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2022 REI Written Boards > Surgery / Extra Q's > Flashcards

Surgery / Extra Q's Flashcards

1
Q

Mnemonic for potency of glucocorticoids

A

“Cold Hands Palpate My Dead Body” (least to most potent)

Cortisone -> hydrocortisone -> prednisone/prednisolone –> methylprednisolone –> dexamethasone –> betamethasone

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2
Q

Thyroid and adrenal disorders – what do you replete in what order

A

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

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3
Q

Differential of tall and primary amenorrhea

A

Complete AIS – no uterus

Complete 46, XY GD – (DAX dup) - uterus

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4
Q

Most common malignancy associated with IVF?

A
  • Borderline
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5
Q

Hypercarotenemia associated with what HPO axis anomaly?

A

Hypo hypo (anorexia)

Also hypothyroidism, diabetes

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6
Q

Causes of falsely elevated cortisol:

overall?

Late-night salivary test?

DST?

A

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)

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7
Q

Normal BMI and PCOS, best treatment?

Clomid, metformin, or both

A

Clomid

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8
Q

Career most likely to have heterophilic antibodies?

A

Vet tech

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9
Q

Kappa statistic

A

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.

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10
Q

What is Interceed made of?

How long to degrade?

intra-op contraindication?

A
  • oxidized regenerated cellulose sheet
  • 2 weeks
  • wet surface
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11
Q

What is Seprafilm made of?

How long to degrade?

A
  • sodium hyaluronate-based carboxymethylcellulose sheet
  • 7 days
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12
Q

Most common L/S complication

A

Bladder injury - 1/300

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13
Q

Hysteroscopy: Fluid deficits for electrolyte-rich?

A

750 mL: Plan completion of procedure

2500 mL: Stop procedure (or earlier in patients who are elderly or have comorbidities)

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14
Q

Hysteroscopy: Fluid deficits for electrolyte-poor?

A

(glycine, manitol, sorbitol)

750 mL: Plan completion of procedure OR Stop procedure in patients who are elderly or have comorbidities

1000 mL: Stop procedure

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15
Q

Most common UAE complication?

Chance of ovarian failure?

A

40% have fever/malaise in POD 10-14 (self-limited)

Ovarian failure in 2-3% under age 45

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16
Q

Hysteroscopy complications of:

Hykson?

Sorbitol 3% & Glycine 1.5%?

CO2?

A

Hykson - DIC/Bleeding diasthesis

Sorbitol 3% & Glycine 1.5% - Acute hyponatremic; Hypoosmolar → Cerebral edema

CO2 - emboli

17
Q

What % of ectopics are on the same side as the CL?

A

80-85%

18
Q

Management for interstitial ectopic pregnancy?

A

Multi-dose MTX first, unless unstable

19
Q

What influences the growth of fibroids? (11)

A
  1. E2 and P4 receptors
  2. Bcl-2 protein expression
  3. IGF-II (also EGF, IGF-1)
  4. ECM
  5. Wnt/β-catenin
  6. TGF-β
  7. growth factors
  8. epigenetic and epitranscriptomic regulation
  9. YAP/TAZ
  10. Rho/ROCK
  11. DNA damage repair pathways
20
Q

Expected reduction in size of fibroids with GnRHa?

A

40-50% in 3-6months

21
Q

What tumors produce:

hCG

A
  • Dysgerminoma (malignant germ cell tumor)
  • Choriocarcinoma
  • Embryonal carcinoomas
  • Trophoblastic disease
22
Q

What tumors produce:

LDH

A
  • Dysgerminoma (malignant germ cell tumor)
23
Q

What tumors produce:

CA-125

A

Epithelial ovarian cancer

24
Q

What tumors produce:

AFP

A
  • Dysgerminoma (malignant germ cell tumor)
  • Endodermal sinus tumor
  • Embryonal carcionmas
  • Immature teratomas
25
Q

What tumors produce:

Inhibin B

A

Granulosa cell tumor

26
Q

Arrhenoblastoma (Sertoli-Leydig cell tumor):

Mutation & symptoms

A
  • DICER1 gene
  • Elevated testosterone / masculinization
27
Q

Drugs that decrease OCP effectiveness:

How? (2)

Types of each

A

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
28
Q

Differences between PMDD and PMS (2)

A

PMDD diagnosis does NOT require somatic symptoms

PMDD CAN be diagnosed in the setting of another psychiatric condition, PMS can NOT

29
Q

Diagnosis of PMS requires…

A
  • 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
30
Q

Class of Ig found in cervical mucus

A

IgA

31
Q

Heterophile antibodies are associated with what?

A

False positive serum hCG

32
Q

Which vaccine should not be given to a woman trying to conceive?

A

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
33
Q

Fibroid risks (8)

A
  1. developmental exposure to EDCs
  2. age
  3. race
  4. obesity
  5. parity
  6. hypertension
  7. vitamin D deficiency
  8. diet (in late life)
34
Q

What mutation promotes fibroid formation?

what does it disrupt?

A

Pathogenic exon 2 mutations in MED12 promote uterine fibroids formation and disrupt CDK8/19 kinase activity.

2022 REI Written Boards (21 decks)

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