5yrs; >18yo w/ risk factors (autoimmune, Fh thyr)
  5. Thyroid US: calcifcations, hypoechoic, irreg borders –> biopsy
  6. do not biopsy
  7. biopsy. If biopsy with c/f follicular neop, Scinti to det if hot or cold…all cold get biopsies
84
Q
  1. Why do we give T? What level do we want it to be?
  2. What labs are monitored? Why?
  3. What cancers are patients on T at increased risk for?
  4. At what age do we start?
A

Testosterone therapy is administered to suppress menses and induce masculine secondary sex characteristics. 500

Laboratory testing is done to assess hemoglobin, hematocrit, liver function, and serum testosterone level.

Screening for cervical and breast cancers should be continued in patients who have not yet undergone mastectomy or complete hysterectomy.

Patients on testosterone therapy may be at increased risk of endometrial and ovarian cancers.

According to the American College of Obstetricians and Gynecologists, this cross-gender puberty induction typically begins at 16 years of age and should be initiated in conjunction with the patient, a therapist, and ideally, support persons in the patient’s life.

85
Q

Triptans are contraindicated in HTN or CV disease. t or f

A

t

86
Q
  • UAE increases which of the following: misscarriage, malpresentation, PTB, PPH
A
  • all
87
Q

urethral caruncle

  1. what is it?
  2. Rx?

urethral diverticulum

  1. What is it?
  2. Rx?
A

urethral caruncle:

  1. A urethral caruncle is a benign polypoid lesion at the distal portion of the urethral meatus.
  2. Obs if no sx; E if sx

urethral diverticulum

  1. outpouching of the urethra: dyspareunia, dribbling, discahrge, dysuria
  2. If not bothersome, can obs. otherwise excise
88
Q
  1. Anterior repairs are rarely performed alone. What procedures usually accompany them?
  2. What is the most common post-op compilication of a sling?
  3. What is the MOA of bethanecol?
  4. Most common complication of transvaginal POP surgery?
  5. What vessel can be injured in an ASC? What does it run on?
  6. Macrobid carries a risk of ____ in older women and should not be used for UTI supression in this population.
  7. Most meshes are MONOfilament and MACROporous. T or F
  8. What structures run behind the sacrosp ligament? Where do we throw the stitch for a SSLF?
  9. What is autonomic hyper-reflexia?
  10. T or F: colpocleisis is assoc with rectal prolapse. T or F
  11. Vertebral osteom after ASC is dx with ?? and most commonly caused by?
A
  1. Apical suspension
  2. retention
  3. cholinergic agonist used in detrusor hypotonia
  4. mesh erosion
  5. middle sacral artery; anterior long lig
  6. chronic interstitial lung disease
  7. T
  8. Pud art, sciatic nerve, inf gluteal art; place the stitch 2cm medial to the spine
  9. seen in individulas w/ cord lesions above SPINAL LVEL T6. Excess sympathetic responce 2/2 stimulation below the level of the injury
  10. T
  11. MRI; staph aureus
89
Q
  1. Dose interval for Hep B series.
  2. A patient steps on a nail. Last Tetanus vaccine was 3 years ago. What do you give?
  3. For routine 65 yr old patients, what pneumococcal vaccines are given?
  4. Pneumococcal immunization, with one dose of __, is recommended for patients age 19 to 64 who are at increased risk, including those with anatomical or functional asplenia.
  5. <15yo, HPV vaccines are given __ months appart. If given less than __ m apart, must give a 3rd dose.
  6. Menningococal vaccine is ok in pregnancy, but usualy given @ __ with a booster at __. T or F
  7. Do you give zoster vaccine in patients with h/o shingles?
A
  1. 0,1,6m, booster with one dose when needed.
  2. Nothing. Tetanus toxoid-containing vaccines (eg, TD, Tdap) are recommended for acute wound management if 5 years or more have elapsed since the patient received a tetanus vaccination. (Use Tdap if pregnant).
  3. Photo. ALL get PPSV23
  4. PPSV23 immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implant.
  5. 6-12 months for dose #2; <5 months, give a 3rd dose. HPV vaccine is not a live vaccine.
  6. 11-12, boost at 16. The meningococcal vaccine is indicated in those with functional or anatomic asplenia, those who are known to be exposed to meningococcus, and first-year college students up through age 21 years who reside in residence halls. It is safe to administer in pregnancy because it is not a live attenuated vaccine.
  7. yes.
90
Q
  1. Consider suppresive treatmwnt for BV and yeast if more than __ (BV) and __ (Yeast) episodes per year.
  2. For a patient with vulvodynia, what is first line medication?
A
  1. Consider suppresive treatmwnt for BV and yeast if more than 3 (BV) and 4 (Yeast) episodes per year.
  2. TCA

