OB/GYN: Case Files Flashcards
1
Q
Diagnose and treat: A 39 year-old woman wets her underpants two to three times each day. She feels as though she needs to void, but cannot make it to the restroom in time.
A
Urge incontinence, best treated with anticholinergic medications (I.E. Oxybutynin)
Caused by an overactive detrusor muscle
1
Q
Surgery is indicated in a prepubertal patient with an ovarian mass greater than what size?
A
2 cm
1
Q
What factors increase the risk of preterm premature rupture of membranes (PPROM)?
A
- Lower socioeconomic status
- Sexually transmitted diseases
- Cigarette smoking
- Cervical conization
- Emergency cerclage
- Multiple gestations
- Hydramnios
- Placental abruption
2
Q
What is the treatment for Chlamydia trachomatis infection?
A
Doxycycline or azithromycin
2
Q
What is the most common cause of posmenopausal bleeding?
A
Atrophic endometrium
Friable tissue of the endometrium or vagina due to low estrogen levels
2
Q
What percent of all cases of female infertility is due to ovulatory disorders?
A
30-40%
2
Q
An elevated A2 hemoglobin is suggestive of what?
A
Beta-thalassemia disorder
2
Q
What is the treatment for superficial wound separation?
A
Opening the wound and using wet-to-dry dressing changes
3
Q
At what age is a mammogram indicated in women?
A
>50
Some experts recommend starting at age 40
3
Q
What causes variable decelerations?
A
Cord compression
3
Q
How is the diagnosis of acute salpingitis made?
A
Its a clinical diagnosis based on abdominal tenderness, cervical motion tenderness, and adnexal tenderness
3
Q
What breast condition is characterized by multiple, irregular, “lumpiness of the breast”?
A
Fibrocystic change
3
Q
What is the first sign of hypovolemia?
A
Oliguria (decreased urine output)
3
Q
What is the best treatment of cracked nipples?
A
Air-drying and the avoidance of harsh soaps
4
Q
What is the treatment for Neisseria Gonorrhoea infection?
A
IM Ceftriaxone
Concurrent treatment for Chlamydia infection (Doxycycline or Azithromycin) is usually administered
5
Q
What kind of twin pregnancy would result from division 8 days after fertilization?
A
monochorionic/monoamniotic
6
Q
Which two strains of HPV are most commonly responsible for cervical dysplasia and cancer?
A
HPV 16 and 18
7
Q
What is the most common cause of cystitis in a woman?
A
E. coli
8
Q
What are generally the first two methods used to relieve shoulder distocia during labor?
A
- McRoberts maneuver
- Suprapubic pressure
Other maneuvers that can be used:
- Wood’s Corkscrew maneuver
- Delivery of the posterior arm
- Zavanelli maneuver
8
Q
Asymptomatic bacteriuria leads to acute infection in up to what percent of untreated pregnant women?
A
25%
Asymptomatic bacteriuria occurs when the urine culture grows >100,000CFU per ml of a single organism in an asymptomatic patient. Pregnant women should always be treated to prevent progression to pyelonephritis in the pregnant patient.
8
Q
What is the best treatment for syphilis in pregnancy?
A
Penicillin
Pregnant women with syphilis and an allergy to penicillin should undergo penicillin desensitization and then receive penicillin
8
Q
Precocious puberty with an adnexal mass but without virilization is usually due to what?
A
Granulosa cell tumor
8
Q
Targeted sonography can detect what percent of neural tube defects?
A
95%
9
Q
What is the normal range for fetal heart rate baseline?
A
110-160 bpm
9
An elevated F hemoglobin is suggestive of what?
Alpha-thalassemia
10
What is the best treatment for postpartum mastitis?
An oral antistaphylococcal antibiotic, such as dicloxacillin, and continued breast-feeding/pumping
11
The most common location of an osteoporosis-related fracture is?
A compression fracture of the thoracic spine
11
Define arrest of active phase
No progress in the active phase of labor for 2 hours
11
What is the primary treatment for polycystic ovarian syndrome?
Combined oral contraceptives
13
What is the mostly likely cause of a hCG level that is above threshold but no intrauterine pregnancy is seen on transvaginal ultrasound?
Ectopic pregnancy
14
What is the classical triad of pelvic inflammatory disease?
1. Lower abdominal tenderness
2. Cervical motion tenderness
3. Adnexal tenderness
15
What is the normal length of the second stage of labor for a multiparous woman?
