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Step 2 DIT > Treatments 6 > Flashcards

Treatments 6 Flashcards

1
Q

Central precocious puberty

A

Continuous GnRH

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2
Q

Pseudoprecocious puberty

A

Remove tumor, cortisol replacement for CAH

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3
Q

Pros of HRT for menopause

A

Control symptoms
Reduced risk of osteoporosis
Reduced risk of colorectal cancer
May decrease coronary calcification if taken age 50-59 (unknown correlation w/ cardiac disease)

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4
Q

Cons of HRT for menopause

A

Increases risk of invasive breast cancer, endometrial cancer (NO estrogen w/o progesterone if woman still has uterus)
Increases risk of stroke, heart disease, hypercoagulability, biliary disease

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5
Q

Non-HRT options for hot flashes

A

Desvenlafaxine, venlafaxine
Clonidine
Gabapentin
Time

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6
Q

Menopause treatment

A

Vaginal lubricants (dyspareunia)
Calcium, vitamin D, bisphosphonates, weight bearing exercise (osteoporosis risk)
SERMs (tamoxifen, raloxifene) (osteoporosis risk)

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7
Q

Emergency contraception

A 
High dose OCPs (lots of AE)
Levonorgestrel (Plan B, just progesterone)
Copper IUD (insertion w/i 4-5 days of intercourse)
Mifepristone (RU 486) (low dose, high dose for abortion)
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8
Q

Pros of OCPs

A

Reliable
Reduce risk of endometrial and ovarian cancer
Decreased incidence of ectopic pregnancy
Menses lighter, more regular, less painful

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9
Q

C/I for OCPs

A

Pregnancy
History of DVT/PE/hypercoagulability disorder
History of estrogen-dependent tumor
History of stroke or CAD
Poorly controlled HTN
Smokers >35 yo
Hepatic disease or neoplasm
Abnormal vaginal bleeding of unknown etiology
Migraine w/ aura, neuro sx or vascular involvement

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10
Q

Amenorrhea, behavioral

A

Behavior modification (eating, exercise)

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11
Q

Amenorrhea, anatomic

A

Surgical correction

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12
Q

Amenorrhea, HPO dysfunction

A

Leuprolide (GnRH agonist), pulsatile

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13
Q

Amenorrhea, prolactinoma

A

Dopamine agonists (bromocriptine, cabergoline)

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14
Q

Dysmenorrhea

A

NSAIDs, OCPs

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15
Q

PMS, PMDD

A

NSAIDs, OCPs

Vitamin B6, SSRI +/- alprazolam, exercise, progestins

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16
Q

Endometriosis

A

OCPs, progestins, GnRH, NSAIDs, (danazol)
Laparoscopy
Definitive = hysterectomy + b/l salpingo-oopherectomy

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17
Q

Abnormal uterine bleeding

A

Treat cause
NSAIDs, OCPs
Endometrial ablation / hysterectomy

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18
Q

When to get endometrial biopsy w/ abnormal uterine bleeding

A

Patient >45
Patient w/ multiple risk factors for endometrial cancer
Patient w/ persistent AUB >6 months

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19
Q

PCOS

A 
Exercise, weight loss
OCPs (or at least progesterone by itself)
Spironolactone
Metformin
Consider statin, acne meds as needed
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20
Q

PCOS if patient wants to get pregnant

A

Clomiphene (antiestrogen, acts at hippocampus)

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21
Q

Pelvic prolapse

A

Mild - pelvic floor exercises
Moderate - pessary
Severe - surgery

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22
Q

Uterine fibroids (leiomyomas)

A

Asymptomatic - observation
GnRH agonists (temporary), OCP/IUD (for bleeding)
Myomectomy, hysterectomy, UAE

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23
Q

Endometrial cancer

A

TAH w/ bilateral salpingo-oopherectomy and LN sampling
Progestins to maintain fertility then surgery after finished
Add chemo/radiation for mets

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24
Q

Cervical cancer

A

Microscopic (<5 mm): TAH or conization
Visibly invasive: radical hysterectomy + lymphadenectomy
Major invasion/mets: radiation + chemo

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25
Q

SCC of the vagina

A

Radiation

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26
Q

Lichen sclerosis

A

Punch biopsy to r/o SCC

Steroids (clobetasol)

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27
Q

Benign ovarian tumors

A

Observation for functional cysts
Cysectomy or oopherectomy if malignant potential
TAH-BSO for postmenopausal

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28
Q

Ovarian cancer

A

Epithelial - TAH-BSO w/ pelvic wall sampling, abdominal omentum resection, LN resection w/ adjuvant chemo
Germ cell - oopherectomy +/- debulking w/ chemo

