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USMLE Step 2 CK Flash Cards > Obstetrics/Gynecology > Flashcards

Obstetrics/Gynecology Flashcards

1
Q

How do you suspect septic pelvic thrombophlebitis?

A

Persistent fever unresponsive to broad-spectrum antibiotic therapy and a negative infectious evaluation (blood, urine cultures, etc)→Diagnosis of exclusion

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2
Q

Treatment of septic pelvic thrombophlebitis

A
  • Anticoagulation

- Broad-spectrum antibiotics

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3
Q

Fetal complications of preeclampsia and the mechanism

A

Chronic uteroplacental insufficiency→Oligohydramnios and fetal growth restriction/small for gestational age

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4
Q

Why estrogen agonists (tamoxifen, raloxifene, oral contraceptives) increase the risk of venous thromboembolism?

A

Increase protein C resistance

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5
Q

Treatment for candida vaginitis. How do you identify it?

A
  • Oral or intravaginal antifungals
  • Oral fluconazole (first line treatment)
  • Topical azole intravaginal
  • Thick cottage cheese discharge, vaginal inflammation, pseudohyphae, normal pH (3,8-4,5)
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6
Q

How do you identify an acute cervicitis and differentiate it from pelvic inflammatory disease at the physical exam?

A
  • Acute cervicitis→mucopurulent discharge and a red, inflamed, friable cervix (easily bleeds on contact with a swab)
  • Pelvic inflammatory disease→pain on pelvic bimanual examination. Cervical motion (chandelier sign), uterine or adnexal tenderness
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7
Q

Difference between Bartholin cyst and Gartner duct cyst.

A
  • Batholin cyst→soft, mobile, nontender, cystic mass, at 4 or 8 o’clock position at the base of the labium majus (vulva)
  • Duct obstruction
  • Gartner duct cyst→single o multiple cysts, submucosal along the lateral (parallel) aspect of the upper anterior vagina (DON’T involve vulva)
  • Incomplete regression of the Wolffian duct during fetal development
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8
Q

Treatment of Bartholin cyst according to the symptoms

A
  • Asymptomatic→Observation
  • Symptomatic (same as Bartholin Abscess)→incision and drainage. Word catheter placement►↓risk of recurrence
  • Antibiotics→Bartholin abscess only if cellulitis (erythema, fever)
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9
Q

Difference between vulvar Lichen sclerosus and menopausal atrophy.

A
  • Lichen sclerosus→perianal thickening with fissures

- Menopausal atrophy→No perianal skin involvement

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10
Q

Most common cause of puerperal fever. Treatment

A
  • Postpartum Endometritis

- Clindamycin + Gentamicin

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11
Q

Gold standard diagnostic test for acute cervicitis

A

Nucleic acid amplification test (NAAT)

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12
Q

What do you want to rule out with the Biophysical profile test? What mean each rank of score?

A
  • Fetal hypoxia

- 0-4→fetal hypoxia (urgent delivery), 6→equivocal (repeat in 24 hours), 8-10→rule out fetal hypoxia

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13
Q

What is a fetal heart rate acceleration?

A

> 15 beats/min above base line and >15 seconds long within a 20-minute period in a nonstress test (NST)

*can last up to 40 minutes for 20 minute fetal sleep cycle

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14
Q

How do you define a growth restriction fetus?

A

<10th percentile weight for gestational age

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15
Q

What is the external cephalic version? Reason to do it.

A
  • Maneuvers to convert a breech into a vertex presentation for delivery
  • Between 37 wks and onset of labor, ↓rate of cesarean deliveries
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16
Q

What do you have to rule out first to do external cephalic version?

A

Contraindications to a vaginal delivery

*Fetal well being must be documented (NST)

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17
Q

What is the internal podalic version?

A

Perform in twin delivery to convert the second twin from a transverse/oblique to a breech presentation for subsequent delivery

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18
Q

What is a variable deceleration?

A

Abrupt ↓FHR <30 seconds from onset to nadir, followed by a rapid return to baseline, ↓≥15/min below de baseline, duration ≥15 seconds but <2 min.