_\<_1 hours
*_\<_2 hours if epidural given*
16
What are the risk factors for ectopic pregnancy?
1. Salpingitis (particularly with Chlamydia trachomatis)
2. Tubal adhesive disease
3. Infertility
4. Progesterone-secreting IUD
5. Tubal surgery
6. Prior ectopic pregnancy
7. Ovulation induction
8. Congenital abnormalities of the tube
17
At what age is cholesterol screening indicated in women?
\>45
*Every 5 years*
17
What is the most common cause of maternal mortality?
Embolism (thrombotic or amniotic fluid)
17
What is the most common cause of fever after cesarean delivery?
Endomyometritis
18
How long after the LH surge does ovulation typically occur?
36 hours
18
What should be suspected in a patient with symptoms of UTI but a negative urine culture?
Urethritis
*Commonly caused by Chlamydia or N. gonorrhea*
18
What pathology may be seen in a neonate or child of a mother with hypothyroidism during pregnancy?
Neurodevelopmental delays
19
What are the common tocolytic agents?
1. Terbutaline/Ritodrine: Beta-agonists
2. Nifedipine: Calcium channel blocker
3. Indomethacin: NSAID
4. 17-alpha-hydroxyprogesterone caproate: Synthetic progesterone
5. Magnesium sulfate: Mineral
19
What are the most common locations for DVT after gynecologic surgery?
The lower extremities and the pelvic veins
19
What kind of twin pregnancy would result from division more than 8 days after fertilization?
Conjoined twins
20
By the time hypotension at rest is noted in a young, healthy patient, what percentage of the patient's blood volume is lost?
30-40%
21
Dyspnea occurring in a woman with preterm labor and tocolysis is usually due to what?
Pulmonary edema
21
Delayed puberty is defined as no development of secondary sexual characteristics by what age?
14 years old
22
Early in the course of a normal intrauterine pregnancy , the beta-hCG should rise by at least how much in a 48 hour period?
_\>_66%
22
What should be the first thing one evaluates in a woman with oligomenorrhea and galactorrhea?
Pregnancy test
23
What is the most common cause of secondary amenorrhea after uterine curettage?
Intrauterine adhesions
24
What is the most common cause of conjunctivitis in the first month of life?
Chlamydial conjunctivitis
25
What is the definition of postpartum hemorrhage?
Bleeding \>500mL for a vaginal delivery
or
Bleeding \>1000 mL for a c-section delivery
25
the contraceptive patch is associated with an increased risk of what serious side effect?
DVT
25
What should be considered as the cause of dyspnea in a patient being treated for pyelonephritis?
Acute respiratory distress syndrome (ARDS)
Endotoxin release from gram-negative bacteria is the cause of ARDS
25
What is one of the earliest manifestations of fetal hydrops?
Hydramnios
26
Diagnose and treat: A 35 year old woman has undergone four vaginal deliveries. She notes urinary loss six to seven times a day concurrently with coughing or sneezing. She denies dysuria or an urge to void. Her urine culture is negative.
Genuine stress urinary incontinence, best treated with urethroplexy (Burch procedure) or urethral sling.
## Footnote
*Cytometric or urodynamic evaluation helps differentiate between urge and genuine stress incontinence.*
27
Hyperandrogenism in the presence of an adnexal mass usually indicates what?
Sertoli-Leydig cell tumor of the ovary
*This is usually treated surgically*
29
What is the most common cause of septic shock in pregnancy?
Pyelonephritis
30
What are the risk factors for uterine atony?
1. Magnesium sulfate
2. Oxytocin use during labor
3. Rapid labor and/or delivery
4. Overdistension of the uterus (macrosomia, multifetal pregnancy, hydraminos)
5. Intra-amniotic infection (Chorioamnionitis)
6. Prolonged labor
7. High parity
30
What is the most common cause of late postpartum hemorrhage (after the first 24 hours)
Subinvolution of the uterus
30
What is the most common cause of sexually infantile primary amenorrhea?
Gonadal dysgenesis
31
What is considered an adequate uterine contraction during labor?
200 montevideo units measured with an internal uterine pressure catheter
or
Contractions every 2-3 minutes, firm on palpation, and lasting at least 40-60 seconds
31
Oral contraceptives reduce the risk of which cancers?
Ovarian and endometrial cancers
32
What is a contraindication for prostaglandin F2-alpha given to treat postpartum hemorrhage?
