OB/ Gyn

Question 1

define the first stage of labor

Answer 1

effacement and early dilataion for latent/ dilation > 3cm for active

Question 2

define second stage of labor

Answer 2

full dilation ro delivery of the infant

Question 3

define the third stage of labor

Answer 3

delivery of infant to de;ivery of the placenta

Question 4

criteria for preterm laboe

Answer 4

1. 4 contractions / 20 mniutes or 8 contractions in 60 min
2. cervical dilation >1cm
3. effacement >80%

Question 5

Emergency contraception

Answer 5

works up to 120 hours (5 days) post unprotected intercourse

Types: Paraguard IUD; Ella (uiprisbe); Plan B/one step/myway; Yuzpe Regime (using certain OCPs)

Question 6

HPV not associated with malignancy or neoplasia

Answer 6

types 6,11

Question 7

Gardisil HPV prevents which types of HPV

Answer 7

6,11,16,18

Question 8

Gardisil vaccine schedule

Answer 8

initial injection. 2 months and 6 months

Question 9

pelvic floor muscles injured in childbirth that result in uterine prolapse

Answer 9

transverse and uterosacral ligaments

Question 10

treatment for incompentent cervix

Answer 10

Surgery: cerclage. Additionally bed rest, devices and pharm agent may be used

Question 11

Most common cause of spontaneous abortion in the first 12 weeks

Answer 11

chromosomal abnormalities (50%)

Question 12

what is mcroberts maneuver?

Answer 12

For shoulder dystocia/macrosomia:

flex moms thighs / suprapubic pressure / and episiotomy

Question 13

what is the significance of late FHR decelerations

Answer 13

uteroplacental insufficiency
fetal hypoxia
? cord compression that causes above.

Question 14

diagnositc tool for secondary ammenorrhea and eitology of secondary ammenorrhea

Answer 14

TVUS/ABD US

why: endometriosis; adenomyosis; polyps; fibroids; IUD

Question 15

how can you definitively diagnosis endometriosis?

Answer 15

laparaoscopy

Question 16

what is the hallmark of endometrial cancer; risk factors

Answer 16

postmenopausal bleeding (90%)
exogenous unopposed estrogen therapy; >50lb above ideal body weight;

Question 17

primary reason for dysfunctional uterine bleeding?

Answer 17

anovulatory cycles; best initial treatment: OCPs

Question 18

what is the absolute contraindication for OCPS

Answer 18

female >35 yo smoker (increases risk for thromboembolism)

Question 19

further treatment of cervical lesion that is visible?

not visible?

Answer 19

visible lesion: biospy and send

No visible lesion_ colposcopy

Question 20

symptoms associated with cervical CA?
most common age?
describe a cervical lesion that needs biopsy

Answer 20

postcoital bleeding and abnomal uterine bleeding
average age at diagnosis 50yo
immediately biopsy a new exophytic, friable bleeding cervical lesion

Question 21

patient is diagnosed with GTN (gestational trophobastic neoplasm how do you monitor this after D&C?

Answer 21

monitor b-hcg weekly until 3-4 normal values then monthly for 1 year

Question 22

When do you screen for Gestational diabetes?

what are the tests for this?

Answer 22

usual screening is at 24 weeks with a nonfasting 1 hour glucose tolerance test. : administer 50gm glucose and 1 hour later result should be <140mg/dl IF they fail then 3 hour GTT: administer 100gm and fasting<95; 1 hour <180; 2 hour <155 and 3 hour <140

Question 23

first line treatment for gestational daibetes

Answer 23

metformin/ glipzide/ diet modification

Question 24

what is the best method for controling bleeding in DUB with fibroid

Answer 24

Depo Provera 150mcg/q 28 days - decreases bleeding and fibroid size.

Question 25

how long can the DepoProvera injections alter the menstrual cycle and ovulation?

Answer 25

up to 18 months.

