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Level 2 Boards > Ob/ Gyn/ Male > Flashcards

Ob/ Gyn/ Male Flashcards

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1
Q

Gestational sac is visible on u/s

A

5 weeks

b-hCG 1000-1500

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2
Q

What increases in pregnancy

A

Renal flow

GFR

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3
Q

Weight gain guidelines

A

< 19.8: 12-18 kg
19.8-26: 11-16 kg
26- 29: 7-11 kg
> 29: 5-9 kg

<18.5: 28-40 lbs
18.5-24.9: 25-35 lbs
25-29: 15-25 lbs
> 29.0: 11-20 lbs

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4
Q

Quad screen

A

maternal sesrum Alpha fetoprotein
Inhibin A
Estriol
beta-hCG

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5
Q

Trisomy 18

A

Decreased MSAFP
Decreased Estriol
Decreased Inhibin A
Decreased beta-hCG

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6
Q

Trisomy 21

A

Decreased MSAFP
Decreased Estriol
Increased Inhibin A
Increased beta-hCG

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7
Q

TORCHeS

A 
Tocoplasmosis
Other
Rubella
CMV
Herpes simplex virus
HIV
Syphilis

Other: Parvo, varicella, Listeria, TB, marlaria, fungi

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8
Q

Hydrocephalus
Intracranial calcifications
Chorioretinitis
Ring-enhancing lesions on MRI

  • Name
  • Tx
  • Prophylaxis
A

Toxoplasmosis

Congenital infxn

Pyrimethamine + sulfadiazine

Spiramycin prophylaxis for third trimester

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9
Q 
Rash
Cataracts
Mental retardation
Hearing loss
PDA
A

Rubella

No tx

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10
Q

Petechial rash

Periventricular calcifications

A

CMV

Postpartum ganciclovir

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11
Q 
Maculopapular rash
Lymphadenopathy
Hepatomegaly
Snuffles
Osteitis
A

Syphilis

Penicillin

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12
Q

Abortion

A

Mifepristone + misoprostol
- 49 days

Methotrexate + misoprostol
- 49 days

Vaginal/ sublingual/ buccal misoprostol
- 59 days

Surgical options
- 13 weeks

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13
Q

Oxytocin side effects

A

Hyponatremia
Tachysystole
Hypotension

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14
Q

Decelerations

A

VEaL CHoP

Variable deceleration= Cord compression

Early deceleration= Head compression

Late deceleration= Placental insufficiency

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15
Q

Normal fetal HR

A

110-160 bpm

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16
Q

Reactive Nonstress test

A

Normal response

Two accelerations last at least 15 seconds over 20 minute period

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17
Q

Biophysical profile evaluates

A

Test the Baby, MAN

Fetal Tone
Fetal Breathing
Fetal Movement
Amniotic fluid volume
Nonstress test
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18
Q

Morning sickness lasting past first trimester

  • Name
  • Labs (2)
  • Tx
A

Hyperemesis gradivarum

Persistent vomiting
Acute starvation (large ketonuria)
WL

Increased beta-hCG
Increased estradiol

Evaluate for trophoblastic disease

Dietary changes
Doxylamine-pyridoxine

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19
Q

UA before 20 weeks reveals glycosuria

A

Pregestational diabetes

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20
Q

Gestational HTN

A

BP > 140 or > 90

Develops at > 20 weeks

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21
Q

SE pregestational DM (9)

A

Macrosomia or IUGR
Cardiac and renal defects
Neural tube defects

Hypocalcemia
Polycythemia
Hyperbilirubinemia
Hypoglycemia
Shoulder dystocia
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22
Q

Preeclampsia

A

HTN
Proteinuria
Edema

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23
Q

Hemolytic anemia
Elevated liver enzymes
Low platelets

A

HELLP syndrome

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24
Q

Prophylaxis for seizures with preclampsia

  • Risk of Tx
  • Fix for that
A

Continuous magneisum sulfate drip

Magnexium toxicity (loss of DTRs, respiratory paralysis, Coma)