Asthma
33
What is the treatment for Sheehan syndrome?
Replacement of anterior pituitary hormones
35
What is the most common reason for hysterectomy?
Symptomatic uterine fibroids
*The most common symptom of uterine fibroids is menorrhagia*
36
What is the diagnostic test of choice in assessing placenta previa?
Ultrasound
*Should be performed before digital or speculum examination*
36
Pelvic inflammatory disease (PID) is a clinical diagnosis but what is the gold standard method of confirming the clinical diagnosis?
Laparoscopy
*It visualizes purulent drainage from the fallopian tubes*
37
What is a concern when copious amounts of sero-sanguinous fluid are draining from an abdominal incision?
Fascial disruption
*A surgical site incision with fascial disruption or evisceration should be immediately repaired*
37
Elevated maternal serum alpha-fetoprotein (MSaFP) is most commonly indicative of what?
Neural tube defect
38
What should **not** be used once shoulder dystocia is encountered during labor?
Fundal pressure
38
What is the most common cause of ambiguous genitalia in the newborn?
Congenital adrenal hyperplasia
*This is usually due to 21-hydroxylase enzyme deficiency*
40
What is the imaging test of choice to assess a postoperative patient with a suspected ureteral injury?
Intravenous pyelogram (IVP)
40
What are the treatments for thyroid storm during pregnancy?
1. PTU
2. Steroids
3. Beta-blockers
41
What does thyroid releasing hormone (TRH) stimulate other than TSH?
Prolactin
Primary hypothyroidism can cause hyperprolactinemia and galactorrhea
42
Surgery is indicated in a postmenopausal patient with an ovarian mass greater than what size?
4-5 cm
43
What is the most common cause of neonatal morbiditiy in a preterm infant?
Respiratory distress syndrome
44
What should be suspected in a patient with dyspnea, a clear chest radiograph, and hypoxemia?
Pulmonary embolism
44
What is the next step in analyzing a palpable dominant breast mass in the setting of a negative mammogram?
Histologic diagnosis (biopsy)
*All palpable dominant breast masses must be analyzed regardless of mammographic findings*
45
What is the most common cause of amenorrhea in the reproductive years?
Pregnancy
46
What is a contraindication for ergot alkaloids given to treat postpartum hemorrhage?
Hypertension
47
What is the percent chance that a normal couple will achieve pregnancy in one menstrual cycle?
20-25%
*This probability is the definition of _fecundability_*
48
Postpartum thyroiditis can lead to what?
Hypothyroidism
49
During pregnancy, progesterone is largely produced by the corpus luteum until when?
10 weeks gestation
*When a corpus luteum is excised in a pregnancy of less than 10-12 weeks gestation, progesterone should be supplemented*
50
What is the next step if the triple screen is abnormal?
Basic ultrasound
52
What is the most common cause of anemia in pregnancy?
Iron deficiency
*The two most common causes of microcytic anemia are iron deficiency and thalassemia*
53
What are the 3 priorities of treating preterm labor?
1. Identify cause
2. Give steroids (if gestation is between 24 and 34 weeks)
3. Tocolysis
54
How is endometrial cancer staged?
Surgically
55
What is the most sensitive imaging test to assess pituitary adenomas?
MRI
56
Placenta previa in the face of prior c-section deliveries increases the risk of what?
Placenta accreta
56
What form of contraception can improve bleeding profiles in patients with dysfunctional uterine bleeding and menorrhagia?
Levonorgestrel-releasing IUD (Mirena)
57
By what amount does the body temperature increase after ovulation?
0.5 degrees fahrenheit
59
What is the etiology of Sheehan syndrome?
Anterior pituitary hemorrhagic necrosis caused by hypertrophy of the prolactin-secreting cells in conjunction with a hypotensive episode, usually in the setting of postpartum hemorrhage
61
What should be in the initial evaluation of secondary amenorrhea?
1. Pregnancy test
2. Prolactin levels
3. TSH levels
4. Gonadotropin levels
62
Where do the majority of cervical dysplasias and cancers arise?
Near the squamocolumnar junction of the cervix
62
What is a common sign of ovarian malignancy?
Ascites
64
What is the most common cause of megaloblastic anemia in pregnancy?
Folate deficiency
65
Preterm premature rupture of membranes (PPROM) is usually managed expectantly until what gestational age?
32 weeks
*At 34-35 weeks gestation, induction of labor is the usual management.. Clinical infection is a contraindication to corticosteroid use*
67
In Erb Duchenne palsy, the which muslces are weakened?
