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OB/GYN: Case Files Flashcards

1
Q

Diagnose and treat: A 39 year-old woman wets her underpants two to three times each day. She feels as though she needs to void, but cannot make it to the restroom in time.

A

Urge incontinence, best treated with anticholinergic medications (I.E. Oxybutynin)

Caused by an overactive detrusor muscle

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1
Q

Surgery is indicated in a prepubertal patient with an ovarian mass greater than what size?

A

2 cm

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1
Q

What factors increase the risk of preterm premature rupture of membranes (PPROM)?

A
  1. Lower socioeconomic status
  2. Sexually transmitted diseases
  3. Cigarette smoking
  4. Cervical conization
  5. Emergency cerclage
  6. Multiple gestations
  7. Hydramnios
  8. Placental abruption
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2
Q

What is the treatment for Chlamydia trachomatis infection?

A

Doxycycline or azithromycin

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2
Q

What is the most common cause of posmenopausal bleeding?

A

Atrophic endometrium

Friable tissue of the endometrium or vagina due to low estrogen levels

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2
Q

What percent of all cases of female infertility is due to ovulatory disorders?

A

30-40%

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2
Q

An elevated A2 hemoglobin is suggestive of what?

A

Beta-thalassemia disorder

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2
Q

What is the treatment for superficial wound separation?

A

Opening the wound and using wet-to-dry dressing changes

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3
Q

At what age is a mammogram indicated in women?

A

>50

Some experts recommend starting at age 40

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3
Q

What causes variable decelerations?

A

Cord compression

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3
Q

How is the diagnosis of acute salpingitis made?

A

Its a clinical diagnosis based on abdominal tenderness, cervical motion tenderness, and adnexal tenderness

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3
Q

What breast condition is characterized by multiple, irregular, “lumpiness of the breast”?

A

Fibrocystic change

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3
Q

What is the first sign of hypovolemia?

A

Oliguria (decreased urine output)

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3
Q

What is the best treatment of cracked nipples?

A

Air-drying and the avoidance of harsh soaps

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4
Q

What is the treatment for Neisseria Gonorrhoea infection?

A

IM Ceftriaxone

Concurrent treatment for Chlamydia infection (Doxycycline or Azithromycin) is usually administered

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5
Q

What kind of twin pregnancy would result from division 8 days after fertilization?

A

monochorionic/monoamniotic

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6
Q

Which two strains of HPV are most commonly responsible for cervical dysplasia and cancer?

A

HPV 16 and 18

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7
Q

What is the most common cause of cystitis in a woman?

A

E. coli

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8
Q

What are generally the first two methods used to relieve shoulder distocia during labor?

A
  1. McRoberts maneuver
  2. Suprapubic pressure

Other maneuvers that can be used:

  1. Wood’s Corkscrew maneuver
  2. Delivery of the posterior arm
  3. Zavanelli maneuver
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8
Q

Asymptomatic bacteriuria leads to acute infection in up to what percent of untreated pregnant women?

A

25%

Asymptomatic bacteriuria occurs when the urine culture grows >100,000CFU per ml of a single organism in an asymptomatic patient. Pregnant women should always be treated to prevent progression to pyelonephritis in the pregnant patient.

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8
Q

What is the best treatment for syphilis in pregnancy?

A

Penicillin

Pregnant women with syphilis and an allergy to penicillin should undergo penicillin desensitization and then receive penicillin

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8
Q

Precocious puberty with an adnexal mass but without virilization is usually due to what?

A

Granulosa cell tumor

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8
Q

Targeted sonography can detect what percent of neural tube defects?

A

95%

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9
Q

What is the normal range for fetal heart rate baseline?

A

110-160 bpm

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9
Q

An elevated F hemoglobin is suggestive of what?

A

Alpha-thalassemia

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10
Q

What is the best treatment for postpartum mastitis?

A

An oral antistaphylococcal antibiotic, such as dicloxacillin, and continued breast-feeding/pumping

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11
Q

The most common location of an osteoporosis-related fracture is?

A

A compression fracture of the thoracic spine

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11
Q

Define arrest of active phase

A

No progress in the active phase of labor for 2 hours

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11
Q

What is the primary treatment for polycystic ovarian syndrome?

A

Combined oral contraceptives

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13
Q

What is the mostly likely cause of a hCG level that is above threshold but no intrauterine pregnancy is seen on transvaginal ultrasound?

A

Ectopic pregnancy

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14
Q

What is the classical triad of pelvic inflammatory disease?

A
  1. Lower abdominal tenderness
  2. Cervical motion tenderness
  3. Adnexal tenderness
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15
Q

What is the normal length of the second stage of labor for a multiparous woman?

A

_<_1 hours

_<_2 hours if epidural given

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16
Q

What are the risk factors for ectopic pregnancy?

