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USMLE Step 2 - Top 5% > OBGYN 🤰🏻 > Flashcards

OBGYN 🤰🏻 Flashcards

1
Q

Best contraceptive for women with APLS

A

IU Cu device

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2
Q

What are the signs of partial and complete ovarian torsion

A

Severe Pain on one side. Not too much tenderness. N/V. BP stable. Partial = comes and goes. Complete = constant

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3
Q

Mx of ovarian torsion

A

Laparoscopy

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4
Q

Recall post menopausal bleeding algorithm

A
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5
Q

Tx for endometrial hyperplasia

A

Hysterectomy or Prog IUD (do if wants baby, and has no dysplasia). Will need a biopsy every 3 mo to monitor

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6
Q

Which women get endometrial biopsy for AUB

A

If postmenopausal, above 45, more than 6mo Hx, tamoxifen, obese, trialled COCP that didn’t work

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7
Q

Premenopausal women with AUB, do what?

A

COCP. If doesn’t work, then do biopsy

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8
Q

most common cause of bloody nipple discharge with no existing mass/LN

A

intraductal papilloma

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9
Q

main way to distinguish papilloma and duct ectasia

A

ectasia usually has erythema and pain…. papilloma does not

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10
Q

can hypothyroidism cause galactorrhea

A

yes, low TH can cause high TRH, which increases prolactin

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11
Q

Cervical cancer screening overview

A
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12
Q

Management of breast pain overview

A
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13
Q

Breast pain patient:
Cyclical, bilateral and diffuse.
Mass is present.
Mx?

A

Imaging

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14
Q

Breast pain patient:
Cyclical, bilateral and diffuse.
Mass is absent.
Mx?

A

Observe

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15
Q

Breast pain patient:
Non Cyclical, unilateral and focal.
Mass is present.
Mx?

A

Biopsy and refer to surgeon

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16
Q

Breast pain patient:
Non Cyclical, unilateral and focal.
Mass is absent.
Mx?

A

Imaging (if abnormal then biopsy)

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17
Q

When is BRCA testing indicated

A

More than two first degree relatives with breast cancer. One must have been below 50

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18
Q

what signs can be seen after uterine artery embolisation?

A

pelvic pain and later can see watery/bloody discharge. The FBC should be normal

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19
Q

first line therapy for lactational mastitis

A

dicloxacillin

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20
Q

Mx of androgen insensitivity syndrome?

A

gender ID counselling and gonadectomy

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21
Q

what to enquire, regarding a child with condyloma

A

sexual abuse

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22
Q

Mx of condyloma acuminatum

A

can just observe. but Tx any non resolving/symptomatic ones. can do topical podophyllin/imiquimod, cryotherapy, cauterization etc

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23
Q

Adenomyosis usually seen in which patient population?

A

Above 40yo

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24
Q

What is pelvic thrombophlebitis

A

Septic pelvic thrombophlebitis is a rare diagnosis associated with endometritis and is characterized by relapsing- remitting fevers.

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25
Q

What is genitourinary syndrome

A

Vaginal estrogen therapy is used in patients with genitourinary syndrome of menopause (eg, vaginal dryness,
atrophy) due to estrogen deficiency. In postmenopausal patients, localized estrogen can relieve urinary symptoms (eg,
stress and/or urge incontinence) related to atrophy.

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26
Q

Pruritic urticarial papules and plaques of pregnancy (PUPPP) symptoms and Tx

A

Symptoms
occurs in late third trimester or postpartum
extremely pruritic, erythematous urticarial papules and plaques within striae on abdomen
periumbilical sparing of rash
can spread to extremities, chest, and back
spares palms, soles, and face
lasts 4-6 weeks, typically resolving within 2 weeks postpartum

ToPical CS, or oral if refractory

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27
Q

Kleihauer-Betke test ?

