walls 2020 Flashcards

1
Q

desquamative inflammatory vaginitis (4 criteria)

A

Need all 4 criteria:

•Vaginal symptoms (at least one must be present) – vaginal discharge, dyspareunia, pruritus, burning, irritation.

●Vaginal inflammation (spotted ecchymotic rash, erythema, focal or linear erosion).

●Vaginal pH >4.5.

●Saline microscopy – Increased numbers of parabasal and inflammatory cells with a leukocyte to epithelial cell ratio greater than 1:1

●Exclusion of other infectious etiologies – BV, yeast, trich, CT/GC when indicated

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2
Q

BV increases your susceptibility to which diseases

A
  • pelvic inflammatory disease (PID)
  • postprocedural gynecologic infections,
  • sexually transmitted infections (STIs) such as HIV and herpes simplex virus type 2
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3
Q

what is the most common cause of hemolytic disease of the newborn

A

ABO incompatibility

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4
Q

what is flutamide’s MOA, indication and side effects

A

androgen-receptor agonist
(nonsteroidal antiandrogen) used for hirsutism

Most common side effect is dry skin, but its use has been associated with hepatitis in rare cases.

The risk of teratogenicity with this compound is significant, and contraception should be used

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5
Q

Finasteride MOA, indication and side effects

A

Finasteride inhibits both forms of the enzyme 5-α-reductase (type 1, predominantly found in the skin, and type 2, predominantly found in the prostate and reproductive tissues).

Used to treat hirsiuism in PCOS (Not FDA approved)

Finasteride is better tolerated than other antiandrogens, with minimal hepatic and renal toxicity; however, it has a well-documented risk of teratogenicity in male fetuses, and adequate contraception should be used

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6
Q

what are non-proliferative breast lesions and which is most common

A
simple cysts * most common
mild hyperplasia (usual type)
papillary apocrine change

relative risk of future breast cancer with these is 1.17

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7
Q

most common breast mass in adolescents and young women

A

fibroadenoma

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8
Q

what are the type of atypical hyperplasia of the breast and associated risk of cancer?

A

Atypical ductal hyperplasia and atypical lobular hyperplasia

Typically is an incidental finding on histologic evaluation of abnormal mammography findings or breast masses.

4x increased risk of subsequent invasive cancer in the affected breast and the contralateral breast

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9
Q

Lobular Carcinoma In Situ definition and associated risk

A

typically does not present as a mass or with specific breast imaging abnormalities. It usually is diagnosed as an incidental finding at the time of breast biopsy for another lesion. Unlike DCIS, LCIS usually is not considered a precursor lesion for breast cancer. Rather, it is a risk marker for future development of breast cancer in either breast.

10–20% risk of developing invasive ductal or invasive lobular cancer in the following 15 years (10x general population or 1% per year for life)

tx: increased surveillance can offer endocrine therapy. Does not require excision unless appears abnormal

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10
Q

Ductal carcinoma in situ (DCIS) definition and treatment

A

Ductal carcinoma in situ (DCIS) of the breast represents a group of neoplastic lesions confined to the breast ducts.

The goal of therapy for DCIS is to prevent the development of invasive breast cancer. Therapeutic approaches include surgery, radiation therapy (RT), and adjuvant endocrine therapy

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11
Q

The Pediatric Position Development Conference of the International Society of Clinical Densitometry definition of osteoporosis

A

defines osteoporosis in children as a Z -score less than –2 in addition to having secondary risk factors that reflect a short-term risk of bone mineral loss and fracture

work up if patient ammenorrhic for 6-12 months

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12
Q

primary placental estrogen

A

Estriol

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13
Q

treatement of lichen planus

A

initial treatment for lichen planus is a high-potency topical corticosteroid ointment

other treatments included topical calcineurin inhibitors, intravaginal steriods. dilators can be used to prevent scaring

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14
Q

swyers syndrome presentation and gene mutation

A

aka XY gonadal dysgenesis
normal hieght, typical female external genital appearance, intact müllerian structures, and streak gonads, no secondary sex characteristics, low testosterone, high FSH

46XY, SRY gene mutation

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15
Q

stage I twin twin transfusion syndrome

A

oligo in one twin, poly in other

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16
Q

stage II Twin-twin transfusion syndrome

A

Nonvisualization of fetal bladder in donor twin over 60 minutes of obs

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17
Q

Stage III Twin-twin transfusion syndrome

A

absent or revered umbilical artery diastolic flow

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18
Q

Stage IV Twin-twin transfusion syndrome

A

Fetal hydrops in one or both twins

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19
Q

Stage V Twin-twin transfusion syndrome

A

fetal demise of one or both twins

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20
Q

A Cephalohematoma is located between:

A

Skull and periosteum (since its sub-periosteum it will not cross suture lines)

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21
Q

sub-galeal hematoma

A

bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.

