OBGYN Flashcards
1
Q
2 possible next steps in management after Pap testing shows high-grade squamous epithelial lesion?
A
LEEP or colposcopy
2
Q
Which group of women might be good candidate for LEEP after Pap shows high-grade squamous epithelial lesion?
A
Age > 25 yo, Not pregnant, Completed child-bearing
3
Q
What is involved in LEEP procedure?
A
Excision of cervical transformation zone + surrounding endocervix
4
Q
Who should be screened annually for gonorrhea and chlamydia?
A
Sexually active females < 25 yo
5
Q
Screening test of choice for detection of gonorrhea and chlamydia?
A
Nucleic acid amplification testing (NAAT)
6
Q
Best treatment for gonorrhea and chlamydia detected by NAAT?
A
Azithromycin + Doxycycline
7
Q
In addition to ABX treatment, what is the next step for patients who test (+) for gonorrhea and chlamydia?
A
Screening for other sexually-transmitted infections (HIV, syphilis)
8
Q
Most likely diagnosis in post-menopausal female who presents with new-onset pelvic pressure, uterine mass, and ascites?
A
Uterine sarcoma
9
Q
Most common location of ascites in uterine sarcoma?
A
Posterior cul-de-sac
10
Q
Most common site of metastasis in uterine sarcoma?
A
Lungs
11
Q
Next step of workout for post-menopausal female with suspected uterine sarcoma?
A
Hysterectomy … to confirm diagnosis and stage disease
12
Q
2 risk factors for development of uterine sarcoma?
A
Tamoxifen use, Pelvic radiation
13
Q
3 lab tests that should be performed at 24-28 week prenatal visit?
A
Hemoglobin/hematocrit (or CBC), Antibody screening if mother is Rh(D) negative, 50g 1-hour glucose tolerance test
14
Q
When does gestational thrombocytopenia typically occur?
A
2-3 trimester
15
Q
Typical platelet count of gestational thrombocytopenia?
A
70,000–150,000
16
Q
Typical prognosis of gestational thrombocytopenia?
A
Resolution after delivery
17
Q
2 possible mechanisms for gestational thrombocytopenia?
A
Hemodilution, Accelerated platelet destruction
18
Q
Best management of gestational thrombocytopenia?
A
Serial CBC during pregnancy
19
Q
When might gestational thrombocytopenia be a contraindication to neuraxial analgesia?
A
Severe thrombocytopenia < 70,000
20
Q
Why is severe thrombocytopenia in gestational thrombocytopenia a contraindication to neuraxial analgesia?
A
Associated with increased risk of spinal epidural hematoma
21
Q
Menopausal Hormone Therapy (MHT) is the most effective treatment available for …
A
Menopausal hot flashes
22
Q
4 beneficial effects of Menopausal Hormone Therapy (MHT)?
A
Decreased risk of osteoporosis, colon CA, T2DM, all-cause mortality < 60 yo
23
Q
5 detrimental effects of Menopausal Hormone Therapy (MHT)?
A
Increased risk of CVA, DVT, breast CA, gallbladder disease, CAD > 60 yo
24
Q
3 qualities of physiologic nipple discharge?
A
Bilateral, Multiductal, Expressed only with manipulation
25
Initial workup for patients with nipple discharge?
US for women < 30 yo; Mammogram for women > 30 yo
26
Patients with nipple discharge and (–) US/mammogram findings should undergo …
Prolactin, thyroid studies
27
Endometriosis is defined by …
Presence of endometrial tissue outside uterus
28
4 most common locations of endometrial tissue in setting of endometriosis?
Ovaries, fallopian tubes, cul-de-sac, uterosacral ligaments
29
2 most common symptoms of endometriosis?
Dysmenorrhea, dyspareunia
30
2 DOCs for endometriosis?
NSAIDs, OCPs
31
Definitive treatment for endometriosis?
Hysterectomy + bilateral salpingo-oophorectomy
32
Most common pathogen responsible for acute cystitis?
E. coli
33
Best treatment of acute cystitis in pregnant females?
Empiric treatment with ABX for 3-7 days
34
3 options for Empiric ABX treatment for acute cystitis in pregnant females?
Nitrofurantoin, Cephalexin, Amoxicillin-Clavulanate
35
Best treatment of acute pyelonephritis in pregnant females?
Admission + IV ceftriaxone/cefepime
36
Among the risk factors for recurrent PID, what is the strongest?
Multiple sexual partners
37
Clinical presentation of uterine rupture?
Sudden-onset severe abdominal pain, vaginal bleeding, loss of fetal station
38
Sign of uterine rupture on fetal HR tracing?
Late decelerations
39
Late decelerations on fetal HR tracing suggest …
Fetal hypoxia
40
Major risk factor for uterine rupture?
HX of classical (vertical) C-section, myomectomy
41
Best management of uterine rupture?
Emergency laparotomy for delivery + uterine repair
42
Description of RhD alloimmunization?
RhD (-) mother develops Ig against RhD (+) Ag in fetus
43
When should Anti-D Ig be administered during pregnancy?
28 weeks
44
Who should receive Anti-D Ig during pregnancy?
All RhD (-) females with negative anti-D Ig screen
45
Who should receive Anti-D Ig post-partum?
All RhD (-) females with RhD (+) baby
46
Timing required for diagnosis of peripartum cardiomyopathy?
36 weeks gestation - 5 months postpartum
47
3 risk factors for peripartum cardiomyopathy?
30+ yo, Multiple gestation, Preeclampsia
48
Best tool for assessing risk of recurrence for peripartum cardiomyopathy?
LV function at diagnosis, current LV function … assessed by ECHO
49
3 characteristics of pathologic nipple discharge?
Spontaneous, unilateral, persistent
50
Most common cause of pathologic nipple discharge?
Ductal papilloma
51
Best management of pathologic nipple discharge in women < 30 yo?
Mammogram + US
52
Best management of pathologic nipple discharge in women > 30 yo?
US
53
All post-menopausal females should be asked about …
Vaginal dryness, dyspareunia
54
Medication (not hormonal therapy) that can be used to treat vasomotor symptoms for menopausal females?
SSRIs
55
Best treatment for vaginal atrophy resulting from menopause?
Topical low-dose estrogen
56
3 aspects of clinical presentation for urethral diverticulum?
Dysuria, Dyspareunia, Anterior vaginal mass (which expresses bloody/purulent fluid)
57
Etiology of urethral diverticulum?
Repeated infection, inflammation, urethral trauma during surgery or vaginal delivery
58
Initial workup for urethral diverticulum?
UA, urine culture
59
Diagnostic test for urethral diverticulum?
