Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PROLOG > Patient Mngmnt In The Office > Flashcards

Patient Mngmnt In The Office Flashcards

1
Q

Time difference in postpartum blues va depression

A

Blues should resolve around PPD10, if depression exceeds 10 days consider postpartum depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

BMI cutoff for ulipristal acetate?

A

35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Treatment for Graves’ disease (IgG ab activated thyrotropin receptors increasing production of t3/4)

A

PTU, methimazole, radioiodine therapy, thyroidectomy

(Pregnancy: PTU in first tri to avoid birth defects of methimazole, then switch to methimazole for second/third tri to avoid liver toxicity of PTU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In addition to known birth defects caused by methimazole, what structure should be evaluated by US in a fetus who’s mother is talking PTU or methimazole during pregnancy?

A

US should evaluate for presence of goiter at 28-32 weeks because both PTU and methimazole cross placenta and can cause hypothyroidism in the neonate possibly resulting in goiter formation- caf obstruct newborn airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

This SSRI is the only one found to increase risk of incidence of fetal anomalies, particularly __.

Most neonatal complications are transient including jitters, respiratory depression, however SSRIs have been recently associated with ___.

A

Paroxetine (Paxil). Cardiac defects.

Persistent pulmonary hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Management of bacterial vaginals is evident on Pap smear cytology:

A

Assess for symptoms, if none, not necessary to treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is a main risk of the estrogenic properties of tamoxifen in all users?

A

VTE- lowered levels of antithrombin III and protein C

Endometrial proliferation is mostly seen in post menopausal users (RR 4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Next step in adolescent dysmenorrhea resistant to medical management after 3-6months?

A

Diagnostic lap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Does a lower dose of estrogen in OCP confer less risk in a hypertensive woman >35yo?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

As little as __% weight loss can improve metabolic complications of PCOS and cycle regularity

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Laboratory criteria for APS?

A

+ lupus anticoagulant, B2 glycoproteins, or anticardiolipin x2 >12 weeks apart

Additionally for lupus anticoagulant And anti-beta2 glycoprotein, enzyme assays for igG and IgM should be obtained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lifetime risk of developing ovarian cancer (low risk):

A

1 in 70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

A woman has genital herpes, but her new partner does not, what is best management? How effective?

A

Daily suppressive therapy for her- reduces transmission to a discordant, unintended partner by 50%.

Condoms also help!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Primary HPV testing may even be better for women aged _____, but it does have a higher risk of unnecessary colposcopy.

A

25-29.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Compared to baseline the most well known risks of IVF are:

A

Twin (30 fold, mostly dizygotic), congenital heart defects (1-3% compared to 0.3-1%),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Recurrent pregnancy loss workup

A

Karyotype of products of conception; APS testing; assessment of uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What treatment for genital wart is safe in pregnancy?

A

Trichloroacetic acid or cryotherapy

Iniquidad (not indicated for unteach I am use) has not been studied in pregnancy
Podophyllin (antimitotic) and 5FU (pyrimidine anti metabolite) are not safe in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How should patients be counseled who would like to continue using depo provera for longer than 2 years?

A

Studies have demonstrated 5% BMD loss at 5 yrs of use but it seems to be recoverable after it is discontinued.

No studies have clearly demonstrated increased fracture risk.

Estrogen supplementation and DEXA scans are not recommended.

Discuss ways to improve BMD such as weight bearing activities, Ca and VitD, smoking cessation

They do not have to stop taking it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment for pediatric vulvar lichen sclerosis:

A

Clobetasol propionate ointment twice daily for 2-12 weeks with frequent reassessment then step down management to less potent steroids as soon as possible

Sitz baths and avoiding irritants for prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Management of 17 unvaccinated nulligravida exposed to chicken pox- management:

Management for pregnant woman:

A

Vaccination within 3-5 days is 90->70% effective. 2 doses required 6-8 weeks apart.

CI to vaccinate pregnant women because vaccine is live attenuated. Immune globin can be given.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Breast ca screening for known BRCA carriers beginning at __yo:

A

25yo

MRI annually. Adding annual mammography at age 30

Up to 95% detection rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Most widely studied combination therapy for adolescent depression:

A

Fluoxetine (prozac )and cognitive behavioral therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Of the thrombophilias which should be evaluated in the event of VTE, which are not useful to test for in pregnancy, acute thrombosis, or if a patient is anticoagulated:

(Protein C, S, prothrombin gene mutation, antithrombin, factor V Leiden)

A

Factor v Leiden (dna yet only) and prothrombin gene mutation can be assessed regardless

Protein c and s can be assessed in pregnancy (s varies by trimester) but NOT during acute VTE or when anticoagulated

24
Q

The rate of healing esophagitis from GERD is 30% heater with ___ compared to ___.?

A

PPIs compared to H2 blockers

25
Q

Screening fir women with extremely dense breasts:

A

Digital mammography

26
Q

Best non hormonal treatment for vasomotor sx in menopausal woman taking tamoxifen for h/o breast cancer

A

Venlafaxine because, unlike paroxetine, it does not inhibit CYP2D6 preventing tamoxifen conversion to its active metabolite

27
Q

When to start treating for osteoporosis based on screening-

A

T-score: -2.5 or less

FRAX: 10yr risk of major fracture of 3% or more; OR risk of hip fracture 20% or more

28
Q

Empiric therapy for otitis media

A

Amoxicillin or if sx persist of amoxicillin, add clavulonic acid

29
Q

Most common karyotype associated with _____; an overriding aorta, VSD, pulmonary artery stenosis

A

Normal karyotype, most fetus with isolated cardiac abnormality will be euploid

Tetrology of Fallot

Risk of aneuoidy is 20%

Pts should undergo genomic microarray if interested in genetic testing

30
Q

Risk of fetal cardiac anomaly if parent had structural heart malformation

A

2-3%

Similar for siblings

31
Q

Elevated risk of breast cancer according to the Gail model

A

5yr risk of >1.67% (avg risk of women at age 60) or lifetime risk >20%

32
Q

Main risk factors for use of tamoxifen and reloxifene in women 35+ yo without prior breast ca but increased risk for invasive breast cancer

A

VTE (both) cataracts and endometrial cancer (tamoxifen only)

33
Q

Management of symptomatic urethral caruncle (as opposed to observation)

A

Topical estrogen cream for 2-3mo this

If no improvement- excision, careful reapproximation of urethra to avoid stenosis

34
Q

Endometrial stripe

A

4mm

35
Q

Normal puberty can begin as early as __yo in black and __yo in White girls.

