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UWorld Step 2 > OB-Gyn Rd 2 > Flashcards

OB-Gyn Rd 2 Flashcards

1
Q

What lab value can tell you if there is hyperemesis gravidarum?

Most often occurs when?

What other CF?

A

Urine ketones

1st trimester

> 5% weight loss of prepregnancy weight

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1
Q

Pt that is unstable and is having an inevitable abortion, what is the best step?

A

Suction curettage

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3
Q

What is primary ovarian insufficiency?

A

Menopause before age 40

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4
Q

How do you distinguish bw Mono and Gonococcal pharyngitis?

A

Mono will have TENDER cervical LAD

Gonorrhea will also have lower ABD pain

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5
Q

How does abruptio placeta appear?

What classic symptom?

A

ABD pain, back pain, vaginal bleeding
Frequent contractions

Rising and FIRMING of the uterus

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6
Q

Pt that has hypothyroid and wants to become pregnant, how do you manage it?

A

Inc dose WHEN she becomes pregnant NOT before

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7
Q

Vaginal ulceration and bleeding in postemenopausal woman, what is the best next step?

A

Biopsy of lesion

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8
Q

What causes pituitary apoplexy aka spontaneous pituitary hemorrhage?

Sx?

A

Pituitary adenoma

HA, visual field defects, no pituitary defects

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9
Q

Age < 45 who needs endometrial biopsy?

A

AUB + unopposed Estrogen (obesity, anovulation)
AUB + failed medical management
AUB + Lynch syndrome

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9
Q

Pt that is over 35 and has atypical glandular cells on Pap needs what?

A

Colpo
Endometrial biopsy
Endocervical curettage

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11
Q

What is a RF for preterm labor in pt w/PMHx of cervical surgery?

Assess risk how?

How to decrease risk?

A

Short cervix

TV-US

Give progesterone

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12
Q

Thiamine deficiency results in what?

A

Wernicke encephalopathy - AMS, nystagmus, gait ataxia

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13
Q

What is responsible for preparing the endometrium for implantation of a fertilized ovum?

A

Progesterone

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14
Q

Amphetamine use during pregnancy is associated w/what?

A

Preterm delivery, pre-E, FGR, abruptio placenta, IUFD

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15
Q

How does a hydatidiform mole appear on US?

A

Snowstorm appearance

b-hCG will be > 100,000

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16
Q

What does pseudocyesis mean?

Causes what symptoms?

D/t what etiology?

A

False pregnancy

Weight gain, amenorrhea, tender breasts

Somatization of stress

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16
Q

Ovarian mass is found on pt that is cystic and measures 5cm on US. Pt is 62 y/o and has no symptoms. What is the best next step?

A

CA-125 marker and pelvic US

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17
Q

What can cause ovarian failure aka primary ovarian insufficiency in a woman < 40 y/o?

A

PMHx of Chemotherapy

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17
Q

Pt that comes in with size-date discrepancy and irregular contour of the uterus, what is the reason?

A

Fibroids

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19
Q

Patient that is undergoing preterm labor and is < 32 weeks should receive what?

A

Betamethason
Tocolytics (indomethacin, nifedipine)
Magnesium sulfate (neuroprotective)
PCN if GBS+ or uncertain

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19
Q

US shows an adnexal mass w/lack of Doppler flow, Dx?

A

Ovarian torsion

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21
Q

When is the active stage of labor?

When has it been arrest of labor?

A

6cm to 10cm

NO change in 4 hours w/adequate contractions or >6 hours w/inadequate contractions

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24
Q

What is uterine synechiae?

A

Asherman syndrome

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24
Q

What does malpresentation mean?

A

Anytime the baby is not at vertex (occiput lowest)

Aka Face or breech

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25
Q

Infant born w/thin, loose skin and a thin umbilical cord and wide anterior fontanel has what?

What else is common?

Best step in management?

A

Fetal growth restriction

Meconium-stained amniotic fluid

Send placenta for histopath exam

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25
Q

What fibroids are likely to compress organs?

A

Subserosal and pedunculated

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26
Q

What can occur d/t a traumatic delivery and presents w/radiating suprapubic pain that is exacerbated by ambulation or weight bearing?

Treatment?

A

Pubic symphysis diastasis

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27
Q

Smooth, firm mass protruding through the labia majora w/cyclic ABD Pain indicates what?

A

Imperforate hymen

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27
Q

Friable cervix that bleeds w/manipulation and mucopurulent cervical discharge indicate what?

D/t what?

A

Acute cervicitis

GC

27
Q

What contraception is contraindicated in breast cancer pts?

A

OCPs
Progesterone IUD
Patch
Nuva ring

28
Q

SERMs can cause what structural abnormality in premenopausal women?

A

Endometrial polyps

29
Q

How do you manage intra-amniotic infections?

A

Give Abx and augment labor

NO C-Section

30
Q

What are the risks of external cephalic version?

Can perform when?

A

Abruptio placenta
IUFD

At or beyond 37 weeks

32
Q

What presents w/fever, heavy vaginal bleeding, purulent discharge that smells BAD, and uterine tenderness?

Treat how?

A

Septic abortion

Broad-spectrum ABx and Suction curettage

34
Q

How does embryonal carcinoma present?

A

Teens w/ABD mass and elevated b-hCG

Major Sx: ASCITES

36
Q

How do you differentiate bw endometritis and septic pelvic thrombophlebitis?

A

Endometriosis gets BETTER w/Abx

Pelvic thrombophlebitis PERSISTS w/fever

38
Q

Describe the uterus in adenoma oasis

A

Boggy (soft), TENDER, uniformly enlarged

40
Q

When can menopause be clinically diagnosed?

Otherwise need what in workup?

