Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

UWorld > OBGYN > Flashcards

OBGYN Flashcards

1
Q

2 possible next steps in management after Pap testing shows high-grade squamous epithelial lesion?

A

LEEP or colposcopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is involved in LEEP procedure?

A

Excision of cervical transformation zone + surrounding endocervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Who should be screened annually for gonorrhea and chlamydia?

A

Sexually active females < 25 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Screening test of choice for detection of gonorrhea and chlamydia?

A

Nucleic acid amplification testing (NAAT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Best treatment for gonorrhea and chlamydia detected by NAAT?

A

Azithromycin + Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most likely diagnosis in post-menopausal female who presents with new-onset pelvic pressure, uterine mass, and ascites?

A

Uterine sarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most common location of ascites in uterine sarcoma?

A

Posterior cul-de-sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most common site of metastasis in uterine sarcoma?

A

Lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Next step of workout for post-menopausal female with suspected uterine sarcoma?

A

Hysterectomy … to confirm diagnosis and stage disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

2 risk factors for development of uterine sarcoma?

A

Tamoxifen use, Pelvic radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When does gestational thrombocytopenia typically occur?

A

2-3 trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Typical platelet count of gestational thrombocytopenia?

A

70,000–150,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Typical prognosis of gestational thrombocytopenia?

A

Resolution after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 possible mechanisms for gestational thrombocytopenia?

A

Hemodilution, Accelerated platelet destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Best management of gestational thrombocytopenia?

A

Serial CBC during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When might gestational thrombocytopenia be a contraindication to neuraxial analgesia?

A

Severe thrombocytopenia < 70,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why is severe thrombocytopenia in gestational thrombocytopenia a contraindication to neuraxial analgesia?

A

Associated with increased risk of spinal epidural hematoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Menopausal Hormone Therapy (MHT) is the most effective treatment available for …

A

Menopausal hot flashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4 beneficial effects of Menopausal Hormone Therapy (MHT)?

A

Decreased risk of osteoporosis, colon CA, T2DM, all-cause mortality < 60 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

5 detrimental effects of Menopausal Hormone Therapy (MHT)?

A

Increased risk of CVA, DVT, breast CA, gallbladder disease, CAD > 60 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

3 qualities of physiologic nipple discharge?

A

Bilateral, Multiductal, Expressed only with manipulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Initial workup for patients with nipple discharge?

A

US for women < 30 yo; Mammogram for women > 30 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patients with nipple discharge and (–) US/mammogram findings should undergo …

A

Prolactin, thyroid studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Endometriosis is defined by …

A

Presence of endometrial tissue outside uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

4 most common locations of endometrial tissue in setting of endometriosis?

A

Ovaries, fallopian tubes, cul-de-sac, uterosacral ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

2 most common symptoms of endometriosis?

A

Dysmenorrhea, dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

2 DOCs for endometriosis?

A

NSAIDs, OCPs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Definitive treatment for endometriosis?

A

Hysterectomy + bilateral salpingo-oophorectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Most common pathogen responsible for acute cystitis?

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Best treatment of acute cystitis in pregnant females?

A

Empiric treatment with ABX for 3-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

3 options for Empiric ABX treatment for acute cystitis in pregnant females?

A

Nitrofurantoin, Cephalexin, Amoxicillin-Clavulanate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Best treatment of acute pyelonephritis in pregnant females?

A

Admission + IV ceftriaxone/cefepime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Among the risk factors for recurrent PID, what is the strongest?

A

Multiple sexual partners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Clinical presentation of uterine rupture?

A

Sudden-onset severe abdominal pain, vaginal bleeding, loss of fetal station

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Sign of uterine rupture on fetal HR tracing?

A

Late decelerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Late decelerations on fetal HR tracing suggest …

A

Fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Major risk factor for uterine rupture?

A

HX of classical (vertical) C-section, myomectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Best management of uterine rupture?

A

Emergency laparotomy for delivery + uterine repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Description of RhD alloimmunization?

A

RhD (-) mother develops Ig against RhD (+) Ag in fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When should Anti-D Ig be administered during pregnancy?

A

28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Who should receive Anti-D Ig during pregnancy?

A

All RhD (-) females with negative anti-D Ig screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Who should receive Anti-D Ig post-partum?

A

All RhD (-) females with RhD (+) baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Timing required for diagnosis of peripartum cardiomyopathy?

A

36 weeks gestation - 5 months postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

3 risk factors for peripartum cardiomyopathy?

A

30+ yo, Multiple gestation, Preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Best tool for assessing risk of recurrence for peripartum cardiomyopathy?

A

LV function at diagnosis, current LV function … assessed by ECHO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

3 characteristics of pathologic nipple discharge?

A

Spontaneous, unilateral, persistent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Most common cause of pathologic nipple discharge?

A

Ductal papilloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Best management of pathologic nipple discharge in women < 30 yo?

A

Mammogram + US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Best management of pathologic nipple discharge in women > 30 yo?

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

All post-menopausal females should be asked about …

A

Vaginal dryness, dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Medication (not hormonal therapy) that can be used to treat vasomotor symptoms for menopausal females?

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Best treatment for vaginal atrophy resulting from menopause?

A

Topical low-dose estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

3 aspects of clinical presentation for urethral diverticulum?

A

Dysuria, Dyspareunia, Anterior vaginal mass (which expresses bloody/purulent fluid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Etiology of urethral diverticulum?

A

Repeated infection, inflammation, urethral trauma during surgery or vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Initial workup for urethral diverticulum?

