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USMLE Step 2 - Top 5% > OBGYN III 👘 > Flashcards

OBGYN III 👘 Flashcards

1
Q

Screening for BRCA patients

A

6 monthly ovarian US and CA125. And annual MRI of breast. Consider prophylactic removal at 40

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2
Q

Ovulatory bleed first line Mx

A

COCP

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3
Q

Who gets DEXA scan

A

Above 65

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4
Q

Who gets HRT in menopausal

A

Less than 60 and has symptoms of flushing, vag atrophy, mood issues

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5
Q

E vs E AND P for menopause

A

E only if no uterus

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6
Q

Is liver disease a CI for HRT

A

Yes,

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7
Q

First and second line medical therapy for endometriosis

A

COCP and GnRH ag/Levo IUD

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8
Q

Severe recurrent endometriosis, and patient doesn’t want more kids

A

Can do hysterectomy

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9
Q

Patient has the endometrial hyperplasia…. Bye did the biopsy, just plain hyperplasia, no atypia

A

Just do progesterone. Then after 6mo reassess, doing biopsy. If not improvement, then send to oncology

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10
Q

What is Yasmin

A

Drospirenone + ethinyl estradiol (Yaz; Yasmin)

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11
Q

Tx for premenstrual disorder

A

SSRI if severe

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12
Q

Dx of premenstrual syndrome

A

Clinical. Get patient to take a diary and make the connection

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13
Q

Endometrial stripe size limit

A

> 4mm. Don’t forget to apply this

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14
Q

Cyst rupture but not unstable or severe

A

Reassure and observe

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15
Q

Why ovarian tumour causes precocious puberty in woman

A

Granulosa

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16
Q

<45 with AUB. Failed COCP. Do what

A

Biopsy

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17
Q

Endometrial ablations and salpingograms allowed in unknown cause of AUB

A

No…. Could spread potential cancer

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18
Q

In pregnancy why do we see an increased risk of non-compliance to medications

A

Women are often scared the medications cause harm to the baby, so decrease them

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19
Q

What affect does neuraxial epidural anaesthesia do to 2nd stage

A

Increase is it

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20
Q

Main cause of protracted active phase of labour

A

Catholic pelvic disproportion

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21
Q

Is a platelet range of 100 to 150 okay in pregnancy

A

Yes

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22
Q

Bleeding when rupture of membranes, and fetal heart tones go. Blood pressures are all okay

A

Vasa previa

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23
Q

If postpartum (few days postpartum) you have a little bit of red vaginal discharge. Patient is stable. Do we have to worry

A

Normal lochia rubra

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24
Q

After salpingectomy for ectopic pregnancy, what injection shall I give

A

RhoGAM

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25
Q

If I have ectopic pregnancy and do salpingectomy, do I need methotrexate

A

No

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26
Q

Obvs gravidity is number of preg. What is parity

A

Number of live births beyond 20 weeks

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27
Q

Foods to avoid in preg

A

Fish with mercury, moderate caffeine only, undercooked meat and fish. Delicaneyby

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28
Q

We give folate, calcium, iron to patients!. But what extra for vegans

A

D and B12

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29
Q

Obvs give IV penciclin for GBS prophlx. If allergy? Or if risk of anaphylaxis

A

Ceph

Clinda or vanco resp

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30
Q

When to do the A test in preg

A

10-14 weeks. So do PAPPA and HCG and nuchal trans. Then do the quad screen not long after

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31
Q

When to do the gest DM screen if no risk factors

A

End of second trim or beginning of third

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32
Q

Obvs in first visit we test lots of infx. In high risks, what do we check again at end

A

Chlamydia gonorrhea hiv syphilis

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33
Q

High AFP can be seen on NTD or abdominal wall defect. Where else?

A

Twins, incorrect dating, fetal death, placental A

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34
Q

When does all the aneuploidy stuff start

A

10 weeks onward

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35
Q

SE if amniocentesis

A

PROM, chorioamn, hemorrhage

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36
Q

10-12 weeks gest, or 15-20 weeks gest. Which is CVS and which amnio

A

That ordet t

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37
Q

Mercury affect of fetus

A

Cerebral atrophy. Microcephalic etc

38
Q

Safest testracine in preg

A

Doxy

39
Q

Feta warfarin syndrome

A

Nasal hypo, stippled bone epiphysis, and more

40
Q

Vit A tox to preg

A

Thymic agenesis, CV defect, craniofascial issue, CL/CP etc

41
Q

Infant from HIV mum…. Her titre was less than 1000, do I give Tx?

A

Yes.

42
Q

CMV vs Rubella cong infx?

A

Rubella: Blueberry muffin, cataracts, PDA, hearing loss

CMV: perivent calcification. Petechia rash.

43
Q

Methylene TDF reductase def

A

Same as saying homocysteinuria

44
Q

If spont abortion early (<12 weeks) likely what cause

A

Chromosomal

45
Q

If spont abortion later (12-20weeks) likely what cause

A

Coag, C insuff.

46
Q

How to prevent spont abortion in APLS

A

LMWH and aspirin

47
Q

Spontaneous abortion order

A

, threatened, inevitable, incomplete, complete, missed.

All os closed and POC still there, but bleeding. Then Os opens but POC kept. Then POC half gone. Then POS gone and Os closed

48
Q

Spontaneous abortion. Incomplete, or inevitable. If <12 weeks or after

A

Manual aspiration. Or DandC if after

49
Q

Stillbirth Mx

If < or > 24 weeks

A

DandE

Induce labour

Autopsy to see cause

50
Q

If sus spont abortion. See no fetal pole, no cardiac activity on US… do what?

