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Ob/Gyn Flashcards

1
Q

Most common cause of unilateral nonbloody nipple discharge?

A

Inraductal papilloma

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2
Q

Diagnostic testing for nipple discharge?

A

Mammogram and definitive diagnosis is surgical duct excision. Cytology not helpful.

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3
Q

Bilateral nipple discharge, most likely diagnosis? What test to order?

A

Most likely prolactinoma. Order prolactin and tsh levels.

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4
Q

20-50 year old woman with cyclical bilateral breast lumps with pain that varies with menstrual cycle. Diagnosis?

A

Fibrocystic breast disease

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5
Q

Treatment for fibrocystic breast disease?

A

OCPs, Danazol if severe pain.

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6
Q

Firm, discrete, nontender, highly-mobile breast nodule. FNA shows epithelial and stromal elements. Diagnosis?

A

Fibroadenoma

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7
Q

Steps for diagnosis of breast mass?

A
  1. Clinical breast exam
  2. U/S or mammography (if patient over 40)
  3. FNA biopsy
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8
Q

When do you use ultrasound to evaluate breast mass?

A

If mass feels cystic on palpation, or mass is on younger women with denser breast

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9
Q

Patient with ductal carcinoma in situ (DCIS), what is the treatment?

A

Lumpectomy (with clear margins) along with radiation therapy and tamoxifen for 5 years

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10
Q

Lobular carcinoma in situ (LCIS), what is the treatment?

A

Tamoxifen alone for 5 years, don’t have to perform surgery.

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11
Q

Risks associated with tamoxifen use?

A

Endometrial carcinoma and thromboembolism

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12
Q

Most common form of breast cancer?

A

Invasive ductal carcinoma (85%), mets to bone, liver, and brain

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13
Q

Second most common form of breast cancer?

A

Invasive lobular carcinoma (10%), will be bilateral 20% of cases

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14
Q

Red, swollen, warm breast with pitted, edematous skin. Have to rule out?

A

Inflammatory breast cancer. It metastasizes early

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15
Q

USPSTF breast cancer screening recommendation?

A

Biennial mammography for women age 50-74

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16
Q

Indications for BRCA1 and BRCA2 gene testing?

A
  • Family history of early-onset (before age 50) breast or ovarian cancer
  • Breast and/or ovarian cancer in the same patient
  • Family history of male breast cancer
  • Ashkenazi Jew
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17
Q

Which hormone receptor confers a greater benefit for adjuvant therapy for breast cancer?

A

Estrogen. Both estrogen and progesterone positive tumors are the most responsive, however estrogen alone is nearly as good.

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18
Q

MOA of tamoxifen?

A

SERM. 5 year treatment -> 25% decrease in mortality

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19
Q

MOA of anastrozole, exemestane, letrozole?

A

Aromatase inhibitors. Blocks peripheral production of estrogen. Standard of care for HR+ postmenopausal women.

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20
Q

Indication for chemotherapy in breast cancer?

A

Tumor size >1 cm or positive lymph node

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21
Q

Adverse effects of tamoxifen?

A
  • Worsens menopausal symptoms
  • Increases risk of endometrial cancer
  • Increases risk of thromboembolism
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22
Q

Women with history of of tamoxifen use presents with vaginal bleeding. Next diagnostic step?

A

Endometrial biopsy, need to rule out endometrial cancer.

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23
Q

Pre or postmenopausal women presents with HR-negative invasive breast cancer. Treatment?

A

Chemotherapy w/wo Radiation therapy

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24
Q

Premenopausal women presents with HR-positive invasive breast cancer. Treatment?

A

Chemotherapy w/wo Radiation therapy plus tamoxifen

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25
Q

Postmenopausal women presents with HR-positive invasive breast cancer. Treatment?

A

Chemo w/wo Radiation plus aromatase inhibitor

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26
Q

African american woman presents with enlarged, firm, asymmetric, nontender uterus. Beta-hCG negative. Diagnosis?

