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Step 2 > Ob/Gyn UWorld > Flashcards

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
Q

delivery in pts with HIV

A

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

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26
Q

Patient with colicky pain with an ultrasound seeing an ovarian cyst with calcifications and hyperechoic nodules

A

Mature dermoid cyst

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27
Q

how to manage a pt with a history of preterm birth

A
  • intramuscular progesterone during the second and third trimesters
  • cervical length measurements by transvaginal ultrasound during the second trimester
  • cerlage placed if cervix is short
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28
Q

pagets disease of breast

A

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

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29
Q

how to treat neonatal thyrotoxicosis

A
  • maternal antibodies self-resolve in 3 months

- methimazole PLUS beta-blocker

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30
Q

ABO incompatibility b/w mother and baby

A

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

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31
Q

hemophilia A, B, and C… what are they and what are the inheritance patterns

A

A: factor 8 deficiency, X-linked recessive
B: factor 9 deficiency, X-linked recessive
C: factor 11 deficiency, autosomal recessive

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32
Q

fetal complications from preeclampsia

A

oligohydramnios and fetal growth restriction/small for gestational age infants due to chronic uteroplacental insufficiency

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33
Q

you see an ovarian torsion… WHAT DO YOU THINK

A

cystic teratoma (dermoid cyst)

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34
Q

pt has a cystic teratoma (dermoid cyst)… whatre you worried about

A

ovarian torsion

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35
Q

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)

A

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
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36
Q

management of a shoulder dystocia

A

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

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37
Q

diagnosis and treatment of ashermanns syndrome

A

formation of intrauterine adhesions (pt wont bleed during the progesterone challenge)
-hysteroscopy is used which can lyse the adhesions

38
Q

maternal complications of placental abruption

A

hypovolemic shock

DIC

39
Q

postcoital bleeding and thick mucopurulent discharge with a friable cervix
what is it and what do you do

A

acute cervicitis and you can give empiric treatment with azithromycin and ceftriaxone

40
Q

crunching sound with breathing and retrosternal chest pain that radiates to the back after throwing up a ton

A

esophageal perforation/rupture (boerhaave syndrome)

41
Q

nonspecfic symptoms of sti with vaginal pH of 3.8-4.5

A

candida

note: they dont have to say white cottage cheese discharge

42
Q

HELLP syndrome is due to what

A

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
Q

sheehan syndrome

A

postpartum ischemic necrosis of anterior pituitary
PRESENTS WITH
-lactation failure (prolactin deficiency)
-hypotension
-anorexia (secondary adrenal insufficiency)

44
Q

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

A

tubo-ovarian abscess

45
Q

bilateral milky/green/brown//yellow/gray non-bloody nipple discharge

A

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
Q

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
A

adenomyosis

47
Q

intrauterine fetal demise associated with growth restriction, bent limbs/limb deformities, hypoplastic thoracic cavity…

A

type II osteogenesis imperfecta

48
Q

pseudocyesis

A

condition with nonpsychotic ladies that think they are pregnant and have all the signs except they are definitely not pregnant

49
Q

what do you think of when you see a sinusoidal fetal tracing

A

fetal anemia

50
Q

define and list the complications of oligohydramnios vs polyhydramnios

A

oligohydramnios (AFI< 5)
-meconium aspiration
-preterm delivery
umbilical cord compression

polyhydramnios (AFI > 24)

  • fetal malposition
  • umbilical cord prolapse
  • preterm labor
  • PPROM
51
Q

vulvar irritation, intermittent bleeding, unifocal/friable mass commonly located on the labia majora

A

vulvar squamous cell carcinoma

52
Q

patient with abnormal vaginal bleeding and hyperthyroidism

A

hydatidiform mole

53
Q

list the three features of vasa previa

A

membrane rupture
painless vaginal bleeding
fetal bradycardia

54
Q

pt with previous pelvic surgery has fever unresponsive to antibiotics, no localizing signs/symptoms, and a negative infectious evaluation

A

septic pelvic thrombophlebitis

-treat with anticoagulation and broad spectrum antibiotics

55
Q

cholangitis

A

ascending infection due to biliary obstruction
-fever, jaundice, RUQ pain (charcot triad)

this + hypotension and altered mental status = reynolds pentad

56
Q

how to manage a pregnant pt with HSV

A

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
Q

Multiple glazed erythematous vulvar erosions bordered by white striae, vaginal and oral lesions