Tx Magnesium toxicity: IV calcium gluconate

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25
Tx Eclampsia
IV diazepam for seizures Delivery
26
Tx Asymptomatic bacteriuria and UTI in pregnancy
3-7 days nitrofurantoin, cephalexin or amoxicillin-clavulanate
27
Tx Pyelonephritis in pregnancy
IV fluids | IV third generation cephalosporins
28
Vasa Previa
Velamentous umbilical cord insertion and/or bilobed placenta causing vessels to pass over the internal os
29
Polyhydramnios Oligohydramnios
Polyhydramnios: >= 25 Oligohydramnos <5
30
Antibodies across placenta
IgG
31
Erythroblastosis fetalis
Rh negative mothers
32
Hydrops fetalis
When fetal hemoglobin < 7
33
First trimester uterine bleeding Hyperemesis gravidarum Preeclampsia < 24 weeks - Name - U/S appearance - Lab - Progress to
Gestational trophoblastic disease Snowstorm on pelvic ultrasound Increased beta-HCG > 100,000 Can progress to invasive hydatidiform moles or choriocarcinoma
34
Complete vs incomplete moles
Complete - Sperm fertilization of empty ovum - 46, XX - No fetal tissue Incomplete - Normal ovum fertilized by two sperm - 69, XXY - Contains fetal tissue
35
What is elevated with multiple gestations
Beta-hCG Human placental lactogen MSAFP
36
Rupture of membranes
+ Nitrazine paper test | + Fern test
37
What should be used with c-section
Sodium citrate given to mother to reduce gastric acidity and prevent acid aspiration syndrome
38
Third degree Episiotomy
Extension to anal sphincter
39
Fourth degree Episiomy
Extension to rectum
40
Fever > 38 C within 36 hrs of delivery Uterine tenderness Malodorous lochi Tx
Postpartum Endometritis Tx IV clindamycin and gentamicin
41
Post partum Abdominal pain Back pain Fever that swings from normal to as high as 105 Unresponsive to antibiotics
Septic pelvic thrombophlebitis Pelvic infection leads to infection of vein wall Clot invaded by microorganisms CT for pelvic abscess Broad spectrum antibiotics and anticoagulation
42
Positive VDRL
High sensitivity Low specificity Confirm with FTA-ABS test
43
Positive VDRL Two miscarriages Low platelets Prolonged PTT - Name - Tx
Antiphospholipid antibody syndrome False positive VDRL Started on low molecular weigth heparin (LMWH)
44
Cleft lip Wide anterior fontanelle Distal phalange hypoplasia Microcephaly - Name - Cause (3) - Also seen (2)
Fetal hydantoin syndrome Exposure to antiepileptic - Phenytoin - Carbamazepine - Valproate Cardiac anomalies - pulmonary stenosis - aortic stenosis
45
Alcohol use while in utero (2)
Microcephaly Mid facial hypoplasia [No cleft lip]
46
Oligohydramnios Pulmonary hypoplasia Growth restirctions Limb defects - What - Causes
ACE-I in utero Fetal reanl failure
47
Gestational HTN need evaluation
BPP weekly starting at 32 weeks
48
Pruritus Third trimester Worse on hands No rash Increased total bile acids - Name - Tx
Intrahepatic cholestasis of pregnancy Delivery at 37 weeks Ursodeoxycholic acid Antihistamines
49
Increased Alpha feto protein
Multiple gestation | Abdominal wall defects
50
Tx Intrauterine fetal demise
20-23 weeks - Dilation & evacuation or vaginal delivery >- 24 weeks - vaginal delivery
51
Ultrasound showed a thin endometrial stripe
Suggests an empty and normal uterine cavity
52
Tx Postpartum hemorrhage
1. Bimanual uterine massage + oxytocin 2. Uterotonics - Methylergonovine - carboprost - misoprostol 3. Balloon tamponade 4. Uterine artery embolization 5. Hysterectomy
53
Infants who are small for gestational age are at risk for (7)
``` Hypoxia Perinatal asphyxia Meconium aspiration Hypothermia Hypoglycemia Hypocalcemia Polycythemia ```
54
Discrepancy between uterine size and gestational age Enlarged uterus with irregular contour
Leiomyomata uteri | - uterine fibroids
55
Evaluating risk of preterm labor
Transvaginal ultrasound Measures cervical length
56
short cervix tx
Progesterone maintains uterine quiescence
57
Pregnant Joint pain Malar rash FHR: 80 bpm - Name - Causes (3)
SLE —> Fetal atrioventricular (AV) block Ventricular HR: 50-80/min Fetal bradycardia
58
Optimal fetal position
Occiput anterior Baby head facing back/butt
59
Sharp groin pain in pregnancy
Round ligament pain
60
Bilateral kidney enlargement and bilateral dilation of the renal pelvises and proximal ureters - Name - MOA
Physiologic hydronephrosis of pregnancy Kidney enlargement occurs because there is an increase in maternal blood volume that requires increased filtration
61
Intrauterine fetal demise Multiple limb fractures Hypoplastic thoracic cavity - Name - Inheritence
Type II osteogenesis imperfecta AD
62