Confirmed with imaging … pelvic MRI, transvaginal US
60
All post-menopausal females should be asked about …
Vaginal dryness, dyspareunia
61
Medication (not hormonal therapy) that can be used to treat vasomotor symptoms for menopausal females?
SSRIs
62
Best treatment for vaginal atrophy resulting from menopause?
Topical low-dose estrogen
63
GI complication associated with pregnancy?
Increased incidence of gallstones
64
What accounts for increased incidence of gallstones during pregnancy?
Bile becomes supersaturated with cholesterol; Decreased gallbladder motility
65
Best management of pregnancy-associated gallstones?
Spontaneous resolution within 2 months of delivery
66
3 aspects of 1st trimester combined screening test for aneuploidy?
Nuchal translucency, b-HCG, PAPP-A
67
Does the 1st trimester combined screening test provide a definitive diagnosis of aneuploidy?
No
68
2 tests that provide a definitive diagnosis of aneuploidy?
Chorionic villous sampling, Amniocentesis
69
When can Chorionic villous sampling be performed during pregnancy?
10-13 weeks
70
When can Amniocentesis be performed during pregnancy?
15 weeks
71
BG management for female with gestational DM (treated with insulin regimen), after delivery?
Females do NOT require post-partum insulin treatment
72
Initial screening for T2DM in females with gestational DM?
Fasting BG … 24-72 hours after delivery
73
Next screening for T2DM in females with gestational DM?
Oral glucose tolerance test … 6-12 weeks after delivery
74
Ultimate screening for T2DM in females with gestational DM?
Diabetic screening every 3 years
75
Definition of pre-term labor?
Regular uterine contractions, resulting in cervical dilation at < 37 weeks
76
Best management of pre-term labor at < 32 weeks?
Steroids, Tocolytics, Penicillin, Magnesium sulfate
77
Best management of pre-term labor at 32-34 weeks?
Steroids, Tocolytics, Penicillin
78
Steroid of choice in management of pre-term labor at 32-34 weeks?
Betamethasone
79
Tocolytic of choice in management of pre-term labor at 32-34 weeks?
Nifedipine
80
Who should receive Penicillin in management of pre-term labor?
Patients with (+) or unknown GBS status
81
Best management of pre-term labor at 34-37 weeks?
Steroids, Penicillin
82
42 yo female presents with fever, uterine tenderness on Day 2 after c-section – diagnosis?
Postpartum endometritis
83
Most common pathogens responsible for Postpartum endometritis?
Polymicrobial
84
Etiology of Postpartum endometritis?
Ascent of vaginal floral into uterus
85
Most significant risk factor for Postpartum endometritis?
C-section delivery, especially when preformed after labor has begun / membranes have ruptured
86
4 additional risk factors for Postpartum endometritis?
GBS infection, prolonged rupture of membranes, protracted labor, operative vaginal delivery
87
ABX of choice for patient with Postpartum endometritis?
Clindamycin + gentamicin
88
First step in evaluation of infertility?
Semen analysis
89
17 yo female presents with purulent vaginal discharge; PE shows cervical friability – diagnosis?
Acute cervicitis
90
2 most common pathogens responsible for Acute cervicitis?
Gonorrhea, chlamydia
91
Empiric treatment for Acute cervicitis?
Ceftriaxone (gonorrhea) + Doxycycline (chlamydia)
92
Initial step of workup for patient with suspected Acute cervicitis?
NAAT PCR testing to confirm infection, but with empiric treatment (does not require waiting for NAAT results)
93
Diagnosis of cervical insufficiency can be made via …
2+ painless 2nd trimester losses; Presentation of painless cervical dilation in 2nd trimester of pregnancy
94
2 risk factors for development of cervical insufficiency?
Uterine abnormalities (bicornuate uterus), Ehlers-Danlos syndrome
95
Best management for cervical insufficiency?
Placement of cerclage at 12-14 weeks gestation
96
In patients who are pregnant with diamniotic/dichorionic twins, mode of delivery is determined by …
Fetal presentation (vertex vs. breech)
97
After healthy delivery of Twin A, cervical dilation constricts to 9mm; Fetal station of Twin B is -2; Fetal HR tracing is category 1; Contractions are occurring every 2-3 minutes – next step of management?
Expectant delivery of Twin B
98
ABX of choice for treatment of pelvic inflammatory disease?
Cefoxitin + doxycycline
99
2 most common pathogens responsible for PID?
Neisseria gonorrhea, Chlamydia
100
Which ABX is NOT recommended in treatment of PID?
Ciprofloxacin
101
First-line contraceptive method for adolescent females?
Long-Acting Reversible Contraception (LARC)
102
2 methods of LARC?
IUD + Contraceptive implants
103
How long is copper-containing IUD effective?
10 years
104
How long is progestin-secreting IUD effective?
5 years
105
How long is subdermal implant contraceptive effective?
3 years
106
Which form of contraceptive is recommended for patients with heavy bleeding or dysmenorrhea?
Progestin-releasing IUD
107
Why is IUD preferred to depot medroxyprogesterone in adolescents seeking contraceptive?
Depot medroxyprogesterone has a lower efficacy (94%) compared to IUD (99%)
108
Etiology of HCG hyper-stimulation syndrome?
Presents 1-2 weeks after ovulation induction with HCG infection … when stimulated by b-HCG, ovaries overproduce VEGF … VEGF causes increased vascular permeability, capillary leakage
109
Role of HCG injections before IVF?
b-HCG stimulates multiple follicle production, in preparation for egg retrieval
110
Clinical presentation of HCG hyper-stimulation syndrome?
NV, abdominal pain, ascites, pleural effusion, bilateral ovary enlargement, hypotension
111
Complications of HCG hyper-stimulation syndrome?
Renal failure, ARDS, DIC
112
Initial workup for HCG hyper-stimulation syndrome?
CBC, electrolytes, coagulation studies, b-HCG levels
113
Best management of HCG hyper-stimulation syndrome?
Correct electrolyte abnormalities, perform therapeutic paracentesis/thoracentesis
114
Definition of precocious puberty in males?
Age < 9 yo
115
Definition of precocious puberty in females?
Age < 8 yo
116
How does relationship between bone age + chronologic age change in setting of precocious puberty?
Precocious puberty = Bone Age > Chronologic Age
117
Change to LH and FSH levels in setting of central precocious puberty?
Increased
118
Etiology of central precocious puberty?
Early activation of hypothalamic-pituitary-gonadal axis
119
Change to LH and FSH levels in setting of peripheral precocious puberty?
Decreased
120
Etiology of precocious puberty?
Abnormal secretion of estrogen/testosterone from peripheral organs
121
Best management of central precocious puberty?
