EOR Deck Flashcards
Women's Health End of Rotation Exam (114 cards)
1
Q
In a women presenting in full-term labor, what conditions would a digital cervical exam be contraindicated?
What exam should be done when rupture of membranes is expected?
A
A digital cervical exam is contraindicated in cases of placenta previa or preterm prelabor rupture of membranes
Sterile Speculum Exam
2
Q
At what dilation does active labor begin?
A
After 4cm
3
Q
What hourglass-shaped anatomic ring of the uterus, if present, is associated with obstruction in the second stage of labor?
A
Bandl Ring
4
Q
When is the recommended timeframe of screening for gestationa DM?
Which is the best option for pharmacologic therapy in patients with gestational diabetes mellitus that is not controlled with dietary changes?
A
Between 24 and 28 weeks of Gestation
Insulin
5
Q
In an infant born to a mother with gestational DM, would you expect hyperglycemia or hypoglycemia at birth?
A
Hypoglycemia
6
Q
Gestational diabetes mellitus is clinically significant because it is associated with an increased risk of
A
- gestational hypertension
- preeclampsia
- macrosomia
- neonatal jaundice
- neonatal hypoglycemia
- neonatal RDS
- shoulder dystocia
- cesarean delivery
- diabetes mellitus later in life.
7
Q
What are the serum glucose measurement cutoffs for the fasting, 1-hour, 2-hour, and 3-hour measurements during the second step of the two-step approach used to diagnose gestational diabetes mellitus?
A
Fasting ≥ 95 mg/dL
1-hour ≥ 180 mg/dL
2-hour ≥ 155 mg/dL
3-hour ≥ 140 mg/dL
The diagnosis of gestational diabetes is confirmed in patients who meet at least two of these four criteria.
8
Q
What are the most common causes for postpartum fever?
A
- Mastitis
- Surgical Site Infection
- UTI
- Postpartum endometritis
- Pneumonia
9
Q
What test determines the presence of premature rupture of membranes?
A
Nitrazine paper test or Fern test
10
Q
What is the most common postpartum infection?
What are the most common presenting symptoms?
What broad spectrum antibiotics should be given?
A
Endometritis
fever, abdominal pain, foul-smelling lochia
Clindamycin and Gentamycin - Bactrim if penicillin allergy
11
Q
Which of the following is a contraindication to mifepristone use in a patient needing first-trimester medication abortion?
A. Asthma
B. Chronic adrenal insufficiency
C. Nexplanon implant
D. Tobacco dependency
What is the MOA of mifepristone?
A
Chronic adrenal insufficiency
Mifepristone is contraindicated in chronic adrenal failure, hemorrhagic disorders or anticoagulant use, ectopic pregnancy, allergy to the medication, inherited porphyrias, or intrauterine device
Glucocorticoid receptor antagonist
12
Q
Based on the anatomy of the uterus, where would you expect to find the placenta accreta?
Where anatomically is the placenta found normally?
A
Attached to the myometrium
Attached to the ducida
13
Q
What laboratory finding may be seen in a patient with placenta percreta that has invaded the bladder?
A
Hematuria
14
Q
What liver function markers are needed to diagnose HELLP Syndrome?
A
AST and bilirubin
15
Q
What medications are used to treat hypertension during pregnancy?
A
Labatalol
Nifedipine
Hydralazine
16
Q
A 41-year-old woman presents to her gynecologist for a routine check-up. She was recently married and is now interested in having children but wonders if she needs to find an egg donor. She has never been pregnant before, but she has always had protected intercourse. She has regular menses. What is the best test to screen for her ovarian reserve?
A
Anti-müllerian hormone
17
Q
What is measured during a fetal stress test?
A
Fetal HR and uterine contractions
18
Q
What is the most common indication for a primary C-Section?
What is the most common reason for c-section overall?
A
Failure to Progress
Previous c-section
19
Q
What is the definition of failure to progress leading to the initiation of a primary c-section?
What are the Three P’s?
A
Two hours without cervical change with adequate contractions in the active phase of labor
Patient, Pelvis, Passenger
20
Q
What is the normal vasculature of the placenta? (how many arteries and viens)
A
2 Arteries and 1 Vein
*Should be inspected after the delivery of the placenta
21
Q
What is the first stage of labor?
What occurs in the third stage of labor?
A
Stage 1: Dilation of the cervix to 10cm
Latent phase: cervical effacement with gradual cervical dilation (usually to 4cm)
Active phase: rapid cervical dilation (usually beginning a 4cm)
Delivery of the placenta
22
Q
At 1-minute of life the baby has a blue appearence, and a weak cry. Arms and legs are flexed. Pulse rate is 30bpm and there are slow and irregular respiratory sounds. What is the 1-minute APGAR score?
What is the scoring criteria for pulse during APGAR scoring?
What is considered a normal APGAR score?
A
Blue Appearance - 0
Weak Cry - 1
Arms and legs flexed - 1
Pulse Rate - 0
Slow and irregular breath sounds - 1
Total score = 3 (this baby requires rescucitation)
Pulse = 0, 0 points
Pulse < 100, 1 point
Pulse > 100 2 points
> 7
23
Q
What structure is the most critical in determining fetal position?
What is fetal attitude?
A
Head Postion
Fetal attitude: relationship of fetal parts to one another
24
Q
What is a normal fetal attitude?
A
Fully Flexed - chin on chest; rounded back with flexed arms, legs; smallest diameter of head (suboccipitobregmatic diameter) presents at pelvic inlet
25
What is a normal fetal lie?
| What are abnormal fetal lie positions?
Baby's spine is perpindicular with maternal spine
| Transverse and Oblique
26
In a normal vertex fetal presentation, what bone presents first out of the vaginal vault?
Occipital Bone
27
Describe the different breech positions?
| How is breech presentation diagnosed?
Frank breech: hips flexed; knees extended; bottom presents
Complete breech: hips, knees flexed; bottom presents
Incomplete breech: one/both hips not completely flexed; feet present
Shoulder: transverse lie; shoulders present first
| Physical exam, and confirmed by ultrasound
28
What is the treatment for a breech presentation?
At or near term gestation, an external cephalic version should be done followed by a trial of vaginal birth if successful. If unsuccessful then a planned c-section should be scheduled.
29
Describe the terms typically used to describe multiple births?
**Monozygotic** (Identical) – multiple (typically two) fetuses produced by the splitting of a single zygote
**Dizygotic** (Fraternal) – multiple (typically two) fetuses produced by two zygotes
**Polyzygotic** – multiple fetuses produced by two or more zygotes
30
How are multiples typically diagnosed?
Often diagnosed at first screening ultrasound other clues include
- Fundal height is usually greater than dates
- Extra fetal heart tones
- Elevated maternal alpha-fetoprotein (AFP)
31
What vitamin should be limited in pregnancy?
| What vitamins should be supplemented in pregnancy?
Vitamin A - women should limit intake to 5,000 mu
| Vitamin D and C
32
How is gestational hypertension defined?
| When should BP be taken?
ACOG defines hypertension as BP >140 mm Hg systolic or >90 mm Hg diastolic
| Every prenatal visit
33
What is used to calculate the estimated date of delivery (EDD)?
**Naegele's Rule**
1st day of last menstraul cycle + 7 days subtract 3 months
34
What is the EDD if the fundal height is measuring at the pubic symphysis?
| When does the fetus measure at the level of the umbilicus?
12 Weeks
| 20 weeks
35
During the first trimester blood screenings a low PAPP-A level is detected. What genetic abnormality is this associated with?
| What does a Nuchal Translucency ultrasound screen for?
Trisomy 21 (Down Syndrome)
| Screens for Trisomies 13, 18, and 21
## Footnote
Done at 10-13 weeks. Increased thickness is abnormal. If increased thickness is present, chorionic villous sampling or amniocentesis is offered.
36
When is Quad Testing done? And what is included?
Done in the second trimester between weeks 16-20
AFP, hCG, estriol, inhibin
↑ AFP = neural tube or abdominal wall defects
↑ hCG and inhibin and ↓ AFP and estriol = Down syndrome
↓ AFP, hCG, and estriol = Edwards syndrome
37
What is Chadwick's Sign?
bluish discoloration of vagina, vulva, and cervix due to vascular congestion
Usually around 8-12 weeks
38
What are the indications for chorionic villous sampling (CVS)?
| When is typically done
## Footnote
What are the risks of CVS?
- maternal age is 35 years or older
- prior child had a genetic disorder (e.g., Cystic fibrosis) and chromosomal abnormalities (e.g., Down syndrome)
- parents are carriers of a genetic disorder
- first trimester ultrasound examination suggests a congenital anomaly
- abnormal aneuploidy screening result
| First trimester, weeks 10-13
## Footnote
- maternal alloimmunization (relative contraindication)
- vertical transmission of infection (e.g., HIV)
- miscarriage
- amniotic fluid leakage
39
What are some symptoms associated with preterm labor?
- Vaginal Bleeding
- Contractions (abdominal pain, pelvic pain, or lower back pain)
- Rupture of membranes
40
If RhoGam is indicated when should it be given?
28 Weeks
41
What type of fetal HR variablity is always worrisome?
Late Decelerations: FHR drop at the end of the contraction ⇒ Uteroplacental insufficiency ⇒ Always worrisome
42
When is a laporoscopy indicated in primary dysmenorrhea?
| What is the primary treatment for dysmenorrhea?
After 3-months of failed first-line treatment of NSAIDs or hormonal therapy or combination of both
| NSAIDs (typically Ibuprofen) and/or hormonal therapy (combo pills)
43
A 19-year-old woman presents to urgent care requesting emergency contraception after unprotected intercourse the night prior. What is an effective form of emergency contraception that can be offered to this patient?
In order of maximal to minimal efficacy:
- Copper IUD most effective
- Ulipristol (progestin receptor modulator that delays ovulation)
- Oral Levonorgestrel (ideally given within 72 hours)
- Estrogen-Progestin (ideally given within 72 hours)
44
What is the most common presenting symptom associated with PID?
Lower abdominal pain
| Fever, abnormal vaginal discharge, and bleeding are also common
45
A 24-year-old woman is seen by her gynecologist for pelvic pain and painful, heavy menstrual cycles for the last three months. She has no pain with sexual intercourse. A pregnancy test is negative. On physical exam, a uniformly enlarged and boggy uterus is palpated. What is the most likely diagnosis?
Adenomyosis
Common triad is a "boggy" uterus, abnormal bleeding, and dysmenorrhea (painful periods)
46
A 65-year-old woman presents with a three-month history of intense vulvar itching. Pelvic examination reveals a thick red plaque on the right labia majora without scarring or adhesions. What is the most likely diagnosis?
| How is the diagnosis confirmed?
Vulvar Carcinoma
| Vulvar biopsy
47
What is the treatment of choice for uncomplicated genital chlamydia infection in pregnancy?
Azithromycin
48
How is primary amenorrhea defined?
| What should be included in the work-up?
Failure of menses to occur by age 15 years (some sources say 16 years), in the presence of normal growth and secondary sexual characteristics (breast development, axillary or pubic hair)
| Genetic Testing to look for different karyotypes and physical exam
## Footnote
Turner's syndrome: XO karyotype, webbed neck, broad chest, high FSH
Hypothalamic-pituitary insufficiency: 46, XX, low FSH, LH
Androgen insensitivity: 46, XY, High testosterone, breast development only
Anorexia: 46, XX, very low weight
Mullerian agenesis – secondary sex characteristics, no uterus
49
Pregnancy is the most common cause for secondary amennohrea, but what are some other causes?
| What labs should be ordered when diagnosing secondary amennohrea?
Weight changes
Hypothyroidism
Prolactinoma
| Beta HcG, TSH, Prolactin
## Footnote
Beta HcG should always be initial test
50
What is the diagnostic gold standard for abnormal uterine bleeding (AUB)?
| What is the treatment?
D&C
Usually a diagnosis of exclusion:
* Urinary β-hCG levels—r/o pregnancy
* Labs: CBC, iron studies, PT, PTT, TSH, progesterone, prolactin, FSH, LFTs
* Progestin trial—if the bleeding stops, anovulatory cycles confirmed
* Ovulation journal, Pap smear
* Pelvic U/S, endometrial biopsy, HSG, hysteroscopy (can be done during D&C procedure)
| Oral contraceptives or NSAIDs
## Footnote
In women that don't desire future pregnancies, a hysterectomy or uterine ablation may be considered
51
Primary dysmenorrhea is associated with the over production of what?
| What are the risk factors of primary dysmenorrhea?
Prostoglandins
| Menarche before age 12, nulliparity, smoking, family history, obesity
52
What are some etiologies that may cause secondary dysmenorrhea?
* Endometriosis
* Adenomyosis
* Polyps
* Fibroids
* PID
* IUD
* Tumors, adhesions, cervical stenosis/lesions
* Psych
53
In the patient history, how can primary dysmenorrhea be differentiated from secondary dysmenorrhea?
In primary dysmenorrhea the patient will complain of the onset of pain being the day prior to menses and subsiding 1-3 days into their cycle, while secondary dysmenorrhea pain starts mid-cycle and increases in severity until the end
Secondary dysmenorrhea is pathologic, their is an underlying cause for the pain.
54
What is the Karyotype for Tuner's Syndrome?
XO
| Normal female karyotype is XX
55
What kind of diagnosis is menapause?
| What lab values can be helpful in diagnosing menapause?
A retrospective diagnosis classified as 12 months of no menstraution (amenorrhea)
Mean age of onset is 51
| FSH and Estrogen
## Footnote
FSH will be elevated (> 30) with low estrogen levels on results
56
What are the contraindications to hormone replacement therapy in menapausal women?
| Who should receive estrogen replacement therapy?
↑ triglycerides
Undiagnosed vaginal bleeding
Endometrial cancer
History of breast CA or estrogen-sensitive cancers
CVD History
DVT or PE history
| Women without a uterus
57
What effect does HRT have on a women's lipid profile?
HDL and TG levels ↑, LDL levels ↓
58
What is the MOA of Tamoxifen?
| What are the indications for Tamoxifen?
## Footnote
What is the most significant risk factor of Tamoxifen?
* Selective estrogen receptor modulator (SERM)
* Is an estrogen antagonist in the breast but an estrogen agonist in the endometrium, bone, liver, and coagulation system
## Footnote
* Adjuvant treatment in estrogen and progesterone receptor-positive breast caner
* Breast cancer prevention
* Osteoporosis prevention in postmenopausal women
Increased risk of endometrial cancer
59
What are the two phases within the uterine cycle and what hormones influence them?
The proliferative phase, influenced by estrogen, increases the thickness of the endometrium (aligns with the ovarian cycle of the menstraul cycle)
The secretory phase, influenced by progesterone, increases the vasculature of the endometrium (spiral arteries) (aligns with the luteal phase of the menstrual cycle)
60
A 26-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities. What is the most likely diagnosis?
| What is the first line treatment?
## Footnote
What physical exam findings or postivie ROS may be present?
Premenstrual dysphoric disorder (PMDD)
| SSRIs (fluoxetine 10 mg, sertraline 50 mg QD, etc)
## Footnote
breast tenderness or swelling, joint or muscle pain, a sensation of “bloating,” or weight gain.
61
# What is the most likely diagnosis?
A 19-year-old sexually active woman who presents to your office with complaints of yellow vaginal discharge and intermittent postcoital vaginal bleeding for 1 week. She otherwise feels well. On examination, there is purulent discharge visible in the endocervical canal. After you collect vaginal fluid for a wet prep and cervical samples for gonorrhea and chlamydia cultures, you note bleeding at the cervical os. On bimanual examination, the patient complains of tenderness on cervical palpation but denies uterine or adnexal tenderness. Wet prep reveals vaginal pH 4; negative whiff; 20 white blood cells (WBCs) per high-power field; and no clue cells, trichomonads, or pseudohyphae.
| What is needed for diagnosis?
## Footnote
What is the treatment?
Gonorrhea cervicitis: mucopurulent vaginal discharge gram-negative intracellular diplococci
| Nucleic acid amplification test (NAAT) of discharge or urine
## Footnote
500mg IV of Cetriaxone, if chlymidia is suspected should also treat with Doxycycline for 7 days
62
Nucleic acid amplification test (NAAT) is the gold standard for diagnosing what STI's?
Chlamydia and Gonnorrhea
63
What is the treatment for chlamydia in pregnancy?
| What are the risks to the newborn if mom is infected with chlamydia?
azithromycin 1 gm x 1 dose or amoxicillin 500 TID x 7 days
| Neonatal conjunctivitis or neonatal pneumonia
64
What HPV strains cause genital warts?
| Describe the appearance of genital warts?
## Footnote
What other STI is most commonly seen as a co-infection with genital warts?
HPV 6 and 11
| soft, skin-colored, fleshy lesions usually on the glans penis, prepuce
## Footnote
Trichimonas
65
What is the treatment for genital warts?
Spontaneous remission in months to years is typical of skin warts
Treat to improve symptoms and remove warts
* The provider may apply podophyllin or trichloroacetic acid (TCA)
* Topical imiquimod (Aldara) cream can be applied by the patient
* Surgery: cryotherapy with liquid nitrogen, surgical excision, electrocautery, laser, intralesional interferon
66
What sign of polycystic ovary syndrome can be noted on ultrasound?
"Pearl Necklace"
More than 8 cystic follicles in a line
67
What are the two ovulation promoter medications that can be used in women with diagnosed PCOS and confirmed infertility?
Letrozole (first-line and more effective) and Clomaphine
68
What is the diagnosis criteria for Polycystic Ovarian Syndrome?
| What are the lab findings associated with PCOS?
Diagnosis is based on Rotterdam Criteria (2/3 criteria need to be met)
1. Lab or clinical findings (eg. hirsutism, acne, and male-pattern baldness)
2. Amenorrhea or oligomenorrhea
3. Cystic ovaries on ultrasound ("Pearl Necklace" appearance of 8+ cystic follicles)
| Increased testosterone (DHEA), increased LH:FSH ratio > 3:1
69
What are symptoms of hypoestrogenism?
* Hot flashes
* atrophic vaginitis
* decreased bone mineral density
* dyspareunia
* decreased libido
* sleep disturbances.
70
A 31-year-old G3P2 at 39 weeks gestational age is on a fetal heart monitor in labor and delivery after presenting with ruptured membranes. Fetal heart monitor abruptly changes revealing severe prolonged bradycardia with variable decelerations. In the event of a prolapsed umbilical cord, which of the following can be done to reduce pressure on the cord while preparing for emergency delivery?
Elevating the Fetal Head or placing mom in Trendelenburg - this will increase oxygen delivery to the placenta and improve umbilical blood flow
Emergency delivery is indicated, but the provider can easily perform the motion of elevating the bed while prepping for delivery
71
In a patient receiving magnesium sulfate for eclampsia, what physical exam finding is characteristically the first manifestation of symptomatic hypermagnesemia?
Loss of deep tendon reflexes
72
Although many patients with endometriosis have a normal pelvic exam, but these clinical findings may be present in up to 1/3rd of patients?
Pelvic examination may reveal **tender nodules in the cul-de-sac or rectovaginal septum**, uterine retroversion, **cervical motion tenderness**, **decreased uterine mobility**, and adnexal masses and tenderness.
73
If positive for HPV (anogenital warts) what type of cells will appear on pap smear?
Koilocytic squamous epithelial cells in clumps
74
What strains of HPV does the quadravalent Gardisil prevent?
| What strains does Gardasil 9 prevent?
Targets HPV types 6 and 11 (genital warts) and 16 and 18 (cervical cancer)
## Footnote
same HPV types as the quadrivalent vaccine (6, 11, 16, and 18) as well as types 31, 33, 45, 52, and 58. Protects against 90% of warts 73% of cervical cancers
75
What Gardasil vaccine is only available in the U.S.?
| Who should get it?
Gardasil 9
All persons 11-12 years should receive 2 doses; may be initiated at 9 years old
76
What antibiotic class should be avoided in pregnancy?
Tetracyclines
77
What are the predisposing factors for vaginal candidiasis?
Diabetes
Oral Contaceptives
Antibiotic Use
78
What is the most common type of breast cancer?
| What are the risk factors of breast cancer?
## Footnote
What type of breast cancer is usually bilateral?
infiltrating intraductal carcinoma (IIC)
| Menarche < 12, prolonged estrogen exposure, late menopause
## Footnote
Infiltrating lobular
79
What is the presentation of inflammatory breast cancer?
Red swollen, warm and itchy breast often with nipple retraction and peau d'orange (NO LUMP)
80
What is the treatment of breast cancer?
Seperated by type
**Segmental mastectomy (lumpectomy) **followed by breast irradiation in all patients and adjunctive chemotherapy in women with positive nodes stage I and stage II with tumors less than 4 cm in diameter
**Anti-estrogen Tamoxifen** is useful in tumors that are ER-positive – binds and blocks the estrogen receptor in the breast tissue
**Aromatase inhibitors** are useful in postmenopausal ER-positive patients with breast cancer – reduces the production of estrogen
**Monoclonal AB** treatment is useful in patients with HER2 positivity (Human Epidermal Growth Factor Receptor)
81
What clinical triad is strongly indicative of cervical cancer extension to the pelvic wall?
Unilateral leg edema, sciatic pain, ureteral obstruction
82
What is Fitz-Hugh-Curtis Syndrome?
| How is it diagnosed?
Perihepatitis with hepatic fibrosis, scarring and peritoneal surface of the anterior RUQ in the setting of pelvic inflammatory disease
Clinical Presentation: RUQ pain due to perihepatitis (liver capsule involvement). May radiate to the right shoulder. Will have RUQ tenderness on exam.
| Laparoscopy: will see "violen string" adhesions. Usually LFTs are normal
83
What is Kehr Sign and what condition is it associated with?
Kehr Sign: severe abdominal pain, and left shoulder pain
Associated with Ectopic Pregnancy
84
A couple presents having not been able to conceive over the past 12 months. Evaluation of the male has been normal. The female has had regular menses. Ovulation can be confirmed with mid-luteal phase measurement of which of the following?
| If her cycles were irregular what labs should be drawn?
Progesterone
| LH, FSH, and prolactin confirm ovulation in women with irregular cycles
85
A patient presents with infertility due to chronic anovulation. Laboratory testing reveals a normal follicle stimulating hormone, estradiol, and prolactin levels. The patient's progestin challenge test was positive. Which of the following is the drug of choice for the treatment of infertility in this patient?
**Clomiphene citrate** is the first drug of choice in patients with infertility due to anovulation with normal hormone levels
86
Progesterone influence on the breast tissue prior to menstruation causes
A. proliferation of the mammary ducts.
B. growth of the lobules and alveoli.
C. proliferation of Cooper's ligaments.
D. increase glands
Growth of the lobules and alveoli is under the influence of progesterone. Prior to menses, the breast swelling that women notice is a result of the progesterone which is secreted from the corpus luteum. During menses, the swelling subsides.
87
What is the initial treatment of choice for hyperthyroidism in a 10-week pregnant patient?
Propylthiouracil (PTU)
88
A 35 year-old female presents with multiple ulcerative lesions on her labia and perineum. A Tzanck preparation of one of the lesions reveals multinucleated giant cells. What is the most likely diagnosis?
HSV
89
It is determined that a woman has a nonexistent rubella titer level during her first trimester of pregnancy. When should she receive the rubella vaccine?
After delivery of the infant as if given during pregnancy there is a chance of transmission to baby
90
To relieve dependent edema in a pregnant patient, what should be recommended to the patient?
Elevate Legs
Continue adequate fluid intake
91
A decrease in the fetal heart rate (FHR) occurring late during contractions is noted. The FHR returns to the baseline slowly after the uterine contraction. The physician assistant should be alerted to the possibility of
These are late decelerations which are always worrisome, they indicate placental insufficiency
92
What is the treatment of magnesium sulfate toxicity?
Calcium gluconate
93
A 16 year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she has taken ibuprofen at the time of the discomfort with some relief. Her pelvic examination is unremarkable. What is the most likely diagnosis?
Mittelschmerz
94
Maternal blood pressure normally decreases the most during what period of pregnancy?
Second Trimester: Maternal BP usually reaches its nadir around 16 weeks gestation
By the third trimester BP is usually back to baseline (pre-pregnancy)
95
If a pelvic mass is palpable and moves with the uterus on physical exam it is suggestive of what kind of mass?
Benign Uterine Fibroid
96
A 30 year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. What is the next step in diagnosing and treating this patient?
The patient is likely presenting with a ruptured ectopic pregnancy, therefore a laparotomy is indicated for both diagnosis and treatment as the patient is unstable.
97
During a routine prenatal visit, the fundal height is found to be midway between the pubic symphysis and umbilicus. The number of weeks gestation is estimated to be?
16 to 18 weeks
98
A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. What is the most likely diagnosis?
Due to no temperature, the patient is likely presenting with an ectopic pregnancy
99
A pregnant 28 year-old female presents at 30 weeks gestation complaining of fatigue and headache. Her vital signs and physical examination are normal. Routine hemoglobin screening is 10.1 g/dL. Peripheral smear shows microcytic, hypochromic red blood cells. Besides the physiologic dilution of pregnancy, what type of anemia is most likely in this patient?
Iron Deficiency Anemia
100
A 25 year-old female presents for a routine gynecological examination. You palpate a 2 cm breast mass in her right breast. Her menstrual period was last week. She has no family history of breast cancer. What is the modality of choice to further evaluate her breast mass?
Ultrasound is the imaging modality of choice given breast tissue density
Mammography should be used after the age of 40
101
A 16 year-old nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temperature of 100.4 degrees F and on examination has a tender, enlarged left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment?
This patient has pelvic inflammatory disease and most likely a tubo-ovarian abscess. It is recommended that the patient be hospitalized and treated with high-dose IV antibiotic therapy. For patients with tubo-ovarian abscesses, surgical drainage is often necessary.
102
What is recommended to reduce the risk for perinatal transmission of HIV in a patient with a viral load of >1000 copies/mL?
Cesarean section performed prior to the onset of labor and rupture of membranes significantly reduces the risk of perinatal HIV transmission. Planned cesarean section delivery at 38 weeks of gestation to prevent perinatal transmission of HIV is recommended in women with a viral load of >1000 copies/mL.
103
On physical examination of a pregnant patient, which can be considered a normal finding?
A Increased second heart sound split with inspiration
B Diastolic murmur
C Facial edema
D Hyperreflexia
Increased second heart sound split with inspiration is common in pregnancy due to the increased blood flow across the aortic and pulmonic valves.
104
Your patient has just delivered her baby vaginally without difficulty. The patient has a laceration of the vaginal mucosa including the perineal body. You repair it without difficulty. On the chart you document this as what type of tear?
A second degree tear involves the underlying subcutaneous tissues, but not the rectal sphincter or rectal mucosa.
105
You are following a patient in labor at term. You evaluate the fetal monitoring tracing and note the presence of variable, repetitive decelerations in the heart rates. The contractions have a sharp deceleration slope. What is the recommended treatment for these decelerations?
Variable decelerations occur from umbilical cord compression and oligohydramnios. They are treated by changing maternal positioning to relieve pressure on the umbilical cord. Additionally, amnioinfusion may be used to relieve umbilical cord compression in cases of oligohydramnios.
106
In what pregnancy complication would beta-hCG levels be lower than expected for estimated gestation?
Ectopic Pregnancy where beta-hCG levels fail to double
107
A 46 year-old woman describes her menstrual periods as regular (occurring every 30 days), prolonged, and with a heavy flow. You document this finding as which of the following?
**Menorrhagia** describes long and heavy flow menstrual flow
108
What are the recommended fetal heart rate monitoring intervals for active labor in an otherwise low-risk delivery?
Monitor fetal heart rate every 30 minutes during the first stage of labor and every 15 minutes in the second stage
109
Fetal head compression causes what type of fetal heart rate tracing abnormality?
Early decelerations
Normal uterine contractions compress the fetal head and cause changes in intracranial pressure. They are considered benign and do not pose a hypoxic risk to the fetus. There is no immediate treatment needed for early decelerations, but patients should continue to be monitored for the development of more concerning decelerations.
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What is the recommended antibiotic regimen in patients with a tubo-ovarian abscess?
Cefoxitin or cefotetan plus doxycycline
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A 25-year-old G2P1 woman presents to the clinic for her first prenatal visit. She is 16 weeks pregnant according to her last menstrual period, and ultrasound examination is consistent with this dating. Vital signs include a BP of 120/80 mm Hg, HR of 80 bpm, RR of 20/min, T of 98.6°F, and SpO2 of 99% on room air. Exam findings include a soft and nontender abdomen with a palpable fundal height between the pubic symphysis and umbilicus. The patient is interested in screening for Down syndrome. What results on quad testing would be the most indicative of Down Syndrome?
↑ hCG and inhibin and ↓ AFP and estriol = Down syndrome
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When elevated, which hormone is responsible for the development of acanthosis nigricans?
Insulin
113
What is the standard dose of calcium supplement in postmenapausal women?
1,200 mg of calcium daily
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