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COMAT OB/GYN > Incorrect Questions > Flashcards

Incorrect Questions Flashcards

1
Q

what is increased in a granulosa-theca cell tumor

A

inhibin

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2
Q

what is inhibin

A

a peptide that is produced by the ovaries in response to follicle-stimulating hormone and luteinizing hormone
- most sensitive tumor marker for granulosa cell tumor

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3
Q

granulosa-theca cell tumors produce what

A

estrogen

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4
Q

sertoli-leydig cell tumors produce what

A

androgens (androstenedione and testosterone)

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5
Q

symptoms of hyperestrogenism

A

postmenopausal bleeding, menstrual abnormalities, and sexual precocity in children

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6
Q

how do granulosa cell tumors present

A

hyperestrogenism and abdominal or pelvic pain

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7
Q

granulosa-theca cell tumor in a postmenopausal patient

A

unopposed estrogen can lead to endometrial hyperplasia or carcinoma

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8
Q

postmenopausal woman with vaginal bleeding and a large ovarian mass

A

hyperplasia or carcinoma of endometrium, but think granulosa cell tumor

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9
Q

when is CA-125 elevated

A

epithelial ovarian tumors

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10
Q

when is lactate dehydrogenase elevated

A

dysgerminomas

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11
Q

patient with mosaic Turner’s syndrome cc of infertility, menses started at 15, ended at 19. what is the diagnosis?

A

ovarian failure

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12
Q

definition of preterm labor

A

uterine contractions that affect cervical change experienced prior to 37wks of gestation

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13
Q

how do you confirm diagnosis of preterm labor

A

rupture of membranes or vaginal bleeding

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14
Q

what is the initial management of preterm delivery prior to 34wks?

A

corticosteroid therapy to hasten lung maturity and reduce perinatal morbidity and mortality
- betamethasone or dexamethasone

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15
Q

when should corticosteroids be given for fetal lung maturity

A

any pregnant woman likely to deliver her baby within the next 2wks so long as she is between 24 and 34wks gestational age

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16
Q

signs of ovarian carcinoma

A

frequently asymptomatic

late stage with vague GI symptoms including dyspepsia, anorexia, and abdominal fullness and/or bloating

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17
Q

risk factors of ovarian carcinoma

A

family history of ovarian cancer, BRCA1 and 2 gene mutations and hereditary non-polyposis colorectal cancer (HNPCC) mutations
nulliparity, early menarche, late menopause (d/t increased risk of mutations with ovulation)

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18
Q

why do patients with ovarian carcinoma present in late stages?

A

lack of reliable routine screening test

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19
Q

what will rectovaginal exam show in ovarian carcinoma?

A

solid, irregular adnexal mass or fullness and/or nodularity in the posterior cul-de-sac

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20
Q

what is an ominous sign for ovarian carcinoma?

A

ascites

- sign of intra-abdominal spread of disease

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21
Q

what is a uterine leiomyoma

A

benign smooth muscle tumor of the uterus

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22
Q

how does a patient with uterine leiomyoma present

A

hemorrhagia, pelvic pain and pelvic pressure, and/or infertility

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23
Q

how is uterine leiomyoma diagnosed

A

transvaginal ultrasound

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24
Q

presentation of placental abruption

A

sudden onset vaginal bleeding associated with severe abdominal or back pain

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25
Q

how is placental abruption diagnosed

A

ultrasound reveals separation of the placenta from the uterine wall

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26
Q

what is a serious maternal complication of placental abruption?

A

DIC

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27
Q

what are the fetal complications of DIC

A

hypoxemia, asphyxia, preterm labor, and low birth weight

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28
Q

how is a severe placental abruption managed

A

prompt cesarean delivery

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29
Q

what is a severe placental abruption

A

maternal hypotension
severe coagulopathy
ongoing maternal blood loss
non-reassuring fetal status

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30
Q

what is DIC

A

disruption of the hemostatic process, during which a massive activation of the clotting cascade leads to widespread thrombosis causing depletion of platelets and fibrinogen

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31
Q

what are risk factors for DIC

A

severe preeclampsia, amniotic fluid embolism, sepsis, placental abruption, and prolonged retention of fetal tissue after fetal demise

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32
Q

what is the most common long term complications of hysterectomy

A

incontinence, pelvic organ prolapse, and pelvic organ fistula

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33
Q

treatment of iron deficiency anemia in 2nd and 3rd trimester

A

IV iron supplementation

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34
Q

treatment of iron deficiency anemia in 1st trimester

A

oral iron replacement

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35
Q

clinical signs and symptoms of anemia

A

fatigue, pallor, palpitations or throbbing pulse, headache, dizziness or lightheadedness, and pica

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36
Q

what maternal complication is a patient with multiple gestations at an increased risk?

A

anemia
- in twin pregnancies, cardiac output increases up to 20% higher than singleton pregnancies -> increased plasma volume -> physiologic anemia

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37
Q

what are risks of multiple gestations

A

gestational hypertension and preeclampsia, gestational diabetes and physiologic anemia

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38
Q

next step in management of LSIL on pap smear

A

perform a colposcopy

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39
Q

what is a colposcopy

A

applying acetic acid to the cervix, which will turn dysplastic areas ‘acetowhite’
- these lesions should be biopsied and sent for histologic diagnosis

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40
Q

what receives a prompt colposcopy as the next step in management?

A

pregnant women with an LSIL pap smear
any woman regardless of age or pregnancy with high-grade intraepithelial lesion (HSIL)
women who have an atypical squamous cells of undetermined significance (ASCUS) + positive HPV
any woman with ASCUS cannot exclude high grade lesion

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41
Q

appropriate management of an LSIL on pap smear (or ASCUS) in a woman under 21

A

repeat pap in 1 year

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42
Q

patient requests the most accurate test to diagnose fetal anomaly at 10wks. what do you perform?

A

chorionic villus sampling

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43
Q

what is CVS

A

placing a needle transcervically to obtain a sample of the placenta for fetal karyotyping

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44
Q

what is asherman syndrome

A

condition of intrauterine adhesions (synechiae)

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45
Q

etiology of asherman syndrome

A

direct endometrial trauma, which causes endometrial inflammation, scarring, and the formation of adhesions

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46
Q

who presents with asherman syndrome

A

woman who have had several D&Cs, but may occur as a result of chronic uterine inflammation due to infection

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47
Q

asherman syndeom presentation

A

irregular menstrual bleeding (either hypomenorrhea or secondary amenorrhea) and infertility

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48
Q

risk factors for endometrial cancer

A

late menopause, obesity, irregular ovulation, olgomenorrhea, and nulliparity

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49
Q

most common pathologic type of endometrial cancer

A

adenocarcinoma

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50
Q

signs of endometrial cancer/hyperplasia

A

any postmenopausal bleeding until proven otherwise

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51
Q

congenital varicella

A

limb hypoplasia, IUGR, cicatricial skin lesions, chorioretinitis

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52
Q

what to do if a patient has no immunity to varicella zoster and is exposed between 8 and 20wks?

A

varicella zoster immune globulin to prevent transmission of disease and/or to minimize the severity of the infection

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53
Q

elective termination of pregnancy before 7wks?

A

medically induced

methotrexate, mifepristone, +misoprostol

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54
Q

elective pregnancy termination after 7wks, but before 14wks

A

suction dilation and curettage

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55
Q

what is a contraindication to trial of breech vaginal delivery?

A

absence of immediately accessible to operating rooms and staff for cesarean delivery if necessary

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56
Q

what is the first line therapy for a woman with acute episode of prolonged or heavy menstrual bleeding who has normal vital signs?

A

high dose oral estrogen-progesterone

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57
Q

what is a nucleic acid amplification test?

A

a way gonorrhea and chlamydia are tested

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58
Q

what is annual protocol for women under 24 who are sexually active

A

tested annually for chlamydia, gonorrhea, and HIV

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59
Q

what is the only benefit of laser vaporization for cervical intraepithelial neoplasia?

A

preservation of the squamocolumnar junction

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60
Q

what are the benefits of cryoablation for CIN

A

less perioperative bleeding
less perioperative pain
less risk of disease recurrence
lower cost of procedure

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61
Q

how is grade 1 CIN handled

A

generally left untreated until it has persisted for greater than 2 years or progressed to a higher grade lesion

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62
Q

what is the management of CIN 1 if persisted for 2 years?

A

ablation

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63
Q

what is the best treatment of the management of hot flashes and emotional lability due to menopausal symptoms with a history of thromboembolism?

A

paroxetine

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64
Q

what is the first line treatment for hot flashes

A

hormone replacement therapy

  • estrogen and progesterone
  • progesterone is added in women who still have a uterus to protect the endometrium from constant stimulation that results in an increase in endometrial cancer
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65
Q

what is a contraindication for HRT

A

risk of coronary artery disease and thromboembolic events

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66
Q

what is the second line treatment for hot flashes

A

venlafaxine or an SSRI

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67
Q

what does HRT relieve

A

hot flashes and vaginal atrophic

helps prevent osteoporosis

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68
Q

what is the next appropriate step in management of a 28wk-er 3/90% with a bulging bag after betamethasone and indomethacin are administered?

A

administer magnesium sulfate

- provide fetal neuroprotection

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69
Q

management of preterm labor: 34w0d - 36w6d

A

+- betamethasone

PCN if GBS positive/unknown

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70
Q

management of preterm labor: 32w0d - 33w6d

A

betamethasone
tocolytics
PCN if GBS positive/unknown

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71
Q

management of preterm labor: <32wks

A

betamethasone
tocolytics
magnesium sulfate
PCN if GBS positive/unknown

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72
Q

risk factors for preterm labor

A

multiple gestation, history of preterm delivery, history of cervical surgery (conization)

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73
Q

what is a first-line tocolytic?

A

nifedipine

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74
Q

what is a positive fetal fibronectin test

A

a positive fetal fibronectin test and a shortened cervix are associated with increased risk of preterm delivery

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75
Q

potential complications of Hepatitis C in pregnancy

A

gestational diabetes
cholestasis of pregnancy
preterm delivery

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76
Q

maternal management of Hepatitis C in pregnancy

A

Ribavirin is teratogenic & should be avoided
no indication for barrier protection in serodiscordant, monogamous couples
Hep A & B vax

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77
Q

prevention of vertical transmision of hepatitis C in pregnancy

A

vertical transmission strongly associated with maternal viral load
cesarean delivery not protective
scalp electrodes should be avoided
breastfeeding should be encouraged unless maternal blood present (nipple injury)

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78
Q

risk factors for vaginal cancer

A

age >60
HPV
tobacco use
in utero DES exposure (clear cell adenocarcinoma only)

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79
Q

clinical features of vaginal cancer

A

vaginal bleeding
malodorous vaginal discharge
irregular vaginal lesion

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80
Q

diagnosis of vaginal cancer

A

vaginal biopsy

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81
Q

management of vaginal cancer

A

surgery +/- chemoradiation

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82
Q

what is the initial evaluation of mixed incontinence?

A

voiding diary

  • tracks fluid intake, urine output, and leaking episodes
  • classify predominant type of urinary incontinence and determine optimal treatment
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83
Q

treatment of mixed incontinence

A

all require bladder training with lifestyle changes (weight loss, smoking cessation, decreased alcohol and caffeine intake) and pelvic floor muscle exercises

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84
Q

clinical presentation of mittelschmerz

A

recurrent mild and unilateral mid-cycle pain prior to ovulation
pain lasts hours to days

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85
Q

ultrasound findings of mittelschmerz

A

not indicated

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86
Q

clinical presentation of ectopic pregnancy

A

amenorrhea, abdominal/pelvic pain & vaginal bleeding

positive ß-hCG

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87
Q

ultrasound findings of ectopic pregnancy

A

no intrauterine pregnancy

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88
Q

clinical presentation of ovarian torsion

A

sudden-onset, severe, unilateral lower abdominal pain; nausea and vomiting
unilateral, tender adnexal mass on examination

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89
Q

ultrasound findings of ovarian torsion

A

enlarged ovary with decreased or absent blood flow

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90
Q

clinical presentation of ruptured ovarian cyst

A

sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity

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91
Q

ultrasound findings of ruptured ovarian cyst

A

pelvic free fluid

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92
Q

clinical presentation of pelvic inflammatory disease

A

fever/chills, vaginal discharge, lower abdominal pain & cervical motion tenderness

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93
Q

ultrasound findings of PID

A

+/- tubo-ovarian abscess

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94
Q

epidemiology of vulvar lichen sclerosus

A

prepubertal girls & perimenopausal or postmenopausal women

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95
Q

clinical features of vulvar lichen sclerosus

A

thin, white, wrinkled skin over the labia majora/minora; atrophic changes that may extend over the perineum & around the anus
excoriations, erosions, fissures from severe pruritus
dysuria, dyspareunia, painful defecation

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96
Q

workup of vulvar lichen sclerosus

A

punch biopsy of adult-onset lesions to exclude malignancy

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97
Q

treatment of vulvar lichen sclerosus

A

superpotent corticosteroid ointment

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98
Q

definition of preterm prelabor rupture of membranes (PPROM)

A

membrane rupture at <37wks prior to labor onset

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99
Q

risk factors for PPROM

A

prior PPROM
GU infection (ASB, BV)
antepartum bleeding

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100
Q

diagnosis of PPROM

A

vaginal pooling or fluid from cervix
nitrazine-positive fluid
ferning on microscopy

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101
Q

management of PPROM in <34wks, reassuring

A

latency abx, corticosteroids

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102
Q

management of PPROM in <34wks, non-reassuring

A

delivery

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103
Q

management of PPROM in >34wks

A

delivery

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104
Q

complications of PPROM

A

preterm labor
intraamniotic infection
placental abruption
umbilical cord prolapse

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105
Q

risk factors of postpartum urinary retention

A

primiparity
regional neuraxial anesthesia (suppress micturition reflex and decrease detrusor tone -> bladder atony)
operative vaginal delivery
perineal injury (damage to pudendal nerve -> decreased voiding sensation and EUS dysfunction)
cesarean delivery

