Week 2 UWorld and Case Files 5-8

Question 1

symptoms of ruptured ovarian cyst?

Answer 1

unilateral abdominal pain following activity

Question 2

what is a complication of a ruptured ovarian cyst? when can this arise?

Answer 2

hemoperitoneum with patients on anti coags

Question 3

what are signs, symptoms and way to diagnose hemoperitoneum from ovarian cyst rupture?

Answer 3

hemodynamic instability and peritoneal signs..dx with pelvic US

Question 4

what is first line rx for dysmenorrhea in sexualy active female?

Answer 4

OCPs combined

Question 5

what if fitz hugh curtis disease?

Answer 5

PID extension into liver capsule

Question 6

what is classic symptom of fitz hugh curtis?

Answer 6

RUQ pleuritic pain in addition to fever and lower abdominal tenderness

Question 7

following a c sxn a patient becomes hemodyamically unstable, what is best next step? what likely happened?

Answer 7

emergent laporotamy…likely injury to uterine artery in c sxn

Question 8

how do you manage pregnant patient with pyelonephritis?

Answer 8

inpatient iv abx until afebrile for 24 hrs

Question 9

complications of pyelonephritis in pregnancy 3

Answer 9

ARDS
sepsis
preterm labor

Question 10

age cutoff for primary ovarian insufficiency

Answer 10

less than 40 years

Question 11

what is often associated with primary ovarian insufficienc

Answer 11

autoimmune disease

Question 12

three gyn issues that can raise ca125

Answer 12

ovarian cancer
fibroids
endometriosis

Question 13

when is CA125 most specific for ovarian cancer?

Answer 13

in post menopausal women bc they wont have chance of fibroids and endometriosis

Question 14

two treatment options for pelvic organ prolapse

Answer 14

surgical repair or pessary fitting

Question 15

name the severe features of preeclampsia

Answer 15

elevated transaminases, thrombocytopenia, pulm edema, SBP over 160 or DBP over 110, increased creatinine

Question 16

what is management of delivery with preeclampsia with severe featurs?

Answer 16

deliver at 34 weeks

Question 17

what is management of delivery with preeclampsia without severe featurs?

Answer 17

deliver at 37 weeks

Question 18

what is risk to fetus in preeclampsia?

Answer 18

uteroplacental insufficiency leading to fetal growth restriction and low birth weight

Question 19

what are risks to mom in preeclampsia?

Answer 19

DIC, eclampsia and abruptio placenta

Question 20

what is ICP? when do you get it?

Answer 20

intrahepatic cholestasis of pregnancy in 3rd tri

Question 21

what are sx of ICP?

Answer 21

pruritis and RUQ pain

Question 22

what are lab findings in ICP?

Answer 22

elevated liver enzymes and total bile acids

Question 23

what is treatment for ICP?

Answer 23

ursodeoxycholic acid and antihistamine

Question 24

what are fetal risk with ICP?

Answer 24

demise, preterm birth, neonatal RDS

Question 25

define intrauterine fetal demis

Answer 25

no cardiac activity after 20 weeks gestation

Question 26

what is management of intrauterine fetal demise?

Answer 26

20-23 wks can do DE | 24+ need vaginal delivery induced when mom is ready

Question 27

what causes peripheral edema in pregnancy?

Answer 27

plasma volume expansion

Question 28

is shivering and chills and low fever common in post partum window of 24 hours?

Answer 28

yes..due to withdrawal of estrogen and progesterone

Question 29

what trimester US is most accurate for dating? least?

Answer 29

1st is most and 3rd is least

Question 30

what is etiology of primary dysmenorrhea?

Answer 30

increase in progesterone production

Question 31

what is 1st and 2nd line rx of primary dysmenorrhea?

Answer 31

1st is NSAIDs to decrease progesteron | 2nd is combo OCP

Question 32

finding of androgen insensitivity syndrome

Answer 32

Xy genotypye with female phenotype...outer genitalia female with breast developed but no pubic hair...inner no female parts

Question 33

four risks for abruptio placentae

Answer 33

HTN/preeclampsia, trauma, cocaine/smoking

Question 34

aside from bleeding and pain, what are two other signs of abruptio placentae?

Answer 34

high frequency contractons and firm tender uterus

Question 35

risks for having cervical insufficiency?

Answer 35

ehlers danlos, OB injury, conization

Question 36

rx for cervical insufficincy?

Answer 36

cerclage

Question 37

what happens with cervical insufficiency in pregnancy?

Answer 37

common to lose in 2nd tri...will have cervical dilation and increased vaginal discharge

Question 38

what is rx of vaginosis and trichamonis?

Answer 38

metro 500mg bid 7 days

Question 39

what are two look alikes of menopause?

Answer 39

hypothyroid and DM

Question 40

what are two signs of placenta accreta?

Answer 40

postpartum hemorrhage, difficulty delivering placenta

Question 41

how do you manage placenta accreta?

Answer 41

hysterectomy

Question 42

what are two risk factors for placenta accreta?

Answer 42

placenta previa and prior uterine surgeries

Question 43

when does septic pelvic thrombophlebitis occur?

Answer 43

post op or post partum

Question 44

why does septic pelvic thrombophlebitis occur post op and post partum?

Answer 44

because there is endothelial injury, hypercoag state and venous stasis/dilation

Question 45

what is management of septic pelvic thrombophlebitis?

Answer 45

broad spectrum abx with anticoagulation

Question 46

what are signs of septic pelvic thrombophlebitis?

Answer 46

fever that is unresponsive to abx and no infxious sx

Question 47

main symptoms of congenital Zika virus

Answer 47

microcephaly is number 1 | thinned cortices and calcifications

Question 48

in exam questions, positive leukocyte esterase means what?

