OB/Gyn

Question 1

What are absolute contraindications to oral contraceptive pills, there are four

Answer 1

Pregnancy.
Liver disease
Breast cancer
Breast-feeding at less than six weeks

Question 2

How many visits to the doctor while pregnant are considered adequate prenatal care?
When is a pregnant woman screened for group B strep

Answer 2

Eight visits
Between 36 to 37 6/7 weeks gestation 

Question 3

If a mother requires in partum, antibiotic prophylaxis for GBS, which three antibiotics can be given? At least how many hours prior to delivery?

Answer 3

Penicillin, ampicillin, cefazolin.
At least four hours prior to delivery

Question 4

What are three scenarios in which you need to give intrapartum antibiotic prophylaxis for GBS?

Answer 4

A previous pregnancy where the infant had invasive GBS.
Positive GBS in the urine at any time during this pregnancy regardless of treatment.
Positive reactive vaginal GBS screening culture 36 to 37 6/7 weeks in this pregnancy

Question 5

If the mother’s GBS status is unknown, which for scenarios require antibiotic prophylaxis

Answer 5

Less than 37 week gestation
Rupture of membranes more than 18 hours
Intrapartum fever of greater than or equal to 100.4
Positive intrapartum NAAT testing

Question 6

Which two scenarios other than just a normal pregnancy is intrapartum antibiotic prophylaxis not indicated?

Answer 6

GBS positivity in a previous pregnancy line C-section done with intact membranes

Question 7

Which four tests should be done in a newborn with concerning signs for GBS infection?
House long should antibiotics be continued if cultures are negative?

Answer 7

CBC, blood culture, chest x-ray if there are respiratory symptoms and/or lumbar puncture with CSF culture at high risk.
Stop antibiotics if cultures are negative for 48 hours

Question 8

Which two antibiotics are good impaired treatments for GBS if it is a suspected, but not confirm?
Which antibiotic should be added on if meningitis is suspected?
If GPS is confirmed which antibiotic should be used.

Answer 8

Ampicillin and gentamycin
Extended spectrum cephalosporin like cefotaxime, ceftazidime,cefepime
Penicillin G

Question 9

GBS infection in a newborn is considered early onset at what time.? Late onset at what time.?

Answer 9

Early is from birth to day of life six
Late is after day of life six

Question 10

In late onset, GBS disease, bacteremia, UTI are treated with which antibiotics?
How was meningitis treated?
How was cellulitis/adenitis treated?

Answer 10

 ampicillin or vancomycin plus gentamycin or cefotaxime
Ampicillin or vancomycin plus gentamycin plus cefotaxime
Nafcillin or vancomycin plus gentamycin or cefotaxime

Question 11

Is gestational diabetes associated with gestational abnormalities?
When is AFP screening offered?
If it is elevated, what is usually cause?

Answer 11

No
At 16 weeks gestation.
Neural tube defect

Question 12

If AFP is elevated which test should be ordered?
If this test is negative, which test should be ordered next?
In addition to neural tube defects, elevated AFP is also seen in which other situations.

Answer 12

Fetal ultrasound.
Amniocentesis to get amniotic AFP levels.
Gastroschisis, other abdominal wall defects, fetal demise, renal, anomalies, wrong dates, wrong number of kids

Question 13

Low serum AFP is associated with which syndrome?
What does chorionic villous sampling test?
Around what time of gestation is it offered?

Answer 13

Down syndrome
Test, fetal karyotype, think of it as chromosome villous sampling.
12 weeks

Question 14

Neural tube defects are likely due to deficiency and what vitamin question?
During what time of the pregnancy is amniocentesis offered? What does it look for?
What is the only indication for amniocentesis in the third trimester?

Answer 14

Folic acid
15–18 weeks, looks for identifiable, genetic issues.
To assess fetal lung maturity

Question 15

In the triple screen/quadruple screen in the second trimester, what pattern of AFP, unconjugated estriol,hCG, and inhibit A seen in down syndrome?

Answer 15

Low AFP, low estriol, high hCG, high inhibin A

Question 16

And pregnancy, what does a non-stress test measure and what is it used to measure?
For what complaint of the mother would you get a non-stress test?
What is a good result of this test?

Answer 16

It measures fetal heart rate in response to fetal movement, used to measure integrity of the fetal nervous system.
Mom says her baby is not moving.
Reactive is good

Question 17

In a non-stress test if it is non-reactive what test should be done?
what test is involved in a biophysical profile?
What does it check, five things

Answer 17

A biophysical profile
An ultrasound breathing, tone, movement, amniotic, fluid, heart rate

Question 18

In pregnancy, what does a stress test assess?
What is it assessing the fetus for?

Answer 18

The fetal response to contractions.
Assesses the fetus for uteroplacental insufficiency and tolerance of labor 

Question 19

How much folic acid should a woman of childbearing age consume daily?
If a woman wants to get pregnant again and has had a baby with a neural tube defect in the past, how much should she take?

Answer 19

0.4 mg per day.
4 mg per day starting one month before trying to get pregnant

Question 20

Which two tests can be used to test fetal lung maturity?

Answer 20

Phosphatidyl glycerol, this is the best.
Lecithin-sphyngomyelin ratio should be greater than two

Question 21

What does monoamniotic mean?
Diamniotic?
What does monochorionic mean?
Dichorionic?
Which is the only combination that is not possible

Answer 21

One amniotic sack containing both twins
Two amniotic sacks, each housing, one twin.
One placenta supporting both twins.
Two placentas , one for each twin.
The only possible is monoamniotic/dichorionic

Question 22

In dizygotic twins, what is always the arrangement of amniotic, sac and placenta?
Which pneumonia in a neonate is associated with a staccato cough?