A
  1. Salpingitis (particularly with Chlamydia trachomatis)
  2. Tubal adhesive disease
  3. Infertility
  4. Progesterone-secreting IUD
  5. Tubal surgery
  6. Prior ectopic pregnancy
  7. Ovulation induction
  8. Congenital abnormalities of the tube
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17
Q

At what age is cholesterol screening indicated in women?

A

>45

Every 5 years

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17
Q

What is the most common cause of maternal mortality?

A

Embolism (thrombotic or amniotic fluid)

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17
Q

What is the most common cause of fever after cesarean delivery?

A

Endomyometritis

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18
Q

How long after the LH surge does ovulation typically occur?

A

36 hours

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18
Q

What should be suspected in a patient with symptoms of UTI but a negative urine culture?

A

Urethritis

Commonly caused by Chlamydia or N. gonorrhea

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18
Q

What pathology may be seen in a neonate or child of a mother with hypothyroidism during pregnancy?

A

Neurodevelopmental delays

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19
Q

What are the common tocolytic agents?

A
  1. Terbutaline/Ritodrine: Beta-agonists
  2. Nifedipine: Calcium channel blocker
  3. Indomethacin: NSAID
  4. 17-alpha-hydroxyprogesterone caproate: Synthetic progesterone
  5. Magnesium sulfate: Mineral
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19
Q

What are the most common locations for DVT after gynecologic surgery?

A

The lower extremities and the pelvic veins

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19
Q

What kind of twin pregnancy would result from division more than 8 days after fertilization?

A

Conjoined twins

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20
Q

By the time hypotension at rest is noted in a young, healthy patient, what percentage of the patient’s blood volume is lost?

A

30-40%

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21
Q

Dyspnea occurring in a woman with preterm labor and tocolysis is usually due to what?

A

Pulmonary edema

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21
Q

Delayed puberty is defined as no development of secondary sexual characteristics by what age?

A

14 years old

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22
Q

Early in the course of a normal intrauterine pregnancy , the beta-hCG should rise by at least how much in a 48 hour period?

A

_>_66%

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22
Q

What should be the first thing one evaluates in a woman with oligomenorrhea and galactorrhea?

A

Pregnancy test

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23
Q

What is the most common cause of secondary amenorrhea after uterine curettage?

A

Intrauterine adhesions

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24
Q

What is the most common cause of conjunctivitis in the first month of life?

A

Chlamydial conjunctivitis

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25
Q

What is the definition of postpartum hemorrhage?

A

Bleeding >500mL for a vaginal delivery

or

Bleeding >1000 mL for a c-section delivery

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25
Q

the contraceptive patch is associated with an increased risk of what serious side effect?

A

DVT

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25
Q

What should be considered as the cause of dyspnea in a patient being treated for pyelonephritis?

A

Acute respiratory distress syndrome (ARDS)

Endotoxin release from gram-negative bacteria is the cause of ARDS

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25
Q

What is one of the earliest manifestations of fetal hydrops?

A

Hydramnios

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26
Q

Diagnose and treat: A 35 year old woman has undergone four vaginal deliveries. She notes urinary loss six to seven times a day concurrently with coughing or sneezing. She denies dysuria or an urge to void. Her urine culture is negative.

A

Genuine stress urinary incontinence, best treated with urethroplexy (Burch procedure) or urethral sling.

Cytometric or urodynamic evaluation helps differentiate between urge and genuine stress incontinence.

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27
Q

Hyperandrogenism in the presence of an adnexal mass usually indicates what?

A

Sertoli-Leydig cell tumor of the ovary

This is usually treated surgically

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29
Q

What is the most common cause of septic shock in pregnancy?

A

Pyelonephritis

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30
Q

What are the risk factors for uterine atony?

A
  1. Magnesium sulfate
  2. Oxytocin use during labor
  3. Rapid labor and/or delivery
  4. Overdistension of the uterus (macrosomia, multifetal pregnancy, hydraminos)
  5. Intra-amniotic infection (Chorioamnionitis)
  6. Prolonged labor
  7. High parity
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30
Q

What is the most common cause of late postpartum hemorrhage (after the first 24 hours)

A

Subinvolution of the uterus

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30
Q

What is the most common cause of sexually infantile primary amenorrhea?

A

Gonadal dysgenesis

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31
Q

What is considered an adequate uterine contraction during labor?

A

200 montevideo units measured with an internal uterine pressure catheter

or

Contractions every 2-3 minutes, firm on palpation, and lasting at least 40-60 seconds

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31
Q

Oral contraceptives reduce the risk of which cancers?

A

Ovarian and endometrial cancers

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32
Q

What is a contraindication for prostaglandin F2-alpha given to treat postpartum hemorrhage?

A

Asthma

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33
Q

What is the treatment for Sheehan syndrome?

