OB GYN and peds

Question 1

Breast Cancer

Answer 1

Common malignancy in females, fam hx with BRCA marker
Breast lump, retraction of nipple, edema, axillary node enlargement, sanguinous nipple discharge, tethering of skin
Biopsy, excision, chemo –> Breast specialist

Question 2

Fibroadenoma:

Answer 2

Common benign breast mass
Painless, freely mobile lesion w/o axillary node involvement
Mammography to exclude cancer –> Breast specialist

Question 3

Fibroadenosis/fibrocystic disease of the breast:

Answer 3

Common benign breast condition
Multiple painful lumps in both breasts worse in PMS and disappears after menses
Mammography to exclude cancer –> Breast specialist

Question 4

Inflammatory breast cancer:

Answer 4

Rare + aggressive MC in African American women in 50’s
Warm, red, swelling >1/3 of breast + peau d’orange and nipple retraction
Biopsy confirms diagnosis, refer to breast specialist

Question 5

Mastitis:

Answer 5

Acute inflammation of breast during lactation caused by Staph aureus entering cracked nipples
Hot, painful and swollen breast
M.D. or hospital fr antibiotics

Question 6

Paget’s disease of the nipple:

Answer 6

Uncommon
Eczematous (red oozing, crusting) rash of nipple w/underlying breast cancer
Biopsy confirmatory refer to breast specialist

Question 7

Cryptomenorrhea

Answer 7

Menstruating with no external evidence

Question 8

Metorrhagia

Answer 8

Intermenstrual bleeding

Question 9

Parity vs gravidity

Answer 9

# of times a woman has delivered a child
# of times a woman has been pregnant

Question 10

Pap smear recommendations:

Answer 10

Begin @21, every two years in 30’s if 3 normal pap smears in a row every 3 years, or women with hysterectomies who still have a cervix

Question 11

Asherman’s syndrome:

Answer 11

Caused by rigorous curettage for incomplete abortion in which most of the endometrial tissue has been removed and uterine cavity is replaced by fibrous tissue
Amenorrhea following D&C
Refer to gynecologist –> Dx confirmed by hysterctomy

Question 12

Cystocele:

Answer 12

Herniation of bladder into anterior wall of vagina in older women with numerous children due to stretching of fascia supports of pelvic organs
Presents with feeling of heaviness in vulvar region, stress incontinence and bulge in anterior wall of the vagina
Refer to gynecologist

Question 13

Dysfunctional uterine bleeding:

Answer 13

Irregular bleeding in absence of clinical or ultrasonographic evidence of structural abnormalities, inflammation or pregnancy MC blamed on hormone imbalances in women in 30-40’s
Prolonged bleeding during menstruation with clots
Refer to gynecologist (dx of exclusion) co-manage after

Question 14

Rectocele:

Answer 14

Herniation of rectum into posterior wall of vagina in older woman with numerous children due to stretching of fascial supports of pelvic organs
Feeling of heaviness in vulvar region, urge to defecate and bulge in posterior wall of vagina
Refer to gynecologist

Question 15

Sheehan’s syndrome:

Answer 15

Endocrine condition caused by death of anterior pituitary lobe associated with severe postpartum hemorrhage
Failure to lactate after delivery + amenorrhea, later loss of axillary and pubic hair and fatigue, low prolactin, FSH, LH, TSH confirm
Refer to endocrinologist

Question 16

Turner syndrome:

Answer 16

Absence of one X in makeup of female pt
Short stature, web neck, underdeveloped breasts with widely spaced nipples, infantile genitalia
Gynecologist

Question 17

Bluish discolouration of cervix and vagina

Answer 17

Chadwick’s sign

Question 18

Chloasma

Answer 18

Brownish discolouration over cheeks and nose (mask of pregnancy)

Question 19

Softening of the intravaginal portion of the cervix

Answer 19

Goodell’s sign

Question 20

Softening of region between uterine body and cervix

Answer 20

Hegar’s sign

Question 21

McDonald’s sign

Answer 21

Easy flexibility of the uterus on cervix

Question 22

Enlarged sebaceous glands in the aerola in pregnancy

Answer 22

Montgomery’s tubercles

Question 23

Piscacek’s sign

Answer 23

Softening at the site of implantation

Question 24

EDC

Answer 24

Estimated date of confinement

Question 25

Gestational age is from?

Answer 25

Last menstrual period

Question 26

HELLP synrome

Answer 26

Hemolysis, elevated LFT, low platelets associated w/pre-eclampsia

Question 27

Naegele's rule?

