OB/Gyn: UWorld Flashcards
What disorder is characterized by a patient with a blind ended vaginal pouch with little or no uterine tissue and a XX genotype?
Mullerian agenesis
The differential diagnosis for a patient with a female phenotype but lacking a normal vagina and uterus includes mulerian agenesis, androgen insensitivity, and 5-alpha-reductase deficiency. Of these, only mullerian agenesis is characterized by an XX genotype.
What is the first-line medication for the treatment of hypertension in pregnancy?
Methyldopa
Methyldopa is a pregnancy category B agent.
Patients with 47 XXY have what diagnosis?
Klinefelter’s syndrome
This is associated with male phenotype and small testes.
Large genital warts (lesions) can be treated with what?
Excision or fulguration (electric current)
Regardless of the method of treatment, rates of recurrence are high.
When is Trimethoprim-Sulfamethoxazole (TMP-SMX) permissible during pregnancy?
2nd trimester
What happens to total T4 and TSH during pregnancy?
Total T4 increases but TSH stays the same
Increased estrogen during pregnancy leads to an increase in thyroid binding globulin (TBG) which results in an increase in TBG-bound T3 and T4. Thus total T4 and T3 are increased, but free T4 and T3 remain normal so TSH also remains normal.
Congenital anomalies, congenital infections, and chromosomal abnormalities usually result in what kind of intrauterine growth restriction (IUGR)?
Symmetric IUGR
In symmetric IUGR, the insult to the fetus often begins before 28 weeks gestation, and growth of both the head and the body are similarly lagging behind dates.
What should you suspect in a post-menopausal female with symptoms of vaginal dryness and dysuria, and physical exam findings of pale, dry vaginal mucosa, diminished labial fat pad, and scarce pubic hair?
Atrophic vaginitis
Moderate and severe cases require local estrogen therapy.
An antepartum hemorrhage with fetal heart changes progressing from tachycardia to bradycardia and finally to a sinusoidal pattern occurring suddenly after rupture of membranes suggests the diagnosis of what?
Vasa previa
The bleeding in this setting is fetal in origin, so maternal vital signs will remain stable while the fetus exsanguinates. When this condition is diagnosed, the treatment is an immediate caesarian section delivery (crash c-section).
Patients with what diagnosis present with primary amenorrhea and anosmia?
Kallmann’s syndrome
They have a normal female karyotype and will have laboratory findings consistent with GnRH deficiency (low FSH and LH).
A finding of atypical squamous cells of undetermined significance on cytology in a patient aged between 21 and 24 years is managed how?
Repeat cytology in 1 year
In this young patient population, HPV infection is transient and malignant transformation is rare. For this reason, colposcopy is not performed unless the patient demonstrates ASC3 on 3 consecutive pap smears. However, colposcopy is recommended for any ASC-H, atypical glandular cells, or high-grade squamous intraepithelial lesion.
What is characterized clinically by a fever and uterine tenderness in the postpartum period and is often associated with foul-smelling lochia
Endometritis
- Risk factors include prolonge rupture of membranes (ROM), prolonged labor, operative vaginal delivery, and C-section.*
- Broad spectrum antibiotics are required to treat this typically polymicrobial infection*.
What presents similarly to mastitis but lacks a fever and systemic symptoms?
Plugged ducts
Treatment is by improving the quality of breastfeeding. Persistently plugged ducts resulting in a galactocele may be treated with aspiration.
Female offspring of women who ingested diethylstilbestrol during pregnancy are at increased risk of developing what?
Clear cell adenocarcinoma of the vagina and cervix
As well as cervical anomalies (hypoplasia) and uterine malformations (T-shaped/small uterine cavity), vaginal adenosis, and vaginal septae. Many have difficulty conceiving and maintaining pregnancy.
What pregnancy-associated disorder is characterized by markedly elevated alkaline phosphatase and cholesterol levels in conjunction with intense pruritis?
Primary biliary cirrhosis
Multinucleated giant cells and a vesicular rash seen on genital exam are characteristic of what?
Genital herpes
What is the treatment of choice for postpartum endometritis?
IV clindamycin and IV gentamicin
In what phase of the menstrual cycle is cervical mucus thicker, less stretchable, and inhospitable to sperm?
The mid- and late-luteal phase
What is the most commonly identified infectious agent associated with fetal growth restriction (FGR)?
Cytomegalovirus (CMV)
This can not be effectively prevented or treated in most cases.
What causes gestational maternal virilization and virilization of XX fetuses leading to affected girls with normal internal genitalia with ambiguous external genitalia?
Congenital aromatase deficiency
Loss of peripheral conversion of androgens to estrogens.
How many days after unprotected intercourse can levonorgestrel be given?
5 days (120 hours)
Levonorgestrel = Plan B
Which vaginitis/vaginosis is characterized by inflammation, pruritus, and a thin malodorous vaginal discharge?
Trichomonas vaginitis
In contrast, bacterial vaginosis does not cause inflammation, and candida vaginitis causes a discharge that is thick and white.
