Gynecology Flashcards
Outcomes for fertility/recurrent ectopic pregnancies after salpingectomy/salpingostomy?
Subsequent pregnancy 60% for salpingostomy, 53.8% for salpingectomy; recurrence rate of ectopic pregnancy 18.3% for salpingostomy, 7.7% for salpingectomy
Which ovary is more likely to torse?
R - 3:2 ratio compared to left; thought to be 2/2 more free space (mobile cecum on R compared to fixed sigmoid on L)
Rate of infertility with fibroids and rates of pregnancy 1-2y after myomectomy?
5-10% of women with infertility have fibroids; fibroids are sole cause of infertility in 1-2.4% of women; 40-60% of women with fibroids become pregnant in 1-2y after myomectomy
% of endometrial cavity sampled by an endometrial biopsy?
5-15%
Workup of a palpable breast mass in woman >30 yo?
Diagnostic mammogram -> BI-RADS score 1-3 do US, score 4-5 do tissue biopsy (core needle preferred, reserve excisional biopsy for selected patients with masses not amenable to core or with implants) - always need to do a biopsy before proceeding with surgery
Expected bHCG monitoring and drop after giving single-dose MTX for ectopic pregnancy?
Single dose: give 50 mg/m2 on d1 and check bHCG, then check on d4 and d7 -> should see minimum of 15% drop between d4-7 or else need to redose
Patients at high risk for HPA-axis suppression if taking what steroids/doses or what disease?
More than 20 mg/d prednisone x 3w
More than 2 mg/d dexamethasone x 3w
More than 80 mg/d hydrocortisone x 3w
Clinical Cushing syndrome
Patients taking steroids without risk of HPA-axis suppression?
Glucocorticoids <3w regardless of dose
Alternating day therapy
<5 mg daily of prednisone (or equivalent)
Stress dose steroids for patients at high risk of HPA axis suppression? Moderate surgical stress?
High risk: 100 mg hydrocortisone IV just before procedure -> 50 mg IV q8h x 24h -> taper 1/2 per day until return to maintenance
Moderate risk: 50 mg hydrocortisone IV just before -> 25 mg IV q8h x 24h -> then normal dose
