CREOGs 2018 - part uno

beddowme's version from 2017-12-26 06:07

TrueLearn notes

Question Answer
% failure of detection of endometrial cancer on EMB1%
ITP in pregnancy...treat when?Plt <30K or clinically significant bleeding
in general, when do you transfuse platelets?<10K, or <50K if undergoing surgery
when do Plt levels return to normal in gest thrombocytopenia?2-12 weeks after delivery
when a copper IUD is used for emergency contraception, preg rate is1 in 1000
risk of recurrence of third or fourth degree laceration3%
_% of infertile pts carry PCOS as a dx?25-30%
why would a result of cffDNA come back as "no call"?maternal obesity, early sampling (<10wga), aneuploidy
wt restriction to deliver vaginal breech2500-4000g
lidocaine dosing limits4mg/kg without epi, 7mg/kg with epi; total max 500mg
cryoprecipitate is made from thawed _, and containsFFP; FFP, factors VIII, XIII, fibrinogen, & vWF
start zidovudine _ hours prior to C-section3
% of pregnant women with asx bacteruria who develop pyelonephritis30%
most thrombogenic inherited thrombophiliaantithrombin deficiency
% of preterm labor patients whose labor resolves spontaneously30%
when is risk of VTE highest in preg<20wga (even higher postpartum)
you get APGAR points for whatHR, respiratory effort, muscle tone, reflex irritability, color
average risk of developing ovarian cancer in a lifetime is one in _75
test pregnant women for _ only if sx; _ if any exposurelisteria, parvovirus
% of women who do not attend a postpartum visit40
T/F - estrogen-containing contraceptives are contraindicated in lupus patientstrue, if autoantibodies
BRCA mutations account for _% of breast cancer and _% of ovarian cancer3-5, 10
% risk that a shoulder dystocia recurs10
when is obesity linked to breast cancer?only in postmenopausal state
most common cause of death after uterine artery embolizationsepticemia
postpartum depression occurs in _% of women10-20
is breastfeeding safe for women with PKU?yes, if baby does NOT have PKU
highest risk group for cystic fibrosisAshkenazi Jews (higher than Caucasian)
hep _ can lead to hepatocellular carcinoma, hep _ can lead to B-cell lymphomaB, C
SAB rate in pregestational DM26.8%
SAB rate in general population7.7%
nerve roots for erb palsyC5 & C6
nerve roots for Klumpke palsyC8 & T1
gestational choriocarcinoma occurs after 1 in _ normal pregnancies30K
theca lutein cysts grow with exposure toLH or B-hCG
biopsy Bartholin's gland cysts starting at age _40
VAVD at _wga at the earliest34wga
% of patients with elevated MSAFP who are actually carrying a child with a neural tube defect2%
what type of mutation is the prothrombin gene mutation?point
if a patient is on tamoxifen, don't use _ for vasomotor sx b/c _SSRI, messes with metabolism; you can use SNRI though
when can you do a cffNDA?between 10wga and term
heterotopic pregnancy occurs in 1 in _ pregnancies30K
benefits of delayed cord clampingimproves RBC count, dec need for transfusion, and dec rates NEC & IVH
CA-125 over _ in post-menopausal or _ in pre-menopausal --> gyn onc35, 200
feed _ patients BH4 (sapropterin)PKU
periviable period20w0d through 25w6d
blood pressure ranges for preHTN, stage I, and stage 2 HTN120-139/80-89, 140-159/ 90-99, >160/>100
AFE classic triadhypotension, hypoxia, coagulopathy
fetal loss rate with amniocentesis1 in 200
_% of fetuses enter the pelvis OP, _% OA, _% occiput transverse20% OP, 50% OA, 25% transverse
chorionic villus sampling between _-_wga, and amniocentesis not before _wga10-12, 15
main blood supply to the anterior abdominal walldeep inferior epigastric artery
recommendations for stable vasa previaBMZ at 28-32wga, hospitalization 30-34wga, delivery 34-37wga
hemoglobin H disease occurs when _3 alpha-globin genes are missing on csome 16
fetal umbilical arteries arise frominternal iliac arteries
IgG avidity will be (low/high) with primary infection within the past 2-4 monlow
more tissue damage - bipolar energy or monopolar energy?monopolar
pts with Marfan syndrome should be delivered via C-section if aortic root diameter is40-45mm
ovarian cancers are diagnosed at stage _ half the time, which means3; involving one/both ovaries, peritoneal implants, small bowel/omentum
malignant transformation of endometriosis to clear cell adenocarcinoma occurs _% of the time0.7 to 1%
PCOS women need to lose _% of their weight to ovulate5
dosing of MTX and B-hCG checking for ectopic1mg/kg MTX, leucovorin 0.1mg/kg if rescue doses needed; BhCG on days 1,3,5,7
four criteria for HIE1. Apgar <5 at 5&10 min, 2. fetal UA academia, 3. multisystem organ failures, 4. dev spastic quadriplegia or dyskinetic cerebral palsy

lymph drainage

Question Answer
from upper 1/3 of vaginapelvic lymph nodes to paraaortic
from distal 1/3 of vaginainguinalfemoral lymph nodes to pelvic lymph nodes
endometrial cancer[ovarian to paraaortic] OR [paracervical & parametrial --> pelvic]
cervicalparametrial to pelvic

