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UWorld Flashcards

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1
Q

Most beneficial long-term Rx of Stress Incontinence

A

Urethroplexy

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2
Q

Why is a gonadectomy deffered until puberty in Androgen Insensitivity Syndrome?

A

Benefit of gonad-stimulated puberty outweighs the risk of malignancy (1-5%)

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3
Q

Risk factors for cervical insufficiency

A 
LEEP/Cone biopsy
Obstetric injury
Mullerian anomalies
Multiple gestation
Preterm delivery
2nd trimester abortion
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4
Q

What is physiologic leukorrhea

A

Non-malodorous copious white/yellow vaginal discharge in absence of other physical findings

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5
Q

Amsel Criteria for Bacterial Vaginosis

A

3/4 of:

  • Thin grey/white discharge
  • pH > 4.5
  • Positive whiff test with addition of KOH to discharge
  • Clue cells on wet mount
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6
Q

What are clue cells?

A

Vaginal epithelial cells with adherent coccobacilli

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7
Q

Complications of maternal HTN

A 
Abruption placentae
Superimposed pre-eclampsia
IUGR
Preterm
C-section
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8
Q

Fasting glucose in GDM

A

≤ 95mg/dL

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9
Q

1hr post-prandial glucose in GDM

A

≤ 140mg/dL

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10
Q

2hr post-prandial glucose in GMD

A

≤ 120mg/dL

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11
Q

Hallmarks of endometriosis

A

Dyspareunia
Dysmenorrhea
Dyschezia (pain with defecation)

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12
Q

Empiric Rx for suspected endometriosis

A

NSAIDS

OCPs

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13
Q

Indications for surgical rx for endometriosis

A 
Sx intolerable/refractory
Severe incapacitating pain
Need to exclude malignancy in adnexal mass
Need fertility rx
Evidence of complications
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14
Q

Greatest risk factor for clear cell adenocarcinoma

A

DES exposure in utero

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15
Q

Definition of infertility

A

Unable to conceive for >1 yr

>6mos if >35

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16
Q

Presenting Sx in Intrahepatic Cholestasis of Pregnancy (ICP)

A

Pruritis

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17
Q

Lab value changes in ICP

A

Elevated Bile Acids
Elevated Liver Enzymes
Dx of Exclusion

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18
Q

RFs for tubal torsion

A

Pregnancy
Ovarian masses
Ovulation induction in infertility rx

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19
Q

Which side is more at risk in tubal torsion

A

Right (longer)