GnRH agonist … down-regulates LH and FSH release from pituitary
122
Pregnant patient presents with thin, malodorous vaginal discharge – diagnosis?
Bacterial vaginosis (BV)
123
Pathogen most commonly responsible for Bacterial vaginosis (BV)?
Gardnerella
124
Vaginal pH in Bacterial vaginosis (BV)?
pH > 4.5
125
Result of microscopy that suggests Bacterial vaginosis (BV)?
Clue cells (epithelial cells covered in bacteria)
126
DOC for Bacterial vaginosis (BV)?
Metronidazole, Clindamycin
127
Complication of Bacterial vaginosis (BV)?
PPROM, preterm labor, post-partum endometritis
128
Role of ABX treatment in setting of Bacterial vaginosis (BV)?
Symptom relief … ABX will NOT prevent adverse outcomes
129
For female with HX of epilepsy, at what point should valproate be discontinued to avoid fetal congenital abnormalities in pregnancy?
6 months prior to conception
130
How should valproate be adjusted for females with HX of epilepsy, now pregnant?
Do not discontinue valproate (abrupt discontinuation increases risk of seizure recurrence)
131
2 tests used to screen for congenital abnormalities in pregnant female currently taking valproate?
US, serum AFP
132
Are antiepileptic drugs contraindicated in breastfeeding?
No … although they are excreted in breastmilk
133
Definition of PPROM?
Preterm Premature Rupture Of Membranes (PPROM) = leakage of fluid at < 37 without contractions
134
4 risk factors for development of PPROM?
Heavy lifting, Anemia, HX of PPROM, 1st trimester bleeding
135
Complication of PPROM?
Umbilical cord prolapse
136
Complication of Umbilical cord prolapse?
Fetal hypoxia
137
3 complications of PPROM?
Chorioamnionitis, Preterm delivery, Placental abruption
138
Best management of PPROM?
Relieve cord compression, C-section
139
How long is ulipristal effective as emergency contraception?
Up to 5 days
140
How long is copper IUD effective as emergency contraception?
Up to 5 days
141
Contraindication to copper IUD as form of emergency contraception?
Acute pelvic infection (cervicitis)
142
Sexual assault victims should be provided with empiric post-exposure prophylaxis for …
Chlamydia, Gonorrhea, HIV, Hepatitis B (unless vaccinated), Trichomonas (unless flagellated organisms are not seen on microscopy)
143
HIV post-exposure prophylaxis is offered to Sexual assault victims for up to …
72 hours after assault
144
2 mechanisms by which thyroid hormone production increases during pregnancy?
Estrogen stimulates production of thyroid-binding globulin (TBG), increasing demand for more thyroid hormone production; hCG shares a subunit with TSH, stimulating TSH receptors … decreased TSH release = greater T3/T4 release
145
Change to total T4 during pregnancy?
Increased
146
Change to TSH during pregnancy?
Decreased
147
Antiphospholipid Syndrome is an autoimmune disorder characterized by …
Hypercoagulability + Obstetric complications
148
3 antibodies that are present in setting of Antiphospholipid Syndrome?
Anti-cardiolipin, SLE anticoagulant antibodies, anti-b2 glycoprotein
149
Which type of contraceptive is contraindicated in Antiphospholipid Syndrome?
Estrogen-containing contraceptives
150
Which type of contraceptive is indicated for patients with Antiphospholipid Syndrome who are on long-term anticoagulation?
Progestin IUD … improves heavy menstrual bleeding, decreases risk of anemia
151
When should Pap testing begin in female?
21 yo
152
Which patients should undergo Pap testing before 21 yo?
Immunocompromised
153
Clinical presentation of shoulder dystocia during labor?
Retraction of fetal head into maternal perineum immediately after delivery
154
Initial management of shoulder dystocia during labor?
McRoberts maneuver
155
Description of McRoberts maneuver used in setting of shoulder dystocia during labor?
Maternal hips are hyperflexed; Physician applies suprapubic pressure
156
Phenotype of Androgen Insensitivity Syndrome?
Female
157
Genotype of Androgen Insensitivity Syndrome?
Male – 46XY
158
Clinical presentation of Androgen Insensitivity Syndrome?
Breast development in female; Primary amenorrhea; Lack of axillary + pubic hair
159
Etiology of Androgen Insensitivity Syndrome?
Mutation of androgen receptor gene … causes peripheral tissues to be unresponsive to androgens, despite normal levels of androgens in circulation
160
Inheritance pattern of Androgen Insensitivity Syndrome?
X-linked recessive
161
External genitalia present in Androgen Insensitivity Syndrome?
Vagina that ends in blind pouch
162
Internal genitalia present in Androgen Insensitivity Syndrome?
Absent uterus + fallopian tubes; Cryptorchid testes
163
Initial steps of workup for Androgen Insensitivity Syndrome?
Pelvic US, karyotype, testosterone level
164
Diagnostic lab value for Androgen Insensitivity Syndrome?
Male-range testosterone level
165
What accounts for breast development in Androgen Insensitivity Syndrome?
Excessive testosterone is aromatized to estrogen
166
Most common AE of oral contraceptives?
Irregular, break-through bleeding
167
2 additional AE of oral contraceptives?
Nausea, Breast tenderness
168
2 AE of copper IUD?
Heavy menses, dysmenorrhea
169
What is NOT an AE of oral contraceptives?
Weight gain
170
Definition of pre-eclampsia?
New-onset HTN + proteinuria and/or endo-organ damage at 20+ weeks gestation
171
Best management of patient with HX of severe preeclampsia, now pregnant again?
ASA initiated at 12 weeks gestation
172
Relationship between levothyroxine and pregnancy?
Levothyroxine dose should be increased by 30% when pregnancy is first detected
173
Additional step of hypothyroidism management in pregnancy?
TSH should be measured every 4 weeks
174
Long-term post-operative complications of breast implants?
Capsular contracture … resulting in pain, shape distortion, implant deflation, rupture; NO association between breast implant + breast CA
175
Effect of breast implants on pregnancy + breastfeeding?
None! … No evidence that silicone breast implants cause harmful effects on developing fetus, or are a contraindication to breastfeeding
176
At what age should women with breast implants begin mammogram screening?
NML timeframe … 40-50 yo
177
Appearance of cervix in setting of Trichomoniasis infection?
“strawberry” cervix
178
Best management of Trichomoniasis infection?
Metronidazole treatment for patient AND partner
179
Untreated Trichomoniasis infection is associated with increased risk for …
HIV transmission
180
4 maternal contraindications to pregnancy (termination of pregnancy recommended)?
