GYN

Question 1

2hr GTT

What are the dia criteria for DM?

Answer 1

Fasting:

• Normal is <100
• 100-125 is c/w Pre DM
• >=126 DM

2hr

>=200 is DM

140-199 PreDM

Question 2

1. The coccygeous muslce overlies the SSL and is a component of the lev ani muscle. T or F
2. Components of the levator ani
3. in a transobturator sling, what muscles are passed?
4. Origin of Inf and superior epigastric arteries.

Answer 2

1. True, but not a part of the lev ani
2. Puborectalis, pubococcugeons, ilieo coccygeous
3. photo
4. They include the superior epigastric artery and the musculophrenic artery, both originating from the internal thoracic artery, and the inferior epigastric artery and the deep circumflex iliac artery, both originating from the external iliac arteries.

Question 3

How do you manage anticoagulated patients preoperatively?

Answer 3

Question 4

1. AGC on PAP
2. Atypical Endometrial cells on PAP
3. You did the work up for AGC and it was all negative. What do you do now?
4. What if they has specified AGC favor neoplasia and the results were all normal?

Answer 4

1. Colpo, Ecc, Ebx if >=35 or risk factors
2. Ecc + EBx (if normal, then do a colpo…start with looking at the most obvious glandular source)
3. If no CIN2+, AIS, or CA -> cotest @1 and 2 yrs
4. Excise

Question 5

1. What do you do if AIS on cytology?
2. What do you do if AIS on biopsy?
3. What do you do after CKC if margins positive?
4. What do you do after CKC if margins negative?
5. After a hyst, what is the follow-up?
6. How does this all chage for fertility preservation?

Answer 5

1. Colpo, ECC, Ebx if >35yo or risks!
2. Everyone gets a cone!
3. If margins positive, you re-excise even if a hyst is planned to rule out cervical CA.
4. If margins negative, proceed to hysterectomy.
5. HPV based test q1yr x3, then q3yr x25 yrs
6. Once negative margins obtained, cotest + ECC q6m x3 years, then annually x2yrs. Hyst when done childbearing.

Question 6

1. What do you do after HSIL is confirmed on biopsy?
2. What is the follow up if negative margins?
3. What if positive margins?

Answer 6

1. Excisional procedure.
2. Negative margins: HPV based test at 6 months, if neg HPV based test annually x3 yrs, then Q3y X 25 years
3. Repeat excision, or colpo + ECC @ 6 months

Question 7

1. How do you manage a young woman with CIN3?
2. How do you manage CIN2 in <25?
3. >=25 + fertility desired?
4. Lets say <25yrs…what do we do and at what interval?
5. How about >25yrs and desiring fertility?
6. If results remain abnormal for __yrs, excision.

Answer 7

1. TREAT!
2. OBS is preferred if less than 25 years.
3. If >25 and fertility desired, OBS is acceptable.
4. Colpo + cyto @ 6m and 12m
5. Colpo + HPV based test @ 6m and 12 m
6. 2yr of persistent CIN2, RX!

Question 9

1. How do we screen HIV patients?
2. 2019 ACS screening?
3. When do we DC screening?
4. What is the screening following a hyst for cervical disease (CIN2-3 / AIS)?

Answer 9

1. Start w/in 1 year of sexual activ ity, latest 21yo, 3 in a row, then space q3yrs, can use HPV at 30 but never spaces > 3yrs
2. <25yo no screening; 25-65 1ty HPV Q5 preferred, cotest q5 and cyto alone q3 also acceptable
3. >65 if prior adequate screen if >=25 yrs from CIN2 or greater (this includes AIS)
4. HPV based test q1yr x3, then q3yr x25 yrs
5. t

Question 10

ASCCP Unsatisfactory Cyto:

1. What generally guides management?
2. HPV neg…
3. HPV +…unk genotype and >25
4. HPV+..16/18

Answer 10

1. HPV status
2. Repeat in 2-4m, colpo if unsatisfactory again
3. Colpo
4. Colpo

Question 11

CIN3 risk is used as the benchmark for the ASCCP 2019 quidelines.

1. At what threshhold and above is colpo recommnended?
2. At what threshhold can you treat expideted or colpo?
3. How about expedited Rx?`

Answer 11

1. >=4%
2. 25-59
3. 60-100%

Question 12

Athlete Triad

1. Definition
2. 1st line Rx

Answer 12

1. Menstrual dysf, low energy availability, and low BMD
2. Corretion of the energy imbalance, ok to supp Ca/D, no OCP or bisphosphos or E

BUT, if evidence of dec bone density, could use Patch low doese E + cyclic P (no OCP, no bisphos…ocps can mask menses, these lowe doses will not)

Question 13

Bartholin cyst in >40yo requires excision. T or F

Answer 13

True

Question 14

1. MOA of Ella.
2. Plan B Kg above which efficacy drops
3. T or F: highest risk of post sterilization regret is young age.
4. Patch has dec effacy after __kg.

Answer 14

1. SPRM; inhibits follic rupture
2. BMI >25 (165lb)
3. T
4. 90kg

Question 15

Bladder Injury

1. Non-trigonal injury <1cm
2. Non-trigonal injury >1cm
3. Trigonal injury

Answer 15

1. Expectant management (foley 1 week)
2. Primary repair (foley for 1-2 weeks)
   
   • Running non-locked x1
   • Embricating x1
   • Retrograde fill w/ 300cc (vs cysto)
   • Foley 2 weeks
   • Plain vs CT urogram

Question 16

1. How to treat intraductal papilloma?
2. What is the appearance of ductal ectasia?
3. Pagets? Rx?
4. What is the algorithm for nipple discharge work-up? What characteristics warrant age-appropriate imaging immediately
5. T or F, in workup of discharge, always get an US, and a mmmo if >30 as well. T or F
6. Periductal mastitis is associated w/ what risk factor?
7. Inflammatory breast ca rx

Answer 16

1. Excise.Generally, intraductal papillomas are surgically excised when they are identified by core biopsy due to the risk of areas of ductal carcinoma in-situ or atypia within the lesion.
2. The discharge typically is very thick and sticky and either green or black in color but occasionally can become sero- sanguineous or bloody. Ductal ectasia is not associated with breast carcinoma, but the surrounding tissue may become fibrotic, causing a confusing palpable density.
3. Paget disease of the breast is an intraductal carcinoma, which presents as a scaly skin lesion similar to eczema appearing on the nipple and spreading to the areola. Ulceration can be present, and there may be a clear yellowish exudate with crusting. Breast conserving surgery with radiation, mastectomy
4. See photo.
5. t
6. smoking
7. mastectomy, axillary dissection, neoadjuvant chemotherapy, and radiation therapy. Lymph node involvement is present in the majority of cases, even in the absence of physical exam findings. This explains why axillary dissection is indicated as part of treatment, and sentinel lymph node biopsy is not appropriate.

