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295 Cards in this Set

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Hyperplasia without atypia - should have high or low threshold for hysterectomy?

how to tx?
high - they respond v. well to cyclic progestins! - be sure to repeat bx in 3-6 months
Pruritis, inflammation, and elevation of vaginal d/c pH - dx?
trichomonas - NOT BACTERIAL VAGINOSIS/GARDNERELLA!!!

no discomfort with BV
primary amenorrhea, bilar ing masses, breast devo but no pubic hair or axillary hair in a female - dx?
androgen insensitivity syndrome - they need gonadectomy so they don't get cancer and estrogen aroudn teh time of puberty
Two things that stimulate prolactin
TRH and serotonin
Pregnancy luteoma - what is it?
HCG makes luteal stromal cells replace the normal ovarian parenchyma so they get ovarian masses. More common in AAs. Sx similar to PCOS (virilization, hirsutism).
what hormone develops breasts?
estrogen
primary amenorrhea in a pt with no sex characteristics - first test to order?
fsh to tell if it is central (hypothal/pit) or gonadal

if high - periph lesion so get a karyotype
if low - central lesion so get gnrh stim test
work-up of low grade squamous intraepith lesions ( which is mild dysplasia or CIN 1)
adolescents - repeat pap in 12 months (takes a while to develop anyway)

premenopausal - colposcopy and then biopsy (because they are a hgih risk group)

postmenopausal - hpv testing and if positive, colposcopy
Tx of vaginal squamous cell ca
steage 1-2 - localized and <2cm - remove surgically

stage 1-2 - localized and <2cm - radiation

over 4cm or extensive - combination chemo
ovarian masses that do not produce estrogen or androgens
dysgerminoma, mature teratoma, serous cystadenoma

NOT GRANULOSA CELL TUMORS!
role of alcohol and risk of osteoporosis
a very serious one - and it is dose dependent
pt has suspected ___ towards end of pregnancy, don't do vaginal exam!
placenta previa
Cause of early decelerations
fetal head compression leading to a vagal response
cause of variable decelerations during labor
umbilical cord compression
parameters of biophysical profile
nonstress test (reactive)
fetal tone (flexion or ext of an extrem)
fetal movements (at least 2 in 30min)
fetal breathing (at elast 20 seconds in 30 minutes)
amniotic fluid volume (single pocket >2cm in vertical axis)
when to deliver based on biophysical profile
decreased amniotic fluid - consider it

<=6 and >37wks - if <37 repeat BPP in 24 hours and deliver if not improved

<=4 and >26 wks - deliver
Kallmann's syndrome - what is it? associated with...?
congen absence of GnRH secretion

assoc with anosmia
mullerian duct leads to devo of...
proximal vagina and uterus
so blind pouch without it
pt has female phenotype but then virilization at puberty - dx?
5-alpha-reductase deficiency - XY genotype
pink smooth teardrop lesions on vulva that go away with trichloroacetic acid or podophyllin - dx?
HPV warts (condyloma acuminata)
what do clue cells look like in bacterialvaginosis (gardnerella)
epithelial cells coated with bacteria
metro safe to use during preg?
yes
azithromycin or erthromycin - which safe to use in pregnancy?

AE of erythro?
azith

eryth can cause acute cholestatic hepatitis
post-term pregnancy - definition and what to watch for?
>42 weeks
watch for oligohydramnios
name of plan b? how long out can you give it?
levonorgestrel
120 hours
main organ issue in pts with turner's syndrome
ovarian dysgenesis
Tx of candida vaginitis
fluconazole
Definition of mild vs. severe preeclampsia
Mild - proteinuria >0.3g/24h
BP>140/90

Severe - HTN>160/110; >5g/24h, or organ dysfunc
Chronic HTN in pregnancy - what is it?
HTN not due to pregnancy, so before 20th week or present before preggo - if get proteinuria with it, it's called chronic HTN with superimposed preeclampsia
Tamoxifen - agonist/antag where?
agonist - endometrium, osteoclasts (so less osteopor risk)
antag - breast

no known effect with ovaries
when is ionizing radiation most harmful to a fetus?
8-15 weeks
hormone malfunc in anorexics
low gnrh and lh, so low estrogen states
who is most at risk for fetal limb defect when getting chorionic villus sampling
babies <9-10weeks gestation - so you typically do it btwn 10-12 weeks
how to assess infertility due to aging -
early follicular phase FSH level, clomiphene challenge test or inhibin B level