A

Replacement of anterior pituitary hormones

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35
Q

What is the most common reason for hysterectomy?

A

Symptomatic uterine fibroids

The most common symptom of uterine fibroids is menorrhagia

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36
Q

What is the diagnostic test of choice in assessing placenta previa?

A

Ultrasound

Should be performed before digital or speculum examination

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36
Q

Pelvic inflammatory disease (PID) is a clinical diagnosis but what is the gold standard method of confirming the clinical diagnosis?

A

Laparoscopy

It visualizes purulent drainage from the fallopian tubes

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37
Q

What is a concern when copious amounts of sero-sanguinous fluid are draining from an abdominal incision?

A

Fascial disruption

A surgical site incision with fascial disruption or evisceration should be immediately repaired

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37
Q

Elevated maternal serum alpha-fetoprotein (MSaFP) is most commonly indicative of what?

A

Neural tube defect

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38
Q

What should not be used once shoulder dystocia is encountered during labor?

A

Fundal pressure

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38
Q

What is the most common cause of ambiguous genitalia in the newborn?

A

Congenital adrenal hyperplasia

This is usually due to 21-hydroxylase enzyme deficiency

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40
Q

What is the imaging test of choice to assess a postoperative patient with a suspected ureteral injury?

A

Intravenous pyelogram (IVP)

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40
Q

What are the treatments for thyroid storm during pregnancy?

A
  1. PTU
  2. Steroids
  3. Beta-blockers
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41
Q

What does thyroid releasing hormone (TRH) stimulate other than TSH?

A

Prolactin

Primary hypothyroidism can cause hyperprolactinemia and galactorrhea

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42
Q

Surgery is indicated in a postmenopausal patient with an ovarian mass greater than what size?

A

4-5 cm

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43
Q

What is the most common cause of neonatal morbiditiy in a preterm infant?

A

Respiratory distress syndrome

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44
Q

What should be suspected in a patient with dyspnea, a clear chest radiograph, and hypoxemia?

A

Pulmonary embolism

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44
Q

What is the next step in analyzing a palpable dominant breast mass in the setting of a negative mammogram?

A

Histologic diagnosis (biopsy)

All palpable dominant breast masses must be analyzed regardless of mammographic findings

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45
Q

What is the most common cause of amenorrhea in the reproductive years?

A

Pregnancy

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46
Q

What is a contraindication for ergot alkaloids given to treat postpartum hemorrhage?

A

Hypertension

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47
Q

What is the percent chance that a normal couple will achieve pregnancy in one menstrual cycle?

A

20-25%

This probability is the definition of fecundability

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48
Q

Postpartum thyroiditis can lead to what?

A

Hypothyroidism

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49
Q

During pregnancy, progesterone is largely produced by the corpus luteum until when?

A

10 weeks gestation

When a corpus luteum is excised in a pregnancy of less than 10-12 weeks gestation, progesterone should be supplemented

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50
Q

What is the next step if the triple screen is abnormal?

A

Basic ultrasound

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52
Q

What is the most common cause of anemia in pregnancy?

A

Iron deficiency

The two most common causes of microcytic anemia are iron deficiency and thalassemia

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53
Q

What are the 3 priorities of treating preterm labor?

A
  1. Identify cause
  2. Give steroids (if gestation is between 24 and 34 weeks)
  3. Tocolysis
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54
Q

How is endometrial cancer staged?

A

Surgically

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55
Q

What is the most sensitive imaging test to assess pituitary adenomas?

A

MRI

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56
Q

Placenta previa in the face of prior c-section deliveries increases the risk of what?

A

Placenta accreta

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56
Q

What form of contraception can improve bleeding profiles in patients with dysfunctional uterine bleeding and menorrhagia?

A

Levonorgestrel-releasing IUD (Mirena)

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57
Q

By what amount does the body temperature increase after ovulation?

A

0.5 degrees fahrenheit

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59
Q

What is the etiology of Sheehan syndrome?

A

Anterior pituitary hemorrhagic necrosis caused by hypertrophy of the prolactin-secreting cells in conjunction with a hypotensive episode, usually in the setting of postpartum hemorrhage

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61
Q

What should be in the initial evaluation of secondary amenorrhea?

A
  1. Pregnancy test
  2. Prolactin levels
  3. TSH levels
  4. Gonadotropin levels
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62
Q

Where do the majority of cervical dysplasias and cancers arise?

A

Near the squamocolumnar junction of the cervix

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62
Q

What is a common sign of ovarian malignancy?

A

Ascites

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64
Q

What is the most common cause of megaloblastic anemia in pregnancy?

A

Folate deficiency

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65
Q

Preterm premature rupture of membranes (PPROM) is usually managed expectantly until what gestational age?

A

32 weeks

At 34-35 weeks gestation, induction of labor is the usual management.. Clinical infection is a contraindication to corticosteroid use

67
Q

In Erb Duchenne palsy, the which muslces are weakened?