A

UA, urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Diagnostic test for urethral diverticulum?

A

Confirmed with imaging … pelvic MRI, transvaginal US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

All post-menopausal females should be asked about …

A

Vaginal dryness, dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Medication (not hormonal therapy) that can be used to treat vasomotor symptoms for menopausal females?

A

SSRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Best treatment for vaginal atrophy resulting from menopause?

A

Topical low-dose estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

GI complication associated with pregnancy?

A

Increased incidence of gallstones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What accounts for increased incidence of gallstones during pregnancy?

A

Bile becomes supersaturated with cholesterol; Decreased gallbladder motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Best management of pregnancy-associated gallstones?

A

Spontaneous resolution within 2 months of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

3 aspects of 1st trimester combined screening test for aneuploidy?

A

Nuchal translucency, b-HCG, PAPP-A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Does the 1st trimester combined screening test provide a definitive diagnosis of aneuploidy?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

2 tests that provide a definitive diagnosis of aneuploidy?

A

Chorionic villous sampling, Amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When can Chorionic villous sampling be performed during pregnancy?

A

10-13 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

When can Amniocentesis be performed during pregnancy?

A

15 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

BG management for female with gestational DM (treated with insulin regimen), after delivery?

A

Females do NOT require post-partum insulin treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Initial screening for T2DM in females with gestational DM?

A

Fasting BG … 24-72 hours after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Next screening for T2DM in females with gestational DM?

A

Oral glucose tolerance test … 6-12 weeks after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Ultimate screening for T2DM in females with gestational DM?

A

Diabetic screening every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Definition of pre-term labor?

A

Regular uterine contractions, resulting in cervical dilation at < 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Best management of pre-term labor at < 32 weeks?

A

Steroids, Tocolytics, Penicillin, Magnesium sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Best management of pre-term labor at 32-34 weeks?

A

Steroids, Tocolytics, Penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Steroid of choice in management of pre-term labor at 32-34 weeks?

A

Betamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Tocolytic of choice in management of pre-term labor at 32-34 weeks?

A

Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Who should receive Penicillin in management of pre-term labor?

A

Patients with (+) or unknown GBS status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Best management of pre-term labor at 34-37 weeks?

A

Steroids, Penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

42 yo female presents with fever, uterine tenderness on Day 2 after c-section – diagnosis?

A

Postpartum endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Most common pathogens responsible for Postpartum endometritis?

A

Polymicrobial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Etiology of Postpartum endometritis?

A

Ascent of vaginal floral into uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Most significant risk factor for Postpartum endometritis?

A

C-section delivery, especially when preformed after labor has begun / membranes have ruptured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

4 additional risk factors for Postpartum endometritis?

A

GBS infection, prolonged rupture of membranes, protracted labor, operative vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

ABX of choice for patient with Postpartum endometritis?

A

Clindamycin + gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

First step in evaluation of infertility?

A

Semen analysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

17 yo female presents with purulent vaginal discharge; PE shows cervical friability – diagnosis?

A

Acute cervicitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

2 most common pathogens responsible for Acute cervicitis?

A

Gonorrhea, chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Empiric treatment for Acute cervicitis?

A

Ceftriaxone (gonorrhea) + Doxycycline (chlamydia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Initial step of workup for patient with suspected Acute cervicitis?

A

NAAT PCR testing to confirm infection, but with empiric treatment (does not require waiting for NAAT results)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Diagnosis of cervical insufficiency can be made via …

A

2+ painless 2nd trimester losses; Presentation of painless cervical dilation in 2nd trimester of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

2 risk factors for development of cervical insufficiency?

A

Uterine abnormalities (bicornuate uterus), Ehlers-Danlos syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Best management for cervical insufficiency?

A

Placement of cerclage at 12-14 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

In patients who are pregnant with diamniotic/dichorionic twins, mode of delivery is determined by …

A

Fetal presentation (vertex vs. breech)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

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?

A

Expectant delivery of Twin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

ABX of choice for treatment of pelvic inflammatory disease?

A

Cefoxitin + doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

2 most common pathogens responsible for PID?

A

Neisseria gonorrhea, Chlamydia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Which ABX is NOT recommended in treatment of PID?

A

Ciprofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

First-line contraceptive method for adolescent females?

A

Long-Acting Reversible Contraception (LARC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

2 methods of LARC?

A

IUD + Contraceptive implants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

How long is copper-containing IUD effective?

A

10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

How long is progestin-secreting IUD effective?

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How long is subdermal implant contraceptive effective?

A

3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Which form of contraceptive is recommended for patients with heavy bleeding or dysmenorrhea?

A

Progestin-releasing IUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Why is IUD preferred to depot medroxyprogesterone in adolescents seeking contraceptive?

A

Depot medroxyprogesterone has a lower efficacy (94%) compared to IUD (99%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Etiology of HCG hyper-stimulation syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Role of HCG injections before IVF?

A

b-HCG stimulates multiple follicle production, in preparation for egg retrieval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Clinical presentation of HCG hyper-stimulation syndrome?

A

NV, abdominal pain, ascites, pleural effusion, bilateral ovary enlargement, hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Complications of HCG hyper-stimulation syndrome?

A

Renal failure, ARDS, DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Initial workup for HCG hyper-stimulation syndrome?

A

CBC, electrolytes, coagulation studies, b-HCG levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Best management of HCG hyper-stimulation syndrome?

