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OBGYN Step 2 > OBGYN Uworld > Flashcards

OBGYN Uworld Flashcards

1
Q

tx of PID

A

3rd generation ceph (rocephin)

+ azithromycin OR doxycycline

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2
Q

hypotension after epidural due to ?

when to really worry

A

blood redistribution to LEs and venous pooling from sympathetic blockage
worry if hypotension, bradycardia, and respiratory difficulty, may be a sign of OD or intrathecal injection leading to depression of brainstem or cervical spinal cord activity (“high spinal” or “total spinal”)

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3
Q

intense vulvar pruritus with white atrophic plaques, “cigarette paper” skin (not involving vagina) think ?
what to do ?

A

lichen sclerosis
may have dyspareunia, dysuria, painful defecation
dx: punch biopsy to rull out vulvar squamous cell carcinoma, although it is a “premalignant” lesion
tx: topical steroid (clobetasol)

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4
Q

2/3 necessary for PCOS dx

A

abnormal/lack of ovulation
clinical/biochem hyperandrogenemia (hirsutism or testosterone)
polycystic ovaries on imaging

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5
Q

hirsutism, menstrual irregularities, ^17-OHP, ^androgens, ^LH/FSH, think ?

A

nonclassic CAH

in contrast to PCOS: both may have ^ LH/FSH, CAH will have ^17-hydroxyprogesterone (17-OHP) but PCOS will not

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6
Q

Erb-Duchenne palsy prognosis

A

most cases will resolve in a few months

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7
Q

irregular vaginal lesion + bloody malordorous discharge, think ?

A

vaginal cancer (SqCC)
commonly found in upper 1/3 of posterior vagina wall
risks: smoking, HPV

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8
Q

severe pre-E may lead to ? because of ^SVR, cap perm, ^pulm cap hydrostatic pressure, and decreased albumin

A

pulmonary edema

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9
Q

pathogenesis of HELLP

A

hepatic and systemic inflammation, activation of coag cascade, and platelet consumption
+ microangiopathic hemolytic anemia

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10
Q

cervical cancer risk factors

A

immunosuppressed (HIV), early sexual activity, muliple/high risk sexual partners, previous STI, hx of vulv/vag cancer, smoking

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11
Q

cervical cancer manifestations

A

may be asymptomatic

bleeding after sex or between menses, ^vaginal discharge, low back/pelvic pain

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12
Q

endometrial cancer risk factors

A

unopposed estrogen exposure: estrogen-only OCPs, prolonged menstrual timeline, nulliparity, anovulation, PCOS, obesity, tamoxifen (estrogen agonist in uterus)

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13
Q

ovarian cancer risk factors

A

endometriosis, family history, prolonged menstruation

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14
Q

when does mittelschmerz occur in contrast to endometriosis

A

middle of menstrual cycle (10-14) corresponding with ovulation
endometriosis typically causes pain before and during menses rather than mid cycle

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15
Q

chemo/radiation may cause amenorrhea due to what mechanism?

what hormone levels will be present?

A

ovarian failure

^FSH, ^LH, normal prolactin and TSH, estrogen deficiency

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16
Q

uterus in endometriosis vs adenomyosis vs fibroids

A

endometriosis: not enlarged
adenomyosis: bulky, tender, uniformly enlarged
leiomyomata uteri (fibroids): irregularly enlarged uterus, may present with anemia

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17
Q

fetal presentation vs position

A

presentation: what’s lowest i.e. vertex (good) or breech
position: OA (good), occiput transverse or OP (not good), may cause arrest of 2nd stage

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18
Q

C-section is indicated in arrested labor if cervix is dilated to ? and no cervical change for how long?

A

if cervix dilated +6cm and no cervical change for 4+ hrs with adequate contractions of +6hrs with inadequate contractions

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19
Q

neonate with facial hypoplasia, microcephaly, cleft lip/palat, digital hypoplasia, hirsutism, developmental delay, think ?

A

fetal hydantoin syndrome, caused by exposure to anticonvulsant meds in pregnancy

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20
Q

fetus with lethal abnormalities in breech position, how to deliver?