Question 26

Describe the symptoms associated with vaginal atrophy

Answer 26

thin, clear, sometimes bloody vag discharge; dyspareunia pH 5-7 decreased vaginal ruggae

Question 27

symptoms of and treatment for lichen sclerosis of the vulva

Answer 27

vulvar pruritis; dyspareunia looks like white patches of the vuvar skin in a figure 8 down to the anus Treatment : Clobetasol topical to area BID for 14 days

Question 28

At what age can you recommend a woman to stop screening for PAP and then mammo ( without risk factors)

Answer 28

minimal age for stopping PAP is 65 - needs to have documented 3 consecutive normal paps MAy stop if hysterectomy snf no history of invasive cervical disease. May elect to stop mammos at 70`

Question 29

how is PCOS diagnosed?

Answer 29

by history: hirsute(90%), moderately overweight with acne, menstrual irregularity(90%) and infertility (75%)

Question 30

Can HIV cross the placenta?

Answer 30

no - it has to be due to contact of fluids - which can occur during delievery. hIV is screened in first trimester labs, and oral treatment initiated if tested positive. If treated 1-8% of maternal/fetal transmission

Question 31

what are the classic symptoms of endometriosis?

Answer 31

``` dysmenorrhea deepthrust dyspareunia infertility abnormal uterine bleeding pelvic pain ```

Question 32

Abruptio placenta

Answer 32

painful uterine bleeding; medical emergency to deliver baby if large abruption;if minor and baby stable and premature, may closely monotor and bed rest may occur after trauma

Question 33

Risks for ectopic pregnancy

Answer 33

history of PID; endometriosis, previous tubal surgery; previous ectopic

Question 34

treatment for ectopic pregnancy

Answer 34

goal: remove ovum if early and small , may try injection of methotrexate to dissolute cells and reduce size; otherwise - surgery

Question 35

causes for Placenta previs

Answer 35

previous c-section/uterine surgery; leiomyoma, endometriosis. Treat with bed rest, diagnosied with US, no digital exams for fear of disrupting the placenta "Painless third trimester bleeding"

Question 36

what hormone is the secretory phase of the menstrual cycle dominated by (days 14-28)?

Answer 36

progesterone

Question 37

is a nulliparous or multiparous woman more likely to develop pre-eclampsia?

Answer 37

nulliparous

Question 38

Purulent cervical discharge should raise your suspicions for what diagnosis?

Answer 38

neisseria gonorrhea

Question 39

how could a girl with Turner's syndrome appear?

Answer 39

Webbed neck, wide shield chest, history of primary ammenorrhea

Question 40

Cervical biopsy comes back with CIN 1 - what is the next step?

Answer 40

repeat pap in 6 months and repete colposcopy in 12 months

Question 41

what is the MOST COMMON CAUSE of secondary ammenorrhea?

Answer 41

pregnancy

Question 42

what 3 labs should be ordered in the work up of secondary ammenorrhea?

Answer 42

b-hcg, TSH, prolactin level

Question 43

define premature birth

Answer 43

delievery before 37 weeks

Question 44

what is metrorrhagia?

Answer 44

bleeding between menstural cycles

Question 45

A single mobile firm, nontender solid breast mass is most liekly?

Answer 45

fibroadenoma

Question 46

What are 3 treatments for uterine prolapse?

Answer 46

pessary, Kegel's maneuvers; surgical repair

Question 47

what is the most common causative organism in mastitis?

Answer 47

Staph aureus

Question 48

Approximately how many weeks pregnant are you when the top of the fundus reaches the pubis symphsis? the umbilicus? the xiphoid?

Answer 48

10-12; 18-20; 37

Question 49

what is the most common cause of post partum hemmorhage?and the others?

Answer 49

uterine atony retained products of conception cervical/vaginal laceraction

Question 50

Define missed abortion

Answer 50

no vaginal bleeding, cervical os is closed; products of conception are still intrauterine.

Question 51

define incomplete abortion

Answer 51

