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Level 2 COMLEX CE > OB-GYN > Flashcards

OB-GYN Flashcards

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1
Q

Following ovulation, the corpus luteum secretes ___ to stimulate glandular cells, building tortuous & dilated/filled lumens.

A

progesterone

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2
Q

Oxygenated blood from the placenta reaches the IVC through the __.

A

ductus venosus, which bypasses the liver.

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3
Q

The most important screening for Down’s syndrome measures levels of ___, which will be (inc/decr) in an affected child.

What quad screen results would indicate trisomy 21?

A

alpha-fetoprotein will be decreased.

Estriol (uE3) will also be decreased.
Inhibin A and hCG will be increased.

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4
Q

What is the genetic inheritance of cystic fibrosis?

A

AR

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5
Q

Bacterial vaginosis is associated with the presence of ___ on microscopy and is tx with __.

A

clue cells

Metronidazole

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6
Q

Trichomonas vaginalis is tx with __.

A

Metronidazole

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7
Q

The left ovarian vein drains into the __.

A

left renal vein.

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8
Q

The placental is delivered in the ___ stage of labor.

A

third

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9
Q

Chlamydia alone is tx with (1 of 2) __.

A

doxycycline or azithromycin

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10
Q

Chlamydia & gonorrhea are treated with which antibiotics?

A

ceftriaxone for gonorrhea

doxy or azithro for chlamydia

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11
Q

Condyloma accuminata, aka ___, is associated with which infection/organism?

A

aka genital warts

HPV

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12
Q

Condyloma lata is associated with which infection/organism?

A

syphilis (secondary)

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13
Q

70% of cervical cancers are caused by (organism and serotype)

A

HPV 16 and 18

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14
Q

How is endometriosis diagnosed?

A

Laparoscopy with Biopsy

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15
Q

Most common cause of postmenopausal bleeding?

A

Endometrial Carcinoma

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16
Q

What crosses under the uterine artery and ovarian vessels?

A

ureter

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17
Q

The left ovary drains into the ___.

A

left renal vein

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18
Q

What is the medical treatment for an ectopic pregnancy?

A

Methotrexate

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19
Q

The biophysical profile uses abdominal US to assess five parameters in the fetus:

A 
fetal breathing
fetal tone
fetal movement
amniotic fluid volume
reactive NST
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20
Q

How is a fetal biophysical profile scored?

A

Each parameter is either 2 (normal) or 0 (abnormal).
8-10 = reassuring for fetal well-being
6 = equivocal; consider delivery if at term
<4 = worrisome; consider emergent delivery.

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21
Q

Dichorionic-diamniotic twins form when splitting of the zygote occurs ___ after fertilization.

A

by day 3

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22
Q

Monochorionic-diamniotic twins form when splitting of the zygote occurs ___ after fertilization.

These twins share __.

A

between days 4-8

one placenta

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23
Q

Monochorionic-monoamniotic twins form when splitting of the zygote occurs ___ of fertilization.

A

between days 9-12

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24
Q

Patients with premature rupture of membranes are at increased risk for __ and present with (3) __.

A

chorioamnionitis

fever, abd pain, and tachycardia

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25
Q

The risk of premature rupture of membranes is at least doubled in patients who __.

A

smoke (tobacco, cocaine, whatever).

Other RF for PROM include: 
prior PROM (appx 2x)
short cervical length
prior preterm delivery
polyhydramnios
multiple gestations
bleeding in early pregnancy (aka threatened abortion).
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26
Q

Which physiologic change in pregnancy results in anemia?

A

Expansion of blood volume by 50%.
RBC mass expands by about 25%.

This causes physiologic anemia of pregnancy.

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27
Q

The CDC defines anemia in pregnancy as ___ below ___ in 1st or 3rd trimesters OR below ___ in the second trimester.

A

hematocrit below 33% in 1st & 3rd trimesters, or below 32% in the second trimester.

If below these levels, workup is recommended even if pt is asymptomatic.

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28
Q

A patient continues to bleed following delivery. MedHx includes asthma. Which uterotonic agent is contraindicated?