A

vaginal, C/S is not necessary as no need to protect fetus

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21
Q

CVS vs amniocentesis

A

CVS at 10-13 wks, amniocentesis at 15-20 wks

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22
Q

post-term complications (think fluid)

A

oligohydramnios: decreased fetal perfusion with aging placenta, decreased UOP of fetus
-indication for delivery
also: meconium aspiration, fetal convulsions/stillbirth
(not all complications)

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23
Q

week cutoff for C/S or expectant management vs. tocolytics in preterm contractions

A

34 weeks

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24
Q

multiple fetal fractures, hypoplastic thoracic cavity + intrauterine fetal demise, think ?

A

osteogenesis imperfecta type II (most severe)

mutation in type 1 collagen, autosomal dominant

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25
Q

vaccines contraindicated in pregnancy

A

HPV, MMR, live attenuated influenza, varicella

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26
Q

safe vaccines in pregnancy

A

inactivated influenza, Tdap, Rho(D) IgG

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27
Q

secondary amenorrhea in female athletes results from

A

hypothalamic amenorrhea (GnRH deficiency)

28
Q

symmetric vs asymmetric IUGR and etiologies

A

symmetric (whole body): 1st trimester insults
-chromosomal anomalies, congenital infeciton
asymmetric (body smaller than head): 2/3 trimester
-maternal HTN, smoking (placental insufficiency), maternal malnutrition

29
Q

pelvic mass and ascites, keep ? in mind?

what to do?

A

consider advanced ovarian cancer

exploratory laparotomy with cancer resection and staging

30
Q

postpartum female (w.in 6 mos of delivery) with dyspnea, infiltrates on CXR, irregular vaginal bleeding, and enlarged uterus, think ?

A

choriocarcinoma

may metastasize to lung, vagina

31
Q

46, XY with female external genitalia and no internal genitalia

A

androgen insensitivity syndrome
testicular secretion of anti-Mullerian hormone, resulting in primary amenorrhea
testosterone secreted from testes is converted to estrogen, so breast develop

32
Q

atypical glandular cells on pap test in female +35 yo, do what next?

A

colposcopy, endocervical curettage, and EMB

33
Q

only definitive way to dx endometriosis

A

laparoscopy with visualization and bx of endometrial implants
indicated with tx failure (NSAIDs, OCPs)
risk of infertility with endometriosis

34
Q

infertility in PCOS due to ?

A

failure of follicle maturation (resulting in anovulation)

35
Q

confusion, nystagmus, ataxia, ^LFTs in pregnant female, think?

A

Wernicke encephalopathy

may also be caused by hyperemesis gravidarum and anorexia (in addition to chronic alcoholism)

36
Q

1st w/u in amenorrhea (after HCG)

A

prolactin, TSH, FSH

OR if prior uterine procedure or infection perform hysteroscopy

37
Q

secondary amenorrhea defined as ?

A

absences of menses for 3+ cycles or 6+ months in women who menstruated previously

38
Q

adnexal fullness and u/s findings of hyper echoic nodules and calcifications in premenopausal female

A

mature cystic teratoma (dermoid ovarian cyst)

39
Q

tx for PID

A

inpatient: IV cefoxitin or cefotetan + doxycycline
OR IV clindamycin + gentamicin
outpatient: IM ceftriaxone + PO doxycycline

40
Q

pelvic pain, bloating + u/s findings of solid mass with thick septations and peritoneal free fluid in mass (ascities)

A

epithelial ovarian carcinoma

41
Q

when would ABO incompatibility occur in pregnancy and what symptoms would occur?

A

mom: O and infant: A, B, or AB

mild hemolytic disease of newborn: asymptomatic but may have mild anemia, jaundice

42
Q

Down’s quad screen

A

low ms-AFP, low estriol, ^B-hCG, ^Inhibin-A

43
Q

if ^ms-AFP, think?

A

NTDs, ventral wall defects, multiple gestation

44
Q

when to give RhoGAM?
when to screen for asymptomatic bacteriuria?
when to screen for rubella and HIV?
when to screen for GBS?