Question 17

1. Fibrocystic breast dz:

How does it present? How to rx?

Answer 17

Patient will be a woman 30 – 50-years-old

Complaining of intermittent breast pain and tenderness that peak before each menstruation

Ultrasound would show dense, prominent, fibroglandular tissue with cysts but no discernable mass

Most commonly caused by fluctuating estrogen levels during menstrual cycles

Treatment is well-fitting supportive bras, applying heat to the breasts or over-the-counter pain relievers. NOT OCPS.

Comments: Most common lesion of the breast. Fibrocystic changes are generally benign and do not increase risk for breast cancer

Question 18

1. Mammo recs from ACOG
2. Clinical breast exam from ACOG

Answer 18

1. offer at 40, recommend at 50
2. Offer: Q yr at 40; Q1-3yr if 20-39

Question 19

1. ___therapy is the first-line treatment for patients with eating disorders.
2. Second-line RX: __.
3. Bupriprion is CI in patients with __ .

Answer 19

1. CBT
2. SSRI
3. Bulimia; + seuzires

Question 20

Calcium Recs if <50? >50?

Vid d recs <50? >50?

Answer 20

19-50: 1000mg; 600 D

51-70: 1200mg; 600 D

Question 21

1. 95% of cases of CAH are caused by ___ deficiency. This results in decreased levels of ___ & ___ and increased levels of ___.
2. There are two types, classic, and non-classic. How do we test for it?
3. Inheritance pattern?
4. How does a neonate present? How do we treat it?
5. What other enzyme def can casue virilization of a female?

Answer 21

1. 21a, aldost/cortisol, androgens
2. Use 17OP level, may need acth stim test
3. Autosomal recessive
4. hypotension, dec NA/gluc, inc K; vom, diarr, dec weight: FLUIDS, LYTES, STEROIDS
5. 21-alpha-hydroxylase, 11-beta-hydroxylase, or 3-beta-hydroxysteroid dehydrogenases. resulting overproduction of androgens

Remember than in a patient with PCOS, late onset adult CAH is in the differential! 17ohp FASTING, FOLLICULAR PHASE, MORNING). level is greater than 200 ng/dLand less than 800 ng/dL, further testing with a cosyntropin (ie, adrenocorticotropic hormone) stimulation test shouldbe performed. A baseline 17-OHP greater than 800 ng/dL confirms the diagnosis and further testing is not necessary.

Question 22

Rx for chancroid

Answer 22

azithro 1g

Or cftx 250mg

Isolation of the bacteria to confirm the disease is technically challenging and not always available, therefore, the diagnosis is primarily clinically made

Question 23

1. Chancroid geographic region
2. Causative organism?
3. Diagnosis (physical exam and lab)
4. Rx

5. Causative organism for LGV and geographic region.
6. Diagnosis (physical exam and lab).
7. RX

8. Causative organism for GI/donovanosis
9. Dx (physical exam and lab).
10. Rx

11. Of all ulcerative lesions, which does not have associated LAD?

Answer 23

1. Africa/Caribbean
2. H. Ducrey
3. Eryhtematous base with clear borders, grey exudate + unilateral LAD (suppurative); special culture or PCR; school of fish
4. Azithro 1g PO (or CFTX, or Cipro or Erythro

5. Chlamydia L1-L3; tropics and subtropics (africa, india)
6. Painless ulcer; + unilateral LAD (fibrosis + strictures); chlamidya serology + PCR
7. Doxy 3w

8. Kelbsiella
9. Painless ulcer, bleeds easily, NO LAD; donovan bodies on microscopy
10. Doxy 3wk

11. No LAD with GI

Question 24

Colon Cancer Screening Modalities

1. Colonoscopy @ age __ q __ yrs. Stop at __ yrs.
2. Flex sig q __ yrs.
3. Fecal Immunochemical Test (FIT)
4. FOBT
5. What if you are high risk…when do you start?
6. What if IBD?
7. IN WHI, the E/P arm showed dec rates of colon Ca. T or F
8. When do you start if 1st degree rel had cc?

Answer 24

1. Colonoscopy @ age 45/50 q 10 yrs - 75yrs old.
2. Flex sig q 5 yrs.
3. Fecal Immunochemical Test (FIT) q1 year.
4. FOBT (3 samples from 3 consec stools) q1year.
5. 10yr before index case, or age 40.
6. surveillance colonoscopy should be initiated 8 – 9 years after the onset of symptoms in individuals with a personal his- tory of inflammatory bowel disease and performed every 1–2 years thereafter.
7. T. No effect in the E arm alone .
8. at 40 or 10 yrs before dx

Question 25

1. Cushing syndrome has multiple etiologies. What are they? 2. What are the stigmata? 3. What tests can be used to dx?

Answer 25

1. Oversecretion of cortisol, which could be related to oversecretion of * **pituitary ACTH**, * **ectopic ACTH**, * **CRH from hypothalamus**, * **autonomous secretion by the adrenal gland.** 2. **​ see photo** 3. **24hr urinary cortisol**, overnight dex supp, late night saliv cortisol

Question 26

DVT PPx in GYN Surgery 1. Who gets no specific PPX + early mobilization? (LOW RISK) 2. What do Mod and High risk patients get? 3. At what point is heparin added to SCDs? (HIGH RISK)

Answer 26

1. Surg **\< 30'**, **\<40yo**, **no risk factors**. LOW RISK 2. SCDs **_or_** pharmacotherapy 3. **Majors** + **\>60** + **Prior VTE, cancer, or hypercoag state.** HIGH RISK

Question 27

EIN 1. What are the three classifications? 2. If EIN, what is the next step? 3. How do you treat BEH? 4. How do you treat EIN? What if desires future fertility? 5. Approximately \_\_% of patients who received a diagnosis of complex atypical hyperplasia were found to have concomitant carcinoma diagnosed on hysterectomy.

Answer 27

1. Benign endometrial hyperplasia, EIN, AdenoCA 2. If EIN, must D&C to rule out CA! 3. **Must treat BEH: prov, megace, aygestin, microg progest, IUD; EBX q3months!** 4. Surgery, must be ready to stage and have ONC on backup. 5. 40%

Question 28

Endo Rx: 1. MOA for Elagolix? SE? 2. Lupron MOA. SE? Addback when and with what? 3. Letrazone MOA. Add back when? 4. Laparoscopic ovarian cystectomy may be recommended for women with endometriomas larger than __ cm in diameter to improve fertility.