A

Leiomyoma

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27
Q

What is adenomyosis and how does it present?

A

Abnormal location of endometrial glands and stroma within myometrium of uterine wall. Uterus feels soft, symmetric, and is tender.

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28
Q

Ultrasound findings of adenomyosis?

A

Diffusely enlarged uterus with cystic areas within myometrial wall

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29
Q

Options for leiomoma management?

A

Observation, myomectomy, embolization, or hysterectomy (reserved for once fertility is completed)

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30
Q

Risk factors for endometrial carcinoma?

A

Unopposed estrogen states (obesity, nulliparity, late menopause/early menarche, chronic anovulation)

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31
Q

Endometrial biopsy shows adenocarcinoma, next step?

A

TAH w/ BSO, pelvic and para-aortic lymphadenectomy, and peritoneal washings, may need RT or chemo if mets

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32
Q

Indications for surgical removal of an asymptomatic simple cyst?

A
  • Cyst >7 cm

- Previous steroid contraception without resolution of cyst.

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33
Q

31 y/o F w/ sudden severe abdominal pain for 3 hours, 8 cm adnexal mass present, must rule out?

A

Ovarian torsion

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34
Q

9 y/o F w/ R adnexal pain and complex cystic mass on u/s. Most likely diagnosis? What tumor markers should order?

A

Germ cell tumor.

Tumor markers: LDH, b-hCG, aFP

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35
Q

Postmenopausal F with weight loss, distended abdomen and L adnexal mass. Most likely diagnoses? Tumor markers?

A

Epithelial tumor

Tumor markers: CA-125, CEA

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36
Q

Postmenopausal F w/ bleeding. Endometrial bx shows endometrial hyperplasia. Pelvic U/S shows R ovarian mass. Most likely diagnosis? Tumor markers?

A

Granulosa-theca (stromal tumor), these tumors secrete estrogen which cause endometrial hyperplasia
Tumor markers: Estrogen

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37
Q

48 y/o F w/ increased facial hair and deepening of voice. Adnexal mass noted on exam. Most likely diagnoses? Tumor markers?

A

Sertoli-Leydic cell (stromal tumor), these tumors secrete testosterone which causes masculinization syndromes.
Tumor markers: testosterone

38
Q

64 y/o F w/ hx of gastric ulcer, worsening dyspepsia, weight loss, adnexal mass found on exam. Most likely diagnosis? Tumor markers?

A

Metastatic gastric cancer (Krukenberg tumor), these are mucin producing adenocarcinomas from stomach that metastasize to the ovaries, often times both ovaries.
Tumor markers: CEA

39
Q

Benign HPV is which numbers, and what do they cause?

A

6 and 11, causes condyloma acuminata

40
Q

Age range for Pap smear screening?

41
Q

Below 30 yr screening frequency for average risk pt?

A

every 3 years, cytology only

42
Q

After 30 y/o screening frequency for average risk pt?

A

Every 3 years w/ cytology alone. Or, every 5 years w/ HPV testing

43
Q

Most common type of cervical cancer?

A

Squamous cell carcinoma

44
Q

Age for gardasil vaccine?

45
Q

Antibiotics for chlamydia?

A

Azithromycin PO or Doxycycline PO

46
Q

Abx for Gonorrhea?

A

Ceftriaxone IM or Cefixime PO

47
Q

Ultrasound shows bilateral cystic pelvic masses, most likely diagnosis?

A

Chronic PID

48
Q

30 y/o female with dysmenorrhea, dyspareunia, painful bowel movements, and infertility. Most likely diagnosis?

A

Endometriosis

49
Q

First and second most common sites of endometriosis?

A
  1. Ovaries (chocolate cysts)

2. Cul-de-sac

50
Q

Work up for endometriosis?

