Pretest Ob/gyn Iv Prev Care Onwards

Front 1

mammography indicated for what ages?

Back 1

all women yearly over 50

Front 2

bone scan for what age women?

Back 2

all women over 65 and all
post mp women w/o hrt

Front 3

pap smear ages?, frequency?

Back 3

YEARLY...
over 21 or 3 yrs after sex activity began; until:
over 30 and 3+ negative pap smears

Front 4

TB screening for which women?

Back 4

contact with TB
IV drug users
HIV inf
residents of nursing home/care facilities
health care profession

Front 5

vaccines for women over 65?

Back 5

tet diph booster every 10yrs
influ vaccine yearly
one time pneumococcal vaccine

Front 6

is CA125 screening indicated for elderly women?

Back 6

ONLY if high risk for ov cxr

Front 7

parabasal cells on pap smear?

Back 7

indicate estrogen lack = normal in elderly woman postmenopausal

Front 8

causes of death in teens?

Back 8

mva's
homicide
suicide
cxr
accidents
heart dis
cong anoms
copd's

Front 9

gartner's duct cyst def?

Back 9

embryonic remants of m/n duct that course along outer ant aspect of vag canal...small and asx usually

Front 10

inclusion cyst def?

Back 10

post lower vag surface...M/C VAGINAL CYSTS! = due to birth trauma or prev gyn surg

Front 11

bartholin duct cyst?

Back 11

m/c large cysts of vulva - open into groove b/w hymen and labia minora

Front 12

age 45-64 mammography?

Back 12

start every 1-2yrs, then anualy after 50

Front 13

age 45-64 chol testing?

Back 13

every 5 yrs

Front 14

ocp use decreases ov cxr by what %?

Back 14

by 40%!!

Front 15

what % of pts who stop smoking relapse w/in 3 mo?

Back 15

65%

Front 16

m/c germ cell tumors in women?

Back 16

benign cystic teratoma (dermoids) = 25% of all ovarian neoplasms!!

Front 17

% of dermoids that are bilat?

Back 17

15%!!

Front 18

how does ov cxr metastasize?

Back 18

mainly via para aortic and plevic lymphatics, but also hematogenously

Front 19

cerv cancer staging?

Back 19

Ia = microscopic
Ib = macroscopic limited to cervix
IIa = vag involvement (not lower 1/3)
IIb = " +parametrial involvement
IIIa = lower 1/3 vag
IIIb = extension to pelvic wall or hydronephrosis or nonfx kid due to cxr
IV = spread outside repro tract

L/N's NOT used in staging!!

Front 20

are l/n's used in cerv cxr staging?

Back 20

NO b/c staging is CLNICAL!!

Front 21

NSIM for removed stage Ia cerv cxr? for stage IB or IIA? past what pt do you only do chem/rad w/no surg?

Back 21

either simple hysterectomy or careful observation after complete excision
IB or IIA = rad hysterect + chem/rad...
past IIA (IIB and beyond) do only chem/rad tx and no surg

Front 22

Is HRT indicated solely for the tx of osteoporosis?

Back 22

no

Front 23

increased risk for osteoporosis?

Back 23

wt under 70kg;
fam hx of osteoporosis
smoking

Front 24

desired BMI range as a goal for anorexia?

Back 24

18.5-24.9

Front 25

mom has homogenous goiter 3-6 mo post delivery, with low TSH and High T4? results on RAI uptake scan?

Back 25

postpartum thyroiditis; presents initially like Grave's disease; due to acute autoimmune thyrotoxicosis after delivery; resolves in 1-3mo
HOWEVER UNLIKE grave's, uptake scan will have DECREASED uptake b/c is due to
damaged gland

Front 26

HRT is indicated for what?

Back 26

SHORTterm relief of postmenopausal sx

Front 27

what % increase in Breast cxr does HRT cause, accordint to women's health initiative study?

Back 27

26% increase!!