A

Correct electrolyte abnormalities, perform therapeutic paracentesis/thoracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Definition of precocious puberty in males?

A

Age < 9 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Definition of precocious puberty in females?

A

Age < 8 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

How does relationship between bone age + chronologic age change in setting of precocious puberty?

A

Precocious puberty = Bone Age > Chronologic Age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Change to LH and FSH levels in setting of central precocious puberty?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Etiology of central precocious puberty?

A

Early activation of hypothalamic-pituitary-gonadal axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Change to LH and FSH levels in setting of peripheral precocious puberty?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Etiology of precocious puberty?

A

Abnormal secretion of estrogen/testosterone from peripheral organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Best management of central precocious puberty?

A

GnRH agonist … down-regulates LH and FSH release from pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Pregnant patient presents with thin, malodorous vaginal discharge – diagnosis?

A

Bacterial vaginosis (BV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Pathogen most commonly responsible for Bacterial vaginosis (BV)?

A

Gardnerella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Vaginal pH in Bacterial vaginosis (BV)?

A

pH > 4.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Result of microscopy that suggests Bacterial vaginosis (BV)?

A

Clue cells (epithelial cells covered in bacteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

DOC for Bacterial vaginosis (BV)?

A

Metronidazole, Clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Complication of Bacterial vaginosis (BV)?

A

PPROM, preterm labor, post-partum endometritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Role of ABX treatment in setting of Bacterial vaginosis (BV)?

A

Symptom relief … ABX will NOT prevent adverse outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

For female with HX of epilepsy, at what point should valproate be discontinued to avoid fetal congenital abnormalities in pregnancy?

A

6 months prior to conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How should valproate be adjusted for females with HX of epilepsy, now pregnant?

A

Do not discontinue valproate (abrupt discontinuation increases risk of seizure recurrence)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

2 tests used to screen for congenital abnormalities in pregnant female currently taking valproate?

A

US, serum AFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Are antiepileptic drugs contraindicated in breastfeeding?

A

No … although they are excreted in breastmilk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Definition of PPROM?

A

Preterm Premature Rupture Of Membranes (PPROM) = leakage of fluid at < 37 without contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

4 risk factors for development of PPROM?

A

Heavy lifting, Anemia, HX of PPROM, 1st trimester bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Complication of PPROM?

A

Umbilical cord prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Complication of Umbilical cord prolapse?

A

Fetal hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

3 complications of PPROM?

A

Chorioamnionitis, Preterm delivery, Placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Best management of PPROM?

A

Relieve cord compression, C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

How long is ulipristal effective as emergency contraception?

A

Up to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

How long is copper IUD effective as emergency contraception?

A

Up to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Contraindication to copper IUD as form of emergency contraception?

A

Acute pelvic infection (cervicitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Sexual assault victims should be provided with empiric post-exposure prophylaxis for …

A

Chlamydia, Gonorrhea, HIV, Hepatitis B (unless vaccinated), Trichomonas (unless flagellated organisms are not seen on microscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

HIV post-exposure prophylaxis is offered to Sexual assault victims for up to …

A

72 hours after assault

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

2 mechanisms by which thyroid hormone production increases during pregnancy?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Change to total T4 during pregnancy?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Change to TSH during pregnancy?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Antiphospholipid Syndrome is an autoimmune disorder characterized by …

A

Hypercoagulability + Obstetric complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

3 antibodies that are present in setting of Antiphospholipid Syndrome?

A

Anti-cardiolipin, SLE anticoagulant antibodies, anti-b2 glycoprotein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Which type of contraceptive is contraindicated in Antiphospholipid Syndrome?

A

Estrogen-containing contraceptives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Which type of contraceptive is indicated for patients with Antiphospholipid Syndrome who are on long-term anticoagulation?

A

Progestin IUD … improves heavy menstrual bleeding, decreases risk of anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

When should Pap testing begin in female?

A

21 yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Which patients should undergo Pap testing before 21 yo?

A

Immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Clinical presentation of shoulder dystocia during labor?

A

Retraction of fetal head into maternal perineum immediately after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Initial management of shoulder dystocia during labor?

A

McRoberts maneuver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Description of McRoberts maneuver used in setting of shoulder dystocia during labor?

A

Maternal hips are hyperflexed; Physician applies suprapubic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Phenotype of Androgen Insensitivity Syndrome?

A

Female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Genotype of Androgen Insensitivity Syndrome?

A

Male – 46XY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Clinical presentation of Androgen Insensitivity Syndrome?

A

Breast development in female; Primary amenorrhea; Lack of axillary + pubic hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Etiology of Androgen Insensitivity Syndrome?

A

Mutation of androgen receptor gene … causes peripheral tissues to be unresponsive to androgens, despite normal levels of androgens in circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Inheritance pattern of Androgen Insensitivity Syndrome?

A

X-linked recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

External genitalia present in Androgen Insensitivity Syndrome?

A

Vagina that ends in blind pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Internal genitalia present in Androgen Insensitivity Syndrome?

A

Absent uterus + fallopian tubes; Cryptorchid testes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Initial steps of workup for Androgen Insensitivity Syndrome?

A

Pelvic US, karyotype, testosterone level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Diagnostic lab value for Androgen Insensitivity Syndrome?

A

Male-range testosterone level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What accounts for breast development in Androgen Insensitivity Syndrome?

A

Excessive testosterone is aromatized to estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

Most common AE of oral contraceptives?

A

Irregular, break-through bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

2 additional AE of oral contraceptives?

