repro

Question 1

when can you dx primary amenorrhea

Answer 1

13y w/o 2ndary sex characteristics

15y w/ 2ndary sex characteristics

Question 2

primary amenorrhea. breasts and uterus are both present.

Answer 2

outflow obstruction

Question 3

primary amenorrhea. breasts are absent, uterus is present.

Answer 3

1. (if high FSH/LH) ovarian causes e.g. premature ovarian failure, Turners (XO)
2. (if low FSH/LH) hypothalamus/pituitary failure or late puberty

Question 4

primary amenorrhea. breasts present, uterus is absent

Answer 4

mullerian agenesis (46xx)
androgen insensitivity (46xy)

Question 5

primary amenorrhea, short stature, webbed neck, low hairline, low set ears, wide nipples

Answer 5

turners syndrome (45xo)

Question 6

acquired endometrial scarring

Answer 6

ashermans syndrome

Question 7

tender and “boggy uterus” on exam

Answer 7

adenomyosis (endometrial tissue within the myometrium)

Question 8

what is the most effective therapy for adenomyosis

Answer 8

total abdominal hysterectomy

Question 9

what are medical treatments for leiomyomas

Answer 9

progestins

leuprolide* (shrinks uterus by 50%)

Question 10

what is the mgmt of leiomyomas to preserve fertility

Answer 10

myomectomy

Question 11

what is the definitive tx for leiomyomas

Answer 11

hysterectomy

Question 12

postpartum uterine infx due to retained products of conception

Answer 12

endometritis

Question 13

postpartum fever, abdominal pain, and uterine tenderness, think this

Answer 13

endometritis

Question 14

tx for endometritis

Answer 14

abx

Question 15

cyclic premenstrual pelvic pain, dysmenorrhea, dyspareunia, think this

Answer 15

endometriosis

Question 16

definitive dx for endometriosis

Answer 16

laparoscopy with bx

Question 17

chocolate cyst

Answer 17

endometrioma of the ovaries

Question 18

mgmt for endometriosis

Answer 18

1. suppress ovulation w meds
2. laparoscopy with ablation (if fertility desired)
3. TAH with salpingoophorectomy

Question 19

screening test for endometrial hyperplasia

Answer 19

transvaginal ultrasound

Question 20

consider endometrial hyperplasia if endometrial lining is greater than ____

Answer 20

4mm

Question 21

definitive dx for endometrial hyperplasia

Answer 21

endometrial bx

Question 22

tx for endometrial hyperplasia w/o atypia

Answer 22

progestin, repeat bx in 3-6mo

Question 23

tx for endometrial hyperplasion w/ atypia

Answer 23

hysterectomy +/- BSO, treat as previous card if not surgical candidate or wish for fertility

Question 24

what if a pt has postmenopausal bleeding, you do US, and endometrial stripe is < 4mm?

Answer 24

repeat US in 4mo if continued bleeding, consider bx

Question 25

pt presents with vaginal bleeding + abd pain + recent amenorrhea. think?

Answer 25

threatened abortion or nonviable pg

Question 26

what drug induces ovulation and is often given in infertility

Answer 26

clomiphene

Question 27

what size ovarian cyst is usually functional and resolves on its own

Answer 27

< 6-8cm

Question 28

when should you repeat US for functional cyst

Answer 28

6 weeks

Question 29

tx for ovarian cancer

Answer 29

TAH-BSO, lymphectomy, chemo

Question 30

a pg woman has painless dilation and effacement of the cervix in her 2nd trimester. what is this

Answer 30

cervical incompetency

Question 31

how to manage cervical incompetency

Answer 31

1) bed rest, weekly injections of 17 a-hydroxyprogesterone | 2) cerclage if you wanna

Question 32

older pt presents with vaginal itching and on exam you see red/white ulcerative, crusted lesions. suspect?

Answer 32

vulvar cancer

Question 33

included in the mgmt for an ectopic pregnancy, you should give rhogam if the mother is RH_____

Answer 33

negative

Question 34

painless vaginal bleeding. US shows snowstorm appearance

Answer 34

complete molar pregnancy

Question 35

painless vaginal bleeding .US shows cluster of grapes appearance

Answer 35

partial molar pregnancy

Question 36

US shows no products of conception (above scenario)

Answer 36

complete

Question 37

US shows gestational sac

Answer 37

partial

Question 38

mgmt of these trophoblastic diseases

Answer 38

uterine suction curretage asap, follow weekly Bhcg levels

Question 39

when is the screening for gestational diabetes

Answer 39

24-28 weeks

Question 40

what is a + result for the 50g oral glucose challenge test

Answer 40

>/ 140mg/dl after 1h

Question 41

if they fail the 50g oral glucose challenge, they go onto the 3-hour oral glucose tolerance test. what is a + result for this

