ObGyn1

Question 1

When do you do gestational DM screening?

Answer 1

Weeks 24-28. Do 1 hr 50g GTT&raquo_space; 3 hr 100g GTT

Question 2

Lichen sclerosus vs atrophic vaginitis:

Answer 2

Lichen sclerosus - DOES NOT affect vagina. Vulvar skin appears thin and wrinkled like “cigarette paper”. Plaques obliterate labia majora and minora&raquo_space; scarring of local landmarks.

Atrophic vaginitis - vulvovaginal dryness, irritation and pruritus. Dyspareunia, vaginal bleeding. Narrowed introitus, thing & regressed tissue, labial regression.

Question 3

Carcinoembryonic antigen (CEA) is used as a marker for what disease?

Answer 3

Used for colorectal cancer recurrence after colon resection. Used to monitor disease state.

Question 4

Next step for recurrent variable decels:

Answer 4

Maternal repositioning is first step. Helps reduce cord compression and restores BF to placenta.

Amnioinfusion is a second line option because ROM may decrease amount of amniotic fluid. Just give NS into amniotic sac.

Question 5

Target Blood Glucose levels for Gestational DM (fasting, 1 & 2 hr)

Answer 5

Fasting = < 95 mg/dL
1 hr GTT = < 140
2 hr GTT = < 120

** Can do a trial of dietary modification first before jumping to insulin.

Question 6

Pt with painless extensive and nonprogressive genital ulcer with granulation tissue at the base. No lymphadenopathy. Intracytoplasmic cysts on gram stain

Answer 6

Granuloma inguinale (donovoniasis), Klebsiella granulomatis

Question 7

Postpartum woman (6 wks) with enlarged uterus, irregular vaginal bleeding, pulmonary symptoms (chest pain, dyspnea, hemoptysis), and multiple infiltrates on CXR:

Answer 7

Choriocarcinoma. Can occur after normal gestation or spontaneous abortion and typically happens <6 mo after a pregnancy. Get B-HCG to confirm.

Question 8

Congenital abnormalities due to Li3+

Answer 8

Cardiac. Ebstein’s anomaly

Question 9

Absence of fetal cardiac activity on U/S. Dx of IUFD is made. Gestation 28 wks. How do you manage? Spontaneous delivery or induce?

Answer 9

Vaginal delivery preferred if > 24 wks (can do C/S if less). Should induce sooner than later (when mom feels ready). Keeping fetus in longer may lead to coagulopathy so should not allow spontaneous delivery.

Question 10

Outpatient vs inpatient regimen for PID:

Answer 10

Outpatient = IM CTX + Doxy

Inpatient = IV cefoxitin (or cefotetan) + PO Doxy
[can also use IV clinda + Gent]

Question 11

Dysgerminomas are germ cell tumors that differentiate into ___ and secrete ___

Answer 11

synctiotrophoblast cells of placenta, b-HCG + LDH

Question 12

Granulosa cell tumors produce ___

Answer 12

estradiol and inhibin. GC tumors are ovarian sex-cord stromal tumors made of granulosa and theca cells.

Question 13

PCOS increases risk of developing what type of cancer?

Answer 13

Endometrial (due to decreased progesterone from chronic anovulatory cycles). Rx = cyclic progesterone, combined OCP,

Question 14

Screen asymptomatic pregnant patients who are recent immigrants for TB?

Answer 14

NO. Universal screening is not recommended. Reserve for Pt who are at active risk for disease/immunocompromised.

Question 15

What point in the cycle is assoc with Mittelschmerz?

Answer 15

Mittelschmerz = Middle of cycle.

Midcycle pain assoc with folliculre rupture of ovulation. Typically mild, unilateral, and lasts less than a day.

Question 16

How do you manage placenta previa differently from normal prenatal care?

Answer 16

No intercourse, pelvic rest, no digital cervical exam (speculum exam ok), and inpatient admission required for any bleeding episodes.

Vaginal delivery discouraged. C/S at 36-37 weeks because cervical changes and uterine contractions can cause placental detachment from cervix.

Note that sometimes placenta previa may resolve spontaneously by the third trimester due to growth of the lower uterine segment and growth of placenta towards fundus.

Question 17

Microcephaly, hypoplasia of distal phalanges, excess hair and cleft palate. Due to maternal use of:

Answer 17

Anticonvulsants (i.e phenytoin + carbamazepine). This is fetal hydantoin syndrome. Presents with microcephaly, midfacial hypoplasia, cleft lip, etc.