OB/GYN

Question 1

First line therapy for women hirsutism

Answer 1

Combined oral contraceptives then anti-androgen medicines like spironolactone. Do not use metformin

Question 2

Treatment for heavy menstrual bleeding in an adolescent female.

Answer 2

Monophasic combined oral contraceptive with 30- 50 µg of ethinyl Estradiol taken every eight hours until bleeding stops

Question 3

How do you work up a breast lump in a woman under 30 and in a woman over 30.

Answer 3

Under 30 if you feel a palpable mass get an ultrasound because mammogram is very non-specific. If they are over 30 then you should get an ultrasound also a diagnostic mammogram in case one study mises something and the other one can capture it. If the imaging does not reveal a mass that can be felt by either the patient or the clinician have the patient wait two or three menstrual cycles and follow up for reevaluation. At that time possibly go to a surgeon
Mammograms alone can mess 10–15% of breast cancer’s

Question 4

What is the lifetime risk of developing breast cancer and what are the chances of dying from breast cancer

Answer 4

The risk of developing breast cancer if you live until age 85 is one in every eight women but only one N 36 women with breast cancer will die from it unlike lung cancer one and 20 will die from it

Question 5

First line for nausea in pregnancy

Answer 5

Doxylamine (unisom) and B6

Question 6

Starting new birth control. When do you need a negative HCG before starting a birth control….

Answer 6

If >7 days ago and has had unprotected sex then get a Neg HCG and need a backup method x 7 days. If <7 days use backup method for 7 days. start new birth control immediately.

Question 7

Resources for medication safety in lactation

Answer 7

LactMed

Question 8

SSRI to avoid in lactation

Answer 8

Prozac. Others safe. Sertraline, paroxetine and nortriptaline undectable in breast milk.

Question 9

what is the cause of PCOS

Answer 9

Insulin Resistance

Question 10

LH/FSH ratio suggestive of PCOS?

Answer 10

3:1,

Question 11

Oral Contraceptives can lower risk of what?

Answer 11

Ovarian cancer by 50%

Question 12

Alternative for estrogen for hot flashes?

Answer 12

zoloft, paxil, clonidine 100 patch, gabapentin

Question 13

What level of progesterone represents recent ovulation?

Answer 13

Progesterone >3 ng/mL

Question 14

How often should maternal TSH be checked in first 20 wks gestation?

Answer 14

Every 4-6 wks.

Question 15

In general what happens to TSH levels during pregnancey?
What is goal TSH during pregnancy?

Answer 15

TSH lowers starting at 6 wks due to increased TBG due to estrogen mediated hepatic production.
TSH < 2.5, Usually dble dose x2/wk (28%) is needed.

Question 16

Why is it so important to keep thyroid levels adequate during pregnancy?

Answer 16

After the 14th week fetal brain development may already be irreversibly affected by a lack of thyroid hormones.

Question 17

what is most common reason for female infertility?

Answer 17

Primary ovulatory insufficiency (ovulatory dysfunction) is the most commonly identified cause of infertility in women and is present in up to 40%

Question 18

Some initial testing for female who is infertile?

Answer 18

Hypothyroidism and hyperprolactinemia are among the more common causes of anovulation and require early evaluation and specific treatment. Timed FSH and estradiol levels will distinguish between hypothalamic/pituitary, ovarian, and other causes of ovulatory dysfunction. Ovulation should be documented by serum progesterone level measurement at cycle day 21 of a 28-day cycle or 1 week before the predicted onset of menses.

Question 19

2 simple questions to screen for IPV (intimate partner violence)

Answer 19

“Have you ever been hit, slapped, kicked, or otherwise hurt by your partner?
Have you ever been forced to participate in sexual activities?”

Question 20

After sexual assualt what time frames are important to know as to when you can prevent certain consequences of the assualt?

Answer 20

If presented within 72 hours after the assault, she would have been eligible for HIV postexposure prophylaxis.
If presented within 5 days of the assault, provision of emergency contraception would have been appropriate.

Question 21

How prevelant is sexaul assualt in the US

Answer 21

43% lifetiime risk for females

Question 22

what is the best imaging in women with breast mass?

Answer 22

In women younger than 30, ultrasonography of the breast is the preferred imaging modality to begin the evaluation (SOR C).
For women older than 30, starting with diagnostic mammography is recommended. MRI is rarely indicated in the evaluation of a breast mass (SOR B).