A

Prostaglandin F2-alpha (Hemabate)

potent smooth muscle constrictor with bronchio-constrictive effect

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29
Q

Oral contraceptives increase/decrease the risk of these cancers:
breast, cervical, colorectal, endometrial, ovarian

A

Increase risk of breast and cervical cancer

Decrease risk of colorectal, endometrial, and ovarian cancer

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30
Q

Pt with Pap smear indicating ASC-US who is negative for HPV. Next step in management?

A

repeat cytology (aka repeat Pap smear) in 1 year

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31
Q

Pap smear results: ASC-H (atypical squamous cells, cannot exclude HSIL). Next step in mgmt?

A

colposcopy with biopsies

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32
Q

Pap smear: ASC-US.
HPV screen positive.
Next step mgmt in patient 21-24?
Pt > or = 25 yoa?

A

21-24: repeat Pap (cytology) in 1 year

25 and up: colposcopy

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33
Q

Pap smear: LSIL
Next step in mgmt?
Pt 21-24, and also pt 25 & up.

A

21-24: repeat Pap (cytology) in 1 year

25 and up: colposcopy

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34
Q

Pap smear: HSIL.

Next step in mgmt?

A

Colposcopy with endocervical curettage (ECC) and endometrial sampling.

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35
Q

The ovarian artery branches off of the __.

A

abdominal aorta

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36
Q

The uterine artery branches off of the __.

A

anterior division of the internal iliac artery

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37
Q

The vaginal artery branches off of the __.

A

anterior division of the internal iliac artery.

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38
Q

The right ovarian vein empties into the __.

A

IVC.

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39
Q

The Kleihauer Betke test is used to __.

A

detect fetal blood from a sample of maternal blood.

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40
Q

A patient presents for prenatal checkup. You are unable to detect heart sounds. What is next step in mgmt?

A

Fetal ultrasound.

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41
Q

When is the triple (or quad) screen performed during pregnancy?

A

Second trimester, between 16-18 weeks

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42
Q

What is included in the triple screen?

A
  • maternal serum alpha-fetoprotein
  • estriol
  • human chorionic gonadotropin
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43
Q

Maternal serum alpha-fetoprotein is elevated in four general conditions. Name them, and indicate the most common cause of an elevated level.

A
  • abdominal wall defects (e.g. gastroschisis, omphalocele)
  • neural tube defects (spina bifida, anencephaly)
  • multiple gestation
  • inaccurate gestational age (MC)
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44
Q

Fetal triple screen at 17 weeks returns an elevated alpha-fetoprotein.

What is next step in mgmt?

A

ultrasound to rule out multiple gestation and/or inaccurate gestational age

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45
Q

Fetal quad screen is notable for maternal serum alpha-fetoprotein. What conditions might cause this result?

A
  • Chromosomal abnormalities (trisomy 21 or trisomy 18)

- inaccurate gestational age

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46
Q

What is the most impt diff between physiologic N/V of pregnancy (morning sickness) and hyperemesis gravidarum?

A

Hyperemesis gravidarum is characterized by intractable vomiting with dehydration and weight loss > 5% of body weight.

Metabolic alkalosis, hypokalemia, hyponatremia, hypochloremia, and elevated hematocrit are also present.

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47
Q

The incidence of hyperemesis gravidarum peaks between weeks ___ of pregnancy.

A

8-12

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48
Q

Pt presents with oligomenorrhea, hirsutism, infertility, HTN, and insulin resistance.

What test differentiates PCOS from an adrenal tumor?

A

Dehydroepiandrosterone sulfate (DHEA-S) is produced by the adrenal gland, not the ovaries - so high levels of DHEA-S would be consistent with hyperandrogenism from an adrenal source rather than PCOS.

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49
Q

A patient with a history of insulin-dependent DM or gestational DM may require early glucose screening by measuring __ levels at ___ visit.

A

HbA1C at first prenatal visit.

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50
Q

GBS infections can cause meningitis, sepsis, or pneumonia. Pts are tested for GBS between ___ weeks gestation.

A

35-37

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51
Q

What is appropriate screening for gestational DM in a pt with no RF or hx of DM?