1. Deltoid
2. Infraspinatus
3. Flexor muscles of the forearm
*Brachial plexus injury involving C5 and C6*
69
What is the most common cause of postpartum hemorrhage?
Uterine atony
70
What are the risk factors for cervical cancer?
1. Early age of coitus
2. Sexually transmitted diseases
3. Early childbearing
4. Low socioeconomic status
5. Human papillomavirus
6. HIV infection
7. Cigarette smoking
8. Multiple sexual partners
71
A superficial wound separation usually occurs due to what?
Infection or hematoma
72
What is the normal length of the second stage of labor for a nulliparous woman?
_\<_2 hours
*_\<_3 hours if epidural given*
74
What chromosome is the BRCA1 gene located on?
Chromosome 17
76
What is the underlying pathophysiology of preeclampsia?
Vasospasm and leaky vessels
77
Surgery is indicated in a reproductive age patient with an ovarian mass greater than what size?
8 cm
* Size between 5 and 8 cm require a sonogram to look for septations, solid components/excrescences. Operate if present.*
* Size \< 5 cm can be observed*
79
Define latent phase of labor
The initial part of labor during which the cervix mainly effaces (thins) rather than dilates.
*Usually*
81
What is the most common subtype of epithelial ovarian tumor?
Serous subtype
*More often bilateral*
82
What should be the first test for any patient with primary or secondary amenorrhea?
Pregnancy test
84
What is Asherman Syndrome?
Scar tissue that forms in the endometrium, leading to amenorrhea caused by unresponsiveness of the endometrial tissue
84
What subtype of epithelial ovarian tumor is large in size?
Mucinous subtype
*May lead to pseudomyxoma peritonei if ruptured, which leads to repeated bouts of bowel obstruction*
85
What breast mass is characterized as firm, rubbery, mobile, and solid in consistency?
Fibroadenoma
## Footnote
*Typically do not respond to ovarian hormones and do not vary during the menstrual cycle*
86
What increases the risk for placenta accreta?
1. Prior uterine incision (C-section)
2. Placenta previa
87
What is the best treatment for suspected uterine rupture?
Immediate cesarean delivery
89
What is the most common presenting symptom of pulmonary embolism?
Dyspnea
90
What is the most likely diagnosis for an adolescent female with an asymptomatic, 1-cm, nontender, mobile breast mass?
Fibroadenoma
90
Gross hematuria should raise suspicion for what?
Nephrolithiasis
91
How many first-degree family members with breast cancer does it take to suggest a familial syndrome?
Two first-degree relatives
91
The presence of fluctuance in a red, tender, indurated breast suggests what?
Abscess
*This requires surgical drainage*
92
What is the most common cause of hemoperitoneum in early pregnancy?
Ectopic pregnancy
94
What is the most common time period in which fascial disruption or evisceration occurs postoperatively?
5-14 days post-op
96
The lesions of Pruritic urticarial papules and plaques of pregnancy (PUPPP) usually begin where and spread to where?
They begin on the abdomen and spread to the thighs and sometimes the buttocks and arms
96
Emergency contraception is most effective within what window of time?
72 hours from intercourse
97
Which two strains of HPV are most commonly responsible for condylomata acuminata (venereal warts)?
HPV 6 and 11
98
What antibodies are associated with postpartum thyroiditis?
Antimicrosomal antibodies
99
What kind of twin pregnancy would result from division between 4 and 8 days after fertilization?
Monochorionic/diamniotic
101
What are the diagnostic criteria for mild and severe preeclampsia?
_Mild_: Two BP measurements _\>_140 systolic or _\>_90 diastolic at 6 hr intervals and proteinuria _\>_300mg in a 24hr period (1+ or 2+ on urine dipstick is consistent with the mild disease)
_Severe_: Two BP measurements _\>_160 systolic or _\>_110 diastolic at 6 hr intervals and proteinuria _\>_5g in a 24hr period (3+ or 4+ on urine dipstick is consistent with the severe disease)
101
What is the most common ovarian tumor in a woman younger than 30 years old
Benign cystic teratoma (dermoid cyst)
102
What kind of twin pregnancy would result from division within the first 72 hours of fertilization?
Dichorionic/diamniotic
103
What is the best treatment for advanced cervical cancer?
Radiotherapy with a chemotherapeutic radiosensitizer
103
An intrauterine gestational sac is usually seen on transvaginal ultrasound when the hCG level equals or exceeds what level?
1500-2000 mIU/mL
*If hCG level is this high but no gestational sac is seen, the patient has a high likelihood of having an ectopic pregnancy*
105
What are the causes of low maternal serum alpha-fetoprotein (MSaFP)?
1. Overestimation of gestational age
2. Chromosomal trisomies
3. Molar pregnancy
4. Fetal death
5. Increased maternal weight
106
What are the risk factors for preterm labor?
1. Preterm premature rupture of membranes
2. Multiple gestations
3. Previous preterm labor or birth
4. Hydramnios
5. Uterine anomaly
6. History of cervical cone biopsy
7. Cocaine abuse
8. African American race
9. Abdominal trauma
10. Pyelonephritis
11. Abdominal surgery in pregnancy
108
What is the accepted treatment for septic pelvic thrombophlebitis?
Antibiotic therapy and heparin
109
The rapid onset of hirsutism or virilization usually indicates the presence of what?
An androgen-secreting tumor
110
What is the most common cause of unilateral serosanguineous nipple discharge from a single duct?
Intraductal papilloma
111
Meticulous ureteral dissection can cause what?
Devascularization injury to the ureter
## Footnote
*The vascular channels run along the adventitia of the ureter*
113
At what age is colon cancer screening indicated in women?
\>50
* Colonoscopy q10yrs*
* or*
* Barium enema with flexible sigmoidoscopy q5yrs*
114
What medications may trigger anemia in a patient with G-6-P dehydrogenase deficiency?
1. Sulfonamides
2. Nitrofurantoin
3. Antimalarial agents
116
What chromosome is the BRCA2 gene located on?
Chromosome 13
118
What is the most common cause of mucopurulent cervical discharge?
Chlamydial infection
*Gonorrheal infection is the second most common cause of mucopurulent cervical discharge*
119
Painless anterpartum vaginal bleeding suggests the diagnosis of what?
Placenta previa
120
What is the most common cause of postpartum hemorrhage with a firm well-contracted uterus?
Genital tract laceration
122
What is the most common benign breast mass in the premenopausal woman?
Fibrocystic change of the breast
*It is caused by an exaggerated response to ovarian hormones*
124
What is the most common cause of a dominant breast mass in woman in her teens or 20s?
Fibroadenoma
125
What are the normal arterial blood gas values in a _pregnant_ woman (pH, PO2, PCO2,HCO3)?
1. pH: 7.45 (Non pregnant: 7.40)
2. PO2: 95-105 (Non pregnant: 90-100)
3. PCO2: 28 (Non pregnant: 40)
4. HCO3: 19 (Non pregnant: 24)
126
At what age is the varicella zoster vaccine indicated in women?
Age 60
127
What causes late decelerations?
Uteroplacental insufficiency (hypoxia)
129
At what age is a fasting blood sugar level indicated in women?
\>45
*Every 3 years*
130
What is the difference in hormone levels between Sheehan and Asherman syndromes?
Sheehan syndrome has low levels of T4, TSH, FSH, Estradiol, Cortisol, Prolactin, and has no LH surge
vs
Asherman syndrome is characteristic of amenorrhea in the setting of normal hormone levels
132
What are the risk factors for placental abruption?
1. _Hypertension (Chronic HTN and preeclampsia)_
2. _Cocaine use_
3. Short umbilical cord
4. _Trauma_
5. Uteroplacental insufficiency
6. Submucosal fibroid
7. Sudden uterine decompression (too much amniotic fluid)
8. Cigarette smoking
9. Preterm premature rupture of membranes
*\*_Major risk factors_*
133
Bacterial vaginosis is associated with what complications of pregnancy?
1. Preterm delivery
2. Postpartum endometritis
3. Pelvic inflammatory disease
134
What is the most common cause of postpartum hemorrhage?
Uterine atony
135
What is the most common cause of ovulatory dysfunction in a reproductive-aged woman?
Polycystic ovarian syndrome (PCOS)
136
At what age is a bone mineral density study indicated in women?
\>65
138
What is usually the best therapy for a patient with an early pregnancy who is hypotensive or has severe adnexal pain?
Surgery
*These signs/symptoms are suggestive of a ruptured ectopic pregnancy*
139
What are the causes of hydramnios?
1. Fetal central nervous system anomalies
2. Fetal gastrointestinal tract malformations
3. Fetal chromosomal abnormalities
4. Fetal nonimmune hydrops
5. Maternal diabetes
6. Isoimmunization
7. Multiple gestations
8. Syphilis
141
At what age is the annual influenza vaccine most important in women?
\>50
142
Patients with polycystic ovarian syndrome whould be screened for what?
Glucose intolerance and lipid abnormalities
143
How is the diagnosis of molar pregnancy made?
Sonography
144
What is the most likely diagnosis for a patient that presents with cyclic, painful, engorged breasts, more pronounced just before menstruation, and occaisionally associated with serous or green breast discharge?
Fibrocystic change
145
What should be suspected if clinical improvement for pyelonephritis has not occurred after 48-72 hours of appropriate antibiotic therapy?
Urinary tract obstruction or a perinephric abscess
146
Where are testosterone and DHEAS secreted in women?
1. Testosterone: Ovary
2. DHEAS: Adrenal gland
148
What is it called when a pregnancy is less than 20 weeks gestation and associated with cramping, bleeding, and cervical dilation, but no passage of tissue?
Inevitable abortion
149
What is the best treatment of a dermoid cyst in a young woman?
Ovarian cystectomy
150
What is the most common cause of a first-trimester miscarriage?
Fetal karyotypic abnormality
151
What color fluid on aspiration of a breast cyst is considered benign and can be observed?
Straw-colored fluid in a mass that disappears after aspiration
152
What is the most frequent and serious complication of a benign ovarian cyst?
Ovarian torsion
153
What are the best treatments for chlamydial cervicitis in pregnancy?
1. Erythromycin
2. Azithromycin
3. Amoxicillin
155
When does postpartum thyroiditis usually occur?
1-4 months postpartum
156
Define active phase of labor
The portion of labor where dilation occurs more rapidly
*Usually when the cervix is \>4cm dilated*
158
What is the most likely diagnosis in a woman in her 20s who complains of breast pain, which increases with menses, and who has a lumpy-bumpy consistency to her breast?
Fibrocystic change
159
A sinusoidal fetal heart-rate pattern is associated with what?
Severe fetal anemia or asphyxia
160
What are the risk factors for placenta previa?
1. Grand multiparity (_\>_5 pregnancies)
2. Prior C-section
3. Prior uterine curettage
4. Previous placenta previa
5. Multiple gestation
161
Amenorrhea, vaginal spotting and abdominal pain make up the classic triad of what?
Ectopic pregnancy
162
What is the best route of delivery for placenta previa?
C-section
163
What pathogen is "strawberry cervix" associated with?
Trichomonas
165
What is it called when a pregnancy is less than 20 weeks and associated with vaginal bleeding, generally without cervical dilation?
Threatened abortion
166
What causes early decelerations?
Fetal head compression
167
What would be suspected in a pregnancy characterized by vaginal spotting, absence of fetal heart tones, and a size greater than dates?
Molar pregnancy
168
What is the initial test for intrauterine shape and tubal patency?
Hysterosalpingogram
It should be performed between days 6 and 10 of the cycle
169
What is the gold standard in diagnosing endometriosis?
Laparoscopy
171
What can mimic an ectopic pregnancy?
Ruptured corpus luteum
172
Parvovirus infection in pregnancy can cause fetal anemia leading to what?
Hydrops fetalis
173
What percent of neonatal herpes infections occur in utero?
5-10%
174
Nulliparity and IUD use are risk factors for what?
Pelvic inflammatory disease (PID)
*OCP is protective against PID by virtue of the progestin thickening the cervical mucus and thinning the endometrium.*
175
What characteristics are shared by bacterial vaginosis and trichomoniasis but not candidal vaginitis?
1. Alkaline pH
2. Positive whiff test
176
What signs/symptoms suggest advanced cervical cancer?
Flank tenderness or leg swelling
177
What is the most common cause of generalized pruritus in pregnancy in the absence of skin lesions?
Cholestasis of pregnancy
178
What is the most common bacterial etiology of septic abortion?
Polymicrobial with normal flora from the vaginal tract
179
What is a common skin condition of unknown etiology unique to pregnancy characterized by intense pruritus and erythematous papules on the abdomen and extremities?
Pruritic urticarial papules and plaques of pregnancy (PUPPP)
180
Painful anterpartum bleeding should make one suspicious of what?
Placental abruption
181
Transvaginal ultrasound indicating a shortened cervix especially with funneling and/or breaking is suggestive of what?
Preterm delivery
182
What is the name for a preinvasive lesion of the cervix with abnormal cellular maturation, nuclear enlargement, and atypia?
Cervical intraepithelial neoplasia (CIN)
* CIN 1: Mild dysplasia, or abnormal cell growth. It is confined to the basal 1/3 of the epithelium. Corresponding cytology: Low grade squamous intraepithelial lesion (LSIL)*
* CIN 2: Moderate dysplasia confined to the basal 2/3 of the epithelium. Corresponding cytology: High grade squamous intraepithelial lesion (HSIL)*
* CIN 3: Severe dysplasia that spans more than 2/3 of the epithelium, and may involve the full thickness. This lesion may sometimes also be referred to as cervical carcinoma in situ. Corresponding cytology: High grade squamous intraepithelial lesion (HSIL)*
183
What are the normal arterial blood gas values in a **_non_**pregnant woman (pH, PO2, PCO2,HCO3)?
1. pH: 7.4
2. PO2: 90-100
3. PCO2: 40
4. HCO3: 24
*A pulse oximetry reading of less than 90% corresponds to an oxygen tension of less than 60mmHg*
184
The most common ovarian tumors in women over the age of 30 years are of what origin?
Epithelial
185
What thickness of the endometrial stripe assessed via transvaginal ultrasound is considered abnormal in a postmenopausal woman?
\>5mm
187
What is the most common cause of postpartum hemorrhage in a patient with a firm uterus?
Genital tract laceration
188
What are two risk factors for shoulder distocia?
1. Gestational diabetes: Results in fetal macrosomia
2. Obesity
3. Multiparity
189
What is the best treatment for intrauterine adhesions?
Hysteroscopic resection
191
What is the most common finding with uterine rupture?
Fetal heart rate abnormality
193
What are the treatments for fibrocystic change of the breast?
1. Decrease caffeine intake
2. NSAIDs
3. Tight-fitting bra
4. Oral contraceptives
5. Oral progestin therapy
6. Danazol (a weak antiestrogen and androgen compound) can be used in severe cases
7. Mastectomy if severe enough
195
What is the first sign of magnesium toxicity in the treatment of preeclampsia?
Loss of deep tendon reflexes
196
What is the most likely diagnosis in a woman in her 30s who complains of unilateral serosanguineous nipple discharge from the breast, expressed from one duct, but with no palpable mass?
Intraductal papilloma
198
What is found in at least 1/3 of cases of placental abruption that is significant enough to cause fetal death?
Coagulopathy
199
What are the steps that must be taken when fetal bradycardia occurs?
1. Confirm fetal heart rate vs maternal heart rate
2. Vaginal examination to assess for cord prolapse
3. Positional changes
4. Oxygen
5. Intravenous fluid bolus
6. Discontinue oxytocin
200
What distinguishes ovarian failure from central nervous system dysfunction?
FSH levels
FSH is elevated in gonadal dysgenesis
201
What is usually the earliest sign of chorioamnionitis (intramniotic infection)?
Fetal tachycardia
202
What are the causes of elevated maternal serum alpha-fetoprotein (MSaFP)?
1. Underestimation of gestational age
2. Multiple gestations
3. Neural tube defects
4. Abdominal wall defects
5. Cystic hygroma
6. Fetal skin defects
7. Sacrococcygeal teratoma
8. Decreased maternal weight
9. Oligohydramnios
203
Which anatomical structure attaches the uterine cervix to the pelvic side walls through which the uterine arteries traverse?
Cardinal ligaments
204
Placenta accreta is associated with a defect in what?
The decidua basalis layer of the uterus
206
What are the signs/symptoms of acute salpingitis?
1. Abdominal tenderness
2. Cervical motion tenderness
3. Adnexal tenderness
4. Vaginal discharge
5. Fever
6. Pelvic mass on physical examination or ultrasound
208
What are the quadruple screen findings of a down syndrome pregnancy?
1. Elevated hCG
2. Low maternal serum alpha-fetoprotein (MSaFP)
3. Low unconjugated estriol
4. Elevated inhibin A
## Footnote
*Inhibin A is not included in the triple screen.*
210
What are some characteristics of polycystic ovarian syndrome (PCOS)?
1. Obesity
2. Anovulation
3. Hirsutism
4. Glucose intolerance
5. Estrogen excess
211
What is the most common cause of bloody (serosanguineous) nipple discharge when only one duct is involved and in the absence of a breast mass?