LVEF < 40%, HX of peripartum cardiomyopathy, Severe pulmonary HTN, Aortic dilation > 40mm
181
Alternative name for Severe pulmonary HTN, resulting from untreated VSD?
Eisenmenger Syndrome
182
Pathogen responsible for condyloma acuminata?
HPV
183
Clinical presentation of children with vertical transmission of HPV?
Lesions in oropharynx, larynx, trachea
184
Best management of pregnant females in labor with active cervical condyloma acuminata?
Expectant vaginal delivery
185
Value of vaginal delivery in pregnant females in labor with active cervical condyloma acuminata?
Vertical transmission of HPV can still occur during C-section
186
Firstline management for primary dysmenorrhea in non-sexually active patients?
NSAIDs
187
Next management for primary dysmenorrhea in patients that did not experience symptomatic relief with NSAIDs?
OCPs
188
Clinical presentation of placenta previa?
Painless vaginal bleeding at > 20 weeks gestation
189
Bleeding from placenta previa is ___ in origin
Maternal
190
3 risk factors for placenta previa?
Prior c-section, Smoking, Multiple gestation
191
1st step in patient with suspected placenta previa?
Transvaginal US
192
Which step of workup is contraindicated in patients with suspected placenta previa?
Digital cervical exam
193
Placenta previa is an absolute contradiction to …
Vaginal delivery … placenta previa necessitates c-section delivery
194
Clinical presentation of amniotic fluid embolism?
Sudden-onset hypoxia, hypotension, bleeding
195
3 complications of amniotic fluid embolism?
Cardiogenic shock, Hypoxenic respiratory failure, DIC
196
Best management of amniotic fluid embolism?
Supportive care … intubation, transfusion
197
What is the single greatest risk factor for breast CA in males?
BRCA2 mutations … (100-fold increased risk)
198
Additional risk factor for breast CA in males?
Klinefelter syndrome … (20-fold increased risk)
199
Inheritance pattern of Klinefelter syndrome?
Sporadic
200
Pathogen responsible for acute lactational mastitis?
Staph aureus
201
2 ABX of choice for treatment of mastitis?
Dicloxacillin, cephalexin
202
Suspected diagnosis for patient with lactational mastitis whose symptoms do not improve with ABX treatment?
Breast abscess
203
Best next step of workup for patient with suspected breast abscess?
US
204
Definition of fetal post-maturity syndrome?
Fetus delivered after 42 weeks
205
Clinical presentation of fetal post-maturity syndrome?
Wrinkled + peeling skin; Long fingernails; Lots of hair; Small for gestational age; Green skin
206
What accounts for green skin in fetal post-maturity syndrome?
In utero meconium passage
207
4 complications associated with fetal post-maturity syndrome?
Meconium aspiration, respiratory distress, hypoglycemia, seizures
208
When should external cephalic version be performed for a breech baby?
37+ weeks
209
Reason for delaying ECV until after 37 weeks?
ECV can cause non-reassuring fetal HR due to abruptio placentae
210
Risk of breech delivery?
Increased risk of asphyxia + fetal injury
211
Appearance of ovarian torsion on Doppler US?
Adnexal mass with absent Doppler flow to ovary
212
First time imaging in diagnosis of suspected ovarian torsion?
Pelvic US
213
Best step of workup for a 35 yo female with a palpable breast mass?
Mammogram … US is first step for women < 30 yo
214
Complication of prolonged pelvic organ prolapse?
Vaginal + cervical erosions … causing abnormal vaginal bleeding
215
Best management of vaginal erosions resulting from prolonged pelvic organ prolapse?
Vaginal estrogen
216
Clinical presentation of prolonged pelvic organ prolapse?
Mass protruding past hymenal ring
217
Clinical presentation of asymptomatic bacteriuria?
Urine culture that grows bacteria … in a patient without clinical signs of UTI
218
Best management of asymptomatic bacteriuria?
Reassurance
219
___ refers to emotional and physical symptoms that occur in second half of menstrual cycle, with resolution promptly with onset of menses
Premenstrual syndrome (PMS)
220
___ refers to a severe form of PMS that is characterized by predominant anger and irritability
Premenstrual Dysphoric Disorder (PMDD)
221
First-line treatment for PMS/PMDD?
SSRI
222
Second-line treatment for PMS/PMDD?
Try a different SSRI
223
Third-line treatment for PMS/PMDD?
Benzodiazepine, or GnRH agonist (leuprolide)
224
Complication associated with PMS/PMDD?
Mood or anxiety disorder
225
3 most common infections that cause vaginitis?
Bacterial vaginosis, Candida, Trichomonas
226
Best workup for patient with vaginitis?
Need to come to office for pelvic exam, wet mount microscopy, and NAAT … (to avoid misdiagnosis, inappropriate treatment)
227
Epidemiology of posterior urethral valve?
Males
228
Appearance of GU system in posterior urethral valve?
Bilateral hydronephrosis, Thickened + dilated bladder, Dilated proximal urethra
229
Additional clinical presentation of posterior urethral valve?
Potter sequence … (oligohydramnios, pulmonary hypoplasia, flattened facies)
230
Best diagnostic test for posterior urethral valve?
Voiding cystourethrogram (VCUG)
231
Appearance of posterior urethral valve on VCUG?
Dilated proximal urethra
232
Best treatment for posterior urethral valve?
Place Foley catheter; Cystoscopy for ablation of the valve (curative)
233
Clinical presentation of ureteropelvic junction obstruction?
Recurrent UTI + unilateral hydronephrosis + no bladder dilation
234
Clinical presentation of vesicoureteral reflux?
Recurrent UTI … without bladder dilation
235
Etiology of vesicoureteral reflux?
Abnormal flow of urine from bladder back into ureter during bladder contraction
236
Change to estrogen in setting of Primary Ovarian Insufficiency?
Decreased
237
Change to FSH in setting of Primary Ovarian Insufficiency?
Increased
238
Clinical presentation of Primary Ovarian Insufficiency?
Amenorrhea before 40 yo
239
Best management of Primary Ovarian Insufficiency?
Combined estrogen + progesterone therapy
240
___ refers to an abnormal collection of blood between the gestational sac and uterine wall
Subchorionic hematoma
241
Etiology of subchorionic hematoma?
Partial separation of chorion from uterine wall
242
Appearance of subchorionic hematoma on US?
Blood collection appears as a crescent on US … hypoechoic lesions adjacent to gestational sac
243
Best management of subchorionic hematoma?
Reassurance with serial US
244
4 activities that should be avoided in pregnancy?
Skiing, gymnastics, horseback riding, scuba diving
245
Pathogen responsible for punctate hemorrhage in vagina + cervix?
