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Level 2 Boards > Ob/ Gyn/ Male > Flashcards

Ob/ Gyn/ Male Flashcards

1
Q

Gestational sac is visible on u/s

A

5 weeks

b-hCG 1000-1500

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2
Q

What increases in pregnancy

A

Renal flow

GFR

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3
Q

Weight gain guidelines

A

< 19.8: 12-18 kg
19.8-26: 11-16 kg
26- 29: 7-11 kg
> 29: 5-9 kg

<18.5: 28-40 lbs
18.5-24.9: 25-35 lbs
25-29: 15-25 lbs
> 29.0: 11-20 lbs

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4
Q

Quad screen

A

maternal sesrum Alpha fetoprotein
Inhibin A
Estriol
beta-hCG

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5
Q

Trisomy 18

A

Decreased MSAFP
Decreased Estriol
Decreased Inhibin A
Decreased beta-hCG

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6
Q

Trisomy 21

A

Decreased MSAFP
Decreased Estriol
Increased Inhibin A
Increased beta-hCG

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7
Q

TORCHeS

A 
Tocoplasmosis
Other
Rubella
CMV
Herpes simplex virus
HIV
Syphilis

Other: Parvo, varicella, Listeria, TB, marlaria, fungi

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8
Q

Hydrocephalus
Intracranial calcifications
Chorioretinitis
Ring-enhancing lesions on MRI

  • Name
  • Tx
  • Prophylaxis
A

Toxoplasmosis

Congenital infxn

Pyrimethamine + sulfadiazine

Spiramycin prophylaxis for third trimester

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9
Q 
Rash
Cataracts
Mental retardation
Hearing loss
PDA
A

Rubella

No tx

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10
Q

Petechial rash

Periventricular calcifications

A

CMV

Postpartum ganciclovir

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11
Q 
Maculopapular rash
Lymphadenopathy
Hepatomegaly
Snuffles
Osteitis
A

Syphilis

Penicillin

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12
Q

Abortion

A

Mifepristone + misoprostol
- 49 days

Methotrexate + misoprostol
- 49 days

Vaginal/ sublingual/ buccal misoprostol
- 59 days

Surgical options
- 13 weeks

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13
Q

Oxytocin side effects

A

Hyponatremia
Tachysystole
Hypotension

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14
Q

Decelerations

A

VEaL CHoP

Variable deceleration= Cord compression

Early deceleration= Head compression

Late deceleration= Placental insufficiency

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15
Q

Normal fetal HR

A

110-160 bpm

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16
Q

Reactive Nonstress test

A

Normal response

Two accelerations last at least 15 seconds over 20 minute period

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17
Q

Biophysical profile evaluates

A

Test the Baby, MAN

Fetal Tone
Fetal Breathing
Fetal Movement
Amniotic fluid volume
Nonstress test
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18
Q

Morning sickness lasting past first trimester

  • Name
  • Labs (2)
  • Tx
A

Hyperemesis gradivarum

Persistent vomiting
Acute starvation (large ketonuria)
WL

Increased beta-hCG
Increased estradiol

Evaluate for trophoblastic disease

Dietary changes
Doxylamine-pyridoxine

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19
Q

UA before 20 weeks reveals glycosuria

A

Pregestational diabetes

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20
Q

Gestational HTN

A

BP > 140 or > 90

Develops at > 20 weeks

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21
Q

SE pregestational DM (9)

A

Macrosomia or IUGR
Cardiac and renal defects
Neural tube defects

Hypocalcemia
Polycythemia
Hyperbilirubinemia
Hypoglycemia
Shoulder dystocia
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22
Q

Preeclampsia

A

HTN
Proteinuria
Edema

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23
Q

Hemolytic anemia
Elevated liver enzymes
Low platelets

A

HELLP syndrome

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24
Q

Prophylaxis for seizures with preclampsia

  • Risk of Tx
  • Fix for that
A

Continuous magneisum sulfate drip

Magnexium toxicity (loss of DTRs, respiratory paralysis, Coma)

Tx Magnesium toxicity: IV calcium gluconate

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25
Q

Tx Eclampsia

A

IV diazepam for seizures

Delivery

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26
Q

Tx Asymptomatic bacteriuria and UTI in pregnancy

A

3-7 days nitrofurantoin, cephalexin or amoxicillin-clavulanate

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27
Q

Tx Pyelonephritis in pregnancy

A

IV fluids

IV third generation cephalosporins

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28
Q

Vasa Previa

A

Velamentous umbilical cord insertion and/or bilobed placenta causing vessels to pass over the internal os

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29
Q

Polyhydramnios

Oligohydramnios

A

Polyhydramnios: >= 25

Oligohydramnos <5

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30
Q

Antibodies across placenta

A

IgG

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31
Q

Erythroblastosis fetalis

A

Rh negative mothers

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32
Q

Hydrops fetalis

A

When fetal hemoglobin < 7

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33
Q

First trimester uterine bleeding
Hyperemesis gravidarum
Preeclampsia < 24 weeks

  • Name
  • U/S appearance
  • Lab
  • Progress to
A

Gestational trophoblastic disease

Snowstorm on pelvic ultrasound

Increased beta-HCG > 100,000

Can progress to invasive hydatidiform moles or choriocarcinoma

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34
Q

Complete vs incomplete moles

A

Complete

  • Sperm fertilization of empty ovum
  • 46, XX
  • No fetal tissue

Incomplete

  • Normal ovum fertilized by two sperm
  • 69, XXY
  • Contains fetal tissue
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35
Q