Front 28

headaches, unilat, no aura, coming within regular 3-5 day intervals 1x / month in female?

Back 28

menstrual migraines!!

Front 29

tx for prego w/ uti?

Back 29

cephalexin (1st gen ceph) or ampicillin;
NOT normal first line for women = tmpsmx b/c sulfa's may cause fetal inhibition of albumin binding and a resulting fetal hyperbilirubinemia; not 2nd line = nitrofurantoin bc nausea and fetal hemolysis due to fetal def of erythrocyte phosphate dehydrogenase

Front 30

% of women with peripartum cardiomyopathy that spont resolve? tx for?

Back 30

only 50%...the rest need tx with ie
salt restriction, ace i's, diur's, digitalis, b-blockers,etc

Front 31

tx for vulvar carcinoma?

Back 31

surgical - radical vulvectomy +bilat inguinal lymphadenectomy; or if mets = bilat full PELVIC lymphadenectomy

Front 32

most sensitive pelvic organ to radiation?

Back 32

ovary

Front 33

pregnant woman at highest risk for which cancer?

Back 33

cervical - due to assoc of preg w/ younger age

Front 34

only time that a cone bx is indicated in pregnancy?

Back 34

if microinvasive disease is apparent from previous colposcopy and cerv bx. otherwise, trauma to cervix during preg is too risky

Front 35

m/c cancers in adults?

Back 35

The most common cancers in adults are skin cancer, lung cancer, colon cancer, rectal cancer, breast cancer, endometrial cancer, ovarian cancer and prostate cancer.

Front 36

m/c cancers in women?

Back 36

Brcxr
Lungs
CRC
Endom / uterine
NHL
Ovarian

Men:
Prostate
Lung
CRC
Bladder
NHL

Front 37

radical hysterectomy indicated for what stage cerv cxr?

Back 37

Ib-IIa

Front 38

what is a radical hysterectomy?

Back 38

remove:
uterus
upper 1/3 vag
all pelvic l/n's
uterosacral/uterovesical ligaments
entire parametrium on both sides of cervix

Front 39

automatic indications for explorative laparotomy for suspected ov cxr?

Back 39

papillary veg on pathology
>10cm size
ascites
torsion
solid lesions

Front 40

if see ovarian cyst on U/S, what NSIM?

Back 40

follow for 1 menstr cycle to detm if follicular cyst which should regress.

Front 41

clitoral vs rest of vulvar L/N drainage?

Back 41

clit drainage = directly to deep fem nodes-->ext iliac
vulva = sup ing l/n's --> deep fem--> ext iliac

so if carcinoma is near the midline, it's possible that only the deep fem nodes involved w/o sup inguinals

Front 42

7 y/o girl with grape-bunch-like mass in vagina and vaginal bleeding?

Back 42

sarcoma botryoides

Front 43

most epith tumors of ovary are benign or malignant?

Back 43

90% benign; 25% of these are dermoids (teratomas)

Front 44

m/c epithelial malignant tumor?

Back 44

serous carcinoma

Front 45

serous carcinoma of ovary has what on histology?

Back 45

psammoma bodies (30% of tumors)

Front 46

what % serous carcinoma of ovary are bilateral?

Back 46

33%

Front 47

histology: loss of rete pegs within the dermis and chronic inflamm infiltrate below dermis; decrease in number of cellular layers?

Back 47

lichen sclerosis

Front 48

tx of lichen sclerosis?

Back 48

steroids
laser or cryo if this doesn't work

Front 49

hpv type causing condylomata acuminata ? causing CIN /cxr?

Back 49

6,11

16, 18, 31

Front 50

tumor assoc with excessive estrogen production, 15% also causing endom carcinoma?

Back 50

granulosa / theca cell tumor of ovary

Front 51

tumor of 45 xx/46 xy female with ambiguous genitalia?

Back 51

gonadoblastoma

Front 52

s/e of this drug is hemorrhagic cystitis and alopecia?