A

Nausea, Breast tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

2 AE of copper IUD?

A

Heavy menses, dysmenorrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is NOT an AE of oral contraceptives?

A

Weight gain

170
Q

Definition of pre-eclampsia?

A

New-onset HTN + proteinuria and/or endo-organ damage at 20+ weeks gestation

171
Q

Best management of patient with HX of severe preeclampsia, now pregnant again?

A

ASA initiated at 12 weeks gestation

172
Q

Relationship between levothyroxine and pregnancy?

A

Levothyroxine dose should be increased by 30% when pregnancy is first detected

173
Q

Additional step of hypothyroidism management in pregnancy?

A

TSH should be measured every 4 weeks

174
Q

Long-term post-operative complications of breast implants?

A

Capsular contracture … resulting in pain, shape distortion, implant deflation, rupture; NO association between breast implant + breast CA

175
Q

Effect of breast implants on pregnancy + breastfeeding?

A

None! … No evidence that silicone breast implants cause harmful effects on developing fetus, or are a contraindication to breastfeeding

176
Q

At what age should women with breast implants begin mammogram screening?

A

NML timeframe … 40-50 yo

177
Q

Appearance of cervix in setting of Trichomoniasis infection?

A

“strawberry” cervix

178
Q

Best management of Trichomoniasis infection?

A

Metronidazole treatment for patient AND partner

179
Q

Untreated Trichomoniasis infection is associated with increased risk for …

A

HIV transmission

180
Q

4 maternal contraindications to pregnancy (termination of pregnancy recommended)?

A

LVEF < 40%, HX of peripartum cardiomyopathy, Severe pulmonary HTN, Aortic dilation > 40mm

181
Q

Alternative name for Severe pulmonary HTN, resulting from untreated VSD?

A

Eisenmenger Syndrome

182
Q

Pathogen responsible for condyloma acuminata?

A

HPV

183
Q

Clinical presentation of children with vertical transmission of HPV?

A

Lesions in oropharynx, larynx, trachea

184
Q

Best management of pregnant females in labor with active cervical condyloma acuminata?

A

Expectant vaginal delivery

185
Q

Value of vaginal delivery in pregnant females in labor with active cervical condyloma acuminata?

A

Vertical transmission of HPV can still occur during C-section

186
Q

Firstline management for primary dysmenorrhea in non-sexually active patients?

A

NSAIDs

187
Q

Next management for primary dysmenorrhea in patients that did not experience symptomatic relief with NSAIDs?

A

OCPs

188
Q

Clinical presentation of placenta previa?

A

Painless vaginal bleeding at > 20 weeks gestation

189
Q

Bleeding from placenta previa is ___ in origin

A

Maternal

190
Q

3 risk factors for placenta previa?

A

Prior c-section, Smoking, Multiple gestation

191
Q

1st step in patient with suspected placenta previa?

A

Transvaginal US

192
Q

Which step of workup is contraindicated in patients with suspected placenta previa?

A

Digital cervical exam

193
Q

Placenta previa is an absolute contradiction to …

A

Vaginal delivery … placenta previa necessitates c-section delivery

194
Q

Clinical presentation of amniotic fluid embolism?

A

Sudden-onset hypoxia, hypotension, bleeding

195
Q

3 complications of amniotic fluid embolism?

A

Cardiogenic shock, Hypoxenic respiratory failure, DIC

196
Q

Best management of amniotic fluid embolism?

A

Supportive care … intubation, transfusion

197
Q

What is the single greatest risk factor for breast CA in males?

A

BRCA2 mutations … (100-fold increased risk)

198
Q

Additional risk factor for breast CA in males?

A

Klinefelter syndrome … (20-fold increased risk)

199
Q

Inheritance pattern of Klinefelter syndrome?

A

Sporadic

200
Q

Pathogen responsible for acute lactational mastitis?

A

Staph aureus

201
Q

2 ABX of choice for treatment of mastitis?

A

Dicloxacillin, cephalexin

202
Q

Suspected diagnosis for patient with lactational mastitis whose symptoms do not improve with ABX treatment?

A

Breast abscess

203
Q

Best next step of workup for patient with suspected breast abscess?

A

US

204
Q

Definition of fetal post-maturity syndrome?

A

Fetus delivered after 42 weeks

205
Q

Clinical presentation of fetal post-maturity syndrome?

A

Wrinkled + peeling skin; Long fingernails; Lots of hair; Small for gestational age; Green skin

206
Q

What accounts for green skin in fetal post-maturity syndrome?

A

In utero meconium passage

207
Q

4 complications associated with fetal post-maturity syndrome?

A

Meconium aspiration, respiratory distress, hypoglycemia, seizures

208
Q

When should external cephalic version be performed for a breech baby?

A

37+ weeks

209
Q

Reason for delaying ECV until after 37 weeks?

A

ECV can cause non-reassuring fetal HR due to abruptio placentae

210
Q

Risk of breech delivery?

A

Increased risk of asphyxia + fetal injury

211
Q

Appearance of ovarian torsion on Doppler US?

A

Adnexal mass with absent Doppler flow to ovary

212
Q

First time imaging in diagnosis of suspected ovarian torsion?

A

Pelvic US

213
Q

Best step of workup for a 35 yo female with a palpable breast mass?

A

Mammogram … US is first step for women < 30 yo

214
Q

Complication of prolonged pelvic organ prolapse?

