NBME Questions Flashcards
Fibroadema:
- part of cycle?
- tender or painless?
luteal (so close to time for period)
painful
will be small, usually younger woman
What test evaluates “Rh antibody status”?
anti-globulin, coombs test
Initial symptoms of HELLP syndrome
viral like illness (late) in pregnancy
- nausea, vomiting etc
- some Pre-E symptoms possible (H/A vision changes)
- RUQ pain
Labs/signs assc with HELLP syndrome
low Hb
low platelets elevated liver enzymes
lower blood pressure
high liver enzymes
high bilirubin
high LDH
Labs assc with intrahepatic cholestasis
- high bile acids
- mildly high bilirubin and AST/ALT
Most serious sequelae of any cellulitis?
necrotizing fasciitis
Possible preventative measure against UTIs?
voiding after coitus
Treatment of CIN
cone biopsy/ LEEP
Most common cause endometritis/chorioamnionitis?
polymicrobial infection
“Fetal small parts above the fundus” should be a buzz word for ______.
uterine rupture
Most common type of cervical cancer?
vaginal cancer?
endometrial?
cervix + vagina: squamous cell (HPV induced)
endometrial: adenocarcinoma
42 year old with amenorrhea + mood changes + night sweats: first test
pregnancy test before diagnosing climacteric
Exquisitively tender ulcer on the labia should be a buzz word for”:
HSV
Apnea, cyanosis, hypotension, DIC following placental delivery suggests ______.
amniotic fluid embolism
All multifetal gestations are at risk for ______
preterm labor
Atypical (glandular) cells on pap smear + normal colposcopy warrants ______.
endometrial biopsy
Scarred cervical os + enlarged tender uterus suggests _____
cervical stenosis
Test of choice for hyperemesis gravidarum
urinary ketones + electrolytes (BMP)
Polyhydramnios, fetal ascites, skin thickening are suggestive of what infection?
Parvovirus B12 (hydrops fetalis)
If a fetal presenting part is not felt during intrapartum care, what test should be done?
ultrasound
What is the use of amnioinfusion?
variable decels, relieves cord compression
When are low amniotic fluids relatively common and what do they mean? what is the treatment in this case?
postterm pregnancy (42+ weeks) represent declining placental function treat by delivering baby
**not treated with amnioinfusion if baby isn’t symptomatic
What medication dilates the cervix to induce labor?
prostaglandins
What is a normal post-void bladder volume?
What does an increased value mean?
What are these patients at risk of?
20-25 mL
increased value suggestive of atonic bladder
at risk of UTI
First step in evaluation of abnormal AFP levels
ultrasound to verify dating
What lab values are expected to be increased during menopause
FSH, LH
Erbs palsy is caused by injury to which nerve roots?
C5-6
Following hysterectomy for leiomyomata, how often should pap smears be done?
not. don’t.
Microcytic anemia + alcohol abuse suggests what deficiency?
folate
Treatment of steroid induced osteoporosis
–dronates
bisphosphonates
Best birth control for woman taking chemo/AED/other medications that change liver metabolism?
cooper IUD
Macrosomia + pulmonary disease in newborn may be related to increased serum levels of _____
insulin
What are the normal pH findings in bacterial vaginosis vs trich vs candida
BV + trich: higher than 4.5
candida: 4.5 or less
Which of the three vaginal infections (BV, trich, candida) has a negative “whiff test”?
candida
Trich and BV both have 4.5+++ pH and + whiff test, how are they distinguished?
trich: motile organisms, green frothy discharge
BV: white discharge, clue cells
What medication treats both BV and trich?
metronidazole
Treatment of suspected appendicitis?
surgical exploration
What type of endometrium is present during the follicular vs luteal phases of the menstrual cycle?
follicular: proliferative
luteal: secretory
What determines the risk of fetal demise in case of IUGR?
US of the umbilical artery
Ovarian failure in young woman with previous history of normal menstruation + normal FSH/LH/TSH is caused by?
autoimmune ovarian destruction
12.5 year old with abnormal menstrual cycles: cause
normal development.
abnormal menstrual patterns normal up to age 15
MCC fetal tachycardia?
infection/ maternal fever
Fluctuant mass during breast feeding- DDx
galactocele: afebrile, no erythema
mastitis/abscess: fever, erythma, warmth
Basic way to normalize menstrual cycles
cyclic progesterone therapy
Evaluation for primary amenorrhea:
karyotype analysis
Sexually active patients under 25 get what screening?
G&C, pap if age 21+
Most appropriate therapy to induce ovulation in PCOS patients
clomiphene, estrogen antagonist at the hypothalamus
Fetal hydrops + ascites think ______
parvovirus B19
Drug associated with placental abruption
cocaine
bHCG 1500+ with no fetus on U/S of uterus = _____
ectopic
fluctuant mass of labium majus =
Bartholin duct abscess
Preterm breech presentation in the vagina without contractions or bleeding:
cause
treatment
incompetent cervix
cerclage
Ovarian mass + endometrial hyperplasia suggests that the ovarian mass is what type?
granulosa cell tumor – estrogen producing
+ Qtip test + stress incontinence suggests what cause?
uretherocele
“echogenic structures in the uterus” = buzzword for
hydatidiform mole
snowstorm pattern
amnorrhea + tanner stage four breast and hair development is suggestive of?
imperforate hymen
if hair were absent, androgen insensitivity syndrome
How long does it take herpes lesions to spontaneously resolve?
1 week
The following symptoms are suggestive of what disease process:
- suprapubic tenderness
- urinary urgency
- anterior vaginal wall tenderness
interstitial cystitis
Renal anomalies are associated with what other anatomic anomalies?
mullerian
Protracted labor in a patient with DM is likely due to ______
cephalopelvic disproportion
head too big for pelvis
Treatment of hydatidiform mole
suction and curettage
Risk factor for persistent yeast infection
DM (poor healing)
HELLP syndrome is a severe _______
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.
“Fundal placenta” rules out what cause of bleeding in pregnancy?
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)
Treatment of breast engorgement/ cysts caused by estrogen replacement therapy
stop the replacement therapy
How to distinguish mastitis vs abscess
key buzzwords:
abscess: fluctuant
mastitis: nonfluctuant
both may have LOCALIZED swelling and fever, abscess less likely to respond to typical abx, needs draining
Cause of oligohydramnios in lupus patients:
uteroplacental insufficiency due to clotting
Tinnitus + metallic taste following administration of epidural suggests…
accidental intravascular injection
bicornuate uterus puts woman at risk of …..
preterm labor
Ddx abdominal organs outside of cavity in fetus
gastroschisis: not covered
omphalocele: covered
Why no combination OCPs in breast feeding?
decreased milk protein content
Labs needed to diagnose pyelonephritis
pyuria + bacteruria
**NOTE: may get systemic edema with pyelo/nephritic syndrome.
U/A findings in appendicitis
mild pyuria, proteinuria and hematuria
What abx is typically given for UTI px
TMP-SMX
Strongest risk factor for endometrial hyperplasia/cancer
anovulation
DOC for hyperthyroidism in pregnancy
PTU
What hormone level is expected to be elevated in turners?
FSH/LH
Normal post op pain assc with cesarean
pulling/tugging near lateral areas of wound
Treatment of hyperemesis gravidarum
admission to hospital for IV hydration + antiemetics
PID + rash is suggestive of ….
TSS (staph aureus)
Presence of new pubic hair suggests….
imminent menarche
Treatment of 5 cm simple ovarian cyst in a 25 year old
OCP therapy and re-examine
Active labor with no palpable presenting part:
first step in management
ultrasound
Microcytic anemia + normal iron levels warrants ____.
hemoglobin electrophoresis
MC ADR of suction curettage
amenorrhea (ashermans)
Diagnostic test of choice for DVT
duplex venous U/S
Why does growth restriction occur with PreE
placental dysfunction
Most common fetal effect of PreE
growth restriction
Treatment of newborn exposed to chickenpox
VZIG
Treatment for painful intercourse post partum
lubricant
Bleeding with rupture of membranes suggests what diagnosis>?
vasa previa –> cesarean section
Tachysystole + late decels cause:
oxytocin
Cystic mass with calcium deposits suggests…
teratoma
Bacterial vaginosis treatment
vaginal metronidazole
Cause of primary dysmenorrhea
prostaglandins
SERMs assc ADRs
endometrial cancer/ benign pathology
uterine sarcomas
**prevents osteoporosis
Tamoxifen/ Raloxifene: action at -breast -bone -uterus
tamoxifen: breast antagonist, bone/uterine agonist
raloxifene: breast/ uterine antagonist, bone agonist
*raloxifene not effective in breast cancer
Major risk factor for placenta previa
uterine surgery
Treatment of variable decels
amnioinfusion
Decreased breath sounds at lung bases: cause
atelectasis
Why are adolescents susceptible to PID?
increased cervical cell vulnerability
Red beefy mass hanging out of adult vagina: cause
pedunculated submucosal leiomyoma
Cause of fetal demise in clotting disorder
uteroplacental artery thrombosis
Cause of no accelerations
fetal sleep state
Bloody culdocentesis, peritoneal signs, negative pregnancy test: cause
ruptured corpus luteum cyst
Positive pregnancy test, fronding pattern, hemoperitoneum: cause
ruptured corpus luteum cyst
Treatment of imperforate hymen
transvaginal incision and drainage
Treatment for endometrial adenocarcinoma
hysterectomy
Cause of urge incontinence
detrusor hyperreflexia
Duodenal bubble on U/S= suspicious for:
Downs, duodenal atresia
Post-coital spotting in young patient is suspicious for….
cervicitis
If membranes are ruptured for more than 18 hours, what medication must be started?
Penicillin if:
- unknown GBS status
- previous baby was positive for infection
- any culture positive for group B in this pregnancy
Treatment for post-cesarean infection
IV abx, CT if no improvement within 48 hours
Management of nonviable pregnancy with no fetal pole and falling B-Hcg levels pre-intervention:
follow hcg levels to zero
Common sites of invasion: cervical cancer
- ureter
- parametrium
- lower vagina
Twin types:
two yolk sacs + thick dividing membrane
di/di
At how many weeks is amniocentesis done?
CVS? What are the indications?
CVS: 10-13 weeks
Amnio: 11-14
*Indicated for disease in PARENT or AMA
How does fundal weight correlate to gestational age?
Fundal height, when expressed in centimeters, roughly corresponds to gestational age in weeks between 16 to 36 weeks for a vertex fetus
What should fundal height be between 10-15 weeks?
5-10 cm
Pap smear screening in HIV women
annually
Is evidence of parvo in mom needed to diagnose hydrops secondary to parvo in baby?
no
Cervical finding with trich
strawberry cervix or ectropion
ROM –> loss of fetal heart rate
What diagnoses are expected?
cord prolapse - cord on exam
vasa previa - bleeding
Foul smelling discharge in kid, expect…
foreign body
Macrosomia = mom at risk for what condition in future pregnancies?
GDM
Treatment for transverse lie at term
cesarean
Size small for dates: evaluation
NST/ BPP
Type 1 DM cause of Size greater than dates
poly
Woman in her 40s… always rule out ____ before diagnosing menopause
pregnancy
Most common cause unilateral bloody nipple
intraductal papilloma
Discharge color assc with ductal ectasia or fibrocystic changes
green, brown, yellow… non bloody
Steroid dosage for PPROM
2 doses 24 hours apart
Signs of retained POC following D&C
profuse vaginal bleeding and if not removed may lead to a septic abortion.
Signs of post op uterine perforation
Physical examination reveals rebound tenderness and abdominal guarding
Unexplained primary infertility:
first steps in diagnosis
semen analysis —-> HSG
Management of umbilical cord prolapse
- 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
How do SVR and PVR compare in pregnancy?
The systemic vascular resistance (SVR) is normally greater than the pulmonary vascular resistance.
If reversed, get shunt.
Why does cardiac output increase in pregnancy?
The cardiac output increases up to 33% due to increases in both the heart rate and stroke volume
Karyotype in mullerian agenesis
46, XX
FHT in the 170s with decreased variability and a sinusoidal pattern. + increased uterine tone.
Suspect _______
placental abruption
Recipient twin in TTS has what cardiovascular complications?
cardiomegaly, tricuspid regurgitation, ventricular hypertrophy and hydrops fetalis for the recipient twin
Surviving twins of TTS have what post partum complications?
neurological morbidity (CP)
Which SSRI is contraindicated in pregnancy?
paroxetine (Paxil) has been changed to a category D drug because of the increased risk of fetal cardiac malformations and persistent pulmonary hypertension
Describe appearance of dysmaturity
withered, meconium stained, long-nailed, fragile and have an associated small placenta
What patients are at risk of having fetus with dysmaturity?
post term
3 MC findings in trisomy 18
overlapping fingers, micronathia, and cardiac defects
Pain control for mastitis
use ibuprofen in addition to acetaminophen for pain relief
not breast binders
Treatment for Hep B exposure
HBIG (Hepatitis B Immune Globulin) and the HBV (Hepatitis B Vaccine Series) within 7 days of blood or 14 days of sex
Incubation period for hep B
is six weeks to six months
Describe PMDD cyclic nature
symptoms that begin to resolve with the beginning of the follicular phase
Colon cancer screening with family history
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
Treatment of worsening asthma in pregnancy
albuterol inhaler + inhaled corticosteroids or cromolyn sodium.
Rh hemolytic disease: Measurement of which of the following in the amniotic fluid is best indicative of the severity of the disease
bilirubin
Describe microinvasive cervical cancer
In microinvasive cancer, cells invade less than 3 mm beyond the BM
Describe cervical carcinoma in situ
Carcinoma in situ (CIS) represents abnormal cells involving the entire epithelium to the basement membrane.
Contrast cervical cancer, cyst, and
Cancer: hard and bloody
Polyp: soft and bloody
Cyst: soft no bloody
What defines primary HSV infection?
seronegative for HSV antibodies
Most common source of infection s/p c section
The lungs are the most common source of fever on the first postpartum day, particularly if the patient had general anesthesia
How to remove an escaped IUD
visible on U/S in uterus - HSG
visible outside of cavity- lap
At what weeks GA are the risks highest for developing ID?
between eight and 15 weeks gestation
Folic acid requirements for women with previous NTD pregnancy
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
Is polyhydramnios assc with growth restriction?
not associated with asymmetric growth restriction since an asymmetric growth pattern reflects poor uterine blood flow and limited substrate availability
How does HRT effect lipid levels?
HDL levels increase and LDL levels decrease
How to suppress lactation
Breast binding, ice packs and analgesics
Physical indications for cesarean section
- 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
Neonatal risks assc with GDM
- hypoglycemia, hypocalcemia
- polycythemia, hyperbilirubinemia
- respiratory distress
Adult diseases assc with growth restriction as a fetus (4)
cardiovascular disease, chronic hypertension, chronic obstructive lung disease and diabetes
How do birth control pills treat dysmenorrhea?
The progestin in oral contraceptives causes endometrial atrophy. Since prostaglandins are produced in the endometrium, there would be less produced
Common ADR of GnRH antagonist
Hot flashes are experienced by >75% of patients
Female diagnosed with bleeding secondary to fibroids should also receive…
An endometrial biopsy should be performed on all women over age 40 with irregular bleeding to rule out endometrial carcinoma
intrauterine pressure catheter is placed, and a significant amount of vaginal bleeding is noted.. .what do you do?
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
Best form of permanent birth control for a morbidly obese patient
vasectomy
For cervical lesion, if entire transformation cannot be seen with colposcopy, what must be done?
cone
Fat seen in suction during D&C… next step in management?
Laparoscopy
In addition to U/S and quant, what should be done in the evaluation of molar pregnancy
CXR…the lungs are the most common site of metastatic disease in patients with gestational trophoblastic disease
Labium majora mass in post menopausal woman should be assumed to be…
Bartholin gland cyst in a post-menopausal woman should be further investigated for malignancy
Two carrier parents for an autosomal recessive condition…. child is unaffected… what are the odds child is a carrier?
not a carrier: 1/3
carrier: 2/3
Odds baby is affected by an AR disease
odds mom carrier x odds dad carrier x 1/4
What confirms presence of an IUP
fronding
yolk sac
Treatment for drain pipe urethra (intrinsic sphincteric deficiency)
Urethral bulking
Most important risk for PROM
primary risk factor for preterm rupture of membranes is genital tract infection, especially associated with bacterial vaginosis
chronic pelvic pain occurring in the setting of pelvic varicosities… DIAGNOSIS?
Pelvic congestion syndrome
What is assc with retained placenta? (4)
Cesarean delivery, uterine leiomyomas, prior uterine curettage and succenturiate lobe of placenta.
Treatment of vulvar carcinoma
radical vulvectomy and groin node dissection. Only microinvasive squamous cell carcinoma of the vulva can be treated by wide local excision
When is mifepristone acceptable for pregnancy termination?
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
FIRST STEP IN EVALUATION OF ABNORMAL UTERINE BLEEDING
. It is vitally important to rule out pregnancy in the evaluation of abnormal uterine bleeding
MC cause abnormal AFP with certain dating
twin pregnancy
*note poly is not a cause
Four conditions to worry about in Ashenkazi Jews
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
B thal is common in what group?
Mediterannean
Where is the best place to post information for domestic violence treatment?
The best place to have literature is where there is the most privacy such as an office restroom
Risk of isoimmunization in Rh- patient without Rhogam
The risk of isoimmunization is 2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy so less than 20% total
Terbutaline ADR
Tachy
Pulm Edema
How is menopause diagnosed
no periods for one year, don’t have to order FSH
When is HRT given
menopause symptoms interfering with functioning
Baby size in type 1 GDM
small, hypoglycemic
Treatment of breast engorgement
- good bra
- frequent nursing
- analgesic before feeding
- warm compress
What is diagnostic of chorio on amniocentesis
Amniotic glucose less than 20 mg/dl
Three fetal conditions assc with post term pregnancies
- placental sulfatase deficiency
- fetal adrenal hypoplasia
- anencephaly
MOA MgSO4
competing with calcium entry into cells
Terbutaline and ritodrine are contraindicated in what patients?
Terbutaline and ritodrine are contraindicated in diabetic patients
MGSO4 is contraindicated in what neuro condition?
Magnesium sulfate is contraindicated in myasthenia gravis
Most reliable dating method in pregnancies near term
The crown-rump length
Best way to stop lactation?
Breast binding, ice packs and analgesics
When is BRCA testing indicated?
A combination of first and second-degree relatives on the same side of the family diagnosed with breast and ovarian cancer
How to diagnose decreased ovarian reserve?
clomiphene challenge test
Management of septic abortion
broad-spectrum antibiotics and uterine evacuation
What causes postpartum telogen effluvium (hair loss)?
high estrogen during pregnancy
What B-HCG is suggestive of molar pregnancy?
combined with the findings of an enlarged uterus and vaginal bleeding, a Beta-hCG value >1,000,000 mIU/mL may be diagnostic
How do OCPs effect testosterone levels?
lower ovarian androgen production
increase SHBG, decrease free testosterone
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.
Ilioinguinal nerve T12, L1
The following symptoms are assc with entrapment of what nerve?
loss of cutaneous sensation to the groin and the skin overlying the pubis
iliohypogastric T12, L1
Damage to what nerve causes inability of the patient to adduct the thigh?
obturator
What vitamin deficiencies are assc with PMS?
A, E, B6
most common abnormal karyotype encountered in spontaneous abortuses
autosomal trisomy
