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OBGYN > NBME Questions > Flashcards

NBME Questions Flashcards

1
Q

Fibroadema:

  • part of cycle?
  • tender or painless?
A

luteal (so close to time for period)
painful
will be small, usually younger woman

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2
Q

What test evaluates “Rh antibody status”?

A

anti-globulin, coombs test

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3
Q

Initial symptoms of HELLP syndrome

A

viral like illness (late) in pregnancy

  • nausea, vomiting etc
  • some Pre-E symptoms possible (H/A vision changes)
  • RUQ pain
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4
Q

Labs/signs assc with HELLP syndrome

A

low Hb
low platelets elevated liver enzymes
lower blood pressure

high liver enzymes
high bilirubin
high LDH

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5
Q

Labs assc with intrahepatic cholestasis

A
  • high bile acids

- mildly high bilirubin and AST/ALT

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6
Q

Most serious sequelae of any cellulitis?

A

necrotizing fasciitis

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7
Q

Possible preventative measure against UTIs?

A

voiding after coitus

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8
Q

Treatment of CIN

A

cone biopsy/ LEEP

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9
Q

Most common cause endometritis/chorioamnionitis?

A

polymicrobial infection

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10
Q

“Fetal small parts above the fundus” should be a buzz word for ______.

A

uterine rupture

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11
Q

Most common type of cervical cancer?
vaginal cancer?
endometrial?

A

cervix + vagina: squamous cell (HPV induced)

endometrial: adenocarcinoma

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12
Q

42 year old with amenorrhea + mood changes + night sweats: first test

A

pregnancy test before diagnosing climacteric

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13
Q

Exquisitively tender ulcer on the labia should be a buzz word for”:

A

HSV

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14
Q

Apnea, cyanosis, hypotension, DIC following placental delivery suggests ______.

A

amniotic fluid embolism

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15
Q

All multifetal gestations are at risk for ______

A

preterm labor

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16
Q

Atypical (glandular) cells on pap smear + normal colposcopy warrants ______.

A

endometrial biopsy

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17
Q

Scarred cervical os + enlarged tender uterus suggests _____

A

cervical stenosis

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18
Q

Test of choice for hyperemesis gravidarum

A

urinary ketones + electrolytes (BMP)

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19
Q

Polyhydramnios, fetal ascites, skin thickening are suggestive of what infection?

A

Parvovirus B12 (hydrops fetalis)

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20
Q

If a fetal presenting part is not felt during intrapartum care, what test should be done?

A

ultrasound

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21
Q

What is the use of amnioinfusion?

A

variable decels, relieves cord compression

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22
Q

When are low amniotic fluids relatively common and what do they mean? what is the treatment in this case?

A 
postterm pregnancy (42+ weeks) 
represent declining placental function 
treat by delivering baby

**not treated with amnioinfusion if baby isn’t symptomatic

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23
Q

What medication dilates the cervix to induce labor?

A

prostaglandins

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24
Q

What is a normal post-void bladder volume?
What does an increased value mean?
What are these patients at risk of?

A

20-25 mL
increased value suggestive of atonic bladder
at risk of UTI

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25
Q

First step in evaluation of abnormal AFP levels

A

ultrasound to verify dating

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26
Q

What lab values are expected to be increased during menopause

A

FSH, LH

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27
Q

Erbs palsy is caused by injury to which nerve roots?

A

C5-6

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28
Q

Following hysterectomy for leiomyomata, how often should pap smears be done?

A

not. don’t.

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29
Q

Microcytic anemia + alcohol abuse suggests what deficiency?

A

folate

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30
Q

Treatment of steroid induced osteoporosis

A

–dronates

bisphosphonates

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31
Q

Best birth control for woman taking chemo/AED/other medications that change liver metabolism?

A

cooper IUD

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32
Q

Macrosomia + pulmonary disease in newborn may be related to increased serum levels of _____

A

insulin

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33
Q

What are the normal pH findings in bacterial vaginosis vs trich vs candida

A

BV + trich: higher than 4.5

candida: 4.5 or less

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34
Q

Which of the three vaginal infections (BV, trich, candida) has a negative “whiff test”?

A

candida

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35
Q

Trich and BV both have 4.5+++ pH and + whiff test, how are they distinguished?

A

trich: motile organisms, green frothy discharge
BV: white discharge, clue cells

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36
Q

What medication treats both BV and trich?

A

metronidazole

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37
Q

Treatment of suspected appendicitis?

A

surgical exploration

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38
Q

What type of endometrium is present during the follicular vs luteal phases of the menstrual cycle?

A

follicular: proliferative
luteal: secretory

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39
Q

What determines the risk of fetal demise in case of IUGR?

A

US of the umbilical artery

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40
Q

Ovarian failure in young woman with previous history of normal menstruation + normal FSH/LH/TSH is caused by?

A

autoimmune ovarian destruction

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41
Q

12.5 year old with abnormal menstrual cycles: cause

A

normal development.

abnormal menstrual patterns normal up to age 15

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42
Q

MCC fetal tachycardia?

A

infection/ maternal fever

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43
Q

Fluctuant mass during breast feeding- DDx

A

galactocele: afebrile, no erythema

mastitis/abscess: fever, erythma, warmth

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44
Q

Basic way to normalize menstrual cycles

A

cyclic progesterone therapy

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45
Q

Evaluation for primary amenorrhea:

A

karyotype analysis

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46
Q

Sexually active patients under 25 get what screening?

A

G&C, pap if age 21+

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47
Q

Most appropriate therapy to induce ovulation in PCOS patients

A

clomiphene, estrogen antagonist at the hypothalamus

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48
Q

Fetal hydrops + ascites think ______

A

parvovirus B19

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49
Q

Drug associated with placental abruption

A

cocaine

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50
Q

bHCG 1500+ with no fetus on U/S of uterus = _____

A

ectopic

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51
Q

fluctuant mass of labium majus =

A

Bartholin duct abscess

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52
Q

Preterm breech presentation in the vagina without contractions or bleeding:
cause
treatment

A

incompetent cervix

cerclage

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53
Q

Ovarian mass + endometrial hyperplasia suggests that the ovarian mass is what type?

A

granulosa cell tumor – estrogen producing

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54
Q

+ Qtip test + stress incontinence suggests what cause?

A

uretherocele

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55
Q

“echogenic structures in the uterus” = buzzword for

A

hydatidiform mole

snowstorm pattern

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56
Q

amnorrhea + tanner stage four breast and hair development is suggestive of?

A

imperforate hymen

if hair were absent, androgen insensitivity syndrome

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57
Q

How long does it take herpes lesions to spontaneously resolve?

A

1 week

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58
Q

The following symptoms are suggestive of what disease process:

  • suprapubic tenderness
  • urinary urgency
  • anterior vaginal wall tenderness
A

interstitial cystitis

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59
Q

Renal anomalies are associated with what other anatomic anomalies?

A

mullerian

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60
Q

Protracted labor in a patient with DM is likely due to ______

A

cephalopelvic disproportion

head too big for pelvis

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61
Q

Treatment of hydatidiform mole

A

suction and curettage

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62
Q

Risk factor for persistent yeast infection

A

DM (poor healing)

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63
Q

HELLP syndrome is a severe _______

A

Pre-E
(look for severe pre-E if HELLP is not answer choice, damn tricksters)

**Note that BP will NOT be in severe range despite being considered a “severe variant of Pre-E.

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64
Q

“Fundal placenta” rules out what cause of bleeding in pregnancy?

A

placenta previa, painless bleeding not caused by previa if US shows “fundal placenta”

causes of painless bleeding may include cervical cancer, cervical trauma, etc. (cervical cancer rare in YOUNG women, bimodal…. 30s-60s)

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65
Q

Treatment of breast engorgement/ cysts caused by estrogen replacement therapy

A

stop the replacement therapy

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66
Q

How to distinguish mastitis vs abscess

A

key buzzwords:

abscess: fluctuant
mastitis: nonfluctuant

both may have LOCALIZED swelling and fever, abscess less likely to respond to typical abx, needs draining

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67
Q

Cause of oligohydramnios in lupus patients:

A

uteroplacental insufficiency due to clotting

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68
Q

Tinnitus + metallic taste following administration of epidural suggests…

A

accidental intravascular injection

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69
Q

bicornuate uterus puts woman at risk of …..

A

preterm labor

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70
Q

Ddx abdominal organs outside of cavity in fetus

A

gastroschisis: not covered
omphalocele: covered

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71
Q

Why no combination OCPs in breast feeding?

A

decreased milk protein content

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72
Q

Labs needed to diagnose pyelonephritis

A

pyuria + bacteruria

**NOTE: may get systemic edema with pyelo/nephritic syndrome.

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73
Q

U/A findings in appendicitis

A

mild pyuria, proteinuria and hematuria

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74
Q

What abx is typically given for UTI px

A

TMP-SMX

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75
Q

Strongest risk factor for endometrial hyperplasia/cancer

A

anovulation

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76
Q

DOC for hyperthyroidism in pregnancy

A

PTU

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77
Q

What hormone level is expected to be elevated in turners?

A

FSH/LH

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78
Q

Normal post op pain assc with cesarean

A

pulling/tugging near lateral areas of wound

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79
Q

Treatment of hyperemesis gravidarum

A

admission to hospital for IV hydration + antiemetics

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80
Q

PID + rash is suggestive of ….

A

TSS (staph aureus)

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81
Q

Presence of new pubic hair suggests….

A

imminent menarche

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82
Q

Treatment of 5 cm simple ovarian cyst in a 25 year old

A

OCP therapy and re-examine

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83
Q

Active labor with no palpable presenting part:

first step in management

A

ultrasound

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84
Q

Microcytic anemia + normal iron levels warrants ____.

A

hemoglobin electrophoresis

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85
Q

MC ADR of suction curettage

A

amenorrhea (ashermans)

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86
Q

Diagnostic test of choice for DVT

A

duplex venous U/S

87
Q

Why does growth restriction occur with PreE

A

placental dysfunction

88
Q

Most common fetal effect of PreE

A

growth restriction

89
Q

Treatment of newborn exposed to chickenpox

A

VZIG

90
Q

Treatment for painful intercourse post partum

A

lubricant

91
Q

Bleeding with rupture of membranes suggests what diagnosis>?

A

vasa previa –> cesarean section

92
Q

Tachysystole + late decels cause:

A

oxytocin

93
Q

Cystic mass with calcium deposits suggests…

A

teratoma

94
Q

Bacterial vaginosis treatment

A

vaginal metronidazole

95
Q

Cause of primary dysmenorrhea

A

prostaglandins

96
Q

SERMs assc ADRs

A

endometrial cancer/ benign pathology

uterine sarcomas

**prevents osteoporosis

97
Q 
Tamoxifen/ Raloxifene: 
action at 
-breast 
-bone 
-uterus
A

tamoxifen: breast antagonist, bone/uterine agonist
raloxifene: breast/ uterine antagonist, bone agonist

*raloxifene not effective in breast cancer

98
Q

Major risk factor for placenta previa

A

uterine surgery

99
Q

Treatment of variable decels

A

amnioinfusion

100
Q

Decreased breath sounds at lung bases: cause

A

atelectasis

101
Q

Why are adolescents susceptible to PID?

A

increased cervical cell vulnerability

102
Q

Red beefy mass hanging out of adult vagina: cause

A

pedunculated submucosal leiomyoma

103
Q

Cause of fetal demise in clotting disorder

A

uteroplacental artery thrombosis

104
Q

Cause of no accelerations

A

fetal sleep state

105
Q

Bloody culdocentesis, peritoneal signs, negative pregnancy test: cause

A

ruptured corpus luteum cyst

106
Q

Positive pregnancy test, fronding pattern, hemoperitoneum: cause

A

ruptured corpus luteum cyst

107
Q

Treatment of imperforate hymen

A

transvaginal incision and drainage

108
Q

Treatment for endometrial adenocarcinoma

A

hysterectomy

109
Q

Cause of urge incontinence

A

detrusor hyperreflexia

110
Q

Duodenal bubble on U/S= suspicious for:

A

Downs, duodenal atresia

111
Q

Post-coital spotting in young patient is suspicious for….

A

cervicitis

112
Q

If membranes are ruptured for more than 18 hours, what medication must be started?

A

Penicillin if:

  • unknown GBS status
  • previous baby was positive for infection
  • any culture positive for group B in this pregnancy
113
Q

Treatment for post-cesarean infection

A

IV abx, CT if no improvement within 48 hours

114
Q

Management of nonviable pregnancy with no fetal pole and falling B-Hcg levels pre-intervention:

A

follow hcg levels to zero

115
Q

Common sites of invasion: cervical cancer

A
  • ureter
  • parametrium
  • lower vagina
116
Q

Twin types:

two yolk sacs + thick dividing membrane

A

di/di

117
Q

At how many weeks is amniocentesis done?

CVS? What are the indications?

A

CVS: 10-13 weeks
Amnio: 11-14

*Indicated for disease in PARENT or AMA

118
Q

How does fundal weight correlate to gestational age?

A

Fundal height, when expressed in centimeters, roughly corresponds to gestational age in weeks between 16 to 36 weeks for a vertex fetus

119
Q

What should fundal height be between 10-15 weeks?

A

5-10 cm

120
Q

Pap smear screening in HIV women

A

annually

121
Q

Is evidence of parvo in mom needed to diagnose hydrops secondary to parvo in baby?

A

no

122
Q

Cervical finding with trich

A

strawberry cervix or ectropion

123
Q

ROM –> loss of fetal heart rate

What diagnoses are expected?

A

cord prolapse - cord on exam

vasa previa - bleeding

124
Q

Foul smelling discharge in kid, expect…

A

foreign body

125
Q

Macrosomia = mom at risk for what condition in future pregnancies?

A

GDM

126
Q

Treatment for transverse lie at term

A

cesarean

127
Q

Size small for dates: evaluation

A

NST/ BPP

128
Q

Type 1 DM cause of Size greater than dates

A

poly

129
Q

Woman in her 40s… always rule out ____ before diagnosing menopause

A

pregnancy

130
Q

Most common cause unilateral bloody nipple

A

intraductal papilloma

131
Q

Discharge color assc with ductal ectasia or fibrocystic changes

A

green, brown, yellow… non bloody

132
Q

Steroid dosage for PPROM

A

2 doses 24 hours apart

133
Q

Signs of retained POC following D&C

A

profuse vaginal bleeding and if not removed may lead to a septic abortion.

134
Q

Signs of post op uterine perforation

A

Physical examination reveals rebound tenderness and abdominal guarding

135
Q

Unexplained primary infertility:

first steps in diagnosis

A

semen analysis —-> HSG

136
Q

Management of umbilical cord prolapse

A
  • continue to elevate the fetal head with a hand in the patient’s vagina and call for assistance to perform a Cesarean delivery
  • Do NOT replace umbilical cord
137
Q

How do SVR and PVR compare in pregnancy?

A

The systemic vascular resistance (SVR) is normally greater than the pulmonary vascular resistance.

If reversed, get shunt.

138
Q

Why does cardiac output increase in pregnancy?

A

The cardiac output increases up to 33% due to increases in both the heart rate and stroke volume

139
Q

Karyotype in mullerian agenesis

A

46, XX

140
Q

FHT in the 170s with decreased variability and a sinusoidal pattern. + increased uterine tone.

Suspect _______

A

placental abruption

141
Q

Recipient twin in TTS has what cardiovascular complications?

A

cardiomegaly, tricuspid regurgitation, ventricular hypertrophy and hydrops fetalis for the recipient twin

142
Q

Surviving twins of TTS have what post partum complications?

A

neurological morbidity (CP)

143
Q

Which SSRI is contraindicated in pregnancy?

A

paroxetine (Paxil) has been changed to a category D drug because of the increased risk of fetal cardiac malformations and persistent pulmonary hypertension

144
Q

Describe appearance of dysmaturity

A

withered, meconium stained, long-nailed, fragile and have an associated small placenta

145
Q

What patients are at risk of having fetus with dysmaturity?

A

post term

146
Q

3 MC findings in trisomy 18

A

overlapping fingers, micronathia, and cardiac defects

147
Q

Pain control for mastitis

A

use ibuprofen in addition to acetaminophen for pain relief

not breast binders

148
Q

Treatment for Hep B exposure

A

HBIG (Hepatitis B Immune Globulin) and the HBV (Hepatitis B Vaccine Series) within 7 days of blood or 14 days of sex

149
Q

Incubation period for hep B

A

is six weeks to six months

150
Q

Describe PMDD cyclic nature

A

symptoms that begin to resolve with the beginning of the follicular phase

151
Q

Colon cancer screening with family history

A

first degree relative with colon cancer before age 60: then begin screening with colonoscopy at age 40 or 10 years before the youngest relative diagnosis, and repeat every five years

152
Q

Treatment of worsening asthma in pregnancy

A

albuterol inhaler + inhaled corticosteroids or cromolyn sodium.

153
Q

Rh hemolytic disease: Measurement of which of the following in the amniotic fluid is best indicative of the severity of the disease

A

bilirubin

154
Q

Describe microinvasive cervical cancer

A

In microinvasive cancer, cells invade less than 3 mm beyond the BM

155
Q

Describe cervical carcinoma in situ

A

Carcinoma in situ (CIS) represents abnormal cells involving the entire epithelium to the basement membrane.

156
Q

Contrast cervical cancer, cyst, and

A

Cancer: hard and bloody
Polyp: soft and bloody
Cyst: soft no bloody

157
Q

What defines primary HSV infection?

A

seronegative for HSV antibodies

158
Q

Most common source of infection s/p c section

A

The lungs are the most common source of fever on the first postpartum day, particularly if the patient had general anesthesia

159
Q

How to remove an escaped IUD

A

visible on U/S in uterus - HSG

visible outside of cavity- lap

160
Q

At what weeks GA are the risks highest for developing ID?

A

between eight and 15 weeks gestation

161
Q

Folic acid requirements for women with previous NTD pregnancy

A

Prevention recommended that all women with a previous pregnancy complicated by a fetal neural tube defect ingest 4 mg of folic acid daily before conception and through the first trimester

Non high risk = 0.6 mg

162
Q

Is polyhydramnios assc with growth restriction?

A

not associated with asymmetric growth restriction since an asymmetric growth pattern reflects poor uterine blood flow and limited substrate availability

163
Q

How does HRT effect lipid levels?

A

HDL levels increase and LDL levels decrease

164
Q

How to suppress lactation

A

Breast binding, ice packs and analgesics

165
Q

Physical indications for cesarean section

A
  • head with measurements greater than 12 cm
  • fetal weight greater than 4000 grams in a diabetic and greater than 4500 grams in a non-diabetic patient
  • Uterine fibroids located in the lower uterine segment
166
Q

Neonatal risks assc with GDM

A
  • hypoglycemia, hypocalcemia
  • polycythemia, hyperbilirubinemia
  • respiratory distress
167
Q

Adult diseases assc with growth restriction as a fetus (4)

A

cardiovascular disease, chronic hypertension, chronic obstructive lung disease and diabetes

168
Q

How do birth control pills treat dysmenorrhea?

A

The progestin in oral contraceptives causes endometrial atrophy. Since prostaglandins are produced in the endometrium, there would be less produced

169
Q

Common ADR of GnRH antagonist

A

Hot flashes are experienced by >75% of patients

170
Q

Female diagnosed with bleeding secondary to fibroids should also receive…

A

An endometrial biopsy should be performed on all women over age 40 with irregular bleeding to rule out endometrial carcinoma

171
Q

intrauterine pressure catheter is placed, and a significant amount of vaginal bleeding is noted.. .what do you do?

A

withdrawing the catheter, monitoring the fetus and observing for any signs of fetal compromise would be the most appropriate management

*consider placental perforation or abruption

172
Q

Best form of permanent birth control for a morbidly obese patient

A

vasectomy

173
Q

For cervical lesion, if entire transformation cannot be seen with colposcopy, what must be done?

A

cone

174
Q

Fat seen in suction during D&C… next step in management?

A

Laparoscopy

175
Q

In addition to U/S and quant, what should be done in the evaluation of molar pregnancy

A

CXR…the lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease

176
Q

Labium majora mass in post menopausal woman should be assumed to be…

A

Bartholin gland cyst in a post-menopausal woman should be further investigated for malignancy

177
Q

Two carrier parents for an autosomal recessive condition…. child is unaffected… what are the odds child is a carrier?

A

not a carrier: 1/3

carrier: 2/3

178
Q

Odds baby is affected by an AR disease

A

odds mom carrier x odds dad carrier x 1/4

179
Q

What confirms presence of an IUP

A

fronding

yolk sac

180
Q

Treatment for drain pipe urethra (intrinsic sphincteric deficiency)

A

Urethral bulking

181
Q

Most important risk for PROM

A

primary risk factor for preterm rupture of membranes is genital tract infection, especially associated with bacterial vaginosis

182
Q

chronic pelvic pain occurring in the setting of pelvic varicosities… DIAGNOSIS?

A

Pelvic congestion syndrome

183
Q

What is assc with retained placenta? (4)

A

Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta.

184
Q

Treatment of vulvar carcinoma

A

radical vulvectomy and groin node dissection. Only microinvasive squamous cell carcinoma of the vulva can be treated by wide local excision

185
Q

When is mifepristone acceptable for pregnancy termination?

A

Mifepristone, a progesterone receptor blocker, is used for pregnancy termination. It is recommended for use within 49 days of the last menstrual period, but there is data to show that it can be effective up to nine weeks

..after 9 weeks use misoprostol

186
Q

FIRST STEP IN EVALUATION OF ABNORMAL UTERINE BLEEDING

A

. It is vitally important to rule out pregnancy in the evaluation of abnormal uterine bleeding

187
Q

MC cause abnormal AFP with certain dating

A

twin pregnancy

*note poly is not a cause

188
Q

Four conditions to worry about in Ashenkazi Jews

A

Fanconi anemia, Tay-Sachs disease, Cystic Fibrosis, and Niemann-Pick disease are all autosomal recessive conditions that occur at an increased incidence in Jews of Ashkenazi descent

189
Q

B thal is common in what group?

A

Mediterannean

190
Q

Where is the best place to post information for domestic violence treatment?

A

The best place to have literature is where there is the most privacy such as an office restroom

191
Q

Risk of isoimmunization in Rh- patient without Rhogam

A

The risk of isoimmunization is 2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy so less than 20% total

192
Q

Terbutaline ADR

A

Tachy

Pulm Edema

193
Q

How is menopause diagnosed

A

no periods for one year, don’t have to order FSH

194
Q

When is HRT given

A

menopause symptoms interfering with functioning

195
Q

Baby size in type 1 GDM

A

small, hypoglycemic

196
Q

Treatment of breast engorgement

A
  • good bra
  • frequent nursing
  • analgesic before feeding
  • warm compress
197
Q

What is diagnostic of chorio on amniocentesis

A

Amniotic glucose less than 20 mg/dl

198
Q

Three fetal conditions assc with post term pregnancies

A
  • placental sulfatase deficiency
  • fetal adrenal hypoplasia
  • anencephaly
199
Q

MOA MgSO4

A

competing with calcium entry into cells

200
Q

Terbutaline and ritodrine are contraindicated in what patients?

A

Terbutaline and ritodrine are contraindicated in diabetic patients

201
Q

MGSO4 is contraindicated in what neuro condition?

A

Magnesium sulfate is contraindicated in myasthenia gravis

202
Q

Most reliable dating method in pregnancies near term

A

The crown-rump length

203
Q

Best way to stop lactation?

A

Breast binding, ice packs and analgesics

204
Q

When is BRCA testing indicated?

A

A combination of first and second-degree relatives on the same side of the family diagnosed with breast and ovarian cancer

205
Q

How to diagnose decreased ovarian reserve?

A

clomiphene challenge test

206
Q

Management of septic abortion

A

broad-spectrum antibiotics and uterine evacuation

207
Q

What causes postpartum telogen effluvium (hair loss)?

A

high estrogen during pregnancy

208
Q

What B-HCG is suggestive of molar pregnancy?

A

combined with the findings of an enlarged uterus and vaginal bleeding, a Beta-hCG value >1,000,000 mIU/mL may be diagnostic

209
Q

How do OCPs effect testosterone levels?

A

lower ovarian androgen production

increase SHBG, decrease free testosterone

210
Q

The following symptoms are assc with entrapment of what nerve?

right lower quadrant pain and numbness, radiating into the right inguinal area and medial thigh.

A

Ilioinguinal nerve T12, L1

211
Q

The following symptoms are assc with entrapment of what nerve?

loss of cutaneous sensation to the groin and the skin overlying the pubis

A

iliohypogastric T12, L1

212
Q

Damage to what nerve causes inability of the patient to adduct the thigh?

A

obturator

213
Q

What vitamin deficiencies are assc with PMS?

A

A, E, B6

214
Q

most common abnormal karyotype encountered in spontaneous abortuses

A

autosomal trisomy

OBGYN (3 decks)

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