What is elevated with multiple gestations

A

Beta-hCG
Human placental lactogen
MSAFP

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36
Q

Rupture of membranes

A

+ Nitrazine paper test

+ Fern test

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37
Q

What should be used with c-section

A

Sodium citrate given to mother to reduce gastric acidity and prevent acid aspiration syndrome

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38
Q

Third degree Episiotomy

A

Extension to anal sphincter

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39
Q

Fourth degree Episiomy

A

Extension to rectum

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40
Q

Fever > 38 C within 36 hrs of delivery
Uterine tenderness
Malodorous lochi

Tx

A

Postpartum Endometritis

Tx IV clindamycin and gentamicin

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41
Q

Post partum
Abdominal pain
Back pain
Fever that swings from normal to as high as 105

Unresponsive to antibiotics

A

Septic pelvic thrombophlebitis

Pelvic infection leads to infection of vein wall

Clot invaded by microorganisms

CT for pelvic abscess

Broad spectrum antibiotics and anticoagulation

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42
Q

Positive VDRL

A

High sensitivity
Low specificity

Confirm with FTA-ABS test

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43
Q

Positive VDRL

Two miscarriages
Low platelets
Prolonged PTT

  • Name
  • Tx
A

Antiphospholipid antibody syndrome

False positive VDRL

Started on low molecular weigth heparin (LMWH)

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44
Q

Cleft lip
Wide anterior fontanelle
Distal phalange hypoplasia
Microcephaly

  • Name
  • Cause (3)
  • Also seen (2)
A

Fetal hydantoin syndrome

Exposure to antiepileptic

  • Phenytoin
  • Carbamazepine
  • Valproate

Cardiac anomalies

  • pulmonary stenosis
  • aortic stenosis
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45
Q

Alcohol use while in utero (2)

A

Microcephaly
Mid facial hypoplasia

[No cleft lip]

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46
Q

Oligohydramnios
Pulmonary hypoplasia
Growth restirctions
Limb defects

  • What
  • Causes
A

ACE-I in utero

Fetal reanl failure

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47
Q

Gestational HTN need evaluation

A

BPP weekly starting at 32 weeks

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48
Q

Pruritus
Third trimester
Worse on hands
No rash

Increased total bile acids

  • Name
  • Tx
A

Intrahepatic cholestasis of pregnancy

Delivery at 37 weeks
Ursodeoxycholic acid
Antihistamines

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49
Q

Increased Alpha feto protein

A

Multiple gestation

Abdominal wall defects

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50
Q

Tx Intrauterine fetal demise

A

20-23 weeks
- Dilation & evacuation or vaginal delivery

>

  • 24 weeks
  • vaginal delivery
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51
Q

Ultrasound showed a thin endometrial stripe

A

Suggests an empty and normal uterine cavity

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52
Q

Tx Postpartum hemorrhage

A
  1. Bimanual uterine massage + oxytocin
  2. Uterotonics
    - Methylergonovine
    - carboprost
    - misoprostol
  3. Balloon tamponade
  4. Uterine artery embolization
  5. Hysterectomy
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53
Q

Infants who are small for gestational age are at risk for (7)

A 
Hypoxia
Perinatal asphyxia
Meconium aspiration
Hypothermia
Hypoglycemia
Hypocalcemia
Polycythemia
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54
Q

Discrepancy between uterine size and gestational age

Enlarged uterus with irregular contour

A

Leiomyomata uteri

- uterine fibroids

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55
Q

Evaluating risk of preterm labor

A

Transvaginal ultrasound

Measures cervical length

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56
Q

short cervix tx

A

Progesterone maintains uterine quiescence

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57
Q

Pregnant

Joint pain
Malar rash

FHR: 80 bpm

  • Name
  • Causes (3)
A

SLE

—> Fetal atrioventricular (AV) block

Ventricular HR: 50-80/min

Fetal bradycardia

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58
Q

Optimal fetal position

A

Occiput anterior

Baby head facing back/butt

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59
Q

Sharp groin pain in pregnancy

A

Round ligament pain

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60
Q

Bilateral kidney enlargement and bilateral dilation of the renal pelvises and proximal ureters

  • Name
  • MOA
A

Physiologic hydronephrosis of pregnancy

Kidney enlargement occurs because there is an increase in maternal blood volume that requires increased filtration

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61
Q

Intrauterine fetal demise

Multiple limb fractures

Hypoplastic thoracic cavity

  • Name
  • Inheritence
A

Type II osteogenesis imperfecta

AD

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62
Q 
Macrocephaly
Frontal bossing
Midface hypoplasia
Genu varum
Limb shortening
A

achrondroplasia

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63
Q

Inevitable abortion presents at

A

< 20 weeks

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64
Q

Placental abruption vs placenta previa

A

Placental abruption

  • Vaginal bleeding
  • Constant abdominal pain
  • Tender uterus
  • Fetal decelerations

Placenta previa

  • Vaginal bleeding
  • non tender uterus
  • normal fetal HR
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65
Q

Medication to avoid in delivery with myasthenia gravis (6)

A

Magnesium sulfate

Fluroquinolones

Opioids

Beta blockers

CCB

Statins

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66
Q

Sudden vaginal bleeding

Severe lower abdominal pain

Gestational diabetes

Smoker

Dilated cervix
3+ protein
158/96

Contractions every 2 minutes and last for 20 seconds

  • Name
  • Feature (2)
  • At risk for
A

Placental abruption

High frequency, low intensity contractions

Hypertonic tender uterus

RISK of: DIC

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67
Q

When to use tocolytics

- Examples (2)