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20
Q

What makes the confirmatory dx of tubal torsion

A

U/S with colour doppler

- Enlarged edematous ovary

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21
Q

Cervical mucous appearance in ovulatory phase

A

Profuse
Clear
Thin

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22
Q

Cervical mucous appearance in post and pre-ovulatory phases

A

Scant
Opaque
Thick

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23
Q

What causes amenorrhea in postpartum women

A

High levels of prolactin inhibiting GnRH

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24
Q

Definition of stillbirth

A

Fetal death at ≥20 wks

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25
RFs for stillbirth
HTN DM Smoking >10cigs/day Advanced maternal age
26
Most common presenting sx for stillbirth
Decreased/Absent fetal movement
27
Confirmatory test for stillbirth
U/S with no fetal cardiac activity
28
First step in management of stillbirth
Counseling risks/benefits of all delivery methods
29
Stillbirth delivery optionsin 2nd trim
D & C IOL NSVD
30
Stillbirth delivery options in 3rd trim
IOL +/- cervical ripening agents NSVD Repeat C-section on request if hx of previous
31
Management of placenta previa in active uncontrolled antepartum hemorrhage
Emergency C-section
32
Function of hCG
Maintenance of the corpus luteum
33
Most important risk of tamoxifen
Endometrial CA
34
Why is PID uncommon in pregnancy
Cervical mucus plug protects uterus from ascending bacteria
35
RFs for ectopic pregnancy
``` Previous hx Pelvic/tubal surgery In utero DES exposure Infertility rx Current IUD use PID Multiple sex partners ```
36
Aggravating factors for stress incontinence
Morbid Obesity Pregnancy COPD Smoking
37
Therapy for stress incontinence
``` Kegels Pessaries Estrogen replacement Burch procedure Sling procedure ```
38
Thyroid related changes in pregnancy
Increased T3, T4 | Normal TSH
39
Why do T3, T4 increase in pregnancy
Increased TBG due to Increased estrogen | TSHr stimulation by hCG
40
Safe HTN drugs in pregnancy
Methyldopa Hydralazine Labetalol Nifedipine
41
Lab values in premature ovarian failure
Increased FSH/LH | Decreased estrogen
42
What is the most common cause of pregnancy while on DPMA
Missed shot
43
What stimulates prolactin production
Serotonin | TRH
44
What inhibits prolactin production
DA
45
Management if endometrial hyperplasia w/o atypia
Progestin
46
Management if endometrial hyperplasia w/ atypia
Hysterectomy | Progestin if wish for future pregnancy
47
Definition of secondary amenorrhea
Absence of menses for >3cycles or >6mos in women who previously had menses
48
RFs for chorioamnionitis
Prolongued ROM (>24hrs) Prolongued labor Internal fetal/uterine monitoring devices Presence of genital tract pathogens
49
Delivery option with suspected placental abruption
Vaginal delivery with augmentation of labor if necessary
50
What is the most common cause of abnormal uterine bleeding in adolescents?
Dysfunction in hypothalamus-pituitary-ovarian axis leading to anovulatory cycles
51
First line therapy of abnormal uterine bleeding in hemodynamically stable patients
High dose estrogen
52
First step in management of suspected lichen sclerosus
Vulvar punch biopsy
53
Clinical manifestations of lichen sclerosus
Anogenital discomfort Pruritis Dyspareunia Painful defecation
54
What does lichen sclerosus look like
Porcelain-white polygonal macules and patches with atrophic "cigarette paper" quality
55
Rx of lichen sclerosus
Topical steroids | BID x 4wks
56
Clinical presentation of placental abruption
Sudden-onset vaginal bleeding Abd/back pain High-frequency, low-intensity CTX Hypertonic, tender uterus
57
Rx for placental abruption
Emergency C-section
58
Clinical presentation of uterine rupture
``` Vaginal bleeding Intraabdominal bleeding Decels Loss of station Palpation of fetal parts Loss if intrauterine pressure ```
59
RFs of uterine rupture
Prior uterine surgery Induction of labor/prolongued labor Congenital uterine anomalies Fetal macrosomia
60
Sx control in breast engorgement
Cool compress Acetaminophen NSAIDs
61
Sx in breast engorgement
Fullness Tenderness Warmth
62
Only seen in false labor
Ctx in lower abd Irregular CTX every 10-20min No cervical chenges CTX Relieved by sedation