Answer 28

1. GNRH antagonist. 150mg QD. hot flushes, night sweats, beeding, HA, nausea, **suicidal ideation** 2. GNRH agonist. 3.75QM or 11.25 Q3m. Hot flushes, night sweats, moody, **bone loss**, HA, nausea. Add back reduces bone loss, usually start @ 6m with norethidrone 5mg or prov 2.5mg 3. 3cm

Question 29

1. Highest incidence CA. 2. Highest mortality. 3. **first acog visit at age**

Answer 29

1. Br 2. lung 3. **13-15 When you become a teen!**

Question 30

1. Dietary fiber daily amount recommended 2. 1st line rx for fecal incontinance (which meds) 3. Age is the most important risk factor fo fecal incontinence. What are others? 4. **\_\_\_is the STRONGEST risk factor for _urinary_ incontinence.**

Answer 30

1. 20-35mg 2. Loperamide/Immodium (FIRST), opiate that does not cross BBB Then consider Diphenoxylate (lamotil), opiate derivative that can be addictive and has **antichol SE** 4. **Obesity**

Question 31

1. What is the karyotype for CAIS, 5a reduct, Sweyer? 2. In **CAIS**, how is development of Wolfian and Mullerian structures affected, and how does this determine the phenotype? What do we do with the testes and why? T levels? 3. In 5a reductase def, whendo we remove the testicles? Why? 4. What is the molecular hallmark of Sweyer syndrome? What do we do with goads and when and why? 5. What two enzymatic def also present as femenized males? 6. Which condition is frequenlty confused with MRKH because of the lack of Mullerian structures? 7. You take the tested out right away except in? 8. What is a gonadoblastoma

Answer 31

**CAIS** * XY, X-linked recessive * SRY present: AMH leads to **mullerian duct degeneration**, testosterone is made but cannot bind, so no wolffian structures; DHT is made but also cannot bind, so female external genitalia. * Leave testes in place to allow for femenization. At puberty, T is made (**T --\> E (femenization)**), but no pubic hair development as no functional R. * Normal testes, normal breasts * **When _puberty complete_, remove testes** (dysgerm/gonodoblast risk) * Normal to high T **5a reductase** * XY -\> SRY -\> **No mullerian structures,** Wolffian duct develops, but no DHT to form external genitalia. * Raised as female, but masculinized at puberty. **Remove testes _before puberty_**! **Sweyer** * No SRY --\> all **mullerian structures develop** * No T --\> female ext genitalia * **_Streak gonads - \> Take them out ASAP_** * Sparce pubic hair from adrenal androgens * Raised as female * an individual with Swyer syndrome presents with delayed puberty, **no breast development**, and a +**uterus** and +**vagina** 5. 3Bhydroxysteroid, 17Bhydroxysteroid 6. CAIS 7. CAIS (leave so they femenize at puberty from aromatization of T) 8. Gonadoblastomas are benign or in situ germ cell ovarian neoplasms composed of germ cells and sex cord stroma that can develop into a dysgerminoma, which is malignant. Gonadoblastomas can also contain components of other types of germ cell malignancies, such as immature teratoma, yolk sac tumor, embryonal carcinoma, or choriocarcinoma.

Question 32

Vesico-Vaginal Fistula Management: 1. At what size cutoff can they be expectantly managed? Recto-Vaginal Fistula Management: 1. **How/when is it repaired?**

Answer 32

1. 1cm. Expectant. CBD 4-6 weeks. 2. early vs late repair; after repair and drainage, cystogram Recto-Vaginal Fistula Management: 1. **\<4mm obs** 2. **\>=5mm operate using a simple layered approach if no infection**

Question 33

Fragile X What is the premuation? **Inheritance pattern?** How do they Conceive?

Answer 33

FMR1 gene premutation (between 55 and 200 repeats), and the syndrome has an X-linked dominant inheritance pattern. IVF donnor egg

Question 34

Endoscopic evaluation with biopsies is warranted in the presence of alarm symptoms for GERD, such as?

Answer 34

(ie, dysphagia, bleeding, weight loss, anemia, recurrent vomiting) as well as for screening of patients at high risk of complications.

Question 35

1. What is the threshold for workup of assymptomatic low risk never smoking women aged 35-50: __ RBC/HPF. 2. What is the initial workup for bladder CA? 3. What are the strongest predictors of urologic cancer?

Answer 35

1. 25 2. Cysto + CT urography 3. being **older than 60 years, having a history of smoking, and having gross hematuria** are the strongest predictors of urologic cancer.

Question 36

How do the following Rx for hirsutism work? 1. OCP 2. Spiranolactone 3. Eflornithine 4. Fonasteride 5. Flutamide

Answer 36

1. SHBG inc (oral, no patch or ring), dec lh which dec androgens, inhibit skin 5a reduct 2. aldost antagonist (fem of male fetus); do not use if dec liver or kidney funct; R antagonist 3. irreversible inhibitor of the enzyme ornithine decarboxylase 4. 5s reduc inhi 5. androgen r blockade (hepatotox, dry skin)

Question 37

1. What two agents are approved for PREP? 2. What side effects is Truvada associated with? 3. What criteria must be met prior to initiation of PREP? 4. Postexposure prophylaxis for HIV exposure includes \_\_days of HAART therapy. 5. Prophylaxis should be initiated within __ hours of exposure to HIV. If this the case for all patients? 6. Following a sexual assault in a victim with no or unknown history of previous hepatitis B vaccinations, the hepatitis B vaccine **without HBIG should be given**. T or F. 7. All adults and adolescents age __ should be tested at least once for HIV Annually for anyone who has unsafe sex or shares injection drug equipment 8. Screening for HIV is done with a 4th gen immunoassay. Confirmatio is with \_\_.

Answer 37

1. Truvada (emtricitabine/tenofovir disoproxil fumarate) and Discovy (emtricitabine & tenofovir alafenamide). 2. Osteoporois and renal damage 3. Chart 4. 28 5. 72. Expectant management is inappropriate in high risk settings with high HIV prevelance. in certain geographical areas of the United States, expectant management could be entertained with repeat HIV at **6w, 3m, 6m.** 6. Following a sexual assault, STI prophylaxis against trichomoniasis, chlamydia, and gonorrhea should be provided to the patient. In patients who have not received hepatitis B vaccinations or in those with an unknown history of vaccination, the hepatitis B vaccine without HBIG should be administered. Following a clinical exam and patient history, prophylaxis against HIV may be provided to the patient as well. Currently, there are no recommendations on providing prophylaxis for hepatitis C to a sexual assault victim. 7. **15-64** 8. HIV1/2 differentiation assay.

Question 38

HSV Discordance 1. If patient has it and partner does not, who gets suppressed? Pt? Prtner? Both?

Answer 38

1. Patient only

Question 39

When are anti HTN agents indicated in stage 1 HTN?

