Practice Bulletins Grade A recommendations Flashcards by Jessa Suhner

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

400 micrograms

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

1 month

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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

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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

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What is the most effective way to repair apical prolapse?

Sacrospinous and uterosacral ligament fixation are equally effective

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

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

Yes

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

higher

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

Epidural can always be offered to someone TOLAC-ing

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Can you use misoprostol for inducing someone undergoing TOLAC?

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

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Who are candidates for TOLAC?

One prior C/S with low transverse incision

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

Hypertension- IM 0.2mg q2-4 hours

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

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

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

BRCA 1

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

BRCA 1- age 35-40

BRCA 2- age 40-45

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When should Rh neg, unsensitized women get Rhogam?

@ 28 weeks

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

within 72 hours of delivery

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

Insulin

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When do you screen for GDM?

24-28 weeks

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

5000g

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

4500g

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

measuring peak systolic velocity in the middle cerebral artery.

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What additional testing should be performed for IUGR fetuses?

NST, BPP, and doppler velocimetry of the umbilical artery

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What U/S characteristics are concerning for adnexal masses?

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

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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?

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?

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