Kobgyn 900-950

Front 1

Q900. Dx:; irregular or heavy bleeding during early pregnancy, hyperemesis gravidarum, preeclampsia, hyperthyroidism, large uterine size, b-hCG > 50,000

Back 1

A900. Complete mole

Front 2

Q901. what is the lab sign of a Complete mole?; Dx test sign on US?

Back 2

A901. b-hCG > 50,000; US: "snowstorm" pattern

Front 3

Q902. Tx for Complete and Incomplete moles; (2 steps)

Back 3

A902. 1. Immediate D&E; 2. IV Pitocin (post D&E)

Front 4

Q903. what is the average time to normalize the hCG levels for molar pregnancies?; what percent results in malignancy?

Back 4

A903. 8 - 14 weeks; to CA: 15 - 25%

Front 5

Q904. Definition:; pregnancy caused by simultaneous fertilization of a normal ovum by two sperm; Karyotype?

Back 5

A904. Incomplete mole; (69,XXY)

Front 6

Q905. GYN bug:; Giant multinucleated cells with intracellular inclusions on Wright stain

Back 6

A905. HSV

Front 7

Q906. GYN bug:; Granular-appearing epithelial cells that are coated with coccobacillary organisms on saline

Back 7

A906. Baterial Vaginosis; (Gardinella)

Front 8

Q907. GYN bug:; Motile, flagellated organisms on saline

Back 8

A907. Trichomonas

Front 9

Q908. GYN bug:; Squamous cells with perinuclear halos on Pap

Back 9

A908. HPV

Front 10

Q909. (3) types of Malignant Gestational Trophoblastic Disease

Back 10

A909. Persistant/Invasive moles; Choriocarcinoma,; Placental Site trophoblastic Tumors

Front 11

Q910. Tx for all types of Malignant Gestational Trophoblastic Disease if it is confined to the uterus; (2 possible)

Back 11

A910. Single-agent therapy: Methotrexate or Actinomycin-D

Front 12

Q911. Tx for the (3) types of Malignant Gestational Trophoblastic Disease if it has mets to outside the uterus; (5)

Back 12

A911. Multi-agent therapy: [EMA/CO]; Etoposide,; Methotrexate,; Actinomycin-D,; Cytoxan,; Oncovin (Vincristine)

Front 13

Q912. Dx:; plateauing or rising b-hCG after molar evacuation; Chemotherapy Tx?; (inside vs outside)

Back 13

A912. Persistent/Invasive moles; Tx: Inside uterus only: M or A, Outside: EMA/CO

Front 14

Q913. Definition:; malignant necrotizing tumor that can arise from trophoblastic tissue weeks to years after any type of gestation; (molar, live birth, etc)

Back 14

A913. Choriocarcinoma

Front 15

Q914. Histology:; sheets of anaplastic cytotrophoblasts and synctiotrophoblasts in the absence of chorionic villi

Back 15

A914. Choriocarcinoma

Front 16

Q915. Histology:; tumors with absence of villi and proliferation of intermediate cytotrophoblasts

Back 16

A915. Placental Site Trophoblastic Tumors

Front 17

Q916. what is the only Gestational Trophoblastic Disease that presents with low b-hCG?

Back 17

A916. Placental Site Trophoblastic Tumors

Front 18

Q917. what is the only Gestational Trophoblastic Disease that does not respond to chemotherapy?; what is the Tx of choice?

Back 18

A917. Placental Site Trophoblastic Tumors; Tx: Hysterectomy (with multi-agent chemo [EMA/CO] one week after surgery to prevent recurrence)

Front 19

Q918. chance of a woman having breast cancer in her lifetime?

Back 19

A918. 1 in 8

Front 20

Q919. what is the major blood supply to the breasts?; (2)

Back 20

A919. Internal Mammary; and Lateral thoracic artery

Front 21

Q920. what does estrogen do for breast development?; (2)

Back 21

A920. Ductal development,; Fat deposition

Front 22

Q921. what does Progesterone do for breast development?

Back 22

A921. Lobular-alveolar development (makes lactation possible)

Front 23

Q922. what is responsible for milk letdown?

Back 23

A922. Oxytocin

Front 24

Q923. when should self breast exams be performed?

Back 24

A923. monthy about 5 days after menses

Front 25

Q924. what are the mammography screening guidelines?

Back 25

A924. start every other year at 40yo then every year at age 50yo;; women with history of breast CA in family should start 5 years before youngest Dx of breast CA

Front 26

Q925. what percent of breast cancers are not detected by mammography?