A

Indomethacin
Nifedipine

< 34 weeks

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68
Q

Preeclampsia prevention

A

Low-dose aspirin at 12 weeks gestation

Daily until delivery

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69
Q

When to manual rotation breech baby

A

> = 37 weeks

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70
Q

Pain when ambulating

Sharp lower midline abdominal pain

Tenderness to palpation just below bladder

Nontender uterine fundus

  • Name
  • MOA
A

Pubic symphysis diastasis

Levels of progesterone and relaxin increase pelvic mobility and promote a physiologic widening of pubic symphysis

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71
Q

Postcoital bleeding

Thick mucopurulent discharge

Pregnant

A

Acute cervicitis

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72
Q

Pulmonary hypoplasia

Oligohydramnios

Distended bladder
Enlarged kidneys
Thin renal cortices

A

Posterior urethral `

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73
Q

Indomethacin tocolysis can cause

A

decreases prostaglandin production —> fetal vasoconstriction (premature closure of ductus arteriosus)

Decreased renal perfusion —> oligohydramnios

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74
Q

Gestational DM when you need insulin

A

Fasting <= 95
1 hr <= 140
2 hr <= 120

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75
Q

Shoulder dystocia what to do

A

BE CALM

Breathe; do not push

Elevate legs & flex hips (McRoberts)

Call for help

Apply suprapubic pressure

EnLarge vaginal opening with episiotomy

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76
Q

No fetal pole

A

No embyo

Missed abortion
Closed cervix

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77
Q

Tx Preterm labor

A

< 32 weeks

Corticosteriods (Betamethasone)
Tocolytics (indomethacin)
Magnesium sulfate (provide fetal neuroprotection)
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78
Q

Infection that causes temporal lobe edema and hemorrhage

A

Herpes simplex virus

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79
Q

Feel bulging bag with no palpable presenting fetal part

A

Get transabdominal ultrasound

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80
Q

Risk factors Shoulder dystocia (5)

A 
Fetal macrosomia
Maternal obesity
Excessive weight gain in pregnancy
Gestational diabetes
Postterm pregnancy
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81
Q

Group B strep tested at

A

35-37 weeks

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82
Q

Do what at 28 weeks

A

Anti-D immune globulin

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83
Q

HIV delivery

A

Viral load > 1,000 = high risk vertical transmission

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84
Q

Decreased fetal movement what to do

A

Reactive NST

Next Biophysical profile or contraction stress test

[Dont use CST if placenta previa]

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85
Q

Single fluid pocket of 1.5 x 1 cm

A

Oligohydramnios

Single deepest pocket < 2cm

or amniotic fluid index < 5

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86
Q

Intrauterine fetal demise

Watery diarrhea after eating at picnic

A

Listeria monocytogenes

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87
Q

Pericardial effusion
Bilateral pleural effusions
Polyhydramnios

on ultrasound of fetus

  • Name
  • Due to
  • Causes
A

Fetal hydrops

Rh(D) alloimmunization

Parvovirus B19
Thalassemia

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88
Q

SLE nephritis in pregnancy symptoms (5)

A

Edema
Malar rash
Arthritis
Hematuria

Proteinuria

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89
Q

Medication CI in postpartum atony and hemorrhage

  • Name
  • CI
  • CI due to
A

Methylergonovine

CI in HTN disorders

Due to risk of stroke

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90
Q

HELLP results in

A

Distension of liver capsule

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91
Q

Premature rupture of membranes give when

A

Prophylactic latency antibiotics

Corticosteriods

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92
Q

Preeclampsia risk factors (3)

  • Prophylaxis
A

DM
Chronic HTN
Multiple gestations

Give lose dose aspirin

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93
Q

Lochia timeline

A

3-4 days dark or bright red

4-14 pink/ brownish

11th - 6 wk: white/ yellow creamy

Increase after breastfeeding

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94
Q

Fetus with double bubble sign

  • Name
  • Causes
  • Associated with (2)
  • Check for
A

Duodenal atresia

causes polyhydramnios

Duodenal atresia associated with trisomy 21 and VACTERL

Vertebral
Anal atresia
Cardiac
Trachoesophageal fistula
Esophageal atresia
Renal 
Limb

Check for VSD

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95
Q

Post labor

Preeclampsia

Patellar reflexes absent

A

Magnesium sulfate toxicity

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96
Q

No cervical change for >4 hours despite adequate contractions (>200)

A

Arrest

Cesarean delivery

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97
Q

Breast development age

Menarche age

A

8-13

10-16

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98
Q

Menopause duration

Labs

A

at least 12 months

Increased FSH and LH

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99
Q

Start screening for osteoporosis

A

65 years old

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100
Q

Absence of menses

Absence of 2nd sexual characteristics

A

Turners

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101
Q

Absence of menses

Secondary sexual characteristics

Absence of upper two third of vagina

A

Mullerian agenesis

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5
Perfectly
102
Q

Absence of menses

Secondary sexual characteristics

Breast development
No pubic hair

A

Complete androgen insensitivity

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103
Q

Turner heart conditions

A

Streak gonads

Amenorrhea

Aortic coarctation
Bicuspid aortic valve

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104
Q

Amenorrhea

Present uterus

Increased FSH

A

Turner’s

Primary ovarian insufficiency

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105
Q

WIthdrawal bleed from progestin challenge

Increased LH

A

PCOS or premature menopause

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106
Q

Pain
Menorrhagia
Enlarged boggy symmetrical uterus

Tx

A

Adenomyosis

NSAIDS

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107
Q

Acute heavy bleeding

A

High dose estrogen IV stabilizes the endometrial lining

If bleeding not controlled within 12-24 hours then D&C

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108
Q 
Serum pH > 7.45
HTN
Hypokalemia
Decreased aldosterone
Increased cortisol
  • Acquired from
  • Tx
A

