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64 Cards in this Set
- Front
- Back
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MCC preventable infertility in the US?
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PID
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"Most likely cause of infertility in a normally menstruating woman below the age of 30? Above the age of 30, if it is not the answer to the previous question?"
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1. PID 2. Endometriosis
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What symptoms are necessary to diagnose PID?
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"1. Abdominal Pain 2. Adnexal Tenderness 3. Cervical motion tenderness 4. One of the following: Elevated ESR/CRP, Leukocytosis, fever, purulent cervical discharge"
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How do you treat PID?
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1. Outpatient: Cefoxitin/Ceftriaxone + Doxycycline 2. Inpatient: Clindamycin + Gentamycin
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What are the most common organisms you have to cover for when treating PID?
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"Gonorrhea, Chlamydia"
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What causal organism do you have to consider in PID when a patient has a history of an IUD?
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Actinomyces israelii
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What are the signs and symptoms of endometriosis?
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1. Dysmenorrhea (painful menstruation) 2. Dyspareunia (painful intercourse) 3. Dyschezia (painful defecation) 4. Perimenstrual spotting
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How do you treat endometriosis?
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1. Birth control pills 2. Danazol and GnRH agonists 3. Surgery & Cautery 4. In older patients: Hysterectomy & Bilateral salpingoopherectomy
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Candida: Findings and treatment
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"1. Findings: ""cottage cheese,"" pseudohyphae on KOH prep, Hx diabetes, antibiotic treatment, pregnancy. 2. Treatment: Topical or oral antifungal"
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Trichomonas vaginalis: Findings and treatment
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"1. Findings: Bugs swimming under microscope, pale green, frothy, watery, discharge, ""Strawberry cervix"" 2. Treatment: Metronidazole"
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Gardnerella vaginalis: Findings and treatment
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"1. Findings: Malodorous discharge, fishy smell on KOH prep, clue cells 2. Treatment: Metronidazole"
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HPV: Findings and treatment
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"1. Findings: Venereal warts, koilocytosis in PAP smear 2. Treatment: Acid therapy, cryotherapy, laser therapy, podophyllin"
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Herpes virus: Findings and treatment
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"1. Findings: Multiple shallowl, painful ulcers, recurrence and resolution 2. Treatment: Acyclovir"
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Syphilis (stage 1): Findings and treatment
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"1. Findings: Painless chancre, spirochete on dark-field microscopy 2. Treatment: Penicillin"
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Syphilis (stage 2): Findings and treatment
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"1. Findings: Condyloma lata, maculopapular rash on palms, serology is positive at this point. 2. Treatment: Penicillin"
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Chlamydia trachomatis: Findings and treatment
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"1. Findings: Most common STD, dysuria, positive culture and antibody tests 2. Treatment: Doxycycline or azithromycin"
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Neiserria gonorrhea: Findings and treatment
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1. Findings: Muculopurulent cervicitis; gram negative bug on Gram-stain 2. Treatment: Ceftriaxone or fluoroquinolone
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Molluscum contagiosum: Findings and treatment
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"1. Findings: Characteristic appearance of lesions, intracellular inclusions 2. Treatment: Curette, cryotherapy, electrocauterization/coagulation"
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Pediculosis: Findings and treatment
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"1. Findings: ""Crabs,"" look for itching, lice can be seen on pubic hairs 2. Treatment: Permethrin cream (or lindane)"
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What do you need to treat for if you suspect a patient has gonorrhea?
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"You need to treat for gonorrhea, with Ceftriaxone or fluoroquinolone. You also need to treat for presumed chlamydial infection, with doxycycline or azithromycin."
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What do you need to treat for if you suspect a patient has chlamydia?
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"You need to treat for chlamydia, with doxycycline or azithromycin."
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How do you treat chlamydia in pregnancy?
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"Instead of doxycycline or azithromycin, use erythromycin."
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"In a patient over 40, with dysmehorrhea, metrorrhagia, and a large, boggy uterus on physical exam: 1. What do you suspect? 2. How do you diagnose? 3. How do you treat?"
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"1. You suspect Adenomyosis 2. Diagnose with dilation and curettage to rule out endometrial cancer 3. Treat with hysterectomy, or GnRH agonists to relieve symptoms"
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What is the relationship between leiomyomas and hormones?