Trichomonas
246
pH level seen in Trichomonas infection?
Elevated (pH > 4.5)
247
DOC for Trichomonas infection?
Single-dose of oral metronidazole (2g)
248
How does management of Trichomonas infection change in breastfeeding females?
Females should express + discard breastmilk for 24 hours after metronidazole administration
249
Why should breastmilk be expressed + discarded after a dose of metronidazole?
Metronidazole may cause loose stools and candidiasis in infants
250
1 ho male is evaluated in newborn nursery; Mother had asymptomatic GBS infection during 1st trimester, then received 1 dose IV ampicillin 2 hours before delivery - what is best management of child?
Observation
251
When should IV ampicillin be administered to mothers who test (+) for GBS during pregnancy?
At least 4 hours before delivery
252
Best management of infants born to mother with inadequate IV ampicillin for GBS during pregnancy, but no signs of sepsis?
Observation
253
Best management of infants born to mother with inadequate IV ampicillin for GBS during pregnancy, with signs of infant sepsis, maternal fever, preterm delivery?
Blood cultures, ABX
254
36 yo female presents at 10 weeks gestation for initial prenatal visit; HX of gonococcal cervicitis as teenager; Otherwise normal workup - in addition to routine prenatal labs, which test should be offered to patient today?
Cell-free DNA
255
Role of Cell-free DNA testing?
Fetal sex determination; Screening for trisomy 21-18-13
256
Indication for offering Cell-free DNA testing?
Maternal age > 35 yo, sonographic finding associated with fetal aneuploidy, prior pregnancy with fetal aneuploidy
257
32 yo female presents at 19 weeks due to vaginal pressure and spotting; PE reveals amniotic membranes bulging at vaginal introitus; Cervix is dilated and 100% effaced - diagnosis?
Cervical insufficiency
258
4 risk factors for Cervical insufficiency?
Connective tissue disorder, cervical conization, uterine abnormalities, obstetric injury
259
Time in pregnancy at which cervical insufficiency can be diagnosed?
> 24 weeks
260
Prognosis for cervical insufficiency?
Even with cerclage placement, prognosis for current pregnancy is poor
261
When is cerclage typically placed for cervical insufficiency?
12-14 weeks gestation
262
Recommendation about folate supplementation for women planning to conceive?
0.4mg folic acid for 1+ month prior to conception
263
What is best management of NV in a pregnant female who is HD stable, with (-) ketones on UA?
Not hyperemesis gravidarum; oral vitamin B6, H1 antihistamine, outpatient management
264
25 yo female presents at 28 weeks for initial prenatal visit; She is Rh(D) negative, husband is Rh(D) positive; Patient’s previous pregnancy was complicated by placental abruption; She received standard dose of anti-D Ig at 28 weeks, and immediately post-partum; Today, patient’s anti-D Ig titers are 1:32 - what is likely cause of (+) Ig results in this patient?
Inadequate dose of anti-D Ig post-partum
265
30 yo female presents at 14 weeks for routine prenatal visit; Initial prenatal labs were NML, except for urine culture, which grew GBS - what is best next step?
Treat with amoxicillin now, then penicillin PPX during labor
266
Role of “now” treatment in GBS infection during pregnancy?
Prevent obstetric complications
267
Role of “at delivery” treatment in GBS infection during pregnancy?
Prevent neonatal GBS infection
268
22 yo female presents for wellness visit; Only engages in WSW sexual activity - best counseling for this patient regarding health-related issues associated with WSW?
WSW have a higher risk of BV, higher risk of cervical CA
269
9 health conditions that are over-represented in WSW?
CAD, T2DM, OB, Cervical CA, BCA, Ovarian CA, Depression, Intimate partner violence, BV
270
11 yo female presents with vulvar pruritis, causing her to awaken from sleep at night; Reports perianal pruritis and constipation; PE shows white lesions covering vulva, perineum, and anus; Labia majora/minora are edematous with thickened skin - diagnosis?
Lichen sclerosis
271
Best management of Lichen sclerosis?
Super potent corticosteroid ointment
272
46 yo female presents after microcalcifications were found on MMG; Core needle BX shows LCIS in L breast - what is best next step of management?
Excisional Bx
273
Best management of leiomyoma in females who wish to preserve fertility?
OCPs, IUDs
274
3 aspects of the athlete triad?
Low caloric intake, amenorrhea, bone loss
275
3 aspects of clinical presentation for functional hypothalamic amenorrhea?
Amenorrhea, hypoestrogenism, low BMI
276
female with Stage 4 BCA is admitted to hospice; Currently on statin, basal insulin (A1c 8.8), lisinopril, levetiracetam, sertraline, oxycodone; Vitals show BP 125/84, HR 76, RR 14; Which change should be made to patient’s medication regimen?
Discontinue lisinopril and statin
277
3 types of medications that should be discontinued for patients with end-of-life care?
Cardiovascular prevention (statin, ASA), anti-HTN, pre-meal insulin
278
52 yo female presents for 8 months of irregular vaginal bleeding; Also experiencing hot flashes, difficulty sleeping, HA, insomnia; BMI is 35 - what is best explanation of patient’s symptoms?
Likely menopause transition, but also need endometrial Bx to further evaluate
279
Which females need endometrial Bx in setting of menopause transition?
Females > 45 with anovulatory bleeding (heavy, irregular vaginal bleeding)
280
16 yo female presents with breast lump; LKMP was 1 week ago; PE shows rubbery 4cm mass in superior outer quadrant of L breast - diagnosis?
Fibroadenoma
281
Best management of Fibroadenoma in adolescents?
Observation with repeat exam
282
Clinical prognosis for Fibroadenoma?
Will decrease in size after menses
283
Best managemnt of 18 yo female who presents for heavy vaginal bleeding with several clots?
OCPs
284
28 yo female presents for lump in L breast; LKMP was 5 days ago; Patient uses progestin-containing subdermal impalant for contraception; PE reveals 1.5 cm round, mobile mass in upper outer quadrant of L breast - what is best management?
Obtain US
285
What is best management of palpable US in females < 30?
US
286
29 yo female presents for 7 hours of lower abdominal pain, worse with movement and deep inspiration; Underwent laparoscopic appendectomy at 14 yo; Sexually active, uses condoms; LKMP was 5 weeks ago; BP 84/60, HR 124, RR 18; PE shows diffusely tender abdomen with rebound and guarding; Pelvic exam shows cervical motion tenderness with diffuse uterine and adnexal TTP; Labs show WBC 11, B-HCG 1,100 - diagnosis?
