Prolog Flashcards
An elevated anti-Yo antibody level usually points to?
Paraneoplastic syndrome, most likely of breast or ovarian origin
Preferred initial therapy for VTE (except in the case of renal insuff)
LMWH
Stains for CK7, CA 125, PAX8, and WT1 are positive for ?
Serous ovarian tumors
Stains for CK20, CEA, and CDX2 are positive for?
GI tumors
Obese women who undergo bariatric surgery should use reliable contraception to avoid pregnancy for at least
12 months!
Osteopenia is defined as a T-score between??
-2.5 and -1.0
1st line medical therapy recommended for adolescents with depression?
Fluoxetine
PEP for HIV is ineffective thus not recommended if it has been more than how long since exposure?
72hrs
Use of hormonal contraceptives/HT is not recommended for pts w HIV on what antiretroviral bc they have been shown to decrease antiretroviral levels?
Fosamprenavir
Most sensitive test to detect local recurrence after hysterectomy for endometrial Ca. Is?
Physical exam
Recommended Tx of hyperthyroidism in 1st trimester?
PTU
Recommended Tx of hyperthyroidism in 2nd&3rd trimester?
Methimazole
Why is it recommend to switch from one thioamide anti thyroid agent to another after 1st trimester?
To balance the rare risks of hepatotoxicity ( assoc w PTU) and embryopathy (methimazole assoc aplasia cutis & esophageal/choanal atresia, so switch to this in 2nd trimester)
Cesarean delivery should be offered/ considered when the EFW is ??
> 5000g in a nondiabetic & >4500g in a diabetic woman
MC malformation assoc w an increased NT & normal karyotype?
Cardiac defects (Septal defects are the MC)
Best initial Tx for gDM?
Lifestyle and dietary changes
All OBGYNs should be vaccinated aged against Hep B therefore are at greatest risk of infection by needlestick from a pt infected with what?
Hep C (risk is 1.8% compared with 0.3% for HIV)
The only approved therapy for PrEP is?
Combo of emtricitabine and tenofovir
If placenta previa is dxed in 2nd trimester, repeat US is recc when?
Follow up from there?
32wks; if placental edge is >2cm from internal os-> routine antenatal care,
if <2cm from os or still a previa-> repeat US @36wks
Best option to reduce vasomotor Sxs in a pt on Tamoxifen for breast Ca ? Which med should be avoided?
Venlafaxine ;
Not paroxetine since it may decrease the cnvsn of tamoxifen to its active metabolite
(V and T go together not P)
Tx is recommended for osteoporosis for pts with a T-score of ___ ? Or for women w a FRAX score w a 10-yr risk of what??
-2.5 or less ;
3% or greater for a hip fracture or a risk of 20% or greater for a major osteoporotic fracture
This galactagogue is a dopamine antagonist used to promote stomach emptying & GI motility, & has been shown to increase breast milk supply ?
Black box warning for?
Metoclopramide;
Tardive dyskinesia
Studies have shown an association btwn periodontal disease and what pregnancy complication?
Preterm birth
Preventing a disease process before it occurs through prevention of exposures that may cause the disease (ex is vaccination)
Primary prevention
Decreases the effect of a disease or injury that has already occurred, mainly by early detection & prompt Tx to hat or slow progression (ie cervical ca screening & mammography)
Secondary prevention
The thrombophilia test most influenced by pregnancy?
Protein S activity level
ie testing for Protein S deficiency is NOT reliable in preg
The component of the umbilical cord blood that is most consistent with a neurologic injury that is a result of an acute intrapartum event?
Base deficit
Most likely congenital infection w the US finding- echogenic bowl/intraabdominal calcifications & symmetric fetal growth restriction?
CMV
Most likely congenital infection w the US finding- placentomegaly?
Syphilis
Microcephaly primarily associated with what 3 congenital infections?
Toxo and Zika and varicella
Most likely congenital infection w the US finding- ascites?
Parvovirus B19
Most likely abnormal fetal karyotype w the US findings- cerebral ventriculomegaly & echogenic bowl
47, XX, +21 (trisomy 21)
Holoprosencephaly is assoc w fetal aneuploidy in ~40% of cases, of aneuploid fetuses w this finding, 75% are a result of ?
Trisomy 13
Most likely abnormal fetal karyotype w the US findings- overlapping fingers or clenched hands, cardiac & CNS anomalies, CPCs?
Trisomy 18
Urticarial papules and plaques that begin on abdomen esp around umbilicus
Pemphigoid gestationis
Urticarial papules and plaques that begin on abdomen with sparing of the umbilical region
Polymorphic Eruption of Pregnancy
APGAR score for HR?
2 pts if HR >100bpm
1 pt if <100bpm
0 if absent
Thickened NT (>3mm), elevated b-hCG (>2 MoM), & low PAPP-A (<0.5 MoM)
Down syndrome
Lithium exposure assoc w increased risk of what cardiac malformation?
Ebstein’s anomaly (tricuspid valve is displaced into the RV)
Risk of fetal malformation from exposure to this drug is as high as 20 -25%, with defects including craniofacial ie microtia, hydrocephalus, CV, neurologic, Thymic, and neurocognitive impairment in 30-60%
Isoretinoin for acne
Best test to screen for glucose intolerance/ DM in a pt with PCOS?