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"Leiomyomas are estrogen-dependent. Rapid growth occurs during pregnancy or use of oral contraceptive pills, while regression occurs after menopause."
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What is the management of dysfunctional uterine bleeding after the age of 35?
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1. D&C to r/o endometrial cancer 2. Hemoglobin & Hematocrit (or CBC) to make sure that the patient is not anemic from excessive blood loss.
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What is the most common nonphysiologic cause of dysfunctional uterine bleeding?
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Polycystic ovarian syndrome
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How do you treat polycystic ovarian syndrome?
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Oral contraceptive pills or cyclic progesterone
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What is the sequence of steps in evaluating infertility?
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"1. History and physical exam 2. Semen analysis: (>1ml, >20million/ml, >50% moving forwards, >60% normal morphology) 3. Documentation of ovulation (check basal body temperature, luteal phase progesterone levels, endometrial biopsy) 4. Hysterosalpingogram 5. Laparoscopy (last resort)"
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What medications are used to restore female fertility?
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1. Clomiphene citrate (ovulation induction in a woman with adequate estrogen) 2. Human menopausal gonadotropin (combination of FSH and LH to induce ovulation in a woman who is hypoestrogenic) 3. If medications fail: use IVF
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What are the causes of secondary amenorrhea?
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"PCOS, anorexia, endocrine disorder (think of a pituitary tumor in a woman with headaches, galactorrhea, and visual field defects), antipsychotics (due to increased prolactin), previous chemotherapy (which causes premature ovarian failure and menopause), and menopause."
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What is the pathophysiology of exercise-induced amenorrhea?
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Exercise-induced depression of GnRH.
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What is required to make a diagnosis of anorexia?
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Amenorrhea
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How do you evaluate the cause of secondary amenorrhea? (If SUFFicient estrogen)
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"1. Rule out pregnancy (check hCG) 2. Do H & P to look for obvious causes 3. Administer progesterone to assess the patient's estrogen status. If vaginal bleeding develops within 2 weeks, the patient has sufficient estrogen. Check LH. If high, consider PCOS. If low or normal, check prolactin and TSH levels. High TSH levels in hypothyroidism cause high prolactin levels. If the prolactin is high with a normal TSH level, order an MR scan of the brain to rule out pituitary prolactinoma. If prolactin is normal, then look for low levels of GnRH, which may be induced by drugs, stress, or exercise. In these patients, clomiphene may be used to facilitate pregnancy."
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How do you evaluate the cause of secondary amenorrhea? (If INSUFFicient estrogen)
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"1. Rule out pregnancy (check hCG) 2. Do H & P 3. Administer progesterone. If no bleeding: estrogen levels are inadequate. 4. Check FSH. If elevated, premature ovarian failure is the problem, check for autoimmune disorders, karyotype abnormalities, history of chemotherapy. If FSH is low or normal, problem may be a brain tumor (craniopharyngioma). Order an MR of the brain."
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When do you suspect primary amenorrhea?
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"If no menstruation by the age of 16, no secondary sexual characteristics by age 14, or no menstruation within 2 years of secondary sex characteristics."
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What is the algorhythm for diagnosing the cause of amenorrhea?
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"1. Pregnancy test 2. If negative, administer progesterone 3. Evaluate if bleeding or no bleeding 4. With symptoms of hypothyroidism or pituitary tumor, order TSH and/or prolactin"
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What medications can cause nipple discharge?
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"OCPs, hormone therapies, antipsychotics, hypothyroidism symptoms."
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"How do you evaluate bilateral, non-bloody nipple discharge?"
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1. Check prolactin level to evaluate prolactinoma 2. Check TSH to evaluate for endocrine disorder
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"How do you evaluate unilateral, bloody nipple discharge?"
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1. Biopsy if any mass is present.
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What are the characteristics of fibrocystic disease? What is the management?
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"1. Bilateral, multiple, cystic lesions tender to the touch. 2. OCPs, progesterone or danazol to relieve symptoms."
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What are the characteristics of a fibroadenoma? What is the management?
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"1. Painless, discrete, sharply circumscribed, unilateral, rubbery, mobile mass. 2. Observe, pregnancy and OCPs may stimulate growth, since these are hormone-dependent. Excision for cosmetic reasons."
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What are the characteristics of mastitis/abscess? What is the management?