A

HCG

51
Q

Medical abortion:

If < or > 10 weeks gest

A

Misoprostol and mifepristone

DandC with vaccum aspiration

52
Q

Complications of abortion

A

Retained POC (causing DIC of endometritis or septic abortion)

53
Q

Way to remember Os open and spont abortion

A

If begins with I…. Then it’s open Os (inevitable and incomplete)

54
Q

First invx in hyperemesis G

A

Usually US to check for twins or molar or chorio

55
Q

Main step approach to Tx for hyperemesis G

A

Diet, anti H, metaclo, ondansteorn

56
Q

Reasons for doing early GTC I’m first trim

A

Fat mum, PCOS, previous macrosomic, previous test of insulin resistance (HbA1c above 5.7), previous gest DM, first degree relative with DM, CVD.

57
Q

Reasons to do early GTC in preg (first trim)

A

Fat mum, PCOS, previous macrosomic, previous test of insulin resistance (HbA1c above 5.7), previous gest DM, first degree relative with DM, CVD.

58
Q

Greater than 8, invegstiagte. In terms of Gest DM

A

If HBAC1 large that 8 in preg… check for congetsinal issues

59
Q

What is considered macrosomic

A

> 4000g. If EFW is above 4500 do C-section

60
Q

Gestational DM. In labour what do we do

A

Infuse insulin and dextrose to keep steady glucose

61
Q

We all know chronic HTN is Dx before 20 weeks. How else can we Dx retrospectively

A

If persists >3mo post partum

62
Q

List all the elements that make preeclampsia severe

A

TCP, Cr high, LFT *2 high, pulmonary edema, Neuro issues and headache unresponsive to meds, eye issues

63
Q

General Mx on delivery for:

Preeclampsia not severe
Severe features
Eclampsia

A

37
34
Immediate

64
Q

Some preeclampsia stuff to Mx

37 weeks
Far from terms (before 34)
Severe features
If Mg tox
24 hr postpartum

A

Deliver
Expectant, with BP control, Mg drip,
Same as above
Calcium gluconate
Continue seizure prophlx

65
Q

Patient with preeclampsia has headache and RUQ pain. Is this severe

A

Yes severe features

66
Q

RF for preeclampsia

A

Renal disease (SLE DM), nulliparoty and twin, fam Hx, HTN, extremes of age. Molar preg

67
Q

If eclampsia seizure recurs, give what

A

Diazepam

68
Q

Do you need routine monitoring of Mg levels when giving Mg in eclampsia/preeclampsia with severe features

A

No

69
Q

Intrahep cholestasis vs AFLP quick facts

A

Pruritus, like pain mild elevated LFT. Best to measure bile acids (sens and spec). Give Urso and deliver at 36

RUQ pain, low glucose, jaundiced, only 200-300 LFT. TCP and DIC
Deliver!

70
Q

Does ectopic preg cause vag spotting

A

Yes

71
Q

Risk factors for molar preg

A

Extreme age, folate def or carotene def

72
Q

Stable abruption can be Mxd expectantly. What about more severe

A

Bag deliver if mother and fetus ok

C sec if not

73
Q

Risk factors for acreta

A

Low lying placenta, downs, prior Sx to endemtrium

74
Q

Baby with EFW of >5000, or 4500 with DM

A

C-SECTION

75
Q

Main thing to rule out at first in Oligohydramnios

A

ROM

76
Q

Does all women get RhoGAM

A

Only Rh neg women with positive or unknown man. Then if baby positive for Rh, give after birth. Not for all!

77
Q

when do we actually do fetal movement assessment and NST in preg

A

For pregnancies at high risk of fetal demise… around 30 weeks can start

78
Q

What is a reactive stress test?

A

2 accel over 20 mins.

79
Q

Causes for non reactive stress test

A

Less than 32 week, sleeping (wake up with vibration), CNS issue, narcotic mum. Do follow up with CST or BPPP

80
Q

When not to do contraction stress test

A

If risk of premature/Previa/ Hx of urge time Sx

81
Q

What is a positive CST

A

Worry some (unlike NST). Deliver. Is when late decals usually

82
Q

What are the abnormal umbilical artery dipole findings

A

Decrease, absent, reverse end diastolic flow. High velocity diastolic flow is good

83
Q

BPP
Test the Baby MAN

A

Tone, Breathing, movement, amniotic FI, Non stress

84
Q

When do we use umbilical Doppler velocity

A

If sus FGR

85
Q

When do we use umbilical Doppler velocity

A

FGFR

86
Q

List of CI to breast feed

A

HIV in US, Tb unTx, varicella, herpes on boob. Chemo, radioTx, cocaine PCP, cannabis. TETRACYCLINE CHLORAMPHENICOL m, galactosemia

87
Q

Mx for those not wanting to breastfeed

A

Supportive bra, avoid nipple stun, apply ice and NSAID.

88
Q

If no improvement in breast mastitis in 48 hours… do what

A

US to see if abcess

89
Q

Breastfeeding and get painful tender lump…. No fever or chills. No leuko

A

Localised plugged duct

90
Q

Breast engorment Mx

A

Frequent breast feed, or suppress lactation if not feeding. Warm compress before and cold between feed.

USMLE Step 2 - Top 5% (34 decks)

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