Answer 39

**Antihypertensive medication is recommended for primary prevention of cardiovascular disease (CVD) (i.e., coronary heart disease, heart failure, and stroke) in patients with stage 1 hypertension (blood pressure 130–139/80–89 mm Hg) and an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of ≥ 10%.** These medications are also recommended for patients with stage 1 hypertension and a history of CVD, and all patients with stage 2 hypertension (blood pressure ≥ 140/90 mm Hg). Calcium channel blockers (**CCB**), like amlodipine, have been shown to be highly effective in lowering blood pressure and reducing the risk of stroke. In the general population, they lower the risk by 36% and, along with **thiazide diuretics, are the preferred choice for initial single-drug therapy for African American patients.**

Question 40

1. What meds can lead to elevated P? 2. What labs/w-up does one order? 3. What dictates whether a microP is Rxed? 4. How is a microprolactinoma managed in pregnancy? 5. How is a macroprolactinoma managed in pregnancy? 6. T or F. **1/3 of macroprolactinomas advance in pregnnacy**? 7. Do you follow P levels in Pregnancy? 8. If needs rx in preg, which med to use? 9. Can women breastfeed with dopamine agonist rx?

Answer 40

1. antipsychotics/antidepessants, antiemetics, **opiates**, antiacids 2. fasting P, hcg, TSH, CMP, med list, MRI 3. symptoms; all macro need Rx and lab eval of other pit hormones + visual field testing 4. Discontinue medication. 5. Larger tumors abutting the optic chiasm require continued rx with dopamine agonists during pregnancy. for smaller tumors away from the chaism, can DC meds as in microadenomas. 6. T 7. No. Asx about sx only. 8. Bromocriptine has more safety data (n/v, hypoT..so outside preg we use cabergoline) 9. Cannot BF with D agonist

Question 41

IBS ROME III Criteria Rx

Answer 41

Recurrent **abdominal pain** or **discomfort** and a marked change in **bowel habit** for **at least 6 months**, with symptoms experienced on at least 3 days of at least 3 months and two or more of the following: * Pain is relieved by a bowel movement * Onset of pain is related to a change in frequency of stool * Onset of pain is related to a change in the appearance of stool Therapeutic Doc-Pt relationship. High fiber diet.

Question 42

imperf hymen optimal time for correction

Answer 42

after puberty to allow for endogenous E exposure

Question 43

T or F: Monofollicular development is a characteristic feature of clomiphene citrate, whereas multifollicular development is associated with letrozole. Days ___ are the most fertile days of an idealized 28-day cycle.

Answer 43

1. False. Rememebr we use letraazole in PCOS..these pts do not ovulate, we just need to get one egg out! 9-14

Question 44

1. What type of trigger is associated with OHSS? 2. In a hypo/hypo patient, what is the best OI agent. 3. How to treat unexplained infert? 4. What treatment as the highest risk of multiples?

Answer 44

1. **HCG**; luprolide is better avoid OHSS. 2. urinary human menopausal gonadotropins (fsh alone wont do much without LH, which is needed for androgen production in theca cells) 3. OI + IUI (better than OI alone) 4. **OI with gonadotropins** + IUI

Question 45

1ry, 2ry, 3ry prevention.

Answer 45

1. Primary prevention refers to preventing a disease process before it occurs through prevention of exposures that may cause the disease. 2. Secondary prevention decreases the effect of a disease or injury that has already occurred. **ID disease before problems are serious.** 3. Tertiary prevention refers to interventions that **reduce or eliminate long-term impairments or disabilities, minimize suffering, and promote lifestyle adjustments for chronic conditions.**

Question 46

Lipid levels normals What med targets low HDL? At what AVCD risk do we consider statins? TPA cannot be given if:

Answer 46

1. Total **Chol \< 200; LDL \< 100; HDL \<50** 2. **Niacin targets low HDL** 3. **7.5%** **TPA** **-\>4.5hrs** **recent bleeding** **SAH, BP 185/110, active bleeding** **glucose derrangements** **warfarin with inc INR, hep with inc PTT or dec plt** **evidence of bleed on head CT**

Question 47

Who gets a spiral CT for lung cancer screening?

Answer 47

Patients aged **55–80** years with a significant smoking history (30 packs-per-year history).

Question 48

1. Leuprolide acetate induces amenorrhea in most women and results in decreased size of a leiomyomatous uterus by as much as **\_\_%** after 3 months of use. 2. Adverse effects of leuprolide acetate include:

Answer 48

60% Adverse effects of leuprolide acetate include **vasomotor** symptoms, **vaginal dryness**, and **_joint aches_**.

Question 49

1. Cyclic mastalgia usually presents during what part of menstrual cycle? Uni or bilat? 2. Rx 1st line? 3. Danazol is FDA pproved for Rx fo noncyclical mastitis. T or F

Answer 49

1. Uniformly benign. It presents as pain in the late luteal phase of the menstrual cycle, resolves with the onset of menses, and is usually bilateral and diffuse, as in the described patient 2. NSAIDs. Not OCPS. 3. Danazol is FDA approved. Check LFTs. can be used for fibrocystic beeast dz too. Tamoxifen can be used but is not approved for this.

Question 50

What EMS measurement is concerning after a med ab?

Answer 50

\>=3cm

Question 51

Metabolic Syndrome Criteria When do we screen for Lipids? DM? TSH?

Answer 51

the presence of any three of the five criteria listed constitutes a diagnosis of metabolic syndrome...Screen again q 1-2 years. Lipids: start at **45yo. Q5y** Those with a 10-year risk of **\>20%** **are treated with statins** and those with 10-year risks **10%-20% may also benefit** from statin therapy. In general, statin therapy reduces the relative risk of cardiovascular events by 20%-25% when used as primary prevention. DM: start at **45yo. q3y.** TSH: ?

Question 52

1. femoral 2. obturator 3. sciatic 4. common peroneal 5. ilioinguinal 6. iliohypogatric 7. genitofemoral

Answer 52

1. Femoral: **L2-L4** * m: dec quad strength, no pat reflec * s: dec **ant thigh**, **medial leg and thigh, no patellar reflex** * i: deep retractors, excessive hip flexion * CANT WALK UPSTAIRS 2. Obturator * cant adduct thigh * dec sens over **medial thigh** * i: paravaginal defect, transobt tape, LND 3. Sciatic **L4-S3** * dec hamstring strength * burning pain down the posterior thigh * **no achiles reflex** * SSLF, hip flex with extended knee 4. Common peronial * foot drop, **inversion** * dec sens ant leg and dorsom of foot * fixed pressure at fibular head 5. _iliohypogastric_ (most common injury at time of pfann) * **mons**, **labia**, **inner thigh** 6. _ilioinguinal_ * dec sens **inguinal** and **suprapubic** areas * suture after LTCS 7. _Genitofemoral_ * dec sens over **femoral triangle**+ **labia** * Injury most commonly occurs during external iliac lymph node dissection or resection of a large sidewall

Question 53

1. What are the exercise recs for all? 2. When can you offer meds? 3. 1st line med? MOA? side effects? 4. When do you offer bariatric sx? 5. XR meds should be avoided in bariatric surg pts.