Syndrome of Apparent Mineralocorticoid Excess (SAME)

Hereditary deficiency of 11beta-hydroxysteroid dehydrogenase
- cortisol not converted to cortisone

Can acquire from glycyrrhetinic acid (present in licorice)

Tx: Corticosteriods

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109
Q

Deficiency in 21 alpha hydroxylase

  • Features (6)
  • Elevated
  • MOA
A

Masculization
Hypotension

Cant make aldosterone or cortisol

Hypotension
Hyponatremia
HYPERkalemia

High 1-OH progesterone

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

110
Q

Deficiency in 11b- hydroxylase

  • Features
  • Build up
  • Didnt lose
  • MOA
A

Masculization
Hypertension

Build up of 11-deoxycorticosterione
Still have mineralocorticoid properties

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

111
Q

Deficiency of 17a- hydroxylase

  • Features (5)
  • MOA
A

HTN
Ambiguous genitalia

Can only make mineralocorticoids
Salt and H20 retention

Hypokalemia

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

112
Q

13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient

A. 21-hydroxylase 
B. 17a- hydroxylase 
C. 11b-hydroxylase 
D. Side chain cleavage enzyme 
E. 5a-reductase
A

B. 17a- hydroxylase

113
Q

Hirsutism vs virilization

A

Hirsutism= male hair pattern

Virilization= frontal balding, muscularity, clitoromeglay, deepening of voice

114
Q

Hypotension

Virilzation

A

21-hydroxylase deficiency

115
Q

Obesity
Amenorrhea
Acne
Hirsutism

A

PCOS

Increased testosterone and estrogen
High LH
Low FSH

Tx: hormonal contraception or progestin + metformin

If trying to conceive= Clomiphene (SERM) + Metformin

116
Q

Tx of Trichomonas

SE of flushing

A

Metronidazole

Causes disulfram like reactions

117
Q

Chandelier sign

A

Cervical motion tenderness

Pelvic inflammatory disease

118
Q

Abrupt onset fever
Vomiting
Watery diarrhea

Diffuse macular erythematous rash involving palms and soles

Hypotension
Blood culture negative

  • Name
  • Tx (3)
  • Death from (4)
A

Toxic shock syndrome

Rapid rehydration
Removal foreign object

Clindamycin + vancomycin

Death: arrhythmias, cardiomyopathy, respiratory failure, DIC

119
Q

Galactocele

  • What is it
  • Due to
  • Description
A

Milk retention cyst

Due to obstructed duct

Soft and cystic

120
Q

Palpable breast mass pathway

A

< 30
U/S +- mammogram

Simple cyst —> Need aspiration

Complex cyst —> Image guided core biopsy

> 30 Mammogram

Suspicious for malignancy —> core biopsy

121
Q

Guaiac positive discharge test

A

Positive for blood

122
Q

Raloxifene

  • What is it
  • Other form
  • Used for
  • AE
A

SERM

Tamoxifen: adjuvant tx of breast cancer
Raloxifene: postmenopausal osteoporosis

AE: venous thromboemoblism

Tamoxifen: endometrial hyperplasia and carcioma

123
Q

Vaginal spotting
Increasing pelvic pressure

Breast cancer 3 years ago
- Tamoxifen

Large irregular mass palpable above the symphysis pubis

Uterus doesnt descend with valsalva maneuver

  • Name
  • Causes (3)
  • Tx
A

Uterine sarcoma

Pelvic radiation
Tamoxifen use
Postmenopausal patients

Tx: Hysterectomy

124
Q

Abnormal uterine bleeding
Enlarged uterus

Just had baby

A

Choriocarcinoma

125
Q

Post menopausal
Thin white wrinkled skin over labia majora/minora

Fissure

Severe pruritus

Painful defecation

  • Name
  • Tx
A

Lichen sclerosus

Tx: Corticosteroid ointment

126
Q

Lichen planus

  • Caused by
  • Description (2)
A

Autoimmune

Pruritic purple plaques

Thin white striae around labia and vulva

127
Q

Thicken leathery skin around labias

  • Name
  • Due to
A

Lichen simplex chronicus

  • due to repetitive scratching
128
Q

Volvovaginal atrophy

  • Features (3)
  • Not seen
A

Vulvar pruritus
Thinned vulvar skin
Fusion of labia minora that causes narrowing of vaginal introitus

Doesnt involve perianal region

129
Q

Genital warts

A

Condylomata acuminata

130
Q

Condylomata acuminata

A

Genital warts

131
Q

Condylomata lata

  • Name
  • Description
A

Secondary syphilis

Raised gray-white lesions on mucosal surfaces

132
Q

8 cm cyst with calcifications and hyperechoic nodules

  • Name
  • Risk
  • Tx
A

Mature cystic teratoma (Dermoid cyst)

Risk ovarian torsion

Remove

133
Q

Purulent polymicrobial fluid collection

Multiloculated cystic adnexal mass

A

Tubo-ovarian abscess

134
Q

Virilization rapid onset

Acne

Increased testosterone
Normal DHEAs

  • Name
  • Type
  • Increase
A

Androgen secreting tumor

Sertoli Leydig cell tumor

Increased testosterone

[PCOS doesnt cause virilzation, only mildly elevated testosterone]

[Aromatase deficency has high DHEA]

