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Contraception and other meds
Adenexal Mass - Older Women
Contraception & Cardiac Risk
Adenexal Masses in Preg
Trichomonas
100
Interactions of combined contraceptives, progestin only contraceptives and progestin from the progestin implant may interact with which other medications because of their interactions with the hepatic cytochrome p450 pathway? A - Antiretrovirals B - Antiepileptics C - Antibiotics D - All of the above E - None of the above
What is D.
100
Which of the following imaging modalities is the least helpful for the initial work-up of an adenexal mass in a 70 y/o patient? A - MRI B - Ultrasound C - Color Doppler Sonography D - CT or PET-CT
What is D. If you are highly suspicious of a neoplasm this may be needed for surgical planning but is not part of the initial work-up. Ultrasound in the preferred modality.
100
Hypertension and combined hormonal contraceptives Which is not paired correctly? A - Hypertension (140-159/90-99) = Category 3 B - Hypertension on meds = category 3 C - Severe hypertension (>160/>100) = category 4 D - Severe hypertension (>160/>100) = category 5
What is D - there is no category 5 ;)
100
The overall prevalence of adenexal patholgy is ____% with ____ % of those persistent masses being malignant. A - <6% ; <1% B - <6% ; <5% C - <6% ; <10% D - <3% ; <1% E - <3% ; <5% F - <3% ; <10%
What is C. Overall prevalence is 1-6% 3-7% of those that persist will be malignant
100
Risk factors for trichomonas infection include all of the following except A - Female B - African american C - low education level D - Multiple sexual partners E - Living in poverty
What is D. Although I find this hard to believe it is not listed as a risk factor for infection.
200
In patients with HIV on HAART - which medications should you look out for in regards to interference with combined OCPs? A - Efavirenz (Sustiva) B - Nevirapine (Viramune) C - Ritonavir-boosted protease inhibitors D - All of the above
What is D These all utilize the cytochrome P450 pathway- if you patient is on one of these you want an estrogen dose of at least 30ug of ethiny estradiol. Consistent and correct use of condoms is also recommended to protect against HIV transmission and make up for the loss of contraceptive efficacy.
200
Which of the following lab tests could be useful? (Pick all) A - CA125 B - BHCG C - HE4 D - OVA1 E - LDH
What is A, C and D BHCG, LDH and AFP are of limited value. Most cancers in this age group are epithelial.
200
Best contraceptive for a patient with Class R diabetes. A - Mirena B - Copper IUD C - Vaginal Ring D - Depo-provera E - All of the above F - A or B G - A or B or D H -
What is F Depo-provera has some concern about lipid effect Patients with end organ damage should avoid combined contraceptives due to the risk of thrombosis.
200
Which of the following u/s features is not suggestive of malignancy? A - Abnormal Wall structure B - Thick septations C - Solid components D - Papillary projections E - Increasing size F - Hypo echoic center with hyper echoic walls
What is F. This describes a simple cyst
200
Which of the following is not paired correctly with its sensitivity of detection of trichomonas? A - Wet mount - 85% B - Trichomonas antigen testing - 83-88% C - Nucleic acid testing - 83% D - Pap smear - 55-70% E - Culture - 90%
What is A wet mount. The sensitivity of this test is only 55-70% (same as on a PAP test) - although a PAP test has more false positives which would lead to overtreatment - so if a positive result is found on a PAP test he best practice is to do another test to confirm.
300
In a patient with epilepsy - which anti-epileptics are the most potent enzyme inducers? A - Phenytoin, carbamazepine, phenobarbital B - Topiramate, felbamate, oxcarbazepine C - Lamotrigene, valproate
What is A A is the most potent enzyme inducers B is medium enzyme inducers C is anti-epileptics whose levels decrease with contraceptive and so may need to be increased in dose
300
You checked a CA125 on your postmenopausal patient as part of her work-up for a newly diagnosed adenexal mass. What value would prompt referral to a GYN-ONC? A - >35 B - >100 C - >135 D - >200
What is A Postmenopausal >35 Pre-menopausal >200
300
Obesity Which is the best contraceptive to recommend for a BMI of 43? A - Mirena IUD B - Copper IUD C - Vaginal Ring D - Depo-provera E - All of the above F - A or B G - A or B or D
What is A. Protects against increased risk of endometrial abnormalities. Depo provera has SE of weight gain > in obese population CHC and POC are generally safe in BMI >30 but have concerns about decreased efficacy and small increase in venous thromboembolism so are not the BEST choice.