A

Lichen planus

Treat with topical corticosteroids

58
Q

pregnant pt presents with RUQ pain, leukocytosis, and mildly elevated liver enzymes, profound hypoglycemia

A

acute fatty liver of pregnancy

-manage with immediate delivery

59
Q

how to manage a pt with PPROM

A

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
Q

encephalopathy, oculomotor dysfunction, and gait ataxia in a pregnant patient

A

wernicke encephalopathy is a complication of hyperemesis gravidarum that results from thiamine deficiency

61
Q

unilateral nipple discharge

A

intraductal papilloma (benign)

62
Q

when a pt with hypothyroidism gets pregnant what do you do to their levothyroxine dose

A

increase the dose when they get pregnant

63
Q

newborn with thin cerebral cortices and multiple intracranial calcifications

A

congenital zika

64
Q

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

A

pubic symphysis diastasis

-conservative management with NSAIDs, physical therapy, and pelvic support

65
Q

pregnant woman suddenly gets shortness of breath, atrial fibrillation, pulmonary edema, and pulmonary congestion… what is this

A

rheumatic mitral stenosis

66
Q

biggest risk factor for vaginal cancer (squamous cell metaplastic changes)

A

age >60
HPV infection
tobacco use

in utero DES exposure (clear cell adenocarcinoma only)

67
Q

super heavy periods in woman in her 40s + boggy uterus

A

adenomyosis leads to symmetrically enlarged uterus

68
Q

brenner tumor

A

benign epithelial ovarian tumor in asymptomatic woman

69
Q

what levels will be high in a pt with an embryonal carcinoma

A

alpha-fetoprotein

hCG

70
Q

how does a yolk sac tumor present

A
  • young woman with high alpha-fetoprotein
  • grow rapidly
  • acute onset pelvic pain
71
Q

large ovarian tumor in woman with post menopausal bleeding

A

granulosa cell tumor

72
Q

single most important risk factor for pts with placental abruption

A

hypertension

73
Q

if a patient has endometrial adenocarcinoma what are the two biggest risk factors and whats the basis of both of them

A

unopposed estrogen!!!

  1. obesity
  2. chronic anovulation
74
Q

postpartum urinary retention

A

inability to void >6hrs after vaginal delivery
bladder atony –> usually causes an overdistended bladder
pudendal nerve injury –> you will see a perineal laceration

75
Q

physiologic leukorrhea

A

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
Q

complications of a short pregnancy interval

A

maternal anemia
PPROM
preterm delivery
low birth weight

77
Q

mittelschmerz

A

physiologic cause of unilateral abdominal pain in young women
-usually occurs in the middle of a womans cycle around the time of ovulation

78
Q

what is apt testing and why would it be done

A

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
Q

how to treat magnesium toxicity

A

stop magnesium and give IV calcium gluconate bolus (reverses neuromuscular paralysis, stabilizes cardiac membranes, and prevents cardiac arrest)

80
Q

OB question that mentions mid-epigastric pain. what do yo think of

A

that suggests fundal placenta

81
Q

why are cocaine and tobacco bad in pregnancy

A

they are potent vasoconstrictors that readily cross the placenta and cause placental vasoconstriction and ischemia

82
Q

first line treatment for migraine prevention in pregnant ladies

A

beta-blockers

-propranolol or metoprolol

83
Q

how to treat pyelo in pregnancy

A

inpatient abx cause of the severe maternal and fetal complications
-empiric ceftriaxone

84
Q

delusional disorder

A

delusions lasting >1 month in the absence of other psychotic or mood symptoms

85
Q

how to treat a labial adhesion (fused labia minora)

A

first-line: topical estrogen cream for symptomatic lesions

-usually on prepubertal girls due to low estrogen production

86
Q

what is the most serious complication of pregnant pts with lupus or sojgrens

A

fetal AV block

-due to passive placental transfer of anti-SSA and SSB antibodies

87
Q

how does AV block look on fetal hr tracing

A

fetal bradycardia

88
Q

how to deal with pts with ruptured ovarian cyst

A

hemodynamically stable- observe and reassure

hemodynamically unstable- may have continued bleeding so surgical intervention

89
Q

dysuria and sterile pyuria

A

chlamydia trachomatis urethritis

90
Q

pt has sickle cell and shes pregnant… what do you think of

A

possible risk of uteroplacental insufficiency

91
Q

woman gets hyperthyroid within 1 year of having a baby

A

postpartum thyroiditis

  • painless autoimmune thyroiditis
  • hyperthyroid pt with low uptake on radioactive iodine uptake scan

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