OB/GYN

Question 1

Fevers, chills, bloody virulent discharge, abdominal pain, hypotension, tachycardia, dilated cervix. Dx? Management?

Answer 1

Septic Abortion. IVF and IV abx then emergent curettage. If pt doesnt respond to abx, then hysterectomy is next.

Question 2

Management of shoulder dystocia?

Answer 2

BE CALM 1. Breathe 2. Elevate legs (for Mcroberts) helps rotate pelvis 3. Call for help 4. Apply superbupic pressure to anterior shoulder 5. Enlarge vagina (episiotomy) 6. Attempt other maneuvers, (applying pressure to posterior shoulder, hands and knees, C-section last resort (Zanvenelli)

Question 3

Next step in management if pt has HSIL on pap?

Answer 3

Immediate Colpo or Loop Electrosurgical excision/Conization (if nonpregnamt). If colpo inconclusive then excision is next. CIN 2, 3 -> RX if NO CIN 2,3 -> then excision if not done already or colpo at 6 months and 12 months.

Question 4

Management of 21-24 yo with ASCUS or LSIL?

Answer 4

Pap in 1 year. Pt needs to have pap showing negative for 3 years consecutively then routine screening can commence. If not then colpo after 1 year

Question 5

Management of 21-24 yo with ASG, ASC-H, HSIL ?

Answer 5

Colpo

Question 6

Management of >25 with ASCUS?

Answer 6

HPV testing, if positive -> colpo if negative repeat pap and HPV in 3 years

Question 7

Management of cystic mass >5cm in pregnant pt?

Answer 7

Surgical removal by 2nd trimester if it does not regress. (prevent, rupture, torsion which leads to pre-term delivery)

Question 8

With group B when do you not give IV amp?

Answer 8

When there is a planned C section without rupture or if the pt was culture + previous preg and now culture (-)

Question 9

Varicella prevention and treatment ?

Answer 9

Give live attenuated to nonpregnant. Rx: Maternal: Oral acyclovir + VariZIG Congenital Varicell: IV acyclovir + VariZIG

Question 10

Toxo prevention and treatment?

Answer 10

Avoid cat feces, undercooked meat. Pyrimethamine and sulfadiazine.

Question 11

CMV (periventricular calcifications, chorioretinitis, penumonitis) prevention and treatment?

Answer 11

Universal preacuations. Rx: Gangciclovir or fsocarnet.

Question 12

HIV treatment in pregnancy?

Answer 12

Give Triple therapy regardless of CD4 and viral load to decrease transmission. Give intrapartum IV ZDV if viral load is at time of delivery. - ifant ppx give ZDV for 6 weeks.

Question 13

Management of mother with HSV?

Answer 13

IV Acyclovir. If lesions are visible at time delivery the C-section.

Question 14

Hep B prevention and treatment?

Answer 14

Give immunization during pregnancy if negative. If contracted give immunization and vaccine. Give immunization and vaccine to neonate if contracted.

Question 15

Etiologies for primary amenorrhea w/ absence of secondary sex characteristics (no estrogen)?

Answer 15

1. Constitutional growth delay (most common), 2. Ovarian insufficiency (turner’s, chemo/rad) 3. Central hypogonadism (tumor, stress, Kallman syndrome- no gnrh, anosmia)

Question 16

Etiologies for primary amenorrhea w/ presence of secondary sex characteristics?

Answer 16

1. Mullerian agenesis 2. Impeforate hymen 3. Androgen insensitivity (XY phenotype Males w/ breast because of aromatization of testosterone to estrogen) but no menses

Question 17

Management of primary Amenorrhea?

Answer 17

1. Preg test 2. Radiography of bone to make sure ir matches with chronological age (if bone age equal chronological age then constitutional growth delay) 3.GNRH, LH/FSH level 4. US to evaluate ovaries (r/o anatomic problem) Rx with HRT if hypogonadism. Surgery if anatomic problem

Question 18

Management of secondary amenorrhea?

Answer 18

1. Preg test 2. Check TSH and prolactin levels to check for hyperprolactinema(tumor) or hypothyroidism 3. Progestin challenge (+ w/drawal bleeding ->anovulation (PCOS, iodpathic), - w/drawal bleeding -> anatomic or estrogen deficiency)

Question 19

What is test at initial prenatal visit? 24-28 wks ? 35-37 wks?

Answer 19

1. CBC, UA/Urine culture, HIV, VRDL/RPR, Hep B, G&C, Varicella and Rubella immunity 2. CBC, UA, Urine culture, 50g glucose, Rh(D) if negative 3. Group b strept

Question 20

Name that rash: 1. Disseminated eczematous or papular rash associated with seasonal allergies? 2. Generalized rash of the palms and soles associated with increased bile acids? 3. Puritic and erythematous rash that begins in abdominal striae and spread to the extremities, the face, palms and soles are spared?

Answer 20

1. Atopic eruption of pregnancy 2. Intrahepatic cholestasis of pregnancy 3. Polymorphic eruption of pregnancy

Question 21

Autoimmune inflammatory rash due to antibody attack on the basement membrane, pruritic, papules, plaques. Dx? Rx?

Answer 21

Pemphigoid gestationis. Steroids and antihistamines. If not treated can progress to pre-term, fetal growth restriction and neonatal pemphigoid.

Question 22

Management of endometriosis?

Answer 22

Depends on complaint. Infertility -> laprosocopy Mild pain-> NSAID Severe Pain-> Opoids, surgery. TAH-BSO is definitive therapy.

Question 23

Management of PCOS?

Answer 23

1. Weightloss, Metformin 2. Infertilty- clomiphene + metformin 3. Hirtusim- OCP

Question 24

Management of Vulvovaginitis: 1. Fishy oder, clue cells, + whiff test 2.White curd like discharge, psuedohyphae 3. yellow, green, malodorous discharge, motile flagellated protozoans

Answer 24

1. KOH. Flagyl 2. Topical clomitrazole cream for 7 days or oral flucanazole x 1 dose. 3. Flagly

Question 25

Management of PID inpatient and outpatient.

Answer 25

Inpatient: Cefoxitin + doxy + flagyl x 14 days. If no improvement consider US for tubo-ovarian abscess. Transition to PO once stable. Outpatient: Cefoxitin + doxy

Question 26

Management of Ectopic Pregnancy In unstable and stable patient?

Answer 26

Hemodynamically stable: BCG of 3000, will no always show IUP so trend over 48 hrs. If BCG does not double then it is ectopic. If BCG < 5000 and IUP < 3cm -> Methotrexate ( No renal, liver failure.) Expectant management if BCG < 200, unikely to rupture. >5000, >3cm -> surgery. Hemodynamically unstable: Surgery. Must treat all Rh- with rhogam.

Question 27

Contrainidications to HRT?

Answer 27

Vaginal bleeding, Cancer, MI/Stroke, Recent DVT