A

Vaginal + cervical erosions … causing abnormal vaginal bleeding

215
Q

Best management of vaginal erosions resulting from prolonged pelvic organ prolapse?

A

Vaginal estrogen

216
Q

Clinical presentation of prolonged pelvic organ prolapse?

A

Mass protruding past hymenal ring

217
Q

Clinical presentation of asymptomatic bacteriuria?

A

Urine culture that grows bacteria … in a patient without clinical signs of UTI

218
Q

Best management of asymptomatic bacteriuria?

A

Reassurance

219
Q

___ refers to emotional and physical symptoms that occur in second half of menstrual cycle, with resolution promptly with onset of menses

A

Premenstrual syndrome (PMS)

220
Q

___ refers to a severe form of PMS that is characterized by predominant anger and irritability

A

Premenstrual Dysphoric Disorder (PMDD)

221
Q

First-line treatment for PMS/PMDD?

A

SSRI

222
Q

Second-line treatment for PMS/PMDD?

A

Try a different SSRI

223
Q

Third-line treatment for PMS/PMDD?

A

Benzodiazepine, or GnRH agonist (leuprolide)

224
Q

Complication associated with PMS/PMDD?

A

Mood or anxiety disorder

225
Q

3 most common infections that cause vaginitis?

A

Bacterial vaginosis, Candida, Trichomonas

226
Q

Best workup for patient with vaginitis?

A

Need to come to office for pelvic exam, wet mount microscopy, and NAAT … (to avoid misdiagnosis, inappropriate treatment)

227
Q

Epidemiology of posterior urethral valve?

A

Males

228
Q

Appearance of GU system in posterior urethral valve?

A

Bilateral hydronephrosis, Thickened + dilated bladder, Dilated proximal urethra

229
Q

Additional clinical presentation of posterior urethral valve?

A

Potter sequence … (oligohydramnios, pulmonary hypoplasia, flattened facies)

230
Q

Best diagnostic test for posterior urethral valve?

A

Voiding cystourethrogram (VCUG)

231
Q

Appearance of posterior urethral valve on VCUG?

A

Dilated proximal urethra

232
Q

Best treatment for posterior urethral valve?

A

Place Foley catheter; Cystoscopy for ablation of the valve (curative)

233
Q

Clinical presentation of ureteropelvic junction obstruction?

A

Recurrent UTI + unilateral hydronephrosis + no bladder dilation

234
Q

Clinical presentation of vesicoureteral reflux?

A

Recurrent UTI … without bladder dilation

235
Q

Etiology of vesicoureteral reflux?

A

Abnormal flow of urine from bladder back into ureter during bladder contraction

236
Q

Change to estrogen in setting of Primary Ovarian Insufficiency?

A

Decreased

237
Q

Change to FSH in setting of Primary Ovarian Insufficiency?

A

Increased

238
Q

Clinical presentation of Primary Ovarian Insufficiency?

A

Amenorrhea before 40 yo

239
Q

Best management of Primary Ovarian Insufficiency?

A

Combined estrogen + progesterone therapy

240
Q

___ refers to an abnormal collection of blood between the gestational sac and uterine wall

A

Subchorionic hematoma

241
Q

Etiology of subchorionic hematoma?

A

Partial separation of chorion from uterine wall

242
Q

Appearance of subchorionic hematoma on US?

A

Blood collection appears as a crescent on US … hypoechoic lesions adjacent to gestational sac

243
Q

Best management of subchorionic hematoma?

A

Reassurance with serial US

244
Q

4 activities that should be avoided in pregnancy?

A

Skiing, gymnastics, horseback riding, scuba diving

245
Q

Pathogen responsible for punctate hemorrhage in vagina + cervix?

A

Trichomonas

246
Q

pH level seen in Trichomonas infection?

A

Elevated (pH > 4.5)

247
Q

DOC for Trichomonas infection?

A

Single-dose of oral metronidazole (2g)

248
Q

How does management of Trichomonas infection change in breastfeeding females?

A

Females should express + discard breastmilk for 24 hours after metronidazole administration

249
Q

Why should breastmilk be expressed + discarded after a dose of metronidazole?

A

Metronidazole may cause loose stools and candidiasis in infants

250
Q

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?

A

Observation

251
Q

When should IV ampicillin be administered to mothers who test (+) for GBS during pregnancy?

A

At least 4 hours before delivery

252
Q

Best management of infants born to mother with inadequate IV ampicillin for GBS during pregnancy, but no signs of sepsis?

A

Observation

253
Q

Best management of infants born to mother with inadequate IV ampicillin for GBS during pregnancy, with signs of infant sepsis, maternal fever, preterm delivery?

A

Blood cultures, ABX

254
Q

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?

A

Cell-free DNA

255
Q

Role of Cell-free DNA testing?

A

Fetal sex determination; Screening for trisomy 21-18-13

256
Q

Indication for offering Cell-free DNA testing?

A

Maternal age > 35 yo, sonographic finding associated with fetal aneuploidy, prior pregnancy with fetal aneuploidy

257
Q

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?

A

Cervical insufficiency

258
Q

4 risk factors for Cervical insufficiency?

A

Connective tissue disorder, cervical conization, uterine abnormalities, obstetric injury

259
Q

Time in pregnancy at which cervical insufficiency can be diagnosed?

A

> 24 weeks

260
Q

Prognosis for cervical insufficiency?

A

Even with cerclage placement, prognosis for current pregnancy is poor

261
Q

When is cerclage typically placed for cervical insufficiency?

