OBGYN Uworld

Question 1

Ovarian mass

- workup x2?

Answer 1

Pelvic U/S
CA-125 level - elevated in malig

Don’t do needle aspiration as may drag CA cells everywhere
No malignant features:
- small, simple cyst

Question 2

How does obesity get you to cancer in female?

Answer 2

Peripheral conversion of androgens to estrogens
Aromatization of andro’s to estrone

Then endometrial hyperplasia or CA

Question 3

3 things lead to shoulder dystocia:

Answer 3

1. Post-term pregnancy > 42 weeks
2. DM and macrosomia
3. Excess maternal weight gain

Question 4

When see increased 17-hydroxyprogesterone levels?

Answer 4

Think CAH: congenital adrenal hyperplasia

• 90% due to 21-hydroxylase deficiency
• low cortisol, get high ACTH
• ACTH gets adrenal hyperplasia
• since can’t make cortisol, shunt to androgens

Question 5

How treat just:

• chlamydia
• gonorrhea

Answer 5

Chlamydia: azithromycin or doxycycline

Gonorrhea: ceftriaxone

Screen for both with NAAT (nucleic acid amplification test) which is 96/99 sen/spec

Question 6

Sjogren syndrome

• think what?
• test for what?

Answer 6

Inflammation of exocrine glands
 - low lacrimal production
 - dry mouth (dental caries)
 - dry vaginal mucosa (dysparunia)
\+ Raynaud
Test for anti-Ro (SSA) or Anti-La (SSB)

Question 7

How confirm fetal demise?

Answer 7

1. No fetal movement felt
2. Doppler ultrasound no heartbeat
3. Diagnosis w/ transabdominal U/S which shows no fetal heartbeat

Question 8

Adenomyosis buzzwords
- dysmenorrhea w/ heavy menstrual bleed
- soak pad every 1-2 hours
…..chronic pelvic pain

Answer 8

Boggy (soft/flaccid) uterus
Tender uterus
UNIFORMLY enlarged uterus

Question 9

All pregnant women should receive screening for:

Answer 9

HIV
Hep B
Chlamydia trachomatis
Syphilis: treat penicillin G (1dose/week for 3 weeks)
- rapid plasma reagin = nontreponemal
- Fluorescent trep Ab absorption = treponemal.

Question 10

Antiphospholipid syndrome

sometimes seen w/ SLE

Answer 10

Recurrent pregnancy loss
Transient Ischemic Attack
. . . think thrombophilia & hyper coagulability

Membrane antibodies
Have to give heparin

Question 11

3 modifiable risk factors for osteoporosis after menopause?

Answer 11

1. Smoking
2. Alcohol
3. Calcium/Vitamin D

Question 12

Hyperechoic nodules on ovarian cyst
Adnexal fullness
 - expect what else?
 - age?  
 - diagnosis?

Answer 12

Expect calcifications
Often younger women
Dermoid ovarian cyst = mature cystic teratoma

Question 13

HTN, PROM or PPROM and why?

Answer 13

HTN = PROM, abruption, stillbirth, IUGR

Infection or hx PPROM = PPROM

Question 14

Itchy palms/soles during preg?

Answer 14

Intrahepatic cholestasis of pregnancy

• pruritis, palms/soles, worse at night
• increased alk phase
• increased liver enzymes

Tx: ursodeoxycholic acid to increase bile flow and reduce itching

Question 15

Fetal station reverses from 0 to -3

Answer 15

Uterine rupture