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Ob/Gyn UWorld Flashcards

1
Q

what should you be concerned about in a baby with shoulder dystocia

A

clavicular fractures may result in C8-T1 brachial plexus injury that may result in Horner syndrome, Erb-Duchenne palsy, or Klumpke palsy

-usually resolve spontaneously

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2
Q

cystocele
rectocele
enterocele
apical prolapse

A

bladder prolapse
rectum prolapse
small intestine prolapse
uterus or vaginal valt prolapse

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3
Q

what can cause sharp groin pain in a pregnant woman

A

round ligament pain

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4
Q

what increases risk of uterine rupture the most during pregnancy/labor

A

past uterine surgeries (like a classical/vertical c-section or a uterine myomectomy)

-if these pts are giving birth again do a laparotomy and delivery

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5
Q

what do amphetamines do to a baby in utero

A

fetal growth restriction

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6
Q

second line to oxytocin (ptosin) in a pt with postpartum hemorrhage and why would each of these be contraindicated

A

Methylergonovine (contraindicated in hypertension)

Carboprost (contraindicated in asthma)

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7
Q

risks of combined OCPs

A
  • venous thromboembolism
  • hypertension
  • hepatic adenoma
  • stroke/MI (both rare)
  • cervical cancer
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8
Q

pt with breast dimpling, peau d’orange, edematous, erythematous, and painful breast with nipple flattening/retraction

A

inflammatory breast carcinoma

-if pt also has axillary lymphadenopathy you can assume its likely spread

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9
Q

unilateral bloody nipple discharge

A

intraductal papilloma

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10
Q

management of intrauterine fetal demise

A

20-23 weeks –> dilation and evacuation OR vaginal delivery
24+ weeks –> vaginal delivery (induce labor)

*Note: retention of the fetus for several weeks can lead to coagulopathy in the mom

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11
Q

cervical insufficiency and whatre the risk factors

A

painless dilation of the cervix that can lead to second trimester pregnancy loss

risk factors

  • cervical conization or LEEP
  • mechanical cervical dilation
  • obstetric cervical laceration
  • uterine anomalies
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12
Q

modifiable breast cancer risk factors

A

hormone replacement therapy
nulliparity
increased age at first live birth
alcohol consumption

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13
Q

lifetime risk of breast cancer for every woman

A

1/8

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14
Q

melasma

A
  • acquired hyperpigmentation disorder that commonly occurs during pregnancy
  • usually involves sun-exposed areas on the face
  • diagnosed clinically and resolves postpartum
  • tell pt to avoid sun exposure and use sunscreen
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15
Q

what is a major contraindication of any estrogen containing contraceptives

A

hypertension

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16
Q

what to lookout for when given pap smear data on a postmenopausal woman

A

endometrial cells seen after the age of 45 is an abnormal finding (this is normal on women less than 45yo)

  • endometrial shedding may be due to endometrial hyperplasia/cancer
  • do endometrial biopsy if this finding is seen
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17
Q

intermenstrual spotting without uterine enlargement (no prolonged menses)

A

endometrial polyps

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18
Q

pt seems like a girl then during puberty is more like a boy and you find clitoromegaly and bilateral labial masses

A

5-alpha reductase deficiency

-virilization during puberty due to increased levels of testosterone

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19
Q

how does androgen insensitivity present

A

normal female with no uterus or fallopian tubes, rudimentary vagina
–possibly with bilateral labial masses

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20
Q

patient postop from hysterectomy with unilateral nonradiating costovertebral angle pain, nausea, and vomiting
-normal renal function

A

hydronephrosis from ureteral injury during surgery

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21
Q

steps in dealing with a uterine inversion

A
  1. manual replacement of the uterus
  2. placental removal
  3. administer uterotonics
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22
Q

