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OBGYN > Duff Questions > Flashcards

Duff Questions Flashcards

1
Q

What is the normal sequence of pubertal development?

A

1) thelarche
2) adrenarche/pubarche
3) growth spurt
4) menarche

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2
Q

Regulation of menstruation:

Hypothalamus regulatory role?

A

Produce GnRH

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3
Q

Regulation of menstruation:
Pituitary Gland regulatory role?
ps. which lobe of the pituitary gland?

A

Produce LH FSH

Anterior lobe

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4
Q

Regulation of menstruation:
Ovary regulatory role?
Theca cells - stimulated by? produce?
Graunulosa cells - stimulated by? produce?

A

LH –> theca; androgen precursors for estrogens

FSH –> granulosa; androgen precursors for estradiol

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5
Q

When does ovulation usually occur in relation to the onset of the next menstrual period?

A

14 days prior to next menstrual period

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6
Q

What is the average interval from one cycle to the next? What is the range of normal?

A

Average cycle: 28 days
3-5 days of bleeding
21-35 day range

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7
Q

Bacterial Vaginosis:

Clinical manifestations

A

Thin gray discharge
Odor
Minimal inflamation
No puritis

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8
Q

Bacterial Vaginosis:

Diagnostic tests

A

pH >4.5
+ amine test
+ saline microscopy

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9
Q

Bacterial Vaginosis:

Treatment

A

Oral metronidazole (500 mg 2x daily for 7 days)

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10
Q

Candida:
Clinical manifestations
ps. which candida is most common

A

Albicans

Puritis, erythema, edema, satelite pustules, white curd-like discharge

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11
Q

Candida:

Diagnostic tests

A

Normal vaginal pH
KOH
+/- culture

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12
Q

Candida:

Treatment

A

Topical antifungals - Miconazole, clortimazole, terconazole

Oral antifungals - Fluconazole

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13
Q

Trich:

Clinical manifestation

A

Frequency, dysuria, dyspareunia, erythema, puritis, yellow-green frothy discharge, punctate cervical hemorrhages

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14
Q

Trich:

Diagnostic tests

A

pH >4.5
pap smear
saline prep - moving! (not sperm)
+/- culture

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15
Q

Trich:

Treatment

A

Single 2g dose of metronidazole

Tx sexual partner

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16
Q

What organisms are most likely to cause a Bartholin’s gland abscess?

A

Gonorrhea, Chlamydia, coliforms, anaerobes

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17
Q

What is the best initial course of management for a Bartholin’s gland abscess?

A

Drainage + abx + sitz baths

Abx: doxy (100mg BID) + metronidazole (500 mg BID)

OR

amoxicillin + clavulanic acid (875 mg)
*augmentin

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18
Q

What is the best initial course of management for a Batholin’s gland cyst?

A

Drainage + sitz baths

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19
Q

What are the management options for a recurrent Batholin’s gland cyst of abscess?

A

Marsupialization + abx

* dont excise

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20
Q

What is the purpose of a Pap smear?

A

To screen for cervical ca./abnormal cervical cytology

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21
Q

What is the optimal methodology for obtaining a Pap smear?

A

Spatula + cytobrush in a liquid medium

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22
Q

What is the appropriate screening interval for a Pap smear in a 21yo nulligravid, unmarried, sexually active woman?

A

Every 3rd year w/o HPV co-test

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23
Q

What is the appropriate screening interval in a 60yo married woman who has never had an abnormal pap smear?

A

One more or no more

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24
Q

What are the principal risk factors for cervical cancer?

A 
Young at @ 1st intercourse
Multiple sexual partners
Smoking
HPV infection with high-risk strains
Other STDs
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25
Q

What are the best methods to prevent cervical cancer?

A

Safe sexual practices
Cervical cytology (routine Pap smears)
HPV vaccine

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26
Q

A 24yo married woman, G2P2002 with no prior hx of an abnl Pap smear, has the following cytology report: “atypical squamous cells of undertemined significance, ASC-US,” What should be the next step in her eval?

A

Recreen @ appropriate interval

Reflex HPV test (low = rescreen, high = refer to OBGYN)

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27
Q

A 28yo woman G3P2103 has a cytology report which states: “high grade squamous intraepithelial lesion; HSIL.” What should be the next step in management of this patient?