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29
Q

Fibrocystic changes

A

Observation

Caffeine and dietary fat reduction, OCPs

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30
Q

Breast abscess

A

I&D, antibiotics (dicloxacillin, cephalexin, amoxicillin-clavulanate, TMP-SMX for MRSA, metronidazole for anaerobes), continue breastfeeding

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31
Q

Phyllodes tumor

A

Excision (some malignant potential)

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32
Q

Fibroadenoma

A

May observe if asymptomatic

Surgical excision or US-guided cryotherapy

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33
Q

Intraductal papilloma

A

Surgical excision (rare malignant potential)

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34
Q

Physiologic anemia of pregnancy

A

Iron supplementation if Hct <10.5 (second trimester)

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35
Q

Increased nutritional demands of pregnancy

A

Folic acid, calcium, iron
Protein, fluids
Vitamin D, B12 for strict vegetarians

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36
Q

Vaccines indicated during pregnancy

A

Tetanus q10 years (esp P of TdaP) in 2nd/3rd trimester
Influenza (shot) annually
Only if indicated: pneumococcal, meningococcal, Hep A/B

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37
Q

Vaccines C/I during pregnancy

A

Live
MMR, varicella
Oral polio, intranasal influenaza

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38
Q

Postpartum or post-abortion vaccines

A

Rubella before discharge if non-immune
TDaP if none in last 10 years
Varicella before discharge if non-immune (2nd dose 4-8 weeks later)

39
Q

Gestational or pregestational diabetes

A

Diet and exercise

Insulin = DOC

40
Q

Preeclampsia

A

Delivery is only definitive cure
Monitor patient closely (out or inpatient)
Blood pressure control
MgSO4 until 24 hrs post delivery

41
Q

Eclampsia

A

Delivery is only definitive cure
Stabilize w/ O2 and blood pressure control
MgSO4 until 48 hrs post delivery
Try diazepam to control acute seizure

42
Q

BP medications in pregnancy

A 
HTN moms love nifedipine
Hydralazine
Methyldopa
Labetalol (BB)
Nifedipine
43
Q

Epilepsy in pregnancy

A

Keep on anticonvulsants w/ folate supplementation

Diazepam to break active seizures (Mg is useless)

44
Q

Asthma in pregnancy

A

Same as non-pregnant
Mild intermittent: short-acting B agonists (albuterol) PRN
Mild persistent: add low dose inhaled steroid
Moderate persistent: medium dose steroid or low dose steroid + long-acting B agonist (salmeterol)
Severe persistent: high dose inhaled steroid + long-acting B agonist

45
Q

Hyperemesis gravidarum

A

Hydration, avoid large meals
Vitamin B6 + ginger
OTC doxylamine
Prescription ondansetron or promethazine

46
Q

DVT in pregnancy

A

Heparin / LMWH until 6 weeks postpartum (stop during L&D)

Can switch to warfarin PP (safe during breastfeeding)

47
Q

UTI in pregnancy

A

Amoxicillin, nitrofurantoin, cephalexin x7 days

NO fluoros

48
Q

Toxoplasmosis in pregnancy

A

Pyrimethamine, sulfadiazine, folinic acid

avoid cat litter boxes, raw meat, unpasteurized milk, gardening

49
Q

Rubella in pregnancy

A

No treatment while pregnant

50
Q

Rubeola in pregnancy

A

Immune serum globulin during pregnancy

51
Q

Syphilis in pregnancy

A

Maternal or neonatal penicillin

52
Q

CMV in pregnancy

A

No treatment while pregnant

Ganciclovir may decrease effects in newborns

53
Q

HSV in pregnancy

A

Acyclovir starting wk 34-36
Deliver by c-section if active lesions
Acyclovir may be beneficial in newborns

54
Q

Hep B in pregnancy

A 
Maternal vaccination (can be during pregnancy)
Vaccination and Ig for neonate
55
Q

HIV in pregnancy

A

HAART during pregnancy (avoid certain drugs)
AZT during labor
Usually c-section
No breastfeeding

56
Q

Gonorrhea/chlamydia in pregnancy

A

Erythromycin for mom or baby (can be eye drops for neonate)

57
Q

VZV in pregnancy

A

Varicela Ig to nonimmune mother and neonate born during active infection

58
Q

GBS in pregnancy

A

IV B-lactams (penicillin/ampicillin) or clindamycin if:
+GBS screening at week 36
+GBS bacteruria during pregnancy
Previous infant with GBS infection
If no screening, intrapartum fever, preterm labor or prolonged rupture of membranes