A

identification of fetal blood cells to screen for the degree of fetomaternal hemorrhage.
measures the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream
can inform Rh Ig therapy in Rh-negative patients to prevent Rh disease in future pregnancies

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28
Q

Relationship between rosette and kleihauer betke test

A

Rosette test
to detect fetal-maternal hemorrhage
Kleihauer-Betke test

if Rosette test is positive, can conduct this test
measures fetal red blood cells in utero in maternal circulation to determine dose of RhoGAM

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29
Q

What is pseudocyesis

A

a rare somatic symptom disorder where a non-pregnant and non-psychotic woman thinks she is pregnant, patients also exhibit signs and symptoms of pregnancy

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30
Q

Child with Very insist, and premature Thelarche

A

Follicular cyst, producing oestrogen

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31
Q

Pre-menopausal woman with ovarian cyst. Has delayed menses. What could this cyst be

A

It could be a corpus luteal cyst, which produces progesterone.

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32
Q

Pelvic ultrasound findings compared follicular cyst versus luteal cyst

A

Follicular cyst is thin walled, luteal cyst is thick walled and has high vascularity

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33
Q

What type of ovarian cysts form due to GnRH stimulation (PCOS, clomiphene, ovulation induction, multi gestation)

A

Theca luteal cyst

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34
Q

Presentation of theca luteal cyst

A

Usually a symptomatic, but can cause hyperandrogenism

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35
Q

Brief overview of Pat testing regime

A

21 to 30, du Pape every three years. Then 30 to 65 to Pap every three years or cotest every five years. After 65 stop if all previously were negative.

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36
Q

Pap smear management

ASC – undetermined significance in a patient with positive HPV

A

Colposcopy

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37
Q

Pap smear management

Patient between 20 and 30 with ASC - Undetermined significance

A

Redo PAP test in one year

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38
Q

Pap smear management

Patient with ASC – undetermined significance, who is above 30 and HPV negative

A

Repeat co test in three years

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39
Q

Pap smear management

Patient with low grade squamous intraepithelial lesion (LSIL), who is between 21 and 24

A

Repeat Pap in one year

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40
Q

Pap smear management

Patient with LSIL, who is between 25 and 29 years old

A

Do you colposcopy

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41
Q

Pap smear management

Patient with LSIL and is above 30. Consider if the patient has HPV or does not have HPV

A

Colposcopy if HPV. Can do colposcopy or Pap test first if HPV unknown

42
Q

Pap smear management

Patient with a typical squamous cells, can’t exclude HSIL. Regardless of age or HPV status

A

colposcopy

43
Q

Pap smear management

If patient has high Grade squamous intraepithelial lesion (HSIL). Consider if patient between 21 and24, 25 and onwards, and if HPV positive or negative

A

Colposcopy in all, but if above 25 do excision (LEEP, CKC, laser)

44
Q

Breast atypical hyperplasia mx

A

Yearly mammogram and Tamoxifen (aromatase inhibitor is postmenopausal)  This is the only breast pathology you struggle with management wise

45
Q

Which antibiotic is given in every toxic shock syndrome regime, and why

A

Clindamycin, because it has an anti-toxic affect

46
Q

Post partum blues should be over within?

A

~ 2 weeks of birth . Usually begins in days after birth

47
Q

Post partum depression timeframe usually

A

Within a month and can last for up to a year. Meets criteria for MDD

48
Q

Prior HSV infx. Do what at 36 weeks

A

Give acyclovir until birth. If patient has lesions near time of delivery, then do c sec

49
Q

Recall fetal hydatoin syndrome PHEN mnemonic

A
50
Q

3 differentials for late post partum hemorrhage

A

Retained POC - boggy or firm uterus (do DandC)
Post partum endometritis - uterus will be tender and patient has fever (broad spectrum Abx)
Placental site subinvolution - stony of uterus (give uterotonic)

51
Q
A

Study this

52
Q

Vasa preview only produces small amount of bleeding, why?

