Primary Care

Question 1

primary dysmenorrhea w/up after OCP and NSAID failure

Answer 1

requires dx L/S (cannot empirically tx for endo like adults)

Question 2

contraception and HTN

Answer 2

even well controlled hypertension is a contraindication to estrogen containing methds (including patch, ring).

Question 3

NNT formula

Answer 3

ARR = control - tx
NNT = 1/ARR

Question 4

HSV suppressive tx w/ discordant partner

Answer 4

daily suppressive tx reduces recurrenc by 80%. also reduces transmission to uninfected partner by 50% (3.6 to 1.9%). there is no role for treating the nonaffect partner.

Question 5

what is the most common congenital anomaly of the female reproductive tract? how is it managed? what is the most common obstructive anomaly? how is it managed?

Answer 5

incomplete perforation of the hymen. can be excised in the office w/ local anesthetic. imperforate hymen is the most common obstructive cause and needs to be treated in the OR.

Question 6

To be an eligble professional through the medicaid EHR incentive program, the volumed covered by medicaid must be at least

Answer 6

30%

Question 7

what is the most common d/i in the IVF population compared w/ general obstetric population

Answer 7

congenital cardiac defects (1-3%)

Question 8

exposure to varicella w/o evidence of immunity?

Answer 8

vaccinate w/in 3-5 days as long as no contraindictions. 90% effective w/in 3 days. 70% effective w/in 5 days.

Question 9

threatened AB when plans to terminate?

Answer 9

pregnancy termination ( do not need to confirm viability first- do not expectantly manage)

Question 10

define osteoporosis, osteopenia. what is the recommended tx for each?

Answer 10

osteopenia -1 to -2.5. Osteoporosis -2.5 or less. Osteopenia- SERM. Osteoporosis- bisphosphonate.

Question 11

“most likely” fetal karyotype w/ cardiac malformation?

Answer 11

The risk of anuploidy w/ cardiac malformations are identified is about 30; however, most fetuses w/ ISOLATED cardiac malformations are euploid.

Question 12

when would you start breast cancer chemoprevention?

Answer 12

when a pt’s 5 yr breast ca risk is ≥ 1.67% or if her lifetime risk if ≥ 20%

Question 13

most common abnormality of the female urethra? how is it managed?

Answer 13

urethral caruncle. for asumptomatic pts no tx is needed, if sx (bleeding, pain) tx would be vaginal estrogen

Question 14

zika testing in pregnancy

Answer 14

PCR is diagnostic but needs to collected w/in 3-7 days of when symptoms arise. IgM Ab testing can be used after 4 days.

Question 15

most common cause of precocious puberty. how is this dx’d?

Answer 15

idiopathic central precocious puberty. however need to r/o primary cause (pituitary tumor etc). An LH over 5-8 after GnRH stim test would be diagnostic.

Question 16

what is the most important modifiable risk factor for stroke in women?

Answer 16

HTN

Question 17

describe the structure of HSV

Answer 17

ds DNA

Question 18

tx most likely to reduce vaginal atrophy sx in breast ca hx pt

Answer 18

vaginal estrogen (no increased recurrence)

Question 19

what is the leading cause of disability in women?

Answer 19

depression. 30% of women affected in their lifetime, 15% postpartum

Question 20

edinburgh PND score cutoff for abnormal, postpatum depression?

Answer 20

10 and 13 respectively

Question 21

cause of macrocytic anemia in elderly?

Answer 21

b12 deficiency. need to r/o folate deficiency before tx can mask cause.

Question 22

evaluation for PCOS must include what? best tx for PCOS and insulin resistance?

Answer 22

TSH, prolactin, AM 17OHP, non-classical CAH. other cv risk factors should be screen for- t2DM, CHTN. dyslipidemia, PSA, obesity
- best tx = diet, lifestyle modification

Question 23

what are the three labs for APS? Who should be screened?

Answer 23

lupus anticoagulant, anticardiolipin antibody, anti-b2 glycoprotein.
- venous/arterial thrombus OR 1+ 2nd TM loss morho normal fetus, 3+ 1st TM losses, HDP prior to 34 wk gestation

Question 24

best lifestyle modification to decrease blood pressure?

Answer 24

weight loss. one out of three adult deaths is relatable to elevated blood pressure!

Question 25

safe tx for HPV warts in pregnancy?

Answer 25

cryotherapy ahd TCA are both safe.

Question 26

DMPA and BMD

Answer 26

black box warning re DMPA and deceased BMD after 2 years, however, can continue if pt prefers this form of tx b/c the loss is reversible. There have been no well-desifned studies that demonstrate a higher fx risk.

Question 27

what percentage of endometrial adenocarcinoma cases are accompanied w/ bleeding? what percentage are not? what is the most common finding to explain PMB?

Answer 27

90% associated w/ bleeding, 1-12% are not. The MC cause is endometrial atrophy.