Question 23

Pregnant pt with worsening asthma during preganancy. what can she do?

Answer 23

budesonide/formoterol with mild asthma is a single inhalation of 200/6 µg as needed for symptom relief, with a maximum formoterol dose of 72 µg in a single day

Question 24

Common methods of emergency contraception?

Answer 24

Copper IUD up to 7 days, Levonorgestrel,
Combined OCP (100 µg ethinyl estradiol and 0.5 mg levonorgestrel (equivalent to 1 mg norgestrel) given as two doses 12 hours apart within 72 hours of intercourse), within 72 hours, NNT 17
Oral mifepristone,
ulipristal selevtive progeterone receptor modulator effective up to 120 hours after.

Question 25

Normal age for puberty in females.

Answer 25

The normal age range for the onset of puberty in girls is 8–14 years. The average age at menarche is 12.5 years, and the absence of any pubertal development by 13 years of age is an indication to evaluate the patient for delayed puberty.

Question 26

What is first sign of puberty in females

Answer 26

thelarche

Question 27

Signs that menarche is close to starting?

Answer 27

Menarche generally follows peak skeletal growth by about a year.

Question 28

Define Primary Amenorrhea?

Answer 28

Primary amenorrhea is defined as the absence of menarche by age 15, or within 3 years of thelarche

Question 29

How to screen and how often to screen female with history of high grade SIL on pap?

Answer 29

After the initial 6-month testing, HPV testing or co-testing should be performed annually until three consecutive negative tests are documented. Beyond this initial surveillance period, continued testing is recommended at 3-year intervals for at least 25 years after treatment of high-grade histology such as this patient’s cervical intraepithelial neoplasia (CIN) 3. Post-treatment HPV testing has been shown to be the most accurate predictor of treatment outcome

Question 30

Female who has migraine with aura should avoid what type of birth control?

Answer 30

Migraine with aura is a category 4 condition for any estrogen-containing contraception Category 1: A condition for which there is no restriction for the use of the contraceptive method Category 2: A condition for which the advantages of using the method generally outweigh the theoretical or proven risks Category 3: A condition for which the theoretical or proven risks usually outweigh the advantages of using the method Category 4: A condition that represents an unacceptable health risk if the contraceptive method is used

Question 31

Some true statements about SUD in women vs men

Answer 31

Women metabolize nicotine faster than men women more likely to relapse Menstral cycle changes contribute to more or less use of drugs Shorter time from start to dependence than men

Question 32

describe fetal - maternal transfusion and why can it be risky for the fetus?

Answer 32

Rh incapatabily and the resultant antibodies that form and then cross placenta.

Question 33

Define postpartum endometritis?

Answer 33

2 of the first 10 days of fever over 100.4. With lack of other cause of infection. Start intravenous clindamycin plus gentamicin, the traditional gold-standard therapy After clinical improvement has been observed with intravenous antibiotics, additional oral antibiotics are not needed, as they have not been proven to be beneficial.

Question 34

Things to think of with menorrhagia? AUB

Answer 34

-Abnormal uterine bleeding can be categorized as ovulatory (regular cycles) or anovulatory (irregular cycles). -Ovulatory (menorrhagia) evidenced by heavy bleeding that lasts for more than 7 days and occurs at regular intervals every 24–35 days. -Up to 20% of women presenting with heavy menstrual bleeding will have an underlying inherited bleeding disorder, with a higher prevalence in adolescent females. The onset of heavy menses at menarche is often the first sign

Question 35

How long does it take for ovarian cysts to resolve? What is on DDX for ovarian cyst? When is surgery needed?

Answer 35

-most resolve spontaneously in 8–12 weeks without the need for surgical intervention. Follow-up ultrasonography is recommended in 4–6 weeks. -Surgical management is indicated if the cyst persists beyond 8–12 weeks or if other high-risk signs are present on ultrasonography. - (infection, malignancy, ectopic pregnancy, ovarian torsion)

Question 36

When is most likely time women will sex produce a pregnancy?

Answer 36

Start 5 days before and continue until 24 hrs after ovulation (7 days). Ovulation occurs between day 10 and 16 but average is day 14. Slight increase in body temp, mucous changes, incresed libido and breast tenderness can signal ovulation as well. Sperm stay viable for up to 5 days in female body. egg viable for 12-24 hrs after ovulation.

