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Oral Boards > Last Minute Review > Flashcards

Last Minute Review Flashcards

1
Q

Pudendal Nerve

A

S2, 3, 4

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2
Q

Erb’s Palsy

A

Waiter’s Tip, C5-C6

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3
Q

Klumpke’s Paralysis

A

hand/wrist paralysis, C8-T1

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4
Q

Diagonal Conjugate

A

Symphysis to sacral prominence

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5
Q

Obstetrical Conjugate

A

Diagonal conjugate minus 2cm

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6
Q

Ant-Post Diameter of Mid pelvis

A

Sacrum to symphysis (11.5cm or more)

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7
Q

Interspinous Diameter

A

10cm or more

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8
Q

Anthropoid Pelvis

A

Oval shape, narrow
OP presentation

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9
Q

Android Pelvis

A

Heart shape Masculine pelvis, Prominent notch, 1st stage arrest MC

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10
Q

Platypelloid Pelvis

A

Wide diameter, OT presentation

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11
Q

Leopold’s Maneuvers

A

Fetal part at the upper and lower poles of uterus, side of the back, head flexed or extended

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12
Q

Cardinal Movements of Labor

A

Engage
Descent
Flexion
Internal Rotation
Extension
External Rotation
Expulsion

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13
Q

APGAR

A

Activity, Pulse, Grimace, Appearance, Respiration

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14
Q

Favorable Bishop Score

A

8 or more
(6 or less unripe)
1-2/50/-2 mid, med (1 point each=5)

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15
Q

Arrest of Descent

A

Nullip 3 hrs (4 hrs with epidural)
Multip 2hrs (3 hrs with epidural)

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16
Q

Lidocaine Side Effects

A

Metallic taste, perioral numbness, slurred speech, tinnitus, blurry vision, seizure, cardiac arrhythmia/arrest

maximum dose for lidocaine is 3.0 mg/kg body weight
without epinephrine and 7 mg/kg with epinephrine

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17
Q

Sensitivity

A

True Pos/ (True Pos + False neg)
Chance that people with disease actually test positive

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18
Q

Specificity

A

True Neg/ (True neg + False Pos)
Chance that people without the disease test negative

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19
Q

PPV

A

True Pos/ (True and False Pos)
Chance that positive test is correct

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20
Q

NPV

A

True neg/ (True and False neg)
Chance that negative test is correct

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21
Q

Weight Based Insulin

A

0.7-1.0 units/KG = total daily dose of insulin
AM dose (2/3 total daily dose)
- NPH is 2/3 AM dose
- Regular is 1/3 AM dose
PM dose (1/3 total daily dose)
- NPH is 1/2 PM dose
- Regular is 1/2 PM dose

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22
Q

Rapid Acting Insulin (onset, peak, duration)

A

Onset < 15 min
Peak 1-2 hrs
Lasts 4-5 hrs

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23
Q

Regular Insulin (onset, peak, duration)

A

Onset 30-60min
Peak 2-4 hrs
Lasts 6-8 hours

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24
Q

NPH Insulin (onset, peak, duration)

A

Onset 1-3 hrs
Peak 5-7 hrs
Lasts 13-18 hrs

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25
Q

Thyroid Storm Tx

A

PTU , Lugol Iodide, Dexamethasone
B blockers

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26
Q

Folic acid dose for high risk pt in preg

A

4mg/day

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27
Q

Normal folic acid dose in preg

A

400mcg/day

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28
Q

APLS Criteria

A

1 or more fetal losses at 10w or more, 1 or more PTD <34w due to Pre E, FGR, or placental insuff, 3 or more losses less than 10 weeks (not including chromosomal or anatomic issues)

+

Lab evidence of a positive LAC, ACA, or B2G on 2 occasions at least 12 weeks apart

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29
Q

Timing of Twinning Chorionicity

A

Di- Di : 0-3 days
Mono Di: 4-8 days
Mono Mono: 9-12 days
Conjoined: > 13 days

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30
Q

Estimated EFW for 20, 30, 40 weeks

A

400g @ 20w
1200g @ 30w
3600g @ 40w

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31
Q

GBS Treatment

A

PCN G 5 mil units, then 2.5 q4h
Amp 2g, then 1g q4h
Cefazolin 2g, then 1g q8h
Clinda 900mg q8hrs
Vanc 20mg/kg q8hrs

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32
Q

Avidity IgG

A

Low ~2-4 mo (recent)
High >6 months (more distant)

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33
Q

Rhogam Coverage for Volume of Fetal RBCs vs Whole Blood

A

1 dose covers 15cc of fetal RBCs (30cc whole blood)

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34
Q

Caprini Score (VTE Risk)

A

1-2 = low risk
3-4 intermediate risk
5 or more = high risk

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35
Q

Modified Wells Score for DVT risk/PE

A

If low (<4), get D Dimer
If high (4 or more), then US

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36
Q

Apixaban or rivaroxaban
Mechanism of Action

A

Factor Xa inhibitor

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37
Q

Dabigatran
Mechanisim of Action

A

Direct Thrombin Inhibitor

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38
Q

Heparin Antidote

A

Protamine Sulfate

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39
Q

Magnesium Antidote

A

Calcium gluconate

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40
Q

LMWH
Mechanism of action

A

Inhibits factor Xa

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41
Q

Heparin
Mechanism of action

A

Binds Antithrombin to prevent thrombin binding

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42
Q

TXA
Mechanism of action

A

Anti fibrinolytic

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43
Q

LMWH wait time before regional anesthesia

A

If ppx then 12hr
If therapeutic then 24 hrs

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44
Q

Anterior Abd Wall Muscle Layers

A

Ext Oblique
Internal Oblique
Transversus Abdominus
Rectus Abdominus

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45
Q

Ovarian Vein Drainage

A

R ovarian vein drains into IVC
L ovarian vein drains into L renal vein

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46
Q

Posterior Division of Internal Iliac (Hypogastric) Artery

A

Ilio-lumbar
Lateral sacral
Superior Gluteal

“I Love Sex” mnemonic

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47
Q

Anterior Division of Internal Iliac (Hypogastric) Artery

A

Umbilical art remnant
Superior, middle, inferior vesical
Middle rectal
Obturator
Internal Pudendal
Sciatic
Uterine
Vaginal