*Can be but not necessarily associated with contractions. Onset, depth, and duration of each deceleration may vary.

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19
Q

Etiologies that may suggest a variable deceleration

A
  • Cord compression
  • Oligohydramnios
  • Cord prolapse (prolonged deceleration and bradycardia)

*Common after rupture of membranes

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20
Q

What may suggest a late deceleration?

A

Uteroplacental insufficiency→Fetal hypoxia

*Placental abruption, post-term pregnancies

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21
Q

What may suggest a early deceleration?

A

Head compression

*Can be normal fetal tracing

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22
Q

What is the difference and the implication between intermittent and recurrent variable decelerations?

A
  • Intermittent variable decelerations→associated with <50% of contractions►well tolerated by fetus, typically not cause fetal hypoxia, close observation
  • Recurrent variable decelerations→occur with >50% of contractions►↑ risk fetal acidosis (as ↑frequency and severity of decelerations), treat
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23
Q

Treatment for recurrent variable decelerations when cord compression is suspected

A
  • Maternal repositioning (ex, left lateral)→first line►↓cord compression and improve blood flow to the placenta
  • Amnioinfusion→second line→instillation of saline into the amniotic sac (if ↓amniotic fluid after rupture membranes)
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24
Q

When do you suspect fetal acidemia and what is the best next step?

A
  • Recurrent variable decelerations + loss of fetal heart rate variability
  • Cesarean
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25
Q

Possible adverse effects and manifestations of prolonged administration of high doses of oxytocin

A
  • Hyponatremia→headaches, abdominal pain, vomiting, nausea, lethargy and tonic-clonic seizures
  • Hypotension
  • Tachysystole
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26
Q

Which options do you think when report an enlarged uterus?

A
  • Pregnancy (first to discard - ask for B-hcg)
  • Leiomyoma (Asymmetric and nontender uterus)
  • Adenomyosis (diffusely enlarged uterus, Symmetric and tender uterus)
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27
Q

Which disease correspond to postmenopauseal bleeding until proven otherwise? What test do you do?

A
  • Endometrial cancer

- Endometrial biopsy

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28
Q

Which type of tumor do you expect to find in a postmenopausal woman with vaginal bleeding and ovarian mass? Important fact at the uterus and why does it happen?

A

Granulosa-theca cell tumor→Estrogen secretor→Endometrial hyperplasia

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29
Q

Most common cause of second stage prolonged or arrested labor

A

Fetal malposition→deviation from occiput anterior (occiput transverse, occiput posterior)→cause cephalopelvic disproportion

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30
Q

Optimal fetal position

A

Occiput anterior→facilitated cardinal movements of labor

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31
Q

Diagnosis of choriamnionitis

A

Maternal fever plus at least one of these:

  • Fetal tachycardia >160/min for at least 10 min
  • Maternal leukocytosis
  • Maternal tachycardia
  • Purulent amniotic fluid
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32
Q

Main risk factor for chorioamnionitis

A

Premature or Prolonged (>18 hours) rupture of the membranes

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33
Q

Treatment of Chorioamnionitis

A
  • Antibiotics: Ampicilin + Gentamycin for vaginal delivery, add Clindamycin for C-section
  • Expedited Delivery: labor augmentation; cesarean delivery is reserved for standard obstetric indications
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34
Q

Which medication is contraindicated in chorioamnionitis?

A

Tocolytics regardless gestational age

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35
Q

Common renal abnormalities in Mayer-Rokitansky-Küster-Hauser syndrome, why?

A

Unilateral renal agenesis, pelvic kidneys, duplication of the collecting system►Internal genitalia and primitive kidney have common embryologic source

*Müllerian (paramesonephric) agenesis

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36
Q

Structures derived from Müllerian (paramesonephric) ducts

A

1/3 upper vagina, cervix, uterus, fallopian tubes

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37
Q

Best management for recurrent late decelerations

A
  1. Intrauterine resuscitative interventions→O2, IV fluids, discontinuing uterotonics►Improve uteroplacental blood flow and fetal oxygenation
  2. If remote for delivery (not 10 cm dilated) and no improvement with initial management→Cesarean
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38
Q

What are recurrent late decelerations?

