Surgery / Extra Q's Flashcards
Mnemonic for potency of glucocorticoids
“Cold Hands Palpate My Dead Body” (least to most potent)
Cortisone -> hydrocortisone -> prednisone/prednisolone –> methylprednisolone –> dexamethasone –> betamethasone
Thyroid and adrenal disorders – what do you replete in what order
Glucocorticoid then mineralcorticoid and last thyroid replacement
T4 should not be administered until adrenal function, including ACTH reserve, have been evaluated and either found to be normal or treated. In patients with coexisting hypothyroidism and hypoadrenalism, treatment of hypothyroidism alone may increase the clearance of the little cortisol produced, increasing the severity of the cortisol deficiency
Differential of tall and primary amenorrhea
Complete AIS – no uterus
Complete 46, XY GD – (DAX dup) - uterus
Most common malignancy associated with IVF?
- Borderline
Hypercarotenemia associated with what HPO axis anomaly?
Hypo hypo (anorexia)
Also hypothyroidism, diabetes
Causes of falsely elevated cortisol:
overall?
Late-night salivary test?
DST?
Obesity
Late night salivary cortisol test: licorice, chewing tobacco, smoking, shift workers, night owls
Dexa suppression test: OCPs (increase CBG and assay measures total cortisol), anticonvulsant medication (accelerates metabolism of dexamethasone)
Normal BMI and PCOS, best treatment?
Clomid, metformin, or both
Clomid
Career most likely to have heterophilic antibodies?
Vet tech
Kappa statistic
Measure of agreement between 2 observers (-1.0 to +1.0). Perfect agreement = 1.0 If agreement is what would be expected by chance alone then = 0. If degree of agreement less than what would be expected by chance then < 0.
What is Interceed made of?
How long to degrade?
intra-op contraindication?
- oxidized regenerated cellulose sheet
- 2 weeks
- wet surface
What is Seprafilm made of?
How long to degrade?
- sodium hyaluronate-based carboxymethylcellulose sheet
- 7 days
Most common L/S complication
Bladder injury - 1/300
Hysteroscopy: Fluid deficits for electrolyte-rich?
750 mL: Plan completion of procedure
2500 mL: Stop procedure (or earlier in patients who are elderly or have comorbidities)
Hysteroscopy: Fluid deficits for electrolyte-poor?
(glycine, manitol, sorbitol)
750 mL: Plan completion of procedure OR Stop procedure in patients who are elderly or have comorbidities
1000 mL: Stop procedure
Most common UAE complication?
Chance of ovarian failure?
40% have fever/malaise in POD 10-14 (self-limited)
Ovarian failure in 2-3% under age 45
Hysteroscopy complications of:
Hykson?
Sorbitol 3% & Glycine 1.5%?
CO2?
Hykson - DIC/Bleeding diasthesis
Sorbitol 3% & Glycine 1.5% - Acute hyponatremic; Hypoosmolar → Cerebral edema
CO2 - emboli
What % of ectopics are on the same side as the CL?
80-85%
Management for interstitial ectopic pregnancy?
Multi-dose MTX first, unless unstable
What influences the growth of fibroids? (11)
- E2 and P4 receptors
- Bcl-2 protein expression
- IGF-II (also EGF, IGF-1)
- ECM
- Wnt/β-catenin
- TGF-β
- growth factors
- epigenetic and epitranscriptomic regulation
- YAP/TAZ
- Rho/ROCK
- DNA damage repair pathways
Expected reduction in size of fibroids with GnRHa?
40-50% in 3-6months
What tumors produce:
hCG
- Dysgerminoma (malignant germ cell tumor)
- Choriocarcinoma
- Embryonal carcinoomas
- Trophoblastic disease
What tumors produce:
LDH
- Dysgerminoma (malignant germ cell tumor)
What tumors produce:
CA-125
Epithelial ovarian cancer
What tumors produce:
AFP
- Dysgerminoma (malignant germ cell tumor)
- Endodermal sinus tumor
- Embryonal carcionmas
- Immature teratomas
What tumors produce:
Inhibin B
Granulosa cell tumor
Arrhenoblastoma (Sertoli-Leydig cell tumor):
Mutation & symptoms
- DICER1 gene
- Elevated testosterone / masculinization
Drugs that decrease OCP effectiveness:
How? (2)
Types of each
Ones that increase cytochrome P450 function – breaks down estrogen
- Rifampin (treatment of TB; also stimulates a progestin binding protein making progestin unavailable)
- Barbituates (anti-seizure medications)
Ones that decrease conversion of ethinyl estradiol to free estrogen in the intestines
- Penicillins
- Cephalosporins
- Chloramphenicol
- Tetracycline
Differences between PMDD and PMS (2)
PMDD diagnosis does NOT require somatic symptoms
PMDD CAN be diagnosed in the setting of another psychiatric condition, PMS can NOT
Diagnosis of PMS requires…
- prospective symptom diary showing cyclic symptoms associated with the luteal and menstrual phases of the cycle and evidence of socioeconomic dysfunction
- 1 or more affective symptom AND 1 or more somatic symptom in the 5 days preceding menses in each of 3 menstrual cycles
- Relief from symptoms within 4 days after onset of menses and no recurrence before CD12
- Absence of any medications, hormone therapy, drug or alcohol use
- Socioeconomic dysfunction
Class of Ig found in cervical mucus
IgA
Heterophile antibodies are associated with what?
False positive serum hCG
Which vaccine should not be given to a woman trying to conceive?
Before pregnancy
- Influenza live virus (avoid conception for 4 weeks)
- MMR (avoid conception for 4 weeks)
- Varicella (avoid conception for 4 weeks)
During pregnancy
- HPV
- Influenza live virus
- MMR
- Varicella
Fibroid risks (8)
- developmental exposure to EDCs
- age
- race
- obesity
- parity
- hypertension
- vitamin D deficiency
- diet (in late life)
What mutation promotes fibroid formation?
what does it disrupt?
Pathogenic exon 2 mutations in MED12 promote uterine fibroids formation and disrupt CDK8/19 kinase activity.