(inhibin inhibits FSH)
Chancroid - what is the bug, what does the lesion look/feel like
ulcer that is deep and purulent and painful lymphadenopathy

caused by haemophilis ducreyi
adenopathy with granuloma inguinale?
pain?
no - painless too
First step if you suspect fetal compromise?

Fetal demise?
compromise - NST

demise - ultrasound
pt has lichen sclerosis - next step?
punch bx to make sure there is no SCC
When to give GBS ppx
if test positive 2-3 weeks before delivery, had baby with gbs in past, or tested positive in the past
role of human placental lactogen - other name for it?
maternal lipolysis and insulin resistance so the baby gets more glucose

chorionic somatomammotropin
what causes variable decels
fetal cord compression
dysmennorhia, heavy menses, large uterus - dx?
fibroid uterus
fsh and lh - low or high with klinefelter's?
high
Primary dysmenorrhea - signs/sx, cause, and tx?
s/s - lower abd pain rad to thighs and back during menstruation

cause - increase prostaglandins during breakdown of endometrium

tx - nsaids
fixed retroverted uterus should make you think of...
endometriosus
is endometriosus a risk factor for infertility?
yes
Baby sequalae of maternal diabetes
polycythemia (due to increase BMR and resultant epo)

macrosomia, hypocalcemia (PTH suppression), hypogly, resp diff, cardiomyopathy, CHF
why do we worry about asymp bacteruria in preggo pt?
can get pyelonephritis --> septicemia, preterm labor and low birth weight babies
normal 1 hour GTT (50g)
<140
in general, baby is going to die, mother is preterm, do a c section or vaginal deliv?
vaginal
corpus luteum secretes...
progesterone, and it is maintained by hcg
role of progesterone during preg
inhibit uterine contractions
hormone that induces prolactin during pregnancy
estrogen - actually - wait - this might be wrong...
urinary urgency/freq and chronic pelvic pain - also dysparunia - negative UA - consider which dx?
chronic interstitial cystitis
signs of ovulation -
breast tenderness, midcycle pelvic pain (Mittelschmertz)
serum inhibin b levels used for...
determining ovulatory reserve
Treatment of infertility in pt with PCOS
metformin and clomiphene
DES causes...
clear cell adenocarcinoma of vagina and cervix in the children
steroids to mature lungs - no benefit after...
34 weeks
can ERT help with urine incontinence?
yes
when to do uterine artery embolization
PP hemorrhage but not excessive bleeding and pt wants to maintain fertility (contrast to hysterectomy)
RFs for uterine atony
distention of uterus intrapartum or prolonged labor
oxybutynin - used for which incontinence?
urge - anticholinergic
urethopexy - used for what incontinence?
stress - supports urethra
w/u of infertility
1.) check male
2.) assess for ovulation
3.) hysterosalpingogram
Pseudocyesis
conversion disorder - mimics pregnancy in a pt who really wants to become pregnant
when to screen for gestational DM
hx of DM - first prenatal visit
all others - btwn 24 and 28 weeks
initial screening test for gestational DM
1 hour 50g glucose tolerance (if >140 - do 3 hours GTT or 2 hour 75g)
criteria for 3 hour glucose tolerance test
2 or more are elevated:
fasting >95
1 hour >180
2 hour > 155
2 hour > 140
US - useful to dx placenta previa or abruption?
previa
septic abortion - gentle or vigorous curettage?
gentle - don't want to perforate it.
next steps of action when BPP is...
<4 - deliver

4 without oligohydramnios and
fetal lungs are not mature - steroids and repeat BPP in 24h

6 without oligohydramnios - contraction stress test

oligohydramnios present - deliver
woman comes in with PROM at <37 weeks - what to do?