135
Q

Regular painful menses with normal pelvic exam

Cramping 1-2 days before

N/V

Stops on day 2 of period

  • Name
  • MOA
  • Tx
A

Primary dysmenorrhea

Excessive prostaglandin production

NSAIDS
Combination oral contraceptives

136
Q

Pain 2 weeks prior to menses

  • Name
  • MOA
A

Mittelschmerz pain

Peritoneal inflammation from ovarian follicle rupture occurs during ovulation

137
Q

Post menopausal

5 cm right ovarian cyst

A

Serum CA-125 level and pelvic U/S

138
Q

HELLP syndrome is what

  • Is what
  • Features (6)
  • Results from
  • Results in
  • Lab
  • Overall description of MOA
A

Severe type of preeclampsia

Hemolysis
Elevated liver enzymes
Low platelet counts
HTN
Proteinuria
Edema

Result from abnormal placentation, triggering systemic inflammation and activation of coagulation system and complement cascade

Circulating platelets are rapidly consumed and microangiopathic hemolytic anemia, which is detrimental to liver

Results in hepatocellular necrosis
- Liver swelling and distension

MAHA causes increased bilirubin production

  • Systemic inflammation and platelet consumption
139
Q

Always having to go to bathroom

Involuntary loss of urine 2x a day

Wakes up to wet garments

Doesnt lose control while coughing

Normal postvoid residual volume

Vulvar skin shows reduced elasticity with labia minora retratction

  • Due to
  • Name
  • Feature
  • Tx
A

Estrogen deficiency

Genitourinary syndrome of menopause

Urogenital atrophy

Moisturizers and lubricants

next vaginal estrogen

140
Q

Urethral hypermobility

A

Stress urinary incontience

141
Q

Vaginal mass

Worse with valsalva

Vaginal erosions

A

Uterine prolapse

142
Q

Infertility
Irregular menses

Mobile uterus without adnexal masses

TSH and prolactin normal

Elevated testosterone

  • Name
  • Lab
  • MOA
  • Tx
A

Polycystic ovary syndrome

LH/FSH imbalance —> lack of LH surge

Results in failure of follicle maturation and oocyte release (anovulation)

Tx: 1st- WL

  • Oral contraceptives
  • Letrozole for ovulation
143
Q

Tx Uterine leiomyomas (Fibroids)

A

Symptomatic: Hysteroscopic myomectomy

Combined hormonal contraception

144
Q

Leuprolide

  • Is what
  • Used for
A

Gonadotropin releasing hormone agonist

Tx endometriosis by suppressing ovulation

145
Q

DES exposure in utero

A

Risk of clear cell carcinoma of cervix and vagina

146
Q

Malignant stromal tissue

A

Uterine sarcoma

147
Q

History cancer

Amenorrhea

Vaginal dryness

  • Name
  • Due to
  • Causes
  • Increase in
A

Ovarian failure

Secondary to chemo

Estrogen deficiency

[Primary ovarian insufficency]

Increased FSH and LH

148
Q

Ovarian mass

Breast tenderness

  • Name
  • Lab
  • Seen on biopsy
A

Granulosa cell tumor

Increased Estradiol
Increased Inhibin

Call-Exner bodies (cells in rosette pattern)

149
Q

Elevated alpha-fetoprotein

Ovarian mass

  • Name
  • Feature (2)
A

Yolk sac tumors

Aggressive germ cell tumor

Abdominal pain

150
Q

Elevated hCG

Ovarian mass

  • Name
  • Type
  • Feature
A

Embryonal carcinoma

  • Ovarian germ cell tumor
  • Rapid onset pelvic pain

Gestational trophoblastic disease

151
Q

Elevated Lactate dehydrogenase

Ovarian mass

  • Name
  • Type
  • Description
A

Dysgerminomas

Malignant germ cell tumors

Rapidly enlarging painful masses

152
Q

Itch rash on breast

Eczematous plaque on left nipple and areola

A

Paget disease

Adenocarcinoma

153
Q

Primary amenorrhea

A

Lack of menses without secondary characteristics at >= 13

or >=15 with secondary sex characteristics

154
Q

Endometrial hyperplasia risk factors (5)

A

Obesity

Chronic anovulation/ PCOS

Nulliparity

Early menarche or late menopause

Tamoxifen use

155
Q

Severe dysmenorrhea
Infertility

Lateral cervical displacement

Pain with cervical manipulation

Cervical motion tenderness

  • Name
  • Tx
A

Endometriosis

Oral contraceptives
NSAIDS

156
Q

Vulvar pruritus

Fusing of posterior labia minora

  • Features (2)
  • Tx (2)
A

Labial adhesion

Low estrogen production

Mild asymptomatic resolve spontaneously

Complete adhesion or partial symptomatic adhesion
- Topical estrogen cream

157
Q 
Bloating
Fatigue
Headaches
Hot flashes
Breast tenderness
  • Name
  • Tx
A

Premenstrual syndrome (PMS)

Symptom diary over 2 menstrual cycles

SSRI

Combined oral contraceptive not recommended in those with migraines

158
Q

Premenopausal

Adnexal mass

5 cm irregular right adnexal mass

A

1st pelvic ultrasound if premenopausal

159
Q

Pregnant

High grade squamous intraepithelial lesions

  • Name
  • Dx
A

Invasive cervical cancer

Immediate colposcopy

Next would be endocervical curettage (deferred during pregnancy

Pregnant

  • colposcopy
  • cervical excision
160
Q

Trichloroacetic acid therapy

A

Vulvar or vaginal warts

161
Q

Cervical insufficiency due to (4)

