Just Might Be On This Damn Exam Flashcards

Based on Review Session and Pat's Own Mouth

1
Q

Diagnostic test for identifying reasons for infertility, galactorrhea, and amenorrhea. Good at identifying possible hormone secreting tumor as well.

A

Serum Prolactin Level

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2
Q

You think she might have something going on “down there”…you think it might be trichamonas or BV. How you gonna find out? What might you see?

A

Wet mount. Flagellated and motile trichomonads for trich. May see Clue cells for BV

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3
Q

Oh crap…she’s positive for a qualitative Hcg test…but she is definitely NOT pregnant. What might this be?

A

Ovarian cancer!!!

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4
Q

She’s trying to get pregnant, Hcg is present in qualitative Hcg test. What do you tell her?

A

Congrats!

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5
Q

A woman has severe one sided abdominal pain, and has been suddenly spotting. A quantitative Hcg test is performed and Hcg is present but it is there in very low amounts. What might be happening?

A

Ectopic pregnancy or miscarriage

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6
Q

She thinks she might be pregnant, a quantitative Hcg test is performed and she has HUGE levels…what might be happening?

A

Molar pregnancy or even twins. Better find out…cuz one might be awesome and one might suck!

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7
Q

There is a thick, white, curdy discharge coming from her vagina. She’s in a bit of pain and is uncomfortable. What test might you perform? What might you find?

A

KOH smear. Hyphae and mycelia if candidiasis is the culprit.

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8
Q

According to the amsel criteria…how you gonna know if someone has BV?

A

3 of 4 of the following: Graying/white vaginal discharge, pH>4.5, fishy WHIFF after KOH, presence of CLUE cells - it was the BV…in the vagina…with the lead pipe.

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9
Q

How do you test gestational diabetes in the 3rd trimester?

A

GTT (glucose tolerance test)

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10
Q

This test is commonly used to monitor infertility.

A

FSH.

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11
Q

This might be elevated in women who have adrenal tumors, congenital adrenal hyperplasia, ovarian tumors, PCOS.

A

Testosterone

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12
Q

Serum testosterone may be helpful in identifying what?

A

Ovarian tumors, virilizing conditions in women.

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13
Q

This is the best test to determine if ovulation has occurred.

A

Serum progesterone level (on day 21 of the cycle)

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14
Q

Low levels of progesterone indicate (decreased/increased) risk of spontaneous abortion and/or onset of menopause.

A

Increased

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15
Q

Serum estrogen levels are checked to assess what?

A

Menstrual and fertility problems

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16
Q

This test can the presence of absence of ovulation or the time of ovulation. If there is a non “frond-like” pattern on the slide, it means what?

A

Fern test. It would mean ovulation HAS occurred

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17
Q

Wanna know if it’s chlamydia, gonorrhea, or E. Coli? What do you want to do?

A

Culture that vagina for bacteria

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18
Q

Testing some Rh crap that I don’t understand

A

Coombs test

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19
Q

Let’s talk about PAP’s. Not Blue Ribbon…but the other kind. Who gets screened for cytology and how often?

A

Women age 21-65, every 3 years.

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20
Q

Who gets screened via co-testing on pap smear? Who often?

A

Women age 30-65, every 5 years if they want to cut down on visits.

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21
Q

T/F You should screen women younger than 21

A

FALSE

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22
Q

T/F You should screen a 28 year old for HPV

A

FALSE. Not til she’s 30 will you do co-test screenings

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23
Q

T/F A woman who has had a hysterectomy with the removal of her cervix who has no history of cancer or pre cancer DOES NOT HAVE TO BE SCREENED AT ALL.

A

TRUE

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24
Q

T/F Grandma has been screened every year and she’s been clear. Now she’s turning 65, to celebrate…you take her for a screening.

A

FALSE

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25
Q

T/F You find ASC-US or LGSIL but HPV is negative. You must do a colposcopy to find out wtf is going on!

A

FALSE

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26
Q

You’ve got a kid who lost her IUD…not at home…I mean inside. How you gonna take a look?