Ruptured ectopic pregnancy with signs of hemoperitoneum (abdominal rigidity, HD instability)
287
What is best management of ruptured ectopic pregnancy?
Emergent laparoscopy
288
37 yo female presents for L breast mass; HX of PCOS, benign fibroadenoma; PE shows 2cm smooth, tender mobile mass in L breast; Mammogram is without calcifications; US shows cystic mass with smooth borders, thin walls, no internal septations; Thin, green fluid is extracted from mass during FNA - diagnosis?
Simple breast cyst
289
What is best management of simple breast cyst?
Observation
290
Clinical appearance of vesicovaginal fistula?
Red granulation fistula on anterior surface of vagina
291
What is best workup for suspicious vesicovaginal fistula?
Bladder dye testing
292
What is the best recommendation regarding breast self-examination?
Not recommended at any age
293
42 yo female presents after recent diagnosis of ER+/PR+/HER2- BCA; Will be started on course of tamoxifen; What is best screening strategy for side effects of tamoxifen?
Evaluation only if symptoms develop
294
24 yo female presents at 32 weeks gestation for increased SOB, wheezing, cough; HX of asthma, but currently off maintenance inhaler; PE shows HR 104, mild respiratory distress, inspiratory/expiratory wheezing with prolonged exhalation phase; ABG 7.45/26/100 on 2L NC - what is next best step of diagnosis?
Administer systemic steroids and observe
295
4 aspects of management for asthma exacerbation in pregnancy?
O2 sat > 95%, treat with albuterol/ipratropium; Steroids (PO prednisone) if unresponsive to albuterol/ipratropium
296
2 aspects of treatment for severe asthma exacerbation in pregnancy?
MgSO4, terbutaline
297
Which medication is contraindicated in treatment for asthma exacerbations in pregnancy?
Epinephrine
298
28 yo female presents for 2 days of vaginally spotting; LKMP 6 weeks ago; Pelvic exam shows dark blood in posterior fornix and closed cervix; Bimanual exam shows mild L adnexal TTP with fullness; B-HCG is 37000; TVUS shows 4.6cm L adnexal mass and thickened endometrium - diagnosis?
Ectopic pregnancy
299
3 hallmark features of ectopic pregnancy?
Vaginal bleeding, (+) B-HCG, complex adnexal mass
300
Most common location for ectopic pregnancy?
Ampulla of Fallopian tube
301
30 yo female presents for infertility after trying to conceive for 1 year; During the past 1 year, she has experienced hot flashes; Labs show elevated FSH, low estrogen, NML prolactin, NML TSH, negative urine pregnancy test; US shows normal uterus with thin endometrial stripe, small ovaries - diagnosis?
Primary Ovarian Insufficiency
302
3 best initial steps of workup in patient with Primary Ovarian Insufficiency?
Adrenal antibodies, TSH, karyotype analysis
303
39 yo female G7P7 presents for increased vaginal bleeding, 20 minutes following a vacuum-assisted delivery; At time of delivery, placenta appeared intact; Now experiencing heavy vaginal bleeding with clots; BP 140/80, HR 106 - what is next best step in management?
Perform uterine massage, administer oxytocin
304
What is the most common cause of post-partum hemorrhage?
Uterine atony … failure of uterus to contract after placental separation
305
Firstline management of uterine atony?
Bimanual uterine massage, Oxytocin infusion
306
27 yo female G3P1A1 at 26 weeks presents for abdominal pain, heavy bleeding; Recent trauma to abdomen at 25 weeks; GYN history includes C-section, smoking 0.5 PPD - diagnosis?
Placental abruption
307
Placental abruption refers to …
Separation of placenta before fetal delivery
308
26 yo female presents at 39 weeks for painful contraction; No vaginal bleeding or rupture of membranes; After 2 hours in labor, contractions have slowed, dilation is unchanged - best management?
Administer IV oxytocin
309
Definition of latent phase labor?
Regular contractions to cervical dilation of 6cm
310
Definition of active phase labor?
Cervical dilation from 6cm to 10cm
311
What is the most common cause of labor protraction?
Inadequate uterine contractions
312
What is the adequate rate of cervical dilation?
1 cm per 2 hours
313
Hemolytic disease of newborn due to Rh(D) incompatibility is possible only in a ___ mother and ___ father
Rh(D) negative; Rh(D) positive
314
24 yo female presents at 12 weeks gestation for initial prenatal visit; Labwork is positive for RPR, fluorescent treponemal Ig; HX of rash and SOB when taking penicillin as child; No neurologic symptoms - best management?
Penicillin desensitization … syphilis can vertically transmit … penicillin will cross placenta and treat fetal disease too
315
Which 2nd-line treatment for syphilis is CI in pregnancy?
Doxycycline
316
31 yo female presents at 9 weeks gestation; concerned that she did not take folate supplements during 1st trimester; AFP is 3.0 (NML < 2.5), with repeat 3.1 - what is next best step in management?
Perform a trans-abdominal OB US
317
3 conditions associated with elevated AFP?
NTD, Ventral wall defect, Multiple gestation
318
1 condition associated with decreased AFP?
Trisomy 21/18
319
Most common cause of secondary amenorrhea?
Pregnancy
320
Post-partum preeclampsia may present up to ___ weeks after delivery
12
321
Clinical criteria for diagnosis of preeclampsia?
New-onset HTN + End-organ damage
322
4 examples of end-organ damage seen in cases of pre-eclampsia?
Pulmonary edema, hyperreflexia, HA, vision changes
323
Definition of Fetal growth restriction?
Fetal weight < 10th percentile for gestational age
324
What accounts for development of fetal hypoxemia in cases of Fetal growth restriction?
Placental insufficiency
325
Screening tools used in Fetal growth restriction?
Umbilical artery doppler US, biophysical profiles
326
Which finding on Umbilical artery doppler US suggests fetal hypoxia?
Reversed (or absent) blood flow
327
Next step of management if Umbilical artery doppler US shows reversed (or absent) blood flow?
Immediate delivery
328
3 vaccines that are safe for administration in pregnant females?
Inactivated influenza, TDAP, Rho(D) immunoglobulin
329
What is the optimal time for administration of TDAP vaccine in pregnancy?
3rd trimester (28+ weeks)
330
What is the optimal time for administration of inactivated influenza vaccine in pregnancy?
Every trimester, should be administered to pregnant females as soon as vaccine becomes available
331
Etiology of adenomyosis?
Abnormal endometrial tissue invasion into the myometrium
332
Clinical presentation of adenomyosis?
Dysmenorrhea, Heavy menstrual bleeding, pelvic pain
333
2 risk factors for development of adenomyosis?