Answer 53

1. 150min / week. 75 min if vigorous 2. Fail 5% body weight loss in 6m 3. **orlistat** (panc lipase inhibitor, dec fat abs; inc cramps, flatulance, fecal incont) 4. BMI\>35 w/ comorm, or \>40 with none 5. true; consider non-ocps, wait 1-2yrs before concetion (**18m**)

Question 54

1. You just had an occupational expusure to HepC: * What is the sequence of steps? * What is the approved PEP for HepC? 2. You just had an occupational expusure to HepB: * What is the sequence of steps? 3. You just had an occupational expusure to HIV. * What is the sequence of steps?

Answer 54

1. Test the pt and worker for hepB ab. If worker postive for AB, then chek RNA, if positive, worker alread had chronic hep C. If negative AB, worker needs f/u testing for RNA in 3 weeks. If positive then, Rx! if neg, stop! 2. Try to establish immunity be sending a HepBSAb. If not immune, innitiate HepB vaccine series immeiately 3. TBD

Question 55

1. MOA of bisphosphonates. 2. CI if? 3. If can't do PO, what can they do? 4. MOA of denosumab (Prolia) 5. nasal **calcitonin**, who can use? 6. MOA of teraperetide (**Forteo**) 7. **Raloxefine** is a good choice for a young postmenopausal woman with a planned switch at 60yo. T or F 8. All bisphosphonates dec risk of vertebral fractures, and alandronate and zeledronic acid also dec risk of hip rx. T or F

Answer 55

1. inhibition of osteoclasts 2. **renal** or **GI** issues or **hypoCA** 3. zeledronic acid (CI if **renal dz**) 4. rank ligand: subQ, Q6M 5. those 5 yrs post menopause, **not practical**. The use of calcitonin in the treatment of osteoporosis is controversial because it has been shown to reduce the risk of fractures less than other agents. It has minimal effects of bone mineral density and is not used as first-line therapy. 6. rPTH; builds bone! severe dz only, 2yr use only 7. T 8. T

Question 56

Bone density should be screened in postmenopausal women younger than 65 years if __ risk factors are noted? FRAX individuals with risk factors and DXA if \_\_% overall risk fracture. Cutoffs for osteoporosis. T or F: Peak bone mass at 30 is the strongest predictor of bone mass at 50. T or F Weight for high risk cut off? Who gets rx in setting of osteopenia? What labs are indicated to rule out 2ry causes of osteop?

Answer 56

Medical history of a **fragility** fracture, Body weight less than 57.6 kg (**127 lb**), Medical causes of bone loss (medications or diseases), **Parental history of hip fracture**, Current **smoker**, **Alcoholism**, **Rheumatoid arthritis** 9.3% A T-score of greater than –1.0 is considered to indicate no increased risk of fracture, whereas a score of –2.5 or less defines osteoporosis and usually is the value at which definitive therapy is recommended. A T-score of –1.0 to greater than –2.5 is considered to indicate low BMD and to correlate with a slightly increased fracture risk. True 127lb In the setting of osteopenia, bisphosphonate therapy is not warranted unless the fracture risk assessment (FRAX) tool shows a 10-year risk of major osteoporotic fracture ≥ 20% or a 10-year risk of hip fracture of ≥ 3%. **1st line: CBC, BMP, 24hr urin ca, vit d, TSH** **2nd line: celiac panel, serum protein electroph**

Question 57

Initial Rx for otitis media \_\_. If resistant: \_\_.

Answer 57

The initial treatment for acute otitis media is amoxicillin. If resis: augmentin

Question 58

1. Dx criteria of PBS 2. Management

Answer 58

1. unpleasant sensation related to bladder, associated w/ LUTS \> 6 weeks, NO infection 2. Education! Self-care. Stress management, PT (FIRST LINE); elmiron and amytryp (2nd LINE) No routine use of cysto, KCL.

Question 59

What agents besides metformin can be used for PCOS rx? what are the benefits of metformin?

Answer 59

**thiazolidinediones** like *pioglitazone*, *rosiglitazone*, and the biguanide metformin, also improve ovulation rates and increase circulating sex hormone-binding globulin, lowering bioavailable androgen. **dec circulating androgen levels, improved ovulation rate, and improved glucose tolerance.**

Question 60

1. How do we Rx labial agglut? 2. How does a prolapsed urethra present? rx? 3. Rx lichen sclerosus in a child 4. Common causes of vaginitis in peds.

Answer 60

1. Usually resolves on its own with endog E production at 5-6yo, treat only symptomatic patients; if rx, use E cream 2. pianless bleeding, friable mass age 5-8, chronic constaption or lung dz, AA. doughnut shapped mass on exam. Rx: **treat underlying cause, sitz baths, topical E.** 3. **do not biopsy. educate, avoid irritants. The initial management of vulvar LS children is similar to the management of the disease in adults.** A superpotent topical corticosteroid is the preferred first-line therapy. 4. **GAS (Streptococcus pyogenes)**, Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis, and Moraxella catarrhalis. Pelvic exam not indicated \<21yo unless sig med history

Question 61

1. Oral meds should be withheld the AM of surgery. T or F 2. What do you do with long actin insulin? 3. How long is merformin held? 4. Goal periOP FSG. 5. T1DM, what do you do with their meds? 6. At what FSG do you cancel surgery?

Answer 61

1. True 2. give **half the dose in the AM, or pump basal dose** 3. **Taken until the night before** 4. **80-180** T1: hold meds and drip **Cancellation** of surgery should be considered in non-emergent cases where blood **glucoses are 400-500 mg/dL.**

Question 62

1. Inpt rx of PID 2. Outpt PID Rx

Answer 62

**Inpatient PID Rx:** 1. Cefox + doxy 2. cefotetan + doxy 3. gent + clinda 4. unasyn + doxy **Outpatient PID Rx:** 1. Ceftx + doxy +/- flagyl 2. Ceftx + azithro 1g x2 doses 1 week appart 3. Cefoxitin x1 + Prebenecid + doxy (+/- flagyl)

