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USMLE S2CK > OBGYN > Flashcards

OBGYN Flashcards

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USMLE® Step 1 flashcards
1
Q

cervical cancer screening divided by age group

A

younger than 21 - no screening indicated

21-29 years old - pap smear alone every 3 years

29-65 - pap smear (q3 years), hrHPV alone (every 5 years), cotesting (every 5 years)

65 or older - if previously adequately tested, no screening indicated

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2
Q

breast cancer screening by age group

A

women aged 50-74 years - mammography q2 years

women 40-49 years - depends on the values of the woman and their risk factors. false positives are higher and overdiagnosis is more likely (too much medicine)

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3
Q

what STIs are screened for early in pregnancy?

A

HIV, HBS, chlamydia, syphillis

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4
Q

what are the features of severe preeclampsia?

A

SBP > 160, DBP >110

creat > 1.1

plts < 100,000

transaminitis

headaches/visual changes

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5
Q

what are the uterotonic agents?

contraindications?

A

oxytocin

methylergonovine - hypertension

carboprost - asthma

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6
Q

which uterine operations are so high-risk for uterine rupture that trial of labour is contraindicated?

A

classical cesarean section

extensive myomectomy with entry into the uterine cavity

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7
Q

how do you measure the strength of uterine contractions during labour and what is the value that indicates adequare contractility?

A

intrauterine pressure catheter

measurement in Montevideo units

>200 is adequate

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8
Q

which stage of labour is affected by neuraxial anaesthesia?

A

the second stage

first stage of labour is unaffected

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9
Q

what is the rate of cervical dilation that is expected during the active first stage of labour?

A

active first stage - uterine contractions are dilating the cervix, 6-10 cm

>1 cm/2 hours

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10
Q

when do you give MMR to rubella non-immune pregnant patients?

A

after the pregnancy

MMR is a live vaccine and is contraindicated during pregnancy

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11
Q

what are the indications for anti-D in Rh -ve mothers?

A

28-32 weeks and within 3 days following delivery

other events that will need anti-D:

  • ectopic pregnancy
  • threatened abortion
  • hydatiform mole
  • chorionic villus sampling, amniocentesis
  • abdominal trauma
  • 2nd-/3rd- trimester bleeding
  • ECV
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12
Q

what is the exception to the rule for anti-D prophylaxis?

A

if the father is Rh -ve as well

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13
Q

what is the definition of an acceleration?

A

>15 bpm from baseline achieved in under 30 seconds

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14
Q

what is the definition of a reactive NST?

A

>2 accelerations in 30 mins

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15
Q

a score lower than what on biophysical profile indicates foetal distress?

A

less than or equal to 4

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16
Q

what are the definitions of foetal tachycardia/bradycardia on CTG?

A

tachy > 160

brady <110

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17
Q

what is the follow up for medical management of ectopic pregnancy?

A

measure b-HCG in 4-7 days to ensure a 15% decrease

give another dose of MTX if this is not achieved

continue weekly b-HCG until the level is 0

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18
Q

what is the maximum size of the pregnancy you can offer MTX medical management for?

A

3.5 cm

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19
Q

what is a missed abortion?

A

death of a foetus (no FHB) but POC are in the uterus and the cervical os is closed

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20
Q

what are the endocrine factors for recurrent early miscarriage?

A

uncontrolled hyper/hypothyroidism, diabetes

hypoprolactinaemia

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21
Q

what level of dilation should tocolytics not be used to halt preterm labour?

what is the gestational age and weight criteria for delaying preterm labour? what are the agents used for this?

A

>4 cm

GA 24-33, weight 600-2500 g

tocolytic - CCB or terbutaline

corticosteroids - betamethasone

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22
Q

what is the definition of an early decceleration?

A

mirror image of contractions

reaches nadir slowly , >30 seconds

occurs due to foetal head compression

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23
Q

what is the treatment for PROM?

