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USMLE Step Two > Obstetric/Gynecologic Disorders > Flashcards

Obstetric/Gynecologic Disorders Flashcards

1
Q

hypertension in pregnancy prior to 20 weeks gestation

A

essential hypertension or molar pregnancy

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2
Q

conditions associated with increased nuchal translucency

A

down’s syndrome, turner syndrome, neural tube defects, congenital heart defects

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3
Q

decreased AFP, decreased unconjugated estriol, elevated inhibin A, elevated beta-hCG

A

down’s syndrome or turner’s syndrome

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4
Q

at what hemoglobin level should physiologic anemia of pregnancy be treated as iron deficiency anemia

A

first trimester: hemoglobin < 11

second trimester: hemoglobin < 10.5

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5
Q

what supplements should be given to women on anticonvulsants during pregnancy

A

folate and vitamin K (last month)

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6
Q

what supplements should be given to complete vegetarians during pregnancy

A

vitamin B12, iron, vitamin D

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7
Q

lab findings characteristic of HELLP syndrome

A

hemolysis, elevated liver enzymes, and low platelets

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8
Q

difference between preeclampsia and gestational hypertension

A

proteinuria, gestational hypertension is usually third trimester only

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9
Q

how long is magnesium sulfate continued after delivery in preeclampsia

A

24 hours

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10
Q

how long is magnesium sulfate continued after delivery in eclampsia

A

48 hours

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11
Q

what gestational age is maternal triple or quad screen offered to women?

A

16-18 weeks

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12
Q

when is 1 hour OGTT performed?

A

24-28 weeks

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13
Q

how does TSH change during pregnancy?

A

TSH stays the same, free T3/T4 stay the same

total T3/T4 increase because of increased thyroxine binding globulin

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14
Q

how much folate is needed in pregnancy

A

400 micrograms/day

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15
Q

how much iron is needed in pregnancy

A

30 mg/day

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16
Q

how much calcium is needed in pregnancy

A

1200 mg/day

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17
Q

when can amniocentesis be performed

A

after 16 weeks gestation

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18
Q

when can chorionic villous sampling be performed

A

after 9 weeks gestation

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19
Q

mccune-albright syndrome

A

females, pseudo-precocious puberty, cafe-au-lait macules, fibrous dysplasia of the bone

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20
Q

estrogen generated by ovaries

A

estradiol

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21
Q

estrogen generated by placenta

A

estriol

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22
Q

estrogen generated by fat tissue

A

estrone

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23
Q

nonhormonal options for menopausal hot flashes

A

desvenlafaxine, venlafaxine, clinidine, gabapentin, placebo, or just wait (most hot flashes resolve within 4-5 years)

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24
Q

what lab findings distinguish true precocious puberty from pseudoprecocious puberty

A

elevations of LH, FSH in central/true precocious puberty, further increased by GnRH stimulation

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25
Q

definition of precocious puberty

A

< 8 in girls

< 9 in boys

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26
Q

some causes of pseudoprecocious puberty

A

exogenous hormones, adrenal tumor, congenital adrenal hyperplasia, ovarian tumor, mccune-albright syndrome

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27
Q

definition of premature ovarian failure

A

> 1 year amenorrhea in women < 40

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28
Q

hormone associated with increase in basal body temperature

A

progesterone

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29
Q

how is body basal temperature increase associated with ovulation

A

1 degree increase occurs 1 day before ovulation

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30
Q

4 different options for emergency contraception

A

combination pill, progestin pill, copper IUD, anti-progestin

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31
Q

contraindications to OCP use

A

DVTs, smokers, breast/endometrial cancer, pregnancy, hepatic disease, migraine with aura

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32
Q

medications known for reducing effectiveness of OCPs

A

rifampin, griseofulvin, anti-epileptics, st. john’s wort

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33
Q

definition of primary amenorrhea

A

no menses by 16 w/secondary sexual characteristics or no menses by 13 w/o secondary sexual characteristics

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34
Q

first step in any work-up of amenorrhea

A

beta-hCG

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35
Q

basic components of work-up for secondary amenorrhea

A

beta-hCG, LH, FSH, TSH, testosterone, DHEAS, progestin withdrawal test

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36
Q

diagnosis: primary amenorrhea, absent secondary sex characteristics, anosmia

A

kalmann’s syndrome XXY, congenital absence of GnRH secretion

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37
Q

initial management of a woman presenting with secondary amenorrhea and new galactorrhea when beta-hCG is negative