Intraductal papilloma
*Typically small, benign tumors that grow in the milk ducts, that are most common between age 35-55*
212
What are the risk factors for endometrial cancer?
1. Early menarche
2. Late menopause
3. Obesity
4. Chronic anovulation
5. Estrogen-secreting ovarian tumors
6. Ingestion of unopposed estrogen
7. Hypertension
8. Diabetes Mellitus
9. Personal or family history of breast or ovarian cancer
*Unopposed estrogen is generally the biggest risk factor*
213
What is the most common female genital tract malignancy?
Endometrial carcinoma
214
Manual extraction of the placenta should be attempted if the placenta does not deliver spontaneously after how long?
30 minutes
216
What should be suspected when a patient develops flank tenderness and fever after hysterectomy or oophorectomy?
Ureteral injury
218
What is the most important risk factor for breast cancer?
Increasing age
219
What is the criteria for protraction of active phase?
Cervical dilation in the active phase that is less than
1. Nulliparous: Normal is \>1.2 cm/hr
2. Parous: Normal is \>1.5cm/hr
220
Intrauterine adhesions are diagnosed by what?
Hysterosalpingogram
*This is confirmed by hysteroscopy*
221
What are the 4 components of treating a septic abortion?
1. Maintain adequate blood pressure
2. Monitor: BP, O2 sats, urine output
3. Give antibiotics
4. Uterine evacuation
222
Diagnose and treat: A 55 year-old woman notes constant wetness from her vagina following a total vaginal hysterectomy procedure, which she had undergone 2 months previously. She denies dysuria or urgency to void. The urinalysis is normal.
Vesicovaginal fistula (from surgery), best treated by surgical repair
*Dye instillation into the bladder is the best method to diagnose the etiology of urinary incontinence*
223
An abnormal pregnancy is indicated by hCG levels plateauing within what time frame?
The first 8 weeks
*hCG levels should be doubling every 2-3 days during the first 8 weeks.*
224
Diagnose and treat: A 42-year old woman with long-standing diabetes mellitus complains of small amounts of constant dribbling of urine loss with coughing or lifting.
Overflow incontinence, best treated with intermittent self-catheterization
*Diabetes is a risk factor for overflow incontinence*
225
Name this maneuver: The maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head
McRoberts Maneuver
*Used to relieve shoulder distocia during labor*
226
What is suspected with painless cervical dilation during pregnancy and what is the treatment?
1. Incompetent cervix
2. Best treated with cervical cerclage
227
What is the most common cause of hirsutism and irregular menses?
Polycystic ovarian syndrome (POS)
228
What are the main side effects of combination hormonal emergency contraception therapy?
Nausea/vomiting
229
What is the most common organism responsible for postcesarean endomyometritis?
Bacteroides species
*Anaerobic bacteria are most common of which bacteroides is #1*
230
Pregnancy or use of estrogen has what effect on various thyroid-related levels?
1. Increased thyroid-binding globulin
2. Increased total thyroxin
3. Free T4 does not change
4. TSH does not change
231
What is the most common histological type of breast cancer?
Infiltrating intraductal carcinoma
232
What are 3 long term sequelae of acute salpingitis?
1. Chronic pelvic pain
2. Ectopic pregnancy
3. Involuntary infertility
233
What is the most common karyotype associated with gonadal dysgenesis?
45,X
46,XX and 46,XY are possible
234
What should be suspected as the cause of primary amenorrhea in a patient with:
1. Normal breast development
2. Absent axillary and pubic hair
3. High testosterone
4. 46 XY Karyotype
Androgen insensitivity
## Footnote
*Such a patient would not have a uterus and would require a gonadectomy because the patient's undescended testicles would be at increased risk for cancer*
235
Asymptomatic bacteriuria has a high incidence in women with what?
Sickle cell trait
236
What should be suspected as the cause of primary amenorrhea in a patient with:
1. Normal breast development
2. Normal axillary and pubic hair
3. Normal testosterone
4. 46,XX Karyotype
Mullerian agenesis
*Other findings in such a patient would include:*
1. *Absent uterus and blind vagina*
2. *Renal anomalies*
237
What antibiotic treatment should be used in pregnancies complicated by Preterm premature rupture of membranes (PPROM)?
Broad-spectrum antibiotics such as ampicillin and gentamicin
238
What is the most common cause of abnormal triple screen?
Wrong dates
