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USMLE Step 2 CK > OBGYN > Flashcards

OBGYN Flashcards

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USMLE® Step 1 flashcards
1
Q

Medical management of fibroids?

A

GnRH agonists -> only recommended for 3-6 months

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2
Q

Role of magnesium sulfate in preterm labor?

A

fetal neuroprotections to prevent cerebral palsy, etc

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3
Q

A fetus is showing minimal responsiveness to monitoring after water breaks, next step?

A

Digital scalp manipulation

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4
Q

How to manage cervical incompetence?

A

cervical cerclage at 14 weeks

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5
Q

Side effects of copper IUD?

A

Hypermemorrhea and anemia

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6
Q

What studies are completed at the initial prenatal visit?

A

Rh(D) type, antibody screen,

Hb, Hct, MCV

HIV, VDRL/RPR, HBsAG

Rubella and varicella immunity

Pap test (if indicated)

Chlamydia PCR

Urine culture

Urine protein

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7
Q

First step to managing a woman with suspected biopsy and heavy menstrual bleeding?

A

Endometrial biopsy

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8
Q

How to manage pelvic pain unresponsive to NSAIDS and oral contraceptives?

A

Diagnostic laproscopy

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9
Q

Findings in primaru ovarian insufficiency?

A

oligomenorrhea/amenorrhea, infertility, menopausal symptoms, and elevated FSH and estradiol levels

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10
Q

Supplement of which mineral/vitamin has been shown to improve PMS?

A

Calcium

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11
Q

When do you test for gonorrhea in pregnant patients?

A

High-risk- previous STD< <25, new or multiple partners

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12
Q

Examples of NSAID

A

Ibuprofen, naproxen

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13
Q

Transvaginal vs transabdominal US in pregnancy?

A

Transvaginal early in pregnancy, then transabdominal

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14
Q

abdominal pain, nausea, scant bleeding, and fever, after D&C?

A

uterine perforation

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15
Q

Management of an infant between 2 and 24 months following first febrile UTI?

A

Renal and Bladder US

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16
Q

Theca luteun tumor

A

Pregnancy (especially molar) and often bilateral

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17
Q

Amenorrhea with normal seconary sexual characteristics, development on cyclical abdominal pain

A

OUtflow tract ostruction

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18
Q

Risks for ovarian cancer?

A

Nulliparity, family history, early menarche, late manopause

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19
Q

Next test after suggestion of acanthosis nigricans?

A

Fasting insulin

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20
Q

Should pregnant woman be offered the influenza vaccine?

A

Yes, as soon as it becomes available, if inactivated.

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21
Q

What is the sniffling position?

A

ilting hed backwards and lifting the chin

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22
Q

Karyotype of complete/partial mole?

A

Complete: XY, XX

Partial XXY, XXX, XYY

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23
Q

How to treat involuntary constrction of vaginal musculature?

A

Vaginal dilators

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24
Q

Urge incontinence

A

overactivity of the detrusor muscle -> uninhibited contractions -> increased bladder preddure -> urine leakage

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25
Q

Chancre

A

`Primary syphilis infections caused by treponema pallidum

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26
Q

Alternative name for genital warts?

A

Condylomata acuminata

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27
Q

What testing may be indicated prior to starting tamoxifen?

A

Factor V leiden

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28
Q

Kleihauer-Betke test?

A

Determine necessary dose of Rh(D) andti-D IG needed after delivery of an Rh-positive infant to an Rh-negative mother

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29
Q

Lab test for the diagnosis of PCOS?

A

Testosterone

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30
Q

Treament for hemorrhagic cyst?

A

Monitor with US, most will resolve on their own

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31
Q

What factors are contained in cryoprecipitate?

A

Fibrinogen, factor VIII, von willebrand’s

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32
Q

What should be adminstrated in preterm labor?

A

Steroids, tocolytic (indomethicine, nifidipine), and magnesium sulfate

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33
Q

Woman with complex cyst without any other symptoms late in her cycle?