Answer 41

1h > 180 2h > 155 3h > 140

Question 42

what is the gold standard test for gestational dm

Answer 42

3h GTT

Question 43

if a pt has gestational DM, when should they deliver

Answer 43

38 weeks

Question 44

when do you give rhogam if indicated

Answer 44

28 weeks gestation | within 72h of delivery

Question 45

tests for PROM

Answer 45

1. Nitrazine 2. Fern 3. Speculum exam (infx)

Question 46

mgmt of PROM

Answer 46

await spontaneous labor OR give oxytocin/prostaglandin gel to induce labor

Question 47

what amount of cervical dilation + effacements indicates premature labor (before 37 weeks)

Answer 47

> 3cm dilation | > 80% effacement

Question 48

what drugs are given to suppress uterine contractions

Answer 48

tocolytics (terbutaline, mag sulfate, nifedipine, indomethacin)

Question 49

someone is going into premature labor. IDK what the L:S test is but it is less than 2:1. what is your management

Answer 49

give tocolytics to suppress ctx for 48 hours, give antenatal steroids for fetal lung development

Question 50

when can a pt expect morning sickness to go away

Answer 50

16 weeks

Question 51

what type of morning sickness is more severe and may persist past 16 weeks

Answer 51

hyperemesis gravidarum

Question 52

what anti-emetics are first line in pregnancy

Answer 52

pyridoxine (B6) +/- doxylamine

Question 53

what is the MC cause of 1st trimester bleeding

Answer 53

threatened abortion

Question 54

pregnant pt has bloody vaginal discharge, cramping, uterine size is normal for gestation, no POC expelled, a closed cervical os, what is it and how do you manage

Answer 54

threatened abortion | tx: rest, serial Bhcg

Question 55

pregnant pt has bleeding and cramping, uterine size is normal for gestation, there is progressive cervical dilation but no POC are expelled. what is it and how do you manage

Answer 55

inevitable abortion | tx: D&E, rhogam if indicated

Question 56

pregnant pt has bleeding and cramping with a boggy uterus, some POC has been expelled, cervix is dilated. what is it and how do you tx

Answer 56

incomplete abortion | tx: D&C, rhogam if indicated

Question 57

pregnant pt has bleeding and cramping, the size of her uterus is at a pre-pregnancy state. POC has been expelled. Cervix is closed. what is it and how do you tx

Answer 57

complete abortion | tx: rhogam if indicated

Question 58

pregnant pt presents with bleeding and cramping, no POC has been expelled, her cervix is closed. what is it and how do you manage

Answer 58

missed abortion | tx: D&C/E

Question 59

at what weeks do you perform a D&C

Answer 59

5-13 weeks

Question 60

at what weeks do you perform a D&E

Answer 60

>12 weeks

Question 61

how do you dx placenta previa/placenta abrupta/vasa previa

Answer 61

pelvic US

Question 62

mgmt for placental previa

Answer 62

hospitalize, stabilize fetus (tocolytics, steroids), deliver when stable

Question 63

mgmt for abruptio placenta

Answer 63

hospitalize and immd delivery

Question 64

mgmt for vasa previa

Answer 64

immd c section

Question 65

after how many weeks can you dx gestation htn or pre eclampsia

Answer 65

after 20 weeks gestation

Question 66

when should you deliver a baby for someone who has gestation htn

Answer 66

34-36 weeks

Question 67

what should you give a pt with gestational htn (not a bp med, something else)

Answer 67

mg sulfate to prevent eclampsia

Question 68

fetal heart can be detected at ____ weeks and ______ is normal HR

Answer 68

10-12 weeks | 120-160bpm

Question 69

pelvic US can detect fetus at ____ weeks

Answer 69

5-6 weeks

Question 70

fetal movement can be detected at _____ weeks

Answer 70

16-20 weeks

Question 71

what is triple screening and when is it done

Answer 71

1) a-feto protein 2) b-hcg 3) estradiol done at 15-20 weeks

Question 72

when is GBS screening done

Answer 72

32-37 weeks

Question 73

components of apgar score

Answer 73

``` appearance/skin pulse grimace activity respiration done at 1 + 5 mins after birth ```

Question 74

what qualities give a baby a perfect apgar score (2 pts per section = 10)

Answer 74

appears: pink pulse: >100 grimace: cries or pulls away activity: flexes arm and legs resist extension respiration: strong cry

Question 75

what qualities give a baby a 0 apgar score

Answer 75

appears: blue all over pulse: 0 grimace: no response to stimulation activity: none respiration: none

Question 76

MC cause of postpartum hemorrhage

Answer 76

uterine atony

Question 77

mgmt of uterine atony

Answer 77

massage, oxytocin, misoprostol to get uterus to contract