open os, vaginal bleeding and passage of tissue; usually need to treat with D&C

Question 52

define complete abortion

Answer 52

passage of tissue, pain and cramping subsided, cervical os is closed.

Question 53

At what age is primary amenorrhea diagnosied?

Answer 53

Age 14 if no secondary sex characteristics; 16 if some secondary characteristics present.

Question 54

What is the first line treatment of mastitis?

Answer 54

Dicloxacillan Cephalexin / Erythormycin second line | also hot compresses, may continue breast feeding

Question 55

Should a breast feeding mom stop if she deveolps mastitis?

Answer 55

no, not a reason to stop but if abscess develops then she does need to stop.

Question 56

Physical exam finding of retroverted uterus or uterosacral nodularity is consistent with what diagnosis?

Answer 56

Endometriosis

Question 57

when should an amniocentesis be performed? When should chorionic villa sampling be performed? Triple screen?

Answer 57

15-20 weeks 10-13 weeks 15 week AFP/BHCG/estriol

Question 58

list 4 factors for breast cancer

Answer 58

BRCA1 BRCA2 +; un-opposed estrogen; nulliparity; early menarche; late menopause

Question 59

the follicular phase of the menstrual cycle (day 1-13) is dominated by which hormone/

Answer 59

estrogen

Question 60

how much weight should a woman gain during normal pregnancy?

Answer 60

25-35 lbs

Question 61

treatment for Trichomonas vaginalis is ?

Answer 61

2gm MEtronidazole one time dose

Question 62

what 2 medications are commonly used to treat hypertension in pregnancy?

Answer 62

labetolol and methydopa

Question 63

what is the classic triad of pregnancy?

Answer 63

HTN, edema and proteinuria

Question 64

Why is ovarian cancer so hard to diagnose?

Answer 64

Symptoms are vague and there are no good markers available. however unexplained GI symptoms, nausea. vomiting, pelvic pain and adnexal mass are worrisome

Question 65

What 2 important side effects should patients be counseled prior to prescribing metronidazole?

Answer 65

Avoid alcohol(Disulfram reaction) and avoid sun exposure.

Question 66

Define inevitable abortion

Answer 66

Vaginal bleeding, cramping, open cervix and products of conception are still present.

Question 67

How is the first day of the menstrual cycle defined?

Answer 67

the first day of bleeding

Question 68

What is the karyotype for Turner's syndrome?

Answer 68

45, X they are missing one sex chromosome

Question 69

What culture medium do you need to grow out Neisseria Gonorrhea?

Answer 69

Thayer Martin

Question 70

Which four HPV viruses are linked to cervical cancer?

Answer 70

16, 18, 31,and 33

Question 71

What is the age recommendation for HPV vaccination?

Answer 71

9 - 26 yo

Question 72

List risk factors for Ovarian Cancer

Answer 72

BRCA1, family history, nulliparity, late menopause, late menopause, Caucasian, Asian

Question 73

What characteristic subjective complaint will help to differentiate PID from ectopic pregnancy, appendicitis, ovarian torsion and ovarian cyst?

Answer 73

PID has bilateral pelvic pain, the others are usually unilateral.

Question 74

A patient with primary amenorrhea and low FSH should make you think of what diagnosis?

Answer 74

Hypothalmic pituitary insufficiency

Question 75

define abortion

Answer 75

delievery of uterine products of conception prior to 20 weeks

Question 76

is mastitis unilateral or bilateral ?

Answer 76

Unilateral and in only one quadrant

Question 77

what is full term gestation?

Answer 77

37-42 weeks

Question 78

when does the quickening occur?

Answer 78

Nulliparous - 18-20 weeks | Multiparous - 14-16 weeks

Question 79

List 3 risk factors for placentall abruption

Answer 79

PROM, HTN, smoking, cocaine use, AMA

Question 80

what is the treatment for ovarian cancer?

Answer 80

TAH-BSO, chemo and radiation

Question 81

what is the name given to the bluish tint to the cervix in early pregnancy?

Answer 81

Chadwick's sign

Question 82

