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Ob/Gyn > ABOG study > Flashcards

ABOG study Flashcards

1
Q

what are the 3 possible definitions for primary amenorrhea?

A

No menses by:
1) age 15 w normal 2ndry sexual characteristics
2) within 5 years after breast development if that occurs before age 10
3) by age 13 with no 2ndry sexual characteristics

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2
Q

when doing progestin challenge, within how many days should bleeding occur after completion of progestin course?

A

2-7 days

note: this has high false positive (40-50%) and false negative (20%) rates

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3
Q

estradiol levels can fluctuate greatly so there’s no specific cutoff but in general greater than what level suggests ovarian follicular activity (for example when working up amenorrhea)

A

> 40 pg/mL

dont forget, ultrasound eval with endometrial thickness of at least 2 layer stripe also indicates they have sufficient estrogen.

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4
Q

what FSH level strongly indicates hypogonoadotropic hypogonadism?

A

<5 IU/L

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5
Q

what FSH level strongly indicates ovarian failure? (hypergonadotropic hypogonadism)

A

> 20IU/L

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6
Q

in workup of amenorrhea, what does a normal FSH and estradiol indicate?

A

normal hypothalamus and pituitary function. cause of amenorrhea is due to anovulation or anatomic defects (in 2ndry amenorrhea this would be like asherman syndrome)

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7
Q

cessation of menses before what age is considered primary ovarian insufficiency?

A

40 years old

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8
Q

chromosomal abnormalities will almost always result in POI before age 30. list the two possibilities (hint: not fragile x)

A

1) x and y chroosome mosaicism (note, if Y chromosome present, gonads should be removed due to risk for malignant transformation)
2) x chromosome structural abnormalities (deletions, translocations)

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9
Q

The fragile X gene FMR1 abnormal expansion of the ____ repeat on long arm of X chromosome, with greater than ____ repeats causes full syndrome, and ___ - ____ repeats causes premutation.

A

CGG
>200 full syndrome
55-200 premutation

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10
Q

autoimmune cause of POI can be from adrenal or thyroid disease. which antibodies for these should be tested?

A

adrenal: 21-hydroxlse antibodies (anti-CYP21)

thyroid: thyroid peroxidase, anti-thyroglobulin

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11
Q

which type of chemo drugs is most toxic to ovaries? (2)

A

alkylating agents (cyclophosphamide, cisplatin) and procarbazine

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12
Q

amenorrhea or delayed puberty/sexual development but normal pubic hair, and anosmia is ______ syndrome

A

Kallmann syndrome

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13
Q

what are the 3 main features of McCune-Albright syndrome (aka, Polyostotic Fibrous Dysplasia) ? and what is the pathologic mechanism? (mutation in _____)

A
  1. multiple disseminated cystic bone lesions that easily fracture
  2. cafe au lait skin spots
  3. precocious puberty

bonus: other features: ovarian cysts, growth hormone and prolactin adenomas, hyperthyroidism, hypercortisolism, osteomalacia

mechanism: mutation in the alpha subunit of a G protein

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14
Q

what is the most common cause of precucious puberty onset AFTER 4 years of age?

A

idiopathic

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15
Q

what is the most common cause of precocious puberty onset BEFORE 4 years of age?

A

CNS lesion

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16
Q

what is the most common cause of delayed puberty?

A

ovarian failure. specifically, gonadal dysgenesis (Turner syndrome, Swyer’s syndrome).

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17
Q

what imaging modality should be used to evaluate renal system in someone who has mullerian anomalies?

A

CT urogram or renal ultraosund

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18
Q

ultraound findings diagnostic of pregnancy failure:

1) CRL of ___mm or greater and no heart beat.

2) mean sac diameter of _____mm and no _____

3) absence of EMBRYO W HEARTBEAT, _____ or more after ultrasound that showed ________

4) abscence of embryo WITH HEART BEAT _____ or more after US that showed _________

A

1) 7mm CRL and no heartbeat

2) 25mm sac diameter and no embryo

3)absence of EMBRYO W HEARTBEAT, 2 weeks after scan that showed gestational sac WITHOUT a yolk sac aka empty gestational sac

4) abscence of embryo WITH HEART BEAT 11 days or more after US that showed gest sac WITH yolk sac

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19
Q

criteria for APLS diagnosis:

A

clinical:

lab:

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20
Q

failure to lactate within 7 days after delivery may be the first sign of what syndrome?

A

sheehan’s syndrome

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21
Q

relative vs absolute contraindications for MTX

A
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22
Q

testes determining factor AKA SRY gene is located where?

A

distal short arm of the Y chromosome

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23
Q

what is hereditary pattern/gene of AIS?

A

X-linked recessive
(mutation in androgen receptor gene)

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24
Q

what is hereditary pattern/gene of 5alpha reductase defic?

A

autosomal recessive

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25
Q

what is most common gonadal tumor to occur in people with 46 XY with female phenotype?

A

gonadoblastoma (can also have dysgerminomas and embryonal carcinomas)

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26
Q

mechanism of clomiphene vs letrozole

A

clomiphene:

letrizole:

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27
Q

prevalence of endometriosis in general population of reproductive age is 6-10%. what’s the prevalence in infertile women? in chronic pelvic pain?

A

infertility: 38% (20-50%)

CPP: 71-87%

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28
Q

which inherited thrombophilia testing is affected by pregnancy?

