Gynecology

Question 1

Postpartum endometritis major risk factors

Answer 1

C-section (especially after onset of labor)
Prolonged labor and/or prolonged rupture of membranes
HIV
group B streptococcus colonization
Maternal diabetes.
C-section is still by far the most important, as the rate of endometritis following a C-section after onset of labor, even with antibiotic prophylaxis, is four times higher than with vaginal delivery!!

Question 2

Prolonged rupture of membranes is defined as?

Answer 2

18-24 hours passing between rupture and delivery.

Question 3

Acute fatty liver disease of pregnancy

Answer 3

3rd trimester
Acute liver failure secondary to extensive microvesicular fatty infiltration of the liver. It is due to failure of fatty acid beta-oxidation and presents with right upper quadrant pain, nausea, vomiting, and jaundice.
Elevated aminotransferases and a leukocytosis, hypoglycemia, thrombocytopenia.
Can decompensate quickly with multi-organ failure and fetal compromise.
Management is immediate delivery.

Question 4

A young woman with no family history of malignancy and a nonpalpable mass in the setting of unilateral painless bloody discharge is likely suffering from?

Answer 4

An intraductal papilloma.

Question 5

Letrozole

Answer 5

Aromatase inhibitor used to treat hormone receptor-positive breast cancer, also is the first-line treatment agent for restoring ovulation in women with PCOS and can cause decreased bone mineral density.

Question 6

Infants of women with Sjögren’s are at risk for perinatal complications?,

Answer 6

As circulating anti-Ro(SSA) and anti-La (SSB) autoantibodies can cross the placenta and result in heart block. A pacemaker may be required for the affected infant.

Question 7

Risk factors for placental abruption

Answer 7

Hypertension, previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40.

Question 8

Menopause estrogen treatment indications

Answer 8

Estrogen alone for patients who do not have uterus.

Estrogen + progesterone for patients who have uterus avoiding dysplasia.

Question 9

Different types of decelerations

Answer 9

Early: are slowing of the fetal heart rate in a pattern that is exactly synchronous with the contraction. They indicate fetal head compression within the birth canal.

Late decelerations are slowing of the heart rate that occurs towards the end of the contraction cycle. They signify utero-placental insufficiency.

Variable decelerations vary in onset, duration, and depth. They may occur between or with contractions, and they have an abrupt onset and rapid recovery. Represents umbilical cord compression.

Question 10

Pap smear with atypical squamous cells of undetermined significance (ASCUS). Next best step?

Answer 10

HPV DNA test
patient >25 years: If DNA test is positive after ASCUS on Pap smear, colposcopy is recommended to biopsy cervical tissue.
If it is negative: however, if the HPV DNA test is negative, a Pap smear should be repeated in 3 years.
For patients under 25 years with a Pap smear showing ASCUS, a Pap smear should be repeated in 1 year.

Question 11

Pap testing recommendations

Answer 11

Is recommended every 3 years for patients under 30 years of age.
For patients 30 years of age and over, screening may be either a Pap smear every 3 years or a combination Pap smear and HPV DNA test every 5 years.

Question 12

Key findings for complete molar pregnancy

Answer 12

hyperemesis gravidarum, signs of hyperthyroidism, and a “snowstorm” appearance with theca-lutein cysts on ultrasound.

Question 13

Risk factors for placental abruption

Answer 13

Hypertension, previous placental abruption, abdominal trauma, cocaine use, smoking, premature rupture of membranes, blood-clotting disorders, multiple pregnancy, or age > 40.

Question 14

When a mass is found in the breast, the next step in management is?

Answer 14

Imaging with an ultrasound being performed in young women (< 30 years of age) and a mammogram being performed in older women (> 30 years of age).

If a symptomatic (painful, skin changes, or breast discharge) benign and simple cyst is found on imaging, the next step in management is aspiration with an FNA.

If the mass disappears: the patient can follow up for an exam.

If an FNA yields insufficient or inconclusive results or the mass recurs: a follow-up core needle or surgical biopsy could be indicated.

FNA is preferred when there is a low pretest probability of cancer (such as in a young and otherwise healthy patient).

Question 15

Adenoymosis.

Answer 15

Endometrial tissue within the myometrium.
Enlarged uterus
Heavy bleeding and pelvis pain.

Question 16

Endometriosis

Answer 16

Presence of endometrial tissue outside of the uterus.
painful menstruation.
It typically does not cause the uterine enlargement or heavy bleeding.
A definitive diagnosis of endometriosis requires laparoscopic examination with biopsy.

Question 17

Betamethasone and pregnancy

Answer 17

Should be administered to patients < 34 weeks gestation, or in any case < 36 weeks gestation with a L/S ratio < 2.0.
The L/S ratio suggests fetal lung maturity and should be greater than 2.0.