A

refer for colposcopy and bx

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28
Q

A 56yo multiparous, postmenopausal woman had the following Pap smear report: “Endometrial cells present. No squamous abnormalities notes.” What should be the next step in eval of this pt?

A

RED FLAG: endometrial bx needed immediately

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29
Q

What conditions should be considered in the ddx of acute lower abd pain in a young woman?

A 
adnexal torsion
Ectopic pregnancy
Appendicitis
Ruptured ovarian cyst
TOA
Rapidly growing neoplasm
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30
Q

What is the usual manifestations of endometriosis?

A 
Tetrad:
Dysmenorrhea
Dyspareunia
Chronic pelvic pain
Infertility
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31
Q

What is the best test for the dx of endometriosis?

A

Direct visualization by laparotomy and/or bx

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32
Q

What are the usual txs for endometriosis

A

Medical: oral contraceptives, depo-provera, GnRH analogue
Surgical: laparoscopic surgery, open laparotomy

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33
Q

What are the principlal risk factors for endometrial cancer?

A 
Advanced age
Early menarche
Late menopause
\+ family hx
Obesity
Low parity
Unopposed estrogen stimulation (polycystic ovarian dz or HRT)
HTN
Diabetes
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34
Q

What is the most common histologic type of endometrial ca.?

A

Adenocarcinoma

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35
Q

What is the best diagnostic test for endometrial ca?

A

endometrial bx

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36
Q

What is the usual tx for early stage endometrial ca?

A

surgery or radiation

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37
Q

What are the major organisms that cause PID?

A

Gonorrhea, Chlamydia

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38
Q

What are the major disorders that should be considered in the ddx of PID

A 
Ectopic Pregnancy
Appendicitis
Rupture Ovarian Cyst
Adnexal torsion
Diverticulitis
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39
Q

What lab studies are appripriate in the eval in the of a pt with suspected PID?

A 
CBC (low Hct, inc WBC)
HCG (preg test)
STD screen
US
Laparoscopy
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40
Q

What is the appropriate outpt tx for PID

A

Oflaxacin OR Levofloxacin PLUS Metronidazole

OR

Ceftriaxone PLUS doxy +/- Metronidazole

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41
Q

What is the appropriate inpt for PID

A

Cefotetan + Doxy

OR

Clindamycin + Gentamycin

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42
Q

What are the usual clinical manifestations of polycystic ovarian syndrome (PCOS)?

A

Irregular/absent menses
Obesity androgen excess (acne or hirsuitism)
Infertility
Carbohydrate intolerance
Enlarged polycystic ovaries with a thickened capsule

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43
Q

What are the potential long-term sequelae of PCOS?

A

Persistent infertility
Endometrial hyperplasia
Endometrial cancer

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44
Q

Which type of ovarian tumor is most likely in a teenager and young adult?

A

Germ cell - dermoid cyst/cystic teratoma

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45
Q

Which type of ovarian tumor is most likely in a post-menopausal pt?

A

Serous most common

Mucinous also

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46
Q

What is the most appropriate imaging study to assess and ovarian mass?

A

US

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47
Q

What are the definitions of primary and secondary amenorrhea?

A

Primary: normal secondary sexual characteristics and no period by age 16 OR no secondary sexual characteristics and no period by 14

Secondary: No period in 3 months

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48
Q

What are 2 of the unusual causes of primary, as opposed to secondary amenorrhea?

A

Genetic abnormalities: androgen insensitivity syndrome, turners
Anatomic abnormalities: agenesis, vaginal septum

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49
Q

What is the most common cause of secondary amenorrhea?

A

Pregnancy

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50
Q

What is the usual cause of primary dysmenorrhea?

A

Excessive release of prostaglandin from a secretory endometrium.

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51
Q

What is the most effective treatment for primary dysmenorrhea?

A

NSAIDs

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52
Q

What are the principal causes of abnormal uterine bleeding?

A 
Anovulatory bleeding
Endometrial hyperplasia or ca.
Myoma
Endometrial polyp
Chronic endometritis
Bleeding d/o - VWD or thrombocytopenia
Thyroid dz
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53
Q

What are the 2 tests of greatest value in assessment of a pt with abnormal uterine bleeding?