what is <32 weeks
GBS ppx and let her deliver

if before 32 - give tocolytic and let lungs mature
most preventable cause of fetal growth restriction
smoking
Tons of N/V in a pt at about 10 weeks gestation - consider what dx?
gestational trophoblastic dz

NB - will see elevated liver enzymes and amylase and lipase with hyperemesis gravidarum
spinal anesthesia - can slow labor if given in the ____ stage
latent (before cervix is 3-4cm dilated)
If Rh antibody titers are ___, need Rhogam
<1:6 (numbers less than 6) - this means the Mom is not sensitized.
PCOS - LH is high or low?
high
What week can you confidently say fetal lungs are mature?
34
when to do penicillin desensitization?
pregnant pt has syphilis - erythromycin won't cross the placenta and help the baby
role of thyroid hormones and prolactin?
TRH stimulates prolactin
tx of variable decels
due to umb cord compression, so start O2 and change mom's position. if no help, amnioinfusion

if persists below 70bpm for a while, worry abt fetal hypoxia
When to try to convert breech to vertex?
at 37th week - do external cephalic version
when to give mag sulfate in pt with mild preeclampsia?
during labor and within 24h of delivery
When to do C section in a pt with placental abruption
when there is another indication or fetus or mom is rapidly deteriorating
some main contraindications to vaginal delivery
placenta previa, dystocia, breech, prior c/s (for the most part), uterine rupture
What does ERT do to thyroid hormones?
more hepatic metabolism of them, more TBG, more volume of distrib of thyroid hormones

so you need to give more L-thyroxine in a ERT pt, just like in pregnancy
Raloxifene - what it does, contraindications?
used to prev osteopor bc it increases bone mineral density. decreases risk of breast CA

it is thrombophilic - contraind with DVT

breast and endometrial antagonist, bone agonist
tamoxifen increases risk of...
endometrial CA
w/u of amenorrhea in premenopausal pt
1. preg test
2. prolactin and thyroid
3. estrogen status via progestin challenge
Asherman's syndrome
after procedures, lots of scarring and the endometrium fails to respond to estrogen, infertility, etc
How PCOS affects HPA axis
abnormal gnrh secretion so lots of lh (which stimulates androgens) and not much FSH
mucus during ovulation
abundant, thin, stretches, ferns on microscopic slide
normal amniotic fluid index
5-25
when to do internal podalic version
twins - to convert the second baby from transverse or oblique to breech
OCPs in postpartum pt?
Don't use combined bc the estrogen can affect breast milk production
Pt has placenta previa and is stable - next course of action?
SCHEDULED c section with autologous blood available and close monitoring - but don't send them home
Vagismus what is it and tx?
very tight perineal muscles - can't have intercourse

tx - kegels, pelvic relaxation, inserting dilators or fingers
what causes symmetric vs. asymmetric fetal growth restriction?
symm - congenital or chromosomal abnormalities or TORCH infections - things before week 28

asymm - HTN, toxins, smoking, etc. shunts blood to important organs (e.g. head)
pH of amniotic fluid
7 - 7.5
pH of vagina
3.8 - 4.5
4 test results in aneuploidy
estriol - down
inhibin a - up
hcg - up
AFP - down

***up top HI five***
MCC increased AFP
inaccurate dates
in addition to AFP, what else is elevated with neural tube defects?
acetylcholinesterase
what to do with pregnant mom who has HIV
zidovudine to mom during preg and to neonate after birth