BV: twice weekly gel for 16 weeks

91
Q

What are the resonably certain criteria?

A
  1. =<7days from LMP
  2. =<7days from TAB/SAB
  3. W/in 4 weeks PP
  4. Lactatinonal amenorrhea
  5. No IC since LMP
  6. Using BCM
92
Q

What do we sample in PIGT?

A

throphoectoderm of blastocyst

93
Q

WHI

  1. What two factors decreased in the E/P arm?
  2. What increased in the E/P arm?
  3. What decreased in E arm?
  4. What increased in the E arm?
  5. Do we d/c HRT prior to Sx?
  6. What is the risk of Br Cancer in the e/p arm?
  7. MOA of prasterone and ospemefine?
  8. T or F: subanalyses of the WHI found that when HT was initiated close to the onset of menopause, it was protective against coronary artery disease
A

E+P:

Inc: MI, stroke, dvt, br ca

Dec: colon CA / fractures

E:

Inc: stroke, DVT (NOT MI)

Dec: fractures

We do not d/c HRT unless prolonged immobility expected.

1 additional case per 1000 treated of breast cancer in E/P

Prasterone, synthetic dehydroepiandrosterone, is a daily vaginal suppository to treat dyspareunia and it elevates serum estrone levels. Gets aromaised to E.

Ospemifene, an oral SERM, improves symptoms with no endometrial activity.

True

94
Q
  1. How do we “rx” turner syndrome?
A

Treatment for Turner syndrome in adolescence includes growth hormone to maximize adult height and estradiol. Estrogen replacement should be initiated by age 11 or 12 (or at time of diagnosis, if diagnosed later) to mimic normal progression of puberty. Estrogen therapy induces and maintains sexual development including breast development, improves uterine length and volume, and contributes to growth and height. Estradiol is started at a low dose and gradually increased over two to four years to a young adult dose. The estradiol patch is the preferred route. Cyclic progestin should be added to induce bleeding and prevent endometrial hyperplasia and is typically added two years after initiation of estradiol or when breakthrough bleeding occurs.

95
Q

Rx of fibromyalgia?

A

Fibromyalgia is a disease of chronic widespread musculoskeletal pain without another etiology. The first-line treatment is patient education about the disease, beginning a physical exercise program, and drug monotherapy for symptoms that are not relieved by non-pharmacologic means.

Medications that have been effective include SNRIs, amitriptyline, cyclobenzaprine, and gabapentin or pregabalin.

96
Q

NSAID MOA

A

Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease inflammation by nonselectively inhibiting both cyclooxygenase (COX)-1 and cyclooxygenase (COX)-2 enzymes. Their effect on platelet function is mediated by COX-1 inhibition, thereby decreasing production of thromboxane A2, which decreases platelet aggregation.

97
Q

What are the failure rates of

nexp

male ster

mirena

btl

parag

ocp

A
  • Nexplanon 0.05%
  • Male Sterilization 0.15%
  • LNG-20 IUD 0.2%
  • Female Sterilization 0.5%
  • Copper IUD 0.8%
  • Oral Contraceptive Pills 9%

ABOG GYN (1 decks)

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