Answer 48

UTI

Question 49

what is a urethral diverticulum? what can cause it?

Answer 49

a herniation of urethral tissue into surrounding tissue due to recurrent ant vaginal wall infxns

Question 50

what are sx of urethral diverticulum?

Answer 50

post void dribblinf, infection, and dyspareunia

Question 51

diagnosis and treatment of urethral diverticulum?

Answer 51

dx with MRI rx with surgery

Question 52

what is adequate contraction units in labor?

Answer 52

200 montevido units in 10 minutes

Question 53

2 definitions of arrest of active phase of labor

Answer 53

4 hours with no cervical change despite adequate contractions 6 hours with no cervical change and not adequate contractions

Question 54

what is difference between idiopathic hirsutism and hypertrichosis?

Answer 54

hirsutism hair is coarse and only grows in androgen dependent areas hypertrichosis is fine hair that can grow anywhere

Question 55

what is treatment for chlamydia in pregnancy?

Answer 55

azithromycin

Question 56

until what age do you screen yearly for chlamydia and gono?

Answer 56

25

Question 57

What is interstitial cystitis?

Answer 57

chronic bladder pain not from another condition

Question 58

what are sx of interstitial cystitis?

Answer 58

pain with filling, increased frequency and urgency and dyspareunia

Question 59

what is rx for candida in vagina?

Answer 59

fluconazole

Question 60

what is discharge like in candida in vagina?

Answer 60

thick cottage cheese like

Question 61

what is the external cephalic version maneuver? when is it done?

Answer 61

at 37 weeks move transverse of breech bby to vertex

Question 62

name contraindications to an external cephalic version?

Answer 62

prior classical c sxn prior myomectomy prior placenta previa

Question 63

what is lichen sclerosus?

Answer 63

thin white areas on labias that can extend to rectal area

Question 64

what are symptoms of lichen sclerosus?

Answer 64

ITCHY white area

Question 65

what is rx for lichen sclerosus?

Answer 65

strong corticosteroids

Question 66

who gets lichen sclerosus?

Answer 66

prepubertal and meno women

Question 67

why do postmeno women have increased UTI risk?

Answer 67

because estrogen deficiency leads to higher vaginal pH so e coli can grow more

Question 68

what is therapy to help prvent UTI occurrence in post meno women?

Answer 68

estrogen topical cream

Question 69

6 risks to fetus with illicit drug use

Answer 69

``` preterm birth preeclampsia diminished fetal growth fetal demise spontaneous abortion abruptio placentae ```

Question 70

signs of vulvar cancer?

Answer 70

pruritic vulvar plaque with AUB

Question 71

what are some risks for vulvar cancer?

Answer 71

lichen sclerosus, immunodeficiency, cervical cancer, smoking

Question 72

what is recurrence risk of preeclampsia?

Answer 72

10-20%

Question 73

what is protein cutoff for preeclampsia on 24 hour protein?

Answer 73

300 mg

Question 74

how long after delivery is magnesium continued with preeclampsia with severe features?

Answer 74

24 hours

Question 75

what is treatment for confirmed gonorrhea and negatiive chalmydia?

Answer 75

both ceftriaxone and azithromycin

Question 76

what is treatment for confirmed chlamydia and negative gono?

Answer 76

azithromycin only

Question 77

what is a biophysicsl profile?

Answer 77

non stress test of fetus with ultrasound

Question 78

what four things do you check in biophysical profile?

Answer 78

``` amniotic fluid volume fetal breathing fetal movement fetal tone non stress test result ```

Question 79

4 risk factors for placental dysfunction or insufficiency?

Answer 79

smoking HTN diabetes advanced maternal age

Question 80

how do you score biophysical profile? what is normal?

Answer 80

2 for each category normal is 8 and up

Question 81

what score on biophysical profile means placental insufficiency?

Answer 81

less than 4

Question 82

what are three clinical signs of HELLP syndrome aside from hemolysis, elevated liver enzymes and low platelets?

Answer 82

RUQ pain, preeclampsia and N/V

Question 83

what are two urinary symptoms of menopause?

Answer 83

recurrent UTIs and incontinence

Question 84

what age should cell free DNA testing start being offered for women?

Answer 84

women over 35

Question 85

3-4 days postpartum what is expected pospartum lochia?

Answer 85

dark or red blood with similar smell to menstrual blood, can have clots

Question 86

4-14 days postpartum what is expected pospartum lochia?

Answer 86

pink or brownish old blood

Question 87

14 days to 6 weeks postpartum what is expected pospartum lochia?

Answer 87

white/yellow creamy stuff

Question 88

what is management of spontaneous abortion?

Answer 88

if hemodynamically stable without anemia give misoprostol, if not hemodynamically stable then do DC

Question 89

what is management an sign of an unstable or ruptured ectopic pregnancy?

Answer 89

hemodynamic instability...surgery

Question 90

how does a ureteral laceration present post op?

Answer 90

bloating and abdominal pain with vaginal leakage/discharge that is clear

Question 91

preterm labor prior to 34 weeks gestation age, what is management?

Answer 91

give roids, penicilliin if + or unknown GBS, tocolytics like indomethacin or nifedipine

Question 92

34+ week gestation age preterm labor what is management?

Answer 92

roids and penicillin if indicated...no tocolysis

Question 93

what is a missed abortion?

Answer 93

no vaginal bleeding or cervical dilation, but no cardiac activity

Question 94

what is an inevitable abortion?

Answer 94

vaginal bleeding and dilated cervix but fetal parts all still above internal os

Question 95

what is a threatened abortion?

Answer 95

vaginal bleeding, no cervical dilation, fetal cardiac activity still there

Question 96

what skin condition can you have in vagina?

Answer 96

vitiligo