A

It’s from fetal blood, so it’s minimal. Enough to harm foetus though!

53
Q

Gestational TCP PLT levels roughly. If goes below X, we should search for other causes. What are the other causes

A

100-150. If symptomatic or goes below 100, consider alternative Dx: TTP, ITP, DIC.HELLP

54
Q

Is there an association between hyperemesis gravidarum and thiamine def

A

Yes!

55
Q

Acute fatty liver of preg. Occurs in which trimester

A

3

56
Q

Lochia Rubra

A

Birth to 3-4 days postpartum

Dark or bright red (blood); odor similar to that of menstrual
blood; occasional small clots; quantity decreasing each day

57
Q

Lochia Serosa

A

• 4th postpartum day to 10th or • 14th postpartum day

Serosanguineous (pink); brownish (old blood); quantity
gradually decreasing in amount

58
Q

Lochia Alba

A

11th postpartum day to 6 weeks postpartum

White/yellow; creamy; light quantity

59
Q

When would we be sus of a lochia rubra case.

A

If symptomatic from blood loss, if large blood loss (changing pad every hour), passing large clots

60
Q

What is granulomatous infantsepticum

A

Congenital listeria. Terrible gastroenteritis, meningitis. Many abscess etc.

61
Q

Fetal US findings of congenital CMV

A

Periventricular calcifications
• Ventriculomegaly
Microcephaly
• Intrahepatic calcifications
• Fetal growth restriction
• Hydrops fetalis

62
Q

First phase of labour. When is the active stage? (Cervicle width wise)

A

When cervix is dilated above 6cm

63
Q

In active phas of 1st stage of labour, how much Cervicle lpdilation should we get every 2 hr. If it’s not this, what does it mean?

A

More than 1cm,
. If fails to do this, consider stuck head (macrosomia, cephalopelvic dissociation)

64
Q

How does epidural effect labour time

A

Prologues 2nd stage

65
Q

Choriocarcinoma Mx

A

Dilation and suction curretage. With a lil MTX. Take HCG for weeks then months after. Contraception for 6mo

66
Q

Complications and signs of Choriocarcinoma / hydatid mole

A

Abnormal vaginal bleeding ‡ hydropic tissue
Uterine enlargement > gestational age
Abnormally elevated B-hCG levels
Theca lutein ovarian cysts
• Hyperemesis gravidarum
Preeclampsia with severe features
Hyperthyroidism

67
Q

Does cervicits have Cervicle motion tenderness

A

No

68
Q

Shoulder dystocia complications for baby. And quick point on each one’s presentation

A

Clavicle or humeral fracture. Crepitus, deformity, negative Moro, DTR ok

Erbs. Waiter tip (c5-c6 palsy)

Klumpke. Claw hand (c8-T1 palsy) can be with horners (USMLE Q)

Asphyxia

69
Q

Two types of FGR and the differentials in each

A

Symmetrical: head and body involved equally. Due to Chr issue or infection

Unsymmetrical: head spared. Due to vascular issues (placental insufficiency), where BF is shunted to vital areas like the head. Also seen in malnutrition

70
Q

How many Montevideo’s is a good contraction in active labour

A

More than 200 over 10 mins

71
Q

How to Tx active labour phase arrest

A

C sec

72
Q

What is active phase arrest in labour

A

No cervical change in >4hr if good Montevideo, or >6hr if poor Montevideo. In the active phase of labour. We usually expect more than 1cm in 2 hour

73
Q

Main risk for active phase arrest and protracted active phase of labour

A

Cephalopelvic disproportion (seen in late term, gest diabetes etc.)

74
Q

Dx?

A

Active phase arrest

75
Q

Dx

A

Protracted active phase of labour

76
Q

Can the FetaL presentation change late on?