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22
Q

primary treatment of late onset CAH

A

Corticosteroids

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23
Q

what evaluation of a stillbirth should take place in the absences of identifiable risks factors

A

Evaluation of a stillbirth should include fetal autopsy; gross and histologic examination of the placenta, umbilical cord, and membranes; and genetic evaluation. APLS and KB stain

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24
Q

risk factors for macrosomia

A

constitutional factors, preexisting diabetes and GDM, maternal prepregnancy obesity, excessive gestational weight gain, abnormal fasting and postprandial glucose levels, dyslipidemia, a prior macrosomic newborn (weight more than 4,000 g), and postterm pregnancy

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25
Q

which artery could be injured while passing your

Capio suture through the sacrospinous ligament.

A

inferior gluteal

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26
Q

what does the metanephros form

A

kidney

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27
Q

At term, what is the average PCO2 in the umbilical

cord artery?

A

50 mmHg

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28
Q

Holoprosencephaly is likely associated with

which numerical chromosomal abnormality?

A

Trisomy 13

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29
Q

which conjugate is measurable clinicall

A

diagonal conjugate

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30
Q

what are the 3 conjugates of pelvimetry

A

true (sacral promontory to superior pubic symphysis)
obstetric (SP to mid PS)
diagonal (SP to inferior PS)

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31
Q

how do you determined the obstetric conjugate

A

Diagonal - 1.5 cm

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32
Q

weight loss drug approved by FDA for use in adolescents

A

tetrahydrolipstatin

inhibits digestive lipases to block approximately 25–30% of dietary fat absorption. Adverse effects include fatty or oily stools, abdominal pain, fecal urgency, and diarrhea. Dietary fat reduction can decrease gastrointestinal disturbance and increase tetrahydrolipstatin acceptance in adolescents

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33
Q

what space is entered in a SSLF

A

pararectal fossa

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34
Q

what is the most predictive US finding in a pt with an accreta

A

increased placental lacunae

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35
Q

which chemo drug does not increase the risk of ovarian failure

A

cisplatin

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36
Q

binge drinking increases risk of

A

stillbirth

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37
Q

nerve injury resulting in decreased patellar reflexes

A

femoral

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38
Q

which nerve can be injured in a TVT

A

ilioingunial

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39
Q

contraindications to testosterone therapy for transgender patients

A

absolute contraindications to masculinizing hormone therapy are:

  • current pregnancy,
  • unstable coronary artery disease,
  • polycythemia (hematocrit greater than 55%)
40
Q

For the occiput anterior position of the fetal head,

appropriately applied forceps blades are:

A

Equidistant from the sagittal and lambdoidal suture

41
Q

Which anomaly is associated with Kallman’s syndrome X-linked mutations?

A

Cleft lip and palate

42
Q

how many mL of blood does a super tampon hold

A

15-18 cc

43
Q

During a vasectomy, which structure

is ligated?

A

Ductus deferens

44
Q

Poliglecaprone 25

A

absorbable monofilament (monocryl)

45
Q

describe how progestins work to treat endometrial hyperplasia?

A

Activating progesterone receptors which results in stromal decidualization

46
Q

if a 1A ovarian cancer is ruptured intraoperatively, how does that change her treatment and stage

A

stage 1A > 1C

she will require chemo when she may not have previously

47
Q

who should receive the PPSV23 vaccine?

A
  • all adults > 65
  • immunocompetent people w/ cochlear implants and CSF leaks (8wks after PV13)
  • Immunocompromised people 2 doses (2nd 5 years later)
48
Q

who should receive the PPSV13 vaccine

A
  • immunocompetent people w/ cochlear implants and CSF leaks

- Immunocompromised people 1 dose

49
Q

sensory deficient

on the superior anterior aspect of her right thigh.

A

lateral femoral cutaneous

50
Q

Where is the DNA derived from when performing

Maternal Cell Free DNA testing for aneuploidy?

A

placenta

51
Q

The main arterial blood supply to breast originates from

which artery?

A

Axillary

52
Q

abx after hysterosalpingogram with hydrosalpinx

A

doxy 100 mg BID x 5days

53
Q

Polyglactin 910

A

twisted multifilament absorbable suture with synthetic coating. Last 56-70 days (8-10wks)

54
Q

when should retesting for CT after treatment occur in a nonpregnant patient

A

3 months (can do a TOC no sooner than 4 weeks if high concern for treatment failure)

55
Q

what % acetic acid is used in colpo

A

3-5%

56
Q

which mutation is associated with cardiomyopathy

A

MYH7

57
Q

The most common genetic cardiac disease is?

A

Hypertrophic cardiomyopathy

58
Q

What percentage of brow presentations will covert to a

face presentation?