A
  1. Deltoid
  2. Infraspinatus
  3. Flexor muscles of the forearm

Brachial plexus injury involving C5 and C6

69
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony

70
Q

What are the risk factors for cervical cancer?

A
  1. Early age of coitus
  2. Sexually transmitted diseases
  3. Early childbearing
  4. Low socioeconomic status
  5. Human papillomavirus
  6. HIV infection
  7. Cigarette smoking
  8. Multiple sexual partners
71
Q

A superficial wound separation usually occurs due to what?

A

Infection or hematoma

72
Q

What is the normal length of the second stage of labor for a nulliparous woman?

A

_<_2 hours

_<_3 hours if epidural given

74
Q

What chromosome is the BRCA1 gene located on?

A

Chromosome 17

76
Q

What is the underlying pathophysiology of preeclampsia?

A

Vasospasm and leaky vessels

77
Q

Surgery is indicated in a reproductive age patient with an ovarian mass greater than what size?

A

8 cm

  • Size between 5 and 8 cm require a sonogram to look for septations, solid components/excrescences. Operate if present.*
  • Size < 5 cm can be observed*
79
Q

Define latent phase of labor

A

The initial part of labor during which the cervix mainly effaces (thins) rather than dilates.

Usually

81
Q

What is the most common subtype of epithelial ovarian tumor?

A

Serous subtype

More often bilateral

82
Q

What should be the first test for any patient with primary or secondary amenorrhea?

A

Pregnancy test

84
Q

What is Asherman Syndrome?

A

Scar tissue that forms in the endometrium, leading to amenorrhea caused by unresponsiveness of the endometrial tissue

84
Q

What subtype of epithelial ovarian tumor is large in size?

A

Mucinous subtype

May lead to pseudomyxoma peritonei if ruptured, which leads to repeated bouts of bowel obstruction

85
Q

What breast mass is characterized as firm, rubbery, mobile, and solid in consistency?

A

Fibroadenoma

Typically do not respond to ovarian hormones and do not vary during the menstrual cycle

86
Q

What increases the risk for placenta accreta?

A
  1. Prior uterine incision (C-section)
  2. Placenta previa
87
Q

What is the best treatment for suspected uterine rupture?

A

Immediate cesarean delivery

89
Q

What is the most common presenting symptom of pulmonary embolism?

A

Dyspnea

90
Q

What is the most likely diagnosis for an adolescent female with an asymptomatic, 1-cm, nontender, mobile breast mass?

A

Fibroadenoma

90
Q

Gross hematuria should raise suspicion for what?

A

Nephrolithiasis

91
Q

How many first-degree family members with breast cancer does it take to suggest a familial syndrome?

A

Two first-degree relatives

91
Q

The presence of fluctuance in a red, tender, indurated breast suggests what?

A

Abscess

This requires surgical drainage

92
Q

What is the most common cause of hemoperitoneum in early pregnancy?

A

Ectopic pregnancy

94
Q

What is the most common time period in which fascial disruption or evisceration occurs postoperatively?

A

5-14 days post-op

96
Q

The lesions of Pruritic urticarial papules and plaques of pregnancy (PUPPP) usually begin where and spread to where?

A

They begin on the abdomen and spread to the thighs and sometimes the buttocks and arms

96
Q

Emergency contraception is most effective within what window of time?

A

72 hours from intercourse

97
Q

Which two strains of HPV are most commonly responsible for condylomata acuminata (venereal warts)?

A

HPV 6 and 11

98
Q

What antibodies are associated with postpartum thyroiditis?

A

Antimicrosomal antibodies

99
Q

What kind of twin pregnancy would result from division between 4 and 8 days after fertilization?

A

Monochorionic/diamniotic

101
Q

What are the diagnostic criteria for mild and severe preeclampsia?

A

Mild: Two BP measurements _>_140 systolic or _>_90 diastolic at 6 hr intervals and proteinuria _>_300mg in a 24hr period (1+ or 2+ on urine dipstick is consistent with the mild disease)

Severe: Two BP measurements _>_160 systolic or _>_110 diastolic at 6 hr intervals and proteinuria _>_5g in a 24hr period (3+ or 4+ on urine dipstick is consistent with the severe disease)

101
Q

What is the most common ovarian tumor in a woman younger than 30 years old

A

Benign cystic teratoma (dermoid cyst)

102
Q

What kind of twin pregnancy would result from division within the first 72 hours of fertilization?

A

Dichorionic/diamniotic

103
Q

What is the best treatment for advanced cervical cancer?

A

Radiotherapy with a chemotherapeutic radiosensitizer

103
Q

An intrauterine gestational sac is usually seen on transvaginal ultrasound when the hCG level equals or exceeds what level?