A

Pelvic US

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27
Q

How are you going to dx retroperitoneal lymphadenopathy associated with malignancies or identify the depth of myometrial invasion in endometrial carcinoma and extrauterine?

A

Pelvic/Abdomina CT

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28
Q

This procedure best EVALUATES ENDOCERVICAL CANAL, ENDOMETRIAL CAVITY and FALLOPIAN TUBE LUMINA. It’s good at finding uterine abnormalities as well as tubal abnormalities when assessing fertility issues

A

Hysterosalpingogram (HSG)

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29
Q

I’m gonna take a look at the cervix proper…

A

Colposcopy

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30
Q

I’m gonna stick a needle in the pouch of douglas to figure out what type of inwraperitoneal lesion we’re dealing with here folks…

A

Cultocentesis

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31
Q

Gonna take a “LEEP” of faith and remove some vulvar and cervical lesions. While I’m at it, I’ll remove some vulvar condylomata and cervical dysplasias.

A

Loop electrocautery excision procedure

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32
Q

FDA says the fetus will be jacked up if I give this drug…regardless of benefit.

A

Category X

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33
Q

FDA says that nothing should come between me and this drug…it seems to be safe

A

Category A

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34
Q

FDA says it doesn’t look good, doesn’t look bad…but no animal fetuses have been hurt and no women have even been tested

A

Category B

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35
Q

FDA says animal fetuses have suffered a little, but no human tests have been performed. However, benefits might outweigh the risks.

A

Category C

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36
Q

FDA says tests have been done on humans and the results weren’t very good for the fetuses, but still…in extreme cases…benefits may outwit the risks.

A

Category D

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37
Q

Best medication for osteoporosis, Paget’s disease, and bone metastases

A

Bisphosphonates.

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38
Q

T/F Bisphosphonates should be taken with food

A

FALSE. Need to have an empty stomach

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39
Q

T/F Calcitonin is good at reducing bone resorption as a second line drug for osteoporosis but it does not reduce pain associated with osteoporotic fractures and vertebral fractures

A

FALSE. It’s good at reducing that pain

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40
Q

Most common side effects of bisphosphonates

A

Esophogitis, abdominal pain, diarrhea

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41
Q

Weight bearing exercise, smoking cessation, vitamin D and calcium supplementation, and glucocorticoid avoidance will help reduce…

A

Osteoporosis

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42
Q

Women over 50 should take 1000, 1100, 1200, 1300, or 1400mg/day of calcium. Young women age 9-18 should take how much?

A

>50 = 1200mg/day 9-18 = 1300mg/day 19-50=1000mg/day

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43
Q

How do you stimulate withdrawal bleeding in a woman who is not pregnant but who has no menses?

A

Progesterone challenge. If you do it and there is withdrawal bleeding then an ovulation is the problem causing her lack of menses. If it doesn’t stimulate bleeding, then something else is wrong.

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44
Q

Who do you give clomephine citrate to?

A

Women who respond to progestin challenge with bleeding who want to get pregnant

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45
Q

T/F HRT is indicated for use to prevent osteoporosis

A

FALSE

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46
Q

T/F It is safe to use HRT’s for longer than 5 years in most cases.

A

FALSE

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47
Q

T/F Breast cancer is an absolute contraindication for estrogen use

A

FALSE (according to Pat)

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48
Q

You’ve got hot flashes, I’ve got some natural, alternative stuff for ya…here…try some ____

A

Black cohosh, flaxseed, vitamin E

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49
Q

This natural stuff is an important modulator of hormone metabolism

A

Flaxseed

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50
Q

____ has been touted as an alternative therapy to HRT

A

Soy…yeah…soy

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51
Q

Put this natural stuff on your dry vagina…

A

Vitamin E oil

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52
Q

Who do you treat most often with conjugated estrogens, estradiol, and estrone sulfate (Premarin, Estring)?