A

30%

59
Q

Serous tubal and tubal intraepithelial lesions in transition

are most frequently located in which part of the tube?

A

fimbria

60
Q

maternal vit D deficiency is associated with what in infants

A

disordered skeletal homeostasis, congenital rickets, and fractures in the newborn

61
Q

Which breast cancer is found to have

ductal cells in the dermal lymphatics?

A

inflammatory

62
Q

Fetal growth restriction with polyhydramnios is most classically associated with which chromosomal abnormalities?

A

trisomy 18

63
Q

In what phase of cell division are oocytes arrested between birth and ovulation?

A

Prophase I

64
Q

Cytogenetic karyotype is performed on chromosomes

arrested in what phase of replication?

A

Metaphase

65
Q

In general, what percentage of total circulating cell-free

DNA in maternal plasma is placental in origin?

A

10%

66
Q

a smooth muscle tumor of the
uterus with low grade tumor composed of malignant
mesenchymal component and benign epithelium and rarely metastasizes?

A

adenosarcoma

67
Q

which stages of ovarian cancer can be treated with surgery alone?

A

1A and 1B (bilateral but confined)

68
Q

Why is Meperidine is not generally recommended for peripartum analgesia?

A

its active metabolite, normeperidine, has a prolonged half-life in adults and a half-life of up to 72 hours in the neonate; the normeperidine effect cannot be antagonized by naloxone

69
Q

What percent of early pregnancy loss are due to fetal

chromosomal abnormalities/aneuploidies?

A

50%

70
Q

What percent of the diet should be obtained from protein

when managing a diabetic patient in pregnancy?

A

15-30%

71
Q

which maternal risk factors carry the highest risk of stillbirth

A
  1. SLE
  2. Renal disease
  3. Hx of prior stillbirth
72
Q

Why does uteroplacental blood flow decrease when

intraperitoneal insufflation pressures exceed 15 mmHG?

A

Increases placental vessel resistance

73
Q

The most common gynecological malignancy in

preadolescent females is?

A

germ cell tumors

74
Q

what is the best measure of chronic

asthma severity?

A

FEV1

75
Q

Most commonly reported risk of using a gelatin thrombin

matrix hemostatic agent is:

A

postop abscess

76
Q

In the patient that is unanesthetized, which of the following is the most common symptom of air embolus?

A

chest pain

77
Q

MOA of Recombinant Parathyroid hormone for osteoporosis

A

increases osteoblasts and stimulates bone formation

78
Q

MOA of bisphosphonates

A

inhibits osteoclast resorption

79
Q

MOA for denosumab

A

blocks the KB ligand receptor to decrease bone reabsorption

used if failed other therapies and is high risk

80
Q

what is more effective over 5 years PPS or vasectomy

A

PPS

81
Q

who qualifies for preventative tamoxifen

A

Gail model risk > 1.6% in 5 years or > 20% lifetime risk

82
Q

tamoxifen and anastrozole affect on bone

A

tamoxifen: decreases osteoporosis
anastrazole: increases osteoporosis (give w/ bisphosphonate)

83
Q

side effects of tamoxifen

A
  • increased VTE risk
  • Increased risk of endometrial hyperplasia/CA in postmenopausal pts
  • increased risk of cateracts
84
Q

symptoms of MS

A

Diplopia
Pain
Weakness
Paresthesias

85
Q

What is the most common long term post-operative
complication associated with sacrospinous ligament
fixation?

A

anterior wall prolapse

86
Q

fecundability rate in one year?

A

90%

87
Q

How many weeks after fertilization does the

neural tube form?

A

3-4 wks

88
Q

most likely neonatal injury after a shoulder dystocia

A

fractured clavical

89
Q

is iugr associated with IVF

A

no

90
Q

Which part of the cell does ionization radiation

affect?

A

nucleus

91
Q

spironolactone MOA

A
  • competitive inhibitor of the androgen receptor
  • 5α-reductase inhibitor
  • aldosterone antagonist.
92
Q

The most common early Post-op complication of

lymph node dissection in the groin is:

A

lymphocyst formation

93
Q

Trichloroacetic Acid is a safe treatment for vaginal
warts during pregnancy. What is the agents mechanism of
action?

A

Coagulation of tissue proteins

94
Q

What is the reason for the procoagulant effect of

tamoxifen?

A

decreased antithrombin III and protein C levels

95
Q

What muscle overlies the sacrospinous ligament?

A

Coccygeus

96
Q

You have been treating a 4-month-old infant with
topical estrogen cream for labial adhesions. The mother
points out breast budding, what is your next step in
management?

A

Betamethasone cream

97
Q

major criteria for the diagnosis of Toxic shock syndrome? organism

A

rapid onset of fever, rash, hypotension, and multiorgan system involvement.

S. aureus