A

Hemorrhagic cyst

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34
Q

Risk factors for endometrial cancer?

A

Obensity, nullipartiy, late menopause, complex atypical hyperplasia of the endometrium

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35
Q

Risk associated with twin-twin transfusion syndrome?

A

Neurological morbidity, including cerebral palsy

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36
Q

To treat infertility due to endometriosis?

A

ovarian stimulation with clomiphene citrate -> IVF is last resort

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37
Q

Tamoxifen side effexts?

A

thermoregularory dysfuction (hot flashes), increased risk fo endometrial cancer (post-menopausal) or endometrial polyps (premanopausal patients)

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38
Q

After a molar pregnancy, what is the risk of a second?

A

1-2%

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39
Q

What are postterm pregnasncies associated with?

A

Placental sulfatase deficiency, fetal adrenal hyperplasia, anencephaly

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40
Q

What type of cancers do BRCA2 carrier tend to have?

A

Estrogen receptor positive

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41
Q

Cell-free DNA vs quad screening?

A

Cell-free for high risk pregnancies at > 10 weeks

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42
Q

How should a fetus be managed when heart rate is less than 90?

A

Positive pressure ventilation and prepare to intubate

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43
Q

How much blood does 30mg of rhogam neutralize?

A

15cc of RBCs or 30mL whole blood

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44
Q

Signs of adenomycosis?

A

Dysmenorrhea, pelvic pain, heavy menses, bulky globular and tender uterus

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45
Q

First step in the evaluation of abnormal bleeding?

A

Pelvic Ultrasound

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46
Q

Extended wrist, hyperextended metacaopophalangeal joints flexed interphalangeal joints, absent grasp reflex? Cause?

A

Klumpke palsy, C8-T1

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47
Q

How to treat a missed abortion?

A

Medically with Misoprostol -> induce uterine cramping -> expulsion of fetus

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48
Q

Treatment for genital warts?

A

Small- trichloroacetic acid or podophullin resin

Large-excisional therapy

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49
Q

Signs of uterine rupture? Tx?

A

internse abdominal pain, loss of fetal station,

Tx- emergency laparotomy

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50
Q

high fever, hypotension, diffuse red maqcular rash involving the palms and soles, headache, vomiting, diarrhea

A

Toxic shock syndrome

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51
Q

Fetal complications from preeclampsia?

A

Fetal growth restriction, low birth weigt due to chronic uteroplacental insufficiency

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52
Q

What genetic test can rule out Down? All other chromorsome abnormalities?

A

Cell free DNA-down’s

All chromosomes-amniocentesis

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53
Q

Risk factors from preterm delivery? Best method of prediction in first time pregnancies?

A

Prior pregnancy (strongest), multiple gestations, hx of cervical surgery

Best method of prediction? Transvaginal US

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54
Q

Risks for a Bartholin gland mass in post-menopausal woman?

A

Malignancy, requiring biopsy, especially with rapid development

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55
Q

Treatment for moderately differentiated carcinoma?

A

Radical vulvectomy and groin node dissection

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56
Q

Changes in oxygenation during pregnancy?

A

Increase CO2 expulsion -> alkalosis due to hyperventilation from progesterone

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57
Q

Hypogonadotropic hypogonadism

A

hypothalamic dysfunction, due to severe life stressors

Associated with low LH and FSH

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58
Q

Findings suggesting polyps?

A

40-50 years of age, omcreased, increased menstrual flow, increased cramping and intermenstrual spotting

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59
Q

First step in the management of hrtuism with apparent genetic component?

A

Check 17-hydroxlprogesterone

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60
Q

Intraductal papilloma description

A

blood or serosanguinous dischange from the nipple

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61
Q

Trastuzumab: Use and side-effects

A

Use: Her2 positive breast carcinoma

Side-effects: Cardiotoxicity, get baseline echo. Howeer, damage is reversible with cessation of treatment

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62
Q

Functional ovarian cysts- US characteristics?

