uWise Flashcards
Pt with poorly controlled HTN. what method of contraception is not recommended?
OCPs
best contraception to decrease risk of ovarian cancer?
OCPs
What does levonogestrel IUD protect against?
endometrial cancer
char. of septic abortion
fever + bleed + dilated cervix
char. of threatened abortion
bleed + pos preg test + closed/uneffaced cervix
tx for APLA syndrome when pt wants to become preg?
ASA + heparin
What is 17-OH progesterone used for?
prevention of preterm labor in pts with recurrent pregnancy loss
What complication is worse with medical abortion than surgical?
blood loss (worse with MEDICAL abortion(
mifepristone MOA
antiprogestin used for pregnancy termination
misoprostol MOA
prostaglandin
Up to what gestational age can manual vacuum aspiration be used?
less than 8 weeks
what is the least invasive treatment for a missed abortion?
expectant management with misoprostol (PG E1)
administered orally or vaginally to induce uterine cramping with expulsion of products of conception
likely dx and best management for heavy bleeding after medical abortion?
retained products of conception. perform D&C
Criteria for dx of BV
3 out of 4:
1) thin, gray, homogenous vaginal discharge
2) positive whiff test (KOH -> amine odor)
3) clue cells on saline microscopy
4) elevated vaginal pH > 4.5
what can occur with severe lichen sclerosis?
introital stenosis, resorption of clitoris (phimosis) and labia minora
inflammatory mucocutaneous eruptions characterized by remissions and flares involving hair-bearing skin/scalp, nails, oral mucous membranes & vulva
lichen planus
tx options for vestibulodynia
TCA, pelvic floor rehab, biofeedback, topical anesthetics; last resort: vestibulectomy
condition results from chronic scratching and rubbing of vulva
lichen simplex chronicus
tx: short course topical corticosteroids and antihistamines
parental abx options for GC?
cefotetan or cefoxitin
PLUS doxy or clinda
PLUS gentamicin
outpt abx options for GC?
ceftriaxone, cefoxitin, or other 3rd gen cephalosporin PLUS doxy WITH or WITHOUT flagyl
what is a normal PVR?
50-60cc
what PVR is seen w/ overflow incontinence
usually >300 cc
risk factors for development of pelvic organ prolapse?
increasing parity, increasing age, obesity, Ehlers-Danlos, chronic constipation, family history
best surgical treatment for genuine stress incontinence?
retropubic urethropexy (tension-free vaginal tape or other sling procedures)
what is colpocleisis used to treat?
uterine prolapse; can be performed without need for general anesthesia
what is the treatment for intrinsic sphincteric deficiency?
urethral bulking procedure
what condition is repaired by fixing defects in pubocervical fascia/reattaching to sidewall?
cystocele
pt has elevated serum prolactin level. next step?
FASTING prolactin; stimulation of breast during physical exam can give rise to elevated prolactin; if still elevated -> get TSH level and brain MRI
what activity can worsen the pain associated with fibrocystic breast changes/cyclic mastalgia?
caffeine intake
54 year old woman. mass with bloody discharge. next step?
excisional biopsy to rule out breast cancer
54 year old woman. mass with clear discharge on aspiration, mass resolves. next step?
reexamination in 2 months to check for cyst recurrence
pt with puerperal mastitis. still having pain with acetaminophen. started oral abx. what else to do?
add ibuprofen for add’l pain management
most appropriate abx for mastitis?
dicloxacillin (most is caused by S. aureus); use erythromycin in PCN allergic
42 year old woman with 2cm mass. FNA negative, mass persists. next step?
excisional biopsy
why is breast ultrasound useful?
distinguishes between cyst and a solid mass
what dx does uterosacral ligament nodularity suggest?
endometriosis
What are the treatment options for endometriosis?
- OCPS (first line. - along with NSAIDS. decreased estrogen production, decreased stim of endometrial tissue)
- GnRH agonists (short term use only; have side effects)
- danazol (synthetic androgen, but SE: wt gain, body hair/acne, adverse lipids)
- laparoscopy (if failed medical tx/planning pregnancy)
best tx of infertility of pt with known history of endometriosis and otherwise negative work up?
ovarian stimulation with clomiphene citrate
imaging study for chronic pelvic pain?
laparoscopy
what is interstitial cystitis?
chronic inflamm condition of bladder w/ recurrent urgency and frequency in absence of another cause; often have pelvic pain, may have dyspareunia
how does danazol work?
testosterone derivative; suppresses the mid-cycle surges of LH and FSH
what social factor is chronic pelvic pain often associated with?
physical/sexual abuse
what is pelvic congestion syndrome?
pelvic veins -> chronic dilation with stasis -> vascular congestion
“pelvic fullness/heaviness”
What nerves are at risk with a low transverse incision?
iliohypogastric (T12L1)
ilioinguinal (T12, L1)
next step after diagnosis of cervical dysplasia?
LEEP or cold knife cone
50 year old with onset of heavy periods. next step?
endometrial bx; ddx = endometritis, endometrial polyp, endometrial hyperplasia, fibroid, cancer
complications from LEEP?
infxn, bleed, CERVICAL STENOSIS, persistent disease, risk preterm delivery
CIN 1 diagnosed. benign cells on ECC. next step?
no tx; f/u pap in 1 year
What are the indications for cold knife conization?
positive endocervical curettage; HSIL lesion too large for LEEP, pt not tolerant of exam in office; lesion extending into endocervical canal beyond vision; rule out invasive cancer
best initial step for work up of incidental adnexal mass finding?
pelvic ultrasound