300
Which of the following can be elevated in normal pregnancy? A - CA 125 B - BHCG C - LDH D - AFP E - Inhibin F - All of the above G - None of the above
What is F - all of the above Making it hard to use any of these markers in pregnancy.
300
Acceptable treatments for Trichomonas include (pick all) A - 2 grams metronidazole PO x 1 dose B - 500mg metronidazole BID x 7 days C - 1 gm Metronidazole gel PV x 7 days D - 2 grams Tindazole PO x 1 dose
What is A, B and D Treatment must be ORAL - topical therapy is not effective **Disulfram-like reaction with both metronidazole and tinidazole - so no alcohol for 24 hrs (metronidazole) or 72 hrs (tinidazole)
400
What is the only antibiotic rated MEC Category 3 for use with Combined hormonal contraceptives, Progesterone only contraceptives and the etonogestrel implant? A - Doxycycline B - Levaquin C - Amoxicillin D - Erythromycin E - Rifampin
What is E - Rifampin. Back-up contraception for women on other antibiotics is not recommended.
400
How many of the following characteristics must be present to refer your patient to a GYN-ONC. - Ascites - Evidence of metastasis - First degree relative with breast/ovarian cancer - Elevated CA 125 (>35 postmenopausal, >200 premenopausal) - Fixed Nodular Pelvic Mass
What is 1. Any of these risk factors should prompt refer to GYN-Onc according to ACOG and SGO.
400
Smoking - Which is true? A - No CHC's if >35 B - No CHC's if >2PPD C - Progesterone only method for 6 months then CHC if no problems
What is A. There is a dose relation to smoking so yes in heavy smokers you would encourage a non-combined method but not absolute. C makes no sense.
400
The risk of torsion for an adenexal mass is the highest during which weeks of pregnancy? A - 10-16 weeks B - 3-7 weeks C - 32-36 weeks D - 21-28 weeks
What is A. This is a period of rapid uterine growth - increasing the risk of torsion.
400
Reinfection rates are as high as _____%; due to __________. A - 11% - Incomplete treatment B - 17% - Untreated partner C - 28% - Disulfram reaction D - 35% - Untreated partner
What is B If you suspect re-infection - retreatment is appropriate.
500
What is the best oral contraceptive pill to use for a patient with epilepsy treated with topiramate who has a contraindication to all other methods except pills? A - Alesse (Levonorgestrel 0.1/Ethinyl estradiol 20ug) B - Yaz (Drospirenone 3 / Ethinyl Estradiol 20ug) C - Sprintec (Norgestimate 0.25 / Ethinyl Estradiol 35ug) D - Loestrin 1/20 Fe (Northindrone 1 / Ethinyl Estradiol 20Ug + Iron)
What is C This is the only formulation listed that has an estrogen dose >30ug.
500
Simple unilocular cysts up to 10cm have a ___% risk of malignancy? They can be followed clinically and by US in 4-6 months. ___% will spontaneously regress. A - 1% : 33% B - 5% : 33% C - 10% : 33% D - 1% : 66% E - 5% : 66% F - 10% : 66%
What is D.
500
Age >45 and wants to remain on her birth control pills (sprintec) - which is not recommended? A - BMI - 31 B - No h/o heart disease C - BP 126/87 D - Non-smoker
What is A Obesity is a cardiovascular risk factor - over age 40 combined OCPs should only be continued if no other cardiovascular risk factors are present.
500
What is the most likely outcome for a pregnancy complicated by an ovarian mass? A - Persistence of mass after delivery B - Surgery for torsion or rupture during surgery C - Spontaneous resolution of mass during pregnancy D - Malignancy diagnosed with recommendation to end pregnancy
What is C. From 51%-70% of masses will resolve spontaneously.
500
In 2-5% of infections - organisms may have developed decreased sensitivity to nitroimidazoles. What therapy could be considered in this case? A - 2 grams metronidazole PO x 1 dose B - 500mg metronidazole BID x 7 days C - 2 gm Metronidazole PO x 5 days D - 2 grams Tindazole PO x 5 dose A and B B and C A and B and C B and C and D
What is B and C and D B would be recommended if decreased sensitivity is expected C and D are extended high dose therapy and should be used if B fails.