``` Macrocephaly Frontal bossing Midface hypoplasia Genu varum Limb shortening ```
achrondroplasia
63
Inevitable abortion presents at
< 20 weeks
64
Placental abruption vs placenta previa
Placental abruption - Vaginal bleeding - Constant abdominal pain - Tender uterus - Fetal decelerations Placenta previa - Vaginal bleeding - non tender uterus - normal fetal HR
65
Medication to avoid in delivery with myasthenia gravis (6)
Magnesium sulfate Fluroquinolones Opioids Beta blockers CCB Statins
66
Sudden vaginal bleeding Severe lower abdominal pain Gestational diabetes Smoker Dilated cervix 3+ protein 158/96 Contractions every 2 minutes and last for 20 seconds - Name - Feature (2) - At risk for
Placental abruption High frequency, low intensity contractions Hypertonic tender uterus RISK of: DIC
67
When to use tocolytics | - Examples (2)
Indomethacin Nifedipine < 34 weeks
68
Preeclampsia prevention
Low-dose aspirin at 12 weeks gestation Daily until delivery
69
When to manual rotation breech baby
>= 37 weeks
70
Pain when ambulating Sharp lower midline abdominal pain Tenderness to palpation just below bladder Nontender uterine fundus - Name - MOA
Pubic symphysis diastasis Levels of progesterone and relaxin increase pelvic mobility and promote a physiologic widening of pubic symphysis
71
Postcoital bleeding Thick mucopurulent discharge Pregnant
Acute cervicitis
72
Pulmonary hypoplasia Oligohydramnios Distended bladder Enlarged kidneys Thin renal cortices
Posterior urethral `
73
Indomethacin tocolysis can cause
decreases prostaglandin production —> fetal vasoconstriction (premature closure of ductus arteriosus) Decreased renal perfusion —> oligohydramnios
74
Gestational DM when you need insulin
Fasting <= 95 1 hr <= 140 2 hr <= 120
75
Shoulder dystocia what to do
BE CALM Breathe; do not push Elevate legs & flex hips (McRoberts) Call for help Apply suprapubic pressure EnLarge vaginal opening with episiotomy
76
No fetal pole
No embyo Missed abortion Closed cervix
77
Tx Preterm labor
< 32 weeks ``` Corticosteriods (Betamethasone) Tocolytics (indomethacin) Magnesium sulfate (provide fetal neuroprotection) ```
78
Infection that causes temporal lobe edema and hemorrhage
Herpes simplex virus
79
Feel bulging bag with no palpable presenting fetal part
Get transabdominal ultrasound
80
Risk factors Shoulder dystocia (5)
``` Fetal macrosomia Maternal obesity Excessive weight gain in pregnancy Gestational diabetes Postterm pregnancy ```
81
Group B strep tested at
35-37 weeks
82
Do what at 28 weeks
Anti-D immune globulin
83
HIV delivery
Viral load > 1,000 = high risk vertical transmission
84
Decreased fetal movement what to do
Reactive NST Next Biophysical profile or contraction stress test [Dont use CST if placenta previa]
85
Single fluid pocket of 1.5 x 1 cm
Oligohydramnios Single deepest pocket < 2cm or amniotic fluid index < 5
86
Intrauterine fetal demise Watery diarrhea after eating at picnic
Listeria monocytogenes
87
Pericardial effusion Bilateral pleural effusions Polyhydramnios on ultrasound of fetus - Name - Due to - Causes
Fetal hydrops Rh(D) alloimmunization Parvovirus B19 Thalassemia
88
SLE nephritis in pregnancy symptoms (5)
Edema Malar rash Arthritis Hematuria Proteinuria
89
Medication CI in postpartum atony and hemorrhage - Name - CI - CI due to
Methylergonovine CI in HTN disorders Due to risk of stroke
90
HELLP results in
Distension of liver capsule
91
Premature rupture of membranes give when
Prophylactic latency antibiotics Corticosteriods
92
Preeclampsia risk factors (3) - Prophylaxis
DM Chronic HTN Multiple gestations Give lose dose aspirin
93
Lochia timeline
3-4 days dark or bright red 4-14 pink/ brownish 11th - 6 wk: white/ yellow creamy Increase after breastfeeding
94
Fetus with double bubble sign - Name - Causes - Associated with (2) - Check for
Duodenal atresia causes polyhydramnios Duodenal atresia associated with trisomy 21 and VACTERL ``` Vertebral Anal atresia Cardiac Trachoesophageal fistula Esophageal atresia Renal Limb ``` Check for VSD
95
Post labor Preeclampsia Patellar reflexes absent
Magnesium sulfate toxicity
96
No cervical change for >4 hours despite adequate contractions (>200)
Arrest Cesarean delivery
97
Breast development age Menarche age
8-13 10-16
98
Menopause duration Labs
at least 12 months Increased FSH and LH
99
Start screening for osteoporosis
65 years old
100
Absence of menses | Absence of 2nd sexual characteristics
Turners
101
Absence of menses Secondary sexual characteristics Absence of upper two third of vagina
Mullerian agenesis
102
