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Uworld Step 2 > OB/GYN > Flashcards

OB/GYN Flashcards

1
Q

What are risk factors for placenta previa?

A

Prior c-section, prior placenta previa, multiple gestation, and advanced maternal age (35 or greater)?

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2
Q

What AFI defines polyhydramnios?

A

Greater than or equal to 24 cm.

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3
Q

What vaccine should be offered at the initial prenatal visit?

A

Influenza (initially put glucose levels but a GCT is performed at weeks 24-28).

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4
Q

Is breech presentation a contraindication to vaginal delivery?

A

Yes, so perform a c-section.

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5
Q

When are tocolytics indicated for a preterm delivery?

A

If GA is less than 34 weeks. After 34 weeks tocolytics are not administered due to risks outweighing benefits.

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6
Q

What is sudden onset unilateral abdominal pain in the setting of free pelvic fluid, an ovarian mass, and normal doppler studies indicative of?

A

Ruptured ovarian cyst (initially put adnexal torsion but that would show decreased blood flow on doppler studies).

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7
Q

What is intrauterine synechiae?

A

Intrauterine adhesions (closes the uterine cavity) found in Asherman syndrome following intrauterine surgery. Results in secondary amenorrhea, cyclic pelvic pain, and no vaginal bleeding on progesterone withdrawal test.

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8
Q

What is unilateral bloody nipple discharge suggestive of?

A

Intraductal papilloma.

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9
Q

What is the most common cause of an arrested 2nd stage of labor?

A

Fetal malposition. Remember that arrest is defined as no fetal movement despite pushing after 3 hours for nulliparous patient and 2 for multiparous (all during the 2nd stage of labor of course, when the cervix is 10 cm dilated and progress measured by fetal station).

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10
Q

What is the optimal fetal position?

A

Occiput anterior. Occiput transverse or posterior can cause arrest in the 2nd stage.

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11
Q

When can bleeding from placenta previa occur?

A

> or equal to 20 weeks. Presents with painless vaginal bleeding. Intercourse and digital cervical examination are contraindicated. (initially put cervical insufficiency but this would not have vaginal bleeding).

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12
Q

When is azithromycin or doxycycline monotherapy indicated for chlamydia/gonorrhea infection?

A

For NAAT confirmed chlamydia monoinfection (due to ceftriaxone having no effect). For both empiric/co-infection or gonorrhea monoinfection both azithromycin/doxycycline and ceftriaxone are used.

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13
Q

What is the management of intra-amniotic infection/chorioamnionitis in addition to broad spectrum antibiotics?

A

Labor augmentation (removes the source of infection) (get that baby out of there).

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14
Q

When can chronic hypertension be diagnosed during pregnancy?

A

Anytime before 20 weeks (patient’s LMP was 12 weeks ago) (cannot diagnose GHTN or pre-eclampsia before 20 weeks).

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15
Q

How is hyperemesis gravidarum differentiated from normal nausea/vomiting during the first trimester?

A

Presence of ketones on urinalysis.

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16
Q

What is the cutoff for postpartum fever?

A

100.4 degrees F. Less then that (100.2 for example) is more likely to be part of normal puerperium changes (fever/shivering, uterine contraction, lochia/bloody vaginal discharge).

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17
Q

What does an abnormal BPP (oligohydramnios, lack of fetal breathing, ect) suggest?

A

Placental dysfunction (BPP assesses fetal oxygenation).

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18
Q

What is pharyngitis with lower abdominal pain in a young, sexually active patient suggestive of?

A

Gonococcal pharyngitis with PID. Can present with non-tender cervical lymphadenopathy. (EBV would have exudative pharyngitis and tender cervical lymphadenopathy in contrast).

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19
Q

When is lack of menses considered normal?

A

If patient is less than 15 and secondary sex characteristics are developing normally (ex a 14 year old with tanner stage 4 breasts and stage 3 pubic hair should be offered reassurance).

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20
Q

What is the McRobert’s maneuver for shoulder dystocia?

A

Elevate the legs and flex hips against the abdomen.

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21
Q

Are screening tests indicated for patients with average risk for ovarian cancer (ex. no history of hereditary syndrome, no adnexal mass ect.)?

A

No screening tests are indicated for normal risk of ovarian cancer (ex. 58 year old with a single secondary relative {cousin} diagnosed in her 50’s has no need for any screening).