A

RhoGAM: 28-32 wks and delivery/exposure
asym. bac: 1st trimester, rescreen if risk factors
rubella: prenatal visit
HIV: prenatal visit and 3rd trim if high risk
GBS: rectovaginal culture at 35-37 wks

45
Q

hormone roles:
inhibits uterine contractions and promotes/maintains implantation
induces prolactin production from pituitary
maintains corpus luteum
induces early embryonic division and differentiation

A

inhibits uterine contractions and promotes/maintains implantation: PROGESTERONE
induces prolactin production from pituitary: ESTROGEN
maintains corpus luteum: HCG (before placenta produces progesterone on its own)
induces early embryonic division and differentiation: trick question, occurs before implantation and days before hormone secretion

46
Q

breast cancer risk factors

A

mod: HRT, nulliparity, ^age at 1st birth, etOH

non-mod: genetics, white, ^age, prolonged lifetime menstruation

47
Q

female pt less than 35 yo with amenorrhea:

+menopausal symps (hot flashes, fatigue) think ?

+calorie deficiency or strenuous exercise think ?

A 
menopausal symps (hot flashes, fatigue): primary ovarian insufficiency (^GnRH, ^FSH, low estrogen)
(often hx of autoimmune (hypothyroidism) or Turner's)
calorie deficiency or strenuous exercise: hypothalamic hypogonadism (low GnRH, low FSH, low estrogen)
48
Q

vaginal bleeding and B-hCG is 1000 IU/L with no intra or extra uterine pregnancy found out TVUS, what to do next?

A

repeat B-hCG in 2 days

do not expect to see uterine pregnancy until B-hCG reaches 1500 IU/L, once it does, repeat TVUS

49
Q

management of intrauterine fetal demise

A

20-23 wks: Dilation and evacuation or vaginal delivery
+24 wks: vaginal delivery at mother’s discretion
(however, ^risk coagulopathy longer fetus stays in)

50
Q

best anti-hypertensives for acute maternal HTN crisis

A

hydralazine IV, labetelol IV (not if bradycardic), nifedipine PO
methyldopa for chronic

51
Q

fetal tachycardia in setting of prolonged ROM think

A

chorioamnionitis

52
Q

if want to inquire risk of Downs at 10 wga

A

best test: plasma cell-free fetal DNA (99% sn)

PAPP-A has 85% sn

53
Q

indications that labor is false

A

irregular, infrequent, weak contractions with no/mild pain and no cervical change
reassure and discharge

54
Q

inevitable vs incomplete abortion

A

both have vaginal bleeding and cervical dilation

inevitable: POCs are at or above os (“it’s coming”)
incomplete: some POCS already out, some still in (“it started to happen already”)

55
Q

tx for vaginal candidiasis

A

oral fluconazole

intravaginal nystatin may be used, but oral nystatin is only used to tx oral candidiasis, not vaginal

56
Q

indications and risks of cervical conization

A

CIN 2/3

complications: cervical stenosis, preterm birth, p-PROM, 2nd trimester pregnancy loss

57
Q

what to do if Hepatitis C+ during pregnancy

A

vaccinate for hep A and B

vertical transmission is 2-5%, C-section is not indicated/does not decrease risk

58
Q

u/l reddish-brown nipple discharge with no masses

A

intraductal papilloma

infiltrating ductal carcinoma will have mass + LAD

59
Q

when to give what in preterm labor (less than 37 wks)

A

always betamethasone and PCN if GBS+/unknown
+tocolytics if less than 34 wks
+Mg+ if less than 32 wks (neuroprotective)

60
Q

tocolytics

A

nifedipine, indomethacin

progesterone is not a tocolytic but can be used to prevent preterm delivery in pt with shortened cervix

61
Q

low sodium after induction think

A

oxytocin toxicity: similar to ADH and can cause H2O retention, low Na, and seizures

62
Q

therapeutic Mg range

tox presents how?

A

5-8 mg/dL

hyporeflexia, lethargy, HA, resp failure, cardiac arrest (NOT seizures)

63
Q

cause of hyperandrogenism in pregnancy

A

luteomas and theca luteum cysts

64
Q

painful, itchy, ezcematous/ulcerating breast rash think?

A

Paget’s, associated with adenocarcinoma

65
Q

1st step in working up infertility if hx of PID

A

hysterosalpingogram

OBGYN Step 2 (5 decks)

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