what is a leiomyoma

A

proliferation of smooth muscle cells within myometrium

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23
Q

what is the acid-base normal for a pregnant woman

A

respiratory alkalosis

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24
Q

what is a main cause of stress incontinence

A

weak pelvic floor muscles

-urethral hypermobility and reduced bladder support

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25
delivery in pts with HIV
if they consistently take their meds and have a viral load less than 1000 you can do normal expectant management and delivery without any additional drugs if they are inconsistent with meds and have a viral load more than 1000 you want to administer intrapartum zidovudine and do a c-section
26
Patient with colicky pain with an ultrasound seeing an ovarian cyst with calcifications and hyperechoic nodules
Mature dermoid cyst
27
how to manage a pt with a history of preterm birth
- intramuscular progesterone during the second and third trimesters - cervical length measurements by transvaginal ultrasound during the second trimester - cerlage placed if cervix is short
28
pagets disease of breast
extension of underlying DCIS/invasive breast cancer up the lactiferous ducts and into the contiguous skin of nipple --> eczematous patches over nipple and areolar skin usually associated with intraepithelial adenocarcinoma cells
29
how to treat neonatal thyrotoxicosis
- maternal antibodies self-resolve in 3 months | - methimazole PLUS beta-blocker
30
ABO incompatibility b/w mother and baby
usually mother is O and baby is A or B -affected infants are usually asymptomatic at birth or have mild anemia and may develop neonatal jaundice that typically responds to phototherapy
31
hemophilia A, B, and C... what are they and what are the inheritance patterns
A: factor 8 deficiency, X-linked recessive B: factor 9 deficiency, X-linked recessive C: factor 11 deficiency, autosomal recessive
32
fetal complications from preeclampsia
oligohydramnios and fetal growth restriction/small for gestational age infants due to chronic uteroplacental insufficiency
33
you see an ovarian torsion... WHAT DO YOU THINK
cystic teratoma (dermoid cyst)
34
pt has a cystic teratoma (dermoid cyst)... whatre you worried about
ovarian torsion
35
young pt with little prenatal care and long course of labor/obstructed labor is likely to experience what complication (especially in areas with limited resources)
vesicovaginal fistula - continuous watery vaginal discharge - area of raised red granulation tissue on the anterior vaginal wall - higher pH of vagina - diagnose via pelvic exam and bladder dye test - treat with surgical repair
36
management of a shoulder dystocia
BE CALM Breathe, do not push Elevate legs, flex hips and thighs against abdomen (McRobers) Call for help Apply suprapubic pressure enLarge vaginal opening with episiotomy Maneuvers
37
diagnosis and treatment of ashermanns syndrome
formation of intrauterine adhesions (pt wont bleed during the progesterone challenge) -hysteroscopy is used which can lyse the adhesions
38
maternal complications of placental abruption
hypovolemic shock | DIC
39
postcoital bleeding and thick mucopurulent discharge with a friable cervix what is it and what do you do
acute cervicitis and you can give empiric treatment with azithromycin and ceftriaxone
40
crunching sound with breathing and retrosternal chest pain that radiates to the back after throwing up a ton
esophageal perforation/rupture (boerhaave syndrome)
41
nonspecfic symptoms of sti with vaginal pH of 3.8-4.5
candida note: they dont have to say white cottage cheese discharge
42
HELLP syndrome is due to what
abnormal placentation triggering systemic inflammation and activation of the coagulation system and complement cascade - platelets rapidly consumed - MAHA - hepatocellular necrosis (abdominal pain due to liver swelling with distension of the hepatic Glissons capsule)
43
sheehan syndrome
postpartum ischemic necrosis of anterior pituitary PRESENTS WITH -lactation failure (prolactin deficiency) -hypotension -anorexia (secondary adrenal insufficiency)
44
pt with sexually risky behavior (possible PID) presents with fever, abdominal pain, high white count, complex multiloculated adnexal mass with thick walls and internal debris on ultrasound
tubo-ovarian abscess
45
bilateral milky/green/brown//yellow/gray non-bloody nipple discharge
physiologic galactorrhea - most common cause is hyperprolactinemia - to work this up you should get a pregnancy test, measure prolactin and TSH, and get a possible MRI of the brain
46
multiparous woman in her 40s with... - new onset dysmenorrhea - symmetrically enlarged (globar) uterus thats boggy and tender but is smaller than 12 weeks in size - heavy menstrual bleeding
adenomyosis
47
intrauterine fetal demise associated with growth restriction, bent limbs/limb deformities, hypoplastic thoracic cavity...
type II osteogenesis imperfecta
48
pseudocyesis
condition with nonpsychotic ladies that think they are pregnant and have all the signs except they are definitely not pregnant
49
what do you think of when you see a sinusoidal fetal tracing
fetal anemia
50
define and list the complications of oligohydramnios vs polyhydramnios
oligohydramnios (AFI< 5) -meconium aspiration -preterm delivery umbilical cord compression polyhydramnios (AFI > 24) - fetal malposition - umbilical cord prolapse - preterm labor - PPROM
51
vulvar irritation, intermittent bleeding, unifocal/friable mass commonly located on the labia majora
vulvar squamous cell carcinoma
52
patient with abnormal vaginal bleeding and hyperthyroidism
hydatidiform mole
53
list the three features of vasa previa
membrane rupture painless vaginal bleeding fetal bradycardia