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48
Q

Ureter Course and Length

A

15cm x2
1. From renal pelvis descends from lateral to medial over psoas muscle
2. Enters pelvic brim at bifurcation of the common iliac vessels
3. Descends along sidewall posterior and inferior to ovarian vessels
4. Crosses under cardinal
5. Crosses under uterine (water under bridge)
6. Moves anteromedially to insert into bladder

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49
Q

Ureteral Injury Points

A
  1. near IP ligament
  2. Under uterine artery
  3. Near uterosacrals
  4. Near corners of vaginal cuff
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50
Q

Closing Bowel Laceration

A

Perpendicular to the long axis of the bowel

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51
Q

Cherney Incision

A

Excise rectus tendon off of pubis

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52
Q

Maylard Incision

A

Cut rectus, but must ligate the inferior epigastrics

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53
Q

Postop Fevers Causes

A

Wind (1-2 days) SBO, Ileus, Pneumonia
Water (2-5 days) - UTI
Wound (3-5 days) - SSI
Walk (7-10 days) - DVT/PE
Wonder drugs - allergies/reaction

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54
Q

Baden Walker

A

Stage 0 - no prolapse
Stage 1- more than 1cm above hymen
Stage 2- less than 1cm above or below hymen
Stage 3- more than 1cm below hymen (no more than 2 cm)
Stage 4- complete procidentia

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55
Q

Urethral Mobility

A

greater than 30 degrees

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56
Q

Intrinsic Sphincter Deficiency for Urethra

A

less than 60mmHg (leak point pressure)

and/or less than 20mmHg urethral closing pressure

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57
Q

Rectovaginal Fistula

A

Methylene blue in rectum
Or
Air in vagina, fluid in rectum, look for bubbling

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58
Q

Vesicovaginal fistula

A

Methylene blue in bladder, tampon test
Decompress up to 12 weeks (need at least 6 weeks foley)

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59
Q

Ureterovaginal fistula

A

Pyridium oral , tampon test
CT urogram or Retrograde pyelography

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60
Q

Discriminatory Zone

A

HCG 3,500 mIU/ml

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61
Q

MTX absolute contraindications

A

Renal, liver, or pulm disease
Peptic ulcer disease
Blood dyscrasia
Breastfeeding
Immunosuppression
Sensitivity to MTX
Ruptured
Unstable

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62
Q

MTX Relative Contraindications

A

HCG >5,000
Size >4cm
+Fetal cardiac activity

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63
Q

MTX dose

A

50mg/m2 BSA

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64
Q

Heterophile Antibodies

A

Serum HCG +
Urine HCG neg

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65
Q

BRCA1 Ovarian Cancer risk

A

40%, rrBSO 35-40yrs

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66
Q

BRCA2 Ovarian Cancer risk

A

20%, rrBSO 40-45yrs

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67
Q

Cervical Cancer: Stage IA1 and IA2

A

IA1 - 3mm or less depth
- CKC or simple hyst
IA2 - 3-5mm depth
- modified rad hyst + nodes

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68
Q

Cervical Cancer: Stage IB1-3

A

Invasion more than 5mm
IB1- 2cm or less
IB2 - 2-4cm
IB3 - more than 4cm

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69
Q

Cervical Cancer: Stage 2A-B

A

Upper 2/3 vaginal w/ or without parametrial involvement
2A- no parametria
2B- parametria

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70
Q

Cervical Cancer: Stage 3 A-C

A

Lower 1/3 vagina, side wall, hydronephrosis
3B- lower vagina only
3B - side wall or hydroneph
3C Pelvic or Para-aortic LN

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71
Q

Cervical Cancer: Stage 4 A-B

A

4A: Bladder or rectum
4B: Distant mets

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72
Q

Tumor Marker: Mucinous Epithelial Tumor

A

CEA

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73
Q

Tumor Marker: Non-Mucinous Epithelial Tumor

A

CA 125 (neg for 50% early epithelial ovarian cancers)

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74
Q

Tumor Marker: endodermal sinus or Embryonal

A

AFP, hCG

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75
Q

Tumor Marker: Choriocarcinoma, Germ Cell Tumor

A

HCG, (possible AFP or LDH)

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76
Q

Tumor Marker: Granulosa Cell tumor

A

Estrogen, Inhibin

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77
Q

Tumor Marker: Dysgerminoma

A

LDH, hCG

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78
Q

Lynch Screening

A

Colonoscopy q1-2 yrs starting at 20-25 or 2-5yrs before earliest cancer

Annual EMB at age 30 (or 10 yrs earlier than youngest)

+/- Annual pelvic/TVUS, possibly CA 125 q6 months

Discuss option of ppx hyst bso after chilbearing (age 40-45)

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79
Q

EIN- Cancer risk

A

10-25%

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80
Q

Benign Hyperplasia- Cancer risk

A

<5%

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81
Q

Endometrial Cancer Stage 1A-B

A

IA - less than 50% myometrial invasion
IB - more than 50% myometrial invasion

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82
Q

Endometrial Cancer Stage 2

A

2: Cervical stroma

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83
Q

Endometrial Cancer Stage 3A-C

A

3A - uterine serosa +/- adnexa
3B- vaginal +/- parametria
3C- Pelvic or Paraaortic LN

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84
Q

Endometrial Cancer stage 4A-B

A

4A- bladder rectum
4B- distant mets

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85
Q

Endometrial Cancer Follow up

A

Every 3 months for 2 years, then 6 months for 3 years, then annually

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86
Q

Partial Mole

A

Triploid (69 XXX or XXY) (2 sperm, 1 egg)
Fetal parts
SGA
GTN risk 5%
Stop after neg HCG (can repeat at 1 month)

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87
Q

Complete Mole

A

Diploid (46 XX or XY) - sperm and empty ovum
Snowstorm
LGA
Theca Lutein
Thyroid abnormalities
GTN risk 20%
Stop after HCG neg for at least 3-6 months

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88
Q

GTN WHO FIGO staging

A

Score 0-6 - single agent chemo
7+ high risk - combo chemo
(age, duration from last preg, HCG, size, mets # and location, failed chemo)

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89
Q

Screening: GCCT

A

Annually between 13-24

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90
Q

Screening: Diabetes

A

Annual if high risk or every 3 years after age 45

A1C 6.5 or higher (5.7-6.4 pre)
Fasting 126 or higher (100-125 pre)
Random 200 w/ symptoms
2*GTT