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"1. Swollen, erythematous breasts postpartum. 2. Treat with analgesics, continue to breastfeed, if severe symptoms, give antistaphylococcal antibiotics (Cephalexin, dicloxacillin). If fluctuant mass develops, or no response to antibiotics, mass is likely present and must be drained."
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What is the main sign of fat necrosis in the breast?
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History of trauma in the area of the mass.
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How do you diagnose a breast lesion in women <30?
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"Ultrasound or biopsy. Do not to mammography, because breast tissue is too dense to discern a mass."
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Causes and symptoms of a cystocele
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"Bladder bulges into upper anterior vaginal wall. Symptoms include urinary urgency, frequency, and/or incontinence."
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Causes and symptoms of a rectocele
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Rectum bulges into the lower posterior vaginal wall. Watch for difficulty with defecation.
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Causes of an enterocele
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Loops of bowel bulge into the upper posterior vaginal wall.
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Causes and symptoms of a urethrocele.
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"Urethra bulges into the lower anterior vaginal wall. Common symptoms include urinary urgency, frequency and/or incontinence."
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What are the risks of an IUD?
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Increased risk of ectopic pregnancy and PID (Actinomyces!!!)
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What is the classic cause of ambiguous genitalia on step 2?
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Adrenogenital syndrome (congenital adrenal hyperplasia). 90% caused by 21-hydroxylase deficiency.
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What are the symptoms of 21-hydroxylase deficiency? Treatment?
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"Females: ambiguous genitalia Males: Precocious sexual development, salt-wasting, hyperkalemia, hypotension, elevated 17-hydroxyprogesterone. Treatment: Treat with steroids, IV fluids to prevent death."
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"MCC ""bunch of grapes"" protruding from a pediatric vagina?"
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"Sarcoma botryoides, a malignant tumor"
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"How do you diagnose precocious puberty in males and females, and how do you treat and why?"
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"1. Girls <8 years old, Boys <9 years old. 2. If idiopathic, treat with GnRH analog until age is appropriate. 3. Prevent premature epiphysial closure. "
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What causes vaginitis or discharge in prepubescent girls?
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"Vaginal foreign body, sexual abuse, candida (R/O diabetes!)"
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What is the cause of vaginal bleeding in neonates?
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"Physiologic, due to maternal estrogen withdrawal. No treatment required."
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What are the benefits of estrogen therapy?
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"1. Decreased osteoporosis and fractures (hip!) 2. Decreased coronary heard disease, because estrogen increases HDL 3. Reduced hot flashes, genitourinary symptoms of menopause (dryness, urgency, atrophy-induced incontinence, frequency)"
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What are the risks of estrogen therapy?
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1. Increased risk of endometrial cancer 2. Increased risk of venous thromboembolism 3. Possible increased risk of breast cancer 4. Increased risk of gallbladder disease
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What are the side effects of estrogen therapy?
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1. Endometrial bleeding 2. Breast tenderness 3. Nausea 4. Bloating 5. Headaches
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What are the absolute contraindications to estrogen therapy?
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1. Unexplained vaginal bleeding 2. Active liver disease 3. History of thrombophlebitis or thromboembolism 4. History of endometrial or breast cancer
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What are the relative contraindications to estrogen therapy?
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1. Known seizure disorder 2. HTN 3. Uterine leiomyomas 4. Familial hyperlipidemia 5. Migraines 6. Thrombophlebitis 7. Endometriosis 8. Gallbladder disease
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What are the absolute contraindications to OCP use?
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"1. Smoking after age 35 2. Pregnancy 3. Breast feeding 4. Active liver disease 5. Hyperlipidemia 6. Uncontrolled HTN 7. DM with vascular changes 8. Prolonged immobilization of an extremity 9. History of thromboembolism or thrombophlebitis 10. CAD 11. History of stroke, sickle cell, estrogen dependent neoplasm (breast, endometrial,), liver adenoma, cholestatic jaundice of pregnancy"
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OCPs and surgery
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"Need to stop OCPs one month before elective surgery, restart 1 month after."
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Side effects of OCPs
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"Glucose intolerance, depression, edema, weight gain, cholelithiasis, benign liver adenomas, melasma, nausea, vomiting, headache, hypertension, drug interactions."
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Relationship between OCPs and ovarian and endometrial cancer?
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"OCPs reduce the incidence of ovarian cancer by 50%, also decrease incidence of endometrial cancer."
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