OB/Gyn (40)

Question 1

pain drug of choice in pregnancy

Answer 1

acetaminophen

Question 2

Avoid bismuth salicylate and NSAIDs, aspirin during what semesters?

What category?

Answer 2

all (premature closure of FA)

all are category D

Question 3

Warfarin, isotretinoin, FU, MTX - what pregnancy class

Answer 3

X - absolute CI

Question 4

Tx of her2-neu positive breast cancer

Answer 4

trastuzumab (herceptin)

Question 5

PCOS, hyperandrogenism, ovulatory dysfunction - tx with what SERM that inhibits hypothalamic E receptors, blocking E’s (-) f/b on GnRH pulse generator –> release of FSH and LH from ant pit

Answer 5

clomiphene

Question 6

At 28wks gestation, what should be tested for and administered?

Answer 6

test gestational diabetes

Tdap and prophylactic dose of RhoD IgG if mom is Rh(-)

Question 7

what should all pregnant women receive, in any semester?

Answer 7

inactivated influenza vaccine

***NEVER give active/live, MMR, zoster, varicenna

Question 8

when should GBstrep test be done?

DoC?

Answer 8

36wk

penicillin or cefazolin

Question 9

PCOS increases risk of what cancer

Answer 9

endometrial cancer dt unopposed estrogen

Question 10

Dx and risk factor - new onset abd pain persisting bw contractions, vaginal bleeding, fetal HR changes(decrease)

Answer 10

urterin erupture

hx of cesarean delivery TOLAC - trial of labor after cesarean)

Question 11

what happens to AFP during pregnancy?

Answer 11

rises in fetal plasma until 10-13

rises in maternal

Question 12

Pap smear when used for cervical cancer screening should be performed every __ years in women __-__yo.

Answer 12

Pap smear when used for cervical cancer screening should be performed every THREE years in women 21-65 yo.

Question 13

When can HPV testing be started? And what is the time interval if used with a pap smear?

Answer 13

after age of 30, every 5 years.

Question 14

What is recommended for pregnant patients over 21y during initial OB appointment.

Answer 14

cervical cancer screen with Pap

Question 15

If mom is Rh- and baby Rh+, when should RhoDIgG be given?

Answer 15

28 weeks (lasts for 12 weeks) and then 72hrs postpartum

Question 16

Young F less than 30y w/ painless, well circumscribed, smooth, rubbery, mobile mass usually in UOQ unilaterally.

Answer 16

fibroadenoma

Question 17

Young F with a bilateral breast pain in UOQs starting 1wk prior to menstruation and disappearing after. Dt hormoal factors associated with menstruation.Can have sweling and yellow greenish dischage.

US - thin walled/clusters

Answer 17

fibrocystic disease

Question 18

Unexplained hyperthyroidism in a F, but negative TS Ig and normal radioiodine uptake) with a pelvic mass.

Answer 18

struma ovarii - mature (B9) thyroid follicle teratoma of ovary

Question 19

Define a reactive nonstress test.

Answer 19

Two fetal heart accelerations within 20 minutes with or without fetal movement detecetd by patient.

This is good!

Question 20

what is an acceleration in a NST?

Answer 20

fetal HR inc by at least 15bpm for duration of 15-120 sec.

Question 21

very common cause of 3rd trimester vaginal bleeding (varies in intensity) afteer vaginal intercourse of pelvic exam. No pain or trauma. Mostly when no prenatal care.

Answer 21

placenta previa

Question 22

placenta accreta associated wtih what type of prior delivery

Answer 22

hx of c section

placental villi attach to uterine myometrium no endometrium

Question 23

Evaluate mastitis and breast abscess in lactating women how?

then what?

Answer 23

evaluate the mass with US and use to guide direct needle aspiration for drainage.

Question 24

pelvic itching, pain, dyspareunia with malodorous green/yellow frothy discharge.

Answer 24

trichomonas

Question 25

cottage cheese discharge odorless with KOH, NORMAL vaginal pH. vulvar pruritis

Answer 25

vaginal candidiadis

Question 26

KOH, fishy odor, grey-white vaginal discharge cells covered in bacteria

Answer 26

bacterial vaginosis "clue cells"

Question 27

First two lines of treatment for endometriosis

Answer 27

1. NSAIDs | 2. Combination oral contraceptives

Question 28

When should chlamydia screening begin?

Answer 28

all sexually active women and pregnant women age

Question 29

Bp screening begins?

Answer 29

18 and older

Question 30

Cervical cancer screening

Answer 30

Pap every 3 years 21-65 | Pap+HPV every 5 years 30-65

Question 31

70yo F with nipple inversiona nd discharge that appears white w/ creamy consistency. Blood tinged. Smoking and increased age are risk factors. Ductoscopy = dilated ducts filled iwth secretions and fibrotic debris.

Answer 31

duct ectasia

Question 32

Appropriate weight gain for a normal BMI (18.5-24.9) female during pregnancy

Answer 32

25-35lbs

Question 33

``` #1 DoC for vulvovaginal candidiasis #2 DoC ```

Answer 33

1. topical azole (i.e. clotrimazole) | 2. orgal fluconazole if pt cannot comply

Question 34

DoC for bacterial vaginosis (garderella, ureaplasma, prevotella) and trichomoniasis

Answer 34

po metronidazole

Question 35

ferning = ?

Answer 35

chorioamnionitis

Question 36

pregnant with rise in BP >15/10 from baseline, worsening/new proteinuria, end organ damage. dx and tx

Answer 36

preeclampsia Magnesium sulfate for seizure treatment and prophylaxis to prevent eclampsia.

Question 37

what class of drug increases baseline fetal HR and incidence of fetal tachycardia?

Answer 37

beta-adrenergic agonists (terbutaline, ritodrine, albuterol)

Question 38

tocolysis drugs and function

Answer 38

used to suppress labor - relax sm m beta-adrenergic agonists (terbutaline, ritodrine, albuterol) CCB (nifedipine) NSAIDs (indomethacin) oxytocin antagonists Mg sulfate

Question 39

pt has HTN or preeclampsia. What should be avoided if she gets uterine atony? pt has asthma. What should be avoided if she gets uterine atony?

Answer 39

methylergonovine carboprost

Question 40

A woman has a surgical or surgical abortion. a) more than two weeks followingn surgical evacuation procedure she has persistent vaginal bleeding b) evidence of infection with foul smelling discharge and a boggy tender uterus with cervical dilation

Answer 40

a) retained products of conception | b) septic abortion

Question 41

type of spontaneous abortion with a closed cervical os (products of conception have not been expelled). No fetal HR detected

Answer 41

missed abortion

Question 42

type of spontaneous abortion with vacinal bleeding, pelvic pain, open cervical os with products of conception visible in cervical canal. MC after 12 weeks gestational age

Answer 42

incomplete abortion

Question 43

type of spontaneous abortion with vaginal pink-brown to red bleeding and pelvic pain. beginning of a spontaneous abortion with dilated cervix, open cervical os, products of conception in internal os

Answer 43

inevitable abortion

Question 44

a young female w/ unilateral breast tenderness and purulent nipple discharge. MCC? MC risk factor?

Answer 44

periductal mastitis, smoker.

Question 45

tx periductal masttits

Answer 45

amoxicillin-clavulanate

Question 46

50yo F annual checkup. always choose....

Answer 46

mammogram - the first year of screening

Question 47

Dx: 12wks post partum HTN

Answer 47

chronic HTN

Question 48

acute rise in BP from baselie, new/worsening proteinuria and/or evidence of end organ damage

Answer 48

preeclamspia superimposed on chronic HTN

Question 49

absence of proteinuria if pt is >20wks gestation

Answer 49

gestational HTN

Question 50

>2 BPs>140/90 and 300mg and

Answer 50

mild preeclampsia

Question 51

BP and prteinuria above mild ranges with evidenc of end organ damage

Answer 51

severe eclampsia

Question 52

gran mal seizure or coma on top of preeclampsia

Answer 52

eclampsia

Question 53

date of "confinement" math. naegele's rule

Answer 53

(28 day cycle) = x days = 7 (35 day cycle) = x days = 14 (21 day cycle) = x days = 0 add x-days to first day of LMP + 9mo

Question 54

MCC of genetic abnormality causing pregnancy loss

Answer 54

trisomy 16

Question 55

wait until after this level of b-hCG ("discriminatory zone")

Answer 55

1500

Question 56

hypothyroid pt on levothyroxine. most appropriate management now?

Answer 56

increase levothyroxine (if nt, possible cretinism)

Question 57

Type of abortion used to describe vaginal bleeding w/in first 20wks of gestation w/o evidence of spontaneous abortion. Sx: presents with vaginal bleeding and pelvic pain

Answer 57

threatened abortion

Question 58

white, hairy appearing lesions on lateral tongue. associated with immunocompromised

Answer 58

EBV

Question 59

An infant presents with jaundice w.in first 24 hrs of life (Br>12mg/dL in first 24hrs or 5mg/dL inc in first 24hrs). Next step?

Answer 59

direct coomb's test to chekc for foreign antibodies attached to infant's RBC. often due to ABO and/or Rh incompatibility

Question 60

Infant with: -Elevated direct Br (>20% of total Br level) - do what? -

Answer 60

U/S

Question 61

tx of aphthous ulcers

Answer 61

trimcinolone (CS)

Question 62

MCC of sideroblastic anemia (iron accumulates in mito, causing marrow to roduce the rnged sideroblasts)

Answer 62

excesive alcohol use

Question 63

Threatened abortion v. inevitable abortion

Answer 63

btoh : vagina bleeding, cramping,

Question 64

MCC of elevated AFP during wk16-18 quad screen? MCC of decreaed AFP

Answer 64

1. incorrect gestational dating. 2. multiple gestational 3. open NTD decreased - tri21