A

12-14 weeks gestation

262
Q

Recommendation about folate supplementation for women planning to conceive?

A

0.4mg folic acid for 1+ month prior to conception

263
Q

What is best management of NV in a pregnant female who is HD stable, with (-) ketones on UA?

A

Not hyperemesis gravidarum; oral vitamin B6, H1 antihistamine, outpatient management

264
Q

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?

A

Inadequate dose of anti-D Ig post-partum

265
Q

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?

A

Treat with amoxicillin now, then penicillin PPX during labor

266
Q

Role of “now” treatment in GBS infection during pregnancy?

A

Prevent obstetric complications

267
Q

Role of “at delivery” treatment in GBS infection during pregnancy?

A

Prevent neonatal GBS infection

268
Q

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?

A

WSW have a higher risk of BV, higher risk of cervical CA

269
Q

9 health conditions that are over-represented in WSW?

A

CAD, T2DM, OB, Cervical CA, BCA, Ovarian CA, Depression, Intimate partner violence, BV

270
Q

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?

A

Lichen sclerosis

271
Q

Best management of Lichen sclerosis?

A

Super potent corticosteroid ointment

272
Q

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?

A

Excisional Bx

273
Q

Best management of leiomyoma in females who wish to preserve fertility?

A

OCPs, IUDs

274
Q

3 aspects of the athlete triad?

A

Low caloric intake, amenorrhea, bone loss

275
Q

3 aspects of clinical presentation for functional hypothalamic amenorrhea?

A

Amenorrhea, hypoestrogenism, low BMI

276
Q

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?

A

Discontinue lisinopril and statin

277
Q

3 types of medications that should be discontinued for patients with end-of-life care?

A

Cardiovascular prevention (statin, ASA), anti-HTN, pre-meal insulin

278
Q

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?

A

Likely menopause transition, but also need endometrial Bx to further evaluate

279
Q

Which females need endometrial Bx in setting of menopause transition?

A

Females > 45 with anovulatory bleeding (heavy, irregular vaginal bleeding)

280
Q

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?

A

Fibroadenoma

281
Q

Best management of Fibroadenoma in adolescents?

A

Observation with repeat exam

282
Q

Clinical prognosis for Fibroadenoma?

A

Will decrease in size after menses

283
Q

Best managemnt of 18 yo female who presents for heavy vaginal bleeding with several clots?

A

OCPs

284
Q

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?

A

Obtain US

285
Q

What is best management of palpable US in females < 30?

A

US

286
Q

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?

A

Ruptured ectopic pregnancy with signs of hemoperitoneum (abdominal rigidity, HD instability)

287
Q

What is best management of ruptured ectopic pregnancy?

A

Emergent laparoscopy

288
Q

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?

A

Simple breast cyst

289
Q

What is best management of simple breast cyst?

A

Observation

290
Q

Clinical appearance of vesicovaginal fistula?

A

Red granulation fistula on anterior surface of vagina

291
Q

What is best workup for suspicious vesicovaginal fistula?

A

Bladder dye testing

292
Q

What is the best recommendation regarding breast self-examination?

A

Not recommended at any age

293
Q

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?

A

Evaluation only if symptoms develop

294
Q

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?

A

Administer systemic steroids and observe

295
Q

4 aspects of management for asthma exacerbation in pregnancy?

A

O2 sat > 95%, treat with albuterol/ipratropium; Steroids (PO prednisone) if unresponsive to albuterol/ipratropium

296
Q

2 aspects of treatment for severe asthma exacerbation in pregnancy?

A

MgSO4, terbutaline

297
Q

Which medication is contraindicated in treatment for asthma exacerbations in pregnancy?

A

Epinephrine

298
Q

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?

A

Ectopic pregnancy

299
Q

3 hallmark features of ectopic pregnancy?

A

Vaginal bleeding, (+) B-HCG, complex adnexal mass

300
Q

Most common location for ectopic pregnancy?

A

Ampulla of Fallopian tube

301
Q

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?

A

Primary Ovarian Insufficiency

302
Q

3 best initial steps of workup in patient with Primary Ovarian Insufficiency?

A

Adrenal antibodies, TSH, karyotype analysis

303
Q

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?

A

Perform uterine massage, administer oxytocin

304
Q

What is the most common cause of post-partum hemorrhage?

A

Uterine atony … failure of uterus to contract after placental separation

305
Q

Firstline management of uterine atony?

A

Bimanual uterine massage, Oxytocin infusion

306
Q

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?

A

Placental abruption

307
Q

Placental abruption refers to …

A

Separation of placenta before fetal delivery

308
Q

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?

A

Administer IV oxytocin

309
Q

Definition of latent phase labor?

A

Regular contractions to cervical dilation of 6cm

310
Q

Definition of active phase labor?

A

Cervical dilation from 6cm to 10cm

311
Q

What is the most common cause of labor protraction?

A

Inadequate uterine contractions

312
Q

What is the adequate rate of cervical dilation?

A

1 cm per 2 hours

313
Q

Hemolytic disease of newborn due to Rh(D) incompatibility is possible only in a ___ mother and ___ father

A

Rh(D) negative; Rh(D) positive

314
Q

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?

A

Penicillin desensitization … syphilis can vertically transmit … penicillin will cross placenta and treat fetal disease too

315
Q

Which 2nd-line treatment for syphilis is CI in pregnancy?

A

Doxycycline

316
Q

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?

A

Perform a trans-abdominal OB US

317
Q

3 conditions associated with elevated AFP?

