Surgery Gone Wrong
What are two scenarios where cefozolin should be redosed during surgery?
EBL >1500 cc
>4 hours of surgery
When should women start bone density screening (without and with risk factors)?
Age 65 or older
OR
Age 50-64 with risk factors
What is the treatment for an uncomplicated gonorrhea infection?
Ceftriaxone 500 mg IM x1 (<150 kg)
Which IUD can be used for emergency contraceptive? How many days after intercourse is it effective?
Paragard IUD
5 days
What is the average age of menopause?
Age 51
A patient presents with difficulty rotating and adducting her thigh after hysterectomy. Which nerve was injured?
Obturator Nerve
Two doses
Give second dose 6-12 months after first dose
What are the Amsel criteria and what does it diagnose?
Diagnose bacterial vaginosis
Must have 3 of the following: grayish-white discharge, vaginal pH >4.5, positive whiff test, >20% clue cells
Which medical conditions are contraindications to levonorgestrel emergency contraception?
None
What is the first choice SSRI/SNRI in treatment of vasomotor symptoms of menopause (FDA approved)?
Paroxetine
You are performing a hysteroscopy and patient develops decreased end tidal CO2, hypotension, and tachycardia. You suspect air embolism. Which murmur will you hear? Which position do you place them in?
Mill-wheel murmur
Left lateral decubitus and trendelenburg position
What are the recommendations for STI testing?
All women that are sexually active <25 years old or >25 years old with risk factors
What is the recommend treatment for syphilis in pregnant patients who are allergic to penicillin?
Penicillin desensitization, then give penicillin
Which emergency contraceptive is a selective progestin receptor modulator?
Ulipristal
In patients with a uterus taking a standard dose of estrogen, how often is progesterone required?
At least monthly
You're performing a cesarean section with dense bladder adhesions. During dissection, you see the foley catheter. You find a 2 cm cystotomy at the dome. How do you repair this? How long should you keep a foley catheter in?
Close in two layers with absorbable suture. First layer closes bladder mucosa with simple running suture. Second layer closes bladder serosa/muscularis in imbricating fashion. Leave foley in for 7-14 days.
When is the shingles vaccine recommended? How many doses?
Age 50+, two doses, 2-6 months apart
What is the outpatient PID treatment regimen?
IM ceftriaxone 500 mg x1
doxycycline 100 mg bid x14 days
metronidazole 500mg bid x14 days
What is the most effective emergency contraceptive?
Copper IUD
What metabolism benefit does transdermal estrogen have over oral forms?
Reduced hepatic effects due to first pass metabolism
Your patient is on Warfarin for atrial fibrillation. You are planning to perform a laparoscopic hysterectomy. When should the patient stop her Warfarin and when should she resume after surgery?
Hold 5 days prior to surgery (goal INR 1.5-2) and resume 12-24 hours after surgery
What are the cervical cancer screening recommendations for patients with HIV? When should screening be stopped?
Start at age 21, repeat every 12 months for 3 consecutive screenings and if normal, can go to every 3 years
Do not recommend stopping screening
What is the treatment for hidradenitis suppurativa stage 1?
Topical clindamycin
Which emergency contraceptive is less effective for patients weighing more than 165 lbs?
Levonorgestrel
What is the underlying cause of elevated FSH in menopause?
Decreased inhibin