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91
Q

Screening: Lipid Profile

A

Every 5 years starting age 21

formally at age 40 with calculate CV risk with ASCVD risk calculator

Total cholesterol < 200 mg/dL, LDL < 100 mg/dL, HDL >60 mg/dL, and Triglycerides of <150 are normal values

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92
Q

Screening: Hep C/HIV

A

Once in lifetime

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93
Q

Shingles Vaccine

A

Age 50 - 2 dose series

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94
Q

Pneumococcal Vaccine

A

Age 65 or younger if risk factors

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95
Q

T score

A

SD from mean peak bone density of normal young adult
Low bone mass between T -1.0 and -2.5

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96
Q

Z score

A

SD from reference population of same age, sex, ethnicity
(better for premenopausal women)

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97
Q

FRAX

A

women 40-65 with frax of >8.4% = bone age of 65yo
If osteopenia and FRAX >3% hip fx or >20% major bone fracture in next 10 years > treat

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98
Q

Calcium Daily Intake

A

1300 less than age 18
1000mg for 19-50
1200mg for over age 50

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99
Q

Vit D Daily Intake

A

600 IUD until age 70
800 IU after age 70

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100
Q

Osteoporosis Tx options

A

Bisphosphonates (empty stomach w/ water, sit upright 30 min , CI: GERD, esophagitis)
SERM (raloxifene)
Rank L inhibitor (prolia)

inhibit bone resorption/osteoclast activity

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101
Q

Tamoxifen vs Raloxifene

A

Tamoxifen - prevents breast cancer [ useful for bRCA 2] (but increased risk of endo cancer)

Raloxifene - osteoporosis prevention but also good for decreasing breast cancer risk (no increased risk of endo cancer)

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102
Q

Vitamins to Screen for in Bariatric Patients

A

Vit D, Ca, Folic Acid, iron, B12, CBC

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103
Q

Syphilis Treatment (Primary or early latent, <1 yr)

A

Benzathine PCN 2.4mu IM x1

(doxy 100 BID for 14 days)

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104
Q

Syphilis Treatment (late latent > 1 yr or unknown)

A

Benzathine PCN 2.4million u IM q weekly x3

(doxy 100 BID for 28 days)

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105
Q

Puberty

A

TPAM
Thelarche (breast)
Pubarche (pubic hair)
Adrenarche (axillary hair)
Growth spurt
Menarche

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106
Q

Expected HCG Rise

A

49% for less than 1500
40% for 1500 to 3000
35% for greater than 3000

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107
Q

Cat 1 Definition

A

Normal baseline with moderate variability, with or without accels, no late or variable decels

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108
Q

Cat 3 Definition

A

Any baseline with absent variability with late or variable decelerations or sinusoidal pattern

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109
Q

MAP Calculation

A

[(2* Diastolic) + Systolic] / 3
or
(Diastolic + Diastolic + Systolic)/3

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110
Q

Magnesium Units, therapeutic range, and Toxicity

A

5 to 9 mg/dL
Loss of reflexes >9
respiratory arrest >12
cardiac arrest 30
antidote calcium gluconate 1 g 10 cc over 3 min

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111
Q

Magnesium contraindications

A

Myasthenia gravis
instead use phenytoin or diazepam

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112
Q

Chronic hypertension causes

A

Essential hypertension, coarctation, Cushing’s, renal disease, renal art stenosis, OSA, drug use

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113
Q

Incidence of TTTS in Monochorionic

A

10-15%

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114
Q

Twin Delivery timings

A

Di-Di - 38-39
Mono-Di 34-38
Mono-Mono 32-34 (must be C/S)

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115
Q

Calculation for discordance

A

(Larger fetus - smaller fetus)/ larger fetus = 20% or more

116
Q

Quintero staging of TTTS in twins

A

Stage one: Polyhydramnios oligohydramnios
Stage two: absent bladder of donor twin
stage three: abnormal Doppler’s
stage four: hydrops
stage five: death

117
Q

Early term

A

37+0 through 38 +6w

118
Q

Full term

A

39+0 - 40+6

119
Q

Late term

A

41+0-41+6w

120
Q

Post term

A

42+0w or more

121
Q

Toxoplasmosis (Fetal effects)

A

All head issues
Intracranial calcification, hearing loss, Chorioretinitis, low IQ

122
Q

CMV (fetal effects)

A

Chorioretinitis, hearing loss, Hepatosplenomegaly, brain, abdominal and liver calcifications, FGR, hydrops

123
Q

Parvovirus ( Fetal effects)

A

Spontaneous abortion, Fetal anemia, heart failure, hydrops, IUFD

124
Q

Varicella (fetal effects)

A

Spontaneous abortion, IUFD, varicella Embryopathy (between 13-20w) - limb hypoplasia/cutaneous scarring

High fetal mortality if maternal infection <5 days before delivery

125
Q

Listeria treatment

A

IV Ampicillin (at least 6g daily) for 14 days
If allergies then Bactrim

126
Q

Hep B transmission risk

A

If Envelope antigen positive 90%
If only surface antigen positive 20%
Baby should get vaccine at birth and HBIG within 12-24 hrs
Hep D co-infection possible

127
Q

Hep C transmission risk

A

6% ( doubles if also HIV+)
Much lower than Hep B
No treatment available in pregnancy

128
Q

HIV Transmission risk

A

Without zidovudine 24%
With zidovudine 8%
Viral load <1000 copies/ml = 1- 2% if on HAART

129
Q

HIV in Labor

A

Antepartum should be on HAART (3 agents, 2 diff classes)
Intrapartum should get 3hrs ZDV prior to CD
Do not need ZDV if undetectable viral load or viral load <1000 while on HAART

130
Q

HIV Delivery Route

A

If VL >1000 then CD prior to labor at 38w
If VL <1000 then CD not needed, can have SVD
If VL unknown then CD

131
Q

HSV transmission risk in preg

A

Primary infection 50% risk (40-80%)
Recurrent infection 3% risk

132
Q

HSV Primary Treatment

A

Acyclovir 400mg TID for 7-10 days
Valacyclovir 1000mg BID for 7-10 days

133
Q

Recurrent HSV treatment

A

Acyclovir 400 TID for 5 days
Valacyclovir 500 BID for 3 days

134
Q

Suppressive HSV treatment

A

Acyclovir 400 BID
Valacyclovir 1000mg daily or 500 daily
(Valacyclovir 500 BID if pregnant, starting at 36w)