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106
Q

clinical features of postpartum urinary retention

A

small-volume voids or inability to void
incomplete bladder emptying
dribbling of urine

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107
Q

management of postpartum urinary retention

A

self-limited condition

intermittent catheterization

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108
Q

etiology of condylomata acuminata

A

HPV 6 & 11

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109
Q

clinical features of condylomata acuminata

A

multiple pink or skin-colored lesions

lesions ranging from smooth, flattened papules to exophytic/cauliflower-like growths

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110
Q

treatment of condylomata acuminata

A

chemical: podophyllin resin, trichloracetic acid
immunologic: imiquimod
surgical: cryotherapy, laser therapy, excision

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111
Q

prevention of condylomata acuminata

A

vaccination

barrier protection

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112
Q

pathology of a mature cystic teratoma

A

benign ovarian germ cell tumor

endoderm, mesoderm, ectoderm tissue

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113
Q

clinical features of mature cystic teratoma

A

most asymptomatic
ovarian torsion
struma ovarii subtype: hyperthyroidism
unilateral adnexal mass
ultrasound: complex, cystic, calcifications
gross appearance: sebaceous fluid, hair, teeth

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114
Q

management of mature cystic teratoma

A

ovarian cystectomy or oopherectomy

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115
Q

risk factors of ABO hemolytic disease

A

infants with blood types A or B born to a mother with blood type O

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116
Q

clinical features of ABO hemolytic disease

A 
jaundice within 24hrs of birth
anemia
increase reticulocyte count
hyperbilirubinemia
positive Coombs test
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117
Q

management of ABO hemolytic disease

A

serial bilirubin levels, oral hydration, & phytotherapy for most neonates
exchange transfusion for severe anemia/hyperbilirubinemia

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118
Q

contraindications to copper IUD & progestin IUD placement (shared c/i)

A 
pregnancy
endometrial or cervical cancer
unexplained vaginal bleeding
gestational trophoblastic disease
distorted endometrial cavity
acute pelvic infection
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119
Q

contraindications to progestin IUD

A

active liver disease

active breast cancer

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120
Q

contraindications to copper IUD

A

Wilson disease

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121
Q

risk factors for intraamniotic infection (chorioamnionitis)

A 
prolonged rupture of membranes (>18hrs)
PPROM
prolonged labor
internal fetal/uterine monitoring devices
repetitive vaginal examinations
presence of genital tract pathogens
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122
Q

diagnosis of chorioamnionitis

A

maternal fever PLUS >/= 1 of the following:

  • fetal tachycardia (>160/min)
  • maternal leukocytosis
  • purulent amniotic fluid
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123
Q

management of chorioamnionitis

A

broad-spectrum abx

delivery

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124
Q

maternal complications of chorioamnionitis

A

postpartum hemorrhage, endometritis

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125
Q

neonatal complications of chorioamnionitis

A

preterm birth, pneumonia, encephalopathy

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126
Q

what is the postexposure prophylaxis for sexual assault?

A 
chlamydia - azithromycin
gonorrhea - ceftriaxone
trich - metronidazole
HIV - multidrug regimen (tenofovir-emtricitabine with raltegravir)
hep B - hep B vax +/- hep B IG
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127
Q

indications for prophylactic administration of anti-D IG for Rh (D) - negative patients

A
  • at 28-32wks gestation
  • <72hrs after delivery of Rh(D)-positive infant
  • <72hrs after spontaneous abortion
  • ectopic pregnancy
  • threatened abortion
  • hydatidiform mole
  • chorionic villus sampling, amniocentesis
  • abdominal trauma
  • 2nd- & 3rd- trimester bleeding
  • external cephalic version
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128
Q

clinical features of PCOS

A

androgen excess : acne, male pattern baldness, hirsutism
oligoovulation or anovulation : menstrual irregularities
obesity
polycystic ovaries on ultrasound

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129
Q

pathophysiology of PCOS

A

increase testosterone
increase estrogen
LH/FSH imbalance

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130
Q

comorbidities of PCOS

A

metabolic syndrome
obstructive sleep apnea
nonalcoholic steatohepatitis
endometrial hyperplasia/cancer

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131
Q

treatment options of PCOS

A

weight loss (first line)
OCPs for menstrual regulation
letrozole for ovulation induction

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132
Q

evaluation of unilateral nipple discharge

A

pathologic discharge

  • breast ultrasound
  • mammography if >30yo
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133
Q

evaluation of bilateral nipple discharge that is bloody or serous

A

pathologic discharge

  • breast ultrasound
  • mammography if >30yrs old
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134
Q

evaluation of bilateral nipple discharge if milky, nonbloody with palpable lump or skin change

A

pathologic discharge

  • breast ultrasound
  • mammography if >30
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135
Q

evaluation of bilateral nipple discharge if milky, nonbloody and without palpable lump or skin change

A

likely physiologic

  • pregnancy test
  • guaiac test
  • serum prolactin, TSH
  • consider MRI of pituitary
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136
Q

risk factors for uterine sarcoma

A

pelvic radiation
tamoxifen use
potsmenopausal patients

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137
Q

presentation of uterine sarcoma

A

abnormal/postmenopausal bleeding
pelvic pain or pressure
uterine mass

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138
Q

diagnosis of uterine sarcoma

A

ultrasound +/- additional imaging
endometrial biopsy
histopathology of surgical specimen

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139
Q

treatment of uterine sarcoma

A

hysterectomy

+/- adjuvant chemotherapy, radiation therapy

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140
Q

risk factors of chlamydia & gonorrhea in women

A

age <25

high-risk sexual behavior

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141
Q

manifestations of chlamydia & gonorrhea in women

A

asymptomatic
cervicitis
urethritis
perihepatitis (Fitz-Hugh-Curtis syndrome)

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142
Q

diagnosis of gonorrhea and chlamydia in women

A

nucleic acid amplification testing

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143
Q

treatment of chlamydia and gonorrhea in women

A

empiric: azithromycin + ceftriaxone
confirmed chlamydia: azithromycin
confirmed gonorrhea: azithromycin + ceftriaxone

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144
Q

complications of gonorrhea and chlamydia in women

A

pelvic inflammatory disease
ectopic pregnancy
infertility

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145
Q

genotype of α-thalassemia minima

A

1 gene loss

aa/a-

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146
Q

genotype of α-thalassemia minor

A

2 gene loss

aa/– or a-/a-

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147
Q

genotype. of hemoglobin H disease

A

3 gene loss

a-/–

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148
Q

genotype of hydrops fetalis, hemoglobin Barts

A

4 gene loss

–/–

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149
Q

clinical features of α-thalassemia minima

A

asymptomatic, silent carrier

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150
Q

clinical features of α-thalassemia minor

A

mild microcytic anemia

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151
Q

clinical features of hemoglobin H disease

A

chronic hemolytic anemia

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152
Q

clinical features of hydrops fetalis, hemoglobin Barts

A

high-output cardiac failure, anasarca, death inutero

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153
Q

definition of nonalcoholic fatty liver disease

A

hepatic steatosis on imaging or biopsy
exclusion of significant alcohol use
exclusion of other causes of fatty liver

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154
Q

clinical features of non-alcoholic fatty liver disease

A

mostly asymptomatic
metabolic syndrome
+/- steatohepatitis (AST/ALT ratio <1)
hyperechoic texture on ultrasound

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155
Q

treatment of non-alcoholic fatty liver disease

A

diet & exercise

consider bariatric surgery if BMI >/= 35

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156
Q

Rome IV diagnostic criteria of irritable bowel syndrome

A

recurrent abdominal pain/discomfort >/= 1 day/week for past 3 months & >/= 2 of:

  • related to defecation (improves or worsens)
  • change in stool frequency
  • change in stool form
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157
Q

alarm features of irritable bowel syndrome

A 
older age of onset (>50)
GI bleeding
nocturnal diarrhea
worsening pain
 unintended weight loss
iron deficiency anemia
elevated CRP
positive fecal lactoferrin or calprotectin
family history of early colon cancer or IBD
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158
Q

modifiable breast cancer risk factors

A

hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption

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159
Q

non-modifiable breast cancer risk factors

A

genetic mutation or breast cancer in first-degree relatives
white race
increasing age
early menarche or later menopause

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160
Q

reactive nonstress test

A

baseline of 110-160/min
moderate variability (6-25/min)
>2 accelerations in 20mins, each peaking >15/min above baseline & lasting >15sec

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161
Q

nonreactive nonstress test

A

does not meet criteria for reactivity

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162
Q

recommended vaccines during pregnancy

A

Tdap
inactivated influenza
Rho(D) IG

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163
Q

vaccines indicated for high risk pregnant patients

A 
Hep B
Hep A
pneumococcus
Haemophilus influenzae
Meningococcus
Varicella-zoster IG
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164
Q

vaccines contraindicated in pregnancy

A

HPV
MMR
live attenuated influenza
varicella

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165
Q

risk factors for ectopic pregnancy

A

previous ectopic pregnancy
previous pelvic/tubal surgery
PID

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166
Q

clinical features of ectopic pregnancy

A

abdominal pain, amenorrhea, vaginal bleeding
hypovolemic shock in ruptured ectopic pregnancy
cervical motion, adnexal &/or abdominal tenderness
+/- palpable adnexal mass

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167
Q

diagnosis of ectopic pregnancy

A

positive hCG

TVUS revealing adnexal mass, empty uterus

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168
Q

management of ectopic pregnancy

A

stable: methotrexate
unstable: surgery

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169
Q

pregnancy management of patient with no prior HSV infection

A

routine prenatal care

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170
Q

pregnancy management of patient with prior HSV infection

A

antiviral suppression beginning at 36 wks

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171
Q

pregnancy management of patient with lesion/prodromal symptoms of HSV during labor

A

Cesarean delivery

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172
Q

pregnancy management of patient with history of HSV without lesion/prodromal symptoms of HSV during labor

A

vaginal delivery

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173
Q

risk factors of intrauterine adhesions

A

infection - septic abortion, endometritis

intrauterine surgery - curettage, myomectomy

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174
Q

clinical features of intrauterine adhesions

A 
abnormal uterine bleeding
amenorrhea
infertility
cyclic pelvic pain
recurrent pregnancy loss
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175
Q

evaluation of intrauterine adhesions

A

hysteroscopy

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176
Q

etiology of condyloma acuminata in children

A

HPV

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177
Q

clinical features of condyloma acuminata in children

A

pink/flesh-colored, verrucous papules & plaques
asymptomatic (most common)
pruritic, friable lesions

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178
Q

management of condyloma acuminata in children

A

sexual abuse assessment, especially age >4

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179
Q

clinical features of intrahepatic cholestasis of pregnancy

A 
develops in 3rd trimester
generalized pruritus
pruritus worse on hands and feet
no associated rash
RUQ pain
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180
Q

laboratory abnormalities of intrahepatic cholestasis of pregnancy

A

increase total bile acids (>10micromol/L)
increase transaminases (<2x normal)
+/- increase total & direct bilirubin

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181
Q

obstetric risks of intrahepatic cholestasis of pregnancy

A

intrauterine fetal demise
preterm delivery
meconium-stained amniotic fluid
neonatal respiratory distress syndrome

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182
Q

management of intrahepatic cholestasis of pregnancy

A

delivery at 37wks gestation
ursodeoxycholic acid
antihistamines

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183
Q

clinical features of chronic autoimmune thyroiditis (Hashimoto thyroiditis)

A

predominant hypothyroid features

diffuse goiter

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184
Q

diagnostic testing of chronic autoimmune thyroiditis (hashimoto thyroiditis)

A

positive TPO antibody

variable radioiodine uptake

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185
Q

clinical features of painless thyroiditis (silent thyroiditis)

A

variant of chronic autoimmune thyroiditis
mild, brief hyperthyroid phase
small, nontender goiter
spontaneous recovery

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186
Q

diagnostic testing of painless thyroiditis (silent thyroiditis)

A

positive TPO antibody

low radioiodine uptake

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187
Q

clinical features of subacute thyroiditis (deQuervain thyroiditis)

A

likely postviral inflammatory process
prominent fever & hyperthyroid symptoms
painful/tender goiter

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188
Q

diagnostic testing of subacute thyroiditis

A

elevated ESR & CRP

low radioiodine uptake

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189
Q

GU syndrome of menopause symptoms

A 
vulvovaginal dryness, irritatoin, pruritus
dyspareunia
vaginal bleeding
urinary incontinence, recurrent UTIs
pelvic pressure
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190
Q

GU syndrome of menopause physical examination

A

narrowed introitus
pale mucosa, decreased elasticity, decreased rugae
petechiae, fissures
loss of labial volume

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191
Q

GU syndrome of menopause treatment

A

vaginal moisturizer & lubricant

topical vaginal estrogen

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192
Q

risk factors for cervical cancer

A 
immunocompromise
early onset of sexual activity
multiple or high-risk sexual partners
previous STI
tobacco use
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193
Q

pathogenesis of cervical cancer

A

HPV infection (16 & 18)

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194
Q

clinical manifestations of cervical cancer

A 
asymptomatic
postcoital or intermenstrual bleeding
increased vaginal discharge
inguinal lymphadenopathy
pelvic or low back pain
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195
Q

diagnosis of cervical cancer

A

cervical biopsy on colposcopy

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196
Q

clinical presentation of epithelial ovarian carcinoma

A

asymptomatic; incidental adnexal mass

subacute: pelvic/abdominal pain, bloating, early satiety
acute: dyspnea, obstipation/constipation, abdominal distension

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197
Q

risk factors of epithelial ovarian carcinoma

A 
family history
genetic mutations (BRCA1, BRCA2)
age >50
HRT
endometriosis
infertility
early menarche/late menopause
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198
Q

protective factors of epithelial ovarian carcinoma

A

OCPs
multiparity
breastfeeding

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199
Q

laboratory findings of epithelial ovarian carcinoma

A

increase CA-125

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200
Q

ultrasound findings of epithelial ovarian carcinoma

A

solid, complex mass
thick septations
ascites

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201
Q

management of epithelial ovarian carcinoma

A

surgical exploration

+/- chemotherapy

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202
Q

pathogenesis of sertoli-leydig cell tumor

A

sex cord-stromal tumor

increase testosterone

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203
Q

clinical features of sertoli-leydig cell tumor

A 
rapid onset virilzation
- voice deepening
- male-pattern balding
- increased muscle mass
- clitoromegaly
oligomenorrhea
unilateral, solid adnexal mass
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204
Q

management of sertoli-leydig cell tumors

A

surgery (tumor staging)