Question 37

When does Mastitis appear? What bacteria commonly present? How to treat?

Answer 37

2-3 wks postpartum, Effects 10% of women, Consider ways to better drain milk from breast, avoid cracked nipples. Staph aureas main bug. Augmentin, keflex, clida? baby can still nurse. make sure no abcess.

Question 38

Best way to switch contraception?

Answer 38

7 days of back up method Depo shot, cont pill x 7 days Nuvaring, insert ring one day before last pill start patch 2 days before last pill Continue pill x 4 days after nexplanon inserted

Question 39

What is ICP, how is it treated? what are some risks?

Answer 39

intrahepatic cholestasis of pregnancy (ICP), evidenced by generalized pruritus, elevated liver enzymes, and increased serum bile salts, generally in the absence of a rash. This is a pregnancy-specific reversible condition that results from impaired metabolism and excretion of bile acids from the maternal bloodstream. Ursodeoxycholic acid, 500 mg twice daily, has been shown to provide symptomatic relief from pruritus, decrease elevated liver enzymes and maternal serum bile salts (SOR B), and improve fetal outcomes Risk of stillbirth.

Question 40

What is Lichen Sclerosis? sxs? treatment?

Answer 40

Lichen sclerosus (LS) is a chronic, benign, inflammatory dermatologic disorder that most commonly involves the vulvar and anogenital regions. Common symptoms include severe pruritus and dyspareunia, as well as dysuria and a burning sensation or pain with defecation. The etiology is unknown but it most commonly occurs in hypoestrogenic states such as peri- or postmenopause and before puberty Treatment is high potency steroid oitments or pimecrolimus 1% cream twice daily

Question 41

what should you think of in someone with severe insulin resistence?

Answer 41

HAIR-AN syndrome, a rare subphenotype of PCOS, consists of hyperandrogenism, severe insulin resistance, and acanthosis nigricans, and occurs in nearly 5% of women with hyperandrogenism

Question 42

Always check these labs when diagnosing PCOS?

Answer 42

TSH and Prolactin

Question 43

Med to consider in women at high risk for ER positive breast cancers?

Answer 43

Tamoxifen for premenopause Raloxifen for postmenopausal can reduce breast cancer risk by up to 48%

Question 44

Combined OCPs can reduce what kind of cancer?

Answer 44

Ovarian

Question 45

What is ASB of pregnancy? what problems can it cause? how common is it? What is a good treatment choice?

Answer 45

Asymptomatic bacteria of pregnancy can. happen in 2 - 15% of all pregnancies. can lead to preterm labor, treatment reduces very-low-birthweight infants. All pregnant women should have a urine culture. 12 - 16 weeks gestation. Macrobid is good choice assuming no resistence or allergy. No repeat culture needs to be done if based on culture sensitivities. 4-7 day course recommended.

Question 46

Describe "baby blues"

Answer 46

a period of increased emotional lability, irritability, and fatigue that can begin in the first 24–48 hours post partum, has limited impact on functioning, and usually disappears within 2 weeks

Question 47

What percent of women with hx of prior depression treatment will have postpartum depression?

Answer 47

30%

Question 48

What should you think if female comes in with hyperthyroid symptoms within first 12 mo of delivery? How do you treat?

Answer 48

Postpartum thyroiditis is an autoimmune disorder that affects up to 10% of women. It should be considered anytime a woman has symptoms consistent with hyperthyroidism within the first 12 months after delivery, and it can also occur following an abortion or miscarriage. The hyperthyroid phase of postpartum thyroiditis is caused by autoimmune destruction of the thyroid, causing a release of thyroid hormone. This typically lasts for 1–2 months, followed by a hypothyroid phase lasting 4–6 months. Up to 25% of women will become permanently hypothyroid, whereas the majority will become euthyroid. Beta Blockers

Question 49

At what age does the risk for MI increase for women who smoke and use combiined oral contraception?

Answer 49

Age ≥35 and smoking 15 or more cigarettes per day is a category 1 condition for the progestin-only pill, the etonogestrel implant, the copper IUD, and the levonorgestrel IUD

Question 50

Best imaging to perform in a treatment puzzle likely gynecological cause of pelvic pain. If it’s an older female or likely G.I. cause considering a CT scan.

Answer 50

Transvaginal ultrasound