Question 63

1. What phase of menses affected in PMS? 2. What is PMDD? 3. How is PMS dx? 4. Initial Rx? 5. What is first line med rx?

Answer 63

1. Luteal -\> menses onset 2. In premenstrual dysphoric disorder, symptoms are more **severe** and **debilitating** and consistently involve affective symptoms that affect the patient’s relationships and functioning, socially and at school or work. 3. The American College of Obstetricians and Gynecologists recommends diagnosing PMS based on **prospective symptom diaries** to confirm that the symp- toms occur during the luteal phase. 4. The goal of treatment is symptom relief and often begins with **dietary changes, exercise, and stress reduction**. **SSRI**, taken daily or only during the luteal phase of menstruation, constitute first-line medical therapy for severe PMS or premenstrual dysphoric disorder if no BCM disired. **COC if BCM desired.**

Question 64

1. Most common cause of community-acquired pneumonia: 2. Rx CAP

Answer 64

1. Strep pneumo

Question 65

1. POP-Q points and grid. 2. Stages 3. BW stages

Answer 65

1. See Photo. stage 1: leading age **stage 2: leading edge -1 +1** stage 3: leading edge +1, but \< TVL -2 grade 4: \> TVL -2 BW: stage 1: descent halfway to hymen **stage 2: to the hymen** stage 3: halfway past hymen stage 4: max possibel descent

Question 66

1. Characteristics? 2. Timing? 3. Rx

Answer 66

The symptoms of postembolization syndrome, which is common after uterine artery embolization, include **_pain, fever, nausea, and malaise._** The uterine tissue ischemia and necrosis cause an inflammatory process, leading to one or more of the symptoms associated with postembolization syndrome. Generally is not associated with purulent vaginal discharge. **Peak 1–2 days post procedure** and usually resolve within 7 days. Symptoms that last longer should be evaluated for infection. Prophylactic perioperative use of **analgesics**, **antipyretics**, and **antiemetics** often are used to limit the symptoms of postembolization syndrome.

Question 67

Which procedures require ABX?

Answer 67

hysterectomy, colporrhaphy, and pelvic reconstruction procedures including those using mesh

Question 68

1. What is the standard progression of pubertal events? 2. When do we worry and initiate workup? 3. What are the two general types? 4. DDx for the dependant type. 5. DDx for the independent type. 6. What is a GnRH challenge test (in which instance is it postive) 7. GnRh dep process is treated with? 8. MCune albright rx with? 9. What happends to bone in in most cases of precocious puberty? What is the exeption? 10. Benign variants include isolated thelarchy or puberche, in which cases bone age is \_\_\_. 11. Premature thelarche tends to be gonadotropin-independent and is not progressive. The most important diagnosis to rule out is true precocious puberty, which is marked by acceleration of linear growth and pubertal elevation of gonadotropins. What test can be done?

Answer 68

1. **Thelarche**, **Adrenarche**, **growth** spurt,**menarche (TAGM)** 2. \<6yo w/ thelarche **_or_** adrenarche **OR** \<8yo with both 3. GNRH dep and GNRH indep 4. Constitutional/**_Ideopathic_** or CNS pathology (hemartoma, cranipharyng, GH def, hydroceph, trauma, CNS infection. (**MRI**) 5. Think ovarian tumors (functinoal cysts, granulosa cell, leydig, gonodoblast), adrenal tumor, CAH, McCune Albright, hypothyroidism, environmental 6. **GNRH is given, and LH is measured and increases if GNRH dependent.** If peripheral, then brain will not respons 7. Lupron. 8. Aromatase inhibitors 9. Advanced, not the case in hypothyroidism (delayed). Patients with secondary sexual characteristics should have radiographic assessment of bone age. An advance in bone age (greater than two standard deviations beyond chronological age) suggests precocious puberty. 10. Not advanced. 11. bone age.

Question 69

1. What should trigger an evaluation for delayed puberty? 2. What is the first step once you determine an eval is needed? What other 3 tests are always included? 3. There are no breasts on exam...what is next and what is the ddx? 4. There are breasts on exam...what is the ddx?

Answer 69

1. **No menarche by age 15 years ("bleed by 15")**, no menarche within 3 years of thelarche, or **no thelarche by age 13 years ("tits by 13").** 2. Determine **E status on exam (and draw** _TSH, Prolactin, HCG_)!!!! 3. NO BREASTS --\> Draw an FSH: 1. **FSH High**: Think issue with gonads! 1. **PCOS** 2. Genetic: Turner's (XO), Fx prem, Sewyer (XY), 17a-hydrox deficiency **(ideopathic most common)** 3. Acquired: chemo, rad, surg 4. Autoimmune 2. **FSH Low**: --\> **MRI** 1. immature HPO axis **(most common**) 2. hypothalamic suppresison (exercise, stress, weight loss) 3. ***_hypothyroidism_***, ***_prolactinoma_*** 4. PCOS 5. Kallman 6. tumor (cranyopharyng most common) , brain injury, infection 7. Sheehan 8. Cushing 9. Empty sella 4. BREASTS 1. Think structural: imperf hymen, transv septum, aquared cvx stenosis 2. Mullerian agenesis 3. Complete AIS 4. 5 alpha reductase 5. think dysfunciton (PCOS! TSH! prolactin!) A patient with gonadal dysgenesis requires supplemen- tal hormonal treatment to initiate or complete her pubertal development and enhance bone health.

Question 70

T or F The 2017 ACC/AHA guidelines suggest that the BEST method for diagnosing hypertension involves _ambulatory_ blood pressure monitoring. T or F

Answer 70

True Stage 1 hypertension: 130-139 mm Hg or 80-89 mm Hg diastolic Stage 2 hypertension: Systolic \>140 mm Hg or diastolic \>90 mm Hg.

Question 71

Raloxefine Raloxifene is a SERM approved by the U.S. Food and Drug Administration for the prevention and treatment of osteoporosis, but fracture risk reduction has consistently been proved only for __ fractures. T Or F: Raloxefine is approved for reductiong of the risk of invasive breast cancer in **_post_**menopausal women. What side effects to we worry about?

Answer 71

Spinal True. Raloxifene has a similar thromboembolic disease risk to that posed by estrogen, and women may experience an increase or reappearance of vasomotor symptoms.

Question 72

1. What are the components of the ROMA?

Answer 72

1. CA125, HESP 4, menopausal status

Question 73

Treatment for 1. **Female sexual interest and arousal disrorder**? 2. Sexual aversion d/o? 3. Sexual arousal d/o? 4. Female orgasmic d/o? 5. genitopelvic pain and penetration d/o? 6. vulvodynia?

Answer 73

1. dec int or arousal **\>6m**; ssri. antihist, antichol, psychotropic, tca, **ocp**; **flibanserin** (5HT R ag/ant) or **Bremalanotide.** **Both only in preM women.** 2. Aversive responce to genital contact **(Rx: psychotherapy and antidepressants)** 3. innability to attain or maintain suff arousal (address inciting factors) 4. persistent or recurrent delay in or abscese of orgasm **(Rx: masturbation, increaseed stim, inc comunication)** 5. **lubrication, pelvic floor PT** 6. vulval pain \>3m no ID cause **(rule out other causes: breastfeeding, stop OCP/P, topical E rx)**

Question 74

Sheehan syndrome, workup includes: Women with hypogonadism due to pituitary disease who are not interested in fertility should be treated with: If a woman with a history of Sheehan syndrome wishes to conceive, what is the only available treatment for ovarian stimulation?