A

Collagen defects

Uterine abnormalities

Cervical conization

Obstetric injury

162
Q

Upper outer quadrant breast pain

Right axillary lymphadenopathy

Fever, chills, muscle aches and fatigue

Been feeding baby pumped breast milk at night

  • Name
  • Tx
A

Lactational mastitis

Antibiotic therapy
Continue breastfeeding

163
Q

Breast mass

Cystic

FNA- yellow
Doesnt resolve with aspiration

A

Get core needle biopsy

164
Q

Most effective emergency contraception method

A

Copper containing IUD

165
Q

Blue tinged bulge

Lower abdominal pain

A

Imperforate hymen

166
Q

Beefy red plaque with white in creases

  • Name
  • Location
  • Feature
  • Organism
  • Worsen by
  • Tx
A

Intertrigo

Dermatitis taht occurs in inguinal axillary gluteal and inframammary folds

Satellite lesions near primary infection

Candida albicans

Worse w/ corticosteriod use

Tx: Clotrimazole ointment

167
Q

Pregnant 8 weeks

Ovarian torsion with oophorectomy

A

Give progesterone supplementation until 10 weeks when placenta takes over

168
Q

Low FSH
Low LH
Low Estradiol

Infertility

Normal Prolactin
Normal TSH
Normal Testosterone

A

Hypogonadotropic hypogonadism

169
Q

High FSH
High LH
Decreased estradiol

Infertility

A

Primary ovarian insufficiency

170
Q

Gas passing through vagina

Malodorous vaginal discharge

Patch of erythema on the posterior vaginal wall

Sinus with purulent drainage is also present in the perianal skin

  • Name
  • Imaging
A

Rectovaginal fistula

Transmural inflammation of the bowel

171
Q

Pubic hair

No breasts

Uterus with small ovaries

  • Name
  • Genetics
A

Turner syndrome

Congenital absence of an X chromosome

172
Q

Granuloma inguinale

  • Name
  • Description
  • Not seen
  • Location
A

Klebsiella granulomatis

Extensive progressive and painless genital ulcers

Without lymphadenopathy

India
Guyana
New Guinea

173
Q

Endometrial cells on Pap

Post menopausal

A

Endometrial hyperplasia/ cancer

Endometrial biopsy

174
Q

Concern for Sertoli Leydig tumor

A

Virilization

Deepening of voice
Clitoromegaly

[Not acne, hairs, acanthosis nigraicans]

175
Q

Mullerian agenesis check for

A

Normal FSH

Renal abnormalities

  • unilateral renal agenesis
  • pelvic kidneys
  • duplications of collecting systems
176
Q

Irregular bleeding
Obesity

Endometrial hyperplasia

A

Peripheral aromatization of androgens to estrone

177
Q

Amenorrhea
Increased FSH

No reaction to progesterone challenge

  • Name
  • Due to
  • Lab
  • Common in
A

Primary ovarian insufficiency

Ovarian failure

Low Estrogen levels

Common in women who are Fragile X syndrome carriers

178
Q

Peau d’ orange

  • Name
  • Features (3)
A

Inflammatory breast carcinoma

Superficial dimpling
Edematous
Erythematous

179
Q

Vaginal foreign bodies

A

Warm irrigation

Vaginoscopy under sedation/ anesthesia

180
Q

13 y.o girl

Virilization
Clitoromegaly
Nodulocystic acne

Amenorrhea

Bilateral masses in labia majora

  • Name
  • Genetic
  • Due to
A

5- alpha reductase deficiency

46 XY

Impaired testosterone to DHT conversion

181
Q

OCPs and WG

A

not related

182
Q

Tx Endometriosis

A

NSAIDs

Then Laparoscopy

183
Q

Premenopausal

Regular menses

Intermenstrual bleeding

A

Endometrial polyp

184
Q

Strenuous exercise

Amenorrhea

  • Name
  • Lab
A

Hypothalamic amenorrhea

Decreased GnRH
Decreased LH/FSH
Decreased Estrogen

Relative caloric deficiency

185
Q

Androgenic steroid use

A

Virilization

186
Q

Menstrual bleeding > 5 days

Heavy

Anemia
Syncope

Irregular enlarged uterus

  • Name
  • Due to
A

Leiomyomata uteri (fibroids)