Back 52

CP

Front 53

s/e of this chemo drug is renal failure and neural toxicity?

Back 53

Cisplatin -
pts must be WELL hydrated to prevent renal failure

Front 54

s/e of this chemo drug is allergic rxns and bone marrow depression?

Back 54

taxol

Front 55

s/e of this chemo drug are pulm fibrosis?

Back 55

bleomycin

Front 56

s/e of this chemo drug is cardiac toxicity?

Back 56

doxyrubicin

Front 57

s/e of this chemo drug is peripheral neuropathy?

Back 57

vincristine

Front 58

invasive mole vs choriocarcinoma?

Back 58

invasive mole = has chorionic villi; 15% of hydat moles become this
choriocarc = none; 3% of hydat moles become this ; met spread to lungs is early; easily tx'd with chemo

Front 59

tx for large condylomata acuminata on vagina?

Back 59

local excision;
if smaller, may do podophyllin, 5fu, or imiquimod, or TCAcid application

Front 60

painless chancre that later becomes macular rash vs. painless chancre that later becomes painful adenopathy in inguinal and perirectal areas? vs. painless chancre with donovan bodies on histo? vs painful chancre?

Back 60

1) syphilis
2) Lymphogranuloma venereum of chlamydia - tx tetracycline
3) granulmoa inguinale - tx tetracycline
4) h ducreyi - tx azithro

Front 61

inguinal granulomas caused by? what see on pathology? tx?

Back 61

granuloma inguinale; C. granulomatis; see donovan bodies
tx = tetracycline

Front 62

antibody titers tested for HIV how long after exposure?

Back 62

initially right away, but then wait 6-12 weeks as it may take 6 weeks for seroconversion; then follow up again 1 yr later for late seroconverters

Front 63

NSIM for Pap showing HSIL but colposcopy only showing CIN 1 ?

Back 63

this is descrepancy b/w pap and colp; thus, CONE BIOPSY is indicated

Front 64

agus found on pap smear, NSIM?

Back 64

colposcopy!

Front 65

LSIL on pap smear, NSIM?

Back 65

probably CIN 1 so can watch and wait, but most will still do colposcopy

Front 66

intense burning with pain on intercourse; several punctate erythematous lesions 3-8mm b/w bartholin's glands? tx?

Back 66

vulvar vestibulitis
looser clothing, stop tampon use,
if this doesnt work,
tx with topical lidocaine, steroids, and estrogen

Front 67

m/c sx of lichen sclerosis?

Back 67

chronci vulvar pruritis

Front 68

tx for bact vaginosis? trichomonas? candidiasis? c trachomatis?

Back 68

metronidazole 500mg bid for 7 days
metro single dose 2g
triazoles, fluconazole (diflucan)
doxycycline (+ceftriaxone for gon)

Front 69

initial inpatient managment of PID? NSIM for tuboovarian abscess?

Back 69

cefoxitin (2nd gen ceph) + cefotetan + doxy
Or outpatient mangament (pg 235)

NSIM = hospitalize and give IV ab's; if doesnt resolve, drain abscess via lapscopy or percut CT guidance

Front 70

what therapy is contraindiciated for pts with atypical endometrial hyperplasia?

Back 70

OCP's

Front 71

is there any use for OCP's in postmenopausal bleeding?

Back 71

NO

Front 72

ABSOLUTE c/i's to postmp HRT?

Back 72

breast/uterus (est dependent) tumors;
active thromboembolic disease;
undiagnosed genital tract bleeding;
severe liver disease
malignant melanoma

Front 73

order of puberty?

Back 73

tag'm
thelarche (NORM AGE 9-11)
adrenarche/pubarche (pubic hair) age 11-12.8
growth spurt
menarche

Front 74

pubertal delay? tx?

Back 74

no thelarche by 13, or
adrenarche by 14,
or menarche by 16
tx = eval for cause;

Front 75

precocious puberty def? tx?