Absence of menses Secondary sexual characteristics Breast development No pubic hair
Complete androgen insensitivity
103
Turner heart conditions
Streak gonads Amenorrhea Aortic coarctation Bicuspid aortic valve
104
Amenorrhea Present uterus Increased FSH
Turner's Primary ovarian insufficiency
105
WIthdrawal bleed from progestin challenge Increased LH
PCOS or premature menopause
106
Pain Menorrhagia Enlarged boggy symmetrical uterus Tx
Adenomyosis NSAIDS
107
Acute heavy bleeding
High dose estrogen IV stabilizes the endometrial lining If bleeding not controlled within 12-24 hours then D&C
108
``` Serum pH > 7.45 HTN Hypokalemia Decreased aldosterone Increased cortisol ``` - Acquired from - Tx
Syndrome of Apparent Mineralocorticoid Excess (SAME) Hereditary deficiency of 11beta-hydroxysteroid dehydrogenase - cortisol not converted to cortisone Can acquire from glycyrrhetinic acid (present in licorice) Tx: Corticosteriods
109
Deficiency in 21 alpha hydroxylase - Features (6) - Elevated - MOA
Masculization Hypotension Cant make aldosterone or cortisol Hypotension Hyponatremia HYPERkalemia High 1-OH progesterone Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands
110
Deficiency in 11b- hydroxylase - Features - Build up - Didnt lose - MOA
Masculization Hypertension Build up of 11-deoxycorticosterione Still have mineralocorticoid properties Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands
111
Deficiency of 17a- hydroxylase - Features (5) - MOA
HTN Ambiguous genitalia Can only make mineralocorticoids Salt and H20 retention Hypokalemia Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands
112
13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient ``` A. 21-hydroxylase B. 17a- hydroxylase C. 11b-hydroxylase D. Side chain cleavage enzyme E. 5a-reductase ```
B. 17a- hydroxylase
113
Hirsutism vs virilization
Hirsutism= male hair pattern Virilization= frontal balding, muscularity, clitoromeglay, deepening of voice
114
Hypotension | Virilzation
21-hydroxylase deficiency
115
Obesity Amenorrhea Acne Hirsutism
PCOS Increased testosterone and estrogen High LH Low FSH Tx: hormonal contraception or progestin + metformin If trying to conceive= Clomiphene (SERM) + Metformin
116
Tx of Trichomonas SE of flushing
Metronidazole Causes disulfram like reactions
117
Chandelier sign
Cervical motion tenderness Pelvic inflammatory disease
118
Abrupt onset fever Vomiting Watery diarrhea Diffuse macular erythematous rash involving palms and soles Hypotension Blood culture negative - Name - Tx (3) - Death from (4)
Toxic shock syndrome Rapid rehydration Removal foreign object Clindamycin + vancomycin Death: arrhythmias, cardiomyopathy, respiratory failure, DIC
119
Galactocele - What is it - Due to - Description
Milk retention cyst Due to obstructed duct Soft and cystic
120
Palpable breast mass pathway
< 30 U/S +- mammogram Simple cyst —> Need aspiration Complex cyst —> Image guided core biopsy >30 Mammogram Suspicious for malignancy —> core biopsy
121
Guaiac positive discharge test
Positive for blood
122
Raloxifene - What is it - Other form - Used for - AE
SERM Tamoxifen: adjuvant tx of breast cancer Raloxifene: postmenopausal osteoporosis AE: venous thromboemoblism Tamoxifen: endometrial hyperplasia and carcioma
123
Vaginal spotting Increasing pelvic pressure Breast cancer 3 years ago - Tamoxifen Large irregular mass palpable above the symphysis pubis Uterus doesnt descend with valsalva maneuver - Name - Causes (3) - Tx
Uterine sarcoma Pelvic radiation Tamoxifen use Postmenopausal patients Tx: Hysterectomy
124
Abnormal uterine bleeding Enlarged uterus Just had baby
Choriocarcinoma
125
Post menopausal Thin white wrinkled skin over labia majora/minora Fissure Severe pruritus Painful defecation - Name - Tx
Lichen sclerosus Tx: Corticosteroid ointment
126
Lichen planus - Caused by - Description (2)
Autoimmune Pruritic purple plaques Thin white striae around labia and vulva
127
Thicken leathery skin around labias - Name - Due to
Lichen simplex chronicus - due to repetitive scratching
128
Volvovaginal atrophy - Features (3) - Not seen
Vulvar pruritus Thinned vulvar skin Fusion of labia minora that causes narrowing of vaginal introitus Doesnt involve perianal region
129
Genital warts
Condylomata acuminata
130
Condylomata acuminata
Genital warts
131
Condylomata lata - Name - Description
Secondary syphilis Raised gray-white lesions on mucosal surfaces
132
8 cm cyst with calcifications and hyperechoic nodules - Name - Risk - Tx
Mature cystic teratoma (Dermoid cyst) Risk ovarian torsion Remove
133
Purulent polymicrobial fluid collection Multiloculated cystic adnexal mass
Tubo-ovarian abscess
134
Virilization rapid onset Acne Increased testosterone Normal DHEAs - Name - Type - Increase
Androgen secreting tumor Sertoli Leydig cell tumor Increased testosterone [PCOS doesnt cause virilzation, only mildly elevated testosterone] [Aromatase deficency has high DHEA]
135
Regular painful menses with normal pelvic exam Cramping 1-2 days before N/V Stops on day 2 of period - Name - MOA - Tx
Primary dysmenorrhea Excessive prostaglandin production NSAIDS Combination oral contraceptives
136
Pain 2 weeks prior to menses - Name - MOA
Mittelschmerz pain Peritoneal inflammation from ovarian follicle rupture occurs during ovulation
137
Post menopausal 5 cm right ovarian cyst
Serum CA-125 level and pelvic U/S
138
HELLP syndrome is what - Is what - Features (6) - Results from - Results in - Lab - Overall description of MOA
Severe type of preeclampsia ``` Hemolysis Elevated liver enzymes Low platelet counts HTN Proteinuria Edema ``` Result from abnormal placentation, triggering systemic inflammation and activation of coagulation system and complement cascade Circulating platelets are rapidly consumed and microangiopathic hemolytic anemia, which is detrimental to liver Results in hepatocellular necrosis - Liver swelling and distension MAHA causes increased bilirubin production * Systemic inflammation and platelet consumption
139
Always having to go to bathroom Involuntary loss of urine 2x a day Wakes up to wet garments Doesnt lose control while coughing Normal postvoid residual volume Vulvar skin shows reduced elasticity with labia minora retratction - Due to - Name - Feature - Tx
Estrogen deficiency Genitourinary syndrome of menopause Urogenital atrophy Moisturizers and lubricants next vaginal estrogen
140
Urethral hypermobility
Stress urinary incontience
141
Vaginal mass Worse with valsalva Vaginal erosions
Uterine prolapse
142
Infertility Irregular menses Mobile uterus without adnexal masses TSH and prolactin normal Elevated testosterone - Name - Lab - MOA - Tx
Polycystic ovary syndrome LH/FSH imbalance —> lack of LH surge Results in failure of follicle maturation and oocyte release (anovulation) Tx: 1st- WL - Oral contraceptives - Letrozole for ovulation
143
Tx Uterine leiomyomas (Fibroids)
Symptomatic: Hysteroscopic myomectomy Combined hormonal contraception
144
Leuprolide - Is what - Used for
Gonadotropin releasing hormone agonist Tx endometriosis by suppressing ovulation
145
DES exposure in utero
Risk of clear cell carcinoma of cervix and vagina
146
Malignant stromal tissue
Uterine sarcoma
147
History cancer Amenorrhea Vaginal dryness - Name - Due to - Causes - Increase in
Ovarian failure Secondary to chemo Estrogen deficiency [Primary ovarian insufficency] Increased FSH and LH
148
Ovarian mass Breast tenderness - Name - Lab - Seen on biopsy
Granulosa cell tumor Increased Estradiol Increased Inhibin Call-Exner bodies (cells in rosette pattern)
149
Elevated alpha-fetoprotein Ovarian mass - Name - Feature (2)
Yolk sac tumors Aggressive germ cell tumor Abdominal pain
150
Elevated hCG Ovarian mass - Name - Type - Feature
Embryonal carcinoma - Ovarian germ cell tumor - Rapid onset pelvic pain Gestational trophoblastic disease
151
Elevated Lactate dehydrogenase Ovarian mass - Name - Type - Description
Dysgerminomas Malignant germ cell tumors Rapidly enlarging painful masses
152
Itch rash on breast Eczematous plaque on left nipple and areola
Paget disease Adenocarcinoma
153
Primary amenorrhea
Lack of menses without secondary characteristics at >= 13 or >=15 with secondary sex characteristics
154
Endometrial hyperplasia risk factors (5)
Obesity Chronic anovulation/ PCOS Nulliparity Early menarche or late menopause Tamoxifen use
155
Severe dysmenorrhea Infertility Lateral cervical displacement Pain with cervical manipulation Cervical motion tenderness - Name - Tx
Endometriosis Oral contraceptives NSAIDS
156
Vulvar pruritus Fusing of posterior labia minora - Features (2) - Tx (2)
Labial adhesion Low estrogen production Mild asymptomatic resolve spontaneously Complete adhesion or partial symptomatic adhesion - Topical estrogen cream
157
``` Bloating Fatigue Headaches Hot flashes Breast tenderness ``` - Name - Tx
Premenstrual syndrome (PMS) Symptom diary over 2 menstrual cycles SSRI Combined oral contraceptive not recommended in those with migraines
158
Premenopausal Adnexal mass 5 cm irregular right adnexal mass
1st pelvic ultrasound if premenopausal
159
