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Uworld Shelf Questions DF > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

maternal serum alpha-fetoprotein screening

incrased indicates what

decreased indicates what

A

increased: open neural tube defects, ventral wall defects, multipile gestation
decresased: aneuploidies

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2
Q

hypothyroidism FSH, LH, prolactin TSH

A

fsh and lh down

[prolactin and tsh up

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3
Q

bladder atony risk factors

when to suspect

A

prolonged labor, perineal injury, regional analgesia

suspect if cannot void by 6 hours after vaginal delivery

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4
Q

pseudocyesis

pt presents with what
risk factors

what can cause it

treatment

A

pt presents with sx of early pregnancy, and believes that she is pregnant

-office exam shows thin endometrial stripe, negative urine preg test

risk factors are hx of infertility and prior pregnancy loss

somatization of stress can affect HPO axis and cause early preg symtpoms or when bodily changes are misinterpreted

-psychaitric eval and tx

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5
Q

treatment for uterine leiomyomas (fibroids)

if asx
if sx

A

asx: observation
sx: hormonal contraception, embolization, or surery if sx

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6
Q

theca luteum cyst can cause ___ in pregnancy

maternal clincal features

fetal virilzation risk

A

hyperandrogenism

bilateral ovarian cyst on US
molar preganancy and multp gestation
regress spont

low risk fetal virilzation

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7
Q

initial diagnostic workup of suspected adenomyosis

tx

A

pelvic US and or MRI

definitive dx is histopathologic examination of a hysterectomy specimen

hysterectomy is the definitive tx if hormaonal methods do not work

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8
Q

management of cord compression and recurrent variable decelerations

A

maternal repositioning

next would be amnioinfusion

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9
Q

treatement for anovulatory cycles (AC causes prolonged heavy bleeds)

A

progesterone therapy

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10
Q

risks with combined estrogen-progestin contraceptives

A

VTE
HTN
hepatic adenoma
stroke or MI

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11
Q

treatment of chorioamnionitis

A

intraamnoiotic infection

broad spectrum antibiotics
delivery

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12
Q

disseminated gonococcal infection presents as what

A

pustular dermatitis, ensosynovitis and migratory asymmetric polyarthralgia

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13
Q

abnormal lab finding in intrahepatic cholestasis of pregnancy

A

serum total bile acids increased

sometimes increased alk phos and total and direct bilirubin increased

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14
Q

edemaatous, erythematous and painful cutanesous thickening of breast with superficial dimpling and fine pitting

may have ithing and retraction of nipples

what other feature common

A

inflammatoru breast carcinoma or peau d;orange

axillary LAD

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15
Q

medroxyprogesterone

A

systemic progestin contraceptive

stops GnrH but not emergency

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16
Q

management of intraductal papilloma

A

mammography and ultrasound
biopsy and excision

US or mam would show single dilated breast duct

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17
Q

painless genital ulcers without LAD, in india it is common

A

granuloma inguinale (klebsiella granulomatis)

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18
Q

what drug was used in pregnancy?

-fetal hydantoin syndrome: midfacial hypoplasia, microcepahly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay

A

phenytoin or carbamazepine

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19
Q

appearance of fetus in fetal growth restriction

A

large anterior fontanel
thin umbilical cord
loose peeling skin
minimal subcutaneous fat

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20
Q

management of ovarian torsion

A

laparoscpoic cystectomy and detorsion

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21
Q

pain to superficial touch on the vestibule

A

localized provoked vulvodynia

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22
Q

amniotic fluid embolism syndrome

risk factors

A

older mom, 5 births or more, c section, placenta previa or abruption, preeclampsia

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23
Q

what kind of breach has flexed hips and knees

A

complete

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24
Q

pathophysiology of functional hypothalamic amenorrhea: what causes it

A 
excessive training
low calorie diet
weight loss 
chronic illness
stress and depression
anorexia nerovsa
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25
Q

chronic, inflammatory, skin dystrophy resulting in glazed, birghtly erythematous lesions on the vulva with erosive ulcerated areas

may have extragenital sites too

A

lichen planus

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26
Q

adenomyosis typically occurs in what women

leads to what

describe uterus

A

multiparous women over 40 with dysmenorrhea with heavy menstrual bleeding

leads to chronic pelvic pain

boggy, tender, uniformly enlarged uterus

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27
Q

complex multiloculated adnexal mass with thick walls and internal debris is what

A

tubo-ovarian abscess

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28
Q

atypical glandular cells on pap testing may be due to either what or what and whats the next step in management

A

cervical or endometrial adenocarcinoma

colposcopy, endocervical curettage, and endometrial biopsy

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29
Q

if you have an elevated AFP screen then what do you need to do to evaluate the fetus

A

ultrasound

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30
Q

what is the most accurate method of determining gestational age

A

first trimester US with crown rump length measurement

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31
Q

treatment of simple breast cyst in sx patients

follow up?

A

aspiration which should yield a clear fluid and make the mass disappear

-can reaccumulate so pt should return in 2-4 months for a follow up xam

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32
Q

intermenstrual spotting without uterine enlargement is hallmark of what

A

endometrial polyps

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33
Q

hypoxic brain injury in pregnancy to fetus in what

A

acute uteroplacental insufficiency like abruptio placentae

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34
Q

post term preg

A

42 weeks or more from LMP

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35
Q

underweight mom at risk for what in baby

A

intrauterine growth restriction

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36
Q

risk factors for vulvovaginal candidiasis

A 
DM check for hemoglobin A1C
immunosuppression
pregnancy
Ocs
antibiotics
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37
Q

epithelial ovarian carcinoma

confirm cx diagnosis

__ should be drawn to correlate with cx findings and monitor treatment in future

___ should be done as definitive treatment with high clnical suspicion of EOC especially with acute presentation

A

pelvic US

CA-125

exploratory laparotomy with cancer resection, staging, and inspection of entire abdominal cavity

chemo after (paclitaxel)

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38
Q

how can oxytocin tox cause seizure

other AE of oxytocin tox

A

bc it acts like ADH and incrases water which decrases sodium level which can lead to seizureds

can also cause hypotension and tachysystole

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39
Q

is hpv cotesting recommended for ages 21-29

A

no

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40
Q

late term pregnancy length

A

41 weeks to 41 weeks and 6 days

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41
Q

antepartum hemorrhage from blunt abdominal trauma

in pregnant woman what happens and what is management

A

blood flow away from uterus and so no accelerations on fetal tracing

first step in management is AGGRESSIVE fluid resuscitation with crystalloids

place in left lateral decubitus position to displace uterus off aortocaval vessels and max out CO

only transfuse blood after fluid doesn’t work

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42
Q

bleeding and closed cervix, US reveals intrauterine gestation with normal heartbeat, increaseing b-hCG levels

what kind of abortion

A

threatened abortion

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43
Q

if pt has HIV and a partner that she does not want to inform what do you do

A

have to report her to the health department and encourage pt to tell her husband but you cannot tell husband if she does not want you to. The health department usually will make contact with all of pts sexual partners and inform them without IDing wife

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44
Q

biopsy of fat necrosis

mammography

from what causes this

A

fat globules and foamy histiocytes

often fixedd irregular mass with calcifications on mamm

post surgery or trauma

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45
Q

possible really bad effects with placental abruption

A

DIC
hypovolemic shock
hypoxia
preterm deliver

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46
Q

risk factors for preterm delivery

A

prior preterm delivery

multiple gestation

history of cervical surgery
-particularly cold knife conization for CIN

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47
Q

indication of raloxifene

A

postmenopausal osteoporosis

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48
Q

androgen insensitivity syndrome is also known as what

what doe these pts secrete

A

testicular feminization

AMH and testosterone

amh stimulates regression of the mullerian ducts

wolffian duct degenerates bc of androgen resistance

external femal genitalia and breast development

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49
Q

missed aboriton

bleeding?
os?
cardiac activity?

A

no vaginal bleed
closed os
no fetal cardiac activity or empty sac

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50
Q

postpartum fever is what temp

A

38 degrees celcius or greater or 100.4 F

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51
Q

fetal growth restriction risk factors

A

maternal HTN
pregestational DM
genetic abnormalities
congenital infection

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52
Q

lactation suppression with engorged breast from preg

A

wear supportive bra, avoid nipple stimulation, apply ice packs, and NSAIDs

-oral dopamine is no longer approved by FDA for lactation suppression due to side effects

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53
Q

treatment for women with engorgement of breast who want to breastfeed

A

involves frequent emptying of breasts for adequate milk drainage

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54
Q

premenstrual syndrome

sx
evaluation
tx

A

bloating, fatigue, HA, hot flash, breast tenderness, being a bitch too

eval: symptom/menstrual diary for 2 cycles
treatment: SSRI can give combined OCs but not in pt with migraines with aura

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55
Q

what kind of urinary incontinence

impaired detrusor contractility, bladder outlet obstruction

incomplete emptying emptying and persistent involunatary dribbling

A

overflow

can be from diabetes

markedly increased PVR

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56
Q

numbers for inadequate contractions

A

less than 3 in 10 mintues

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57
Q

oese or low body weight increases risk of osteoperosis

A

low body weight

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58
Q

intrauterine prenancy can be seen with a TVUS with a b-hcg of what and how often do these levels increase

A

1500-2000 every 2 days

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59
Q

neonatal thyrotoxicosis pathophys

tx

A

transplacental passage of maternal anti-TSH receptor antibodies that bind to infants TSH receptors

tx: self resolves witin 3 months or methimazole plus b blocker

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60
Q

pts with ambiguous external genitalia, normal uterus and ovaries and electrolye abnormalities (____) with 17-a hydroxylase deficiency

A

CAH

hyponatremia

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61
Q

normal preganancy pulmonary co2 and o2 change

A

chronic respiratory alkalosis with metabolic compensation

increased PaO2 and decrased PaCO2

progesterone directly stimulates Central resp centers to increase tidal volume and minute ventilation

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62
Q

breast cancer risk factors

nonmodifiable

A

genetic mutation or breast cancer in 1st degree relatives

white

increaseingage

early menarche or later menopause

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63
Q

what happens to the liver in HELLP syndrome

A

hepatocellular necrosis and thrombi elevate liver enzymes, liver swelling, and distension of the hepatic capsule

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64
Q

missed abortion

A

asx or decreased preg symptoms

embryo without cardiac activity or an empty gestations sac without a fetal pole (no embryo)

repeat US and seriel b-HcG to confirm
-decreased b-hCG indicate demise and exclude normal pregnancy

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65
Q

management of uterine inversion

A

fluid replace
manual replacement
placental removal and uterotonic drugs after uterine replacement

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66
Q

preeclampsia under 20 weeks gestation can be a complication of what

A

hydatidiform mole

abnormal trophoblastic tissue proliferation can result in preeclampsia and lead to enlarged uterus that is greater than expected for gestational age

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67
Q

diagnosing ectopic pregnancy

A

b-hcg and TVUS

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68
Q

sx with hemorrhage from a ruptured cyst

A

sudden acute ab pain with peritoneal signs

simple ovarian and CL cysts usually cause this

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69
Q

a failed progestin challenge test can indicate what?

A

intrauterine adhesions (asherman syndrome) in a pt with a history of uterine instrucmentation or endometritis

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70
Q

maternal HTN and tobacco use during pregnancy are associated with ______ fetal growth restriction

A

asymettric

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71
Q

large fibroids can cause local compressive symptoms like what

A

constipation, urinary frequency/retention, and back/pelvic pain

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72
Q

PID treatment in pt

A

IV cefoxitin or cefotetan plus oral doxycycline

or IV clindamycin plus gentamicin

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73
Q

unsafe activites in pregnancy

A

contact sports
high fall risk
scuba diving
hot yoga

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74
Q

sx with acute fatty liver of pregnancy

A

in 3rd trimester or early postpartum period

prolonged PT and PTT, hypoglyemia, and encephalopathy

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75
Q

crampy lower abdomen and back pain during menses with a normal exam

what kind of dysmenorrhea

tx

A

primary

NSAIDs and hormonal contraception

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76
Q

if left untreated do recurrences of genital herpes increase or decrease with time

A

decrease bc of cell mediated immunity

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77
Q

US of breast shows posterior acoustic enhancement which is indicative of ____ and no echogenic debris or solid components, these features are consistent with a what

A

fluid

simple breast cyst

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78
Q

dysmenorrhea as well as noncyclic pain that can be exacerbated by exercise

A

endometriosis

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79
Q

uterine atony, if oxytocin and bimanual massage fail what is next step

A

administer other uterotonic agent like methylergonovine

causes SM constirction, uterine contraction, and vasoconstriction

history of HTN contraindicated bc causes this

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80
Q

in pts with negative syphillis serology but strong clinical evidence of primary syphillis should have what done

A

empiric treamtent with benzathine penicilin G
repeat nontreponemal serology in 2-4 weeks to establish baseline titers and 6-12 months later check again and 4 fold decrase in titer means adequate treatment

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81
Q

periumbillical pain that migrates to the RLQ with nausea, vomiting, and anorexia

A

appendiceal abscess

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82
Q

screening for ovarian cancer in a pt who has a cousin who died of the disease

A

no screening bc average risk pt and no test exist to detect ovarian cancer in its early more treatable stages

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83
Q

soft enlarged uterus after delivery with bleeding

A

uterine atony

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84
Q

preeclampsia severe features

A

160/110 2 times 4 hours apart

thrombocytopenia

incrased cretinine

increased transaminases

pulmonary edema

visual or cerebral symtpoms

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85
Q

medications that can cause galactorrhea due to _____ inhibtion

A

dopamine

antipsychoiitcs, antidepressnats, opiods, chronic histamine receptor blockers like cimetidine

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86
Q

what complication during pregnancy puts mom at risk for alloimmunization

these women need higher dose

what test used to determine dose?

A

placental abruption,

also after a delivery, or procedures

klaeihauer betke test

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87
Q

granulosa cell tumor of the ovary cx features child and postmenospausl woman

if find mass on US then what next

A

child: precocious puberty
postmenopause: bleed/endometrial hyperlplasia

increased estrogen

endometrial biopsy

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88
Q

biophysical profile scoring: 0-10 to 4-10

A

indicates fetal hypoxia due to placental dysfunction

risk factors: tobacco, HTN, diabetes

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89
Q

prolactinoma

fsh
lh
prolactin
tsh

A

fsh and lh down
prolactin up
tsh normal

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90
Q

which pop has most fibroids

A

black women

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91
Q

sudden onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity and what see on US

A

ruptured ovarian cyst

see pelvic free fluid

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92
Q

_____ serves as a barrier to ascending infection during pregnancy, this brown red or yellow thick mucus typically is shed before or during labor

A

cervical mucus plug

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93
Q

anechoic, cystic spaces mass

A

snowstorm appearance

hydatidiform mole

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94
Q

placenta previa mom and fetus sx

A

fetus not affected bc materanal bleed

painless bleed 3rd trimester

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95
Q

magnesium toxicity

mild

mod
severe

tx

A

mild: nausea, flushing, HA, hyporeflexia
mod: areflexia, hypocalcemia, somnolence
severe: resp paralysis, cardiac arrest

txL calcium gluconate bolus

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96
Q

late term and postterm preg complications in fetus

A

MOMS Con

meconium aspiration
oligohydramnios
macrosomia
stillbirth 
convulsions
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97
Q

ultrasound findings on epithelial ovarian carcinoma

and then management once this is found

A

solid mass
thick septations
ascites

manage: exploratory laparotomy

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98
Q

when should all pregnant women be screened for gestational DM

A

24-28 weeks

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99
Q

guaiac test in physiologic galactorrhea is what

A

negative

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100
Q

diagnosis/management of placenta previa once diagnosed

A

pelvic rest and abstinence from intercourse

no digital cervical exam by doctors

c section scheduled at 36-37 weeks

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101
Q

labs in hyperemesis gravidarum

A

(often have hypochloremic met acidosis, hypokalemia, hypoglycemia, and elevated aminotransferases

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102
Q

bulky tender uterus that is uniformly enlarged

A

adenomyosis

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103
Q

fetal heart tracing shows tachy, what are possible etiologies

A

maternal infection
poor maternal hyperthyroidism control
terbutaline
abruptio placentae

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104
Q

how much exercise in pregnancy is recommended

A

20-30 mintues of mod-intensity exercise on most or all days of the week

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105
Q

intrauterine fetal demise associated with growth restriction, multiple limb fractures and a hyoplastic thoracic cavity is consistent with what

genetics

collagen

prognosis

A

type II osteogenesis imperfecta

AD

type 1 collagen

lethal

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106
Q

after the first trimester what is used to estimate gestational age

A

fetal abdominal circumference, biparietal diameter, femur length

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107
Q

what is fetal scalp stimulation used for

A

to perform an attempt to induce accelerations when they are absent

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108
Q

evaluating fetal growth restriction

A

placenta histopathology
consider karyotype, urine to, serology
if doesn’t look like infant has syndromic etiology don’t get karyotype

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109
Q

a BPP of 6/10 is equivocal and should be repeated when

A

in 24 hours

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110
Q

luteoma can cause ___ in pregnancy

maternal clinical features

fetal virilization risk

A

hyperandrogenism

yello or Y-brown mass
solid ovarian masses on US
regress spontaneously after delivery

high risk

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111
Q

uterine inversion what do you see when pull out too quick

other physical findings

A

smooth, round mass protruding through the cervix or vagina

uterine fundus no longer palpable transabdominally

accompanied by hemorrhagic shock and lower abdominal pain

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112
Q

evaluation of amenorrhea (missed 3 cycles or none for 6 months

A

if b-hcg negative

  • check prolactin, TSH, FSH
  • if prolcatin is increased then get brain MRI

if had prior uterine procedure or infection then do hysteroscopy

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113
Q

diagnosis of chorioamnionitis

A

maternal fever plus any of the following

fetal tachy
maternal leukocytosis
purulent amniotic fluid
maternal tachy
uterine fundal tenderness
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114
Q

with intrauterine fetal demise what is the best way to deliver baby

A

vaginally induced when pt is ready

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115
Q

hyperemesis gravidarum is what and causes what

A

severe vomiting during the first to early second trimesters and is associated with weight loss, volume depletion and ketonuria

metabolic alkalosis is often present due to loss of gastric acid

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116
Q

renal changes and urinary in normal pregnancy

RBF,
GFR
renal basement memrbane perm

BUN, Cr, renal protein excretion

think about what

A

1) all increase

-BUN, Cr decrease
renal protein excretion increase

renal excreted drugs monitored

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117
Q

infiltrating ductal carcinoma or lobular breast carcinoma may cause dimpling or breast contour changes but is diff from inflammatory breast carcinoma how

A

no diffuse breast erythema, edma and peau d orange appearance

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118
Q

violetn muscle contractions as seen in a seizure or electrocution injury are a common cause of what dislocation

position

A

posterior shoulder

shoulder held in adduction and internal rotation with visible flattening of anterior aspect of shoulder

light bulb sign on radiograph

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119
Q

GU syndrome of menopause

sx:
PE
treatment

A

sx: dryness, irritation, pruritius, dysparenunia, bleeding, urinary incontinence, recurrent UTI, pelvic pressure

PE: narrowed introitus, pale mucosa, desecreased elasticity and rugae, petechiae and fissures

treat with lube or topical vaginal estrogen

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120
Q

the only current indication for HRT in menopause is what

not for what anymore

A

vasomotor symptoms in women under 60 who have undergone menopause wihtin past 10 yrs and have severe hot flashes

no longer for heart disease, dementia, or osteoporosis

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121
Q

are persistent variable decelerations normal?

A

no

concern for uterine rupture

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122
Q

pubic symphysis diastasis

A

after traumatic delivery pts can develop this

risk factors are big baby or forceps and multiparity

suprapubic pain that radiates to the back or hips, worse with weight bearing, walking or position changes
tenderness ofver pubic symphissis

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123
Q

initial menstrual cycles in adolescents are usually what

A

irregular and anovulatory due to HPGonadal axis immaturity and insufficient secretion of GnRH

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124
Q

vesicovaginal fistula presents with

A

clear watery vaginal discharge (urine) with a fistulous tract on the anterior rather than posterior, vaginal wall

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125
Q

if mom gets varicella in pregnancy then do what

mom doesn’t have varicella immunity, neg IgG antibody, no history of childhood infection

A

postexposure prophylaxis

VCZ Ig administration

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126
Q

_____ is a common anatomic cause of primary amenorrhea

A

imperforate hymen

127
Q

dry vagina after chemo and ammenorhea

A

ovarian failure secdonary to chemo

hypogonadotropic hypogonadism in women under 40 is Primary ovarian insufficiency

-no developing follicles, so decreased estrogen

chemo affects prolfierating granulosa and theca cells of ovary

128
Q

all patients with chronic hep C infection including pregnant women whould be immunized with what

A

against hepatitis A and B if not already immune

129
Q

variable decelerations

A

abrupt drops in fetal HR of varying depth and duration likely due to compression of the umbillical cord causing transient fetal HTN

130
Q

when to stop pap testing

A

age 65 or hysterectomy plus

no history of CIN 2 or higher and

3 consecutive negative pap test

or

2 consecutive negative co testing results

131
Q

HELLP and tranfusion before delivery platelet count

A

prophylactic transufion if platelets under 20,000 and for c section can do if under 40,000

132
Q

breaast cancer risk factors

modifiable

A

HRT
nulliparty
increased age at first live birth
alcohol

133
Q

risk factor of PPROM

A

genital tract infection and history of prior PPROM

134
Q

how to treat postpartum endometritis

A

clinamycin + gentamicin

135
Q

management of shoulder dystocia

A

BE CALM

breath, do not push

elevate legs and flex hips, thighs aginast abdomen (mcroberts)

call for help

apply suprapubic pressure

enLarge vaginal opening with episiotomy

Maneuvers
-deliver post arm, rotate post shoulder, adduct post shoulder, mother on all fours, replace fetal head into pelvis for c section delivery (if all else fails)

136
Q

flank pain that radiates to the groin with microscopic hematuria

A

renal colic
stones
pelvic ultrasound is diagnositc

137
Q

____ is suspected when a persistent, eczematous and or ulcerating rash is localized to the nipple and spreads to the areola

what is associated with it

A

mammary paget disease

adeoncarcinoma is often found in pagets disesae

138
Q

gonococcal pharyngitis

LAD?

A

N gonorrhoeae
pharyngitis with fever and lower abdominal pain (PID) in young, sexual active pt
from sucking off an infected dude or cunnilinging an infected female

nontender cervical LAD

139
Q

mom in pregnancy

protein S
fibrinogen

A

decrease protein S activity

increase in fibrinogen

140
Q

positive TPO antibody in what

A

hashimoto thyroiditis

141
Q

complications of cervical conization

A

cervical stenosis
preterm birth
PPROM
2nd trimester preg loss

142
Q

RUQ pain with PID

other symptoms

A

increased pain during inspiration
perihepatitis or ritz hugh curtis disease

intermenstrual spotting

lower abdominal tenderness

fever

CMT

143
Q

adolescent pts with an imperforate hymen present with

A

cyclic lower abdominal pain in absence of apparent vaginal bleeding

blood collects behind hymenal membrane (hematocolpos)

pelvic exam typically reveals a blue, bulging vaginal mass or membrane that swells with valsalva

144
Q

pathophysiology of preeclampsia likely involves what which can lead to what

A

chronic uteroplacental insufficiency which can lead to fetal growth restriciton/low birth weight

145
Q

in pts with AUB, bleeding after exogenous progesterone administrations confirms what

A

normal endogenous estrogen production and proliferative endometrium

eliminates cuases of

estrogen deficiency
endometrial abnormalities
outlet tract abnormalities

146
Q

risk factors of hyperemesis gravidarum

A

hydatidiform mole
multifetal gestation
history of it
history of GERD

147
Q

when should pregnant women undergo oral glucose challenge test

A

24-28 weeks at end of 2nd trimester

1 hr 50 g GCT

confirm with 3 hr 100 g glucose test

148
Q

risk factors of placenta previa

A

multiparity, smoking, and previous uterine surgery

149
Q

normal internal genitalia, external virilization (clitoromegaly) and undetectable serum estrogen levels in a female pt dx

what happens to mom in pregnancy

A

aromatase deficiency

leads to transient masculinzation in mother that resolves with birth

150
Q

breast feeding contraininidcations

A 
active untreated TB
maternal HIV infection
herpetic breast lesion
active varicella
chemo or radiation therapy 
active substance abuse

infant: galctosemia

151
Q

risk factors uterine atony

A

pronlonged labor, induction of labor, operative vaginal delivery and
fetal weight over 4000 grams (8.8 lbs) ***

152
Q

choriocarcinoma presnetation

A

amenorrhea or AUB, pelvic pain

SYMPTOMS from metastases (LUNGS and vagina)***
elevated b-HCG
-sx of metast to lung = chest pain, hemoptysis, and dyspnea

can occur after normal gestation or SPONTANEOUS abortion and usually presents <6 months after pregnancy

153
Q

can uterine fibroids cause stress incontinence

A

yes

154
Q

intra-amniotic infection (chorioamnionitis) risk factors

A 
prolonged ROM over 18 hours
prolonged labor
internal fetal unterine monitors 
repetitive vaginal exams
presence of genital tract pathogens
155
Q

endometrial biopsy indications

A

45 and up
-AUB, postmenopausal bleed

under 45

  • AUB + unopposed estrogen (obesity, anovulation)
  • failed medical management
  • lynch syndrome

35 and up
-atypical glandular cells on pap test

156
Q

cafe au lait spots, polyostotic fibrous dysplasia, and autonomous endocrine hyperfunction (gonadotropin independent precocious puberty)

A

mcune albright syndrome

157
Q

sjogren syndrome can cause what ob gyn problem

sicca syndrome

A

dyspareunia from dry vaginal mucosa

sicca is impaired fnct of salivary and other exocrine glands

158
Q

pruritic utricarial papules and plaques of pregnancy PUPP is what

classical finding
spares what

A

skin condition that develops in third trimester of pregnancy

classic finding on abdominal exam is redpapules within striae with sparing around umbillicus sometimes goes to extremeties

palms soles and face not usually involved

159
Q

postpartum endometritis presents as

A

polymicrobial infection with fever >24 hours postpartum, purulent lochia, and uterine tenderness

160
Q

syphilis diagnostic serology

A

nontreponemal (RPR and VDRL)
Ab to cardiolipin cholest-lechithin antigen
-possible negative result early in infection
-decrease in tgiters confirms treatment

treponemal
antibody to trep antigens
greater sensitivity in early infecion, positive even after treament

161
Q

can hep c be transmitted through breast milk

A

no

162
Q

what lab finding can distinguished on UA SLE flare up from preeclampsia

A

presence of RBC casts on urinalysis is SLE

163
Q

woman with blood type O and baby stuff

A

in pts with blood type O they produce antibodies to antigen A and B early on in life and already have IgG antibodies when pregnant to these. ABO compatability can occur in first pregnancy

most of these newborns will have only mild hemolytic disease

164
Q

symptoms of pelvic organ prolapse

A

urinary retention

difficulty intitiaing stream

incontinence

bowel dysfunction

165
Q

target blood glucose levels in pregnant woman

fasting, 1 hr post prand, 2 hour postprand

A

fasting: under 95

1 hr post prand under 140

2 hr post prand under 120

166
Q

treatment of hydati mole

A

suction curettage

167
Q

what is pathologic for ovarian cancer

A

peritoneal fluid in postmenopausal women with bloating and pain and abdominal distension

168
Q

when use vibroacoustic stimulation

A

to awaken fetus for a NST

169
Q

acute appendicitis in pregnancy managment

A

get US with graded compression technique

if US not diagnositc then MRI can be performed in pregnant pts

170
Q

managmetn of suspected ectopic pregnancy

hemodynamically unstable

A

immediate surgery consult

171
Q

etiology of second stage arrest of labor

tx

A

cephalopelvic disproportion
malposition
inadequate contractions
maternal exhaustion

operative vag delivery or c section

172
Q

bilateral, symmetric fullness, tenderness and warmth of breast

A

breast engorgment cx features

173
Q

is methyldopa used to treat HTN emergencies in pregnancy

A

no, chronic HTN only

174
Q

how to try to R/O fibroids vs adenomysosis

A

fibroids: dysmenorrhea is less common and does not typically progress to chronic pelvic pain

also nontender, firm, and irregulary enlarged

175
Q

septic pelvic thrombophlebitis cause and sx

A

postoperative or postpartum infected thrombosis of the deep pelvic or ovarian veins

pts have persistent fevere urepsonsive to antibiotics

tx with anticoags and broad spectrum antibiotics

176
Q

cocaine abuse can increase the risk of what in pregnancy

A

placental abruption

177
Q

the most common symptoms of vaginal cancer are ____ and _____ a SCC lesion is generally seen where

managment

risk factors

A

vaginal bleeding and malodorous vaginal discharge

upper third of the posterior vagina

get biopsy

risk factors are hpv and smoking etc

178
Q

bilateral, gray, nonbloody nipple discharge,

A

physiologic glactorrhea

179
Q

treatment for PCOS

A

weight loss is first line to reestablish ovulation

180
Q

AE and risks with combined oral contraceptives

A 
breakthrough bleed
breast tenderness, nausea, bloating
amenorrhea
htn
vte
increased risk cervical cancer
hepatic adenoma
increased TGs
181
Q

uterine rupture cx presentation

A 
vaginal bleed
intraabdominal bleed (hypotension and tachy)
fetal heart decels
loss fetal station
loss intrauterine pressure
182
Q

HIV treatment in pregnancy

drugs

A 
2 NRTIs (zidovudine, tenofovir) +
1 NNRTI or a protease inhbitor
183
Q

q tip test
an angle of at or greater than ___ degrees from horizontal on increase on intra abdominal pressure signifies urethral hypermobility

A

30 degrees

184
Q

how is mg excreted and why does this matter

A

excreted by the kidneys and a common risk factor for mg tox is renal insufficiency

185
Q

emergency contraception options

A

copper IUD 99% effective, 0-120

ulipristal pill (antiprogestin, delay ovulation) 85% or more, 0-120

levonorgestrel (progestin, delay ovul) 85%, 0-72 hrs

OCPs 75%, 0-72 hrs

CULO

186
Q

when is a breast MRI done

A

in pts with known cancer to evaluate for disesae recurrence and to screen for breast cancer in high risk pts with known BRCA or first degree relatives with breast cancer

187
Q

which type of masson ovary has highest chance of causing ovarian torsion

A

dermoid cyst

188
Q

krukenberg tumorcan cause what in pregnancy

maternal clincial features

fetal virilization risk

A

hyperandrogenism

bilateral solid ovarian masses on US

high risk

189
Q

management of CIN3 in pt over 25 and not pregnant

A

LEEP
cold knife conization
cryoablation

then pap test with HPV 1 and 2 years postprocedure

190
Q

fundal height and gestation age

A

can be measured after 20 weeks gestation
+/- 3 weeks

not as accurate

191
Q

what do you use to test for PID

A

hysterosalpingogram

192
Q

etiololgy of variable decelerations

A

cord compression, oligohydramnios, cord prolapse

193
Q

is weight gain associated with OCs

A

no

194
Q

risk of fracture with osteoperosis is highest in what population

A

people with prior history of fragility fracture

195
Q

first line treatment for asx bacteruria in pregnancy

why treat in pregnancy?

A

fosfomycin
amoxicillin-clavulanate
nitrofurantoin
Cephalexin

dat ask bacteruria is FANC

treat bc can lead to pyelonephritis and preterm delivery, low birth weight

196
Q

tutle sign

A

retratction of the fetal head into the perineum after delivery

in macrosomic baby

197
Q

false labor

timing
strength
pain
cervical change

A

irregular, infrequent

weak

none to mild

no change

braxton hicks contractions

198
Q

medically emancipated minor situations

A 
STI
emergency care
substance abuse
pregnancy care
contraception

minors need to Control their PESS

199
Q

what kind of dysmenorrhea

dull and ill defined pelvic ache that worsens with standing
dyspareunia

A

pelvic congesion

200
Q

ebstein anomaly with lithium use in pregnancy

A

malformed and inferiorly attached tricuspid valve so atrialized RV

also ASD

201
Q

management of breast abscess frommastitis

A

needle aspiration and antibiotics (dicloxacillin, cephalexin)

continued breast feeding for continued milk drainage

202
Q

soft mobile nontender asx mass on labium majorum

A

bartholin duct cyst

usually 4 or 8 o clock position

203
Q

pt with a palpable breast mass then what for algorhytm

pt under 30

if pt over 30 and suspicious for malignancy

A

ultrasound

if shows simple cyst = needle aspirations if pt wants
if shows complex cyst/mass then core biopsy

over 30 and suspicious = core biopsy

204
Q

only ____ can confirm a diagnosis of a palpable breast mass

A

biopsy

205
Q

pathophysiology of functional hypothalamic amenorrhea: what causes it on the physiological level

A

increased ghrelin, NPY, CRH, gaba, and beta endorph, decreased leptin

decreased GnRH, decreased FSH and LH and decreased Estrogen

206
Q

tenderness over anterior vaginal wall occurs with _____

presents with discomfort upon bladder filing, dysuria, and urinary frequency

A

bladder pain syndrome

207
Q

order of puberty in females

A

BAG Me

Breast 8
axillary hair growth 9
growth spurt 10 (beofre menarche)
menarche 12.5 (within 2 to 2.5 yrs of breast development)

208
Q

has does prolactin stop ovulation

A

negative inhibition of GnRH

209
Q

is a hyperechoic mass on US mean benign or malignant?

A

benign

210
Q

HTN in pregnancy incrases risk of what in pregnancy

A

superimposed preeclampsia, abruptio placentae, fetal growth restriction, preterm labor, stillbirth

211
Q

side effect of epidural anesthesia in 10% of pts

A

hypotension by vasodilation and venous pooling

212
Q

acute cervicitis

caused by what
sx

dx

A

chlamydia, gonn

mucopurulent cervical discharge and edematous friable cervix that bleeds with manipulation

dx: NAAT
- wont see anything on light microscopy

213
Q

risk of uterine rupture is greatest in laboring pts with what

tx

A

prior uterine surgery, (c section or myomectomy with uterine cavity entry to remove fibroids)

tx: uregent laparotomy and delivery

214
Q

lab abnormalities of hyperemesis gravidarum

acid base and electrolytes and heme and sugar

A 
ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hypoglycemia
hemoconcentration
215
Q

all sexually active women under age 25 are recommended to get tested for what along with routine pap screen and why

A

chlamydia and gonorrhea bc can be asx

216
Q

breast feeding effect on breast cancer

A

protective effect

217
Q

_____ causes variable decelerations

A

umbilical cord compression

218
Q

what is internal podalic version used for

A

breech extraction of a malpresenting second twin

219
Q

how does levonorgestrel stop pregnancy

A

releases progestin which creates a physical barrier by thickening cervical mucus and impairing implantation

-SE is amenorrhea

220
Q

most common urinary incontinence in pregnancy

A

stress urinary incontinence

221
Q

postpartum urinary retention with overflow incontinence

risk factors

dx

managment

A

RF: analgesia, nulliparity, prolonged labor

dx: uretrhal cath and urinary drainage of 150 ml or more confirms retention
tx: urethral catheterization to decompress bladder

222
Q

high secretion of b-Hcg in a Hyd mole causes what

A

hyperstimulation of the ovaries and formation of theca lutein cysts which are large, bilateral and multilocular

223
Q

management of uterine rupture

A

laparotomy for delivery and uterine repair

224
Q

misoprostol in abortions

A

used to treat incomplete or missed abortion

causes cervical dilation and myometrial contraction to expel intrauterine contents

225
Q

history of preterm labor and short cervix

management of preg

A

cerclage and progesterone

if history of preterm labor offer progest injections

226
Q

pelvic pain in a pt with a known ovarian mass should be suspected as what until proven otherwise

A

ovarian torsion

227
Q

persistent fever unresponsive to broad spectrum antibiotic therapy and a negative infectious evaluation after birth or pelvic surgery sgugests what

A

septic pelvic thrombophlebitis

(endometritis would usually respond to antibiotics

228
Q

treatment for lichen sclerosus

A

coritcosteroids (clobetasol) ointment

229
Q

lack of menses is considered normal at age of less than what if 2ndary sex characteristic development has been appropriate

A

15 yrs old

230
Q

biophysical profile results

what are the things assessed

A

abormal = 0,2,4

equivocal = 6

normal = 8 or 10

fetal: breathing, movement, tone, and amniotic fluid

231
Q

Preeclampsia managment

without severe features
with severe fetures

A

mg sulfate and anti HTN

severe then deliver at 34 weeks or greater

without severe deliever at 37 weeks or greater

232
Q

wernicke encephalopathy can be caused by what in pregnancy

sx

tx

A

hyperemesis gravidarum

encepth

oculomotor dysfunction (horiz nystagmus and bilateral abducens palsy)

postural and gait ataxia

tx: IV thiamine then glucose

233
Q

tx for placenta previa

A

C section at 36-37 weeks

234
Q

modifiable risk factors for osteoporosis

A

smoking
excessie alcohol intake (over 2 drinks a day)
sednetary lifestyle

235
Q

anovulation secondary to morbid obesity

A

obesity is a common cause of amenorrhea

in anovulation, the FSH and LH levels are normal

ovaries still produces estrogen but no progesterone being produced at normal post ovulation levels, so pregeterone withdrawal menses does not occur

236
Q

routine administrations of the hpv vaccine series begins at age _____ and catch up vaccination should be offered until age ___

A

11-12

26

237
Q

definition of preterm labor

A

regular contractions at <37 weeks that cause cervical dilation and or effacement

238
Q

antibodies in antiphospholipid syndrome

management

A

anti-cardiolipin antibody
lupus anticoagulant
anti-beta2-glycoprotein antibody

management: anticoagulation with hep or warfarin

239
Q

focal tenderness and firmness and or erythema and no fever of breast

A

plugged duct

240
Q

if pap shows HSIL or CIN 2 or 3 then what next

A

immediate colposcopy
if not visualized during colposcopy then endocervical curettage is performed to evaluate endocervical canal (don’t do during pregnancy)

cervical biopsy is performed even in pregnancy if lesion has high grade features

241
Q

how does clomiphene work

A

estrogen receptor antagonist on hypothalamus so stops negative inhibition of GnRH

242
Q

mom has 1:32 titer after getting standard anti d at 28 weeks in first preg and 1 day postpartum, what happened

A

inadequate dose of anti d immune globulin after her first delivery

standard dose is usually adequate at 28 weeks gestation, after delivery or procedures ned to use kleihauer betke test to determine dose for post delivery dose

243
Q

biophysical profile what is normal fetal movement
tone
breathing

A 
movement = 3 or more
tone = 1 or more flex extension

breating 1 or more in 30 seconds

244
Q

cx presentation of amniotic fluid embolism syndomre

A

cardiogenic shock

hypoxemic resp failure
DIC
coma or seizure

245
Q

concentration of what increases close to ovulation and can be perceived as discharge from vagina in pts

A

cervical mucus

246
Q

management of lichen sclerosus

A

punch biopsy recommended bc it is a vulvar premalignant lesion of SCC

247
Q

subareolar, mobile, well-circumscribed, nontender mass; no fever breast

A

galactocele

248
Q

what patients does placenta accreta usually occur in

A

pts with prior c section, myomectomy, or D and C

-surgery

249
Q

management of suspected ruptured ovarian cyst

A

blood count for anemia, and pregnancy test to exclude ectopic, US to see pelvic free fluid

250
Q

what is the most important direct role of hCG in pregnancy

A

maintenance of the corpus luteum from syncytiotrophoblast

251
Q

what population does a dermoid ovarian cyst (mature cystic teratoma) most commonly occur in

A

premonpausal women

hyperchoic nodules and calcifcations

252
Q

if pt has GBS positive when do you give penicillin

A

during labor

253
Q

gold standard treatment for a ruptured ectopic pregnancy is what

A

laparoscopy

254
Q

if known placental accreta then management

A

planned c section

255
Q

pain on and an aversion to attempted vaginal penetration

tx

A

genito pelvic pain/penetration disorder

tx: desensitization and kegal exercises

256
Q

diagnostic workup for urethral hypermobility

test

PVR

tx

A

Q tip test
determines whether pt has abnormal urethrovesical angle

urinalysis and postvoid residual volume should be normal
( <150 in women and <50 in men)

kegel exercises first then urethral sling surgery if that does not work

257
Q

If moms anti-D antibody titer is less than what it cannot harm baby

A

1:8

if over 1:8 not good

258
Q

proliferation of smooth muscle cells within the myometrium that causes irregular uterine enlargement

A

leiomyomata uteri (fibroids)

259
Q

___ ___ can cause heavy and prolonged menstrual bleeding and can prolapse through the cervical os presenting with a typical labor like pain due to cervical distension by the solid mass

A

submucous fibroids

260
Q

when should external cephalic version be done

A

at or over 37 weeks

261
Q

outpt regimen for PUD

A

intramuscular ceftriaxone plus oral doxycycline

262
Q

tenderness/erythema and fever with breast

above plus fluctuant mas

A

mastitis

abscess

263
Q

submucosal along lateral aspects of the upper anterior vagina that don’t involve vuvlva

cyst

A

gartner duct cyst

from incomplete regression of wolffian duct during fetal development

264
Q

a typical NST will last ___ minutes but a nonreactive NST should be extended ___ minutes to ensure what

A

20, 40-120 to ensure not from fetal sleep cycle

265
Q

beclomethasone, isotretinoin and lithium in pregnancy

A

beclo okay
stop iso

wean lithium (ebstein anomaly)

266
Q

preterm labor management

if >34 to <37 weeks then do what

if >32 to <34 then what

if under 32 then what

A

1) betamethasone and penicllin if GBS + or unknown
2) betamethasone, tocolytics, penicillin if needed

3) betamethasone, tocolytics, Mg sulfate, pencilin if needed
- can add indomethacin with mg sulfate too

add one every time gets lower

267
Q

treatment of hpv warts

A

small lesions can be treated with trichloroacetic acid or podophyllin resin

cryotherapy, laser therapy, excision of larger ones

268
Q

when does routine screening for breast cancer start in women and with what

A

mammography at age 50 or older

269
Q

contraindicated vaccines in pregnancy

A

HPV
MMR
live attenuated influenza
varicella

270
Q

PE with GU syndrome of menopause

A

urinary incontinence, reccurent UTI

narrowed introitus
pale mucosa, decrased rugae

petechiae, fissures

271
Q

are transient rigors/chills in postpartum period normal

how about peripheral edema

A

yes

yes

272
Q

abruptio placentae

risk factor
sx
uterus texture
contraction amplitude and frequency

A

HTN, cocaine

abdominal and or back pain and vaginal bleeding (can be concealed behind placenta)
-blood can cause a firm uterus and low amplittude but frequent contractions

fetal brady

273
Q

breast engorement occurs when and how

tx

A

3-5 days after delivery when colostrum is replaced by milk

cool compresses, tyleonl, nsaids
breastfeeding and pumping should help

274
Q

fetal fibronectin and preterm delivery

A

FFN are high until 20 weeks gestation, low after that then increase at term

elevated levels prior to term are used as indicator for increased risk of preterm delivery

275
Q

hydrosalpinx is caused by what

A

fluid accumulation in fallopian tube due to blockage by either adhesions (PID) or surgery (bilat tubal ligation)

mass would be seperate from ovary on US

276
Q

ectopic pregnancy tx

stable

unstable

A

stable: methotrexate
unstable: surgery

277
Q

management of suspected ectopic pregnancy

positve urine hcg, lower abdom pain, and or vag bleeding and stable next step

A

TVUS

  • adenexal mass = treat ectopic
  • intrauterine = nothing else to do
  • nondiagnostic = get B-hcg
    • if over 1500 = repeat b-hcg and TVUS in 2 days
    • if under 1500 repeat b hcg in 2 days
278
Q

epithelial ovarian carcinioma refers to malignancy involving what sites and can present at any of these sites

A

ovary, fallopian tube and peritoneum

279
Q

intrauterine fetal demise pathophysiology and figuring out cause

A

maternal, fetal, or placental

fetus undergo autopsy, karyotype studies, placenta evealuated for disesae

labs for mom as well like antiphospholipid antibody syndrome

280
Q

management if have no history of preterm labor and short cervix

A

progesterone

281
Q

symptoms of mass effect like pelvic pressure in fibroids or adenomyosis?

A

only fibroids

282
Q

tx of HELLP syndrome

timeline

A

stablize (mg and anti-HTN) then
delivery
at 34 weeks or greater
or at any age with abnormal fetal testing or severe or worsening maternal status

283
Q

pt presents with hyperemesis gravidarum, an enlarged uterus, and bilaterally enlarged ovaries which is a presentation concerning for a

A

complete hydatidiform mole (gestatinoal trohoblastic disease)

284
Q

tuboovarian abscess is a complication of what disease and presents with what

from what infection

labs

dx

A

PID

presents with fever, ab pain and mass

polymicrobial infection

labs: leukocytosis, CRP, and CA-125 elevated and fever
dx: US, CT scan

285
Q

FSH LH prolactin and TSH in asherman syndrome

A

normal all

286
Q

most common cause of fetal demise

A

frequently unknown

287
Q

what is lochia rubra and is it normal in postpartum period

A

red or reddish-brown vaginal discharge (normal shedding of ther uterine decidua and blood)

normal

runs pink or brown then yellow eventually

288
Q

in PID what do you see on US

A

tubo-ovarian abscess

289
Q

assessing for syphillis in pregnancy when

A

universal at first prenatal visit
third trimester and delivery if high risk

non treponemal RPR and VDRL
treponemal FTA-ABS

290
Q

tx for gestational diabetes

A

1st line: dietary mod

2nd line: insulin, metformin, glyburide

291
Q

ursodeoxycholic acid used to treat what in pregnancy

A

intrahepatic cholestasis

292
Q

early decelerations are caused by what

A

fetal head compression

not alarming

293
Q

vaccines recommended during pregnancy

A

Tdap
inactivated influenza
rho(D) gam

294
Q

Adverse effects of tamoxifen and raloxifene

A

hot flashes
venous thromboembolism
endometrial hyperplasia and carcinoma (tamoxifen only) (estrogen antagonist in breast)

295
Q

clinical features of a vesicovaginal fistula and dx

A

painless, continuous urine leakage from the vagina following surgery

dx: dye tests or cystourethroscopy

296
Q

carboprost in delivery

A

synthetc prostaglandin that stimulates uterine contraction

causes bronchoconstriction and asthma is a contraindication

297
Q

contraindications of HRT therapy

A

histroy of coronary heart disease, thromboembolism, TIA, breast cancer, endometrial cancer

298
Q

progesterone and preterm delivery treatment

A

it is administered to pts with history of preterm delivery or a shortened cervix to prevent preterm delivery

299
Q

smooth undulating waveform with no variablilty or sinusoidal fetal heart tracing on fetal monitor suggests what

A

fetal anemia

300
Q

rist step in evaluating risk of preterm delivery is what

A

TVUS measuring cervical length in second trimester

301
Q

when c section with HIV

A

if mom viral load over 1,000

302
Q

maternal thyroid in pregnancy first trimester

A

total t4 increased bc b-hcg stimulates thyroid hormone produciton in 1st semester

fre t4 same or mild increase

tsh decrased

estrgoen stimulates syn of TBG which leads to increased pool of bound thyroid hormone

303
Q

septic abortion presents with what

usually from what

uterus description

tx

A

fever lower abdominal pain and heavey vag bleeding and malodorous purulent vaginal discharge

usually after unsterile abortion

enlarged boggy tender uterus with echogenic material

tx: broad spectrum antibiotics and suction curettage

304
Q

normal amniotic fluid volume

A

single fluid pocket equal to or greater than 2X1 cm or amniotic fluid index over 5

305
Q

comorbidities with PCOS

A

diabetes, HTN
obstructive sleep apnea
nonalcoholic steatohepatitis
endometrial hyperplasia/cancer

306
Q

risk factors of preterm labor

A

multiple gestation
history of preterm delivery
history of cervical surgery (conization)

307
Q

preeclampsia is likely due to abnormal what

A

placental spiral artery development

308
Q

preeclampsia at <20 weeks gestation can be a complication of what

A

hydatidiform mole

309
Q

breast engorgement tx for pt who does not want to breast feed

A

comfortablebra, avoid nipple stimulation, ice and NSAIDs

310
Q

breast engorgement tx for pt who wants to breast feed

A

frequent emptying of breasts

311
Q

difference from LS and menopausal atrophy

A

menopausal atrophy does not affect the perianal skin like LS

312
Q

how old do you have to be to get an endometrial biopsy when you get atypical glandular cells on a pap test

A

35 or older

313
Q

thickening of the uterosacral ligaments

A

endometiosis

314
Q

cervical cancer upper 2/3 of vagina

A

stage IIa

Uworld Shelf Questions DF (8 decks)

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