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205
Q

clinical features of uterine leiomyomas (fibroids)

A 
heavy, prolonged menses
pressure symptoms
- pelvic pain
- constipation
- urinary frequency
obstetric complications
- impaired fertility
- pregnancy loss
- preterm labor
enlarged, irregular uterus
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206
Q

workup of uterine leiomyomas

A

ultrasound

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207
Q

treatment of uterine leiomyomas

A

asymptomatic: observation
symptomatic: CHC, surgery

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208
Q

clinical features of PMS/PMDD

A

physical: bloating, fatigue, headaches, hot flashes, breast tenderness
behavioral: anxiety, irritability, mood swings, decreased interest

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209
Q

evaluation of PMS/PMDD

A

symptom/menstrual diary

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210
Q

treatment of PMS/PMDD

A

SSRI

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211
Q

ultrasound findings of congenital CMV

A 
periventricular calcifications
ventriculomegaly
microcephaly
intrahepatic calcifications
fetal growth restriction
hydrops fetalis
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212
Q

neonatal features of congenital CMV

A

petechiae
hepatosplenomegaly
chorioretinitis
microcephaly

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213
Q

long-term sequelae of congenital CMV

A

sensorineural hearing loss
seizures
developmental delay

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214
Q

description of lochia rubra

A

dark or bright red (blood)
odor similar to that of menstrual blood
occasional small clots
quantity decreasing each day

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215
Q

expected duration of lochia rubra

A

birth to 3-4 days postpartum

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216
Q

description of lochia serosa

A

serosanguineous (pink)
brownish (old blood)
quantity gradually decreasing in amount

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217
Q

expected duration of lochia serosa

A

4th postpartum day to 10th or 14th postpartum day

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218
Q

description of lochia alba

A

white/yellow
creamy
light quantity

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219
Q

expected duration of lochia alba

A

11th postpartum day to 6wks postpartum

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220
Q

risk factors of pyelonephritis in pregnancy

A

asymptomatic bacteriuria
diabetes mellitus
age <20

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221
Q

common pathogens of pyelonephritis in pregnancy

A

Escherichia coli
Klebsiella
Enterobacter
Group B strep

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222
Q

complications of pyelonephritis in pregnancy

A

preterm labor
low birth weight
acute respiratory distress syndrome

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223
Q

treatment of pyelonephritis in pregnancy

A

IV abx

supportive therapy

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224
Q

contraindication to labetalol

A

asthma

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225
Q

treatment of pre-eclampsia acutely

A

IV hydralazine, IV labetalol, or nifedipine PO

- lower BP acutely to decrease stroke risk

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226
Q

prevention/treatment of eclamptic seizures

A

magnesium sulfate IV or IM

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227
Q

management of CIN 3 if not currently pregnant

A

LEEP
cold knife conization
cryoablation

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228
Q

follow-up testing for CIN 3

A

pap testing with HPV co-testing 1 and 2 years postprocedure

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229
Q

definition of postpartum hemorrhage

A

> 500mL after vaginal delivery

>1000mL after cesarean delivery

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230
Q

risk factors for postpartum hemorrhage

A 
prolonged or induced labor
chorioamnionitis
multiple gestation
polyhydraminos
grand multiparity
operative delivery
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231
Q

causes of postpartum hemorrhage

A 
uterine atony (most common)
retained placenta
genital tract laceration
uterine rupture
coagulopathy
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232
Q

treatment of postpartum hemorrhage

A 
bimanual uterine massage, oxytocin
IV fluids, oxygen
uterotonics - methylergonovine, carboprost, misoprostol
intrauterine balloon tamponade
uterine artery embolization
hysterectomy
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233
Q

how does neonatal lupus occur

A

passive placental transfer of maternal anti-SSA (Ro) and anti-SSB (La) antibodies

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234
Q

fetal findings of neonatal lupus

A

cardiac and cutaneous

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235
Q

most serious fetal finding of neonatal lupus

A

fetal atrioventricular block -> fetal bradycardia

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236
Q

what can prolonged fetal heart block cause?

A

cardiomyopathy and hydrops fetalis

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237
Q

what is the treatment of retroperitoneal hematoma

A

emergency laparotomy

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238
Q

what is the cause of post-cesarean delivery patients with hemorrhagic shock?

A

if no signs of uterine atony, most likely have intraabdominal bleeding from uterine artery injury

  • most likely retroperitoneum bleeding
  • no incisional bleeding
  • minimal abdominal or back pain
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239
Q

what are the signs of hypovolemic shock due to postpartum hemorrhage

A

hypotension, tachycardia, and signs of decreased end-organ perfusion (e.g. fatigue, lightheadedness, cold skin)

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240
Q

most common cause of postpartum hemorrhage

A

uterine atony

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241
Q

what can be diagnosed in the second-trimester quadruple screen?

A

trisomy 18
trisomy 21
neural tube or abdominal wall defect

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242
Q

what markers are tested in the second-trimester quadruple screen?

A

maternal serum α-fetoprotein
ß-hCG
estriol
inhibin A

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243
Q

what are the markers for trisomy 18?

A

decreased maternal serum α-fetoprotein, ß-hCG, and estriol

normal inhibin A

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244
Q

what are the markers for trisomy 21?

A

decreased maternal serum α-fetoprotein, estriol

increased ß-hCG, inhibin A

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245
Q

what are the markers for neural tube or abdominal wall defects?

A

increased maternal serum α-fetoprotein

normal ß-hCG, estriol, inhibin A

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246
Q

how do you evaluate suspected polyuria?

A

complete 24hr urine collection

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247
Q

what to do if complete 24hr urine output is <3L?

A

not true polyuria

work up causes of urinary frequency

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248
Q

what is the diagnosis of complete 24hr urine output >3L?

A

polyuria present

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249
Q

if urine output in 24hrs >3L AND dilute:

A

water diuresis

primary polydipsia, diabetes insipidus

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250
Q

if urine output in 24hrs >3L AND concentrated

A

osmotic diuresis

increased solute excretion (glucose, urea, saline)

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251
Q

benefits of estrogen-progestin contraceptives

A 
pregnancy prevention
endometrial &amp; ovarian cancer risk reduction
menstrual regulation (e.g. anovulation, dysmenorrhea, anemia)
hyperandrogenism treatment (e.g. hirsutism, acne)
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252
Q

risks of estrogen-progestin contraceptives

A 
venous thromboembolism
hypertension
hepatic adenoma
stroke, myocardial infarction (both very rare)
cervical cancer
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253
Q

who are high-risk patients for STI screening in pregnancy

A

age <25
prior STI
high-risk sexual activity (e.g. multiple partners, commercial sex work)

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254
Q

what is the required screening of high-risk STIs in pregnancy

A

performed at initial PNV & 3rd trimester

  • HIV
  • syphilis
  • hepatitis B
  • gonorrhea
  • chlamydia
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255
Q

what is the pathogenesis of endometriosis

A

ectopic implantation of endometrial glands

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256
Q

clinical features of endometriosis

A 
dyspareunia
dysmenorrhea
chronic pelvic pain
infertility
dyschezia
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257
Q

physical examination of endometriosis

A

immobile uterus
cervical motion tenderness
adnexal mass
rectovaginal septum, posterior cul-de-sac, uterosacral ligament nodules

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258
Q

diagnosis of endometriosis

A

direct visualization and surgical biopsy

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259
Q

treatment of endometriosis

A

medical (OCPs, NSAIDs)

surgical resection

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260
Q

etiology of vulvar cancer

A

persistent HPV infection

chronic inflammation

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261
Q

risk factors of vulvar cancer

A 
tobacco use
vulvar lichen sclerosus
immunodeficiency
prior cervical cancer
vulvar/cervical intraepithelial neoplasia
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262
Q

clinical features of vulvar cancer

A

vulvar pruritus
vulvar plaque/ulcer
abnormal bleeding

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263
Q

diagnosis of vulvar cancer

A

biopsy

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264
Q

management of preterm prelabor ROM - first question

A

<34 wks or 34 to <37wks?

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265
Q

management of preterm prelabor ROM if 34 to <37wks

A 
delivery
GBS prophylaxis (e.g. PenG)
\+/- corticosteroids
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266
Q

management of preterm prelabor ROM if <34wks and uncomplicated

A

expectant management
latency antibiotics (e.g. ampicillin & azithromycin)
corticosteroids
fetal surveillance

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267
Q

management of preterm prelabor ROM if <34 wks and complicated by infection, fetal/maternal compromise

A

delivery
intra-amniotic infection treatment (e.g. ampicillin & gentamicin)
corticosteroids
magnesium if <32wks

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268
Q

what is eclampsia

A

severe preeclampsia + seizures

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269
Q

clinical features of eclampsia

A 
hypertension
proteinuria
severe headaches
visual disturbances
right upper quadrant or epigastric pain
3-4mins of tonic-clonic seizure, usually self-limited
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270
Q

management of eclampsia

A

administer magnesium sulfate
administer antihypertensive agent
deliver the fetus

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271
Q

etiology of esophageal perforation

A 
instrumentation (e.g. endoscopy), trauma
effort rupture (Boerhaave syndrome)
esophagitis (infectious/pills/caustic)
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272
Q

clinical presentation of esophageal perforation

A

chest/back &/or epigastric pain, systemic signs (e.g. fever)
crepitus, Hamman sign (crunching sound on auscultation)
pleural effusion with atypical (e.g. green) fluid

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273
Q

diagnosis of esophageal perforation on chest x-ray or CT scan

A

widened mediastinum pneumomediastinum, pneumothorax, pleural effusion

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274
Q

diagnosis of esophageal perforation on CT scan

A

esophageal wall thickening, mediastinal fluid collection

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275
Q

diagnosis of esophageal perforation on esophagography with water-soluble contrast

A

leak from perforation

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276
Q

management. of esophageal perforation

A

NPO, IV antibiotics & proton pump inhibitors

emergency surgical consultation

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277
Q

what is the inheritance of hemophilia A

A

x-linked recessive

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278
Q

maternal contraindications to breastfeeding

A 
active untreated tuberculosis
HIV infection
herpetic breast lesions
active varicella infection
chemotherapy or radiation therapy
active substance abuse
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279
Q

infant contraindications to breastfeeding

A

galactosemia

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280
Q

clinical features of engorgement

A

bilateral, symmetric fullness, tenderness & warmth

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281
Q

clinical features of nipple injury

A

abrasion, bruising, cracking &/or blistering from poor latch

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282
Q

clinical features of plugged duct

A

focal tenderness & firmness &/or erythema

no fever

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283
Q

clinical features of galactocele

A

subareolar, mobile, well-circumscribed, nontender mass

no fever

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284
Q

clinical features of mastitis

A

tenderness/erythema + fever

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285
Q

clinical features of abscess

A

symptoms of mastitis + fluctuant mass

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286
Q

risk factors of hyperemesis gravidarum

A

hydatidiform mole
multifetal gestation
history of hyperemesis gravidarum

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287
Q

clinical features of hyperemesis gravidarum

A

severe, persistent vomiting
>5% loss of prepregnancy weight
dehydration
orthostatic hypotension

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288
Q

laboratory abnormalities of hyperemesis gravidarum

A

ketonuria
hypochloremic metabolic alkalosis
hypokalemia
hemoconcentration

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289
Q

treatment of hyperemesis gravidarum

A

admission to hospital

antiemetics & IV fluids

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290
Q

pathogenesis of granulosa cell tumor

A

sex cord- stromal tumor
increase estradiol
increase inhibin

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291
Q

clinical features of granulosa cell tumor

A 
complex ovarian mass
juvenile subtype
- precocious puberty
adult subtype
- breast tenderness
- abnormal uterine bleeding
- postmenopausal bleeding
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292
Q

histopathology of granulosa cell tumor

A

Call-Exner bodies (cells in rosette pattern)

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293
Q

management of granulosa cell tumor

A 
endometrial biopsy (endometrial cancer)
surgery (tumor staging)
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294
Q

definition of fetal growth restriction

A

ultrasound estimated fetal weight <10th percentile for gestational age

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295
Q

onset of symmetric fetal growth restriction

A

1st trimester

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296
Q

onset of asymmetric fetal growth restriction

A

2nd/3rd trimester

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297
Q

etiology of symmetric fetal growth restriction

A

chromosomal abnormalities

congenital infection

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298
Q

etiology of asymmetric fetal growth restriction

A

utero-placental insufficiency

maternal malnutrition

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299
Q

clinical features of symmetric fetal growth restriction

A

global growth lag

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300
Q

clinical features of asymmetric fetal growth restriction

A

‘head-sparing’ growth lag

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301
Q

management of fetal growth restriction

A

weekly biophysical profiles
serial umbilical artery Doppler sonography
serial growth ultrasounds

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302
Q

primary syphilis manifestations

A

painless genital ulcer (chancre)

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303
Q

secondary syphilis manifestations

A 
diffuse rash (palms &amp; soles)
lymphadenopathy (epitrochlear)
condyloma latum
oral lesions
hepatitis
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304
Q

latent syphilis manifestations

A

asymptomatic

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305
Q

tertiary syphilis manifestations

A

CNS (tabes dorsalis, dementia)
cardiovascular (aortic aneurysm/insufficiency)
cutaneous (gummas)

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306
Q

first test in evaluation of secondary amenorrhea

A

ß-hCG

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307
Q

if ß-hCG negative in secondary amenorrhea, what is checked next?