Proliferation of smooth muscle cells in the myometrium

187
Q

Cyclic bleeding of ectopic endometrial glands

A

Endometriosis

188
Q

Proliferation of endometrial glands inside the uterine myometrium

A

Adenomyosis

189
Q

Trastuzumab

SE

A

Monoclonal antibody for HER2 positive breast carcinoma

SE: cardiotoxicity

190
Q

Estrogen receptor positive breast cancer tx

Risk of

A

Aromatase inhibitors

  • Anastrozole
  • Letrozole

Increase the risk of osteoporosis

191
Q

Solid complex ovarian mass
Thick septations
Ascites

A

Epithelial ovarian carcinoma

192
Q

Inflammation of liver capsule

  • Name
  • Due to
A

Fitz-Hugh curtis syndrome

Secondary to chlamydia trachomatis and neisseria gonorrhoeae infxn

193
Q

Flesh colored 2 cm cystic mass at 4 oclock position of labium majus

  • Name
  • Tx
A

Bartholin duct cyst

Observation and expectant management

Resolve on own

194
Q

Gartner duct cyst

  • Due to
  • Description
  • Doesnt involve
A

Incomplete regression of wolffian duct

Cyst appear along the lateral aspects of the upper anterior vagina

Do not involve vulva

195
Q

Mass lateral to urethral meatus

A

Skene gland duct obstruction

196
Q

Intermittent blood staining the left side of her bra

No lumps or masses

No calcifications

  • Name
  • Description
A

Intraductal papilloma

Unilateral bloody nipple discharge

197
Q

Intraductal papillomas

A

Microcalcifications

198
Q

Lobular breast carcinoma

A

Fixed palpable breast mass with irregular borders

Can be bilateral

199
Q

Tx Menopause

A

Vasomotor symptoms

If CI to estrogen
- SSRI

No CI and intact uterus
- Estrogen & progestin

No CI and no uterus
- Estrogen only

200
Q

Fixed breast mass in upper outer quadrant

Foamy macrophages
Fat globules

A

Fat necrosis

Post trauma/ surgery

Benign

201
Q

Endometrial cells on PAP

A

<45 normal

> 45 concerning for endometrial hyperplasia or cancer

202
Q

Ambiguous external genitalia at birth

Normal internal genitalia

External virilization

Bone fractures

No breast development

Elevated FSH, LH
Elevated Testosterone
Elevated Androstenedione

Multiple ovarian cysts

  • Name
  • Risk of
A

Aromatase deficiency

Osteoporosis

203
Q

Tender purulent mass in vagina

  • Name
  • Dx
  • Tx
A

Urethral diverticulum

MRI

Surgical excision

204
Q

Abdominal myomectomy with uterine cavity entry

A

Trial of labor contraindicated due to uterine rupture

205
Q

Cesarean delivery with vertical incision

A

Trial of labor contraindicated

206
Q

Painless vaginal bleeding

Rapid fetal demise

A

Vasa previa

[Abruptio placentae has severe abdominal pain]

207
Q

Irregular contractions

No cervical change

A

False labor

Discharge home with labor precautions

208
Q

Twins

N/V
RUQ pain
Epigastric pain

Scleral icterus

Hypoglycemia
Increase liver enzymes
Increased bilirubin
Thrombocytopenia

  • Name
  • Tx
A

Acute fatty liver of pregnancy

Deliver immediately

Third trimester

Get DIC

209
Q

Heavy vaginal bleeding

Irregular nonpainful contractions

No prenatal care

A

Placenta previa

210
Q

Vaginal bleeding

Abdominal pain

FHR: decelerations

A

Placental abruption

211
Q

Cord avulsion

Severe hemorrhage

A

Placenta accreta

Attach to myometrium

212
Q

Risk Group B strep infection (5)

A

GBS bacteriuria or UTI in current pregnancy

Unknown GBS status

  • < 37 weeks
  • intrapartum fever
  • Rupture of membranes > 18 hours

Prior infant with early-onset neonatal GBS infection

213
Q

Fever > 24 hr postpartum

Uterine fundal tenderness

Purulent lochia

  • Name
  • Tx
A

Postpartum endometritis

Tx Clindamycin + gentamicin

214
Q

Cigarettes and pregnancy

A

Asymmetric FGR

215
Q

Postpartum urinary retention

Inability to void > 6 hours

Overflow incontinence

A

Bladder atony

216
Q

Risk factor for placenta previa

A

Previous cesarean delivery

217
Q

FHR smooth, wave-like oscillation

A

Category III tracing

Severe fetal anemia

Ruptured vasa previa

218
Q

Normal changes in pregnancy (3)

A

Decreased BUN
Decreased creatinine

Increased renal protein excretion

219
Q

Postpartum seizure

Normal blood pressure

Normal magnesium level

Sodium 112

A

Severe hyponatremia

Side effect oxytocin

220
Q

Hyperemesis gravidarum check for

A

Ketones on urinalysis

Differentiates from normal pregnancy N/V

Hypochloremic metabolic alkalosis

Hypokalemia

221
Q

Pregnant with positive STI on first screen

A

Repeat STI in third trimester

28 weeks

222
Q

Risk factor abruptioplacentae

A

Tobacco

Cocaine

223
Q

Abdominal pain
Vaginal bleeding
Fetal bradycardia

Irregular abdominal pass

A

Uterine rupture

224
Q

Pap smear

A

Every 3 years

Pap + HPV every 5 years

225
Q

Lynch II syndrome

  • Name
  • Risk of
A

Hereditary nonpolyposis colorectal cancer (HNPCC)

Increased risk of colon, ovarian, endometrial and breast cancer

226
Q

When to observe ovarian mass

  • Features (5)
A

Premenopausal

Asymptomatic
Mobile
Unilateral
Simple cystic mass

< 8-10 cm

227
Q

Detrusor hyperreflexia or sphincter dysfunction

A

Urge incontience

228
Q

Central precocious puberty

  • Labs (3)
  • Causes (4)
  • Tx
A

Increased Estradiol
Increased LH
Increased FSH

Hypothalamic lesions (tumors)
Dysgerminomas
Neurofibromatosis
Tuberous sclerosis

Tx: Leuprolide

229
Q

Peripheral precocious puberty

  • Labs (3)
  • Causes ( 6)
  • Tx
A

Increased Estradiol

Decreased LH
Decreased FSH

Congenital adrenal hyperplasia
Adrenal tumors
McCune-Albright
Granulosa cell tumor
Esogenous estrogen
Ovarian cysts

Tx: Treat cause

230
Q

Pediatric vaginal discharge common organism

A

Group A streptococcus

231
Q

Precocious puberty steps

A

Determine bone age

1) Bone age within 1 year of chronologic age= puberty hasnt started
2) Bone age > 2= puberty started > 12 months ago

GnRH agonist (leuprolide) stimulation test

1) Positive LH response
- Central precocious puberty
- Get MRI to check for CNS tumor

2) Negative LH response
- Peripheral precocious puberty
- U/S of ovaries, gonads
- Ovarian cyst, Adrenal tumor, gonadal tumor
- U/S negative= Exogenous estrogen, CAH

