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USMLE Step 2 > OB/gyn > Flashcards

OB/gyn Flashcards

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USMLE® Step 1 flashcards
1
Q

how do you manage GBS in pregnant women with history of previous GBS+ pregnancy?

A

prophylactic IV penacillin

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2
Q

when do you give anti-D Ig?

A

screen at 24-28 weeks –> if negative, give at 28 weeks and within 72 hours of delivery of Rh+ baby

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3
Q

rubella in pregnancy

A

rash the spreads face down, spares palms and soles
postauricular LAD
arthralgias

**sx tx after 18 weeks

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4
Q

risks for endometritis? treatment?

A

prolonged labor and/or C section after onset of labor

tx with IV clinda/gent (polymicrobial infx)

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5
Q

t/f: active maternal HSV infx is an indication for csection?

A

yes

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6
Q

approach to meconium ileus?

A

gastrograffin enema= diagnostic and therapuetic

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7
Q

signs/sx of chorio?

A 
maternal tachy
WBC >15k
uterine tenderness
malodorous discharge
fetal tach >150

***give IV amp/gent and deliver!

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8
Q

c section or NSVD in chorio?

A

csection if hemodynamically unstable or other pathology

add CLINDA to amp/gent

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9
Q

nerve injury moms at risk for (especially from prolonged labor)

A

common peroneal –> footdrop

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10
Q

hepatic adenoma vs focal nodular hyperplasia on imaging

A

FNH has stella scar (central area of fibrosis)
-FNH is less risk of bleeding than Hepatic adenoma

-If on OCPs and hepatic adenoma found, you should dc OCP

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11
Q

cut off ages for HPV vax?

A

girls <26

boys <21

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12
Q

character of variable decels?

A

differ in amplitude, duration and form

**indication of cord compression –> reposition and administer O2 —> amnioinfusoin if previous attemps are unsuccessful

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13
Q

hyperkeratotic exophytic papules that turn white with acetic acid?

A

HPV

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14
Q

vaginismus

A

severe pain/ anticipatroy anxiety on insertion of anything into the vagina

if complaints are due to pain: pelvic floor PT
if complaints are due to anxiety and stress: sex psychotherapy

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15
Q

preterm infants exclusively breast fed are at greater risk for….

A

Fe deficiency anemia

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16
Q

how does clomiphene induce ovulation?

A

SERM –>blocks hypothalamic endogenous estrogen receptors therefore blocking negative feedback inhibition –> this increases pulsatory GnRH –> inc FSH/LH –> ovulation

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17
Q

tx for ectopic (After its out)// contraindications

A

methotrexate –> check after 7 days, expect to see >15% drop in Hcg

CI:

  • immunodeficiency
  • non compliant patients
  • hepatotoxicity
  • ectopic > 3.5 cm (high failure rate)
  • fetal heart beat (high failure rate)
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18
Q

HPO immaturity

A

cycles in girl with recent menarche that are heavy and occur >45 days apart

*lack progesterone signal

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19
Q

non stress test

A

20 minutes on the montior looking for >2 accels for at least 15 seconds

-indicated after 32 weeks in high risk pregnancies or when mom stops feeling movement

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20
Q

3 D’s of entrometriosis

A

dsymennorrhea
dysperuenia
dyschezia (painful poops)

*rectovaginal nodularity in the posterior cul-de-sac

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21
Q

management of stable PPROM < 35 weeks

A

steroids
antibiotics
mag if <32 weeks
delivery

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22
Q

BP lowering meds for preE

A

IV hydral
IV labetalol –> look at HR
PO nifedipine –> is patient able to take PO?

*methyldopa is for chronic HTN

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23
Q

treating syphillis in pregnancy with reported hx of allergy?

A

there are no alternatives. Do a skin test. Do a sensitization if you need to.

(if someone is not pregnant, you can use IV ceftriaxone)

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24
Q

how to treat vulvovaginal candadiasis

A

pregnant= intravaginal clomitrazole

not pregnant= oral fluconazole

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25
Q

BV

A
  • clue cells = epithelial cells covered in coccobacili (gram indeterminate)
  • alkali pH
  • treat with oral metro
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26
Q

when to use FNA vs core needle in breast mass?

A

FNA is not definitive, jsut shows abnormal cells. Use this to evaluate non suspicious cystic lesions in women under 30

Core needle used in suspicious mass in older women

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27
Q

up until what age do you screen for GC/CT?

A

25

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28
Q

physiologic nipple discharge

A

BILATERAL, can be milky or greenish, in young women with normal endo fx is physiological. Avoid nipple stimulation

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29
Q

large, rapidly growing breast mass, that appears sharply demarcated from normal tissue on imaging?

A

phyllodes –> benign!

however, treat like a cancer because they can rarely become malignant

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30
Q

distinguish pagets of the breast from inflammatory breast CA?

A

paget’s generally involves/ is limited to the areola

31
Q

how to treat breast cancer in pregnancy

A

chemo can be given after the first tri?