A

prolactin
FSH
testosterone
TSH

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308
Q

in evaluation of secondary amenorrhea: ß-hCG negative, increase prolactin, normal TSH

A

pituitary adenoma

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309
Q

in evaluation of secondary amenorrhea: ß-hCG negative, increase FSH

A

primary ovarian insufficiency

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310
Q

in evaluation of secondary amenorrhea: ß-hCG negative, hormones normal

A

prior uterine procedure

Asherman syndrome

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311
Q

in evaluation of secondary amenorrhea, ß-hCG negative, increase testosterone

A

PCOS

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312
Q

in evaluation of secondary amenorrhea: ß-hCG negative, increase TSH

A

hypothyroidism

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313
Q

definition of intrauterine fetal demise

A

fetal death at >20wks

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314
Q

diagnosis of intrauterine fetal demise

A

absence of fetal cardiac activity on ultrasound

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315
Q

management of intrauterine fetal demise at 20-23wks

A

dilation & evacuation
OR
vaginal delivery

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316
Q

management of intrauterine fetal demise at >24wks

A

vaginal delivery

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317
Q

complication of intrauterine fetal demise

A

coagulopathy after several weeks of fetal retention

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318
Q

clinical features of primary ovarian insufficiency

A

amenorrhea at age <40
hypoestrogenic symptoms (e.g. hot flashes)
increase FSH
decrease estrogen

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319
Q

major causes of primary ovarian insufficiency

A 
Turner syndrome (45, XO)
fragile X syndrome (FMR1 premutation)
autoimmune oophoritis
anticancer drugs
pelvic radiation
galactosemia
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320
Q

management of primary ovarian insufficiency

A

estrogen therapy (with progestin if intact uterus)

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321
Q

management of endometriosis

A

suspected endometriosis

  • chronic pelvic pain
  • dysmenorrhea
  • deep dyspareunia
  • dyschezia
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322
Q

questions to ask in management of endometriosis

A

contraindications to medical therapy?
need for definitive diagnosis?
history of infertility?
concern for malignancy or adnexal mass?

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323
Q

if the answer is yes to questions re endometriosis:

A

laparoscopy

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324
Q

if the answer is no to questions re endometriosis

A

NSAIDs +/- oral contraceptives

-> laparoscopy

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325
Q

pathogenesis of endometriosis

A

ectopic implantation of endometrial glands

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326
Q

clinical features of endometriosis

A 
dyspareunia
dysmenorrhea
chronic pelvic pain
infertility
dyschezia
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327
Q

physical examination of endometriosis

A

immobile uterus
cervical motion tenderness
adnexal mass
rectovaginal septum, posterior cul-de-sac, uterosacral ligament nodules

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328
Q

diagnosis of endometriosis

A

direct visualization & surgical biopsy

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329
Q

treatment of endometriosis

A

medical (OCPs, NSAIDs)

surgical resection

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330
Q

what is the management of shoulder dystocia?

A

BE CALM
B - breathe; do not push
E - elevate legs & flex hips, thighs against abdomen (McROberts)
C - call for help
A - apply suprapubic pressure
L - enLarge vaginal opening with episiotomy
M - Maneuvers
- deliver posterior arm
- rotate posterior shoulder (Woods screw): apply pressure to anterior aspect of the posterior shoulder
- adduct posterior fetal shoulder (Rubin): apply pressure to the posterior aspect of the posterior shoulder
- mother on hands & knees : ‘ all fours’ (Gaskin)
- replace fetal head into pelvis for cesarean delivery (Zavanelli)

331
Q

severe side effect of oxytocin

A

severe hyponatremia

-> seizure

332
Q

treatment of oxytocin-induced hyponatremia

A

cessation of oxytocin infusion
gradual administration of hypertonic saline in symptomatic patients (e.g. seizures) to raise serum osmolality and reverse cerebral edema

333
Q

what risk factors make methotrexate more likely to fail for ectopic pregnancy

A

ß-hCG >5000
gestational sac >3-4cm
positive fetal heart tones

334
Q

treatment of symptomatic condyloma acuminata in pregnancy

A

trichloroacetic acid

335
Q

treatment of endometriosis

A

laparoscopy

336
Q

screening tests in the first trimester (before 14wks)

A

nuchal translucency ultrasound with PAPP-A

hCG measurement

337
Q

relative contraindication to IUD

A

history of STI within the past 3 months

338
Q

what is the initial diagnostic testing for PCOS

A

serum testosterone

339
Q

after stabilizing the patient’s airway what is the most appropriate management for hypovolemic shock?

A

massive transfusion of packed red blood cells

340
Q

what is the most appropriate course of action for a patient with suspected domestic violence?

A

ask open-ended questions to learn about possible abuse

341
Q

what can poorly controlled blood sugars in the second and third trimester cause?

A

diabetic fetopathy

  • fetal hyperinsulinemia
  • hyperglycemia
  • macrosomia
342
Q

what is the screening test for HIV

A

HIV-1/2 antibodies and p24 antigen assay

343
Q

presentation of tubo-ovarian abscess

A

fever, abdominal pain, and a complex multiloculated adnexal mass with thick walls and internal debris

344
Q

laboratory findings in tubo-ovarian abscess

A

nonspecific increases

  • leukocytosis, CRP, CA-125
  • paired with fever -> infection rather than malignancy
345
Q

how to diagnose tubo-ovarian abscess

A

imaging (pelvic ultrasound/CT scan)

346
Q

treatment of TOA

A

broad-spectrum parenteral antibiotics

347
Q

risk factor for magnesium toxicity

A

renal insufficiency

- excreted by the kidneys

348
Q

clinical features of magnesium toxicity

A

mild: nausea, flushing, HA, hyporeflexia
moderate: areflexia, hypocalcemia, somnolence
severe: respiratory paralysis, cardiac arrest

349
Q

maternal cardiopulmonary adaptations in pregnancy

A 
cardiac:
- increase cardiac output
- increase plasma volume
- decrease SVR
respiratory:
- increase tidal volume
- decrease functional residual capacity (elevation of diaphragm
350
Q

clinical manifestations of maternal cardiopulmonary adaptations to pregnancy

A 
peripheral edema
decrease BP
increase HR
systolic ejection murmur
dyspnea
351
Q

pathogenesis of adenomyosis

A

abnormal endometrial tissue within the uterine myometrium

352
Q

risk factors for adenomyosis

A

age >40
multiparity
prior uterine surgery (e.g. myomectomy)

353
Q

clinical features of adenomyosis

A 
dysmenorrhea
heavy menstrual bleeding
chronic pelvic pain
diffuse uterine enlargement (e.g. globular uterus)
\+/- uterine tenderness
354
Q

diagnosis of adenomyosis

A

clinical presentation
MRI & ultrasound: thickened myometrium
confirmation via pathology

355
Q

treatment of adenomyosis

A

hysterectomy

356
Q

adenomyosis vs. fibroids

A

adenomyosis

  • chronic pelvic pain
  • boggy and tender symmetrically enlarged uterus

fibroids

  • pelvic pressure
  • firm, irregularly enlarged uterus
357
Q

what are endometrial polyps

A

common, well-vascularized, hyperplastic endometrial gland growths that extend into the uterine cavity

358
Q

signs of endometrial polyps

A

abnormal uterine bleeding due to their friability and vascularity
- do not affect ovulation, so typically have regular monthly menses with painless, light intermenstrual bleeding

359
Q

treatment of endometrial polyps

A

hysteroscopic polypectomy

360
Q

definition of urethral diverticulum

A

urethral mucosa herniated into surrounding tissue

361
Q

clinical features of urethral diverticulum

A

dysuria
postvoid dribbling
dyspareunia
anterior vaginal wall mass - associated expressed purulent or bloody urethral discharge

362
Q

treatment of urethral diverticulum

A

surgical excision of the diverticulum

363
Q

symptoms of PID

A

lower abdominal pain

abnormal bleeding

364
Q

physical exam of PID

A

cervical motion tenderness
fever >38.3 C (>100.9)
mucopurulent cervical discharge

365
Q

treatment of PID

A

third-generation cephalosporin + azithormycin or doxycycline

366
Q

complications of PID

A

tubo-ovarian abscess
infertility
ectopic pregnancy
perihepatitis

367
Q

what is Fitz-Hugh-Curtis disease

A

infection extends from the upper genital tract to spread throughout the abdomen and cause liver capsule inflammation
- patients with hepatic involvement present with symptoms of acute PID (fever, lower abdominal pain) as well as pleuritic RUQ pain

368
Q

clinical features of acute fatty liver of pregnancy

A

nausea, vomiting
RUQ pain/epigastric pain
fulminant liver failure

369
Q

laboratory findings of acute fatty liver of pregnancy

A 
profound hypoglycemia
increase aminiotransferases (2-3x normal)
increase bilirubin
thrombocytopenia
DIC
370
Q

management of acute fatty liver of pregnancy

A

immediate delivery regardless of gestational age

371
Q

clinical features of menopause

A
  • vasomotor symptoms
  • oligomenorrhea/amenorrhea
  • sleep disturbances
  • decreased libido
  • depression
  • cognitive decline
  • vaginal atrophy
372
Q

diagnosis of menopause

A

clinical manifestations

increase FSH

373
Q

treatment of menopause

A

topical vaginal estrogen

systemic hormone replacement therapy

374
Q

what is ovulation

A

transition from the follicular phase to the luteal phase

375
Q

what occurs before ovulation

A

LH surge

376
Q

what is cervical mucus

A

secreted close to ovulation (late follicular phase) increases in quantity and can be perceived by patients as vaginal discharge

  • clear, elastic, thin in consistency, and described similar in appearance to an uncooked egg white
  • thought to facilitate transport into the uterus for conception
377
Q

clinical presentation of acute appendicitis

A

nausea, vomiting, anorexia
initially: diffuse abdominal pain (visceral pain)
later: localized RLQ pain (somatic pain)
mild leukocytosis

378
Q

examination of acute appendicitis

A

McBurney point tenderness
psoas sign: pain with right hip extension
obturator sign: pain with right hip internal rotation
rovsing sign: RLQ pain with LLQ palpation

379
Q

diagnosis of acute appendicits

A

clinical presentation

CT scan or ultrasound

380
Q

treatment of acute appendicitis

A

surgical appendectomy

381
Q

acute appendicitis vs. ectopic pregnancy vs. ovarian torsion

A

acute appendicits: intrauterine pregnancy with normal adnexa and normal Doppler

ectopic pregnancy: non-intrauterine pregnancy

ovarian torsion: intrauterine pregnancy with abnormal Doppler

382
Q

what is tranexamic acid

A

antifibrinolytic agent that prevents the breakdown of blood clots to achieve hemostasis

383
Q

neonatal abstinence syndrome

A

high-pitched cry and irritability, sleep/wake disturbances, hyperactive primitive reflexes, hypertonicity, difficulty feeding, GI disturbances, autonomic dysfunction, and failure to thrive

384
Q

what is the first step in managing postmenopausal bleeding

A

endometrial biopsy to exclude endometrial hyperplasia or endometrial carcinoma

385
Q

causes of chronic neuropathic pelvic pain

A

entrapment of the ilioinguinal and/or iliohypogastric nerves during closure of a low-transverse fascial incision

386
Q

where does ilioinguinal nerve entrapment occur

A

commonly at the lateral edge of the fascial incision where the nerves are coursing between the transversalis and internal oblique muscles

387
Q

hallmark of neuropathic pain by nerve entrapment

A

burning or searing pain that is reproducible with palpation

388
Q

trigger point nodule palpated at the lateral incision of c/section

A

inject with local anesthetics for diagnostic & therapeutic relief

389
Q

what is the most common neonatal complication associated with vacuum-assisted delivery

A

cephalohematoma

  • can result in hyperbilirubinemia as the extra blood products in the hematoma break down and enter the bloodstream
  • causes jaundice
390
Q

what is Kleihauer-Betke testing

A

serum evaluation that detects and quantifies fetal blood cells within maternal circulation

391
Q

what is massive fetomaternal hemorrhage

A

blood loss of greater than 20mL/kg fetal weight

can occur spontaneously and can lead to intrauterine fetal demise

392
Q

how is a stillbirth defined

A

fetal demise after 20wks GA

393
Q

maternal symtpoms of fetal demise

A

decreased fetal movement and decrease in pregnancy symtpoms (breast tenderness, nausea, fatigue)

394
Q

how is an unexplained stillbirth evaluated

A

postmortem diagnostic testing

  • complete blood count
  • urine toxicology
  • serology for syphilis (in absence of prior testing)
  • blood antibody screen (r/o alloimmunization)
  • fasting glucose or glycosylated glucose testing (in absence of prior gestational diabetes testing)
  • Kleihauer-Betke testing or flow cytometry to detect presence of fetomaternal hemorrhage
395
Q

how to evaluate fetal hypoxemia

A

fetal scalp stimulation to induce accelerations

396
Q

what is acute salpingitis

A

synonymous with pelvic inflammatory disease

397
Q

most common cause of acute salpingitis

A

chlamydia trachomatis

neisseria gonorrhea

398
Q

sexually active woman without a more likely cause for abdominal pain

A

PID - minimal diagnostic criteria:

- adnexal, uterine, or cervical tenderness on exam

399
Q

supportive findings for diagnosis of PID

A 
vaginal discharge
fever >101
elevated CRP or ESR
positive chlamydia/gonorrhea testing
pelvic ultrasound = dilated tortuous fallopian tube (hydrosalpinx)
400
Q

what’s the first thing a patient should receive upon admission for delivery?

A

IV catheter

401
Q

what to give a patient who is stable, likely to deliver immediately, <34wks GA?

A

tocolytics to allow administration of a full course of antenatal corticosteroids, which takes 48hrs

402
Q

most commonly given tocolytics

A

indomethacin
CCBs
terbutaline (beta2-agonist)
magnesium sulfate

403
Q

what causes functional hypogonadotropic hypogonadism

A

excessive weight loss
strenuous exercise
chronic illness
eating disorder

404
Q

what does hypogonadotropic hypogonadism cause?