A

NTD, Ventral wall defect, Multiple gestation

318
Q

1 condition associated with decreased AFP?

A

Trisomy 21/18

319
Q

Most common cause of secondary amenorrhea?

A

Pregnancy

320
Q

Post-partum preeclampsia may present up to ___ weeks after delivery

A

12

321
Q

Clinical criteria for diagnosis of preeclampsia?

A

New-onset HTN + End-organ damage

322
Q

4 examples of end-organ damage seen in cases of pre-eclampsia?

A

Pulmonary edema, hyperreflexia, HA, vision changes

323
Q

Definition of Fetal growth restriction?

A

Fetal weight < 10th percentile for gestational age

324
Q

What accounts for development of fetal hypoxemia in cases of Fetal growth restriction?

A

Placental insufficiency

325
Q

Screening tools used in Fetal growth restriction?

A

Umbilical artery doppler US, biophysical profiles

326
Q

Which finding on Umbilical artery doppler US suggests fetal hypoxia?

A

Reversed (or absent) blood flow

327
Q

Next step of management if Umbilical artery doppler US shows reversed (or absent) blood flow?

A

Immediate delivery

328
Q

3 vaccines that are safe for administration in pregnant females?

A

Inactivated influenza, TDAP, Rho(D) immunoglobulin

329
Q

What is the optimal time for administration of TDAP vaccine in pregnancy?

A

3rd trimester (28+ weeks)

330
Q

What is the optimal time for administration of inactivated influenza vaccine in pregnancy?

A

Every trimester, should be administered to pregnant females as soon as vaccine becomes available

331
Q

Etiology of adenomyosis?

A

Abnormal endometrial tissue invasion into the myometrium

332
Q

Clinical presentation of adenomyosis?

A

Dysmenorrhea, Heavy menstrual bleeding, pelvic pain

333
Q

2 risk factors for development of adenomyosis?

A

Multiparity, Prior uterine surgery (myomectomy)

334
Q

Change to appearance of uterus in adenomyosis?

A

Global enlargement of uterus

335
Q

Definitive diagnostic test for adenomyosis?

A

Biopsy … showing endometrial tissue within the myometrium

336
Q

Appearance of adenomyosis on MRI or US?

A

Thickened myometrial layer

337
Q

Treatment for adenomyosis?

A

Hysterectomy

338
Q

Patients with PCOS are at increased risk of developing ___ CA

A

Endometrial

339
Q

What accounts for increased risk of endometrial cancer in patients with PCOS?

A

Unopposed estrogen causes endometrial proliferation

340
Q

Best exercise recommendation for pregnant patients with cerclage placed?

A

Exercise is contraindicated

341
Q

Additional contraindication to exercise during pregnancy?

A

Active vaginal bleeding

342
Q

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?

A

Renal, pelvic US

343
Q

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?

A

Kidney stones

344
Q

What accounts for increased risk of kidney stones during pregnancy?

A

Increased urinary excretion of Ca2+, urinary stasis, decreased bladder capacity

345
Q

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?

A

Administer latent ABX

346
Q

What is the most likely etiology of PPROM?

A

Subclinical intrauterine infection

347
Q

4 risk factors for development of PPROM?

A

Genital tract infection (BV), tobacco use, 1st trimester bleeding, HX of PPROM in previous pregnancy

348
Q

Definition of PPROM?

A

Membrane rupture with absence of contractions

349
Q

Best management of PPROM < 34 weeks, without infection?

A

PPx ABX

350
Q

Best management of PPROM < 34 week, with infection?

A

Delivery, Steroids, Mag if < 32 weeks, Ampicillin + gentamicin

351
Q

ABX of choice for PPROM < 34 weeks?

A

Ampicillin + azithromycin

352
Q

Best management of PPROM > 34 weeks?

A

Delivery, GBS prophylaxis

353
Q

For a female with PCOS struggling with infertility – what are 2 best treatment options for infertility?

A

Letrozole, clomiphene

354
Q

MOA of Letrozole in treatment of infertility in PCOS?

A

Inhibits conversion of androgen to estrogen at the ovary; Stimulates increased production of GnRH and FSH/LH … inducing ovulation

355
Q

MOA of Clomiphene in treatment of infertility in PCOS?

A

Acts on estrogen receptors at the hypothalamus … Hypothalamus perceives low estrogen levels, stimulates increased production of LH and FSH … inducing ovulation

356
Q

Definition of spontaneous abortion?

A

Pregnancy loss < 20 weeks

357
Q

3 risk factors for spontaneous abortion?

A

Advanced maternal age, substance abuse, previous spontaneous abortion

358
Q

Most common cause of spontaneous abortion?

A

Fetal chromosomal abnormality

359
Q

Definition of preeclampsia?

A

New-onset hypertension at > 20 weeks gestation with proteinuria and/or end-organ damage

360
Q

BP required for diagnosis of preeclampsia?

A

> 140/90

361
Q

6 clinical features of preeclampsia with severe features?

A

BP > 160/110, thrombocytopenia, elevated creatinine, transaminitis, pulmonary edema, CNS symptoms

362
Q

When is delivery indicated for preeclampsia without severe features?

A

> 37 weeks

363
Q

When is delivery indicated for preeclampsia with severe features?

A

> 34 weeks

364
Q

Best management before delivery planning for preeclampsia?

A

Magnesium sulfate, antihypertensives

365
Q

Role of Magnesium sulfate in management of preeclampsia?

A

Seizure prevention

366
Q

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?