63
Complications of DES exposure in utero
Clear cell adenoma Pregnancy programs Structural anomalies of the repro tract
64
Test for aneuploidy at 9-13wks
1st trim combined test | Pregnancy associated plasma protein, bHCG, nuchal translucency
65
Test for aneuploidy at 15-20 wks
2nd trim quadruple screen (Maternal serum aFP, estriol, bHCG, inhibin A) Amniocentesis
66
Test for aneuploidy at 10-13 wks
Chorionic villus sampling
67
Test for aneuploidy at 18-20 wks
2nd trim U/S
68
Test for aneuploidy at >10wks
Cell-free fetal DNA
69
Best next step in suspected unruptured ectopic pregnancy
Transvaginal U/S
70
Lab abnormalities in intrahepatic cholestasis of pregnancy
Elevated bile acids Transaminitis Dx of exclusion
71
Clinical presentation of adnexal torsion
``` Sudden onset moderate-severe pelvic pain Unilateral and tender adnexal mass N/V Low grade fever Abnormal vaginal bleeding ```
72
RFs of adnexal torsion
Ovarian mass Women of reproductive age Pregnancy Infertility rx with ovulation induction
73
Dx anf Rx of adnexal torsion
B-hCG Pelvic color doppler U/S Laparoscopy with detorsion Salpingo-oophorectomy for necrosis or malignancy
74
Cervical appearance in the ovulatory phase
Abundant mucus | Clear cervical secretion
75
Clinical features of endometriosis
Pain with menses Dyspareunia Infertility
76
Clinical features of fibroids
Heavy menses with clots Constipation, urination frequency, pelvic pain/heaviness Enlarged uterus
77
Clinical features of adenomyosis
Dysmenorrhea, pelvic pain Menorrhagia Bulky, globular and tender uterus
78
Clinical features of endometrial cancer/hyperplasia
Hx obesity, nulliparity, chronic anovulation Irregular intermenstrual or postmenopausal bleeding Small, non-tender uterus
79
Clinical features of endometritis
Recent instrumentation of the uterus Foul-smelling discharge Fever
80
Pt with hypothyroidism gets pregnant. How should she manage it?
Increase her medication
81
Appearance of HPV lesions
Teardrop shaped growths at vestibule of vulva
82
Rx of HPV lesions
Trichloroacetic acid
83
Cause of amenorrhea in female athletes
Estrogen deficiency
84
Features of threatened abortion
Vaginal bleeding Closed os Fetal cardiac activity
85
Features of missed abortion
No vaginal bleeding Closed os No fetal cardiac activity or empty sac
86
Features of inevitable abortion
Vaginal bleeding Dilated os Products of conception may be seen or felt
87
Features of incomplete abortion
Vaginal bleeding Dilated os Some products expelled and some remain
88
Features of complete abortion
Vaginal bleeding Closed os Products completely expelled
89
Precocious puberty definition
Secondary characteristics before 8 in girls and 9 in boys
90
What causes central precocious puberty
Early activation of the hypothalamus-pituitary-ovarian-axis
91
When do you do serial b-HCGs in a +preg test but no evidence of pregnancy?
Initial U/S is indeterminate
92
What do you suspect with a-fib and pulm edema sx?
Mitral stenosis
93
Other name for chorioamnionitis
Intraamniotic infection
94
Who commonly has chorio?
Prolongued ROM
95
Prolonged ROM definition
>18hrs
96
Dx criteria of chorio
``` Maternal fever >1 and one of: Uterine tenderness Maternal/fetal tachy Malodorous amniotic fluid Purulent vaginal discharge ```
97
Initial management step in chorio
Broad spectrum ABX | Oxytocin
98
What lessens the adverse effects of menopause
Conversion of adrenal androgens to estrogens by adipose
99
Severe pre-eclampsiais is any of:
``` BP >160 sys or >110 dia on 2 occasions >4hrs apart Plts 1.1 or doubling Elevated transaminases Pulm edema New onset visual or cerebral sx ```
100
HTN management in pregnancy
Hydralazine Labetalol Mg sulfate
101
What prevents pre-eclampsia seizures?
Mg sulfate
102
Rx for pre-eclampsia-eclampsia
Delivery
103
Screening test for secondary amenorrhea
Prolactin and TSH levels
104
Pathophysiology of primary amenorrhea
Release PGs from endometrium causes uterine CTX
105
What is IUFD?
Death of fetus in utero >20wks prior to labor
106
Confirming dx of IUFD
Real-time ultrasonogram
107
Postpartum management of IUFD
Autopsy of fetus and placenta
108
Late/post-term fetal complications
``` Oligo Meconium aspiration Stillbirth Macrosomia Convulsions ```
109
Late/post-term maternal complications
Cesarean Infection Postpartum hemorrhage Perineal trauma
110
When do you perform PAP every 5 years
Age >30
111
Definitive Rx for HELLP
Delivery
112
Rx for Placenta Previa
Scheduled C/S
113
Classic findings in aortic coarctation
Elevated BP in upper extremities | Low BP in lower extremities
114
What causes poor ovarian function in Turner's?
High FSH
115
Rx options for acute abnormal uterine bleeding
High dose IV/oral estrogen High dose combined OCPs High dose progestin Tranexamic acid
116
What is NST?
Non-stress test | Recording FHR while monitoring for spontaneous perceived fetal movements
117
What is a normal NST?
2 accels 15bpm or more above baseline lasting 15s within 20min
118
What is a non-reactive NST?
<2 accels
119
What is the most common cause of a non-reactive NST?
Fetal sleep cycle
120
Rx for hyperemesis gravidum
Ginger Hydration Pyridoxine +/- doxylamine
121
Does Sheehan affect the posterior pituitary?
Very rarely
122
Common regimen for antepartum PID
Cefotetan and Doxy Clinda and genta Cefoxitin
123
What does lithium use in 1st trim cause?
Increased risk of congenital heart disease | Classically Ebstein's
124
What does isoretinoin cause in pregnancy?
Craniofacial dysmorphism Heart defects Deafness
125
Diagnostic test for endometriosis
Laparoscopy
126
First line Rx for suspected endometriosis
NSAIDs +/- OCPs
127
Classic presentation of endometriosis
Chronic pelvic pain worsening with the onset of menses
128
Appearance of acne
Open and closed comedones and inflammatory nodules at various stages of evolution
129
Appearance steroid-induced folliculitis
Monomorphous pink papules and absence of comedones
130
Is alloimmunization a big concern in a first pregnancy?
No
131
Clinical feature of Normal Labor
Intermittent pain with CTX | Small amount of blood tinged mucous (bloody show)
132
Clinical feature of Placental abruption
Sudden onset vaginal bleeding Abd pain Hypertonic/tender uterus
133
Clinical feature of Placental Previa
Painless vaginal bleeding | Low lying placenta
134
Clinical feature of Uterine Rupture
``` Sudden-onset vaginal bleeding Constant abdominal pain Cessation of uterine CTX Palpable fetal parts Fetal deterioration ```
135
Clinical feature of Vasa previa
Painless vaginal bleeding on ROM | Fetal deterioration
136
What is Vasa Previa?
Fetal BVs traverse fetal membranes across lower segment of uterus between fetus and internal os
137
Management of threatened abortion
Expectant management until: Sx resolution Progression to inevitable/incomplete/missed
138
Management of incomplete/inevitable/missed abortion
Hemodynamically unstable, heavy bleeding: Surgical evac | Hemodynamically stable, mild bleeding: expectant, PGs, evac
139
Management of Septic abortion
Blood, endometrial cx Broad spectrum ABX Surgical evac
140
What is pseudocyesis?
Sx of pregnancy with no evidence of it
141
Vertical HIV transmission ppx
Triple antiviral therapy throughout pregnancy
142
Rx gonoccocal cervicitis
Ceftriaxone with azithro or doxy
143
What causes RUQ pain in HELLP?
Liver swelling and distention of Glisson's capsule
144
Rare life-threatening complication of pre-eclampsia
Pulmonary edema
145
Clinical feature of fibroids
Frequency, constipation Havy, prolongued menses with clots Pelvic pressure/pain Pregnancy difficulties
146
Fibroid workup
U/S
147
Fibroid rx
Observation if no sx Hormonal contraception Embolization Surgery if sx
148
Benefits of combination OCPs
Prevent pregnancy Endometrial and ovarian cancer risk reduction Menstruation regulation Reduction in benign breast CA risk
149
RIsks of combination OCPs
VTE HTN Hepatic adenoma Stroke/MI (very rare)
150
What is a contraction stress test?
External FHR monitoring during spontaneous/induced CTX
151
What is the purpose of umbilical artery doppler velocimetry?
Evaluation of umbilical artery flow in fetal IUGR only
152
Delivery option in preterm labor with fetal distress
C/S 2/2 non-reassuring fetal tracing
153
Arrest of dilation in first stage of labor
Dilation >6cm with ROM and either: No cervical change for >4hrs with adequate CTX No cervical change for >6hrs with inadequate CTX
154
What causes epidural induced hypotension?
Vasodilation and venous pooling
155
Clinical features of placental previa
Painless 3rd trim bleeding | Bleeding with uterine CTX
156
Features of granulosa cell tumor