Back 75

pub changes before 8 yrs in females, 9 in males
tx =gnrh agonist (in past tx was MPA)

Front 76

mcune albright syndrome?

Back 76

cafe aulait spots
precocious puberty
osteofibrous dysplasia (cystic degen of longbones)

Front 77

CNS tumors acct for what % of precocious puberty? what is most common cause precocious puberty?

Back 77

11%
m/c is idiopathic

Front 78

rf's for osteoporosis?

Back 78

Thin, smoker, whit/asian, little physical activity

Front 79

why do pts with adren insuff syndrome (test feminization) have breasts?

Back 79

b/c at puberty, hothal signals testes to produce testosterone,which is converted to estradiol - causes breast formation

Front 80

galactorrhea with primary amenorrhea?

Back 80

think first hypothyroidism: low T4=high TRH stims release of prolactin and TSH from pit = hyperprolactinemia =galactorrhea.

OR also consider cranial tumor/ pit gland tumor

Front 81

tx for dysmenorrhea?

Back 81

ocp's, and antiprostoglandins

Front 82

tx for endometriosis? mech?

Back 82

1) danazol -a modified testosterone; inhibits ovarian steroidogenesis so inhibits estradiol prod; causes endometrial tissue atrophy and a 'pseudomenopausal state' to ensue with no cycles
2) OCP's
3) GNRH analogues
4) progestins continuous

Front 83

anosmia and primary amenorrhea, delayed puberty, and normal stature?

Back 83

kallman's = just test sense of smell

Front 84

tx for precocious puberty?

Back 84

gnrh agonist = leuprolide

Front 85

dysmenorrhea and menorrhagia with
tender, symmetrical, enlarged uterus with no adnexal px,

Back 85

adenomyosis

Front 86

pt with pituitary ablation requires what for normla ovulation?

Back 86

hMG (gonadotropin, since cant produce anymore FSH / LH since pit is gone) and hCG timed to take place of LH surge (like done during infertility schedule)

Front 87

climiphen citrate stimulates what? how?

Back 87

stimulates GNRH release by competing w/circulating estrogens to BLOCK neg feedback on hypoth

Front 88

prolactin levels normal? of pregnancy?

Back 88

normal = 25 ng/mL
preg = up to 250 ng/mL is normal

Front 89

tx for hyperprolactinemia?

Back 89

dop agonist = parlodel

Front 90

is bleeding a sx of fibroids, endometriosis, or both?

Back 90

mainly fibroids, not endometriosis (cyclical PX mainly)

Front 91

salpingitis isthmica nodosa?

Back 91

diverticuli of fallopian tubes

Front 92

tx for asherman's syndrome?

Back 92

hysteroscopy with lysis of adhesions

Front 93

stress, phenothiazine, and hypthalamic lesions all may cause what?

Back 93

decreased PIF = causing hyperprolactinemia

Front 94

estradiol
estrone
estriol

Back 94

1 ovaries
2 adipose conversion of
androstenedione
3 dhea-s of adrenals converted
to estriol in placenta

Front 95

normal male with a uterus..Dx?

Back 95

mullerian inhibitory factor deficiency

Front 96

progesterone levels in mid-luteal phase of what = luteal phase defect?

Back 96

less than 7ng/mL

Front 97

what is luteal phase defect?

Back 97

failure of ovary to produce enough prog to stimulate adequate endometrial support during luteal phase; NOT due to low LH levels

Front 98

HIrsutism + HIgh LH:FSH ratio ...dx?

Back 98

PCOS

Front 99

DHAS is marker of ?

Back 99

adrenal androgen production; if elevated in hirsutism, know source

Front 100

s/e's of gnrh agonists?

Back 100

flushing, headaches
OSTEOPOROSIS

Front 101

tx for primary dysmenorrhea? tx for primary dysmenorrhea in sex active female who doesn't wnt pregnancy?