Pregnant High grade squamous intraepithelial lesions - Name - Dx
Invasive cervical cancer Immediate colposcopy Next would be endocervical curettage (deferred during pregnancy Pregnant - colposcopy - cervical excision
160
Trichloroacetic acid therapy
Vulvar or vaginal warts
161
Cervical insufficiency due to (4)
Collagen defects Uterine abnormalities Cervical conization Obstetric injury
162
Upper outer quadrant breast pain Right axillary lymphadenopathy Fever, chills, muscle aches and fatigue Been feeding baby pumped breast milk at night - Name - Tx
Lactational mastitis Antibiotic therapy Continue breastfeeding
163
Breast mass Cystic FNA- yellow Doesnt resolve with aspiration
Get core needle biopsy
164
Most effective emergency contraception method
Copper containing IUD
165
Blue tinged bulge Lower abdominal pain
Imperforate hymen
166
Beefy red plaque with white in creases - Name - Location - Feature - Organism - Worsen by - Tx
Intertrigo Dermatitis taht occurs in inguinal axillary gluteal and inframammary folds Satellite lesions near primary infection Candida albicans Worse w/ corticosteriod use Tx: Clotrimazole ointment
167
Pregnant 8 weeks Ovarian torsion with oophorectomy
Give progesterone supplementation until 10 weeks when placenta takes over
168
Low FSH Low LH Low Estradiol Infertility Normal Prolactin Normal TSH Normal Testosterone
Hypogonadotropic hypogonadism
169
High FSH High LH Decreased estradiol Infertility
Primary ovarian insufficiency
170
Gas passing through vagina Malodorous vaginal discharge Patch of erythema on the posterior vaginal wall Sinus with purulent drainage is also present in the perianal skin - Name - Imaging
Rectovaginal fistula Transmural inflammation of the bowel
171
Pubic hair No breasts Uterus with small ovaries - Name - Genetics
Turner syndrome Congenital absence of an X chromosome
172
Granuloma inguinale - Name - Description - Not seen - Location
Klebsiella granulomatis Extensive progressive and painless genital ulcers Without lymphadenopathy India Guyana New Guinea
173
Endometrial cells on Pap Post menopausal
Endometrial hyperplasia/ cancer Endometrial biopsy
174
Concern for Sertoli Leydig tumor
Virilization Deepening of voice Clitoromegaly [Not acne, hairs, acanthosis nigraicans]
175
Mullerian agenesis check for
Normal FSH Renal abnormalities - unilateral renal agenesis - pelvic kidneys - duplications of collecting systems
176
Irregular bleeding Obesity Endometrial hyperplasia
Peripheral aromatization of androgens to estrone
177
Amenorrhea Increased FSH No reaction to progesterone challenge - Name - Due to - Lab - Common in
Primary ovarian insufficiency Ovarian failure Low Estrogen levels Common in women who are Fragile X syndrome carriers
178
Peau d' orange - Name - Features (3)
Inflammatory breast carcinoma Superficial dimpling Edematous Erythematous
179
Vaginal foreign bodies
Warm irrigation | Vaginoscopy under sedation/ anesthesia
180
13 y.o girl Virilization Clitoromegaly Nodulocystic acne Amenorrhea Bilateral masses in labia majora - Name - Genetic - Due to
5- alpha reductase deficiency 46 XY Impaired testosterone to DHT conversion
181
OCPs and WG
not related
182
Tx Endometriosis
NSAIDs Then Laparoscopy
183
Premenopausal Regular menses Intermenstrual bleeding
Endometrial polyp
184
Strenuous exercise Amenorrhea - Name - Lab
Hypothalamic amenorrhea Decreased GnRH Decreased LH/FSH Decreased Estrogen Relative caloric deficiency
185
Androgenic steroid use
Virilization
186
Menstrual bleeding > 5 days Heavy Anemia Syncope Irregular enlarged uterus - Name - Due to
Leiomyomata uteri (fibroids) Proliferation of smooth muscle cells in the myometrium
187
Cyclic bleeding of ectopic endometrial glands
Endometriosis
188
Proliferation of endometrial glands inside the uterine myometrium
Adenomyosis
189
Trastuzumab SE
Monoclonal antibody for HER2 positive breast carcinoma SE: cardiotoxicity
190
Estrogen receptor positive breast cancer tx Risk of
Aromatase inhibitors - Anastrozole - Letrozole Increase the risk of osteoporosis
191
Solid complex ovarian mass Thick septations Ascites
Epithelial ovarian carcinoma
192
Inflammation of liver capsule - Name - Due to
Fitz-Hugh curtis syndrome Secondary to chlamydia trachomatis and neisseria gonorrhoeae infxn
193
Flesh colored 2 cm cystic mass at 4 oclock position of labium majus - Name - Tx
Bartholin duct cyst Observation and expectant management Resolve on own
194
Gartner duct cyst - Due to - Description - Doesnt involve
Incomplete regression of wolffian duct Cyst appear along the lateral aspects of the upper anterior vagina Do not involve vulva
195
Mass lateral to urethral meatus
Skene gland duct obstruction
196
Intermittent blood staining the left side of her bra No lumps or masses No calcifications - Name - Description
Intraductal papilloma Unilateral bloody nipple discharge
197
Intraductal papillomas
Microcalcifications
198
Lobular breast carcinoma
Fixed palpable breast mass with irregular borders Can be bilateral
199
Tx Menopause
Vasomotor symptoms If CI to estrogen - SSRI No CI and intact uterus - Estrogen & progestin No CI and no uterus - Estrogen only
200
Fixed breast mass in upper outer quadrant Foamy macrophages Fat globules
Fat necrosis Post trauma/ surgery Benign
201
Endometrial cells on PAP
<45 normal >45 concerning for endometrial hyperplasia or cancer
202
Ambiguous external genitalia at birth Normal internal genitalia External virilization Bone fractures No breast development Elevated FSH, LH Elevated Testosterone Elevated Androstenedione Multiple ovarian cysts - Name - Risk of
Aromatase deficiency Osteoporosis
203
Tender purulent mass in vagina - Name - Dx - Tx
Urethral diverticulum MRI Surgical excision
204
Abdominal myomectomy with uterine cavity entry
Trial of labor contraindicated due to uterine rupture
205
Cesarean delivery with vertical incision
Trial of labor contraindicated
206
Painless vaginal bleeding Rapid fetal demise
Vasa previa [Abruptio placentae has severe abdominal pain]
207
Irregular contractions | No cervical change
False labor Discharge home with labor precautions
208
Twins N/V RUQ pain Epigastric pain Scleral icterus Hypoglycemia Increase liver enzymes Increased bilirubin Thrombocytopenia - Name - Tx
Acute fatty liver of pregnancy Deliver immediately Third trimester Get DIC
209
Heavy vaginal bleeding Irregular nonpainful contractions No prenatal care
Placenta previa
210
Vaginal bleeding Abdominal pain FHR: decelerations
Placental abruption
211
Cord avulsion Severe hemorrhage
Placenta accreta Attach to myometrium
212
Risk Group B strep infection (5)
GBS bacteriuria or UTI in current pregnancy Unknown GBS status - < 37 weeks - intrapartum fever - Rupture of membranes > 18 hours Prior infant with early-onset neonatal GBS infection
213
Fever > 24 hr postpartum Uterine fundal tenderness Purulent lochia - Name - Tx
Postpartum endometritis Tx Clindamycin + gentamicin
214
Cigarettes and pregnancy
Asymmetric FGR
215
Postpartum urinary retention Inability to void > 6 hours Overflow incontinence
Bladder atony
216
Risk factor for placenta previa
Previous cesarean delivery
217
FHR smooth, wave-like oscillation
Category III tracing Severe fetal anemia Ruptured vasa previa
218
Normal changes in pregnancy (3)
Decreased BUN Decreased creatinine Increased renal protein excretion
219
Postpartum seizure Normal blood pressure Normal magnesium level Sodium 112
Severe hyponatremia Side effect oxytocin
220
Hyperemesis gravidarum check for
Ketones on urinalysis Differentiates from normal pregnancy N/V Hypochloremic metabolic alkalosis Hypokalemia
221
Pregnant with positive STI on first screen
Repeat STI in third trimester 28 weeks
222
Risk factor abruptioplacentae
Tobacco | Cocaine
223
Abdominal pain Vaginal bleeding Fetal bradycardia Irregular abdominal pass
Uterine rupture
224
Pap smear
Every 3 years Pap + HPV every 5 years
225
Lynch II syndrome - Name - Risk of
Hereditary nonpolyposis colorectal cancer (HNPCC) Increased risk of colon, ovarian, endometrial and breast cancer
226
When to observe ovarian mass - Features (5)
Premenopausal Asymptomatic Mobile Unilateral Simple cystic mass < 8-10 cm
227
Detrusor hyperreflexia or sphincter dysfunction
Urge incontience
228
Central precocious puberty - Labs (3) - Causes (4) - Tx
Increased Estradiol Increased LH Increased FSH Hypothalamic lesions (tumors) Dysgerminomas Neurofibromatosis Tuberous sclerosis Tx: Leuprolide
229
Peripheral precocious puberty - Labs (3) - Causes ( 6) - Tx
Increased Estradiol Decreased LH Decreased FSH ``` Congenital adrenal hyperplasia Adrenal tumors McCune-Albright Granulosa cell tumor Esogenous estrogen Ovarian cysts ``` Tx: Treat cause
230
Pediatric vaginal discharge common organism
Group A streptococcus
231
Precocious puberty steps
Determine bone age 1) Bone age within 1 year of chronologic age= puberty hasnt started 2) Bone age > 2= puberty started > 12 months ago GnRH agonist (leuprolide) stimulation test 1) Positive LH response - Central precocious puberty - Get MRI to check for CNS tumor 2) Negative LH response - Peripheral precocious puberty - U/S of ovaries, gonads - Ovarian cyst, Adrenal tumor, gonadal tumor - U/S negative= Exogenous estrogen, CAH