A patient has a higher than expected BHCG level and is measuring fundal height more than expected. on Ultrasound there is a snowstorm appearance in the uterus. What do you suspect?

Answer 82

Hydatidiform mole

Question 83

What medication may be used to control bleeding in uterine atony post delievery

Answer 83

Oxytocin (pitocin)

Question 84

why is folic acid given as a prenatal vitamin?

Answer 84

to prevent neural tube defects.

Question 85

what is the most common endometrial cancer?

Answer 85

75% are adenocarcinomas

Question 86

A patient has Strawberry cervix with copious yellow/green discharge on examination - what does she have??

Answer 86

Trichomonas vaginitis

Question 87

What organism is present in soft cheese and deli meats that pregnant women are warned to avoid in pregnancy?

Answer 87

Listeria monocytogenes. can cause menigitis

Question 88

The baby was delivered several minute ago. Suddenly there is an increase in blood flow from the vagina and the cord noticable lengthens. what is the most likely cause of these signs?

Answer 88

Placental separation

Question 89

What is the most type common type of ovarian cyst?

Answer 89

Functional cyst no treatment is needed.

Question 90

Is FSH high or low in Turners syndrome?

Answer 90

High - there are no ovaries to respond to the FSH - so there is no negative feed back.

Question 91

what is the cause of septic arthritis is sexually active young adults?

Answer 91

Neisseria gonorrhea

Question 92

How many days after conception is a serum bHCG positive?

Answer 92

8 days

Question 93

If PAP smear come back with anything other than negative or ASCUS what is your next step?

Answer 93

Colposcopy and biopsy

Question 94

What medication is used to increase surfactant levels and help with fetus lung maturity in preterm labor?

Answer 94

Betamethasone

Question 95

Name 2 tocolytic agents

Answer 95

MAgnesium sulfate and calcium channel blockers

Question 96

A woman presents to the ER concerned that she is in preterm labor. What is your first treatment even prior to getting any imaging or lab results?

Answer 96

Give IV fluids - she is likely dehydrated

Question 97

Name 3 ways to check for ruptured membranes

Answer 97

Pooling in the vagina Ferning on a slide Nitrazine test testing the pH visulize leakage from the cervix with a sterile speculum.

Question 98

What is the normal range for fetal heart rate?

Answer 98

120-160

Question 99

What is menorrhagia?

Answer 99

heavy prolonged menstrual flow

Question 100

What RH combination for mom and dad can cause the mom to create antibodies against the baby's red blood cells

Answer 100

RH negative mom and Rh positive dad.

Question 101

When do you give Rhogam to mom?

Answer 101

28 weeks

Question 102

What are the risks for mom and baby in Gestational Diabetes?

Answer 102

Preeclampsia, macrosomia causing traumatic birth, slowing fetal lung development

Question 103

What medications are used to treat postpartum metritis?

Answer 103

Clindamycin and gentamycin together

Question 104

What is the most common infection following a C-section?

Answer 104

Metritis

Question 105

where is the most common site for ectopic pregnancy?

Answer 105

within a fallopian tube

Question 106

in a normal early pregnancy , serial bHCG should double over what time?

Answer 106

every 48-72 hours

Question 107

what is procidentia?

Answer 107

uterine prolapse that extends beyond the introitus

Question 108

What is the common term for Stein-Levinthal syndrome?

Answer 108

polycystic ovary syndrome.

Question 109

What is Neigels rule in calcuating a pregnacy EDC?

Answer 109

First day of the last menstrual period +7 days - 3 months

Question 110

What are the 5 components of the biophysical profile?

Answer 110

non-stress test fetal breathing, 2 body movements, fetal muscle tone and amniotic fluid index

Question 111

what is a reassuring fetal non-stress test

Answer 111

a positive (reactive) stress test is 2 fetal heart rate accelarations in 20 minutes