do an elective c section
do OCPs cause weight gain?
no
most reliable measurement on US of fetal weight
abdominal circ - affected by symm and asymm fetal growth restriction
autoimmunity or immunodef associated with premature ovarian failure?
autoimmunity
placenta accreta - what is it? who is at risk? what surgery might they need?
placenta abnormally implants too far in uterine wall - common in pts who had c section in the past - they often need hysterectomy to stop the bleeding
uWISE - 18 y.o. with ASCUS and concerning hx - next step?
hpv typing - if highly oncogenic, get colpo
Findings in trichomoniasis
erythematous cervix, yellow d/c
cadidiasis in vagina - color of d/c?
white and cottage cheese
Justice - ?
treat all cases alike
Contraception options with <1% failure rate
dop provera, iud, sterilization, implanon
which immun contraind in pregnancy
mmr, vz
when start screening for breast ca
never earlier than 40
does RR change during preg?
NO!!!! but tidal volume does
plasma osmolality is increased or decreased in preg?
decreased
issue with using terbutaline (beta 2 agonist) or alpha agonist to stop uterine contractions?
increased risk of pulmonary edema
next step after diagnosing gestational trophoblastic disease
CXR (lungs are the most common site of metastases)
Congen dzs Jewish are more likely to have
Fanconi anemia, Tay-Sach's, Niemann-Pick, CF
serum marker that distinguishes quad screen from triple
inhibin a
pt has gestational DM - tx?
try diet modificationbefore insulin
is IUGR associated with gestational DM?
no, but it is with pre-existing DM
valproic acid - main AE to think about...
neural tube defects
obese woman - how much wt to gain in preg?
11-20 pounds
if you place an intrauterina pressure catheter and you get blood - next step?
assume you perforated the uterus. check the baby's status - if ok, you can put in the monitor
with use of mg sulfate in mother, what do you worry abt in child?
respiratory distress after birth
MCC post-partum fever
endometritis - espec after a c section
Time frame for PP blues
2 weeks - if greater, it may be PP depression

also with PP depression, pt may not care abt the newborn
is cmplicated labor and deliv a RF for PP depression
no
mother is brestfeeding a baby and she develops very sensitive nipples with feeding, burning pain in breasts. tips of nips are pink and shiny and are peeling at the periph - dx?
candidiasis - inspect baby's oral cavity.
pt is hemodynamically unstable and has an abortion - how to get rid of fetus?
d&c - can only do misoprostol or expectant waiting if hemodyn stable
when to place cervical cerclage?
14 weeks
can you give metro during preg?
yes
ot with pulm htn - good prognosis during preg?
no - very dangerous - 25-50% mortality
pregnant woman has intermitt chest pain, palpitations; normal ekg - tx?
beta blockers for her MV prolapse
can get cxr in preg pt?
yes
how to relieve ureteral obstruction in pregnant pt
double j ureteral stent
how to tx severe lupus in pregnancy?
steroids

if mild, nsaids
which ssri contraind in pregnancy?
paroxetine
Tx of pruritis gravidarum (variant of intrahepatic cholestasis of pregnancy)
1.) antihistamines
2.) ursodeoxycholic acid
how to workup appendicitis in a pregnant pt
graded compression ultrasound
hypermagnesemia - common side effect
resp depression
pt has severe pre-eclampsia - platelet level < ___ makes you need to dewliver now?
100k

also deliver if oliguria, harm to fetus, can't control bp with two meds, lfts > 2x normal
goal diastolic bp in a pt with severe preeclamp
90-100
Test to determine whether there is fetal anemia
middle cerebral artery peak systolic velocity
Baby is affected by Rh disease and is getting poor hepatic protein production - what will you see on US?
fetal hydrops - fluid in body cavities
delta OD450 measurement of amniotic fluid sample - what does it test for?
bilirubin - looking for hemolysis
what to do if baby is having severe hemolytic anemia but at 30 weeks
intraperitoneal transfusion into umb vein until mature
are congenital anomalies more common in twins?
yes
what kind of twins can get twin-twin transfusion syndrome?
monochorionic, monozygotic
biggest issue with multiple gestations
preterm birth
things you can use to dilate a cervix before giving oxytocin
misoprostol or PGE2
things associated with breech presentation