Answer 22

always diamnionic, dichorionic
Chlamydia pneumonia

Question 23

Conjunctivitis in a neonate less than one month old should raise concern for what?
Describe lymphogranuloma venereum

Answer 23

Chlamydia infection, transmitted vertically
Starts with small, nontender, papules, or shallow ulcers that resolve and then a tender unilateral inguinal lymph node appears that can rupture and possibly drain for months

Question 24

What is the first line treatment for chlamydia STD infection?
If there is concern for treatment, failure, recurrence, or noncompliance or an allergy to this antibiotic, Which two other antibiotics can be used.

Answer 24

Doxycycline for seven days.
A single dose of azithromycin or levofloxacin for seven days

Question 25

How do you treat chlamydia conjunctivitis?
How do you treat lymphogranuloma venereum?

Answer 25

Oral erythromycin to eradicate nasopharyngeal colonization
Doxycycline or erythromycin

Question 26

If you see, the phrase, intracytoplasmic inclusions, think of which STD?
What is the most common STD

Answer 26

Chlamydia.
HPV, chlamydia is the most common bacterial STD

Question 27

Since gonorrhea is usually asymptomatic, it should be considered in any adolescent patient with which symptom?
An uncomplicated gonorrhea infection is treated with which antibiotic?
If there is an allergy to this anabiotic, which two antibiotics should be used together.

Answer 27

 arthritis
Ceftriaxone
Gentamycin plus azithromycin

Question 28

If you do not roll out chlamydia in a patient, who test positive for gonorrhea, how should you presumptively treat?

Answer 28

With doxycycline for seven days in case there is common infection with chlamydia 

Question 29

What symptoms present in disseminated gonorrhea?
If you hear, intracellular Diplococci, think of which STD?

Answer 29

Rash, arthritis, plus or minus meningitis, endocarditis, fitz-Hugh Curtis (inflammation of the tissue surrounding liver with right upper quadrant pain) or pelvic inflammatory disorder
Gonorrhea

Question 30

If you suspect pelvic inflammatory disease, but there is no improvement on the appropriate outpatient therapy and cultures are negative, which three tests should be done?
How is PID treated in the outpatient setting?

Answer 30

 pelvic ultrasound to evaluate for tubo, ovarian abscess, RPR for syphilis and HSVPCR, not HSV titers

A single dose of ceftriaxone plus doxycycline twice daily for 14 days plus or minus Flagyl

Question 31

How do you treat pelvic inflammatory disorder inpatient?
What are two other alternative regimens?

Answer 31

Cefotetan or cefoxitin plus doxycycline twice daily.
Alternatives are clindamycin plus gentamycin or unasyn plus doxycycline

Question 32

Describe the LFTs in Fitzhugh Curtis syndrome.
Which two test should be done if this is suspected?

Answer 32

LFT will be normal, do not test them.
Do a pelvic exam and obtain cultures 

Question 33

If RPR is positive what test needs to be done to confirm syphilis
A neonate born to a mother with a reactive RPR should have what test done?

Answer 33

Treponemal test or FTA
AnRPR on their serum

Question 34

If a new RPR titer is lower than the mothers it’s safe to assume to not test, in what situation would you treat however?
If the mother was given which antibiotic during pregnancy to treat for syphilis, you should also treat

Answer 34

If the mother was treated less than one month ago
Erythromycin, it does not cross the placenta

Question 35

What are four physical exam findings in a baby with congenital syphilis?
What are four main complications of untreated congenital syphilis?

Answer 35

Maculopapular rash, hepatosplenomegaly, generalized lymphadenopathy, peeling skin
Perforated, palette, perforate nasal septum, hearing loss, Hutchinson teeth

Question 36

If an FTA test is positive, but RPR or VDRL is negative what other infection should you think of?
Which cells are associated with bacterial vaginosis?
Describe the pH of vaginal fluid.
What is the most common bacteria that causes this?

Answer 36

Lyme disease
Clue cells.
It is alkaline with a pH greater than 4.5
Gardnerella

Question 37

Describe the vaginal PH in trichomonas infection.
What is the classic sign associated with this?
How do you treat it?

Answer 37

pH greater than 4.5
Intense, pus and a strawberry cervix.
Metronidazole

Question 38

Which STD is described as vesicles clustered on an erythematous base?
How is it diagnosed?
How was it treated?

Answer 38

Herpes simplex virus
PCR and viral culture.
Acyclovir for seven days

Question 39

If a patient presents with fever, seizures, mention of temporal lobe on a CT of the brain which infection is likely the cause?
How do you treat?
What might an EEG show?

Answer 39

Herpes simplex encephalitis
IV acyclovir
Periodic lateralizing, epileptiform, discharges

Question 40

If a female presents with a malodorous vaginal discharge, what should be kept on the differential?
How do you treat this?

Answer 40

Vaginal foreign body.
Remove the object and prescribe sitz baths

Question 41

If a patient has painless vaginal ulcers, which two STDs do you think of?
If they are painful, which do you think of? What other syndrome can present with painful vaginal ulcers?

Answer 41

Syphilis or lymphogranuloma venereum
HSV or hemophilia deceryi
Behchet syndrome presents with apthous and genital ulcers plus uveitis plus arthritis plus GI symptoms

Question 42

If you see a bloody or pink vaginal discharge in a newborn along with petechia, what should you think could be the cause cause?
Which four infections in a child should make you think you need to rule out abuse?

Answer 42

Vitamin K deficiency
Pediculosis pubis (crabs), gonorrhea, chlamydia, HPV/condyLoma acuminata