Back 26

A925. up to 20%

Front 27

Q926. why is US useful in breast masses?

Back 27

A926. detects if cystic or solid

Front 28

Q927. what is the first step in Dx a breast mass?; what if this doesn't work?

Back 28

A927. Needle aspiration (if not working -> excisional biopsy)

Front 29

Q928. Dx Nipple discharge:; Bloody; (2)

Back 29

A928. Invasive Papillary CA,; Intraductal CA

Front 30

Q929. Dx Nipple discharge:; Serous; (4)

Back 30

A929. normal Menses,; OCPs,; Fibrocystic Disease,; early pregnancy

Front 31

Q930. Dx Nipple discharge:; Yellow-tinged; (2)

Back 31

A930. Fibrocystic Disease,; Galactocele

Front 32

Q931. Dx Nipple discharge:; Green, sticky

Back 32

A931. Mammary Duct Ectasia

Front 33

Q932. Dx Nipple discharge:; Purulent

Back 33

A932. Breast abscess

Front 34

Q933. Dx:; cyclic breast pain with multiple, bilateral masses

Back 34

A933. Fibrocystic Disease

Front 35

Q934. reducing what should help with ameliorating fibrocystic disease?

Back 35

A934. Caffeine (coffee, tea, chocolate)

Front 36

Q935. what drugs are used to help Sx of Fibrocystic Disease?; (4)*

Back 36

A935. TPD Bro:; Tamoxifen,; Progestins,; Danazol,; BROmocriptine

Front 37

Q936. Dx:; rubbery, non-tender breast mass in patient younger then 25yo

Back 37

A936. Fibroadenoma

Front 38

Q937. Dx:; large, bulky mobile breast mass with overlying skin being warm, erythematous, shiny and engorged; Tx?

Back 38

A937. Cystosarcoma Phyllodes; Tx: wide local excision (b/c 10% go to CA)

Front 39

Q938. what (4) breast problems require only "Local excision" as the Tx of choice?

Back 39

A938. Phyllodes,; Papilloma,; Ectasia,; LCIS

Front 40

Q939. Dx:; inflammation of the ductal system at or after menopause causing nipple retraction, discharge and pain, usu bilateral; Tx?

Back 40

A939. Mammary Duct Ectasia (Plasma cell Mastitis); Tx: Local excision of inflammed area

Front 41

Q940. what are the top three risk factors for Malignant Breast cancer?

Back 41

A940. 1. First-degree relative with bilateral premenopausal onset; 2. Previous breast cancer; 3. first birth after age 34

Front 42

Q941. Dx:; bilateral malignant breast cells, non-palpable, not seen on mammography; Tx?

Back 42

A941. Lobular Carcinoma In Situ (LCIS); Tx: Local excision

Front 43

Q942. Dx:; malignant epithelial cells in mid-50's woman, microcalcifications on mammography, unilateral; Tx?

Back 43

A942. Ductal Carcinoma In Situ (DCIS); Tx: Simple Mastectomy (additional Radiation if margins < 10mm)

Front 44

Q943. what is the most reliable predictor for survival in breast cancer?

Back 44

A943. the stage of breast cancer at the time of diagnosis

Front 45

Q944. what is the recommended follow-up for breast cancer patients?

Back 45

A944. Exam every 3 months for first year,; every 4 months in second year,; every 6 months thereafter (mammogram, LFTs and Alk-phos is done 6 months after Tx)

Front 46

Q945. what percent of breast cancer is related to genetic predisposition?

Back 46

A945. 5 - 10%

Front 47

Q946. what is the criteria in treating a Breast cancer patient if she has negative or positive lymph nodes versus her ER/PR (receptor) status?

Back 47

A946. Neg LN + ER/PR Neg - Chemo ONLY (Cyclophosphamide, Methotrexate, 5-FU); Neg LN + ER/PR Pos - Tamoxifen or Anastrozole ONLY; Pos LN: Always Chemo (CMF),; Pos LN + ER/PR Pos - Chemo plus Tamoxifen or Anastrozole

Front 48

Q947. "Double-bubble" on US indicates what problem?

Back 48

A947. Down's syndrome

Front 49

Q948. what should the mother avoid during first trimester b/c it could lead to increased risk of neural tube defects?

Back 49

A948. Hyperthermia (fevers and hot tubs)

Front 50

Q949. what are the (2) possible initial tests for syphillis that become negative over time?

Back 50

A949. RPR,; VDRL

Front 51

Q950. what are the (2) confirmatory tests for syphillis that are always reactive (positive) if you are exposed?

Back 51

A950. FTA-ABS,; TP-PA