Back 101

antiprostoglandins (indometh, naproxen, ibuprofen)
OCP's (will do both)

Front 102

tx of MRKH (MULLERIAN AGENESIS)

Back 102

vaginal dilatation or artific vag created withsplit thickness skin grafts

Front 103

test fem vs mullerian agenesis?

Back 103

both have blind vag pouch and no uterus; test fem has much less sexual hair; and is 46 XY

Front 104

greatest efficacy tx for PMS?

Back 104

SSRI's !!

Front 105

what part of puberty progression is NOT caused (even in part) by estrogen

Back 105

thelarche IS
adrenarche IS NOT (hair is b/c of androgens from adrenals and then from ovaries)
growth spurt IS in part
Menses IS

Front 106

first indications of puberty (hormonal)

Back 106

nocturnal LH pulses

Front 107

normal semen analysis?

Back 107

over:
20mill sperm
50% forward motility
60% norm morphology
2 mL volume

Front 108

What day of cycle should the following tests be done?
1)postcoital test
2) prog levels for inad lut phase test?
3)ENDOM BX?
4)HSG?
5)GONADOTROPINS?

Back 108

1)sex on day 14
2) 21 (MIDLUTEAL PHASE)
3) 26 = 2 days before expected onset of menses, when endom should be thickest
4) 8 = midfoll phase when endom is thinnest
5) 3 = early follicular phase

Front 109

M/C cause of hirsutism? proposed mechof action?

Back 109

PCOS
selective insulin resistance

Front 110

woman with RAPIDLY virilizing characteristics...dx?

Back 110

Sertoli/leydig cell tumor secreting testosterone

Front 111

pcos produces elevated levels of what?

Back 111

DHEAS

Front 112

estrone is made in adipose tissue....are levels for estrone req'd in workup for PCOS?

Back 112

no

Front 113

how does spironolactone work to tx PCOS?

Back 113

competes for androgen receptor

Front 114

tx for CAH?

Back 114

dexamethasone

Front 115

change of regular, monthl pds to irregular, infrequent vaginal bleeding pds withunderlying diabetes and morbid obesity?

Back 115

classic case of chronic anovulation

Front 116

tx for woman with heavy and acute bleeding due to anovulation?

Back 116

HIGH DOSE conjugated estrogen every 4 hours until bleeding abates

Front 117

hrt use increases risk of what in women? by what amt?

Back 117

thromboembolic events 2-3fold increase

Front 118

estrogen / HRT use effects on lipid levels?

Back 118

increases HDL, trig, decreases LDL and total chol

Front 119

first sx of ovarian dysfxn in normal menopause?

Back 119

hot flashes

Front 120

what tx for hot flashes? time before tx begins to work?

Back 120

estrogen, takes 3-6 weeks

Front 121

main cause of true precocious puberty? isosexual?

Back 121

true = idiopathic, or tumors, hx of meningitis, hypoth, or mcune albright
iso= ovarian tumor

Front 122

salpingitis isthmica nodosa findings on HSG?

Back 122

see diverticulum of tube and salt and pepper pattern of tubal fililng

Front 123

m/c type of stress incontinence?

Back 123

GENUINE usi = anatomic defect of u/v jxn / incompetence of ureth sphincter caused by one or both of: 1) p floor damage, nerve damage due to childbearing, etc. 2) hypermobility of urethra (also due to weakend pelvic floor) such that bladder and angle of u/v jxn moves down

Front 124

less common type of stress incontinence?

Back 124

intrinsic urethral sph deficiency, usually caused by surgical failure for procedures trying to correct Genuine SUI

Front 125

m/c cause of urge incontinience?

Back 125

detrusor instability: urine loss WHEN desire to voide when feeling bladder is full; cause unknown; demonstrated by sponaenous detrusor contractions when bladder is full
other causes are urethral instability and detrusor hyperreflexia (in elderly, due to cns disorder)

Front 126

GSUI vs Detrusor instability on urodynamic tests?