which kind of hydramnios?
prematurity, multiple pregs, genetic disorders, polyhydramnios, hydrocephaly, anencephaly, previa, uterine fibroids
what is a prolonged latent phase?
before 4cm dilated - >20h if nulliparous and >14 ifmultiparous
what is prolonged active phase?
after 4cm dilated and no change in over 2h - tx with amniotomy
t/f? the more c sections in the past, the higher risk during vbac
true
risk factors for placenta accreta
low, anterior placenta and previous c sections
can bloody show/mucus plug cause bleeding for a while?
yes - e.g. 30 min
threatened abortion - can have it in 2nd or 3rd trimester?
no - only first
definition of preterm labor
regular uterine contractions LEADING TO CERVICAL CHANGE!!!
terbutaline and ritodrine - class of drug and purpose?
beta2 agonist - stop premature contractions
mg sulfate - contraind with what condition?
myasthenia gravis
side effects of mg sulfate
LOSS OF DEEP TENDON REFLEXES, resp depression, cardiac depression - things are less active
benefits of betamethasone for the baby
lung maturity, less incidence of intracerebral hemorrhage and necrotizing enterocolitis in the newborn.
best part of fetal fibronectin test -
great negative predictive value - if negative, the mom will almost definitely not deliver in the next 14 days.
cutoff for when you can give indomethacin
only before 32 weeks
biggest risk factor for PROM
genital tract infections - especially BV
what can give you 7 days of latency prolongation in a pt who had PROM
antibiotics
tender fundus is a sign of...
chorioamnionitis - probably want to deliver if you see it.
what does positive phosphatidylglycerol mean?
fetal lung maturity is there - can assume it is positive at 34 weeks.
what is better marker in amniotic fluid of infxn - low glucose or presence of leukocytes?
low glucose
what to do when you first see late decels and mom seems ok
move her to left lateral decubitus
is chorioamnionitis a risk factor for uterine atony?
yes - so is big uterus,general anes, prolonged labor
what is an agent that increases uterine contractions but is contraindicated in pts with HTN/preeclampsia
methylergonovine
definition of post partum hemorrhage
>500cc vaginal or 1L c section
first steps in management of PP hemorrhage
make sure uterus is firm, no retained placental tissue, look for lacerations
risk factors for retained placenta
prior section, fibroids, previous curettage of uterus, and succenturiate lobe of placenta.
IM - never IV!!!
how to administer PGF2 or methylergonovine
which artery can you ligate before you try hysterectomy in a pt with PPH
hypogastric (internal iliac)
can breast engorgement cause fever?
yes
can you take sertraline during preg?
no
does sertraline get in teh breast milk?
yes - but not in the baby
when in the cycle does premenstrual dysphoric disorder happen?
luteal phase - towards the end of it
things associated with postterm pregnancy
placental sulfatase deficiency, fetal adrenal hypoplasia, anencephaly
postterm preg associated with polyhydramnios or oligo?
oligo
when to do amnioinfusion?
not if there is meconium stained fluid, but rather if you see repetitive variable accelerations
tests to order when baby stops growing (3)
NST, amniotic fluid volume (bad if it is low), and systolic to diastolic umb artery pressures (bad if it is high - means lots of PVR in the baby)
is polycythemia associated with IUGR?
yes
IUGR is a risk factor for the baby developing...
CVDisease, chronic htn, copd, diabetes
is poorly controlled pre-existing DM a risk factor for congenital anomalies?
yes - but gestational DM is not.
boundaries of laceratsions - 1st to 4th
1 - vaginal mucosa
2 - vaginal fascia and perineum
3 - rectal partial or complete transection of the rectal sphincter
4 - sphincters and mucosa.
definition of macrosomia
>4kg in diabetic and >4.5kg in non-diabetic
complications more likely to happentwith vacuum delivery vs. forceps
cephalohematoma (scalp dislocates off head), jaundice, lateral rectus paralysis.
when does irreg bleeding end after depo?
2-3 months
female sterilization is associated with reduced risk of...
ovarian cancer - not sure why
contraceptive patch - estrogen or progestin?
ethinyl estradiol and norelgestromin - so both
prolonged dilute russel viper venom - what does that mean?
antiphospholipid antibody syndrome - tx is asa and heparin
what has more blood loss - surgical elective termination or medical?
medical
when to do d&c vs. d&e
<16wks - d&c
16-24 weeks - d and evac
how late can you do manual vacuum aspiration
<8wks
lichen sclerosis - signs/sx
polygonal ivory papules or figure of 8