A

Menopausal women

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53
Q

The most potent estrogen therapy

A

Estradiol

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54
Q

For a women with an intact uterus, _____ is always included with the estrogen therapy because the combination reduces the risk of endometrial carcinoma associated with unopposed estrogen

A

Progestin

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55
Q

For women who have undergone hysterectomy, unopposed ____ therapy is recommended

A

Estrogen

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56
Q

Plan be treatment med is ____. Treatment is should be administered within ____hrs after intercourse.

A

Levonorgestrel, 72 hours.

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57
Q

Preven medication is ____ and should be administered within ____hrs after intercourse.

A

Estradiol and Levonorgestrel. 72 hours.

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58
Q

Nausea is worse with (Plan B, Preven).

A

Preven

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59
Q

IUD’s should be inserted within ____ after intercourse to be effective for emergency contraception

A

7 days

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60
Q

Ortho Evra is a ____

A

Birth control patch

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61
Q

A patch and ring both have ____% effectiveness

A

92-99%

62
Q

It is very important to do what before inserting an IUD?

A

CHECK FOR PREGNANCY!!!

63
Q

What factor most affects the benefits of a patch?

A

Obesity. Should be below 90kg

64
Q

What can you do if your male partner is bothered by your IUD?

A

Remove it for intercourse but replace it within 3 hours.

65
Q

Who should NOT use a nuvaring?

A

Smokers, young girls who have not reached normal menarche age, women who are pregnant

66
Q

How often do people get Depo shots?

A

Every 3 months

67
Q

What is implanon?

A

A contraceptive implant

68
Q

ACHES stands for ____ and is used for ____

A

Abdominal pain, Chest discomfort, Headaches, Eye problems, Serious pain in arms or legs. Used to assess pts prior to contraceptive treatment

69
Q

A woman who is going on hormonal contraceptives should not be or suffer from…

A

Pregnant, over 35 and smoker, breast cancer, undiagnosed vaginal bleeding, thromboembolic disorders, uncontrolled HTN, DM with vascular disease

70
Q

Dilation and aspiration surgical abortions are done between ____

A

7-15 weeks

71
Q

Dilation and evacuation surgical abortions are done between ____

A

16-24 weeks

72
Q

Mifepristone does what?

A

Aborts fetuses < 8 weeks gestation

73
Q

APGAR is measuring….

A

Appearance (color) 0-2, Pulse (absent, 100) 0-2, Grimace (none, grimace, crying) 0-2, Activity (movement) 0-2, Respirations (absent, slow/irregular, good) 0-2

74
Q

The most popular obstetric nerve block is…

A

Pudendal

75
Q

You’re going to perform an episiotomy on a pt who has not received any pain medication or anesthesia. What will you consider?

A

Pudendal anesthetic

76
Q

You’re in a hurry, the baby’s vital signs are plummeting and the mother is in distress…what will you do in a hurry with regard to anesthesia?

A

Spinal

77
Q

A 60yo is postmenopausal and white, she has been taking large amounts of unopposed estrogen for fun because she thought it was candy (dumb but you get the idea…she’s been taking estrogen for too long). You perform an assessment and notice a large uterus and also some notice some unexplained abnormal uterine bleeding. PAP was negative. What might this be? Is it common?

A

Endometrial cancer. It’s the most common type.

78
Q

With vulvar cancer, is usually what type?

A

Small cell carcinoma!

79
Q

What is the common offender with vulvar cancer?

A

HPV (40-60%)

80
Q

A 50yo postmenopausal woman has a history of smoking and HPV, as well as a history of genital warts, vulvar irritation, pruritus, and some local discomfort and bleeding in the vagina. The area is beginning to look a little like cauliflower. What are you thinking? How so you screen for it? How do you know if you’re right?

A

Vulvar cancer. Screening is not reliable. Biopsy it if found and surgically remove it if dx is confirmed.

81
Q

A 50yo pt presents with vague GI discomfort. During your assessment you note a solid, fixed, adnexal mass. Labs show elevated CA125, hCG, lactate dehydrogenase, and alpha-fetoprotein. What are you thinking? Should you have screened for it?

A

Ovarian cancer. No screening is recommended.

82
Q

Cervical cancer is most common woman > ____yo and is mediated by ____. A pt presents early with ____ bleeding and a ____cervix.

A
  1. HPV. Postcoital bleeding, friable
83
Q

Beginning of breast development

A

Thelarche

84
Q

Look mom…pubes.

A

Pubarche

85
Q

I’m having a period, but you can’t see it because it’s blocked.

A

Crypto-menarrhea

86
Q

One sided lower abdominal pain associated with the time an egg is released from the ovary.

A

Mittelschmerz

87
Q

My periods don’t seem as heavy and don’t last as long.

A

Hypo-menorrhea

88
Q

Too much menstrual bleeding and for too darn long.

A

Menorrhagia/hyper-menorrhea

89
Q

I just have my first period.

A

Menarche

90
Q

My cycles happen at least 35 days apart

A

Oligo-menorrhea

91
Q

My periods are regular but sort of more frequent than most people.

A

Poly-menorrhea

92
Q

28 weeks gestation to 7 days of life

A

Peri-natal

93
Q

Up to 6 weeks after birth

A

Post-natal

94
Q

Days 1-5 of cycle

A

Menstrual uterine phase of follicular ovarian phase

95
Q

Days 15-28 of cycle

A

Secretory uterine phase of luteal ovarian phase

96
Q

Days 6-14 of cycle

A

Proliferative uterine phase of follicular ovarian phase

97
Q

On about what day of the cycle does ovulation occur?

A

12-14 or so

98
Q

Estrogen and progesterone are low during this phase of the cycle causing the endometrium to do what?

A

Menstrual phase. Slough

99
Q

An increase in estrogen causes SURGE OF LH which triggers ____ during this this phase…

A

Ovulation

100
Q

During this phase of the cycle, estrogen and progesterone are secreted by the corpus luteum which make the environment ripe for baby life.

A

Secretory phase

101
Q

As estrogen increase, the endometrium is stimulated to ____ during this phase by the same name…

A

Proliferate

102
Q

Who gets tested/screened for what and when?

A

1) Cytology alone = 21-65 every 3 years 2) Cytology + HPV (cotest) = 30-65 every 5 years 3) Screening can stop = >65yo with good history of screening 4) Screening after hysterectomy = STOP 5) Bimanual exam = no recommendation. Up to pt and provider 6) Women with HPV vaccine = screen them anyway 7) Breast exam = USPSTF - don’t. ACOG - Annual CBE > 40yo. CBE 20-39 every 1-3 years 8) Mammography = USPSTF - biannual 50-74. ACOG - >40 9) HIV = USPSTF - screen anyone at risk and anyone pregnant. ACOG - screen 19-64 10) STI’s = USPSTF - screen all sexually active women for gonorrhea. ACOG - screen any sexually active woman age 25 or younger for gonorrhea and chlamydia

103
Q

Key to PMS diagnosis

A

Must occur in luteal phase, must have 7 consecutive symptom free days in follicular phase, must occur in at least 2 consecutive cycles, symptoms must be severe

104
Q

What % of women experience PMS?

A

Up to 75%

105
Q

The absence of menses in a 13yo in the absence of normal growth or sexual development OR in a 15yo in the presence of normal growth and sexual development.

A

Primary amenorrhea

106
Q

97% of women have their periods by age ____

A

15

107
Q

Absence of menses for 3 cycles or 6 consecutive months in a woman who has previously menstruated.

A

Secondary amenorrhea

108
Q

Most likely etiologies of primary amenorrhea

A

Hypothalamic/pituitary disfunction. No GnRH = no FSH or LH, Turners, other genetic issues.

109
Q

Most common cause of secondary amenorrhea

A

PREGNANCY!!!

110
Q

Common causes of DUB (after pregnancy, cancer, and other systemic diseases are ruled out) are…

A

Anovularion, PCOS, fibroids, polyps, etc

111
Q

How do you treat DUB?