59
Q

Parvovirus B19 in pregnancy

A

Monitor fetal hemoglobin

Possible transfusion by PUBS

60
Q

Ectopic pregnancy

A

MTX (<5,000 B-hCG, etc) or surgical excision

61
Q

Threatened abortion

A

Bed rest, limited activity

62
Q

Missed abortion

A

Expectant management (most pass w/i 2 weeks)
Misoprostol (PGE1)
D&C

63
Q

Inevitable abortion

A

Expectant management
Misoprostol (PGE1)
D&C

64
Q

Incomplete abortion

A

Misoprostol (PGE1)

D&C

65
Q

Complete abortion

A

None

66
Q

Intrauterine fetal demise

A

<24 weeks can undergo D&E

Induce labor and delivery (oxytocin, PGE1, 2)

67
Q

IUGR

A

Monitor
Nutrition/O2/bed rest for mom
Delivery if fetal growth slows further or maternal or fetal distress

68
Q

Oligohydramnios

A

Expectant management if no fetal distress
Delivery if fetal distress
Hydration +/- bed rest

69
Q

Polyhydramnios

A

Percutaneous drainage if mom very uncomfortable or threat of pre-term labor
32 weeks: amnioreduction alone

70
Q

PROM / PPROM

A

34 weeks: abx + delivery

71
Q

Preterm labor, tocolysis

A

MgSO4, terbutaline, indomethacin or nifedipine (48 hrs)

72
Q

Preterm labor, overall

A

Tocolysis + glucocorticoids <34 weeks

Ampicillin if delivery imminent

73
Q

Placenta previa

A

Bed rest, RhoGam, tocolysis + steroids

C-section usually (can try vaginal in low-lying)

74
Q

Placenta abruptio

A

Bed rest inpatient

Usu have quick delivery, if not perform c-section for hemodynamic instability

75
Q

Molar pregnancy

A

D&C

Follow B-hCG to zero and then 1 year after

76
Q

Choriocarcinoma

A

Hysterectomy
Chemo (MTX, etc) if metastatic
Follow B-hCG to zero and then 1 year after

77
Q

Early decels during labor

A

None (head compression)

78
Q

Variable decels during labor

A

Change mother position

79
Q

Late decels during labor

A

Possibly need prompt delivery

80
Q

Labor dystocia - assessment

A

3Ps
Power - contraction strength (>200 MVU/10 min), duration and frequency (every 2-3 min)
Passenger - baby size, lie (anterior occiput/looking down > posterior occiput/looking up)
Pelvis - shape and diameter

81
Q

Non-reassuring fetal heart tones during labor

A

Maternal O2, movement to LLD
Turn off oxytocin/cervidil (maybe terbutaline to stop)
Manage maternal hypotension
Vaginal exam for cord prolapse

82
Q

Breech presentation

A

Offer ECV at 37 weeks

C-section if unchanged

83
Q

Indications for c-section

A

Maternal: eclampsia, prior uterine surgery (inc c-section), cardiac disease, birth canal obstruction, maternal death, cervical cancer, active genital herpes
Fetal: acute fetal distress, malpresentation, cord prolapse, macrosomia
Both: failure to progress in labor, placenta previa or abruptio, cephalopelvic disproportion

84
Q

Postpartum bleeding

A

Uterine massage + oxytocin/pitocin

85
Q

Mastitis

A

Continue nursing
Rest, ibuprofen, antibiotics (dicloxacillin cephalexin, TMP-SMX for MRSA, metronidazole for anaerobes)
I&D for abscess

86
Q

Oral contraceptives for lactating women

A

Progesterone only

87
Q

Postpartum bleeding w/ HTN

A

Hemabate (if no asthma)

88
Q

Postpartum bleeding w/ asthma

A

Methergine (methylergonovine) (if no HTN)

89
Q

Postpartum bleeding, non medical options

A

Uterine or iliac artery ligation, arterial embolization, hysterectomy
D&C for retained placenta
Tamponade

90
Q

Postpartum endometritis

A

Gentamicin + clindamycin +/- ampicillin

91
Q

Infantile thrush

A

Nystatin oral suspension

92
Q

SIDS prevention

A 
Sleep on back
Sleep on firm surface
Avoid soft objects in bed
Avoid overheating
Use pacifier while sleeping
No smoking
93
Q

Work-up on newborn w/ single umbilical artery

A

Renal sonogram for abnormalities

94
Q

Car seat guidelines

A

<13 in back seat

Step 2 DIT (23 decks)

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