75-g 2-hr oral GTT
Pts who sustain spinal cord lesions above what spinal column level are at risk of autonomic hyperreflexia?
Above T6
For a pt having surgical repair of a symptomatic urethral diverticula, who also has known SUI, best concomitant anti-incontinence surgery is? Why?
Autologous fascial sling; would serve as an additional tissue layer btwn the repaired urethra and vaginal epithelium, decreasing risk of fistula formation
For a pt having surgical repair of a symptomatic urethral diverticula, who also has known SUI, need to avoid what kind of anti-incontinence surgery? Why?
Avoid synthetic midurethral sling And periurethral bulking agents; Placement of foreign body materials should be avoided in pts w urethral diverticula bc they could increase risk of fistula formation
What size rectovaginal fistulas have up to a 40% chance of spontaneous closure so a period of expectant management is advised?
Less than 4 mm
Fistulas >5mm in size however rarely close without surgical intervention
The characteristic of pelvic mesh that results in the lowest rate of mesh extrusion is ?
Monofilament
Type 1 mesh is best it’s monofilament and macroporous
Most likely complication after vaginal placement of synthetic mesh is?
Mesh exposure
Nitrofurantoin carries what rare but real risk in older adults?
Chronic interstitial lung disease
therefore would not be ideal in a patient with COPD
What used to be recommended for evaluation of painful bladder syndrome but is no longer recommended unless there exists a concern for calculi, bladder foreign body, carcinoma, or bladder diverticulum ?
Office cystoscopy ( potassium sensitivity test also used to be but is no longer recommended)
1st line Tx of vaginal mesh erosion?
Estrogen
When a postop vesicovaginal fistula occurs, what evaluation must be done? Via?
Must confirm there is no ureteral injury which can occur in up to 12% of iatrogenic vesicovaginal fistulas, options for upper tract imaging inc CT urography or bilateral retrograde pyelography
MC complication assoc w retropubic midurethral sling procedure is?
Postop UTI (~30% of cases, vs bladder perforation ~5% of the time)
Will POP-Q point C be + or - in a pt with stage III prolapse?
+ (= cm below/distal to hymen; negative number is cm above/proximal to hymen)
What type of cysts are commonly found along the posterior or lateral vagina cephalad to the hymen, many of which are asymptomatic?
Gartner duct cysts
Which is the embryonic remnant of the mesonephric duct
Biggest RF for developing GTN?
Complete molar pregnancy in the antecedent pregnancy (which tend to have higher bhCG levels ie greater than 100,000)
Stains strongly + for placental alkaline phosphatase and p63
Epitheliod trophoblastic tumors
Stain strongly for Mel-CAM and human placental lactogen
Placental site trophoblastic tumors
For Tx of low-grade serous ovarian Ca, presence of BRAF mutation Correlates to response to what kind of targeted therapy?
MEK inhibitors
Ovarian cancer in patients with the BRCA mutations are particularly sensitive to??
PARP inhibitors
This easy and inexpensive test can be performed in the office and can confirm the presence of a bladder injury immediately
Blue dye test = tampon test
Tenderness’s erythema, or edema beyond the apparent confines of infection accompanied by systemic features of infection concerning for??
Necrotizing soft tissue infection
NCCN guidelines recommend sentinel LN biopsies for vulvar Ca. When ??
The tumors are less than 4cm in diameter
NCCN guidelines recommend full inguinofemoral lymphadenectomy for vulvar Ca. When ??
Tumors of 4cm or greater in diameter and when there is palpable lymphadenopathy
When is ipsilateral LN evaluation sufficient for vulvar cancer?
For well lateralized vulvar tumors ie >1-2cm from the midline
Which dopamine agonist is 1st line for the Tx of hyperprolactinemia 2/2 microadenoma in a pt wanting to get pregnant ?
Cabergoline
Which dopamine agonist is preferred to manage pts that require them in pregnancy?
Bromocriptine
Needs to be cont in preg of tumor abuts the optic chiasm
This drug has the strongest evidence of benefit in patients with advanced cancer with a nausea and vomiting without identifiable cause
It should be avoided if what is suspected?
Metoclopramide;
Malignant bowel obstruction
Pts with a BMI of 30-34.9 are candidates for bariatric surgery if they have one of what 2 conditions?
Diabetes or metabolic syndrome
Best test to predict patients clinical response to pembrolizumab?
Test for PD-L1
Most appropriate anti-emetic comb for prevention in a patient with ovarian cancer scheduled to receive IV Carbo-taxel?
5-HT3 receptor antagonist (ie zofran), dexamethasone, and NK1 antagonist (ie aprepitant)
What level of emetic- risk are cisplatin and cyclophosphamide? Ie need how many antiemetics?
High-risk, need 4 (zofran, dexamethasone, aprepitant, and olanzapine
Fetus of obese women are adding increase risk of multiple malformations the highest attributable increased risk from obesity if for what structural malformation ?
Neural tube defects