A

1-hour 50-gram glucose challenge test between 24-28 weeks of gestation

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52
Q

A pt with gestational DM is said to be “White classification A1.” What does this mean?

A

Pt’s GDM is controlled with diet alone.

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53
Q

A pt with GDM, White classification A2/F would have what conditions?

A

GDM controlled by insulin (A2), accompanied by nephropathy (F).

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54
Q

What is the onset/duration of DM in a patient who is White Classification B?

A

DM onset >20 yoa, duration <10 years.

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55
Q

In diabetic patients, what is the difference between White classification C and D?

A

C: onset 10-19 yoa, duration <20 years
D: onset 10-19 yoa, duration > 20 years

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56
Q

Why are women at higher risk for UTI than men?

A

shorter urethra

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57
Q

Which organism is the most common cause of UTIs?

A

E. coli

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58
Q

The Bishop score is used to determine __.

A

the likelihood of vaginal delivery.

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59
Q

When evaluating a pregnant patient, a Bishop score >8 indicates a high likelihood of __.

A

vaginal delivery

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60
Q

When evaluating a pregnant patient, a Bishop score of 6 or lower indicates that

A

the cervix is unfavorable and will require a ripening agent.

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61
Q

What are the five characteristics used in determining a Bishop score?

A
  1. Fetal position
  2. cervical dilation
  3. cervical effacement
  4. station
  5. consistency
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62
Q

Most vaginal cancers in postmenopausal women are what kind?

A

squamous cell carcinoma

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63
Q

What is appropriate tx for vaginal squamous cell carcinoma?

A

Combination of radiation & surgery depending on stage, location, and size of the tumor

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64
Q

Viscerosomatic changes to the vagina & cervix can cause TART changes at what spinal level?

A

S1-S4

autonomic innervation to the vagina & cervix

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65
Q

How do Depo-Provera shots compare to an IUD in regard to effectiveness in preventing pregnancy?

A

about the same effectiveness

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66
Q

A breastfeeding mother presents with a fever of 101.3 F. The left breast is notable on PE for erythema around the nipple and a hard, non-fluctuate mass that is not draining. What is dx and most appropriate mgmt?

A

antibiotics for the mother alone while continuing to breastfeed.

Dx: mastitis.

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67
Q

A patient with mastitis might have TART changes at what spinal level?

A

T3-T5

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68
Q

What organism is the MCC of mastitis?

A

Staph aureus

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69
Q

What is the leading cause of antepartum hemorrhage?

A

Placenta previa (small section shears off, causing a bleed)

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70
Q

Patients with which placental abnormality (accreta, increta, percreata, or previa) are least likely to require blood transfusion during a primary C-section?

A

Placenta previa

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71
Q

Placenta previa is a leading cause of antepartum hemorrhage and is a RF for what other placental disorders?

A

Placenta accreta (including increta and percreta)

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72
Q

Placenta accreta attaches; increta invades; percreta penetrates. What is appropriate management for pts with any of these conditions?

A

C-section, usually with hysterectomy

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73
Q

What is the term for “irregularly prolonged or heavy menstrual period that maintains a normal menstrual cycle”?

A

menorrhagia

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74
Q

What term means “uterine bleeding at irregular intervals, typically between menstrual periods”?

A

metrorrhagia

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75
Q

Term for “regular menstruation cycles occurring at irregularly shortened inter-menstruation intervals (defined as 21 days or fewer)”?

A

polymenorrhea

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76
Q

Term for a menstruation cycle that is heavy/prolonged AND irregular

A

menometrorhagia

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77
Q

In women, lichen sclerosus is associated with an increased risk of developing ___.

A

squamous cell cancer (SCC) of the vulva

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78
Q

Which tocolytic agent is useful in women with asthma, DM, and/or contraindictions to indomethacin?

A

Nifedipine, a calcium channel blocker

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79
Q

Which tocolytic is generally first-line for tx of cessation of premature labor <32 weeks gestation?

A

indomethacin

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80
Q

What is the MOA and ADV of ritodrine and terbutaline when used as tocolytics?

A

beta-2 agonists

hyperglycemia in DM mothers.

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81
Q

Magnesium is CI in patients with ___ as it promotes hypotonia.

