ob gyn

Question 1

breast hyperplasia is caused by decrease in _____ and/or increase in _____

Answer 1

dec progesterone

inc estrogen

Question 2

women >25 y/o with breast hyperplasia need what workup?

Answer 2

baseline mammography to rule out carcinoma

Question 3

woman has cyst in breast. you aspirate. fluid is bloody and/or there is still residual mass. what is next step?

Answer 3

must open biopsy

Question 4

woman < 30 years old with sharply circumscribed mobile nodule in breast. what is it most likely?

Answer 4

fibroadenoma. benign but have malignant potential

Question 5

50 yr old woman just starting to feel symptoms of menopause. complaining of bloody or serous nipple discharge. what is most likely dx and tx?

Answer 5

intraductal papilloma (benign)
dx: mammogram shows single dilated duct
tx is excisional biopsy of lesion and involved duct

Question 6

breast carcinoma extension to skin causes ______, to nipple causes _____, to skin lymphatics causes ______

Answer 6

skin - retraction and dimpling
nipple - nipple retraction
lymphatics - lymphedema + skin thickening = peau d’orange

Question 7

common acute complications of radiation to pelvic area (gyn onc) and their presenting symptoms (4)

Answer 7

acute cystitis - hematuria, urgency and frequency incontinence

proctosigmomiditis (IBD) - tenesmus, diarrhea, blood and mucus in stool

enteritis - nausea, v/d, colicky abdominal pain

bone marrow suppression

Question 8

chronic complications of radiation (occur 6+months after radiation) (3)

Answer 8

1. endarteritis
2. fibrosis
3. permanent reduction in epithelial and parenchymal cell populations
4. bowel stuff - strictures and fistulas and IBD

Question 9

what is MOA of tamoxifen

Answer 9

ER antagonist in breast
agonist in bone
partial agonist in endometrium

Question 10

giving estrogen contraindications

Answer 10

hypercoaguability (clotting disorders, immobile?)
chronic htn
breast cancer or hx of
migraines with aura or neurologic deficits
liver tumors

Question 11

colonoscopy start at ___, Q___
mammograms start at ___, Q___
pap smears start at ___, Q___
(Qs are if everything is normal)

Answer 11

colonoscopy start at 50, Q10yrs
mammograms start at 40 or 50, Q1yrs
pap smears start at 21, Q3yrs

Question 12

what gyn cancer presents as post coital bleeding in reproductive age

Answer 12

cervical cancer

Question 13

what gyn cancer presents as black vulvar lesions

Answer 13

vaginal melanoma (squamous cell carcinoma)

Question 14

what gyn cancer presents as red vulvar lesions

Answer 14

vaginal carcinoma - Paget’s

Question 15

what gyn cancer presents as ascities/pelvic mass/asymptomatic

Answer 15

ovarian cancer

Question 16

what gyn cancer presents as post menopausal bleeding

Answer 16

endometrial cancer (adenocarcinoma)

Question 17

what gyn cancer presents as increased B-hCG (nausea/vomiting, other) despite delivery or abortion

Answer 17

molar pregnancy/choriocarcinoma

Question 18

what is most common cause of elevated AFP

Answer 18

even tho its a screening test for genetic defects,
UNDERESTIMATION OF GESTATIONAL AGE is most common reason!
other causes include fetal demise, multiple gestation, ventral wall defect (omphalacele/gastrochesis), and liver tumor or dz

Question 19

what is associated w/ late decelerations on fetal heart tracing? early decels? variable decels?

Answer 19

early - head compression. (normal, from the contractions)
late - placental insufficiency
variable - umbilical cord compression (oligiohydramnois increases the risk of this but itself does not cause variable decels)

Question 20

Hgb and Hct cutoffs for maternal anemia 3rd trimester screening?

Answer 20

Hgb <10
Hct <30

btw next step is get iron studies. ferritin will be low, MCV low, RDW elevated

tx: iron

Question 21

initial steps to stabilize for if woman is bleeding out of her uterus and is hemodynamically stable (either PPH or just other gyn bleeding)

Answer 21

2 large bore IVs
intravenous fluid bolus
type and cross, transfuse as needed
To turn off uterine bleeding, IV estrogen is administered

Question 22

triple abx tx for chorioamnitis/endometritis

Answer 22

gent + amp + clinda

Question 23

management of intrahepatic cholestasis of pregnancy (3)

Answer 23

ursodeoxycholic acid (decrease bile acid levels)
frequent NST to moniter baby
deliver by 37 weeks

Question 24

med for pregnant woman with symptomatic MVP (palpitations, chest pain)

Answer 24

B blockers

Question 25

which SSRI is class D drug (not recommended)

Answer 25

paroxetine

Question 26

reversal agent for too much magnesium

Answer 26

calcium

Question 27

“safe” drug for bipolar pregnant patients

Answer 27

lamotrigine

Question 28

in testing for varicella and rubella, is it igG or igM that infers immunity?

Answer 28

igG = immunity
igM = infected.

if both positive, then that means they were recently infected but our now immune.

Question 29

what drug to give for fertility if patient is not ovulating (like in PCOS)

Answer 29

clomiphene