Multiparity, Prior uterine surgery (myomectomy)
334
Change to appearance of uterus in adenomyosis?
Global enlargement of uterus
335
Definitive diagnostic test for adenomyosis?
Biopsy … showing endometrial tissue within the myometrium
336
Appearance of adenomyosis on MRI or US?
Thickened myometrial layer
337
Treatment for adenomyosis?
Hysterectomy
338
Patients with PCOS are at increased risk of developing ___ CA
Endometrial
339
What accounts for increased risk of endometrial cancer in patients with PCOS?
Unopposed estrogen causes endometrial proliferation
340
Best exercise recommendation for pregnant patients with cerclage placed?
Exercise is contraindicated
341
Additional contraindication to exercise during pregnancy?
Active vaginal bleeding
342
29 yo female (G1P0 at 18 weeks), develops severe, paroxysmal right flank pain, radiating into labia; Pain is sharp, not associated with fever, hematuria, dysuria; Patient develops associated NV when the pain occurs; PE shows TTP along R abdomen – what is next step of workup?
Renal, pelvic US
343
29 yo female (G1P0 at 18 weeks), develops severe, paroxysmal right flank pain, radiating into labia; Pain is sharp, not associated with fever, hematuria, dysuria; Patient develops associated NV when the pain occurs; PE shows TTP along R abdomen – most likely diagnosis?
Kidney stones
344
What accounts for increased risk of kidney stones during pregnancy?
Increased urinary excretion of Ca2+, urinary stasis, decreased bladder capacity
345
33 yo female at 33 weeks gestation presents with PPROM (cervix appears visibly closed); Amniotic fluid index is 3cm – what is the next best step of management?
Administer latent ABX
346
What is the most likely etiology of PPROM?
Subclinical intrauterine infection
347
4 risk factors for development of PPROM?
Genital tract infection (BV), tobacco use, 1st trimester bleeding, HX of PPROM in previous pregnancy
348
Definition of PPROM?
Membrane rupture with absence of contractions
349
Best management of PPROM < 34 weeks, without infection?
PPx ABX
350
Best management of PPROM < 34 week, with infection?
Delivery, Steroids, Mag if < 32 weeks, Ampicillin + gentamicin
351
ABX of choice for PPROM < 34 weeks?
Ampicillin + azithromycin
352
Best management of PPROM > 34 weeks?
Delivery, GBS prophylaxis
353
For a female with PCOS struggling with infertility – what are 2 best treatment options for infertility?
Letrozole, clomiphene
354
MOA of Letrozole in treatment of infertility in PCOS?
Inhibits conversion of androgen to estrogen at the ovary; Stimulates increased production of GnRH and FSH/LH … inducing ovulation
355
MOA of Clomiphene in treatment of infertility in PCOS?
Acts on estrogen receptors at the hypothalamus … Hypothalamus perceives low estrogen levels, stimulates increased production of LH and FSH … inducing ovulation
356
Definition of spontaneous abortion?
Pregnancy loss < 20 weeks
357
3 risk factors for spontaneous abortion?
Advanced maternal age, substance abuse, previous spontaneous abortion
358
Most common cause of spontaneous abortion?
Fetal chromosomal abnormality
359
Definition of preeclampsia?
New-onset hypertension at > 20 weeks gestation with proteinuria and/or end-organ damage
360
BP required for diagnosis of preeclampsia?
> 140/90
361
6 clinical features of preeclampsia with severe features?
BP > 160/110, thrombocytopenia, elevated creatinine, transaminitis, pulmonary edema, CNS symptoms
362
When is delivery indicated for preeclampsia without severe features?
> 37 weeks
363
When is delivery indicated for preeclampsia with severe features?
> 34 weeks
364
Best management before delivery planning for preeclampsia?
Magnesium sulfate, antihypertensives
365
Role of Magnesium sulfate in management of preeclampsia?
Seizure prevention
366
Female is born at 39 weeks gestation; FHX of cystic fibrosis, IDA; Prenatal US shows cystic sac over lumbar spine; PE shows red sac with overlying membrane over L spine – diagnosis?
Spina bifida
367
What is most common complication of Spina bifida?
Neurogenic bladder
368
Etiology of Spina bifida?
Failure of neural tube to close
369
Risk factor for Spina bifida?
Inadequate maternal folate intake
370
4 aspects of clinical presentation for Spina bifida?
Neurogenic bladder, hydrocephalus, scoliosis, motor/sensory dysfunction
371
Best management of Spina bifida after delivery?
Defect wrapped in moist, sterile dressing, covered with plastic wrap to prevent infection + feat loss; Surgical repair
372
26 yo female at 30 weeks gestation presents for hematuria, dysuria; Seen in the office 2 days ago for similar symptoms, urine culture still pending; Prescribed nitrofurantoin for suspected UTI, unable to take first dose until today; PE shows no CVA tenderness; Labs show WBC 16, HCO3 18; UA (+) for leukocyte esterase, nitrites, many bacteria – what is next step in management?
Reassure and continue nitrofurantoin
373
Best management of pyelonephritis in pregnancy?
Ceftriaxone
374
Risk of pyelonephritis in pregnancy?
Rapid progression to sepsis
375
Normal respiratory change in pregnancy?
Respiratory alkalosis
376
What accounts for Respiratory alkalosis in pregnancy?
Low tidal volume and minute ventilation
377
Change to HCO3 seen in pregnancy?
Decreased
378
Change to WBC seen in pregnancy?
Mild leukocytosis (5-15)
379
2 key aspects of Clinical presentation for pyelonephritis in pregnancy?
Fever, CVA tenderness
380
32 yo female presents at 11 weeks gestation; At 6 weeks gestation, US showed 12cm complex R adnexal mass with multiple septations; Repeat US at 11 weeks shows no change in appearance of R adnexal mass, but mild increase in size to 13cm – what is next best step in management?
Perform surgical removal at beginning of 2nd trimester
381
When is excision of surgical mass recommended for pregnant females with pelvic mass?
Complex features (thick septations), >10 cm in diameter (increased risk of torsion, rupture, labor obstruction)
382
Lab finding associated with epithelial ovarian carcinoma?
Increased CA-125
383
6 risk factors associated with epithelial ovarian carcinoma?
BRCA, HRT, endometriosis, infertility, early menarche, late menopause
384
3 protective factors for epithelial ovarian carcinoma?
OCPs, Multiparity, breastfeeding
385
3 US findings associated with epithelial ovarian carcinoma?
Solid + complex mass, thick septations, ascites
386
Management of epithelial ovarian carcinoma?
Surgical excision, CTX
387
Firstline treatment for infertility in PCOS?