A

1500-2000 mIU/mL

If hCG level is this high but no gestational sac is seen, the patient has a high likelihood of having an ectopic pregnancy

105
Q

What are the causes of low maternal serum alpha-fetoprotein (MSaFP)?

A
  1. Overestimation of gestational age
  2. Chromosomal trisomies
  3. Molar pregnancy
  4. Fetal death
  5. Increased maternal weight
106
Q

What are the risk factors for preterm labor?

A
  1. Preterm premature rupture of membranes
  2. Multiple gestations
  3. Previous preterm labor or birth
  4. Hydramnios
  5. Uterine anomaly
  6. History of cervical cone biopsy
  7. Cocaine abuse
  8. African American race
  9. Abdominal trauma
  10. Pyelonephritis
  11. Abdominal surgery in pregnancy
108
Q

What is the accepted treatment for septic pelvic thrombophlebitis?

A

Antibiotic therapy and heparin

109
Q

The rapid onset of hirsutism or virilization usually indicates the presence of what?

A

An androgen-secreting tumor

110
Q

What is the most common cause of unilateral serosanguineous nipple discharge from a single duct?

A

Intraductal papilloma

111
Q

Meticulous ureteral dissection can cause what?

A

Devascularization injury to the ureter

The vascular channels run along the adventitia of the ureter

113
Q

At what age is colon cancer screening indicated in women?

A

>50

  • Colonoscopy q10yrs*
  • or*
  • Barium enema with flexible sigmoidoscopy q5yrs*
114
Q

What medications may trigger anemia in a patient with G-6-P dehydrogenase deficiency?

A
  1. Sulfonamides
  2. Nitrofurantoin
  3. Antimalarial agents
116
Q

What chromosome is the BRCA2 gene located on?

A

Chromosome 13

118
Q

What is the most common cause of mucopurulent cervical discharge?

A

Chlamydial infection

Gonorrheal infection is the second most common cause of mucopurulent cervical discharge

119
Q

Painless anterpartum vaginal bleeding suggests the diagnosis of what?

A

Placenta previa

120
Q

What is the most common cause of postpartum hemorrhage with a firm well-contracted uterus?

A

Genital tract laceration

122
Q

What is the most common benign breast mass in the premenopausal woman?

A

Fibrocystic change of the breast

It is caused by an exaggerated response to ovarian hormones

124
Q

What is the most common cause of a dominant breast mass in woman in her teens or 20s?

A

Fibroadenoma

125
Q

What are the normal arterial blood gas values in a pregnant woman (pH, PO2, PCO2,HCO3)?

A
  1. pH: 7.45 (Non pregnant: 7.40)
  2. PO2: 95-105 (Non pregnant: 90-100)
  3. PCO2: 28 (Non pregnant: 40)
  4. HCO3: 19 (Non pregnant: 24)
126
Q

At what age is the varicella zoster vaccine indicated in women?

A

Age 60

127
Q

What causes late decelerations?

A

Uteroplacental insufficiency (hypoxia)

129
Q

At what age is a fasting blood sugar level indicated in women?

A

>45

Every 3 years

130
Q

What is the difference in hormone levels between Sheehan and Asherman syndromes?

A

Sheehan syndrome has low levels of T4, TSH, FSH, Estradiol, Cortisol, Prolactin, and has no LH surge

vs

Asherman syndrome is characteristic of amenorrhea in the setting of normal hormone levels

132
Q

What are the risk factors for placental abruption?

A
  1. Hypertension (Chronic HTN and preeclampsia)
  2. Cocaine use
  3. Short umbilical cord
  4. Trauma
  5. Uteroplacental insufficiency
  6. Submucosal fibroid
  7. Sudden uterine decompression (too much amniotic fluid)
  8. Cigarette smoking
  9. Preterm premature rupture of membranes

*Major risk factors

133
Q

Bacterial vaginosis is associated with what complications of pregnancy?

A
  1. Preterm delivery
  2. Postpartum endometritis
  3. Pelvic inflammatory disease
134
Q

What is the most common cause of postpartum hemorrhage?

A

Uterine atony

135
Q

What is the most common cause of ovulatory dysfunction in a reproductive-aged woman?

A

Polycystic ovarian syndrome (PCOS)

136
Q

At what age is a bone mineral density study indicated in women?

A

>65

138
Q

What is usually the best therapy for a patient with an early pregnancy who is hypotensive or has severe adnexal pain?

A

Surgery

These signs/symptoms are suggestive of a ruptured ectopic pregnancy

139
Q

What are the causes of hydramnios?

A
  1. Fetal central nervous system anomalies
  2. Fetal gastrointestinal tract malformations
  3. Fetal chromosomal abnormalities
  4. Fetal nonimmune hydrops
  5. Maternal diabetes
  6. Isoimmunization
  7. Multiple gestations
  8. Syphilis
141
Q

At what age is the annual influenza vaccine most important in women?