A

OCP, IUD, DEPO, myotomy to remove fibroids (if cause), hysterectomy to be considered

112
Q

What are the there types of dysmenorrhea and what are their causes?

A

Primary - no organic cause, secondary - pathologic (endometriosis, adenomyosis, PID, fibroids, etc), Membranous - cast of endometrium comes off all at once.

113
Q

Pt is experiencing nausea, vomiting, diarrhea, and HA. She has pelvic tenderness over her uterus. It’s her FIRST DAY of her period. SHE IS NOT PREGNANT. What are you thinking. How will you treat her?

A

Dysmenorrhea. NSAIDs

114
Q

MOA, failure rate (theoretical), failure rate (real life) - Male condom

A

Mechanical barrier, 2%, 10-30%

115
Q

MOA, failure rate (theoretical), failure rate (real life) - Female condom

A

Mechanical barrier, 2.6%, 15-20%

116
Q

MOA, failure rate (theoretical), failure rate (real life) - Vaginal diaphragm

A

Mechanical barrier, 6%, 15-20%

117
Q

MOA, failure rate (theoretical), failure rate (real life) - Cervical cap

A

Mechanical barrier - 6%, 15-20%

118
Q

MOA, failure rate (theoretical), failure rate (real life) - Natural family planning

A

Prediction - 10-25%, 5%

119
Q

MOA, failure rate (theoretical), failure rate (real life) - Spermicides

A

Toxic effect on sperm, 15%, 30%

120
Q

MOA, failure rate (theoretical), failure rate (real life) - IUD

A

Copper wire, LARC, inflammation response preventing motility, toxic to sperm, 0.6%, 0.8%

121
Q

MOA, failure rate (theoretical), failure rate (real life) - Pull out method

A

Just pull and pray - 0%, 100% hahaha…dudes who try this are now dads…

122
Q

MOA, failure rate (theoretical), failure rate (real life) - Sterilization

A

Tubal ligation, vasectomy - <1% across the board

123
Q

An old woman and young girl present with severe pruritus! (extragenital manifestations generally nonpruritic) dyspareunia, dysuria, and painful defecation. On exam you note erythema and hypo pigmentation that looks like it is becoming more like porcelain-white plaques with sharp borders

A

Lichen sclerosis

124
Q

A female pt presents with thin-walled vesicles and bullae around her vaginal area that display reddened edges and crusted surfaces after rupture. How would you treat it?

A

Impetigo. Treat with mupirocin ointment and or oral dicloxacillin

125
Q

A female pt presents with periodic painful swelling on either side of the introitus and consequent dyspareunia. What might this be?

A
126
Q

A female presents with istinctive shiny, flat-topped papules, symmetrically dispersed on flexor surfaces, trunk, and linear scratch marks (Koebner phenomenon) on anterior wrists and legs. They appear to be papules, that are purple, and polygonal, and pruritic. You look closely and see fine white streaks (Wickham striae) as well. She says there is a problem “down there” too…so you have a look and you see painful lesions of the buccal and vaginal mucosa.

A
127
Q

A woman who has a history of using perfumed pads as well as chronic vulvovaginal infections presents with solid plaque of lichenification around her vaginal area that is a “pleasure to scratch” (wow)…

A

Lichen simplex chronicus. Gotta stop the scratching!!!

128
Q

You can’t see anything wrong with this 20 yo patient, but she complains of severe vaginal burning, rawness, irritation, dryness, and hyperpathia (pain provoked by very light touch) and i

ntroital pain on vestibular or vaginal entry. What might this be? What should you do about it?

A

Vulvodynia. 3 level plan = 1) pelvic floor physical therapy, hygeine, topical lidocaine, soothing oils. 2) TCA (amytriptyline, pregabalin, gabapentin) 3)

129
Q

Mucus filled lump on surface of cervix. It is a normal finding

A
130
Q

Female pt is parous (hx of childbirth), middle aged woman with menorrhagia and dysmenorrhea w/symmetrically enlarged uterus. She is having some pain and cramping. What is it and how should you treat it?