A

decreased adipose tissue/fat reserves -> decrease leptin production

  • > decrease GnRH from hypothalamus
  • > decrease LH, FSH from pituitary
  • > decrease estrogen from ovaries
  • > amenorrhea, bone loss
405
Q

risk factors for cervical insufficiency

A

collagen defects
uterine abnormalities
cervical conization
obstetric injury

406
Q

clinical features of cervical insufficiency

A

> /= 2 prior painless, 2nd-trimester losses

painless cervical dilation

407
Q

management of cervical insufficiency

A

cerclage placement

408
Q

how to diagnose cervical insufficiency

A

1 of:
- painless cervical dilation in the current pregnancy
OR
- second-trimester cervical length of = 2.5cm plus a prior preterm delivery (i.e. ultrasound-based)
OR
>/= prior consecutive, painless, second-trimester losses (i.e. history-based), which typically present with mild symptoms (e.g. vaginal discharge, light spotting) followed by precipitous delivery

409
Q

risk factors for placenta previa

A

prior placenta previa
prior cesarean delivery
multiple gestation

410
Q

clinical features of placenta previa

A

painless vaginal bleeding >20wks gestation

411
Q

diagnosis of placenta previa

A

transabdominal followed by transvaginal sonogram

412
Q

management of placenta previa

A

no intercourse
no digital cervical examination
inpatient admission for bleeding episodes

413
Q

risk factors for septic abortion

A

retained POC from:

  • elective abortion with nonsterile technique
  • missed or incomplete abortion (rare)
414
Q

clinical presentation for septic abortion

A

fever, chills, abdominal pain
sanguinopurulent vaginal discharge
boggy, tender uterus, dilated cervix
pelvic ultrasound: retained POC, thick endometrial stripe

415
Q

management of septic abortion

A

IV fluids
broad-spectrum antibiotics
suction curettage

416
Q

presentation of adenomyosis

A

heavy monthly menstrual bleeding with dysmenorrhea

417
Q

what is the Jarisch-Herxheimer reaction

A

patients receiving antibiotics for syphilis

418
Q

what is Jarisch-Herxheimer reaction characterized by

A

headache, fever, flushing, tachycardia, and hypotension

  • begins within 1-2hrs after initiation
  • self-limited to 24-48hrs
419
Q

treatment of Jarisch-Herxheimer

A

supportie

- acetaminophen and IV fluids

420
Q

cause of Jarisch-Herxheimer

A

occurs after abx treatment of spirochete disease

- caused by release of large amounts of treponemal lipopolysaccharides and cytokines

421
Q

major risk factor for primary dysmenorrhea

A

nulliparity

422
Q

what viral load is HIV at greatest risk of causing vertical transmission

A

> 1000 RNA copies/mL

423
Q

how to handle HIV viral load >1000

A

final viral load evaluation at 34-36wks

- Cesarean delivery at 38wks prior to the onset of labor or the rupture of membranes

424
Q

treatment of HIV in pregnancy

A

IV zidovudine to decrease vertical transmission

- all HIV-positive mothers should receive a minimum of 6wks of oral zidovudine therapy for prophylaxis

425
Q

what is a rectocele

A

rectum bulges into the posterior vaginal wall

426
Q

how is a rectocele identified

A

posterior vaginal wall prolapses while the vaginal apex and anterior vaginal wall are fixated with a bi-valved speculum

427
Q

what is the next step in management of PROM after 34wks?

A

induction of labor

428
Q

characteristics of klinefelter syndrome

A

tall slender male with lack of secondary sexual characteristics and infertility
history of learning disorder
shy and immature

429
Q

cause of Klinefelter syndrome

A

non-disjunction of chromosomes during either meiosis I or meiosis II resulting in XXY karyotype

430
Q

where does the corpus luteum come from

A

results from LH-induced ovulation

431
Q

cause of postpartum hemorrhage in a patient with presence of firmly contracted uterus

A

cervical laceration

432
Q

what are you thinking if child presents with age-innappropriate sexual behaviors that are disruptive or intrusive to others

A

child abuse

433
Q

potential signs of child abuse

A

inappropriate genital touching and knowledge of sexually explicit anatomy or behavior
regression

434
Q

red flags for child abuse

A 
unexplained injuries
changes in behavior
regression to earlier behaviors
signs of neglect
inappropriate sexual behaviors
435
Q

how to diagnose congenital CMV

A

PCR for CMV DNA in the amniotic fluid obtained via amniocentesis

436
Q

what is hysteroscopy used for

A

evaluation of abnormal uterine bleeding when an endometrialc ause is suspected

437
Q

classic bleeding pattern of an endometrial polyp

A

metrorrhagia or intermenstrual spotting

438
Q

proper breast examination

A

sitting and supine

439
Q

what is the first line treatment fo prevention of progression of stress/urge urinary incontinence and pelvic organ prolapse

A

pelvic floor muscle training

440
Q

what is the most likely cause of irregular bleeding in an adolescent

A

anovulatory bleeding

- failure of the ovary to develop a corpus luteum

441
Q

where does the corpus luteum come from

A

results from LH-induced ovulation

442
Q

why is the corpus luteum important

A

produces progesterone during a normal menstrual cycle and during pregnancy until about 8-10wks when placenta takes over

443
Q

what is used to avoid cervical lacerations during dilatin

A

cervical preparation with prostaglandins or osmotic dilators

444
Q

what are important allergies to remember for surgical patients

A

latex

- may vary from mild to anaphylaxis

445
Q

most common presentation of anaphylaxis

A

tachycardia
hypotension
bronchospasm
cutaneous signs - flushing, urticaria

446
Q

what has a cross-allergy to shellfish?

A

iodine

447
Q

fetal alcohol syndrome characterized by

A

facial dysmorphisms
- short palpebral fissure, thin upper lip, smooth philtrum
growth retardation
CNS abnormalities

448
Q

what is the preferred med to assist with alcohol cessation during pregnancy

A

naltrexone

449
Q

what is the most common cause of hypothyroidism

A

hashimoto thyroiditis

450
Q

what are symptoms of hypothyroidism

A 
weight gain
fatigue
dry skin
low pulse
menstrual dysfunction
- secondary amenorrhea -> decreased fertility
451
Q

what is decreased in normal pregnancy

A

SVR

- widespread vasodilation

452
Q

what is the next step in managing a visible lesion on the cervix

A

biopsy

453
Q

what does a person have with a visible lesion on cervical exam, postcoital bleeding, and dyspareunia

A

cervical cancer

454
Q

risks of staphylococcal toxic shock syndrome

A

tampon use
nasal packing
surgical/postpartum wound infection

455
Q

pathogenesis of staphylococcal toxic shock syndrome

A

staphylococcus aureus

exotoxin release acting as superantigens

456
Q

clinical features of staph toxic shock syndrome

A

fever >38.9 (102)
hypotension
diffuse macular rash involving palms & soles
desquamation 1-3wks after disease onset
vomiting, diarrhea
altered mentation without focal neurological signs

457
Q

treatment of toxic shock syndrome

A 
supportive therapy (fluid replacement)
removal of foreign body (tampon)
antibiotic therapy (clindamycin + vancomycin)
458
Q

toxic shock rash vs. secondary syphilis

A

patients with syphilis have an indolent course rather than acute-onset hypotension and tachycardia (shock)

459
Q

disease associations with HPV

A 
cervical cancer
vulvar &amp; vaginal cancers
anal cancer
oropharyngial cancer
penile cancer
anogenital warts
recurrent respiratory papillomatosis
460
Q

vaccine indications for HPV

A

all female and male patients age 11-26

NOT indicated in pregnant women

461
Q

pathogenesis of fetal hydrops

A

increase cardiac output demand causing heart failure

increase fluid movement into interstitial spaces (third spacing)

462
Q

clinical features of fetal hydrops

A 
pericardial effusion
pleural effusion
ascites
skin edema
placental edema
polyhdramnios
463
Q

etiology of fetal hydrops

A

immune
- Rh(D) alloimmunization

Nonimmune

  • parvovirus B19 infection
  • fetal aneuploidy
  • CV abnormalities
  • thalassemia (hemoglobin Barts)
464
Q

pathophysiology of androgen insensitivity syndrome

A

X-linked mutation in androgen receptor

465
Q

clinical features of androgen insensitivity syndrome

A

genotypically male (46, XY)
phenotypically female
breast development
absent or minimal axillary & pubic hair
female external genitalia
absent uterus, cervix, & upper 1/3 of vagina

466
Q

management of androgen insensitivity syndrome

A

gender identity/assignment counseling

gonadectomy (malignancy prevention)

467
Q

5-α reductase deficiency

A

cannot convert testosterone to dihydrotestosterone

  • appear phenotypically female at birth
  • develop virilization at puberty
  • no breast development
468
Q

Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)

A

primary amenorrhea due to lack of female internal genitalia

  • otherwise normal female development
  • female-range testosterone levels
469
Q

cause of postoperative, unilateral back pain, nausea with vomiting and CVA tenderness

A

hydronephrosis from ureteral injury

470
Q

risk of ureteral injury increases with

A

obesity
distorted pelvic architecture from malignancy
prior pelvic surgery

471
Q

renal function in ureteral obstruction

A

normal because only 1 ureter is affected

- normal creatinine and urinalysis

472
Q

diagnosis of ureteral obstruction

A

renal ultrasound

473
Q

treatment of ureteral obstruction

A

surgical correction

474
Q

complications of shoulder dystocia

A 
fractured clavicle
fractured humerus
Erb-Duchenne palsy
Klumpke palsy
Perinatal asphyxia
475
Q

fractured clavicle

A
  • clavicular crepitus/bony irregularity
  • decrease Moro reflex due to pain on affected side
  • intact biceps & grasp reflex
476
Q

fractured humerus

A
  • upper arm crepitus/bony irregularity
  • decrease Moro reflex due to pain on affected side
  • intact biceps & grasp reflex
477
Q

Erb-Duchenne palsy

A
  • decrease Moro & biceps reflexes on affected side
  • “waiter’s tip” = extended elbow, pronated forearm, flexed wrist & fingers
  • intact grasp reflex
  • damage to 5th and 6th cervical nerves
478
Q

Klumpke palsy

A
  • “claw hand” = extended wrist, hyperextended metacarpophalangeal joints, flexed interphalangeal joints, absent grasp reflex
  • Horner syndrome (ptosis, miosis)
  • intact Moro & biceps reflexes
  • injury to 8th cervical nerve and 1st thoracic nerve & sympathetic fibers that run along
479
Q

Perinatal asphyxia

A
  • variable presentation depending on duration of hypoxia

- altered mental status (irritability, lethargy), respiratory or feeding difficulties, poor tone, seizure

480
Q

differential diagnosis for postpartum hemorrhage

A

uterine atony
retained products of conception
genital tract trauma
inherited coagulopathy

481
Q

risk factors for uterine atony

A 
prolonged labor
chorioamnionitis
uterine overdistension (multiples, fetal macrosomia, polyhydramnios)
482
Q

examination of uterine atony

A

enlarged, boggy uterus

483
Q

management of uterine atony

A

bimanual uterine massage

uterotonic medications

484
Q

risk factors for retained products of conception

A

succenturiate placenta
manual extraction of placenta
history of previous uterine surgery

485
Q

examination of retained products of conception

A

enlarged, boggy uterus
placenta missing cotyledons
retained placental fragments on ultrasound

486
Q

management of retained products of conception

A

manual extraction

487
Q

risk factors for genital tract trauma

A

operative vaginal delivery

488
Q

examination of genital tract trauma

A

laceration of cervix or vagina

enlarging hematoma

489
Q

management of genital tract trauma

A

laceration repair

490
Q

risk factors for inherited coagulopathy

A

history of abnormal bleeding in patient or family members

491
Q

examination of inherited coagulopathy

A

continued bleeding despite contracted uterus

492
Q

management of inherited coagulopathy

A

correction of coagulopathy

493
Q

first line treatment for severe hot flashes (vasomotor symptoms)

A

hormone replacement therapy

494
Q

monochorionic diamniotic twins at risk for

A

twin-twin transfusion syndrome

495
Q

monochorionic diamniotic twins on ultrasound

A

T-sign

- 2 embryos, a single placenta, and a thin intertwin membrane that meets the placenta at a 90degree angle

496
Q

dichorionic diamniotic twins on ultrasound

A

λ sign

497
Q

complication of monochorionic monoamniotic

A

cord entanglement

conjoined twins

498
Q

complication of dichorionic diamniotic twins

A

vanishing twin syndrome

499
Q

what causes a fever within first 48hrs after surgery?

A

cytokine-mediated reaction initiated by normal tissue trauma encountered during the procedure

500
Q

management of fever prior to 48hrs postoperatively

A

expectant management

- very unlikely to imply true infection

501
Q

what is primary infertility

A

inability to conceive a child, despite efforts of regular unprotected intercourse, for a period of greater than 1yr

502
Q

what is an important cause of infertility

A

pelvic inflammatory disease

  • occurs in patients with an incompletely treated/untreated STI
  • results in inflammation and scarring of reproductive organs
503
Q

most common causes of PID

A

chlamydia trachomatis

neisseria gonorrhoeae

504
Q

classic symptoms of PID

A

abdominal pain, vaginal discharge, fever, cervical motion tenderness, dyspareunia, and irregularities in menstrual cycle

505
Q

how to decrease risk of neonatal sepsis

A

intrapatum maternal antibiotic therapy

506
Q

causes of early-onset neonatal sepsis

A

group B streptococcus or Escherichia coli

507
Q

who should receive antibiotics during labor to decrease risk of neonatal sepsis?

A

all women who are GBS positive during the current pregnancy or had a previous child affected by GBS
women with unknown GBS status who are either preterm or who have ruptured membranes >18hrs or who have fever/chorioamnionitis

508
Q

signs of sepsis in the infant

A

lethargy, hypoxia, temperature instability, respiratory distress, poor perfusion, and hypotension

509
Q

risk factors for neonatal sepsis

A

preterm delivery, premature rupture of membranes, prolonged rupture of membranes during delivery, chorioamnionitis, known vaginal GBS colonization during pregnancy, and maternal fever during labor

510
Q

routine postoperative care after cesarean delivery

A

pain management
maternal-infant bonding (breastfeeding)
prophylaxis for infection
thromboembolism and hemorrhage

511
Q

what is the standard staging and treatment procedure for all endometrial carcinoma?

