Bothersome Bleeding
In a patient with nexplanon who has bothersome irregular bleeding, what is the first and second line treatment?
NSAIDs, OCPs
In smokers, at what age limit are CHC's contraindicated?
35 and older :(
What are indications for mirena use?
Temporary undesired fertility, menorrhagia
What are some natural methods for family planning?
Calendar method, Basal body temperature, cervical mucous/ovulation method, cycle beads, MANY MANY APPS (Ovia)!!!
What are natural ways to help with nausea and vomiting?
Ginger, dietary modifications, small meals, trigger avoidance
In a postmenopausal patient, what is your first step to evaluate irregular bleeding?
Transvaginal US to look for endometrial stripe thickening (>4mm).
If CHC's are ineffective in treating hirsutism, what medication can you try and what labs will you monitor?
After starting spironolactone, you have to monitor electrolytes and also place patient on birth control.
If your patient has current breast cancer or a malignant liver tumor, what is the best IUD for her?
Paragard
Explain how to counsel someone with a regular cycle (26-32d interval) on the calendar method? (what days do you avoid unprotected intercourse?)
Have unprotected intercourse from day 8 to day 19 of the cycle (12 days).
What are first line medical treatments for nausea and vomiting in pregnancy?
Vitamin B6 (Pyridoxine), doxylamine. BONUS (100pts per): What are the doses and frequency?
In a 45y G1P0 Obese Premenopausal patient with DM2 irregular frequent bleeding (interval <21d, duration >5d) nl PE, and negative labs/PAP, what is the next step for evaluation?
Endometrial biopsy
In an obese patient with oligomenorrhea, how many months can your patient wait before she needs treatment to have her period?
3 months before she needs treatment
Can you place an IUD in a patient with no documented GC/CT testing?
YOU CAN! (as long as they have no active infection/PID) you can test for GC/CT at the time of insertion
How many mcg of folic acid should be recommended to G0P0 woman trying to conceive, and how long does it take to build up stores?
At least 400mcg, and it take one month to build up stores
What are 3 over the counter medications that are safe to use in a pregnant woman with a cold? (100 points per answer)
Claritin, Rhinocort, Tylenol, Guaifenisen DM, Benadryl
A G1P0 sees you in the emergency room for painful bleeding in early pregnancy (LMP 8 weeks ago), as you look for the gestational sac using your epic TVUS skills, what specific labs/results are you getting?
Quant hcg, CBC, type and screen. The discriminatory zone is serum hCG level above which a gestational sac should be visualized by TVUS if an IUP is present (~1,500 - 2,000)
For a patient with HTN, which contraceptive methods can you recommend?
IUD's, Nexplanon, POP.
Not DMPA which is category 3 for BP>160/100 and vascular disease.
Not Estrogen which is category 3 and 4 (can refer to OBGYN if pt adamant about estrogen)
You are doing an IUD removal but can't visualize the strings. What are your steps for string localization? (100 points for each answer)
cytobrush, IUD hook, alligator forceps, endocervical speculum (to visualize, then use long kelly clamp to grasp)
When is a women's fertile period (days around the time of ovulation)?
Fertile period is ~6 days although one can get pregnant outside of these 6 days. Highest chance is 5 days before ovulation and day of ovulation. Highest probability of conception is 1-2 days before ovulation and day of ovulation. Once ovulation has occurred, egg can be fertilized for 12-24 hours.
What are herbal teas that can lead to spontaneous abortion in early pregnancy?
Chamomile, Licorice, Peppermint, Rasberry. Resource is Update on prenatal care AFP 2014
In a patient with hormonal IUD, what would be your differential for bothersome prolonged/heavy bleeding (3 mo after placement)?
IUD malposition or expulsion, pregnancy, infection, cervical dysplasia.
Insert subdermally into the inner side of non dominant upper arm 8-10cm (3-4 inches) above medial epicondyle of the humerus.
Counsel about irregular bleeding, hair changes, weight changes
Soon after a procedural abortion, when is the only time/condition you cannot place an IUD?
Septic abortion :(
How long do you wait to do an infertility work up in these woman: younger than 35 years old, 35-40 years old, older than 40 years old?
Workup those aged:
< 35y after 1 year
35-40y after 6 months
>40 y immediately when they want to conceive
what are treatment options for candida vaginitis in early pregnancy?
Topical imidazole/miconazole/clotrimazole. PO Azoles in early pregnancy is an increased risk of miscarriage in 1st trimester, possible birth defects with high doses