A

Adenomyosis. Hysterectomy

131
Q

A 30yo black woman presents with being abnormal uterine bleeding and iron deficiency anemia associated with it. Benign tumor fibroids that have grown in her uterus are the cause. You note a mass on exam. What is this called? How would you treat it? What should you rule out first before you get carried away?

A

Leiomyoma. Surgery. Pregnancy

132
Q

Biggest culprits to cause PID

A

Untreated gonorrhea or chlamydia

133
Q

A female pt presents with pelvic and lower abd pain as well as cervical motion tenderness, u

terine tenderness, and a

dnexal tenderness. What is it? How would you treat it?

A

PID. Ceftriaxone, Doxy, Metro (for BV)

134
Q

How do you treat gonorrhea?

A

IM ceftriaxone PLUS azithromycin

135
Q

Syphillis

A

Primary

Painless genital sore (chancre

Painless lymphadenopathy

Secondary

Bilateral papulosquamous lesions, often on hands/feet

Lymphadenopathy

Tertiary

Cardiac, neurologic, ophthalmic, and auditory lesions

Gumma

136
Q

Treat syphillis with?

A

PCN

137
Q

Pt presents with malodorous, purulent, frothy dc, dyspareunia, and vulvovaginal erythema. What is it? How would you treat it?

A

Trich. METRO

138
Q

Painless fishiness…with offwhite vaginal discharge. What is it? What will you do about it?

A

BV. Metro

139
Q

A pt presents with small, but coalescing white papillomatous growths on the vagina, cervix, vulva, oropharynx, perineal and perianal areas. What is it? What to do?

A

Condylomalata

140
Q

A female pt presents with pruritis, dyspareunia, vulvar erythema, fissures, and a curd-like dc. What is it? How will you know? What will you do?

A

Candidiasis. KOH. Fluconazole

141
Q

Which of the following are transmitted vertically from mother to fetus?

Syphillis

Trich

HSV

Gonorrhea

Chlamydia

Hep B

Hep C

HIV

A

Syphillis - yes

Trich - yes by passage through infected vagina

HSV - 30-50% transmission if mother is infected near time of delivery

Gonorrhea - yes…bad - with chlamydia…cause most neonatal conjuctivitis

Chlamydia - yes…bad - woth gonorrhea…cause most neonatal conjuctivitis

Hep B - 20% transmission if mother is HBsAG positive and 90% if mother is both HBsAG and HBeAG positive

Hep C - yes. Not transferred in breastmilk

HIV

142
Q

T/F Infertility is defined by the inability for a couple to conceive within 1 year

A

True…but only if the couple is having sex:)

143
Q

When menstual bleeding has ceased for 1 year, _____ is said to have occured.

A
144
Q

Average age of menopause is ____

A
145
Q

The most common cause of cyclic breast pain or mastalgia in reproductive age women that happens as a r

esult of hormonal imbalance that may produce asymptomatic breast lumps that are discovered by palpation

A

Fibrocystic changes

146
Q

Most common cause of mastitis?

A

Staph infection associated with

147
Q

T/F Lactational mastitis is more common than non-lactational mastitis

A
148
Q

A woman has a unilateral engorged swollen breast and a sore or fissured nipple. There is

redness, tenderness, and local warmth. She is starting to complain of

fever, chills, and malaise and the pain

is now extending beyond the indurated area

A
149
Q

A woman just had mastitis that didn’t clear…it looks the same…bu for the pitting edema over the inflamed area and a degree of fluctuation.

A

Breast abscess

150
Q

A postpubescent black woman presents with a round, firm, discrete, relatively movable, non-tender mass 1–5 cm in diameter in her breast.

A

Fibroadenoma

151
Q

A 45yo female presents with a breast mass on palpation that is mobile with well-defined margin

A
152
Q

A woman presents with eczematoid eruption and ulceration that arises from the nipple and is

spreading to the areola. She is experiencing pain, itching, and/or burning. You note a superficial erosion or ulceration of the breast.

A

Paget’s disease of the breast