Practice Bulletins Grade A recommendations Flashcards
What is the recommended amount of folic acid for women of reproductive age?
400 micrograms
How long prior to pregnancy should women start folic acid supplementation?
1 month
How much folic acid should women at high risk for NTD take? When should they start?
4mg folic acid, started 12 weeks prior to planned pregnancy
What makes a woman high risk for pregnancy with NTD?
- prior child born with NTD
- They themselves have NTD
- Partner has a child with NTD
- Partner has a NTD
What is the most effective way to repair apical prolapse?
Sacrospinous and uterosacral ligament fixation are equally effective
Does the use of synthetic mesh or grafts in transvaginal repair of posterior vaginal wall prolpase improve outcomes?
No
Is polypropylene mesh agumentation of anterior vaginal wall prolapse improve outcomes compared to native tissue anterior repair?
Yes
Is morbidity lower or higher with polypropylene mesh compared to native tissue anterior repair?
higher
At what point is epidural no longer able to be used during TOLAC?
Epidural can always be offered to someone TOLAC-ing
Can you use misoprostol for inducing someone undergoing TOLAC?
NO! also not for someone who has had major abdominal surgery
Who are candidates for TOLAC?
One prior C/S with low transverse incision
What is a medical contraindication to methergine? What is the dosing?
Hypertension- IM 0.2mg q2-4 hours
What is a medical contraindication to hemabate? What is the dosing?
Asthma- 0.25mg q15-90mins for a maximum of 8 doses
What has a higher risk of ovarian cancer? BRCA1 or BRCA2?
BRCA 1
When should ppx bilateral salpingoophorectomy be recommended to those with BRCA1 or 2 mutations?
BRCA 1- age 35-40
BRCA 2- age 40-45
When should Rh neg, unsensitized women get Rhogam?
@ 28 weeks
Within what time frame should women be offered Rhogam is the baby is none to be Rh positive?
within 72 hours of delivery
What is considered first line treatment in women with GDM who fail diet control?
Insulin
When do you screen for GDM?
24-28 weeks
At what weight should women without GDM be offered a c/s?
5000g
At what weight should women with GDM be offered a c/s?
4500g
What is the most appropriate method to screen for fetal anemia?
measuring peak systolic velocity in the middle cerebral artery.
What additional testing should be performed for IUGR fetuses?
NST, BPP, and doppler velocimetry of the umbilical artery
What U/S characteristics are concerning for adnexal masses?
> 10cm, solid/papillary components, irregularity, ascites, and high color doppler flow
What is the recommended screening for cervical ca in women 21-29yo?
Cytology only- q3yrs
What is the recommeneded cervical ca screening in women 30-65yo?
Cotesting with cytology and HPV q5yrs -OR- cytology alone q3yrs
What constitutes adequate negative screening tests in order to discontinue screening at age 65?
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
When do you restart screening in someone who had a total hysterectomy?
never- as long as they never had a h/o CIN2 or higher
How long after a diagnosis of CIN2 or higher do you need to continue screening for cervical cancer?
20 years after they’ve received the appropriate treatment
How do we screen HIV+ women for cervical ca who are <30yo?
<30yo, do annual cytology. If cytology is negative x3, then can screen every 3 years
Cervical ca screening for HIV+ women >30yo?
Can do cytology annually or co-testing. If cytology is neg x3, can screen q3yrs. If co-testing is negative x1, can screen q3yrs
When does USPSTF recommend starting mammogram screening?
50yo and annually
What is the risk-reduction therapy for atypical hyperplasia in premenopausal women?
Tamoxifen
What is the risk-reduction therapy for atypical hyperplasia in postmenopausal women?
Raloxifene or Aromatase inhibitors
What is mastalgia and what is the treatment?
Breast pain that is sometimes indicative of cancer. Treatment for benign mastalgia is danazol or tamoxifen
What is the next step in evaluation after diagnosis of lobular carcinoma in situ (LCIS)?