A

TSH, free T4

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38
Q

positive beta-hCG, intrauterine pregnancy, closed os

A

threatened abortion

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39
Q

enlarged uterus, menometrorrhagia for months

A

uterine fibroids

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40
Q

bleeding associated with severe menstrual pelvic pain

A

endometriosis

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41
Q

menorrhagia, perimenopausal

A

endometrial hyperplasia until proven otherwise

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42
Q

abnormal uterine bleeding started with menarche

A

hereditary bleeding disorder

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43
Q

positive beta-hCG, severe pain, no fetus in uterus on US

A

ectopic pregnancy

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44
Q

metrorrhagia after intercourse, no pain, normal sized uterus

A

endometrial or cervical polyp

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45
Q

depression, constipation, abnormal uterine bleeding

A

hypothyroidism

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46
Q

outpatient treatment for abnormal uterine bleeding

A

estrogen 21-25 days
progesterone 10 days
heavy withdrawal bleed will occur

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47
Q

inpatient treatment for abnormal uterine bleeding with hemodynamic instability

A

2-4 L normal saline, transfuse PRBC
introduce tamponade transcervically and inflate to stop bleeding
IV premarin to stabilize and regrow endometrium
IV /phenergan to prevent N/V a/w high dose estrogen

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48
Q

medications used for PMS and PMDD

A

exercise, B6, NSAIDs, OCPs, progestins, SSRIs +/- alprazolam

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49
Q

treatment of choice for primary dysmenorrhea

A

OCPs, NSAIDs

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50
Q

most common cause of hirsutism in the US

A

PCOS

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51
Q

lab findings to diagnose PCOS

A

elevated LH, elevated total testosterone

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52
Q

medications used for syphillis

A

penicillin G, doxycycline, tetracycline

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53
Q

diagnosis of pelvic inflammatory disease

A

clinical diagnosis, abdominal/pelvic pain in the absence of other pathologies, cervical motion tenderness, leukocytosis, vagina/cervical discharge, elevated ESR/CRP

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54
Q

medications used for PCOS

A

exercise/weight loss
OCPs, clomiphene to induce pregnancy, metformin, sprionolactone
progestin withdrawal if cannot tolerate OCPs

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55
Q

which STD can be mistaked for IBD due to fistula formation

A

lymphogranuloma venereum due to L1, 2, L3 serotypes of chlamidya trachomatis

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56
Q

ASCUS on pap smear

A

surveillance, repeat pap smear 3-6 months

perform HPV screening

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57
Q

ASCUS x 2 on pap smear

A

colposcopy

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58
Q

ASCH on pap smear

atypical squamous cells, cannot exclude HSIL

A

colposcopy + ECC

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59
Q

AGUS on pap smear

atypical glandular cells

A

colposcopy + ECC

if age > 35, also perform endometrial biopsy

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60
Q

CIN1 on pap smear

A

surveillance, repeat pap smear 3-6 months

alternatively, go straight to colposcopy

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61
Q

CIN1 x 2 on pap smear

A

colposcopy

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62
Q

HSIL with precancerous lesion on pap smear

A

colposcopy + LEEP or conization

repeat cervical cytology every 6 months

63
Q

management: squamous cell carcinoma of the cervix

A

surgical resection +/- chemotherapy

64
Q

most important prognostic factor in endometrial cancer

A

histologic grade is more important than depth of invasion

65
Q

management: squamous cell carcinoma of the vagina

A

< 2 cm, resection or internal radiation
> 2 cm, external beam radiation

generally, no chemotherapy

66
Q

lichen sclerosis diagnosis and management

A

chronic inflammatory condition of anogenital region, most commonly affecting women
ivory/porcelain white macules and plaques with pruritis

treatment: low threshold for punch biopsy to r/o squamous cell carcinoma, steroids (clobetasol), or pimecrolimus

67
Q

differential diagnosis for gynecomastia

A 
puberty
medications (spironolactone, cimetidine, amiodarone, ketoconazole, haloperidol, HAART therapy, digoxin
herbal agents (tea tree oil, lavender oil), cirrhosis, hypogonadism, testicular germ cell tumor, hyperthyroidism, hemodialysis patients
68
Q

herbal causes of gynecomastia

A

tea tree oil, lavender oil

69
Q

most likely cause of bloody nipple discharge

A

intraductal papilloma

70
Q

most common breast cancer

A

invasive ductal carcinoma

71
Q

breast cancer often presents with serous or bloody nipple discharge

A

intraductal papilloma

72
Q

most common breast mass in patients 35-50

A

fibrocystic changes of the breast

73
Q

most common breast tumor in teen and young women

A

fibroadenoma

74
Q

breast mass accompanied by redness, pain, and heat

A

inflammatory breast carcinoma

75
Q

risk factors for endometrial cancer

A

unopposed estrogen, PCOS, obesity, nulliparity, diabetes, hypertension, family history, high fat diet, HNPCC

76
Q

risk factors for ovarian cancer

A

ovulation, nulliparity, family history, BRCA1, BRCA2

77
Q

serum marker elevated in endometrial cancer

A

CA-125 sometimes

78
Q

serum marker elevated in ovarian cancer

A

CA-125 frequently

79
Q

next step in management of CIN 2 cervical lesion identified on biopsy

A

excise with LEEP or conization or laser

80
Q

next step in management of ASCUS pap smear

A

repeat pap smear 3-6 months

81
Q

next step in management of AGUS pap smear

A

colposcopy with ECC

> 35, also endometrial biopsy

82
Q

ovarian tumor associated with psammoma bodies

A

serous cyst adenocaricnoma

83
Q

ovarian tumor associated with estrogen excess

A

granulosa cell tumor

84
Q

ovarian tumor associated with androgen secretion

A

leydig cell tumor

85
Q

treatment for DCIS

A

lumpectomy, possible radiation

consider mastectomy in high-risk individuals

86
Q

treatment for LCIS

A

observation, possible treatment with tamoxifen/raloxifene

87
Q

normal reactive nonstress test

A

two or more 15 bpm accelerations lasting at least 15 seconds within 20 minutes

88
Q

fetal tachycardia

A

> 160 bpm
caused by maternal infection, dehydration, chorioaminionitis, fetal anemia, maternal thyrotoxicosis, fetal tachyarrhythmias, tertbutaline (beta-agonist), fetal hypoxia

89
Q

fetal bradycardia

A

< 110

90
Q

what causes a fetal heart rate with a sinusoidal pattern

A

fetal anemia

91
Q

normal fetal variability

A

x6-25 bpm

92
Q

what is the definition of PROM

A

premature rupture of membranes before the onset of labor, increased risk with vaginal/cervical infection or cervical incompetence, prior to 37 weeks

93
Q

when to suspect chorioamnionitis in a patient with PROM

A

if fever present with maternal or fetal tachycardia, maternal leukocytosis, or uterine tenderness or foul smelling discharge

94
Q

at what gestational age is labor managed actively instead of expectantly in preterm labor

A

34 weeks or if there is proven fetal lung maturity in younger fetuses

95
Q

what are the risk factors for placental abruption

A

trauma, cocaine, smoking, chronic HTN, preeclampsia, PROM, multiple gestations, multiparity

96
Q

drugs used for tocolysis

A

tertbutaline, ritodrine, magnesium sulfate, or less commonly indomethacin, nifedipine

97
Q

reversal agent in cases of magnesium toxicity

A

calcium gluconate

98
Q

components of biophysical profile for assessment of fetal well being

A

amniotic fluid index, fetal tone, fetal breathing, fetal movement, non-stress test

99
Q

early decelerations

A

fetal head compression, no treatment necessary

100
Q

variable decelerations

A

cord compression, reposition mother

101
Q

late decelerations

A

uteroplacental insufficiency, fluid resuscitation, address underlying problem if posisble

102
Q

definition of oligohydramnios

A

AFI < 5

103
Q

definition of polyhydramnios

A

AFI > 25

104
Q

classic signs and symptoms of magnesium toxicity

A

decreased DTRs, respiratory arrest, cardiovascular arrest

105
Q

infertility work-up

A

semen analysis, LH/FSH, HSP, endometrial biopsy

106
Q

ideal fetal presenting position

A

occiput anterior

107
Q

maternal indications for induction

A

preeclampsia, diabetes, chorioamnionitis, greater than 40-42 weeks

108
Q

how should breech presentation be managed after 36 weeks

A

external cephalic rotation

109
Q

definition of postpartum hemorrhage

A

> 500cc in vaginal delivery

> 1000cc in c-section

110
Q

treatment for woman who does not wish to breastfeed postpartum

A

ice packs, tight fitting bra, analgesics

second line: OCPs, bromocriptine

111
Q

diagnosis: postpartum female presents with pain in breast localized to one region, no redness or warm

A

galactocele

112
Q

when can OCPs be initiated in women who do not wish to breast feed

A

wait 6 weeks due to risk of DVT

113
Q

diagnosis: postpartum woman develops sudden onset of hypoxia, cardiogenic shock, and DIC

A

amniotic fluid embolism

114
Q

diagnosis: patient loses 500cc of blood postpartum and now has anemia, attempts at breast feeding have been unsuccessful as she is unable to secrete milk

A

sheehan syndrome

115
Q

medications used to control postpartum hemorrhage

A

uterine massage, oxytocin

second line: methergen, hemabate, surgical options

116
Q

definition of prolonged latent phase in labor

A

> 20 hours in nulliparous

> 14 hours in multiparous

117
Q

definition of prolonged active phase in labor

A

< 1.2 cm/hr in nulliparous

< 1.5 cm/hr in multiparous

118
Q

definition of arrest of descent in labor

A

> 2 hours in nulliparous
1 hour in multiparous

add 1 hour for epidural injection

119
Q

first steps in management of uterine hyperstimulation, nonreassuring fetal heart tones

A

remove stimulating agent, maternal oxygen, turn the mom to the left lateral decubitus position, may need to adminster tertbutaline to stop contractions, place fetal scalp electrode and IUPC

120
Q

treatment for lichen planus

A

high dose steroids (clobetasol)

biopsy to rule out malignancy

121
Q

sinusoidal fetal heart changes (tachycardia to bradycardia)

A

ruptured fetal umbilical vessel

122
Q

condition where fetal blood vessels traverse fetal membranes across lower segment of uterus between baby and internal cervical os

A

vasa previa

123
Q

most significant risk factor for distal limb reduction defects associated with chorionic villi sampling

A

< 9-10 weeks associated with greater risk of limb defects

124
Q

BPP: score 8-10

A

normal

125
Q

BPP: score 6 without oligohydramnios

A

> 37 weeks: deliver

< 37 weeks: repeat BPP in 24 hours and deliver if unimproved

126
Q

BPP: score 6 with oligohydramnios

A

> 32 weeks: deliver

< 30 weeks: daily monitoring

127
Q

BPP: score 4

A

> 26 weeks: deliver

128
Q

high FSH/LH with low estrogen
ambiguous genitalia at birth
polycystic ovaries later in life

A

aromatase deficiency

129
Q

cafe-au-lait macules, fibrous dysplasia of bone, precocious puberty

A

mccune-albright syndrome

130
Q

pseudohermaphroditism, salt wasting, virilization

A

congenital adrenal hyperplasia

131
Q

etiology of lower abdominal pain during periods that radiates to the thighs

A

prostaglandins

132
Q

management of fetal demise < 24 weeks

A

dilation and evacuation

133
Q

management of fetal demise < 28 weeks

A

prostaglandin E2

134
Q

management of fetal demise > 28 weeks

A

misoprostol or oxytocin

135
Q

PROM < 32 weeks

A

steroids, antibiotics

induce when amniotic fluid indicates fetal lung maturity

136
Q

PROM 32-34 weeks

A

aminotic fluid analysis to determine lung maturity dictates management

137
Q

PROM > 34 weeks

A

antibiotics and delivery is induced

138
Q

painless genital ulcer with beefy red base

A

granuloma inguinale (donovania/klebsiella granulomatis)

139
Q

painless ulcer with subsequence inguinal buboes, associated with fistula formation

A

lymphogranuloma venereum (c. trachomatis)

140
Q

painful ulcer from tropical regions, gray base and foul odor, possible inguinal lymphadenopathy

A

chancroid (haemophilus ducreyi: gram-positive rod)

141
Q

induces ovulation midcycle

A

LH surge

142
Q

stimulates development of ovarian follicle

A

FSH

143
Q

stimulates endometrial proliferation

A

estrogen

144
Q

stimulates endometrial gland development

A

progesterone

145
Q

decrease in levels leads to menstruation

A

progesterone

146
Q

increases basal body temperature

A

progesterone

147
Q

inhibits uterine contractions

A

progesterone

148
Q

increases thickness of cervical mucus

A

progesterone

149
Q

inhibits LH and FSH secretion

A

progesterone

150
Q

inhibits FSH secretion

A

estrogen

151
Q

induces LH surge

A

estrogen

152
Q

maintains corpus luteum

A

hCG

153
Q

benign ovarian cyst in beginning of cycle

A

follicular cyst

154
Q

benign ovarian cyst in later weeks of cycle

A

corpus luteum cyst of theca cells

USMLE Step Two (17 decks)

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