A

Unilocaular simple cyst without evidence of blood, soft tissue elements, or excrescences

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63
Q

Coarse facial hair in a pregnant woman with a solid mass found on US? Diagnosis? Treatment?

A

Leueoma, serial us and observation as they often resolve after delivery

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64
Q

How to treat Linchen sclerosus?

A

Hihg potency topical steroids

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65
Q

Spare pubic hair, loss of fullness of the labnia, vulvar and vaginal discomfort in post menopausal women?

A

Atrophic vaginitis -> due to decreased estrogen

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66
Q

Management of chirioamnionitis?

A

Broad spectrum antibiotics (ampicillin, gentamycin, clindamycin) and delivery. Oxytocin to speed up delivery

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67
Q

Amenorrhea for emenses for 3 cycles or > 6 months?

A

beta-HCG -> if negative, check prolactin, TSH, FSH

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68
Q

Endometriosis-us findings?

A

hemogenous cyst with internal echoes (“Ground glass”)

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69
Q

21-hydroxylase deficiency?

A

Unable to produce adequate cortisol due to a blockage of 17-hydroxyprogesterone

Also known as congenital adrenal hyperplasia

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70
Q

Anxiety, chest pain, palpitations, syncopy with systolic murmur with click?

A

Mitral valve prolapse, treat with beta blockers

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71
Q

What treatment(s) are most effective for menopause?

A

Estrogen

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72
Q

How do you diagnose choriocarcinoma?

A

b-HCG levels

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73
Q

How long can the latent phase of labor last in pregnancy?

A

20 hours in first time, 14 for multi-

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74
Q

ASCUS management options?

A

Performing HPV DNA testing or repeat cytology @12 months following abnormal Pap. If HPB is negative, then routine screening can be resumed at three years

If HPV is positive, or repeat is ASCUS or higher, then colposcopy should be performed

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75
Q

Which drugs require baseline audiometry?

A

Cisplatin, carboplatin

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76
Q

McCune Albright Syndromes sexual development?

A

Menarche, before breast and pubic hair development

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77
Q

Physical exam findings associated with down syndrome?

A

flattened nasal bridge, small size, small rotated cup-shaped ears, sandal gap toes, hypotonie, protruding tongue, short, broad hands, simian creases, epicanthic folds, and oblique palpebral fissueres

78
Q

Which SSRI is now category D? Why?

A

Paroxetine, cardiac malformations and persistent pulmonary hypertension

79
Q

Interstitial cystitis?

A

Chronic inflammatory condition of the bladder with in characterized by recurrent irritation, voiding symptoms of uregency and frequency, in the absence of other diseases

80
Q

isolated cystic mass in the anterior vaginal wall?

A

Urethral diverticulum

81
Q

Donovan bodies

A

Deeply straning gram-negative intracytoplasmic cysts caused by Klebsiella granulomatis

82
Q

Most important prognostic factor in the treatment of patients with breast cancer?

A

TNM staging

83
Q

Risk factors for delayed separation of placenta?

A

Uterine leiomyomas, prior c-section, prior uterine curettage and succenturiate lobe of placenta

84
Q

How should an infant exposed to meconium-sained amniotic fluid be managed after delivery?

A

Intubate the trachea and suction merconium and other asporated material from beneath the flottis immediately after delivery only if the infant is depressed

85
Q

Findings suggesting antiphospholipid syndrome in pregnancy?

A

prolonged dilute russell viper venom time, hx of 3 early pregnancy losses, hx of venous thrombosis

86
Q

If OCPs fail to treat dysmenorrhea, what should be the next step?

A

Lapropscopy after 3 months of OCP trials

87
Q

Most common risk associated with valprioc acid?

A

Neural tube defects (meningomyolocele)

88
Q

Cordlike thickening and bilateral non-focal premenstrual tenderness in the breasts? Treatment?