Answer 27

EDC = LMP + 7 days - months + 1 year

Question 28

Clinically important and dangerous infections in pregnancy:

Answer 28

Toxoplasmosis - sporozoan type of protozoa spread by handling infected cat feces Others/HIV Rubella: single stranded enveloped icosahedra Toga RNA virus; droplet infxn CMV - Double stranded DNA herpes type 5 virus; close intimate contact Herpes: double stranded enveloped DNA herpes 2; close intimate contact Syphilis: faintly gram - flexible spirochete; STI

Question 29

Leopold's maneuvers

Answer 29

>20 weeks to establish fundal height (approximate gestation), location of back of fetus and brow, ID presenting part (Pawlick's grip)

Question 30

Abruptio placenta

Answer 30

Premature separation of normally implanted placenta from uterus during late pregnancy; idiopathic Sudden painful vaginal bleeding, ab pain with tender uterus HOSPITAL for transab US

Question 31

Anemia of pregnancy

Answer 31

Cuz hemodilution and iron/folate deficiencies Pale mucous membranes and fatigue CBC confirm co-manage w/obstetrician

Question 32

Antepartum hemorrhage:

Answer 32

Bleeding per vaginum >24th week of gestation Painless (due to placenta previa) or painful (abruptio placenta) Cal 911

Question 33

Herpes Gestiatonis:

Answer 33

Florid infection of vulva/vagina not from Herpes 1/2, maybe autoimmune Itching papules --> vesicles --> bullae in genital area Refer to obstetrician for immunofluorescence exam

Question 34

Hydatidiform mole:

Answer 34

Proliferation of trophoblastic tissue In early pregnancy with larger uterine size vomiting and nausea w/o fetal heart beat and high bHCG levels Refer to obstetrician

Question 35

Placenta Previa:

Answer 35

Implantation of placenta over/near internal os more common if multiple pregnancies or pts with uterine surgery Painless bright red vaginal bleeding, vaginal exam contraindicated Call 911 need US

Question 36

Pre-eclampsia:

Answer 36

HTN >140/90, proteinuria, after 20th week gestation

Question 37

Stages of Labour:

Answer 37

1: Onset of contraction to 10cm dilation of cervix 2: Full dilation to delivery of infant 3: Delivery of infant to delivery of placenta Involution: reduction of size of uterus after expulsion of placenta

Question 38

Cardinal movements during normal labour of a vertex presentation:

Answer 38

Engagement, descent, flexion, internal rotation, extension, external rotation (L occiput ant), expulsion

Question 39

Colostrum is rich in?

Answer 39

IgA

Question 40

Dystocia:

Answer 40

Difficult labour: large fetus, small pelvis, shoulder/brow presentation

Question 41

Lightening:

Answer 41

Fetus drops two weeks before birth into pelvic inlet

Question 42

Placenta accreta:

Answer 42

Placenta invades uterine musculature, doesn't separate at time of birth

Question 43

Who is more likely to have a premature rupture of membranes?

Answer 43

Teens, single women + smokers

Question 44

Lochia:

Answer 44

Discharge of blood, mucus, tissue from uterus after delivery

Question 45

Puerperium:

Answer 45

7 week period after expulsion of fetus and placenta

Question 46

Puerperal sepsis:

Answer 46

Blood borne infection in postpartum period Spread of infection from mastitis, pneumonia, UTI or endometritis Fever, bacteria in blood Hospital for IV antibiotics

Question 47

APGAR score

Answer 47

Appearance, pulse rate (absent, <100, >100), grimace, activity, respiratory effort

Question 48

Rooting reflex? Sucking reflex? Tonic neck reflex?

Answer 48

Stroking corner of mouth causes mouth to open and infant turn to that side Nipple in mouth of newborn stimulates sucking (survival) Head of supine baby rotated ipsilateral arm and leg extend while contralateral arm and leg flex

Question 49

Umbilicus falls off within? | Holds head/closure of posterior fontanelle by?

Answer 49

7-10 days | 3 months

Question 50

Infants smile by? Can hand grip by? Get their first tooth by? Eat their first food by?

Answer 50

8 weeks 4-6 months 6-8 months 6 months

Question 51

Babies can use assisted walking by? Unassisted? First words by? Able to feed by and closure of anterior fontanelle? Use three word sentenced by?

Answer 51

10-14 months, 12-18 months 18 months 3 years

Question 52

Acyanotic heart disease:

Answer 52

VSD, ASD, PDA no cyanosis at birth

Question 53

Cri du chat:

Answer 53

Deletion of short arm of chromosome 4/5 - laryngeal defect, mental retardation, microcephaly

Question 54

Edward syndrome:

Answer 54

Trisomy 18 (triplication), GI and facial and CVS malformations

Question 55

Asperger vs autism

Answer 55

Impaired social skills, rep behaviours, no language problem | Impaired social interactions, communication and behaviour in a child

Question 56

Kwashiokor vs Marasmus vs Pellagra

Answer 56

``` Disease caused by diet deficient in proteins (red hair, swollen ab and legs with dry wrinkled skin and flaky paint dermatitis) Calorie deficiency (loss of subcutaneous tissue, ribs, facial bones prominent loose thin skin) Niacin (B3) deficiency ```

Question 57

Botulism:

Answer 57

Flaccid muscle paralysis from clostridium botulinum (honey) prevents ACH release at NMJ Drooling, dysphagia, constipation Refer to hospital - stool testing

Question 58

Diptheria:

Answer 58

C. Diphtheriae from droplet infection Fever, sore throat with dirty grey pseudomembrane, arrhythimas or diplopia Hospital for throat swab

Question 59

Pertussis:

Answer 59

Bordetella pertussis droplet infection Runny eyes (catarrhal phase) then paroxysms (cough and whoop) and vomiting Refer to pediatrician

Question 60

Wilms' tumor:

Answer 60

MC intra-ab tumor in children - nephroblastoma Large mass in abdomen Pediatric oncologist after biopsy confirms (CT or MRI)