A

6 and 7 years old (Avg age is 10 and 12.5yo)

36
Q

How to differentiate between central and peripheral precocious puberty.

A

GnRH stimulation… if LH/FSH rise, then likely central. If LH/FSH remain low, likely peripheral.

Central also tends to have accelerated timing but normal sequence of pubertal events

37
Q

Further diagnosis and management of precocious puberty:

A

Central- get head MRI to rule out mass.

Peripheral- ultrasound to rule out ovarian mass. 17-OHP to rule out CAH

38
Q

Management of labial agglutination:

A

Typically spontaneously resolves with endogenous estrogen at 5-6yo; treatment reserved for symptomatic patients with voiding problems.

Topical Estrogen cream applied twice daily to area of adhesion. Avoiding irritants. Avg of 2-4 month treatment. Success 80-100%, then bland ointment.

Potential adverse effects are thelarche, vaginal bleeding

39
Q

Normal spermanalysis values

A 
Concentration of 15 million 
At least 39 million spermatozoa 
32% progressive motility 
40% total motility 
4% normal morphology 
58% vitality 
1.5 mL

This is the 5th percentile, below these values is abnormal

40
Q

Next step after patient has immunohistochemistry staining of endometrial cancer specimen absent for MLH1

A

Test for MLH1 methylation. 20-30% of absence of MLH1 will be due to methylation. If methylation present, not Lynch, no further testing.

If methylation absent- further germline testing for protein absence

41
Q

Typical antiemetic which can used to increase breast milk supply:

A

Metoclopramide- dopamine antagonist

Effect Will typically last 7-14days

42
Q

For single dose MTX protocol, what should the minimum fall in BHCG between day 4-7

A

15%

43
Q

Treatment with lowest risk of recurrence for C diff

A

Fidaxomicin

Other tx include metronidazole and vancomycin

44
Q

Best mood stabilizer to initiate for bipolar disease after prep ganan y in a mom who intends to breastfeed

A

Valorous acid - safe in breastfeeding

Lithium L4 (breastfeeding category), lamotrigine L3, Quetiapine L4

45
Q

Primary amenorrhea definition

A

Absence of menses by age 15, no menarche within 3 years of thelarche, no thelarche by age 13

46
Q

Causes of primary amenorrhea:

A

Without breast development, high FSH: turners, swyer’s (types of gonadal dysgenesis)

Without breast development, low FSH: constitutional delay, prolactinoma, Kallman, CNS depression with anorexia/weight loss, CAH, PCOS

Breast development: outflow obstruction, mullerian agenesis or MRKH, androgen insensitivity syndrome

47
Q

When to recommend bariatric surgery

A

BMI 40+ or 35 with obesity related comorbidities

48
Q

Management of G1P0 with negative HBsAg and anti-HBsAg…

A

Give HBV vaccine in pregnancy or give booster

49
Q

MOA and main sfx of spironolactone?

A

Aldosterone antagonist, competitive inhibition of androgen receptors and inhibition of 5a-reductase

Menstrual irregularities, hyperkalemia, diuresed, postural hypotension, teratogenic feminization of male fetus

50
Q

When do we stop screening for breast cancer according to ACOG?

A

We don’t, if the patient is predicted to live more than 10 yrs and the risks of detecting non-life threatening disease are discussed, annual mammography is recommended

51
Q

How effective is medical management of early pregnancy loss?

A

About 85%

52
Q

Management of vulvodynia ina patient taking OCPs

A

COCs May be an exacerbating cause of vulvodynia, trial of stopping COCs is warranted for 3-6months. Needs other contraceptive

53
Q

If a patient received Tdap vaccine at 12 weeks of pregnancy after she stepped on a rusty nail, does it need to be repeated in her pregnancy?

A

No, normally given at 27-36 weeks, no need to repeat.

DTap has considerably higher antigen concentration- normally given to infants and children <7yo. Local reaction risk in adults

54
Q

When to treat suspected bacterial sinusitis?

A

Severe sx of fever, nasal discharge and sinus pain lasting for >10 days

55
Q

Primary ovarian insufficiency is cessation of menses prior age —- yo and evidence of hypergonadotropism. It accounts for —-% of secondary amenorrhea.

The most common genetic etiologies are: and

A

40 years old
2-10%

Tuner’s and Fragile X permutation (other abnormalities include Swyers syndrome and trisomy x)

56
Q

When to stop cervical cancer screening

A

65yo+ with negative testing for ten years prior with the last being performed within 5 years.

OR after total hysterectomy if they have never had CIN2+ within the past 20 years. (If they have had CIN2+ in past 20 years, continue screening for 20 yrs after first post-hyst screen is reasonable)

57
Q

Colon ca screening for lynch syndrome patients:

A

Colonoscopy q1-2 years starting at age 20-25 or 2-5 yrs prior to earliest cancer diagnosis in family

PROLOG (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions