GYN Final Dz Overview

Question 1

Macrosomia?

Answer 1

Baby > 8 lbs and 13 oz or 4500 g.
Mom has hx of DM and macrocosmic baby.
Unchanged/arrest of descent.
C-section indicated.

Question 2

Uterina Atony?

Answer 2

Bleeding and soft boggy uterus.
Given Oxytocin during labor and multiple gestations.
Bimanual uterine massage –> IV Oxytocin –> Methylergonovine.

Question 3

Gestational Trophoblastic Dz/Choriocarcinoma?

Answer 3

Painless bleeding during pregnancy.
Large uterus and elevated hCG.
D+C and hysterectomy while monitoring hCG.

Question 4

Polycystic ovary syndrome (PCOS)?

Answer 4

Androgen excess, anovulation, and small ovarian cysts.
Bleeding b/w periods, irregular, acne, hair growth on body.
DM 2.
Hormonal contraception if still symptomatic Spironolactone.
LH:FSH ratio of 2:1 or greater.

Question 5

Endometriosis?

Answer 5

Pelvic pain, dysmenorrhea, dyspareunia.
Nodularities and CMT.
Laparoscopy.
Oopherectomy, COCs/NSAIDs.

Question 6

US for lump on breast?

Answer 6

< 30 y/o.

Determine if solid or cystic.

Question 7

Fibroids?

Answer 7

Abnormal bleeding, pressure/fullness, dysmenorrhea, urinary frequency, fatigue.
Enlarged mobile irregular contour on biannual palpation.
Lumpy bumpy cobblestone sensation.
Pelvis US.
GnRH agonist- Leuprorelin, COCs, myomectomy.

Question 8

PID/tubo-ovarian abscess?

Answer 8

Acute abdomen w/ high risk sex and fever.
Elevated WBC and negative hCG.
Uterine tenderness (unable to perform speculum exam), CMT or adnexal masses.
FEVER.
Ceftriaxone 250mg IM once and
Doxycycline 100mg PO bid x 14 d.

Question 9

RH- mom and possible Rh + baby?

Answer 9

Hemolytic disease of the newborn.

Question 10

Ovarian Cancer?

Answer 10

“Heartburn”.
Fatigue, bloating, early satiety, constipation, diarrhea, ascites.
Solid irregular fixed lesion in LLQ.
Transvaginal US.
Total abdominal hysterectomy (cervix & uterus) and bilateral salpingo-oophorectomy.

Question 11

Abruptio placentae?

Answer 11

Hx of smoking.
Premature partial or complete separation of the normally implanted placenta.
Painful (severe) cramps/abdominal pain and vaginal bleeding.
Deliver baby.

Question 12

Acute cervicitis caused by Trich?

Answer 12

Purulent, malodorous, thin, greenish-yellow, frothy discharge w/ vaginal irritation and strawberry cervix.
pH > 4.5 and motile trichomonads.
Metronidazole.

Question 13

Bartholin gland cyst?

Answer 13

Located at Introitus.
Painful to sit on.
I&D.

Question 14

Invasive duct carcinoma?

Answer 14

Firm, irregular non tender mass with rock hard consistency.
Redness and dimpling of skin w/ nipple retraction.
Bloody nipple discharge.
Fibroglandular tissue with possible microcalcifications or immobile hypoechoic mass.
Biopsy.

Question 15

Norethindrone?

Answer 15

Progestin. Inhibiting release of luteinizing hormone (LH) secretion from the anterior pituitary.

Question 16

Ectopic pregnancy?

Answer 16

Amenorrhea, adnexal mass, elevated hCG.
Hx of PID.
Cramping abd pain.

Question 17

Pre-eclampsia

Answer 17

Headache, visual disturbances, abdominal pain, vomiting, face swelling.

Question 18

Mastitis?

Answer 18

Breast pain/tenderness w/ malaise and fevers.
Breast Feeding
S. Auerus.
Breast erythema and swelling.

Question 19

Largest risk factor for endometrial cancer?

Answer 19

Estrogen exposure.

Question 20

Umbilical cord prolapse?

Answer 20

Severe variable decelerations or bradycardia occur after membrane rupture.
Low birth weight, malpresentation, long umbilical cord.
Preoperative intrauterine resuscitation.

Question 21

PROM/PPROM?

Answer 21

37 or >: PROM
< 37: PPROM
Check for cervical dilation.
PROM: Admit and start fetal monitoring & await spontaneous labor (90% will go into labor within 24 hours)
Monitor for infection (chorioamnionitis or endometritis).
If labor or infection does not occur prior to 18 hours, induce labor.

PPROM:
Admit and start fetal monitoring.
If 34 weeks or less, give Betamethasone to enhance fetal lung maturity**
Tocolytics can be given to delay delivery up to 48 hours to allow the steroids to work (as long as not already 4 cm or more dilated, no sign of infection and no fetal distress.
Ampicillin & Azithromycin often given to prevent infection
Prompt delivery (Oxytocin) is required with any signs of maternal or fetal infection or distress.

Question 22

What is protective against breast cancer?

Answer 22

Breast feeding.

Question 23

Vaginal bleeding post menopause?

Answer 23

Endometrial biopsy.

Question 24

DM 2 in pregnant female?

Answer 24

Diet, exercise, and insulin therapy if blood glucose remains high despite diet control

Question 25

What statement is true regarding dysfunctional uterine bleeding? 1 It is seen in all age groups equally 2 Dilatation and curettage is the only treatment 3 The condition is most common after 40 years of age 4 The condition is not seen in adolescents 5 It is never associated with ovulatory cycles

Answer 25

3

Question 26

A 28-year-old woman in her 2nd trimester of pregnancy presents with a 3.5 cm painless mass on her left breast. She has no other associated symptoms. She has a positive family history of breast cancer. She is afebrile; pulse is 80/min, and BP is 110/72 mmHg. On examination of the breasts, you notice engorgement and hypertrophy. The mass appears solid on ultrasonography (USG). What is the next step in evaluation of this mass? Answer Choices 1 Magnetic Resonance Imaging (MRI) 2 Percutaneous biopsy under local anesthesia 3 Fine needle aspiration cytology (FNAC) 4 Sentinel lymph node sampling using blue dye 5 Avoid any intervention at this time

Answer 26

2

Question 27

Placenta praevia?

Answer 27

The placenta covers part of the internal cervical os. Painless bleeding. Transabdominal US. Complete blood count, type and hold, administration of IV fluids. C-section.

Question 28

Her Pap smear is reported as "atypical squamous cells of undetermined significance". What is the most appropriate next step in regards to evaluating the patient? ``` 1 Colposcopy 2 Cone biopsy 3 Hysterectomy 4 Loop electrosurgical excision procedure (LEEP) 5 Repeat PAP in one yea ```

Answer 28

1

Question 29

Using Nägele's rule, what is the patient's estimated date of confinement (EDC) if LMP February 23? ``` Answer Choices 1 November 16 2 November 30 3 November 23 4 September 23 5 September 30 ```

Answer 29

2 | LMP-3 months+7 days

Question 30

Post partum endometriosis?

Answer 30

sore breasts from breast-feeding and a sore abdomen. She also admits to an odorous vaginal discharge, but she denies any associated vaginal bleeding. FEVER.

Question 31

Fetal fibronectin Positive Dried secretions on glass slide Ferning present Nitrazine paper Color change of yellow to blue?

Answer 31

Rupture of membranes.

Question 32

what is her greatest risk factor for developing breast cancer? ``` Answer Choices 1 Use of oral contraceptive pills 2 Menarche at 15 years of age 3 Menopause at age 45 years of age 4 Excessive caffeine consumption 5 Nulliparity ```

Answer 32

5

Question 33

Vaginal trichomoniasis has been associated with adverse pregnancy outcomes. What is an example of such an outcome? ``` Answer Choices 1 Hyperemesis gravidarum 2 Premature rupture of membranes 3 Preeclampsia 4 Gestational Diabetes 5 Eclampsia ```

Answer 33

2

Question 34

While performing a Doppler ultrasound on a woman at 30 weeks gestation, you notice that the fetal heart rate is consistently within the range of 130 - 140 beats/minute. What can you conclude about the heart rate of the fetus? ``` Answer Choices 1 Structural heart disease 2 Normal heart rate 3 Asphyxia 4 Bradycardia 5 Tachycardia ```

Answer 34

2 | The fetus has a normal fetal heart rate, as it is within the range of 110 - 160 beats/minute.

Question 35

Bacterial vaginosis?

Answer 35

Thin discharge with the fishy odor on KOH prep, and clue cells on wet prep (amine odor w/ KOH). pH > 4.5. Metronidazole.

Question 36

What do you prescribe if you suspect gonorrhea/chlamydia?

Answer 36

azithromycin 1 g PO, and ceftriaxone 250 mg IM once

Question 37

When the fetal head is engaged?

Answer 37

the widest portion of the fetal head has successfully passed through the pelvic inlet.

Question 38

The physician would like to screen for gestational diabetes and opts to perform a 50-g oral glucose challenge test. Regarding performance and interpretation of this test, what is true? 1 A standard fasting 50-g glucose challenge test with a glucose level of ≥100 mg/dL after 1 hour is abnormal and warrants further testing 2 A standard nonfasting 50-g glucose challenge test with a glucose level of ≥135 mg/dL after 1 hour is abnormal and warrants further testing 3 A standard fasting 50-g glucose challenge test with a glucose level of ≥110 mg/dL after 1 hour is abnormal and warrants further testing 4 A standard nonfasting 50-g glucose challenge test with a glucose level of ≥110 mg/dL after 1 hour is abnormal and warrants further testing 5 A standard fasting 50-g glucose challenge test with a glucose level of ≥95 mg/dL after 1 hour is abnormal and warrants further testing

Answer 38

2