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CREOG Intern Year > Practice Bulletins Grade A recommendations > Flashcards

Practice Bulletins Grade A recommendations Flashcards

1
Q

What is the recommended amount of folic acid for women of reproductive age?

A

400 micrograms

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2
Q

How long prior to pregnancy should women start folic acid supplementation?

A

1 month

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3
Q

How much folic acid should women at high risk for NTD take? When should they start?

A

4mg folic acid, started 12 weeks prior to planned pregnancy

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4
Q

What makes a woman high risk for pregnancy with NTD?

A
  1. prior child born with NTD
  2. They themselves have NTD
  3. Partner has a child with NTD
  4. Partner has a NTD
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5
Q

What is the most effective way to repair apical prolapse?

A

Sacrospinous and uterosacral ligament fixation are equally effective

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6
Q

Does the use of synthetic mesh or grafts in transvaginal repair of posterior vaginal wall prolpase improve outcomes?

A

No

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7
Q

Is polypropylene mesh agumentation of anterior vaginal wall prolapse improve outcomes compared to native tissue anterior repair?

A

Yes

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8
Q

Is morbidity lower or higher with polypropylene mesh compared to native tissue anterior repair?

A

higher

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9
Q

At what point is epidural no longer able to be used during TOLAC?

A

Epidural can always be offered to someone TOLAC-ing

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10
Q

Can you use misoprostol for inducing someone undergoing TOLAC?

A

NO! also not for someone who has had major abdominal surgery

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11
Q

Who are candidates for TOLAC?

A

One prior C/S with low transverse incision

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12
Q

What is a medical contraindication to methergine? What is the dosing?

A

Hypertension- IM 0.2mg q2-4 hours

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13
Q

What is a medical contraindication to hemabate? What is the dosing?

A

Asthma- 0.25mg q15-90mins for a maximum of 8 doses

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14
Q

What has a higher risk of ovarian cancer? BRCA1 or BRCA2?

A

BRCA 1

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15
Q

When should ppx bilateral salpingoophorectomy be recommended to those with BRCA1 or 2 mutations?

A

BRCA 1- age 35-40

BRCA 2- age 40-45

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16
Q

When should Rh neg, unsensitized women get Rhogam?

A

@ 28 weeks

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17
Q

Within what time frame should women be offered Rhogam is the baby is none to be Rh positive?

A

within 72 hours of delivery

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18
Q

What is considered first line treatment in women with GDM who fail diet control?

A

Insulin

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19
Q

When do you screen for GDM?

A

24-28 weeks

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20
Q

At what weight should women without GDM be offered a c/s?

A

5000g

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21
Q

At what weight should women with GDM be offered a c/s?

A

4500g

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22
Q

What is the most appropriate method to screen for fetal anemia?

A

measuring peak systolic velocity in the middle cerebral artery.

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23
Q

What additional testing should be performed for IUGR fetuses?

A

NST, BPP, and doppler velocimetry of the umbilical artery

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24
Q

What U/S characteristics are concerning for adnexal masses?

A

> 10cm, solid/papillary components, irregularity, ascites, and high color doppler flow

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25
Q

What is the recommended screening for cervical ca in women 21-29yo?

A

Cytology only- q3yrs

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26
Q

What is the recommeneded cervical ca screening in women 30-65yo?

A

Cotesting with cytology and HPV q5yrs -OR- cytology alone q3yrs

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27
Q

What constitutes adequate negative screening tests in order to discontinue screening at age 65?

A

No history of CIN2 or higher AND either 3 consecutive negative cytology results or 2 consecutive negative co-tests in the last 10 years, with the most recent screening being performed within the last 5 years

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28
Q

When do you restart screening in someone who had a total hysterectomy?

A

never- as long as they never had a h/o CIN2 or higher

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29
Q

How long after a diagnosis of CIN2 or higher do you need to continue screening for cervical cancer?

A

20 years after they’ve received the appropriate treatment

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30
Q

How do we screen HIV+ women for cervical ca who are <30yo?

A

<30yo, do annual cytology. If cytology is negative x3, then can screen every 3 years

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31
Q

Cervical ca screening for HIV+ women >30yo?

A

Can do cytology annually or co-testing. If cytology is neg x3, can screen q3yrs. If co-testing is negative x1, can screen q3yrs

32
Q

When does USPSTF recommend starting mammogram screening?

A

50yo and annually

33
Q

What is the risk-reduction therapy for atypical hyperplasia in premenopausal women?

A

Tamoxifen

34
Q

What is the risk-reduction therapy for atypical hyperplasia in postmenopausal women?

A

Raloxifene or Aromatase inhibitors

35
Q

What is mastalgia and what is the treatment?

A

Breast pain that is sometimes indicative of cancer. Treatment for benign mastalgia is danazol or tamoxifen

36
Q

What is the next step in evaluation after diagnosis of lobular carcinoma in situ (LCIS)?

A

Surgical excision. Consider risk reduction therapy, same as atypical hyperplasia (tamoxifen=premenopausal, raloxifene/aromatase inhibitors=postmenopausal)

37
Q

What works better after one year for urinary stress incontinence? Midurethral sling or pelvic floor therapy?

A

Midurethral sling

38
Q

Voiding dysfunction is more common after open colposuspension or synthetic midurethral slings?

A

open colposuspension

39
Q

Which has fewer adverse events? Synthetic midurethral slings or suburethral fascial slings?

A

synthetic midurethral slings

40
Q

How can you decrease the incidence of postop stress incontinence during surgery for POP?

A

During abdominal sacrocolpopexy perform a burch colposuspension and during vaginal surgery for POP perform retropubic midurethral sling

41
Q

What behavioral change has been proven to improve urinary incontinence?

A

weight loss

42
Q

What is the most efficacious emergency contraception?

A

Copper IUD

43
Q

What is more effective, Ella (Ulipristal acetate) or Plan B (levonorgestol only)?

A

Ella! (Hellooo)

44
Q

For what thrombophilia has ASA been proven to actually decrease the risk of early pregnancy loss?

A

Antiphospholipid syndrome ONLY

45
Q

Define early pregnancy loss?

A

non-viable pregnancy in the first trimester

46
Q

What is the dosing of rhogam to be given?

A

50mcg. If not available, can give the standard 300mcg to unsensitized women

47
Q

How should you evaluate someone for lynch syndrome in someone who is personally affected by either endometrial or colorectal cancer?

A

perform tumor testing on collected endometrial or colorectal tumors

48
Q

How often should EMBx be performed in those diagnosed with lynch?

A

q1-2 years starting at age 30-35 yo

49
Q

When should colonoscopy screening start in those diagnosed with lynch?

A

c-scope every 1-2 years starting at 20-25yo or 2-3 years prior to the earliest diagnosed colon cancer in the family

50
Q

What is the most effective treatment for vasomotor sxs in menopause?

A

estrogen and progestins hormone therapy

51
Q

What are the risks of combined hormone therapy in the treatment of menopausal sxs?

A

thromboembolic disease and breast cancer

52
Q

What are alternatives to HT in menopausal vasomotor sxs?

A

SSRIs, SNRIs, clonidine and gabapentin

53
Q

What is the only FDA approved non-hormonal therapy for vasomotor sxs?

A

paroxetine

54
Q

What drug did the FDA approve for the treatment of mod-severe dyspaeurunia in postmenopausal patients?

A

ospemifene- an SERM

55
Q

What is the next step if cervical cytology comes back ASC-US?

A

reflex HPV testing is preferred

56
Q

If ASC-US and HPV+, what is the next step?

A

Colposcopy

57
Q

What is the next step if LSIL on cytology, and either HPV+ /-?

A

Colposcopy

58
Q

What is the next step if colpo is CIN2 or greater?

A

Excisional procedure

59
Q

What is the most effective regimen for medical abortion in the 2nd trimester?

A

miffy 200mg followed by miso 800mcg in the next 24-48 hours

60
Q

What are FDA approved treatments for osteoporosis?

A

raloxifene, bisphosphonates, calcitonin, PTH, denosumab

61
Q

When do you start medical treatment for osteoporosis?

A

T-score less than -2.5
Women with low-impact fracture
T-score from -1 to -2.5 with a frax score of 3% for hip fx or >20% for other major osteoporotic fx

62
Q

At what age do you start screening for osteoporosis with DEXA?

A

65yo. Can be performed earlier if they are postmenopausal and have risk factors. Screen no more than q2yrs

63
Q

What are the daily recommended dose of calcium and vitamin D?

A

1200mg calcium

600U vitamin D

64
Q

What is the treatment for female sexual desire disorder?

A

testosterone patch

65
Q

What is the imaging modality used for suspected endometriosis?

A

TVUS

66
Q

Should an endometrioma be excised or drained?

A

Excised

67
Q

Should you use OCPs to treat existing functional cysts?

A

NO

68
Q

What is the first line treatment for ovulation induction in PCOS?

A

clomiphene citrate

69
Q

Is ppx abx indicated for elective abortion?

A

Yes

70
Q

Is ppx abx indicated for diagnostic laparoscopy/operative/tubal?

A

No

71
Q

Is ppx abx indicated for hysterectomy?

A

Yes

72
Q

How does preop treatment of fibroids with GnRH agonists affect the upcoming surgery?

A

decreased blood loss, decrease length of hospital stay, decrease length of surgery time

73
Q

What is the treatment for lichen sclerosis?

A

Topical corticosteroids, like clobetasol propionate

74
Q

How many days of abx treatment are indicated for pyelonephritis, IP and OP?

A

14 days

75
Q

How many days do you treat uncomplicated cystitis in nonpregnant patients?

A

3 days

CREOG Intern Year (1 decks)

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