Mehl. OBGYN bullet point in general nr 3 Flashcards
Which fetal parameter most reflective of IUGR?
abdominal circumference
Intrauterine growth restriction (IUGR) of the fetus; which lifestyle factor most contributory; answer =?
What imaging to do?
smoking, not alcohol -> causes decreased placental blood flow.
answer = “Doppler ultrasonography of the umbilical artery.”
45F + mammography shows cluster of microcalcifications in upper-outer quadrant; next best step?
needle-guided open biopsy (FNA wrong answer)
microcalcifications are ductal carcinoma in situ (DCIS) until proven otherwise.
45F + SLE + commencing third course of corticosteroids during past 18 months; Q asks what else she should be given; answer = “alendronate now”
give bisphosphonate to patients commencing
steroids indefinitely, or to patients receiving steroids frequently.
Female at 24 weeks’ gestation + HTN + proteinuria; most likely cause for her findings?
“uteroplacental insufficiency” or “placental dysfunction”; this is the cause of preeclampsia.
Female at 16 weeks’ gestation + HTN + proteinuria + fundal height measured at the umbilicus; Dx?
answer = hydatidiform mole, not preeclampsia; preeclampsia will occur after 20 weeks’ gestation; molar pregnancy presents large for gestational age -> fundal height at umbilicus is normally reflective of 20 weeks’ gestation.
When to give RhoGAM?
normally at 28 weeks’ gestation + again at parturition; also give for spontaneous or instrumental abortions + procedures (e.g., amniocentesis) + trauma/insults (e.g., abruptio placentae).
67F + T2DM + vaginal candidiasis Tx with topical miconazole + doesn’t respond to Tx, why?
answer = T2DM.
21F + recently took Abx + red vaginal introitus and itching + cervical and vaginal discharge are normal
+ KOH prep and wet mount show no abnormalities; Dx?
answer on Obgyn NBME = vaginal candidiasis (thick white discharge is otherwise classic).
Tx = topical nystatin or oral fluconazole.
Mechanism for increased cholesterol gallstones in pregnancy? what does progesterone?
progesterone slows biliary
peristalsis
Mechanism for increased cholesterol gallstones in pregnancy? what does Estrogen?
estrogen increased activity of HMG-CoA reductase (compensatory for lowering serum levels of cholesterol).
18F + tampon use + diffuse rash + BP 90/60; Dx?
Toxic shock syndrome (S.aureus).
25F + normal periods + LMP 20 days ago + 5cm mobile mass in right adnexa on examination + slightly tender to palpation; Dx?
answer = hemorrhagic corpus luteum cyst; wrong answer is endometrioma (chocolate cyst seen in endometriosis).
36F + 26 weeks’ gestation + severe flank pain + feels faint when attempting to urinate; Dx?
urolithiasis (progesterone slows ureteral peristalsis).
26F + three first-trimester miscarriages + has single kidney; Q asks most likely reason for recurrent
miscarriage; answer = ?
congenital uterine abnormalities
24F + 30 weeks’ gestation + spotting on underwear 12 hours after sexual intercourse + bleeding
gradually increasing since + USS normal; Dx?
answer = cervical trauma.
Fetus has HR at 120bpm (NR 110-160), however there’s zero variability; Dx?
fetal sleep state.
!!!29F + G1P0 + 2nd or 3rd trimester + intensily itchy eruption around umbilicus that spreads outward; Dx + Tx?
answer = herpes gestationis (gestational pemphigoid);
not HSV, but instead an idiopathic autoimmune phenomenon;
Tx = topical steroids.
Anovulation + hirsutism + BMI 27; Dx?
PCOS.
Best Tx for PCOS? conserv
if high BMI, weight loss first always on USMLE;
Best Tx for PCOS? drugs is want and dont want pregnancy?
OCPs (if not wanting pregnancy);
clomiphene (if wanting pregnancy; estrogen receptor partial agonist ->leads to increased GnRH outflow).
PCOS increases risk of what ??????? important
Endometrial cancer (unopposed estrogen); insulin resistance also
greater risk of T2DM
!!!28F + Hashimoto thyroiditis + hot flashes for 6 months + high FSH; Dx?
answer = “autoimmune ovarian failure”; this is a cause of premature ovarian failure (autoimmune diseases go together).
32F + unable to conceive for 3 years + BMI 30 + acanthosis nigricans; Dx?
T2DM (PCOS or anovulation not listed as answers; wrong answer is “hypercortisolism”)àQ doesn’t mention any characteristic features such as purple striae, muscle wasting, or central obesity.