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22
Q

Is anencephaly an example of a non-viable fetus?

A

Yes, so allow for spontaneous vaginal delivery upon rupture of membranes (don’t do a c-section even though fetus was in breech and had a heart beat. It was non-viable so allow it to be passed vaginally).

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23
Q

What are contraindications to vaginal delivery?

A

Prior classical c-section, placenta previa, prior extensive uterine myomectomy. Thus a patient with any of these and a fetus in breech presentation should be scheduled for c-section.

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24
Q

What is first line for PMS/PMDD?

A

SSRIs (also remember that the first step in suspected PMS/PMDD should always be a symptom diary).

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25
Q

What are potential complications of oxytocin overdose?

A

Hyponatremia, hypotension, tachysystole(abnormally frequent uterine contractions).

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26
Q

What is the next best step if fetal heart tones are not heard by doppler ultrasound?

A

Trans-abdominal ultrasound to confirm intrauterine demise or not (doppler ultrasound is not diagnostic and can give false absent FHT).

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27
Q

What is the next best step for CIN 3 diagnosed following colposcopy?

A

Cervical conization.

28
Q

What is the next best step if a patient comes in with irregular uterine contractions?

A

Reassurance and discharge home (irregular uterine contractions are Braxton-Hicks contractions/false labor).

29
Q

In addition to pap tests what should women ages 25 and under be screened for?

A

Gonorrhea and chlamydia.

30
Q

What is blunt abdominal trauma (motor vehicle accident, ect.) a significant risk factor for in the pregnant patient?

A

Abruptio placenta, which must be managed with fluid resuscitation and placement into left lateral decubitus position (initially put BPP but the fetus is usually sheltered from maternal trauma and complications arise from maternal circulation issues, so maternal stabilization is priority).

31
Q

What is the best step for confirming a diagnosis of fibroadenoma?

A

Biopsy (imaging such as ultrasound and mammography are appropriate steps in management but are not diagnostic).

32
Q

What are the teratogenic effects of phenytoin?

A

Cleft lip/palate, microcephaly, wide anterior fontanelle, distal phalange hypoplasia, cardiac anomalies.

33
Q

Can prophylactic Rhogam be administered at 28 weeks gestation?

A

Yes (28-32 weeks). Given again within 72 hours of delivery if infant found to be Rh(+).

34
Q

Can levothyroxine cross the placenta?

A

No. A neonate with a mother with Grave’s disease can present with thyrotoxicosis because of placental transfer of TSH receptor antibodies. Treatment is methimazole and beta-blockers.

35
Q

What is the most effective emergency contraceptive?

A

The copper IUD. It can be placed up to 5 days following unprotected intercourse.

36
Q

Is IUGR due to uterplacental insufficiency or malnutrition symmetric or asymmetric?

A

It is asymmetric with a “head-sparing” growth lag. Symmetric IUGR is seen with chromosomal abnormalities or congenital infection.

37
Q

What percentile defines IUGR?

A

<10th percentile. Above that is normal.

38
Q

What are the fetal risks of post-term delivery?

A

Macrosomia, oligohydramnios, dysmaturity syndrome (initially put increased risk of pre-eclampsia but there is none).

39
Q

What is the appearance of a mature cystic teratoma on ultrasound?

A

A partially calcified mass (teeth) with multiple thin echogenic bands (hair).

40
Q

Which IUD is best for patients with anemia and/or heavy vaginal bleeding?

A

The levonorgestrel IUD (the copper IUD can cause bleeding and is not recommended in such patients).

41
Q

What is a fixed, immobile uterus in the setting of dysmenorrhea and infertility suggestive of?

A

Endometriosis. (initially put unicornuate uterus but while that can cause pregnancy loss it would not affect fertility).

42
Q

What is the age range in women for which the HPV vaccine is indicated?

A

11-26 years of age.

43
Q

What is an empty gestational sac, no vaginal bleeding, and a closed cervical os indicative of?

A

A missed abortion.

44
Q

What vitamin deficiency can occur due to hyperemesis gravidarum?

A

Thiamine. Be aware of Wernicke’s encephalopathy in first/second trimester pregnant women (altered mental status, gait ataxia, nystagmus).

45
Q

What physical features can fetal growth restriction present with?