Estrogen releasing Secondary sexual characteristics Precocious puberty
157
Changes in acid/base status in pregnancy
Increased pH Some metabolic compensation Decreased bicarb
158
Physical manifestations of PMS
Bloating Fatigue HA Breast tenderness
159
Psychological manifestations of PMS
``` Anxiety Mood swings Difficulty concentrating Decreased libido Irritability ```
160
What is renal colic?
Flank pain that radiates to the groin with microscopic hematuria
161
Test of choice to diagnose renal stones in pregnancy
Renal + Pelvic U/S
162
Physical manipulation to correct breech position
External cephalic version
163
What are the contraindications to external cephalic version
``` Indications for C/S Placental abnormalities Oligo ROM Hyperextened fetal head Fetal/Uterine abnormality Multiple gestation ```
164
When is external cephalic version performed
37 weeks until onset of labor
165
Chlamydia rx
Single dose azithro
166
What breast discharges are likely pathologic?
Unilateral Bloody or serous Palpable lump or skin changes
167
What are physiological breast discharges
``` Pregnancy Pituitary prolactinoma Medications Hypothyroidism OCPs Chest wall/nipple stimulation ```
168
Cervical cancer screening <21
None
169
Cervical cancer screening 21-29
Cytology every 3 years
170
Cervical cancer screening 30-65
Cytology every 3 years OR cytology + HPV testing every 5 years
171
Cervical cancer screening >65
No screening if negative prior screen and not high risk
172
When is GDM tested for?
24-28 wks
173
If GDM test shows glucose <140
No GDM
174
If GDM test shows glucose >140
Administer 100g glucose | Check fasting serum each hour for 3 hrs
175
GDM test
Administer 50g glucose | Check serum 1hr later
176
How is the diagnosis of GDM made?
``` 2 or more of the following: Fasting >95 1hr >180 2hr >155 3hr >140 ```
177
Conditions causing increased MSAFP
Neural tube defects Ventral wall defects Congenital nephrosis, obstructive uropathy Multiple gestation
178
Side effects of OCPs
``` Breakthrough bleeding Breast tenderness, nausea, bloating Amenorrhea HTN VTE Decreased ovarian & endometrial cancer risk Increased cervical cancer risk Liver disorders Increased triglycerides ```
179
PCOS treatement
Clomiphene citrate
180
Lactation suppression means
Tight fitting bra Ice packs Analgesics for pain Avoid nipple stimulation
181
Before when can abortion be considered
20wks
182
Painful genital ulcers
HSV | H. ducreyi
183
Painless genital ulcers
Syphilis Chlamydia Klebsiella
184
Evaluating primary amenorrhea
Pelvic U/S for presence of uterus Present = FSH testing Absent = Karyotyping + Testosterone
185
Atrophic vaginitis sx
``` Dryness Pruritis Dyspareunia Dysuria Frequency ```
186
Atrophic vaginitis rx
Moisturizers and lubricants | Vaginal estrogen replacement
187
What kind of sports should be discontinued in pregnancy
High impact and contact
188
Modifiable risk factors for osteoporosis
``` Low estrogen Malnutrition Decreased vit D Meds Smoking Excess drinking ```
189
Sx premature ovarian failure
Amenorrhea Hot flashes Vaginal and breast atrophy Anxiety, depression, irritability
190
Lab values in premature ovarian failure
Markedly Elevated FSH | Elevated LH
191
Most appropriate initial test for Hb identification
CBC
192
Best emergency contraception option
Copper IUD
193
Sx of fetal hydantoin syndrome
``` Midfacial hypoplasia Microcephaly Cleft lip and palate Digital hypoplasia Hirsuitism Developmental delay ```
194
What causes fetal hydantoin syndrome?
Phenytoin
195
What is the earliest sign of Mg toxicity?
Decreased DTRs
196
What is the rx of Mg sulfate toxicity?
Calcium gluconate
197
What is the initial workup of an adnexal mass in a postmenopausal woman?
Transvaginal U/S and serum CA-125
198
Indications for ppx anti-D IG
``` 28-32wks Within 72hrs of Rh+ or spontaneous/threatened abortion Ectopic preg Molar preg CVS, amniocentesis 2nd/3rd trim bleeding ECV ```
199
Non-recommended vaccines in pregnancy
``` HPV MMR Varicella Smallpox Live attenuated influenzae ```
200
Routine pregnancy vaccines
Tdap | Inactivated influnzae
201
Preg vaccines for special circumstances
``` Hep B Hep A Pneumococcus H. influenzae Meningicococcus Anti-D ```
202
Defect in Kallman
No migration of GnRH and olfactory nerves

OB/GYN (3 decks)

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