A

tocolytics and steroids

ampicillin and stat azithromycin

mild-pen allergic: cefazolin and stat azithromycin
pen-anaphylaxis: clindamycin and stat azithromycin

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24
Q

what are the indications for emergency delivery in placenta praevia?

A

unstoppable labour (>4 cm dilation)

heavy vaginal bleeding

foetal distress

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25
Q

how should the foetus be delivered if there is extensive concealed placental abruption and foetal demise?

A

vaginal delivery

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26
Q

foetus was descending into the pelvis until onset of abdominal pain followed by ascension…

what is the management?

A

uterine rupture

laparotomy - not cesearian section

can repair the uterus after deliver of the foetus, or hysterectomy

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27
Q

what are the upper foetal weight threshold for cesearian section delivery?

A

4500 g in diabetic mothers

5000 g in non-diabetic mothers

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28
Q

what is the treatment algorithm for hyperemesis gravidarum?

A
  1. non-pharmacologic therapy
    1. ginger
    2. vitamin B6
    3. accupuncture
  2. antihistamines
    1. doxylamine, diphenhydramine
  3. antidopaminergics
    1. metoclopramide
  4. antiserotonergics
    1. ondansetron
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29
Q

what is the screening and management of bacteuria in pregnancy?

A

screen with urine MC&S at 12 and 16 weeks

if present, even asymptomatic, give anitbiotics

  • nitrofurantoin, cefalexin, amoxicillin
30
Q

what is the difference between chronic hypertension diagnosed in pregnancy and gestational hypertension?

A

chronic HTN - diagnosis <20 weeks

gestational HTN - diagnosis >20 weeks

31
Q

patch of scalp missing from a newborn

what was the teratogen?

A

aplasia cutis - methimazole/carbimazole

32
Q

what are the definitions for prolonged latent stage?

A

primiparous - more than 20 hours to reach 6 cm

multiparous - more than 14 hours to reach 6 cm

33
Q

what are the aetiologies of protracted cervical dilation?

what are the management options?

A

3 P’s - power, passage, passenger

power - irregular/weak uterine contractions - oxytocin

passage/passenger - cephalopelvis dysproportion - cesearian section

34
Q

what is the management of uterine inversion?

A

manual repositioning manouvers

uterine relaxing agents - terbutaline, GTN, MgSO4

laparotomy

35
Q

what are the first timester screening and diagnostic tests for foetel aneuploidy?

A

screening

  • first-trimester screen (NT, bHCG, PAPPa)
  • cell-free foetal DNA

diagnostic

  • chorionic villus sampling
36
Q

what are the second trimester diagnostic and screening tests for foetal aneuploidy?

A

screening

  • quadruple screen (E3, inhibin A, bHCG, AFP)

diagnostic

  • amniocentesis
  • anomaly scan (>20 week US)
37
Q

what are the limits for oligohydramnios and polyhydramnios by amniotic fluid index

A

<5 - oligo

>24 - poly

38
Q

what is the management of prior genital herpes in pregnancy?

A

no active infection - viral supression from 36 weeks

lesions during labour - cesearian section

no lesions during labour - vaginal delivery

39
Q

how do you manage short cervical length?

A

no previous preterm birth - vaginal progesterone

40
Q

what is the management if the mother had a previous preterm birth?

A

serial TVUS-CL until 24 wk gestation, progesterone injections

if short cervix - cervical circlage

41
Q

after what gestation are tocolytics contraindicated?

A

>34 weeks

42
Q

what are the complications of PROM?

A

intra-amniotic infection

placental abruption

preterm labour

umbilical cord prolapse

43
Q

what are the associations with increased and decreased maternal AFP levels?

A

high - neural tube defects, abdominal wall defects, multiple gestation

low - aneuploidy

44
Q

what are the glucose control targets in GDM?

A

fasting <95

1-hour post-prandial <140

2-hours post-prandial <120

45
Q

what is the medical management of preterm labour before 32 weeks?

