last minute

Question 1

Explain the MOA of Danazol and why it’s not preferred over GnRH agonists

Answer 1

synthetic androgen that induces amenorrhea
side effects of hypo estrogen and androgens
more side effects than GnRH agonists-especially the deep voice that won’t go away

Question 2

How do you appropriately administer goserelin?

Answer 2

GnRH agonist which needs to be accompanied by add back therapy of hormones similar to those used in HRT. Eliminate menopausal symptoms including vaginal atrophy and bone demineralization without diminishing the effect of endometrial inhibition.

Question 3

chronic use of GnRH agonist can be described as affecting the ovaries in what way?

Answer 3

like a medical oophorectomy

Question 4

Describe the treatments for endometriosis

Answer 4

NSAID
COC
POPs
GnRH
Danazol

Question 5

tranexamic acid can also be called what? Name another similar drug

Answer 5

lysine analogue

Aminocaproic acid

Question 6

tinidazole same MOA as metronidazole how is it administered?

Answer 6

oral or intravaginal

Question 7

Trichomonas vaginitis should be treated with tinidazole or metronidazole how:

oral
IV
IM
Sub cutaneous
transvaginal

Answer 7

oral only

Question 8

What is liberal? how should it be used?

Answer 8

continuous COC

no bleeding regular except BTB occurs

Question 9

drospirenone is a spironolactone analogue with what type of activity?

Answer 9

antimineralcorticoid and antiandrogenic

potassium sparing diuretic

Question 10

What are some risk factors for acquiring PID? Which type of infection is more likely to lead to infertility; N. Gonorrhea or a NGI?

Answer 10

Anything that transmits to the upper vagina: Tampons, douching, IUD, intercourse, and within 7 days of menses the cervical mucus thins helping both bacteria and sperm to enter the endometrium.

Infertility is more likely in NGI; and is the most common cause of involuntary infertility in women

Question 11

Patient presents with lower abdominal pain 3 days after her LMP. In addition she has a moderate fever, and increased vaginal discharge. While questioning her about her hx she says she feels nauseous. You palpate a tender adnexal mass. How should you treat this patient?

Answer 11

Likely has PID treat as a mixed infection. Typically Nisseria Gonorrhea or Chlamydia T.

Question 12

what do you think of with violin strings between liver and abdominal wall, and guitar strings on anorectal exam?

Answer 12

violin Fitz Hugh Curtis syndrome

Anorectal endometriosis

Question 13

What bacteria exibits molar tooth colonies?

Answer 13

actinomyces israelii

Question 14

What cancers are associated with HPV infection

Answer 14

Cervix, oropharynx, anus

Question 15

Most genital HPV infections are:

1. transient, asymptomatic, or subclinical
2. ASC-H and require a colposcopy
3. 6, 11 and require only “wart removal” or Rx Tx
4. cancer causing and not covered by gardazil

Answer 15

1 transient asymptomatic or subclinical

Question 16

Whats the natural course of HVP infection?

Answer 16

Infection
wks-months first lesion
wks-months CIN1 or warts (immune response)
Remission or persistence with risk CIN2,3

Low risk usually clears in 4-9months
High risk 12-18 months

Question 17

HPV to become cancer requires what?

Answer 17

persistant infection
interference with pRb and p53

pRb cell cycle regulation
p53 induce apoptosis

Question 18

How does the body fight HPV?

Answer 18

usually it’s cleared by cell mediated immunity

Inhibits viral infection but doesn’t kill virally infected cels. No activated T-cells just plasma cells.

Question 19

what’s the composition of gardasil?

Answer 19

Proteins from outer membrane of virus

not live no DNA

Question 20

How does the innate host defense recognize foreign material?

Answer 20

PRR

Question 21

HPV is implicated in what percentage of cervical and anal cancer? A patient of yours has anal cancer likely from having sex with men why is this likely so common?

Answer 21

99% cervical, 80% anal

men with penile HPV are often asymptomatic

Question 22

your in the pediatric unit and notice that one of the crying babies has what looks like a laryngeal papilloma. what’s the likely etiology?

Answer 22

Mom had HPV warts and gave it to the kid

Question 23

Name the vegetable that looks most like condylomata acuminate?

Answer 23

cauliflower

Question 24

How does chronic inflammation and immunosuppression come into play with HPV?

Answer 24

Increases the risk of cancer development in these oncogenic viruses. Trauma or inflammation at the transition zone increase risk of an effective infection from HPV. Especially on an immunocompromised background.

Question 25

Match the following E6,7 with pRB, P53. What are the functions of these proteins?

Answer 25

E6 with p53 apoptosis

E7 with pRb cell cycle reg.

Question 26

How do you diagnose HPV?

Answer 26

clinical visualization of warts, or colposcopy and biopsy

DNA probes and PCR of cervical swabs is method of choice for dx and typing

Question 27

Dejango is a 24 y/o, iliterate, former sex worker, of african american decent who grew up in a Detroit getto and was recently released from a correctional facility. He likes to meet new partners on the internet and has a long STI hx, as well as some minor illicit drug use. He’s unmarried and recently hooked up with someone in the past 60 days. what is he at risk for? What’s your advice?

Answer 27

MORE STIs has all the risk factors!

wrap it, test it, treat it, and call your partner

Question 28

Describe the vaginal pH, discharge, amine/fish test, and microscopy for normal vaginal discharge, bacterial vaginosis, trichomoniasis, and mycotic vulvovaginitis

Answer 28

Normal, vaginosis, protozoan, yeast

pH 3.8-4.2, >4.5
Discharge- thin white flocculent, thin white milky or gray, yellow green and frothy, white cottage cheese like

Amine- absent, Fishy, Fishy, absent

micro- lactobacilli epithelial cells, clue cells no WBC,
Trichomonads and WBC, Budding yeast pseudohyphae