A

Protein S deficiency

29
Q

first line treatment and alternatives (2) for chlamydia

A

1st line: doxy 100mg bid x7 days

alternatives:
azithromycin 1000mg single dose, or
levofloxacin 500mg qd x7days

30
Q

first line treatment and alternatives (1) for gonorrhea

A

1st line: ceftriaxone. 500mg IM if <150kg. 1000mg if =>150kg

alternatives:
Gentamycin 240mg IM PLUS Azithromycin 2g

31
Q

if someone has genital ulcer what 3 stds should you test for?

A

syphilis, HSV, HIV

32
Q

prophylaxis after rape includes rocephin x1, doxy and flagyl x7 days, and offer what other 4 things?

A
  1. offer hep B vaccine initial dose
  2. offer HIV 28 day PEP
  3. offer HPV vaccine ages 9-26
  4. tetanus booster
33
Q

redose cephazolin intraop at ____ hours, and if >= ______ml blood loss

A

4 hours
1500ml

34
Q

average age of diagnosis of interstitial cystitis?

A

40 yrs old

35
Q

what med can help food related exacerbation of interstitial cystitis?

A

calcium glycerophosphate (prelief)

36
Q

what is embryologic origin of primary oocytes?

A

yolk sac

37
Q

when does meiosis I occur?

A

starts in utero
arrests in prophase until that egg is selected for ovulation.
becomes 23x from 46 xx

38
Q

when does meiosis II occur?

A

when selected for ovulation, goes from prophase I then arrests in metaphase II until fertilization.
becomes mature oocyte +2nd polar body. still 23x

39
Q

after fertilization, the zygote undergoes ______ to multiply after which it becomes a Morula (16-32 cells)

A

cleavage

40
Q

what phase is the developing embryo in when impantation occurs?

A

blastocyst (morula day 4, then starts to accumulate fluid called blastocoel, together= blastocyst)

41
Q

what does urogenital sinus give rise to (4)?

A
  1. urethra
  2. bladder
  3. distal 2/3 of vagina
  4. skenes and bartholins glands
42
Q

what is embryologic origin of penis (2)

A

phallus and urogenital folds

43
Q

what is embryologic origin of uterus and fallopian tubes?

A

paramesonephric duct

44
Q

what is embryologic origin of labia? (2)

A

labia minora- urogenital folds
labium majora- labioscrotal swellings

45
Q

what is embryologic origin of hymen?

A

mullerian tubercle

46
Q

what are the 3 shunts in fetal circulation?

A
  1. ductus arteriosis- right atrium to left atrium (bypass lung)
  2. foramen ovale- pulmonary artery to aorta (bypass lung)
  3. ductus venosus- come off of umbilical vein , bypass liver, go to vena cava
47
Q

lithium is associated with what fetal anomaly?

A

Ebstein anomaly (downward displacement of tricuspid valve)

48
Q

thalodimide is associated with what fetal anomaly?

A

limb abnormalities

49
Q

warfarin is associated with what fetal anomaly?

A

nasal and mid-facial hypoplasia, stippled femoral and vertebral epiphysis

50
Q
A
51
Q

for mono-di twins, how many days after fertilization did egg undergo cleavage?

A

4-8 days

52
Q

schiller-duval bodies (invaginated papillary structures with a central vessel) are associated with what type of tumor?

A

yolk sac tumor

53
Q

3 branches of posterior internal iliac artery?

A

ILS:

Iliolumbar (travels upwards toward spine)
Lateral sacral artery
superior gluteal (actually travels down ish. towards glutes)

54
Q

3 branches of external iliac

A

inferior epigastric artery
deep circumflex iliac artery
femoral artery

55
Q

what histological finding in clear cell carcinoma?

A

hobnail cells (bulbous nuclei that protrude into lumen at cytoplasmic limits of the cell)

56
Q

what histological finding in granulosa cell tumor?

A

Call-Exner bodies (giving a follicle-like appearance, are small eosinophilic fluid-filled punched out spaces between granulosa cells)

57
Q

what histological finding in papillary serous carcinoma?

A

psammoma bodies (round, calcium phosphate spherules that look like hardened concentric rings)

58
Q

which germ cell tumor has solely elevated AFP?

A

endodermal sinus tumor

59
Q

which germ cell tumor has elevated AFP and B hcg?

A

embryonal carcinoma

60
Q

what is treatment for toxoplasmosis?

A

Pyrimethamine and sulfadiazine

61
Q

neonatal mortality rate for severe neonatal varicella and whats delivery time frame this is highest risk for

A

4-5 days before to 2 days after mom gets it

20% mortality rate

62
Q

most common antigen involved in NAIT (fetal-neonatal alloimmune thrombocytopenia)?

A

HPA-1a

63
Q

cytoplasmic glycogen demonstrated with periodic acid-Schiff stain is pathognomonic for what type of tumor?

A

dysgerminoma

64
Q

which ovarian neoplasm has elevated inhibin and CA 125?

A

granulosa cell tumor
(obvis estrogen also elevated but you dont normally get that with tumor markers)

65
Q

if patient is taking _____, this is a contraindication to taking paroxetine (FDA approved for vasomotor menopausal symptoms)

A

tamoxifen

66
Q

what chromosome is brca 1 and brca 2 located on (they are different)

A

brca 1 = chromosome 17
brca2 = chromosome 13

67
Q

what 2 drugs are FDA approved for vasomotor menopausal symptoms besides HRT?

A

fenolizetant
paroxetine

68
Q

overlapping fingers and rocker bottom feet are features of _____ syndrome

A

edwards syndrome

69
Q

polydactyly (extra fingers) and microcephaly and cleft lpalate and absent eyebrows are signs of ____ syndrome

A

patau (T13)

Ob/Gyn (2 decks)

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