What is the most appropriate infertility treatment for a patient with premature ovarian failure who wants to get pregnant?
In vitro fertilization with donor oocytes
Estrogen replacement therapy affects the metabolism of what other hormone?
Thyroid hormone
The requirement for L-thyroxine increases when estrogen replacement therapy is started. Pregnancy also increases thyroid hormone requirements and patients should be monitored every 4-6 weeks for dose adjustments.
Multinucleated giant cells on Tzanck smear are characteristic of what?
Herpes and Varicella
During which phase of the menstrual cycle is the cervical mucus profuse, clear, and thin, and will stretch to approximately 6cm and exhibit ferning on a microscope slide smear preparation?
The ovulatory phase
What is the standard of care for a threatened abortion?
Reassurance and outpatient follow up in 1 week for repeat ultrasonogram
Bed rest and abstaining from sexual intercourse are usually recommended because this will prevent any feelings of guilt on the part of the parents in the case that pregnancy is actually lost, however, there is no evidence of the benefit of these interventions on the outcome.
What is the next step in working up a patient with bilateral guaiac-negative nipple discharge?
Workup includes ruling out pregnancy, measuring serum prolactin and TSH levels, and possibly an MRI of the brain to rule out prolactinoma
Prolactinoma, hypothyroidism, overstimulation of the nipple, oral contraceptice pills, and medications which lower dopamine levels are common causes of galactorrhea.
What is the next step in management of a woman with HELLP syndrome at 34 weeks of gestation?
Induction of labor
Prior to 34 weeks or lung maturity, steroids can be considered to promote lung maturity prior to delivery, contingent on the mother and fetus being stable.
When should a pregnant woman be tested for group B strep colonization?
35-37 weeks
- Women who are colonized with GBS receive prophylactic antibiotics (penicillin or ampicillin) at the time of delivery.*
- Women who have had GBS bacteriuria during pregnancy or who have previously delivered a child that developed an early-onset GBS infection are automatically given prophylactic antibiotics regardless of the results of a rectovaginal culture.*
Women affected by polycystic ovarian syndrome (PCOS) are at increased risk of what cancer?
Endometrial hyperplasia and carcinoma
Women with PCOS are oligo- or an-ovulatory and are deficient in progesterone secretion; thus, they usually have a constant and unbalanced mitogenic stimulation of the endometrium by estrogens leading to endometrial hyperplasia, intermittent breakthrough bleeding and dysfuntional uterine bleeding. This unopposed estrogen stimulation leaves them at increased risk for endometrial cancer.
What can sometimes be seen in patients with systemic lupus erythematosus (SLE) and is a potential cause of recurrent pregnancy loss due to thrombus development within the placenta?
Lupus anticoagulant
Polycystic ovarian syndrome is a common cause of amenorrhea due to anovulation. What is another common cause of anovulatory amenorrhea?
Obesity
FSH and LH levels are usually normal.
What is the diagnosis for a newborn with a small body size, microcephaly, digital hypoplasia, nail hypoplasia, midfacial hypoplasia, hirsutism, cleft palate and rib anomalies?
Fetal hydantoin syndrome
Caused by maternal phenytoin or carbamazepine use during pregnancy
What is the treatment of choice for candida vulvovaginitis?
An azole antifungal such as oral fluconazole
Topical Nystatin can also be used.
Patients with what diagnosis present with primary amenorrhea, nondeveloped internal reproductive organs, a normal XX karyotype, normal female levels of testosterone, and normal axillary and pubic hair development?
Mullerian agenesis
45 XO is the genotype found in patients with what diagnosis?
Turner syndrome
These patients have primary amenorrhea, but the FSH level is generally elevated due to primary ovarian failure.
What two tests are used to screen for syphilis?
Nontreponemeal serologic tests: Venereal Disease Research Laboratory (VDRL) and Rapid Plasma Reagin (RPR)
What is the recommended management of a patient with an active genital herpetic lesion who is in active labor?
Immediate C-section
Neonatal HSV is a severely morbid and potentially fatal illness
Infants born to patients with Graves disease treated with surgery are at risk for what?
Thyrotoxicosis
This would occur because of the passage thyroid stimulating immunoglobulin across the placenta. Thyroid stimulating immunoglobulin remains as high as 500 times the normal value for several months following thyroidectomy.
What is the most common preventable cause of fetal growth restriction in the United States?
Cigarette smoking
1 in 3 cases of FGR is attributable to smoking, and women who smoke while pregnant have a 3 to 4-fold increased risk of having a growth restricted infant.
When do amniotic fluid embolisms usually occur?
During amniocentesis or during labor
What are the 3 hallmark features of endometriosis?
- Dyspareunia
- Dysmenorrhea
- Dyschezia
Other features include pelvic pain and infertility. Treatment options include combined oral contraceptives, GnRH analogs (IE Leuprolide), and danazol
How does hyperprolactinemia cause amenorrhea?
