Women's Health Rosh Boost Exam

If a vulvar squamous cell carcinoma is suspected, what is the best diagnostic test?

Vulvar colposcopy.

pink, sharply marginated, smooth, and flat-topped 1-2 cm moist papules and small plaques

Condyloma lata - anogenital form of secondary syphilis

may present as flesh-toned papules or when irritated, as inflamed, red, and dome-shaped 2-3mm papules in clusters with central umbilication and a white core

Mollucsum contagiosum

typically presents as a friable, bright red 7 mm papule at the urethral meatus

urethral caruncle

urethral caruncle tx

usually asymptomatic

can do topical estrogen for 2-3 mo if symptoms

a persistent, erythematous, and scaly macule or patch with or without mild tenderness

in situ vulvar squamous cell carcinoma

presents as a friable papule, ulcer, or mass on the labia majora

Increased vascularity around the lesion is common and associated tenderness, erythema, and vulvar pruritus may be present

vulvar squamous cell carcinoma

_____ is an inflammatory, cutaneous, autoimmune disease.

It typically presents as white, lichenified, adherent 2-3 cm plaques on the bilateral labia minora or mucosal surface of the labia majora (although it may present on any cutaneous area of the body).

Lichen sclerosus et atrophicus

Vulvar squamous cell carcinoma is most often caused by ___, however, a longstanding history of uncontrolled ______ may also lead to the development of vulvar squamous cell carcinoma

HPV

vulvar lichen sclerosus et atrophicus

While most cases of vulvar lichen sclerosus are well-controlled with _____, it is a proliferative disease and there is an increased risk for the development of vulvar squamous cell carcinoma.

For this reason, women with a history of vulvar lichen sclerosus should have screening exams every _____ and any suspicious lesion should be biopsied immediately.

potent topical steroids

six months

risk factors for vulvar cancer

vulvar or cervical intraepithelial neoplasia

prior hx cervical cancer / HPV

cigarette smoking

vulvar lichen sclerosus

immunodeficiency syndrome

Premenstrual syndrome shares many of the symptoms of premenstrual dysphoric disorder, however, the criteria for premenstrual dysphoric disorder are more severe, including _____ symptoms or more of both physical and mental complaints.

five

does PMS or PMDD have both physical and mental complaints

both have both physical and mental

Key point between PMS and PMDD is _______

PMDD symptoms usually hinder personal or professional life (unlike PMS)

When does the follicular phase of the menstrual cycle begin?

the day menses begins

The volume of blood loss is considered normal at < ____ mL per cycle

80

When does the follicular phase of the menstrual cycle end?

the day before the LH surge

When does the luteal phase of the menstrual cycle begin?

the day of the LH surge / day of ovulation

When does the luteal phase of the menstrual cycle end?

the day menses begins

In the late follicular phase, FSH and LH _____ slightly due to increasing estradiol levels.

fall

_____ levels peak 1 day before ovulation.

Estradiol

Estradiol levels peak ______

1 day before ovulation.

A substantial ____ in LH and FSH occurs, and ovulation takes place.

increase

In the luteal phase, gradual _____ in LH will lead to gradual _____ in estradiol and progesterone if fertilization does not occur.

decreases

decreases

In the case of fertilization, the fertilized egg implants into the endometrium, and the early embryo is sustained by producing _____.

chorionic gonadotropin

In what phase of the menstrual cycle is the endometrium the thickest?

The luteal phase.

While most patients with PID can be treated outpatient, inpatient treatment is recommended for patients with _____

severe illness (severe abdominal pain, high fever, or nausea and vomiting preventing oral intake)

suspected pelvic abscess

pregnancy.

outpatient PID tx

ceftriaxone IM + doxy PO + metro PO

inpatient PID tx

cefotetan or cefoxitin + doxy

Why is pelvic inflammatory disease less common during pregnancy?

The mucus plug and decidua seal off the uterus from ascending bacteria. However, pelvic inflammatory disease can happen during the first 12 weeks before this occurs.

Most cases of TSS are secondary to ____ producing exotoxins

methicillin-susceptible Staphylococcus aureus

2 causes of TSS

staph or strep (GAS) exotoxins

is there a rash in TSS

yes and will cause skin desquamation 1-2 weeks after rash

In the postmenopausal uterus, tamoxifen acts as an estrogen ____, thereby increasing the incidence of endometrial hyperplasia and endometrial cancer.

agonist

Tamoxifen is used in the treatment of ____ breast cancer.

hormone receptor-positive

risk factors for endometrial cancer

ENDOMET

oldEr age

Nulliparity

Diabetes

Obesity

Menstrual irregularity

Estrogen monotherapy

HyperTension

True or false: multiple gestation pregnancies can be differentiated from singleton pregnancies using serial serum human chorionic gonadotropin (hCG) measurements.

false - While commonly higher than singleton pregnancies, there is no diagnostic criteria or threshold for using serum hCG to identify multiple gestation.

The concentration of hCG doubles every 29–53 hours during the first 30 days of gestation and peaks at ____ gestation.

8–10 weeks

A handheld transabdominal Doppler can detect fetal heart tones at _____ gestation.

9–12 weeks

Chadwick sign and occurs at _____ gestation

8-12 weeks

For small asymptomatic cystoceles, ____ is recommended.

observation

What specific muscle do kegel exercises (pelvic floor muscle training exercises) target?

Levator ani.

____ work by inhibiting bacterial cell wall synthesis, eventually also causing the lysis of bacterial cells

cephalosporins - safe in preg

_____ inhibits protein synthesis by binding to the 50S ribosomal subunit.

azithromycin / macrolides

The mechanism of action of ____ is to damage bacterial DNA

fluoroquinolones

_____ inhibit protein synthesis by binding with the 30S ribosomal subunit

Tetracyclines / doxy

are generally not as safe in pregnancy due to the increased risk of dental staining, fetal growth restriction and bone loss, and spontaneous abortion

tetracyclines / doxy

doxycycline may be used if under _____ days of gestation

21 - but usually avoided

Large follicular cysts can form during ____ when undergoing ____, which increases the risk of ovarian torsion

ovulation induction

infertility treatment

Anti-D immune globulin should be given to Rh D-negative patients at ____ weeks gestation, Rh D-negative patients within ____ hours of delivery, and any Rh D-negative individual who at any time during pregnancy experiences significant vaginal bleeding, abdominal trauma, cephalic version, spontaneous or induced abortion, or ectopic pregnancy or has an amniocentesis performed without having received the anti-D immune globulin.

28

72

What fetal complication of Rh alloimmunization refers to abnormal fluid collection in the fetus?

Hydrops fetalis.

Hepatomegaly, ascites, pleural effusion, pericardial effusion, and subcutaneous edema can occur.

____reflexia can be seen in preeclampsia

hyperreflexia

Obesity, nulliparity, advanced maternal age, and a family history of preeclampsia are considered moderate risk factors for ______.

preeclampsia

Autoimmune disease, chronic hypertension, a personal history of preeclampsia, and multifetal gestation are considered high-risk factors for _____.

preeclampsia

Preeclampsia is considered when systolic blood pressure exceeds ____ mm Hg or diastolic blood pressure exceeds ____ mm Hg (measured twice and 4 hours apart) and proteinuria or other serious disorders are present.

140

90

Delivery is recommended after ____ weeks gestation for patients with preeclampsia without severe features.

37

Intravenous labetalol, intravenous hydralazine, or oral nifedipine are recommended for patients with blood pressures > ____ mm Hg

160/110

RF for ______

prior preterm birth, prior cervical surgery, and uterine anomalies

preterm birth

prior ob hx

RF for ______

advanced maternal age, maternal medical conditions (hypertension, diabetes, thyroid disorders), lower socioeconomic status, < 18 months between pregnancies, poor access to medical care, BMI classified as underweight, poor nutritional status, and long working hours (> 80 hours per week)

preterm birth

current maternal status

RF for ______

multiple gestations, fetal chromosome disorder, substance use, and infections, including urinary tract infections like asymptomatic bacteriuria, bacteria vaginosis, sexually transmitted infections, and severe viral infection

preterm birth

current pregnancy characteristics

4 risk factors for preterm birth that have a particularly strong association with PPROM

genital tract infection (asymptomatic bacteriuria, pyelonephritis)

previous PPROM

antepartum bleeding

cigarette smoking.

