jmanderson's version from 2016-01-06 00:07

Section 1

Question Answer
Screening for breast CA: Gail Model?Age, early menarche, late menopause, family history, previous tumor (biopsy), race
What receptors are associated with breast CA?ER, PR, HER2
Tx for HER2 breast CA?Give Herceptin (Trastuzumab)
What indicates stage 4 breast CA?Distant metastasis
What type of breast CA carries the worst prognosis?Inflammatory breast dz
48yo woman with unilateral nipple discharge, Most common cause?Papilloma
How does a fibroadenoma present?Well circumscribed, rubbery
Cyclical breast tenderness tx?NSAIDS
Stress incontinence tx?Kegal maneuvers
Urge incontinence tx?Increase time before voids, drugs
Overflow incontinence tx?Have a schedule for when to pee
Endometriosis presentation?Pelvic pain, dyspareunia, irregular vaginal bleeding
Where would you find endometrial implants?Ovaries
How do you treat endometriosis?OCPs, GnRH agonist (leuprolide)
Endometrial CA risks?Unopposed estrogen, (pt should increase diet, exercise)
Preterm labor time?btw 20-36 wk
Preterm labor risk factors?hx of preterm birth (biggest), short cervical length, cervical incompetence, behavioral
Reduce morbidity in PROM?Antibiotics (only one proven to prolong latency)
Other tocolytics?Nifedipine (CCB) Indomethasine (NSAID) don’t use with renal dysfunction, MgSO4
Tx for PROM if >34wks?Delivery
How do you diagnose DM?OGTT, hemoglobin A1C, random glucose >200 fasting glucose >126
What is the most common alloimmunization Ag?Rh D
What is a response of alloimmunization?Hemolytic dz, Hydrops fetalis, Kernicteris
What is the most common reason why mom would be allo immunized (blood-crossed w/ baby)?Delivery
How do you check if mom has been allo immunized?Check for antibodies, KB (Kleihauer-Betke) test
What hormone is associated with sexual desire?Serotonin
What is the most common female sexual problem?Decreased desire
Dyspareunia in a postmenopausal female?Atrophic vaginosis, tx= topical estrogen
What common BP med leads to psychosexual dysfunction?Beta blockers
LH and body temperatures?ovulation 1 d after LH surge and 1 d before basal temp inc. (d 7-12)
Overweight pt with infertility and multiple ovarian cysts, Dx?PCOS
PCOS diagnosis labs?LH FSH ratio increased
How would you treat this infertility in PCOS pts?Metformin (insulin resistance with PCOS, that causes neg feedback for LH and FSH, LH increases more to try to ovulate)
Who do old women get osteoporosis?Decrease estrogen decreases osteoclastic activity
What is the difference between menopause and premature ovarian failure?menopause is anovulation for 1 y after 40 yo, premature ovarian failure is anovulation for 1 y before 40 yo
Pharmacological tx for hot flashes?Oral estrogen
Tx of hot flashes if pt has h/o PE?SSRI, clonidine (BP), venlafaxine, paroxetine, gabapentin
Differential for chronic pelvic pain?Endometriosis, Interstitial cystitis, atrophic vaginitis

Section 2


Question Answer
When to deliver baby in gestation DM39 wk
Delivery options with gestation DMC-section if >4500 g, elective C-section if >4000g
Most common antigenRhD
How is mother alloimmunizedBirth
How to tell if mother has been alloimmunized if she has traumaKleinhauer Betke test (mom’s blood)
Positive Kleinhauer Betke, what next?give rhogam (anti-D Ig)
Preeclampsia how to monitorDoppler, want to see blood flow into baby
Preeclampsia dxproteinuria, BP 140/90 after 20 wk
What is preeclampsia with severe features?preE with signs of end organ damage (BP > 160/110, platelets <100k, impaired liver fxn, renal insufficiency [Cr>1.1], pulm edema, cerebral/visual disturbances)
Distinguish stage IV breast cancermetastasis, size does not matter
Cyclical mastitisOCP & NSAIDs
Most common female sexual problemlack of desire
Neurotransmitter reduces sexual desire serotonin
Pelvic pain ddxmenopause, endometriosis, interstitial
Endometriosis dxvisualization
Normal endometriosis site?ovaries most common, posterior cul-de-sac 2nd most
Most common 1st trimester lossChromosomal abnormalities
Most common 3rd trimester lossUteroplacental insufficiency
Placental abruptionCocaine, trauma
How to prolong a pregnancy in preterm laborMgSO4, Nifedipine
Ruptured membranes and preterm prolong preg.Steroids, antibiotics, tocolytics
Contraindications for MgSO4myasthenia gravis (and drug interaction w/ nifedipine  hypotension)
Contraindications for Indomethacinclosure of ductus arteriosis, platelet disorder, hepatic dysfunction, GI ulcer, renal dysfunction, asthma (in women allergic to asprin)
4 Ts for postpartum bleedingtone, tissue, thrombin, trauma
#1 reason for post partum bleeduterine atony
Risk factor for postpartum bleedover-distension of uterus (mult. gestation, polyhydramnios, fetal macrosmia), grand multiparty, prolonged labor, oxytocin augmentation, Mg-sulfate, chorioamninitis, leiomyomas
First degree vaginal lacerationinvolves only vaginal epithelium or perineal skin (best case)
Second degree vaginal lacerationinvolves subepithelial tissues of the vagina or perineum, +/- perineal body
Third degree vaginal lacerationinvolves anal sphincter (partial or complete)
Fourth degree vaginal lacerationinvolves rectal mucosa (worst)
Treatment of uterine atonyBimanual massage
Why do women get osteoporosis in menopause?low estrogen increases osteoclastic activity
Temperature monitoring, dipstick for ovulation1 day after LH surge
Infertile pt who is hirsute, obese how to tx?Metformin, wt loss
Most common infertility reason?Old age