A

total extrafasical hysterectomy with bilateral salpingo-oopherectomy with pelvic and paraaortic lymph node dissection

512
Q

what is stage Ia endometrial carcinoma

A

tumor invades less than half the myometrium or endometrium

513
Q

stage Ib endometrial carcinoma

A

tumor invades more than half of the myometrium

514
Q

stage II endometrial cancer

A

tumor invades stromal connective tissue but confined to uterus

515
Q

stage III endometrial cancer

A

tumors involves vagina, adnexa, with positive regional lymph nodes

516
Q

stage IV endometrial cancer

A

tumor involves bladder mucosa with distant metastasis

517
Q

treatment of low risk endometrial cancer

A

stage I

surgical resection only

518
Q

treatment of intermediate risk endometrial cancer

A

stage Ib or stromal invasion

radiation therapy, but no clear data

519
Q

treatment of high risk endometrial cancer

A

stage III or IV

chemotherapy and radiation therapy

520
Q

how to diagnose herpes simplex virus

A

Tzanck smear of vesicle fluid

521
Q

what are typical findings on Tzanck smear

A

multinucleated giant cells and epithelial cells containing eosinophilic intranuclear inclusion bodies

522
Q

bacterial vaginosis examination

A

thin, off-white discharge with fishy odor

no inflammation

523
Q

trichomoniasis examination

A

thin, yellow-green, malodorous, frothy discharge

vaginal inflammation

524
Q

candida vaginitis examination

A

thick ‘cottage cheese’ discharge

vaginal inflammation

525
Q

BV lab findings

A

pH >4.5
clue cells
positive whiff test (amine odor with KOH)

526
Q

trich lab findings

A

pH >4.5

motile trichomonads

527
Q

candida lab findings

A

normal pH

pseudohyphae

528
Q

BV treatment

A

metronidazole or clindamycin

529
Q

trich treatment

A

metronidazole

treat sexual partner

530
Q

candida treatment

A

fluconazole

531
Q

how to diagnose vesicovaginal fistula

A

bladder dye test

532
Q

cause of vesicovaginal fistula

A

excessive fetal head compression during obstructed labor causes injury & necrosis to the maternal vagina, rectum, and bladder -> erosion and fistula development
- occurs within the first weeks postpartum

533
Q

signs of vesicovaginal fistula

A

continuous vaginal discharge with an abnormally elevated pH (due to urine) which may be malodorous (due to surrounding necrotic tissue)

534
Q

pelvic exam of vesicovaginal fistula

A

vaginal pooling of urine, visible defect, or an area of raised, red granulation tissue on the anterior vaginal wall

535
Q

what does total/free T4 do in pregnancy and why

A

increases
ß-hCG stimulates thyroid hormone production in first trimester
estrogen stimulates TBG; thyroid increases hormone production to maintain steady free T4 levels

536
Q

how is TSH changed in pregnancy and why

A

decreased

increased ß-hCG & thyroid hormone suppress TSH secretion

537
Q

what to do with levothyroxine dose during pregnancy?

A

increase levothyroxine when patient becomes pregnant

538
Q

definition of recurrent cystitis in women

A 
>/= 2 infectons in 6 months
>/= 3 infections in a year
539
Q

risk factors for recurrent cystitis in women

A

sexually active
postmenopausal
first UTI at age <15
spermicide use

540
Q

prevention of recurrent cystitis in women

A

daily abx prophylaxis

postcoital prophylaxis

541
Q

presentation of a theca lutein cyst

A

multilocular
bilateral
10-15cm ovaries

542
Q

pathogenesis of theca lutein cyst

A

ovarian hyperstimulation due to:

  • gestational trophoblastic disease
  • multifetal gestation
  • infertility treatment
543
Q

clinical course of theca lutein cyst

A

resolve with decreasing ß-hCG levels

544
Q

pathogenesis of sheehan syndrome

A

obstetric hemorrhage complicated by hypotension

postpartum pituitary infarction

545
Q

clinical features of sheehan syndrome

A

lactation failure (decrease prolactin)
amenorrhea, hot flashes, vaginal atrohpy (decrease FSH, LH)
fatigue, bradycardia (decrease TSH)
anorexia, weight loss, hypotension (decrease ACTH)
decreased lean body mass (decrease growth hormone)

546
Q

what is sheehan syndrome

A

postpartum hypopituitarism

547
Q

manifestations of Sheehan syndrome

A

fatigue, weight loss, hypotension, inability to breastfeed

548
Q

associated conditions of wernicke encephalopathy

A

chronic alcoholism (most common)
malnutrition (e.g. anorexia nervosa)
hyperemesis gravidarum

549
Q

pathophysiology of wernicke encephalopathy

A

thiamine deficiency

550
Q

clinical features of wernicke encephalopathy

A

encephalopathy
oculomotor dysfunction (e.g. horizontal nystagmus, bilateral abducens palsy)
postural & gait ataxia

551
Q

treatment of wernicke encephalopathy

A

IV thiamine followed by glucose infusion

552
Q

exocrine features of sjögren syndrome

A

keratoconjunctivitis sicca
dry mouth, salivary hypertrophy
xerosis

553
Q

extraglandular features of sjögren syndrome

A 
raynaud phenomenon
cutaneous vasculitis
arthralgia/arthritis
interstitial lung disease
non-hodgkin lymphoma
554
Q

diagnostic findings of sjögren syndrome

A

objective signs of decreased lacrimation (Schirmer test)
positive anti-Ro (SSA) &/o anti-La (SSB)
salivary gland biopsy with focal lymphocytic sialoadenitis
classification: primary if no associated CTD, secondary if comorbid CTD (SLE, RA, scleroderma

555
Q

what is late-term pregnancy

A

> /= 41wks gestation

556
Q

what is post-term pregnancy

A

> /= 42wks gestation

557
Q

risk factors for late & post term pregnancy

A 
prior post term pregnancy
nulliparity
obesity
age >/= 35
fetal anomalies (e.g. anencephaly)
558
Q

complications of late & post term pregnancy

A 
fetal/neonatal
- macrosomia
- dysmaturity syndrome
- oligohydramnios
- demise
maternal
- severe obstetric laceration
- cesarean delivery
- postpartum hemorrhage
559
Q

management of late & post term pregnancy

A

frequent fetal monitoring (nonstress test)

delivery prior to 43wks gestation

560
Q

onset of anaphylactic transfusion reaction

A

within seconds to minutes

561
Q

cause of anaphylactic transfusion reaction

A

recipient anti-IgA antibodies directed against donor blood IgA

562
Q

key features of anaphylactic transfusion reaction

A

angioedema, hypotension, respiratory distress/wheezing, shock
IgA deficient recipient

563
Q

onset of acute hemolytic transfusion reaction

A

within 1hr

564
Q

cause of acute hemolytic transfusion reaction

A

ABO incompatibility (often clerical error)

565
Q

key features of acute hemolytic transfusion reaction

A

fever, flank pain, hemoglobinuria
disseminated intravascular coagulation
positive Coombs test

566
Q

onset of febrile nonhemolytic transfusion reaction

A

within 1-6hrs

567
Q

cause of febrile nonhemolytic transfusion reaction

A

cytokine accumulation during blood storage

568
Q

key features of febrile nonhemolytic transfusion reaction

A

fever & chills

569
Q

onset of urticarial transfusion reaction

A

within 2-3hrs

570
Q

cause of urticarial transfusion reaction

A

recipient IgE against blood product component

571
Q

key features of urticarial transfusion reaction

A

urticaria

572
Q

onset of transfusion-related acute lung injury

A

within 6hrs

573
Q

cause of transfusion-related acute lung injury

A

donor anti-leukocyte antibodies

574
Q

key features of transfusion-related acute lung injury

A

respiratory distress

noncardiogenic pulmonary edema with bilateral pulmonary infiltrates

575
Q

onset of delayed hemolytic transfusion reaction

A

within days to weeks

576
Q

cause of delayed hemolytic transfusion reaction

A

anamnestic antibody response

577
Q

key features of delayed hemolytic transfusion reaction

A

often asymptomatic
laboratory evidence of hemolytic anemia
positive Coombs test, positive new antibody screen

578
Q

onset of graft vs. host

A

within weeks

579
Q

cause of graft vs. host

A

donor T-lymphocytes

580
Q

key features of graft vs. host

A

rash, fever, GI symptoms, pancytopenia

581
Q

gestational thrombocytopenia in pregnancy

A

isolated, mild (100-150k)
asymptomatic
diagnosis of exclusion

582
Q

preeclampsia with severe features/HELLP syndrome causing thrombocytopenia in pregnancy

A

moderate to severe (<100k)
hypertension +/- headache/scotomata
+/- increase creatinine, increase AST & ALT

583
Q

immune-mediated thrombocytopenia in pregnancy

A

isolated, moderate to severe (<100k)
asymptomatic or mucosal bleeding/bruising
normal PT, aPTT

584
Q

thrombotic thrombocytopenic purpura (TTP)

A

severe (<30k)
neurologic symptoms (e.g. confusion, seizure), fever, abdominal pain, petechiae
normal PT, aPTT

585
Q

disseminated intravascular coagulopathy (DIC)

A

moderate to severe (<100k)
bleeding (e,g. oozing IV sites) +/- thrombosis
increase PT, increase aPTT, decrease fibrinogen

586
Q

how does levonorgestrel-containing IUD work

A

thickens cervical mucus

impairs implantation through decidualization of the endometrium

587
Q

common side effect of levonorgestrel IUD

A

amenorrhea - can be used to improve anemia and abnormal uterine bleeding
systemic - mood changes, breast tenderness, headaches
weight gain is not a side effect

588
Q

definition of vasa previa

A

fetal vessels overlying the cervix

589
Q

risk factors of vasa previa

A

placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe

590
Q

clinical presentation of vasa previa

A

painless vaginal bleeding with ROM or contractions
FHR abnormalities (bradycardia, sinusoidal pattern)
fetal exsanguination & demise

591
Q

management of vasa previa

A

emergency cesarean delivery

592
Q

vasa previa vs. placenta previa

A

painless vaginal bleeding
placenta previa is primarily maternal blood loss -> heavy, persistent, signs of maternal hemorrhagic shock (hypotension, tachycardia) are present prior to severe fetal compromise

593
Q

what is a urethral diverticulum

A

abnormal localized outpouching of the urethral mucosa into surrounding tissues

594
Q

cause of urethral diverticulum

A

recurrent periurethral gland infections, which can develop into an abscess

595
Q

urethral diverticulum presentation

A

tender anterior vaginal wall mass
- dyspareunia or a palpable mass on pelvic examination
may collect urine and debris -> purulent discharge, dysuria, postvoid dribbling

596
Q

how to confirm diagnosis of urethral diverticulum

A

MRI

597
Q

how to treat urethral diverticulum

A

surgical excision

598
Q

acute management of tachyarrhythmias in pregnant women

A

adenosine

599
Q

second-line agents for symptomatic SVT in pregnancy

A

digoxin
calcium channel blockers (verapamil)
ß blockers (metoprolol)

600
Q

what are common causes of hyperandrogenism in pregnancy?

A

placental aromatase deficiency
luteoma
theca lutein cyst
Sertoli-leydig tumor

601
Q

clinical features of placenta aromatase deficiency in pregnancy

A

no ovarian mass
high maternal & fetal virilization risk
resolution of maternal symptoms after delivery

602
Q

clinical features of luteoma in pregnancy

A

solid, unilateral/bilateral ovarian masses
moderate maternal virilization risk; high fetal virilization risk
spontaneous regression of masses after delivery

603
Q

clinical features of theca lutein cyst in pregnancy

A

cystic, bilateral ovarian masses
moderate maternal virilization risk; low fetal virilization risk
spontaneous regression of masses after delivery

604
Q

clinical features of sertoli-leydig tumor in pregnancy

A 
solid unilateral ovarian mass
high maternal &amp; fetal virilization risk
surgery required (2nd trimester or postpartum)
605
Q

pathogenesis of müllerian agenesis

A

müllerian duct system defect

abnormal development of uterus, cervix, & upper third of vagina

606
Q

clinical features of müllerian agenesis

A 
primary amenorrhea
normal female external genitalia
blind vaginal pouch
absent or rudimentary uterus
bilateral functioning ovaries (normal FSH)
607
Q

management of müllerian agenesis

A 
evaluate for renal tract abnormalities (renal ultrasound)
vaginal dilation (surgical or nonsurgical)
608
Q

definition. ofvasa previa

A

fetal vessels overlying the cervix

609
Q

risk factors for vasa previa

A

placenta previa
multiple gestations
in vitro fertilization
succenturiate placental lobe

610
Q

clinical presentation of vasa previa

A

painless vaginal bleeding with ROM or contractions
FHR abnormalities (bradycardia, sinusoidal pattern)
fetal exsanguination & demise

611
Q

management of vasa previa

A

emergency cesarean delivery

612
Q

prenatal care for sickle cell disease in pregnancy

A 
baseline 24hr urine for total protein
baseline chemistry panel
serial urine culture
pneumococcal vaccination
folic acid supplementation
aspirin
serial fetal growth ultrasound
613
Q

obstetric complications of sickle cell disease

A

spontaneous abortion
preeclampsia, eclampsia
abruptio placentae
antepartum bleeding

614
Q

fetal complications of sickle cell disease

A

fetal growth restriction
oligohydramnios
preterm birth
from uteroplacental insufficiency

615
Q

causes of hirsutism in women

A 
polycystic ovary syndrome
idiopathic hirsutism
nonclassic 21-hydroxylase deficiency
androgen-secreting ovarian tumors, ovarian hyperthecosis
cushing syndrome
616
Q

clinical features of PCOS

A

oligomenorrhea, hyperandrogenism, obesity

associated with type 2 diabetes, dyslipidemia, hypertension

617
Q

clinical features of idiopathic hirsutism

A

normal menstruation

normal serum androgens

618
Q

clinical features of nonclassic 21-hydroxylase deficiency

A

similar to PCOS

elevated serum 17-hydroxyprogesterone

619
Q

clinical features of androgen-secreting ovarian tumors, ovarian hyperthecosis

A

more common in postmenopausal women
rapidly progressive hirsutism with virilization
very high serum androgens