A

Spina bifida

367
Q

What is most common complication of Spina bifida?

A

Neurogenic bladder

368
Q

Etiology of Spina bifida?

A

Failure of neural tube to close

369
Q

Risk factor for Spina bifida?

A

Inadequate maternal folate intake

370
Q

4 aspects of clinical presentation for Spina bifida?

A

Neurogenic bladder, hydrocephalus, scoliosis, motor/sensory dysfunction

371
Q

Best management of Spina bifida after delivery?

A

Defect wrapped in moist, sterile dressing, covered with plastic wrap to prevent infection + feat loss; Surgical repair

372
Q

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?

A

Reassure and continue nitrofurantoin

373
Q

Best management of pyelonephritis in pregnancy?

A

Ceftriaxone

374
Q

Risk of pyelonephritis in pregnancy?

A

Rapid progression to sepsis

375
Q

Normal respiratory change in pregnancy?

A

Respiratory alkalosis

376
Q

What accounts for Respiratory alkalosis in pregnancy?

A

Low tidal volume and minute ventilation

377
Q

Change to HCO3 seen in pregnancy?

A

Decreased

378
Q

Change to WBC seen in pregnancy?

A

Mild leukocytosis (5-15)

379
Q

2 key aspects of Clinical presentation for pyelonephritis in pregnancy?

A

Fever, CVA tenderness

380
Q

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?

A

Perform surgical removal at beginning of 2nd trimester

381
Q

When is excision of surgical mass recommended for pregnant females with pelvic mass?

A

Complex features (thick septations), >10 cm in diameter (increased risk of torsion, rupture, labor obstruction)

382
Q

Lab finding associated with epithelial ovarian carcinoma?

A

Increased CA-125

383
Q

6 risk factors associated with epithelial ovarian carcinoma?

A

BRCA, HRT, endometriosis, infertility, early menarche, late menopause

384
Q

3 protective factors for epithelial ovarian carcinoma?

A

OCPs, Multiparity, breastfeeding

385
Q

3 US findings associated with epithelial ovarian carcinoma?

A

Solid + complex mass, thick septations, ascites

386
Q

Management of epithelial ovarian carcinoma?

A

Surgical excision, CTX

387
Q

Firstline treatment for infertility in PCOS?

A

Weight loss … improves ovulation due to decreased adipose tissue volume

388
Q

Patients with PCOS who do not respond to weight loss as treatment of infertility should be treated with …

A

Letrozole

389
Q

MOA of letrozole?

A

Aromatase inhibitor

390
Q

Most common cause of abnormal uterine bleeding in adolescents?

A

Anovulation

391
Q

Etiology of Anovulation in adolescents?

A

Immature HPO axis

392
Q

5 fetal complications of adolescent pregnancy?

A

Gastroschisis, Omphalocele, Preterm birth, Low birth weight, Perinatal death

393
Q

5 maternal complications of adolescent pregnancy?

A

Anemia, Postpartum depression, Preeclampsia, Operative delivery, Hydatidiform mole

394
Q

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?

A

History of migraine headaches with aura

395
Q

What are 10 contraindications (absolute) to use of combined hormonal contraception?

A

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
Q

Foot her 3 options for combined hormonal contraception?

A

Estrogen/progestin pills, transdermal patch, vaginal ring

397
Q

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?

A

ABO hemolytic disease

398
Q

Best treatment for mild cases of ABO hemolytic disease?

A

Photo-therapy

399
Q

Best management of severe ABO hemolytic disease (bilirubin 20-25)?

A

Exchange transfusion (infants RBCs and replaced with donor RBCs)

400
Q

3 indications for exchange transfusion for severe ABO hemolytic disease?

A

Severe hyperbilirubinemia (20-25), worsening hyperbilirubinemia on phototherapy, signs of bilirubin induced neurologic dysfunction

401
Q

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?

A

Progestin subdermal implant

402
Q

What is the most effective type of contraception?

A

Progestin subdermal implant

403
Q

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?

A

Septic abortion

404
Q

Best management of septic abortion?

A

Broad-spectrum IV ABX, suction curettage

405
Q

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?

A

Order a Kleihauer-Betke test, continue fetal monitoring

406
Q

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?

A

Concealed placental abruption

407
Q

Role of Kleihauer-Betke test?

A

Determines presence of fetal maternal hemorrhage, so that amount of R(D) antibody to be administered can be calculated

408
Q

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?

A

Gestational DM

409
Q

Definition of polyhydramnios?

A

Amniotic fluid index > 24

410
Q

Change to amniotic fluid index seen in preeclampsia?

A

Oligohydramnios

411
Q

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?

A

Perform C-section delivery after consent is obtained

412
Q

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?

A

2nd stage labor arrest

413
Q

Definition of second stage labor arrest?

A

No fetal descent after nulliparous patients pushed for more than 3 hours without epidural, or more than 4 hours with epidural

414
Q

Best management of second stage labor arrest?

A

C-section

415
Q

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?

A

Cervical cancer

416
Q

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?

A

Cervical punch biopsy

417
Q

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?

A

Hysteroscopy with uterine defect repair

418
Q

With addition of her current pregnancy loss?

A

3+ consecutive spontaneous abortions (less than 20 weeks gestation?

419
Q

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?

A

Endometriosis

420
Q

Complication of endometriosis?

A

Infertility, chronic pelvic pain

421
Q

Accounts for infertility in the setting of endometriosis?

A

Pelvic adhesions and inflammation

UWorld (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions