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family medicine EOR exam > repro > Flashcards

repro Flashcards

1
Q

treatment for DUB

A

oral contraceptives or progestin. may need D&C or hysteroscopy if cannot control it.

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2
Q

menorrhagia

A

intervals normal, duration and flow excessive

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3
Q

hypermenorrhea

A

cycles normal, excessive flow

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4
Q

metrorrhagia

A

interval irregular, duration and flow excessive

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5
Q

menometrorrhagia

A

interval irregular, duration and flow excessive and intermenstrual bleeding

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6
Q

oligomenorrhea

A

interval over 45 days with normal flow

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7
Q

polymenorrhea

A

interval less than 21 days, normal flow

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8
Q

hypomenorrhea

A

cycles regular, flow decreased

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9
Q

menopause symptoms

A

hot flashes, vaginal atrophy, insomnia, anxiety/irritability, poor concentration, mood changes, dyspareunia, loss of libido

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10
Q

premature menopause age

A

before 40

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11
Q

contraindications of HRT

A

vaginal bleeding, breast or endometrial cancer, hx of thromboembolism, liver disease, hypertriglyceridemia

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12
Q

options for menopause tx other than HRT

A

SSRIs, SNRIs, clonidine, gabapentin, topical estrogens

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13
Q

what causes dysmenorrhea?

A

uterine vasoconstriction, anoxia, sustained contractions mediated by an excess of prostaglandin

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14
Q

common causes of secondary dysmenorrhea

A

endometriosis, adenomyosis, fibroids, adhesions, polyps, PID

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15
Q

adenomyosis

A

endometrial tissue in the myometrium of the uterus

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16
Q

endometriosis

A

functional endometrial glands and stroma OUTside the uterus

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17
Q

triad of adenomyosis

A

noncyclical pain, menorrhagia, enlarged uterus

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18
Q

workup of abnormal uterine bleeding

A

b-hcg, CBC to look for anemia, pap smear to r/o cervical cancer, US to look for uterine masses, polycystic ovaries, thickened endometrium. platelets/pt/ptt for won villebrands, TFTs to r/o thyroid disorders and hyperprolactinemia.
endometrial biopsy in postmenopausal woman/obese/if endometrium is over 4mm thick

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19
Q

options of tx if medical management fails DUB

A

D&C, hysteroscopy/hysterectomy, endometrial ablation

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20
Q

redness, tenderness, induration in breast during nursing

A

breast abscess. most common organism is s. aureus. need to do an US if suspect abscess not just mastitis and excision if doesn’t go away with antibiotics

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21
Q

round or ovoid, rubbery, discrete, movable nontender mass in breast of young woman

A

fibroadenoma

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22
Q

you suspect fibroadenoma. next step?

A

fine needle biopsy. no tx necessary or may use cryoablation

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23
Q

painful, tender discomfort of breast. cyst-like structure that fluctuates in size and appearance or disappearance of mass and often cyclical

A

fibrocystic breast disease. most common in ages 30-50

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24
Q

you suspect fibrocystic breast disease. next step?

A

mammography…US if less than 30yo. suspicious lesions need to be biopsied

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25
Q

tx fibrocystic breast disease

A

not indicated although may aspirate if needed to alleviate pain and confirm cystic nature of mass

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26
Q

tx of mastitis

A

dicloxacillin 500mg poq6hrs for 10-14 days

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27
Q

risk factors for breast cancer

A

female, age, fhx, smoking, early menarche, late menopause, nulliparity, HRT, alcohol

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28
Q

mammogram recommendations

A

all patients 30 and older, annually definitely if any risk factors

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29
Q

most common breast CA

A

ductal carcinoma

30
Q

risk factors for PID

A

young, nulliparous, sexually active women with multiple partners. nonwhite, douching, smoking

31
Q

protection factors for PID

A

barrier or oral contraceptives

32
Q

lower abdominal pain, chillis and fever, menstrual disturbances, purulent cervical discharge, positive chandelier sign

A

PID

33
Q

you suspect PID. next step?

