Outpatient Flashcards
Lichen planus
Wickham striae
Oral and non-genital lesions
Erythematous shiny plaques, ulcers, loss of architecture
Rx high dose topical steroids, tacrolimus
Lichen simplex chronicus
Vulvar irritation> persistent scratching
Scaly plaques, thickened leathery appearance
Rx hygiene, treat underlying cause, topical steroids
LNG-IUD failure rate
0.2%
Copper IUD failure rate
0.8%
Nexplanon failure rate
0.05%
Vasectomy failure rate
0.15%
Female sterilization failure rate
0.5%
Depo failure rate
6%
OCP/patch/ring failure rate
9%
Diaphragm failure rate
12%
Metabolic syndrome
Presence of 3/5 of the following:
- waist circ >88 cm or 35 in
- TG >150 or on meds for elevated TGs
- HDL <50 or on meds
- BP >130/85 or on meds
- fasting BG >100 or on meds
BRCA1/2 cancer risks
Breast
- BRCA1 55-70%
- BRCA2 45-70%
Ovarian
- BRCA1 35-45%
- BRCA2 15-20%
Criteria for annual breast MRI screening
- 1st degree relative of carrier for breast CA mutation
- 20% lifetime risk of breast CA
- Chest radiation between 10-30yo
- 25-29yo with BRCA variant
IBS diagnostic criteria
Recurrent abdominal pain 1+ day/wk in past 3 months with 2+ of the following:
- related to defecation
- change in stool frequency
- change in form of stool
Most common causes of vaginitis prior to puberty
- improper hygiene
- sexual abuse
Medications that can cause hyperprolactinemia
Elevations to 25-100 ng/mL
- Antipsychotics
- Domperidone
- Metoclopramide
- Methyldopa
- Verapamil
- Opioids
21-hydroxylase deficiency inheritance
Autosomal recessive
Duchenne’s muscular dystrophy inheritance
X-linked recessive
PTU side effect
Agranulocytosis
Kallman syndrome
Primary amenorrhea
Anosmia
Hypogonadotropic hypogonadism
Cleft lip/palate
Sensitivity formula
a/a+c
test’s ability to correctly identify pts with a disease
Specificity formula
d/b+d
test’s ability to correctly identify pts without a disease
PPV
a/(a+b) x100
likelihood that a pt with a positive test actually has the disease
NPV
d/(c+d) x100
likelihood that a pt with a negative test is disease free
Odds ratio
ad/cb
Accuracy
(a+d)/(a+b+c+d) x100
FMR1 trinucleotide repeats (intermediate, premutation, full mutation)
CGG repeats, fragile X syndrome
Unaffected: <45
Intermediate: 45-54
Premutation: 55-200
Full mutation: >200
Fragile X syndrome
Most common form of intellectual disability, X-linked
Males with long narrow face, prominent ears, large testes, joint/skin laxity, hypotonia, speech delay, MVP
Premutation associated with female premature ovarian insufficiency, male tremor/ataxia
HSV vertical transmission rates (primary vs. recurrence)
Primary: 40-80%
Recurrence: 1.3-3%
Copper IUD failure rate
Typical 0.8%
Perfect 0.6%
LNG-IUD failure rate
0.2%
Nexplanon failure rate
0.05%
CHCs and POPs failure rate
9% typical
0.3% perfect
Female sterilization failure rate
0.5%
Male sterilization failure rate
0.15% typical
0.1% perfect
TTP
Absence of ADAMTS-13 (vWF cleaving protease)
Symptoms: hemolytic anemia (schistocytes, elevated bili), thrombocytopenia, neuro abnormalities, fever, renal dysfunction
Rx plasmapheresis
Androgen insensitivity vs. Swyer
Both 46 XY female phenotype, absent body hair
AIS:
- nonfunctional androgen-R, normal male testosterone, absent AMH/uterus/cervix, +breast development
- remove testes after puberty
Swyer:
- SRY mutation, streak gonads, low testosterone, absent AMH/breasts, uterus/cervix present
- remove testes at diagnosis
MRKH
46 XX, female phenotype
- no paramesonephric development> absent uterus/cervix/AMH
- Breast development and body hair present
NSAID mechanism of action
Inhibits COX1 and COX2
- COX1 affects platelet aggregation, GI mucosal integrity, renal function
- COX2 affects growth, regulation of female reproduction, bone formation, renal function
Gonorrhea treatment
Single dose of ceftriaxone 500 mg IM (1000 mg if >150 kg or 300 lbs)
- If chlamydia not excluded include doxy 100mg BID x7d