A

pelvic US or endometrial bx

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54
Q

What is the preferred test for the dx of gonorrhea and chlamydia?

A

Nucleic acid probe: PCR or NAAT

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55
Q

What are the drugs of choice for treating an uncomplicated chlamydia infection?

A

Azithromycin 1000 mg po 1 dose

Also doxy or erythromycin

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56
Q

What are the drugs of choice for treating an uncomplicated gonococcal infection?

A

Ceftriaxone (250 mg I.M. x1) PLUS Azithromycin (1000 mg ps x1)

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57
Q

What are the major l/t sequelae of gonorrhea and chlamydial infection?

A

Infertility (d/t damaged fallopian tubes)
Ectopic pregnancy
Chronic pelvic pain

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58
Q

In a primary care practice, what is the most likely stage os syphilis at the time of initial dx?

A

Latent –> wont usually see lesion, by they will test positive

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59
Q

What are the most useful diagnostic tests for the diagnosis of syphilis?

A

Serology
UDRL/RPR to screen
MHA/FTA to confirm

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60
Q

What is the characteristic lesion of primary syphilis?

A

Painless chancre lasting <2weeks

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61
Q

What are the characteristic lesions of secondary syphilis?

A

Condyloma latum

Mucous patches

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62
Q

What are the usual clinical manifestations of tertiary syphilis?

A

Destructive gummas
Aortic valve injury
CNS manifestations: dementia, tabes dorsalis, pupillary abnormalities

63
Q

What is the drug of choice for tx syphilis?

A

PCN

64
Q

What are the most useful tests for the dx of HSV infection?

A

PCR

65
Q

What are the drugs of choice for tx HSV?

A

Acyclovir

Valacyclovir

66
Q

What percent of pregnancies in the US are unplanned?

A

50%

67
Q

What is the difference btwn the “theoretical effectiveness” vs. the “user effectivness” of a contraceptive method?

A 
Theoretical = if you use it perfectly
User = true to life (MOST IMPORTANT)
68
Q

What are the 3 major natural family planning methods?

A

1) Basal Body Temp
2) Calendar rhythm
3) Observation of cervical mucous

69
Q

What are the advantages and disadvantages of the IUD as a method of contraception?

A

Ads:
Highly effective
Red’n in menstrual blood loss and cramping (progesterone IUD only)
Inexpensive in long run

Disads:
Pain w insertion
infection, perforation, dysmenorrhea, menorrhagia
High initial cost

70
Q

What is the max duration of use of the cervical cap? do you need an Rx? is it reusable?

A

<48h, no Rx, not reusable

71
Q

How long should the diaphragm be left in place after intercourse?

A

6 hr

72
Q

If a contraceptive method is classified as Category 3 by the CDC Medical Eligibility Criteria, what is the clinical implication for the patient?

A

Theoretical/proven risk outweighs advantages.

73
Q

What is the primary mechanism of action of combination oral contraceptives?

A

Blocking ovulation

74
Q

What is the overall effectiveness of combination oral contraceptives?

A

99% when used correctly

75
Q

What is the difference btwn “absolute risk” and “relative risk”?

A

Absolute: x/1000 women will see this (MORE IMPORTANT)
relative: 4x as likely to get this compared to woman not using xyz

76
Q

What are the absolute contraindications to use of combination oral contraception?

A 
LOTS!
Estrogen dependent rumor
Hx of DVT or PE
Pregnancy
Hx of undiagnosed genital tract bleeding 
Liver, heart dz
Smoking and >35yo
Diabetes w/ vascular dz
HTN, SLE
migrane w aura
Stroke
Solid organ transplant
77
Q

What are the major non-contraceptive medical benefits of combination oral contraceptives?

A 
Decrease in:
menstrual blood loss
severity of dysmenorrhea
freq of functional ovarian cysts
freq of ectopic pregnancy
78
Q

Which pts are candidates for the contraceptive patch and contraceptive ring?

A

Forgetful pts

79
Q

What is the most appropriate regimen for emergency post-coital contraception?

A 
Plan B (levonorgestrel) - 75% effective
Copper IUD - 99% effective
80
Q

What are the advantages and disadvantages of progestin-only oral contraceptives?

A

Adv: Rx for lactating women
Disad: pregnancy and breakthrough bleeding

81
Q

What are the advantages and disadvantages of Deop-Provera?