Answer 74

Sheehan syndrome, workup includes **estradiol** and **follicle-stimulating hormone levels**, which would both be low. Magnetic resonance imaging (**MRI**) will show a small pituitary within a normal-sized sella and will sometimes be read as an empty sella. Women with hypogonadism due to pituitary disease who are not interested in fertility should be treated with estrogen therapy, typically with transdermal estradiol similar to patients with premature ovarian failure. Cyclic progesterone should be added for endometrial protection in any woman with a uterus. If a woman with a history of Sheehan syndrome wishes to conceive, gonadotropin therapy (exogenous luteinizing hormone and follicle-stimulating hormone) is the only available treatment for ovarian stimulation.

Question 75

0. Sinusitis 1st line Rx. 1. Most common pathogens 2. When to give abx? 3. What abx? 4. pcn allergic?

Answer 75

0. Analgesics/antipyretics and decongestants. 1. Step Pne and H. Influenzae 2. persistence of symptoms beyond **10 days**, **severe symptoms** (high fever of at least 39°C [102°F], purulent nasal discharge, or facial pain **lasting for at least 3–4 consecutive days** from the beginning of theillness; **worsening of symptoms with new onset of fever, headache, or increased discharge initiated by a typical upper respiratory infection that was improving in the initial 5–6 days** (“double sickening”) 3. Augmentin:The addition of clavulanate improves coverage for ampicillin-resistant Haemophilus influenzae and Moraxella catarrhalis. 4. doxy

Question 76

Hormonal contraception is MEC __ in Lupus pts that have antiphosplipids. In pts with no antiphos, MEC \_\_.

Answer 76

3, 2

Question 77

Semen Analysis Parameters

Answer 77

**1.5 ml** **15 million / ml concentration & 40 million total** **4% morphology** **40% total motility** **32 % forward progression**

Question 78

XY (SRY) Testes --\> Sertoli + Leidig. What do each make? What ducts form/degen? T --\> DHT (what enzyme?) Female external genitalia results from?

Answer 78

Sertoli -\> AMH -\> Mullerian ducts degenerate Leidig -\> Testosterone -\> Wolffian Duct Develops 5a reductase No Y, No SRY, T synthesis defect, androgen R defect, 5 alpha reductase def (No T (no SRY or no Y chromosome), unable to covert T, unable to bind T)

Question 79

1. SSRI use is associaed with what fetal and neonatal risks?

Answer 79

Fetal: Paroxetine increases fetal cardiac malf risk Neonatal: jitteriness, TTN, resp distress, NICU admit, PersPulmHTN

Question 80

1. NNT 2. Ab Risk Red 3. Rel Risk Red 4. Odds ratio 5. Using 4 mm or less as a cut-off, there is a 99.6–100% ___ to exclude adenocarcinoma on PMB.

Answer 80

1. **NNT:** 100/(difference in event rates) 2. **ARR: Not a ratio**, but the actual quantitiy by which some outsome is reduced (e.g. 98.9% in the intervention group - 98.7% in the non-tervention group=0.2%). 3. RRR: Absolute risk reduction / baseline rate of the event in question (a ratio of the % of people who experience the outcome / percentage of controls that experience the outcome) 4. Odds ratio: outcome of odds in 1 group / odds in another (**case control studies**) 5. NPV

Question 81

polyglactin is what suture? polypropylene suture is permanent T or F Polydioxanone is permanent. T or F

Answer 81

VICRYL True (PROLINE) F: PDS is slowly absorbed

Question 82

1. MOA for tamoxifen 2. If a womens risk of Br Cancer is **\>1.6% for the next 5 years**, or **lifetime risk of \>20%**, she is a candidate for tamoxifen chemoprevention. T or F. 3. What are the adverse SE? 4. PMP users have lower rates if osteoporosis because of its antiosteoclast activity. T or F 5. T or F: Aromatase inhibitors, such as anastrozole, have not been approved for breast cancer chemoprevention. 6. Tamoxifen and raloxifene have been approved in postmenopausal women, and **tamoxifen** has been approved for use in **premenopausal** women only. T or F 7. Tamoxifens and SSRI interfere. T or F 8. What if wants to conceive while tamoxifen? 8. Raloxifene is not used in premenopausal women because it can cause ovarian stim. t or f

Answer 82

1. SERM 2. T 3. VTE; EndoCA (mostly in postmenopausal women); vaginal discharge, sleep disturbance, _cataracts_ 4. True 5. False, but! arom inh inc bone loss and fractures in PM women 6. True 7. True 8. Cant. Must wait 5 yrs +3m grace period. Craniofacial malformations and ambiguous genitalia 9. T

Question 83

1. How do you differentiate gestational thyroid toxicosis from hyperthyroidism in pregnancy? 2. How do you treat gestational thyroid toxicosis? 3. **What is the preferred treatment for patients with Graves disease and severe ophthalmopathy?** 4. when do you start TSH screening and how often? 5. The workup of a thyroid nodule begins with \_\_. What characterisitcs are c/f malig? 6. What do you do with purely cystic nodules? 7. If c/f malignancy, what do yuo do?

Answer 83

1. antithyropid R antibodies 2. you dont. 3. thyroidectomy and glucocorticoids. 4. age 50, Q5yrs; \>18yo w/ risk factors (autoimmune, Fh thyr) 5. Thyroid US: **calcifcations, hypoechoic, irreg borders --\> biopsy** 6. do not biopsy 7. biopsy. If biopsy with c/f follicular neop, Scinti to det if hot or cold...all cold get biopsies

Question 84

1. Why do we give T? What level do we want it to be? 2. What labs are monitored? Why? 3. What cancers are patients on T at increased risk for? 4. At what age do we start?

Answer 84

Testosterone therapy is administered to suppress menses and induce masculine secondary sex characteristics. **500** Laboratory testing is done to assess **hemoglobin**, **hematocrit**, **liver** function, and serum **testosterone** level. Screening for cervical and breast cancers should be continued in patients who have not yet undergone mastectomy or complete hysterectomy. Patients on testosterone therapy may be at **increased risk of endometrial and ovarian cancers.** According to the American College of Obstetricians and Gynecologists, this cross-gender puberty induction typically begins at **16 years of age** and should be initiated in conjunction with the patient, a therapist, and ideally, support persons in the patient’s life.