135
Q

PPROM Latency Abx

A

(total 7 days)
Ampicillin IV + Azithromycin IV for 48 hrs
Amoxicillin PO and Azithromycin PO for 5 days

136
Q

Critical Antibody Titer

A

1:16 (cutoff lower for Kell, titers not helpful)
Will need MCA dopplers at this level

137
Q

Antibodies HDFN risk

A

Kell (Kills}, Kidd, Duffy (Dies), RhD, Little c, Big E
(DEcKK)

No HDFN: Lewis Lives

138
Q

Autosomal Dominant

A

BRCA1 and 2
Lynch Syndrome
Osteogenesis imperfecta
Achondroplasia
Marfan
VW Type 1

139
Q

Autosomal Recessive

A

CF, SMA
Sickle Cell anemia
CAH
Thalassemias

140
Q

Alpha thalassemia

A

1 gene absent - asymtopmatic
2 genes absent - carrier, a-thal minor
3 genes absent- Hb H disease
4 genes absent - Barts- hydrops, a-thal major

141
Q

Beta thalassemia

A

Hgb electrophoresis A2 >2.5%
Heterozygous - minor , asymptomatic, just mild anemia
Homozygous - major,severe anemia, death

142
Q

Antibody to minor antigen - Alloimmunization Management

A

Check indirect coombs titers and Paternal testing
- if father neg, no more testing
- if positive - find out zygosity
Homozygous - MCA dopplers
Heterozygous - fetal blood type to determine risk

*(titers not helpful for Kell)

143
Q

X linked recessive

A

Fragile X
Red green color blindness
Hemophilias

144
Q

Thrombophilias

A

Factor V Leiden, Prothrombin mutation, Protein C or S deficiency, antithrombin deficiency, APLs

145
Q

Other causes of elevated CA 125

A

Pregnancy, endometriosis, non-gyn malignancy, TOA/PID, inflammatory conditions (SLE/IBD)

146
Q

Benign hyperplasia Cancer Risk

A

1-3%

147
Q

EIN cancer risk

A

10-25%

148
Q

Call Exner Bodies

A

Granulosa cell tumor
Brenner tumor (also has coffee bean nuclei)

149
Q

Fried egg cells

A

Dysgerminoma

150
Q

Psammoma bodies

A

Papillary serous and clear cell adenocarcinoma

151
Q

Signet ring cells

A

Krunkenberg tumor

152
Q

Langhan’s giant cells

A

TB

153
Q

Islands pale core with dark rim

A

Hydatidiform mole

154
Q

Schiller Duval Bodies

A

Endodermal sinus tumor (Yolk sac)

155
Q

Next step if AGC on pap

A

Colpo with ECC
EMB if 35 or older OR risk factors

156
Q

Follow up for Atypical endometrial cells on pap

A

ECC and EMB
If both neg then add Colpo

157
Q

When to treat Woman under 25 for abnormal colpo results

A

CIN 3 - treat
CIN 2 persistent for 2 Years (would have colpo with cytology every 6 months)

158
Q

Screening S/P LEEP

A

If neg Margin- Pap/HPV in 6 month then annually x3 if neg then q3 years for 25 yrs

If pos margin- Colpo/ECC in 6 months or repeat excision ( hyst if re-excision unsafe)

159
Q

Lung Cancer screening

A

Adults age 50 to 60 with 20 pack yr history in current smoker or quit in the last 15 years need low-dose CT chest annually
Can discontinue screening once more than 15 years since quitting

160
Q

T Score vs Z score

A

T is SD from mean peak bone density of a normal young adult (-2.5 is osteoporosis)
Z is from population of the same age, sex, race (-2.0 is osteoporosis)

161
Q

Sexual Assault PPX

A

500mg ceftriaxone IM
100mg doxy BID x7 days
500mg metronidazole BID x 7 days
Hep B and HPV vaccines
If HIV pos assailant or suspected - HAART within 72 hrs

162
Q

PID treatment regimen

A

Ceftriaxone 1g IM and Doxy 100 BID PO x 14 days and Flagyl 500mg BID x 14 days

Outpatient can do PO
Inpatient do IV ceftriaxone, can do PO or IV doxy + PO or IV flagyl

163
Q

Amsel’s criteria for BV

A

pH > 4.5
+KOH whiff test
>20% clue cells
White gray homogenous discharge
OR
NAAT test

164
Q

CAH

A

XX with ambiguous genitalia
Usually 21 Hydroxylase deficiency (created high levels 17 OHP)
Sometimes shock from salt wasting due to lack of cortisol

165
Q

No uterus
+ Breast present

A

RKHS - mullerian agenesis - has pubic hair

AIS XY - no hair- need to remove gonads after puberty

166
Q

Uterus present
Absent breast

A

Turners
Hypo hypo gonadism (Kallman)
Constitutional delay

167
Q

Hormone Units: Progesterones, androgens, Prolactin

A

Progesterone ng/ml
AMH ng/ml
Prolactin ng/ml

Testosterone ng/dL
17OHP ng/dL

DHEA mcg/dL

168
Q

Hormone units: Estrogen

A

pg/ml

169
Q

Hormone units: FSH, LH, HCG, TSH

A

mIU/ml

170
Q

MTX MOA

A

Dihydrofolate reductase inhibitor

171
Q

Tamoxifen MOA

A

SERM
Anti-estrogen at breast.
Estrogenic at bones and endometrium

172
Q

Clomiphene Citrate MOA

A

SERM
Anti estrogenic (weakly estrogenic)
Clomiphene 50 to 150 mg (Days 5-9)

173
Q

Letrozole MOA

A

Aromatase inhibitor
Blocks estrogen production
Letrozole 2.5-7.5mg (day 3-7)

174
Q

Gonadotropin MOA

A

Exogenous FSH acts in FSH receptors

175
Q

Leuprolide MOA

A

GNRH Agonist - continuous instead of pulsatile
Creates an initial symptom flare

176
Q

Cabergoline MOA

A

Dopamine agonist promotes Prolactin inhibiting factor
Less side effects than bromocriptine (nausea, HA, hypotension)