A

>50

142
Q

Patients with polycystic ovarian syndrome whould be screened for what?

A

Glucose intolerance and lipid abnormalities

143
Q

How is the diagnosis of molar pregnancy made?

A

Sonography

144
Q

What is the most likely diagnosis for a patient that presents with cyclic, painful, engorged breasts, more pronounced just before menstruation, and occaisionally associated with serous or green breast discharge?

A

Fibrocystic change

145
Q

What should be suspected if clinical improvement for pyelonephritis has not occurred after 48-72 hours of appropriate antibiotic therapy?

A

Urinary tract obstruction or a perinephric abscess

146
Q

Where are testosterone and DHEAS secreted in women?

A
  1. Testosterone: Ovary
  2. DHEAS: Adrenal gland
148
Q

What is it called when a pregnancy is less than 20 weeks gestation and associated with cramping, bleeding, and cervical dilation, but no passage of tissue?

A

Inevitable abortion

149
Q

What is the best treatment of a dermoid cyst in a young woman?

A

Ovarian cystectomy

150
Q

What is the most common cause of a first-trimester miscarriage?

A

Fetal karyotypic abnormality

151
Q

What color fluid on aspiration of a breast cyst is considered benign and can be observed?

A

Straw-colored fluid in a mass that disappears after aspiration

152
Q

What is the most frequent and serious complication of a benign ovarian cyst?

A

Ovarian torsion

153
Q

What are the best treatments for chlamydial cervicitis in pregnancy?

A
  1. Erythromycin
  2. Azithromycin
  3. Amoxicillin
155
Q

When does postpartum thyroiditis usually occur?

A

1-4 months postpartum

156
Q

Define active phase of labor

A

The portion of labor where dilation occurs more rapidly

Usually when the cervix is >4cm dilated

158
Q

What is the most likely diagnosis in a woman in her 20s who complains of breast pain, which increases with menses, and who has a lumpy-bumpy consistency to her breast?

A

Fibrocystic change

159
Q

A sinusoidal fetal heart-rate pattern is associated with what?

A

Severe fetal anemia or asphyxia

160
Q

What are the risk factors for placenta previa?

A
  1. Grand multiparity (_>_5 pregnancies)
  2. Prior C-section
  3. Prior uterine curettage
  4. Previous placenta previa
  5. Multiple gestation
161
Q

Amenorrhea, vaginal spotting and abdominal pain make up the classic triad of what?

A

Ectopic pregnancy

162
Q

What is the best route of delivery for placenta previa?

A

C-section

163
Q

What pathogen is “strawberry cervix” associated with?

A

Trichomonas

165
Q

What is it called when a pregnancy is less than 20 weeks and associated with vaginal bleeding, generally without cervical dilation?

A

Threatened abortion

166
Q

What causes early decelerations?

A

Fetal head compression

167
Q

What would be suspected in a pregnancy characterized by vaginal spotting, absence of fetal heart tones, and a size greater than dates?

A

Molar pregnancy

168
Q

What is the initial test for intrauterine shape and tubal patency?

A

Hysterosalpingogram

It should be performed between days 6 and 10 of the cycle

169
Q

What is the gold standard in diagnosing endometriosis?

A

Laparoscopy

171
Q

What can mimic an ectopic pregnancy?

A

Ruptured corpus luteum

172
Q

Parvovirus infection in pregnancy can cause fetal anemia leading to what?

A

Hydrops fetalis

173
Q

What percent of neonatal herpes infections occur in utero?

A

5-10%

174
Q

Nulliparity and IUD use are risk factors for what?

A

Pelvic inflammatory disease (PID)

OCP is protective against PID by virtue of the progestin thickening the cervical mucus and thinning the endometrium.

175
Q

What characteristics are shared by bacterial vaginosis and trichomoniasis but not candidal vaginitis?

A
  1. Alkaline pH
  2. Positive whiff test
176
Q

What signs/symptoms suggest advanced cervical cancer?

A

Flank tenderness or leg swelling

177
Q

What is the most common cause of generalized pruritus in pregnancy in the absence of skin lesions?

A

Cholestasis of pregnancy

178
Q

What is the most common bacterial etiology of septic abortion?

A

Polymicrobial with normal flora from the vaginal tract

179
Q

What is a common skin condition of unknown etiology unique to pregnancy characterized by intense pruritus and erythematous papules on the abdomen and extremities?

A

Pruritic urticarial papules and plaques of pregnancy (PUPPP)

180
Q

Painful anterpartum bleeding should make one suspicious of what?

A

Placental abruption

181
Q

Transvaginal ultrasound indicating a shortened cervix especially with funneling and/or breaking is suggestive of what?