A

myasthenia gravis

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82
Q

The MOA of progestin-only OCPs is __.

A

thickening cervical mucus to inhibit sperm penetration.

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83
Q

Combined estrogen-progesterone OCPs have MOA of __.

A

inhibiting FSH production from the pituitary.

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84
Q

What is tx for molar pregnancy?

A

Suction dilatation and curettage; if childbearing is complete, hysterectomy can be offered to remove risk of local invasion.

b-hCG should be drawn 48h after evacuation to confirm levels are falling, then weekly until 3 consecutive negative results, then monthly until negative for six months.

85
Q

In pt with elevated b-hCG levels following evacuation of a molar pregnancy, what is next step of mgmt?

A

If persistent ds suspected, chemotherapy.

86
Q

Test for pyelonephritis?

A

Urinalysis and/or urine culture (“clean-catch midstream” for culture sample)

87
Q

Treatment for pyelonephritis?

A

TMP-SMX, cipro- or levofloxacin

88
Q

Pap smear recommended q3y for women of what age?

A

21-29; every 3y w cytology. Also women 30-65.

89
Q

Pap smear q5y with cytology + HPV is recommended for women of what ages?

A

30-65

90
Q

Treatment for HTN during pregnancy?

A

Hydralazine (preferred)
Methyl-dopa
Labetolol
Nifepidine

91
Q

The Muellerian ducts form 3 structures:

A

Fallopian tubes, uterus, upper vagina

92
Q

A pt with increased abdominal growth presents wondering why, since no BMI change. US shows ovarian cyst much larger than usual. What is dx?

A

serous cystadenoma

93
Q

Large, multilocular ovarian cysts are likely __ cystadenomas.

A

mucinous

94
Q

Which of these vaccines is CI in pregnancy: PNA, hep B, MMR, polio, influenza?

A

MMR - bc live vaccine

95
Q

What acid/base imbalance is common in pregnancy - and what is its cause?

A

compensated respiratory alkalosis caused by increased minute ventilation

96
Q

A patient experiencing significant blood loss during delivery is at increased risk for Sheehan syndrome. What hormones are deficient in Sheehan syndrome?

A
  • gonadotropin
  • TSH
  • ACTH

all produced by anterior pituitary

97
Q

A postpartum patient presents with decreased mental function, fatigue, difficulty staying warm, and no milk production. Why?

A

Excessive bleeding during delivery –>
anterior pituitary necrosis –>
Sheehan syndrome

98
Q

Tx for Sheehan syndrome?

A

estrogen and progesterone replacement; supplement thyroid and adrenal hormones

99
Q

Endometritis is inflammation of the uterus lining, usually caused by __.

A

infection, usually polymicrobial (aerobes and anaerobes) - S aureus and Staph.

100
Q

In postpartum patients, incidence of endometritis is related to __, and is increased in __.

A

mode of delivery; 5-10x incidence in C-sections.

101
Q

The most common cause of postpartum fever is __.

A

endometritis

*with or wo uterine fundal tenderness

102
Q

What is safest means of suppressing lactation in a postpartum patient?

A

breast binding, ice packs, analgesics

103
Q

Why are hormonal interventions CI for suppressing lactation?

A

risk of thromboembolic events; rebound engorgement

104
Q

Breastfeeding is associated with decreased incidence of __ cancer.

A

ovarian

105
Q

How does breastfeeding decrease postpartum maternal blood loss?

A

increased uterine contraction due to oxytocin release during milk letdown

106
Q

How is an ectopic pregnancy dx with US?

A

by visualizing fetal pole outside of the uterus

no intrauterine pregnancy seen on US with elevated b-hCG

107
Q

In a pt with no intrauterine pregnancy seen on US, what lab results suggest ectopic pregnancy?

A

beta-hCG over discriminatory zone, which is the level at which intrauterine pregnancy should be seen on US, usually 1500-2000 mIU/mL

108
Q

A pregnant patient’s b-hCG rises less than 50% in 48 hours. After D and C, levels do not fall. What dx should be evaluated?

A

ectopic pregnancy

109
Q

Pregnant pt is using albuterol >2x/wk. What two meds might be good additions?