177
Q

Emergency Contraception within 72 hrs

A

COCP
Two doses of 100ug estrogen and 0.5mg levonorgestrel 12 hrs apart

Progestin only Plan B
One dose is 1.5mg levonorgestrel OR
Two dose is 0.75mg 12 hrs apart

Copper and 52mg Levonorgestrel IUD and Ulipristal

178
Q

Emergency Contraception within 5 days

A

Copper IUD (99%) (FDA approved)
52 mg LNG IUD
Ulipristal 30mg single dose

179
Q

HRT dosing - preferred regimen

A

PO progesterone or micronized progesterone 200mg qHS (can also be done cyclic 12 days a month)
Transdermal estrogen (eg 0.025mg/d patch) patched applied once or twice weekly

180
Q

WHI - combination tx (E+P)

A

Reduction of bone FX and colon cancer
Increased heart disease, breast cancer, stroke

181
Q

WHI - estrogen alone ET

A

Reduction in bone fx rates
Increased stroke

*Statistically insignificant decrease in heart disease and breast cancer

182
Q

Genitourinary syndrome of menopause Tx options

A

Vaginal estrogen (cream, pills, ring)
Ospemifene (SERM)

183
Q

Non hormonal vasomotor Sx Tx

A

SSRI, SNRI - paroxetine, fluoxetine, venlafaxine
Gabapentin
Clonidine

184
Q

Von Willebrand disease

A

Type 1 autosomal dominant - VWF deficiency
Type 2 -defective VWF
Type 3 autosomal recessive - absent VWF

Check CBC, PTT, PT
vWD factor antigen, Ristocetin cofactor activity, Factor 8

185
Q

FTS components

A

NT
HCG
PAPP-A

186
Q

QUAD screen

A

AFP
Inhibin
Estriol
HCG

H and I are high for Downs. Everything else is Low
65-80% sensitive

187
Q

Ashkenazi Jewish Screening

A

CF
Tay Sachs
Canavan
Familial Dysautonomia

188
Q

Risk factors for ureteral injury

A

Prior surgery, malignancy, large uterus, endometriosis, prolapse, infection

189
Q

Mechanisms of ureteral injury

A

Kinking, laceration, transection, ligation, thermal injury, devascularization, crush injury

190
Q

Postop imaging evaluation for ureteral injury

A

CT urogram or retrograde pyelography

191
Q

How to decrease tension with Ureteral repairs

A

Boari flap (mid or distal)
Psoas hitch (distal)

192
Q

DNA Mismatch repair genes a/w Lynch Syndrome

A

MSH2, MSH6
MLH1
PMS2
EPCAM

193
Q

Lynch Syndrome cancer risks

A

Endometrial 20-60%
Colon 20-60%
Ovarian 5-10%

194
Q

Risk of SCC with Lichen Sclerosis

A

5%

195
Q

How to confirm pregnancy dating

A

US dating <20w, +UPT >36w, +FHTs for >30w

196
Q

Anti seizure medication safe in pregnancy

A

Lamotrigine and Levetiracetam
(Lamictal and Keppra)

197
Q

Anti-seizure meds that cause NTD

A

Valproate and Carbemazepine

( resistant to folate supplementation)

198
Q

First Trimester Screen

A

HCG (elevated in T21, low in T18)
PAPP A. (Low if abnormal)
NT

85% sensitive

199
Q

3hr GTT normal value cutoffs

A

95/180/155/140

200
Q

Stress dose steroids

A

Prednisone 20mg daily (or it’s equivalent) for 3 or more weeks in the last 6 months

Stress dosing- 100mg IV hydrocortisone pre anesthesia and then 50-100mg IV q8h for 24hrs

201
Q

Magnesium Toxicity levels

A

Therapeutic level
5-9 mg/dL

Loss of deep tendon reflexes
9 to 10 mg/dL

Respiratory Paralysis
12 to 16 mg/dL

Cardiac arrest
>30mg/dL

Antidote: 1gram (10ml) calcium gluconate IV over 2 min

202
Q

Nerve Injury from a Pfannenstiel

A

Iliohypogastric and ilioinguinal

Temporary triangle of numbness above incision

203
Q

Femoral nerve injury - cause and effect

A

Deep pelvic surgery, lateral retractors, excessive abduction

Loss of sensation anteromedial thigh
Weak hip flexion and knee extension

204
Q

Pudendal nerve injury- cause and effect

A

Entrapment during SSLF

Perineal/mons/vulvar pain

205
Q

Sciatic Nerve injury- cause and effect

A

Candy cane stirrups/external rotation of hip

Weak knee flexion and dorsiflexion of foot

206
Q

Peroneal nerve injury- cause and effect

A

Allen leg supports, pressure on upper lateral tibia

Foot drop
Parenthesis over dorsal foot and lateral shin

207
Q

Obturator nerve injury - cause and Effect

A

Paravaginal repair, TOT sling, radical pelvic dissection

Inability to abduction thigh, inner thigh numbness

208
Q

Lidocaine dosage

A

LEEP 5-10cc 1% lido with Epi (1:100,000)

CS under local
30cc 1% lido without epi
60cc 1% lido with epi. (.5%)

209
Q

Lidocaine side effects

A

Metallic taste. Peri-oral numbness. Tinnitus
Slurred speech. Altered consciousness
Convulsions
Cardia arrhythmias or arrest

210
Q

PCOS Labs

A

Total and free testosterone, SHBG

Rule out other causes, consider-
HCG
FSH/LH, TSH, prolactin
testosterone (r/o androgen, secreting, ovarian tumor), DHEA (r/o adrenal tumor), 17 OHP(non classical CAH, 24 hour urinary free cortisol (r/o Cushing’s),

2*GTT and lipid panel

211
Q

Metabolic Syndrome Criteria

A

3 or more of the following:
Blood pressure 130/85
Waist circumference 35 inches
Elevated fasting glucose over 100
HDL Less than 50.
Elevated triglycerides over 150

212
Q

MC cause of CAH

A

21 hydroxylase deficiency (90%)

Presents like PCOS
17OHP level will be >200ng/dL

Confirm with a ACTH stim test

213
Q

IV estrogen dosing

A

IV 25mg q4 hours up to 6 doses

214
Q

Hirsutism treatment

A

Laser, shaving, waxing, depilatory management

OCP
Spironolactone
Finasteride
Flutamide
Eflornithine cream (FDA approved)
Weight loss