A

Start with ultrasound, definitive diagnosis with laparoscopic visualization

51
Q

First/Second line treatment and general management of endometriosis?

A
  1. Continuous oral progesterone
  2. Testosterone derivatives (danazol) or GnRH analogs (Lupron)
    Additionally laparoscopic lysis adhesions, laser vaporization of lesions - can help w/ infertility
    Or TAH/BSO for severe symptoms
52
Q

Premenarchal bleeding, must rule out?

A 
Sarcoma botryoides (cancer of vagina or cervix, will see grapelike mass arising form vaginal lining)
Also rule out tumors pituitary gland, adrenal gland, ovaries, and sexual abuse
53
Q

Evaluation of premenarchal bleeding?

A

Pelvic exam, followed by CT or MRI of brain, abdomen, pelvis to look for estrogen-producing tumor. If work-up negative -> Idiopathic Precocious Puberty

54
Q

Primary amenorrhea diagnosis criteria?

A
  • Absence of menses at age 14 w/o secondary sexual development or,
  • Absence of menses at age 16 w secondary sexual development
55
Q

16 y/o f w/ primary amenorrhea, breasts present but uterus absent on ultrasound. Differential diagnosis? What tests do you order next?

A
  • Mullerian agenesis versus Complete androgen insensitivity
  • Order testosterone levels and karyotype. Mullerian agenesis XX karyotype, and normal testosterone for female. Complete androgen insensitivity, XY karyotype, and normal testosterone for male.
56
Q

16 y/o f w/ primary amenorrhea, breast absent and ultrasound shows uterus present. Differential? What tests do you order next?

A
  • Differential: Gonadal dysgenesis (Turner’s syndrome) versus Hypothalamic-pituitary failure
  • Order FSH and karyotype. Turner syndrome will see XO karyotype and elevated FSH. Hypothalamic-pituitary failure will have XX karyotype, low FSH.
57
Q

Androgen insensitivity management?

A

Removal of testes before age 20 (risk of testicular cancer). Followed by estrogen replacement.

58
Q

Turner syndrome management?

A

Estrogen and progesterone replacement for development of secondary sex characteristics

59
Q

Evaluation of secondary amenorrhea?

A
  1. beta-hCG
  2. TSH
  3. Prolactin level
  4. Progesterone challenge test
  5. Estrogen-Progesterone Challenge test
60
Q

Treatment for premenstrual dysphoric disorder?

A

SSRIs, may add Vitamin B6 (pyridoxine)

61
Q

Presence of gestional sac visible at approximately what b-HCG level?

62
Q

Fetal heart sounds first heard at approximately what age?

A

8-10 weeks

63
Q

Fetal movements first felt by approximately what week?

64
Q

What caution is there for nitrofurantoin for UTI’s in pregnancy?

A

Avoid after 30-38 weeks, may cause neonatal anemia

65
Q

Rubella antibody negative pregnant mother, next step?

A

Immunize after pregnancy, do not give immunization during pregnancy

66
Q

Trisomy 21 early testing in pregnancy consists of?

A

b-hCG, PAPP-A, Fetal nuchal translucency

67
Q

Increased MS-AFP for triple marker testing, differential diagnosis?

A

Neural tube defect, ventral wall defect, twin pregnancy, placental bleeding, renal disease, sacrococcygeal teratoma, gestational dating error

68
Q

Decreased MS-AFP in triple marker screening, differential diagnosis?

A

Trisomy 21, Trisomy 18, gestational dating error

69
Q

What are the 3 types of placenta accreta?

A

Placenta accreta - Placenta does not penetrate entire thickness of myometrium
Placenta increta - extends further into myometrium
Placenta percreta - penetrates entire myometrium to uterine serosa

70
Q

Pregnant women in first trimester. Gets mononucleosis type symptoms. Says she handled cat feces, drank raw goats milk, and ate some undercooked meat. Diagnosis? Confirmation? Treatment?

A
  • Toxoplasmosis gondii infection
  • Diagnose by testing serum toxoplasma IgG and Igm levels
  • Treat with pyrimethamine and sulfadiazine
71
Q

Can you give live attenuated varicella vaccine to pregnant women?

72
Q

Congenital varicella infection presentation?

A

Zigzag skin lesions, limb hypoplasia, microcephaly, microphthalmia, chorioretinitis, cataracts

73
Q

Congenital rubella presentation?

A

Congenital deafness, congenital heart defects, “blueberry muffin” rash

74
Q

Late-acquired congenital syphyllis presents as?

A

Diagnosed after 2 years of age:

  • Hutchinson teeth
  • “Saddle” nose
  • “Saber” shins
  • Deafness
  • “mulberry” molars
75
Q

Pregnant women with hx of DVT in previous pregnancy, what do you do in this pregnancy?

A

Prophylactic LMWH throughout pregnancy. Unfractionated heparin during L&D. Warfarin for 6 weeks post-partum

76
Q

First and Second line agents for Graves’ disease in pregnancy?

A

First line - Propylthiouracil

Second line - Methimazole

77
Q

Surveillance of fetus in diabetic mothers?

A
  • Monthly ultrasounds to look for macrosomia or IUGR
  • Monthly BPPs
  • Weekly NSTs and AFIs starting at 32 weeks, start at 26 weeks if poor glycemic control
78
Q

Gestational diabetic mother, what weight fetus do you proceed with cesarean section?

A

> 4500 grams, because of risk of shoulder dystocia

79
Q

31 y/o multigravida having twins, itching of palms and soles, no physical exam findings, dark-colored urine. Diagnosis? Labs? Treatment?

A

Diagnosis - Intrahepatic cholestasis of pregnancy
Labs - will see 10-100x increase in serum bile acids
Tx - Ursodeoxycholic acid, can also give choleysteramin and antihistamines.

80
Q

Management of septic abortion?

A

D&C and IV levaquin and flagyl

81
Q

Prolonged fetal demise (>2 weeks), most serious complication?

A

DIC, from release of tissue thromboplastin from deteriorating fetal organs. Always order CBC, D-dimer, Fibrinogen, PT, PTT

82
Q

Beta-hCG level at which intrauterine pregnancy should be seen?

A

1500 mIU using transvaginal ultrasound

83
Q

Pregnant patient at 19 weeks presents with cervical insufficiency. Must first rule out?

A

chorioamnionitis

84
Q

When do you place and remove elective cerclages, and for whom?

A

Place at 13-16 weeks for pts with 3 unexplained midtrimester losses, remove at 36-37 weeks

85
Q

Definition of IUGR?

A

Less than 5-10% weight for gestation age, or

<2500 g

86
Q

How do you differentiate symmetric from asymmetric IUGR?

A

Asymmetric has decreased abdominal size but normal head size

87
Q

Causes of symmetric IUGR?

A

anything that causes decreased growth potential:

  • Aneupoloidy
  • TORCH infxs
  • Structural anomalies
88
Q

Causes of asymmetric IUGR?

A

Anything that causes decreased placental perfusion:

  • Maternal causes - HTN, malnutrition, smoking, alcohol, drugs
  • Placental causes - Infarction, abruption, twin-twin transfusion, velamentous cord insertion
89
Q

Definition of macrosomia?

A

Estimated fetal weight > 90-95% for gestational age, or >4500 g

90
Q

Size cut-off values to proceed with elective c-section in fetal macrosomia?

A

Estimated fetal weight >4500 g in diabetic mothers, >5000g in normal mothers

91
Q

Most common risk factor for PROM?

A

ascending infection from lower genital tract

92
Q

Chorioamnionitis diagnosed clinically as?

A
  • Maternal fever w/ uterine tenderness

- Confirmed rupture of membranes w/ absence of UTI or URI

Medicine (10 decks)

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