A

inhaled corticosteroids

cromolyn sodium

110
Q

What meds are indicated in a pregnant pt experiencing an acute asthma attack nonresponsive to albuterol?

A

subQ terbutaline

systemic corticosteroids

111
Q

What is BP threshold for initiating HTN therapy in a pregnant patient?

A

> 160/105

112
Q

What is goal of HTN therapy in a pregnant patient?

A

reduce diastolic BP to 90-100 mmHg to prevent maternal stroke or abruption w/o compromising uterine perfusion

113
Q

What is the current recommendation for prophylatic RhoGAM therapy in Rh-negative women?

A
  • at 28 wks gestation (after indirect Coomb’s test) and w/in 72 hours of delivering Rh-positive baby
  • after spontaneous or induced abortion
  • after antepartum hemorrhage
  • following amniocentesis or CVS
114
Q

How much fetal blood is neutralized by a normal 300 microgram dose of RhoGAM?

A

30 cc of fetal blood, equivalent to 15 cc of fetal RBCs

115
Q

Twin-twin transfusion syndrome is most common in (__ chorionic, __ amniotic) twins.

A

monochorionic

diamniotic

116
Q

In twin-twin transfusion syndrome, which twin experiences ADV related to polyhydramnios?

A

recipient twin

117
Q

In twin-twin transfusion syndrome, which twin may experience tricuspid regurgitation or ventricular hyptertrophy?

A

recipient twin

118
Q

PALM-COEIN is the mnemonic for remembering __.

A

causes of abnormal uterine bleeding

119
Q

PALM in PALM-COEIN stands for __.

A

Structural causes of abnormal uterine bleeding.

  • Polyp
  • Adenomyosis
  • Leiomyoma
  • Malignancy and hyperplasia
120
Q

COEIN in PALM-COEIN stands for __.

A

nonstructural causes of abnormal uterine bleeding.

  • Coagulopathy
  • Ovulatory dysfunction
  • Endometrial
  • Iatrogenic
  • Not yet classified
121
Q

A patient presents with suspected premature rupture of membranes. What fluid should be tested, and what conditions are a positive test for amniotic fluid?

A

Test vaginal fluid for ferning and nitrazine testing.

Nitrazine test: turns blue if amniotic fluid (pH ab 7.1).

Normal vaginal fluid
pH is 4.5-6.0

122
Q

What is tx for PROM in these patients?

  1. > 34 weeks
  2. 24-34 weeks
  3. <24 weeks
A
  1. deliver
  2. steroids for fetal lung maturation
  3. abortion
123
Q

Uterine fibroids in the ___ may obstruct labor by preventing fetal head from entering the pelvis, thus indicating a C-section

A

lower uterine segment

124
Q

C-section is indicated if the fetal head is larger than __.

A

12 cm

125
Q

Macrosomia, 42 weeks gestation, or polyhydramnios (are/are not) indications for a C-section.

A

are not

126
Q

A pt presents with vaginal bleeding, positive pregnancy test, and a closed cervical os. Dx?

A

threatened abortion

127
Q

A pt has retained a nonviable intrauterine pregnancy for an extended period. Dx?

A

Missed abortion

128
Q

A pt presents with fever, bleeding, and a dilated cervix. Dx and Tx?

A

Septic abortion

Tx: broad-spectrum antibiotics and uterine evacuation.

129
Q

A pt with recurrent loss of pregnancies may have what ds?

A

antiphospholipid antibody syndrome

130
Q

What is workup for antiphospholipid antibody syndrome (4 parts)?

A
  1. anticardiolipin antibodies
  2. beta-2 glycoprotein antibodies
  3. PTT
  4. Russell viper venom time`
131
Q

What is the tx for antiphospholipid antibody syndrome?

A

aspirin & heparin

132
Q

What medications are given to cause medical abortion?

A

mifepristone and misoprostol

133
Q

Medical abortion is associated with (higher/lower) ___ blood loss than surgical abortion.

A

higher

134
Q

What is affect of medical abortion on future fertility?

A

none

135
Q

What is MOA of mifepristone in causing medical abortion?