% of babies that are breech at each gestational age

Question Answer
38 to 40 wga3%

Inheritance patterns

Question Answer
Marfansaut dom
Neurofibromatosis type 1aut dom
Noonan syndromeaut dom
Tuberous sclerosisaut dom
PKUaut rec
von Willebrandsaut dom
spinal muscular atrophy geneticsSMN1 gene, aut rec, leading cause of infant death

twin types and days of zygote division

Question Answer


Question Answer
specificity from a tabled / (b+d) x100% (true negatives / all negative disease)
accuracy from a table(a+d) / (a+b+c+d) which is (true pos + true neg) / (all)
level one evidence means...?evidence from one or more randomized trials
level three evidence means...? from expert committees/case reports/case series
maternal mortality is defined as death per _100,000 births
birth rate is births per_1000 population
fertility rate islive births per 1000 women aged 15-44
neonatal period is from _ to _delivery to 28 days
perinatal death isstillbirth plus neonatal death in the first week of life
stillbirth rate isdeaths 20wks through delivery per 1000 births
neonatal death rate expressed per1000 live births
perinatal death rate expressed per1000 total births
percentage discordance in twins (formula)(larger twin - smaller twin) / larger twin


the lower third of the vagina is derived from _ and upper 2/3 from _urogenital sinus, mullerian ducts
labia minoramedian raphe
round ligamentgubernaculum
skene's glandprostate
bartholin glandcowper's
vestibular bulbcorpus spongiosum
gartner's ductvas deferens
granulosa cellssertoli cells

Primary care things

Question Answer
start screening for colorectal cancerat age 50, or 45 in African Americans
screen for DM at age _, every _ years45, BS every 3 years
screen for hyperlipidemia every _ years starting at age _5, age 45
screen thyroid every _ years starting at age5, 50
varicella zoster vaccine should be given at age50 and over
pneumococcal vaccine should be given at age65 (or before with risk factors)
cervical cancer screening before age 21 ifHIV (begin at time of dx, q6mo for 1yr, then annually), or immunocompromised (organ tx or long-term steroid use, same rec)
if FRAX 10-year risk for osteoporotic fx is _>9.3%, refer for DEXA scan
maximum target heart rate220 minus patient's age
exercise at _ to _ % of maximum target heart rate for 20-45 minutes at least 3x/week50-70
risk stratification for lipid screeningFramingham Model or ATP III panel
want LDL to be<100
want total cholesterol to be<200
want triglycerides to be<150
metabolic syndrome diagnosis3 of the following: 1. blood pressure >130/85; 2. blood glucose >100; 3. waist circumference >35in or 88cm; 4. HDL <50; 5. triglycerides >150

The Sugar

Question Answer
dosing insulin in the non-pregnant patient0.3 - 0.5 U/kg per day, 2/3 of the dose in AM (1/3 regular, 2/3 NPH), 1/3 in the PM (1/2 regular, 1/2 NPH)
glyburide is asulfonylurea
sulfonylureas and secretagogues function bystimulating release of endogenous insulin from the pancreas
metformin is abiguanide
metformin works bydecreasing hepatic glucose production; may increase peripheral insulin sensitivity
pioglitazone and rosiglitazone arethiazolidinedione
thiazolidinediones work byuncoupling obesity from insulin resistance; suppress glucose production from the liver; stimulate glucose uptake by skeletal muscle
alpha-glucosidase inhibitors (acarbose) work byslowing digestion and absorption of CHO from the gut

Smoking cessation

Question Answer
the 5 A'sfor patients ready to quit: ask, advice, assess, assist, arrange
the 5 R'spatients not ready to quit: relevance, risks, rewards, roadblocks, repetition
doses of nicotine patch7 mg (<1/2 ppd), 14mg (>1/2 ppd), 21mg (>1 ppd)
doses of nicotine gum2mg or 4mg
Wellbutrin dose150mg/day for three days, then bid
contraindications for wellbutrinseizures, anorexia, bulimia
Chantix is also called _ and caution pts about _varenicline; bad dreams, depression, suicidal ideation

Dolor de cabeza

Question Answer
a tension headache is chronic if _, and episodic if_>15 days/month, <15 days/month
a thunderclap headache could be a sign ofsubarachnoid hemorrhage, effect of MAOIs, or pheochromocytoma
ddx of posterior leukoencephalopathycerebral angiitis, drug toxicity (cyclosporine, intrathecal MTX/cytarabine, pseudo ephedrine, or cocaine), post transfusion effects, postpartum antipathy
vasoconstriction of a thunderclap HA treatmentresolves spontaneously, or use nimodipine
neck circumference less than _ gives you low probability of having sleep apnea43cm

High blood pressure

Question Answer
treat a caucasian with HTNACEi, beta blockers
treat an African American with HTNCa channel blockers, diuretics
what should be given to a person with dm?ACEi, to protect kidneys
first line tx for HTNdiuretics


