OFFICE

Question 1

Preconception Counseling: Purpose

Answer 1

The goal of prepregnancy care is to reduce the risk of adverse health effects for the woman, fetus, and neonate by optimize health, address modifiable risk factors, and provide education about healthy pregnancy

Question 2

Oligomenorrhea (definition)

Answer 2

Cycles >35 in length of between 3-9 cycles per year

Question 3

Amenorrhea

Question 4

What is Hirsutism

Answer 4

Hirsutism is the growth of excessive male-pattern hair in women after puberty. It affects facial and body areas dependent on androgens, namely mustache and beard, pubic hair, buttocks, and thighs.

Question 5

Lichen Simplex Chronicus: definition

Answer 5

common form of chronic dermatitis that presents as dry, patchy areas of skin that are scaly and thick.

Question 6

Aura for migraines

Answer 6

sensory disturbance - vision changes - sparks, loss of vision, halos
tinnitus
olfactory
inability to speak clearly

Question 7

Aura duration

Answer 7

usually up to 1 hr prior to the migraine

Question 8

Complications of POP

Answer 8

vaginal bulge and pressure,
voiding dysfunction,
defecatory dysfunction,
sexual dysfunction, which may adversely affect quality of life.

Question 9

Support structures of Pelvic Organs

Question 10

how do you treat hirsutism?

Question 11

what is PCOS?

Question 12

What labs do you get for PCOS Work up?

Question 13

Inpatient criteria for PID

Answer 13

1) Pregnancy
2) Failed outpatient management
3) inability to tolerate outpatient treatment (nausea/vomiting)
4) Severe illness - n/v/high fever
5) TOA

Question 14

Stage III prolapse description

Answer 14

most distal prolapse more than 1 cm below hymen and no less than 2 cm TVL

Question 15

microscopic hematuria - who needs work up?

Answer 15

if 35-50 and > 25 RBC per HPF (and never smoked)

Question 16

How do you work up urinary incontinence?

Answer 16

History and physical exam, urinalysis, cough stress test for SUI and evaluating urethral mobility, PVR, urinalysis

Question 17

When are urodynamics needed?

Answer 17

rarely. Unclear diagnosis
prior incontinence surgery
persistent incontinence
complex conditions present

Question 18

Normal PVR

Answer 18

<150 ml

Question 19

Benefits of breastfeeding > 1 year

Answer 19

decreased risk cancers: breast, ovarian
DM and HTN heart disease

Question 20

Breast feeding contraindications

Answer 20

Substance abuse (cocaine, PCP)
HIV Positive
Untreated TB or varicella (pump and feed)
HSV on breast (do not feed until lesions resolve)

Question 21

what are androgens?

Answer 21

Testosterone, DHEA, DHEAS, androsterone

Question 22

How do you diagnose PID?

Answer 22

Sexually active female
One: adnexal or uterine pain, CMT
+
Fever, mucopurulent VD, WBC on saline wet mount, GC/C, leukocytosis, CRP/ESR elevated

Question 23

Clomiphene Citrate
Dose
MOA
Monitor
LH surge
Side Effects
Risk Multiples

Answer 23

CD between 2-5, 50 mg x 5 days or increasing to 100
MOA: SERM –>low estrogen stimulates increased GNRH secretion/FSH/LH release = follicles
Monitor: OPK and cycle day 21 progesterone
LH surge: 5-12 days after last dose
Intercourse 5 days after last dose
A/E: hot flashes, mood swings, headache, pelvic pain
9% risk of multiples
*discontinue if HA and vision changes

Question 24

Femara
Dose
MOA
Side Effects
Risk Multiples

Answer 24

CD 3-7, 2.5 mg/d, increase to 5 mg
MOA:suppresses estradiol secretion from ovary and thus negative feedbacks at the pituitary and increases FSH
A/E: hot flashes, fatigue, dizziness
Risk multiples: 5%

Question 25

What are criteria for Metabolic Syndrome? How do you evaluate?

Answer 25

Obtain lipid panel and view BP. Need 3 of these criteria

1) EBP > 135/80
2) Waist > 35
3) HDL<50
4) Glucose > 100
4) TG >150

Question 26

What is congenital adrenal hyperplasia?
What does it cause?
Inheritance?
Pathophys?
Phenotype?

Answer 26

MCC cause of ambiguous genitalia
Autosomal recessive, 21 hydroxyls def
Blocks cortisol production, no negative feedback to switch off ACTH… high levels 17 OHP
female fetus with ambiguous genitalia

Question 27

What are events of puberty?

Answer 27

Gonadarche- activation of gonads by FSH/LH
Adrenarche- increased androgens produces by adrenal cortex

Question 28

Femara vs. Clomid

Answer 28

Femara has high rates of mono follicular development (lower multiple risk), lower risk of teratogenicity (due to shorter half life) and no direct anti-estrogenic effect on endometrium

Question 29

HRT contraindications

Answer 29

Pregnancy
Breast cancer
Estrogen sensitive tumor
CVA/TIA
Coronary heart disease
HX DVT/thrombophilia
Undx VB

Question 30

What is not CIN with HRT?

Answer 30

HTN, smoking, migraine with aura ARE NOT CONTRAINDICATED, transdermal preferred!

Question 31

Methotrexate MOA
Dose
Contraindication

Question 32

Uterine Artery Embolization
Benefits
Complications

Answer 32

Benefits:
shorter hospital stays,
quicker return to work
more unscheduled visits
complications

Complications: fevers
bleeding or hematoma at arrteriotomy site
myometrial necrosis
perforation of arterial site or uterus, with resultant bowel injury

Question 33

Jehova’s witness and refusal of blood products. Is cell saver an option?

Answer 33

1) Confirm refusal of blood products and types
2) Plasma expanders like albumin may be used
3) No as this required circulation of the patients blood into her body from an external source