A

progesterone receptor blocker

136
Q

What is MOA of misoprostol in causing medical abortion?

A

prostaglandin E1 analog that induces uterine cramping & expulsion of products of conception

Medical abortion is the least invasive option.

137
Q

A pt presents with complains of continual bladder fullness. The bladder does leak a little bit all the time. What is dx and causes?

A

Overflow incontinence
caused by:
1. underactive detrusor muscle
2. bladder obstruction

138
Q

A pt complains that every time he laughs hard, he pees a little bit. Dx and associated structural deficits?

A

Stress incontinence

associated with cystocele or urethrocele

139
Q

Normal post-void residual is about ___ cc’s.

In overflow incontinence, this is elevated to > ___ cc’s.

A

50-60

> 300 cc’s in overflow incontinence.

140
Q

Which form of incontinence is caused by urethral hypermobility OR intrinsic sphincteric deficiency of urethrea?

A

stress incontinence

141
Q

Overactivity of the detrusor muscle leads to ___ incontinence

A

urge

142
Q

What is tx for urge incontinence?

A

Anticholinergics (e.g. oxybutynin), but not TCAs bc ADV.

143
Q

Which nerve (and root) provides cutatneous sensation to the groin and skin overlying the pubis?

A

iliohypogastric n (T12-L1)

144
Q

Which nerve (and roots) provides cutaneous sensation to the groin, symphysis, labium, and upper inner thigh?

A

ilioinguinal (T12-L1)

145
Q

Pain from entrapment of what nerve is reproduced with thigh aDduction?

A

iliohypogastric (T12-L1)

146
Q

What is the MC type of benign breast condition?

A

fibrocystic breast changes

147
Q

Cyclic mastalgia is often associated with what breast condition?

A

fibrocytic breast changes

148
Q

How does caffeine affect fibrocytic breast changes?

A

Increases pain

149
Q

What is the first-line therapy for painful menses?

A

NSAIDs

150
Q

List 8 RF for cervical cancer.

A
  1. early-onset sexual activity
  2. multiple partners
  3. partner w multiple partners
  4. Hx of HPV or other STDs
  5. immunosuppression
  6. smoking
  7. low SES
  8. lack of regular Pap smears
151
Q

A mass in the lower vulva, near the ___, is highly suspicious for malignancy.

A

Bartholin gland.

Requires excision/biopsy

152
Q

What cancer most likely rises from the Bartholin gland?

A

Primary vulvar adenocarcinoma

153
Q

___ increases risk of vulvar cancer, especially in setting of HPV infection.

A

Smoking

154
Q

What are major RF for molar pregnancy?

A
  1. Asian
  2. <20 yoa
  3. > 40 yoa
  4. deficiency in beta-carotene/folic acid
  5. 2+ miscarriages
155
Q

Why are oral contraceptives best tx for pt with dysmenorrhea?

A

Progestin in OCS causes endometrial atrophy. Without endometrium, there will be less prostaglandins (which are produced in endometrium), thus reduced pain.

156
Q

Pt with menstrual pain not relieved with NSAIDs nor OSA nor Depo-Provera. What is next step?

A

Diagnostic Laparoscopy

157
Q

The most important ovarian abnormality contributing to sub-fertility is ___.

A

polycystic ovarian disease (PCO)

NOTE: diff from PCOS!
PCO syndrome has additional sx: obesity, hirsutism, oligo- or amenorrhea.

158
Q

A critical diagnostic feature of polycystic ovarian disease is an abnormal ___.

A

LH/FSH balance.

LH increased bc increased androgen production

FSH decreased

159
Q

What test evaluates the possibility of Fallopian tube dysfunction?

A

hysterosalpingogram

160
Q

Indomethacin is a PG inhibiter commonly used as a tocolytic. What are two maternal ADV?

A

thrombocytopenia

anemia

161
Q

Nifedipine is commonly used as a tocolytic. What is an ADV?

A

hypotension

162
Q

What is the fetal ADV of indomethacin used as a tocolytic?