Question 85

Triptans are contraindicated in HTN or CV disease. t or f

Answer 85

t

Question 86

* UAE increases which of the following: **misscarriage, malpresentation, PTB, PPH**

Answer 86

* all

Question 87

urethral caruncle 1. what is it? 2. Rx? urethral diverticulum 1. What is it? 2. Rx?

Answer 87

urethral caruncle: 1. A urethral caruncle is a benign polypoid lesion at the distal portion of the urethral meatus. 2. **Obs if no sx; E if sx** urethral diverticulum 1. outpouching of the urethra: dyspareunia, dribbling, discahrge, dysuria 2. If not bothersome, can obs. otherwise excise

Question 88

1. Anterior repairs are rarely performed alone. What procedures usually accompany them? 2. **What is the most common post-op compilication of a sling?** 3. What is the MOA of bethanecol? 4. Most common complication of transvaginal POP surgery? 5. What vessel can be injured in an ASC? What does it run on? 6. Macrobid carries a risk of ____ in older women and should not be used for UTI supression in this population. 7. Most meshes are MONOfilament and MACROporous. T or F 8. What structures run behind the sacrosp ligament? Where do we throw the stitch for a SSLF? 9. What is autonomic hyper-reflexia? 10. T or F: colpocleisis is assoc with rectal prolapse. T or F 11. Vertebral osteom after ASC is dx with ?? and most commonly caused by?

Answer 88

1. Apical suspension 2. retention 3. cholinergic agonist used in detrusor hypotonia 4. mesh erosion 5. middle sacral artery; anterior long lig 6. chronic interstitial lung disease 7. T 8. Pud art, sciatic nerve, inf gluteal art; place the stitch 2cm medial to the spine 9. seen in individulas w/ cord lesions above SPINAL LVEL T6. Excess sympathetic responce 2/2 stimulation below the level of the injury 10. T 11. MRI; staph aureus

Question 89

1. Dose interval for Hep B series. 2. A patient steps on a nail. Last Tetanus vaccine was 3 years ago. What do you give? 3. For routine 65 yr old patients, what pneumococcal vaccines are given? 4. Pneumococcal immunization, with one dose of \_\_, is recommended for patients age **19** to **64** who are at increased risk, including those with anatomical or functional asplenia. 5. \<15yo, HPV vaccines are given __ months appart. If given less than __ m apart, must give a 3rd dose. 6. Menningococal vaccine is ok in pregnancy, but usualy given **@ __ with a booster at \_\_**. T or F 7. Do you give zoster vaccine in patients with h/o shingles?

Answer 89

1. 0,1,6m, booster with one dose when needed. 2. Nothing. Tetanus toxoid-containing vaccines (eg, TD, Tdap) are recommended for acute wound management if **5 years or more have elapsed since the patient received a tetanus vaccination**. (Use Tdap if pregnant). 3. Photo. ALL get PPSV23 4. **PPSV23** immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leak, or cochlear implant. 5. 6-12 months for dose #2; \<5 months, give a 3rd dose. HPV vaccine is not a live vaccine. 6. 11-12, boost at 16. The meningococcal vaccine is indicated in those with functional or anatomic asplenia, those who are known to be exposed to meningococcus, and first-year college students up through age 21 years who reside in residence halls. It is safe to administer in pregnancy because it is not a live attenuated vaccine. 7. yes.

Question 90

1. Consider suppresive treatmwnt for BV and yeast if more than __ (BV) and __ (Yeast) episodes per year. 2. For a patient with vulvodynia, what is first line medication?

Answer 90

1. Consider suppresive treatmwnt for BV and yeast if more than **3 (BV) and 4 (Yeast)** episodes per year. 2. TCA BV: twice weekly gel for 16 weeks

Question 91

What are the resonably certain criteria?

Answer 91

1. =\<**7days** from LMP 2. =\<**7days** from TAB/SAB 3. W/in **4 weeks PP** 4. Lactatinonal amenorrhea 5. No IC since LMP 6. Using BCM

Question 92

What do we sample in PIGT?

Answer 92

throphoectoderm of blastocyst

Question 93

WHI 1. What two factors decreased in the E/P arm? 2. What increased in the E/P arm? 3. What decreased in E arm? 4. What increased in the E arm? 5. Do we d/c HRT prior to Sx? 6. What is the risk of Br Cancer in the e/p arm? 7. MOA of *prasterone* and *ospemefine*? 8. T or F: subanalyses of the WHI found that when HT was initiated close to the onset of menopause, it was protective against coronary artery disease

Answer 93

E+P: **Inc**: MI, stroke, dvt, br ca **Dec**: colon CA / fractures E: **Inc**: stroke, DVT (**_NOT MI_**) **Dec:** fractures We do not d/c HRT unless prolonged immobility expected. 1 additional case per 1000 treated of breast cancer in E/P **Prasterone**, synthetic dehydroepiandrosterone, is a daily vaginal suppository to treat dyspareunia and it elevates serum estrone levels. *Gets aromaised to E.* **Ospemifene**, an oral **SERM**, improves symptoms with no endometrial activity. True

Question 94

1. How do we "rx" turner syndrome?

Answer 94

Treatment for Turner syndrome in adolescence includes **growth hormon**e to maximize adult height and **estradiol**. Estrogen replacement should be initiated by age 11 or 12 (or at time of diagnosis, if diagnosed later) to mimic normal progression of puberty. Estrogen therapy induces and maintains sexual development including breast development, improves uterine length and volume, and contributes to growth and height. Estradiol is started at a low dose and gradually increased over two to four years to a young adult dose. The estradiol patch is the preferred route. **Cyclic progestin should be added to induce bleeding and prevent endometrial hyperplasia and is typically added two years after initiation of estradiol or when breakthrough bleeding occurs**.

Question 95

Rx of fibromyalgia?

Answer 95

Fibromyalgia is a disease of chronic widespread musculoskeletal pain without another etiology. **The first-line treatment is patient education about the disease**, beginning a **physical exercise program**, and **drug monotherapy** for symptoms that are not relieved by non-pharmacologic means. Medications that have been effective include **SNRIs**, **amitriptyline**, **cyclobenzaprine**, and **gabapentin** or **pregabalin**.

Question 96

NSAID MOA

Answer 96

Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease inflammation by nonselectively inhibiting both cyclooxygenase (COX)-1 and cyclooxygenase (COX)-2 enzymes. Their effect on platelet function is mediated by COX-1 inhibition, thereby decreasing production of thromboxane A2, which decreases platelet aggregation.

Question 97

What are the failure rates of nexp male ster mirena btl parag ocp

Answer 97

* Nexplanon **0.05%** * Male Sterilization **0.15%** * LNG-20 IUD **0.2%** * Female Sterilization **0.5%** * Copper IUD **0.8%** * Oral Contraceptive Pills **9%**