Cephalosporin allergy: gent 240mg IM + azithro 2g PO
- EPT: cefixime 800mg PO +/- doxy depending on chlamydia status
Adnexal mass malignant features
- Irregular solid tumor
- Ascites
- 4+ papillary structures
- Irregular, multilocular, solid, diameter 10+ cm
- High color doppler content
Adnexal mass benign (B) features
- Unilocular
- Solid components, largest <7cm
- Acoustic shadows
- Smooth multilocular
- No doppler flow
Amsel criteria
Thin gray discharge
pH >4.5
Positive whiff
>20% clue cells
MDD diagnosis
5 or more symptoms lasting for at least 2 weeks
- one must be depressed mood or diminished interest
Bisphosphonates
Antiresorptive/osteoclast inhibition, used for osteoporosis prevention and treatment
- side effects: GI upset, atypical femoral fractures, osteonecrosis of jaw
Denosumab
Osteoporosis treatment, blocks RANKL (osteoclast)
- Side effects: rash, infections, atypical femoral fractures, osteonecrosis of jaw, hypocalcemia
Raloxifene
Osteoporosis prevention and treatment, SERM (agonist at bone, antagonist at uterus/breast)
- Side effects: VTE, vasomotor symptoms
Ulipristal mechanism, timing
30 mg, SPRM (selective progesterone receptor modulator)
Inhibits follicle rupture to delay ovulation
up to 5d after unprotected intercourse
Plan B mechanism/timing
Progesterone/levonorgestrel 1.5 mg once or 0.75mg x2
Delays follicle development
Up to 3d after unprotected intercourse
HPV vaccine timing
Ideally begin between 11-12y
Give as early as possible if hx sexual abuse starting at 9yo
<15yo: 2 doses at 0 and 6-12 months
15-45yo: 3 doses at 0, 1-2, and 6 months
Risk factors for early bone density screening <65y
History of fragility fracture
Weight <127 lb
Secondary causes of bone loss
History of parental hip fracture
Smoker, Alcoholism
Rheumatoid arthritis
Pneumococcal vaccine recs
2 regimens: either 1 dose of PCV15 then PPSV23 1 year later OR 1 dose of PCV20
- all pts 65+ yo
- immunocompromised
- medical risk - alcoholism, heart/liver/lung disease, renal failure, smoking, diabetes
Methimazole mechanism and fetal risks
Inhibits TPO
- fetal effects: aplasia cutis, esophageal atresia, choanal atresia
- agranulocytosis rare
- transition from PTU in second trimester
PTO mechanism and fetal risks
Inhibits TPO and conversion of T4 to T3
- side effect: hepatotoxicity
- agranulocytosis rare
Outpatient PID treatment
Ceftriaxone 500mg (1g if >150 kg) + doxy 100mg BID x14d + flagyl 500mg BID x14d
Sexual assault prophylaxis
Treat chlamydia, gonorrhea, trich
- HIV if high risk
- hep B vaccine if non-immune
Chlamydia: doxy x7d preferred, azithro x1 alternative
Gonorrhea: IM ceftriaxone preferred, IM gent+azithro x1 if allergic to penicillin
trich: flagyl x7d
NYHA functional classes
I: cardiac disease without limitation of physical activity
II: slight limitation of physical activity; ordinary activity leads to fatigue, palpitations, dyspnea, angina. Comfortable at rest
III: marked limitation of physical activity; less than ordinary activity causes symptoms. Comfortable at rest
IV: inability to carry on any physical activity without discomfort; symptoms can occur at rest, worse with activity
Ulcerative colitis
Mucosal layer only
Almost always involves the rectum
Protective factors: smoking, appendectomy
Crohn’s disease
Skip lesions, transmural involvement
- All areas of GI tract (mouth to proximal colon)
- Increased risk with smoking, appendectomy increases risk
Normal hCG rise in early pregnancy
Up to 1500: 49%
1500-3000: 40%
>3000: 33%
Discriminatory level 3500
DCIS breast biopsy management
Mastectomy with or without radiation
Endocrine therapy if ER+
Lymphogranuloma venereum
C. trachomatis L1-3
Urethritis, inguinal lymphadenopathy, rectal ulcers/pruritis
Rx doxy 100 BID x21d
H. ducreyi
Painful, non-indurated ulcer with friable base and exudate, tender lymphadenopathy
Rx aspiration of buboes, Rx azithro or ceftriaxone IM x1