A

necrotizing enterocolitis (NEC)

death of intestinal tissue; survival 70-80%

163
Q

Progesterone should be offered between ____ weeks in women with a prior pre-term birth (20-36 6/7 wks)

A

16-36

164
Q

Preterm delivery is unlikely if cervical length > __ mm

A

30

165
Q

A pt with fever on postpartum day 3 after a C-section. PE reveals breast engorgement and uterine fundal tenderness. Dx?

A

Endometritis

166
Q

Excessive traction on the umbilical cord during stage 3 of delivery is the MC RF for ___.

A

uterine inversion

167
Q

When attempting to deliver the placenta, a globular pale mass appears in the introitus. What is the most likely etiology for this?

A

uterine inversion

168
Q

A patient with hx of C-sections is now pregnant at 24 weeks. US reveals low-lying anterior placenta with previa. What is the most serious complication that could lead to postpartum hemorrhage?

A

placenta accreta

Placental abruption and uterine atony are common, but in the presence of a low-lying anterior placenta in a
patient with a history of multiple cesarean births, dx of placenta accreta must be entertained.

169
Q

First trimester vaginal bleeding. Blood in the vault; dilated os. Dx?

A

inevitable abortion

*occurs in any pt in whom the cervix has dilated during the first trimester.

170
Q

Pt w three first trimester losses should be tested for three systemic ds:

A

lupus (anticoagulant test)
Thyroid
DM

171
Q

Patient with 1st-trimester bleeding. RLQ tenderness; rebound & bilateral LQ guarding. Scant old blood in vagina. Empty uterus on US. Dx?

A

Ectopic pregnancy

172
Q

What is the recommended screen for Down syndrome in the seconc trimester?

A

Quad screen

173
Q

What is a normal fasting glucose value for a pregnant patient?

A

95

174
Q

What are the abnormal values for a 3-hour glucose challenge test?

A

fasting 90
1 hour 180
2 hours 155
3 hours 140

175
Q

Braxton-Hicks contractions are false labor because __.

A

there is no cervical change.

176
Q

If fetal HR cannot be confirmed externally, the most reliable way to document fetal well-being is to apply a ____.

A

fetal scalp electrode

177
Q

A 4-year-old girl is being evaluated for premature pubic hair growth. She has no breast development and has had no menstrual bleeding. Labs: high DHEA and DHEAS; low LH and FSH. Dx/Tx?

A

Congenital adrenal hyperplasia (21-OH)

Steroid replacement

178
Q

Adolescent with heavy menstrual bleed. OCS do not help. MedHx normal. Dx?

A

Coagulation disorder, most likely Factor V Leiden.

179
Q

Pt with vulvar irritation and slight itch. Grayish, frothy vaginal discharge. Dx?

A

Trichomonas

180
Q

A 16yo G0 presents to ED with 2-day hx of “belly pain.” She is sexually active w new partner and is not using contraception. Temp is 100.5°F. PE: lower abd tenderness and guarding. Pelvic exam: diffuse tenderness bilaterally over uterus. BHCG <5. Dx?

A

acute salpingitis.

Important criteria:
lower abd tenderness
uterine/adnexal tenderness
mucopurulent cervicitis

181
Q

A 30yo G2P1 at 38 weeks gestation presents to LnD with contractions every 2-3 min. Membranes are intact. 5 cm dilated; 100% effaced, and -1 station. Reassuring fetal HR. Two hours later: 7 cm dilated and 0 station.
Two hours after that, exam is unchanged (7/100/0). Fetal HR still reassuring. What next?

A

amniotomy

182
Q

MCC of amenorrhea?

A

Preggers

183
Q

Patient near term with active bleeding from a placenta previa. Appropriate next step?

A

delivery via C-section

184
Q

Regardless of disease severity, the only definitive therapy for preeclampsia is __.

A

delivery of the fetus.

185
Q

Pt had Depo-Provera shot six weeks ago, and presents with unpredicatable bleeding. Next step?

A

reassurance that this is normal initially; usually resolves in 2-3 months.

186
Q

Pt with severe menstrual pain unchanged by NSAIDs or OCS. What next?

A

Diagnostic laparoscopy to confirm dx of endometriosis and exclude other causes of secondary dysmenorrhea.