Surgical excision. Consider risk reduction therapy, same as atypical hyperplasia (tamoxifen=premenopausal, raloxifene/aromatase inhibitors=postmenopausal)
What works better after one year for urinary stress incontinence? Midurethral sling or pelvic floor therapy?
Midurethral sling
Voiding dysfunction is more common after open colposuspension or synthetic midurethral slings?
open colposuspension
Which has fewer adverse events? Synthetic midurethral slings or suburethral fascial slings?
synthetic midurethral slings
How can you decrease the incidence of postop stress incontinence during surgery for POP?
During abdominal sacrocolpopexy perform a burch colposuspension and during vaginal surgery for POP perform retropubic midurethral sling
What behavioral change has been proven to improve urinary incontinence?
weight loss
What is the most efficacious emergency contraception?
Copper IUD
What is more effective, Ella (Ulipristal acetate) or Plan B (levonorgestol only)?
Ella! (Hellooo)
For what thrombophilia has ASA been proven to actually decrease the risk of early pregnancy loss?
Antiphospholipid syndrome ONLY
Define early pregnancy loss?
non-viable pregnancy in the first trimester
What is the dosing of rhogam to be given?
50mcg. If not available, can give the standard 300mcg to unsensitized women
How should you evaluate someone for lynch syndrome in someone who is personally affected by either endometrial or colorectal cancer?
perform tumor testing on collected endometrial or colorectal tumors
How often should EMBx be performed in those diagnosed with lynch?
q1-2 years starting at age 30-35 yo
When should colonoscopy screening start in those diagnosed with lynch?
c-scope every 1-2 years starting at 20-25yo or 2-3 years prior to the earliest diagnosed colon cancer in the family
What is the most effective treatment for vasomotor sxs in menopause?
estrogen and progestins hormone therapy
What are the risks of combined hormone therapy in the treatment of menopausal sxs?
thromboembolic disease and breast cancer
What are alternatives to HT in menopausal vasomotor sxs?
SSRIs, SNRIs, clonidine and gabapentin
What is the only FDA approved non-hormonal therapy for vasomotor sxs?
paroxetine
What drug did the FDA approve for the treatment of mod-severe dyspaeurunia in postmenopausal patients?
ospemifene- an SERM
What is the next step if cervical cytology comes back ASC-US?
reflex HPV testing is preferred
If ASC-US and HPV+, what is the next step?
Colposcopy
What is the next step if LSIL on cytology, and either HPV+ /-?
Colposcopy
What is the next step if colpo is CIN2 or greater?
Excisional procedure
What is the most effective regimen for medical abortion in the 2nd trimester?
miffy 200mg followed by miso 800mcg in the next 24-48 hours
What are FDA approved treatments for osteoporosis?
raloxifene, bisphosphonates, calcitonin, PTH, denosumab
When do you start medical treatment for osteoporosis?
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
At what age do you start screening for osteoporosis with DEXA?
65yo. Can be performed earlier if they are postmenopausal and have risk factors. Screen no more than q2yrs
What are the daily recommended dose of calcium and vitamin D?
1200mg calcium
600U vitamin D
What is the treatment for female sexual desire disorder?
testosterone patch
What is the imaging modality used for suspected endometriosis?
TVUS
Should an endometrioma be excised or drained?
Excised
Should you use OCPs to treat existing functional cysts?
NO
What is the first line treatment for ovulation induction in PCOS?
clomiphene citrate
Is ppx abx indicated for elective abortion?
Yes
Is ppx abx indicated for diagnostic laparoscopy/operative/tubal?
No
Is ppx abx indicated for hysterectomy?
Yes
How does preop treatment of fibroids with GnRH agonists affect the upcoming surgery?
decreased blood loss, decrease length of hospital stay, decrease length of surgery time
What is the treatment for lichen sclerosis?
Topical corticosteroids, like clobetasol propionate
How many days of abx treatment are indicated for pyelonephritis, IP and OP?
14 days
How many days do you treat uncomplicated cystitis in nonpregnant patients?
3 days