A

r/o ectopic pregnancy

34
Q

tx PID

A

ceftriaxone 250 IM plus doxy 100mg BIDx10 plus metronidazole 500mg BID x 14d

35
Q

hyphae and spores on KOH prep

A

candidiasis

36
Q

tx candidiasis

A

diflucan 150mg po 1-3 days

37
Q

motile organisms on wet prep

A

trichomonas

38
Q

strawberry cervix

A

trichomonas

39
Q

tx trichomonis

A

metronidazole 2g po 1 dose

40
Q

clue cells

A

BV

41
Q

tx BV

A

metronidazole 500mg po BID x 7days

42
Q

contraindications to OCP

A

MI, thromboembolic disease, cerebrovascular disease (smoking, HTN, over 35) carcinoma, HA, lactation–before 6 weeks postpartum

43
Q

who is the progestin minipill good for?

A

smokers who are over 35 or clotting disorders, safe during lactation

44
Q

other options for contraception similar to OCP

A

depo shot, implanon, patch, ring

45
Q

contraindications for IUD

A

pregnancy, PID

46
Q

IUD options

A

mirena (contains hormones, good for 5 years, reduces cramping and menstrual flow)
copper (good for 7 years)

47
Q

plan B

A

effective for up to 120 hours after intercourse.

48
Q

cystocele

A

hernia of bladder wall into vagina, causing soft, anterior fullness and may be accompanied by urethrocele or sagging of urethra

49
Q

rectocele

A

herniation of terminal rectum into posterior vagina due to vaginal childbirth, genetics, age, prior pelvic surgery

50
Q

stages of rectocele

A

1–halfway to hymen
2–to hymen
3–halfway past hymen
4–maximum descent

51
Q

clinical findings in cystocele or rectocele

A

sensation of bulge or protrusion in vagina, urinary or fecal incontinence, sense of incomplete emptying, dyspareunia

52
Q

bleeding or cramping occurs, but pregnancy continues, cervix not dilated

A

threatened abortion

53
Q

cervix dilated, membranes may be ruptured, but passage of products of conception has not yet occured. bleeding and cramping persist

A

inevitable abortion

54
Q

products of conception completely expelled, os is closed

A

complete abortion

55
Q

cervix dilated, some of products remain in uterus, mild cramps and bleeding persists

A

incomplete abortion

56
Q

pregnancy ceased to develop, conceptus not yet expelled but sxs of pregnancy disappear. brownish discharge but not free bleeding

A

missed abortion

57
Q

tx of missed abortion

A

cervical dilation follwed by aspiration

58
Q

tx threatened abortion

A

bed rest, resumption of usual activities and abstinence

59
Q

tx incomplete or inevitable abortion

A

removal of products remaining

60
Q

workup of ectopic pregnancy

A

serial b-hcg, transvaginal US. laparoscopy surgical procefure of choice to confirm ectopic and permit removal or it

61
Q

tx of ectopic

A

methotrexate IM if <3.5 cm and no active bleeding or fetal heart tones

62
Q

CI to MTX treatment of ectopic

A

unstable patient

63
Q

where does cervical cancer most likely take place?

A

transformation zone

64
Q

HPV strains causing cervical cancer

A

16 and 18

65
Q

gardasil protects against what strains of HPV?

A

6, 11, 16, 18

66
Q

symptoms of cervical cancer

A

metorrhagia, postcoital spotting, cervical ulceration, discharge

67
Q

screening recommendations for cervical cancer

A

start at age 21. pap smear with cytology once every 2 years, then if 30 and had 3 negatives can move to every 3 years, DQ at 70 if never had 3 normals in a row

68
Q

ASCUS. net step?

A

HPV testing. if positive, colposcopy. if negative, repeat in 12 months

69
Q

LSIL. now what?

A

colposcopy.

70
Q

LSIL and negative colposcopy,

A

repeat at 6 and 12 months

71
Q

tx CIN 1

A

pap smear at 6 and 12 months.

72
Q

tx CIN 2 or 3

A

cryotherapy or laser ablation or LEEP or conization or hysterectomy

family medicine EOR exam (14 decks)

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