OB/GYN 7 Flashcards
What is the Cervical Cancer Screening Recommendations for the following groups?
- <21 yo?
- 21-29 yo?
- Age 30-65 yo?
- Age > 65 yo?
- No PAP
- PAP q 3 years.
- PAP q 3 years (OR) PAP + HPV DNA q 5 years
- No PAP
What is the Cervical Cancer Screening Recommendations in these special populations?
- Hysterectomy + Cervical removal?
- HIV
- Immunocompromised (organ transplant, SLE)?
- No PAP if prior -ve screen and low risk.
- PAP @ dx of HIV or onset of sex, then annually until -ve X 3, then routine.
- PAP @ onset of sex, then annual PAP + HPV DNA.
What ages should you administer Gardasil (HPV vaccine) in boys and girls?
Boys 11-21 yo
Girls 11-26 yo
During a PAP test, there are three possible results…NORMAL vs ASCUS vs ABNORMAL…
What is the next step in management if NORMAL?
What is the nest step in management if ASCUS?
What is the next step in management if ABNORMAL/HSIL?
NORMAL –> routine PAP q 3 years.
ASCUS –>
- Get HPV DNA OR Repeat PAP in 6 months
- -> IF HPV +ve or ASCUS or worse on repeat PAP = COLPOSCOPY. - IF HPV DNA negative, can go back to q 3 years PAP.
ABNORMAL –>
- COLPOSCOPY
- -> IF ectocervical change but NO endocervical = LEEP or cryotherapy.
–> IF Ecto + Endo cervical change = Cone Bx.
Pelvic organs can prolapse through the vagina..
Bladder = Cystocele Rectum = Rectocele Uterus = Uterine prolapse
What symptoms can you see?
TRX?
- Pelvic pressure
- Bowel.Bladder dysf
- vaginal/cervical erosions causing vaginal bleed.
TRX = Pessary + Vaginal Estrogen
What is the first line trx for endometriosis?
First line = medical = NSAID + OCP
IF above fails surgery.
Selective Estrogen Receptor Modulators (Tamoxifen and Raloxifene) are used as adjuvant treatment in E receptor positive non-met breast CA.
Which associated with Endometrial CA?
Do you need any special cancer screening while on SERMS, given this increased risk?
TAMOXIFENE (E antagonist in breast, but agonist in Endometrium)
NO, screening for endometrial CA has not proven beneficial.
What is the outpatient trx for PID?
What is the inpatient trx for PID?
Outpatient = Ceftrixone + Doxycycline
Inpatient = Cefoxitin + Doxycycline
What are the 4 options for EMERGENCY CONTRACEPTION?
How effective are each?
What time frame do you need to administer?
- COPPER IUD
- 99% effective (most effective)
- within 120 hours - URLIPRISIL PILL
- > 85% effective
- within 120 hours - LEVONOGESTREL PILL (PLAN B)
- 85% effective
- within 72 hours (effectiveness decreases over time) - OCP
- 75% effective
- within 72 hours
COPPER IUD is the most effective emergency contraception…but in what 3 situations is it contraindicated?
URLIPRISTIL PILL is the next best option, but should be avoided in what 2 situations?
- Active PID or cervicitis
- Undiagnosed vaginal bleed
- Wilsons disease
- Hepatic or Renal impairment
- Uncontrolled Asthma
There are 4 diseases that are standard ppx after sexual assault…What is the Post-Exposure ppx after sexual assault for:
- HIV
- Hep B
- G/C
- Trichomoniasis Vaginalis
HIV –> Tripple therapy (Tenofovir, Emtricitabine, raltegravir) for 1 month.
HEP B –> Immunoglobulin + start vaccine series.
G/C –> Ceftriaxone + Azithromycin
Trichomoniasis –> Metronidazole.
Normal breast cancer screening with mammogram should start at what age?
What are 6. HIGH RISK Fam hx that would prompt earlier screening?
Start 50 yo. Q 2 years.
HIGH RISK FAM HX: (screen 40 yo)
- 2 1st degree relative with breast ca, one < 50 yo.
- 3 or more 1st/2nd degree relative with breast ca.
- Relative with breast AND ovarian ca
- 1st degree relative with bilateral breast ca
- male relative with breast ca
- Askenazi jew + relative with breast or ovarian ca.
Only after B-HCG level reaches above what threshold can you visualize a pregnancy via US?
1500
What is the first step in evaluation of suspected ectopic pregnancy?
Urine B-HCG
Transvaginal US.
What are the three abs that can be found in Anti-Phospholipid Syndrome?
- Lupus anticoagulant
- Anti-cardiolipin Ab
- Anti- Beta-2 glycoprotein 1 Ab
