Contraindication for levonorgestrel releasing IUD (where copper IUD might be preferred)
women with severe cirrhosis or liver cancer, copper IUD is
... [Show More] preferred -> levo-releasing and copper IUD have no differences in risk for DVT/PE, totes ok in smokers/nulliparous
First test for painless post-meno bleeding
transvag US (endometrial biopsy if TVUS no available)
TVUS endometrial thickness suspicious for cancer
more than 3-4 cm
Best class of antidepressants for pregnant women
SSRIs
First line treatment for primary dysmenorrhea
NSAIDs (start at onset of menses, continue for first two days) > OCP, lack of high quality evidence (good if no baby wanted)
Risk factors for still birth
advanced maternal age, smoking > 0.5 packs a day, congenital anomalies, BMI > 30 (vigorous exercise is okay!) "old, fat, smk"
All preg should be screened for this b/w 11 and 16 weeks gestation and should be tx'ed appropriately if (+)
urinalysis and urine culture screening for asymptomatic bacteriuria (cause repeat UTIs, pyelo, preterm labor if untx'ed)
When group B strep screening in pregnancy should be done
35-37 weeks of gestation
How to treat pregnant woman w/GBS first line? if allergic to first line?
first line: ampicillin; if allergic use cefazolin
When DM screening should be done in pregnancy
24-28 weeks of gestation (with a 50 g glucose dose)
Drug of choice for pregnant women w/opioid abuse
methadone, no long term effects noted
A condition that represents an unacceptable health risk if the contraceptive method is used
Migraines with aura (2-4 times more likely to have a stroke if headaches, if w/aura the risk is higher thus unacceptable risk)
Normal number of arteries and veins in umbilical cord
2 arteries, 1 vein
Who is legally responsible for ensuring the patient gets notified of the mammogram results?
facility performing the mammogram
First line therapy for menstrual abnormalities, hirsutism, and acne in PCOS
hormonal contraceptives
Gestational HTN after 37 weeks -> next best step?
induction of labor; if less than 37 weeks do twice weekly office visits
Pregnant woman has not been vaccinated for rubella (neg titers for rubella), when do you immunize?
right after childbirth, MMR is live attenuated so you can't give during or shortly before pregnancy
Pt w/preeclampsia is given Mg -> suddenly becomes apneic and areflexic -> NBS?
this is Mg toxicity, give calcium (CaCl if central line or Ca-gluconate if peripheral line)
Drugs for uterine atony and postpartum bleed
Oxytocin, misoprostol, methylgonovine (don't use if HTN), carboprost (don't use if asthma)
Antiemetic during pregnancy first line (after lifestyle and diet changes didn't work)
doxylamine (Unisom 12.5 mg 3-4/d) and pyridoxine (vitB 10-25 mg once/d) + avoid certain foods (spicy/fat), eat high prt snacks, crackers in AM b4 rising
Persistent occiput posterior fetal position has a lesser chance of what kind of delivery
normal, spontaneous vaginal delivery -> higher risk of cesarean delivery and assisted vaginal delivery
Young female with positive gonorrhea test and negative Chlamydia test, NBS tx?
treat with ceftriaxone 250 mg IM plus (azithromycin 1 g PO once or doxycycline 100 mg x2 daily for 7 days); tx all partners in prvs 60 days as well
Immunization indicated for all pregnant women at any stage of the pregnancy
influenza vaccine (avoid preg 28 days after MMR or varicella vaccines; HPV not rec during preg)
Healthy 30yo w/regular menses has been trying with healthy sperm analysis husband for 15mo -> NBS?
confirm ovulation with a luteal-phase progesterone level above 5 ng/mL on day 21 of cycle (if confirmed, check for tube patency)
Likely side effect with aromatase inhibitors (letrozole) not seen with SERMs (tamoxifen)
myalgias (DVT occurs rarely); endometrial cancer can happen with long term tamoxifen use
First line for N/V in pregnancy during first trimester?
vitamin B6, safe and less assoc w/drowsiness vs other meds (scopolamine effective/safe during 2 or 3rd trimesters only)
Which contraceptive should be used with caution due to risk of hyperkalemia when used with spironolactone?
oral drospirenone/ethinyl estradiol (Yaz, Yasmin), it too can lead to hyperkalemia, don't mix with spironolactone
From the list, which is a teratogen: atenolol, bupropion, metformin, fluoxetine, glargine
atenolol, causes growth restriction and reduced placental weight
Pap reveals normal cytology but infection with HPV serotypes that are not 16 and 18 -> NBS?
return in one year for repeat pap/HPV testing; if still HPV positive a year later, get a colposcopy. If it would have been 16 or 18, colposcopy would have been indicated
PCOS dx requirement? First line treatments in obese PCOS?
dx'ed by high testosterone + ovulatory dysfunction or polycystic ovaries; tx: if obese lifestyle mods +/-metformin which can improve abnormal menstruation
Most effective method of natural family planning?
cervical mucus monitoring (can determine the beginning and end of most fertile period
MC causes of secondary amenorrhea? NBS once PE, preg test, TSH are unremarkable in 2o amenorrhea pt?
PCOS, menopause, hypothalamic amenorrhea, hyperprolactenemia; get hormone levels (LH, FSH)
Work up for primary amenorrhea?
pelvic US (anatomical), karyotyping (Turner's and androgen insensitivity syndrome)
Benefits of treating gestational DM w/metformin or insulin
decreased risk of operative delivery, big baby, shoulder dystocia, maternal preeclampsia (doesn't decrease chance of getting actual DM later on or perinatal death)
What do you need to get on a patient before starting them on OCPs?
blood pressure (severe HTN is a contraindication to OCPs), also assess if they are pregnant [Show Less]