32
Q

trich

A

pH> 4.5
burning with urination
strawberry cervix

33
Q

5a-reductase deficiency

A

X,Y but maintain female external genitalia because they lack testosterone to convert from default

-increasing levels of T at puberty cause adrenarche and virilization but no secondary sex characteristics

34
Q

aromatase deficiency

A 
ambiguous genitalia at birth
-decrease est, increased T 
---> virilization of mom during pregnancy as androgens cross placenta
tall stature
osteoporosis
35
Q

function of aromatase

A

converst androgens to estrogens

36
Q

endometrial tissue within the uterine wall. associated with pelvic pain in a woman closer to menopause

A

adenmyosis

**uniformly enlarged uterus but assymetrical thickening, wahtever that means

37
Q

what factor, generally, has greatest impact on prognosis of breast cancer

A

nodal status

38
Q

endometrial thickness >5mm, with no atypia, in postmenopausal woman?

A

endometrial hyperplasia

  • risk: estrogen replacement without P, obesity, PCOS
  • ***at risk for malignant transformation
  • tx= progestin
39
Q

endmetrial hyperplasia with atypia, tx?

A

hyst +bso

40
Q

confirmation of fat necrosis of the breast?

A

oil cysts

multinucleated giant cells

41
Q

approach to primary dysmennorrhea

A

nsaids

OCPs

42
Q

mastitis

A

caused by over production of milk or insufficient drainage –> staph infection

  • occurs 2-4 weeks after birth
  • tx with a pcn of sorts and continue breast feeding
43
Q

linchen sclerosis

A
  • vaginal pruritis in post menopausal women
  • figure 8 pattern
  • do punch to r/o SCC
  • treat with high dose steroids
44
Q

GnRH ago 3 months before definitive surgery for leiyomyomas

A

decreases size, decreases surgical time/ complications

-decreases dysmennorrhea/mennorhagia in the mean time

45
Q

first line tx for PMDD

A

SSRIs

should also advise to stop smoking

46
Q

pharmacological tx of acute AUB in hemodynamically stable patient

A

high dose conjugated estrogen therapy –> triggers rapid growth of endometrium, stops bleeding from endometrial surface

47
Q

age of endometrial cancer

A

> 45

>35 with risk factors (ie obesity, nulliparity)

48
Q

t/f: isolated precocious adrenarche in an obese (probably african america feamle) can be caused by insulin resistance?

A

true.

It’s a complicated mechanism that bascially leads to increased free T

49
Q

most common vaginal forein body in a young girl and easy office procedure to get it out?

A

TP –> warm saline irrigation

50
Q

how to manage delivery in HIV positive mom

A

cART during pregnancy, C/S, zidovudine for baby at birth for prophylaxis PEP

brings vert transmission risk down to ~2%

51
Q

contraindication to breast feeding:

A

MOM

  • maternal HIV
  • active TB
  • drug abuse (MARIJUANA!)
  • meds: tetracyclines, chemo, chloramphenicol

BABY
-active galactosemia

52
Q

quickie on physiologic change in pregnancy:

  • acid base?
  • hgb?
  • renal fx?
A

acid base= chronic compensated respiratory alkalosis (bicarb will be up)

hgb= dec by 2mg/dL due to increase in plasma volume by 40-50%

renal= 50% decrease in GFR due to inc blood flow= increase filtration –> dec Cr, BUN, uric acid

53
Q

oral glucose challnege should occur when?

A

24 weeks (24-28)

54
Q

risk factors for intrauterine hypoxia? sequelae of this in baby?

A
  • maternal smoking, MGD, SGA, LGA

- polycythemia

55
Q

safe managment of preE with severe features

A

if stable, >34 weeks, induce labor. Vaginal > CS

if stable <34 weeks, give IV mag, steroids and BP meds

56
Q

you admin IV Mag to prevent progression of pre-E, and then patient looses DTRs. What do you do?

A

d/c Mag and start Ca-gluc.

loss of reflexes is earliest sign of Mg toxicity

57
Q

what is the CONFIRMATORY test for Downs?

A

chorionic villous sampling, between 10-15 weeks.

amnio at 15-17 weeks

58
Q

whats a way to distinguish abruption from rupture when presentation is looking very similar?

A

abruption = rigid uterus with hypertonic contractions

rupture= cessation of previously adequate contractions (they’ll give you a hx of a previously scarred uterus)

59
Q

GBS test timing?

A

35-37

60
Q

Rh antibody testing

A

28-29 weeks

61
Q

“chronic” hypertension in pregnancy

A

before 20 weeks, or persisting after 42 weeks

62
Q

ruptured vasa previa

A

presents with antepartum hemorrhage and signs of FETAL distress/ blood loss. There will be no signs of maternal blood loss.

63
Q

management of threatened abortion:

A

reassurance –> f/u ultra sounds –> limit physical activity/ sex

***intact IUP + closed os + intrauterine bleeding

64
Q

management of APLA in pregnancy

A

ASA + heparin

**d/c ASA in third trimester to prevent premature closure of ductus

65
Q

anti epileptics in pregnancy

A

they are all bad, so choose one that best controls moms seizures at lowest dose possible

66
Q

placental thrombosis causing abortion in first/second tri?

A

think APLS/ SLE –> look for prolonged PTT!

67
Q

rosette test

A

tests for fetal/maternal hem

68
Q

gestational hypertension causes:

A

IUGR.

69
Q

hypotension and increased HR after spinal epidural?

A

sympathetic blockadge

70
Q

incomplete abortion? management?

A

retained products, dilated os

d/c! give abx for retained products

71
Q

genetic contraindication to copper IUD?

A

wilson’s

72
Q

breast imaging modality in pt under 30?

A

US!

73
Q

whats a good lab to check in someone presenting with menopause like sx?

A

TSH!!!!!!!

USMLE Step 2 (18 decks)

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