A
  • Late decelerations→gradual ↓FHR with nadir after the peak of uterine contraction, no return baseline until contraction ends
  • Recurrent→with =>50% of contractions
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39
Q

When do you suspect an androgen-secreting neoplasm of the ovaries or adrenal glands?

A
  • Rapid onset hirsutism (<1 year)

- Virilization→temporal balding, excessive muscular development, enlarged clitoris

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40
Q

How do you evaluate the patients with suspected androgen-secreting neoplasm? Why?

A
  • ↑Testosterone and ↓DHEAS►ovarian source, more common

- ↑Dehydroepiandrosterone sulfate (DHEAS)→adrenal tumor, far less common

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41
Q

Secondary amenorrhea, negative pregnancy test, normal prolactin and TSH levels, progestin challenge test confirming low estrogen levels

A

Functional hypothalamic amenorrhea

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42
Q

Patients with functional hypothalamic amenorrhea have a great risk to develop which condition?

A

Decreased bone mineral density

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43
Q

Hyperandrogenism signs and symptoms in polycystic ovary syndrome

A

Male pattern hair loss, hirsutism, severe acne (nodulocystic, on the back)

*Laboratory: ⬆serum testosterone

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44
Q

Which diseases must be screening in PCOS patients?

A

Metabolic syndrome→Hypertension, DM, dyslipidemia

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45
Q

Gold standard test for DM screening in PCOS

A

Two-hour oral glucose tolerance test→more sensitive in detecting intolerance than fasting glucose and HbA1C

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46
Q

Indication for BRCA mutation testing

A

Family history ovarian cancer at any age or personal/family history of breast cancer <=50 in first degree relative

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47
Q

How do you distinguish typical nausea and vomiting of pregnancy from hyperemesis gravidarum?

A
  • Ketones on urianalysis (due prolonged hypoglycemia)
  • Hypochloremic metabolic alkalosis, Hypokalemia
  • ↑Aminotransferases
  • Change volume status→dehydration, orthostatic hypotension
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48
Q

Clinical manifestations of hyperemesis gravidarum

A
  • Severe and persistent vomiting
  • > 5% loss weight or 6 lb compared with pregnancy weight
  • Dehydration→hypotension, dry mucous membranes, decreased skin turgor
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49
Q

Causes of Abnormal uterine bleeding

A

PALM (structural causes)-COEIN (nonstructural causes)

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy/Hyperplasia
  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic (anticoagulants, OCPs, IUD) or Infection/Inflammation
  • Not yet classified
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50
Q

When do you suspect AUB secondary to ovulatory dysfunction?

A

Heavy bleeding menses in adolescents

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51
Q

Cause of ovulatory dysfunction

A

Immature hypothalamic-pituitary-ovarian axis

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52
Q

Treatment of AUB secondary to ovulatory dysfunction

A

Intravenous estrogen (conjugated equine estrogen) or high-dose oral estrogen/progestin contraceptive pills

*High dose progestin in case contraindications of estrogen (history of throboembolism) - Not as effective as estrogen

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53
Q

What is the combined test, when you may run it?

A
  • B-hcg, Maternal PAPP-A, nuchal translucency

- 9-13 weeks to assess for Down syndrome

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54
Q

What is the triple and quad screen and when do you run it?

A
  • Maternal serum alpha fetoprotein (MSAFP), B-hcg, Estriol + Inhibin A (quad)
  • 15-20 weeks to screen congenital problems
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55
Q

Quad screen profile in trisomy 18 vs trisomy 21

A
  • Trisomy 18→↓MSAFP, ↓Estriol, ↓ or normal Inhibin A, ↓B-hcg

- Trisomy 21→↓MSAFP, ↓Estriol, ↑Inhibin A, ↑B-hcg

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56
Q

What would an increase MSAFP elevation suggest?

A
  • Open neural tube defects (anencephaly, spina bifida)
  • Abdominal wall defects (gastroschisis, omphalocele)
  • Multiple gestation
  • Incorrect gestational dating
  • Fetal death
  • Placental abnormalities (eg, placental abruption)
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57
Q

Why do you use tocolytics?