____ is the first-line treatment for patients showing signs of cardiac or respiratory effects of magnesium toxicity.

Calcium gluconate

How long after delivery can preeclampsia-eclampsia occur?

Up to 6 weeks.

The most important risk factors for gestational trophoblastic neoplasia are _____ and ______

prior molar pregnancy

advanced maternal age (age > 40 years)

cytotrophoblasts and syncytiotrophoblasts without chorionic villi

choriocarcinoma

which mole has 2 paternal haploid sets and 1 maternal haploid set

69, XXY

partial

which mole has 2 haploid sets, both paternal

androgenically diploid

46, XX

complete

which mole has focal hyperplasia of villi

partial

which mole has generalized hyperplasia

complete

virtually all ____ moles are androgenically diploid

invasive

histologically different from a hydatidiform mole by the absence of villi

choriocarcinoma

Which histologic types of gestational trophoblastic neoplasia have low human chorionic gonadotropin levels?

Placental site trophoblastic tumor and epithelioid trophoblastic tumor.

Contraindications for _____ biopsy include active cervicitis, pregnancy, bleeding disorder, and immunosuppression

colposcopic

prior cone biopsy is a CI to _____

endocervical curettage

In patients with a prior cone biopsy, the transformation zone will have likely receded deeper into the endocervical canal, which prevents accurate sampling.

What size of ovarian mass most raises suspicion for ovarian torsion?

5 cm in diameter or larger.

The current dietary recommendations for patients trying to conceive include

____ of calcium, which is important for bone and muscle health

1,000 mg

The current dietary recommendations for patients trying to conceive include

_____of folic acid for appropriate fetal neural tube development (____ from a supplement and ____ from diet);

600 mcg

400 mcg, 200 mcg

The current dietary recommendations for patients trying to conceive include

____ of elemental iron to correct iron deficiency anemia

30 mg

The current dietary recommendations for patients trying to conceive include

____ of omega-3 fatty acids for fetal brain and eye health

650 mg

The current dietary recommendations for patients trying to conceive include

_____ of vitamin D daily for bone and muscle health

600 IU

What is the disadvantage of taking calcium and iron simultaneously?

Calcium can inhibit iron absorption.

When can pregnancy first be detected by transvaginal ultrasound?

At 4.5-5 weeks gestation, an intrauterine fluid collection consistent with pregnancy or a gestational sac can be visualized.

The uterus reaches pre-pregnancy size by _____ postpartum

6–8 weeks

The uterus in the lactating mother is generally _____ at 3 months postpartum.

smaller

telogen effluvium

hair loss

occurs when the ratio of non-growing hair to growing hair increases. This is a self-limiting condition and commonly resolves by 5 months postpartum

the postpartum patient is likely to lose about half of gestational weight gain within the first ___ weeks after delivery

6

puerperium uterine involution

day ____: lie midway between the pubic symphysis and umbilicus

7

puerperium uterine involution

day ____: no longer palpable

17

he uterus is likely to be palpated just above the umbilicus ______ after delivery.

12 hours

lochia alba begins ____ postpartum and can last up to ____ postpartum

2-3 weeks

up to 8 weeks

Physiologic leukorrhea

normal vaginal discharge

a left occiput posterior position can be defined by palpating the _____ fontanel between the ___ and ____ o’clock positions with the occiput located on the left side of the birth canal

posterior

4 and 5

The most common tocolytic used to delay birth is ____

indomethacin

delays birth by 48 hours

a common tocolytic used if indomethacin or nifedipine are contraindicated, such as in cases of platelet dysfunction or bleeding diathesis, kidney or hepatic dysfunction, ulcerative gastrointestinal disease, myasthenia gravis, or hypersensitivity to aspirin

magnesium sulfate

when is mag sulfate recommended for neuroprotection against cerebral palsy

< 32 weeks

What is the minimum gestational age at which tocolysis should be attempted during preterm labor?

22 weeks.

dietary intake of ______mg of calcium daily is recommended to prevent bone loss in pts who are postmenopausal

1200 mg daily

is lupus a CI to combined OCP

yes

Tubo-ovarian abscesses are found most often in ____-age women and usually occur as a complication of ____

reproductive

pelvic inflammatory disease

The classic presentation of a _____ is acute lower abdominal pain, vaginal discharge, fever, and chills.

tubo-ovarian abscess