A

FIbrocystic breast changes

Tx: NSAIDS, oral contraceptives

89
Q

What is repaired by repairing the pubocervical fascia or reattaching it to the sidewall if separated from the white line?

A

Center and lateral cystoceles

90
Q

Flinanserin-use

A

premanopausal hypoactive sexual desire disorder

91
Q

multiple small, papular growths that are fragile and bleed upon manipulation?

A

Condylomatra acuminata

92
Q

Why have c-sections increased in recent years?

A

Studies have demonstrated increased risks with VBAC

93
Q

Where does lubrication in the vagina come from?

A

ransuldate of fluid across vaginal mucosa

94
Q

What drugs are contraindicated in vaginal deliveries with a previous c-sections?

A

Prostaglandins -> increased risk of rupture

95
Q

In pre-term labor, what medications must be included?

A

Ampicillin with known GBS status

96
Q

Primary risk for preterm rupture of membrane?

A

Genital tract infection

97
Q

continuous painless urine leakage after pelvic surgery? Diagnosis?

A

Vesicovaginal fistula

Diagnosis: cystourethroscopy

98
Q

Mullarian agenesis

A

congenital absence of vagina, uterus, fallopian tubes

99
Q

Treatment for multifocality VIN?

A

Laser ablation

100
Q

Demoid tumor

A

Most common tumor in women of all ages

Contain teeth, sweat and sebaceous glands, cartilage, bone, fat

101
Q

When do you administer Rho(D) immunoglobulins?

A

28 weeks gestation

102
Q

Order of sexual development in girls?

A

Breast budding (thelarche), adrenarche (hair growth), growth spurt, menarche

103
Q

Which race has the highest risk of molar pregnancies?

A

Asian

104
Q

What drugs requirement baseline bone density scans?

A

Aromatase inhibitors (anastrozole, letrozole)

105
Q

Gonorrhea/Chlamydia prophylactic treatment?

A

Ceftriaxone and Azithromycin

106
Q

What components does fresh frozen plasma?

A

Fibrinogen, Factors V and VIII

107
Q

What does molding of the fetal head mean?

A

Deformations in the skiull doe to fetal malpositioning during delivery

108
Q

First step in the managment of a post-menopausal adenexal mass?

A

Transvaginal US (provides better visualization that transabdominal

109
Q

What is atrophic vaginitis? Treatment?

A

Vulvovaginal dryness, loss of vaginal elastacity/rugae, thinning vulvar skin/loss of minora, decreased vaginal diameter

Tx- low dose topical estrogen

110
Q

Risk factors for PMS?

A

Family hx, vitamin B6, calcium, magnesium deficiencies

111
Q

Slowly increasing b-HCG, think endometrial strip, think?

A

Ectopic pregnancy

112
Q

cyclic midline abdominal cramping pain post D&C?

A

hematometra

113
Q

Absolute contraindications for vacuum aspiration of pregnancy?

A

Greater than 8 weeks gestation

114
Q

Risks associated with gestational diabetes?

A

Shoulder dystocia, metabolic disturbances, preeclampsia, polyhydramnios, fetal macrosomia

115
Q

Side affects of fluoxetine?

A

Insomnia

116
Q

Most concerning colpscopy findings?

A

Atypical blood vessels -> greater degree of angiogenesis, this more concerning

117
Q

Hemorrhage, uterine tenderness and contractions in a pregnant woman?

A

Abruptio placentae

118
Q

What is overflow incontinence?

A

Failure to empty the bladder adequately -> due to underactive detrusor muscle or obstruction

119
Q

persistant, ulcerating, eczematous rash localized to the nipple, spreading to the areola

Most common co-malignancy?

A

Mammary paget disease

Common co-malignancy: Adenocarcimoma

120
Q
A
121
Q

Extended elbow, pronated forearm, flexed wrist and fingers with normal grasp reflex-name? Cause?

A

Erb-Duchenne palsy, C5-C6

122
Q

Highest risk factor for ectopic pregnancies?