215
Q

Athlete Triad

A

Low energy availability
Menstrual dysfunction
Low bone density

216
Q

Bladder volumes

A

First sensation of bladder filling : 100cc
First urge to void: 200cc
Full bladder, difficulty holding: 300cc
Average bladder capacity: 350cc

217
Q

OAB/Urge incontinence treatment options

A

Anticholinergics (oxybutynin - CI closed angle glaucoma, tolterodine)
Beta 3 agonist (mirabegron - CI HTN)
Intravesicular Botox q6 months
Implantable nerve stimulators

218
Q

SUI treatment options

A

Bladder training, weight loss, pelvic exercises, bladder diet, timed voiding, decreased fluid intake

Dish pessaries with knob
TVT, TOT slings
Urethral bulking (collagen) best for ISD
Burch procedure

219
Q

BRCA Risk reduction with Mastectomy and BSO

A

90% decrease in breast cancer
80% decrease in ovarian cancer (not 100% because of peritoneal cancers)

220
Q

Breast cancer screening for BRCA carriers

A

Clinical breast exam twice yearly
MRI annual from age 25
At age 30 add annual mammogram (stagger q6 months)

221
Q

Contraindications to HRT

A

Pregnancy, breast cancer, estrogen sensitive tumor, undiagnosed vaginal bleeding, severe liver disease, history of DVT, or thrombophilia, coronary heart, disease, CVA

ASCVD risk > 10%

222
Q

Delivery timing for abnormal Doppler

A

Elevated - 37w
Absent - 33-34w
Reversed - 30-32w

223
Q

FGR delivery timings

A

Isolated FGR 3-10%ile - 38-39+6w
Severe FGR <3% - 37+0w

FGR with comorbidities 34-37+6w

(elevated UAD: 37, absent UAD:33-34, reversed UAD: 30-32)

224
Q

Advantages of LMWH over UFH

A

Better bioavailability
Less frequent dosing
Lower risk HIT
Does not cross placenta
No lab testing

225
Q

Genitofemoral Nerve Palsy - cause and effect

A

Pelvic Sidewall Dissection

Sensory loss only (no motor) of mons, vulva, ant thigh

226
Q

Cephalosporin Generations

A

1st- cefazolin, cephalexin
2nd - cefaclor
3rd - ceftriaxone, cefixime
4th - cefepime

227
Q

Major Depression: SIG E CAPS

A

Need 3 + anhedonia
sleep, interest, guilt
energy
concentration, appetite, psychomotor slowing, suicidal thoughts

228
Q

Alcohol Screen

A

TACE

Tolerance - 2 or more drinks to feel it
Annoyed
Cut back
Eye opener

229
Q

Smoking Assessment - 5A’s

A

Ask (ask smoking hx)
Advise (counsel on risks)
Assess (willingness to quit)
Assist (meds, support groups)
Arrange (follow up/quit date)

230
Q

EPDS Score, PHQ9 score

A

EPDS: Score > 10

PHQ9 : 5 (mild), 10 (mod, fairly sensitive/specific), 15 (mod severe), 20 severe

231
Q

Arousal/Interest Disorder Tx

A

Bupropion or SSRI

Postmenopause - testosterone
Premenopause Addyi

232
Q

Genitopelvic Pain causes

A

Vulvodynia, Vaginismus

Endometriosis, PID/infection, interstitial cystitis, abuse Hx/psychological

Other: GI, MSK, or Urinary

233
Q

Vaginismus treatment

A

Psychotherapy, Extensive Pelvic PT, serial vaginal dilators, genital digital assessment, relaxation techniques, biofeedback

234
Q

Vulvodynia Treatment options

A

Dx of exclusion (r/o infection, atrophy, dermatoses)

Vulvar care measures

Topical lidocaine 5%, estrogen cream, compounded tricyclic antidepressants

Oral amitriptyline or gabapentin

Biofeedback, pelvic PT, vaginal dilation, CBT, sexual counseling

Vestibulectomy

235
Q

GU Syndrome of Menopause Treatment

A

Vaginal Lubricants (water or silicone)
Vaginal Moisturizers (hyaluronic acid or polycarbophil)
Low dose vaginal estrogen (0.5-1g 2x weekly)
Intravaginal prasterone/DHEA (intrarosa) - daily vaginal suppository
Ospemifene - SERM 60mg daily

236
Q

Empiric Treatments after Sexual Assault

A

Ceftriaxone 500 mg IM
Doxycycline 100mg PO BID for 7 days
Metronidazole 500mg PO BID for 7 days
Vaccine: Hepatitis B if nonimmune or Gardasil
PEP HIV prophylaxis (antiretroviral + protease inhibitors) for 28 days (must be within 72 hours of contact)
Emergency contraception

Repeat testing for HIV, RPR, Hepatitis B at 6 weeks, 3 months, 6 months

237
Q

Contraception Failure Rates

A

Etonorgestrel implant (0.05%), Vasectomy (0.15%), LNG IUD (0.2%), Cu IUD (0.8%), Depo Provera (6%), COC (9%)

Sterilization similar to IUD’s <1%

238
Q

OCP Side Effects

A

Progesterone - mood changes/ fatigue, decreased libido
Estrogen - HTN, headaches, nausea, breast tenderness

239
Q

OCP Contraindications

A

Breast Cancer, MI, Migraine with Aura, VTE, Known thrombogenic mutations, HTN (≥140/90), Smoker > 35

Other: Active Gallbladder or Liver disease, SLE with APLs +, HIV (on Efavirenz)

240
Q

When to start Statin

A

LDL > 190
Age 40+ with Diabetes
ASCVD Score > 20% + age 40-75
Known vascular disease

241
Q

How is asthma categorized?

A

Intermittent < 2 /week, <2 nights/month
(FeV1 normal)

Mild Persistent > 2 /week , 3-4 nights/month
(FeV1 normal)

Moderate Persistent Daily, > 1 night per week
(FeV1 = 60-80 predicted FeV1 )

Severe Persistent -Throughout day and night (FeV1 < 60 predicted)

242
Q

Asthma Management

A

Intermittent -Beta-agonist (SABA) prn
(FeV1 normal)
Mild Persistent - Low dose inhaled steroid + SABA prn
(FeV1 normal)
Moderate Persistent - Med inhaled steroid + LABA
(FeV1 = 60-80 predicted FeV1 )
Severe Persistent - High inhaled steroid + LABA, or
Oral Steroid, or Theophylline
(FeV1 < 60 predicted)

Budesonide (Pulmicort): preferred Low dose inhaled steroid

243
Q

Emergent Acute Vaginal Bleeding Treatment options

A

Conjugate equine estrogen (CEE) 25 mg IV q4h X24 h

OCP (ethinyl estradiol 35 meg) PO tid X 7 days, then daily

Medroxyprogesterone 20mg PO tid x 7days/ then daily

Tranexamic acid 1.3 g PO tid x 5 days

244
Q

Definition of Primary Amenorrhea

A

13 without secondary sexual characteristics
15 with or without secondary sexual characteristics

Constitutional delay, outflow tract anomalies,
Turner’s, AIS, Mullerian Agenesis, secondary amenorrhea causes, endocrinopathies (PCOS, thyroid/adrenal disease, Cushing syndrome, DM)

245
Q

Swyer Syndrome

A

46XY Sry gene mutation
Mullerian structures + testes
Amenorrhea, no ovaries, underdeveloped testes

246
Q

Secondary Amenorrhea Workup

A

HCG, TSH, prolactin

FSH, progestin withdrawal challenge

247
Q

Grading Hirsutism

A

Ferriman Gailwey score
9 sites graded 0-4
Grade of 8 or more is positive findings (cut offs vary by ethnicity)

248
Q

Add back therapy for Leuprolide

A

Start before 6 months therapy

Norethindrone acetate 5mg PO daily, 0.625mg conjugated ethinyl estradiol- bone protective and contraception

Lupron max 12 months

249
Q

Borderline Tumor (Low malignant potential)

A

USO, Pelvic washings, biopsy of visible lesions

Risk of recurrence: 30% if cystectomy, 15% if oophorectomy

Frozen is LMP mass, Likelihood of malignancy on final path: 40- 45%

250
Q

PMDD criteria

A

History of two consecutive menstrual cycles demonstrating luteal phase symptoms and the exclusion of other medical conditions

5 or more symptoms must have been present during the week prior to menses, resolving within a few
days after menses starts

251
Q

HRT Risks

A

E only: increased for VTE, Hip Fractures, Lung CA

(Benefits: Decreased risk of CHD, Breast cancer, Stroke Colorectal cancer, All bone fractures, All-cause mortality, Diabetes)

E+P: increased CHD, Breast cancer, Stroke, VTE

(Benefits: Decreased risk of Colorectal and Lung cancer, All bone fractures, hip fractures, All- cause mortality, Diabetes)

252
Q

Risk factors of osteoporosis

A

history of fragility fractures, weight < 127 pounds, medical causes of bone loss (meds or dz), parental hip fracture, current smoker, alcoholism, RA

253
Q

Secondary causes of Osteoporosis

A

Malabsorption, gastric bypass, vitamin D deficiency, adrenal insufficiency, smoker, alcoholism, multiple myeloma, leukemia, anticonvulsants, anorexia, bulimia, sickle cell disease, hyperparathyroidism, thyrotoxicosis.
Medications: Heparin, Lithium, H+ pump blocker.

254
Q

When to use Raloxifene for Osteoporosis

A

Younger postmenopausal women with osteoporosis who have a low risk of hip fracture and stroke but concerned about breast cancer risk.
SE: hot flashes

255
Q

DEXA scan timing

A

If normal - > q 15 years
If (-1.5 to -1.99) -> q 5 years
If (-2 to-2.49) -> q 2-3 years

256
Q

Gail Model Risk of Breast Cancer

A

Age, menarche, age of first birth, # of first-degree family members with breast cancer, # of biopsies, atypical hyperplasia

Chemoprevention with tamoxifen/raloxifene indicated when:
5 - year risk: 1.7% or higher
Lifetime risk: 20%

257
Q

Vulvar Paget’s - Next step in management

A

Mammogram, Colonoscopy, Pap Smear
90% time peri-anal disease is present associated with colorectal carcinoma
25% time associated with cervical adenocarcinoma
Gyn Onc for WLE with 2cm margins

258
Q

Genetics : Integrated vs Sequential vs Contingent

A

Integrated: results released after both 1st and 2nd tri screens complete (96% sensitive)

Sequential: 1st tri results released then final result after 2nd tri tests (95%)

Contingent: 1st tri test is low, med or high risk. If high risk then offered 2nd tri test (88-94%)

259
Q

First trimester screen vs Quad screen

A

FTS: PAPP A, HCG, NT (81-87%)

Quad: HCG inhibin A estriol AFP (81%)

260
Q

Contraindications to operative vaginal delivery

A

Gestation less than 34 weeks
Head not engaged
Unknown fetal position
Osteogenesis imperfecta
Fetal bleeding disorder

261
Q

Risks of macrosomia

A

Prior macrosomic infant
GDM or preGDM
Obesity
Postdates

262
Q

Recurrent BV and Yeast

A

BV 3x in a year, initial treatment (500mg flagyl BID 1 week) then 2x weekly metrogel for 4-6 months

Yeast 3x or more in a year, initial treatment (diflucan every other day x3) then weekly oral or intravaginal azole for 6 months
(Check A1C and HIV)

263
Q

OASIS Risk Factors

A

Hx of OASIS
Operative delivery
Midline episiotomy
Primiparity
Asian ethnicity
Increased fetal birth weight
OP presentation

264
Q

Polycystic Ovaries Definition

A

Volume of ovary 10cm^3 or >12 follicles measuring between 2-9mm

265
Q

Risk factors for ectopic

A

Prior hx of ectopic
Damaged tubes
Hx of STI/PID
IVF
IUD
Smoking

266
Q

Intra amniotic infection (IAI) criteria

A

Fever 38.0-38.9 lasting more than 30 min with 1 risk factor (fetal tachycardia, malodorous or purulent fluid, elevated WBC count)
Or
temp of 39.0 or higher