232
Bloody nipple discharge
Intraductal papilloma | Mammary duct ectasia
233
Leaf like appearance breast mass
Phyllodes tumor
234
Papillary projections of stroma, lined with epithelium - Name - Tx
Phyllodes tumor Completely excised Axillary LN dissection not necessary
235
CI with breast cancer
All hormone-containing contraception Use copper IUD
236
U/S vs mammogram
<30 get U/S
237
Breast cancer stages
Primary tumor I: < 2 cm II: 2-5 cm III: > 5 cm IV: Extension to chest wall, skin LN I: Moveable LN II: Fixed axillary LN III: Supraclavicular LN
238
HER 2 + ER/PR +
HER2+= trastuzumab ER/PR+= Tamoxifen
239
Tx Turner to make taller
High FSH
240
Recurrent cystitis tx
Postcoital
241
Adnexal mass Pelvic pain SOB Postmenopausal Solid mass Thick septations Ascites - Name - MOA - Tx
Epithelial ovarian carcinoma Abnormal proliferation of tubal epithelium Exploratory laparotomy for metastasis
242
Adnexal mass that is complex multiloculated with thick walls and internal debris on ultrasound Fever Leukocytosis
Tubo-ovarian abscess
243
Tender anterior vaginal mass is palpable Causes expression of bloody discharge at urethral meatus Leakage of urine - Name - MOA
Urethral divertciulum Localized outpouching of urethral mucosa
244
Uterine atony (7)
Uterine massage Correct bladder distension Oxytocin, misoprostol Tranexamic acid Carboprost, methylergonovine Balloon tamponade Surgical intervention
245
Cystic breast mass Goes away with aspiration
Repeat breast exam in 2 months
246
Amennorrhea Normal FSH Normal TSH
Asherman syndrome Adhesions
247
Maternal estrogen effects in newborn
Breast hypertrophy Swollen labia Whitish vaginal discharge Uterine withdrawal bleeding
248
Pain exacerbated by bladder filling Relieved by voiding
Interstitial cystitis Amitriptyline
249
Vulvar itching Thin, white skin with excoriations extending to the perianal area Small anal fissure
Lichen sclerosus
250
Infertility of klinefelters due to
Dysgenesis of the seminferious tubules
251
Medications that cause persistant erection (priapism)
Alpha 1 antagonists - Prazosin Antidepressants - Trazodone - SSRI PPD5 - sildenafil Stimulants - Methylphenidate - Cocaine Sickle cell leukemia
252
Acute fatty liver of pregnancy - When - Lab (2) - Feature
Third trimester Elevated aminotransferases RUQ pain Thrombocytopenia
253
Continuous painful vaginal bleeding Pregnant
Placental abruption
254
Tertatogenic antibiotics
Tetracycline Fluoroquinoles Aminoglycosides Sulfonamides
255
Typical antibiotics for GBS prophylaxis
IV penicillin or ampicillin
256
Amenorrhea with normal prolactin No response to estrogen-progesterone challenge History of D&C
Asherman syndrome
257
Medication to induce ovulation
Clomiphene citrate
258
Indications for medication tx of ectopic pregnancy (4)
Stable patient Unruptured < 35 cm < 6 weeks gestation
259
Medical options for endometriosis
OCPs Danazol GnRH agonists
260
Most common location for ectopic pregnancy
Ampulla of oviduct
261
Increased vaginal discharge Petechial patches in upper vagina and cervix
Trichomonal vaginitis
262
Patients with PID and RUQ pain
Fitz-Hugh Curtis syndrome
263
30 y.o with unpredictable urine loss Exam normal Medications?
Anticholinergics - Oxybutynin B-adrenergics - Metaproterenol For urge incontience
264
Morning sickness Abdominal distension Breast fullness Last menstrual period was 2 months ago Home pregnancy test positive Negative pregnancy test at office Thin endometrial stripe
Pseudocyesis Somatization of stress
265
Bipolar medication safe in pregnancy
Lamotrigine
266
Mammogram how often
45-54 every year 55 and older every 2 years
267
Lipids checked how often
Every 5 years
268
What to give is labor is protracted, cervical change not progressing
Oxytocin [Misoprostol not used in those with spontaneous labor only to induce]
269
When to stop mammograms
> 75
270
Oral contraceptives decrease risk of
Ovarian cancer | Endometrial cancer
271
Tocolytic used at 33 weeks Develop headache,nausea, and flushed. Hypotension and decreased glucose. GIven what? A. Beta-adrenergic receptor stimulation B. CCB C. Circulation of synthetic glucocorticoids D. Cyclooxygenase inhibition E. Decreased acetylcholine release at myoneural junction
B. CCB Nifedipine First line tocolytic [Cyclooxygenase inhibitors, indomethacin used to toxolysis between 24 and 32 weeks by decreasing prostaglandin synthesis, risk PDA closure after 32 weeks]

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