A

Prior ectopic pregnancy

123
Q

What is the value of the fibronectin test?

A

Negative predictive value?

124
Q

How to detect exercise-induced amenorrhea?

A

Check FSH and estrogen

High FSH, low estrogen

125
Q

Signs of molar pregnancy?

A

US -> than LMP dating, bleeding, high bHCG

126
Q

Management of placenta previa during pregnancy?

A

No intercourse or dignital vaginal examination (pelvic rest)

127
Q

Affects of STD on the cervix during pregnancy?

A

Causes bleeding -> increased blood flow

128
Q

Affect of type 1 diabetes on fetal size?

A

Fetus is generally smaller

129
Q

Overflow incontinence

A

sensation of fullness, pressure, and frequency -> small amount of continuous leaking

130
Q

How to measure ovarian reserve?

A

Anti-mullerian hormone levels

131
Q

Treatment for molar pregnancies?

A

Suction curettage

132
Q

Chancriod

A

Painful ulcer caused by haemophilus ducreyi

133
Q

Hyperthecosis?

A

More severe form of PCOS

134
Q

If an unsatisfactory colposcopy is obtained, how should acetowhile stains that enter the cervical canal be managed?

A

Conization

135
Q

Treatment for PCOS?

A

OCPs

136
Q

Risk associated with endometriosis?

A

Infertility

137
Q

HOw do treat bartholin cysts?

A

Asymptomatic- Observation

Symptomatic- Incision and drainage

138
Q

bleeding and/or endomedtiral hyperplasia in a postmenopausal woman with large adnexal mass?

A

Granulosa cell tumor

139
Q

What causes cervical cancer?

A

HPV infection

140
Q

Treatment for fungal infection

A

“-azole” drug

141
Q

Best place to place intimate partner handouts?

A

Bathrooms, or other private places

142
Q

Ternitaline? side-effects?

A

Beta-adrenergic

Side-effects: Tachycardia, hypotension, anxiety, chest tightening/pain

143
Q

What structural abnormaities can cause recurrent miscarraiges?

A

uterine cavity abnormalities (intrauterine adhesions, congenital anomalities, large submucous fibroids)

144
Q

Most common fetal part to feel other than the head?

A

Buttocks in breech presentation

145
Q

Affect of chorioamnionitis on fetal appearance?

A

Pale, lethargic, high temperature

146
Q

Risk associated with polyhydramnios?

A

Placenta abruption due to rapid decompression in intrauterine cavity

147
Q

Whaat are the risks for isoimmunization?

A

2% antepartum, 7% after full term delivery, and 7% with subsequent pregnancy

148
Q

Mature teratoma- Alternative name? US findings? Tx?

A

Altermative name: dermoid ovarian cyst

Findings- hyperechoic nodules and calcifications

Tx: Removal of cyst

149
Q

Weight needed for menses to begin?

A

85-106 lbs

150
Q

Treatment for VINIII?

A

wide excision

151
Q

What are methods for sterilization?

A

Laparoscopic tubal ligation

Essure placement

Mini-laparotomy with tubal ligation

152
Q

pelvic pain in a patient with ovarian mass?

A

Torsion until proven otherwise -> ischemia and necrosis of the ovary

153
Q

beta-HCG level required to detect fetus with transvaginal US? transabdominal?

A

2000

Transabdominal- 5000

154
Q

Most common causes of pelvic pain?

A

Adhersion, endometriosis

155
Q

What are Lewis antibodies?

A

igM antibodies that do not cross the placenta, therefore do not cause isosensitization or hemolytic disease

156
Q

Does a granulosa tumor secrete anything?

A

Yes, estrogen

157
Q

How does a history of depression affect a new mother?

A

Much higher risk of depression

158
Q

What type of fibroids cause recurrent pregnancy loss? Why?

A

Submucosal or intracavitary

  1. focal endometrial vascular disturbance
  2. endometrial inflammation

. secretion of vasoactive substances

159
Q

Treatment for antiphospholipid syndrome?