A 
Ads:
Highly effective
Good for forgetful people
Doesnt adversely affect fertility
Doesnt cause congenital anomalies
Doesnt increase risk of cancer
Can breast feed immediately
Dis: 
Breakthrough bleeding
Wt gain
Depression
Bone loss
82
Q

What are the most common clinical manifestations of menopause?

A 
Amenorrhea
Hot flashes
Vaginal dryness
Sleep disturbances
Mood changes
83
Q

What is the best test to confirm the diagnosis of menopause?

A

FSH –> elevated

84
Q

What are the specific objectives of hormone replacement therapy?

A

Decrease hot flashes

85
Q

What are the potential harmful effects of HRT in pts who are >60yo and/or have pre-existing CAD?

A

Increase risk of CAD

86
Q

In addition to HRT, what are other appropriate interventions for a pt in early menopause?

A

Nutritional and psychological counseling, antidepressants, lifestyle modifications (quit smoking, wt loss, exercise)

87
Q

What are the principle complications associated with osteoporosis?

A

Bone fractures: vertebral column and hip

88
Q

What is the best test to confirm the diagnosis of osteopenia and osteoporosis?

A

BMD –> Bone Mineral Density

89
Q

In addition to estrogen replacement, what other medications are of value in preventing/treating osteoporosis?

A

Calcium supplements
Vit D
Selective Estrogen Receptor Modifiers (SERMs)
Anti-resporptive agents - Bisphosphonates

Specific drugs: alendronate, risedronate, ibandronate, zoledronic acid

90
Q

What is the most common cause of most pelvic support defects?

A

Childbirth (vaginal)

91
Q

What is the most appropriate tx for vaginal vault prolapse?

A

Pessary

Surgery –> resuspend vault

92
Q

What are the most appropriate tests for the evaluation of a pt with urinary incontinence?

A

Urodynamic testing

93
Q

What is the most effective medical tx for a pt with urge incontinence?

A

Muscarinic receptor blockers

94
Q

What is the preferred surgical approach for a patient with stress incontinence?

A

Transvaginal slings (TVT, TOT)

95
Q

What lifestyle changes are of value in the management of a pt with urge or stress incontinence?

A

Urge:
Reduce wt, Stop smoking
Decrease/eliminate caffine intake
Re-train bladder

Stress:
Lose weight, Avoid caffeine
Re-train bladder
Empty bladder immediately before exercise

96
Q

What is the frequency of infertility in the United States?

A

15%

97
Q

What are the most common causes of male infertility?

A

Low sperm count

Diminished sperm mobility

98
Q

What are the most common causes of female infertility?

A

Anovulation
Tubal obstruction
Endometriosis
Unexplained

99
Q

What diagnostic tests should be performed to eval an infertile couple?

A

Female:
Serum progesterone = assess ovulation
BBTS = assess ovulation
Clomid challenge test = assess ovarian reserve
TSH = r/o hypothyroidism
Prolactin = assess pituitary microadenoma
HSG = ID tubal obstruction
Laparoscopy = assess uterine anomaly or endometriosis

Male:
Sperm analysis = count sperm, assess motility and morphology

100
Q

What is the most appropriate tx for the major causes of infertility?

A

Female: fertility drugs, surgery for anatomic concerns
Male: IUI, ICSI, repair varicocele

101
Q

What are the most common causes of 1st trimester pregnancy loss?

A

Karyotype abnormalities

Serious sytstemic dz (like antiphospholipid syndrome)

102
Q

What are the principal maternal and fetal indications for pregnancy termination?

A

Maternal: serious systemic dz (antiphospholipid syndrome, diabetes)
Fetal: fatal genetic abnormalities, life threatening structural abnormality

103
Q

What are the two options for 1st trimester pregnancy termination?

A

1) Medical: mifepristone + misoprostol

2) Suction curretage

104
Q

What are the two options for 2nd trimester pregnancy termination?

A

1) Misoprostol

2) Dilation and evacuation - rare

105
Q

What are the most important predisposing factors for an ectopic pregnancy?

A

PID and tubal surgery

106
Q

What is the most common site for an ectopic pregnancy?

A

Ampulla (d/t it being the location of fertilization)

107
Q

What 2 tests are of greatest value in diagnosing an ectopic pregnancy?

