GYN Joy

Question 1

Initially after Depo-Provera injection there may be ___________. This usually resolves in 2-3 months.

Answer 1

unpredictable bleeding

In general, after one year of using Depo-Provera, nearly 50% of users have amenorrhea.

Question 2

Contraindications to estrogen include

Answer 2

a history of thromboembolic disease
women who are lactating
over age 35 who smoke
develop severe nausea with combined OCPs

Question 3

__________ should be used with caution in women with a history of depression.

Answer 3

Progestins

Question 4

Both ___________ can be a potential side effect from using oral contraceptive pills.

Answer 4

hypertension and thromboembolic disorders

Question 5

After Essure, patients are required to use a back up method of contraception for three months following the procedure until?

Answer 5

a hysterosalpingogram is performed confirming complete occlusion of the tubes.

Question 6

Decribe “the patch” as controception

Answer 6

releases ethinyl estradiol and norelgestromin steady serum levels for 7 days.

Does not work if over 198 lbs

Question 7

What is the most effective emergency birth control

Answer 7

copper IUD

Question 8

pregnant with fever and bleeding with a dilated cervix which are findings seen with ____________

Answer 8

septic abortion.

Question 9

Threatened abortions clinically have

Answer 9

vaginal bleeding
a positive pregnancy test
cervical os closed or uneffaced.

Question 10

retention of a nonviable intrauterine pregnancy for an extended period of time

Answer 10

Missed abortions

Question 11

The management of septic abortion includes?

Answer 11

broad-spectrum antibiotics and uterine evacuation

medical termination is not the best option since prompt evacuation of the uterus is indicated for septic abortion.

Question 12

___________________ is a laboratory test often used for detection of lupus anticoagulant

Answer 12

Dilute Russell’s viper venom time (dRVVT)

Question 13

antiphospholipid antibody syndrome treatment is ?

Answer 13

aspirin plus heparin. There is roughly a 75% success rate with combination therapy versus aspirin alone.

Question 14

What is used in medical abortion

Answer 14

Mifepristone (an antiprogestin) can be administered, followed by misoprostol (a prostaglandin) to induce uterine contractions to expel the products of conception. This approach has proven to be effective (96%) and safe.

Question 15

Manual vacuum aspiration is more than 99% effective in early pregnancy, which is defined by

Answer 15

less than eight weeks prego

Question 16

condition where the cavity of the uterus develops scar tissue (adhesions).

Answer 16

Asherman’s syndrome, also known as intrauterine adhesions

increased risk with multiple abortions

Question 17

Mifepristone, a progesterone receptor blocker, is used for pregnancy termination. It is recommended for use within ________

Answer 17

49 days of the LMP

maybe effective up to nine weeks

Question 18

______ can be administered orally or vaginally and will induce uterine cramping with expulsion of products of conception. Potential risk factors of use include hemorrhage as well as failure.

Answer 18

Misoprostol

Question 19

Mifepristone is a _________moa

Answer 19

progesterone receptor blocker,

Question 20

Symptoms of Lichen sclerosus

Answer 20

Patients typically present with extreme vulvar pruritus and may also present with vulvar burning, pain and introital dyspareunia.

Question 21

findings of Lichen sclerosus

Answer 21

Early skin changes include polygonal ivory papules involving the vulva and perianal areas, waxy sheen on the labia minora and clitoris, and hypopigmentation.

Question 22

tell me bout the trich

Answer 22

Diagnosis performed by saline microscopy of vaginal secretionss, ensitivity of only 60% to 70%.

treatment is metronidazole 2 grams orally in a single dose or metronidazole 500mg orally bid for 7 days

The patient’s sexual partner also should undergo treatment prior to resuming sexual relations.

Question 23

describe Lichen planus

Answer 23

a chronic dermatologic disorder involving the hair-bearing skin and scalp, nails, oral mucous membranes and vulva.

can have progressive adhesion formation and loss of normal architecture, the vagina can become obliterated.

Question 24

Vestibulodynia (formally vulvar vestibulitis) syndrome consists of ?

Answer 24

symptoms/findings limited to the vulvar vestibule,

• severe pain on vestibular touch or attempted vaginal entry
• tenderness to pressure and erythema

Question 25

Vestibulodynia treatment

Answer 25

• tricyclic antidepressants to block sympathetic afferent –pain loops
• pelvic floor rehabilitation
• biofeedback
• topical anesthetics.

vestibulectomy reserved for patients who do not respond to standard therapies and are unable to tolerate intercourse.

Question 26

Lichen simplex chronicus rx

Answer 26

Treatment involves a short-course of high-potency topical corticosteroids and antihistamines to control pruritus.

Question 27

how do you treat gon and clam

Answer 27

-azithromycin
-doxycycline
for chlamydia

-cephalosporin
-quinolone
for gonorrhea.

Question 28

herpes ddx and rx

Answer 28

Clinical diagnosis of genital herpes should be confirmed by viral culture, antigen detection or serologic tests.

Treatment consists of antiviral therapy with acyclovir, famciclovir or valacyclovir.

Question 29

Vulvodynia is?

Answer 29

a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause.

all other causes of pain must first be excluded, including infectious etiologies as well as other vulvar conditions.

Question 30

________ has been shown to have alpha-adrenergic properties and may improve urethral tone in the treatment of stress incontinence.

Answer 30

Pseudoephedrine

Question 31

Kegel exercises are used to strengthen the pelvic floor and decrease urethral hypermobility for the treatment of _______________

Answer 31

stress urinary incontinence.

Question 32

The parasympathetic system is involved in bladder emptying and works via?

Answer 32

acetylcholine –> stimulates the bladder to contract through muscarinic receptors.

Thus, anticholinergics are the mainstay of pharmacologic treatment. Oxybutynin is one example.

Question 33

Herpes simplex virus presentation

Answer 33

Initial infection is characterized by viral-like symptoms preceding the appearance of vesicular genital lesions.

Question 34

Hep B exposure rx

Answer 34

Post-exposure prophlaxis should be inititated ASAP up till

• 7 days after blood contact
• 14 days after sexual exposure

Question 35

In individuals who are unvaccinated but exposed to persons who are HBsAG positive, recommendations are to?

Answer 35

receive one dose of HBIG (Hepatitis B Immune Globulin) and the HBV (Hepatitis B Vaccine Series).

Question 36

If exposure is HBsAG negative or unknown status, then?

Answer 36

HBV series is used.

Question 37

If exposed individual is vaccinated to Hep B and a non-ep responder, then rx is?

Answer 37

HBIG plus HBV or HBIG times two doses is used.

Question 38

ddx of Acute salpingitis

Answer 38

. Important diagnostic criteria include lower abdominal tenderness, uterine/adnexal tenderness and mucopurulent cervicitis.

Question 39

rx of covering both gonorrhea and chlamydia.

Answer 39

In pt IV Cefotetan or cefoxitin PLUS doxycycline or clindamycin PLUS gentamicin

out-pt:
-ceftriaxone, cefoxitin, or other third-generation cephalosporin (such as ceftizoxime or cefotaxime)
PLUS
doxycycline WITH or WITHOUT metronidazole.

Question 40

Acute cystitis in a healthy, non-pregnant woman is considered uncomplicated and is very common and caused by

Answer 40

• escherichia coli 85%
• Staphylococcus saprophyticus
• Klebsiella pneumoniae
• Enterococcus faecalis
• Proteus mirabilis.

Question 41

Mildly symptomatic or asymptomatic urinary tract infection must be considered in patients who present with

Answer 41

low pelvic pain
 urinary frequency
urinary urgency
hematuria
new issues with incontinence.