Question Answer
plan B isprogestin-only (levonorgestrel 1.5mg)
cOCPs emergency contraceptionestrogen and progestin, two doses with 100mcg ethinyl estradiol, and 0.5mg levonorgestrel
copper IUD can be used up to _ days after intercourse5
plan B and cOCPs can be used _ hrs after intercourse for contraception72h
ulipristal acetate can be used up to _ hrs after intercourse120
the lipid abnormality that is an absolute contraindication to use of OCPsfamilial hypertriglyceridemia
dose of depo, works for how long150mg IM q3mo, works for 14wks
MOA of depo proverbblocks LH surge, thickens cervical mucus, alters endometrium
method of tubal ligation that has the highest reversal success ratecilps/bands
the disease that would prevent use of Copper IUDWilson's disease


Question Answer
model for risk of breast cancerGail model
ethnic groups more likely to have BRCA 1&2Ashkenazi Jews, French Canadians, Icelands
ovarian cancer associated with BRCA 1&2high grade serous or endometrioid
risk-reducing salping0-oophorectomy if BRCA 1&2 when40yo or done with child bearing
BRCA 1 on csome _17
BRCA 2 on csome _13
fraction of masses found in women's reproductive years that are benign2/3
most common benign tumor of the female breast in females under age 25, and what you should do about themfibroadenoma, excise if >2-3cm
most efficacious approved tx for cyclic breast pain is _; other effective drugsdanazol; evening primrose oil, bromocriptine, OCPs, Tamoxifen
most common histologic pattern of breast cancerinvasive ductal cancer (second most common is invasive lobular)
most common pathogen involved in mastitisStaph aureus
meds that may cause galactorrheaphenothiazines, alpha methyldopa, TCAs, reserpine

La matriz

Question Answer
_% of reproductive-aged women undergoing laparoscopy have evidence of endometriosis15
Etiology of endometriosis, Sampson's idearetrograde flow
Etiology of endometriosis, Halban's idealymphatic-vascular spreading (lung, brain, pericardium)
Etiology of endometriosis, Meyer's ideacoelomic (found in males & infants)
Etiology of endometriosis, Dimowski's ideadecrease in cellular immunity
most common type of degeneration of myomashyaline (65%)
most acute form of myoma degenerationcarneous; complicates 5-10% of pregnancies in women with myomas
amenorrhea is no menses for _>6 months
oligomenorrhea is _>35days between cycles
% progression to cancer if EMB shows complex hyperplasia with atypia25%
% progression to cancer if EMB shows simple hyperplasia without atypia1%
difference between primary and secondary dysmenorrheaprimary has no underlying pelvic disease; secondary has an underlying cause

Vagina & lower genital tract

Question Answer
normal vaginal pH3.8-4.2
vaginitis associated with pH <4.5candida albicans, c. glabrata, c. tropicalis
vaginitis associated with pH >4.5BV, gardnerella, trich, atrophic vaginitis
excising a Barton's gland/duct should be done whenpersistent deep infx, recurrent abscesses, or enlargement over age 40 to r/o adenocarcinoma
treat pubic licepermethrin (Nix) or Lindane (don't use in kids, pregnancy, or lactation)
phthirus pubic iscrab louse/pediculosis pubic
itching in pubic lice vs scabieslice is constant itching, scabies is intermittent
treat scabiesname as lice - permethrin or lindane
"water wart" ismolluscum contagiosum, caused by pox virus
# of subtypes of HPV, and # involved in genital infx>70, 21 of which are involved in genital infx
genital herpes can lie dormant in dorsal root ganglia of which level?S2-4
recurrence rate of HSV I is _ and HSV 2 is _ within 12 months55%, 80%
Donovan bodies (of Donovanosis) diagnose what conditionGranuloma inguinale (common in tropics)
treat granuloma inguinaletetracycline x2-3 weeks
lymphogranuloma venereum is caused bychlamydia trachomatis
what is the "groove sign" and what does it dx?double genitocrural fold, lymphogranuloma venereum
though there are a lot of tx methods for LGV, the CDC recommendsdoxycycline
Haemophilus ducreyi causeschancroid
gram stain of chancroid"school of fish" pattern
treat chancroiderythromycin
secondary syphilic is _ and develops when?systemic disease, 6w-6mo after primary chancre
findings of secondary syphilispalm/soles maculopapular rash, and vulvar condyloma latum
when is syphilis infectious (what stage of disease)?primary, secondary, and first year of latent syphilis
_% of untreated patients with syphilis develop tertiary syphilis33%
treat primary/secondary/1st year of latent syphilisbenzathine PCN 2.4 million u IM
treat late latent syphilisbenzathine PCN 7.2 million u total
treat neurosyphilisaqueous crystalline PCN G


Question Answer
most common organisms are E. Coli (obviously) and _S. saprophyticus, Proteus mirabilis, Enterococcus
_% of of UTIs resolve without therapy50
UTI present if >_organisms on clean catch, or _ on cath specimen100k, 10k
treat a complicated UTI7-10 days of a fluoroquinolone

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