A

1) Anbornal increase in quantitative HCG (failure to double in 72h)
2) U/S: absence of intrauterine pregnancy; adnexal mass; blood in sac of douglas

108
Q

What is the most appropriate management for a small unruptured ectopic pregnancy?

A

Methotrexate

  • effective in 90% of patients (the other 10% will require a 2nd dose)
109
Q

What is the most appropriate management for a larger, ruptured ectopic pregnancy?

A

Surgery: removal of ectopic or removal of tube

110
Q

What is a molar pregnancy?

A

Gestational Trophoblastic Dz (GTD)
Tumor of placental tissue
Genotype: 46XX

  • Can develop de novo or after a spontaneous abortion/term pregnancy
111
Q

What are the most common clinical manifestations of a molar pregnancy?

A

1) Persistent bleeding in early 1/2 of pregnancy

2) Uterus large for dates

112
Q

What are the most valuable tests for diagnosing a molar pregnancy?

A

1) Quantative HCG = markedly elevated

2) U/S

113
Q

How should a pt with a molar pregnancy be treated?

A

Suction evacuation

*also monitor serum HCG to check for persistence

114
Q

What are the most common medical diseases that complicate pregnancy?

A 
HTN
Diabetes (increasing prevalence d/t obese mothers)
Connective tissue dz (lupus)
Acquired heart dz (Mitral valve dz)
STDs
115
Q

Which medications are clearly teratogenic?

A 
Valproic acid (unless it is the only drug that works)
Carbamazepine
Chemo tx
Warfarin (use lovanox or heparin)
Lithium
Tetracyclines - affects fetal heart
Quinolones
ACE inhs
BBlockers
Isotretinoin
Topiramate
NSAIDs
Heat
Radiation
116
Q

What are the potentially harmful effects of smoking in pregnancy?

A

1) more preterm deliveries
2) more placental abruptions
3) smaller babies

117
Q

What is the purpose of screening for hep B in pregnancy?

A

HepB can pass from mother to fetus during birth; can give mother HepB-IG to prevent transmission
(vaccine infant at 0 months and 6 months)

118
Q

What is the purpose of the Quad Screen test?

A

ID Neural Tube Defect (NTD) and Trisomy 18 & 21
(75-80% sensitive)
2nd trimester test

119
Q

A 28 year old woman G2P1001, at 6 weeks gestation has a BMI of 21. What is an appropriate weight gain during pregnancy for this patient?

A

25-30lbs

120
Q

What is the best diagnostic test to resolve discrepancies between uterine size and dates?

A

U/S

121
Q

What are the most likely MATERNAL complications associated with chronic HTN in pregnancy?

A 
CVA
Renal dz
Retinopathy
Abruption
Super-imposed pre-eclampsia
122
Q

What are the most likely FETAL complications associated with maternal HTN

A

Interuterine Growth Restriction (IUGR)

Fetal Death

123
Q

What are the clinical criteria for the dx of pre-eclampsia?

A

Triad:
BP >140/90 after 20w gestation
Proteinuria >300mg/24h
Edema

124
Q

What are the 2 likely criteria that determine the management of pre-eclampsia?

A

severity of disease, gestational age

125
Q

What are the usual clinical manifestations of placental abruption?

A 
Abdominal pain
Tetanic uterine contraction
Dark red vaginal bleeding
Coagulopathy
Abnormal fetal heart rate pattern
126
Q

What are the usual clinical manifestations of placenta previa?

A

Painless
Bright red vaginal bleeding
NO CHANGE IN FETAL HR
NO COAGULOPATHY

127
Q

What are the major factors that cause preterm delivery?

A 
Preterm PROM
Multiple gestation
Polyhydramnios
Uterine anomaly
Abruption
Previa
128
Q

What are the four most serious complications of prematurity?

A

Hyalinemembrane dz
IVH
NEV
Infection

129
Q

Why are corticosteroids administered to mothers at risk for perterm delivery

A

decreased frequency of RDS, IVH, NEC

130
Q

What percent of twins are monozygotic?

A

1/3

131
Q

What is the best test to ID twins and assess zygosity?

A

U/S

132
Q

What factors are associated with an increased risk of dizygotic twins?