vulvar pruritis

fissures/erosions

itch-scratch-itch cycle

introital stenosis
lichen planus - signs/sx
involves more than the vagina

remissions and flares

can involve the vaginal canal (contrast to sclerosis) - more than the introitus
tx of vulvar vestibulitis
tricyclic antidepressants, pelvic floor rehab, topic anesthesia
lichen simplex chronicus
chronic scratching/rubbing - often pruritis is worse at night
abx to tx chlamydia? gonorrohea?
c - azithro or doxy
g - ceftriaxone
recurrent genital herpes infxn - more likely hsv1 or 2?
2
bladder contracts while filling - what sort of incontinence?
urge
pt has urethral sphincteric deficiency - tx options?
urethral bulking is first, do an artificial sphincter last line.
colpocleisis - what is it?
procedure where the vagina is surgically obliterated but you can do it under local. good for vaginal/uterine prolapse
post menopausal pt has ovarian mass - next step?
exploratory surgery
tx ovarian torsion?
surgery
tx of infertility caused by endometriosis
1.) clomiphene +/- IUI
2.) laparoscopy to remove lesions
young pt has history concerning of endometriosis - failed nsaids and ocps - next step?
laparoscopy

don't do gnrh agonist until you confirm the dx of endometriosis
clomiphene mech of action
estrogen antag at pituitary so there is no negative feedback
what is pelvic congestion?
chronic pelvic pain due to pelvic varicosities
mech of action of danazol in treating endometriosis
testosterone deriv - suppresses lh and fsh mid cycle surges so no estrogen release
best way to measure prolactin?
fasting - and touching the breast can elevate the level
___can increase pain during cyclic mastalgia due to fibrocystic breast changes
caffeine
if breast mass has bloody discharge, next step?
excision biopsy!!!
abx for mastitis
1.) dicloxacillin
2.) erythromycin if they are pen allergic
if you do FNA of a breast mass and it comes up negative, next step?
excisional biopsy - FNA often can have false negatives
what is adrenarche?
hair growth
3 things that can delay puberty
low weight, poor sleep, little sunlight exposure
what happens if you have partial deletion of the long arm of chrom x?
premature ovarian failure
how to tx precocious puberty
gnrh agonist - only treat if they are pretty far from "normal"

e.g. 8 year old - treat
normal age for menarche
9-17
tx of congenital adrenal hyperplasia
steroid replacement
mullerian agenesis - signs/sx
absent uterus and cervix, primary amenorrhea, XX karyotype, RENAL ANOMALIES!!!

therefore the test to confirm is a renal ultrasound
with anorexia - what happens to levels of gonadotropins
hpa dysfunction so low fsh and lh
pt has amenorrhea after stopping ocps - what part of history is important?
cycles before ocps - she may have post-pill amenorrhea if they were irregular before then.
does CAH cause hirsutism?
yes
high estrogen level withdrawal after preg can lead to what cosmetic issue?
hair loss
sertoli-leydig cell tumors - where are they found?
can be found on an ovary
what is hyperthecosis?
a more severe form of PCOS
long term side effect of leuprolide
osteoporosis - so don't use it over 6 months
what is dysfunctional uterine bleeding?
irreg/increased menstrual bleeding without a clear etiology
how do OCPs relieve primary dysmenorrhea?
progestin sheds the endometrium, and that is what makes prostaglandins
steps in treatment of dysmenorrhea in a yonug pt
ibuprofen
ocps
depo
laparoscopy looking for endometriosis or gnrh agonist
first line medical tx for adenomyosis
gonadotropin releasing agents
can you tx osteoporosis without a dexa scan?
yes - e.g. had a pathologic fracture
raloxifene - will it improve hot flashes?
no - may actually worsen them
what does HRT do for serum lipids?
good things - less LDLs, more HDLs
test of choice to eval for mets after early detection of endometrial ca
cxr
AE of imipramine
hyperprolactinemia
how can you confirm exercise induced amenorrhea
check estrogen levels (should be low)
use of clomiphene challenge test
to determine ovarian reserve - good if old lady isn't fertile
deficiencies of what vitamins can increase PMS?
A, E, B6
whic is worse, PMS is PMDD?
pms = premenstrual syndrome
pmdd = premenstrual dysphoric disorder - this one is worse
tx of pms
OCPs (suppresses the HPA axis)
risk factors for PMS
vit A, E, b6, calcium or mg deficiency. fam hx. other mood disorders. increasing age
risk factors for molar pregnancies
asian, <20 or >40, low folic acid or beta carotene intake
best test to rule out molar preg
quant hcg
treatment of a molar preg
suction curettage
describe a partial mlar preg?
69XXY - fetus is present in there and lower risk of developing post-molar GTD