A

Aspirin plus heparin

160
Q

When to suspect ectopic pregnancy?

A

missed menstrual period, vaginal bleeding

161
Q

With a t-score of -1.7 what should be discussed with patients?

A

Evaluation of factors for fracture

162
Q

Benefit of breast feeding, to the mother?

A

Decreased incidence of ovarian cancer

163
Q

Neonatal thyrotoxicosis? Cause? Treatment?

A

materal hx of grave’s diese, low birth weight, tachycardia, warm skin, irrtability

Cause: passage of anti-TSH receptor antibodies during third trimerster

Treatment: beta blockers, methimazole; eventually self resolves

164
Q

Initial management for a woman with late decellerations?

A

Maternal position adjustments to left lateral position

165
Q

Epithelial ovarian carcinoma-US finding?

A

US-solid mass, thick septations, ascites

166
Q

Affects of hypothyroidism in woman?

A

Irregular periods, infertility

167
Q

When should pap smears begin?

A

21 years

168
Q

Fetal dysmaturity

A

“postmaturity syndrome” 0> fetal growth has beens restricted post-term

Described as withered, meconium stained, long-nailed, gradile, with a small placenta

169
Q

Next step in management of mullerian agenesis?

A

Renal US, high association with renal abnormalities

170
Q

First step in the management of urine leakage?

A

Obtain urinalysis and cultures

171
Q

management of an actively bleeding patient with anemic after spontaneous aborption

A

D & C

172
Q

What causes positive nitrates in urine?

A

Enterobaceteria special (gram-negative E. Coli)

173
Q

Are chronic medical conditions associated with early spontaneous abortions?

A

Yes

174
Q

Risks associated with HRT?

A

Increased risk of breast cancer, however, decreased risk of colon

175
Q

Cause of stress urinary incontinence?

A

Cystocele or increased intraabdomianl pressure (obesity, etc)

176
Q

Affect of anorexia on hypothalamic-pituitary dysfunction?

A

Can cause amenorrhea

177
Q

Papillomas vs ductal carcinoma of the breast?

A

ductal carcinoma of the breast contains microcalcifications

178
Q

Benefits of progesterone IUD

A

protective against endomedrial cancer,

low failue rate

179
Q

How can a total hysterectomy and bilateral salpingo-oophorectomy lead to menopausal-like symptoms in a post-menopausal woman?

A

Decrease circulating androgens due to loss of androgens being produces in the ovaries

180
Q

Histology of fat necrosis? MRI?

A

Foamy histocytes and fat globules

MRI: calcifications and hyperechoic mass

181
Q

Decreased fetal movement, asymmetrical growth with a young women with DVT prior?

A

Factor V liiden

182
Q

When do screen for Hep C during pregnancy?

A

HIV positive, intravenous drug use

183
Q

After physical exam, what is the next step is the work up of abnormal uterine bleeding?

A

Pelvic US

184
Q

Risk factors for vulvar cancer?

A

HPV exposure, smoking, vulvar dystrophy, immunocompromised states

185
Q

How to myomas grow after removal of GNRH?

A

At same pace as prior to treatment

186
Q

Missed aborption findings?

A

Embryo without caridac activity, empty gestations sax without fetal pole

187
Q

Signs of placental abruption?

A

Abdominal pain, bleeding, uterine hypertonus, fetal distress

188
Q

How to manage arrest in the second stage of labor?

A

Augmentsation with amniotomy, oxyton

189
Q

Stages of grief?

A

Denies, abger, bargaining, depression, acceptance

190
Q

Microinvasive cervical cancer?

A

Invasion into the basement membrane less than 3mm

191
Q

Delivery for twins when the first twin is breeched?

A

C-section

192
Q

Treatment for chlamydia? Gonorrhea

A

Azithromycin-chlamydia

Ceftriaxone- gonorrhea

USMLE Step 2 CK (12 decks)

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