A

Advanced age of mother, increased use of ART, African americans, + fam hx

133
Q

What are the most common antepartum complications associated with a twin gestation?

A 
#1 = preterm labor and delivery
Spontaneous abortion
Anomalies
Impaired growth
Polyhydraminos
Twin-twin transfusion syndrome
Pre-eclampsia
Placental abnormalities
134
Q

What are the most common intrapartum and postpartum complications associated with a twin gestation

A 
Dysfunctional labor
Malpresentation
Abruption
Abnormal FHR tracing
Cesarean delivery
Postpartum hemorrhage
135
Q

What tests are of greatest value in identifying complications related to twins?

A 
Early prenatal care
Early U/S to determine zygosity
Second trimester scan for anomalies, cervical length
Third trimester scan for fetal growth 
Frequent prenatal appointments
Limited activity 
Antepartum monitoring
136
Q

What factors should be considered in determining the mode of delivery for twins?

A

Positioning of fetus (cephalic-cephalic, cephalic breech, both breech)

137
Q

What is the principal cause of higher order multiples?

A

Assisted reproductive technologies (ARTs)

138
Q

What are the 3 stages of labor?

A

1) onset of contractions
* latent: 0-4hr
* active: 4+hrs - dilating more quickly
2) full dilation until delivery
3) delivery of baby until delivery of placenta

139
Q

What are the 2 phases of the 1st stage of labor?

A

latent and active

140
Q

What are the most likely causes of abnormal labor?

A 
Poor uterine contractility 
Over-sedation
Intrauterine infection
Malpresentation
Malposition
Fetopelvic disproportion
141
Q

Which type of anesthetic provides the most consistent and uniform effect during labor and delivery?

A

Epidural

142
Q

What are the most common indications for cesarean delivery?

A 
Dystocia 
Repeat
Stress
Bleeding
Malpresentation
143
Q

What is the most common intraoperative complication of cesarean delivery?

A

Hemorrhage

144
Q

What is the most common postoperative complication of cesarean delivery?

A

Infection (endometritis)

145
Q

What is the preferred type of uterine incision for cesarean delivery?

A

Low transverse (Kerr) - 98% of all deliveries

146
Q

An 18 year old primigravid woman at 39w gestation has been in labor for 10 hours. Her cervix has been 5cm dilated for 2 hrs. Her membranes are intact. She is having contractions eery 5-6 minutes. She rates the strength of the contractions 5+ on a scale of 10. What are the most appropriate next steps in management of this patient?

A

“Arrest of dilation”

Give pitocin or break amniotic sac

147
Q

A 28 year old woman, G2P1001 at 41 weeks gestation has been in the 2nd stage of labor for 2 hrs. The fetal head has remained at 0 station despite strong contractions and excellent voluntary pushing efforts. The pts previous baby was delivered spontaneously and weighed 3080g. The estimated weight of the present baby is 3480 grams. What is the most appropriate next step in management of this patient?

A

Arrest of descent d/t fetopelvic discrepancy (size mismatch with weight) –> c-section

can only deliver vaginally if +3 +4 or +5 station

148
Q

What are the principal causes of postpartum hemorrhage?

A

Uterine atony (drugs, chorioamnionitis, uterine overdistention, uterine malformation)
Retained placenta (accreta, increta, percreta)
Lacerations (cervical, vaginal)
Coagulopathy (severe preeclampsia, abruptio placentae, sepsis, amniotic fluid embolism)

149
Q

What are the principal risk factors for postpartum endometritis?

A 
Labor
Ruptured membranes
Multiple vaginal exams
Pre-existing vaginal infection
Cesarean delivery
150
Q

What are the most appropriate antibiotics for tx of postpartum endometritis?

A

Clindamycin + gentamicin

Metronidazole + PCN + gentamicin

Cefotetan or timentin

151
Q

What is the most appropriate treatment for a wound infection following esarean delivery?

A

Surgical drainage

Modify abx to target staphylococci and streptococci (Nafcillin, vancomycin)

152
Q

What is the best test for the diagnosis of a pulmonary embolism?

A

Spiral CT scan

Also ventilation-perfusion scan, pulmonary angiogram

153
Q

What is the most appropriate treatment for a pulmonary embolism?

A

Anticoagulation - lovanox ideally

Thrombolytic therapy

OBGYN (1 decks)

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