54
pt with previous pelvic surgery has fever unresponsive to antibiotics, no localizing signs/symptoms, and a negative infectious evaluation
septic pelvic thrombophlebitis | -treat with anticoagulation and broad spectrum antibiotics
55
cholangitis
ascending infection due to biliary obstruction -fever, jaundice, RUQ pain (charcot triad) this + hypotension and altered mental status = reynolds pentad
56
how to manage a pregnant pt with HSV
antiviral prophylaxis from 36 weeks gestation until delivery to decrease risk of active lesions - if no active lesions then vaginal delivery is ok - if pt has active lesions then give them a c-section
57
Multiple glazed erythematous vulvar erosions bordered by white striae, vaginal and oral lesions
Lichen planus | Treat with topical corticosteroids
58
pregnant pt presents with RUQ pain, leukocytosis, and mildly elevated liver enzymes, profound hypoglycemia
acute fatty liver of pregnancy | -manage with immediate delivery
59
how to manage a pt with PPROM
before 34 weeks do expectant management with prophylactic antibiotics, corticosteroids, and inpatient monitoring at or after 34 weeks deliver the baby (or sooner if there are complications)
60
encephalopathy, oculomotor dysfunction, and gait ataxia in a pregnant patient
wernicke encephalopathy is a complication of hyperemesis gravidarum that results from thiamine deficiency
61
unilateral nipple discharge
intraductal papilloma (benign)
62
when a pt with hypothyroidism gets pregnant what do you do to their levothyroxine dose
increase the dose when they get pregnant
63
newborn with thin cerebral cortices and multiple intracranial calcifications
congenital zika
64
patient just gave birth to a macrosomic baby and a day or so later is having trouble ambulating, radiating suprapubic pain, pubic symphysis tenderness, and an intact neurological exam -symptoms get worse with walking
pubic symphysis diastasis | -conservative management with NSAIDs, physical therapy, and pelvic support
65
pregnant woman suddenly gets shortness of breath, atrial fibrillation, pulmonary edema, and pulmonary congestion... what is this
rheumatic mitral stenosis
66
biggest risk factor for vaginal cancer (squamous cell metaplastic changes)
age >60 HPV infection tobacco use in utero DES exposure (clear cell adenocarcinoma only)
67
super heavy periods in woman in her 40s + boggy uterus
adenomyosis leads to symmetrically enlarged uterus
68
brenner tumor
benign epithelial ovarian tumor in asymptomatic woman
69
what levels will be high in a pt with an embryonal carcinoma
alpha-fetoprotein | hCG
70
how does a yolk sac tumor present
- young woman with high alpha-fetoprotein - grow rapidly - acute onset pelvic pain
71
large ovarian tumor in woman with post menopausal bleeding
granulosa cell tumor
72
single most important risk factor for pts with placental abruption
hypertension
73
if a patient has endometrial adenocarcinoma what are the two biggest risk factors and whats the basis of both of them
unopposed estrogen!!! 1. obesity 2. chronic anovulation
74
postpartum urinary retention
inability to void >6hrs after vaginal delivery bladder atony --> usually causes an overdistended bladder pudendal nerve injury --> you will see a perineal laceration
75
physiologic leukorrhea
white odorless mucoid cervical discharge that typically occurs midcycle due to increasing estrogen levels prior to ovulation -lots of discharge and squamous cells/leukocytes seen
76
complications of a short pregnancy interval
maternal anemia PPROM preterm delivery low birth weight
77
mittelschmerz
physiologic cause of unilateral abdominal pain in young women -usually occurs in the middle of a womans cycle around the time of ovulation
78
what is apt testing and why would it be done
most commonly used testing in cases of vaginal bleeding late during pregnancy (antepartum hemorrhage) to determine if bleeding is from mother or fetus -positive = fetal blood (think vasa previa)
79
how to treat magnesium toxicity
stop magnesium and give IV calcium gluconate bolus (reverses neuromuscular paralysis, stabilizes cardiac membranes, and prevents cardiac arrest)
80
OB question that mentions mid-epigastric pain. what do yo think of
that suggests fundal placenta
81
why are cocaine and tobacco bad in pregnancy
they are potent vasoconstrictors that readily cross the placenta and cause placental vasoconstriction and ischemia
82
first line treatment for migraine prevention in pregnant ladies
beta-blockers | -propranolol or metoprolol
83
how to treat pyelo in pregnancy
inpatient abx cause of the severe maternal and fetal complications -empiric ceftriaxone
84
delusional disorder
delusions lasting >1 month in the absence of other psychotic or mood symptoms
85
how to treat a labial adhesion (fused labia minora)
first-line: topical estrogen cream for symptomatic lesions | -usually on prepubertal girls due to low estrogen production
86
what is the most serious complication of pregnant pts with lupus or sojgrens
fetal AV block | -due to passive placental transfer of anti-SSA and SSB antibodies
87
how does AV block look on fetal hr tracing
fetal bradycardia
88
how to deal with pts with ruptured ovarian cyst
hemodynamically stable- observe and reassure hemodynamically unstable- may have continued bleeding so surgical intervention
89
dysuria and sterile pyuria
chlamydia trachomatis urethritis
90
pt has sickle cell and shes pregnant... what do you think of
possible risk of uteroplacental insufficiency
91
woman gets hyperthyroid within 1 year of having a baby
postpartum thyroiditis - painless autoimmune thyroiditis - hyperthyroid pt with low uptake on radioactive iodine uptake scan

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