Back 126

GSUI= after cough, pt loses urine and anatomic descent of bladder neck occurs
DI = sponatneous contractions of bladder muscles

Front 127

what's the q-tip test for?

Back 127

for GSUI: if q-tip placed in urethra when pt in lithotomy position, and upon cough/increased abd pressure, it moves > 30% from horizontal = GSUI

Front 128

tx of SUI?

Back 128

transvag Tape procedure or retro pubic urethropexy (but older method: MMK causes osteitis pubis often, so Burch procedure done, OR actually, TVT sling procedure done more commonly now)

Front 129

first thing in workup for SUI?

Back 129

urine culture for UTI!!

Front 130

cystometry and cystoscopy mainly done for what?

Back 130

to rule out causes of SI other than U/V angle descent (ie detrusor instability, or neoplasms, stones, infection, diverticula, etc.

Front 131

complic of sling procedure?

Back 131

infection and ulceration due to foreign body

Front 132

detrusor instability def?

Back 132

involuntary, uninhibited bladder contractions of > 15cmH2) with urethrral relaxation

Front 133

m/c cause of stress incontinence in elderly women?

Back 133

detrusor instability

Front 134

does uterine prolapse cause USI?

Back 134

no, it often causes continence b/c pressure on urethra; thus, often the surgery to correct it causes incontinence

Front 135

frequent uti's, dribbling, hematuria, dypareunia, due to what problem w/ urethra?

Back 135

urethral diverticula - affects 4% of all women!

Front 136

severed ureter during hysterectomy: how to tx?

Back 136

re-implant ureter into bladder

Front 137

ut artery in relation to ureter?

Back 137

water under the bridge: ureter passes immediately inferior to uterine artery near the lateral fornix of vagina

Front 138

primary reason to perform cystometrogram?

Back 138

to rule out detrusor instability in pt with suspected GSUI. urethral pressur e profile should be NORMAL if just GSUI.

Front 139

normal first sensation of fullness , urge felt on cystometrogram?

Back 139

at 100ml, urge at 350
max cap = 450

Front 140

sx of detrusor instability?

Back 140

urgency, frequency, and nocturia

Front 141

painless continous loss of urine from vagina?

Back 141

vesicovaginal fistula

Front 142

tx for stress incontinence caused by cystocele?

Back 142

still is surgery

Front 143

fecal incontinence is related to what common disease?

Back 143

diabetes = 20% of diabetics report f.i.!

Front 144

painless and continous loss of urine starting 8 days after a gyn procedure/

Back 144

Vesicovag fistula

Front 145

what is procidentia?

Back 145

= same as 3rd degree uterine prolapse: uterus is located outside of body

Front 146

tx for: 1)elderly pt with ut prolapse that does not bother pt? 2) causes px but pt has high surgical risk? 3) causes px in pt with low surg risk? 4) same as 3 but pt doesn't require sexual fxn anymore?

Back 146

1-reassurance
2- pessary
3- hysterectomy + Ant & Post vaginal repair
4- le Fort procedure ( partial obliteration of vag by suturing upper walls together

Front 147

tx for vaginal vault prolapse in surg high risk pt? if ulcer on prolapse tissue?

Back 147

pessary
if ulcer - tx first with topical estrogen cream

Front 148

urge incontinence tx?

Back 148

bladder training, eliminate excessive h20 and caffeine intake, biofeedback. if these don't work, give anticholinergics to decrease bladder contractions caused by Parasympathetic innervation; or b ag's, antidep's, or dop agonists (all these stim bladder relaxation)

Front 149

1st line tx for UTI in female? if allergic?

Back 149

tmp-smx (bactrim)
or
nitrofurantoin if allergic

Front 150

if no sepsis and AB's tolerable, can pt with acute pyelonephritis be txed as outpatient?

Back 150

yes.

Front 151

recurrent uti's directly after sexual intercourse tx?

Back 151

suggest voiding after intercourse; if this doesn't work, igve prophyl ab tx!