Elevated prolactin levels suppress GnRH release thereby suppressing LH and FSH production and ovulation. This is the reason for anovulation and amenorrhea in lactating mothers
Why is Trimethoprim-Sulfamethoxazole contraindicated in the first and third trimesters?
1st Trimester: Interferes with folic acid metabolism
3rd Trimester: Increases risk of kernicterus (bilirubin-induced brain dysfunction) in the newborn
What is the treatment of choice for treating a deep vein thrombosis (DVT)?
Anticoagulation with heparin
Why are fluoroquinolones contraindicated during pregnancy?
They can potentially cause arthropathy in the unborn fetus
What is the gold standard for evaluation the cervix for cervical incompetence in pregnancy?
Transvaginal ultrasound
A cervical length below the 10th percentile for gestational age is considered a short cervix. This includes cervices less than 25 mm at gestational age 23-28 weeks
What test is necessary to confirm the diagnosis of missed abortion?
Transvaginal ultrasound
What is the most important intervention for preventing spread of HIV from mother to fetus?
Zidovudine to the mother throughout pregnancy and labor, as well as to the neonate for the first 6 weeks of life
Bleeding is seen in what percent of placental abruptions?
80%
What is the first step in management of a pregnant patient who presents with vaginal bleeding and hemodynamic instability?
Obtain venous access (with two large bore needles)
Maintainance of airway, breathing, and circulation is always the first priority in any patient presenting for emergent care. C-section may later be needed if the patient continues to be unstable.
All pregnant women should have an oral glucose tolerance test at what gestational age of pregnancy?
24 to 28 weeks gestation
High-risk patients (markedly obese, family history of diabetes) can be screened earlier in pregnancy.
What can be used to differentiate symmetric from asymmetric fetal growth restriction (FGR)?
Head to abdomen circumference ratio
What is the preferred form of hormonal contraception for lactating mothers?
Progestin-only oral contraceptives
What should be performed early in the evaluation of an infertile couple, usually as the initial screening test?
Semen Analysis
Male factor accounts for 20-30% of infertility cases.
What is indicated for a patient with polycystic ovarian syndrome (PCOS) and impaired glucose tolerance?
Metformin
Metformin is indicated in PCOS patients with impaired glucose tolerance becuase it helps in preventing type 2 diabetes mellitus as well as improving obesity, hirsutism, menstrual irregularity, and infertility.
Idiopathic central precocious puberty is managed with GnRH agonist therapy in order to prevent what?
Premature fusion of the epiphyseal plates
This would otherwise lead to a short stature.
Hypotension is a common side effect of epidural anesthesia. What is the mechanism of this effect?
Blood redistribution to the lower extremities and venous pooling
Hyperemesis gravidarum presents with severe and persistent vomiting, weight loss, and what?
Ketonuria
Does the use of combination oral contraceptive pills cause weight gain?
No
Numerous recent studies have determined that weight gain is not associated with the use of combination oral contraceptives. Weight gain has been reported with medroxyprogesterone use but controlled studies have not been done to substantiate this effect.
Post-term pregnancies are at an increased risk for what?
Oligohydramnios
This is associated with increased fetal morbidity. Post-term pregnancies should be monitored for oligohydramnios twice weekly.
Isotretinoin is associated with what congenital abnormalities?
- Craniofacial dysmorphism
- Heart defects
- Deafness
Patients with what diagnosis present with amenorrhea, normally developed breasts, absent pubic and axillary hair, absent internal reproductive organs, and a 46 XY karyotype?
Androgen resistance
In this condition, serum testosterone levels are in a range typical for males. The internal reproductive organs do not develop because the testes are still present and secrete mullerian inhibiting factor.
What most commonly affects postmenopausal women and manifests with vulvar pruritus and discomfort? Exam shows porcelain-white atrophy.
Lichen sclerosus
Biopsy should be considered to rule out vulvar squamous cell carcinoma.
What is considered first-line therapy for lichen sclerosus?
High-potency topical steroids
How long after infection with Treponema pallidum before the patient develops a painless papule at the site of inoculation?
2-3 weeks after infection
If left untreated, the chancre of primary syphilis heals spontaneously within one to three months.
Human chorionic gonadotropin (hCG) is secreted by what?
Syncytiotrophoblast
What is a common cause of recurrent mid trimester abortions?
Cervical incompetence
- What stimulates prolactin secretion?
- What inhibits prolactin secretion?
- Serotonin and TRH stimulate prolactin
- Dopamine inhibits prolactin
Hypothyroidism results in elevated TSH and TRH levels and can subsequently cause hyperprolactinemia.
What is caused by increased levels of prostaglandins and presents with lower abdominal pain that occurs with mestruation?
Primary dysmenorrhea
NSAIDS and oral contraceptive pills can be used to improve symptoms.
What is the treatment for vaginismus?
Relaxation, Kegel exercises (to relax vaginal muscles), and insertion of objects of gradually increasing size to encourage desensitization