A

Preterm labor management

  • Allow time for steroids to work➡⬇risk of neonatal respiratory distress syndrome
  • Transportation to another medical center
58
Q

Best initial test when suspect placenta previa

A

Transabdominal ultrasound and then Transvaginal ultrasound

59
Q

Post-cesarean patient with shock, no signs of uterine atony, no incisional bleeding and minimal abdominal pain. Management.

A
  • Postpartum hemorrhage►intrapartum uterine artery injury→intraabdominal bleeding→retroperitoneal hematoma
  • Rapid and massive blood loss→Hemodinacally unstable→Emergency laparotomy
60
Q

Which contraceptive method is contraindicated in hypertension and why?

A
  • Combined estrogen-progestin oral contraceptives, estrogen-progestin vaginal ring
  • Estrogen-induced angiotensinogen synthesis

*Use copper-containing uterine devices

61
Q

Clinical presentation of Vasa previa

A
  • Painless vaginal bleeding with ROM or contractions (tear unprotected fetal vessels)
  • Fetal heart abnormalities (bradycardia, sinusoidal pattern)
  • Fetal exsanguination and demise
62
Q

Pathognomonic sign of uterine rupture

A

Loss of fetal station→presenting fetal part may retract

63
Q

Indications for endometrial biopsy in women with AUB under 45

A
  • Failed medical management (combined oral contraceptives)
  • Persisten >6 months AUB
  • Tamoxifen therapy
  • Obesity

*Rule out endometrial hyperplasia/cancer (Risk: Unregulated excess of estrogen)

64
Q

Use of Progesterone withdrawal test

A
  • Evaluate secondary amenorrhea (no menses >6 mo with previous irregular menses)
  • Determine if amenorrhea is from low estrogen levels→no bleeding after progesterone
65
Q

What is an early deceleration?

A

A visually apparent, gradual (onset to nadir in >30 seconds) ↓FHR, with return to baseline that mirrors the uterine contraction.

*Onset, nadir, and recovery of the deceleration are coincident with the beginning, peak, and ending of the contraction respectively (“mirror image”)

66
Q

What is a late deceleration?

A

A visually apparent, gradual (onset to nadir in >30 seconds) ↓FHR, nadir occurs after peak of contraction

67
Q

What is the Fitz Hugh Curtis Syndrome?

A

Gonococcal perihepatitis or perihepatitis syndrome

*Complication of pelvic inflammatory disease: Neisseria gonorrhoeae and Chlamydia trachomatis

68
Q

Etiology of primary dysmenorrhea

A

↑Endometrial prostaglandin production→uterine hypercontractility, hypertonicity→ischemia

69
Q

Most accurate test for Pelvic Inflammatory Disease

A

Laparoscopy➡Only if diagnostic is unclear, symptoms persist despite therapy, recurrent episodes of unclear reasons

70
Q

Findings on intrapartum fetal heart rate monitoring during cord prolapse

A

May present with variable decelerations, but typically: Abrupt, prolonged deceleration or bradycardia

*Umbilical compressed with no subsequent decompression

71
Q

Use of fetal scalp stimulation

A

Evaluate fetal acidosis in patients without accelerations on FHR monitoring

*Do NOT perform in patients with prolonged decelerations or bradycardia

72
Q

Which benign condition might mimic breast cancer in the clinical and mammography findings? How do you distinguish them?

A
  • Fat necrosis of the breast➡associated with breast surgery (reduction/reconstruction) and trauma (Ex, seatbelt injury)
  • Clinical examination: Fixed, firm irregular mass, skin or nipple retraction
  • Mammography: Calcifications
  • Distinguish
  • Ultrasonography: hyperechoic mass (suggest benign etiology)
  • Biopsy: Fat globules, foamy histiocytes
73
Q

Management of CIN 3 (cervical intraepithelial neoplasia 3)

A

High grade dysplastic lesion of squamous epithelium; In nonpregnant >25 yrs:
- Excision of the transformation zone➡cervical conization▶LEEP, cold knife conization, cryoablation

*Risk progression to invasive squamous cell cervical carcinoma

74
Q

Treatment of hyperemesis gravidarum

A
  • Dietary changes
  • Antihistamines: doxylamine or diphenhydramine, adding pyridoxine
  • If no response, discontinue doxylamine-pyridoxine and add metoclopramide, promethazine, or prochlorperazine (dopamine antagonist)
  • No response, 5HT antagonist (Ondansetron)
75
Q

What is the arrest of cervical dilation?

A

No dilation of the cervix for more than 2 hours

76
Q

What is a prolonged latent stage?

A
  • Primipara: more than 20 hours to reach 6 cm of dilation (reach active phase)
  • Multipara: more than 14 hours to reach 6 cm of dilation
77
Q

What is protracted cervical dilation?

A

Less than 1.2 cm of dilation per hour (primipara) and 1.5 cm (multipara), during the active phase of stage 1 labor

78
Q

Causes and treatment for protracted cervical dilation

A
  • Cephalopelvic disproportion: Cesarean delivery

- Weak uterine contraction: Oxytocin

79
Q

Treatment of simple breast cyst

A

Aspirate IF patient is in severe pain

80
Q

Best initial test for probable breast mass

A
  • Mammogram
  • Regardless when was the last mammogram, even under age of 30 - MTB source
  • Ultrasonography to differentiate a mass from fluid-filled vs solid➡Fine-needle aspiration (FNA) [alleviate pain and confirm that is cystic]➡Excisional biopsy if no fluid is obtained or if the fluid is bloody on aspiration
  • FA source
81
Q

What is the Paget disease of the vulva? Clinical presentation

A

Intraepithelial neoplasia➡vulvar soreness and

pruritus; red lesion with a superficial white coating

82
Q

Management in pregnants to prevent neonatal group B Streptococcus infection. Indications of treatment.

A
  • GBS bacteriuria or GBS urinary tract infection in current pregnancy
  • GBS-positive rectovaginal culture (screen at 35-37 wks)
  • unknown GBS status + any: <37 wks, intrapartum fever, ROM >18 hrs
  • Prior infant with early-onset neonatal GBS infection
  • Intravenous Penicilin
83
Q

Management of normal labor during intrapartum in an HIV positive pregnant

A
  • Based upon the viral load at delivery:
  • <=1.000 copies➡ART, vaginal delivery
  • > 1.000 copies➡ART, Zidovudine, cesarean delivery
84
Q

What is gestational thrombocytopenia and how do you assess it?

A
  • Thrombocytopenia during second half of pregnancy
  • Peripheral blood smear➡paucity of platelets

*Most common cause of thrombocytopenia during pregnancy. Mild, without fetal or maternal morbidity.

85
Q

What is primary amenorrhea?

A

Absence of menarche age≥13 with no secondary sexual characteristics; or age≥15 with secondary sexual characteristics (Ex, axillary/pubic hair)

86
Q

Laboratory markers of primary ovary insufficiency. Usual clinical presentation.

A
  • ⬇Estradiol▶⬆FSH

- Oligomenorrhea, amenorrhea, infertility, menopausal symptoms (hot flashes)

87
Q

Etiology and risk factor for vaginal squamous cell carcinoma

A
  • Persistent HPV infection (types 16, 18)

- Chronic tobacco use➡⬇Immune response➡❌viral clearing

88
Q

Which type of cancer is associated with Diethylstilbestrol (DES) in-utero exposure?

A

Vaginal clear cell adenocarcinoma

89
Q

Most common cause of vesicovaginal fistula

A

Obstructed labor➡injury and necrosis to the maternal vagina, rectum and bladder▶erosion, fistula

*Associated with resource-limited areas, young maternal age (small pelvis), lack prenatal care

90
Q

How do you identify or suspect vesicovaginal fistula?

A
  • Continuous ⬆pH vaginal discharge (due urine, malodorous due necrotic tissue)
  • Pelvic examination: vaginal pool of urine, visible defect or area of raised, red granulation tissue in anterior vaginal wall
91
Q

How do you confirm the diagnosis of vesicovaginal fistula?

A

Bladder dye testing

*Particularly in whom have small fistulas not visualized on pelvic examination

92
Q

Most common brain complications of preeclampsia

A

Endothelial cell damage▶Acute stroke

  • ➕Coagulation system + platelet aggregation➡microthrombi formation▶Ischemic stroke
  • Dysregulated cerebral blood flow➡inappropriate cerebral vasospasm➡⬆⬆perfusion pressure➡ruptured intracerebral vessels▶Hemorrhagic stroke
93
Q

Fetal heart rate tracing of uterine rupture

A

Might be the first sign

  • Bradycardia
  • Late decelerations
  • Variable decelerations

*Palpable fetal parts➡irregular protuberance in lower abdomen

94
Q

Management of a pregnant patient with history of genital HSV infection and no recent outbreaks

A

Beginning at 36 weeks gestation until delivery➡antiviral prophylaxis (acyclovir, valacyclovir) regardless of symptoms

95
Q

When do you suspect a Sertoli-Leydig cell tumor in a woman?

A
  • Rapid-onset virilization➡voice deepening, male-pattern balding, ⬆muscle mass, clitoromegaly
  • Oligomenorrhea
  • Unilateral, solid adnexal mass
96
Q

Anemia in pregnancy

A
  • Hb<11 g/dL in 1st and 3rd trimester

- Hb<10.5 g/dL in 2nd trimester

97
Q

Teratogenic effects of ACEI and ARBs

A
  • Fetal renal hypoplasia: bilateral small, underdeveloped fetal kidneys, small fetal bladder with minimal urine
  • Oligohydramnios: AFI≤5cm▶⬆Risk of pulmonary hypoplasia and facial and limb defects (Potter sequence)

*Angiotensin II required for fetal renal development and maintenance of fetal GFR

98
Q

First-line test for a patient with primary infertility and a history of PID

A

Hysterosalpingogram➡assess fallopian tube patency

*PID is an important cause of infertility due to tubal scarring and obstruction

99
Q

Prophylaxis for preeclampsia and in which patients may we use it?

A
  • Daily low-dose aspirin at 12 weeks gestation (12-28 wks, optimally before 16 wks)
  • High-risk patients: DM, HTN, multiple gestations, prior preeclampsia, CKD, autoimmune disease
100
Q

Indication of indomethacin for preterm labor management

A

Tocolysis at <32 weeks

101
Q

Best next step in a young woman (<25) with dysuria and sterile pyuria

A

Common presentation of Chlamydia trachomatis-associated urethritis➡nucleic acid amplification testing for chlamydia (also gonorrhea because common co-infection)

*Urine or vaginal/cervical swab

102
Q

Best next step when identifying mixed urinary incontinence (stress and urgency symptoms)

A

Urodynamic testing➡tracks fluid intake, urine output, leaking episodes➡ classifies predominant type to determine appropriate treatment

103
Q

What is Mittelschmerz and what are the symptoms?

A

Ovulation (in the middle of menstrual cycle)➡unilateral sudden lower quadrant pain and enlarged anexa

*May mimick appendicitis

104
Q

Does the cesarean decrease the risk of having late-onset GBS neonatal sepsis and/or meningitis from a positive screened mother?

A
  • No, horizontal transmission (late-onset) may happen.
  • Intrapartum antibiotics ⬇risk of early-onset GBS disease, but are not needed in cesarean. Nevertheless, cesarean nor antibiotics do not eliminate colonization▶horizontal transmission
105
Q

Risk factors for placenta previa

A
  1. Prior cesarean delivery
  2. Prior placenta previa
  3. Multiple gestation
  4. Advance maternal age (≥35)
106
Q

How do you identify the acute fatty liver of pregnancy?

A
  • 3rd trimester RUQ pain, ⬆risk multiple gestation
  • Hepatic inflammation (leukocytosis, ⬆aminotransferases)➡Liver failure (⬆ bilirubin, profound hypoglycemia)➡Multiorgan system failure (CID, AKI)
  • Placenta hypoperfusion➡Fetal hypoxemia, acidosis, death

*Defective maternal-fetal fatty acid metabolism

107
Q

High risk of sexually transmitted infection during pregnancy

A
  • Age <25
  • Prior STI
  • High-risk sexual activity (multiple partners, commercial sex work)
108
Q

Screening for high-risk STI during pregnancy

A

At the initial prenatal visit and 3rd trimester

  • HIV
  • Syphilis
  • Gonorrhea
  • Hepatitis B virus
  • Chlamydia
109
Q

Therapy to induce ovulation in polycystic ovary syndrome

A
  1. if Obese→weight loss►↓peripheral estrogen conversion
  2. Letrozole (aromatase inhibitor)→inhibits the conversion of androgens to estrogens► normalizing FSH, LH levels→surge of LH►Ovulation (higher live birth rate than clomiphene citrate)
110
Q

Diagnosis of cervical insufficiency

A

Any one of the following criteria:

  • Examination-based: Painless cervical dilation in the current pregnancy
  • Ultrasound-based: Second-trimester cervical length ≤2.5 cm plus a prior preterm delivery
  • History-based: ≥2 prior consecutive, painless, second-trimester losses
111
Q

When do you use Fetal fibronectin (fFN) testing?

A

Distinguish between preterm and false labor in patients with preterm contractions between 22 and 35 weeks gestation

*Extracellular matrix protein located between the maternal decidua and fetal chorion

112
Q

How do you distinguish vasa previa vs placenta previa?

A

Both present with painless vaginal bleeding:

  • Placenta previa: early stage of bleeding is primarily maternal in origin→reactive (normal) fetal heart rate tracing
  • Vasa previa: bleeding is primarily fetal in origin→rapid deterioration of the fetal heart rate tracing
113
Q

Potential vitamin deficiency as a complication of hyperemesis gravidarum

A

Thiamine deficiency➡Wernicke encephalopathy

  • Altered mental status (encephalopathy)
  • Oculomotor dysfunction (horizontal nystagmus, bilateral abducens palsy)
  • Postural and gait ataxia
114
Q

Best next step in a postmenopausal woman with a benign-appearance adnexal mass (eg, ovarian cyst)

A

CA-125 level➡malignancy risk stratification

115
Q

How do you distinguish the source of severe hyperandrogenism in females?

A

Suggestive androgen-secreting tumor:

  • Ovarian androgen-secreting tumor➡⬆⬆Testosterone (>150 ng/dL)
  • Adrenal tumor➡⬆Dehydroepiandrostenedione (DHEAS) (>700 mcg/dL)
116
Q

Complication of ovulation induction for infertility treatment

A

Ovarian hyperstimulation syndrome:

  • 1-2 weeks after injection
  • Abdominal pain, ascites
  • Bilateral enlarged, cystic ovaries
  • Third spacing➡intravascular volume depletion (hemoconcentration), thromboembolism, multiorgan failure, death
117
Q

How do you evaluate Atypical glandular cells (AGC) result on Pap testing?

A
  • Colposcopy
  • Endocervical curettage
  • Endometrial biopsy (ectocervix, endocervix, endometrium)

*Could be Cervical or Endometrial adenocarcinoma

118
Q

Most probable diagnosis in an HIV patient with postcoital bleeding and ulcerative lesion on the cervix that bleeds with contact

A

Cervical cancer (AIDS-defining illness)

*HPV 16 & 18

119
Q

Best next step when resection of corpus luteus (e.g. oophorectomy by ovarian torsion) is done during pregnancy before week 10?

A

Progesterone supplementation until week 10➡prevent pregnancy loss

*Corpus luteus provides progesterone until week 10, then placenta takes over

120
Q

Which test should be done in patients with a high risk of preeclampsia at the beginning of the pregnancy?