A

Preterm delivery

182
Q

What is the name for a preinvasive lesion of the cervix with abnormal cellular maturation, nuclear enlargement, and atypia?

A

Cervical intraepithelial neoplasia (CIN)

  • CIN 1: Mild dysplasia, or abnormal cell growth. It is confined to the basal 1/3 of the epithelium. Corresponding cytology: Low grade squamous intraepithelial lesion (LSIL)*
  • CIN 2: Moderate dysplasia confined to the basal 2/3 of the epithelium. Corresponding cytology: High grade squamous intraepithelial lesion (HSIL)*
  • CIN 3: Severe dysplasia that spans more than 2/3 of the epithelium, and may involve the full thickness. This lesion may sometimes also be referred to as cervical carcinoma in situ. Corresponding cytology: High grade squamous intraepithelial lesion (HSIL)*
183
Q

What are the normal arterial blood gas values in a nonpregnant woman (pH, PO2, PCO2,HCO3)?

A
  1. pH: 7.4
  2. PO2: 90-100
  3. PCO2: 40
  4. HCO3: 24

A pulse oximetry reading of less than 90% corresponds to an oxygen tension of less than 60mmHg

184
Q

The most common ovarian tumors in women over the age of 30 years are of what origin?

A

Epithelial

185
Q

What thickness of the endometrial stripe assessed via transvaginal ultrasound is considered abnormal in a postmenopausal woman?

A

>5mm

187
Q

What is the most common cause of postpartum hemorrhage in a patient with a firm uterus?

A

Genital tract laceration

188
Q

What are two risk factors for shoulder distocia?

A
  1. Gestational diabetes: Results in fetal macrosomia
  2. Obesity
  3. Multiparity
189
Q

What is the best treatment for intrauterine adhesions?

A

Hysteroscopic resection

191
Q

What is the most common finding with uterine rupture?

A

Fetal heart rate abnormality

193
Q

What are the treatments for fibrocystic change of the breast?

A
  1. Decrease caffeine intake
  2. NSAIDs
  3. Tight-fitting bra
  4. Oral contraceptives
  5. Oral progestin therapy
  6. Danazol (a weak antiestrogen and androgen compound) can be used in severe cases
  7. Mastectomy if severe enough
195
Q

What is the first sign of magnesium toxicity in the treatment of preeclampsia?

A

Loss of deep tendon reflexes

196
Q

What is the most likely diagnosis in a woman in her 30s who complains of unilateral serosanguineous nipple discharge from the breast, expressed from one duct, but with no palpable mass?

A

Intraductal papilloma

198
Q

What is found in at least 1/3 of cases of placental abruption that is significant enough to cause fetal death?

A

Coagulopathy

199
Q

What are the steps that must be taken when fetal bradycardia occurs?

A
  1. Confirm fetal heart rate vs maternal heart rate
  2. Vaginal examination to assess for cord prolapse
  3. Positional changes
  4. Oxygen
  5. Intravenous fluid bolus
  6. Discontinue oxytocin
200
Q

What distinguishes ovarian failure from central nervous system dysfunction?

A

FSH levels

FSH is elevated in gonadal dysgenesis

201
Q

What is usually the earliest sign of chorioamnionitis (intramniotic infection)?

A

Fetal tachycardia

202
Q

What are the causes of elevated maternal serum alpha-fetoprotein (MSaFP)?

A
  1. Underestimation of gestational age
  2. Multiple gestations
  3. Neural tube defects
  4. Abdominal wall defects
  5. Cystic hygroma
  6. Fetal skin defects
  7. Sacrococcygeal teratoma
  8. Decreased maternal weight
  9. Oligohydramnios
203
Q

Which anatomical structure attaches the uterine cervix to the pelvic side walls through which the uterine arteries traverse?

A

Cardinal ligaments

204
Q

Placenta accreta is associated with a defect in what?

A

The decidua basalis layer of the uterus

206
Q

What are the signs/symptoms of acute salpingitis?

A
  1. Abdominal tenderness
  2. Cervical motion tenderness
  3. Adnexal tenderness
  4. Vaginal discharge
  5. Fever
  6. Pelvic mass on physical examination or ultrasound
208
Q

What are the quadruple screen findings of a down syndrome pregnancy?

A
  1. Elevated hCG
  2. Low maternal serum alpha-fetoprotein (MSaFP)
  3. Low unconjugated estriol
  4. Elevated inhibin A

Inhibin A is not included in the triple screen.

210
Q

What are some characteristics of polycystic ovarian syndrome (PCOS)?

A
  1. Obesity
  2. Anovulation
  3. Hirsutism
  4. Glucose intolerance
  5. Estrogen excess
211
Q

What is the most common cause of bloody (serosanguineous) nipple discharge when only one duct is involved and in the absence of a breast mass?