Diagnosis confirmed with amniotic fluid culture or gram stain

267
Q

Carrier testing for Ashkenazi Jews

A

CF, Tay Sachs, Canavan, Familial dysautonomia

268
Q

Carrier testing for all patients

A

CF, SMA, Fragile x, hemoglobinopathies

269
Q

GYN MOC Articles

A
  • updated Markov model argues for the consideration of concurrent salpingo-oophorectomy for patients who are undergoing hysterectomy at age 50 and older and suggests that initiating estrogen in those who need salpingo-oophorectomy before age 50 years mitigates increased mortality risk
    -RFA procedures have comparable or favorable safety profiles, recovery timelines, and reintervention rates. Data on future fertility and pregnancy are limited, although early reports are promising
  • Daily fezolinetant [Veozah] (30 and 45 mg were nonhormonal, efficacious and well tolerated for treating moderate to severe VMS associated with menopause
  • new, single-dose clindamycin vaginal gel was highly effective, with excellent safety, in women disproportionately affected by bacterial vaginosis, with Nugent scores of 7-10 at study entry.
  • Over 24 weeks, relugolix-CT significantly reduced moderate-to-severe uterine leiomyoma-associated pain with a more pronounced effect on menstrual pain
  • In participants with recurrent vulvovaginal candidiasis, oteseconazole was safe and efficacious in the treatment and prevention of recurrent acute vulvovaginal candidiasis episodes and was noninferior to vulvovaginal candidiasis standard-of-care fluconazole
  • povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative
  • In the presence of an intrauterine fluid collection, the rate of ectopic pregnancy is very low. The size of the intrauterine fluid collection in a woman with a pregnancy of unknown location cannot be used to distinguish between a gestational sac and a pseudogestational sac, In assessing pregnancies of unknown location, clinicians should incorporate the entire clinical picture, including other sonographic findings
  • Patients undergoing ovarian cystectomy for endometriomas had higher rates of perioperative adverse events than patients un- dergoing ovarian cystectomy for other benign neoplasms. Laparotomies were performed more often during oophorectomies for endometriomas than for other benign indications.
270
Q

OB MOC Articles

A
  • Despite a significant increase in GDM diagnosis and treatment with one-step testing, there is no difference in rate of LGA neonates compared with two-step testing among RCTs
  • No difference in maternal serum AFP values was identified between Black and non-Black pregnant individuals when adjusted by maternal weight and gestational age at blood draw. These findings suggest that routine race-based adjustment of maternal serum AFP screening should be discontinued
  • Congenital syphilis rates in the United States increased 261% during 2013–2018 and continues to increase in 2021
  • Among nulliparous patients in the second stage with neuraxial analgesia, immediate pushing, compared with delayed pushing, did not increase perineal lacerations, POP-Q measures, or patient-reported pelvic floor symptoms
  • cohort study of patients with a current singleton pregnancy suggests that VP was not associated with a reduction in recurrent PTB
  • Manual rotation increased the rate of spontaneous vaginal delivery
  • Amniotomy within 1 hour of Foley catheter expulsion resulted in 2.3 times faster delivery than expectant management. Therefore, early artificial rupture of membranes should be considered in individuals undergoing mechanical cervical ripening at term.
271
Q

Office MOC articles

A
  • > 50% of women under 25 years with CIN2 will regress to CIN1 or normal within 24 months, Absence of HPV 16 is the most important predictor of regression
  • Regression rate of CIN 2 is high. Patients aged 25 to 30 years WITHOUT HPV16 should generally be recommended active surveillance for 15 months, whereas immediate treatment should be considered in cases with HPV 16
  • Estrogen therapy use in premenopausal women who underwent BSO for benign gynecologic diseases has declined substantially over the past decade esp with increasing age
  • Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression
  • Studies demonstrate that self-administration of subcutaneous DMPA (DMPA-SC) outside clinical settings is safe, effective, feasible, acceptable, and can improve continuation.
    -Recent use of DMPA was associated with reduced leiomyoma development and increased leiomyoma loss. Such changes in early leiomyoma development in young women could delay symptom onset and reduce the need for invasive treatment.
272
Q

If immediate CIN3+ risk is > 4%

A

Colpo if risk 4-24%

Expedited Tx or Colpo if risk 25-59%

Expedited Tx if risk 60% or more

273
Q

If immediate CIN3+ risk is <4%

A

Return in 5 years if risk is <0.15%

Return in 3 years if risk is 0.15-0.54%

Return in 1 year if risk is 0.55% or more

274
Q

Singleton Pregnancy, No prior PTB
- how to screen cervix

A

Screen at time of anatomy
If less than 25mm, then offer vaginal progesterone
If less than 10, can consider cerclage
If dilated, exam indicated cerclage

275
Q

Singleton Pregnancy, WITH prior PTB before 34w
- how to screen cervix

A

Offer serial CL q2weeks from 16-24w
If less than 25mm, then offer cerclage or vaginal progesterone
If dilated then cerclage

276
Q

Hx indicated Cerclage

A

Prior cerclage or
Hx of 2nd trimester loss due to painless dilation

277
Q

TSH Goals in Pregnancy

A

First trimester, 0.1–2.5 mIU/L
Second trimester, 0.2–3.0 mIU/L
Third trimester, 0.3–3.0 mIU/L

278
Q

Neonatal Herpes

A

Disseminated disease (25%)
CNS disease (30%)
Skin, eyes, or mouth (45%)

high mortality risk

279
Q

Cervical Ectopic Tx

A

Multidose MTX (could do intraamniotic KCL if +FHT)
D&C if unstable - high hemorrhage risk
(PreOp cervical artery ligation, cerclage, vasopressive, UAE)
( Postop balloon tamponade, implantation site sutures, UAE, Uterine artery ligation)

280
Q

Interstitial/Cornual Ectopic Tx

A

Multidose MTX
or Cornual resection

281
Q

Cesarean Scar Ectopic Tx

A

MTX (hcg <5000mUI/mL and myometrium thickness <2mm)
KCl
or
Laparoscopy/laparotomy/hysteroscopy/D&C/ Combined

282
Q

Pemphigoid Gestationis

A

Autoimmune blistering, large tense bullae, periumbilical

Tx w/ oral steroids

283
Q

Polymorphic Eruption of Pregnancy (PEP)

A

AKA PUPPS

spares umbilicus, pruritic urticarial rash, erythematous papules and plaques

Tx antihistamines, topical steroids

284
Q

Atopic Eruption of Pregnancy (AEP)

A

Eczematous changes on trunk and limbs

Tx Topical steroids

285
Q

Congenital Rubella

A

Hearing loss, cataracts, rash, heart defects

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