partial - fetus is there - it's not all molar
how quickly can you get pregnant again after a molar preg?
6 months after hcg reaches 0 - should take ocps in the meantime - you don't want to confuse a new pregnancy with a recurrence of teh molar
how to treat recurrent trophoblastic disease
chemotherapy
should you biopsy a lesions suspicious for metastatic choriocarcinoma?
no - very vascular. just get quant hcg instead
vulvar intraepithelial neoplasia is associated with what virus?
hpv
what is trichloroacetic acid used for?
warts (note - not VIN!!!)
paget's disease of the vulva - what does it look like? any risk factors?
fiery red background with bague white hyperkeratotic areas

assoc with breast ca
how often to do paps in woman with hiv
twice in the first year - if normal, annual after that
what is an ectropion
typically with cervix - area of columnar epithelium that has not yet undergone squamous metaplasia
what do you do if there is a lesion extending into endocervical canal?
bx with cold knife cone
if there is huge difference btwn pap smear results and bx results - next step?
cervical conization - need to be aggressive
when is cervical conization indicated?
cervical bx shows severe dysplasia, CIS, or a positive endocervical curettage
main sx associated with fibroids
menorrhagia
how to tx fibroids symptomatically?
gnrh agonists can be good bc the fibroid is estrogen responsive - so this is useful in a pt who is going to get surgery soon or will have menopause soon

6 months max

can always try nsaids first, too
what to do for an infertile pt who has fibroids
myomectomy
risk factors for ovarian ca
family, white, more periods in lifetime

NOT SMOKING!!!
do ocps reduce risk of ovarian ca?
yes
which is typically bigger - serous cystadenoma or functional cyst?
serous cystadenoma - pt may have increasing abdominal girth
serous cystadenoma or mucinous - which tend to be multilocular?
mucous
difference btwn stage and grade
stage - most important for ovarian ca -

grade - histology
standard of care - after you resect an ovarian cancer, next step?
chemotherapy - even if you got all of it
most common tumor in women of all ages
dermoid - on ultrasound there will be cystic and solid components
use of oral progesterone in a postmenopausal pt
decrease hot flashes
young girl is on abx and now has linear abrasions on her vulva - dx?
yeast infection - give antifungals
course of action when you have an adult rape victim
offer abx prophylaxis, screen for STDs, offer emergency contraception, colect forensic specimens, preg test
shockwave lithotripsy - ok in pregnancy?>
NO!!!
McCune-Albright syndrome - what is their puberty like?
early - gonadotropin independent
test to get ifg you are suspecting gestational trophoblastic disease
quant hcg
adequate cervical length?
>25mm at 24 weeks
prolacting suppresses ___
gnrh
Tx of DUB
mild - iron
mod with no active bleeding - progestin
mod with active bleeding - estrogen
severe and unstable - D&C and transfusion
mcc DUB
anovulation - it is a diagnosis of exclusion
tx of postpartum endometritis
gent and clinda - polymicrobial
when in menstrual period should a benign breast lump go aaway?
after the period is over
mech of action of epidural causing hypotension
sympathetic fiber block --> vasodilation --> blood pooling in veins - especially in lower extremities

no cns involvement - all peripheral
tx of mag sulfate overdose
stop the mg sulfate and calcium gluconate
anesthesia can prolong labor if given in the ____ stage
latent
endometritis - more3 common after vaginal deliv or c section?
c section
steps when thinking of arrest of labor
membranes ruptured?
give ptocin - adeequate contractions via IUPC?
terbutaline and ritodrine contracindicated in pts with...
diabetes