232
Q

Bloody nipple discharge

A

Intraductal papilloma

Mammary duct ectasia

233
Q

Leaf like appearance breast mass

A

Phyllodes tumor

234
Q

Papillary projections of stroma, lined with epithelium

  • Name
  • Tx
A

Phyllodes tumor

Completely excised
Axillary LN dissection not necessary

235
Q

CI with breast cancer

A

All hormone-containing contraception

Use copper IUD

236
Q

U/S vs mammogram

A

<30 get U/S

237
Q

Breast cancer stages

A

Primary tumor

I: < 2 cm
II: 2-5 cm
III: > 5 cm
IV: Extension to chest wall, skin

LN

I: Moveable LN
II: Fixed axillary LN
III: Supraclavicular LN

238
Q

HER 2 +

ER/PR +

A

HER2+= trastuzumab

ER/PR+= Tamoxifen

239
Q

Tx Turner to make taller

240
Q

Recurrent cystitis tx

A

Postcoital

241
Q

Adnexal mass

Pelvic pain
SOB

Postmenopausal

Solid mass
Thick septations
Ascites

  • Name
  • MOA
  • Tx
A

Epithelial ovarian carcinoma

Abnormal proliferation of tubal epithelium

Exploratory laparotomy for metastasis

242
Q

Adnexal mass that is complex multiloculated with thick walls and internal debris on ultrasound

Fever
Leukocytosis

A

Tubo-ovarian abscess

243
Q

Tender anterior vaginal mass is palpable

Causes expression of bloody discharge at urethral meatus

Leakage of urine

  • Name
  • MOA
A

Urethral divertciulum

Localized outpouching of urethral mucosa

244
Q

Uterine atony (7)

A

Uterine massage

Correct bladder distension

Oxytocin, misoprostol

Tranexamic acid

Carboprost, methylergonovine

Balloon tamponade

Surgical intervention

245
Q

Cystic breast mass

Goes away with aspiration

A

Repeat breast exam in 2 months

246
Q

Amennorrhea

Normal FSH
Normal TSH

A

Asherman syndrome

Adhesions

247
Q

Maternal estrogen effects in newborn

A

Breast hypertrophy

Swollen labia

Whitish vaginal discharge

Uterine withdrawal bleeding

248
Q

Pain exacerbated by bladder filling

Relieved by voiding

A

Interstitial cystitis

Amitriptyline

249
Q

Vulvar itching

Thin, white skin with excoriations extending to the perianal area

Small anal fissure

A

Lichen sclerosus

250
Q

Infertility of klinefelters due to

A

Dysgenesis of the seminferious tubules

251
Q

Medications that cause persistant erection (priapism)

A

Alpha 1 antagonists
- Prazosin

Antidepressants

  • Trazodone
  • SSRI

PPD5
- sildenafil

Stimulants

  • Methylphenidate
  • Cocaine

Sickle cell
leukemia

252
Q

Acute fatty liver of pregnancy

  • When
  • Lab (2)
  • Feature
A

Third trimester

Elevated aminotransferases

RUQ pain

Thrombocytopenia

253
Q

Continuous painful vaginal bleeding

Pregnant

A

Placental abruption

254
Q

Tertatogenic antibiotics

A

Tetracycline
Fluoroquinoles
Aminoglycosides
Sulfonamides

255
Q

Typical antibiotics for GBS prophylaxis

A

IV penicillin or ampicillin

256
Q

Amenorrhea with normal prolactin

No response to estrogen-progesterone challenge

History of D&C

A

Asherman syndrome

257
Q

Medication to induce ovulation

A

Clomiphene citrate

258
Q

Indications for medication tx of ectopic pregnancy (4)

A

Stable patient

Unruptured

< 35 cm

< 6 weeks gestation

259
Q

Medical options for endometriosis

A

OCPs
Danazol
GnRH agonists

260
Q

Most common location for ectopic pregnancy

A

Ampulla of oviduct

261
Q

Increased vaginal discharge

Petechial patches in upper vagina and cervix

A

Trichomonal vaginitis

262
Q

Patients with PID and RUQ pain

A

Fitz-Hugh Curtis syndrome

263
Q

30 y.o with unpredictable urine loss

Exam normal

Medications?

A

Anticholinergics
- Oxybutynin

B-adrenergics
- Metaproterenol

For urge incontience

264
Q

Morning sickness
Abdominal distension
Breast fullness

Last menstrual period was 2 months ago

Home pregnancy test positive

Negative pregnancy test at office

Thin endometrial stripe

A

Pseudocyesis

Somatization of stress

265
Q

Bipolar medication safe in pregnancy

A

Lamotrigine

266
Q

Mammogram how often

A

45-54 every year

55 and older every 2 years

267
Q

Lipids checked how often

A

Every 5 years

268
Q

What to give is labor is protracted, cervical change not progressing

A

Oxytocin

[Misoprostol not used in those with spontaneous labor only to induce]

269
Q

When to stop mammograms

270
Q

Oral contraceptives decrease risk of

A

Ovarian cancer

Endometrial cancer

271
Q

Tocolytic used at 33 weeks

Develop headache,nausea, and flushed. Hypotension and decreased glucose.

GIven what?

A. Beta-adrenergic receptor stimulation
B. CCB
C. Circulation of synthetic glucocorticoids
D. Cyclooxygenase inhibition
E. Decreased acetylcholine release at myoneural junction

A

B. CCB

Nifedipine

First line tocolytic

[Cyclooxygenase inhibitors, indomethacin used to toxolysis between 24 and 32 weeks by decreasing prostaglandin synthesis, risk PDA closure after 32 weeks]

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