Weight loss … improves ovulation due to decreased adipose tissue volume
388
Patients with PCOS who do not respond to weight loss as treatment of infertility should be treated with …
Letrozole
389
MOA of letrozole?
Aromatase inhibitor
390
Most common cause of abnormal uterine bleeding in adolescents?
Anovulation
391
Etiology of Anovulation in adolescents?
Immature HPO axis
392
5 fetal complications of adolescent pregnancy?
Gastroschisis, Omphalocele, Preterm birth, Low birth weight, Perinatal death
393
5 maternal complications of adolescent pregnancy?
Anemia, Postpartum depression, Preeclampsia, Operative delivery, Hydatidiform mole
394
33-year-old female presents for contraception; reports history of migraine headaches, current smoking 1.5 PPD - what is her contraindication to combined hormonal contraception?
History of migraine headaches with aura
395
What are 10 contraindications (absolute) to use of combined hormonal contraception?
History of thromboembolic disease, antiphospholipid antibody syndrome, history of stroke, breast cancer, cirrhosis, < 3 weeks postpartum, hypertension greater than 160/100, heavy smokers (15+ cigarettes per day), migraines with aura, diabetes
396
Foot her 3 options for combined hormonal contraception?
Estrogen/progestin pills, transdermal patch, vaginal ring
397
48-year-old male presents with jaundice; has been breast-feeding exclusively with good latch; maternal blood type O+, fetal blood type A+; direct antiglobulin test is positive; total bilirubin 25.1, direct bilirubin 0.6 - diagnosis?
ABO hemolytic disease
398
Best treatment for mild cases of ABO hemolytic disease?
Photo-therapy
399
Best management of severe ABO hemolytic disease (bilirubin 20-25)?
Exchange transfusion (infants RBCs and replaced with donor RBCs)
400
3 indications for exchange transfusion for severe ABO hemolytic disease?
Severe hyperbilirubinemia (20-25), worsening hyperbilirubinemia on phototherapy, signs of bilirubin induced neurologic dysfunction
401
31-year-old female presents for contraception; maternal aunt diagnosed with breast cancer, passed away from complications related to pulmonary embolism; what is best contraception option for this patient?
Progestin subdermal implant
402
What is the most effective type of contraception?
Progestin subdermal implant
403
22-year-old female presents for fever, abdominal pain; 1 week ago underwent elective termination of pregnancy; for the past 3 days, patient has had increasing purulent vaginal discharge; T102.2, BP 93/52, HR 120; PE reveals cervical motion tenderness; US reveals echogenic mass in endometrial cavity near the uterine fundus; beta hCG is positive -- diagnosis?
Septic abortion
404
Best management of septic abortion?
Broad-spectrum IV ABX, suction curettage
405
35-year-old female presents at 27 weeks gestation, after involved in MVA; airbag was deployed, patient restrained by lap seatbelt; patient reports dull abdominal pain; PE reveals mild tenderness at uterine fundus; tocometer exhibits low amplitude contractions every 3 minutes; labs revealed maternal blood type A-, with negative antibody screen -- what is next step in management?
Order a Kleihauer-Betke test, continue fetal monitoring
406
35-year-old female presents at 27 weeks gestation, after involved in MVA; airbag was deployed, patient restrained by lap seatbelt; patient reports dull abdominal pain; PE reveals mild tenderness at uterine fundus; tocometer exhibits low amplitude contractions every 3 minutes; labs revealed maternal blood type A-, with negative antibody screen -- possible diagnosis?
Concealed placental abruption
407
Role of Kleihauer-Betke test?
Determines presence of fetal maternal hemorrhage, so that amount of R(D) antibody to be administered can be calculated
408
36-year-old female presents at 34 weeks gestation for 4 hours of decreased fetal movement; last prenatal visit was at 16 weeks gestation; BP 160/90, fundal height 38 cm; bedside US reveals amniotic fluid index of 30; UA shows 2+ protein, glucose -- what is most likely etiology of patient's ultrasound findings?
Gestational DM
409
Definition of polyhydramnios?
Amniotic fluid index > 24
410
Change to amniotic fluid index seen in preeclampsia?
Oligohydramnios
411
18-year-old female presents at 40 weeks gestation with several hours of contractions; contractions occur every 2-3 minutes; fetal head is at -1 station; after 3 hours of correct pushing technique, fetal vertex does not descend past -1 station; patient reports that she feels fatigued -- what is next step in management?
Perform C-section delivery after consent is obtained
412
18-year-old female presents at 40 weeks gestation with several hours of contractions; contractions occur every 2-3 minutes; fetal head is at -1 station; after 3 hours of correct pushing technique, fetal vertex does not descend past -1 station; patient reports that she feels fatigued -- diagnosis?
2nd stage labor arrest
413
Definition of second stage labor arrest?
No fetal descent after nulliparous patients pushed for more than 3 hours without epidural, or more than 4 hours with epidural
414
Best management of second stage labor arrest?
C-section
415
39-year-old female presents at 7 weeks for vaginal bleeding; denies abdominal pain or cramping; patient has history of HIV, but has declined treatment; reports extensive smoking history; BP 130/80; speculum exam reveals bright red blood in vaginal vault, 3 cm firm, white irregular mass on anterior cervix; labs show O- maternal blood type, hCG > 4,000, CD4 165, viral load > 44,000 --diagnosis?
Cervical cancer
416
39-year-old female presents at 7 weeks for vaginal bleeding; denies abdominal pain or cramping; patient has history of HIV, but has declined treatment; reports extensive smoking history; BP 130/80; speculum exam reveals bright red blood in vaginal vault, 3 cm firm, white irregular mass on anterior cervix; labs show O- maternal blood type, hCG > 4,000, CD4 165, viral load > 44,000 --best next step in management?
Cervical punch biopsy
417
30-year-old female G3, P0 A3 presents for recurrent spontaneous abortions; history of laparoscopic right ovarian cystectomy at age 18 for large benign cyst; hysterosalpingogram demonstrates filling defect in the middle of uterine cavity and bilaterally patent fallopian tubes; what is the best management to prevent recurrent miscarriage?
Hysteroscopy with uterine defect repair
418
With addition of her current pregnancy loss?
3+ consecutive spontaneous abortions (less than 20 weeks gestation?
419
22-year-old female presents for 3 weeks of RLQ pain, which is exacerbated by bowel movements; on exam, right adnexa is enlarged and tender; there is nodularity, tenderness on rectovaginal examination -diagnosis?
Endometriosis
420
Complication of endometriosis?
Infertility, chronic pelvic pain
421
Accounts for infertility in the setting of endometriosis?
Pelvic adhesions and inflammation