A

Intraductal papilloma

Typically small, benign tumors that grow in the milk ducts, that are most common between age 35-55

212
Q

What are the risk factors for endometrial cancer?

A
  1. Early menarche
  2. Late menopause
  3. Obesity
  4. Chronic anovulation
  5. Estrogen-secreting ovarian tumors
  6. Ingestion of unopposed estrogen
  7. Hypertension
  8. Diabetes Mellitus
  9. Personal or family history of breast or ovarian cancer

Unopposed estrogen is generally the biggest risk factor

213
Q

What is the most common female genital tract malignancy?

A

Endometrial carcinoma

214
Q

Manual extraction of the placenta should be attempted if the placenta does not deliver spontaneously after how long?

A

30 minutes

216
Q

What should be suspected when a patient develops flank tenderness and fever after hysterectomy or oophorectomy?

A

Ureteral injury

218
Q

What is the most important risk factor for breast cancer?

A

Increasing age

219
Q

What is the criteria for protraction of active phase?

A

Cervical dilation in the active phase that is less than

  1. Nulliparous: Normal is >1.2 cm/hr
  2. Parous: Normal is >1.5cm/hr
220
Q

Intrauterine adhesions are diagnosed by what?

A

Hysterosalpingogram

This is confirmed by hysteroscopy

221
Q

What are the 4 components of treating a septic abortion?

A
  1. Maintain adequate blood pressure
  2. Monitor: BP, O2 sats, urine output
  3. Give antibiotics
  4. Uterine evacuation
222
Q

Diagnose and treat: A 55 year-old woman notes constant wetness from her vagina following a total vaginal hysterectomy procedure, which she had undergone 2 months previously. She denies dysuria or urgency to void. The urinalysis is normal.

A

Vesicovaginal fistula (from surgery), best treated by surgical repair

Dye instillation into the bladder is the best method to diagnose the etiology of urinary incontinence

223
Q

An abnormal pregnancy is indicated by hCG levels plateauing within what time frame?

A

The first 8 weeks

hCG levels should be doubling every 2-3 days during the first 8 weeks.

224
Q

Diagnose and treat: A 42-year old woman with long-standing diabetes mellitus complains of small amounts of constant dribbling of urine loss with coughing or lifting.

A

Overflow incontinence, best treated with intermittent self-catheterization

Diabetes is a risk factor for overflow incontinence

225
Q

Name this maneuver: The maternal thighs are sharply flexed against the maternal abdomen to straighten the sacrum relative to the lumbar spine and rotate the symphysis pubis anteriorly toward the maternal head

A

McRoberts Maneuver

Used to relieve shoulder distocia during labor

226
Q

What is suspected with painless cervical dilation during pregnancy and what is the treatment?

A
  1. Incompetent cervix
  2. Best treated with cervical cerclage
227
Q

What is the most common cause of hirsutism and irregular menses?

A

Polycystic ovarian syndrome (POS)

228
Q

What are the main side effects of combination hormonal emergency contraception therapy?

A

Nausea/vomiting

229
Q

What is the most common organism responsible for postcesarean endomyometritis?

A

Bacteroides species

Anaerobic bacteria are most common of which bacteroides is #1

230
Q

Pregnancy or use of estrogen has what effect on various thyroid-related levels?

A
  1. Increased thyroid-binding globulin
  2. Increased total thyroxin
  3. Free T4 does not change
  4. TSH does not change
231
Q

What is the most common histological type of breast cancer?

A

Infiltrating intraductal carcinoma

232
Q

What are 3 long term sequelae of acute salpingitis?

A
  1. Chronic pelvic pain
  2. Ectopic pregnancy
  3. Involuntary infertility
233
Q

What is the most common karyotype associated with gonadal dysgenesis?

A

45,X

46,XX and 46,XY are possible

234
Q

What should be suspected as the cause of primary amenorrhea in a patient with:

  1. Normal breast development
  2. Absent axillary and pubic hair
  3. High testosterone
  4. 46 XY Karyotype
A

Androgen insensitivity

Such a patient would not have a uterus and would require a gonadectomy because the patient’s undescended testicles would be at increased risk for cancer

235
Q

Asymptomatic bacteriuria has a high incidence in women with what?

A

Sickle cell trait

236
Q

What should be suspected as the cause of primary amenorrhea in a patient with:

  1. Normal breast development
  2. Normal axillary and pubic hair
  3. Normal testosterone
  4. 46,XX Karyotype
A

Mullerian agenesis

Other findings in such a patient would include:

  1. Absent uterus and blind vagina
  2. Renal anomalies
237
Q

What antibiotic treatment should be used in pregnancies complicated by Preterm premature rupture of membranes (PPROM)?

A

Broad-spectrum antibiotics such as ampicillin and gentamicin

238
Q

What is the most common cause of abnormal triple screen?

A

Wrong dates

Step 2 (17 decks)

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