A

24-hour urine collection for total protein

*Baseline and help determine if patient develop gestational hypertension (HTN without proteinuria or organ damage) vs. preeclampsia (HTN + worsening proteinuria)

121
Q

Most important negative prognostic factor for breast cancer

A

Tumor stage➡includes lymph node involvement

*Estrogen and progesterone receptor expression➡improved outcomes

122
Q

Treatment of menopause vasomotor symptoms when HRT (estrogens) are contraindicated

A

Non-hormonal therapy: SSRI

123
Q

Contraindications of systemic hormone replacement therapy

A

CAD, thromboembolism, TIA, stroke, breast cancer, endometrial cancer

124
Q

Most common cause of heavy, regular menses in adolescents

A

Von Willebrand disease

125
Q

Pre-gestational diabetes mellitus screening indication

A

Early screening with 1-hr glucose challenge test at the first prenatal visit if high risk➡obesity (or BMI≥25 kg/m2 - NBME) + ≥1:

  • Prior Gestational diabetes mellitus
  • Prior macrosomic infant (≥4kg at birth)
  • Family history of DM (first-degree relative)
  • PCOS
  • Maternal age≥40
  • Hypertension
126
Q

Most important risk factors for placenta acreta

A
  • Prior cesarean delivery

- Placenta previa

127
Q

Most common risk factor for endometrial hyperplasia/cancer

A

Obesity➡⬆⬆estrogen➡unopposed estrogen exposure

128
Q

Treatment for labial adhesion. Which are the typical physical findings found?

A
  • Topical estrogen cream (partial symptomatic or complete)

- Adhesive ridge fusing the posterior labia minora in the midline

129
Q

Clinical presentation of Labia adhesion

A
  • Partial➡asymptomatic or pain/prutitus, escoriations➡⬆adhesion development
  • Complete➡small orifice for urine to come out, covering urethral meatus➡⬆recurrent UTI
130
Q

Tocolytics indicated by gestational age

A
  • <32 weeks➡Indomethacin

- 32-34 weeks➡Nifedipine

131
Q

Role of Magnesium sulfate in preterm labor management

A

Fetal Neuroprotection➡⬇Risk of cerebral palsy at <32 weeks

132
Q

Treatment for new-onset severe-range hypertension* in preeclampsia

A
  • IV Labetalol: do not use if bradycardia
  • IV Hydralazine: can cause tachycardia
  • Oral Nifedipine: if tolerate oral intake

*SBP≥160 mmHg or DBP≥110 mmHg

133
Q

Most common cause of unilateral bloody nipple discharge without a coexisting breast mass or lymphadenopathy

A

Intraductal papilloma

134
Q

Most common mechanism of peripartum urinary retention

A
  • Pudendal nerve injury➡external urethral sphincter dysfunction
  • Regional neuraxial anesthesia➡bladder atony
135
Q

Side effects of indomethacin on the fetus

A

⬇Prostaglandins➡fetal vasoconstriction

  • Premature closure of ductus arteriosus
  • ⬇Renal perfusion➡fetal oliguria➡oligohydramnios
  • Give for up to 48 hours as tocolysis (preterm labor) between 24-32 weeks
  • Side effects increase if given 32-34 weeks
136
Q

Management of a patient with preterm labor at 35 weeks with no contraindication of vaginal delivery

A
  • Expectant management
  • No tocolytics indicated after 34 weeks➡⬆risk of tocolytics side effects

*Penicillin prophylaxis if GBS (+) or unknown

137
Q

Risks of complications for short interpregnancy interval

A

<6-28 months from delivery to next pregnancy

  • Maternal anemia
  • Preterm prelabor rupture of membranes (PPROM)
  • Preterm delivery
  • Low birth weight
138
Q

Best next step in management in a 12 years old female with one week of suprapubic pain, history of cyclic lower abdominal pain, suprapubic mass on examination a blue-tinged bulge between the labia (hematocolpos)

A

Imperforate hymen

  • Hymenal incision and drainage
  • Laparoscopy is wrong because drainage should be done first. If pain and chronic pain do not resolve, consider laparoscopy
139
Q

Management of second-stage arrest

A

Operative vaginal delivery (eg, vacuum-assisted)

140
Q

Best next step in a patient with a firm, immobile mass in the left or right adnexa and rectovaginal nodularity, confirmed by a CT scan, with elevated CA-125

A
  • Highly suggestive of epithelial ovarian carcinona➡Exploratory laparotomy
  • Do not do guided biopsy because it can lead to rupture of the mass and spreading of cancerous cells throughout the abdomen

USMLE Step 2 CK Flash Cards (17 decks)

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