A

Thin/loose skin, a wide anterior fontanelle, and a thin umbilical cord. Best next step is to send placenta for histopathological evaluation to find reason for IUGR.

46
Q

What is green amniotic fluid suggestive of?

A

Meconium stained amniotic fluid.

47
Q

What is the best next step after FNA/drainage of a simple breast cyst? (tender mobile cyst with no discerning features on US and yields clear fluid)

A

Follow-up breast exam in 2 months to monitor for re-occurrence.

48
Q

What dislocation can muscle spasms during tonic-clonic seizures (such as in eclampsia) commonly cause?

A

A posterior shoulder dislocation (arm held internally rotated and adducted with loss of external rotation).

49
Q

What is the best next step for cord compression (variable decelerations)?

A

Maternal re-positioning (left lateral) to prevent uteroplacental insufficiency, followed by amnioinfusion if unsuccessful.

50
Q

What is recommended following suction and curettage for a hydatidiform mole?

A

Contraception for 6 months (to ensure that a pregnancy won’t interfere with beta-hCG monitoring for choriocarcinoma).

51
Q

What is the first step in evaluating risk of preterm labor?

A

Transvaginal ultrasound for cervical length.

52
Q

When is fetal fibronectin (FFN) not appropriate for preterm delivery risk assessment?

A

Before 20 weeks (FFN levels are normally high during this period).

53
Q

What is the next best step after visualization of a short cervix in the 2nd trimester (i.e. preterm delivery risk)?

A

Exogenous progesterone to maintain uterine quiescence.

54
Q

What are the first and second line treatments for management of infertility in PCOS?

A

First line is weight loss (decreased peripheral conversion of estrogen) followed by clomiphene citrate if unsuccessful (induce ovulation via hypothalamus estrogen antagonism).

55
Q

What is the next best step if a HSIL is found on pap smear in a pregnant patient?

A

A colposcopy, with cervical conization performed only if colposcopy shows an invasive lesion (normally go straight to conization after pap smear but this is avoided in pregnant patients due to risk of preterm delivery).

56
Q

What urinary symptoms can be seen with atrophic vaginitis/genitourinary syndrome of menopause?

A

Dysuria, urge incontinence, and recurrent UTIs.

57
Q

What IUD should be used in a patient with breast cancer?

A

The copper IUD. All hormonal contraceptives (including a progesterone IUD) are absolutely contraindicated in breast cancer.

58
Q

What should be administered to a preterm patient at 28 weeks who has received indomethacin?

A

Magnesium sulfate, bethamethasone (indomethacin is a tocolytic so another like nifedipine is not indicated).

59
Q

In addition to steroids and tocolytics, what should be given to a preterm labor <32 weeks?

A

Magnesium sulfate to decrease risk of cerebral palsy. If 32-33 weeks give just tocolytics and steroids, and if >34 weeks just steroids (no tocolytics after 34 weeks). In all of these give penicillin if GBS +.

60
Q

What fetal finding is pathognomonic of uterine rupture?

A

Retraction of presenting fetal part/loss of fetal station (ex: if fetal station was 0 an hour ago but is now -3).

61
Q

Is metronidazole safe for pregnancy?

A

Yes, so a patient with bacterial vaginosis is treated the same regardless of pregnancy status.

62
Q

What is the next best step in the management of a pregnant patient who tests positive for syphilis but has a penicillin allergy?

A

Skin testing and penicillin desensitization (penicillin is the only effective antibiotic for syphilis in pregnancy so you must find a way to use it).

63
Q

What should be assessed in a woman with recurrent vulvuvaginal candidiasis?

A

HbA1c to check for diabetes melitus.

64
Q

In addition to abdominal pain what kind of pain can placental abruption present with?

A

Back pain (suspect placental abruption in a third trimester patient with new-onset back pain, vaginal bleeding, and a history of HTN even if it is controlled).

65
Q

What is required for the diagnostic workup of an ectopic pregnancy?

A

Pregnancy test and a transvaginal ultrasound.

66
Q

What is a potential cause of post-partum hemorrhage is a patient who underwent an operative vaginal deliver (forceps assisted, ect)?

A

Genital tract laceration (perform a genital tract inspection).

67
Q

Is weight gain an adverse effect of OCPs?

A

No, weight gain is not associated with OCP use.

Uworld Step 2 (6 decks)

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