A

tocolytics, betamethasone and magnesium sulphate

46
Q

what is the mangement for hypothyroidism ahead of planning for pregnancy?

A

need to increase the dose of levothyroxine by 30% then measure TSH and T4 at 4-week intervals

compare with pregnancy-specific normal values

47
Q

what are the quad screen results for downs?

A

low AFP

high bHCG

low E3

high inhibin A

48
Q

what are the quad screen results for trisomy 18 (edwards syndrome)

A

low AFP, low E3, low bHCG

normal inhibin A

49
Q

what are the foetal complications of hyperemesis gravidarum?

A

preterm labour

foetal growth restriction

50
Q

what are the foetal complications of late-term delivery?

A

foetal dysmaturity syndrome

oligohydramnios (preferential perfusion to head, hypoperfusion to kidneys)

macrosomia

demise

51
Q

what are the physiologic renal changes in pregnancy?

A

increased circulating volume and cardiac output - increase renal perfusion

no change in creatinine and BUN production

decreased serum Cr and BUN

more permeable glomerular membranes

increased urinary protein excretion

52
Q

what is the antibiotic treatment for postpartum endometritis?

A

clindamycin and gentamicin

53
Q

what is the presenting complaint, diagnostic test and treament for intraductal papilloma?

A

bloody nipple discharge

core needle Bx

excision to remove occult CA

54
Q

antibiotic treatment for mastitis?

A

dicloxacillin

cephalexin

55
Q

what is the screening age for breast cancer and what is the test?

A

50-74 every other year with mammogram

start at age 40 if they have a family history of breast CA

56
Q

what are the contraindications to HRT?

A

oestrogen-dependant CA: breat or endometrial

history of VTE

57
Q

what are the contraindications to OCP?

A

migraine with aura

hypertension

smokers >35 years

58
Q

how long is a depot progestogen injection valid contraception for?

A

3 months

59
Q

what is the treatment for trich vaginalis?

A

metronidazole for both patient and partner

60
Q

what is the underlying malignancy in paget’s disease of the nipple?

A

adenocarcinoma

61
Q

what is the screening for gonorrhoea and chlamydia in young adults?

A

screening annually in sexually active women <25 years

62
Q

what is the inheritance pattern of androgen insensitivity syndrome?

what is the management

A

X-linked recessive

gender councelling, gonadectomy

will have cryptorchid testes with increased risk of malignancy

63
Q

what is the antibiotic treatment for postpartum endometritis?

A

clindamycin and gentamicin

64
Q

what is the initial management of active phase arrest?

how long until you would opt for LSCS?

A

oxytocin infusion - the most common cause would be inadequate contractions that may be resolved with medical therapy

arrest for 4-6 hours

65
Q

chancroid

presentation and treatment

A

painful ulceration

treat with azithromycin

66
Q

lymphogranuloma venerium

presentation and treatment

A

supurrative tender lymphadenopathy

doxycycline

67
Q

US findings that differentiate MCDA or DCDA(fused) twins?

A

MCDA - thin intertwin membrane, T sign

DCDA - thick intertwin membrane, lamba sign, representing the placenta that has creeped up inbetween the adjacent amniotic sacs

68
Q

how long after rupture of membranes do you have to start antibiotics regardless of GBS status?

A

18 hours

risk of chorioamionitis is high at this point

69
Q

what are the risks of a short interpregnancy interval?

A

maternal anaemia

PPROM

preterm birth

low birth weight

70
Q

what are the indications for intrapartum antibiotics GBS prevention in those with unknown GBS status?

A
  • ROM >18 hours
  • <37 weeks gestation
  • maternal fever
71
Q

positive whiff test

what will the pH be?

A

bacterial vaginosis

G vaginalis

metronidazole or clindamycin only for the patient

alkalinization - pH >4.5

72
Q

pH for vaginal candidiasis?

A

normal: 3.8-4.5

USMLE S2CK (6 decks)

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