187
Q

41 yo pt with vaginal bleeding and pelvic pain slightly helped by NSAIDs. Exam reveals 14-wk-size uterus with fibroids. Next step?

A

Endometrial biopsy to r/o endometrial carcinoma.

188
Q

Pt presents with inability to conceive for 1 year. Sex has become painful. Dx?

A

endometrial glands outside of uterine cavity (endometriosis)

189
Q

First clinical sign of vulvar cancer?

A

Pruritis

190
Q

Which medication decreases risk of colon cancer?

A

OCPs

191
Q

63 yo pt presents with complex ovarian mass about 5 cm. Next step?

A

Exploratory surgery.

Complex ovarian mass in postmenopausal pt needs surgical exploration.

192
Q

26 yo pt with suspected endometriosis. NSAIDs and OCS have not helped. How is dx confirmed?

A

exploratory lap.

Endometriosis can be dx/tx clinically; if tx fails, exploratory lap indicated to confirm dx.

193
Q

Pt with hx of endometriosis who is unable to conceive and has otherwise negative
workup for infertility. Next step?

A

ovarian stimulation with clomiphene citrate

194
Q

17 yo pt with severe dysmenorrhea. NSAIDs and OCS have not helped. She misses 2-3 days/school/month with pain. Not sexually active; Tanner stage IV. Next step?

A

laparoscopy

laparoscopic evaluation of chronic pelvic pain in adolescents should not be deferred based on age.

195
Q

A 48-yo G2P2 complains of progressively heavier and longer menstrual periods over the last year. Pt previously had normal periods. Denies sx other than fatigue over last few months.
Pelvic exam noted for irregularly shaped 16 weeks size uterus. Dx?

A

Uterine fibroids

196
Q

31 yo w uterine fibroids distorting the uterine cavity and large enough to cause infertility. Tx?

A

myomectomy

197
Q

17 yo w acute RLQ pain, nausea. Normal genitalia; mild pink-yellow discharge on speculum exam. Next step?

A

beta-hCG to r/o ectopic pregnancy.

198
Q

A 30-yo G1P1 presents toER with left-sided abd pain. PE
notable for a 5x6 cm mobile left adnexal mass. US shows a left ovarian mass with
cystic and solid components. What is most likely dx?

A

Dermoid tumor

The most common tumor found in women of all ages is the dermoid. 80% occur during reproductive years,
median age of occurrence 30. Dermoids may contain differentiated tissue from all three embryonic germ layers. Dermoid tumors can contain teeth, hair, sweat and sebaceous glands, cartilage, bone, fat and teeth

199
Q

Most effective tx for hot flashes associated w menopause?

A

estrogen

200
Q

A patient with ____ DM is most likely to have a macrosomic infant.

A

gestational diabetes

201
Q

Which US marker is suggestive of dizygotic (fraternal) twins?

A

two separate placentas (dichorionic)

202
Q

The ____ test has great value in determining the incidence and size of fetal transplacental hemorrhage.

A

Kleihauer-Betke

203
Q

Pt has been trying to get pregnant for 3 months. Tx?

A

reassure and observe; not infertile until 1 year of trying w/o contraception.

204
Q

Infertile pt w hx of pelvic infection. Periods are regular; last 2 wks ago. Never abnormal Pap. What is most useful dx test to eval infertility?

A

hysterosalpingogram

205
Q

Infertile pt w high BMI, hirsutism, abd striae. Which test will help identify cause of infertility?

A

Testosterone levels help confirm dx of PCOS, esp in presence of hirsutism.

206
Q

Tx for 32 yo pt w PCOS and infertility?

A

ovulation induction agents (clomiphene)

207
Q

Pt w infertility for 1 yr. Normal cycles; no med hx; no abnormal Pap. Normal pelvic exam, thyroid, prolactin levels. She’s perfect. Most appropriate next step?

A

Semen analysis.

Woman is fine. Check the father.

208
Q

Woman with tender LN and normal mammogram. Most likely cause?

A

infection

Nontender LN is associated with carcinoma.

209
Q

Most impt test to order in pt with famHx of DM and PE revealing acanthosis nigricans?

A

fasting insulin

Level 2 COMLEX CE (3 decks)

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