OB/GYN stuff

Question 1

At what age should breast cancer screening start?

Answer 1

All groups agree 50-75 mammography is preferred. Ages 40-49 shared decision making. <40 usually the risk outweighs the benefits

Question 2

True or false: breast self exam teaching is recommended as a positive screening tool.

Answer 2

False! it is no longer recommended due to false positive findings and lack of benefit.

Question 3

What is Cyclic mastalgia?

Answer 3

Bilateral “soreness” that is relieved after menses, related to a hormonal cause.

Question 4

What is non-cyclic mastalgia? What age does it most commonly occur in?

Answer 4

Most commonly occurs in women 40-50. It is a unilateral, sharp, burning sensation with multiple potential causes including: large breasts, fibroadenoma, cyst, ductal ectasia (inflammation/distension of ducts), mastitis, inflammatory breast CA

Question 5

What is part of a Galactorreha lab workup? When would this be ordered?

Answer 5

TSH
Prolactin
Renal labs
Pregnancy test. 
Referral for imaging: US for everyone, Mammogram for women >30 yrs. 

This would be ordered if there was visual nipple discharge of unknown cause.

Question 6

What is the HPV vaccine in the US?

Answer 6

Gardasil

Question 7

What is the recommended age to receive the HPV vaccine?

Answer 7

Ideally 11-12 (2 doses) but is recommended for 9-26 and approved through age 45. For adults 27+ catch-up vaccination is not routinely recommended d/t likelihood of previous HPV exposure

Question 8

If ages 15-26, how man doses of HPV vaccination will one receive?

Answer 8

Three! Typically it is two but if received late 3 is recommended.

Question 9

What are risk factors for HPV infection and cervical cancer?

Answer 9

• Early onset of sexual activity
• Multiple partners
• High risk sexual partner
• Hx of STIs
• Hx of vulvar or vaginal squamous intraepithelial neoplasia or cancer
• Immunosuppression
• Lower socioeconomic status, non-white race

Question 10

What is the preferred screening for average risk, asymptomatic, immunocompetent patients?

Ages 21-24
25-29
30-65

Answer 10

21-24: cytology alone every 3 years

25-29: cytology with reflex HPV test every 3 years

30-65: cotesting (cytology + HPV test) every 5 years or cytology alone every 3 years

Question 11

What are risk factors for ovarian cancer?

Answer 11

Hereditary factors
Having children later in life or never having children
Use of estrogen after menopause

Question 12

What are risk factors for uterine/endometrial cancer?

Answer 12

Obesity
Unopposed estrogen therapy 
increased number of lifetime menstrual cycles
Use of Tamoxifen
Age: >55 yrs
PCOS
Hereditary
DM2

Question 13

What are the presenting sx of Ovarian cancer?

Answer 13

Nonspecific subacute symptoms: adnexal mass, pelvic pain, bloating. Acute include: pleural effusion, bowel obstruction

Question 14

What are the presenting sx of Uterine/Endometrial cancer?

Answer 14

Abnormal uterine bleeding= CARDINAL symptom

abnormal cervical cytology

Question 15

What are common symptoms of Menopause? What age do women go through this?

Answer 15

Age: 43-57 but average is 51.4. 
Symptoms:
-menstrual irregularities
-hot flashes
-sleep disturbances
-mood symptoms
Atrophic vaginitis: dryness, itching, pain with sex
-joint pain/OA

Question 16

What are common side effects of estrogen?

Answer 16

Breast tenderness, bloating, uterine bleeding

Question 17

What are absolute contraindications to systemic estrogen therapy?

Answer 17

Unexplained vaginal bleeding
Hx DVT, PE or clotting disorder
Hx breast/endometrial or other estrogen-dependent cancer
Hx CHD, stroke or TIA
Hypersensitivity to hormone therapy

Question 18

What are benefits of hormone therapy for menopause treatment?

Answer 18

lowers the risk of: hip fracture, vasomotor symptoms, diabetes

Question 19

What are risks of hormone therapy for menopause treatment?

Answer 19

Increased risk of stroke, VT and gallbladder disease

Question 20

What are the major risk factors for decreased bone density (in osteopenia and osteoporosis)?

Answer 20

Increased age
Previous fracture
long term glucocorticoid treatment
low body weight (<127 lbs)
Parental history of hip fracture
Excess alcohol intake
White race
Cigarette smoking

Question 21

When should bone density screening occur for women?

Answer 21

Women: 65+ OR postmenopausal women <65 at increased risk for osteoporosis

Question 22

What’s the initial pharmacological therapy of Osteopenia and Osteoporosis treatment?

Additional therapy?

Answer 22

Bisphosphonates including Alendronate or Risedronate.
MOA: inhibit bone resorption
Contraindications: esophageal disorders, CKD, inability to sit up for 30-60 min following dosing

Additional: Selective estrogen receptor modulators (Raloxifene, Tamoxifen), Estrogen/progesterone therapy, Anabolic agents

Question 23

What are the top tier birth control methods?

Answer 23

the implant
IUDs
Copper IUDs
Sterilization

Question 24

What are mid tier birth control methods?

Answer 24

The pill, the patch, the ring, the shot

Question 25

What are the advantages of the Nexplanon implant?

Answer 25

Highly effective, safe, few contraindications, no estrogen, long-term protection, convent, high user satisfaction, relief of dysmenorrhea, reversible, reduced risk of ectopic pregnancy, cost effective

Question 26

What are the disadvantages of Nexplanon?

Answer 26

Uterine bleeding abnormalities (irregular, infrequent, amenorrhea), clinician dependent, lack of protection against STIs, ovarian cysts, possible decrease in bone density