Cancer Screenings
The screening test of choice to diagnose breast cancer in asymptomatic, average risk women
What type of contraception is contraindicated in women with migraine with aura?
What is: Combined hormonal contraceptives (CHCs = pills, patch, ring)
**CHCs are class 4 for women who have migraine with aura (past or present). This is based on studies that showed a 3 fold increase in the risk of ischemic stroke with the use of combined oral contraceptives in women with migraine with aura
What is the treatment of choice (include dose) for Trichomonas vaginalis?
What is:
Metronidazole (Flagyl) 500mg twice daily x 7 days (failure rate is significantly less than with the single dose regimen of 2gm once)
Retesting should be done 3 months after treatment
"Sneeze and Pee"
No urge
No nocturnal symptoms
What is:
Stress Urge Incontinence
The most common endocrine disorder in reproductive aged women
PCOS
Per the 2016 ACOG guidelines, at what age do you begin cervical cancer screening? and at what age do you start cervical cytology with HPV co-testing?
Begin cervical cancer screening at age 21 years, REGARDLESS of the first age of sexual intercourse
Between the ages of 21-29, women should be screened every 3 years with cervical cytology only
Between the ages of 30-65 years, women should be screened every 5 years with cervical cytology and HPV testing
What type of contraception is preferred for women with multiple sclerosis who have prolonged immobility?
The choice of contraceptive method for a woman with MS depends on her level of immobility, since prolonged immobility increases the risk of VTE. If you have to pick a CHC, pick one with a lower dose of estrogen component and a second generation progestin (ex, levonorgestrel) which minimizes the VTE risk
Note: some of the 3rd generation progestins (ex desogestrel, gestodene) are associated with increased VTE risk
What is the treatment of choice for Chlamydia trachomatis? (Pregnant vs Nonpregnant)
Doxycycline 100mg twice daily x 7 days is preferred in the nonpregnant patient
Azithromycin 1 gm dose is preferred for pregnant
Diagnostic test for stress urge incontinence?
What is:
Q-tip test = urethral hypermobility
Leakage of urine from urethra with valsalva or cough
Criteria for PCOS
What is:
need two of three
1. Hyperandrogenism (labs or physical)
2. Anovulatory (AUB, infertility)
3. Polycystic ovaries
Name 5 family history factors associated with an increased likehood of BRCA1/2 mutations
Breast cancer diagnosis before 50 years of age
Bilateral breast cancer
Family members with both breast and ovarian cancer
Breast cancer in > or equal to 1 male family member
Multiple cases of breast cancer in the family
> or equal to 1 family member with 2 primary types of BRCA-related cancer
Ashkenzai Jewish ethnicity
What is the preferred contraception for women with epilepsy?
What is:
For women with epilepsy, all contraceptive methods are safe, but antiepileptic drug interactions with implants, injectable agents, progestin-only methods, and oral contraceptives may decrease the efficacy of the contraceptive method. Using another form of contraception (barrier method, IUD) in combination with CHCs or progestin-only pills is an option to mitigate decrease in efficacy.
Yellow-green vaginal discharge with motile pear-shaped protozoa on saline prep
What is:
Trichomonas vaginalis
First line treatment for stress urge incontinence
What is:
pelvic floor exercises and pessaries
Anticoagulation for DVT/PE in Pregnancy
What is:
Warfarin: teratogenic, avoid use in all trimesters
LMWH: safe, therapy of choice
NOACs: No safety data is available
Breast cancer screening recommendations for transgender men per American College of Radiology
What is:
Breast reduction surgery or no chest surgery-> Breast exam and mammography as for natal women (annual mammography starting age 40 years)
Bilateral mastectomy-> yearly chest wall and axillary examination
Preoperative->Mammography only if patient meets usual natal female requirements
Which form of contraception have the HIGHEST efficacy and the largest window for use (120 hours) in preventing expected pregnancies?
What is:
Copper IUD (Paraguard)
Acute PID requires inpatient management if there is a tubo-ovarian abscess, high fever, pregnancy, or the inability to tolerate PO. What is the initial antibiotic choice for inpatient treatment of PID?
What is:
"cefoxi and doxy" = cefoxitin and doxycycline
What is:
Overflow urinary incontinence
Contraindications to antimuscarinic (oxybutynin)
What is:
dementia and narrow angle glaucoma
Breast cancer screening recommendations for transgender women per American College of Radiology
What is:
> or equal to 50 years of age with past or current hormone use--> annual mammography if patient has additional risk factors (hormone therapy > 5 years, BMI > 35, family hx)
No hormone use--> routine screening not indicated unless other known risk factor present (ex. Klinefelter)
What is the only emergency contraception that requires an interruption of breast feeding following administration?
What is:
Ulipristal (Ella)
Name the micro and preferred diagnostic test for Candida, BV, and Trich
Candida: Hyphae (KOH prep)
BV: Clue cells (saline prep)
Trich: Motile flagellated (saline prep)
Random spastic detrusor contractions and treatment options
What is:
Urgency urinary incontinence
antimuscarinic agents (oxybutynin)
or Beta agonist (mirabegron)
Contraindications to Mybetriq (beta agonist)
What is:
elderly with hypertension or arrhythmia