A

Yes! Must keep checking as it can change. Also, can do digital cervical exam to palpate presenting part in labour. If cannot palpate, do trans abdominal US. RECALL USMLE Q

77
Q

Tip to age foetus based on uterus fundal height

A

They are the same. Roughly 32cm is 32 weeks

78
Q

If foetus was dated using early first trimester US, is the chance of incorrect dating likely?

A

No

79
Q

RFs for shoulder dystocia

A

Maternal obesity, large weight gain in preg, macros increased foetus, DM, post term preg

80
Q

After birth, suspected endometritis. But with Abx, the pain is still relapsing remitting.

A

Septic pelvic thrombophlebitis

81
Q

Only fetal based CI to breast feed?

A

Galactosemia

82
Q

Can women with hep B or C breastfeed

A

Yes. Child needs to have had the Hep B ig and vx at birth though. And don’t breastfeed if there are visual cracks on nipples

83
Q

Spontaneous abortion. Mx if stable, vs unstable or septic. In simple terms (mx sheets overcomplicates it)

A

Can do observant, misoprostol. If unstable or septic do suction curretage.

84
Q

Why is oxytocin not useful for abortion or to expel spontaneous abortion; in first and second trimester

A

There are few oxytocin receptors in these periods.

85
Q

Recommendations to prevent listeria in pregnant women

A

Avoid raw meat, cheese stuff, deli, raw veg, wash hands if handle soil

86
Q

Patient has cervical insufficiency. Mx? When do we not do this specific Mx..

A

Do rescue cerclage. If there is bulging amniotic sac, don’t do cerclage (risk of rupture)

87
Q

How to calculate Montevideo units in a labour

A

Take difference between baseline uterine tone and peak contraction pressure (mmHg). Add these contraction pressures within 10 mins. 200-250 is good in active phase

88
Q

Tx for congenital todo

A

Sulfadiazine, pyrimethamine, folinic acid

89
Q

Disseminated abcesses and sepsis….. which congenial or perinatal infx?

A

Listeria

90
Q

Signs of congenital varicella syndrome

A

Malformed digits, skins lesions (in dermatomal areas)

91
Q

Less than how many CM, do we do cerclage

A

Less than 2.5 cm length of cervix

92
Q

Causes and risk factors for second phase arrest

A

Maternal obesity, large weight gain in pregnancy, DM = cause cephalopelvic disproportion

Also malpresentation, inadequate Montevideo, tired mum

93
Q
A

Fetal decent stations

94
Q

During delivery, we prefer which occipital position

A

Occipital anterior. Not occipital transverse

95
Q

Hydroneohrosis of pregancy

A

In first trim, the ureter relaxes. Then the uterus compresses the ureters. May cause a little discomfort, but generally it’s ok. No need to Mx. Bilateral hydronephrosis with normal urinalysis (rules stones out)

96
Q

Causes of hydrops fetalis

A

• Rh(D) alloimmunization

• Parvovirus B19 infection
o Fetal aneuploidy
• Cardiovascular abnormalities
• Thalassemia (eg, hemoglobin Barts)

97
Q

Symptoms of Sheehan and cause for each symptoms

A

• Lactation failure (1 prolactin)
• Amenorrhea, hot flashes, vaginal atrophy (I FSH, LH)
• Fatigue, bradycardia (1 TSH)
• Anorexia, weight loss, hypotension (¡ ACTH)
Decreased lean body mass (¡ growth hormone)

98
Q

What’s going on here:

Fetus with edematous scalp, polyhydramnios, ascites, thick nuchal fold, thickened placenta, increased FHR

A

Hydrops

99
Q

Stage 1 of labour is what?

A

Cervical dilation. We have passive and active phase (active when dilated beyond 6cm)

100
Q

In the first stage of labour, when do we put in a Pressure catheter and measure Montevideo’s

A

When the active phase slows <1 cm dilation in 2 hours

101
Q

What is considered an alkali vag pH

A

Above 4.5

USMLE Step 2 - Top 5% (34 decks)

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