620
Q

clinical features of Cushing syndrome

A

obesity (usually of the face, neck, trunk, abdomen)

increased libido, virilization, irregular menses

621
Q

antepartum fetal surveillance

A

nonstress test
biophysical profile
contraction stress test
doppler sonography of umbilical artery

622
Q

description of nonstress test

A

external fetal heart rate monitoring for 20-40mins

623
Q

normal result of nonstress test

A

reactive: >/= 2 accelerations

624
Q

abnormal resul of nonstress test

A

nonreactive: <2 accelerations

recurrent variable or late decelerations

625
Q

description of biophysical profile

A

nonstress test plus ultrasound assessment of:
- amniotic fluid volume
- fetal breathing movement
- fetal movement
- fetal tone
2 points per category if normal & 0 points if abnormal
max of 10

626
Q

normal result of biophysical profile

A

8 or 10 points

627
Q

abnormal result of biophysical profile

A

equivocal: 6 points
abnormal: 0, 2, or 4 points
oligohydramnios

628
Q

description of contraction stress test

A

external fetal heart rate monitoring during spontaneous or induced (e.g. oxytocin, nipple stimulation) uterine contractions

629
Q

normal result of contraction stress test

A

no late or recurrent variable decelerations

630
Q

abnormal result of contraction stress test

A

late decelerations with >50% of contractions

631
Q

description of doppler sonography of the umbilical artery

A

evaluation of umbilical artery flow in fetal intrauterine growth restriction only

632
Q

normal result of doppler sonography of umbilical artery

A

high-velocity diastolic flow in umbilical artery

633
Q

abnormal result of doppler sonography of umbilical artery

A

decreased, absent, or reversed end-diastolic flow

634
Q

components of biophysical profile (BPP)

A 
nonstress test
amniotic fluid volume
fetal movements
fetal tone
fetal breathing movements
635
Q

normal finding of nonstress test for BPP

A

reactive fetal heart rate monitoring

636
Q

normal finding of amniotic fluid volume for BPP

A

single fluid pocket >/= 2cm x 1cm or amniotic fluid index >5

637
Q

normal finding of fetal movements for BPP

A

> /= 3 general body movements

638
Q

normal finding of fetal tone for BPP

A

> /= 1 episodes of flexion/extension of fetal limbs or spine

639
Q

normal finding of fetal breathing movements for BPP

A

> /= 1 breathing episode for >/= 30 seconds

640
Q

BPP score of 0-4 /10 indicates

A

fetal hypoxia due to placental dysfunction

641
Q

risk factors for placental insufficiency

A

advanced maternal age
tobacco use
hypertension
diabetes

642
Q

risk factors for pubic symphysis diastasis

A

fetal macrosomia
multiparity
precipitous labor
operative vaginal delivery

643
Q

presentation of pubic symphysis diastasis

A

difficulty ambulating
radiating suprapubic pain
pubic symphysis tenderness
intact neurologic examination

644
Q

management of pubic symphysis diastasis

A

conservative
NSAIDs
physical therapy
pelvic support

645
Q

clinical presentation of epithelial ovarian carcinoma

A

acute: shortness of breath, obstipation/constipation with vomiting, abdominal distention
subacute: pelvic/abdominal pain, bloating, early satiety
asymptomatic adnexal mass

646
Q

laboratory findings of epithelial ovarian carcinoma

A

increase CA-125

647
Q

ultrasound findings of epithelial ovarian carcinoma

A

solid mass
thick septations
ascites

648
Q

management of epithelial ovarian carcinoma

A

exploratory laparotomy

649
Q

assessing arterial blood gas

A

1 - look at pH
- <7.35 acidemia
- >7.45 alkalemia
2 - determine primary process
- in alkalemia, if elevated bicarb & PaCO2 = primary metabolic alkalosis
3 - determine degree of compensation
- Winter’s formula: PaCO2 = (0.9 * bicarb) + 16 +/- 2

650
Q

metabolic acidosis

A

low pH <7.35
low HCO3- < 22
compensation:
- respiratory alkalosis (decrease PaCO2)

651
Q

respiratory acidosis

A

low pH < 7.35
high PaCO2 >45
delayed compensatory response:
- metabolic alkalosis (increase HCO3-)

652
Q

respiratory alkalosis

A

high pH > 7.45
low PaCO2 < 35
delayed compensatory response:
- metabolic acidosis (decrease HCO3-)

653
Q

metabolic alkalosis

A

high pH >7.45
high HCO3- >28
compensatory response:
- respiratory acidosis (increase PaCO2)

654
Q

commonly causes metabolic alkalosis in pregnancy

A

hyperemesis gravidarum

655
Q

pathogenesis of congenital zika syndrome

A

single-stranded RNA flavivirus
transplacental transmission ot fetus
targets neural progenitor cells

656
Q

clinical features of congenital zika

A

microcephaly, craniofacial disproportion
neurologic abnormalities (spasticity, seizures)
ocular abnormalities

657
Q

diagnosis of congenital zika

A

neuroimaging: calcifications, ventriculomegaly, cortical thinning
zika RNA detection

658
Q

risk factor for listeria monocytogenes

A

consumption of unpasteurized dairy products

659
Q

in utero L monocytogenes

A

fetal demise or neonatal disseminated granulomatous disease

660
Q

modifiable breast cancer risk factors

A

hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption

661
Q

non-modifiable breast cancer risk factors

A

genetic mutation or breast cancer in first-degree relatives
white race
increasing age
early menarche or later menopause

662
Q

common cause of acute cervicitis

A

Chlamydia trachomatis

Niesseria gonorrhea

663
Q

classic findings of acute cervicitis

A

mucopurlent cervical discharge and edematous, friable cervix that bleeds with manipulation

664
Q

what would be visualized on light microscopy for acute cervicitis

A

no organisms

665
Q

clinical features of bacterial vaginosis

A

thin, off-white discharge with fishy odor

no vaginal inflammation

666
Q

laboratory findings of BV

A

pH >4.5
clue cells
positive whiff test

667
Q

treatment of BV

A

metronidazole or clindamycin

668
Q

complications of BV

A

increase risk of preterm birth

increase risk for acquisition of HIV, HSV type 2, gonorrhea, chlamydia, & trichomonas infections

669
Q

risks of metronidazole in first trimester?

A

no! treat BV!

670
Q

approach to postmenopausal bleeding

A

endometrial biopsy or TVUS endometrium

671
Q

in evaluation of postmenopausal bleeding, if TVUS endometrium reveals >4mm

A

endometrial biopsy

672
Q

in evaluation of postmenopausal bleeding, if TVUS endometrium reveals = 4mm

A

observation

673
Q

in evaluation of postmenopausal bleeding, if endometrial biopsy benign

A

observation

674
Q

in evaluation of postmenopausal bleeding, if endometrial biopsy atypic neoplasia

A

progestins

surgery

675
Q

clinical presentation of hydatidiform mole

A 
abnormal vaginal bleeding +/- hydropic tissue
uterine enlargement > gestational age
abnormally elevated Bega-hCG levels
theca lutein ovarian cysts
hyperemesis gravidarum
preeclampsia with severe features
hyperthyroidism
676
Q

risk factors for hydatidiform mole

A

extremes of maternal age

history of hydatidiform mole

677
Q

diagnosis of hydatidiform mole

A

‘snowstorm’ appearance on ultrasound
quantitative serum ß-hCG
histologic evaluation of uterine contents

678
Q

management of hydatidiform mole

A

dilation & suction curettage
serial serum ß-hCG post evacuation
contraception for 6 months

679
Q

clinical features vulvar lichen planus

A 
women age 50-60
vulvar pain or pruritus
dyspareunia
erosive variant (most common)
- erosive, glazed lesions with white border
- vaginal involvement +/- stenosis
- associated oral ulcers
papulosquamous variant
- small pruritic papule with purple hue
680
Q

diagnosis vulvar lichen planus

A

vulvar biopsy

681
Q

treatment vulvar lichen planus

A

high-potency topical corticosteroids

682
Q

lichen planus vs. lichen sclerosus

A

lichen sclerosis has no vaginal involvement

683
Q

management of hydatidiform mole

A

suction curettage -> weekly ß-hCG levels until undetectable

684
Q

for hydatidiform mole, if weekly ß-hCG are increasing/plateauing

A

diagnosis of gestational trophoblastic neoplasia

685
Q

for hydatidiform mole, if weekly ß-hCG are decreasing

A

monthly ß-hCG levels x6 months

686
Q

for hydatidiform mole, if monthly ß-hCG x 6 months undetectable

A

surveillance complete

can attempt pregnancy

687
Q

for hydatidiform mole, if monthly ß-hCG x 6 months becomes detectable

A

diagnosis of gestational trophoblastic neoplasia

688
Q

example of gestational trophoblastic neoplasia

A

choriocarcinoma

689
Q

clinical features of intraductal papilloma

A

unilateral bloody nipple discharge

no associated mass or lymphadenopathy

690
Q

management of intraductal papilloma

A

mammography & ultrasound

biopsy, +/- excision

691
Q

side effects & risks of combination oral contraceptives

A 
breakthrough bleeding
breast tenderness, nausea, bloating
amenorrhea
hypertension
venous thromboembolic disease
decreased risk of ovarian &amp; endometrial cancer
increased risk of cervical cancer
liver disorders (hepatic adenoma)
increased triglycerides (due to estrogen component
692
Q

examples of selective estrogen receptor modulators (SERMs)

A

tamoxifen

raloxifene

693
Q

mechanism of SERMs

A

competitive inhibitor of estrogen binding

mixed agonist/antagonist action

694
Q

indications for SERMs

A

prevention of breast cancer in high-risk patients
Tamoxifen: adjuvant treatment of breast cancer
Raloxifene: postmenopausal osteoporosis

695
Q

adverse effects of SERMs

A

hot flashes
venous thromboembolism
endometrial hyperplasia & carcinoma (tamoxifen only)

696
Q

missed abortion

A

no vaginal bleeding
closed cervical os
no fetal cardiac activity or empty sac

697
Q

threatened abortion

A

vaginal bleeding
closed cervical os
fetal cardiac activity

698
Q

inevitable abortion

A

vaginal bleeding
dilated cervical os
products of conception may be seen or felt at or above cervical os

699
Q

incomplete abortion

A

vaginal bleeding
dilated cervical os
some products of conception expelled & some remain

700
Q

complete abortion

A

vaginal bleeding
closed cervical os
products of conception completely expelled

701
Q

bartholin duct cyst

A

occurs due to blockage of the bartholin gland duct

702
Q

location of bartholin glands

A

bilaterally at the posterior vaginal Introits and have ducts that drain into the vulvar vestibule at 4 and 8 o’clock positions

703
Q

signs of bartholin duct cyst

A

often asymptomatic

increased tissue tension & friction -> vaginal pressure & discomfort with sexual activity, walking, or sitting

704
Q

pelvic exam of bartholin duct cyst

A

soft, mobile, nontender, cystic mass palpated behind the posterior labium magus with possible extension into the vagina

705
Q

treatment of bartholin duct cyst

A

I&D with possible Word catheter placement

706
Q

what is external cephalic version

A

manual rotation of fetus to cephalic presentation

decreases cesarean delivery rate

707
Q

indications for external cephalic version

A

breech/transverse presentation

>/= 37wks gestation

708
Q

absolute contraindications to external cephalic version

A

contraindication to vaginal delivery

  • prior classical cesarean delivery
  • prior extensive uterine myomectomy
  • placenta previa
709
Q

complications of external cephalic version

A

abruptio placentae

intrauterine fetal demise

710
Q

presentation of inflammatory breast cancer

A

rapid-onset edematous cutaneous thickening with a ‘peau d’orange’ appearance
edematous, erythematous, and painful
axillary lymphadenopathy suggestive of metastatic disease

711
Q

next step in evaluation of inflammatory breast cancer

A

mammography and ultrasound

tissue biopsy necessary to confirm diagnosis

712
Q

what is duodenal atresia

A

complete bowel obstruction

- fluid filled stomach and proximal duodenum with no distal intestinal air or fluid

713
Q

duodenal atresia on ultrasound

A

double bubble sign

- fluid-filled stomach ad duodenum

714
Q

signs of duodenal atresia

A

impairs fetal swallowing of amniotic fluid -> polyhdramnios

715
Q

definition of polyhydramnios

A

single deepest pocket of amniotic fluid >/= 8cm

716
Q

what is VACTERL associated with

A

trisomy 21 (Down syndrome)

717
Q

what is VACTERL

A 
Vertebral = 
Anal atresia
Cardiac = ventricular septal defct
Tracheoesophageal fistula
Esophageal atresia
Renal
Limb
718
Q

what is the two step approach for screening and diagnosing gestational diabetes

A

at 24-28wks:

  • step 1: administer 50g oral glucose load, check serum glucose 1hr later
  • step 2: if blood glucose >/= 140, administer 100g oral glucose load, check fasting serum glucose each hour afterwards for 3hrs
719
Q

how to diagnose gestational diabetes

A

> /= 2 abnormals:

  • fasting >/= 105
  • 1hr >/= 190
  • 2hr >/= 165
  • 3hr >/= 145
720
Q

what are physiologic adaptations to pregnancy as it relates to diabetes

A

pancreatic ß cell hyperplasia
increased insulin secretion
increased peripheral insulin resistance

721
Q

what is pseudothrombocytopenia

A

laboratory error caused by platelet aggregation in vitro

722
Q

how is pseudothrombocytopenia identified?

A

mild thrombocytopenia has peripheral blood smear evidence of large clumps of platelets

723
Q

idiopathic thrombocytopenic purpura

A

presents with mild thrombocytopenia
often asymptomatic and no history of bleeding disorder
peripheral blood smear shows a paucity of platelets without platelet clumping

724
Q

definition of preeclampsia

A

new-onset hypertension at >/= 20 weeks
plus
proteinuria &/or end-organ damage

725
Q

severe features of preeclampsia

A 
SBP >/= 160/110 ( 2x >/= 4hrs apart)
thrombocytopenia
increase creatinine
increase transaminases
pulmonary edema
visual or cerebral symptoms
726
Q

management of preeclampsia

A 
without severe features: delivery at >/= 37wks
with severe features: delivery at >/= 34wks
magnesium sulfate (seizure prophylaxis)
antihypertensives
727
Q

breech types

A

frank
complete
incomplete

728
Q

frank breech

A

hips flexed & knees extended (buttock presenting)

729
Q

complete breech

A

hips & knees flexed

730
Q

incomplete breech

A

1 or both hips not flexed (feet presenting)

731
Q

risk factors for breech presentation

A 
advanced maternal age >/= 35
multiparty
uterine didelphys, septet uterus
uterine leiomyomas
fetal anomalies (e.g. anencephaly)
preterm (<37wks)
oligohydramnios/polyhydramnios
placenta previa
732
Q

management of breech presentation

A

external cephalic version

cesarean delivery

733
Q

risk factors for vulvovaginal candidiasis

A 
diabetes mellitus
immunosuppression
pregnancy
OCPs
antibiotic use
734
Q

when to stop Pap testing

A 
age 65 or hysterectomy
PLUS
- no history of CIN 2 or higher
AND
- 3 consecutive negative Pap tests
OR
- 2 consecutive negative co-testing results
735
Q

Graves disease

A

thyroid stimulated by autoantibodies to increase tissue metabolic activity causing increased thyroid hormone synthesis

736
Q

Graves disease radioactive iodine uptake

A

increased reuptake

increased release of thyroid hormone

737
Q

painless autoimmune thyroiditis

A

the thyroid tissue is destroyed, leading to increased release of preformed thyroid hormone and resulting hyperthyroidism

738
Q

painless autoimmune thyroiditis radioactive iodine uptake

A

low radioactive iodine uptake due to destroyed thyroid cells being unable to synthesize thyroid hormone

739
Q

when to order CA-125

A

in a postmenopausal patient, measured in conjunction with pelvic ultrasonography to categorize an ovarian mass as likely malignant or benign

740
Q

risk factors for endometrial hyperplasia/cancer

A

excess estrogen

  • obesity
  • chronic anovulation/PCOS
  • nulliparity
  • early menarche or late menopause
  • tamoxifen use
741
Q

clinical features of endometrial hyperplasia/cancer

A

heavy, prolonged, intermenstrual &/or postmenopausal bleeding

742
Q

evaluation of endometrial hyperplasia/cancer

A 
endometrial biopsy (gold standard)
pelvic ultrasound (postmenopausal women)
743
Q

treatment endometrial hyperplasia/cancer

A

hyeprplasia: progestin therapy or hysterectomy
cancer: hysterectomy

744
Q

definition of shoulder dystocia

A

failure of usual obstetric maneuvers to deliver fetal shoulders

745
Q

risk factors for shoulder dystocia

A 
fetal macrosomia
maternal obesity
excessive pregnancy weight gain
gestational diabetes
post-term pregnancy
746
Q

warning signs for shoulder dystocia

A

protracted labor

retraction of fetal head into the perineum after delivery (turtle sign)

747
Q

methods of emergency contraception

A

copper-containing IUD
ulipristal
levonorgestrel
oral contraceptives

748
Q

timing after intercourse for copper IUD emergency contraception

A

0-120hrs

749
Q

timing after intercourse for ulipristal emergency contraception

A

0-120hrs

750
Q

timing after intercourse for levonorgestrel emergency contraception

A

0-72hrs

751
Q

timing after intercourse for OCPs emergency contraception

A

0-72hrs

752
Q

efficacy of copper IUD for emergency contraception

A

> /= 99%

753
Q

efficacy of ulipristal for emergency contraception

A

98-99%

754
Q

efficacy of levonorgestrel for emergency contraception

A

59-94%

755
Q

efficacy of OCPs for emergency contraception

A

47-89%

756
Q

contraindications for copper IUD for emergency contraception

A

acute pelvic infection
severe uterine cavity distortion
Wilson disease
complicated organ transplant failure

757
Q

diagnostic findings of amenorrhea in ovarian failure

A

increase FSH, LH

normal prolactin, TSH

758
Q

diagnostic findings of amenorrhea in functional hypothalamic amenorrhea

A

decrease FSH, LH

normal prolactin, TSH

759
Q

diagnostic findings of amenorrhea in Asherman syndrome

A

normal FSH, LH, prolactin, TSH

760
Q

diagnostic findings of amenorrhea in prolactinoma

A

decrease FSH, LH
increase prolactin
normal TSH

761
Q

diagnostic findings of amenorrhea in hypothyroidism

A

decrease FSH, LH

increase prolactin, TSH

762
Q

normal findings in the postpartum period

A 
transient rigors/chills
peripheral edema
lochia rubra
uterine contraction &amp; involution
breast engorgement
763
Q

routine care in postpartum period

A 
rooming-in/lactation support
serial examination for uterine atony/bleeding
perineal care
voiding trial
pain management
764
Q

clinical features of obsessive compulsive disorder

A

obsessions
- recurrent, intrusive, anxiety-provoking thoughts, urges, or images
compulsions
- response to obsessions with repeated behaviors or mental acts
- behaviors not connected realistically with preventing feared event
time consuming (>1hr/day) or causing significant stress or impairment

765
Q

treatment of OCD

A

SSRI

cognitive behavioral therapy (exposure & response prevention)

766
Q

physiologic corpus luteum cyst

A

confirmed by ultrasound revealing a simple-appearing ovarian cyst with normal Doppler flow

767
Q

clinical features concerning for malignancy of adnexal mass

A

postmenopausal age
chronic or worsening pelvic pain
mass symptoms (bloating, constipation)

768
Q

ovarian cancer screening

A

no screening tests exist

769
Q

routine prenatal laboratory tests at initial prenatal visit

A 
Rh (D) type, antibody screen
Hgb/Hct, MCV
HIV, VDRL/RPR, HBsAg
Rubella &amp; varicella immunity
Pap test 
Chlamydia PCR
urine culture
urine protein
770
Q

routine prenatal laboratory tests at 24-28wks

A

Hgb/Hct
antibody screen if Rh (D) negative
50-g 1-hr GCT

771
Q

routine prenatal laboratory tests at 35-37wks

A

Group B streptococcus culture

772
Q

who requires endometrial sampling with benign-appearing endometrial cells on Pap?

A

pemenopausal women with:
- abnormal uterine bleeding OR
- risk for endometrial hyperplasia
postmenopausal women

773
Q

who requires endometrial sampling with atypical glandular cells on Pap?

A

women >/= 35 OR at risk for endometrial hyperplasia

774
Q

who requires endometrial sampling with atypical glandular cells, favor neoplastic on Pap?

A

all women

775
Q

mature cystic teratoma on ultrasound

A

hyperechoic nodules and calcifications

776
Q

evaluation of intimate partner violence

A

routine annual exam
suspicious signs/symptoms
prenatal visits

777
Q

consequences of intimate partner violence

A 
homicide
mental health disorders
unintended pregnancy
pregnancy complications (abrupt placentae)
sexually transmitted infections
778
Q

management of intimate partner violence

A 
safety planning (e.g. local shelter referral)
psychosocial counseling
779
Q

high risk preeclampsia

A 
prior preeclampsia
chronic kidney disease
chronic hypertension
diabetes mellitus
multiple gestation
autoimmune disease
780
Q

moderate risk preeclampsia

A

obesity
advanced maternal age
nulliparity

781
Q

prevention of preeclampsia

A

low-dose aspirin at 12wks gestation

782
Q

pathophysiology of neonatal thyrotoxicosis

A

transplacental passage of maternal anti-TSH receptor antibodies
antibodies bind to infant’s TSH receptors and cause excessive thyroid hormone release

783
Q

clinical features of neonatal thyrotoxicosis

A

warm, moist skin
tachycardia
poor feeding, irritability, poor weight gain
low birth weight or preterm birth

784
Q

diagnosis of neonatal thyrotoxicosis

A

maternal anti-TSH receptor antibodies >/= 500% normal

785
Q

treatment of neonatal thyrotoxicosis

A

self-resolves within 3 months (disappearance of maternal antibody)
methmiazole plus ß blocker

786
Q

fetal diagnosis of nonviable fetus

A 
acardia
anencephaly
bilateral renal genesis
holoprosencephaly
intrauterine fetal demise
pulmonary hypoplasia
thanatophoric dwarfism
787
Q

obstetric management of nonviable fetus

A

vaginal delivery

no fetal monitoring

788
Q

neonatal management of nonviable fetus

A

palliative care if not stillborn

789
Q

management of Erb-Duchenne palsy

A

observation and physical therapy

up to 80% have spontaneous recovery within 3 months

790
Q

risk factors of ovarian torsion

A

ovarian mass
women of reproductive age
infertility treatment with ovulation induction

791
Q

treatment of ovarian torsion

A

laparoscopy with detorsion
ovarian cystectomy
oopherectomy if necrosis or malignancy

792
Q

major causes DIC

A

sepsis
severe traumatic injury
malignancy
obstetric complications

793
Q

pathophysiology of DIC

A

procoagulant excessively triggers coagulation cascade ->
formation of fibrin-/platelet-rich thrombi & fibrinolysis ->
bleeding & organ damage (e.g. kidneys, lungs)

794
Q

laboratory findings of DIC

A 
thrombocytopenia
prolonged PT &amp; PTT
decrease fibrinogen
increase D-dimer
microangiopathic hemolytic anemia (schistocytes)
795
Q

congenital parvovirus 19

A

anemia (aplastic)
high-output congestive heart failure
cardiomyopathy

796
Q

mom presentation of parvovirus 19

A

febrile illness with myalgia, arthralgias, lymphadenopathy, and lacy, erythematous rash

797
Q

mom presentation of varicella-zoster

A

febrile illness

pruritic vesicular lesions in all stages of healing

798
Q

congenital toxoplasmosis

A

intracranial calcifications
disseminated purpuric rash
seizures
chorioretinitis, hydrocephaly

799
Q

classic triad of congenital toxoplasmosis

A

chorioretinitis
intracranial calcifications
hydrocephaly

800
Q

congenital cmv vs. toxoplasmosis

A

toxoplasmosis has more diffuse calcifications and hydrocephaly
CMV has periventricular calcifications and microcephaly

801
Q

congenital CMV

A

low birth weight, ventriculomegaly, hearing impairment

periventricular calcifications

802
Q

congenital rubella syndrome

A

patent ductus arteriosus
hearing impairment
petechial, puerperal rash (‘blueberry muffin’ rash)

803
Q

supplement for history of PPROM

A

spontaneous preterm birth prior to 37 weeks gestational age is an indication for 17-hydroxyprogesterone in subsequent pregnancies

804
Q

when is progesterone given in history of PPROM

A

16 and 36 weeks

805
Q

false labor

A

uterine contractions that do not result in cervical change

806
Q

most likely cause of irregular bleeding in an adolescent

A

anovulatory bleeding

- failure of the ovary to develop a corpus luteum

807
Q

most sensitive indicator of IUGR

A

abdominal circumference

808
Q

independent risk factor for preterm labor

A

African American race

809
Q

contraindications to MTX in ectopic pregnancy

A 
ß-hCG >5000
fetal cardiac activity on TVUS
heterotopic pregnancy
hypersensitivity
breastfeeding
immunodeficiency
active pulmonary disease
peptic ulcer disease
inability/unwillingness to comply with close follow-up
<4cm
810
Q

treatment of ectopic pregnancy >5.5cm

A

laparoscopic surgery

- salpingectomy or salpingostomy

811
Q

pathophysiology of tuberous sclerosis complex

A

mutation in TSC1 or TSC2 gene

Autosomal Dominant

812
Q

clinical features of tuberous sclerosis complex - dermatologic

A

ash-leaf spots
angiofibromas of the malar region
shagreen patches

813
Q

clinical features of tuberous sclerosis complex - neurologic

A

CNS lesions - subependymal tumors
epilepsy - infantile spasms
intellectual disability
autism & behavioral disorders - hyperactivity

814
Q

clinical features of tuberous sclerosis complex - cardiovascular

A

rhabdomyomas

815
Q

clinical features of tuberous sclerosis complex - renal

A

angiomyolipomas

816
Q

surveillance for tuberous sclerosis complex

A 
tumor screening
- regular skin &amp; eye examinations
- serial MRI of the brain &amp; kidney
- baseline echocardiography &amp; serial ECG
baseline EEG
neuropsychiatric screening
817
Q

medications to avoid in myasthenia gravis

A 
magnesium sulfate
fluoroquinolones, aminoglycosides
NMS blocking agents
CNS depressants
muscle relaxants
CCBs
ß blockers
opioids
statins
818
Q

risk of triglyceride-induced pancreatitis

A

triglyceride levels

  • <500 = minimal risk
  • 500-99 = mild risk
  • 1000-1999 = moderate risk
  • > = 2000 = high risk
    other: pregnancy, alcoholism, obesity, uncontrolled diabetes
819
Q

clinical features of triglyceride-induced pancreatitis

A

acute epigastric pain radiating to the back
+/- fever, nausea, vomiting
elevated serum lipase (>3x ULN)

820
Q

management of triglyceride-induced pancreatitis

A

IV fluid hydration, pain control
glucose >/= 500 mg/dL: consider insulin infusion
glucose <500 mg/dL or severe pancreatitis (e.g. lactic acidosis, hypocalcemia): consider aphaeresis (therapeutic plasma exchange

821
Q

risk factors of rectovaginal fistula

A 
pelvic radiation
obstetric trauma
pelvic surgery
colon cancer
diverticulitis
Crohn disease
822
Q

clinical features of rectovaginal fistula

A

uncontrollable passage of gas &/or feces from the vagina

823
Q

diagnostic studies for rectovaginal fistula

A

physical examination
fistulography
MRI
endosonography

824
Q

rectovaginal fistula

A

posterior vaginal wall
dark red, velvety lesion
malodorous, tan-brown discharge

COMAT OB/GYN (1 decks)

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