A

> 45 y/o w/12 month hx of amenorrhea and no other concerning symptoms

TSH, FSH

42
Q

What is an absolute contraindication to vaginal delivery?

A

Pt w/classic (vertical) prior cesarean section
Placenta previa
Prior extensive myomectomy

43
Q

Pt w/infertility and dysmenorrhea and a FIXED, immobile uterus has what?

A

Endometriosis

44
Q

What is a possible SE of oxytocin toxicity?

D/t what?

A

Seizure

Hyponatremia

45
Q

Morbid obesity can cause what?

A

Anovulation

46
Q

What presents w/fever, ABD pain, and a complex multiloculated adnexal mass w/thick walls and internal debris?

What labs are elevated?

A

Tubo-ovarian abscess

CRP, CA-125, leukocytosis

47
Q

Pt is 29 y/o and has a tender, mobile mass, after aspiration yields yellow fluid and resolution of the mass, best next step?

A

Return in 2-4 months for breast eval

48
Q

Inpatient treatment for PID is what?

A

Cefotetan + Doxycycline

50
Q

Pt that is delivering a baby and has herpes, what is the best way to minimize infection?

A

C-section

52
Q

What results from an incomplete regression of the Wolffian duct during fetal development?

Located where?

If symptomatic treat how?

A

Gartner duct cyst

Lateral upper anterior vagina

I+D w/Word catheter placement

53
Q

Pt w/abnormal 1st trimester screen should be followed up how?

A

CVS weeks 10-13

Amniocentesis weeks 15-20

54
Q

Pt that WANTS to stop breast feeding after death of a baby, treat how?

A

NSAIDs

58
Q

Who needs an endometrial biopsy if over 45?

Age >/= 35

A

AUB w/postmenopausal bleeding

Atypical glandular cells on Pap test

59
Q

In the 1st trimester, how does a woman’s thyroid change:
Total T4?
Free T4?
TSH?

A

Inc —> b-hCG stimulates thyroid hormone in 1st trimester
Unchanged
Dec —> b-hCG and thyroid hormone suppress it

60
Q

Stress urinary incontinence can occur even when?

A

Pt coughs and no fluid leaks out

61
Q

Pt that presents w/hyperandrogenism during pregnancy and has b/L ovarian mass on US has what?

D/t what?

A

Benign ovarian tumors

Luteoma or theca lutein cysts

62
Q

Who is at risk for ABO incompatibility?

MC outcome?

A

Infants w/blood type A or B born to mother w/blood type O

Mild hemolytic disease

64
Q

What can present w/pre-E w/severe features at < 20 weeks gestation?

A

Hydatidiform mole

65
Q

What are the normal findings in a biophysical profile?

A 
NST - reactive FHR
Amniotic fluid index > 5
Fetal movements >/= 3
Fetal tone >/= 1 F/E
Breathing >/= 1 episode > 30s
66
Q

MC SE’s of SERMs (tamoxifen and raloxifene)?

A

Hot flashes
VTE
Endometrial hyperplasia (T only)

67
Q

Pt w/multiple abortions and an episode of slurred speech and sudden right arm weakness has what?

A

Anti-phospholipid Ab syndrome —> that is a TIA moron

68
Q

Endometrioma = ?

A

Chocolate cyst

69
Q

How to treat confirmed Chlamydia infection with confirmed negative Gonnorhea?

If reverse is true?

A

Azithromycin ONLY

Ceftriaxone + Azithromycin (d/t inc cephalosporin resistance)

70
Q

How does pregnancy effect ventilation and breathing?

What about acid/base status?

A

Inc ventilation d/t progesterone
Inc TV, Inc MV

Respiratory alkalosis

71
Q

What is a tubo-ovarian abscess?

Presents how?

A

Severe form of PID

Foul smelling vaginal discharge, lower ABD pain, cervical motion tenderness

72
Q

What maintains the corpus luteum?

Secreted by what?

A

B-hCG

Syncytiotrophoblast

76
Q

What is the TARGET BG level for fasting pregnant pt?

1 hour postprandial?

2 hour?

A

< 95

< 140

< 120

77
Q

Pt w/painful urination and pain with the passage of stool, and rectovaginal exam shows modularity in the posterior cul-de-sac has what?

D/t what?

A

Endometriosis

Implantation of endometrial glands and stroma

78
Q

Postpartum woman w/enlarged uterus, irregular vaginal bleeding, pulmonary symptoms and multiple infiltrates on CXR has what?

Confirm how?

A

Choriocarcinoma

b-hCG

80
Q

Pt w/US results that show an intrauterine gestational sac w/yolk sac but no fetal pole, b-hCG that starts at 27,000 but decreases to 25,000 most likely has what?

A

Missed abortion

85
Q

Pt that is still bleeding after delivery of a baby w/forceps or vacuum needs to have what?

Why?

A

Genital tract inspection

To make sure all lacerations are repaired

86
Q

What are the 4 RFs for placental abruption?

Puts you at risk for what?

A

Maternal HTN
Pre-E or E
Prior abruption
Cocaine/tobacco use

DIC and hypovolemic shock

91
Q

L+D are contraindicated in what cases?

D/t what?

What symptoms?

A

Classic Cesarean or extensive myomectomy

Risk of uterine rupture

Intense ABD pain, persistent variable decelerations

93
Q

What does phenytoin use in pregnancy cause?

A

Microcephaly, hypoplasia of distal phalanges of fingers and toes, excess hair, cleft palate

Also Hirsuitism and developmental delay

113
Q

What is the optimal fetal position?

If it is Occiput transverse and there is an arrest of stage 2 labor, what is the cause?

A

Occiput anterior

Malposition

UWorld Step 2 (17 decks)

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